Doctors Hospital

Congenital heart defects (CHDs) remain a leading cause of infant morbidity and mortality worldwide, with current treatments largely focused on symptomatic management rather than addressing underlying genetic causes. This study evaluates the effectiveness, therapeutic potential, and clinical feasibility of CRISPR-based gene-editing interventions in the personalized treatment of CHDs. Using a quantitative research design, data were collected from clinical trials, laboratory experiments, and genomic datasets, with stratified sampling to ensure representation across different CHD types and genetic mutations. Statistical analyses assessed gene correction rates, improvements in cardiac function, survival, symptom reduction, and quality of life, alongside safety metrics including adverse effects, off-target mutations, and immune responses. Results indicate that advanced CRISPR techniques such as base editing and prime editing—achieved high mutation correction rates (72%–88%) with low off-target effects (1.5%–6%) and meaningful improvements in cardiac function (60%–75%). Personalized approaches, including patient-specific guide RNAs, iPSC-based ex vivo editing, genomic profiling-guided prime editing, and AI-assisted targeting, led to increased survival (30%–40%), reduced symptoms (55%–65%), decreased hospital readmissions, and enhanced quality of life (65%–75%), with all findings statistically significant (p < 0.05). Safety evaluation demonstrated acceptable adverse effect rates (6%–14%) and moderate immune responses (4%–9%), while ethical compliance and clinical feasibility scores were high (7.0–9.0 and 6.5–8.5, respectively). These findings suggest that CRISPR-based therapies are both effective and clinically feasible for personalized CHD treatment, supporting a shift from symptom-based interventions to curative, gene-targeted strategies. Future research should focus on optimizing delivery systems, ensuring long-term safety, and developing scalable clinical protocols to advance precision medicine for CHDs.

Background: Cervical cancer is the fourth mostfrequent malignancy in women worldwide. The highest rate of this cancer incidence and mortality are in low- and middle-income countries. It is thesecond leading cause of cancer-related deaths among women in Bangladesh. To assess the level of knowledge among women of reproductive age about cervical cancer. Materials and methods: This descriptive cross-sectional study was conducted from September 2019 to December 2019 in the Gynecology and Obstetrics Outpatient Department (OPD) of Sir Salimullah Medical College and Mitford Hospital. The sampling technique was purposive. A total of 300 women of reproductive age (15 to 49 years) were interviewed using a pretested semi-structured questionnaire. Results: Most participants (75%) did not know aboutcervical cancer. Only 34.7% of women reported understanding symptoms and one-fourth (25%) knew the causes of cervical cancer. Conclusion: Knowledge about cervical cancer among women was revealed to be remarkably poor. Health education and community-based intervention should focus on informing risk factors, symptoms, screening and cervical cancer vaccination. In the future, this study will assist with planning various strategies including sexual health, participation in screening and preventive services. Chatt Maa Shi Hosp Med Coll J; Vol.24 (1); Jan 2025; Page 17-21

Secure exchange of human resource data between cloud based human capital management platforms and downstream payroll systems has become a critical enterprise concern as organizations increasingly rely on distributed integration architectures. This study examines the confidentiality, integrity, and exposure risks inherent in data flows between SAP SuccessFactors and payroll platforms, with particular attention to personally identifiable and financial information subject to stringent regulatory obligations. The paper argues that traditional perimeter based security and static encryption alone are insufficient to address overexposure, misuse, and operational leakage of sensitive HR attributes during routine payroll processing. To address this gap, the study proposes a unified control framework that combines strong cryptographic protection, policy driven masking, and strict data minimization, augmented by AI optimized decision logic appropriate to the technological landscape of 2019. The framework leverages statistical risk scoring, rule augmented learning, and anomaly detection techniques to dynamically select encryption strength, masking profiles, and attribute level payload composition based on data sensitivity, purpose limitation, and operational context. A reference architecture is presented to demonstrate how these controls can be embedded across extraction, transformation, transmission, and ingestion layers without disrupting payroll accuracy or timeliness. Evaluation considerations focus on measurable reductions in data exposure, improved audit evidence generation, and enhanced governance transparency rather than speculative automation claims. The findings suggest that AI optimized security orchestration can materially improve trust and compliance in HR data exchanges while remaining compatible with established enterprise integration patterns. This work contributes a practical and extensible foundation for secure HR system interoperability and offers a defensible baseline for future research on adaptive data protection in enterprise information systems.

