DHQ Faisalabad

Cardiovascular disease (CVD) remains a global health challenge with multifactorial origins, including mental stress, genetic predispositions, and treatment inefficiencies. Emerging interdisciplinary strategies are reshaping prevention and therapeutic paradigms. This narrative review explores recent innovations in cardiovascular disease management, with a focus on the role of mental stress therapies, genetic and personalized medicine, nanotechnology, liposome-based drug delivery systems, and artificial intelligence. Mental stress plays a substantial role in the development of cardiometabolic and cerebrovascular diseases. Pharmacological agents including selective serotonin reuptake inhibitors (SSRIs), beta-blockers, and emerging antiinflammatory therapies such as canakinumab have shown potential in mitigating cardiovascular risk in selected populations, although more clinical evidence is needed to confirm long-term efficacy. Genetic and personalized medicine, particularly through pharmacogenomics, allow for individualized therapeutic approaches by identifying high-risk individuals and optimizing treatment plans. Nanotechnology offers novel avenues for targeted cardiovascular drug delivery using engineered systems such as nanoparticles, liposomes, and biomimetic membrane-coated carriers. While primarily at the preclinical or early clinical stage, these platforms aim to enhance drug bioavailability and reduce systemic toxicity. Finally, artificial intelligence and machine learning provide predictive tools, real-time decision support, and imaging diagnostics to improve clinical outcomes and streamline healthcare delivery. The integration of mental health management, precision medicine, nanotherapeutics, and AI-driven diagnostics offers a comprehensive and future-ready framework for managing cardiovascular disease. Continued interdisciplinary research and clinical translation are essential for optimizing patient care and reducing the global CVD burden.

Background: Sacroiliac joint dysfunction (SIJD) is a significant contributor of both chronic low back pain and disability. The Denver Sacroiliac Joint Questionnaire (DSIJQ) is a condition-specific tool designed to evaluate severity of symptoms and functional limitations related to SIJD. However, the lack of Urdu version, limited its accessibility for Urdu speaking populations. Objective: To translate the DSIJQ into an Urdu version and evaluate its reliability and validity among patients with SIJD. Methodology: The translation of the questionnaire was conducted according to a conventional method of cross-cultural adaptation, which comprises a forward and a backward translation, expert validation, and pilot testing. The Urdu DSIJQ was used to evaluate 110 patients with clinically confirmed SIJD. Psychometric evaluation included content validity (I-CVI and S-CVI/Ave), internal consistency (Cronbach’s alpha), test-retest reliability (intraclass correlation coefficient, ICC), and construct validity through exploratory factor analysis. Results: The I-CVI ranged between 0.75-0.95 and S-CVI/Ave was 0.85, thus confirming content validity. Internal consistency was strong (Cronbach alpha = 0.858) and test-retest reliability was excellent (average ICC = 0.858). Factor analysis identified two components explaining 71.62% of the total variance. Conclusion: Strong validity and reliability make the Urdu version of the DSIJQ an appropriate tool for evaluating sacroiliac joint dysfunction in Urdu-speaking communities. It provides a culturally appropriate choice for clinical assessment and research in Pakistani settings. Keywords: Denver Sacroiliac Joint Questionnaire, ICC, Low Back Pain, Reliability, SIJD, Urdu Translation

ABSTRACT Background and Aims Elevated resting heart rate in heart transplant (HTx) recipients due to graft denervation is associated with adverse outcomes. Ivabradine and beta blockers are commonly used for heart rate control post‐HTx, but their comparative effectiveness and safety remain unclear. This systematic review and meta‐analysis aimed to evaluate the efficacy and safety of ivabradine versus beta blockers in heart transplant recipients. Methods Following PRISMA guidelines, a comprehensive literature search was conducted in April 2025 across PubMed, Cochrane, Embase, and Google Scholar. Original studies, including cohort studies and randomized controlled trials (RCTs) comparing ivabradine to beta blockers in heart transplant patients were considered eligible. The primary outcome was mean heart rate. Secondary outcomes were left ventricular mass, left ventricular mass index, and ejection fraction; adverse events (phosphenes, dizziness, fatigue, sepsis); and mortality and survival. Risk of bias was assessed using Cochrane RoB 2 for the randomized trial and ROBINS‐I for the non‐randomized studies, and statistical analyses were performed using Review Manager 5.4. Results Four studies, including one RCT and three cohort studies, met the inclusion criteria. Ivabradine demonstrated a statistically significant reduction in left ventricular mass index at 24 months (MD −8.82; 95% CI −14.05 to −3.59; p = 0.001) and heart rate at 24 months (MD −11.70; 95% CI −23.36 to −0.05; p = 0.05). Other efficacy parameters, including left ventricular mass, ejection fraction, and heart rate at 12 months, showed no significant differences. Adverse effects and survival outcomes were similar between groups. Sensitivity analysis revealed reduced heterogeneity when one high‐bias study was excluded. Conclusion Ivabradine may offer improved heart rate control and favourable changes in left ventricular mass index compared with beta blockers in heart transplant recipients, with a comparable safety and mortality profile. Given the small evidence base, the predominance of observational studies, and the substantial heterogeneity observed across several outcomes, these findings should be regarded as exploratory and hypothesis‐generating. Further large‐scale RCTs are warranted to confirm these findings and guide clinical decision‐making.

