Background: Nephrostomy tubes are frequently used to relieve upper urinary tract obstruction but may become blocked by blood clots, especially in patients with hematuria. Urokinase, a plasminogen activator, is approved for treating catheter blockages but is rarely used in the urinary tract.Case Presentation: We report the case of a 78-year-old male with bilateral nephrostomies due to metastatic prostate cancer who developed right-sided nephrostomy blockage caused by clots. The patient also experienced acute kidney injury and severe anemia requiring transfusions. After conventional flushing failed, he was treated with intraluminal urokinase instillations (10,000 IU every 8 hours for 48 hours). This led to quick restoration of nephrostomy patency, resolution of hematuria, and clinical stabilization without the need for additional invasive procedures.Conclusion: This case shows that intranephrostomy urokinase instillation can be an effective, minimally invasive option for managing clot-related nephrostomy tube blockage, especially in palliative or fragile patients where procedural risks are high. Continue Reading

Background: Asthma is one of the most common pulmonary disease worldwide. Asthmatic patients are prone to frequent exacerbation of symptoms that range from cough to severe, disabling shortness of breath, leading to significant impairment of quality of life. Airway obstruction causes increased resistance to airflow and decreased expiratory flow rates. Revolizer is useful for inhaling dry medication powder orally for treating lung-related diseases.Objective: To determine the frequency and comparison of ease-of-use of Revolizer among asthmatic patients who were on metered-dose inhalers (MDI’s).Methods: Study Design: Quasi-experimental pre-post design. Setting: Medicine Department, PAEC General hospital Islamabad.Duration: Six months, i.e., 15-10-2024 to 15-4-2025. Data Collection: After meeting the inclusion criteria, 100 patients were enrolled. Then those patients who were using MDIs previously were assorted revolizers and taught about the proper method of using them by investigator. After that, patients were asked to repeat the performance of the inhalation technique in front of the... Continue Reading

Background: Breast carcinoma is the most common malignancy in females, and while a few cases of second primary solid organ malignancies have been reported, the synchronous occurrence of breast cancer and chronic myeloid leukemia (CML) remains exceedingly rare, particularly in patients without prior cytotoxic treatment. CML, a rare myeloproliferative neoplasm, typically develops following exposure to ionizing radiation or chemotherapy. We present the first reported case from Pakistan of synchronous CML diagnosed during staging workup of breast carcinoma. Case Presentation: A 67-year-old female presented with a 10-month history of left breast itching and a palpable mass. The biopsy revealed invasive breast cancer with focal lobular growth pattern (grade 2), ER/ PR negative and HER2 3+.  Laboratory tests showed leukocytosis and thrombocytosis; peripheral smear indicated increased myeloid precursors. Bone marrow biopsy confirmed myeloid hyperplasia without metastasis, and molecular testing detected BCR-ABL fusion, confirming chronic myeloid leukemia. The patient was started on chemotherapy... Continue Reading

Background: Benign ovarian tumours affect around 10–20% of women during their lifetime, with mature ovarian cystic teratomas (MOCTs) comprising about 70% of cases in those younger than 40 years. MOCT fistulation into the bowel is a rare and poorly characterised complication. This systematic review aimed to summarise all reported cases of ovarian teratoma complicated by bowel fistulation, focusing on clinical presentation, diagnostic methods, management strategies, and outcomes. Method: A systematic search of PubMed®, SCOPUS, and EMBASE was conducted from inception to October 2025 in accordance with PRISMA guidelines. All case reports describing ovarian teratoma with bowel fistula were included. Data extracted included demographics, clinical features, imaging, management, histopathology, and outcomes. Results: Thirty-five cases published between 1965 and 2025 were identified. The mean patient age was 41.5 years (range 9–85 years). Abdominal pain (77.1%) and rectal bleeding (30.3%) were the most frequent presenting symptoms. Computed tomography (CT) was the predominant imaging... Continue Reading

Background: Diaphragmatic endometriosis (DE) is a rare and often underdiagnosed type of extrapelvic endometriosis. It usually presents with atypical cyclical symptoms of thoracic involvement. Case Presentations: We present three African women with pelvic endometriosis and thoracic symptoms. The first case involved a 32-year-old nulligravida who presented with dysmenorrhea, cyclical hemoptysis, pleural effusions, and subfertility. An MRI showed a right pleural effusion and associated diaphragmatic lesions. Laparoscopic excision provided a diagnosis of DE, and she improved with postoperative treatment of dienogest (Endogest: 2 mg). The second case was a 33-year-old woman with recurrent cyclical dyspnea and right chest pain with a history of pelvic endometriosis. She was urgently admitted and underwent VATS surgery and subsequent pleurodesis. She was treated successfully with a GnRH agonist (11.25mg) and stabilized on this treatment. The third case was a 29-year-old nullipara who presented with cyclical right chest pain. An MRI demonstrated a right diaphragmatic nodule... Continue Reading