Pakistan Institute of Medical Sciences

Cardiovascular disease (CVD) is caused by chronic inflammation, however it is yet unknown how interleukin-36 cytokines contribute to coronary artery disease (CAD) and dilated cardiomyopathy (DCM), including how different isoforms affect myocardial remodeling and their possible therapeutic applications.

Using a publicly available dataset (GSE97320), we conducted transcriptome analysis to investigate IL-36 expression patterns and associated pathways. To find immunological networks and signaling interactors, functional enrichment and protein-protein interaction studies were performed. RT-qPCR was used to evaluate a validation cohort of 300 patients, and results were further validated in a DCM rat model. The diagnostic performance of interleukin-36 isoforms was assessed using Receiver Operating Characteristic (ROC) curve analysis.

There was a consistent upregulation of interleukin-36 in both DCM and CAD, with IL36G exhibiting the most marked increase (4.9-fold in DCM; p < 0.001). Compared to CAD, expression levels in DCM were noticeably greater. ROC analysis showed good diagnostic accuracy, especially for DCM's IL36A (AUC = 0.98). Interleukin-36 isoform overexpression was verified at the cardiac tissue level in the mouse DCM model. The IL-36R-NF-κB axis is the primary mechanism by which intwerleukin-36 signaling is involved in pro-fibrotic and inflammatory responses, according to pathway and interaction analyses.

This study is the first to characterize IL-36 isoforms expression across human and animal models of DCM. Our research provides new insights into the inflammatory landscape of non-ischemic DCM by identifying IL36G as a putative isoform-specific biomarker in myocardial inflammation and remodeling.

Obstructive sleep apnea (OSA) is frequently underdiagnosed and may influence perioperative outcomes. Postoperative nausea and vomiting (PONV) are common adverse effects following laparoscopic surgery. The purpose of this study was to determine the relationship between PONV and the risk or predisposition of OSA based upon STOP-Bang criteria in laparoscopic surgery patients.

This is a prospective cohort study conducted in government and private hospitals in Lahore from January to July 2025. The sample consisted of 200 patients who underwent elective laparoscopic surgery under general anesthesia, recruited via convenience sampling. The OSA risk was categorised using the STOP-Bang questionnaire, whereas PONV was measured by the Apfel simplified risk score and the visual analogue scale (VAS). Statistical analyses were performed using SPSS v.26, including descriptive statistics, Spearman correlations, Mann-Whitney U tests, Kruskal-Wallis tests, chi-square tests, and multiple linear regression analyses, while controlling for age, gender, medication use, surgical history, and anesthesia history.

Among the 200 participants, 152 (76%) were female, and 48 (24%) were male. The most common age ranges were 56-60 years (73 participants, 36%) and 46-55 years (54 participants, 27%). The relationships among the Apfel, VAS, and STOP-Bang scores showed moderately positive correlations (r = 0.23, p < 0.01; r = 0.19, p < 0.01). Regression analysis showed that STOP-Bang scores (beta = 0.152, p = 0.003), nausea severity (beta = 0.176, p = 0.003), female gender (beta = 0.125, p = 0.008), and medication use (beta = 0.142, p = 0.003) were associated with higher Apfel scores. Younger age was associated with higher PONV scores (χ² = 21.77, p = 0.001). Female patients scored significantly higher on the STOP-Bang, Apfel, and VAS than males (p < 0.05).

STOP-Bang-defined OSA risk has a significant association with PONV in laparoscopic surgery patients. Female gender and younger age increased susceptibility to PONV, whereas OSA risk was augmented in older people. These results illustrate the clinical utility of integrating STOP-Bang screening into preoperative evaluation to optimise perioperative care and individualise preventive measures against PONV. These findings support integrating STOP-Bang screening into preoperative risk assessment to improve postoperative outcomes.

Background and objective Facial nerve palsy (FNP) secondary to ENT-related conditions can lead to lagophthalmos and exposure keratopathy, putting patients at risk of vision-threatening complications. Proper documentation of eye-protection measures in discharge summaries is critical for continuity of care and patient safety. This study aimed to evaluate the quality and completeness of eye-care instructions in discharge summaries of ENT-related FNP patients. Materials and methods A retrospective review was conducted on 104 discharge summaries from the Department of ENT - Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad, over a 32-month period (from January 2023 to August 2025). Patients included had FNP due to ENT-related causes, while non-ENT etiologies and incomplete records were excluded. A checklist based on ENT UK, National Institute for Health and Care Excellence (NICE), and Royal College of Ophthalmology guidelines was used to assess documentation of eye-protection measures. Discharge summaries were scored from 0 to 6 and classified as poor (0-1), fair (2-3), good (4-5), or excellent (6). Statistical analysis was performed using SPSS v27 (IBM Corp., Armonk, NY). Results The mean patient age was 46 ± 13.5 years; 67 (64.4%) were male. The most common etiologies were chronic suppurative otitis media with cholesteatoma (40.5%), head and neck cancer (22.1%), and trauma (16.3%). Documented eye-care measures included daytime lubricating drops (96.2%), eyelid taping (84.6%), follow-up instructions (74.0%), night-time ointment (66.3%), ophthalmology referral (38.5%), and corneal status/lagophthalmos (24.0%). Overall discharge summary quality was excellent in 8.7%, good in 30.8%, fair in 58.7%, and poor in 1.9%. Collapsing the ratings into adequate and inadequate showed that 41 summaries (39.4%) were adequate, and 63 (60.6%) were inadequate. Conclusion While basic eye-care instructions were frequently documented, critical elements such as corneal assessment and ophthalmology referral were often missing. Several discharge summaries were inadequate, emphasizing the need for standardized, comprehensive documentation to improve patient safety and reduce preventable ocular morbidity in ENT-related FNP.