Catastrophic Outcomes Research Articles

The Outcome of COVID-19 Patients with Moderate to Severe Disease: A Single Institution Study

Objective: To determine the outcome of COVID-19 positive patients with moderate to severe disease.Study Design: A cross-sectional study.Place and Duration of Study: This study was conducted at the Department of Medicine of Combined Military Hospital, Malir Karachi, Pakistan, from 1st Jun 2020 to 31st Jul 2020.Materials and Methods: Total 67 SARS-CoV-2 positive cases, including males and females, were studied. All patients were admitted with presenting complaints such as fever, cough, arthralgia, or shortness of breath. Investigations including complete blood count, serum ferritin, quantitative CRP, liver function tests, renal function tests, blood sugar fasting, and random chest radiographs and ECG were performed. Critical patients were admitted to COVID ITC and managed with high-flow oxygen and assisted ventilation. Patients with moderate disease were admitted to a high-dependency unit and managed with oxygen, intravenous dexamethasone, intravenous antibiotics, anticoagulants, and antiviral therapy patients accordingly. Supportive treatments, including zinc, vitamin C and vitamin D, were given to all patients.Results: Out of total 67 patients, 56 were suffering from comorbidities. Eighteen patients have died. Forty-nine patients have recovered with uneventful recovery.Conclusion: All over the world advanced age and comorbidities such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease remain a major health hazard for an increased likelihood of adverse clinical outcomes in patients with COVID-19 infections outcomes. Early diagnosis and prompt treatment of moderate to severe COVID-19 cases could only be possible with good clinical acumen to prevent a catastrophic outcome.

Incremental benefits of circumferential minimally invasive surgery for increasingly frail patients with adult spinal deformity.

Circumferential minimally invasive surgery (cMIS) may provide incremental benefits compared with open surgery for patients with increasing frailty status by decreasing peri- and postoperative complications. Operative patients with adult spinal deformity (ASD) ≥ 18 years old with baseline and 2-year postoperative data were assessed. With propensity score matching, patients who underwent cMIS (cMIS group) were matched with similar patients who underwent open surgery (open group) based on baseline BMI, C7-S1 sagittal vertical axis, pelvic incidence to lumbar lordosis mismatch, and S1 pelvic tilt. The Passias modified ASD frailty index (mASD-FI) was used to determine patient frailty stratification as not frail, frail, or severely frail. Baseline and postoperative factors were assessed using two-way analysis of covariance (ANCOVA) and multivariate ANCOVA while controlling for baseline age, Charlson Comorbidity Index (CCI) score, and number of levels fused. After propensity score matching, 170 ASD patients (mean age 62.71 ± 13.64 years, 75.0% female, mean BMI 29.25 ± 6.60 kg/m2) were included, split evenly between the cMIS and open groups. Surgically, patients in the open group had higher numbers of posterior levels fused (p = 0.021) and were more likely to undergo three-column osteotomies (p > 0.05). Perioperatively, cMIS patients had lower intraoperative blood loss and decreased use of cell saver across frailty groups (with adjustment for baseline age, CCI score, and levels fused), as well as fewer perioperative complications (p < 0.001). Adjusted analysis also revealed that compared to open patients, increasingly frail patients in the cMIS group were also more likely to demonstrate greater improvement in 1- and 2-year postoperative scores for the Oswestry Disability Index, SRS-36 (total), EQ-5D and SF-36 (all p < 0.05). With regard to postoperative complications, increasingly frail patients in the cMIS group were also noted to experience significantly fewer complications overall (p = 0.036) and fewer major intraoperative complications (p = 0.039). The cMIS patients were also less likely to need a reoperation than their open group counterparts (p = 0.043). Surgery performed with a cMIS technique may offer acceptable outcomes, with diminishment of perioperative complications and mitigation of catastrophic outcomes, in increasingly frail patients who may not be candidates for surgery using traditional open techniques. However, further studies should be performed to investigate the long-term impact of less optimal alignment in this population.

