Objective Sun exposure is a primary preventable risk factor for skin cancer. Sunscreen has been shown to reduce the risk of certain skin cancers such as squamous cell carcinoma and melanoma. We aimed to assess the prevalence and predictors of sunscreen use among medical students in Karachi. Methods A multi-center cross-sectional study was conducted among 578 students from multiple medical universities in Karachi, Pakistan. The levels of use of sunscreen were recorded using a comprehensive questionnaire consisting of 29 questions. Descriptive statistics were used and p-values less than 0.05 calculated using the chi-square test were considered significant. Results A majority (n=441, 73.9%) of the participants in this study were female students. Sunscreen use was prevalent in 415 (69.5%) participants. Female students were more aware of the risk of skin cancer from extended sun exposure (n=186, 72.4%). Sunscreen use was significantly associated with gender (p<0.001) and the propensity to get sunburned easily (p=0.001). Few (n=19, 5.0%) students reported being well-versed regarding skin cancer and its risk factors. Most participants were aware of the use of sunscreen for sunburn prevention (n=473, 79.2%), though knowledge of the additional benefits of sunscreen, such as the prevention of skin cancer (n=257, 43.0%) and aging (n=199, 33.3%), was lacking. Conclusion There is an evident lack of knowledge of the importance of sunscreen protection among medical students, particularly regarding the prevention of skin cancer and skin aging. However, an overall positive attitude was observed regarding the use of sunscreen among female students. Medical students are an imperative part of our future healthcare system and should be adequately informed on sunscreen benefits and skin cancer prevention.

Aims This study aimed to investigate the reporting of subgroup analyses in heart failure (HF) randomized controlled trials (RCTs) and to determine the strength and credibility of subgroup claims. Methods and results All primary HF RCTs published in nine high‐impact journals from 1 January 2008 to 31 December 2017 were included. Multivariable regression analysis was used to identify factors that may favour the reporting of results in specific subgroups. Strength of the subgroup effect claimed was classified into (i) strong, (ii) likely, or (iii) suggestive. Credibility of subgroup claim was scored using a pre‐specified 10 pointer criteria. Of the 261 HF RCTs studied, 107 (41%) reported subgroup analyses. Twenty‐five (23%) RCTs claimed a subgroup effect for the primary outcome of which six (24%) made a strong claim, eight (32%) claimed a likely effect, and 11 (44%) suggested a possible subgroup effect. Seven of the 25 RCTs did not employ interaction testing for subgroup claims of the primary outcome. Three out of 10 pre‐specified credibility criteria were satisfied by half of the trials. Fourteen trials justified the choice of subgroups, and 10 explicitly stated they were underpowered to detect differences within subgroups. Source of funding did not influence the frequency of reporting subgroup analyses (OR 0.53, 95% CI 0.78–3.62, P = 0.52). Conclusions Appropriate credibility criteria were rarely met even by HF RCTs that held strong subgroup claims. Subgroup analyses should be pre‐specified, be adequately powered, present interaction terms, and be replicated in independent data before being integrated into clinical decision making.

Background: High prevalence of Chronic heart failure due to Idiopathic Dilated Cardiomyopathy (DCM) is animportant cause of heart failure in Bangladesh. This study was carried out to find the clinical characteristics of thepatients with Idiopathic DCM, so that the data can be used to treat symptoms and improve survival and treatment. Methodology: This prospective observational study was carried out in the Department of Cardiology, BIRDEMGeneral Hospital, Dhaka, Bangladesh from January 2012 to December 2018. Total 50 consecutive admittedpatients fulfilling the criteria of Idiopathic DCM were studied. Clinical information, findings fromEchocardiography and other relevant investigations were collected for analysis. Results: Among total 50 patients, 30(60.0%) were male and 20(40.0%) were female. Majority 20(40.0%) patientsbelonged to age 51-60 years and their mean age was found 55.34±13.24 years. Using NYHA (New York HeartAssociation) functional status classification of the patients, 18(36.0%) patients were found in NYHA class I,15(30.0%) in class II, 12(24.0%) in class III and 5(10.0%)in class IV. Almost all patients presented with three basicsymptoms i.e. exertional dyspnea, easy fatigability and pedal edema. Orthopnea, Paroxosmal Nocturnal Dyspnoea(PND), palpitation & chest pain wewe also reported in almost half of the patients. Mean pulse was found88.78±15.75 beat/min, respiratory rate 20.79±6.48 breath/min, BMI 23.12±3.29 kg/m2, systolic BP 119.03±22.22mmHg and diastolic BP 75.00±12.54 mmHg. Bilateral basal crepitation 45(90.0%), Pedal edema 43(86.0%),Raised JVP 39(78.0%), Hepatomegaly 35(70.0%) were also found. Third heart sound in 34(68.0%), Pan systolicmurmur of Mitral regurgitation 40(80.0%), Pansystolic murmur of Tricuspid regurgitation was present in42(84.0%) among study patients. Mean left ventricular ejection fraction was found 30.44 ±4.91%, LVIDs 5.24±0.51cm and LVIDd 6.18 ±0.52 cm. Conclusion: Majority of the Idiopathic DCM patients belonged to age 51-60 year age group with malepredominance and clinical presentation was variable. Bangladesh Crit Care J September 2019; 7(2): 86-89

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Introduction: Diffuse myocardial fibrosis plays a key role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Cardiac magnetic resonance (CMR) parameters such as native myocardial T1 relaxation time and extracellular volume fraction (ECV) are evolving imaging-based biomarkers of myocardial fibrosis. Therefore, we performed a systematic review to synthesize the available data on the prognostic value of T1 and ECV in patients with HFpEF. Methods and Results:We searched PubMed, Embase and Cochrane Central for relevant studies using predefined search criteria and endpoints. Studies with overlapping patient population were excluded. Four studies were included in the review (TABLE). All included studies were prospective, single-center observational cohorts. Of the 1507 participants, 62% were women, mean age was 74.7 § 8.3 years, and mean left ventricular EF was 63.2 § 9.3%. Two of the 4 studies reported outcomes in relation to native T1 value. Both of them found no significant association of T1 value with adverse cardiovascular outcomes. One study found that lower post contrast T1 times were significantly associated with adverse cardiac events (HR-0.99; 95% CI-0.98-0.99). Three studies reported outcomes in relation to ECV and all of them found that higher ECV was associated with increased risk for adverse cardiovascular events or mortality. Two of the studies also assessed histological ECV (by endomyocardial biopsy) and demonstrated strong correlation between histologically determined ECV and CMR quantification of ECV (R=0.494; P=0.037). Conclusion: Estimation of ECV may provide important prognostic information in patients with HFpEF and has the potential to improve risk stratification.