Search

Madam, preterm birth (PTB) is classified as having a gestational age of fewer than 37 weeks; annually, approximately 15 million infants are born preterm worldwide(1). Major risk factors of PTB include placenta previa, fetal distress, maternal thyroid disease, and maternal asthma(2). Both teenage (35 years) mothers carry an increased risk of giving birth prematurely(2). Previous studies have shown a positive correlation between PTB and numerous disorders, including hypertension, diabetes mellitus, and hyperlipidemia(3). Mounting evidence suggests PTB is a significant risk factor for ischemic heart disease (IHD) and stroke. However, due to prior discrepant findings, there is a possibility that these associations might be spurious. However, recent literature surfaced two cohorts by Crump et al. in 2019(4) and 2021(3). In 2019, compiled data from 2,141,709 participants over 43 years, and preterm babies were found to have a significantly higher risk of developing IHD in the future (aHR: 1.44 [1.19-1.73](4). Moreover, the incidence of IHD was more prevalent among preterm-born men than preterm-born women(4). The 2021 cohort evaluated the frequency of stroke with PTB. It concluded that PTB was associated with higher risks of both hemorrhagic stroke (aHR: 1.15 [0.97–1.35]) and ischemic stroke (aHR: 1.31 [1.07–1.60]), compared with full-term birth(3). These results are worrisome for Pakistan since it has a high tally of PTB cases, as highlighted by a 2017 study by Hanif et al., which showed a 21.64% prevalence of PTB among 1691 females(2). These preterm infants have an increased likelihood of acquiring IHD and Stroke coupled with the already established diseases including hypertension, diabetes, and hyperlipidemia later in life, which exacerbates the already high disease burden in Pakistan. Moreover, unaware of the medicines’ cost-effectiveness, medical practitioners commonly prescribe expensive popular generics for treating IHD(5), which inflicts a substantial financial burden on these patients. Hence, paediatricians should be advised to follow up with preterm babies regularly assess their progress, educate mothers about the risk factors of PTB and minimize the chances of them showing up down the line by emphasizing proper diet, regular exercise, and abstinence from smoking. Nationwide campaigns and awareness drives are a few ways the general population could be made aware of PTB and its threat to the health of these children in the future. Continue...

Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. There is no universally accepted effective treatment for NAFLD. Although various studies propose statins effective in lowering liver enzymes and in improving liver histology, their potency in the treatment and development of NAFLD remains unknown.We conducted this meta-analysis to evaluate the efficacy of statins in the treatment and the development of NAFLD.Electronic databases (MEDLINE and Cochrane CENTRAL) were searched from their inception until May 2021 for observational studies and randomized controlled trials (RCTs) that assessed the efficacy of statins for the treatment of NAFLD and its development. Studies were included irrespective of the dosage or duration, and their risk of bias was assessed. The outcomes of interest for our study were the effect of statins on liver histology (steatosis, fibrosis and necroinflammation, NAFLD activity score [NAS]) and liver enzymes (Alanine transaminase [ALT], Aspartate transaminase [AST], and Gamma-glutamyl transferase [GGT] levels). To pool continuous outcomes, a random-effects model was used to derive weighted mean difference (WMD) or standardized mean difference (SMD) and their corresponding 95% confidence intervals (CIs). Generic inverse variance was then used for different measurement units reported by the studies. For studies investigating the effects of statins on the development of NAFLD, generic inverse variance along with random effects model was used to derive odds ratio (ORs) and its corresponding 95% confidence interval (CI).A total of 14 studies including 1,247,503 participants were short-listed for our analysis. All the studies included in our analysis had a low to moderate risk of bias. The results of our analysis suggest that statins may significantly reduce the risk of developing NAFLD (OR:0.69, 95% CI [0.57,0.84]; p = 0.0002; I² =36%). Statin use significantly reduced ALT levels (WMD: -27.28, 95% CI [-43.06, -11.51]; p = 0.0007; I² =90%), AST levels (WMD: -10.99, 95% CI [-18.17, -3.81]; p = 0.003; I² =79%) and GGT levels (WMD: -23.40, 95% CI [-31.82, -14.98]; p 0.00001; I² = 21%) in patients presenting with NAFLD at baseline. In liver histology outcomes, steatosis grade (SMD: -2.59, 95% CI [-4.61, -0.56]; p = 0.01; I² = 95%), NAS (WMD: -1.03, 95% CI [-1.33, -0.74]; p 0.00001; I² = 33%), necro-inflammatory stage (WMD: -0.19, 95% CI [-0.26, -0.13]; p 0.00001; I² = 0%) and significant fibrosis (OR:0.20, 95% CI [0.04, 0.95]; p = 0.04; I² = 97%) underwent notable reduction. However, fibrosis stage outcome (WMD: 0.07, 95% CI [-0.05, 0.20]; p = 0.27; I² = 0%) was non-significant.There was a significant decrease in transaminase and transferase levels. Marked improvement in liver histology of NAFLD patients was observed. Statin use also remarkably reduced the risk of developing NAFLD. Future large-scale trials can further aid in identifying the positive impact of statins in treatment for NAFLD and those at risk of developing it.