Identification of an inhibitor for atherosclerotic enzyme NOX-1 to inhibit ROS production

BackgroundNOX-1 overexpression has been observed in various studies, persons with diabetes or cardiovascular conditions. NOX-1 orchestrates the disease pathogenesis of various cardiovascular conditions such as atherosclerotic plaque development and is a very crucial biomarker. Therefore, this study was carried out to deduce the three-dimensional modelled structure of NOX-1 using DeepMind AlphaFold-2 to find meaningful insight into the structural biology. Extensive in silico approaches have been used to determine the active pocket, virtually screen large chemical space to identify potential inhibitors. The role of the key amino acid residues was also deduced using alanine scanning mutagenesis contributing to the catalytic process and to the overall stability of NOX-1.ResultsThe modelled structure of NOX-1 protein was validated using ERRAT. The ERRAT statistics with 9 amino acids sliding window have shown a confidence score of 96.937%. According to the Ramachandran statistics, 96.60% of the residues lie within the most favoured region, and 2.80% of residues lie in the additionally allowed region, which gives an overall of 99.4% residues in the three quadrants in the plot. GKT-831 which is a referral drug in this study has shown a GOLD interaction score of 62.12 with respect to the lead molecule zinc000059139266 which has shown a higher GOLD score of 78.07. Alanine scanning mutagenesis studies has shown that Phe201, Leu98 and Leu76 are found to be the key interacting residues in hydrophobic interactions. Similarly, Tyr324, Arg287 and Cys73 are major amino acid residues in the hydrogen bond interactions.ConclusionsNOX-1 overexpression leads to heightened ROS production resulting in catastrophic outcomes. The modelled structure of NOX-1 has a good stereochemistry with respect to Ramachandran plot. The lead molecule zinc000059139266 has shown to have a very high interaction score of 78.07 compared to the referral drug GKT-831 with a score of 62.12. There is an excellent scope for the lead molecule to progress further into in vitro and in vivo studies.

Erroneous Laboratory Reports - Leading to Catastrophic Patient Outcome

In recent years, increased timely and accurate laboratory test results are being produced and this has led to the clinical laboratory being recognized as the nerve centre of the diagnostic process [1]. Laboratory test results play a pivotal role in the diagnosis and management of a patient. Approximately 60–70% of medical decisions related to diagnosis and treatment depend on them [2].

LEADERSHIP IN TIMES OF CRISIS

Leadership encircles the capability of an individual, group or organization to guide others (individuals, teams, or whole organizations). True leadership requires a personality that attracts other people, constant development of relationships with team members, possessing professional and practical knowledge and skills, experience, self-confidence, intuition and empathy. Strong leaders continuously empower other people, because they believe in their team members. Leadership skills are continuosly learned and improved not only during professional development, but throughout person’s life. Crises are inevitable events, that occur sooner or later in all the organizations. They can be triggered by different internal or external factors. Each crisis is specific and unique and requires different approaches for finding solutions. When a crisis occurs, ignoring or avoiding it, is one of the biggest mistakes for the organization. It should be accepted, resolved and used to initiate change, which is necessary for organzations’ survival and further development and growth. Having an organized, planned and structured approach to crisis management can help in damage reduction, restraing the company losses and discover inventive mechanisms to maintain the workforce’s productivity. Crisis leadership is a process that resolves the unforseeable events that happen unexpectedly and have the ability to diminish the organizational structure, to cease growth and development and lead to catastrophic outcomes. Whether the crisis will be successfully resolved, depends on how the leadership will deal with the situation. A positive approach to crisis is to accept it as an opportunity, to take responsibility, manifest confidence and implement changes which will streghtehen the organization and empower the employess to perform better and become stonger people in future. If leaders are bold and act, if they are decisive and willing to adapt their decision to the occurring conditions, they are going to have more success in resolving the crisis, compared to leaders that choose to wait and not take any action. Leadership is a vital process at all times, but when a crisis strikes, a strong leader has cardinal importance for the organization.

