Objective There has been a rise in the magnitude of dermatological diseases in the South East Asian region. This study aimed to determine the pattern of various skin disorders appearing in the Dermatology Department of a tertiary care hospital, which will help people to understand the scale of the rising incidence and possible preventive measures that can be undertaken to curtail it. Methods An observational study was conducted on all the patients who attended the Dermatology Department during a one year span. A thorough medical history with detailed cutaneous examination was carried out on every patient. Investigations and skin biopsies were performed, where required, for confirmation of diagnosis. Results A total of 95,983 patients presented in the outpatient Department of Dermatology, King Edward Medical University Mayo Hospital Pakistan. Out of this sample, 24,302 patients repeatedly came to the hospital for a follow up visit related to their diseases, while 71,681 were enrolled as new cases. This group comprised 58% females and 42% males; most patients were in the 20–40 years age group. Out of 71,681, eczema was diagnosed in 22,275 (31.07%), infections including bacterial, viral, fungal, sexually transmitted infections (STIs) in 20,178 (28.16%), acne 7910 (11.03%), drug reactions 4830 (6.74%), urticaria 2910 (4.06%), and pigmentary disorders such as lichen planus, melasma and vitiligo were reported in 2739 (3.82%) cases. In addition, psoriasis was reported in 2724 (3.80%), bullous disorders in 1187 (1.66%) and connective tissue disorders in 645 (0.90%). The majority of patients presented with advanced eczema and infectious diseases. Conclusion Eczema was the most common skin disease seen in our study, followed by dermatological infections. The emerging challenges for dermatologists are to prevent and reduce these skin diseases that pose a major healthcare burden, as well as affect the quality of patients' lives.

Background Type 2 diabetes is a chronic metabolic disorder that is escalating at an alarming rate worldwide. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are recent oral antihyperglycemic drugs (OADs) with a unique mechanism of action. Objectives This study aimed compared the efficacy and safety profiles of two SGLT-2 inhibitors, empagliflozin and dapagliflozin, in patients with type 2 diabetes as add-on therapy to traditional first-line OADs. Methods We conducted a randomized controlled trial comparing empagliflozin and dapagliflozin in patients with type 2 diabetes. Patients were included in the study if they had type 2 diabetes with inadequate glycemic control, defined as glycated hemoglobin (HbA1c) of 7.5% to 11.0%, treated with conventional first-line OADs. Study participants were randomly assigned into two groups. Group A patients received oral empagliflozin, 10 to 25 mg, and Group B patients received oral dapagliflozin, 5 to 10 mg, for 12 weeks. The primary endpoint was the efficacy profile for each SGLT-2 agent in terms of body weight changes, body mass index (BMI), fasting blood glucose (FBG), and HbA1c. The secondary endpoint was to determine the safety and tolerability profiles of each SGLT-2 agent. Results After 12 weeks of treatment, the mean body weight was reduced significantly in both groups from baseline (empagliflozin: -3.2 kg ± 5.5 kg, p = 0.003; dapagliflozin -2.1 kg ± 4.6 kg, p = 0.008). However, the mean body weight reduction between groups was not statistically significant (p = 0.078). BMI was significantly reduced in both groups (empagliflozin from 28.5 ± 4.9 kg/m 2 to 25.8 ± 5.2 kg/m 2 , p = 0.002; dapagliflozin from 29 ± 5.2 kg/m 2 to 27.7 ± 4.8 kg/m 2 , p = 0.003). However, the patients who received empagliflozin experienced a significantly greater reduction in BMI than patients who received dapagliflozin (p = 0.007). The mean FBG was also reduced in both study groups (empagliflozin: -88.5 mg/dL ± 39.7 mg/dl, p = 0.003; dapagliflozin: -59.8 mg/dL ± 48.5 mg/dL; p = 0.007). However, the patients who received empagliflozin experienced a significantly greater reduction in mean FBG than patients who received dapagliflozin (p = 0.001). HbA1c was also significantly reduced in both groups (empagliflozin: -2.1% ± 1.1%, p = 0.002; dapagliflozin: -1.4% ± 0.9%; p = 0.004). However, patients who received empagliflozin experienced a significantly greater reduction in HbA1c than patients who received dapagliflozin (p = 0.001). The tolerability profiles of both SGLT-2 agents were quite good, and no major adverse effects were reported in the study groups. Urinary infection occurred more often in patients who received dapagliflozin (9.3%) than in patients who received empagliflozin (4.5%; p = 0.002). Patients in the dapagliflozin group also had a higher incidence of genital infections (7.3%) than those in...

