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2. Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study

Author

Knoph, Cecilie Siggaard, Lucocq, James, Kamarajah, Sivesh Kathir, Olesen, Søren Schou, Jones, Michael, Samanta, Jayanta, Talukdar, Rupjyoti, Capurso, Gabriele, de‐Madaria, Enrique, Yadav, Dhiraj, Siriwardena, Ajith K., Windsor, John, Drewes, Asbjørn Mohr, Nayar, Manu, Cark, Neil, Pius, Riinu, Houghton, Eduardo, Gimenéz, Mariano, Uribe, Karla, Rodriguez, Florencia, Gundara, Justin, Mackay, Thomas, Phan, Huynh, Lewin, Joel, McElhatton, Claire, Siriwardhane, Mehan, Hodgson, Russell, Malik, Hassan, Ward, Ryan, Young, Kerilee, Bappayya, Shaneel, Loveday, Benjamin, Samra, Jaswinder, Gall, Tamara, Mittal, Anubhav, Chan, Ting Ting, Lo, Vincent Wing‐ho, Liang, Hui, Wang, Cong, Huang, Wei, Jin, Tao, Wu, Yongzi, Xia, Qing, Georgio, Nikolaou, Koronakis, Nikolaos, Davidsen, Line, Hamed, Emad, Mohamed, Salem, Demetrashvili, Zaza, Tvaladze, Ana, Kachakhidze, Irakli, Zurabashvili, Tea, Ioannidis, Orestis, Kapiris, Stylianos, Mavrodimitraki, Eleni, Sotiropoulou, Maria, Machairas, Nikolaos, Schizas, Dimitrios, Syllaios, Athanasios, Vailas, Michail, Chlorakis, Georgios, Kalaitzakis, Evangelos, Tsafaridou, Maria, Mulita, Francesk, Verras, Georgios‐Ioannis, Gupta, Amit, Rajput, Deepak, Sharma, Oshin, Goud, Rajesh, Unnisa, Misbah, Bains, Lovenish, Singh, Nishu, Dhar, Jahnvi, Abdelmoeti, Mahmoud, Súilleabháin, Criostóir Ó, O'Connell, Robert, Calabro, Marcello, La Terra, Antonio, Muretore, Andrea, Contul, Riccardo Brachet, Diotallevi, Margherita, Mascaro, Annamaria, Millo, Paolo, Biondo, Santino Antonio, Mazzeo, Carmelo, Cucinotta, Eugenio, Fleres, Francesco, Marinak, AOUG, Brocco, Veronica, Ceresoli, Marco, Rennis, Maria, Centonze, Danilo, Distefano, Coatanza, Veroux, Massimiliano, Zerbo, Domenico, Bogoni, Selene, Biloslavo, Alan, Bianchi, Velentina, Candelli, Marcello, Franceschi, Francesco, Gasbarrini, Antonio, Nista, Enrico, Sganga, Gabriele, Tropeano, Giuseppe, Policlinico, Fondazione, Altieri, Caterina, Dinuzzi, Vincenza, Marconi, Matteo, Rivolta, Umberto, Dameno, Vitale Roberto, Papa, Mario V., Balla, Andrea, Lepiane, Pasquale, Saraceno, Federica, Aiolfi, Alberto, Bona, Davide, Sozzi, Andrea, Cianci, Pasquale, Varesano, Marco, Conversano, Ivana, Abete, Roberta, D'Avino, Raffaele, Marra, Ester, Marte, Gianpaolo, Tammaro, Pasquale, Gobatti, Davide, Marmaggi, Serena, Palmieri, Francesco, Sampietro, Roberto, Manca, Roberto, Pilla, Federica, Piras, Enrico, Pignata, Giusto, Canfora, Ilaria, Andreuccetti, Jacopo, D'Alessio, Rossella, Armellin, Claudia, Grossi, Ugo, Massani, Marco, Pontin, Alessandro, Stecca, Tommaso, Pilia, Tiaizna, Pisanu, Adolfo, Podda, Mauro, Giuffrida, Mario, Perrone, Gennaro, Guadagni, Simone, Morelli, Luca, Frontali, Alice, Basurto, Francesca, D'Ugo, Stefano, Manoochehri, Farshad, Spampinato, Marcello, Apadula, Laura, Preatoni, Paoletta, Sartarelli, Lodovico, Al‐Jaiuossi, Osama, Ernisova, Mairam, Sopuev, Andrey, Sua, Bruce, Farfus, Anthony, Teo, Keith, Smith, Brittany, Ratnayake, Bathiya, Buchanan, Jayvee, Clark, Elinor, Connor, Saxon, Hore, Todd, Attari, Salman, Kadir, Bushra, Memon, Sadik, Abbas, Zaigham, Quadeer, Muhammad Ali, Altaf, Abeer, Ameet, Pooja, Devi, Jalpa, Seerani, Nandlal, Afzal, Ameer, Akbar, Ali, Asghar, Mohammad