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Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor's workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively to avert hypertension and to increase donor survival. [ABSTRACT FROM AUTHOR]

Objectives: Comparing the effectiveness of combining ondansetron and dexamethasone vs ondansetron unaided in amounts suggested by SAMBA strategies for stoppage of post-operative nausea and vomiting in laparoscopic cholecystectomy patients. Study Design: Randomized Control trial. Setting: Department of Anaesthesia, Combined Military Hospital, Rawalpindi. Period: Six months (April 2015-October 2015). Material & Methods: A sum of 160 patients were experimented by taking 80 in every group. Group A: of ondansetron. Group B: ondansetron plus dexamethasone. Significance level: 5% Test power: 80% Proportion of the projected population A is 72%1. Foreseen population percentage B is 88%1. Besides successive non-probability specimen system was taken for sample gathering. Patients who were selected were American society of anesthesiologists 1 & 2 while ones with struggle in communiqué e.g. psychologic issues, memory loss, loss of speech etc, pregnant and menstruating ladies3, known of PONV, motion disease, ear problems and vertigo, on long term steroid use3, anguished from diabetes mellitus, hiatal hernia were excluded. The frequency of side effects were duly scribed down and doses of drugs wrote down. Rescue anti vomiting was secondhand for ones of PONV. Results: We deduced that mixture of ondansetron & dexamethasone was effectual in averting post-operative nausea & vomiting equated to Ondansetron unaided. Conclusion: There is variance in incidence of PONV in mutual clusters with combination remedy of ondansetron plus dexamethasone being safer as equated to Ondansetron unaided. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of high dose carboxymaltose vs iron sucrose for anemia among pregnant women managed at our hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Gynecology and Obstetrics department, Pak Emirates Military Hospital Rawalpindi, from Jan 2019 to Jan 2020. Methodology: The study was done on 150 patients receiving carboxymaltose preparation and 150 patients receiving iron sucrose preparation in second or third trimester of pregnancy due to either not responding to or not tolerating the oral preparation. Mean change in hemoglobin was assessed after 12 weeks of standard therapy with both the agents. Complete recovery from anemia (hemoglobin levels), mean corpuscular volume and ferritin levels were also compared in both the groups. Results: Mean age of participants was 32.89±7.191 years. Mean rise in hemoglobin in carboxymaltose was 3.96 ± 4.19 mg/dl while in iron sucrose group was 2.11±1.72 mg/dl (p-value<0.05). With chi-square test it was establishhed that patients achieved normal range of hemoglobin level, mean corpuscular volume and ferritin level statistically more (p-value <0.05) with the carboxymaltose preparation as compared to iron sucrose preparation. Conclusion: Carboxymaltose preparation of iron emerged as more efficacious agent for improving the parameters of anemia in pregnant women when compared with iron sucrose. Not only hemoglobin levels responded better to carboxymaltose but ferritin and mean corpuscular volume also showed marked improvement with carboxymaltose preparation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021. Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo-Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved. Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved. Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if earlygood debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the blood lost in total knee arthroplasty surgery can be salvaged and reused using the auto - transfusion technique without adverse effects and need more blood requirement. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi from Aug 2020 to Dec 2021. Methodology: The study included all the candidates undergoing total knee replacement surgery. Fifty-five patients underwent autologous transfusion using blood bags attached to drains and reusing them within 4-6 hours. All the transfusions were recorded. Results: Out of 55 patients, 49(89%) underwent unilateral knee replacement, and 6(11%) underwent bilateral knee replacement. All 49 patients (89%) received a single blood transfusion, and all 6(11%) bilateral knee replacements received two blood transfusions each. Out of 61 transfusions, no adverse reaction was noted. One patient needed additional blood transfusion while undergoing bilateral knee replacement. Conclusion: Blood autologous transfusion during knee replacement surgeries is a practical and cost-effective measure, especially in rare blood groups. Autotransfusion is a simple and hassle-free approach that can be used routinely while avoiding adverse blood reactions. [ABSTRACT FROM AUTHOR]

Objective: To compare the institutional practices among patients undergoing living-related renal transplants in different hospitals throughout Pakistan. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces of Institute of Urology, Rawalpindi Pakistan, from Jun 2020 to Jan 2021. Methodology: Pakistan's leading kidney transplant centres were sent data electronically to ask about their anaesthetic practices. The methodology adopted was a simple questionnaire model that included 26 questions encompassing all the steps the anaesthesia team took for renal transplant. Uniformity in anaesthetic practices was expected in large centres through rigorous training and workload management. The teams responded according to their standard operating procedures and compared their answers using statistical formulas. Results: Nine out of 11(81.8%) institutes responded. Marked heterogeneity in Anaesthesia practices was found among different institutes. Only 2(18.2%) institutes had Anaesthesia guidelines for a kidney transplant. Conclusion: There is a need for centralized country-specific homogeneous guidelines for Anaesthesia for the kidney transplant to improve outcomes. [ABSTRACT FROM AUTHOR]