Punjab Institute of Cardiology (PIC), located in Lahore, Pakistan, is a 347-bed tertiary care hospital providing nationwide comprehensive cardiac care services.
Background: Conventional left ventricular ejection fraction may not identify subtle myocardial dysfunction relevant to recovery after coronary artery bypass grafting. Global longitudinal strain provides a quantitative measure of myocardial deformation and may offer complementary prognostic information. Objective: To evaluate the association of preoperative global longitudinal strain with early postoperative cardiac output, intensive care unit stay, and complications following elective isolated coronary artery bypass grafting. Methods: This retrospective cohort study included 110 adults who underwent CABG at a tertiary cardiac centre in Central Punjab, Pakistan, between January 2022 and December 2024. Preoperative absolute GLS magnitude was classified as severely impaired (<11.0%), moderately impaired (11.1%–14.0%), or mild-to-preserved (>14.0%). Outcomes included early cardiac output, ICU stay, low cardiac output syndrome, new-onset atrial fibrillation, acute kidney injury, and a composite of postoperative complications. Group comparisons and adjusted regression analyses were performed. Results: ICU stay was 76.4 ± 20.5, 56.2 ± 14.8, and 49.1 ± 11.2 hours across severe, moderate, and mild-to-preserved GLS groups, respectively (p < 0.001). Corresponding cardiac output values were 3.9 ± 0.6, 4.6 ± 0.7, and 5.1 ± 0.7 L/min (p < 0.001). Low cardiac output syndrome occurred in 36.0%, 10.4%, and 0.0%, respectively (p < 0.001). Each one-percentage-point reduction in absolute GLS magnitude was associated with greater odds of postoperative complications (adjusted OR = 1.45, 95% CI: 1.12–1.88; p = 0.005). Conclusion: Impaired preoperative GLS was associated with poorer early recovery after CABG independently of baseline ejection fraction. Prospective validation is required before routine GLS-guided perioperative management can be recommended
Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are used as hematological markers of systemic inflammation. However, their performance compared with conventional biomarkers i.e., erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) requires further investigation. This study assesses the association and diagnostic performance of NLR and PLR against ESR and CRP-defined systemic inflammation. Methods: In this cross-sectional analytical study, 4,553 eligible individuals were enrolled and their laboratory data was noted. Correlation of NLR and PLR with ESR and CRP was tested by applying Spearman’s rank correlation. After categorizing participants into normal and inflammatory group on basis of their ESR and/or CRP status, differences in their NLR and PLR values were assessed using the independent t-test. The diagnostic ability of NLR and PLR to discriminate ESR and/or CRP defined inflammation was analyzed using receiver operating characteristic (ROC) curve. Multivariable logistic regression was applied to test their independent association with systemic inflammation, after adjustment for confounding factors such as age, gender and hemoglobin. Results: NLR and PLR were significantly correlated with ESR and CRP (p<0.001) Participants in the inflammatory group had higher NLR and PLR as compared to those in the normal group. ROC demonstrated the limited discriminatory ability of NLR (AUC=0.574, 95% CI: 0.557–0.591) and PLR (AUC=0.552, 95% CI: 0.535–0.569). Multivariable binary logistic regression showed NLR as independent predictor of systemic inflammation (OR: 1.230, p<0.001) while PLR did not show predictive utility (OR: 1.001, p=0.228). Conclusion: NLR demonstrated a stronger and independent association with systemic inflammation compared to PLR. However, given their limited diagnostic accuracy, NLR should be used as a supportive marker in screening for inflammation. Neither NLR nor PLR can fully replace ESR and CRP
OBJECTIVE:To evaluate the effectiveness of a contextually developed home-based cardiac rehabilitation (HBCR) programme on heart-related quality of life (QoL), cardiac health behaviours (CHB) and cardiac anxiety (CA) among patients with coronary artery disease (CAD) in Lahore, Pakistan. DESIGN:Single-blinded randomised controlled trial (RCT). SETTING:Cardiology department of a public tertiary-care hospital in Lahore, Pakistan. PARTICIPANTS:120 patients aged 18-65 years diagnosed with coronary artery disease who had undergone percutaneous coronary intervention or medical management were recruited and randomly allocated to intervention (n=60) and control (n=60) groups. INTERVENTION:Participants in the intervention group received a nurse-led HBCR programme consisting of discharge education, structured physical activity and exercise guidance, dietary counselling, medication adherence support, and regular telephonic and physical follow-ups over 24 weeks. The control group received routine care and standard discharge advice. PRIMARY OUTCOME MEASURES:Primary outcomes were heart-related quality of life (MacNew HRQoL), cardiac health behaviours (Cardiac Health Behaviour Scale-21) and cardiac anxiety (Cardiac Anxiety Questionnaire-18), assessed at baseline, 3 months and 6 months postdischarge. RESULTS:At 6-month follow-up, the intervention group demonstrated significantly higher global QoL scores compared with the control group (mean difference 30.71, 95% CI 22.90 to 38.50). CHB scores were also significantly higher in the intervention group (mean difference 19.60, 95% CI 16.20 to 23.00). CA scores were significantly lower among participants receiving HBCR (mean difference -18.72, 95% CI -21.00 to -16.40). These improvements were evident after 3 months and sustained at 6 months. CONCLUSION:The nurse-led HBCR programme significantly improved QoL and CHB and reduced CA among patients with CAD. HBCR may provide an effective and scalable secondary prevention strategy in settings where centre-based cardiac rehabilitation services are limited. TRIAL REGISTRATION:Australian New Zealand Clinical Trial Registry, ACTRN12623000049673p.
BackgroundJoint infections, including periprosthetic joint infection (PJI), remain difficult to diagnose because conventional markers such as C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and procalcitonin may lack specificity, particularly after surgery or in inflammatory conditions. Heparin-binding protein (HBP), also known as azurocidin 1, is a neutrophil-derived mediator that is rapidly released during bacterial infection and may provide additional diagnostic value.MethodsA narrative review was conducted using major English- and Chinese-language databases to identify clinical studies evaluating HBP in PJI, musculoskeletal infection, systemic infection, or infection-versus-inflammation settings. Studies reporting diagnostic performance measures, including area under the receiver operating characteristic curve, sensitivity, specificity, or cutoff values, were included.ResultsHBP concentrations were generally higher in infected patients than in non-infected or inflammatory controls. Across included studies, reported HBP AUC values ranged from 0.693 to 0.968. In PJI, serum HBP showed AUCs of 0.856 and 0.968 in available studies, whereas synovial fluid HBP showed more modest individual accuracy. HBP also demonstrated value in differentiating bacterial infection from sterile inflammatory disease, including rheumatoid arthritis with superimposed bacterial infection.ConclusionHBP is a biologically plausible adjunctive biomarker for the diagnosis of bacterial infection and PJI. However, current evidence remains heterogeneous, and further large-scale prospective studies are needed to standardize cutoff values and clarify its role in diagnostic algorithms.