Warfarin is a widely used anticoagulant characterized by having a narrow therapeutic index and exhibiting a wide range of inter-individual and inter-ethnic variation. Single nucleotide polymorphisms in hepatic VKORC1 and CYP2C9 genes causes decreased and increased metabolism of warfarin respectively. The objective of this study was to evaluate the allele frequency of CYP2C9 polymorphic variants *2 and *3 and the association of these allelic variants with PT/INR and daily/weekly dose of warfarin. Seventy-four patients with heart valve replacement were selected. Patients taking low warfarin dose (4.90-17.50 mg weekly) for at least last 3 months and had a stable INR in the range of 2-3 were included in this study. CYP2C9 polymorphism was analyzed by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) technique. Among 74 patients, 9 (12.1 %) showed to have *2 allele, whereas 11 (14.1 %) had *3 allele. Genotype frequencies of wild and variant alleles were, 54.1, 17.6, 21.6 and 6.8 % for *1/*1, *1/*2, *1/*3 and *2/*3 respectively. None of the patient was homozygous for *2 and *3. Statistical analysis showed that low warfarin dose (weekly) is significantly associated with *1/*2 and *1/*3 genotypes (p value ≥ 0.001), whereas PT/INR showed no significant association with the any genotypes of CYP2C9. Our study suggest that polymorphic variants of CYP2C9 (*2 and *3) might influence warfarin dose requirements and associated with the low dose of warfarin in patients.

To evaluate the anti-inflammatory effects of sitagliptin in type 2 diabetic hyperlipidemic patients. Period: 25 August 2015 to 25 November 2015 (12 weeks). Study Design: Randomized clinical trials. Setting: Outdoor of diabetic clinic of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Materials and Methods: Diabetic patients (n=46) with poor glycemic control(HbA1c > 7.2%) and deranged lipid profile were selected. The patient received sitagliptin 50mg twice daily for 12 weeks. Results: A total of 46 patients completed the study. After 12 weeks treatment with sitagliptin, there was a significant reduction in the value of HbA1c from 8.26±0.73% at baseline to 7.33±0.62% (p <0.01). Body mass index also decreased significantly from 31.90±1.57 kg/m 2 at baseline to 27.31±1.60 kg/m 2 at 12 weeks (p<0.01). There was also significant reduction in the serum level of total Cholesterol (TC), triglycerides (TG) and Low density lipoprotein cholesterol(LDL-C) were detected(TC: 255.35±13.89 to 220.76±14.65 mg/dl, TG: 188.80±11.62 to 153.39±9.24 mg/dl,; LDL-C 169.89±12.06 to 147.11±8.1 mg/dl with p-value <0.01. High density lipoprotein cholesterol (HDL-C) increased significantly from 41.21±3.11 mg/dl at baseline to 50.21±2.37 mg/dl (p <0.01) at 12 weeks. There is also significant reduction in the value of inflammatory markers after 12 weeks treatment with sitagliptin, ESR: 27.04±4.07 vs 11.43±1.74 mm/hr, WBC count: 6.90±0.51 vs 5.65±0.34 10 9 /L and hs-CRP: 4.21±0.37 vs 2.16±0.23 mg/L with p-value <0.01. Conclusion: Seeing the multiple benefits of sitagliptin on risk factors and markers of inflammation it is concluded that it should be started early in diabetic patients to prevent micro and macro vascular complications in future.