Prevention of False Data Injection in Dataset using ML and DL

IoT is an interconnected and allotted network of embedded systems communicating through wired and wireless communication technology. It is defined as network of physical objects or things empowered with limited computation storage and conversation capabilities as well as embedded with electronics (sensors and actuators). Nowadays there are literally masses of hundreds of Internet of things (IoT) gadgets easily available to the customers. those consist of security cameras, smart home and smart speaker systems, smart toys and infant monitors, drones, domestic appliances, routers and internet gateways, and basically some other hardware products which can transmit information and be controlled over the net. FDIA is an attack this will result in a catastrophic outcomes. False information injection attack can be executed in each dynamic and static datasets, as a present device we easily discover and prevent in a static environment. in which with the present machine even the dynamic records is made static after which detects FDIA’s. FDIA in a static environment is the existing machine, in which we seek to have few solutions for the FDIA in a dynamic environment or for time collection information. So, to enhance protection in dynamic environment is our proposed challenge towards FDIA and we create a brand-new version known as “PdD” model – Predictive Dynamic version. Proposed framework performs crucial role in live streaming records in terms of heterogeneous environment (dynamic nature). So, we use GRU set of rules because it offers better RMSE value than different AI algorithms. This detects every time there may be a few FDI attack.

Negotiating caste-subaltern imaginations of the 1943 Bengal famine: methodological underpinnings of a creative-collaborative practice

The Bengal famine of 1943 is one of the most catastrophic and violent outcomes of British colonial rule in India. Recently, there has been a surge in understanding the famine from an anti-colonial perspective. However, the relation between the impact of the famine and caste-based subalternities has not received adequate attention. The immediate concerns that arise with the task of filling this gap are ethical-methodological and narrative: even from the lens of caste-subaltern consciousness, how does one arrive at and share stories of the famine, and can they ever be ‘recovered’ and ‘represented’? This paper narrates the story of fieldwork-filming, carried out as part of ongoing research in artistic practice, which attempts to understand and engage with caste-subaltern (especially Dalit) experiences of the Bengal famine of 1943 and to explore methodologically how these experiences can be creatively and collaboratively imagined and negotiated. The paper proposes that there is a need to shift away from ‘recovery’ and ‘representation’ of the ‘authentic’ caste-subaltern experiences of the famine and towards negotiated imagination. To illustrate and make a case for this shift, this paper provides a detailed description and analysis of methodological processes and their implications that emerged during the fieldwork-filming.

Cardiomyopathy and Sudden Cardiac Death Among the Athletes in Developing Countries: Incidence and Their Prevention Strategies.

The incidence of cardiomyopathy in athletes contributes significantly to the public health burden in developing countries. Most effective management strategies primarily rely on the modification of risk factors, and it is less expensive compared to other advanced investigations.Moreover, limited data is available concerning the incidence of adverse events including cardiac arrestand the strategies to prevent them, especially in this population subset. Therefore, devising preventative strategies that can easily be implemented in athletes and provide a cost-effective approach is warranted. We aim to discuss the incidence of major adverse cardiac events in athletes with cardiomyopathies and their associated risk factorsand to evaluate the various strategies proposed to prevent the progression of cardiomyopathy in this population, with the initial hypothesis that the treatment of these pathologies poses a substantial challenge in this population. With regard to methodology, this is a narrative review. Search terms were described using the Population, Exposure, and Outcome (PEO) framework. A comprehensive search strategy was used to screen and identify any relevant literature in the PubMedand Google Scholar databases. This was done in accordance with the Preferred Reporting Items for Systematic Reviewand Meta-Analysis (PRISMA)protocol. Four studies were identified in the final analysis. The incidence of sudden cardiac arrest varied between 0.3% and 0.33% among the athletes affected with cardiomyopathies. Routine and pre-participation screening has shown success in reducing the incidence of sudden cardiac death in athletes as a result of undiagnosed cardiomyopathies. Supervised exercise regimes have been proposed to reduce the incidence of cardiomyopathy in athletes. Beyond identification strategies, the prevention of cardiomyopathies revolves around the modification of risk factors. To conclude, the challenges athletes face, suffering from cardiomyopathy, have been an ongoing issue with unexpected cardiac arrest as the end result. Despite the decreased incidence of cardiomyopathies observed in athletes, the challenge in diagnosis can result in catastrophic outcomes, especially in developing countries. Therefore, adopting prevention strategies can have a profound impact on the identification and management of these pathologies.