Objective: To determine liver enzymes (Alanine Transaminase: ALT and Aspartate Transaminase: AST) abnormalities in β-thalassemia major patients with multiple blood transfusions and to correlate these enzymes with serum ferritin. Methods: This cross-sectional study was conducted at the Pathology Department of The Children’s Hospital and Institute of Child Health, Multan, from December 2024 to February 2025. Children aged 2–14 years with β-thalassemia major, receiving regular transfusions, on chelation therapy, and with serum ferritin >1000 ng/mL were included. Demographic data, transfusion frequency, chelation compliance, and laboratory results were recorded using a structured proforma. Liver enzyme abnormalities were defined as ALT >35 U/L and AST >45 U/L. Patients were categorized into three groups based on serum ferritin levels: 1000–2000 ng/mL, 2001–3000 ng/mL, and >3000 ng/mL to assess their correlation with liver enzyme abnormalities. Results: A total of 107 patients, the median age was 6.0 years (4.0-9.0). There were 70 (65.4%) males and 37 (34.6%) females. Abnormal liver enzymes were observed in 94 patients (87.9%). Liver enzyme abnormality was significantly associated with higher serum ferritin levels (p-value = 0.005) and poor compliance to chelation therapy (p-value <0.001). A significant increase in liver enzymes (ALT and AST) was observed across ferritin categories (both p-values <0.001). Correlation analysis showed a positive correlation between serum ferritin and liver enzymes (for ALT ρ = 0.663, p-value <0.001, for AST ρ = 0.662, p-value <0.001)

Background: Elderly patients undergoing general anesthesia are vulnerable to delayed cognitive recovery and postoperative delirium, partly because age-related physiological changes may increase sensitivity to excessive anesthetic depth. Objective: To compare BIS-guided anesthesia with standard anesthesia management for early postoperative cognitive recovery, delirium incidence, anesthetic consumption, and immediate recovery outcomes in elderly patients undergoing elective non-cardiac surgery. Methods: This parallel-group randomized controlled trial was conducted at a tertiary care teaching hospital in Central Punjab, Pakistan, from August 2025 to January 2026. Eighty patients aged 65–80 years undergoing elective non-cardiac surgery under general anesthesia were randomized to BIS-guided anesthesia or standard anesthesia management. In the BIS-guided group, anesthetic depth was maintained within a BIS range of 40–60. Cognitive recovery was assessed using MMSE and MoCA at baseline, 24 hours, and 72 hours postoperatively, while delirium was assessed using the Confusion Assessment Method. Final complete-case analysis included 73 participants. Results: At 72 hours, the BIS-guided group had higher MMSE scores than the standard anesthesia group (27.1 ± 1.5 vs 25.4 ± 1.9; mean difference, 1.7; 95% CI, 0.90–2.50) and higher MoCA scores (25.0 ± 1.8 vs 22.9 ± 2.1; mean difference, 2.1; 95% CI, 1.19–3.01). BIS-guided anesthesia also reduced sevoflurane consumption, extubation time, and recovery-room stay. Delirium occurred in 8.1% and 25.0% of participants, respectively, with exact testing indicating a clinically relevant but statistically non-definitive difference. Conclusion: BIS-guided anesthesia was associated with better early postoperative cognitive recovery and improved immediate recovery efficiency in elderly surgical patients.