Sohail, Sa, Tiago, Barreira, Ana Lucia, Carvalho, Numo, Cismasiu, Brigitta, Henriques, Susana, Luiz, Francisco Vara, Draghici, Andreea, Grigorean, Valentin, Porojan, Vlad, Stoian, Alexandru‐Rares, Teaca, Lucia, Arbutina, Dragana, Cuk, Vladica, Kovacevic, Bojan, Mandic, Luka, Bonney, Glenn, Gao, Yujia, Pang, Ning Qi, Bellil, Abdalla, Devar, John, Khan, Zafar, Khumalo, Vusi, Smith, Martin, Estevez‐Fernandez, Sergio, Mosquera, Beatriz Romero, Rodriguez, Sergio, Garcia‐Rayado, Guillermo, Piñerua‐Gonsalvez, Jean Felix, Ruiz Rebollo, M Lourdes, Olmos, Jose M., Tejedor‐Tejada, Javier, Diez‐Alonso, Manuel, Matias‐Garcia, Belen, Moreno, Fernando Mendoza, Vera‐Mansilla, Cristina, Roses, Helena Salvador, Gómez, Diego Vázquez, Oballe, Juan Rodriguez, Jayarajah, Umesh, Nandasena, Malith, Pathirana, Aloka, Galal‐Eldin, Sami, Hajibandeh, Shahab, Hamid, Hytham, Colak, Elif, Sydorchuk, Larysa, Knut, Ruslan, Voronyuk, Ksenia, Chooklin, Serge, Baryskyi, Vitalii, Sydorchuk, Ruslan, Mukherjee, Samrat, Patel, Maitreyi, Akhtar, Amina, Asarbakhsh, Miriam, Nolan, Frances, Schuijtvlot, Nicholaas, Prem, Sandhya, Thrikandiyur, Anuradha, Morris, Millicent, Mroczek, Thomas, Sgourakis, George, Sultana, Asma, Varley, Rebecca, Groot‐Wassink, Thomas, Labinoti, Roland, Packham, Brett, Seebah, Keving, Allen, Sophie, Mokhtassi, Shiva, Belgaumkar, Ajay, De'Ath, Henry, Cook, Amy, Delaney, Christopher, Johnson, Roisin, Azibaodinami, Becky Olali, Sartini, Ashley, Stanfield, Mea, Tomasi, Ivan, Kanakala, Venkat, Mbarushimana, Simon, McKeever, Mark, Batilli, Mamata, Bhatta, Gakul, Rai, Subash, Bond‐smith, Giles, Elserafy, Amr, Shams, Mohamed, Al Saoudi, Tareq, Bhardwaj, Neil, Hussain, Wajith, Lancellotti, Francesco, Montagnini, Greta, Cairns, George, Hollyman, Marianne, Rakin, Asef, Shahid, Mishal, Barbour, Fraser, Hawkyard, Jake, McTeer, Matthew, Pandanaboyana, Sanjay, Taylor, Ellie, Kuzman, Matta, Dyer, Sarah, Hopkins, James, Pournaras, Dimitri, Sudlow, Alexis, Kumar, SK, Aujayeb, Avinash, Leo, Alex, Senra, Fatima Lorenzana, Watfah, Josef, Barrie, Jenifer, Brown, Chris, Gomez, Dhanny, Aroori, Somaiah, Ciprani, Debora, Karmarkar, Rahi, Almomani, Eyas, Roberts, Keith, Fale, Madeleine, Gupta, Ajay, Marsden, Max, Seet, Chris, Soni, Lakshya, Hamdan, Mohammed, Sadera, Rohan, Sud, Vikas, Chinnah, Edith, Di Mauro, Davide, Manzelli, Antonio, Orabi, Amira, Presa, Roberto, Reece‐Smith, Alex, Wajed, Shahjehan, Fingret, Jacob, Shah, Nehal, Jatania, Jignesh, Krishna, Arun, Berry, David, Kitsikosta, Loukiani, Helliwell, Jack, Huntley, Benjamin, Pine, James, Yau, Jih‐Dar, Lee, Shiela, Mahawar, Kamal, Shetty, Neehar, Britton, Emily, Shaw, Alice, Laarhoven, Stijn, Gahunia, Sukhpreet, Ortega, Miguel Gargia, Lee, Adam, Ng, Cho Ee, El Kafsi, Jihene, Mason, John, Vithlani, Gauri, Benhmida, Rami, Gunell, James, Parmar, Chetan, Dorkeh, Da‐Costa, Elnagar, Mohamed, Lee, Jih Ian, Nessa, Ashrafun, Yeap, Zhu Hui, Hemadasa, Niroshini, Javed, Saria, Sami, Sharuk, Damaskos, Dimitrios, Healey, Andrew, Soupashi, Maria, Triantafyllou, Tania, Coats, Maria, Douglass, Benjamin, Hendry, Brid, Hussain, Yasmin, Javid, Zhara, Mantyla, Mia, Rajkumar, Khaman, Chin, Carven, Hajibandeh, Shahab, Kumar, Nagappan, Gerogiannis, Ioannis, Kapsampelis, Panagiotis, Gerge, Farid, Anderson, Gulsum, Dinh, Vu, Phillips, Anna, Yadav, Dhiraj, and Pandanaboyana, Sanjay