Uncommon, overlooked and underreported causes of upper gastrointestinal bleeding.

Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics.

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic ‎outcomes if not timely managed. ‎Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is ‎‎currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in ‎studies to investigate and validate ‎ non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) ‎measurement has been found promising in many published research ‎articles. We aim to highlight the validity of sonographic GBWT measurement in the ‎prediction of EVs based on the available evidence.‎ We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Automated Adjustment of PPE Masks Using IoT Sensor Fusion.

The COVID-19 pandemic has led to a dramatic increase in the use of PPE by the general public as well as health professionals. Scientists and health organizations have developed measures to protect people and minimize the catastrophic outcomes of COVID, including social distancing, frequent and periodic sanitizing, vaccinations, protective coverings, and face masks. During this time, the usage of protective face masks has increased dramatically. A mask only provides full safety to the user if it is a proper fit on their face. The aim of this paper is to automatically analyze and improve the fit of a face mask using IoT sensors. This paper describes the creation of a 3D-printed smart face mask that uses sensors to determine the current mask fit and then automatically tightens mask straps. This is evaluated using adjustment response time and the quality of fit achieved using the automatic adjustment approach with a range of sensor types.

Acute Liver Failure: Current Updates and Management

Acute liver failure (ALF) is a rare disease condition with a dynamic clinical course and catastrophic outcomes. Several etiologies are involved in ALF. Hepatitis A and B infections and indiscriminate use of untested herbs or supplemental agents are the most common causes of ALF in Korea. Noninvasive neurological monitoring tools have been used in patients with ALF in recent times. Ongoing improvements in intensive care, including continuous renal replacement therapy, therapeutic plasma exchange, vasopressor, and extracorporeal membrane oxygenation, have reduced the mortality rate of patients with ALF. However, liver transplantation is still the most effective treatment for patients with intractable ALF. There is a need for further research in the areas of better prognostication and precise selection of patients for emergency transplantation.

Design of a pan-betacoronavirus vaccine candidate through a phylogenetically informed approach.

Coronaviruses are a diverse family of viruses that crossed over into humans at least seven times, precipitating mild to catastrophic outcomes. The severe acute respiratory syndrome coronavirus 2 pandemic renewed efforts to identify strains with zoonotic potential and to develop pan-coronavirus vaccines. The analysis of 2181 coronavirus genomes (from 102 host species) confirmed the limited sequence conservation across genera (alpha-, beta-, delta-, and gammacoronavirus) and proteins. A phylogenetically informed pan-coronavirus vaccine was not feasible because of high genetic heterogeneity across genera. We focused on betacoronaviruses and identified nonhuman-infecting receptor binding domain (RBD) sequences that were more genetically similar to human coronaviruses than expected given their phylogenetic divergence. These human-like RBDs defined three phylogenetic clusters. A vaccine candidate based on a representative sequence for each cluster covers the diversity estimated to protect against existing and future human-infecting betacoronaviruses. Our findings emphasize the potential value of conceptualizing prophylaxis against zoonoses in terms of genetic, rather than species, diversity.

Coinfecção de vírus monkeypox e HIV-1 em paciente gravemente imunossuprimido: uma evolução catastrófica

Coinfecção de vírus monkeypox e HIV-1 em paciente gravemente imunossuprimido: uma evolução catastrófica

Coinfection of monkeypox virus and HIV-1 in severe immunosuppressed people: a catastrophic outcome

Coinfection of monkeypox virus and HIV-1 in severe immunosuppressed people: a catastrophic outcome

The development of society and the principle of "minimizing efforts"/"acceptable crisis"

