Clinical efficacy and safety of a new 1000-mg suspension versus twice-daily 500-mg tablets of MPFF in patients with symptomatic chronic venous disorders: a randomized controlled trial

BACKGROUND

Chronic venous disorders (CVD) is estimated to affect 30% to 50% of women and 10% to 30% of men. The most widely prescribed treatment for CVD worldwide is micronized purified flavonoid fraction 500 mg (MPFF). The aim of this clinical trial was to develop a new once daily 1000-mg oral suspension of MPFF.

METHODS

In an international, randomized, double-blind, parallel-group study, symptomatic individuals classified CEAP C0s to C4s were randomized in either treatment arm and treated for 8 weeks. Lower limb symptoms (discomfort, pain and heaviness) were assessed using Visual Analog Scales (VAS), and quality of life (QoL) was measured with the CIVIQ-20 Questionnaire.

RESULTS

A total of 1139 patients were included in the study. Both MPFF treatment regimens were well tolerated and associated with a significant reduction in lower limb symptoms. A non-inferiority of MPFF 1000-mg oral suspension once daily compared to MPFF 500-mg tablet twice daily (P<0.0001) was found for lower limb discomfort (-3.33 cm for MPFF 1000 mg and -3.37 cm for MPFF 500 mg), leg pain (-3.27 cm for MPFF 1000 mg and -3.31 cm for MPFF 500 mg) and leg heaviness (-3.41 cm for MPFF 1000 mg and -3.46 cm for MPFF 500 mg). The patients' QoL was improved by about 20 points on the CIVIQ scale in both groups (19.33 points for MPFF 1000 mg and 20.28 points for MPFF 500 mg).

CONCLUSIONS

MPFF 1000-mg oral suspension and MPFF 500-mg tablets treatments were associated with similar reductions in lower limb symptoms and QoL improvement. The new once daily MPFF1000-mg oral suspension has a similar safety profile to two tablets of MPFF 500 mg, with the advantage of one daily intake, potentially associated with improved patient adherence and easier CVD management.

MMP-9: biomarker for abdominal aneurysm

INTRODUCTION

Matrix Metalloproteinase 9 (MMP-9) has been shown to express significantly on organ tissue culture in Abdominal Aortic Aneurysm (AAA) patients. Prior studies have shown the correlation between MMP-9 concentration levels with AAA raising the probability of its usage as a biomarker in AAA disease. However, results of previous studies have been conflicting. The purpose of this study is to identify the correlation between MMP-9 concentration levels with AAA disease and further define the utility as a biomarker for our center population.

MATERIALS AND METHODS

This is prospective controlled trial. Peripheral venous blood sample is obtained from 20 patients with AAA and 36 normal control subjects. MMP-9 concentration levels were determined by an enzyme-linked immunosorbent assay and compared with subjects abdominal ultrasonography or computed tomography of abdomen.

RESULTS

Mean (± SE) MMP-9 was 23.94 ± 0.60 ng/mL in normal control subjects and 21.39 ± 1.03 ng/mL in patients with AAAs (p ← 0.05 versus normal control subjects). MMP-9 correlate significantly with AAA (p=0.004). There was no correlation of MMP-9 levels with age, gender, or other risk factors. The cutoff point is 12.54 for aorta size <3.0 cm. The sensitivity and specificity of MMP-9 were 60% and 64% respectively.

CONCLUSIONS

MMP-9 levels correlate significantly with AAA with a cutoff point of 12.54. However, the utility of MMP-9 as a diagnostic test is limited due to low sensitivity and specificity. An elevated MMP-9 has limited use to predict the presence of AAA (positive predictive value: 60%) and a normal MMP-9 level was insufficient to determine the absence of AAA (negative predictive value: 36.1%).

