Dow University of Health Sciences

Autoimmune cardiovascular disease (CVD) includes myocarditis, coronary microvascular dysfunction (CMD), and heart failure with preserved ejection fraction (HFpEF). Traditional risk scores often overlook these conditions despite their links to high morbidity. Recent research highlights the significance of immunophenotyping, such as clonal hematopoiesis of indeterminate potential (CHIP), type I interferon activity, Th17/Treg imbalance, and cardiac autoantibodies, to improve risk assessment and guide treatment. This review combines mechanistic and clinical data connecting these immune signatures to endothelial dysfunction, arrhythmias, and fibrotic remodeling. It underscores the atherogenic role of CHIP and its influence on HFpEF prognosis, the vasculopathy driven by type I interferon signaling in CMD, and autoimmunity in myocarditis mediated by Th17 dominance. Cardiac-specific autoantibodies, like anti-heart and v1-adrenergic receptor antibodies, serve as early prognostic markers. Moreover, integrating immune biomarkers with advanced imaging techniques, such as cardiac magnetic resonance and positron emission tomography, could enhance risk stratification and therapy monitoring. Current immunomodulating treatments, including TNF and IL-6 inhibitors, provide cardiovascular benefits, while glucocorticoids and JAK inhibitors carry dose-related risks. In the future, personalized algorithms that incorporate CHIP genotyping, interferon scoring, and continuous biomarker and imaging assessments may transform autoimmune CVD management. This review highlights these translational insights and research priorities to bridge the gap between immune dysregulation and cardiovascular outcomes.

The World Health Organization (WHO) defines health [1] as “a dynamic state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” WHO has lately debated on adding the fourth dimension of Health-Spirituality [2, 3]. Therefore, we will consider definition of health in an expanded version beyond physical, mental and social wellbeing; and add spiritual wellbeing as the fourth dimension in consideration of health. There are several World Health Organization documents stressing on various issues being faced by community in terms of health, which suggest the need for revising the healthcare undergraduate curriculum. Keywords: Medical education, Curriculum reform, 5S’s (Self, Society, State, Systems and Spirituality), Human wellness management, Undergraduate healthcare curriculum, Health management.

Background: Low-grade squamous intraepithelial lesions (LSIL) are commonly associated with persistent human papillomavirus infection and are frequently managed through conservative surveillance due to their potential for spontaneous regression. Emerging evidence suggests that disruption of the cervicovaginal microbiome, particularly depletion of Lactobacillus species, may contribute to lesion persistence. Microbiome-modulating therapies have therefore gained attention as low-risk adjuncts in cervical disease prevention. Objective: To determine whether topical cervical application of Lactobacillus probiotics increases regression rates of LSIL to normal cytology. Methods: A randomized controlled trial was conducted over 12 months in tertiary care gynecology clinics in the Lahore region of Pakistan. Women aged 21–45 years with cytologically confirmed LSIL were randomized to receive either topical cervical Lactobacillus probiotic therapy alongside standard surveillance or standard care alone. Cervical cytology was assessed at baseline, six months, and twelve months. The primary outcome was regression to normal cytology at 12 months. Data were analyzed using parametric statistical tests, with significance set at p < 0.05. Results: At 12 months, regression to normal cytology was observed in 71.9% of women in the probiotic group compared with 50.5% in the control group, representing a statistically significant difference. Persistence of LSIL was lower in the intervention group, while progression to higher-grade lesions was infrequent in both groups. Probiotic therapy was well tolerated, with no serious adverse events reported. Conclusion: Topical cervical Lactobacillus probiotic therapy significantly enhanced LSIL regression and reduced lesion persistence without added safety concerns. These findings support microbiome modulation as a practical and non-invasive adjunct to conservative LSIL management and cervical cancer prevention strategies. Keywords: Cervical Intraepithelial Neoplasia; Lactobacillus; Papillomavirus Infections; Probiotics; Randomized Controlled Trial; Uterine Cervical Dysplasia; Vaginal Microbiome

