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Objective: To determine the association of hyperuricemia with hypertension in patients presenting in the Outpatient Department for regular follow-up. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to 2020. Methodology: Three-hundred patients suffering from hypertension for more than years were recruited in this study. They were evaluated for hyperuricemia during a routine follow-up visit by performing serum uric acid levels. Results: Out of 300 hypertension patients included in the study, 187(62.3%) had no hyperuricemia, while 113(37.7%) showed the presence of hyperuricemia on routine analysis. The mean age of the study participants was 41.72±6.98 years. The mean duration of hypertension in our patients was 6.61±2.75 years. Polypharmacy and long duration of illness had a significant association with the presence of hyperuricemia among the study participants (p-value<0.001). Conclusion: Patients with hypertension showed a high frequency of hyperuricemia in our study. The long duration of hypertension and the use of multiple pharmacological agents to achieve adequate control of hypertension predicted raised levels of uric acid among hypertensive attending the routine outpatient clinic in our study. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group. Study Design: Comparative prospective study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020. Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms (increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B, comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3g stat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tract infection symptoms and bacteriologic response. Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026). Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections. [ABSTRACT FROM AUTHOR]

Objective: To assess the aetiology and outcome of patients admitted with acute kidney injury at the Nephrology Unit of Pak Emirates Military Hospital (PEMH). Study Design: Cross-sectional analytical study. Place and Duration of Study: Nephrology Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to Jun 2020. Methodology: Patients admitted with AKI were included in the study. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines were used to diagnose acute renal injury based on creatinine level or urine output. Results: A total of 300 patients were admitted to the Nephrology Unit with AKI during the study period. Sepsis was the commonest aetiology for acute kidney injury among the target population, followed by injury. 155(51.4%) patients were discharged, 53(17.7%) were stable in the ward, 70(23.4%) patients were shifted to the Critical Care Unit, and 22(7.3%) died. Long duration of hospital stay and the presence of multiorgan failure had a statistically significant relationship with poor outcomes in our study. Conclusion: This study gives an insight into the aetiology and outcome of acute kidney injury among acute kidney injury patients admitted to the nephrology ward. Sepsis and injury were the commonest causes affecting renal function. Most of the patients had a good outcome. Patients with long hospital stays and multiorgan failure should be given special attention as they were more at risk of poor outcomes in our study. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of protein energy wasting among end stage renal disease patients on maintenance hemodialysis. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from May 2019 to Mar 2020. Methodology: Two hundered patients diagnosed with end-stage renal disease on maintenance hemodialysis were included in the study. Protein-energy wasting was assessed using the Malnutrition inflammatory score comprising four x components: medical history, physical examination, laboratory parameters and body mass index. Malnutrition inflammatory score was used to categorize protein-energy wasting. Results: Out of 200 patients with ESRD on maintenance hemodialysis, 73(36.5%) patients had mild, 120(60.0 %) patients had moderate, and 7(3.5%) patients had severe protein-energy wasting. The advanced age group, multiple comorbid (diabetes mellitus, hypertension, ischemic heart disease), and duration of hemodialysis (> 2 years) had a statistically significant association with the protein energy wasting (p-value < 0.05). Protein-energy wasting was also more prevalent in patients with low monthly income (p-value 0.04). Conclusion: Protein-energy wasting is common among patients with end stage renal disease on maintenance hemodialysis. Old age group, multiple comorbid, and duration of hemodialysis are important risk factors. [ABSTRACT FROM AUTHOR]

