Supraventricular tachycardia (SVT) is a common cardiac arrhythmia marked by an abnormally fast heart rate, leading to significant patient discomfort and frequent visits to emergency departments. Carotid sinus massage (CSM) is a widely used vagal maneuver employed to rapidly stop SVT episodes. This research investigates the success and safety profile of CSM in treating SVT among Pakistani patients, offering critical insights for its use in emergency medical practices. A prospective observational cohort study was carried out in the Medicine Department of CMH Hospital, Multan, Pakistan, from January 1, 2024 to June 30, 2024. The study included 200 SVT patients aged 18 and older who presented at the emergency department. Information on patient demographics, medical history, and current clinical status was documented. Patients were laid supine with little neck extension. Gentle pressure was applied to the carotid sinus for 5 to 10 seconds on alternating sides, with a 1-minute interval if needed. The effectiveness of the procedure was determined by the rate of SVT termination, defined as a return to normal sinus rhythm within 30 seconds. Safety was monitored by noting any adverse events during and after the procedure. The average age of the study participants was 55.55 ± 8.86 years. Females made up 59.5% of the sample. CSM successfully terminated SVT in 18.5% of the cases. Adverse effects that were reported included dizziness (3.5%), vomiting (2.5%), syncope (1.5%), exacerbation of arrhythmia (3.5%), and temporary neurological issues (1%). This study assessed the effectiveness and safety of CSM in managing SVT. The findings indicate an 18.5% success rate in SVT termination, consistent with previous studies. Despite moderate efficacy and some side effects, CSM remains a valuable non-pharmacological approach for SVT management, with certain contraindications to be considered.

The circumscribed choroidal hemangioma (CCH) is a benign congenital eye tumor whose etiology is not clear. A 41‐year‐old female patient came with a 2‐year history of slowly progressive deteriorating vision in her right eye. In the left eye, the best‐corrected visual acuity (BCVA) was 6/6, and counting fingers at 1 m in the right eye. The wide‐field fundus showed a yellow macular lesion with indistinct limits, which is a sign of serous retinal detachment. B‐scan ultrasonography revealed a clear‐cut choroidal lesion, high internal reflectivity, and visible intrinsic vascularity on color Doppler. OCT has shown a massive choroidal mass with damaged RPE and outer retinal layers, which has been obscured by serous retinal detachment. The chest x‐ray revealed bronchiectatic opacities, the CT scan revealed no lung lesions, and LFTs and RFTs were normal. The fluorescein angiography revealed a choroidal hemangioma with early vascularity and late hyperfluorescence. Nonetheless, the retinal team chose the option of observation instead of TTT, radiotherapy, or verteporfin photodynamic therapy due to the closeness of the lesion to the macula, low visual acuity, and lack of verteporfin PDT in Pakistan. To sum up, the present case demonstrates the significance of multimodal imaging in the proper diagnosis of choroidal hemangiomas and the necessity to pay close attention to patient‐specific factors when making treatment decisions, especially in limited resource settings.

Introduction: Multiple myeloma (MM) is highly associated with cardiovascular complications, and their co-existence significantly increases the risk of cardiovascular events and mortality, predominantly in older adults. Therefore, we aim to analyze MM and cardiovascular disease (CVD) mortality trends in older adults from 1999 to 2023 in the United States (U.S). Methods: A retrospective analysis of Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was conducted from 1999 to 2023, including death records of adults (aged 65 ≤) with MM and CVDs. Age-adjusted mortality rates (AAMR) per 100,000 population and annual percent changes (APC) in AAMRs were calculated and measured across different demographics and geographies in the U.S. Results: MM and CVD have caused a total of 99,637 deaths. AAMR increased from 9.6 in 1999 to 9.9 in 2023, with a prominent surge noted between 2018 and 2021 (APC: 6.82). Males (12.5) had almost double the AAMR that of females (7.0), while the AAMR of 18.6 was seen in NH African Americans, triple that of other races/ethnicities. Geographically, AAMR was higher in metropolitan areas (9.2) and the Northeast region (10.1). Conclusions: Proper resource distribution and more targeted interventions are needed to address the rising trends in MM and CVD-associated mortality across different geographic and demographic groups.

Atrial fibrillation (AF)/flutter and renal dysfunction commonly coexist and are associated with substantial cardiovascular and thromboembolic risk. Despite this clinical overlap, national mortality patterns among individuals whose death certificates record both conditions have not been well characterized over an extended period. We examined changes over time in deaths documenting both AF/flutter and renal failure and assessed whether these patterns differed across demographic and geographic groups among U.S. adults aged ≥ 45 years from 1999 to 2023. We queried the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple-Cause-of-Death database for death certificates of U.S. adults aged ≥ 45 years in which AF/flutter (International Classification of Diseases, Tenth Revision I48) and renal failure (N17–N19) were both recorded. Either diagnosis could appear as the underlying or a contributing cause of death. Mortality rates were age-standardized to the 2000 U.S. population and expressed per 100,000 persons. Joinpoint regression was used to evaluate changes in annual age-adjusted mortality rates and to estimate annual percentage changes (APCs). The study included 392,927 death certificates meeting these criteria. The age-adjusted mortality rate increased from 6.3 per 100,000 in 1999 to 20.6 per 100,000 in 2023. Significant upward trends occurred during 1999 to 2012 (APC, 6.21%) and 2015 to 2023 (APC, 9.62%). Rates were higher among men than women throughout the study period. In 2023, the age-adjusted mortality rate was 22.55 per 100,000 among non-Hispanic White individuals, 19.91 among non-Hispanic Black or African American individuals, 14.31 among non-Hispanic American Indian or Alaska Native individuals, 11.75 among Hispanic or Latino individuals, and 10.28 among non-Hispanic Asian or Pacific Islander individuals. The age-adjusted mortality rate for deaths documenting both AF/flutter and renal failure increased markedly among U.S. adults aged ≥ 45 years between 1999 and 2023. The magnitude of this mortality pattern differed by sex, race/ethnicity, and geographic location. Because the analysis is based on diagnoses documented on death certificates, the findings reflect population-level co-documentation of the 2 conditions and do not establish that either condition, alone or in combination, directly caused death. Individual-level studies are needed to determine the clinical and healthcare factors associated with these trends.

Femur neck fracture is a significant cause of mortality and morbidity in the U.S. This study examines the long-term temporal trends in femur neck fracture-related mortality among individuals aged ≥ 65 in the United States from 1999 to 2023. A retrospective analysis of death records listing International Statistical Classification of Diseases, Tenth Revision code S72.0 (femoral neck fracture) as the underlying cause of death was conducted using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database from 1999 to 2023. We analyzed crude and age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint regression analysis was used to calculate annual percent changes and evaluate trends across various demographics and geographics in the U.S. Between 1999 and 2023, femur neck fractures caused 323,534 deaths among U.S. adults aged ≥ 65 years. The AAMR peaked at 39.6 in 2002 and declined to 22.4 in 2023. A significant drop occurred from 2002 to 2018 (annual percent change ‐3.00 P < .05). Males (30.81), Non-Hispanic (NH) Whites (34.35) and rural areas (41.47) showed the highest AAMR among their demographic and geographic counterparts. Further, among states, Montana (58.9) and Minnesota (58.8) had the highest cumulative AAMRs. Despite overall declines in mortality among individuals with femur neck fractures, persistent disparities by sex, race, and geography highlight the need for targeted prevention strategies.