Category: 8. Health

• Experts reveal heart attack patients often report no chest pain
• If you feel heaviness while walking or climbing stairs, get an ECG done immediately, cardiologists advise

KARACHI: Senior cardiologists on Saturday shared the shocking findings of a study according to which nearly 50 per cent of heart attack patients in the country are younger than 49 years, and 12 to 15pc of them are under 40 years of age.

The health experts representing the National Institute of Cardiovascular Diseases (NICVD) were speaking at a symposium held at a local hotel here.

The experts warned that this trend — fueled by diabetes, hypertension, obesity, smoking, and unhealthy lifestyles — is making Pakistan one of the world’s worst-hit countries for early-age heart attacks.

The trial was designed and conducted independently by NICVD’s cardiology team and ran from June 7, 2021, to December 31, 2023. It enrolled 261 post-heart attack patients for testing effects of two anticoagulants for treating a blood clot that can form in the heart after an attack and cause stroke or other complications.

The findings have been published in the Journal of the American College of Cardiology: Advances.

According to principal investigator Dr Jehangir Ali Shah, the new drug achieved faster clot resolution in the early phase — 20 per cent at four weeks versus 8.3 per cent (with the old medicine), while both drugs had similar high success rates at 12 weeks.

“This is the largest randomised trial to date in acute left ventricular thrombus, and the results show that the new drug is safe and effective alternative,” he said, adding that 15 per cent of participants were under 40 years.

NICVD Director of Cath Lab Dr Abdul Hakeem called for public health urgency. “Pakistan has the highest rate of young heart attack patients globally. Every third adult has diabetes, 40 per cent have high blood pressure, obesity is common, and smoking rates remain high. Many patients don’t know they’re at risk. After the age of 30, everyone should get a cardiac check-up,” he said.

He added that common misconceptions — such as assuming a heart attack always causes severe chest pain — can delay treatment.

“Nine out of 10 patients have no pain, only heaviness in the chest or acidity-like discomfort. If you feel chest heaviness while walking or climbing stairs, get an ECG done immediately,” he advised.

Dr Hakeem warned that the most dangerous anterior heart attack can damage up to 60 per cent of the heart muscle and often causes a clot that appears four to eight weeks later, increasing stroke risk.

NICVD Executive Director Dr Tahir Saghir said the institute was now moving into further advanced research, including trials on drug-coated balloons that do not require stents — a development that could reduce future artery blockages. “We already have international funding for this work, and the direct beneficiaries will be our patients,” he said.

Senior cardiologist Dr Nadeem Rizvi emphasised the importance of locally conducted clinical research, saying that results based on Pakistan’s environment and healthcare system were more practical and applicable.

Dow Institute of Cardiology Director Dr Tariq Farman said genetic, socioeconomic, and physical differences between Pakistani and western populations required tailored treatment guidelines.

“We need our own data. Sometimes the recommended high doses aren’t suitable for our patients,” he said, adding that early diagnosis and treatment could prevent thousands of strokes in Pakistan’s heart patients every year.

Published in Dawn, August 10th, 2025

A new study published in the Journal of Alzheimer’s Disease suggests that vortioxetine, an antidepressant with a unique multimodal mechanism, may offer greater benefits for both mood and cognitive function in people with Alzheimer’s disease who also experience depressive symptoms, compared to other commonly prescribed antidepressants. Over the course of a year, patients taking vortioxetine showed larger improvements in measures of memory, attention, and reasoning, as well as a greater reduction in depressive symptoms, than those taking escitalopram, paroxetine, or bupropion.

Alzheimer’s disease is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. It is the most common cause of dementia in older adults, gradually impairing a person’s ability to carry out daily activities. Alongside cognitive decline, many people with Alzheimer’s also experience neuropsychiatric symptoms such as depression, anxiety, and apathy. Depression in Alzheimer’s is common and can intensify the difficulties posed by memory loss and disorientation, while also worsening quality of life for both patients and caregivers.

The high prevalence of depression in Alzheimer’s has led to increased prescribing of antidepressants in this population. Yet research on how these drugs affect cognitive function has been limited and sometimes conflicting. Certain antidepressants may worsen cognition due to side effects on neurotransmitter systems, while others could potentially support brain function.

