Influence of transformational leadership on innovative work behavior and task performance of individuals: The mediating role of knowledge sharing.

This research tries to investigate the dynamic link between higher education institution (HEIs) transformational leaders (TFL) and follower's outcome innovative work behavior (IWB) and Task Performance) through Knowledge sharing (KNS) in Pakistan. Using quantitative design an adopted construct was used to obtain response from HEIs leaders and employees behavior. The obtained information was analyzed through structural equation modeling (SEM) technique via Smart PLS. Results depict that direct link between University Transformational leadership and employees Innovative work behavior as well as Task Performance. The results further postulate that KNS mediate the relationship between Transformational leadership and employees TSP in the context of HEIs. Surprisingly, KNS could not evident to become a mediating variable to strengthen the relationship between transformational Leadership and employees IWB in the HEIs sector of Pakistan. In addition to enhancing the theoretical comprehension of higher education leadership, the outcomes of this article provide that promoting knowledge sharing culture is valuable asset for both existing and future HEIs leaders in order to promote the culture of innovation and creativity. Although recent studies investigate the role of KNS as a mediator, however the current study use KNS as contemporaneous intervening variable for IWB and Task Performance for the first time. The study also confirms theoretical underpinning of social exchange mechanism in strengthening the relationship between leader member's continuum.

Nexus of green energy, financial inclusion, militarization, and environmental sustainability: A global perspective.

This article investigates the dynamic impact of green energy consumption (GE), financial inclusion (FI), and military spending (MS) on environmental sustainability (ES) by utilizing a sample of 121 countries from 2003 to 2022. The dataset is divided into high-income, upper-middle income and low and lower-middle-income countries. We employed a two-step system GMM approach, which was further robust through panel Quantile and Driscoll-Kraay (D-K) regressions. The findings divulged that green energy resources benefit ES at global and all income levels because of having a significant negative impact of 5.9% on ecological footprints. At the same time, FI and MS significantly enhance ecological footprints by 7% and 6.9%, respectively, proving these factors detrimental to ES. Moreover, conflicts (CON), terrorism (TM), institutional quality (IQ), and socioeconomic conditions (SEC) also have a significantly positive association with global ecological footprints and most of the income level groups. Dissimilarly, financial inclusion and armed conflicts have a non-significant influence on ecological footprints in low-income and high-income countries, respectively. Furthermore, institutional quality enhances ES in upper-middle and low and lower-middle-income countries by negatively affecting ecological footprints. At the same time, terrorism significantly reduces ecological footprints in high-income countries. This research also provides the imperative policy inferences to accomplish various SDGs.

Prevalence of Workplace Bullying Among Healthcare Professionals in Tertiary Care Hospitals in Pakistan.

Workplace bullying (WPB) in the healthcare system (HCS), whether perpetrated by healthcare professionals (HCPs) or patients, is a serious problem. The goal of this research study was to find out how common WPB is among HCPs. We conducted a questionnaire-based cross-sectional study in the three public tertiary care hospitals of Karachi, Pakistan from May to October 2020. A validated Negative Acts Questionnaire-Revised (NAQ-R) was used to measure WPB prevalence. The final sample size was 449, out of which 72.4% were females and 27.6% were males. The majority of respondents were house officers or 1st-year trainees who had completed their MBBS (n = 252, 56.1%). Residents (n = 197, 43.9%) who were pursuing specialty training made up the remainder of the respondents. As per NAQ-R cut-offs, the prevalence of bullied, being bullied, and not bullied was 41, 29, and 30%, respectively. WPB prevalence was higher in males (53%) than females (38%), whereas it occurred more often in residents (48%) than house officers (36%). We found similar findings while using the self-reported definition for WPB. Based on our findings, we conclude that WPB is pervasive among HCPs, particularly for males and residents in tertiary care hospitals in Pakistan.

Quantification Of Thrombus Burden As An Independent Predictor Of Intra-Procedural No-Reflow In Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Revascularization.

