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ObjectiveFew studies have looked at the predictors of use of home sphygmomanometers among hypertensive patients in low-income countries such as Pakistan. Considering the importance of home blood pressure monitoring (HBPM), cross-sectional study was conducted to evaluate the prevalence and predictors of the usage of all kinds of HBPM devices.MethodThis study was conducted in Karachi during the time period of January-February 2017. Adult patients previously diagnosed with hypertension visiting tertiary care hospitals were selected for the study. Interviews from the individuals were conducted after verbal consent using a pre-coded questionnaire. The data was analyzed using Statistical Package for the Social Sciences v. 23.0 (SPSS, IBM Corporation, NY, USA). Chi-squared test was applied as the primary statistical test.ResultsMore than half of the participants used a home sphygmomanometer (n=250, 61.7%). The age, level of education, family history of hypertension, compliance to drugs and blood pressure (BP) monitoring, few times a month at clinics were significant determinants of HBPM (P values < 0.001). It was found that more individuals owned a digital sphygmomanometer (n=128, 51.3%) as compared to a manual type (n=122, 48.8%). Moreover, avoiding BP measurement in a noisy environment was the most common precaution taken (n=117, 46.8%).ConclusionThe study showed that around 40% of the hypertensive individuals did not own a sphygmomanometer and less than 25% performed HBPM regularly. General awareness by healthcare professionals can be a possible factor which can increase HBPM.

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Background The efficacy and safety of novel oral anticoagulants (NOACs) compared to the current guideline‐recommended vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing transcatheter aortic valve replacement (TAVR) has not been well established. We pooled evidence from all available studies to assess the risks and benefits of this drug class. Methods We queried electronic databases (MEDLINE, Scopus, and Cochrane central) up until January 28th, 2022 for studies comparing NOACs to VKAs in AF patients undergoing TAVR. Results from studies were presented as risk ratios (RR) and pooled using a random‐effects model. Subgroup analysis by study design and meta‐regression analysis were performed to explore heterogeneity. Results A total of 12 studies (3 RCTs and 9 observational) containing 12,203 patients (mean age 81.2 years; 50.5% men) were identified and included in the analysis. Pooled analysis revealed no significant difference between NOACs and VKAs in terms of stroke or systemic embolism (RR: 0.78; p = 0.18), major bleeding (RR: 0.84; p = 0.32), intracranial hemorrhage (RR 0.61; p = 0.06), all‐cause mortality (RR: 0.69; p = 0.07), and myocardial infarction (RR: 1.60; p = 0.24) at a mean length of follow‐up of 15.1 months. RCTs and observational studies did not significantly differ across outcomes on subgroup analysis. Meta‐regression analysis found heterogeneity in all‐cause mortality to be significantly explained by percentage of males (coefficient: 0.049, p = 0.007), mean age (coefficient: 0.221, p < 0.001), and CHA2DS2‐VASc score (coefficient: −1.657, p < 0.001). Conclusions This meta‐analysis suggests that outcomes with NOACs do not significantly differ compared to VKAs following TAVR in patients with AF.

Management of scorpion envenomation in children is a difficult problem. The envenomation syndrome is not very well understood in humans although there has been extensive work on animal envenomation. This is an attempt to bring together the two experiences in order to produce an acceptable management protocol for envenomation in children. This protocol is based on the management of more than 2,500 cases over a period of seven years in Saudi Arabia where the mortality was about five per cent at the start and zero at the end. The management protocol adopted there in 1992 was a result of serious work on clinical data from Ministry of Health hospitals and laboratory work in the pharmacology department of the faculty of Pharmacy, King Saud University