Congestive Heart Failure (HF) and Atrial Fibrillation (AFIB) often coexist. Catheter ablation is a well-established option for symptomatic AFIB that is resistant to drug therapy in patients with otherwise normal cardiac function. This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF. Recently, the study results from the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial were published. After a median follow-up of more than 3 years, patients getting catheter ablation for AFIB had significantly fewer hospital admissions as well as death from worsening HF. In addition, 63% of patients in the ablation group were in sinus rhythm, as compared with 22% of those in the medical-therapy group (P < 0.001). This trial may represent a significant additional therapeutic tool in the clinical prevention and management of cardiovascular mortality and morbidity. While catheter ablation does not eliminate the AFIB per se, it can limit the ventricular rate by eliminating triggers and altering electrophysiological connections in the heart in a similar fashion to rate control anti-arrhythmic drugs. Longer-duration normal sinus rhythm may improve outcomes by means of a number of mechanisms, including greater atrial emptying, all of which translate into improved cardiac output. A better understanding is needed as to why a decrease in density, but not complete elimination of atrial fibrillation, is sufficient for reverse remodelling. It is anticipated that the results of the CASTLE-AF trial will soon be implemented in international guidelines.

Objective: Several biomarkers like NGAL, KIM-1, IL-18, and Cystatin C has been previously reported as reliable marker to predict AKI. However, their predictive accuracy varies widely. We aim to observe the efficacy of multiple markers, NGAL, KIM-1, Cystatin C and IL-18, in obstetric population who are at risk of developing AKI. Methods: This prospective study was carried out between June 2021 to March 2022 at Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital and Sindh Institute of Urology & Transplant (SIUT), Karachi Pakistan. On women brought to OBGYN-ER with the diagnosis of hemorrhage (antepartum and postpartum), hypertension (pre-eclampsia and eclampsia) and sepsis. The urine samples and 3cc blood was collected at the time of admission, blood sample processed for biochemistry at time of admission and repeat blood samples for serum creatinine at 24 and 48 hours. Urine was stored at -80ºC and later evaluated for NGAL, KIM-1, Cystatin C and IL-18. Serum Cystatin C was also processed for the time zero sample. The biomarkers were tested using ELISA assays. Results: A total of 149 women were included in the study, 83% of these women were non-booked. Twenty-six (17%) women developed AKI. Serum Cystatin C, urinary Cystatin C and urinary NGAL were found significantly raised in women who developed AKI. While KIM-1 and IL-18 were not raised to statistical significance in this population. However, urinary KIM-1 along with urinary Cystatin C were significantly raised in women with positive quick sequential organ failure assessment (qSOFA). Conclusion: This study validates the use of serum and urinary Cystatin C and urinary NGAL as highly predictable biomarkers for the development of AKI and nullifies urinary IL-18 and KIM-1 in this regard. doi: https://doi.org/10.12669/pjms.39.1.6930 How to cite this: Naqvi R, Hossain N, Butt S, Bhellar Z, Fatima E, Imtiaz S, et al. Efficacy of multiple Biomarkers: NGAL, KIM1, Cystatin C and IL18 in predicting pregnancy related acute kidney injury. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6930 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Treatment of diabetes-related foot ulcers presents great pressure on the healthcare system in terms of management strategy and allocation of resources. Telemedicine can be used to treat diabetic foot ulcers more effectively. This meta-analysis aims to evaluate the impacts of telemedicine on the treatment of diabetic foot ulcers. The current meta-analysis was conducted as per the reported guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Two reviewers independently searched for relevant articles using PubMed, EMBASE, and the Cochrane Database of Systematic Reviews from inception to 31 August 2022, assessing the impacts of telemedicine on the treatment of diabetic foot ulcers. The primary outcomes assessed in the current meta-analysis included the percentage of foot ulcers healed and the time of healing foot ulcers within 12 months. Secondary outcomes included the percentage of amputation (minor and major) and all-cause mortality. A total of six studies were included in the current meta-analysis enrolling 1876 patients with diabetic foot ulcers. No difference was there between the two groups in terms of the number of patients whose ulcer healed (risk ratio (RR): 1.01, 95% confidence interval (CI): 0.93-1.09), time to healing of wound within 12 months (mean difference: -0.07, 95% CI: -0.31-0.17), the incidence of amputation (RR: 0.73, 95% CI: 0.54-1.00), and all-cause mortality (RR: 0.99, 95% CI: 0.42-2.37). In conclusion, the study found that telemedicine is non-inferior to standard care in terms of reducing healing time and the number of patients with ulcer healing within 12 months. The study also found that the incidence of amputation is also lower in patients assigned to the telemedicine group compared to patients in the control group and no significant differences were reported in terms of mortality.