Abstract

Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings. This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients. This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1‐month follow‐up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses. Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41–71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59–4.04), p< 0.001), and Australian (OR, 5.81 (95% CI, 3.19–10.56), p< 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre‐admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40–2.88), p< 0.001) and Australian (OR, 1.91 (95% CI, 1.28–2.85), p= 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre‐admission pain duration, acute necrotic collections, and walled‐off necrosis also increased the likelihood of opioid prescription at discharge. There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.

Published
2024
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12. Virological and clinical characteristics of hepatitis delta virus in South Asia

Author

Moatter Tariq, Usmani Muhammad T, Khawaja Ali, Memon Sadik, Ahmed Umair S, Mumtaz Khalid, Hamid Saeed, and Jafri Wasim

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background & Aims There is a paucity of data on the impact of hepatitis D virus (HDV) in patients with hepatitis B virus (HBV) infection from South Asia. We studied the impact of HDV co-infection on virological and clinical characteristics. Methods We collected data of 480 patients with HBsAg positive and a detectable HBV DNA PCR, who presented to the Aga Khan University, Karachi and Isra University in Hyderabad, Pakistan in the last 5 years. HDV co-infection was diagnosed on the basis of anti-HDV. ALT, HBeAg, HBeAb and HBV DNA PCR quantitative levels were checked in all patients. We divided all patients into two groups based on anti-HDV, and compared their biochemical, serological & virological labs and clinical spectrum. Clinical spectrum of disease included asymptomatic carrier (AC), chronic active hepatitis (CAH), immuno-tolerant phase (IP), and compensated cirrhosis (CC). Results HDV co-infection was found in 169 (35.2%). There were 164 (34.6%) HBeAg positive and 316 (65.4%) HBeAg negative patients. Mean ALT level was 66 ± 73 IU. 233 (48.5%) had raised ALT. HBV DNA level was ≥ 10e5 in 103(21.5%) patients. Overall, among HBV/HDV co-infection, 146/169 (86.4%) had suppressed HBV DNA PCR as compared to 231/311 (74.3%) patients with HBV mono-infection; p-value = 0.002. Among HBeAg negative patients 71/128(55.5%) had raised ALT levels among HBV/HDV co-infection as compared to 71/188 (37.8%) with HBV mono-infection (p-value = 0.002); levels of HBV DNA were equal in two groups; there were 27/128 (21%) patients with CC among HBV/HDV co-infection as compared to 23 (12%) in HBV mono-infection (p-value = 0.009); there were less AC (p-value = 0.009) and more CAH (p-value = 0.009) among HBV/HDV co-infection patients. Among HBeAg positive patients, serum ALT, HBV DNA levels and the spectrum of HBV were similar in the two groups. Conclusions HBV/HDV co-infection results in the suppression of HBV DNA. A fair proportion of HBV/HDV co-infected patients with HBeAg negative have active hepatitis B infection and cirrhosis as compared to those with mono-infection.

