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Objective: To measure prospectively the effect of treatment with the Amikacin on renal magnesium, potassium and phosphate wasting in patients with extrarenal infections. Study Design: Case series. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul to Dec 2019. Methodology: A total of 40 cases were included in this study in liaison with other departments who were put on Amikacin standard dose. Urinary electrolytes including potassium, magnesium and phosphate were measured at day 4 after the use of Amikacin. Factors like age, gender, cause for which Amikacin was used, day 1 creatinine and day 4 creatinine were correlated with presence of electrolyte wasting in the target population. Results: Mean age of study participants was 39.1±12.56 years. 25(62.5%) were males while 15(37.5%) were females. Commonest cause for the use of Amikacin was drug resistant tuberculosis followed by fractures. Mean urinary magnesium was 39.1±12.56 mmol/24 hours, while potassium was 26.1±15.60 meq/24 hours. Mean phosphate was 66.4±53.55 mg/24 hours. Pearson chi-square test revealed that advanced age and day 4 creatinine were strongly linked with the presence of urinary electrolyte wasting among the patients receiving Amikacin for extra-renal infections with p-value<0.05. Conclusion: Electrolyte wasting emerged as a common finding in the patients put on Amikacin suffering from extra renal infections. Patients with advancing age put on Amikacin should be given special attention and screened for electrolyte wasting at priority. Day 4 creatinine levels could be incorporated in routine screening to have an idea regarding electrolyte wasting or renal damage. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is defined as kidney damage for more than 3 months, as defined by structural and functional abnormalities of the kidney with or without decreased GFR, manifested by either, Pathological abnormalities; or makers of kidney damage, including abnormalities in the composition of the blood or urine, abnormalities in imaging testing. GFR < 60ml/min/1.73 m2 for > 3 months, with or without kidney damage is also described as CKD Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Diabetes and high blood pressure, or hypertension, are responsible for two-thirds of chronic kidney disease cases. There are a few other conditions or circumstances that can cause kidney disease. Glomerulonephritis, autoimmune diseases and other causes: Obstructions caused by kidney stones or tumors can cause kidney damage. An enlarged prostate gland in men or repeated urinary infections can also cause kidney damage. Risk factors are diabetes, high blood pressure, family history of kidney failure, old age and ethnic groups, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians. Most people may not have any severe symptoms until their kidney disease is advanced. However, patient may feel more tired and have less energy, trouble in concentrating, a poor appetite and troubled sleep, muscle cramps at night, swollen feet and ankles, puffiness around eyes, especially in the morning, dry, itchy skin. Patient may need to urinate more often, especially at night. [ABSTRACT FROM AUTHOR]

Background: Immune thrombocytopenic purpura with multimodal incidence having peaks in each age groups is a chronic clinical syndrome in adults, with disease more predominant in females in adults. The aim of the study was to compare the efficacy (response rate) of high dose dexamethasone with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenic purpura. It was a prospective quasi-experimental study, conducted at the Department of Medicine of a tertiary care hospital from Jan to Dec 2019. Subjects and Methods: The sample population comprised of 130 cases of newly diagnosed ITP patients, having platelet count <30,000/ul with or without bleeding symptoms who received either dexamethasone (40 mg/day for 04 days) or prednisolone (0.5-1 mg/kg PSL for 01 week). Treatment response was measured at day 7. Results: Out of 130 patients 65 patients were treated with dexamethasone and 65 patients with prednisolone .83.08% (n=54) cases in Group-A and 33.85% (n=22) in Group-B had response while remaining 16.92% (n=11) in Group-A and 66.15% (n=43) in Group-B had no response. The p value was calculated as 0.000 which shows a significant difference. Conclusion: We concluded that high dose of dexamethasone shows a significantly higher response when compared with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenia purpura. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) has been a highly prevalent medical condition in all parts of the world affecting the haemostasis of the body in number of ways. Epidemiological data suggest that no region of the world has been spared from this condition and both developing and developed countries equally share the burden of this disease. Objective was to compare the vascular calcification and mineral bone disease in non-dialysis vs dialysis patients suffering from chronic kidney disease at a tertiary care hospital of Pakistan. It is a Comparative study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Four months from November 2020 to February 2021. Methods: A total of 310 cases were included in the study, which were diagnosed as chronic kidney disease in nephrology department by a consultant nephrologist on basis of National Kidney Foundation/Kidney Disease Outcome Quality Initiative (NKF/KDOQI) 2002. They were divided into two equal groups by block randomization. Group I had the patients who were not dependent on dialysis (CKD4/5ND) while group II had dialysis dependent patients. Abdominal aorta, mitral and tricuspid valves were assessed to look for vascular calcification. Calcium, phosphate and parathyroid hormone levels were done to assess the mineral bone profile. Results: Out of 310 patients, 192 (61.9%) patients were males and 118 (38.1%) were females. Ninty-eight (31.6%) had evidence of vascular calcification while 212 (68.4%) did not have vascular calcification. 147 (47.4%) had hypocalcaemia, 167 (53.8%) had hyperphosphatemia while 98 (31.6%) patients had raised Parathyroid hormone levels. Regression analysis revealed that vascular calcification and abnormal mineral bone profile was significantly present more among patients who were dependent on dialysis (p-value<0.05). Conclusion: Bone mineral disease and vascular calcification were consistent findings among patients suffering from chronic kidney disease. Patients who were dependent on dialysis were more prone to develop these complications as compared to those who were not dependent on dialysis. [ABSTRACT FROM AUTHOR]

Background: Multiple options have been tried to counter the proteinuria secondary to renal diseases. Clinicians and researchers are trying to find the best option for this purpose. Objective: To compare efficacy of Losartan and Diltiazem in management of proteinuria in nondiabetic renal diseases at a tertiary care hospital of Pakistan. It was a Quasi-experimental study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Five months, November 2020 to March 2021. Methods: A total of 122 patients of non-diabetic renal diseases with significant proteinuria were included in the study. They were randomly divided into two groups via lottery method. Group I received losartan while group II received Diltiazem in standard dose for three months. After three months they underwent 24 hours’ urinary protein levels and divided into complete, partial and non-responders to treatment. Age, gender, duration of illness and type of antiproteinuric treatment was correlated with response to treatment among the study population. Results: Out of 122 patients, 80 (65.6%) were males while 42 (34.4%) were females. Membranous nephropathy 20 (16.4%) was the commonest non-diabetic renal disease seen in our study participants. Thirty (24.5%) had complete remission after three months of treatment, 60 (49.2%) had partial response while 32 (26.3%) had no response to treatment. Chisquare test revealed that use of losartan had statistically significant relationship (p-value<0.001) with good response among the study participants. Conclusion: Membranous nephropathy leading to proteinuria was the commonest non-diabetic renal disease encountered in our setup. Around 2/3rd of our patients showed either complete or partial response to treatment and Losartan was superior to Diltiazem in achieving response in our study participants. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the frequency, risk factors and mortality of post-banding bleeding in cirrhosis. Study Design: Retrospective longitudinal Study. Place and Duration of Study: Department of Medicine, Fauji Foundation Hospital, Rawalpindi Pakistan, from Feb to Jul 2021. Methodology: Esophageal variceal band ligation (EVBL) was done in 123 patients. The study cohort was divided into two groups: Group-1 without re-bleed and Group-2 with re-bleed. Blood chemistry, Child-Pugh and MELD score, including the indications of EVBL and risk factors, were also analysed. Regression analysis was performed. Results: Re-bleed occurred in 10.6% (n=13) of patients. The mean duration between ligation and re-bleed was 8.75±2.8 days. Oesophageal ulcers were the most common cause of re-bleeding (38.5%). Mortality rates among the two groups were 21.8%(n=24) and 30.8%(n=4), respectively. The model for end-stage liver disease score (OR 2.177, CI 1.069-4.43, p.03), APTT (OR 0.593, CI 0.397-0.887, p.01) and Sodium (OR 1.345, CI 1.07-1.69, p<0.01) were detected as the predictors of re-bleed. Conclusion: Although re-bleeding after banding occurs in a trivial number of patients, it contributes to mortality. Coagulopathy, high sodium and MELD score are major predictors. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the efficacy, cost effectiveness and safety of streptokinase as intraluminal thrombolytic for occluded tunneled catheters in dialysis patients of a tertiary care hospital. Study Design: Prospective quasi-experimental study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: The sample population comprised of 66 patients with occluded tunneled HD catheters who received either streptokinase in a dose of 250,000 unit or 375,000 units. Primary endpoint was the proportion of patients with occluded catheters achieving post-thrombolytic blood flow of ≥300 mL/min which persists for about 30min of hemodialysis. Safety endpoints included the adverse complications like bleeding or any serious allergic reaction. Results: Out of 60 patients, 30 patients were treated with streptokinase in a dose of 375,000 units and 30 patients with 250,000 units of streptokinase. Hypertension and diabetes were the main causes of end-stage renal disease (50% vs 40%, p=0.08 and 33% vs 33%, p=0.38, respectively) jugular vein as main vascular access (54.8% vs 62.5%, p=0.57). Primary success was achieved in 60% in the first group and 42% in the second group, p=0.012. Patency was not achieved after the second dose in 10% in group-1 and 6.6% in the second group (p=0.31). Conclusion: Streptokinase, although its efficacy as intraluminal thrombolytic agents is shrouded in disputation but still can be used as a robust and economical thrombolytic agent for occluded HD catheters in our country. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). TCC placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. Methods: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. Results: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). Conclusion: TCC can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of hyperuricemia in predialysis CKD patients in a tertiary care hospital and analyze its relationship with various socio-demographic factors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from 1st Jun 2017 30th Nov 2017. Material and Methods: The sample population comprised of 200 predialysis CKD patients, stage 1-5, of a tertiary care hospital in Rawalpindi, Pakistan. Fasting serum uric acid level was obtained from the patients. Relationship of age, gender, education status, marital status, smoking history, dietary history, BMI, eGFR, lipid profile and blood pressure (systolic and diastolic) was assessed with the serum uric acid level. Results: Out of 200 patients, 62.5% had hyperuricemia and 37.5% had normal levels. After applying the logistic regression we found that presence of increased systolic blood pressure, raised cholesterol level, increasing age, lowe GFR and smoking history had significant association with the hyperuricemia. Conclusion: This study showed a high prevalence of hyperuricemia in predialysis CKD patients. Special consideration should be remunerated to the predialysis CKD population having risk factors like hyperlipidemia, high systolic blood pressure along with hyperuricemia as propitious management can procrastinate the progression of CKD and eventually paring down the cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To document quality of life in haemodialysis patients and to determine predictive factors. Study Design: Cross sectional study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi, from Oct to Nov 2016. Material and Methods: Patients undergoing maintenance haemodialysis were selected by convenience sampling. Patients with acute kidney injury, those on infrequent HD, those on dialysis for less than three months and unwilling patients were excluded. Kidney Disease Quality of Life Short Form Version 1.3 was administered in direct face-to-face interviews. The effects of age, gender, level of education, duration on haemodialysis, smoking, marital status, frequency of dialysis per week, body mass index, presence of comorbid conditions, residence, availability of attendant, type of vascular access and household income on quality of life indices was studied. Results: There were a total of 109 patients, having a mean age of 50.22 ± 13.73 years. Out of these, 86 (78.90%) were males. Mean physical composite score, mental composite score and kidney disease component summary score were 33.41 ± 6.85, 46.10 ± 5.89 and 65.00 ± 6.11 respectively. Adequate physical composite score, mental composite score and kidney disease component summary score were attained by 8.26%, 22.94% and 49.54% patients respectively. A higher level of education predicted a higher mental composite score and a younger age predicted a better kidney disease component summary score. None of the factors studied could predict higher physical composite score. Conclusion: Haemodialysis patients had a poor quality of life. Older age and a lower level of education were best predictive factors in our patients. