KMU Institute of Medical Sciences

Pre-eclampsia is a major cause of maternal and fetal complications in Pakistan, particularly among primigravidas, where poor nutritional status further increases risk. Emerging evidence suggests that underweight pre-eclamptic women may have distinct cardio metabolic adaptations, higher susceptibility to adverse pregnancy outcomes, and increased long-term cardiovascular risk. Lipid-based nutritional supplementation provides essential energy and micronutrients and may help improve maternal metabolic status and pregnancy outcomes in pre-eclamptic women. To determine the effect of lipid-based micronutrient supplementation on lipid profile, Insulin resistance and blood pressure in underweight pre-eclamptic primigravidas at delivery, six months and twelve months postnatal. An open label randomized controlled trial was undertaken to explore the effects of supplementation on the cardio metabolic risk factors in the tertiary care hospitals of KPK, Pakistan. A total of sixty primigravidas were randomized equally into two groups; Group A: control group and Group B; supplement group. At delivery, 26 and 28 participants in Groups A and B, respectively and at 6 and 12 months, 23 and 25 participants were analyzed. In addition to their prescribed antenatal treatment of preeclampsia and IFA (60 mg iron and 400ug FA) daily, the Group B also received one 75gm of lipid-based nutrition supplement (LNS) sachet (MAAMTA) daily from their first antenatal visit after enrollment till one year postnatally. The IFA was stopped 6 weeks after delivery. There was no discernable difference among the baseline cardio-metabolic parameters like insulin, glucose HOMA-IR of two groups at delivery. Also, the difference in BP (systolic) was non-significant while BP (diastolic) was decreased in group B (p = 0.025). Similarly, at delivery the significant declined were observed in triglyceride (TGs) levels with LNS supplementation (p = 0.007), Total cholesterol (p = 0.01), LDL (p = 0.02) and VLDL (p = 0.005). At 6 months follow-up systolic (p = 0.002) and diastolic blood pressure (p = 0.013) were decreased significantly in group B also a significant decline in TGs (p = 0.05), cholesterol (p < 0.001), LDL (p < 0.001) and VLDL levels (p = 0.04) observed in group B. A significant decrease was seen in cholesterol levels (p < 0.001) and LDL levels (p < 0.001) in group B at 12 months postnatal. This study concludes that long term LNS supplementation can cause a decrease in cholesterol, TGs, LDL and VLDL in underweight pre-eclamptic primigravidas and thus may contribute to a more favorable cardio metabolic risk profile. ClinicalTrials.gov Identifier: ISRCTN 15485068. Registered on April 21, 2018: https://doi.org/10.1186/ISRCTN15485068.

Cardiovascular disease remains the leading global cause of mortality despite advances in preventive therapies. Influenza infection is increasingly recognized as a trigger for acute cardiovascular events, prompting interest in influenza vaccination as a potential cardioprotective intervention in high-risk patients. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of influenza vaccination on cardiovascular outcomes in adults with established cardiovascular disease. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until October 2025. Seven studies were included after the final screening. Outcomes were reported as all cause mortality, myocardial infarction, major adverse cardiovascular events and heart failure related hospitalization. Interstudy heterogeneity was assessed using I² and X² statistics. Statistical calculations were performed using Review Manager 5.4.1, with a p-value of < 0.05 indicating statistical significance. Seven randomized controlled trials including 12,224 participants were analyzed. Influenza vaccination significantly reduced major adverse cardiovascular events and cardiovascular mortality. A borderline reduction was observed for myocardial infarction and all-cause mortality. No significant differences were found for stroke, coronary revascularization, or heart failure-related hospitalization. Heterogeneity was low for most primary outcomes. The routine use of influenza vaccination as an effective adjunctive strategy in secondary cardiovascular prevention is supported by the fact that it significantly lowers cardiovascular mortality and major cardiovascular events in patients with established heart disease.

