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To assess the effect of renal failure on the survival of black African patients with cirrhosis, we studied 132 (82 males, 50 females) cirrhotic black African patients with mean age of 47.5 ±14.4 years and mean follow-up period of 373 ± 194 days. The edema and ascitis were the main reasons for admission to hospital. Renal failure was present in 30 (22.7%) patients, and it was positively correlated to the severity of the stage of the liver disease, and associated with severe hyponatremia. Survival at 1 year was 60.1% and 37.6% in the absence or presence of renal failure, respectively (p< 0.001)). The stage of the liver disease was significantly inversely corre-lated with survival, which was further diminished in the presence of renal failure:23.7% versus 12.5% for Child-Pugh-Turcote (CPT) A-B in the absence or presence of renal failure, respectively (p= 0.67), 30.2% versus 81.8% for CPT C in the absence or the presence of renal failure respectively (p< 0.001). Hyponatremia has also appeared detrimental to survival, since mortality was 38.4% versus 81.8% in the absence or the presence of hyponatremia respectively (p< 0.001). By multivariate analysis, renal failure, CPT stage C, and hyponatremia independently significantly correlated to mortality in patients with cirrhosis. We conclude that renal failure is frequently associated with decompensated cirrhosis. The presence of renal failure in this setting often results in high mortality. Renal failure that occurs in the setting of a severe liver disease and hyponatremia may be part of hepatorenal syndrome.

In developing countries, people use Paraphenylenediamine, a highly toxic substance, for suicide and self-harm. It is more common in populations with lower socioeconomic classes and educational backgrounds. The female-to-male ratio is higher. The most common complications are oedema of the upper airway tract and renal failure. The mortality rate is higher due to late hospital presentation and a lack of specific antidotes. The treatment of Paraphenylenediamin poisoning is conservative. In this case report we are presenting Paraphenylenediamine poisoning with a fatal outcome.

Abstract Aims To identify barriers and facilitators to nursing care of individuals with developmental disabilities (DDs). Background Individuals with DDs experience health disparities. Nurses, although well positioned to provide optimal care to this population, face challenges. Design Narrative review of extant published peer‐reviewed literature. Data Sources Electronic databases, ProQuest and EBSCO, were searched for studies published in English between 2000 and 2019. Review Methods Three reviewers reviewed abstracts and completed data extraction. Knowledge synthesis was completed by evaluating the 17 selected studies. Results Emerging themes were: (1) barriers and challenges to nursing interventions; (2) facilitators to nursing care; and (3) recommendations for nursing education, policy and practice. Conclusion Nursing has the potential to be a key partner in supporting the health of people with DDs. Impact There is a need for specific education and training, so nurses are better equipped to provide care for people with DDs.

Objective: To compare the association of vitamin B12 deficiency and metformin use in patients presenting with type II diabetes mellitus. Study Design: Case control study. Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi from Apr 2017 to Sep 2017. Methodology: All patients who fulfilled the inclusion criteria and visited OPD of department of Medicine Military Hospital Rawalpindi, were included in the study. After approval from the ethical review committee, informed written consent was taken from patients. The patients were divided into two groups group A (metformin use) & B (without metformin use). Outcome was checked by comparing both the groups for vitamin B12 deficiency. Results: Two hundred and eighty patients with diabetes mellitus were included. One hundred and seventy one (61.07%) were males and 109 (38.93%) were females, with the mean age of 59.52 ± 12.441. Vitamin B12 deficiency in group I was seen in 30 (10.71%) and in 9 patients (3.21%) in group II (OR >1). Conclusion: In conclusion, our study indicates that patients with type 2 diabetes mellitus treated with metformin should be screened for vitamin B12 deficiency, especially with longer durations of treatment.

Objective: To compare the association of vitamin B12 deficiency and metformin use in patients presenting with type II diabetes mellitus. Study Design: Case control study. Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi from Apr 2017 to Sep 2017. Methodology: All patients who fulfilled the inclusion criteria and visited OPD of department of Medicine Military Hospital Rawalpindi, were included in the study. After approval from the ethical review committee, informed written consent was taken from patients. The patients were divided into two groups group A (metformin use) & B (without metformin use). Outcome was checked by comparing both the groups for vitamin B12 deficiency. Results: Two hundred and eighty patients with diabetes mellitus were included. One hundred and seventy one (61.07%) were males and 109 (38.93%) were females, with the mean age of 59.52 ± 12.441. Vitamin B12 deficiency in group I was seen in 30 (10.71%) and in 9 patients (3.21%) in group II (OR >1). Conclusion: In conclusion, our study indicates that patients with type 2 diabetes mellitus treated with metformin should be screened for vitamin B12 deficiency, especially with longer durations of treatment.

Background and objective: Leprosy is a chronic slowly progressive infection caused by Mycobacterium leprae that primarily affects the skin and peripheral nerves. Lepromatous leprosy is characterized by absence of T-cell responses to M. leprae and advanced clinical disease. It is frequently associated with the presence of autoantibodies, which might be related to CD19+CD5+ and CD19+CD5− B lymphocyte percentages. Therefore, the aim of this study was to evaluate the percentages of CD19+CD5+ and CD19+CD5− B cell subsets as well as the total B cells in lepromatous leprosy patients. Materials and methods: Twenty lepromatous leprosy patients and ten healthy subjects served as control were included in this study. Venous blood samples were analyzed by flow cytometry to determine the B cell subsets and total B cell percentages. Results: Compared to healthy controls, the percentages of CD19+CD5+ B cell subset and total B cells were found to be significantly higher in the patient group. While, the percentage of CD19+CD5− B cell subset was found to be higher in the patient group than the control without any significantly difference. Regarding the eye affection, the percentage of total B cells was observed to be significantly higher in affected patients compared to the non-affected group. Conclusion: The observed significant increases in CD19+CD5+ and total B cell percentages in patients with lepromatous leprosy suggests a possible role of these cells in the disorganized protective immune response as well as the development of eye complications in these patients. Keywords: CD5+B-cells, Autoimmunity, Lepromatous leprosy

Hundreds of highly toxic chemical pesticides and their conventional unsafe formulations of varying toxicities are used extensively to control pests, diseases, and weeds to increase agricultural production. The use of bio or botanical pesticides, which have been found effective, safe, and eco-friendly, could possibly provide a viable solution. Thus, the development and production of environment-friendly botanical pesticides and their water-based formulations, to replace the highly toxic agro-chemicals and unsafe formulations, has gained significant importance towards developing appropriate strategies for crop protection. The present study was aimed to evaluate the nematocidal nature of the aqueous extracts of Allium sativum, Urtica dioica, Sophora mollis, Ephedra intermedia, and Tanacetum baltistanicum. For this purpose, the plant material was dried in shade and mechanically ground into a powder form. The methanolic extracts of each plant sample were obtained and further extracted into different organic and aqueous fractions. The polar organic and aqueous fractions were further subjected to in vitro studies against Meloidogyne incognita, a common root-knot nematode. The results revealed that the polar organic and aqueous extracts of all the tested plants showed excellent results with total mortality of 75-95% at the concentrations of 0.125-1% after 72 h of the treatment. These results can be exploited further for their efficacy against M. incognita through on-field applications. The nematocidal effect of tested extracts indicates that some polar oxygenated secondary metabolites with lipophilic properties may be responsible to damage the cytoplasmic membrane of the nematode cells by interfering with the enzyme protein structure through their functional groups.