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the effectiveness of immunosuppressants along with ACEI and /or ARBS in proteinuria in patients with solitary kidney post nephrectomy. Study Design: Prospective quasi-experimental study. Place and Duration of Study: Combined Military Hospital Peshawar and Multan, from 2010 to 2016. Subjects and Methods: The sample population comprised of 07 cases of post nephrectomy solitary kidney developing proteinuria from 2010-2016 reporting to hospitals. Patients were given initially ACEI and/or ARBS to lower proteinuria for three months. They were followed up to see for complete or partial remission. Deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS was added to patients who didn’t go into remission. Results: Out of 7 patients, 3 (42.9%) were males and 4 (57.1%) were female patients. Addition of deltacortil 1mg/kg max 60mg/day along with ACEI and /or ARBS reduced proteinuria to less than 1 gram in 3 patients (2 males and 1 female) and less than 300mg in 4 patients (1 male and 3 females). There was a reduction in the mean 24hrs urinary protein excretion as a whole from the baseline 2.33 ± 0.84 g/24 hrs to 0.48 ± 0.33 g/24 hrs. Remission was achieved on the average in three months and maintenance on tapering doses for 12 months. Cyclosporine was used in three cases who relapsed on tapering steroids and remission was achieved with 5-10mg steroids and 100-200mg of cyclosporine. Conclusion: Non respondent patients with solitary kidney developing proteinuria being treated with ACEI and /or ARBS had good chance to lower their proteinuria with steroids. Relapses even with steroids responded to cyclosporine. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and association of cognitive decline among the patients of chronic kidney disease (CKD) undergoing hemodialysis. Study Design: Cross-sectional study. Place and Duration of Study: Military Hospital Rawalpindi, between Jul to Dec 2016. Material and Methods: The sample population comprised of patients of chronic kidney disease (CKD) undergoing hemodialysis at a tertiary care hospital in Rawalpindi, Pakistan. Cognitive decline was assessed by using the British Columbia Cognitive Complaints Inventory (BC-CCI). Relationship of age, gender, marital status, psychiatric morbidity, education, occupation, BMI, duration of dialysis, dialysis count per week, level of family income, use of naswar and tobacco smoking was assessed with the presence of cognitive decline. Results: Out of 140 patients screened through BC-CCI, 86.4% showed the presence of cognitive decline while 13.6% had no cognitive decline. After applying the logistic regression we found that psychiatric morbidity and longer duration of dialysis had significant association with the presence of cognitive decline. Conclusion: This study showed a high prevalence of cognitive decline among the patients of CKD undergoing dialysis. Special attention should be paid to the patients who have some sort of psychiatric morbidity or those who are on dialysis for a longer period of time. [ABSTRACT FROM AUTHOR]

Objective: To assess validity of platelet count/spleen diameter ratio in cirrhotic patients, as a non-invasive predictor of high risk esophageal varices (EVs). Study Design: Cross sectional validation study. Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi. Material and Methods: A total of 160 cases with cirrhosis due to any cause were included in this study. The study included both male and female subjects and was restricted to age 35-70 years. Exclusion criteria were also applied to this group of patients. All these patients underwent blood test for platelet count and ultrasound abdomen for splenic diameter. For each patient calculation of platelet/splenic ratio was determined with a cut off value of 909 determined. Values greater than this cut off were supposed not to have high risk esophageal varices. Upper gastrointestinal endoscopies were performed on all patients and then on the basis of endoscopy results the patients were divided into two groups, first group in which high risk EVs (grade 2 and grade 3) were present and second group in which they were absent. Subsequently sensitivity, specificity, predictive values and accuracy were calculated, keeping in view the calculated cut off value and endoscopy findings. Results: In our study, 60% (n=96) were between 35-50 years of age and 40% (n=64) were between 51-70 years of age, mean ± SD was calculated as 50.15 ± 9.28 years, 55.63% (n=89) were male and 44. 