NICVD to get international-standard clinical trials unit
NICVD Executive Director, Tahir Saghir, stated that the facility will support advanced research and improve treatment quality, particularly for children who have had to seek cardiac care abroad due to lack of local facilities. The project is being developed under a Build, Operate and Transfer (BOT) model, with a private firm constructing and handing over the unit, while NICVD focuses on monitoring. The facility will also include a conference hall and library.
The lower floor of the old OPD will be converted into an expanded emergency ward, increasing the current bed capacity from 80 to between 160 and 180, while a centralised medical hall will accommodate multiple emergency departments.
A new OPD building is also under construction and expected to become operational by October or November. This project is also being executed under the BOT model, with an estimated cost of Rs1.25 billion. The building will have a separate entrance from outside the hospital, to reduce congestion within the main building.
Further, the first phase of the pediatric block is expected to be partially functional by November, offering dedicated emergency, ward, and ICU facilities for children. Currently, only one pediatric ward exists, where up to three children often share a single bed. With only two operation theatres available for children, pediatric patients also share cath labs and surgical facilities with adult patients. Despite reduced federal funding, the Sindh government has allocated Rs2.5 billion for the pediatric block, in order to support the completion of two underground levels, and two floors, including all required pediatric facilities.
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Business Recorder
5 days ago
- Business Recorder
12 to 15pc heart attack patients are under 40, say cardiologists
KARACHI: Cardiologists at the National Institute of Cardiovascular Diseases (NICVD) have revealed that nearly 50 percent of heart attack patients in the country are younger than 49 years, and between 12–15 percent are under 40 years. Experts warn that this trend fuelled by diabetes, hypertension, obesity, smoking, and unhealthy lifestyles is making Pakistan one of the world's worst-hit countries for early-age heart attacks. The data was shared during a symposium here on Saturday, where NICVD researchers, in collaboration with local pharmaceutical firm Pharmevo, presented the results of the country's largest clinical trial comparing two anticoagulants for treating acute left ventricular thrombus (LVT) — a dangerous blood clot that can form in the heart after a severe heart attack and cause stroke or other embolic complications. The trial, known as RIVAWAR, was designed and conducted independently by NICVD's cardiology team and ran from June 7, 2021, to December 31, 2023. It enrolled 261 post–heart attack patients, randomising them to receive either rivaroxaban — a newer direct oral anticoagulant — or warfarin, the decades-old standard treatment. All participants had confirmed LVT within seven days of their heart attack, with most suffering severe ST-segment elevation myocardial infarction (STEMI) and reduced heart pumping capacity. According to principal investigator Dr Jehangir Ali Shah, rivaroxaban achieved faster clot resolution in the early phase — 20 percent at four weeks versus 8.3 percent with warfarin — while both drugs had similar high success rates at 12 weeks. He noted that about 16 percent of heart attack patients previously faced a significant stroke risk due to LVT, but this was eliminated in the trial cohort. 'This is the largest randomized trial to date in acute LVT, and the results show rivaroxaban to be a safe, effective alternative to warfarin,' he said, adding that 15 percent of participants were under 40 years old. Dr Shah said the study was significant not only for its clinical findings but also as an example of high-quality, investigator-led research conducted in Pakistan and published in the Journal of the American College of Cardiology: Advances. NICVD's Director of Cath Lab, Dr Abdul Hakeem, stressed the public health urgency. 'Pakistan has the highest rate of young heart attack patients globally. Every third adult has diabetes, 40 percent have high blood pressure, obesity is common, and smoking rates remain high. Many patients don't know they're at risk because, in our culture, loose clothing hides weight gain. After the age of 30, everyone should get a cardiac check-up,' he said. He added that common misconceptions — such as assuming a heart attack always causes severe chest pain — can delay treatment. 'Nine out of ten of our patients had no pain, only heaviness in the chest or acidity-like discomfort. If you feel chest heaviness while walking or climbing stairs get an ECG immediately,' he advised. Dr Hakeem warned that the most dangerous anterior heart attack can damage up to 60 percent of the heart muscle and often causes a clot that appears four to eight weeks later, increasing stroke risk. NICVD Executive Director Dr Tahir Saghir said the institute is now moving into further advanced research, including trials on drug-coated balloons that do not require stents — a development that could reduce future artery blockages. 