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The incidence of cardiovascular diseases (CVDs) in low- and middle-income countries (LMICs) has greatly increased. Previously dominated by infectious diseases, LMICs are the new epicentre of CVDs. CVD is a common problem amongst the population in the African continent; however, many countries in LMICs lack the resources to stem the rise of CVDs. A systematic review was conducted between March and July 2023 to assess barriers to the primary prevention of CVDs in studies conducted in LMICs. Online databases, such as Embase, Cochrane, Scopus, and MEDLINE, were consulted. Keywords included primary prevention, cardiovascular diseases, diabetes, weight loss, and physical fitness, all of which focused on LMICs. To enrich the literature review, efforts were made to check other listed references and more papers were retrieved. The inclusion criteria were countries in LMICs, CVD, full-text, and peer-reviewed journals. Qualitative and quantitative studies were included. Exclusion criteria included high-income countries, secondary prevention, and research unrelated to CVDs, such as barriers in oncology or mental health. A total of 1089 papers were retrieved from the search engines. After applying the exclusion criteria for LMICs, only 186 papers were retained. A further search for quality, relevance, and duplicity reduced the qualifying number to 50 papers. Further efforts to retrieve the data and examine the quality of the studies resulted in 18 final selected studies. Three categories emerged based on the type of barriers: physician barriers, patient barriers, and health system barriers. Evidently, in several LMICs, guidelines for CVD prevention were lacking, and too much emphasis was placed on secondary prevention at the expense of primary prevention, a lack of human resources, and inadequate infrastructure. Overworked healthcare providers were unable to allocate adequate time to the patients. There was no shared decision-making process. Patient barriers included lack of motivation, no symptoms, low level of education, no insurance, long physical distances to the facilities, and inadequate medication or stock out. Some of the major barriers included closing and opening hours, poor operating space, inadequate funding from the government or donors, and lack of electronic medical services. There are many barriers to accessing primary prevention services for CVDs. These barriers can be divided into patient, physician, or health system barriers. More research needs to be conducted in LMICs to address the increasing risk factors for CVDs. Greater investment is required by national governments to provide more resources. Task shifting and shared decision-making are some of the quick wins.
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Introduction A condition in which uric acid levels are elevated but there are no accompanying symptoms is known as asymptomatic hyperuricemia. As a result of the disparity in opinions and findings between the studies, the guidelines regarding whether or not asymptomatic hyperuricemia should be treated are unclear. Material and methods Between the months of January 2017 and June 2022, this research was carried out in the community in collaboration with the internal medicine unit and the public health unit of Liaquat University of Medical and Health Sciences. After obtaining informed consent from each participant, the researchers enrolled 1,500 patients in the study who had uric acid levels that were greater than 7.0 mg/dL. These patients ranged in age from 40 to 70 years old and were of either gender. As a control group, 1,500 patients were recruited who did not have abnormally high levels of uric acid. Patients were monitored for a total of 48 months or until the occurrence of a major cardiovascular event (MACCE) or death from all causes, whichever occurred first. Death, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke were the four categories that made up the primary outcome, also known as MACCEs. Results In the hyperuricemic group, the incidence of myocardial infarction that did not result in death was significantly higher than in the non-hyperuricemic group (1.6% vs. 0.7%; p-value, 0.04). However, the result was not significant for deaths from all causes, deaths from cardiovascular disease, or strokes that did not result in death. Conclusion Asymptomatic hyperuricemia is a potential threat to one's health that can lead to cardiovascular diseases and may go undiagnosed in some cases. It is important to remember that hyperuricemia can lead to delirious complications, so efforts should be made to perform routine monitoring and management of the condition.
