Hypertension in Women: A South-Asian Perspective.

Introduction: Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women. Materials and Methods: Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women. Results: The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the development of hypertension in women, including age, combined oral contraceptives (COCs), polycystic ovarian syndrome (PCOS), preeclampsia, etc. There are several sex specific considerations in antihypertensives drug choices. Discussion: Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in women. Medical treatment and adherence is uniquely challenging for South Asian women due to a variety of socio-cultural-economic factors. Further research is warranted to identify optimal sex-specific treatment options that will improve the control of hypertension and decrease the risk of subsequent cardiovascular disease in both genders.

A mathematical modeling approach to measure the probability of HIV-1 transmission for different high-risk groups of Pakistan.

INTRODUCTION: Since 2010, the number of new HIV-1 cases has declined by 30% globally, however, in few countries, such as Pakistan, the cases have continued to increase, where the country witnessed a 57% increase in the number of new infections between 2010 and 2020. The HIV-1 epidemic in Pakistan is concentrated in certain high-risk groups, however, it is unknown which high-risk group has a higher likelihood of transmitting HIV-1 infections to vulnerable populations. This study aimed to apply mathematical probabilistic modeling to estimate the probability of HIV-1 transmission for different high-risk groups of Pakistan. METHODOLOGY: MATLAB software was used to conduct probabilistic modeling (chance estimation) of HIV-1 transmission for different high-risk groups of Pakistan, and also draw a comparison between Pakistan and different high- and low- HIV-1 prevalence countries. RESULTS: Our results revealed that Pakistan overall had the lowest probability of HIV-1 transmission as compared to other countries included in this study; however, within Pakistan, certain high-risk groups such as people who inject drugs (PWID) and the region of Larkana exhibited a high probability of HIV-1 transmissions. CONCLUSIONS: Our study suggests that the concentrated HIV-1 epidemic in Pakistan has a high likelihood of expansion from certain high-risk groups to other vulnerable populations. Further studies to understand the socio-epidemiological factors driving the expansion of the HIV-1 epidemic within the country will guide specific HIV-1 intervention strategies to control the spread of HIV-1 from high-risk to other vulnerable populations.

Management of spinal-induced hypotension for elective caesarean section: A survey of practices among anesthesiologists from a developing country.

BACKGROUND: In developing countries, more than half of the anesthesia-related maternal deaths are related to spinal hypotension. OBJECTIVE: To explore the practices of management of spinal induced hypotension with respect to fluid and vasopressor administration among anesthesiologists from a developing country. METHODS: After approval from institutional ethics committee, an online questionnaire was sent to anesthesiologists registered with Pakistan Society of Anesthesiologists between July and August 2018 to determine management strategies for prevention and treatment of spinal-induced hypotension. RESULTS: The response rate was 36% (156/433), majority from academic institution (62.8%) with equal representation from attending and trainee anesthesiologist. For prophylaxis 39.1% respondents did not use vasopressors, 32.7% used fluid preloading with crystalloids (54.7%) as fluid of choice followed by combination of co-loading and vasopressor(22.4%). Phenylephrine was the vasopressor of choice for both prophylaxis (33.1%) and treatment (57%). Attending anesthesiologist used a combination of fluid co-loading and vasopressors for prophylaxis as compared to trainee anesthesiologists (37.2% vs. 17.9%; P=0.035) and selected vasopressors according to patient's heart rate (33.3% vs. 19.5%; p=0.05). Prophylactic phenylephrine was used more by respondents from the academic institution (p=0.023). Fluid co-loading was used more by respondents with <30 % compared to those with > 30% of clinical responsibility to obstetric anesthesia (P<0.05). CONCLUSION: Phenylephrine as the vasopressor of choice indicates growing awareness of management strategies among anesthesiologists from developing countries but there is a need to increase its use for prophylaxis. Some variation in practice according to the level of anesthesiologist, practice type and responsibilities to obstetric anesthesia are evident.

BMP4/Smad1 Signalling Promotes Spinal Dorsal Column Axon Regeneration and Functional Recovery After Injury.

Signalling through the BMP4/Smad1 pathway promotes corticospinal tract axon regeneration and functional recovery in mice. However, unlike humans and rats, mice do not cavitate. Here, we investigated if activation of the BMP4/Smad1 pathway promotes axon regeneration and functional recovery in a rat model that cavitates. We show that dorsal root ganglion neurons (DRGN) in injury models, including the non-regenerating dorsal column (DC) and the regenerating sciatic nerve (SN) crush and preconditioning (p) SN + DC (pSN + DC) paradigms, regulate the BMP4/Smad1 signalling pathway. For example, mRNA expression of positive regulators of the BMP4/Smad1 pathway was highly up-regulated whilst negative regulators were significantly down-regulated in DRGN in the regenerating SN and pSN + DC models compared to non-regenerating DC models, matched by concomitant changes in protein expression detected in DRGN by immunohistochemistry. BMP4 peptide promoted significant DRGN survival and disinhibited neurite outgrowth in vitro, whilst AAV-BMP4 delivery in vivo stimulated DC axon regeneration and functional recovery in a model that cavitates. Our results show that activation of the BMP4/Smad1 pathway is a potential therapeutic target in the search for axon regenerative signalling pathways in the CNS.