The prevalence of liver tumors is increasing worldwide. These can be broadly classified into primary and secondary types, depending upon the origin of the tumor. Multiple modalities are available for the management of these tumors. Ablative techniques are becoming the cornerstone of management especially for the tumors which are unresectable. Thermal ablative techniques include radiofrequency ablation (RFA), microwave ablation (MWA), and cryotherapy. Recently, a non-thermal technique known as irreversible electroporation (IRE) is gaining importance owing to its better clinical outcome and a good safety profile. IRE works by high voltage and intensity electrical discharge which makes pores in the membrane of the cells. Its clinical outcome is reported in different studies in terms of progression-free survival (PFS), frequency of complete ablation, and local recurrence of the tumor. Favorable results were seen especially for the small size tumors and very early hepatocellular carcinoma (HCC). It was also found to be useful for the management of tumors which are close to vital structures of the liver. The adverse effects of IRE are also comparable to other ablative techniques like RFA and MWA. The common complications associated with this procedure include liver abscess, bleeding, renal failure, pleural effusion, fever, and partial portal vein thrombosis. In view of this literature review, IRE is found to be a good alternative for the management of liver tumor in patients who cannot undergo surgery, thermal ablative procedures or tumor lying close to vital structures. The safety profile of this procedure is also encouraging. Further studies and clinical trials need to be done to explore this technique.

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Objectives: To study the association of waist circumference (WC), waist to hip ratio (WHR) and body mass index (BMI) with hypertension in type 2 diabetes mellitus (DM) patients in a tertiary care hospital. Methods: The anthropometric measures of patients were recorded in the Diabetic Outdoor of Nishtar Hospital Multan from 2013 to 2018 after taking approval from the Institutional Ethical Review Committee. All patients were evaluated in detail after obtaining informed consent. Data was entered and analyzed in SPSS version 20 (IBM Corp., Armonk, NY, USA). Results: Data of 4556 type 2 DM patients, 2549 (55.9%) females, and 2007 (44.1%) males, was analyzed. Mean age of the study population was 47.72 years. Mean age of females was 47.32 years, while of males was 48.23 years. A total of 3393 (74.5%) of the patients had hypertension, 1912 females and 1481 males. The mean systolic blood pressure (SBP) was 130.84 mmHg, while the mean diastolic blood pressure (DBP) was 82.65 mmHg. Mean WC was 102.85 cm. Mean hip circumference was 100.33 cm. Mean weight was 66.93 kg. Mean height was 1.59 m. Mean WHR was 1.02. Mean BMI was 26.37 kg/m2. Obesity (BMI >27 kg/m2) was found in 1,891 (41.5%) of patients. Central obesity was found in 80.7% and 94.7% of type 2 DM patients according to the WC and WHR cutoff, respectively. Hypertension was significantly associated with all the obesity indicators (p<0.001). Type 2 DM patients with a high WHR were more likely to be hypertensive as compared to those with normal WHR (75% versus 65%, odds ratio (OR) 1.6, p<0.001). A higher than normal WC was also significantly associated with hypertension (79% versus 56%, OR 2.9, p<0.001). Similarly, obese type 2 DM patients with a BMI >27 kg/m2 were more likely to be hypertensive as compared to those with a normal range (18.5 to 22.9 kg/m2) BMI (83.1% versus 64.4%, OR 2.7, p<0.001). Conclusion: Diabetes is more prevalent in females and middle-aged people. Hypertension and obesity are two very common comorbidities of diabetes. Hypertension is strongly associated with all the parameters (WC, WHR, and BMI) of obesity.

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