Valley Hospital

Abstract Introduction Direct oral anticoagulants (DOACs), either minimally interrupted (iDOACs) or uninterrupted (uDOACs), are the preferred anticoagulation strategy peri atrial fibrillation (AF) ablation procedure. Direct comparisons of the two regimens are scarce and in small series. A network meta-analysis of iDOACs and uDOACs safety, compared to uninterrupted vitamin K antagonists (uVKA), with a much larger cohort, provides better insight. Objective To evaluate the thromboembolic and bleeding complications of iDOACs and uDOACs through comparison to uVKA. Methods A literature search from 2011 to 2023 identified 47 studies that directly compared bleeding events and thromboembolic events of iDOACs and/or uDOACs to uVKA. A network meta-analysis was used to pool effect sizes amongst the three regimens, which were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results The total cohort included 26.060 patients, iDOAC: 5.868; uDOAC: 7.048; uVKA: 13.144 (age 61.2 years, male 72.7 %). Patients on iDOAC had a significantly lower risk of bleeding compared to those on uDOACs in the network analysis ( OR: 0.78, 95% CI: 0.62-0.97) and to uVKA in a direct analysis (OR: 0.72, 95% CI: 0.59–0.86; I² = 42.8%) However, there was no significant difference in bleeding events between uDOAC and uVKA (OR: 0.92, 95% CI: 0.81–1.04; I² = 0.0%) (Figure A, B). There was no difference in thromboembolic events among the three strategies (Figure C, D). Conclusions Our findings show that iDOACs strategy has a lower bleeding risk compared to uDOAC and to uVKA regimens, without an increase in thromboembolic complications. These data support the IDOACs as the strategy of choice for periablation anticoagulation.Bleeding complication Thromboembolic complication

Abstract Background A blanking period (BP) of three months has been typically employed following pulmonary vein isolation (PVI), the cornerstone of atrial fibrillation (AF) ablation. However, the length of BP has come under scrutiny by many series using post ablation continuous long-term monitoring, each proposing a different shorter duration. Current AF ablation guidelines propose a BP of 56 days. The optimal extent of BP is yet to be clearly defined. A meta-analysis of published studies using continuous post-ablation monitoring that reported cut-offs for BP were performed. Objective We aim to identify the optimal duration of BP using continuous monitoring after catheter ablation for AF. Methods A search was conducted on PubMed, Springer, and Wiley Online Library for studies published from 2011 to 2024, and studies that enrolled patients undergoing PVI for AF (using cryo or RF), had continuous monitoring post ablation and reported early and long-term AF recurrences were included. Statistical analysis was done using R software and IBM SPSS v29. The ROC curve was plotted using the retisma function from the mada package, and the confidence interval was calculated using the aucboot function from the dmetartools package. The mean optimal BP was calculated using the case weight function of the IBM SPSS package. Results Ten studies with a total number of 2136 patients (age 59 ± 60, male 67.2%, parox AF 74.3%)(average of all the studies). A diagnostic Meta-Analysis using the random effects model was performed. Meta-analytic Study ROC analysis of optimal BP data from five studies identifies 49 days as an optimal duration of BP, with an AUC of 0.83 (95% CI: 0.75–0.87), specificity of 78.4%, and sensitivity of 79.6%. Conclusion This meta-analysis suggests 49 days as the optimal blanking period duration post ablation for AF using thermal energy. This cut-off is shorter than BP duration proposed by the guidelines. These results emphasize the importance of continuous cardiac monitoring for ERAF. Larger studies with continuous monitoring and different ablation energy sources are needed to refine BP extent.

BackgroundMonkeypox (Mpox) is a virulent disease caused by orthopoxvirus. Mpox is emerging as a major global health threat. Currently, more than 100 countries are facing outbreaks. Pakistan, too, is witnessing the spread of this virus, with 11 confirmed cases and one death since its first detection in April 2023. Mpox infection can be diagnosed using polymerase chain reaction (PCR) and treated with antiviral agents. The smallpox vaccine is also proven to be effective against Mpox.MethodologyThis cross-sectional survey aimed to evaluate the knowledge, attitude, and behaviors (KAB) of the Pakistani population toward the Mpox pandemic and determine the factors affecting it. Data were collected through Google Forms using a validated questionnaire to assess the population’s KAB. In total, 1,511 individuals were included in the final analysis.ResultsStudy participants had good knowledge of the disease, poor attitude toward Mpox risk and severity, and poor behavior with low adherence to recommended protocols. Overall, 58% (n = 888) of the participants were male, and most of the respondents were aged between 18 and 30 years (n = 743, 49.2%). Most participants were married (n = 983, 65.1%), from urban areas (n = 837, 55.4%), and living in shared households (n = 876, 58%). Age showed a significant relationship with knowledge level and behavior, but not with attitude. The 18-30-year age group demonstrated higher knowledge levels (p = 0.007), regardless of gender. Shared households were significantly associated with a higher incidence of good knowledge (p < 0.05) compared to independent households (p = 0.038). Additionally, higher income was linked to better attitudes and behaviors. KAB outcomes also varied significantly based on marital status, individual education level, and parents’ education levels.ConclusionsPopulation dynamics such as cultural norms, religious beliefs, misperceptions about the disease associated with sexual behavior, health literacy, education level, rural and urban division of the population, gender role, migrant and refugee population, poverty, cost-seeking healthcare, and distrust in the government and healthcare system should be considered when constructing a public health policy because the behavior of the population is important for the implementation of preventive measures.

This study aimed to observe the impact of laser-assisted hair removal (LAHR) on the quality of life in women with polycystic ovary syndrome (PCOS)-associated hirsutism. An observational study was conducted on 172 women living with PCOSat a specialized clinic. The Dermatology Life Quality Index (DLQI) and Ferriman-Gallwey (FG) score were employed to assess the quality of life and severity of hirsutism, respectively. Laser therapy was administered using ruby diode or alexandrite lasers. Follow-up on the DLQIand FG score assessment was done at 12-, 18-, and 24-weekpost-treatment. The number of cases that reported stress, anxiety, and depression reduced over time. However, there was no correlation between the patient-reporteddecrease and DLQI scores. The FG score was significantly related to mental health. The severity of the hirsutism impacted mental health. The regrowth of hair at six months indicated limited long-term efficacy LAHR. LAHR significantly improves the quality of life in the short term for women living with PCOS. However, the short-term benefit of the therapy indicates a need for research to find new treatment strategies.