A fresh medical report Tuesday submitted to the Lahore High Court (LHC) said PML-N Quaid and former prime minister Nawaz Sharif had been advised against travelling to Pakistan in light of possible health risks amid the ongoing corona crisis. Advocate Amjad Pervez furnished the three-page report during a hearing of Chaudhry Sugar Mills (CSM) case in which members of the Sharif family have been accused of involvement in money laundering under the garb of sale and purchase of the mills’ shares. In the report, Dr Fayaz Shawl, director of the intervention cardiology department at Adventist Healthcare White Oak Medical Centre in the United States and clinical professor of medicine at George Washington University, stated that he had known the PML-N leader since June 13, 2004, when he had performed coronary intervention on him at King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia. He said he had subsequently performed two more procedures on Nawaz at Dubai’s Zulekha Hospital on January 28, 2007. Additionally, the doctor said, he was “periodically updated by his (Nawaz’s) cardiologist in London, as well as by his personal physician, Dr Adnan”. Sharing details of Nawaz’s medical history and medications prescribed to him, Dr Shawl noted that the PML-N supremo had undergone extensive investigations since he arrived in London in 2019, and the investigations confirmed that “he has significant ischemia (a condition in which the blood flow is restricted or reduced in a part of the body) in the distribution of his left circumflex artery”. Referring to his previous evaluation of Nawaz in September 2020, the doctor recommended that the PML-N leader should undergo coronary angiography to “reassess his coronary anatomy so that an appropriate therapeutic modality could be recommended before he returns to Pakistan”. Dr Shawl said depending on his angiography results, Nawaz may need “either complex coronary intervention […] or to again undergo CABGS (coronary artery bypass graft surgery)”. However, he added, the procedures were “on hold” due to the Covid-19 pandemic. Moreover, the doctor recalled that Nawaz had had two episodes of non-ST-elevation myocardial infarction, a type of heart attack, during his stay in prison before he was allowed to travel to the UK. “Any further solitary confinement will have a negative effect […] on his health, both physically and psychologically,” Dr Shawl warned. He added that during his stay in London amid a pandemic crisis, Nawaz had been “managed medically and is under close surveillance”. “He has improved somewhat [because of] medical therapy but more so due to not being in solitary confinement,” he noted, adding that once the Covid-19 crisis was over, Nawaz should proceed with his “coronary angiography and possible angioplasty or again undergo CAGBS if the [former] intervention was not feasible”. The doctor suggested that Nawaz should stay in London under the care of doctors with multiple specialties. “These facilities have provided him the best of care so far without further acute coronary syndromes, which he had sustained before his arrival to London,” he noted in the report. “Given the current Covid-19 crisis in the world, he should, by all means, avoid travelling and/or visiting public places like airport,” Dr Shawl advised, making particular reference to the possibility of the PML-N leader travelling to Pakistan. “In my opinion, until he undergoes coronary angiography, he should stay in close proximity to the facilities where he has been getting his treatment and the Covid-19 [pandemic ends]. His co-morbidities make him a ‘high-risk’ candidate for death, respiratory failure, etc., should he contract the Covid-19 infection,” he added. The doctor further mentioned in the report that during Nawaz’s recent evaluation, “I found Mr Sharif under a lot of stress, [and] if he returns to Pakistan without undergoing a definitive treatment in London, the stress of living in solitary confinement and loss of a partner can further compromise his cardiac status.” “If he returns to solitary confinement, he may develop what we call the takotsubo syndrome (a type of heart failure) due to stressful environment” and it could have “devastating consequences”, Dr Shawl warned. Nawaz has been in London since November 2019, when he was undergoing medical tests, and he was scheduled to undergo cardiac catherisation at the time.