Palliative care, as defined by the World Health Organisation (WHO), focuses on improving the quality of life for patients facing life- limiting illnesses by addressing pain, distressing symptoms, and psychological and spiritual needs. There is an increasing demand for palliative care, while only a small fraction of those in need receive adequate services. In the context of the Emergency Department (ED), patients with life-limiting illnesses often seek care for symptom management or acute exacerbations. They face several challenges that hinder the integration of palliative care into the emergency setting, including a lack of prior training-patient relationships, prognostic uncertainty, time constraints, and resource limitations-especially in developing countries. This short communication proposes an algorithm to enhance the identification, referral, and management of palliative care patients in the ED. This will help streamline palliative care delivery, ensuring that patients with life-limiting illnesses receive timely and appropriate interventions. By addressing these challenges, this approach aims to bridge the gap between patient needs and healthcare system limitations, thereby improving the quality of palliative care in the ED. Key Words: Palliative care, Referral, End-of-life care, Emergency department.

This cross-sectional study aimed to compare serum Retinol-Binding Protein 4 (RBP4) levels in hypertensive and normotensive non-obese individuals. A total of 41 hypertensive and 41 normotensive subjects aged ≥40 years were enrolled. Hypertension was defined as a blood pressure (BP) of ≥140/90 mmHg, whereas normotension was defined as a BP of <120/80 mmHg in the absence of antihypertensive medication (JNC 8 criteria). Five millilitres of venous blood were collected aseptically, and serum RBP4 was measured using a Human RBP4 ELISA kit. Data were analysed using SPSS version 26 with an independent sample t-test; p ≤0.05 was considered statistically significant. Forty-six per cent of participants were male, with a mean age of 53.69 ± 9.86 years in the hypertensive and 52.41 ± 6.30 years in the normotensive group. The mean serum RBP4 was significantly higher in the hypertensive group (62.17 ± 28.22 ng/mL) than in the normotensive group (14.70 ± 5.59 ng/mL), suggesting its potential as a biomarker. Key Words: Hypertension, Normotensive, Serum Retinol-binding Protein-4, Cardiovascular diseases.

Typhoid fever (TF) and paratyphoid fever (PTF), collectively known as enteric fever (EF), are acute febrile illnesses that are common and cause significant morbidity and mortality. EF is responsible for about 26.9 million cases of mortality and morbidity worldwide, with Asian nations accounting for over 90% of all EF deaths. There is not enough data to determine the burden of TF in Pakistan, where it is thought to be endemic. Multidrug-resistant H58 clade Salmonella enterica serovar Typhi has expanded far beyond Asia and Africa. The development of multidrug resistance is expected to significantly increase the difficulty and cost of diagnosing and treating EF, particularly in rural areas where resources are scarce. Hospitalisation costs, prescription drugs, diagnostic testing, and other medical services are included in out-of-pocket expenses (OOPE) for patients with EF in rural areas. The fact that the majority of these patients take antibiotics without consulting a doctor is a serious concern. This needs the implementation of antibiotic stewardship in rural areas of Pakistan and an increase in diagnostic facilities. Key Words: Multidrug-resistant, Paratyphoid fever, Typhoid fever.

Pakistan faces an escalating cancer burden, with approximately 185,748 new cases and 118,631 deaths annually. According to GLOBOCAN data, breast cancer (16.5%), lip/oral cavity cancer (8.6%), and lung cancer (5.1%) are the most prevalent, with breast cancer alone accounting for 31.3% of female cases. The country's limited healthcare resources, including severe shortages of oncologists and radiotherapy facilities, exacerbate this crisis, requiring urgent intervention. The delta Mortality-to-Incidence Ratio (dMIR) metric identifies cancers with the largest outcome gaps between Pakistan and top-performing countries, highlighting where improvements could yield the greatest impact. For instance, stomach cancer (dMIR = 0.60), Kaposi sarcoma (0.58), and oral cavity cancer (0.49) represent critical priorities. By focusing resources on high-dMIR cancers through early detection, treatment access, and prevention programs, Pakistan can significantly reduce preventable mortality. To address these challenges, Pakistan must implement a comprehensive National Cancer Control Plan. Key steps include expanding screening programs for breast, cervical, and oral cancers; training healthcare workers; upgrading radiotherapy infrastructure; and launching public awareness campaigns targeting tobacco use and lifestyle risks. Strategic investments in these areas, coupled with policy reforms and public-private partnerships, could transform cancer outcomes in Pakistan. Key Words: Pakistan, Cancer burden, Delta mortality-to-incidence ratio, Cancer disparities, Low- and middle-income countries.

To investigate the relationship between oral health status and oral frailty in older inpatients, provide a basis for the early detection and treatment of oral frailty, and improve their health and quality of life.

Human immunodeficiency virus drug resistance (HIVDR) creates a threat to the extended success of antiretroviral therapy (ART) while making it harder to control the HIV epidemic. In this study, a meta-analysis was conducted to analyse Pakistani studies from 2015 to 2025 that documented HIVDR prevalence and resistance-associated mutations (RAMs). The review included studies that analysed ART-experienced and ART- naive participants with available sequencing data. A random-effects meta-analysis was performed to estimate the pooled prevalence of HIV drug resistance, and subgroup analyses were conducted to evaluate resistance patterns according to treatment region and antiretroviral regimen. Sensitivity tests were performed to verify the stability of the results. Fifty-one studies were included, which analysed more than 1,500 participants. ART-experienced patients developed HIVDR at a rate of 35% (95% CI: 30-40%). In the reverse transcriptase and protease regions, the most prevalent non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations were M184V, K103N, L90M, and M46I. The time-trend analysis indicated that NNRTI resistance has increased over the past decade. The analysis relied on simulated effect sizes due to the unavailability of raw data from the included studies. The spread of HIVDR in Pakistan remains a significant challenge because of restricted access to viral load and resistance testing, inadequate treatment options, and poor patient adherence. The National AIDS Control Program (NACP) should implement baseline and routine resistance testing while adopting dolutegravir-based treatment regimens and improving patient adherence programmes. Key Words: HIV drug resistance, Antiretroviral therapy, Resistance-associated mutations.

Coronary artery bypass grafting (CABG) is among the most commonly performed cardiac surgical procedures worldwide and frequently requires perioperative blood transfusion. Acute normovolaemic haemodilution (ANH) is a simple and economical strategy that aims to reduce the need for allogeneic blood transfusion. A systematic review was conducted between October 2024 and August 2025 and analysed randomised controlled trials comparing ANH with conventional transfusion practices in patients undergoing coronary bypass surgery. Eighteen studies were evaluated for outcomes such as transfusion rates, blood loss, coagulation profiles, myocardial protection, postoperative complications, and cost-effectiveness. ANH reduced the need for allogeneic blood transfusion without affecting haemodynamic stability or postoperative recovery. Moderate improvements were observed in coagulation preservation and myocardial protection, although the certainty of evidence varied across outcomes. Further large-scale trials are required to establish standardised ANH protocols and clarify long-term clinical outcomes. Key Words: Acute normovolaemic haemodilution, Coronary artery bypass grafting, Blood conservation, Allogeneic transfusion.