Therapeutic efficacy and drug safety comparison of one-week Vonoprazan triple therapy with two-weeks Esomeprazole triple therapy in Helicobacter pylori infection: Findings from a single-centre randomized clinical trial in population of Pakistan.

OBJECTIVE: To compare the therapeutic efficacy and drug safety of Vonoprazan and Esomeprazole triple therapies in Helicobacter pylori infection. METHODS: The randomised clinical trial was conducted from December 2022 to January 2023 at the Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan, in collaboration with the Gastroenterology Department of Pak Emirates Military Hospital, Rawalpindi, and comprised patients found positive for Helicobacter pylori by stool antigen test. They were randomly distributed into two groups. The EAL group received twoweek triple therapy with Esomeprazole 20mgand Amoxicillin 1000mg twice daily with Levofloxacin 500mg once daily. The VAL group was prescribed one-week triple therapy with Vonoprazan 20mg and Amoxicillin 1000mg twice daily with Levofloxacin 500mg once daily. Eradication success was evaluated by stool antigen test 4 weeks after starting the treatment. Safety of the therapy was assessed by noting adverse effects at days 3 and 14 of the treatment. Data was analysed using SPSS 27. RESULTS: Of the 122 patients, there were 61(50%) in each of the 2 groups; 30(49.2%) males and 31(50.8%) females with mean age 38.40±12.25 years in group EAL, and 35(57.4%) males and 26(42.6%) females with mean age 40.98±12.13 years in VAL group. In the EAL group, 57(93.4%) patients were found to be free of Helicobacter pylori infection compared to 58(95%) in the VAL group. Nausea 14(23%), bitter taste 41(67.2%), abdominal pain 16(26.2%) and headache 20(32.8%) were the adverse effects that were significantly more common in the EAL group compared to the VAL group B. CONCLUSIONS: Vonoprazan-based triple therapy was found to be more effective with less reported adverse effects and potential benefits of better patient compliance due to shorter therapy duration. Clinical Trial Number: Iranian Registry of Clinical Trials: IRCT20221207056738N1.

Argon plasma coagulation: an effective treatment for solitary rectal ulcer syndrome.

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy. OBJECTIVES: Determine the efficacy of APC treatment for patients suffering from SRUS. DESIGN: Prospective, single center. SETTINGS: Gastroenterology department at a military hospital in Pakistan. PATIENTS AND METHODS: This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment. MAIN OUTCOME MEASURES: Effectiveness of APC for resistant SRUS. SAMPLE SIZE: 99 patients. RESULTS: The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications. CONCLUSION: APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients. LIMITATIONS: Single centered.

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison With Endoscopic Retrograde Cholangiopancreatography for Detection of the Etiology of Obstructive Jaundice.

BACKGROUND: Despite technological advances, obstructive jaundice has significant morbidity and mortality rates. When studying obstructive jaundice, endoscopic retrograde cholangiopancreatography (ERCP), the "gold standard" for biliary obstruction identification, might be replaced with magnetic resonance cholangiopancreatography (MRCP), which is a non-invasive procedure. OBJECTIVE: Diagnostic accuracy of MRCP in comparison with ERCP for the detection of the etiology of obstructive jaundice. METHODOLOGY: This prospective, observational study included 102 patients who presented with obstructive jaundice as proven by liver function tests. The MRCP was conducted within 24 to 72 hours before the ERCP. A torso phased-array coil (Siemens, Germany) was used for the MRCP. The duodeno-videoscope and general electric fluoroscopy were used to perform the ERCP. The MRCP was evaluated by a classified radiologist who was blinded to the clinical details. An experienced consultant gastroenterologist who was blinded to the results of the MRCP assessed the cholangiogram of each patient. The hepato-pancreaticobiliary system results from both procedures were compared based on the pathology observed, such as choledocholithiasis, pancreaticobiliary strictures, and dilatation of biliary strictures. We determined the sensitivity, specificity, and negative and positive predictive values with 95% confidence intervals. The statistical significance was set at p<0.05. RESULTS: The most commonly reported pathology was choledocholithiasis, and MRCP diagnosed 55 patients, of which 53 were true positive cases when compared with the ERCP results of the same patients. MRCP demonstrated greater sensitivity and specificity (respectively) for screening choledocholithiasis (96.2, 91.8), cholelithiasis (100, 75.8), pancreatic duct stricture (100, 100), and hepatic duct mass (100, 100) and showed statistically significant values. The sensitivity of MRCP is lower for identifying benign and malignant strictures, but its specificity was observed to be reliable. CONCLUSION: When it comes to determining the severity of obstructive jaundice, both in its early and later stages, the MRCP technique is widely regarded as a reliable means of diagnostic imaging. The diagnostic function of ERCP has been significantly reduced as a result of the precision of MRCP as well as its non-invasive nature. In addition to being a helpful non-invasive method to identify biliary diseases and avoid unnecessary ERCPs and their risks, MRCP offers good diagnostic accuracy for obstructive jaundice.