Background: Sarcopenia and sarcopenic obesity are increasingly recognized in kidney transplant recipients (KTRs), yet their molecular underpinnings remain poorly defined. We sought to synthesize current evidence on biomarker associations with muscle loss and function in the post renal transplant setting. Methods: A comprehensive search of PubMed/MEDLINE and Cochrane databases was conducted according to PRISMA guidelines. Studies evaluating biomarkers related to sarcopenia or sarcopenic obesity in adult and pediatric KTRs were included. Quality assessment was performed with the NHLBI tool. Results: Seven studies were included, encompassing 548 KTRs. Myostatin levels predicted sarcopenia in KTRs (cut-off: 390 pg/mL) and inversely correlated with Metabolic equivalent of Tasks (METs), handgrip strength (HGS), and graft performance. Although adiponectin was negatively correlated with body fat, its high-molecular-weight isoform was linked to lower muscle mass and long-term graft decline. Leptin was associated with sarcopenic obesity and lower estimated Glomerular Filtration Rate (eGFR). Insulin like Growth Factor-1 (IGF-1) independently predicted HGS but not muscle mass. Brain-derived neurotrophic factor (BDNF) levels predicted sarcopenia (cut off: 17.8 ng/mL) and reflected physical activity levels. Visfatin showed no association with sarcopenia but it was positively correlated with eGFR. Lastly, certain polymorphisms of Alpha-actinin-3 (ACTN3) were shown to genetically predispose to post-transplant sarcopenia. Conclusions: These emerging candidate biomarkers provide promising mechanistic insight into post-transplant muscle decline and may ultimately support more personalized risk assessment. Further validation is needed, and functional measures remain the most reliable clinical tools at present.

Heart Failure with Preserved Ejection Fraction (HFpEF) is an increasingly prevalent clinical syndrome that poses a significant public health challenge due to its complex pathophysiology, diagnostic limitations, and lack of effective therapies. Central to its development are multifactorial and interrelated mechanisms, including left ventricular diastolic dysfunction, myocardial fibrosis, inflammation, endothelial dysfunction, and cardiomyocyte hypertrophy. In recent years, noncoding RNAs (ncRNAs)—particularly microRNAs (miRNAs) and long noncoding RNAs (LncRNAs)—have emerged as critical regulators of these cellular and molecular pathways. This review outlines the major pathophysiological mechanisms underlying HFpEF and highlights the noncoding RNAs most extensively studied in this context. Several ncRNAs have shown promise as biomarkers for the diagnosis and prognosis of HFpEF, owing to their tissue specificity, stability in circulation, and involvement in disease-relevant pathways. However, their integration into routine clinical practice remains limited. Importantly, the regulatory functions of ncRNAs in HFpEF pathophysiology also position them as potential therapeutic targets. Early experimental studies demonstrate encouraging results, suggesting that ncRNA-targeted interventions may support the development of personalized treatment strategies tailored to the diverse clinical phenotypes observed in HFpEF.

BackgroundHepatitis delta virus (HDV) is the most aggressive form of viral hepatitis, accelerating progression to cirrhosis, hepatocellular carcinoma, and liver failure. Despite its severity, HDV remains underdiagnosed and under-prioritized in Pakistan, where hepatitis B virus (HBV) prevalence is high. Understanding clinician perspectives is essential for informing national strategies related to diagnosis, treatment, and policy integration.MethodsA non-interventional, cross-sectional mixed-methods survey was conducted among 12 clinicians, including hepatologists, gastroenterologists, and infectious disease specialists from Karachi, Islamabad/Rawalpindi, Lahore, Peshawar, and Nowshera. Data were collected using a structured questionnaire adapted from international HDV surveys and contextualized for Pakistan. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis to identify barriers, gaps, and recommendations.ResultsTwelve clinicians from major urban centers in Pakistan participated, representing diverse specialties with 5-30+ years of experience. Fifty percent reported frequently encountering HDV among HBV patients, and most estimated HDV co-infection rates between 10% and 20%. Anti-HDV testing was routinely performed by 75% of clinicians, whereas HDV RNA PCR was routinely performed by only 50%, primarily due to high cost and limited availability; 83.3% reported that HDV diagnostics were available but unaffordable for most patients. Key diagnostic barriers included high cost (75%), lack of awareness (66.7%), limited test availability (41.7%), and absence of national screening guidelines (50%). Two-thirds classified HDV severity as moderate, while 33.4% rated it severe or life-threatening. Perceived clinical risks included rapid progression to cirrhosis (75%), liver failure (66.7%), hepatocellular carcinoma (66.7%), and increased mortality (33.3%). Most clinicians identified major treatment gaps, with 75-83.3% describing an urgent or critical need for a national HDV treatment program. Policy support was strong: 83.3% favored HDV inclusion in the National Hepatitis Program, 83.3% endorsed national screening guidelines and awareness campaigns, and all clinicians (100%) supported an Emergency Use Authorization pathway with safeguards such as Phase II/III data and advisory oversight. Qualitative insights reinforced concerns about worsening liver disease burden, inequitable access, and escalating healthcare costs without immediate policy action.ConclusionThis study reveals substantial diagnostic, therapeutic, and policy gaps in HDV management in Pakistan. Clinicians strongly advocate for nationwide screening, cost reduction of diagnostics, integration of HDV into the national hepatitis program, and early treatment access through regulatory innovation. Urgent action is needed to prevent worsening disease burden, improve equity, and align with global hepatitis elimination targets.