BACKGROUND: Aim of this study was to perform quantitative evaluation of high thrombus burden (Grade ≥4) as an independent predictor of slow/no reflow phenomenon during primary percutaneous coronary interventions (PCI) of patients with ST-segment elevation myocardial infarction (STEMI). METHODS: In this analytical cross-sectional study we included consecutive patients who have undergone primary PCI for STEMI at a tertiary care cardiac center of the Pakistan. High thrombus burden was defined as angiographic thrombus grade ≥4. The thrombolysis in myocardial infarction (TIMI) flow rate < III was defined as slow/no reflow phenomenon. Results of multivariate logistic regression analysis for slow/no reflow phenomenon were reported as odds ratio (OR). RESULTS: This analysis included 747 patients, 78.2% (584) patients were male and mean age was 55.82±11.54 years. High thrombus burden was observed in 68.1% (509) of the patients. Slow/no reflow phenomenon was observed in 33.6% (251) which was more common among patients in high thrombus burden group, 39.7% (202/509) vs. 20.6% (49/238); p<0.001. Adjusted OR of thrombus Grade ≥ 4 was 2.33 [1.6 -3.39]; p<0.001. Other significant variables were female gender (1.51 [1.01 -2.27]; p=0.045), left ventricular end-diastolic pressure (LVEDP) ≥20 mmHg (2.34 [1.69 -3.26]; p<0.001), total lesion length ≥20 cm (1.54 [1.09-2.16]; p=0.014), and neutrophil count ≥8.8 cells/µL (1.72 [1.22 -2.43]; p=0.002). CONCLUSIONS: High thrombus burden (Grade ≥4) is a significant and an independent predictor of the slow/no reflow phenomenon. While predicting slow/no reflow phenomenon, thrombus burden should be given due importance along with other significant factors such as gender, LVEDP, lesion length, and neutrophil counts.

Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma.

Thoracic Splenosis (TS) is a rare medical condition, where there is auto-transplantation of the splenic tissue in the thoracic cavity, often leading to pleural based nodules. Our patient is the first ever case of this condition in Pakistan, and underwent extensive diagnostic procedures as well as medical treatments, before receiving the diagnosis of TS. He underwent HRCT for chronic cough that revealed pleural and mediastinal nodules. This coupled with a vague mass in the testes led to the provisional diagnosis of metastasized testicular tumour, and later a diagnosis of pulmonary tuberculosis was made. However, eventually a 99mTc denatured red blood cell scan confirmed the diagnosis of TS. TS is a benign condition, whereas other causes of pleural nodules are relatively malignant, hence its diagnosis is essential in ruling out malignancies. Among the multiple invasive and non-invasive diagnostic modalities, the gold standard remains 99mTc denatured red blood cell scan, which is a sensitive test that provides an accurate diagnosis and bars the need of multiple invasive procedures.

Breast Cancer Risk and Human Papillomavirus Infection: A Bradford Hill Criteria Based Evaluation.

BACKGROUND: The association between human papillomavirus (HPV) and human breast cancer (BC) has already been thoroughly studied worldwide with contradictory findings. Although the researchers have tried to minimize the conflict using statistical meta-analysis because of its shortcomings, there is still a need to evaluate the correlation between HPV and BC using any additional method. OBJECTIVES: This study was launched to investigate the correlation between HPV and BC through the application of Bradford Hill criteria postulates. METHODS: Population-wide studies associating HPV with BC were searched using the PubMed database. Then, the information of HPV burden in BC, normal/benign samples was analyzed, and ultimately Bradford Hill criteria postulates were applied on the collected evidence to explore the relationship between HPV and BC. In addition, to make the outcomes more authentic, we also reviewed the methodologies of previous studies to address the propensity of false results. RESULTS: After a careful evaluation of the obtained data against major Bradford Hill criteria postulates, it was noted that all these postulates, including strength, consistency, biological gradient, temporality, plausibility, experiment, specificity, and analogy were not fulfilled. CONCLUSION: The results of the present study have failed to establish a causal association between HPV and BC, but they did suggest HPV as a cause-effective agent or at least a co-participant in the pathogenesis of BC. Because of the weakness of association, particularly the lack of consistency between studies and the lack of effect specificity, more research into Bradford Hill criteria postulates is required.

Acute epiploic appendagitis mimicking symptoms of urinary tract infection: A diagnostic enigma in the emergency department.

