Real-world comparison of terlipressin vs. octreotide as an adjuvant treatment in the management of variceal bleeding

Variceal bleeding is a major complication and the leading cause of death in patients with cirrhosis and portal hypertension. This study aims to compare the efficacy and safety of terlipressin vs octreotide as an adjuvant to endoscopic management of patients with esophageal variceal bleeding in a real-time scenario. We reviewed the medical records of patients with esophageal variceal bleeding from January 2005 to December 2020 at our tertiary care Aga Khan University Hospital. Mortality was assessed after 6 weeks. A total of 842 patients with variceal bleed were evaluated. 624 patients (74.1%) and 218 patients (25.9%) received Terlipressin and Octreotide respectively. On multiple regression analysis, cardiac events during hospital stay (OR: 11.22), presence of Porto-systemic encephalopathy (OR: 3.79), and elevated bilirubin levels at the time of presentation were found to be independent risk factors for increased six weeks mortality. Moreover, cardiac events during hospital stay (OR: 3.26), Porto-systemic encephalopathy at presentation (OR: 3.06), and octreotide administration (OR: 1.80) were identified as independent risk factors for increased length of hospital stay. Terlipressin and Octreotide have similar outcomes in terms of control of bleeding, hospital stay, mortality, and side effects when used as adjuvant therapy for the management of variceal bleeding.

New record of Philometra species from the marine edible fish Terapon jarbua collected from the Sindh, Arabian Sea, Pakistan

Diseases in fish due to helminth parasites, especially Philometra species, are the primary worry in aquaculture. Philometra are responsible for health problem in fishes they directly affect fish growth and population parameters. A comprehensive survey was conducted involving the examination of the marine fish species Terapon jarbua, gathered from the coastal waters of Sindh, Pakistan In this research different Philometra species from marine fish Terapon jarbua during 2021 and 2022. Philometra nematodes, belonging to the family Philometridae, are common parasitic organisms inhabiting both marine and freshwater environments. Their prevalence, particularly when existing in high numbers within host organisms, can lead to severe and potentially lethal consequences. Employing light microscopy techniques, diverse species of Philometra were identified, including Philometra teraponi, P. jarbuai, P. arabiai, P. karachii, and P. awarii, localized primarily within the ovaries of the host fish. A total of 140 fish samples were examined and 76 were infected. The intensity of infected fish was 54.28%. The identification process encompassed meticulous analysis of crucial parameters, such as body size, esophagus length, positioning of the nerve ring, dimensions of the ventriculus, and ligament size. Intriguingly, the parasites were found in varying contexts; while some were free within the ovaries, others were embedded within tissues, inducing severe muscular dystrophy. This research presents novel findings of Philometra nematodes in the marine waters of Pakistan, extending their host and geographical distribution records. Future studies are needed to better evaluate and describe the dynamics and the epidemiology of Philometra infection in wild and cultured fish species.

Efficiency of nitrogen, gibberellic acid and potassium on canola production under sub-tropical regions of Pakistan

The global demand for crop production is rapidly growing due to the continued rise in world population. Crop productivity varies generally with soil nutrient profile and climate. The optimal use of fertilizers might help to attain higher crop yield in canola. To circumvent nutrient imbalance issues in soil, two separate field trials were conducted to determine (a) the best source of nitrogen (N) between ammonium sulfate (NH4)2SO4) and ammonium nitrate (NH4NO3), (b) significance of gibberellic acid (GA3) and potassium (K), in an attempt to enhance canola yield and yield attributes. Both experiments were carried out in randomized complete block design (RCBD) with three replicates. The nitrogen source in the form of NH4)2SO4 (0, 10, 20 and 30 kg/ha) and NH4NO3 (0, 50, 75 and 100 kg/ha) was applied in the rhizosphere after 3 and 7 weeks of sowing, referred to as experiment 1 (E1). In another separate experiment (E2), the canola crop was sprayed with four level of GA3 (0, 10, 15, 30 g/ha) and K (0, 2.5, 3.5, 6 g/ha) individually or in combination by using hydraulic spryer, 30 days after sowing (DAS). The data was collected at different growth stages of canola and analyzed statistically. The E1 trail showed that N fortification in the form of NH4NO3 (100 kg/ha) and (NH4)2SO4 (30 kg/ha) had a positive effect on the plant height, number of branches, fruiting zone, seed yield per plant, seed yield per hectare of canola except oil percentage. Moreover, canola plants (E2) also displayed a significant improvement on all studied features with high doses of GA3 (30 g/ha) and K (6 g/ha) individualy and in combined form. The correlation coefficient analysis of (NH4)2SO4 and NH4NO3 was highly significant to plant height, number of branches, fruiting zone, seed yield per plant, seed yield per hectare of canola In a nutshell, compared to both source of N, NH4NO3 was more efficient and readily available source of N. GA3 being a growth elicitor and potassium as a micronutrient serve as potential source to improve yield and to manage nutrient profile of canola.

1123 An Audit of Pick-Up Rate of Random Colonic Biopsies

Aim

We aimed to evaluate optimal random biopsy criteria are being followed in our institution to increase the diagnostic yield of a subsequent histopathological examination and to reduce the number of unnecessary biopsies in which histopathology is unlikely to deliver clinically useful information and causing a burden on health resources in terms of cost and manpower.

Method

Our study was a retrospective on 419 random colonoscopy biopsies performed over 6 months. Data collection included variables such as age, gender, indications, request of urgency, and histology findings. Data analysis was done descriptively.

