On Punjab Home Dept demand…: Nawaz submits ‘conclusive’letter about his health

LAHORE: In response to the Punjab government's letter, former prime minister Nawaz Sharif Friday submitted a detailed conclusive medical letter to the provincial home department.

The document presents a comprehensive picture of his health status based on the latest medical reports, specialists’ opinions and future management plan.

The letter has been addressed to the additional chief secretary Home Department Punjab, under subject "Application under Section 401 (2) of the Code of Criminal Procedure, 1898" and in response to letter No SO (MP) 20-1/2019 (P), dated 29th of January 2020. It stated that as per the judgement of Islamabad High Court, an application dated 23rd of Dec 2019, under Section 401 (2), Code of Criminal Procedure, 1898 (CrPC), had been submitted to the Punjab government on behalf of Nawaz Sharif for continuation of suspension of sentence for treatment of severe ailments and multiple complex co-morbidities he is challenged with.

The application has also been attached with the medical report of Nawaz Sharif, dated 21st of Dec 2019. The report included the latest medical status and was conclusive in nature, according to the letter.

The medical report had been forwarded by the Punjab Home Department for consideration by the Special Medical Board on 27th of Dec 2019, which concluded that the medical reports were not latest to form a conclusive opinion, thereby requiring Nawaz Sharif to furnish the latest reports (although the reports were latest at the time of their submission), after which once again the latest medical reports were delivered to the Punjab government on 14th of January 2020.

This was followed by the Punjab government's letter, dated 18th of January 2020, which sought further reports pertaining to Nawaz Sharif.

Pertinently, each time, the Special Medical Board was convened to report on the medical condition and submitted documents of Nawaz Sharif, the input from Dr Adnan Khan, who is a member of the said board, was not made part of the opinion of the medical board.

Again, a letter was sent to the Punjab government by Attaullah Tarar, dated 20th of January 2020, which was self-explanatory.

The letter reads that the medical summary/clinical reports/ investigations already submitted are all conclusive in respect of the diagnosis and treatment of Nawaz Sharif and provides a detailed account of the Haematological (ITP/Lymphadenopathy) and cardiovascular (CAD / IHD / ECVD / ECAVD) status and that of co-morbidities (hypertension, diabetes and chronic kidney disease).

Nawaz Sharif's platelet count (ITP) is being managed by a haematologists at the Guy's and St Thomas Hospital. Clearly there is an issue with optimisation of his platelet count on medication, being careful neither to let it to a count worsening/ precipitating his coronary and carotid artery stenosis nor to a level to risk his planned coronary intervention on FDG PET scan the lymphadenopathy that has been identified will be addressed once he has had his coronary intervention.

Nawaz Sharif has had extensive investigations at the Royal Brompton including an echocardiogram, which had shown impaired LV function. There is mild aortic stenosis as well.

A Holter monitor has shown first degree heart block and left bundle branch block morphology, quite frequent Saves and a salvo, the longest four beats. There were infrequent ventricular ectopics.

A rubidium - 82 cardiac PET perfusion CT with regardenoson showed an ejection fraction of 49% increasing to 50% with stress. There was good perfusion reserve in the LAD and much of the right coronary territory but reduced perfusion in the circumflex territory. The conclusion was of extensive induceable ischaemia involving the basal interior and anterolateral regions and a separate area of moderate induceable ischaemia involving the mid to basal inferolateral myocardium extending into the inferior wall.

The ischemic burden was 22%. It is suspected some of the ischaemia is due to chronically occluded distal circumflex in addition to graft failure. It is also, however, likely that he has developed some re-stenosis within the previously extensively stented circumflex lateral branch.

Nawaz is planned and scheduled for hospitalisation in due course of time, subject to clinical clearance from Haematologist and Nephrologist, and will undergo cardiac catheterization/coronary intervention to address complex multi vessel coronary artery disease. It will be a challenging high risk procedure. Similarly, the carotid artery disease, documented critical Rt. ICA stenosis, is medically managed at present pending further investigations and / or intervention, to be addressed after cardiac procedure and stabilization.

“Though the already submitted medical reports are sufficient to determine the current medical condition of Nawaz Sharif, I am hereby, once again, unambiguously elaborating in and through this letter, his latest medical status, so as to remove any misconceptions about or misunderstanding of his medical condition," the letter concluded.

Dr Adnan Khan, Nawaz Sharif's personal physician, said former PM Nawaz Sharif’s latest medical summary amply substantiates the seriousness of his multiple, complex ailments which require short-, medium- and long-term treatment and aggressive continuous management.

"Political point scoring on the issue is extremely unfortunate," he added.