Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites.

Introduction: Cirrhotic ascites is conventionally treated with bed rest, salt restriction, and diuretics. In 20-30% of patients it eventually became resistant to diuretic therapy partly because of reduced sodium excretion owing to the development of resistance against atrial natriuretic peptide. Diuretics resistance can be overcome partially by increasing distal tubular sodium delivery by atrial natriuretic peptide and mannitol administration.

Multiple dengue serotypes and high frequency of dengue hemorrhagic fever at two tertiary care hospitals in Lahore during the 2008 dengue virus outbreak in Punjab, Pakistan.

Objective: The objective of this study was to investigate the clinical characteristics of patients with dengue viral infection during the 2008 outbreak in Lahore in order to better understand the clinical pattern and severity of disease in Lahore.

Methods: We analyzed the clinical characteristics of 110 patients infected with dengue virus; data were collected on standardized data collection sheets at two tertiary care hospitals from September to December 2008. Dengue infection was confirmed serologically or by real-time polymerase chain reaction (RT-PCR).

Nutrition-related vitamin B12 deficiency in patients in Pakistan with type 2 diabetes mellitus not taking metformin.

Objective: To estimate the frequency of undiagnosed vitamin B12 deficiency among patients with type 2 diabetes mellitus who had not taken metformin during at least the prior 5 years and to ascertain whether vitamin B12 deficiency among the patients with type 2 diabetes was due to nutritional deficiency or malabsorption.

Methods: Serum vitamin B12 levels were measured in 44 subjects with diabetes and a mean age of 51 years (range, 40 to 70), 21 (48%) of whom had low levels (<200 pg/mL). Of those 21 patients, 10 agreed to enroll in an intervention phase consisting of oral supplementation with mecobalamin, 1,500 microg daily for 3 months.