Muhammad Husnain Ahmad’s research while affiliated with Asian Medical Institute,Kyrgyzstan and other places

Background Intravenous alteplase (ALT) is the standard treatment for acute ischemic stroke (AIS). However, recent trials comparing other tissue plasminogen activators (tPAs) like tenecteplase (TNK) and reteplase with ALT have yielded conflicting results. This necessitated a network meta-analysis to compare the efficacy and safety of various tPAs in AIS patients. Methods We searched MEDLINE, Embase, and CENTRAL (until September 15, 2024) for randomized controlled trials (RCTs) comparing TNK or reteplase (any dose) with ALT (0.9 mg/kg) in AIS patients. A frequentist network meta-analysis was performed using risk ratio (RR) and 95% CI for each comparison, and P-scores ranked treatments. Analyses were done using R Software 4.2.3. Results Sixteen RCTs (9259 patients, 62.1% males) were included. Reteplase 18+18 mg significantly improved excellent functional recovery (mRS 0-1) (RR: 1.13; p<0.01) and independent ambulation (mRS 0-2) at 3 months (RR: 1.07; p<0.01) compared to ALT. The 0.25 mg/kg TNK group also showed improved functional recovery (mRS 0-1) (RR: 1.06; p<0.01). For safety, 0.1 mg/kg TNK was associated with a higher incidence of symptomatic intracranial hemorrhage (s-ICH) (RR: 7.27; p<0.01). No significant differences in ICH or all-cause mortality were found between ALT and other treatments. Reteplase 18+18 mg ranked highest for functional recovery (P-score=0.9638) and ambulation (P-score=0.9749), while ALT ranked highest for s-ICH (P-score=0.8060). No significant differences were observed between reteplase and TNK. Conclusion Reteplase 18+18 mg and TNK 0.25 mg/kg demonstrated higher efficacy and comparable safety to ALT. Larger trials are needed to further explore these agents as alternatives to ALT.

Introduction Tailgut cysts, or retro-rectal cystic hamartomas, are rare congenital lesions arising from embryonic hindgut remnants, typically located in the retro-rectal area. These cysts present some diagnostic challenges due to vague symptoms and potential for malignancy. Case presentation A 25-year-old female presented with a five-year history of perianal swelling. MRI revealed a T2 hyperintense, multiseptated cystic lesion suggestive of a tailgut cyst. The cyst was surgically excised via a trans-sacral approach, and the specimen was sent for histopathological analysis. Clinical discussion The MRI findings were confirmed by histopathology, identifying a benign tailgut cyst. The patient had an uneventful recovery and was symptom-free at the two month follow-up. Conclusion Tailgut cysts can mimic other perianal masses, complicating diagnosis. Accurate diagnosis and successful treatment rely on clinical vigilance, advanced imaging, and histopathological confirmation. Early surgical resection is crucial to prevent complications, including malignancy.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder because of NTRK1 gene mutations, leading to an inability to perceive pain and temperature and lack of sweating. Its rarity and unique clinical challenges, such as severe injuries from the inability to sense pain, make reporting cases critical. A 5‐year‐old boy, the third child of consanguineous parents, was referred for a fractured femur. His history includes recurrent fevers, pain insensitivity, self‐mutilation, and anhidrosis with compensatory hyperhidrosis. Examination showed multiple ulcers, dry skin, missing digits, dental issues, and corneal ulcers. The neurological assessment confirmed loss of pain and temperature sensation. Genetic testing confirmed NTRK1 mutations, diagnosing CIPA. The femur fracture was treated with a hip spica cast, and injury prevention and temperature management were advised to the parents. This case underscores the importance of early diagnosis and comprehensive management of CIPA, highlights the need for genetic counseling for at‐risk families, and provides insights into managing the condition's complex challenges. A multidisciplinary approach is essential to improve patient outcomes and quality of life.

