Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population

BACKGROUND AND AIM

While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population.

METHODS

This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA.

RESULTS

Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the second week of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients.

CONCLUSIONS

The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Residual Level Of Deltamethrin Induced Gastritis And Preventive Role Of Curcumin On Stomach Mucosa

BACKGROUND

Benefits of Curcumin for health have been explained by different experimental models and clinical trials. It is a very potent antioxidant. Curcumin was found to play a preventive and curative role in both acute and chronic gastritis. Deltamethrin is a useful pesticide when applied with caution to crops. However, it also has noxious effects on gastric mucosa once ingested with sprayed crops. Its maximum permissible limit, MRL (Maximum Residual Level) as pesticide food residues is 5 mg/kg body weight as defined by WHO. However, there is still a potential to cause harm at these levels and maybe a serious potential health hazard. The present study aimed to: (a) determine the prevalence and severity of gastritis induced by deltamethrin when administered at MRL doses and (b) To observe the preventive effect on gastric mucosa against the action of Deltamethrin present as a residual pesticide in different vegetables and fruits.

METHODS

In this two-phase subacute toxicity study of seven weeks, forty Sprague Dawley rats were divided into eight subgroups. Control groups were kept on a normal diet and sesame oil. Out of the two treatment groups, one group was given deltamethrin (5 mg/kg body weight) orally along with curcumin 100 mg/kg body weight. The second group was first given deltamethrin (5mg/kg body weight) and curcumin (200mg/kg). All were culled at its end. The stomach samples were collected and processed to obtain histology slides for analysis via microscopy and micrometry. Grading was done to look for changes according to the "Visual Analogue Scale and Operative Link on Gastritis Assessment (OLGA)".

RESULTS

The experimental deltamethrin group when compared to control groups, revealed mild changes in stomach histomorphology while curcumin-treated both groups; Group D (100 mg/kg) and Group E (200 mg/kg) showed no changes.

CONCLUSIONS

Administration of Deltamethrin even in maximum residual dose (permissible) is proven to be toxic. Curcumin is hence proven to protect the gastric mucosa against the toxic effects of deltamethrin ingested in residual form.

Proximal Femur Histo-Morphological Changes Among Hip Fracture In Elderly Patients

BACKGROUND

Hip fracture causes high morbidity in elderly. Decreased bone mineral density is associated with hip fracture risks. The study is conducted to identify relationship of histomorphological changes in proximal femur in the cases of hip fractures in elderly with histomorphological changes in proximal femur.

METHODS

A total of 30 elderly patients with hip fracture were studied in this case series. The study was carried out in Orthopaedic and Pathology departments at Mardan Medical Complex from May 2014 to October 2014. Specimen during surgery, were collected for histopathological study.

RESULTS

Bone biopsy of hip fracture cases revealed cortical thinning, reduced number of osteocytes, thinning and fragmentation of trabeculae.

CONCLUSIONS

This study concluded that bone micro architectural changes seems to be associated with the risk of hip fracture.

A Comparison Of Skeletal Age Of Thalassaemic Patients Of 9-15 Years With Chronological Age By Radiography

BACKGROUND

Thalassemia is inherited disorder characterized by haemolytic anaemia, due to complete absence or reduced β-globin chain synthesis, stimulating pathological bone marrow overstimulation and altered erythropoiesis. The change in bone mass ultimately results into miss interpretation of bone age once assed from x-ray radiograph. The aims compare skeletal age of thalassaemic children of 9-15 years with chronological age by x-ray wrist bones.

METHODS

This was cross sectional analytical study; the study was conducted in conjunction with Fatimid Hospital Peshawar Pakistan and Out Patients Department (OPD) of paediatrics for minor illness (other than Thalassemia) Khyber Teaching Hospital August 2014 to January 2015. A total 156 samples were selected convenient sampling to make comparison of bone age and chronological age between thalassaemic children (age 9-15years) and age sex matched normal control. A structure data collection check list was used to collect data X-ray findings (bone age). SPSS 20 was used for statistical analysis.