Primary caregivers of critically ill ICU patients experience substantial psychological stress, yet this burden remains understudied in lower middle-income countries such as Pakistan. This study assessed the magnitude and predictors of perceived stress among primary family caregivers of patients admitted to medical and surgical ICUs at three tertiary care hospitals in Karachi. A cross-sectional study was conducted among 161 primary caregivers at Jinnah Postgraduate Medical Center, Civil Hospital Karachi, and Liaquat National Hospital. Data were collected through interviews using the Perceived Stress Scale (PSS-10; range 0–40). Ethical approval and informed consent were obtained. Univariable multinomial logistic regression identified factors associated with stress levels, followed by multivariable multinomial logistic regression including significant or clinically relevant predictors. Overall, 65.8% experienced moderate stress (n = 106), 24.8% (n = 40) low stress, and 9.3% (n = 15) high stress. Female caregivers experienced significantly higher stress than males (p = 0.03), and those with comorbidities had elevated stress (40.0%, p = 0.02). Caregivers of medical ICU patients reported greater stress than those in surgical ICUs (p < 0.001). Sepsis, severe infection, and neurological diagnoses predicted moderate stress. Previous hospitalizations and ICU admissions were also associated with higher caregiver stress. Over half reported unaddressed psychological distress (51.2%, n = 82), and 65.4% (n = 104) had unmet mental health needs. After adjustment, medical ICU admission, caregiver comorbidities, and prior ICU admission independently predicted higher stress. Caregivers of critically ill patients experience clinically significant stress, particularly those caring for medical ICU patients and those with comorbidities. High level of unmet psychological needs highlights the urgent requirement for improved communication, targeted interventions, and the integration of psychological support in routine ICU protocols. This could help reduce caregiver burden and enhance patient care in low-resource settings.

Abstract PURPOSE In Pakistan, strong familial bonds make family members as primary caregivers for patients admitted to intensive care units (ICUs). Despite continuous multidisciplinary care in ICUs, caregivers’ mental health needs are often overlooked, creating a significant psychological burden alongside critical decision-making responsibilities. This multicenter cross-sectional study assessed the prevalence and severity of depression among primary caregivers of ICU patients in tertiary-care hospitals in Karachi, Pakistan. METHOD This study was conducted from February to July 2025 in the ICUs of Jinnah Postgraduate Medical Centre (JPMC), Liaquat National Hospital (LNH), and Civil Hospital Karachi (CHK). A total of 161 primary caregivers of medical and surgical ICU patients were enrolled. Participants completed the validated Urdu version of the Patient Health Questionnaire-9 (PHQ-9) and provided sociodemographic as well as clinical data. Eligible participants were first-degree relatives or friends able to communicate in English, Urdu, or Sindhi. Data were analyzed using SPSS version 26 with descriptive statistics, chi-square tests, and multivariable linear regression to identify independent factors associated with PHQ-9 scores. RESULTS The median PHQ-9 score was 6 (IQR: 2–11). Depression severity included 41.6% minimal, 25.5% mild, 19.3% moderate, 9.9% moderately severe depression, and 3.7% severe depression. On multivariable linear regression, admission to a medical ICU, patient mechanical ventilation, and a higher number of caregiver comorbidities were independently associated with higher PHQ-9 scores. Sleep disruption and witnessing other patients’ suffering were strongly associated with increased depressive symptoms. CONCLUSION Primary family caregivers of ICU patients experience a substantial burden of depressive symptoms, highlighting the need for targeted psychological support, language-sensitive communication, and institutional policies addressing caregiver mental health in resource-limited settings.

Objective: To assess the clinical manifestations associated with vitamin B12 deficiency and to investigate the variationsin clinical presentation between different genders.Methodology: This descriptive cross-sectional study was conducted at Department of Medicine, Dow University Hospital,Ojha Campus, Karachi from February 2025 to July 2025. A total of 134 adults presenting with clinical symptoms suggestiveof vitamin B12 deficiency were consecutively enrolled from the outpatient department. Patients were evaluatedabout their medical history and lifestyle habits. Patients were also enquired about their present symptoms and clinicallyexamined. Vitamin B12 deficiency level was confirmed on serum vitamin B12 levels. SPSS version 26 with a p-value of0.05 was used for statistical analysis.Results: Vitamin B12 deficiency was confirmed in 66 (49.3%) patients. Of which 80.3% were male and 19.7% were female(p = 0.043). The most common clinical symptom was easy fatigability (87.9%), followed by pallor (86.4%), palpitations(62.1%), glossitis (50.0%), and shortness of breath grade ≥1 (50.0%).Conclusion: This study concludes that vitamin B12 deficiency presents with a wide spectrum of clinical manifestations,most commonly fatigue, pallor, palpitations, glossitis, and neurological complaints, emphasizing its significant impact onoverall health. Keywords: Fatigue, glossitis, pallor, palpitations, vitamin B12 deficiency.