Published
2011
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14. Clinicopathological features and outcomes of gallbladder cancer in Southern Pakistan

Author

Burney, Asif, Memon, Sadik, Ghaffar, Amna, Salam, Abdul, Aftab, Zia, and Burney, Ikram A.

Subjects
Gallbladder cancer -- Prognosis -- Research, Health
Abstract

Byline: ASIF A BURNEY, SADIK MEMON, AMNA GHAFFAR, ABDUL SALAM, ZIA AFTAB AND IKRAM A. BURNEY ABSTRACT: Background: Gallbladder (GB) cancer is not an uncommon cancer, however, has a geographical [...]

Published
2012

19. MELD era: is this time to replace the original Child-Pugh score in patients with decompensated cirrhosis of liver.

Author

Shaikh S, Ghani H, Memon S, Baloch GH, Jaffery M, and Shaikh K

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Hepatitis C complications, Hospital Mortality, Humans, Length of Stay, Liver Cirrhosis etiology, Male, Middle Aged, Prognosis, ROC Curve, Young Adult, Liver Cirrhosis classification, Liver Cirrhosis mortality
Abstract

Objective: To compare the predictive value of MELD (Model of end stage liver disease) and Child-Pugh (CP) scores in patients with decompensated cirrhosis of liver., Study Design: Descriptive study., Place and Duration of Study: Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007., Methodology: This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR (International normalized ratio) of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance., Results: There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76+12.93 years. There were 72 (65%) male and 38 (35%) females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 (60%) cases. Ascites was present in 93/110 (83%) patients. The mean MELD scores were 2.23+0.712 (95% CI 2.09 - 2.36) and for CTP 2.52+0.586 (95%; CI 2.41-2.63). The outcome of the patients were 12 deaths (11%); 54 (49%) remained hospitalized for up to 14 days and 44 (40%) for > 14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score > 15 as well as with Child-Pugh grade C. The c-statistic was 0.726 (p=0.001) for CP score, and 0.642 for MELD score (p=0.021)., Conclusion: The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study.

Published
2010
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20. Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection.

Author

Masood N, Ghori R, Memon A, Memon S, Memon KI, Memon I, Jaffri M, and Baloch GH

Subjects
Adult, Female, Humans, Interferon alpha-2, Male, Recombinant Proteins, Hepatitis C, Chronic drug therapy, Interferon-alpha adverse effects, Ribavirin adverse effects, Thyroid Diseases chemically induced
Abstract

Objective: The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C (CHC) patients and HCV outcome., Study Design: Descriptive study., Place and Duration of Study: This study was conducted at Outpatient Department of Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad from September 2005 to September 2007., Patients and Methods: One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT4 and FT3 within the normal reference range, who were treated with interferon alpha-2b (3 million unit subcutaneously three times per week) and oral ribavirin (1000-1200 mg per day) were included in this study. All patients were assessed for TSH, FT4, FT3 levels at 12 weeks and 24 weeks during therapy., Results: Among the 100 patients, overt thyroid disease developed in 13 (13%) and sub-clinical thyroid disease in 5 (5%). Out of 13 patients of overt thyroid disorders, 11 (84.6%) had hypothyroidism and 02 (15.3%) hyperthyroidism. Four (80%) patients were of sub-clinical hypothyroidism and 01 (20%) patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 (18%) both as overt and sub-clinical thyroid disorders. Ninety one (91%) patients became negative by HCV RNA., Conclusion: Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment.

Published
2008
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