Objective: To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications. Background: COVID-19 has shown to be a systemic illness, not localized to the respiratory tract and lung parenchyma. Stroke is a common neurological complication. In particular, critically ill patients on ECMO are likely at higher risk of developing hemorrhagic stroke. Case Presentation: 38-year-old man presented with fever, cough, and shortness of breath. Due to severe respiratory failure, he required ECMO support. Subsequently, he was found to have left temporal intraparenchymal hemorrhage. Overall, his clinical course improved, and he was discharged with minimal neurological deficits. Conclusion: Although intracranial hemorrhage is a known complication of ECMO, patients with COVID-19 infection may be at a higher risk of cerebrovascular complications due to vasculopathy.

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OBJECTIVES: To examine the psychological issues following acquired limb amputation and examine the significance of positive self-esteem in the psychological adjustment of amputation. METHODOLOGY: This case study was conducted in the surgical and orthopedic units of different government and private hospitals of Peshawar district. The study includes a sample of 100 acquired limb amputees,both adult males and females admitted in different hospitals of Peshawar. Patients with congenital limb loss or with preexisting psychological issues were excluded from the study. Psychological adjustment scale developed by Sabir (1999) and Self-Esteem scale developed by Rifai’s (1999) was used to determine the amputee’s level of psychological adjustment and self-esteem. RESULTS: Results revealed that amputation leads to number of psychological issues. It was found that males had lowered self-esteem and severe adjustment issues then females while young amputees exhibit greater signs of maladjustment as compared to older amputees. Regression analysis for selfesteem predicting psychological adjustment also displayed pronounced differences in the level of psychological adjustment due changing level of self-esteem. The model suggested a strong positive relation between self-esteem and psychological adjustment (r=0.880, B=0.867, t=18.37, p<.001) and 77.5% of the variance in the dependent variable (psychological adjustment) was caused by predictor variable i.e. self-esteem (R2=0.775, F (98)=337.6, p<.001). CONCLUSION: Amputation badly disturbs the psychological state of an amputee and an amputee’s self-esteem is an important coping tool and has a direct relation with better psychological adjustment to limb loss.

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Background: Following the recent surge in monkeypox cases worldwide, vaccines have gained popularity due to their protective role against the disease in the absence of specific pharmacological therapies for the disease. This article explores the possible challenges associated with the treatment and prevention of monkeypox with special emphasis on cardiovascular concerns relating to vaccines, warranting further investigation and research. Methods: Multiple electronic databases from inception till October 2022 were searched to find articles reporting the cardiovascular adverse events associated with monkeypox immunization. Results: Smallpox vaccines ACAM2000, JYNNEOS, and modified vaccinia Ankara have been used for monkeypox. ACAM2000 has been reported to have major cardiovascular adverse events such as myocarditis, dilated cardiomyopathy, and heart failure. Whereas JYNNEOS and modified vaccinia Ankara are associated with minor cardiovascular adverse events such as tachycardia, palpitation, electrocardiogram changes such as T wave inversion, and ST elevation. Conclusions: Despite having cardiovascular issues with the existing vaccines, clinicians and public health experts should measure the risk benefit aspect of smallpox vaccines to decide whether to go for mass immunization or not. Based on the lessons learned from the COVID-19 pandemic, immunization will be a better strategy to halt the monkeypox spread throughout the globe. However, further research is needed to determine the exact incidence and susceptibility to develop cardiovascular complications among monkeypox immunized individuals.