Vortioxetine is of particular interest because, beyond its action on serotonin receptors, it also influences other neurotransmitter systems involved in learning and memory. Previous studies in people with depression and in those with mild cognitive impairment have hinted at cognitive benefits, but few have directly compared vortioxetine to multiple other antidepressants in patients with Alzheimer’s.

To address this gap, researchers Eduardo Cumbo and Daniela Migliore conducted a 12-month randomized, open-label study at the Neurodegenerative Disorders Unit in Caltanissetta, Italy. The analysis focused on 108 outpatients with mild Alzheimer’s disease and depressive symptoms. Participants were randomly assigned to receive either vortioxetine (n=36) or one of three other antidepressants—escitalopram, paroxetine, or bupropion (n=72 in total)—while continuing standard Alzheimer’s treatments such as cholinesterase inhibitors or memantine. Patients were assessed at the start of the study, after six months, and after twelve months.

Cognitive function was measured using several established tests. The Mini-Mental State Examination evaluated overall cognitive ability, including memory, orientation, and language. The Attentive Matrices test measured selective attention, while the Coloured Progressive Matrices assessed nonverbal reasoning and problem-solving. The Digit Span task tested verbal working memory. Depression severity was measured with the Hamilton Depression Scale and the Cornell Scale for Depression in Dementia.

By the end of the study, patients in all groups showed some improvement on cognitive tests, but gains were generally largest and most consistent in the vortioxetine group. On the Mini-Mental State Examination, vortioxetine-treated patients improved by nearly three points, a statistically significant change. They also showed significant gains in selective attention and nonverbal reasoning, while patients on other antidepressants tended to improve less, and in some cases, not significantly. Working memory scores improved slightly in the vortioxetine group but did not reach statistical significance.

When comparing groups directly, vortioxetine outperformed the other antidepressants on most cognitive measures. The difference was particularly notable when compared to paroxetine, which has anticholinergic properties that can impair cognition in older adults. Escitalopram and bupropion showed moderate improvements on some attention measures, but not to the same extent as vortioxetine.

The study also found that depressive symptoms decreased in all groups over the 12-month period, but the reduction was more pronounced in patients taking vortioxetine. On both depression scales, the vortioxetine group’s scores dropped by about seven points from baseline—an improvement considered clinically meaningful. Between-group comparisons showed that vortioxetine’s effect on depressive symptoms was statistically superior to that of the other antidepressants.

Side effects were relatively uncommon and generally mild. Nausea and headache were the most frequently reported with vortioxetine, occurring in about 8% of patients. Two participants—one on paroxetine and one on bupropion—discontinued treatment due to side effects. No serious adverse events or deaths occurred during the study.

The researchers note some limitations. The trial was conducted at a single site with a modest sample size, which may limit how well the findings apply to the wider Alzheimer’s population. It was also open-label, meaning patients and doctors knew which treatment was being given, which could introduce bias.

Importantly, only patients with mild Alzheimer’s were included, so the results may not extend to those with more advanced disease. The study also could not determine whether the observed cognitive improvements were due directly to vortioxetine’s pharmacological effects or indirectly through relief of depressive symptoms.

Despite these caveats, the findings add to a growing body of evidence suggesting that vortioxetine may have cognitive benefits beyond its antidepressant effects. The authors suggest that larger, longer-term, and double-blind studies are needed to confirm these results and to clarify how vortioxetine’s effects on neurotransmitter systems might influence both mood and cognition in people with Alzheimer’s.

If future research confirms these findings, vortioxetine could be considered a particularly useful option for Alzheimer’s patients who experience depression—addressing not only mood symptoms but also potentially helping to preserve certain cognitive functions.

The study, “Differential effects of antidepressants on cognition in Alzheimer’s disease with depression: A sub-group analysis of an open-label, observational study,” was authored by Eduardo Cumbo and Daniela Migliore.

ISLAMABAD: Zika virus has been confirmed in Pakistan for the first time, with researchers from the Aga Khan University (AKU) reporting laboratory evidence that Zika virus is present and circulating in the country.

