PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Effects of delta-tocotrienol supplementation on glycaemic control in individuals with prediabetes — a randomized controlled study

Objective: To study the effects of delta-tocotrienol on glycaemic control parameters in individuals with pre-diabetes. Method: The randomised control trial was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from July 15 to November 15, 2019, and comprised individuals aged 18-60 years having fasting plasma glucose of 5.6 to 6.9mmol/L or glycosylated haemoglobin of 5.7 to 6.4%. They were randomised into group A receiving 300mg delta-tocotrienol and group B receiving a placebo once daily for 12 weeks. Weight, height, waist circumference, fasting plasma glucose, insulin and glycosylated haemoglobin were measured at the beginning and end of the trial to assess any change. Body mass index and homeostatic model assessment-insulin resistance were also calculated. Data was analysed using SPSS 21. Results: Of the 77participants, 40(52%) were  in group A and 37(48%) in group B. Group A showed significantly greater reduction in terms of fasting plasma glucose, glycosylated haemoglobin, insulin and homeostatic model assessment-insulin resistance index (p?0.001) post-intervention. Conclusion: Delta-tocotrienol supplementation was found to have a significant effect in improving glycaemic control parameters in persons with pre-diabetes. Futures larger scale clinical trials are needed to confirm these findings. Continuous..

Land-Use/Land Cover Changes Contribute to Land Surface Temperature: A Case Study of the Upper Indus Basin of Pakistan

Land-use/land cover (LULC) changes have an impact on land surface temperature (LST) at the local, regional, and global scales. To simulate the LULC and LST changes of the environmentally important area of northern Pakistan, this research focused on spatio-temporal LULC and associated LST changes since 1987 and made predictions to 2047. We classified LULC from Landsat TM and ETM data, using the maximum probability supervised categorization approach. LST was retrieved using the Radiative Transfer Equation (RTE) methodology. Furthermore, we simulated LULC using the integrated approaches of Cellular Automata (CA) and Weighted Evidence (WE) and used a regression model to predict LST. The built-up areas and vegetation have increased by 2.1% and 11% due to a decline in the barren land by &minus;8.5% during the last 30 years. The LULC is expected to increase, particularly the built-up and vegetation classes by 2.74% and 13.66%, respectively, and the barren land would decline by &minus;4.2% by 2047. Consequently, the higher LST classes (i.e., 27 &deg;C to &lt;30 &deg;C and &ge;30 &deg;C) soared up by about 25.18% and 34.26%, respectively, during the study period, which would further expand to 30.19% and 14.97% by 2047. The lower LST class (i.e., 12 &deg;C to &lt;21 &deg;C) indicated a downtrend of about &minus;41.29% and would further decrease to &minus;3.13% in the next 30 years. The study findings are useful for planning and management, especially for climatologists, land-use planners, and researchers in sustainable land use with rapid urbanization

Hepato-Protective Effects of Delta-Tocotrienol and Alpha-Tocopherol in Patients with Non-Alcoholic Fatty Liver Disease: Regulation of Circulating MicroRNA Expression

MicroRNAs (miRNAs) play a key role in the regulation of genes for normal metabolism in the liver. Dysregulation of miRNAs is involved in the development and progression of non-alcoholic fatty liver disease (NAFLD). We aimed to explore changes in circulating miRNA expression in response to delta-tocotrienol (δT3) and alpha-tocopherol (αTF) supplementation and correlate them with relevant biochemical markers in patients with NAFLD. In total, 100 patients with NAFLD were randomized to either receive δT3 (n = 50) 300 mg or αTF (n = 50) 268 mg twice/day for 48 weeks. Plasma expression of miRNA-122, -21, -103a-2, -421, -375 and -34a were determined at baseline, 24 and 48 weeks of intervention using RT-qPCR. Both δT3 and αTF significantly downregulated expression of miRNA-122, -21, -103a-2, -421, -375 and -34a. Moreover, δT3 was more effective than αTF in reducing expression of miRNA-375 and -34a. A significant correlation was observed between miRNA expression and biochemical markers of hepatic steatosis, insulin resistance (IR), oxidative stress (OS), inflammation and apoptosis. δT3 and αTF exert hepato-protective effects by downregulating miRNAs involved in hepatic steatosis, IR, OS, inflammation and apoptosis in patients with NAFLD. Furthermore, δT3 has more pronounced effects than αTF in reducing miR-375 and miR-34a, which are linked to regulation of inflammation and apoptosis

Land-Use/Land Cover Changes Contribute to Land Surface Temperature: A Case Study of the Upper Indus Basin of Pakistan

Land-use/land cover (LULC) changes have an impact on land surface temperature (LST) at the local, regional, and global scales. To simulate the LULC and LST changes of the environmentally important area of northern Pakistan, this research focused on spatio-temporal LULC and associated LST changes since 1987 and made predictions to 2047. We classified LULC from Landsat TM and ETM data, using the maximum probability supervised categorization approach. LST was retrieved using the Radiative Transfer Equation (RTE) methodology. Furthermore, we simulated LULC using the integrated approaches of Cellular Automata (CA) and Weighted Evidence (WE) and used a regression model to predict LST. The built-up areas and vegetation have increased by 2.1% and 11% due to a decline in the barren land by −8.5% during the last 30 years. The LULC is expected to increase, particularly the built-up and vegetation classes by 2.74% and 13.66%, respectively, and the barren land would decline by −4.2% by 2047. Consequently, the higher LST classes (i.e., 27 °C to <30 °C and ≥30 °C) soared up by about 25.18% and 34.26%, respectively, during the study period, which would further expand to 30.19% and 14.97% by 2047. The lower LST class (i.e., 12 °C to <21 °C) indicated a downtrend of about −41.29% and would further decrease to −3.13% in the next 30 years. The study findings are useful for planning and management, especially for climatologists, land-use planners, and researchers in sustainable land use with rapid urbanization

The performance prediction and techno-economic analyses of a stand-alone parabolic solar dish/stirling system, for Jamshoro, Pakistan

This study aims to propose a simulation as well as mathematical model to carry out the performance assessment and efficiency improvement of a stand-alone Parabolic Solar Dish Stirling (PSDS) system. The simulation for a 25 ​kW PSDS system is performed in the System Advisor Model (SAM) under the environmental conditions of Jamshoro, Sindh, Pakistan. The results show that the city has a good potential of direct solar irradiance with yearly average value of 1719.15 ​kWh/m2/y. The system can generate yearly 38.6 ​MWh with overall system net efficiency of 23.39%. Whereas, the maximum energy of 3.38 ​MWh is produced in month of January, due to high solar irradiance. However, the lowest energy of 2.15 ​MWh is produced in July, due to the monsoon spell in selected city. Furthermore, from the techno-economic analyses of the proposed system, the levelized cost of energy is found to be 0.13 $/kWh, which is quite low. As the Stirling Engine (SE) works at higher temperature, so, increasing the diameter of concentrator results more thermal energy at the cavity. The solar radiations are high around the solar noon, therefore, the operating temperature can damage the hot-side of SE due to thermal overloading. In future, to protect the hot-side of SE, it is recommended to use thermo electric generator