'We already have international funding for this work, and the direct beneficiaries will be our patients,' he said. Senior cardiologist Dr Nadeem Rizvi emphasised the importance of locally conducted clinical research, saying results based on Pakistan's environment and healthcare system are more practical and applicable. Dow Institute of Cardiology Director Dr Tariq Furman said genetic, socioeconomic, and physical differences between Pakistani and Western populations require tailored treatment guidelines. 'We need our own data. Sometimes their recommended high doses aren't suitable for our patients,' he said. Pharmevo's Abdul Samad said the company's support for RIVAWAR was part of its commitment to advance evidence-based care. 'These results will help guide treatment choices for post–heart attack clots. We will continue to support medical research in Pakistan so that effective medicines are available locally,' he said. Copyright Business Recorder, 2025
Express Tribune
01-08-2025
- Express Tribune
An Unconscious Patient Led To Saving Thousands of Lives
The writer is a leading public health specialist in Pakistan and has served at the Aga Khan University, USAID and WHO It was a bright, sunny, and hot day in May 1975 when our small clinical batch, posted in Medical Unit-I, made its way toward the outpatient department (OPD) of the Civil Hospital, Karachi (CHK). We had just entered our third year at Dow Medical College (DMC), and this was our very first day of seeing patients in the OPD. Dressed in crisp new white coats, stethoscopes draped neatly around our necks or tucked into our long pockets, we walked briskly alongside Assistant Professor Shamsuddin Rehmatullah—a cheerful, approachable man known for his sharp diagnostic skills. The excitement was visible on every face; after two long years immersed in the basic sciences, we were finally about to feel like doctors. How could anyone forget those first two years that seemed to stretch endlessly? I had found physiology engaging, especially when guided by Guyton's Textbook of Physiology, but biochemistry was an uphill struggle, and following Gray's Anatomy felt like an even greater challenge. Adding to the ordeal were the mandatory dissections of cadavers, a task my mind resisted at every step. The pungent formalin only made matters worse, leaving my nose running and sneezing constantly throughout each session in the dissection hall. Now, with those difficult days behind us, we stood at the threshold of what we imagined to be a 'doctor-like era' in our student lives—an era we eagerly hoped would be both exciting and fulfilling. We entered the OPD and began observing patients under Professor Rehmatullah's guidance. Before long, a stretcher was rushed in, carrying a young man in an unconscious state. To protect his identity, let's call him Moeen, a name that means 'one who assists or gives aid.' He had been brought in by a friend, who explained that Moeen was a BSc student. He had no surviving family; his entire household had been brutally killed by the Mukti Bahini in 1971, during the conflict in East Pakistan, leaving him the sole survivor. The Professor examined Moeen and diagnosed him as suffering from tuberculous meningitis accompanied by hemiplegia. Meningitis is a serious illness in which the protective layers around the brain and spinal cord become swollen, often causing a high fever, headache, stiff neck, and sometimes confusion or sleepiness—and is fatal if not treated promptly. The Professor immediately admitted Moeen, wrote a prescription, and asked his friend to procure the required medicines, as they were not available in the hospital. At this, the friend broke into tears. He explained that purchasing the medicines was beyond his means; he too was a student who had migrated from East Pakistan with his mother and sisters and was surviving on a very modest income earned through odd jobs. That small earning barely kept him and his family fed. We, the new clinical students, were deeply moved by the young man's helplessness. Quietly, we huddled in a corner, pooling together whatever money we had in our pockets. With the Rs. 78 we managed to collect (about US $7.80), we were able to purchase three days' worth of medicines and essential supplies from the only private chemist shop in CHK, located along Baba-e-Urdu Road. For Moeen's friend, it was an immense relief; for us, it bought a little time to gather more help. Fortunately, that same evening, a relative of mine generously contributed a substantial amount on hearing Moeen's ordeal, which allowed us to secure Moeen's medicines for a few weeks. Yet we knew his treatment for tuberculosis would need to continue for several months. While another batchmate and I worked to raise enough funds for Moeen's full treatment, two other incidents unfolded. A twenty-five-year-old man suffering from severe diarrhoea was admitted to the hospital in a state of shock. He was dangerously dehydrated, his pulse was weak, and his blood pressure critically low. Let us call him Miskin, a name that means 'helpless or miserable.' His mother stood by his bedside, weeping and pleading desperately for someone to save her only son. Miskin was not just her child; he was the sole breadwinner for a family that included his mother and six sisters. What he needed immediately were intravenous infusions—at least