Genetic testing shows the strain originated in Brazil in 2016 before spreading to the Americas.

The confirmation comes from a study published in the latest issue of the US Centers for Disease Control and Prevention’s journal Emerging Infectious Diseases, which investigated a mysterious dengue-like outbreak in Karachi in 2021.

At that time, hundreds of patients were reporting high fever, low platelet counts, rash, joint pain and other symptoms resembling dengue, yet repeatedly tested negative for the dengue NS1 antigen.

Alarmed by the unusual pattern, AKU’s infectious disease team, working with global collaborators, carried out advanced molecular testing and metagenomic sequencing on blood samples from symptomatic patients.

The results confirmed the co-circulation of dengue virus serotype 2 and Zika virus in Karachi, including cases where patients were infected with both viruses simultaneously.

Genetic sequencing revealed that the Zika strain in Karachi was more closely related to South American viruses than to strains found in neighbouring countries, indicating that it had been imported and adapted to local Aedes aegypti and Aedes albopictus mosquitoes — the same species responsible for transmitting dengue and chikungunya.

Researchers warned that Zika is likely an unrecognised contributor to the city’s recurring “dengue-like” outbreaks, as its symptoms are almost indistinguishable from other mosquito-borne viruses. They said the lack of testing means infections, particularly in pregnant women, could be going undetected, posing significant risks to newborns. First identified in Uganda in 1947, Zika virus usually causes mild illness or no symptoms in adults, with fever, rash, joint pain and conjunctivitis typically resolving within a week.

However, it can cause devastating effects in unborn children if contracted during pregnancy, including microcephaly, brain damage, vision and hearing problems, and developmental delays. During the 2015–2016 outbreak in Brazil, thousands of babies were born with severe birth defects linked to maternal Zika infection.

Scientific evidence suggests that up to 10-15 percent of infants born to mothers infected with Zika during pregnancy may suffer serious congenital complications, even if the mothers themselves had no obvious symptoms.

While the virus rarely causes death, its long-term impact on children and the strain on health and social care systems make it a serious public health threat. It can also be transmitted sexually, potentially allowing it to spread to areas without high mosquito populations.

In Pakistan, where dengue and chikungunya are already entrenched, the emergence of Zika adds a new layer of complexity to vector-borne disease control. Without routine screening, health workers may continue to misdiagnose Zika as dengue, leading to missed opportunities for intervention, especially in pregnancies.

The AKU researchers have urged health authorities to integrate Zika virus testing into the national arbovirus surveillance system and diagnostic protocols, particularly in high-risk urban areas like Karachi.

They also recommend targeted training for clinicians, especially those working in maternal and child health, to ensure febrile pregnant women are tested for Zika. Public health experts emphasise the need for integrated mosquito control measures, public awareness campaigns, and environmental monitoring of mosquitoes for Zika virus detection.

The confirmation of Zika virus in Pakistan marks a turning point in the country’s understanding of mosquito-borne diseases, suggesting that previous unexplained outbreaks may have involved undetected Zika cases.

Without immediate improvements in diagnostics, surveillance, and prevention efforts, the virus could silently persist, occasionally surfacing as clusters of preventable congenital disease. The AKU study serves as a clear warning that Pakistan’s fight against mosquito-borne illnesses has become more complex and demands an urgent, coordinated response.

LAHORE: The national and provincial leadership has reaffirmed its commitment to ending polio in Pakistan by finalizing a comprehensive “Road to Zero” strategy during a two-day National Polio Management Team (NPMT) meeting, which concluded here on Saturday.

The meeting was chaired by the Prime Minister’s Focal Person on Polio, Ms. Ayesha Raza Farooq, and attended by Emergency Operations Centre (EOC) coordinators from all four provinces as well as representatives from Azad Jammu & Kashmir (AJK) and Gilgit-Baltistan (GB). Senior officials from the federal government, partner agencies, and development organizations were also present.

Presiding over the meeting, Ms. Ayesha Raza Farooq paid rich tribute to the frontline polio workers, acknowledging their unwavering dedication despite persistent challenges such as refusals, misinformation, and access issues in high-risk areas.