Results

Out of 419 random biopsies, only 10.02% had positive findings. The total number of histology results with microscopic colitis was 10. The main indication of the random colonic biopsy was a change in bowel habits (328 cases) followed by significant diarrhea greater than 50 years in 20 cases. In patients with a change in bowel habits, 2.44% of histopathology specimens revealed microscopic colitis. The percentage of random colonic biopsy histology in patients greater than 50 years with significant diarrhea showed microscopic colitis was 10%.

Conclusions

Our study revealed random biopsy during colonoscopy should only be done in selected patients otherwise it has low diagnostic yields biopsy and should only be reserved for patients with risk factors for optimum utilization of health resources and to reduce the cost burden. A scoring system may be helpful to risk-stratify patients in low and high risk for MC to determine which patients qualify for RCB.

The Phytogeographic History of Common Walnut in China

Common walnut (Juglans regia L.) is an economically important hardwood tree species cultivated worldwide for its high quality wood and edible nuts. It is generally accepted that after the last glaciation J. regia survived and grew in almost completely isolated stands in Asia, and that ancient humans dispersed walnuts across Asia and into new habitats via trade and cultural expansion. The history of common walnut in China is a matter of debate, however. We estimated the genetic diversity and spatial genetic structure of 31 walnut populations sampled across its Chinese range using 22 microsatellite markers (13 neutral and 9 non-neutral). Using historical data and population genetic analysis, including approximate Bayesian analysis (ABC), we reconstructed the demographic history of J. regia in China. The genetic data indicated the likely presence of J. regia in glacial refugia in the Xinjiang province (Northwest China), Northeastern China (Beijing, Shandong, and Changbai Mountains), Central China (Qinling and Baishan Mountains and Xi'an), and Southwestern China (Tibet, Yunnan, Guizhou, and Sichuan provinces). Based on DIY-ABC analysis, we identified three ancient lineages of J. regia in China. Two lineages (subpopulation A and subpopulation B+C) diverged about 2.79 Mya, while Southwestern China, and Qinling and Baishan Mountains lineages diverged during the Quaternary glaciations (about 1.13 Mya). Remnants of these once-distinct genetic clusters of J. regia may warrant ecological management if they are to be retained as in situ resources. A population size expansion in Northeastern China was detected in the last five centuries. The present distribution of walnut in China resulted from the combined effects of expansion/contraction from multiple refugia after the Last Glacial Maximum and later human exploitation.

Impacts of Cropping Systems on Aggregates Associated Organic Carbon and Nitrogen in a Semiarid Highland Agroecosystem

The effect of cropping system on the distribution of organic carbon (OC) and nitrogen (N) in soil aggregates has not been well addressed, which is important for understanding the sequestration of OC and N in agricultural soils. We analyzed the distribution of OC and N associated with soil aggregates in three unfertilized cropping systems in a 27-year field experiment: continuously cropped alfalfa, continuously cropped wheat and a legume-grain rotation. The objectives were to understand the effect of cropping system on the distribution of OC and N in aggregates and to examine the relationships between the changes in OC and N stocks in total soils and in aggregates. The cropping systems increased the stocks of OC and N in total soils (0–40 cm) at mean rates of 15.6 g OC m^-2 yr^-1 and 1.2 g N m^-2 yr^-1 relative to a fallow control. The continuous cropping of alfalfa produced the largest increases at the 0–20 cm depth. The OC and N stocks in total soils were significantly correlated with the changes in the >0.053 mm aggregates. 27-year of cropping increased OC stocks in the >0.053 mm size class of aggregates and N stocks in the >0.25 mm size class but decreased OC stocks in the <0.053 mm size class and N stocks in the <0.25 mm size class. The increases in OC and N stocks in these aggregates accounted for 99.5 and 98.7% of the total increases, respectively, in the continuous alfalfa system. The increases in the OC and N stocks associated with the >0.25 mm aggregate size class accounted for more than 97% of the total increases in the continuous wheat and the legume-grain rotation systems. These results suggested that long-term cropping has the potential to sequester OC and N in soils and that the increases in soil OC and N stocks were mainly due to increases associated with aggregates >0.053 mm.

Treatment of advanced chemo-refractory epithelial ovarian cancer with aromatase inhibitor

e16561

Background: In advanced epithelial ovarian cancer non-steroidal antiestrogens yields clinical responses in a significant number of patients. This raises the possibility of therapeutic effectiveness of aromatase inhibitors in epithelial ovarian cancer in post menopausal women. Therefore this study was carried out to document the effectiveness of an aromatase inhibitor, in advanced epithelial ovarian cancer patients with unknown hormone receptor status. Methods: From January 2006 to April 2007, a total of 38 patients were enrolled. Patients with histopathologically confirmed advanced epithelial ovarian cancer were included. Other eligibility requirements were: postmenopausal women, failure of third-line chemotherapy, age between 50–70 years, bidimensionally measurable disease, and CA-125 of more than 100 u/mL. An adequate hematologic, hepatic, and renal profile, and ECOG performance of 0–2 was required. Tablet letrozole 2.5 mg orally once daily was given for 03 months. CA-125 and Miller criteria were used for response evaluation. Results: No patient showed the evidence of complete or partial clinical response. Four patients had stable disease for 8 weeks. All patients showed progressive disease on week 12. Conclusions: In this small series no evidence of effectiveness of aromatase inhibitor letrozole in chemo refractory epithelial ovarian cancer is documented in patients with unknown hormone receptor status. It is, therefore, recommended that further study should only be carried out in the selected patient population with documented positive ER/PR hormone receptors.

No significant financial relationships to disclose.