Objective: To describe a practical surgical approach for mastoid cavity obliteration and canal wall reconstruction using autologous bone dust and conchal cartilage applied either during primary canal wall up (CWU) surgery or in revision of prior canal wall down (CWD) mastoid cavities, with the aim of restoring a self-cleaning, waterproof ear that retained its natural acoustic resonance. Methods: The indications, surgical technique, and follow up and imaging surveillance were described, detailing patient selection, harvesting and application of autologous materials, and the key technical steps for cavity obliteration and posterior canal wall reconstruction. The importance of preserving the ear canal’s standing wave resonance (~2000–2500 Hz) for optimal hearing was emphasized. Postoperative monitoring with non-echo planar diffusion-weighted imaging (DWI) MRI was recommended at least 1.5 years after surgery to detect residual or recurrent cholesteatoma. Results: This technique was performed successfully in 88 patients (32 males and 56 females, aged 6–80 years) across four hospitals in Metro Manila from January 2020 to July 2025. All patients had unremarkable postoperative courses and healed within three months. Among the 67 who underwent DWI MRI after 18 months, two required revision mastoidectomies with mastoid obliteration for cholesteatoma recidivism—one with residual and one with recurrent disease. Conclusion: Mastoid obliteration and reconstruction using autologous bone dust and cartilage has proven to be a safe, effective and cost-efficient technique. It converts problematic open cavities into dry, self-cleaning ears suitable for swimming while preserving the acoustic benefits of a near-normal ear canal. Long-term follow-up with diffusion-weighted imaging (DWI) MRI is essential to ensure durable disease control.

The purpose of this retrospective case series is to describe real-world clinical experience with DermaBind TL or FM, (HealthTech Wound Care, US), a dehydrated full-thickness placental membrane intended for homologous use as a protective wound covering in wounds of various aetiologies that failed to heal with standard of care (SoC). This retrospective observational, uncontrolled case series collected data from healthcare providers in the US. Eligible cases were patients, ≥18 years of age, with hard-to-heal wounds who received DermaBind TL or FM after having completed a minimum of four weeks of SoC without evidence of wound improvement. Data collected included patient demographics, wound characteristics and wound size. The cases of 27 patients encompassing 36 wounds were included. The average age of patients included was 72.4 years (range: 37-101 years). The majority of wounds were pressure ulcers (63.9%), followed by diabetic foot ulcers (19.4%) and venous leg ulcers (8.3%). Wound onset was, on average, 29 weeks prior to the first graft application with the placental membrane, and the average wound size was 34cm2. Graft applications occurred weekly, with an average duration of treatment of 6.7 weeks. The observed average percentage surface area reduction across the 36 wounds was 69.1% (range: -17.6-100%). No adverse events were reported by the provider across all patient cases. These observations describe the clinical use of DermaBind as a wound covering material consistent with its homologous natural protective role. Larger, prospective studies are warranted to further investigate its clinical use. The authors would like to stress that this non-randomised, retrospective uncontrolled case series was used to describe findings, such as number of grafts applied, observed percentage of surface area reduction and graft wasted, and not to demonstrate efficacy.