Assessment of postgraduate educational environment in public and private hospitals of Karachi.

OBJECTIVE: To assess the environment of postgraduate fellowship training in teaching hospitals of an urban centre. METHODS: The cross-sectional study was conducted at one public-sector and two private-sector teaching hospitals in Karachi from December 2014 to June 2015. Data was collected by using a modified version of Postgraduate Hospital Educational Environment Measure, a validated questionnaire, for which clinical residents were selected through convenience sampling. Data was analyzed using SPSS 16. RESULTS: Of the 302 participants, 168(55.6%) were males and 134(44.4%) were females. The overall mean age of the respondents was 28.46±3.03 years. The internal reliability of the questionnaire was good with a Cronbach's alpha of 0.92. The overall mean score of 93.96±20.79suggested more positive than negative perception with room for improvement. After adjusting for all important socio-demographic and residency co-variates, residency in a private hospital was positively associated with Postgraduate Hospital Educational Environment Measure score (p<0.01) compared to residency in public hospitals. CONCLUSIONS: There is an urging need to standardise postgraduate training in terms of teaching, autonomy and social support in public and private hospitals of Karachi.

Trends and disparities in coronary artery disease prevalence among U.S. adults from 2019 to 2022.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in the U.S. Understanding trends and potential disparities in CAD prevalence is crucial for public health strategies. OBJECTIVE: Examine trends and disparities in CAD prevalence among U.S. adults (2019-2022). METHODS: CDC's National Health Interview Survey's data was analyzed, employing regression analysis with Joinpoint and ARIMA models by ChatGPT-4 for trend forecasting. RESULTS: CAD prevalence among U.S. adults was relatively stable, increasing slightly from 4.6 % (95 % CI: 4.3-4.9) in 2019 to 4.9 % (95 % CI: 4.7-5.2) in 2022. Males experienced significant rise in prevalence, with an APC of 3.1 % (95 % CI: 1.45-4.85, p-value < 0.000001), increasing from 5.9 % to 6.4 %. Female prevalence also increased significantly, with APC of 2.0 % (95 % CI: 0.46-3.59, p-value = 0.003599), moving from 3.4 % to 3.6 %. Notable age-related disparities appeared, especially in those aged 75 and over, with rates peaking at 20.0 % in 2020 before decreasing to 19.7 % in 2022. Racial disparities revealed higher prevalence among White adults at 5.4 % and noticeable increase among Asian adults from 2.8 % to 3.8 %. Geographic factors also influenced prevalence, particularly outside metropolitan areas, Northeast, and South regions of US. Employment status influenced CAD rates and a lower prevalence observed in the employed (1.7 % to 1.9 %) compared to unemployed (9.9 % to 10.3 %). Veterans (13.4 % to 12.6 %) reported higher prevalence rates than non-veterans. ARIMA projections suggest stable prevalence until 2026. CONCLUSION: Despite stable overall prevalence, significant disparities exist. Targeted interventions are essential, particularly for high-risk demographics such as males, older adults, and veterans.

Trends and disparities in prevalence of diagnosed hypertension among U.S. Adults from 2019 to 2022.

BACKGROUND: Hypertension (HTN) stands as a significant risk factor for cardiovascular diseases. Identifying trends and disparities in HTN prevalence is vital for developing public health policies. OBJECTIVE: Investigate the trends and disparities in HTN prevalence among U.S. adults from 2019 to 2022. METHODS: Data from the CDC's National Health Interview Survey were utilized, with regression analysis including Joinpoint and ARIMA models performed by ChatGPT-4 to predict future trends. RESULTS: The study observed fluctuations in the overall prevalence of diagnosed HTN starting at 27.0 % (95 % CI: 26.4-27.7, 2019), and reaching 27.2 % (95 % CI: 26.5-27.8, 2022). Males consistently showed higher HTN rates than females throughout the study period, with male prevalence increasing from 27.2 % (95 % CI: 26.3-28.1, 2019) to 27.9 % (95 % CI: 27.0-28.8, 2022), while females experienced decline from 26.9 % (95 % CI: 26.1-27.8, 2019) to 26.5 % (95 % CI: 25.7-27.3, 2022). Southern U.S. exhibited the highest prevalence at 30.1 % (95 % CI: 29.1-31.2, 2022), compared to the lowest in the West at 22.5 % (95 % CI: 21.4-23.8). Black adults showed a higher prevalence of 34.4 % (95 % CI: 32.4-36.4, 2022) compared to White adults at 27.4 % (95 % CI: 26.7-28.2), and significantly lower rates were observed in Asian adults at 14.5 % (95 % CI: 7.4-24.5). CONCLUSION: This study highlights stable trends in HTN prevalence among U.S. adults from 2019 to 2022, with significant disparities by gender, region, and race, underscoring the need for targeted public health interventions to address these inequalities.

The Latest Evidence on Bempedoic Acid: Meta-Analysis of Safety and Efficacy in High Cardiovascular Risk Patients With Hypercholesterolemia⋆.