“Despite the odds, our frontline workers are doing a remarkable job. The NPMT has provided all stakeholders an opportunity to openly discuss and deliberate on the challenges facing the programme and strategize actionable solutions,” she remarked.

While expressing concern over the evolving epidemiological trends, the PMFP noted that although serious challenges remain, substantial progress has been made in areas such as surveillance quality, campaign performance, and risk communication. She called on all stakeholders—including government departments and international partners—to work with renewed commitment and collaboration.

“This year, we will approach things differently. Out-of-the-box solutions must be applied to reach every missed child and eradicate polio once and for all,” she stated.

Ms. Farooq emphasized the critical importance of the pre-campaign phase of Supplementary Immunization Activities (SIAs) to ensure successful outcomes and lasting impact. She also highlighted the growing synergy between the Polio Eradication Initiative (PEI) and the Expanded Programme on Immunization (EPI), terming it a pivotal element for polio eradication.

Addressing specific regional challenges, she urged the Khyber Pakhtunkhwa (KP) team to intensify efforts to overcome security-related barriers, particularly in South KP, which remains one of the most challenging zones for the programme. While maintaining focus on traditional polio hotspots and virus reservoirs, the PMFP cautioned stakeholders not to neglect other areas that currently appear stable.

Copyright Business Recorder, 2025

1. In patients with a brain abscess, use of antiseizure medications (ASM) was not associated with a statistical difference in the risk of epilepsy at 90, 135 and 180 days after initiation of ASMs. 

Evidence Rating Level: 2 (Good)

Epilepsy is a common complication of brain abscesses, yet the literature surrounding the appropriate management of epilepsy in the setting of a brain abscess is limited. Indeed, there have been limited efforts to investigate the effectiveness of ASMs in preventing epilepsy in brain abscess survivors. This retrospective cohort study therefore sought to assess the efficacy of ASMs in reducing epilepsy risk in patients with brain abscesses. 572 adult patients (mean[SD] age, 61.5[16.6] years; 61.6% male) from the United States with a documented acute care visit for brain abscess without prior history of epilepsy were included in the study. These patients were separated into a treatment group defined by having initiation of ASM within 45 days after the index date (n = 478) and no ASMs (n = 94). The primary outcome of the study was a diagnosis of epilepsy or seizures at 15 or greater days after the index date. There was no statistical difference in the incidence of epilepsy at 15 days or greater following the index date, with the marginal risk difference (RD) at 90 days being –0.02% [95% CI, −4.9% to 4.8%], at 135 days being 1.9% [95% CI, −5.0% to 8.5%] and at 180 days being 3.5% [95% CI, –4.4% to 10.8%]. Overall, this study found that the use of ASMs was not associated with a reduced risk of epilepsy. 

Click to read the study in JAMA Network Open

Image: PD

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ISLAMABAD:

A medical specialist on Monday advised a healthy lifestyle, hygienic food, clean water and proper sterilisation of all medical instruments, including blades and syringes, to prevent the spread of Hepatitis in humans.

Talking to a private news channel on the occasion of World Hepatitis Awareness Day, renowned Gastroenterology Professor Zahid Azam shed light on the causes of Hepatitis B, C, D and E pandemic –a silent killer and its cure and preventive measures from its spread.

He said that most patients in Pakistan are suffering from the Hepatitis B virus and that is directly related to the liver’s malfunctioning and in Children, it is present in the form of jaundice and Hepatitis A, adding he said Hepatitis B, C, and D can even cause patients’ death.

He said the most common causes of hepatitis are found in cases of negligence in daily diet, use of already unsterilized syringes and instruments, blood transfusion without prior screening, adding that he said infected tools can transmit hepatitis in other patients easily.

He recommended that the patients should demand from the chemists to use the new blades whenever they visit them in the medical shops. Replying to a question relating to external factors of Hepatitis spread and its slow cure, he said medical doctors, nurses, and surgeons should take extra care while using medical instruments such as blades and syringes to give medical help to the patients.