37% (n=71) were females. Validity of platelet count/spleen diameter ratio in cirrhotic patients for diagnosis of high risk EVs, keeping endoscopy as gold standard was recorded which showed that 58.13% (n=93) were true positive, 5.63% (n=9) were false positive, 27.5% (n=44) were true negative and 8.75% (n=14) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were calculated as 86.92%, 83.01%, 91.18%, 75.86% and 85.63% respectively. Conclusion: Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting EVs in patients with hepatic cirrhosis but some-other trials in our local population are required to further authenticate its accuracy. [ABSTRACT FROM AUTHOR]

Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Nephrology Military Hospital (MH) Rawalpindi, from Jan 2016 till Mar 2016. Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19. Results: Out of the 150 enrolled patients, males were 125 (83.33%) and females were 25 (16.67%). A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 (12.62%) dialysis sessions, followed by hypertension in 208 (8.25%) and fever in 193 (7.66%) sessions. Other complications were muscle cramps in 116 (4.60%), shivering in 94 (3.73%), headache in 70 (2.78%), nausea/ vomiting 60 (2.38%), itching 41 (1.62%), chest pain 37 (1.47%), hypoglycaemia 31 (1.23%), seizures 23 (0.91%) and arrhythmias in 13 (0.52%) dialysis sessions. Conclusion: Haemodialysis, one of the renal replacement therapies, is a life-saving treatment modality but it is not without complications despite the advances in technology. However frequency with which they occur is low and majority are not life threatening. [ABSTRACT FROM AUTHOR]

Objective: To compare short term mortality in non-diabetic ischemic stroke patients with or without stress hyperglycemia. Study Design: Cohort study. Place and Duration of Study: This study was carried out at Neurology Department of Military Hospital, Rawalpindi from Jan 2010 to Jul 2012 for a total duration of six months. Material and Methods: Non-diabetic ischemic stroke patients were included in the study and they were divided in two groups. Each group had 75 patients. Group 'I' (Normoglycemic or control group) had normal blood glucose level while group 'II' (Hyperglycaemic or cohort) had hyperglycaemia on presentation or over next 72 hours. Prognosis in terms of patient either being dead or alive was determined within or at 4 weeks of admission in both groups. Data were entered and analysed using Statistical Package for Social Sciences SPSS version 10. Descriptive statistics were calculated for both qualitative and quantitative variables. For comparison of short term mortality in hyperglycaemic and normoglycemic stroke patients, chi-square test was applied. p-value <0.05 was considered statistically significant. Results: Short term mortality was higher in cohort (hyperglycemic) group as compared to control (normoglycemic) group (34.7% vs. 14.7%). Relative risk was 2.36. The groups had a statistically significant difference in the short term mortality within four weeks with a Chi-Square 'p' value of 0.004 (p=0.004). Conclusion: Short term mortality in non-diabetic ischemic stroke patients with stress hyperglycemia is higher than those patients who do not have stress hyperglycemia. [ABSTRACT FROM AUTHOR]

Objective: To determine seroprevalence of hepatitis B and C among blood donors in 2009 and comparing with the seroprevalence in 2014. Study Design: Cross sectional study with retrospective data collection. Place and Duration of Study: Foundation University Medical College and Fauji Foundation Hospital, Rawalpindi. Data in 2009 and in 2014 were collected. Material and Methods: The blood samples collected from individuals from Province of Khyber Pakhtunkhawa, Azad Kashmir and Northern Punjab including Rawalpindi-Islamabad & comprised 3776 (in the year 2009) and 6740 (in the year 2014) adults ranging from 18 to 60 years who reported to Fauji Foundation Hospital, Rawalpindi voluntarily or as a compulsion to donate blood for their patients. Results: During 2009, there were 71 (1.88%) and 113 (2.99%) donors positive for hepatitis B surface antigen (HBsAg) and anti hepatitis C virus (Anti HCV) respectively out of a total of 3776 donors whereas during 2014 there were 106 (1.57%) and 174 (2.58%) donors positive for HBsAg and anti HCV respectively out of a total donors of 6740. There was no statistical significant difference between the year (2009 and 2014) and seroprevalence of HBsAg (p=0.239) and HCV positive donors (p=0.215). Conclusion: There is no significant change in seroprevalence of hepatitis B and C among blood donors during 2014 as compared to 2009 in Northern Pakistan. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) has been a highly prevalent medical condition in all parts of the world affecting the haemostasis of the body in number of ways. Epidemiological data suggest that no region of the world has been spared from this condition and both developing and developed countries equally share the burden of this disease. Objective was to compare the vascular calcification and mineral bone disease in non-dialysis vs dialysis patients suffering from chronic kidney disease at a tertiary care hospital of Pakistan. It is a Comparative study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Four months from November 2020 to February 2021., Methods: A total of 310 cases were included in the study, which were diagnosed as chronic kidney disease in nephrology department by a consultant nephrologist on basis of National Kidney Foundation/Kidney Disease Outcome Quality Initiative (NKF/KDOQI) 2002. They were divided into two equal groups by block randomization. Group I had the patients who were not dependent on dialysis (CKD4/5ND) while group II had dialysis dependent patients. Abdominal aorta, mitral and tricuspid valves were assessed to look for vascular calcification. Calcium, phosphate and parathyroid hormone levels were done to assess the mineral bone profile., Results: Out of 310 patients, 192 (61.9%) patients were males and 118 (38.1%) were females. Ninty-eight (31.6%) had evidence of vascular calcification while 212 (68.4%) did not have vascular calcification. 147 (47.4%) had hypocalcaemia, 167 (53.8%) had hyperphosphatemia while 98 (31.6%) patients had raised Parathyroid hormone levels. Regression analysis revealed that vascular calcification and abnormal mineral bone profile was significantly present more among patients who were dependent on dialysis (p-value<0.05)., Conclusions: Bone mineral disease and vascular calcification were consistent findings among patients suffering from chronic kidney disease. Patients who were dependent on dialysis were more prone to develop these complications as compared to those who were not dependent on dialysis.

Background: Multiple options have been tried to counter the proteinuria secondary to renal diseases. Clinicians and researchers are trying to find the best option for this purpose., Objective: To compare efficacy of Losartan and Diltiazem in management of proteinuria in nondiabetic renal diseases at a tertiary care hospital of Pakistan. It was a Quasi-experimental study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Five months, November 2020 to March 2021., Methods: A total of 122 patients of non-diabetic renal diseases with significant proteinuria were included in the study. They were randomly divided into two groups via lottery method. Group I received losartan while group II received Diltiazem in standard dose for three months. After three months they underwent 24 hours' urinary protein levels and divided into complete, partial and non-responders to treatment. Age, gender, duration of illness and type of antiproteinuric treatment was correlated with response to treatment among the study population., Results: Out of 122 patients, 80 (65.6%) were males while 42 (34.4%) were females. Membranous nephropathy 20 (16.4%) was the commonest non-diabetic renal disease seen in our study participants. Thirty (24.5%) had complete remission after three months of treatment, 60 (49.2%) had partial response while 32 (26.3%) had no response to treatment. Chisquare test revealed that use of losartan had statistically significant relationship (p-value<0.001) with good response among the study participants., Conclusions: Membranous nephropathy leading to proteinuria was the commonest non-diabetic renal disease encountered in our setup. Around 2/3rd of our patients showed either complete or partial response to treatment and Losartan was superior to Diltiazem in achieving response in our study participants.

Background: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). Tunnelled cuffed catheters placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings., Methods: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure., Results: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001)., Conclusions: Tunnelled cuffed catheters can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.

