A new prognostic scoring system for perforation peritonitis secondary to duodenal ulcers.

OBJECTIVE: To identify prognostic factors for perforated duodenal ulcers and to devise and assess a new scoring system. METHODS: The observational prospective study was conducted at the Mayo Hospital, Lahore in two phases: from March 2010 to September 2011; and from October 2011 to July 2012. It included patients with duodenal ulcer perforation who were observed for identifying factors predicting 30-day prognosis. Each of the predictive factor was given a score based on its severity to devise a new scoring system. Chi-square was used for univariate analysis. Multivariate analysis was done using forward stepwise regression. Accuracy of the new scoring system was calculated using receiver operating curve analysis and its validity was evaluated in the second phase of the study. RESULTS: Predictors of poor prognosis included multiple gut perforations, size of largest perforation >0.5cm, amount of peritoneal fluid >1000ml, simple closure, development of complications, post-operative systemic septicaemia and winter/autumn season of presentation. Overall 30-day mortality rate was 32.3% (n=32) and morbidity rate was 21.2% (n=21). The mean score was higher in the ones with poor prognosis (p=0.001). Similarly, the mean score was greater in those with grave prognosis (p=0.001). The scoring system had an overall sensitivity of 85.12% and specificity of 80.67% and was favourably comparable to other scoring systems. CONCLUSION: The new scoring system is a useful tool in predicting 30-day prognosis for perforated duodenal ulcers in acid peptic disease.

Safety and effectiveness of biphasic insulin aspart 30 (Biasp 30) in people with type 2 diabetes mellitus in the pakistani population: results from the A1chieve study.

OBJECTIVE: To explore the safety and effectiveness of treatment with the insulin analogue, biphasic insulin aspart 30 (BIAsp 30), in people with type 2 diabetes mellitus (T2DM) in a subgroup of a Pakistani population from the A1chieve study. METHODS: A1chieve was a 24-week, international, prospective, multicentre, open label, observational, non-interventional study designed to evaluate the safety and clinical effectiveness of 66,726 people with T2DM who were initiated with basal insulin detemir, fast actinginsulin aspart, and BIAsp 30 (30% soluble insulin aspart, 70% protamine-crystallized insulin aspart). The study was conducted in 28 countries across Asia, Africa, Latin America, and Europe. Here, we report data from a subgroup of 762 people with T2DM from the Pakistani cohort (insulin naïve and insulin users) who were treated withpremix insulin (BIAsp 30) +/- oral antidiabetic drugs (OADs). RESULTS: The decrease in HbAlc at week 24 was statistically significant in the entire cohort, the insulin naïve, and insulin users (1.7 +/- 1.1%, 1.8 +/- 1.3% and 1.7 +/- 0.9%, respectively, p<0.001 for all).There was a statistically significant decrease in the mean fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) from baseline toweek 24 in the entire cohort, in the insulin naïve and in the insulin users with BIAsp 30 treatment (p<0.001 for all).No major hypoglycaemic events were reported during the entire study period. There was a statistically significant decrease in the systolic blood pressure (SBP) in all groups (p<0.001). The improvement in the quality of life score (QoL)was statistically significant in all groups (p<0.001 for all). CONCLUSION: BIAsp 30 treatment appeared to be well tolerated and effective as indicated byimproved glycaemiccontrol and QoL in people with T2DM in the Pakistani population after 24 weeks.

Formulation and characterization of Anacyclus Pyrethrum Emulgels and its in vitro and in vivo evaluation as cosmeceutical product.

BACKGROUND: Plants containing high phenolic and flavonoids contents used widely as antioxidant agent by reducing skin photo damaging effects and play important role in skin rejuvenating. AIMS: This study was performed to explore the cosmetic effects of Anacyclus Pyrethrum extract and to develop stable oil in water (O/W) emulsion base gel loaded with Anacyclus Pyrethrum 10% extract. OBJECTIVE: To explore and quantify phenols and flavonoids present in Anacyclus Pyrethrum extract and determine its cosmetic effects on human skin. METHOD: Emulgel formulation were developed by mixing o/w emulsion with carbopol gelling agent loaded with Anacyclus Pyrethrum (AP) extract and base gel without AP extract. In vitro study was done for the evaluation of color change, liquefaction, hardness, and pH change at different storage condition for the duration of 12 weeks. For in vivo study, emulgel applied on 13 healthy human volunteer's cheeks to evaluate its cosmetics effects and compared with placebo (base). Facial parameters including skin melanin, redness, sebum, moisture content, and skin elasticity were determined by using mexameter, sebumeter, corneometer, elastometer for the study duration of 12 weeks. RESULTS: Total phenolic content in Anacyclus Pyrethrum extract was 80.04 ± 0.0043 mg GAE/g, and flavonoids were 54.64 ± 0.0076 mg QE/g. Anacyclus Pyrethrum extract found significantly effective in reducing skin photo-damage effects (p ≤ 0.05) as compared base gel. CONCLUSION: Anacyclus Pyrethrum extract being rich source of flavonoid and phenolic content, acts as strong antioxidant to protect skin against photo-damaging effect and improve skin conditions.

Iatrogenic post biopsy hemobilia with pseudoaneurysm.

Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct. It is an uncommon cause of upper gastrointestinal hemorrhage and iatrogenic most of the times. We report a case of hemobilia secondary to percutaneous liver biopsy presenting with classical Quincke's triad in a young lady which was treated with combined biliary balloon sweep thrombectomy and transarterial embolization for complete resolution of symptoms.

Time for change: conventional interferon regimes should not be the standard of care for management of Pakistani genotype-3 in chronic hepatitis C.

The aim of the present study was to determine the efficacy and side effect profile of conventional interferon alpha-2b plus ribavirin for treating chronic hepatitis C genotype-3 infections in Pakistan. The study was conducted on treating 220 treatment-naïve individuals at KRL Hospital with conventional interferon given for 6 months. Both the response and side effects were analyzed using simple descriptive statistics. Out of total cohort, 84.92% (169 out of 199) achieved end of treatment response (ETR) while 63.31% (126 out of 199) achieved sustained virological response (SVR). Leukopenia, gastrointestinal and miscellaneous systemic complaints were the most common adverse effects. In the context of a low ETR and SVR but a similar side effect profile as that of pegylated regimes, conventional therapy needs to be replaced with peg-interferon as the treatment of choice.

Diffuse large B-cell lymphoma of stomach presenting with paraneoplastic cerebellar degeneration syndrome.

Paraneoplastic syndromes are most often diagnosed in the setting of a known malignancy. It is not uncommon for a paraneoplastic disorder to develop before a cancer is identified. While syndrome of cerebellar degeneration has been identified as a paraneoplastic manifestation of Hodgkin's lymphoma, thymoma, lung and breast cancer, ovarian and testicular tumors, melanoma, renal cell carcinoma, follicular lymphoma and adenocarcinoma of stomach, its association with non-Hodgkin's lymphoma and particularly diffuse large B-cell lymphoma has not been established previously. This case report describes the primary presentation with signs of paraneoplastic cerebellar degeneration as the only manifestation of an underlying diffuse large B-cell lymphoma making it the first of its kind to be formally reported. Furthermore, it also includes the identification of associated paraneoplastic antibodies for this particular syndrome.