Objective: To study the characteristics and outcome of patients having postpartum Acute Kidney Injury requiring hemodialysis and factors associated with poor outcome. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynecology, Medicine and Nephrology, Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital Kharian Pakistan, Jun 2021 to Feb 2022. Methodology: Fifty patients diagnosed as having Acute Kidney Injury during post-partum period and requiring hemodialysis were included the study. They were managed and followed up by Nephrology team for three months and outcome was recorded as good or bad on the basis of response to treatment and clinical condition. Relevant socio-demographic factors associated with outcome in study participants were also recorded on a data collection proforma. Results: Out of 50 patients with dialysis dependent Acute Kidney Injury, 25(50%) had normal vaginal delivery while 25(50%) had either cesarean or instrumental delivery. Mean age of the study participants was 33.45±6.732 years. 30(60%) patients had good outcome while 20(40%) patients had poor outcome. Statistical test revealed that post-partum hemorrhage and presence of gestational diabetes mellitus or hypertension had statistically significant relationship with poor outcome in patients suffering from dialysis dependent post-partum acute kidney injury (p-value<0.05). Conclusion: Significant number of patients with hemodialysis dependent post-partum acute kidney injury had good outcome at the end of three months. Patients with post-partum hemorrhage and presence of gestational diabetes mellitus or hypertension were more at risk of having poor outcome of acute kidney injury. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of electrolyte imbalance and associated etiological factors among the unconscious patients hospitalized at Pak Emirates Military Hospital. Study Design: Cross-sectional study Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020 Methodology: A total of 240 cases were included in this study in liaison with other departments where the admitted patients became unconscious. Patients with a Glasgow coma scale score <10 were included in the study. Serum electrolytes, including Sodium, Potassium, Magnesium and Chloride, were measured in the study participants. Results: Mean age of study participants was 49.10±7.55 years. One hundred and 62(67.5%) patients were from Medicine-Allied Wards while 78(32.5%) patients were from Surgical-Allied Wards. Thirty-eight patients were from the Critical Care Unit. Mean serum sodium was 139.10±11.52 meq/L, while potassium was 4.60±1.06 meq/L. Mean chloride was 809.4±53.55 meq/L, and Magnesium was 1.40±1.05) meq/L. Our analysis revealed that advanced age, underlying medical illness and duration of hospitalization were strongly linked with electrolyte imbalance among the unconscious patients. Conclusion: Electrolyte imbalance emerged as a common finding in the unconscious patients hospitalized in our tertiary care unit. Patients with advancing age, medical illnesses and long hospitalization should be screened for electrolyte wasting a priority to prevent them from going unconscious. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain the cost-effectiveness of tunneled catheters to nontunneled catheter in dialysis patients of a tertiary care hospital. Study Design: Retrospective cross-sectional study. Study Design: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi. Period: Jan 2016 to Jan 2019. Material & Methods: The sample population comprised of 500 patients, being divided into two groups and followed over a period of 03 yrs. Group A had tunneled double lumen and group B had non tunneled double lumen. Dialysis was started on the same day in both groups. Both groups were compared in terms of cost effectiveness. Cost effectiveness included price of catheter, procedure cost, treatment of infection (if any), and change of catheter in case of catheter malfunction. The amount spent on each patient was added and then an average was calculated. Results: Out of 600 patients, 300 were in group A and 300 patients were in group B. The two groups were analogous in gender (male: 52.8% vs 57.8%, p=0.35)age (41 years vs 49 yrs, p=0.71) hypertension and diabetes as the main causes of ESRD (51% vs 39%, p=0.08 and 32% vs 34%, p=0.38, respectively). Total incurred cost of tunneled double lumen was Rs.19000.00, with average infection free patency time being three months during which Arteriovenous fistula formed. In comparison, non-tunneled double lumen in 300 patients, average cost incurred was Rs.30000.00 including cost incurred on treating sepsis and in two -three insertions in few cases. There was no procedure related mortality. Conclusion: The cost-effectiveness of Tunneled double lumen catheters and clinical benefit of reduction in patency failures and also access related infections make them the first choice for dialysis patients in majority of dialysis centers of our country but large randomized control trials needed as the sample size quite less to detect a difference from the newer agents. [ABSTRACT FROM AUTHOR]

Objective: To look for the relationship between absolute eosinophil count and post-bronchodilator reversibility in chronic obstructive pulmonary disease patients at Pak Emirates Military Hospital, Rawalpindi Pakistan. Study Design: Cross sectional study. Place and During of Study: Pulmonology Department, Pak Emirates Military Hospital Rawalpindi (PEMH) from Jul to Dec 2019. Methodology: The study was conducted on 150 patients suffering from chronic obstructive pulmonary disease admitted in the Medical Ward or reporting in the Outpatient Department. Lung function was assessed using spirometry preand postbronchodilation. The presence and severity of chronic obstructive pulmonary disease were assessed using modified Global Obstructive Lung Disease (GOLD) criteria. The presence of significant bronchodilator responsiveness was taken as ≥12% improvement in the forced expiratory volume (FEV) (1) or the forced vital capacity. Results: Of 150 patients in the final analysis, 95 (63.3%) were male, and 55(36.7%) were female. The mean duration of COPD in our target population was 9.13±1.23 years. 68 (45.3%) had >12% improvement after bronchodilator administration, while 82(54.7%) had <12% improvement. The absolute eosinophilic count was <2% in 49(32.7%), while it was raised in 101(67.3%) patients. Conclusion: Raised eosinophilic count emerged as a predictor of good response after administering bronchodilators among patients suffering from chronic obstructive airway disease. Screening patients for this simple blood component may predict response to the initial treatment and help in the tailoring of the treatment plan by the treating physician. [ABSTRACT FROM AUTHOR]

Background: Haemodialysis is the primary mode of renal replacement therapy for patients of end stage renal disease. The most important determinant for effective haemodialysis is a reliable vascular access. Arterio-venous (AV) fistula is the closest to be an ideal long-term haemodialysis vascular access. The creation of fistulas or grafts is recommended before starting haemodialysis, this study was undertaken to determine the impact of timing of AV fistula creation on its failure rate., Methods: It is a descriptive study. All patients with chronic kidney disease (CKD) reporting to Armed Forces Institute of Urology (AFIU) and Military Hospital (MH) Rawalpindi from January 2008 to October 2009 in whom vascular access was created were included. The patients were followed prospectively and a complete data about their haemodialysis and vascular access was maintained., Results: A total of 168 permanent accesses were created in 112 patients in this study. The mean duration of follow-up was 14.05 +/- 4.45 months. Early access creation group included 23 patients and late access creation group included 89 patients. Out of 168 fistulas that were created, 54 fistulas failed with 45 (83.3%) of these from patients of late access creation group. Age, gender and diabetes mellitus (DM) had no significant affect on failure rate of fistulas., Conclusion: Timely referral to nephrologists and early creation of permanent vascular access by dedicated team work can improve the success rate of AV fistulae so enhancing quality of life of patients of end stage renal disease.