The epiploic appendages (also known as appendices epiploicae) are usually located on the anti-mesenteric surface of the colon, extending from the caecum to the rectosigmoid, and epiploic appendagitis (EA) is the inflammation of these appendages. We report a clinical image of epiploic appendagitis creating a diagnostic challenge.

A case of concomitant pulmonary embolism and pulmonary tuberculosis in the era of COVID 19, a matter of cautious approach.

Tuberculosis (TB) is known to the world for many years. It is associated with various complications and rarely with pulmonary embolism. However, due to its commonalities of presenting features with COVID 19, it can easily be missed and may be life threatening.

DAR-GRACE: Diabetes and Ramadan: glycaemic control, physician counselling and patient practices -experience from a tertiary care hospital in Pakistan.

OBJECTIVE: To identify patient practices and knowledge pertaining to Ramadan fasting and to see whether physicians were providing adequate counselling and adjusting medications accordingly. METHODS: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from June to August 2018, and comprised diabetic patients who fasted during Ramadan. A questionnaire was designed to assess patients' knowledge, risk category, pre-Ramadan counselling, medication adjustment, lifestyle changes, pre- and post- Ramadan glycated haemoglobin levels, and complications during Ramadan. Data was analysed using SPSS 23. RESULTS: Out of 272 diabetics, 176(64.7%) were females. Mean number of fasts kept were 22±10.61. Pre-Ramadan 120(44.1%) patients consulted their physicians and 105(87.5%) of them received relevant counselling. Medications were adjusted in only 30 (25%) such cases. Overall, 41(15.1%) patients were in the high risk category, while 109(40.1%) and 122(44.9%) were in the moderate and low-risk categories. During the month, 17(6.25%) were hospitalised due to diabetes-related complications. Glycated haemoglobin levels fell significantly (p<0.0001). CONCLUSIONS: Anomalous patient behaviours and suboptimal physician practices were noticed.

Replacement reaction-assisted synthesis of silver nanoparticles by jet for conductive ink.

Synthesis of silver (Ag) nanoparticles with controllable morphology and with high purity remains challenging. In this work, single crystalline Ag nanoparticles with uniform morphology and high purity are successfully synthesized based on the replacement reaction between aqueous Ag nitrate (AgNO3) and solid copper (Cu) via jet. We further demonstrate that the developed jet method is facile and morphology-controllable. It is believed that diffusion limited aggregation and oriented attachment mechanisms are responsible for the formation of Ag nanostructures. The synthesized nanoparticles were characterized by different techniques. Finally, the Ag nanoparticles are successfully applied to prepare the conductive ink for flexible electronics and wearable equipment. Furthermore, the conductivity, flexibility and stability of the conductive material are measured. The conductive pattern exhibits lowest resistivity of 6.7 µΩ cm, showing the good conductivity of the prepared conductive material. In addition, the prepared conductive material is flexible in nature and exhibits stability over a long period.

Facile and High-Yield Replacement Reaction-Assisted Synthesis of Silver Dendrites by Jet for Conductive Ink.

Metallic dendrites with uniform morphology, high purity, and large yield remain challenging to synthesize. In this work, single-crystalline silver (Ag) dendrites with uniform morphology, high purity, and large yield are successfully synthesized by employing single replacement reaction between aqueous silver nitrate (AgNO3) and solid copper (Cu) by jet. The combined effect of diffusion-limited aggregation and the locally oriented attachment of Ag particles is responsible for the formation of silver dendrites under nonequilibrium conditions. Finally, the potential applications of as-synthesized silver dendrites are demonstrated by successfully preparing silver-based conductive ink for flexible electronics and wearable equipment. The conductive pattern exhibits resistivity of 7.2 µΩ·cm, showing good conductivity of the prepared conductive material. This facile and time-efficient synthetic route can be extended to synthesize other noble metal nanostructures with desired morphologies by adopting selective precursor salt concentrations and substrate metals with proper redox potentials.

A Flexible, Robust, and Gel-Free Electroencephalogram Electrode for Noninvasive Brain-Computer Interfaces.

