Elevated systolic blood pressure (SBP) is a main adaptable risk factor for controlling ischaemic heart disease (IHD) and contributes significantly to cardiovascular morbidity and mortality globally. In Pakistan, the increasing prevalence of hypertension (HTN) and its associated cardiovascular consequences reflect a serious public health challenge.. An analytical cross-sectional study was conducted on 430 adults aged 30 years and above at tertiary care hospital. Participants were selected using consecutive sampling. Data was collected on socio-demographic characteristics, lifestyle factors, anthropometric measurements, SBP, metabolic comorbidities, and echocardiographic findings. Statistical analysis was performed using SPSS version 29.0. Associations were assessed by chi-square tests and multivariable logistic regression, results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The majority of study subjects was belonging to age group 50-59 years, and 59.5% were male. Elevated SBP ≥130 mmHg was observed in 58.1% of study subjects. The prevalence of IHD was 39.1%. A significant association was found between elevated SBP categories and the prevalence of IHD (p < 0.001). After adjustment for potential confounders, elevated SBP was independently associated with IHD (AOR = 2.48; 95% CI: 1.62-3.79). Adult IHD is strongly and independently correlated with elevated SBP
ABSTRACTGenetic association studies have demonstrated that partial loss ofSLC30A8function protects against type 2 diabetes (T2D) in humans, but the impact of complete loss ofSLC30A8function remains unknown. From whole-exome and genome sequencing of 100,814 participants in the Pakistan Genome Resource, we identified fifteenSLC30A8knockouts, including homozygotes for a variant enriched in South Asians (Gln174Ter) and 615 heterozygotes for loss-of-function (LoF) variants. T2D risk was lower inSLC30A8LoF hetero- and homozygotes, and the protective effect strengthens in a gene dose-dependent manner (ORadditive=0.63 [0.53-0.78, p=7.5E-07], ORrecessive=0.27 [0.09-0.80, p=0.018]). Recall-by-genotype ofSLC30A8LoF hetero- and homozygotes and their family members with oral glucose tolerance tests showed a gene dose-dependent reduction in glucose levels coupled with elevated insulin. Corrected Insulin Response, Disposition Index, and Insulin Sensitivity Index in LoF hetero- and homozygotes indicated higher glucose-stimulated insulin secretion with preserved beta cell function. These data suggest that therapeutic knockdown ofSLC30A8, up to and including complete knockout, may treat T2D safely and effectively.
According to Alba Eban, consensus means that many people collectively agree on something that no one individually believes [1]. Evidence-based medicine (EBM), as defined by Sackett, involves the conscious, judicious, and explicit use of the best available evidence to make decisions regarding patient care [2]. Since the 1990s, the rise of the "guidelines culture"—a result of EBM—has significantly influenced the activities of American and European scientific societies [3]. EBM has been instrumental in determining the best care practices for patients. With the evolution of this culture, randomized controlled trials, expert involvement, and contributions from various medical societies have shaped the development of clinical guidelines. Between 1984 and 2008, only 11% of cardiovascular guidelines had a Level A evidence base, whereas 48% relied on Level C recommendations [4]. These guidelines have faced criticism, particularly regarding the involvement of pharmaceutical and medical device companies, which may prioritize economic interests over patient welfare by promoting expensive treatments or focusing on rare diseases. Economic considerations have also played a role in the introduction of guidelines, aiming to reduce healthcare costs. Additionally, within scientific societies, some authors may represent the interests of specific lobbies rather than reaching a truly unanimous consensus. Despite these concerns, guidelines for conditions such as heart failure, atrial fibrillation, and acute coronary syndrome have been associated with reduced mortality and morbidity due to improved therapeutic measures [5]. An important issue is the medicolegal protection offered by adherence to guidelines. The Balduzzi Law (189/2012) states that healthcare professionals following guidelines set by the scientific community could still face criminal charges for minor negligence. The Gelli Law (24/2017) later modified this, stating that guidelines should be interpreted in the context of individual cases, and that adherence to them does not automatically rule out malpractice [3]. Work on cardiac guidelines in Pakistan and India remains limited. In Pakistan, interventional cardiology guidelines were published in 2017, involving input from government officials. These guidelines aim to facilitate scientific data collection and provide legal protection for physicians [6]. In India, clinical practice guidelines (CPGs) for cardiovascular diseases are generally of low to moderate quality. It has been suggested that improvements could be made through better governance structures and the establishment of principles and standards for reporting and dissemination [7]. Considerations for Developing Local Guidelines When formulating cardiovascular guidelines in this region, the following factors should be taken into account: Integration of International Guidelines: Established international guidelines should be carefully adapted by local experts, considering factors such