Rashid Latif Medical College

Many people with systemic sclerosis-associated interstitial lung disease (SSc-ILD) deal with pulmonary hypertension (PH), which seriously reduces their chances of survival. The study aims to evaluate and compare survival outcomes and causes of mortality in patients with SSc-ILD with and without coexisting PH and to assess the implications for clinical management. A comparative review of observational studies and cohort data was conducted to analyze mortality patterns, underlying mechanisms, and treatment responses in SSc-ILD patients stratified by PH status. Based on the Newcastle-Ottawa Scale (NOS) assessment, the overall methodological quality of the included studies was high. Specifically, 16 studies were classified as high quality, with NOS scores ranging from seven to eight, reflecting strong design and execution across the selection, comparability, and outcome domains. Five studies were rated as moderate quality, each scoring six, often due to selection or comparability component limitations. PH commonly affects a significant proportion of patients with SSc-ILD, particularly older adults, individuals of African American ethnicity, and those with reduced diffusing capacity of the lungs. Overall survival tends to be lower in patients with the pulmonary arterial hypertension (PAH) subtype compared to others. A decline in forced vital capacity (FVC) of 10% or more within the first year is linked with higher mortality risk, especially when combined with a marked drop in lung diffusing capacity. Among the various subgroups, patients with both ILD and PH show the poorest five-year survival rates. Important predictors of mortality include the presence of ILD, reduced lung function, and decreased cardiac output. The study concluded that the presence of pulmonary hypertension significantly worsens survival in SSc-ILD patients, primarily through cardiopulmonary failure. These findings highlight the urgent need for early detection, risk stratification, and tailored therapeutic strategies to improve prognosis in this vulnerable population.

Incisional hernia is a common surgical complication that often requires mesh-based repair. Among the various techniques, sublay (retrorectus) and onlay mesh placements are frequently employed, but their relative effectiveness in terms of surgical outcomes remains debated. This meta-analysis aimed to compare sublay and onlay mesh repair techniques in incisional hernia surgery based on key postoperative outcomes. A systematic search was conducted across PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar for studies published in English between January 2010 and March 2025. Eligible studies included randomized controlled trials and prospective comparative studies directly comparing sublay and onlay mesh repair techniques and reporting on at least one predefined surgical outcome. Six studies involving a total of 468 patients were included in the analysis. Primary outcomes assessed included hernia recurrence, postoperative complications, surgical site infection (SSI), and seroma formation. Secondary outcomes included operative time and length of hospital stay. Data were analyzed using a random-effects model with odds ratios (OR) and mean differences (MD) reported along with 95% confidence intervals (CI). The meta-analysis revealed that sublay mesh repair was consistently associated with lower hernia recurrence rates, though the differences did not reach a statistical significance. Sublay repair also demonstrated significantly fewer postoperative complications in multiple studies, particularly in terms of reduced seroma formation and SSI. Furthermore, hospital stay was significantly shorter in the sublay group in two of the three studies reporting this outcome. Onlay repair, however, was associated with a shorter operative time. In conclusion, sublay mesh repair offers superior outcomes in terms of recurrence, complications, seroma, and hospital stay, suggesting it as the preferred approach for incisional hernia repair in appropriate clinical settings.

The utilization of e-cigarettes among youth in Pakistan is increasing due to their attractive appearance, user-friendly design, reduced smoking discomfort, and availability in a variety of flavors. Although e-cigarettes are often perceived as less toxic than traditional cigarettes, they still pose significant health risks such as respiratory issues, cardiovascular problems, potential neurodevelopmental effects in adolescents, and increased likelihood of transitioning to conventional tobacco products due to the presence of harmful chemicals and ingredients such as nicotine and other toxic substances. Adolescents in Pakistan have strong opinions about e-cigarette use, primarily influenced by sociocultural values; Westernization and globalization have made vaping appear to be a chic and sophisticated lifestyle choice. Moreover, views on addiction, dependency, and substance use are shaped by social backgrounds, religious beliefs, and cultural norms. Aggressive marketing techniques are employed by e-cigarette manufacturers, mainly targeting tech-savvy youth through digital platforms and social media influencers, which have also contributed to the rapid rise in e-cigarette use among young people in Pakistan. The current study underscores the necessity for culturally compatible interventions and policies, including educational programs, stringent regulations to limit access for young people, and comprehensive public health campaigns that counteract the influence of marketing by e-cigarette manufacturers. Additionally, healthcare providers should be trained to offer culturally sensitive cessation programs that support adolescents in quitting e-cigarettes and provide resources to mitigate the health hazards associated with e-cigarette use, including nicotine addiction and other adverse health effects, and to promote tobacco cessation in Pakistan.