Brain-computer interfaces (BCIs) enable direct and near-instant communication between the brain and electronic devices. One of the biggest remaining challenges is to develop an effective noninvasive BCI that allows the recording electrodes to avoid hair on human skin without the inconveniences and complications of using a conductive gel. In this study, we developed a cost-effective, easily manufacturable, flexible, robust, and gel-free silver nanowire/polyvinyl butyral (PVB)/melamine sponge (AgPMS) electroencephalogram (EEG) electrode that circumvents problems with hair. Because of surface metallization by the silver nanowires (AgNWs), the sponge has a high conductivity of 917 S/m while its weight remains the same. The flexible sponge framework and self-locking AgNWs combine to give the new electrode remarkable mechanical stability (the conductivity remains unchanged after 10 000 cycles at 10% compression) and the ability to bypass hair. A BCI application based on steady-state visual evoked potential (SSVEP) measurements on hairless skin shows that the BCI accuracy of the new electrode (86%) is approximately the same as that of conventional electrodes supported by a conductive gel (88%). Most importantly, the performance of the AgPMS on hairy skin is not significantly reduced, which indicates that the new electrode can replace conventional electrodes for both hairless and hairy skin BCIs and other EEG applications.

On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study.

OBJECTIVE: To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery. METHODS: The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19. RESULTS: In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424. CONCLUSIONS: The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit.

Large Piezoelectric Strain in Sub-10 Nanometer Two-Dimensional Polyvinylidene Fluoride Nanoflakes.

Functional polymers such as polyvinylidene fluoride (PVDF) and its copolymers, which exhibit room-temperature piezoelectricity and ferroelectricity in two-dimensional (2D) limit, are promising candidates to substitute hazardous lead-based piezoceramics for flexible nanoelectronic and electromechanical energy-harvesting applications. However, realization of many polymers including PVDF in ultrathin 2D nanostructures with desired crystal phases and tunable properties remains challenging due to ineffective conventional synthesis methods. Consequently, it has remained elusive to obtain optimized piezoelectric performance of PVDF particularly in sub-10 nm regimes. Taking advantage of its high flexibility and easy processing, we fabricate ultrathin PVDF nanoflakes with thicknesses down to 7 nm by using a hot-pressing method. This thermo-mechanical strategy simultaneously induces robust thermodynamic α to electroactive ß-phase transformation, with ß fraction as high as 92.8% in sub-10 nm flakes. Subsequently, piezoelectric studies performed by using piezoresponse force microscopy reveal an excellent piezoelectric strain of 0.7% in 7 nm film and the highest piezoelectric coefficient ( d33) achieved is -68 pm/V for 50 nm-thick nanoflakes, which is 13% higher than the piezoresponse from 50 nm-thick PZT nanofilms. Our results further suggest thickness modulation as an effective strategy to tune the piezoelectric performance of PVDF and affirm its supremacy over conventional piezoceramics especially at nanoscale. This work aims not only to help understand fundamental piezoelectricity of pure PVDF in sub-10 nm regimes but also provides an opportunity to realize other polymer-based 2D nanocrystals.

Upper gastrointestinal tract symptoms are predictors of postoperative large pericardial effusion in cardiac surgery.

In this prospective observational study we evaluated the clinical symptoms in patients who presented with early or late significant pericardial effusion after cardiac surgery and underwent its open drainage in our institution. It was a series of 35 patients where the clinical symptoms and lab investigations were recorded. There were 21 male and 14 female (3:2). Majority of patients presented with postoperative large pericardial effusion within 2 -3 weeks of cardiac surgery. Eighteen (51.4%) patients presented with predominantly nonspecific upper gastrointestinal tract (GIT) symptoms like nausea, vomiting, loss of appetite and epigastric discomfort, 29 (82.85%) patients with postoperative large pericardial effusion had undergone mechanical valve replacement surgery. Majority of patients were on anticoagulation therapy and had prolonged INR. This study showed that non- specific upper gastrointestinal tract (GIT) symptoms like nausea, vomiting, loss of appetite are very frequent in patients with post-operative pericardial effusion. If a patient presents with these non-specific GI symptoms along with raised INR and low haemoglobin in postoperative follow up, significant pericardial effusion should be excluded.