three bottles, each containing one litre of Ringer's lactate or normal saline. Yet none were available in the ward that day. The mother was advised to purchase them, but she had no money. At that time, the total cost of three one-litre bottles of normal saline was just Rs. 30 (about US$3), yet that small amount stood between life and death. Realising the gravity of the situation, and fearing that her son's end was near, the distraught mother screamed and cried aloud. Her cries echoed through the ward, drawing the attention of the medical students present. Once they learned of Miskin's urgent need, they quickly pooled their money, bought the required IV infusions, and secured the additional medicines needed for his treatment. Thanks to their timely help, Miskin recovered rapidly and was discharged from the hospital after two days. Throughout his brief stay, his mother ceaselessly offered prayers for the success, health, and lifelong happiness of those students who had stepped in to save her son's life. A few days later, I learned of another tragic incident. A nineteen-year-old girl, severely anaemic, was brought to CHK. She urgently required a transfusion of two bottles of blood. Unfortunately, the hospital's blood bank did not have any that matched her blood group. Her father, who had brought her in, was advised to purchase the blood from another blood bank in the city. But he did not have the Rs. 60 (about US$6) needed to obtain it. They waited, perhaps hoping for some miracle, but none came. Instead, death did. Beginning with the case of unconscious Moeen in May, many similar incidents unfolded over the next three months. It became painfully clear that there were always patients who simply could not afford their treatment, and this inability often led to fatal outcomes. The custodians of public health and the hospital authorities may have grown desensitised to such tragedies, but for many of my classmates, each episode struck a raw nerve. These recurring scenes weighed heavily on our young consciences, leaving us deeply unsettled. In August 1975, I began reflecting on the situation and shared my concerns with my uncles, aunts, and elder cousins. They proposed establishing a fund under a formal authority, allowing contributions to be raised from multiple sources. Acting on this advice, I initially approached the college administration, hoping they might offer official support or umbrella coverage for the initiative. However, they declined to be involved in any student-run activity of this nature. This prompted me to explore an alternative path. I met the President and the Social Secretary of the Students' Union and shared the idea of creating an autonomous fund for needy patients, one that would operate under the patronage of the Students' Union but without its interference. They agreed to initiate the Fund under the Social Section of the Dow Medical College Students' Union (DMCSU) and assured that it would be allowed to operate independently and autonomously under my management, without any interference from the Union. This commitment to the Fund's autonomy by DMCSU was crucial for keeping it apolitical and preventing its polarisation among students. At the time, the student body was sharply divided between two rival groups: the left-wing National Students Federation (NSF) and the right-wing Islami Jamiat-e-Tulaba, both affiliated with national political parties. In addition, there was a third group, the Young Medicos Organization (YMO), which discouraged students from aligning with political parties. The title, management, and operational framework of the fund were discussed with a group of students. We named it SAVE A HUMAN LIFE – WARD FUND, soon commonly referred to as the Ward Fund. Several ideas were proposed for utilising the donations. One suggested providing medicines and supplies to each ward monthly; another recommended giving a fixed amount of money to the professor in charge. However, both were deemed impractical, as serving 30 wards equally would demand significant resources. Moreover, when these ideas were shared with a few professors, they declined responsibility, unwilling to manage the accounting or distribution of medicines and cash. It was therefore decided that medicines and supplies would be provided directly to patients based on individual needs, and I was tasked with designing the plan. Creating a system to meet the needs of over 1,200 beds, around the clock, was a major challenge. In parallel, a second plan was needed to ensure a steady flow of donations. To my great relief and delight, when I presented the plans to the concerned group of students and to the DMCSU, they were accepted without a single change. To raise funds regularly, the proposal focused on DMC students. If each of the 2,000-plus students could be encouraged to donate at least Rs. 5 per month, the collective contribution would total around Rs. 10,000 (about US$1,000 at the time). This effort was not just about money; it aimed to foster a sense of shared responsibility and involvement in a cause with far-reaching ripple effects. To support this goal, we decided to make a heartfelt appeal through a compelling leaflet. A well-crafted message was designed, printed, and widely distributed at the Fund's launch. In addition to personal