Background: Bempedoic Acid (BA) is a novel drug that has a potential to serve as an alternative to statins to decrease lipid levels and improve cardiovascular disease (CVD) outcomes, particularly for statin-intolerant individuals. However, insufficient statistical power has limited our understanding of the efficacy and safety of BA. This meta-analysis utilizes the latest data to improve our knowledge of BA's effects on lipids and CVD with increased statistical power. Methods: MEDLINE, Embase, Cochrane Central, Clinicaltrials.gov, abstracts of national and international conferences, and reference lists of studies were searched for relevant studies. Rayyan was used to screen the search results, and Revman 5.3 was used for the meta-analysis and sensitivity analysis. Results: Our final analysis included seven randomized control trials (RCTs) with 17,782 participants, 53.6 % in the BA group (n = 9535) and 46.4 % in the placebo group (n = 8247). BA significantly decreased major adverse cardiovascular events (MACE) (OR: 0.86; 95 % CI 0.78-0.95; p = 0.03), non-fatal myocardial infarction (OR 0.72; 95 % CI 0.61-0.85; p = 0.0001), and new onset/worsening diabetes (OR:0.55; 95 % CI 0.30-0.98, p = 0.04), while reducing low-density lipoprotein cholesterol (LDL-C) levels by 22.5 % (MD: -22.53 %; 95 % CI -25.54 to -19.52, p < 0.00001). Conclusion: The findings of this meta-analysis suggest that BA is a promising and effective alternative to statin therapy, particularly for statin-intolerant and high CVD-risk patients. However, further studies with diverse populations are needed to quantify the long-term efficacy and safety endpoints.

A Challenging Case of Managing Septic Arthritis of the Sternoclavicular Joint in a Patient With a History of Intravenous Opioid Use Disorder: A Case Report and Literature Review.

Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition with limited literature available. We present a case of a 31-year-old female patient with a history of opioid drug use who presented with septic arthritis of the left SCJ. The patient exhibited chest wall pain; imaging revealed septic arthritis with an associated retrosternal abscess. Treatment with antibiotics alone resulted in the resolution of the abscess, highlighting the potential for medical management without surgical intervention. This case report and literature review emphasizes the importance of considering septic arthritis in patients with vague chest pain, particularly those with a history of intravenous drug use, and raise awareness about the complications associated with opioid use.

Hydroxyzine-Induced Torsade De Pointes: A Case Report and a Literature Review.

Hydroxyzine is an H1-receptor antagonist used for managing allergies, anxiety, opioid withdrawal, and insomnia. An adverse effect of hydroxyzine, QT prolongation, may lead to torsade de pointes (TdP). Our case report and literature review highlight the risk of TdP with hydroxyzine use. Our patient, a 58-year-old male with an implantable cardioverter defibrillator (ICD) and a history of polysubstance abuse presented with chest pain and shortness of breath. During the admission, the patient started experiencing symptoms of opioid withdrawal, which were refractory to buprenorphine. Hydroxyzine 50 mg was administered as recommended for symptomatic anxiety relief. Overnight the patient developed TdP, which was managed by MgSO4, amiodarone, and lidocaine, but did not resolve the arrhythmia. The patient was sedated and intubated, which led to the episode's resolution. This case report and literature review underscore the importance of cautious prescribing practices for hydroxyzine and other QT-prolonging drugs to prevent TdP. Healthcare providers should conduct personalized risk assessments, monitor electrolyte levels, and perform regular electrocardiograms. Administering the lowest effective dose, avoiding drug interactions, and exercising caution in patients with underlying repolarization abnormalities or a history of TdP are crucial. These measures help minimize the risk of TdP associated with low-dose hydroxyzine therapy.

Managing Patent Foramen Ovale (PFO) in Adults With Cryptogenic Stroke and Lymphoma: A Multidisciplinary Perspective.

​​Cryptogenic strokes are strokes with no clear underlying cause. Patent foramen ovale (PFO) is believed to be one of the causes of cryptogenic strokes. To manage such cases, closing the PFO is usually considered an option. We report a case of a middle-aged male with lymphoma who presented with an altered mental status due to a stroke, which, on investigation, was found to be due to an underlying PFO. This report explores the factors that must be considered when making the decision to close the PFO and emphasizes the vital role of a multi-disciplinary team in determining the best course of action for patients with cryptogenic strokes.

Cannabis Hyperemesis Syndrome in a Young Patient: A Case Report and Literature Review.

Cannabis hyperemesis syndrome (CHS) is a condition characterized by recurrent episodes of severe vomiting, abdominal pain, and intractable nausea in chronic cannabis users. With the legalization of recreational marijuana in many states, awareness of CHS is crucial to prevent delayed diagnosis or misdiagnosis. This case report presents a 25-year-old male with a history of type 1 diabetes mellitus and chronic cannabis use who presented to the emergency department with vomiting and epigastric pain. Our literature review sheds light on existing treatment options for this syndrome and gives future direction for research.