Abstract Background An elevated calcium-phosphate product (CPP), defined as a product of serum calcium and serum phosphate, is a hallmark of CKD-mineral and bone disorder and has been implicated in accelerated coronary artery calcification, arterial stiffness, and left ventricular hypertrophy. These pathological changes contribute to adverse cardiovascular outcomes. While prior studies have shown worse percutaneous coronary outcomes (PCI) outcomes in CKD patients overall, the prognostic impact of CPP levels remains underexplored. The objective is to evaluate post-PCI outcomes in CKD patients with and without hypercalcemia and hyperphosphatemia. Methods A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network, focusing on adult patients with CKD undergoing PCI. Patients were grouped based on serum calcium and phosphorus levels, with those having hypercalcemia and hyperphosphatemia compared to those without. Diagnoses and procedures were identified using ICD-10 and CPT codes. Propensity score matching was applied to account for differences between groups. Post PCI outcomes were analyzed. Primary outcome was all-cause mortality. Secondary outcomes encompass coronary artery bypass grafting (CABG), myocardial infarction (MI), in-stent re-stenosis [redo PCI] and target vessel revascularization, heart failure (HF) exacerbations, and peri-/ post-procedural complications were assessed within a 5-year follow-up period. Kaplan-Meier analysis with log-rank was used for statistical comparisons, with significance set at p&lt;0.05. Results The elevated CPP group was significantly associated with increased post-PCI all-cause mortality [hazard ratio (HR) 1.428], in-stent restenosis [HR 1.589], heart failure exacerbations [HR 1.492], and recurrent angina or MI [HR 1.396]. No significant differences were found in rates of post PCI CABG, periprocedural complications (postprocedural cardiac insufficiency, postprocedural cardiac arrest, postprocedural heart failure, intraoperative cerebrovascular infarction, postprocedural cerebrovascular infarction, and intraoperative cardiac arrest), or redo PCI. Conclusion In this propensity score-matched analysis, elevated CPP in CKD patients undergoing PCI was independently associated with worse outcomes, including higher mortality and cardiovascular event rates. These findings highlight the prognostic value of CPP and the need for closer metabolic monitoring and individualized risk stratification. Abstract Figure

Chemotherapy-Induced Cardiotoxicity (CIC) has become a growing concern in modern oncology. While chemotherapy remains one of the most effective treatments against cancer, its potential to harm the heart often limits its use. The underlying mechanisms involve oxidative stress, mitochondrial dysfunction, and inflammation, all contributing to the gradual weakening of cardiac muscle. As cancer survival improves, the burden of cardiovascular complications is more visible than ever, emphasizing the need for early recognition, prevention, and long-term management. This review draws upon published literature, recent clinical trials, and translational research to explore current understanding and future directions in CIC. Studies on anthracyclines and HER2 inhibitors were reviewed in depth, along with new data on diagnostic biomarkers, imaging techniques, and evolving therapeutic strategies. Particular attention was given to the role of pharmacogenomics, preventive interventions, and emerging therapies aimed at protecting or restoring cardiac function in patients undergoing chemotherapy. CIC can present as heart failure, arrhythmia, hypertension, myocardial ischemia, or thromboembolism. Factors such as age, obesity, cumulative drug exposure, and genetic predisposition significantly raise the risk. Recent advances have improved early detection-troponins, natriuretic peptides, and echocardiography with Global Longitudinal Strain (GLS) allow for identification before overt symptoms appear. Preventive strategies, including dose adjustments, liposomal formulations, and the cardioprotective agent dexrazoxane, have shown measurable benefits. Established cardiotoxicity can be managed with conventional heart failure medications, antihypertensives, and anticoagulants. Experimental approaches-ranging from mitochondrial stabilizers and histone deacetylase inhibitors to mesenchymal stem cell therapy-show promise in reversing cardiac injury. CIC reflects a complex interaction between cancer biology, treatment intensity, and patientspecific vulnerability. A proactive, multidisciplinary approach involving both oncologists and cardiologists is key to balancing cancer control with heart health. Lifestyle measures such as regular exercise and dietary optimization can further strengthen cardiovascular resilience. Advances in genetic testing, molecular imaging, and regenerative therapy are gradually shifting the field toward more personalized cardio-oncology care. Chemotherapy-induced cardiotoxicity continues to challenge clinicians striving for a cure without compromise. The future of cancer care lies in integrating precision medicine with preventive cardiology to minimize cardiac injury while maintaining therapeutic efficacy. Continued research into molecular targets, biomarkers, and cell-based therapies offers genuine hope for improving both survival and quality of life in cancer patients.