We present a Veterans Affairs–sponsored pilot study of U500 concentrated insulin administered via disposable patch insulin pump (DPIP) vs twice-daily (BID) injections with an insulin pen in a case series format. We conducted a prospective, single-center, randomized, intent-to-treat pilot study. Ten participants were enrolled with poorly controlled diabetes, defined as hemoglobin A1C >8.0 and severe insulin resistance defined as total daily dose >200 units. Participants were randomized in a 1:1 ratio to either U500 DPIP or U500 BID insulin titration protocols for 14 weeks. A clinical pattern emerged where four participants randomized to the DPIP treatment arm were withdrawn early as the DPIP did not work well for the purpose studied. There was not a statistically significant difference in the rate of hypoglycemia between treatment arms. Based on our clinical experience and results, we argue against the general use of U500 DPIP in clinical practice.

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

Background: Diabetes is the common predisposing factor for Urinary Tract Infection. In diabetic patients, asymptomatic bacteriuria is more prevalent in females compared to male patients. Bacteria count for similar species over 10^5 per ml in urine specimen of mild stream clean catch without urinary infection is known as Asymptomatic bacteriuria (ASB). Asymptomatic bacteriuria appears to be incurable, recurring in diabetic patients. Aim: The current study aim to determine the outcomes of asymptomatic bacteriuria in patients with diabetes mellitus. Materials and Methods: This cross-sectional study was carried out on 85 women of diabetes mellitus in the department of General Medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Jinnah Medical College Peshawar for duration of six months from June 2020 to December 2020. Detailed and follow-up histories of all the patients were studied, compared, and reported. Individuals who met the inclusive criteria were enrolled in this study. Women on steroid therapy, with immunodeficiency, and incomplete follow-up history were excluded. The outcome of symptomatic and asymptomatic patients was followed for positive culture in a time span of 3 and 6 months. SPSS version 20 was used for data analysis purposes. Results: The mean age of the patients was 57+15.3. Of the total, 13 (15.3%) UTI were symptomatic women with diabetes, and UTI in asymptomatic patients was 72 (84.7%). In symptomatic cases, the prevalence of hypertension, Macroalbuminuria, and Microalbuminuria were 7 (53.4%), 3 (23.3%), and 3 (23.3%) respectively. HbA1C and eGFR (ml/min/1.732) level was 8.5+0.85 and 92.07+10.3 respectively. Conclusion: Our study concluded that urinary culture detected significant bacteriuria without symptoms such as fever, painful micturition, and urgency, frequent micturition, flank pain, burning micturition, and suprapubic pain. Symptomatic and asymptomatic bacteriuria is more common in females. Also, asymptomatic bacteriuria appears to be incurable, recurring in diabetic females. Keywords: Asymptomatic, Bacteriuria, Diabetes mellitus

Background and Aim: Ascitic fluid infection is pre-existing ascites infection of both symptomatic and asymptomatic types without abdominal source in chronic liver disease patients. Culture negative ascites are common infections in patients with chronic liver disease. The aim of the recent study was to determine the prevalence of culture-negative ascitic fluid infection among chronic liver disease patients. Methodology: This cross-sectional study was conducted on 134 patients with ascitic fluid infection due to chronic liver disease in the Department of Medicine and Gastroenterology, Pak International Medical College, Peshawar for six months duration from December 2020 to May 2021. All the ascitic infectious patients due to chronic liver disease regardless of their age and gender showing ascitic fluid infection symptoms such as tenderness, fever, and abdominal pain were admitted and underwent laboratory culture examination. Based on bacterial growth, all the chronic liver disease patients were grouped into two; Group-I of no bacterial growth and Group-II of positive bacterial growth. All the patients having an intra-abdominal infection or taking antibiotics were excluded. Results: Of the total 134 patients, 84 (62.7%) were male and 50 (37.3%) were females. Overall mean age was 47.56±19.8 years with an age range of 20 years to 80 years. Of the total 134 cases, the prevalence of positive and negative culture ascites were 30 (22.4%) and 104 (77.6%) respectively. out of 104 culture-negative patients, 65 (62.5%) were male patients whereas 39 (37.5%) were females. Chronic liver disease means duration was 8.9±2.6 months with a range of 6 months to 18 months. For all the patients above 40 years, the prevalence of culture-positive and negative ascitic infection was 20 (66.7%) and 77 (74.1%) respectively. The prevalence of male patients was higher (62.5%) among culture-negative patients due to chronic liver disease. Conclusion: Our study found that the prevalence of culture-negative ascitic fluid was higher at 77.6% among male patients. Also, ascitic fluid infection due to chronic liver disease was higher in patients of age above 40 years. Keywords: Ascitic fluid, Culture-negative ascitic fluid infections, Chronic liver disease

Background: The conversion from transmissible to non-communicable diseases has taken place for numerous years in all states of the biosphere, including emerging republics. Ischemic heart disease and diabetes mellitus complications belong to the diseases of the second most important group. In current ages, there has been a renewed debate about the importance of weight gain and obesity as risk factors for both diseases. The Aim of the Study: is to govern the association amid the body mass index and the occurrence of ischemic heart disease in patients with type 2 diabetes. Methods: This cross-sectional study was conducted in the medicine department of Jinnah medical college Peshawar for the duration of 06 months from November 2020 to April 2021. The study was directed among 300 patients with type II diabetes mellitus. Data was collected from medical records and then analyzed using the SPSS with Chi-square method. Results: Out of 300 patients with type-II diabetes mellitus, 120 were men and 180 were women. According to the findings of the present study, among patients with type-II diabetes mellitus, 41 (13.7%) had ischemic heart disease, of which 29 were female and 12 were male. The ischemic heart disease prevalence in youth is in 11(26.8%) middle-aged and elderly is 53.7% (22 out of 41 patients) and 19.4% (8 cases out of 41 patients) respectively. Conclusions: Conferring to our conclusions, although the incidence of type-II diabetes in obese and overweight patients is advanced than in those with normal or low body weight, the incidence of ischemic heart complications in subjects with type 2 diabetes does not follow this trend. Varying body mass index and the incidence of coronary heart disease are higher in women than in men in the normal weight group. Keywords: Obesity, Body mass index, ischemic heart disease and type 2 diabetes