Background Private sectors play a significant role in health provision along with the public sector in both developed and developing countries. Given the limited resources of the public sector, public-private partnerships (PPPs) are considered a good solution to address our growing public health challenges. But inadequate assessment of various health-related PPPs have resulted in a failure to gather knowledge and evidence that would facilitate the establishment of effective partnerships, sustain and systematize them over time, as well as determine the role of PPPs in health system strengthening, particularly in terms of urban health provision. The objective of this research is to systematically review the effectiveness of PPPs on the utilization of urban health provision to achieve health outcomes in the urban contexts of least developed, low income, and lower-middle-income countries and territories. Methods This systematic review will follow PRISMA-P guidelines for reporting. Relevant databases ─ EMBASE, MEDLINE, Health Management Information Consortium, Social Sciences Citation Index, Science Citation Index, Emerging Sources, CENTRAL, 3ie, Database of disability and inclusion information resources, and WHO Library Database – will be searched for published articles in the urban context. Reference lists of relevant systematic reviews and commentaries and citations of key included studies will be checked for additional studies. Two reviewers will independently screen the studies in Covidence following the exclusion and inclusion criteria. Data will be thematically analysed and narratively synthesised. Discussion This review will comprehensively assess and appraise all the existing PPP models for urban health provision in the least developed, low income, and lower-middle-income countries and territories. The findings of the review will help to understand the modalities of the existing health related PPPs in urban areas, their functionalities and their contribution in achieving health outcomes. Protocol Registration: This protocol is registered with the International Prospective Register of Systematic Reviews, PROSPERO (ID-CRD42021289509, 23 November 2021).
Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8
Background: Chronic kidney disease (CKD) is progressive loss in kidney function over a period of months or years. CKD is an internationally recognized public health problem affecting 5-10% of the world population and day-by-day the number of cases are increasing at an alarming rate. In CKD, raised levels of prolactin in blood may cause vascular derangements which might lead to worse cardiovascular consequences in CKD patients. Objectives: To assess serum creatinine, hemoglobin (Hb), urea, red blood cell (RBC), protein creatinine ratio (PCR) and prolactin in CKD patients. Material and Methods: This study included 110 patients, 61 were males and 49 were females and their age range 1 to more than 60 years. The control group also consisted of same number of participants as the patients; who were free from signs and symptoms of kidney disease and prolactin hormone disorders. Results: The study shows that all the biochemical parameters in CKD patients were found to be significantly high compared with control group (P<0.001). Serum prolactin concentrations in CKD patients were also increased significantly compared with control group (P≤ 0.05). It was found that level of prolactin hormone secretion was higher in male CKD patients than male control. Conclusion: Although males are more prone to chronic kidney disease, but the percentage of females is not negligible. All the biochemical parameters and prolactin level changed significantly in the CKD patients. It is interesting that in case of CKD, male's prolactin secretion becomes higher.
Background: Statins are the corner stone therapy of atherosclerotic cardiovascular disease (ASCVD). Statins may cause myalgia, myotoxicity, myopathy and rhabdomyolysis along with its lipid lowering properties and pleiotropic effects. Statins associated muscle symptoms (SAMS) are the leading cause of nonadherent and discontinuation. This study was conducted to evaluate and understand the muscle symptoms of high intensity statin therapy (atorvastatin 40 mg and rosuvastatin 20 mg) for a period of three months in individual patient with clinical atherosclerotic cardiovascular disease.Methods: A total of 280 patients with clinical atherosclerotic cardiovascular disease were studied to once daily atorvastatin 40 mg and rosuvastatin 20 mg. It was a randomized controlled single blind trial. The primary end point was muscle symptoms-muscle pain, fatigue, cramp/spasticity and weakness at 4 weeks and in 3 months of study period. Serum creatinine kinase was measured in every patient with muscular symptoms.Results: Patients of atorvastatin group noticed severe pain more than rosuvastatin group at the end of 3 months of treatment period (14.21% vs 4.38%, p <0.05), respectively). Significantly more patients felt extremely bad (12.78% vs 4.38%, p <0.05) and bad (24.66% vs 14.52%, p <0.05) with atorvastatin compared with rosuvastatin. Patients of atorvastatin group showed more marked increase muscle spasm (3.76% vs 1.46%, p <0.05) and slight increase muscle spasm (36.27% vs 16.01%, p <0.05) than rosuvastatin group by spasticity grade. One patient of atorvastatin group developed considerable increase in muscle spasm. Medical research council (MRC) muscle power grade 4 between atorvastatin and rosuvastatin group was observed 20.05% vs 10.90%, p <0.05, respectively. Three patients of atorvastatin group developed grade 3 muscle power. Serum creatine kinase > 1500 U/L was observed more in atorvastatin than rosuvastatin group (14.21% vs 4.38%, p <0.05, respectively). Statin associated muscle symptoms (more severe muscle problem, myositis/myopathy) observed more in atorvastatin than that of rosuvastatin group ( 34.07% vs 13.08% , p <0.05, respectively). Both treatments were well tolerated. No cases of rhabdomyolysis, incident diabetes, hepatic or renal insufficiency were recorded during the study period.Conclusion: Rosuvastatin had better outcome profile of muscle symptoms than atorvastatin in patients with clinical atherosclerotic cardiovascular disease among the Bangladeshi population. Patients in atorvastatin group experienced more muscle pain, fatigue, cramp/spasticity and weakness than rosuvastatin.University Heart Journal Vol. 14, No. 1, Jan 2018; 9-20
We present a 36 years old Bangladeshi male, known smoker, while working in Bahrain, suffered from arterial thromboembolism on left lower extremity resulting in gangrene of left leg. He underwent above knee amputation of the affected limb. After 16 days stay in the hospital with an open amputated stump wound, he was sent back to Bangladesh by air. While in the airplane, he complained of chest discomfort about two hours before landing at Dhaka airport of Bangladesh. Following disembarkation he was admitted into local cardiac hospital where a diagnosis of left ventricular failure with unstable angina was made. Five days later he was transferred to ICU of Ibn Sina Hospital for better management. Patient had high serum D-dimer level and fibrin degradation products (FDP) level. negative antinuclear antibody (ANA) test, negative anti-cardiolipin antibody test, normal troponin I, Homocysteine, antithrombin III, protein S, & protein C levels. Initial X-ray chest showed left lower zone wedge shaped density. ECG showed sinus tachycardia. CT angiogram of chest showed bilateral pulmonary embolism (PE) and large left pleural effusion. Contrast CT abdomen showed bilateral iliac vein thrombus extending to lower inferior vena cava. Left pleural effusion was found to be grossly hemorrhagic. Patient was treated with low molecular weight heparin and warfarin. As thrombolysis was not feasible, he was advised to have thrombo-embolectomy. He refused surgical option and left hospital against medical advice. This case illustrates that multiple risk factors can be responsible for PE, and appropriate & timely interventions are always needed to prevent morbidity and or mortalityBangladesh Crit Care J March 2016; 4 (1): 46-50
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