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Introduction The primary objective of the study was to compare the serum luteinizing hormone (LH) levels in patients with hyperandrogenism on metformin and combined oral contraceptive pills. Secondarily, the study also assessed the serum testosterone, body mass index (BMI), and the time to achieve regular menstruation were also assessed. Methods A quasi-experimental study was conducted at the Department of Medicine, Liaquat University of Medical & Health Sciences (LUMHS) between June 1, 2019 and May 30, 2020. A total of 200 women fulfilling the clinical and biochemical criteria for the polycystic ovarian syndrome (PCOS) were enrolled, 100 in each group. Considering the inclusion criteria, the patients were picked up from the gynecology outpatient department. After taking a detailed history and physical, abdominal, and pelvic examination, pelvic ultrasonography along with biochemical evaluations of serum LH and testosterone were done in selected patients. Metformin was started at an oral dose of 500 mg daily and maintained at 1500 mg for six months in group A, and oral contraceptive pills were given for a period of six months in group B. Besides body weight and hirsutism, serum LH levels, serum prolactin levels, and serum testosterone levels were performed at the start of the treatment and then repeated after three months and after six months. After six months of menstrual cyclicity, changes in serum LH levels and body weights were assessed in the two groups and the rate of conception in the Metformin group. Results A total of 200 women were enrolled and equally divided into metformin and oral contraceptive groups. Follow-up revealed that a significantly higher number of patients achieved regular menstruation in the metformin group as compared to the oral contraceptive groups (p = 0.03). In the metformin group, 72 patients achieved regular menses, while in the oral contraceptive groups, about 58 patients achieved regular menstruation. Both metformin and oral contraceptive therapy were effective in improving patient outcomes in terms of serum LH, testosterone levels, and BMI. However, metformin had considerably higher rates of improvement as compared to oral contraceptive group patients. The mean serum LH level decreased from 38 mIU/ml to 17.6 mIU/ml in the metformin group (p < 0.0001), while the mean serum LH level reduced from 37.5 mIU/ml to 27.7 mIU/ml in the oral contraceptive group (p < 0.01). The change in serum testosterone level after six months was 2.98 ± 0.75 in the metformin group (p < 0.001) and 1.50 ± 0.64 in the oral contraceptive group (p < 0.01). Conclusion We revealed that both metformin and oral contraceptives are effective in improving symptomatology in PCOS patients. However, a significantly higher number of patients achieved normal menses with metformin than with oral contraceptives. Moreover, metformin had considerably higher rates of improvements in serum LH levels and serum testosterone levels as compared to oral contraceptive group patients.
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Background There have been indications of a correlation between serum homocysteine (Hcy) levels and poor patient outcomes in traumatic brain injury (TBI). Thus, we aimed to explore the role of serum Hcy in influencing the outcome post TBI. Methods A case-control study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) between January 15, 2022 and July 1, 2022. All patients between the ages of 18 and 75 years who presented with TBI, irrespective of severity, were included in the study. All patients with neurological disorders and infections, including but not limited to cerebral tuberculosis, Alzheimer's disease, epilepsy, brain cancer, Parkinson's, and stroke, were excluded from the study. For comparison, healthy controls with similar demographics were enrolled in the study. All patients and controls underwent biochemical evaluation of serum Hcy and neurological assessment at presentation. In addition, all sociodemographic and clinical parameters, including the Glasgow Outcome Score (GOS), were collected in a predefined pro forma. Results A total of 175 patients were included who had experienced TBIs, along with an equal number of healthy controls. The most common etiology was road traffic accidents in 82 (46.9%) patients. The mean Glasgow Coma Score (GCS) at presentation was 5.78 ± 1.72. The mean Hcy levels were 31.4 ± 7.97 µmol/L in TBI patients and 11.12 ± 5.87 µmol/L in the control healthy patients (p=0.001). It was found that the severity of hyperhomocysteinemia (HHcy) was significantly related to the worst outcome possible, i.e., death (p=0.001). Conclusion The study concluded that patients who had suffered from a TBI had significantly higher serum Hcy levels. Furthermore, the study highlighted that the patients with the worst outcomes had more severe hyperhomocysteinemia (HHcy) than those with better outcomes. Moreover, patients with low GOS scores were more likely to have HHcy.