So far as the internal factors of Hepatitis virus spread are concerned, he said the major cause of Hepatitis E is due to unhygienic food, polluted water, while Hepatitis B, C, and D are due to blood issues.

He informed about Autoimmune Hepatitis, which is another kind, and it is caused by a patient’s cell that works against their own body, and thus they get infected, but its spread is mostly in European and Western countries and not in Pakistan.

He said, “Fortunately, a cure, medicines, and a vaccine are available for Hepatitis B, while effective medicines are now available for Hepatitis C, raising hopes that the spread of Hepatitis C and D will eventually be eliminated.”

Talking about Pakistan’s EPI programme, he said the govt of Pakistan is equipped with sufficient Hepatitis vaccine for the cure of the diseases adding that Pakistan is on the third position in diseases like Diabetes and blood pressure which are like volcanos for fatty liver issues.

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Environmental change is not just an outside story. It shows up in how people feel, think, and cope. The word many researchers now use for that distress is “solastalgia.” It describes pain tied to unwanted changes in the places people call home.

The term blends solace and nostalgia. It was introduced to capture the ache people report when their familiar landscapes transform in ways they did not choose or expect.

It focuses on present loss, not longing for the past in general. The emphasis is on disruption where someone still lives, not homesickness after moving away.

The new scoping review comes from a group of researchers affiliated with the University of Zurich. The authors followed a formal approach for scoping reviews and mapped the evidence on solastalgia and mental health from 2003 through September 2024.

Solastalgia – where, when, how

A single paper cannot explain every emotional response to climate and ecological shifts. It can, however, show patterns across places and methods.

This review did that by assembling 19 studies that referenced solastalgia and measured mental health in some way, across Australia, Germany, Peru, the United States, and additional countries.

The authors first required tools that explicitly measured solastalgia and paired them with validated mental health scales.

They then broadened the net to include studies that discussed both topics even when the solastalgia tool was not present.

That mixed approach helps when a field is young. It also keeps the focus on what is reproducible across different communities.

What solastalgia studies found

A scoping review reports consistent links between solastalgia and mental health problems, including depression, anxiety, post traumatic stress disorder, and somatisation.

Across the five quantitative studies in the core set, correlations with depression and anxiety typically fell in the small to moderate range, and two studies also found similar sized links with PTSD.

In communities living near a continuously expanding open pit mine in Germany, the reported correlations with depression and anxiety were in the 0.35 to 0.53 range.

That was higher than values observed after discrete events such as fires or floods. One U.S. study tied every 1 point rise on a solastalgia scale to a 26 percent increase in the odds of psychological distress.

Why long change hits harder

Associations tended to be stronger when environmental loss was prolonged or clearly human caused. One time disasters, while severe, often produced smaller correlations with mental health outcomes in these datasets.

That pattern fits a broader trauma literature where repeated or interpersonal harms often predict more persistent symptoms than single incidents.

“Solastalgia might be a factor contributing to the detrimental effects of climate change on mental health,” stated Alicia Vela Sandquist, lead author of the scoping review.

The authors summarized their conclusion in plain language in the paper’s front matter. That statement reflects the weight of the included evidence, while still noting that the studies were observational.

Why solastalgia matters

Climate change already affects mental health through direct events, economic and social stressors, and disruptions to safety and identity.

Solastalgia helps name an important part of that picture. It links place based loss to specific symptoms, which moves conversations from vague worry to measurable risks.

The review looked at outcomes such as depressive symptoms, anxiety, PTSD, and physical symptoms that track with psychological stress. It also flagged lower well being, pessimism, and reduced resilience in several studies.

Together, these measures sketch a consistent profile. The pattern is not uniform everywhere, but the direction of association rarely flips.

Why the pattern likely happens

One suggested pathway is learned helplessness, a response that can arise when people feel they have little control over outcomes, which is common when large scale environmental forces reshape daily life.

The review also notes that cultural ties to land can amplify distress when those ties are disrupted. That matters for indigenous communities, farmers, and others whose identity is rooted in specific places.

Researchers have built several tools to assess this form of distress, including the Environmental Distress Scale (EDS), the Scale of Solastalgia (SOS), and the Brief Solastalgia Scale (BSS).