as healthcare costs, practice diversity, and the complexity of evolving treatment options [8]. Comprehensive Scope: Guidelines should encompass not only therapeutic decisions but also diagnostic workups. Medicolegal Protection: Well-developed guidelines will help cardiologists defend themselves in cases of malpractice allegations. There is an urgent need to mandate documentation of cardiac disease outcomes, treatment protocols, and registries in all hospitals across the country. Cardiac researchers should systematically collect and analyze data to develop locally relevant guidelines tailored to Pakistan’s healthcare landscape. AUTHORS' CONTRIBUTION KAH: Concept and design, data acquisition, interpretation, drafting, final approval, and agree to be accountable for all aspects of the work. Acknowledgment: None. Funding: No specific grant for this research from any public, commercial, or not-for-profit funding agency References Frye RL, Collins JJ, DeSanctis RW, Dodge HT, Dreifus LS, Fisch C, et al. Guidelines for permanent cardiac pacemaker implantation, May 1984. A report of the joint American College of Cardiology/American Heart Association task force on assessment of cardiovascular procedures (Subcommittee on pacemaker implantation). Circulation. 1984;70(2):331A-9A. Sackett DL, Straus SE, Richrdson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. InEvidence-based medicine: how to practice and teach EBM 2000 (pp. 261-261). Rapezzi C, Lorenzini M. How far should guidelines be followed? Eur Heart J Suppl. 2020;22(Suppl L):L121-L123. Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC Jr. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA. 2009;301:831-41. (Erratum in: JAMA. 2009;301:1544). Komajda M, Schöpe J, Wagenpfeil S, Tavazzi L, Böhm M, Ponikowski P, et al. Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. Eur J Heart Fail. 2019;21:921-9. Government of Pakistan. Islamabad Healthcare Regulatory Authority (IHRA): Cardiac Catheterization Laboratory (CCL) Standards and best Practice Guidelines for Pakistan 2017. Accessed: 22nd March 2025. Available at: file:///C:/Users/Musa%20Karim/Downloads/CCL-Standards-and-Best-Practice-Guidelines-for-Pak_250318_124312.pdf Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, et al. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open. 2022;13(12):20542704221127178. Armstrong PW. Do guidelines influence practice?. Heart. 2003;89(3):349-52.
Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy of the upper limb, caused by compression of the median nerve within the carpal tunnel. It is characterized by wrist pain, numbness, tingling, and in severe cases, muscle atrophy. The condition is frequently associated with repetitive hand motions, awkward wrist positioning, and prolonged flexion, making certain occupational groups particularly vulnerable. Among these, retail cashiers are at high risk due to the repetitive nature of their tasks and prolonged working hours. Objective: To determine the prevalence of Carpal Tunnel Syndrome among retail store cashiers in Karachi, Pakistan. Methods: A cross-sectional analytical study was conducted over six months among 191 retail cashiers from various areas of Karachi, using a convenience sampling technique. Participants included males and females aged 18–40 years with a minimum of one year of experience in cashier roles involving repetitive wrist movements. Data were collected using a structured questionnaire comprising the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and the Visual Analogue Scale (VAS), assessing symptom severity and functional status. Data were analyzed using IBM SPSS version 26 with frequency distribution, chi-square tests, and correlation analysis. Results: Out of 191 participants, 41 (21.5%) were diagnosed with CTS. Of the total sample, 176 (92.1%) were male and 15 (7.9%) were female. Participants aged 34–40 years formed the largest group (39.3%). A total of 69 (36.1%) had more than 7 years of work experience, and 145 (75.9%) reported working 40 or more hours per week. There was a statistically significant correlation between age and symptom severity (p = 0.037) and a moderate negative correlation between symptom severity and work-related factors (r = -0.170, p = 0.018). Conclusion: The study identified a considerable prevalence of CTS among retail cashiers in Karachi. The findings emphasize the importance of ergonomic workplace interventions and preventive strategies to reduce CTS risk in high-exposure occupations. Further research is needed to explore occupation-specific risk contributors and evaluate long-term ergonomic solutions.
Hypertension is a rapidly escalating public health concern in Pakistan, with prevalence estimates as high as 46.2%, surpassing both regional and global averages. Sedentary lifestyles, poor dietary habits, obesity, and limited awareness contribute significantly to this burden. Despite the availability of treatment guidelines, poor adherence to lifestyle modifications and medications-often due to financial constraints-results in widespread uncontrolled hypertension, particularly in rural populations. Knowledge gaps among patients, physicians, and healthcare systems further compound the issue. Comprehensive national data remain scarce, as existing evidence stems largely from small-scale studies. To address this crisis, Pakistan urgently requires large population-based surveys, targeted awareness campaigns, improved primary care training, and multi-sectoral collaboration to strengthen prevention, early detection, and management strategies.