Myocardial Protection with multiport antegrade cold blood cardioplegia and continuous controlled warm shot through vein grafts during proximal ends anastomosis in conventional coronary artery bypass graft.

OBJECTIVE: To evaluate the benefits of simultaneous aortic root and vein graft cold blood cardioplegia and continuous controlled warm blood perfusion through vein grafts during proximal aortocoronary anastomosis in conventional coronary artery bypass graft surgery in patients with multi-vessel coronary artery disease. METHODS: The prospective randomised study was conducted at Chaudary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from April 2013 to June 2014, and comprised patients of isolated conventional coronary artery bypass graft surgery. The patients were randomised into 2 groups; Group I had patients in whom multiperfusion set was used for cardioplegia and continuous warm blood perfusion through vein grafts during proximal ends anastomosis, and Group II had patients in whom routine aortic root antegrade cardioplegia was used with no warm blood perfusion during proximal anastomosis of vein grafts. Data was analysed using SPSS 20. RESULTS: There were 434 patients in the study, with Group 1 having 215(49.5%) being the study group, and Group II having 219(50.5%)being the Control group. The groups showed no significant difference in the number of grafts, and aortic cross-clamp time (p>0.05 each). Total bypass time was significantly prolonged in the Control Group (p=0.001). Incidence of intra-operative arrhythmias, peri-operative myocardial infarction, need for inotropic support and intra-aortic balloon counter-pulsation and operative mortality were significantly higher in the Control group (p<0.05 each). CONCLUSIONS: Simultaneous aortic root and vein graft cold blood cardioplegia and continuous controlled warm blood perfusion was beneficial for myocardial protection and early patient outcome.

Early outcome of Coronary Artery Bypass Graft Surgery in patients with significant Left Main Stem stenosis at a tertiary cardiac care center.

OBJECTIVE: Primary objective of this study was to evaluate the impact of significant left main stem (LMS) stenosis on the early outcome of coronary artery bypass graft (CABG) surgery. METHODS: A Retrospective non-randomized analytical study was conducted in Cardiac surgery department, Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan, Pakistan. The data of patients who underwent isolated CABG at our institution from February 2008 to March 2014 were analyzed. Two thousand six hundred two (2602) patients of isolated CABG were divided into 2 groups according to the LMS disease. Group I (n=2088): without significant LMS disease and Group II (n=514): with LMS disease. Data was analyzed using SPSS V16. The groups were compared using Student's t-test for numeric variables. Chi-square test and Fishers Exact test were used for categorical variables. P-value ≤ 0.05 was considered as significant difference. RESULTS: Out of two thousand six hundred two, 2088 patients were in Non.LMS group (Control Group) and five hundred fourteen were in LMS Group (Study Group). Patients with LMS disease were older. In both groups there was no statistically significant difference regarding gender distribution, risk factors of IHD, pre-operative renal function and preoperative CKMB levels. Significant number 50 (9.7%) of patients were unstable in LMS group and they needed urgent surgery (p-value <0.0001). Need and duration for inotropic support and intra-aortic balloon counter-pulsation support were significantly high in LMS group (p-value <0.0001, 0.002, 0.003 respectively). Similarly Mechanical ventilation time and hospital stay were higher in LMS group. Incidence of pulmonary complications and operative mortality were significantly higher in LMS group (p-value 0.005 and 0.001 respectively). Mortality of CABG patients with significant left main coronary stenosis was 13 out of five hundred fourteen (2.5%) as compared to just 17 out of two thousand eighty eight (0.8%) in control group. CONCLUSION: This study showed that significant LMS disease is an independent risk factor for early cardiopulmonary morbidity and mortality after CABG surgery.

Clinical outcomes of intermittent antegrade warm versus cold blood cardioplegia.

