Objective: The purpose of this study is to diagnose metastatic colorectal cancer and its treatment. Study Design: Retrospective/observational study Place and Duration: Department of Gastroenterology, HITEC-IMS Taxila Cantt. 1st July, 2021 To 31 December, 2021 Methods: There 150 patients of both genders were presented in this study. Included patients were aged between 25-85 years. All the presented patients had confirmed metastatic colorectal cancer diagnosed by using CT scan. Informed permission was obtained prior to obtaining detailed demographics, including age, sex and BMI, for all enrolled patients. Mutation of metastatic CRC were recorded and treated in terms of three line treatments by combination of biological and chemotherapy. SPSS 22.0 was used to analyze all data. Results: Males were higher in numbers 90 (60%) than females 60 (40%). Mean age of the patients was 62.16±22.56 years and had mean BMI 9.12 ± 11.45 kg/m2. Most common symptoms were pain in bones, constipation, diarrhea, rectal bleeding and difficulty in breathing among all cases. Frequency of RAS mutation was found in 100 (66.7%) cases, BRAF mutation in 20 (13.3%) cases and MSI-H/dMMR was found in 12 (8%) cases. According to mutational status as first line therpay, frequency of biological targeted therapies in combination with fluoropyrimidine/based combination chemotherapy was 105 (70%), and frequency of combination chemotherapy alone was among 45 (30%) cases. We found 80 (53.3%) patients received biological targeted therapies in combination with chemotherapy, frequency of immunotherapy was 35 (23.3%), combination chemotherapy in 20 (13.3%) and biological targeted therapies in 15 (10%) cases at second line while at third line, combination chemotherapy was received in 90 (60%) cases, frequency of biological targeted therapies was 40 (26.7%), biological targeted therapies in combination with chemotherapy in 13 (8.7%) cases and immunotherapy in 7 (4.7%) cases. Conclusion: This research found that mCRC is a social problem for healthcare systems since therapy is longer but increases patient survival. RAS mutations were frequent. Advances in molecular profiling of metastatic CRC help tailor therapy to particular patient subgroups. Despite few treatments, patients might expect longer longevity. Genomic profiling helps choose treatments so more patients benefit and fewer are exposed to harm. Keywords: Metastatic Colorectal Cancer, Immunotherapy, Chemotherpy, Biological Therapy, Mutation
Objective: To compare the effectiveness of the combination of Lactulose and Polyethylene glycol (PEG) versus Lactulose alone in improving the grade of hepatic encephalopathy (HE) within 24 hours of hospital admission in patients with hepatic encephalopathy due to decompensated liver cirrhosis precipitated by constipation. Study Design: Randomized controlled trial. Place and Duration: The Department of Gastroenterology, Hepatology and GI Endoscopy, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan from 07-05-2020 to 06-05-2021. Methodology: One hundred and sixteen patients (58 in each group) of either gender aged 20-70 years having decompensated liver cirrhosis with HE grade 2 to 4 secondary to constipation were enrolled. Patients were randomly and equally divided into either Lactulose and PEG (Group-1) or Lactulose alone (Group-2) by lottery method. West Haven Criteria was used for labeling HE grades at the baseline and after 24 hours of treatment in both study groups. A one-grade improvement in HE after 24 hours of treatment from the baseline was considered as effectiveness of treatment. Results: Treatment was found effective (at least one HE grade improvement) in 43 (74.1%) patients treated with PEG+Lactulose, while it was 32 (55.2%) in patients who were treated with Lactulose alone (p=0.033). When stratified for age and gender, PEG+Lactulose was significantly effective in improving HE grades in younger age group (p=0.007) and males (p=0.040). Practical Implications: Combination treatment with PEG+Lactulose can be a preferred option for improvement in HE grades in comparison to treatment with lactulose alone Conclusions: Combination treatment with PEG+Lactulose was found to be more effective in improving HE grades when compared to treatment with lactulose alone within 24 hours of hospital admission among patients who had decompensated liver cirrhosis precipitated by constipation. Keywords: Constipation, decompensated liver disease, Hepatic encephalopathy, Lactulose, Polyethylene glycol.
Background and Aim: Hepatitis C virus of chronic nature has been appreciated globally to be a major source of hepatic carcinomas and other abnormalities associated with liver function. The epidemiological data on the prevalence of the Hepatitis C virus shows a trend of 71 million people being affected by the disease globally with an annual mortality rate of 3.5 to 5 million death. Pakistan showed a prevalence of up to 8.2% which is among the most common incidents in countries. Since genotype 3 is the most common variant in Pakistan there remains a literature gap that evaluates the effectiveness of velpatasvir plus sofosbuvir and daclatasvir plus sofosbuvir and compares their efficiency. This study will aim to compare the efficiency of sofosbuvir and velpatasvir with sofosbuvir and daclatasvir. Place and Duration: The study was conducted at the department of Gastroenterology in PIMS Hospital, Islamabad during the period from 21st June 2020 to 20th June 2021. Methodology: The total number of participants recruited in this study was 1000. Participants were recruited after meeting the inclusion and exclusion criteria. The participants were then divided into two groups of n=500 with group one receiving therapy by Sofosbuvir and Daclatasvir and group two receiving a therapy regimen consisting of Sofosbuvir/Velpatasvir. Both the groups underwent therapy for the same amount of time (12 weeks). Before initiation of regimens, patients underwent baseline testing including blood screens, biochemical screens, fibro scans, genotypes, and PCR. These tests we basis for evaluation before and after the treatment. The goal was to achieve detection of no HCV RNA virus at the end of the management protocol. Due to known complications in patients presenting with cirrhosis, the duration of the drug was extended up to 24 weeks. For the patients who presented with relapse of chronic HCV, the end treatment success was measured by HCV RNA less than or equal to 25 IU/ml after 12 weeks of drug use Results: Around 98% of the participants receiving sofosbuvir and velpatasvir management retreatment patients reached the end of treatment assessment and showed sustained viral response and at the end of treatment a small amount of 2% of the participants were found to relapse. The number of patients who reached the end of treatment was 96.2% and 3.8% discontinued the treatment which is more than that compared to the sofosbuvir -velpatasvir regimen. The rate of poor response to treatment management in the sofosbuvir -the daclatasvir group was more than that of the sofosbuvir -velpatasvir group in comparison of 4.3% to 5.8%. This group showed a similar rate of relapse which is 2%. Conclusion: The results of this study showed that sustained viral response was higher in the group managed by sofosbuvir and velpatasvir in comparison to sofosbuvir and daclatasvir. Furthermore, patient compliance to treatment was better in the group treated with sofosbuvir and velpatasvir in comparison to another group. It was also established that the group managed by sofosbuvir and daclatasvir showed a higher incidence of drug adverse events Keywords: Sofosbuvir and Daclatasvir, Sofosbuvir and Velpatasvir, Chronic Hepatitis C
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