Efficacy And Cost-Effectiveness, Comparison Of 7-Days Vonoprazan Versus 14-Days Esomeprazole Based Triple Therapies For Treating Helicobacter Pylori Infection In Pakistani Population: A Randomized Clinical Trial.

Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium which usually resides in the mucoid lining of the stomach and may cause different gastric pathologies e.g., Gastritis, peptic ulcer disease, adenocarcinoma of the gastric system and mucoid associated lymphoma (MALT). The Objective was to compare the effect of 7-days Vonoprazan based triple therapy and 14-days Esomeprazole based triple therapy on eradication rate, compliance and cost effectiveness in Helicobacter pylori infected patients. Methods: This clinical trial was performed in the Department of Pharmacology Army Medical College, National University of Medical Sciences (NUMS) in collaboration with the Gastroenterology Department, Pak Emirates Military Hospital (PEMH) Rawalpindi from December 2022 to March 2023. A total of one hundred and twenty-two patients with dyspepsia symptoms and yielding lab results positive for Helicobacter pylori by stool antigen test were enrolled in the study. They were randomly allocated into two groups. The Esomeprazole group received 14 days of triple therapy orally with Esomeprazole 20 mg twice a day; Amoxicillin 1000 mg twice a day; and Levofloxacin 500 mg one time a day. The comparative Vonoprazan group was given 7-days triple therapy orally with Vonoprazan 20 mg twice a day; Amoxicillin 1000 mg twice a day; and Levofloxacin 500 mg one time a day. Eradication success was evaluated by stool antigen test four weeks later, as counted from the start of treatment. compliance and cost-effectiveness of both therapies were also assessed. Results: The eradication rate was (95.1%) in the Vonoprazan group with 58 out of 61 patients negative for H. pylori and (93.1%) in Esomeprazole group with 54 patients out of 58 yielding a negative result demonstrating p-value of 0.64. Compliance was 95.0% in the Esomeprazole group with p-value of 0.07. Cost effective ratio for Vonoprazan triple therapy was lower (731.8PKR) than the Esomeprazole group. Conclusion: One two-week Vonoprazan regimen demonstrated improved eradication rate, good compliance, and better tolerability in patients with less cost and a half duration of treatment in comparison with two weeks Esomeprazole regimen, attesting that one week Vonoprazan therapy is more cost efficacious in producing better results.

Vitamin D deficiency in patients with tuberculosis.

OBJECTIVE: To determine the frequency and association of Vitamin D deficiency in patients with tuberculosis. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Medical Department, Combined Military Hospital, Kharian, from July 2010 to June 2012. METHODOLOGY: One hundred and five outdoor patients of tuberculosis were selected with 255 gender matched controls. Tuberculosis was diagnosed by presence of acid fast bacilli in sputum smears, positive culture for Mycobacterium tuberculosis or demonstration of chronic caseating granulomatous inflammation in tissue specimens. Controls were drawn randomly from general population. Serum 25 hydroxyvitamin D [25 (OH) D3] levels < 25 ng/ml was considered Vitamin D deficiency. The results were analyzed on SPSS version 17. RESULTS: Mean Vitamin D levels were 23.23 ± 6.81 ng/ml in cases, 29.27 ± 8.89 ng/ml in controls (p < 0.0001). Vitamin D deficiency was found in 57% of cases and 33% controls (p < 0.0001). Mean Vitamin D levels were significantly lower in females with tuberculosis (20.84 ng/ml) as compared to males (25.03 ng/ml, p = 0.002). Mean BMI in patients of tuberculosis with Vitamin D deficiency were 19.51 ± 1.77 kg/m2 and in patients with normal Vitamin D were 21.65 ± 1.79 kg/m2 (p < 0.0001). Mean Vitamin D levels in patients with multi-drug resistant tuberculosis was lower to a mean of 15.41 ± 4.67 ng/ml (p < 0.0001). CONCLUSION: There is significant deficiency of Vitamin D in patients with tuberculosis as compared to controls. This deficiency is more pronounced in females, individuals with low BMI, extra pulmonary and MDR tuberculosis.

Creutzfeldt Jakob disease.

A case of 50 years of age, male with sporadic Creutzfeldt Jakob Disease (sCJD) is reported. Patient had dementia, behavioural abnormalities, unsteady gait and myoclonic jerks. Magnetic resonance imaging (MRI) brain T2 weighted and Fluid Attenuated Inverse Recovery (FLAIR) images showed abnormally increased signal intensity in caudate nucleus and putamen. Scalp electroencephalogram (EEG) revealed periodic synchronous biphasic sharp wave complexes. On the basis of history, clinical findings, typical MRI brain and EEG changes, diagnosis of sporadic CJD was made.

Highland malaria occurring on Siachen Glacier, Pakistan.

A case of plasmodium vivax malaria presenting at very high altitude of 16,900 feet (5151 meters) is reported. This is the first case of its kind to be observed from such a high altitude from Pakistan.