RESULTS

The results showed a total of 156 children with their mean age 11.9±2.2, male were 97 (62.2%) and females 59 (37.8%). Out of thalassaemic (n=76) majority 49 (62.8%) were male as compared to female 29 (37.2%). The mean chorological age among both of group were not significantly different (p=0.67). However, the bone age was significantly different from each other (p=0001). Pearson's correlation analysis revealed that was strong correlation between erupt teeth and bone age (r=0.462, p=0.0001).

CONCLUSION

Skeletal age assessment was found to be suboptimal along with chronological age in children and adolescents suffering from thalassemia.

Scientific investigation of crude alkaloids from medicinal plants for the management of pain

BACKGROUND

Tissue damage is associated with pain, which is an alarming sign. Aspirin and morphine have been widely used in recent decades for management of pain. Medicinal herbs have been in use for treatment of different diseases for centuries. Many of these herbs possess analgesic activity with relatively less incidences of adverse effects. The strong positive correlation of alkaloids in medicinal plants for analgesic activity persuades an intention to determine possible analgesic activity of total alkaloids extracted from the selected medicinal plants using animal models to answer its possible mechanisms.

METHODS

Crude alkaloids from selected medicinal plants (Woodfordia fruticosa, Adhatoda vasica, Chenopodium ambrosioides, Vitex negundo, Peganum harmala and Broussonetia papyrifera) were extracted as per reported literature. The test crude alkaloids were screened foracute toxicity study. Writhings induced by acetic acid, tail immersion method and formalin-induced nociception assay procedures were used for possible analgesic effects of the crude alkaloids.

RESULTS

Crude alkaloids were safe up to dose of 1250 mg/kg body weight in mice. The alkaloids significantly reduced the abdominal constrictions, and increased the time for paw licking response in both phases with a significant raise in latency time in nociception models (P ≤ 0.05). Moreover, the antinociceptive response was significantly attenuated by pretreatment with naloxone suggesting involvement of the opioid receptors for possible antinociceptive action.

CONCLUSIONS

Crude alkaloids of Woodfordia fruticosa and Peganum harmala showed prominent analgesic potentials through inhibition of peripheral as well as central nervous system mechanisms. Further work is required for isolation of the pharmacologically active constituents.

Categorizing sugarcane cultivar resistance to the sugarcane aphid and yellow sugarcane aphid (Hemiptera: Aphididae)

Sugarcane (Saccharum spp.) in Louisiana is colonized by two aphid species, the sugarcane aphid, Melanaphis sacchari (Zehntner), and the yellow sugarcane aphid, Sipha flava (Forbes) (Hemiptera: Aphididae). The main problem associated with M. sacchari is transmission of sugarcane yellow leaf virus, a casual agent of yellow leaf disease whose absence has been added to certification standards for micropropagated sugarcane in Louisiana. Greenhouse studies were conducted to categorize dominant commercial sugarcane cultivars for their ability to tolerate aphid injury and to express antixenotic or antibiotic effects on both aphid species. Antixenosis tests showed no preference among cultivars by either aphid species. Loss of chlorophyll content in tolerance tests also did not show differences among cultivars for both aphid species. However, antibiosis tests revealed that life history parameters such as the duration of the reproductive period and fecundity of both aphid species were negatively affected on 'HoCP 91-555' compared with 'L 97-128'. Estimation of demographic statistics indicated that both aphid species exhibited a significantly lower intrinsic rate of increase (1.8-2.8-fold) and longer doubling time (1.7-3.1-fold) on HoCP 91-555 relative to L 97-128. From these tests, cultivars in the current study can be ranked from most to the least susceptible as L 97-128 > 'LCP 85-384' > 'HoCP 96-540' > 'Ho 95-988' > HoCP 91-555 for M. sacchari and L 97-128 > LCP 85-384 > HoCP 91-555 for S. flava. Therefore, antibiosis is an important category of resistance in sugarcane to both aphid species, and HoCP 91-555 might provide useful germplasm for developing aphid resistant cultivars.