This systematic review and meta-analysis compared the weight loss efficacy of tirzepatide versus semaglutide in overweight and obese adults through direct comparative studies. We systematically searched PubMed, Excerpta Medica database (EMBASE), Web of Science, and Cochrane Library databases from inception to April 25, 2025, identifying studies that directly compared tirzepatide and semaglutide for weight management. Inclusion criteria encompassed randomized controlled trials and observational studies reporting percentage change in body weight from baseline. Seven studies totaling 28,980 participants were included, comprising five observational studies and two randomized controlled trials with follow-up durations ranging from six to 12 months. Data analysis was performed using Review Manager 5.4.1 (The Cochrane Collaboration, London, UK) with random-effects models. Results demonstrated that tirzepatide was significantly superior to semaglutide in achieving weight reduction. The pooled analysis showed greater weight loss with tirzepatide compared to semaglutide (standardized mean difference: 0.75, 95% CI: 0.52 to 0.92). At six months, tirzepatide achieved significantly greater weight reduction than semaglutide (mean difference: 1.33, 95% CI: 0.58 to 2.08). Additionally, participants receiving tirzepatide had significantly higher odds of achieving at least 10% weight loss compared to those receiving semaglutide (OR: 0.21, 95% CI: 0.06 to 0.78). High heterogeneity was observed across studies (I² > 90%). This meta-analysis provides evidence that tirzepatide, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, demonstrates superior weight loss efficacy compared to semaglutide in overweight and obese populations. These findings support tirzepatide as a more effective pharmacological option for weight management, though further long-term head-to-head trials are needed to confirm sustained benefits and safety profiles.

This systematic review and meta-analysis evaluated the efficacy and safety of lorundrostat, a novel aldosterone synthase inhibitor, in patients with uncontrolled or treatment-resistant hypertension. A comprehensive literature search was conducted across major electronic databases, including MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus through July 25, 2025. Randomized controlled trials comparing lorundrostat to placebo in adult patients with uncontrolled hypertension were included. Three studies met the inclusion criteria and were analyzed using Review Manager 5.4.1 (The Cochrane Collaboration, London, England, UK) with random-effects models. The pooled analysis demonstrated that lorundrostat achieved a statistically significant reduction in systolic blood pressure of 8.04 mmHg compared to placebo (95% confidence interval (CI): -10.69 to -5.39) with low heterogeneity (I2 = 28%). Subgroup analysis revealed comparable efficacy between 50 mg and 100 mg doses, suggesting a relatively flat dose-response relationship within this range. This magnitude of blood pressure reduction is clinically meaningful and comparable to established fourth-line therapies like spironolactone. Regarding safety, lorundrostat was associated with a significantly higher risk of adverse events compared to placebo (risk ratio (RR): 1.47; 95% CI: 1.32 to 1.64), though most were mild to moderate in severity. Importantly, no significant difference was observed in serious adverse events (RR: 1.01; 95% CI: 0.39 to 2.63), providing reassurance about the overall safety profile. These findings suggest that lorundrostat represents a promising therapeutic option for treatment-resistant hypertension, offering clinically significant blood pressure reductions with an acceptable safety profile. However, long-term cardiovascular outcome studies and direct comparisons with existing therapies are needed to fully establish its clinical role.

This review aims to compile the available literature on monkeypox, identify risk factors for developing the disease, and recommend effective preventative methods to reduce the number of reported cases and fatalities in children and pregnant women. In seeking out pertinent studies on monkeypox virus in children and pregnant women, we searched the literature using the databases Cochrane Library, Google Scholar, PubMed, EMBASE, Web of Science, and Scopus up to 1st February 2023. This study analyzed data from case studies of monkeypox in children and pregnant women. Clinical data and test findings of monkeypox patients less than 18 years old and pregnant women were analyzed. The Newcastle-Ottawa Scale was used to do the quality evaluation. Our record examination spanned the years 1985 to 2023 and found 17 children and five pregnant female patients treated with monkeypox in various hospitals/community centers. Zaire, Gabon, Chicago, Sierra Leone, Central African Republic, Northern DR Congo, Liberia, Cameroon, the Democratic Republic of the Congo, the United Kingdom, the Netherlands, and Florida all contributed to the 14 studies analyzed. There were no studies identified for meta-analysis of selected case studies of hospitalized children and pregnant women who were diagnosed with monkeypox. The incidence, prevalence, clinical characteristics, diagnosis, management, prevention, vaccinations, infant care, and care for expectant mothers are all discussed in this systematic review of monkeypox in children. Our research findings may provide a foundation for further focused research and the development of related recommendations or guidelines.