The paper analyses the reasons for obvious resource saving and minimization of practical efforts made by society in the solution of significant problems that arise in the process of its development. This phenomenon is recorded in the life of societies of all taxonomic levels (from local groups to states, international unions, humanity in general). It can be referred to as the principle of "effort minimization". The main reasons for the use of this principle by society in its activities are the limited availability of resources, which implies a concentration of efforts on stopping the clip of central threats, as well as the ability of social subsystems in the development process in order to solve some problems without the regulatory involvement of management structures. For the global society, another significant reason is the maximum difficulty in the coordination of the efforts of a large number of actors. While there are significant differences in the methods, strategies and tools used by societies to remove threats, the very mechanism of response to them has several common features, similar stages ("blindness", fixation, practical efforts, effective activity). Minimizing regulatory actions for a long time, society actually contributes to the growth of some problems, deliberately allowing the onset of a crisis situation, with its subsequent regulation (the principle of "acceptable crisis"). It is possible to state that the development of civilization is fundamentally located in the risk zone. Moreover, such riskogenicity is the manifestation of a systemic algorithm responsible for the way of evolution not only of humanity, but of the entire biosphere. It does not secure against a catastrophic outcome (evidence is the disappearance of species and large "clusters" of living things; local societies, states, peoples, entire civilizations). At the same time, the growth of global risks correlates with the expansion of social ability to eliminate them. It remains to be hoped for the width of the time gap between the achievement of a critical level of actualization by global issues (forcing society to actively engage in the process of self-optimization) and the onset of catastrophic changes in the socio-natural system of the Earth, when any regulatory actions on the part of mankind will be useless.

Modeling and Detection of Dynamic Position Sensor Offset Error in PMSM Drives

Rotor position information obtained through a position sensor is crucial for proper field-oriented control (FOC) of permanent magnet synchronous machine-based high dynamic energy conversion applications. In applications such as transportation and industrial, PMSM energy conversion systems are subjected to harsh environmental conditions such as vibration, shock, and thermal shock causing mechanical interfaces holding position sensors to fail, introducing errors to the position measurement. A dynamic position sensor offset error (DPSOE), being such a failure mode has the potential to degrade system torque output or more adversely, reverse machine torque output that may cause catastrophic outcomes. This paper evaluates different DPSOE scenarios, presents an approach to model the failure mode for analysis and proposes two novel, and robust DPSOE detection methods for PMSM drive systems. The proposed detection methods are analytically proven and supported by simulation and experimental results under multiple operating conditions proving robustness.

Energy Drink Consumption in Adolescents is Harmful and Everyone Needs to Know Why

The consumption of energy drinks among adolescents and young adults has escalated tremendously in recent years, with increasing evidence of adverse events related to these beverages resulting in emergency department visits and, at times, catastrophic patient outcomes. While the evidence of harm has grown, little has been done to regulate the advertisement and sales of energy drinks to young people. The regulation of other substances of abuse, such as tobacco and alcohol, serve to similarly protect this young population. These policies should be used as a guide to begin to combat the problem of energy drink consumption among adolescents and young adults.

A Descriptive Study on the Clinical Profile and Outcomes of Patients with COVID-19 and Tuberculosis Co-infection.