Impact of Hurricane Rita storm surge on sugarcane borer (Lepidoptera: Crambidae) management in Louisiana

Twelve thousand to 16,000 ha of Louisiana sugarcane (Saccharum spp.) fields were flooded by saltwater from the Hurricane Rita storm surge in September 2005. A four treatment, 12-replication study comparing storm surge flooded and nonflooded plant and ratoon sugarcane fields was conducted during summer 2006 to assess sugarcane borer, Diatraea saccharalis (F.), pest severity, pest control actions, and soil-associated arthropod abundance and diversity. Even with a significant 2.4-fold increase in the average number of insecticide applications used for D. saccharalis management in flooded fields, growers still incurred higher injury. A significant 2.8-fold reduction in the predaceous red imported fire ant, Solenopsis invicta Buren, was associated with the storm surge, whereas no reduction in abundance of other soil-associated arthropods was recorded. Arthropod diversity measured by the Shannon diversity index significantly increased by a factor of 1.3 in sugarcane fields flooded by the storm surge. Increase in D. saccharalis pest severity associated with the storm surge caused an estimated loss in revenue between $1.9 and $2.6 million to the Louisiana sugarcane industry for the 2006 production season.

Selection and life history traits of tebufenozide-resistant sugarcane borer (Lepidoptera: Crambidae)

Varying susceptibility to tebufenozide was recorded in the sugarcane borer, Diatraea saccharalis (F.) (Lepidoptera: Crambidae), collected from Louisiana sugarcane locations with different selection pressures. Results from diet incorporation bioassays with tebufenozide indicated significant increases in LC50 (3.78-fold) and LC90 (7-fold) values for a colony from Duson (DU), an area with higher selection pressure, compared with a colony from Alexandria (ALEX), an area with no selection pressure. Differences were not detected in LC50 values among colonies from areas where use of tebufenozide was discontinued or rotated with other chemistries. Selections with tebufenozide of DU larvae over 12 generations resulted in a highly resistant colony (DU-R) with 27.1- and 83.3-fold increases in LC50 and LC90 values, respectively. Comparison of pupal weight, days to pupation, and emergence after exposure to an equitoxic (LC20) concentration of tebufenozide revealed a decrease in pupal weight (34 and 33% for males and females, respectively), and an increase in days to pupation (47 and 40% for males and females, respectively), and emergence (43 and 33% for males and females, respectively) for the DU-R colony compared with the parent DU colony. Fecundity of DU-R females decreased to 72 eggs per female compared with 180 (DU) and 261 (ALEX). Egg viability of the ALEX and DU colonies was 61 and 56%, respectively, whereas only 27% of eggs laid by females from the DU-R colony hatched. These results are discussed in terms of their practical implications for control of D. saccharalis in Louisiana sugarcane.

Reduced susceptibility to tebufenozide in populations of the sugarcane borer (Lepidoptera: Crambidae) in Louisiana

Susceptibility of the sugarcane borer, Diatraea saccharalis (F.), to tebufenozide was measured using a feeding bioassay, and values obtained were compared with baselines generated before the use of this insecticide in Louisiana sugarcane, Saccharum spp. Results from our study suggest that susceptibility to tebufenozide is decreasing in field-collected sugarcane borers. Inflections in the log dosage-probit lines were detected for many of the field collections, indicating increased heterogeneity within these populations in response to tebufenozide. Where appropriate, probit transformation was used to estimate susceptibility, and significant differences (1.6 - 2.7-fold) were measured in LC50 values between some field-collected cohorts and the previously measured baseline. In addition, a discriminating concentration (0.5 ppm) was used to estimate resistance frequencies in cohorts for which probit transformation was not appropriate. Results from these tests suggest that frequencies of resistance were high (49% in one cohort) in populations from some locations. Lighter weight pupae of the survivors from one of the more resistant cohorts suggests that tebufenozide resistance mechanisms may have a biological cost in terms of ecological fitness at early stages of resistance development. As a result of continued resistance monitoring, alternation of management chemistry is expected to help preserve this valuable sugarcane integrated pest management tactic.