contributions, students were encouraged to seek donations from their families and friends. To evoke compassion and a sense of urgency from their families and friends, we decided that the leaflet would include brief real-life accounts of needy patients we had recently encountered. It was also decided that each donor would receive an official receipt, stating the Fund operated under the patronage of the Social Section of the DMCSU, to ensure transparency and build trust in its management. The plan for fund utilisation was kept simple. Our class was divided into 30 clinical batches, each assigned to one of the hospital's 30 wards. Within each ward, students were allotted a specific number of beds; for example, in a ward with 50 beds and 10 students, each was responsible for five patients. This ensured all admitted patients were covered, and students were aware of the needs of those under their care. Students identified essential medicines and supplies for patients who couldn't afford them and documented the needs. These were endorsed by the registrar or senior faculty member of the ward, such as a registrar or someone of higher designation, and submitted to me. The items were then purchased and provided to the patient. In emergencies, students could buy the items directly and seek reimbursement with proper receipts and faculty verification. These clear, transparent procedures for collecting and utilising donations were well-received by students from all political groups. The WARD FUND began operating in September 1975 on a modest scale with limited resources but gradually began to expand. Most support provided to patients ranged from Rs. 30 to Rs. 90 (US$3 to US$9), enabling us to assist several needy individuals. It was heartening to see enthusiastic participation from students across different groups, not just those aligned with the ruling party in the DMCSU that year. Some batches even began supporting patients in their assigned wards through their own pooled funds. Thus, a service sparked by one unconscious young patient was steadily growing into a vital lifeline, helping save many lives. The smooth functioning of the Fund was abruptly disrupted by an unexpected incident that drew student politics into its affairs. I tried to salvage the situation by appealing to the professor overseeing the Social Section, but he declined to intervene, unwilling to be drawn into student political tensions. Regrettably, I was forced to step away from the project before mid-1976, despite having managed it successfully for several months. The project was soon discontinued. Although my involvement lasted less than a year, there remains a sense of lasting contentment. The seed planted in 1975 for patient welfare did not go to waste. After graduating from DMC, I learned that a group of students had come together once again to establish the 'Patients Welfare Association,' pursuing similar goals. It's likely that they were aware of the earlier Ward Fund experience, which may have inspired them to build a more structured and formal initiative. They broadened its scope, registered it as an NGO, and over time, it evolved into one of Pakistan's largest student-run volunteer organisations—one that has since served thousands of patients and saved countless lives.
Business Recorder
18-07-2025
- Business Recorder
FIC: Minister displeased with state of affairs
LAHORE: Steps are under way to implement the vision of Punjab Chief Minister Maryam Nawaz Sharif for a healthy Punjab, Provincial Health Minister Khawaja Salman Rafique, said. During his visit to the Faisalabad Institute of Cardiology, Salman expressed his displeasure over the mismanagement of the queue management system and non-availability of medicines at FIC. He also visited the pathology lab and echography ward and inquired about the details of diagnostic tests and reporting time. Khawaja Salman Rafique also expressed his displeasure over the mistreatment of patients by the security staff and the poor hygiene conditions. The Minister and the Provincial Health Secretary inquired about the facilities available to patients individually in the emergency and OPD pharmacies and the provision of medicines. He directed authorities to create a regular mechanism for the availability of medicines other than heart disease for the patients under treatment. He inspected the packaging process and records of the supply of medicines to homes. Khawaja Salman said that Rs 33 billion were provided for the provision of medicines in the last fiscal year. 'Implementation of the SOPs of service delivery set by the Chief Minister of Punjab should be ensured. Strict action will be taken on complaints about ordering medicines from outside the hospital,' he added. The Minister said all medicines related to heart diseases should be available in the hospital, adding there is a zero tolerance policy for negligence in service delivery to patients. Provincial Health Secretary Azmat Mahmood Khan said that Rs 23 billion funds were provided to hospitals to pay the dues of previous years. 'As per the instructions of the Chief Minister, strict action will be taken on the non-availability of medicines to patients,' he said. Executive Director FIC Dr Hamid Saeed and MS Dr Nadeem Akhtar gave a briefing during the visit. Copyright Business Recorder, 2025
