IntroductionDiabetes Mellitus is the most common endocrine disorder and metformin is the most commonly prescribed oral hypoglycemic agent. Metformin is well known to cause viamin B12 deficiency due to effect on calcium-dependent membrane action in the terminal ileum leading to malabsorption of vitamin B12. The purpose of this study is to determine prevalence and associations of Vitamin B12 deficiency in patients of type 2 diabetes mellitus treated with metformin.MethodsThis case control study was carried out in department of medicine, Combined Military Hospital, Kharian from 1st Jan 2012 to 30 december 2012. We enrolled 114 outdoor patients of type 2 diabetes mellitus currently on metformin for atleast 12 months, by consecutive sampling, and 105 age and sex matched patients taken as control. Patients with vitamin B12 levels of less than 150 pg/ml were said to be B12 deficient. The results were analyzed on SPSS version 16.ResultsSerum B12 levels were low in 35 patients (31%) on metformin as compared to only 9 patients (8.6%) among controls,(p value 0.002). Mean B12 levels were significantly low in metformin group 311 pg/ml (±194.4), p value 0.03. Dose of metformin had inverse correlation with B12 levels and the difference was statistically significant with p-value < 0.001.ConclusionOur study demonstrated significantly high prevalence of vitamin B12 deficiency in patients treated with metformin with significant effect of dose and duration of metformin use on B12 levels. Physicians must recognize this important fact and screen diabetics on metformin therapy for underlying B12 deficiency.

The migration of population towards big cities generates rapid construction activities. These activities not only put pressure on natural resources but also produce construction, renovation and demolition waste. There is an urgent need to find out ways to handle this waste owing to growing environmental concerns. This can reduce pressure on natural resources as well. This paper presents the results of experimental studies which were carried out on hot mix asphalt mixture samples. These samples were manufactured by adding recycled aggregates (RA) with natural crushed stone aggregates (CSA). Three levels of addition of RA were considered in the presented studies. RA were obtained from both the concrete waste of construction, renovation and demolition activities and reclaimed asphalt pavement. Separate samples were manufactured with the coarse and fine aggregate fractions of both types of RA. Samples made with CSA were used as control specimens. The samples were prepared and tested using the Marshall method. The performance of the samples was investigated in terms of density-void and stability/flow analysis and was compared with the performance criteria as given by National Highway Authority for wearing course material in Pakistan. Based on this data optimum asphalt contents were determined. All the samples made by adding up to 50% RA conform to the specification requirements of wearing course material as given by National Highway Authority in terms of optimum asphalt contents, voids in mineral aggregates and stability/flow. A statistical analysis of variation of these samples confirmed that addition is also possible statistically.

To describe the indications, endoscopic findings and complications of Endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary care hospital. Study Design: Retrospective analysis of data collected from all patients underwent ERCP in the year 2015. Setting: Gastroenterology department, Military Hospital Rawalpindi. Period: From 1st January 2015 to 31ST December 2015. Materials and Methods: The main outcomes were technical success, safety and complications. Results: Total 469 patients underwent ERCP inmilitary hospital Rawalpindi in year 2015. Common bile duct (CBD) cannulation was achieved in 437 (93.1%) patients. CBD stones were found in 182 (38%) and CBD stricture in 79 (16.8%). Sphincteroplasty was needed for extraction of large stones in 13 (2.7%) cases. CBD stricture with co-existing stones above was seen in 25 cases (5.3%). Large stones not amenable to endoscopic extraction were seen in 24 cases (5.1%). Total 25 cases of ampullary growth (5.3%) and 15 cases (3.1%) of CBD leak post cholecystectomy were noted. 6 cases (1.27%) were identified as choledochal cyst with CBD Stones. PD stones with dilated PD identified in 5 cases (1.06%) and post-cholecystectomy CBD clipped in 3 cases (0.63%). 3 cases of displaced PD stent ended up in successful retrieval. 21 cases developed acute pancreatitis (4.4%) out of which 3 were found to have severe pancreatitis having fluid collections. 3 cases (0.6%)had retroperitoneal perforation (2 were managed conservatively and 1 through surgery). 4 cases (0.8%)had significant post procedure bleed requiring re-scope with adrenal injection at bleeding site, and hemostasis achieved. Conclusions: ERCP in Combined Military Hospital Rawalpindi hospital was associated with a high degree of technical success and a low risk of complications.

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