Pemphigus foliaceus (PF) is a rare autoimmune blistering disorder requiring consistent immunosuppressive therapy for management. A 66‐year‐old male with a history of PF presented with worsening blisters and erosions after discontinuing medication. The patient had flaccid bullae and erosions on the face, scalp, chest, and back. Histopathology confirmed PF. Treatment with oral prednisolone, azathioprine, and reinitiation of dexamethasone‐cyclophosphamide pulse (DCP) therapy led to disease remission. This case underscores the importance of adherence to immunosuppressive therapy in PF management. It also highlights the role of affordable treatment regimens in ensuring patient compliance and successful outcomes.

Introduction and importance Ectopic ureteroceles are primarily found in children, often detected incidentally during antenatal ultrasonography or due to urinary tract infection (UTI) symptoms. However, they are rare in adults, with limited published cases. Case presentation This report details a case of a 24-year-old woman who experienced recurrent UTIs and sudden urinary retention, ultimately needing manual compression to urinate due to poor urine flow. Intravenous urography revealed a large right ectopic ureterocele that protruded through the urethra during urination. Cystoscopy confirmed extensive right-sided ureteroceles affecting the bladder and causing her urinary difficulties. Clinical discussion Although ectopic ureteroceles in adults can present with a range of symptoms, including obstruction and recurrent infections, the management approach is often individualized based on the clinical presentation and imaging findings. In this case, endoscopic incision was chosen for its minimally invasive nature, leading to full recovery without complications. Despite the risks of recurrence and potential scarring, the patient showed no recurrence at follow-up and remains symptom-free. Conclusion This case underscores the rarity of symptomatic giant ectopic ureteroceles in adult females and highlights the importance of considering this condition in women with recurrent UTIs.

Key Clinical Message This case report highlights dilated cardiomyopathy as a cardiovascular complication in autoimmune polyendocrine syndrome type 1 (APS‐1), emphasizing the need for early recognition and a multidisciplinary approach. Comprehensive care and regular follow‐up are crucial in managing these atypical presentations to optimize patient outcomes. Abstract APS‐1, also known as Whitaker syndrome, is characterized by a triad of mucocutaneous candidiasis, adrenal insufficiency, and hypoparathyroidism. This rare autosomal recessive disorder results from mutations in the autoimmune regulator (AIRE) gene. Cardiovascular and pulmonary manifestations in APS‐1 are infrequently reported in the literature. We present a case of a 28‐year‐old male who presented with shortness of breath and pedal edema. Physical examination revealed alopecia, absence of eyebrows, hyperpigmentation on joints, oral candidiasis, and nail dystrophy. Echocardiography demonstrated dilated cardiomyopathy (DCM) and pericardial effusion. Chest x‐ray showed left‐sided pleural effusion. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, low parathyroid hormone (PTH), low cortisol, and high adrenocorticotropic hormone (ACTH) levels. The combination of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency confirmed the diagnosis of APS‐1. To the best of our knowledge, this is the first Pakistani and second worldwide reported case of APS‐1 presenting with such a combination of manifestations. Early recognition and multidisciplinary management are crucial for improving outcomes in these patients.

Key Clinical Message This case underscores the critical importance of timely recognition and management of NMDAR encephalitis in adolescents to mitigate potential long‐term sequelae. If a pediatric patient presents with suspected viral encephalitis, autoimmune etiology must be excluded via cerebrospinal fluid antibody assay to guide appropriate immunosuppressive therapy, and improve patient outcomes. Abstract Autoimmune encephalitis particularly involving the n‐methyl‐d‐aspartate receptor (NMDAR) is recognized as a rare cause of acute encephalopathy in pediatric patients. The following case is of a 14‐year‐old female diagnosed with anti‐NMDAR encephalitis who initially presented with fever, episodic convulsions, and loss of consciousness. She subsequently developed right‐sided body weakness, expressive aphasia, and visual hallucinations. Clinical examination revealed prominent neuropsychiatric manifestations such as altered sensorium, motor deficits, hallucinations, and visual disturbances. Cerebello‐bulbar signs were not appreciable in this particular case. She was treated for viral encephalitis but showed no improvement. Laboratory investigations revealed the presence of NMDAR antibodies in the cerebrospinal fluid confirming the diagnosis of autoimmune etiology. The patient demonstrated notable improvement following immunosuppressive treatment.