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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

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 pre- and 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

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

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 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection 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.

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

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.

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.

Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020. Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials. Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstream infections per 1000 catheter days, with confirmed growth on blood cultures were identified. Gram positive infections were seen in 76 (55.88%) individuals with most common organism being coagulase-negative Staphylococcus (28.68%), followed by Staphylococcus aureus (21.32%). These organisms had low resistance rates to Vancomycin (0%), Tigecycline (0%), Doxycycline (6.6%) and Linezolid (9.5%). Gram negative infections were seen in 60 (44.11%) patients with Klebsiella pneumoniae (13.24%) being the most commonly identified pathogen followed by Acinetobacter baumannii (12.50%) and had relatively higher degree of antimicrobial resistance. Conclusion: Gram positive organisms were the most common cause of bloodstream infection in this study and were found susceptible to vancomycin and doxycycline whereas gram-negative organisms had high rates of antimicrobial......

Objective: To find the prevalence of depression in admitted patients of pulmonary tuberculosis. Study Design: Cross-sectional study. Place and Duration of Study: Tuberculosis centre, Pak Emirates Military Hospital Rawalpindi and Medicine department Combined Military Hospital Peshawar, from Dec 2017 to May 2018. Methodology: One hundred and six patients of both genders admitted due to pulmonary tuberculosis for more than 2 weeks were taken into study. Individuals on treatment for depression before diagnosis of tuberculosis on medical records and patients with chronic debilitating diseases liable to depression were excluded. All patients were interviewed and scored on Hamilton Depression Rating Scale. Data was noted on especially designed proforma. Statistical analysis was done on SPSS-22. Results: Mean age of the patients was 37.452 ± 9.26 years with range from 20 to 60 years. Mean duration of tuberculosis was 4.283 ± 1.21 months and mean duration of hospitalization was 3.584 ± 0.65 weeks while mean weight was 70.839 ± 8.85 Kg. Majority of the patients were male 54 (50.9%) and married 79 (74.5%). Depression was seen in 45 (42.5%) patients. Conclusion: The effects of chronic diseases such as tuberculosis are not only physical but also include mental health dysfunction which can lead to poor drug compliance and ultimately drug resistance. In our study depression was recorded in 42.5% of patients hospitalized for treatment of tuberculosis. Thus, all admitted patients of tuberculosis should be screened for depression and managed in collaboration with psychiatrist.

Objective: To compare the frequency of infection between internal jugular and femoral vein double lumen haemodialysis catheter in chronic kidney disease (CKD) patients. Study Design: Comparative prospective study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Peshawar, from Jan to Jun 2018. Methodology: A total of 400 patients (200 patients in each group) were included in this study. After insertion of catheter the patients were divided into 2 groups, group-A (jugular) and group-B (femoral) by lottery method and followed for development of catheter related blood stream infection (CRBI) within two weeks after its insertion. Results: Mean age of the patients was 51.68 ± 13.29 and 50.89 ± 14.31 years in group-a and b, respectively. In group-A 193 (96.5%) and in group-B 196 (98%) patients presented with chronic kidney disease duration of 5 years. In both groups, 65 (32.5%) were diabetic. Catheter related blood stream infection (CRBSI) was found in 13 (6.5%) and 8 (14%) in group-A & B, respectively. Conclusion: Infection frequently complicates double lumen catheters used for haemodialysis and infections are more frequent in patients with femoral vein catheter as compared to internal jugular vein.

Objective: To estimate the occurrence of “difficult ureter” where stenting was performed as a preliminary step for passive ureteric dilatation before second ureterorenoscopy and to create awareness of the incidence of this abnormality in our setting. Study Design: Cross sectional prospective case review study. Place and Duration of Study: Study was conducted in Urology department of PNS Shifa Karachi, from Jul 2017 to Mar 2018. Material and Methods: All patients who presented to our institute for ureteric calculi with normal creatinine and no urosepsis were included in the study. The procedure was carried out either in spinal anesthesia or general anesthesia using laryngeal mask. The outcome data of ureterorenoscopyin all patients including those patients who required pre-stenting for difficult ureters were documented. Results: Ureterorenoscopy was performed in 164 patients (mean age 34 years, range 14 to 70 years) for treatment of ureteric calculi. Among these 29 patients (17.7%) had upper, 52 patients (31.7%) had middle and 83 patients (51%) had lower ureteric calculi. Stone clearance was achieved in 135 (82%) of patients. In 16 (9.7%) patients the stone had to be pushed back for Extracorporeal Shock Wave Lithotripsy later. “Difficult ureters” were encountered in 13 patients (7.9%) in which Double J stents were placed under fluoroscopy and staged successful ureterorenoscopy were performed after 2 to 3 weeks without any complication. Conclusion: There was a 7.9% (about 8%) incidence of encountering “difficult ureter” while performing ureterorenoscopy for ureteric calculi resulting in failed access for which a Double-J stent will have to be introduced to avoid ureteric injury. This possibility of occurrence of a “difficult ureter” and a staged ureterorenoscopy after 2 to 3 weeks should be discussed with the patients preoperatively, in order to avoid patient dissatisfaction after the procedure and allay his undue emotional suffering.