Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Background: The myoclonus after induction of anesthesia with etomidate can lead to increased risk of regurgitation and aspiration. We conducted this study to compare the effectiveness of midazolam and lidocaine for the prevention of etomidate induced myoclonus. Methodology: This randomized controlled trial was done in the Department of Anesthesiology and Intensive Care, Holy Family Hospital, Rawalpindi from January-June 2015 after approval of hospital ethical committee. Informed consent (written) was taken from 224 patients. Patients were allocated into 2 equal groups randomly with the help of computer-generated numbers. Two minutes after induction with etomidate, Group A got 1 ml of 2% lidocaine, and one ml (1 mg) of midazolam was given to Group B. Myoclonus was evaluated in the following one minute, after which 0.5 mg/kg of succinylcholine was given to the patient to facilitate endotracheal intubation. Time of onset of induction was marked by loss of eyelash reflex. Myoclonus was recorded at 20, 40, and 60 seconds. Drug was found to be effective if there was no myoclonus within one minute of etomidate induction. Analysis of data was done using SPSS 17. Results: Lignocaine was effective in preventing myoclonus in 55.40% of patients and Midazolam prevented it in 69.60%. The variation between the results of the groups was found significant statistically. (P< 0.05) Conclusion: Both midazolam and lignocaine are effective in preventing the occurrence of myoclonus associated with etomidate. However, midazolam is the more effective of the two drugs. Keywords: Etomidate, Lignocaine, Midazolam, Myoclonus

With the recognition of populism emerging in varied forms across the Global South, the lacuna of research on populism in Asia is gradually filling. Yet, research on populism in Pakistan is still limited and focused mostly on the singular case of former Prime Minister Imran Khan and his political party Pakistan Tahreek-e-Insaaf (PTI). There is much lesser attention to the populism of Tahreek-e-Labbaik Pakistan (TLP), a far-right movement-turned-party. This paper addresses this gap by comparing the two cases of populism in Pakistan – PTI and TLP – to outline the similarities and differences in their characterization of “the people,” “the elite” and “the others,” using the framework of civilizational populism. The comparative analysis of public discourse of the leadership of two parties shows an extensive use of civilizational rhetoric by both parties, with varying degrees of religious sloganeering, to cater public support. Civilizational dimension forms an overlay over the vertical-horizontal dimensions of populism. Given that 2023 is the election year in Pakistan and both parties are planning to contest elections, this is a timely piece to warn about the treacherous trajectory taken by Pakistani politics.

Background and Aim: Pathological variation and image overlapping due to several endometrial conditions could be challenging for radiologists. Diffused weighted magnetic resonance imaging (DWI) is a reliable and promising imaging technique for the diagnosis and characteristics of endometrial lesions. The present study aimed to assess the diagnostic accuracy of diffused weighted magnetic imaging resonance in differentiating between malignant and benign endometrial soft-tissue lesions. Methodology: This descriptive cross-sectional study was carried out on 50 suspected endometrial lesions in the department of radiology, Benazir Bhutto hospital, Rawalpindi from January 2021 to December 2021. Non-probability consecutive sampling technique was used for all the participants meeting the inclusion criteria. Patients were categorized into two groups; Group I and Group II comprised 25 suspected benign and malignant endometrial lesions respectively. All the study patients were subjected to ultrasound and MRI examination of the pelvis. DWI imaging was done and the ADC value was calculated at a high b value. Histopathological data was collected. Data were analyzed using SPSS version 23. Results: Of the total 50 endometrial lesions, histopathological results were divided into the malignant group (25 lesions, 50%) and benign group (25 lesions, 50%). Out of 50, 38 lesions (21/25 benign and 17/25 malignant lesions) were correctly diagnosed by the conventional magnetic resonance imaging technique. The sensitivity, specificity, predictive positive value (PPV), and negative-positive value (NPV) of conventional MRI were 76.82%, 79.41%, 74.12%, AND 81.5% respectively. However, combining the apparent diffusion coefficient (ADC) value at b=1000 with DWI, about 48 lesions (24/25 benign and 24/25 malignant lesions) were correctly diagnosed. The sensitivity, specificity, predictive positive value (PPV), and negative-positive value (NPV) of conventional MRI were 94.82%, 93.23%, 91.6%, and 97% respectively. Conclusion: Diffusion-weighted MRI can help in distinguishing uterine endometrial lesions as benign and malignant. The diagnostic accuracy of Combined DWI with ADC mapping is higher than conventional MRI when differentiating benign lesions from malignant lesions. Additionally, sensitivity, specificity, and accuracy of combined DWI with ADC mapping increased in pelvic MRI examination for differentiating endometrial focal lesions. Keywords: Pelvic ultrasound; MRI Pelvis; Benign and Malignant endometrial lesions, Validity.