Those instruments let teams track associations with health outcomes in a comparable way. They also support work on thresholds and change over time, which is essential for planning services.

What this means for services

The evidence suggests that screening for solastalgia in affected regions could help identify people at higher risk of mental health problems.

That may include communities facing chronic drought, repeated wildfire smoke seasons, or long running industrial expansion.

Clinicians and public health planners can then match support to the type of stressor, since prolonged loss often calls for different strategies than single event response.

Most included studies were cross sectional. That design cannot nail down cause or timing, so stronger designs will be needed to map the order of events and the durability of symptoms.

There were also fewer quantitative papers than expected given how widely the concept appears in public discussion.

Longitudinal work can track solastalgia before and after major environmental changes. Quasi-experimental designs can compare affected and unaffected regions that are otherwise similar.

Codesigned studies will matter in indigenous and non Western contexts, so that instruments capture what loss of place means locally rather than importing outside assumptions.

Eco emotions and mental health

Solastalgia is one of several eco emotions, alongside eco anxiety and eco grief. It does not replace those ideas, and it does not cover every mental health pathway tied to environmental change.

It focuses on distress linked to alterations in one’s home environment. That specificity is a strength for measurement, not a claim that other effects are secondary.

Naming and measuring a risk makes it far easier to plan for it. Health systems can estimate potential demand, community groups can design supports, and leaders can factor mental health into adaptation plans.

It also gives residents language to describe what they are experiencing without pathologizing reasonable concern.

People notice when their landscapes shift in ways that feel unsafe or unfamiliar. The review shows that this experience is not just poetic, it correlates with measurable mental health outcomes across different settings.

The study is published in BMJ Mental Health.

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Testing for the most aggressive form of skin cancer could one day be akin to taking a COVID-19 test at home, according to researchers at the University of Michigan.

The researchers have developed a silicone patch – the ExoPatch – to distinguish melanoma from healthy skin. The patch worked when tested on mice. 

What this means

Big picture view:

The ExoPatch could bring the medical world one step closer to rapid at-home melanoma testing, eliminating the need for a biopsy or blood draw, researchers said. 

What they’re saying:

“The star-shaped needles make puncture easier and less painful, but they are so small that they only go through the top-most layer of the skin, the epidermis, and do not draw blood,” said Sunitha Nagrath, a professor of Chemical Engineering at the university and co-corresponding author of the study published in Biosensors and Bioelectronics.

“A fair-skinned person with moles must go to the doctor about every six months to send off a biopsy to see if they’re malignant or benign. With this test, they could instead test at home, get the results right away and follow up with a dermatologist for a positive result,” Nagrath said.

How it works

By the numbers:

The ExoPatch microneedles are 0.6 mm long with a width of less than 100 nanometers (0.0001 mm) at the tip. They’re coated with a gel that picks up exosomes — or “tiny packages released by cells” — from the interstitial fluid that fills the spaces between cells in the epidermis.

READ MORE: Rare flu complication causing brain swelling on the rise in kids, study finds

Dig deeper:

Exosomes contain DNA and RNA fragments that cells use to communicate with each other. Exosomes help tumors spread, and detecting them can catch cancer sooner than other methods of detection, researchers found. 

The researchers first tested the ExoPatch on a tissue sample of pig skin, which closely resembles human skin in thickness and composition. The team also tested tissue samples of mouse skin, half from healthy mice and half from mice injected with a fragment of a human melanoma tumor. Once researchers confirmed that the exosomes stuck to the ExoPatch, they dissolved the gel and ran the sample through the test strips. 

READ MORE: What is Legionnaires’ disease? Symptoms, how you get it

“The test successfully distinguished between melanoma and healthy tissues with a 3.5-fold darker line in melanoma samples,” researchers said. 

What’s next:

Researchers are planning a pilot study in humans, followed by a series of clinical trials. They believe the ExoPatch could be modified, potentially helping to detect other forms of cancer, including lung, breast, colon, prostate and brain cancer. 

“The potential applications are huge,” Nagrath said. 

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