Persistent Mullerian Duct Syndrome: an interesting case report

Transverse testicular ectopia is an uncommon disorder of testicular ectopia. Nearly thirty percent of the cases is associated with Persistent mullerian duct syndrome which is characterized by karyotypically normal males with retained mullerian derivatives. Understanding the natural process of the condition and the association with malignant potential will allow for a better understanding of the optimal surgical approach. This is a case report of young male presented a left sided inguinal hernia in which the sac contained both testes and uterus. The literature review of the syndrome will be discussed.

Misdiagnosed infected aneurysm presenting as pyrexia of unknown origin (PUO)

Infected aneurysm is a life threatening clinical condition that is associated with significant morbidity and mortality. Early detection is essential for a rapid and efficacious initial treatment for better prognosis. Since the introduction of antibiotic therapy and concomitant decline of endocarditis, true mycotic aneurysms are rarely seen. The usual treatment consists of antibiotics along with aggressive surgical debridement of the infected tissue and vascular reconstruction, if needed. We here describe an infected aneurysm presenting as pyrexia of unknown origin and discuss the clinical features and challenges encountered in the treatment.

Iatrogenic inguinal chyle fistula: a rare case report

Chyle fistula may be common in the neck and thorax region but it is a rare entity in the inguinal region. The rarity of the incidence of chyle fistula and the tremendous response to conservative management are the important aspects to be remembered. We hereby report a case of iatrogenic inguinal chyle fistula complicating a femoral vein cannulation.

Clinical and endoscopic features of peptic ulcer bleeding in Malaysia

The characteristics of patients and the endoscopic features of 196 patients with bleeding peptic ulcer in a multi-ethnic population were investigated. There was a male preponderance (M: F= 6.3: 1) and their mean age was 63.5 years. The prevalence of peptic ulcer bleeding in the Malays and Indians was similar to the ethnic distribution of population. However, the Chinese were over represented. Nearly 40% of patients studied had at least one co-existing medical illness. Hypertension and ischaemic heart disease were the most common diseases. History of non-steroidal anti-inflammatory drug usage was identified in 48% of the patients and it was the commonest risk factor associated with bleeding ulcers. More than 80% of bleeding ulcers were located in the duodenum and the pylorus. Endoscopic features of active bleeding or recent bleed were identified in more than 60% of the patients. The study notes that bleeding peptic ulcer is a serious and a potentially life threatening condition. It is a disease of the elderly and, with the steadily increasing elderly population in the country, the admissions rates of peptic ulcer bleeding is expected to rise. There is a need to plan for appropriate technical support, critical care facilities and expertise to avoid unacceptable outcomes.

Bleeding peptic ulcer: experience with endoscopic therapy

Bleeding is a serious complication of peptic ulcer and mortality rate has remained at approximately 10% or more. Traditionally surgeons selected patients who were at significant risk of continued or re-bleeding and advocated early surgery. However, patients with bleeding peptic ulcers are generally elderly with coexisting medical illness and surgery results in significant morbidity and mortality. In the last decade, endoscopic haemostatic therapy has been effective in arresting the bleeding with surgical option considered only after endoscopic treatment has failed. We report the outcome of 196 patients who were endoscopically diagnosed to have bleeding from peptic ulcers. One hundred and thirty patients were to have active bleeding or recent bleed from the ulcer. Endoscopic adrenaline injection therapy was used in 53 patients who had active bleeding ulcers and another 77 patients with endoscopic evidence of recent bleed. The injection therapy was successfully in 127 (97.7%) patients. The treatment failed in three patients and they underwent urgent surgery. Re-bleeding occurred in 26 (20.5%) patients and endoscopic adrenaline therapy was repeated in these cases. Haemostatic was achieved in 19 patients, however 7 patients continued to bleed and required surgery. There were 3 deaths, principally from advanced age and coexisting medical illness. Endoscopic therapy for bleeding peptic ulcers is simply to apply, safe and effective. In cases of re-bleeding after initial endoscopic hemostasis, re-treatment is a preferable alternative to surgery. The role of surgery is limited to bleeding that is refractory or inaccessible to endoscopic control.