Tuberculosis (TB) control has been a challenge in the country and its overall health impact remains significant. COVID-19 has caused significant morbidity and mortality especially among hospitalized patients. TB and COVID-19 co-infection (COVID-TB) may cause more catastrophic consequences and outcomes among afflicted individuals and management may be daunting. There is limited local data on COVID-TB. The clinical profile of COVID-TB patients who were admitted were described. Comparison of the clinical outcomes was also done versus the general admitted COVID-19 patients without concomitant TB in the same institution. Relevant patient outcomes were reported which included admission to an intensive care unit (ICU), length of hospital stay, and mortality rate. This is a descriptive study on the demographics and clinical outcomes of patients admitted in the Philippine General Hospital (PGH) for COVID-19 with TB co-infection from March 2020 to September 2020. We aimed to characterize patients with COVID-TB and analyzed their outcomes. There was a total of 79 patients who were admitted for COVID-19 (confirmed with RT-PCR) with TB co-infection during the study period. Majority of them were males (70.9%) with a median age of 54 (IQR 42 to 64) years. In terms of TB affliction, 75 (94.9%) patients were identified to have pulmonary tuberculosis. Majority of patients had at least one co-morbid illness with hypertension (16.5%), diabetes mellitus (13.9%), and heart failure (11.4%) as the most common. Respiratory symptoms (dyspnea and cough) were the predominant presenting complaint during hospital admission. Majority of the patients were classified as severe (8 or 10.1%) and critical (36 or 45.57%) COVID-19 disease. Fifty-six (70.9%) were bacteriologically confirmed tuberculosis. Radiologic imaging studies revealed findings consistent with pulmonary tuberculosis in 70 (88.61%) through plain radiograph. Forty-seven underwent HRCT and 46 of these (97.8%) had findings suggestive of PTB. Overall, 61 patients (77%) subsequently required oxygen supplementation. The in-hospital mortality within the study population was 36.7% (29/79) in contrast to the general COVID patients admitted in the same period which revealed significantly less fatality at 17.5% (35/200). The length of hospital stay was found to be 21.1 days ± 14.75 days across all study patients, and with median of 20 days for surviving patients. TB treatment outcomes were tracked in the 50 surviving COVID-19 patients where cure was declared in 8/50 (16%) while 22/50 (44%) successfully completed their six-month treatment regimen. This study of COVID-TB provides an initial evaluation of the potential association between active TB infection and COVID-19 severity and mortality. The data generated from this study may be a starting point to assess the interaction of these two diseases. Furthermore, bidirectional screening may be recommended even at hospitals' triage areas since both diseases may have similar presentations.

Hybrid Revascularization of Infrarenal Aortic Occlusion due to Thrombophilia: A Case Report

Background: Infrarenal abdominal aortic occlusive disease has traditionally been treated with aortic endarterectomy, aortobifemoral bypass grafting, or both; however, it has also been associated with up to a 3.3% to 4.6% perioperative mortality rate and an 8.3% to 13.1% major early complication rate. European Guidelines on Peripheral Artery Diseases published in 2017 support a hybrid approach. Thrombophilia is a commonly overlooked cause of peripheral arterial disease (PAD) in younger patients. Thrombophilia is reported to lead to an increased incidence of graft failure and multiple revascularization procedures. This presented a rare case highlighting the surgical approach to complex aortoiliac occlusion due to thrombophilia with subsequent lower limb ischemia and the multi-disciplinary input needed in this vulnerable patient cohort. Case presentation: Herein, we present a case of an acute distal aortic occlusion and failed revascularization with a history of thrombophilia and previous left leg below-knee-amputation (BKA) due to acute limb ischemia. He had a background of recently withholding warfarin for a ureteric stent insertion for renal calculus. The diagnosis of our case depended on CT and angiography, where they confirmed an occluded infrarenal aorta with bilaterally occluded common and external iliac arteries. Our case underwent hybrid revascularisation under bivalirudin cover. An open thrombectomy of the right common femoral artery (CFA) and PFA was performed. A left brachial artery cutdown was performed, and a catheter was placed in the suprarenal abdominal aorta. The right iliac artery occlusion was crossed from the left brachial access with a Command 0.018 wire supported by a Van Schie II catheter with a through-and-through wire able to be retrieved from the open right CFA. The proximal IMA was stented with a 6 x 80mm Absolute Pro-self-expanding stent, deployed in a kissing-stent fashion with a 10 x 100mm Absolute Pro stent in the distal aorta. Overlapping self-expanding stents were deployed from the distal aorta to the right external iliac. Six weeks after the procedures, computed tomography/angiography confirmed the excellent radiologic results. Conclusion: This rare case highlights the catastrophic outcomes that can happen when anticoagulation is withheld in thrombophilic patients. It exhibits the Role of a hybrid open and endovascular approach in complex occlusive aortoiliac disease and the critical importance of early multi-disciplinary involvement in critically unwell patients.