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Neck pain is the fourth leading cause of disability, and is the most common musculoskeletal disorder. High-heel shoes, one of the significant identities of females, cause pain in the neck as well as in feet and ankle regions. The current narrative review was planned to explore evidence to highlight the biomechanical factors of high-heel shoes as the source of neck pain, which mostly remains undiagnosed. PubMed and Google Scholar search engines were explored for full text of research articles published in English language from 2016 to 2021. Of the 82 studies initially found, 22(27%) were shortlisted for full-text assessment, and, of them, 6 (27.27%) were selected for detailed analysis. Despite other contributing factors, kinematics and kinetics should be considered primarily during neck pain management. Based on best available evidence, high heels increase the individual's height, but result in significant decrease in trunk flexion. Evidence also suggests that the type and width of heels do not affect as much as the height of the heels in the context of pain and functional issues in the cervical region.

Objective: To evaluate the prevalence and contributing factors causing post transplant erythrocytosis in renal transplant patients., Methods: This retrospective study was conducted on live related renal transplant patients at SIUT. The records of all transplant recipients transplanted between April 2008 and December 2008 and who had at least 24 months follow up were studied. Patients in whom haematocrit exceeded 51% and those who received treatment for it were classified into post transplant erythrocytosis group., Results: Out of 200 renal transplant patients who had functioning graft at the time of analysis, 40 (20%) developed post transplant erythrocytosis (HCT > or = 51%) after a mean interval of 9.5 +/- 2.5 months. Patients with erythrocytosis were mostly males (95% in PTE group vs 73.75% in non PTE group), had a shorter period on dialysis before undergoing renal transplantation (9.28 months in PTE group vs 14.56 months in non PTE group) and had relatively better graft function at the onset of erythrocytosis as judged by serum creatinine (S. Creatinine of 1.06 +/- 0.29 mg/dl in PTE group vs 1.37 +/- 0.51 mg/dl in non PTE group). No thrombotic complications were observed. All patients with erythrocytosis were treated with enalapril (ACE inhibitors) and 28 out of 40 required phlebotomy in addition to ACE inhibitors. The mean HCT at the time of last follow up in treated patients was 48.61 +/- 1.85%., Conclusion: Post transplant erythrocytosis generally occurs in male patients with good graft function, thrombotic complications are of rare occurrence and response to ACE inhibitors is good.

Objective: To asses the prevalence of post-transplant renal tubular acidosis (RTA) and its associated risk factors., Methods: A cross-sectional study was conducted on 100 live related renal transplant recipients, with a transplant duration of more than one year and an estimated GFR > 40 ml/min/1.73m2. Patients with acute graft rejection within last 6 months, unstable graft function, acute urinary tract infection and diarrhoea were excluded. Renal Tubular Acidosis (RTA) was diagnosed on the basis of plasma bicarbonate, venous pH, urine and serum anion gap measurements., Results: Out of 100 patients (74 male, 26 female) RTA was observed in 40 (29 male, 11 female). Patients with RTA had a lower GFR (65.87 +/- 12.35 versus 74.23 +/- 14.8 ml/min/1.73m2, P = 0.004) and higher number of previous acute rejections. Lower bicarbonate was associated with higher serum chloride (108.2 +/- 3.19 versus 105.72 +/- 3.9 mEq/L, P = 0.001) and higher potassium concentration (3.95 +/- 0.53 vs 3.61 +/- 0.46 mg/dl, P = 0.001). Higher phosphorous level (3.46 +/- 0.71 in RTA vs 3.19 +/- 0.59 mg/dl in non-RTA, P = 0.045) but lower total serum calcium concentrations were found in patients with RTA. Intake of angiotensin converting enzyme inhibitors (ACE 1) was associated with the development of RTA. Calcineurin inhibitor (CNI) therapy was not associated with an increased likelihood of RTA. While no difference was noted in sex, age, pre-transplant dialysis duration, post transplant period, body mass index and serum albumin levels., Conclusion: There is a high prevalence of RTA in renal transplant recipients. In most of the patients, this is subclinical and does not require treatment.

