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Mineralocorticoid receptor antagonists (MRAs) are guideline-recommended medications for patients with heart failure (HF) that reduce the risk of cardiovascular death and hospitalization, and improve survival. Evidence from recent clinical trials has indicated that the use of SGLT2is reduces the risk of HF hospitalization in HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The clinical benefit of these two drugs is based on highest level of clinical trial evidence. However, the risk of hyperkalemia limits the usage of MRAs (1). Considering this risk, both the current European Society of Cardiology (ESC) and American Heart Association/ American College of Cardiology (AHA/ACC) guidelines practice caution and recommend halving the dose and cessation of MRA therapy at serum potassium levels of >5.5 mmol/L and >6.0 mmol/L, respectively (2 – 4). SGLT2is exert diuretic effects and initially impair kidney function in patients. The combination of these two drugs is therefore expected to cause severe exacerbation in hyperkalemia. However, evidence from recent clinical trials has demonstrated that the use of SGLT2i may potentially reduce the rate of hyperkalemia when added to MRA therapy, and thus, can be used to optimize guideline-recommended MRA usage among patients with HF (5 – 7). Data regarding whether the concomitant use of both therapies reduces the risk of precipitating hyperkalemia among patients with HF is unclear. Therefore, we conducted a meta-analysis to evaluate the effect of baseline MRA therapy on the incidence of hyperkalemia in patients taking SGLT2is.

Aims: To determine the prognosis of multivalvular disease in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Methods: Patients undergoing TAVR for aortic stenosis with covariate-adjusted risk of mortality associated with concomitant valve disease (mitral regurgitation [MR], mitral stenosis [MS] or tricuspid regurgitation [TR]) were included. Results: Moderate-to-severe MR was associated with increased mortality at 30 days (hazard ratio [HR]: 1.60; 95% CI: 1.11–2.30; p = 0.01) and 1 year (HR: 1.87; 95% CI: 1.22–2.87; p = 0.004). The presence of all-grade MS did not impact 30-day or 1-year mortality (HR, 30 days: 1.60; 95% CI: 0.71–3.63; p = 0.26; and HR, 1 year: 1.90; 95% CI: 0.98–3.69; p = 0.06); however, an increased risk of 1-year mortality (HR: 1.67; 95% CI: 1.03–2.70; p = 0.04) was observed with severe MS compared with no MS. Moderate-to-severe TR had a higher risk of all-cause mortality at 1 year (HR: 1.49; 95% CI: 1.24–1.78; p < 0.001) compared with no or mild TR. Conclusion: Moderate-to-severe MR or TR, and severe MS, significantly increase mid-term mortality after TAVR.

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Health care professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene related malignancies increases, it demands HCPs’ preparedness to cater to patients’ needs. Therefore, our study aimed to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. A cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population. A total of 210 HCPs, 56.7% (119) were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5 hours/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N=100)]. Our results thus call upon the need for additional training concerning CGT. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting.

Background In Pakistan, the slow pace of declining fertility rate accounts for troubling consequences like multiple pregnancies, induced abortions, the low 34% contraceptive prevalence rate, and overpopulation. This coupled with the lack of literature on this topic in the country makes it pivotal to explore the gender roles and responsibilities of adults in marital life and within the family and their influence on Family Planning decisions in adults, in Karachi, Pakistan. Methods The study design involved purposive selection of 12 consenting married adults belonging to Gulberg Town, from whom detailed qualitative data was collected using open-ended, semi-structured interviews, supported by field notes. For the sake of anonymity, participants were assigned codes. Furthermore, all discussions were conducted in English or Urdu language by the female investigator herself and were audio recorded after obtaining participants’ consent. Thereafter, a rigorous thematic analysis of the interviews was carried out, with the results being double-checked before being securely stored in soft or hard copy. Results The study observations identified that gender roles and responsibilities do affect Family Planning decisions in Pakistan. The results were broadly categorized into two themes: superficial reasons and deeper reasons affecting FP decisions. The first theme has three main categories; interpretation of FP, awareness about FP, and couple as representative of FP decision making whereas the second theme has five categories; roles and responsibilities of men in the family, roles and responsibilities of women in the family, women autonomy, mind the gap or taming the women, and way forward. Conclusions Our study findings suggest that while superficial reasons must be resolved, it is primarily crucial to eliminate the subtler, tap root factors influencing FP decisions by strongly addressing school curricula, nurses, and other Health Care Workers (HCWs) to positively impact the society. Further qualitative and quantitative research is ultimately necessary for assessing the viewpoint of important stakeholders and how, using a multiprong approach, the stringent perceptions pertaining to Family Planning can be altered to benefit the society.

Mineralocorticoid receptor antagonists (MRAs) are guideline-recommended medications for patients with heart failure (HF) that reduce the risk of cardiovascular death and hospitalization, and improve survival. Evidence from recent clinical trials has indicated that the use of SGLT2is reduces the risk of HF hospitalization in HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The clinical bene t of these two drugs is based on highest level of clinical trial evidence. However, the risk of hyperkalemia limits the usage of MRAs (1). Considering this risk, both the current European Society of Cardiology (ESC) and American Heart Association/ American College of Cardiology (AHA/ACC) guidelines practice caution and recommend halving the dose and cessation of MRA therapy at serum potassium levels of >5.5 mmol/L and >6.0 mmol/L, respectively (2 -4). SGLT2is exert diuretic effects and initially impair kidney function in patients. The combination of these two drugs is therefore expected to cause severe exacerbation in hyperkalemia. However, evidence from recent clinical trials has demonstrated that the use of SGLT2i may potentially reduce the rate of hyperkalemia when added to MRA therapy, and thus, can be used to optimize guideline-recommended MRA usage among patients with HF (5 -7). Data regarding whether the concomitant use of both therapies reduces the risk of precipitating hyperkalemia among patients with HF is unclear. Therefore, we conducted a meta-analysis to evaluate the effect of baseline MRA therapy on the incidence of hyperkalemia in patients taking SGLT2is.