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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.

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................

Objective: To compare the efficacy of ultrasound guided bilateral transversus abdominis plane block with conventional analgesic technique for post-operative pain relief, time to first request for analgesic, early mobilization, opioid related side effects in obstetric and gynecological surgeries. Study Design: Quasi experimental study. Place and Duration of Study: Obs & Gynae Department at Combined Military Hospital Lahore and Hyderabad, from, Apr 2017 to Sep 2017. Methodology: In this study 200 mothers were included. The population under study was divided into two groups, group-A mothers had Transversus Abdominis Plane block and group B (control) without Transversus Abdominis Plane block. Results: The mean age was 34 years within a range of 20 to 50 years. Pain score, Visual Analogue Score, was much lower in group A (with TAP block) in comparison to group B (without TAP block) (p-value=0.000). The median time for asking for painkillers was 10 hrs (9, 11) in group A as compared to 3 hrs (2, 6) in group B. Conclusion: Transversus Abdominis Plane block reduced pain intensity, delays the requirement of painkillers and decreased any additional requirements of opiates-analgesics especially when those are used as a part of any painkilling-regimens after obstetric and gynecological surgeries. Downloads

Objective: To evaluate the significance of retrograde air injection for identifying posterior calyx in patients undergoing mini-percutaneous nephrolithotomy. Study Design: Prospective, quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Dec 2016 to Dec 2017. Methodology: We prospectively studied 281 patients, who were undergoing mini-percutaneous nephrolithotomy by single surgeon, fulfilling inclusion criteria. Morbidly obese, hepatitis B or C positive and pregnant women were excluded. After the insertion of ureteric stent in lithotomy position, puncture was carried out in prone position, 3-5 cc of air was injected, in 137 patients among total of 281, when the anatomy of calyces was not clear after retrograde contrast injection with continuous fluoroscopy. The collected data included demographics (age, gender) and success/failure rate with and without air instillation (two groups). Result: Among 281 individuals selected, there was a mean age of 39.48 years in both gender with maximum patients in their 4th decade. A total of 209 were males (74.4%) and 72 were females (25.6%). In non-randomized two groups, one group (n=141, 50.2%) was injected with air for identifying posterior calyx which resulted in successful puncture in 137 patients with failure in 4 patients, similarly in the group which received no air instillation (n=140, 49.8%) failure to localize posterior calyx was seen in 17 patients, which was found to be statistically significant (p-value=0.003) Conclusion: Air injection is an easy and a very useful tool for urologists in identifying posterior calyx with statistically significant success.

Objective: To study the spectrum and antimicrobial sensitivity of bacterial pathogens causing neonatal sepsis, in neonatal intensive care unit (NICU) of Pak Emirates Military Hospital, Rawalpindi. Study Design: Prospective cross sectional study. Place and Duration of Study: This was a prospective cross sectional study, conducted at NICU of Military Hospital, Rawalpindi, from Jul 2017 to Dec 2017. Material and Methods: All neonates admitted to our department who underwent evaluation for sepsis, from Jul 2017 to Dec 2017. Results: Out of 2,480 admitted neonates, 733 were suspected with sepsis, making an incidence of suspected neonatal sepsis to be 29.5%. 421 (57.4%) babies were suspected with early onset sepsis (EOS) and 312 (42.6%) with late onset sepsis (LOS). Majority of the babies (70.3%) were preterm. In 281 (11.3%) neonates, blood culture came out to be positive. 73/281 neonates with culture proven sepsis died making a mortality rate of 25.9%. Gram negative bacilli were most predominant among isolated bacteria. Most of the organisms showed resistance to the first line antibiotics. Conclusion: Sepsis has a high mortality rate in neonates admitted to our department. Gram negative organisms are the most common cause. Most of the isolated organisms are resistant to empirical antibiotics.