Objective: To determine the risk factors of urinary tract infection in renal transplant recipients and its effect on graft function among transplanted patients visiting the outpatients department of Sindh Institute of Urology and Transplantation., Methods: This cohort study was conducted at Transplantation department, Sindh Institute of Urology and Transplantation Karachi. The period of the study enrollment extended from April 2008 to September 2008 included were two hundred adult live related renal transplant recipients who were enrolled during the initial post transplant period and followed up for one year. Analysis was done by using SPSS ver 10.0. The level of significance was taken as 0.05. Student's t test and chi square test were used to compare the variables in both groups., Results: The mean age of the patients was 30 +/- 10 years. Sixty six (33%) renal transplant recipients had at least one episode of urinary tract infection which occurred in 51 (77%) patients during the first two months after renal transplant and 8 (12%) patients had recurrence of infection. Gram negative bacilli were the principally isolated agents. E. coli was found in 34 (51%) patients and Pseudomonas in 12 (18%). Renal stone disease, structural abnormalities, delays in Foleys removal, and post operation hospital stay were statistically significant risk factors for urinary tract infection in the patients. Twenty three recipients of the study developed early graft dysfunction due to urinary tract infection. No graft was lost in either groups., Conclusion: Structural abnormalities, renal stone disease, delay in removal of Foley's catheter and increased post transplant hospital stay are risk factors leading to UTI in renal transplant recipients.

Objective: To determine the prevalence of metabolic syndrome (MS) in renal transplant recipients (RTR) using the modified Asian National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) criteria., Methods: A cross-sectional study was conducted on 200 RTRs between January 2008-August 2008. All were more than six months post transplant and above 18 years of age. Subjects with pre-transplant diabetes or New Onset Diabetes Mellitus after renal transplantation, with overt infections, dyslipidaemia or on lipid lowering medication and taking immunosuppressive drugs of the target organ inhibitor group as rapamycin, were excluded. The prevalence of MS was determined using the (NCEP-ATP III) criteria modified for Asians which includes waist circumference, triglycerides, HDL cholesterol, blood pressure and fasting blood glucose., Results: Of the 200 recipients studied, 87 (43.5%) had MS. There were 58 (39.4%) males and 29 (54.7%) females which shows female predominance. The mean age of the MS group was more then that of the non MS group (p < 0.0001). Hypertension and New Onset Diabetes Mellitus were prevalent more in MS group (p < 0.001 and p < 0.0001 respectively). Mean serum creatinine was higher in MS group but there was no significant difference. The prevalence of MS was 4.5% in the first twelve months, with a rise in this figure to 41.3% between one to five years after transplantation., Conclusion: There is a high prevalence of MS in Renal Transplant Recipients specifically after one year of transplantation.

Factors leading to acute renal failure (ARF) were analysed in 376 consecutive patients between January 1993 and December, 1994 in a Karachi centre. Two hundred and sixteen (57%) had medical conditions, 86 (24%) obstetrical, 28 (7%) obstructive, 18 (5%) surgical and in 28 (7%) the causes were uncertain. Within the medical group, the causes were diarrhoea 30%, drugs 23%, malaria 15% and liver disease 5%. In the obstetrical group majority of the patients had multiple etiologies. Sixty percent of patients had ante-partum haemorrhage, 33% post-partum haemorrhage, intrauterine deaths were seen in 31%, septic abortions in 20% and pre-eclamptic toxemia in 22% cases. In the obstructive group, most of the patients had stone disease, where bilateral ureteric calculi constituted 57% of the cases. In surgical group, 11 (61%) had ARF due to post-operative complications. This data confirms the pattern of ARF from other third world countries where obstetrical and obstructive causes are high as compared to western countries.

Trauma and non-traumatic insults can cause muscle damage to such an extent that serious sequelae to other organs may result. Myoglobinuria and subsequent acute renal failure (ARF) is a well known and widely studied fact of such sequelae. Twelve cases of ARF (between 1990-1993) who have developed renal dysfunction after prolonged muscular exercise e.g., squat jumping, sit-ups and blunt trauma from sticks or leather belts mainly given by law enforcing personnel for certain issues were studied. None of them had previous history of myopathy, neuropathy or renal disease. All were critically ill on presentation and required renal support in the form of dialysis. Although morbidity was high in all, eleven of them recovered and one expired due to sepsis.