Background: It's estimated that almost 2.2% of the world's inhabitants suffer from hepatitis C virus (HCV). The most common cause of chronic liver disease in haemodialysis centres is due to HCV. In 1993, it was first described by Bukh and colleagues that HCV viremia can occur without any detectable antibodies to the HCV. Keeping this in mind the purpose of this cross-sectional study was to assess the frequency of HCV in haemodialysis patients by PCR who are serologically negative for HCV., Methods: This cross-sectional study was conducted from 1st June to 31st December 2016 on all haemodialysis patients at MH Rawalpindi. Epidemiological data for gender, age, duration on haemodialysis, cause of chronic renal failure and any associated risk factor for acquiring hepatitis C infection was asked. Patients undergoing haemodialysis were investigated by fourth generation ELISA for Anti HCV antibodies, HCV DNA polymerase chain reaction, HCV genotype (where required) and liver function test were also done., Results: A total of 201 patients were undergoing haemodialysis. Among these patients 73 were hepatitis "C" negative and 128 were hepatitis "C" positive. Among the 73 patients who were hepatitis C negative by ELISA method 17 (23%) were PCR positive. Of the 17 patients 13 (76.5%) were men and 4 (23.5%) were women. The mean age of the patients was 49.7±18.0 years and mean duration of haemodialysis was 4.4±4.1 months. The most common cause of CKD requiring haemodialysis was hypertension (64.7%). The most common genotype was type 1 (58.8%) followed by genotype 3 (41.2%). The mean viral load was 23583615.70 IU., Conclusions: HCV-RNA detection by PCR should be used as standard of care to detect HCV infection in patients undergoing haemodialysis.

Background: This study was conducted to determine the association between the subjective quality of sleep and cognitive decline among the patients of chronic kidney disease (CKD) undergoing haemodialysis., Methods: In this cross-sectional study 106 patients of chronic kidney disease (CKD) undergoing haemodialysis at a tertiary care hospital in Rawalpindi, Pakistan were included in the final analysis. Cognitive decline was measured by British Columbia Cognitive Complaints Inventory (BC-CCI). Sleep quality was measured by using the Pittsburgh Sleep Quality Index (PSQI). Relationship of age, gender, marital status, education, occupation, BMI, duration of dialysis, dialysis count per week, family income, tobacco smoking and use of naswar was assessed with the cognitive decline.., Results: Out of 106 patients screened through BC-CCI and PSQI, 13.1% had no cognitive decline while 86.9% had significant cognitive decline. Relationship between quality of sleep and cognitive decline was significant on binary logistic regression.., Conclusions: This study showed significant relationship between the sleep quality and cognitive decline among the patients of CKD undergoing haemodialysis. The findings of our study also call for a greater degree of understanding of the physical and psychological state of patients of CKD undergoing haemodialysis.

Objective: To assess the subjective sleep quality and its relationship with the presence of psychiatric morbidity in the patients suffering from chronic kidney disease (CKD) and undergoing the procedure of hemodialysis (HD); and analyze the associated socio-demographic factors., Study Design: Cross-sectional descriptive study., Place and Duration of Study: Nephrology Department, Military Hospital, Rawalpindi, from July to December 2016., Methodology: Patients of CKD undergoing the HD were included in the final analysis. Quality of sleep was determined by using the Pittsburgh Sleep Quality Index (PSQI). Psychiatric morbidity was determined by the General Health Questionnaire 12 (GHQ-12). Relationship of education, BMI, gender, age, duration of dialysis, dialysis count per week, marital status, level of family income, psychiatric morbidity, occupation, biochemical markers (urea, creatinine, BUN, albumin, calcium, phosphorous and hemoglobin), tobacco smoking, and use of naswar was determined with the sleep quality., Results: One hundred and forty patients were screened through the PSQI; 44 (31.4%) had good quality of sleep while 96 (68.6%) had poor sleep quality. Statistical analysis revealed that presence of psychiatric morbidity, increasing age, female gender, being unmarried, low family income, and low frequency of dialysis had significant association with the poor sleep quality., Conclusion: Poor sleep quality was highly prevalent among the patients of CKD receiving the hemodialysis. The patients with low family income, more age, and with two or less dialysis sessions per week should be screened thoroughly for the sleep problems. Presence of psychiatric morbidity emerged as an independent factor responsible for the poor sleep quality in our target population.