LAHORE/LONDON: As pressure from the government mounts on former premier and Pakistan Muslim League-Nawaz (PML-N) supremo Nawaz Sharif to return to the country a day after his London cafe photo went viral, the Punjab government on Tuesday virtually rejected his medical reports submitted to it on Dec 23.

Amid bickering among leaders of the ruling Pakistan Tehreek-i-Insaf and the main opposition party over the London cafe photo, the PML-N on Tuesday submitted a letter from a leading cardiac surgeon terming the ex-PM’s stay in the UK ‘vital’ for his health management.

In the renewed tirade against the Sharif family, Prime Minister Imran Khan joined his cabinet members Firdous Ashiq Awan, Shahzad Akbar and Faisal Vawda besides Punjab Health Minister Dr Yasmin Rashid in criticising Nawaz’s health in the wake of the photo.

“The Sharif family is a fraud,” PM Khan was quoted by a private TV channel as having said in a cabinet meeting in Islamabad. The premier made the comment when he was asked by a cabinet member whether he had seen the restaurant picture of Nawaz Sharif.

Seeks fresh records within 48 hours; Dr Adnan says new statement submitted on Tuesday

Addressing a presser, Dr Rashid said: “Nawaz Sharif’s medical reports submitted to the government earlier from London are not different from that of the one released here by a penal of doctors. We have asked his personal physician Dr Adnan Khan to submit his fresh medical reports within next 48 hours so that the government could decide on his request to grant him more time for treatment abroad. The documents (Sharif medical report) furnished to the Punjab government were not sufficient to form a conclusive opinion,” she noted and warned the home department would take (adverse) action if the reports were not submitted to it within the stipulated period.

Rejection of his medical reports means that a decision on Mr Sharif’s application that he had submitted to the Punjab government for extension in his stay abroad on the expiry of the four-week period may further be delayed.

Not happy to cast a doubt on ‘serious nature’ of his health, the PML-N has invited Punjab Health Minister Yasmin Rashid to London to verify facts in this regard by herself. The PTI has asked Nawaz Sharif to return to the country if he is well to honour his commitment to the court and complete his jail term in the Al-Azizia Mills corruption case.

“From his picture at a London restaurant, it seems Nawaz Sharif is in good health. He should return to the country and complete his jail term. If he returns, he will be given treatment like that of other jail inmates,” Shahzad Akbar declared, adding “no special treatment” would be given to Mr Sharif (this time) and the accountability process would continue. He further said that some arrests had been made in the case against PML-N president Shahbaz Sharif.

Mr Vawda claimed that the government would not let the Sharif family run away from the country. “Why Maryam Nawaz is silent? Her silence shows that these are coward people...how come they talked of giving respect to the vote,” he mocked.

Dr Rashid took a dig at Maryam Nawaz on her request to visit her ‘ailing’ father in London to take care of him. “Where will she (Maryam) go to take care of her father… at a restaurant? A person who is bed-ridden is taken care of and he (Sharif) is not,” she wondered, saying on the one hand it was said his condition was “very critical” and on the other he was socialising…was it too a part of his treatment? “Had he visited the restaurant to catch fresh air,” she taunted.

PML-N information secretary Maryam Aurangzeb said Dr Rashid held the presser on the direction of PM Khan. “It is regrettable that Dr Rashid is a physician herself and she under pressure did politics on the health of Mr Sharif.” Ms Aurangzeb said Dr Rashid must not forget that it was a medical board under herself (Rashid) that had recommended treatment of Sharif abroad. “In the light of the court’s decision, Mr Sharif’s reports attested by doctors concerned in London have been submitted to the Punjab government. Instead of holding a media trial of Mr Sharif on his health, we invite Dr Rashid to come to London and verify facts,” she offered.

About the visit to café, the PML-N had said that Nawaz Sharif went out for a change of environment on doctors’ advice. They insisted that staying indoors would not be good for his health. Hussain Nawaz said doctors had advised his father to walk twice a day. “But despite this advice, Mian sahib could not walk as he experienced breath problems and palpitations,” he added.

Letter, medical report

Dr David Lawrence, a respected and highly skilled cardiac surgeon who is known for performing minimally invasive chest surgery and lung cancer surgery, penned a letter detailing Mr Nawaz’s medical history from 2003 to 2019 as well as his current treatment plan. A copy of the letter was made public on social media by Nawaz’s personal physician Dr Adnan Khan on Tuesday morning.

Dr Adnan said the letter along with Nawaz’s medical reports was submitted to the government and minister concerned.

“The stability of healthcare management is of vital importance for the patient, hence he [Nawaz] should remain under the care of his healthcare providers in the UK until his diseases are adequately addressed,” said Dr Lawrence.

In the letter, Dr Lawrence recommended that Mr Sharif undergo a coronary angiography at the earliest “as there is a significant part of his heart at risk”.

“I would strongly recommend urgent coronary intervention. Failure to do this could compromise his myocardium, his cardiac health and his well-being.”

He added that experts at the Guys’ and St Thomas haemotology department were managing Mr Nawaz’s unstable platelet count so that he could undergo invasive procedures, including a lymph node biopsy.

“The significant carotid artery disease further makes the issue complex and is managed simultaneously on aggressive medical therapy pending an intervention.”

Dr Khan also shared the contents of the fresh medical report of Mr Sharif. “Nawaz Sharif is under the care of the Royal Bromption and Harefield Hospital for cardiovascular management. He had cardiac non-invasive studies to establish disease extent and progression. His echocardiogram shows left ventricular hypertrophy and dysfunction (EF 49% confirmed on Cardiac PET-CT Scan) and Aortic Valve Disease (mild AS). His 24 hour Holter analysis documents marked conduction defects (First Degree AV Block & BBB morphology) with occasional low atrial rates, aberrant conduction and ectopic activity,” it stated.

The report said Mr Sharif underwent Rubidium-82 Cardiac Perfusion PET-CT scan (Rest & Stress), results indicative of significant areas of ischemia more pronounced on stress. “There is extensive inducible ischaemia involving the basal anterior and anterolateral regions of the myocardium and separate area of moderate inducible ischaemia involving mid to basal inferolateral myocardium extending into the inferior wall. The perfusion reserve is significantly reduced in typical circumflex distribution and also in the vessel supplying basal anterolateral myocardium. There is also appearance of the transient ischaemic dilatation suggesting significant ischaemic burden that amount approximately 22% of the myocardium. The impression is of compromised heart blood supply and functionality particularly in the circumflex territory.”

Nawaz is trying to secure an extension in his stay abroad from the Punjab government, which had expressed reservations about the serious nature of his health.

On Dec 23, he had sought extension in his stay abroad on the expiry of the four-week period allowed by the court to visit London for medical treatment. With his application, Mr Sharif attached his medical reports, but the Punjab government sought fresh reports.

Published in Dawn, January 15th, 2020