Hyderabad

Researchers are evaluating the safety and effectiveness of apixaban combined with carvedilol compared to carvedilol alone in preventing complications related to portal hypertension in patients with cirrhosis. This is a prospective, randomized, single-blind, placebo-controlled study conducted at the Asian Institute of Medical Sciences Hospital in Hyderabad, Pakistan. The goal is to provide local evidence for using apixaban in managing cirrhosis and its complications, such as variceal bleeding and portal vein thrombosis. Participants are randomly assigned to one of two groups one receives apixaban 2.5 mg twice daily plus carvedilol, while the other receives a placebo plus carvedilol. Carvedilol doses start at 6.25 mg once daily and are gradually increased every 2 to 4 weeks to a target of 12.5 mg twice daily, based on heart rate and blood pressure. Those with high-risk varices undergo endoscopic band ligation before randomization for safety. The treatment and follow-up last for 12 months. During the study, participants have visits at baseline, 2 weeks, and at 1, 3, 6, 9, and 12 months. Assessments include vital signs, blood tests, abdominal ultrasound with Doppler, and transient elastography. Adherence is tracked through pill counts and diaries. Researchers will monitor the first occurrence of portal hypertension complications, bleeding events, hospitalizations, and mortality. Safety is carefully reviewed by an independent board throughout the trial.

Researchers are evaluating the efficacy and safety of low-dose semaglutide for weight loss and cardiometabolic improvement in obese Pakistani adults without type 2 diabetes. This pilot trial is open-label, single-arm, and conducted at a single center, aiming to provide local clinical evidence to support obesity management with semaglutide in this population. The study will enroll 60 adults aged 18 years or older with a BMI of 27.5 kgm or higher and no diagnosis of type 2 diabetes confirmed by blood tests. Participants will receive once-weekly subcutaneous injections of semaglutide following a dose titration schedule 0.25 mg weekly for 4 weeks, 0.5 mg weekly for 4 weeks, and 1.0 mg weekly for 16 weeks, totaling 24 weeks of treatment. Alongside medication, all participants will receive standardized lifestyle counseling that includes a calorie-restricted diet with a 500-750 kcal daily deficit and at least 150 minutes of moderate-intensity physical activity weekly. This single-arm study does not include a placebo or comparator group. Participants will undergo clinical and laboratory assessments at baseline, 12 weeks, and 24 weeks to monitor treatment effects and safety. Researchers will measure percentage changes in body weight as the primary outcome, alongside secondary outcomes including BMI, waist circumference, blood pressure, lipid profile, liver enzymes, and quality of life. Safety will be closely monitored through continuous tracking of adverse events and drug reactions. Data analysis will use statistical methods to evaluate changes over the study period, with participant confidentiality maintained throughout.

Pulmonary hypertension caused by left heart disease, especially due to rheumatic chronic valvular heart disease, leads to increased health problems and death, mainly in low- and middle-income countries. Many patients arrive late with severe pulmonary hypertension, which complicates surgery and worsens outcomes. Sildenafil, a drug that relaxes blood vessels, has shown benefits for some pulmonary hypertension types but its effect in this specific condition is not well studied. This trial aims to test sildenafils safety and effectiveness as an add-on treatment for severe pulmonary hypertension from rheumatic chronic valvular disease in a controlled setting. Participants will be randomly assigned to receive either sildenafil 25 mg three times daily or a placebo, alongside standard medical care, for six weeks. The study uses a double-blind design, so neither patients nor researchers know who receives sildenafil or placebo. Standard therapy includes treatment for rheumatic fever, diuretics, and heart failure care as needed. The trial is conducted at specialized cardiology centers, and outcome assessments are done by independent, blinded teams. During the study, participants will be monitored for changes in their walking capacity measured by a six-minute walk test, heart and lung function via echocardiography, pulmonary artery pressure, symptom severity by NYHA class, and hospitalization rates. Medication adherence and side effects will be regularly checked by phone. The trial includes safety measures to stop treatment if significant harm is detected. The total participation lasts six weeks with close follow-up to collect all outcome data.