Hurler Syndrome (Mucopolysaccharidosis Type 1): A Case Report.

Hurler syndrome is a rare autosomal recessive disorder of deficiency in the metabolism of glycosaminoglycans (GAGs), including heparan sulfate and dermatan sulfate, which consequently accumulate in the different organs of the body, resulting from deficiency of an enzyme named Alpha-L-iduronidase. Here, we present an interesting case of a young female patient who presented with a combination of skeletal, oro-facial, ophthalmologic, neurological, and radiological findings of this disease. A diagnosis of Hurler syndrome (Mucopolysaccharidosis Type I) was made late in the disease due to lack of facilities, and the patient was ultimately managed supportively.

Prophylactic potential of honey and Nigella sativa L. against hospital and community-based SARS-CoV-2 spread: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: Considering the therapeutic potential of honey and Nigella sativa (HNS) in coronavirus disease 2019 (COVID-19) patients, the objective of the study is defined to evaluate the prophylactic role of HNS. TRIAL DESIGN: The study is a randomized, placebo-controlled, adaptive clinical trial with parallel group design, superiority framework with an allocation ratio of 1:1 among experimental (HNS) and placebo group. An interim analysis will be done when half of the patients have been recruited to evaluate the need to adapt sample size, efficacy, and futility of the trial. PARTICIPANTS: All asymptomatic patients with hospital or community based COVID-19 exposure will be screened if they have had 4 days exposure to a confirmed case. Non-pregnant adults with significant exposure level will be enrolled in the study High-risk exposure (<6 feet distance for >10min without face protection) Moderate exposure (<6 feet distance for >10min with face protection) Subjects with acute or chronic infection, COVID-19 vaccinated, and allergy to HNS will be excluded from the study. Recruitment will be done at Shaikh Zayed Post-Graduate Medical Institute, Ali Clinic and Doctors Lounge in Lahore (Pakistan). INTERVENTION AND COMPARATOR: In this clinical study, patients will receive either raw natural honey (0.5 g) and encapsulated organic Nigella sativa seeds (40 mg) per kg body weight per day or empty capsule with and 30 ml of 5% dextrose water as a placebo for 14 days. Both the natural products will be certified for standardization by Government College University (Botany department). Furthermore, each patient will be given standard care therapy according to version 3.0 of the COVID-19 clinical management guidelines by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcome will be Incidence of COVID-19 cases within 14 days of randomisation. Secondary endpoints include incidence of COVID-19-related symptoms, hospitalizations, and deaths along with the severity of COVID-19-related symptoms till 14th day of randomization. RANDOMISATION: Participants will be randomized into experimental and control groups (1:1 allocation ratio) via the lottery method. There will be stratification based on high risk and moderate risk exposure. BLINDING (MASKING): Quadruple blinding will be ensured for the participants, care providers and outcome accessors. Data analysts will also be blinded to avoid conflict of interest. Site principal investigator will be responsible for ensuring masking. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 1000 participants will be enrolled in the study with 1:1 allocation. TRIAL STATUS: The final protocol version 1.4 was approved by institutional review board of Shaikh Zayed Post-Graduate Medical Complex on February 15, 2021. The trial recruitment was started on March 05, 2021, with a trial completion date of February 15, 2022. TRIAL REGISTRATION: Clinical trial was registered on February 23, 2021, www.clinicaltrials.gov with registration ID NCT04767087 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

Seed Pretreatment and Foliar Application of Proline Regulate Morphological, Physio-Biochemical Processes and Activity of Antioxidant Enzymes in Plants of Two Cultivars of Quinoa (Chenopodium quinoa Willd.).

In the current study, the effects of exogenously applied proline (25 and 50 mM) and low-temperature treatment were examined on the physiochemical parameters in the plants of two cultivars (V1 and V2) of quinoa (Chenopodium quinoa Willd.). The seeds were also exposed to chilling stress at 4 °C before sowing. Plants raised from the seeds treated with low temperature showed reduced plant growth and contents of chlorophyll and carotenoids, but they had significantly increased contents of malondialdehyde, proline, ascorbic acid, total free amino acids, total soluble sugars, and total phenolics, as well as the activity of the peroxidase (POD) enzyme. Cold stress applied to seeds remained almost ineffective in terms of bringing about changes in plant root, hydrogen peroxide, glycine betaine and activities of superoxide dismutase (SOD), and catalase (CAT) enzymes. The exogenous application of proline significantly increased plant growth, the contents of chlorophyll, carotenoids, proline, ascorbic acid, total free amino acids, phenolics, and total soluble sugars, as well as the activities of SOD, POD, and CAT, but it decreased malondialdehyde content. Overall, foliar application of proline was better than the seed treatment in improving root dry weight, root length, chlorophyll a, carotenoids, glycine betaine, ascorbic acid and superoxide dismutase activity, whereas seed pre-treatment with proline was effective in improving shoot dry weight, shoot length, hydrogen peroxide, malondialdehyde, and peroxidase activity in both quinoa cultivars.