OBJECTIVE: To compare clinical outcome in patients undergoing conventional coronary artery bypass graft surgery who received intermittent antegrade warm blood cardioplegia or intermittent antegrade cold blood cardioplegia for myocardial protection. METHODS: The observational, prospective non-randomised analytical comparative study was conducted at the Punjab Institute of Cardiology, Lahore, and Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, from September 2012 to October 2013, and comprised patients undergoing coronary artery bypass graft surgery. They were divided into two groups, with Group I having those who received intermittent antegrade warm blood cardioplegia, and Group II having those who received intermittent antegrade cold blood cardioplegia. SPSS 16 was used for statistical analysis. RESULTS: Of the 215 patients, 94(44%) were in Group I, and 121(56%) in Group II. Total surgical time in Group II was 119.26±22.24 minutes compared to 105.73±31.34 in Group I (p >0.0001). Spontaneous resumption of sinus rhythm and peri-operative myocardial infarction was statistically insignificant (p>0.05). There were 21(17.4%) patients in Group II to whom peri-operative myocardial infarction occurred compared to 9(9.6%) in Group I (p=0.10). CONCLUSIONS: Intermittent antegrade warm blood cardioplegia showed better myocardial protection in early postoperative period compared to intermittent antegrade cold blood cardioplegia.

Frequency and determinants of intracranial atherosclerotic stroke in urban Pakistan.

BACKGROUND: Intracranial atherosclerosis (ICAD) is a frequent underlying mechanism of ischemic stroke. There is little direct evidence on its frequency and determinants from regions of high prevalence. This study explores the conventional and socioeconomic risk factors of ICAD in a South Asian population. METHODS: The Karachi Intracranial Stenosis Study is a case-control study of 313 cases of ischemic stroke secondary to ICAD and 331 controls enrolled from 4 major hospitals in Karachi, Pakistan. Stroke subtype was verified by a vascular neurologist using the Trial of Org 10172 in Acute Stroke Treatment classification. Relationships of conventional and socioeconomic risk factors with ICAD-related strokes are reported by calculating odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: ICAD was the cause of stroke in 81.1% cases with large-artery atherosclerosis and 19.5% of all stroke events. Along with risk factors like history of hypertension (OR, 3.33; CI, 2.31-4.78), history of diabetes (OR, 2.29; CI, 1.56-3.35), use of tobacco (OR, 1.49; CI, 1.03-2.16), waist-to-hip ratio (OR, 1.58; CI, 1.04-2.41), and family history of stroke (OR, 1.89; CI, 1.21-2.95), other significant social determinants of ICAD strokes were monthly income (OR, 1.59; CI, 1.01-2.51), unemployment (OR, 2.15; CI, 1.21-3.83), and chronic stress (OR, 3.67; CI, 2.13-6.34). These social determinants were independent predictors of the risk of ICAD, in addition to those described in other world populations. CONCLUSIONS: ICAD accounted for one fifth of all strokes making it the most common ischemic stroke mechanism. In addition to aggressive risk factor control, data also indicated broader holistic efforts on ameliorating inequity, unemployment, and stress reduction to reduce stroke because of ICAD.

Stroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native South Asian Pakistanis.

BACKGROUND: There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native South Asian Pakistanis. METHODS: Men and women aged ≥ 18 years with acute stroke presenting to four tertiary care hospitals in Karachi, Pakistan were screened using magnetic resonance angiography/transcranial Doppler scans. Trial of ORG 10172 in Acute Stroke Treatment criteria were applied to identify strokes from intracranial atherosclerotic disease. RESULTS: We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89.0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42.2% (87/206) followed by border-zone infarcts (52/206, 25.2%). Increasing degrees of stenosis correlated with the development of both cortical and border-zone strokes (P = 0.002). Important associated findings were frequent atrophy (166/230, 72.2%), silent brain infarcts (66/230, 28%) and a marked lack of severe leukoaraiosis identified in only 68/230 (29.6%). A total of 1870 arteries were studied individually. Middle cerebral artery was the symptomatic stroke vessel in half, presenting with complete occlusion in 66%. Evidence of biological disease, symptomatic or asymptomatic was identified in 753 (40.2%) vessels of which 543 (72%) were significantly (>50%) stenosed at presentation. CONCLUSION: Intracranial atherosclerotic disease is a diffuse process in Pakistani south Asians, with involvement of multiple vessels in addition to the symptomatic vessel. The middle cerebral artery is the most frequent symptomatic vessel presenting with cortical embolic infarcts. There is a relative lack of leukoaraiosis. Concomitant atrophy, silent brain infarcts and recent ischaemia in the symptomatic territory are all frequently associated findings.