Outcome of acute kidney injuries following chronic kidney disease: A systematic review in Nawaz Sharif kidney hospital Swat

Background: Acute kidney injury may increase the risk for CKD and end-stage renal disease. In an attempt to summarize the literature and provide more compelling evidence, we conducted a systematic review comparing the risk for CKD (chronic kidney disease), AKI (Acute kidney injury), Acute gastroententeritis, postnatal AKI, Acute MI (myocardial infarction), AKI 2ndry to chemotherapy, AKI 2ndry to abstractive Nephropathy, AKI 2ndry to sepsis, AKI 2ndry to Drugs (NSAIDS and ARBS), AKI 2ndry to AGN (acute Glomerulonephritis), AKI 2ndry to Rhabdomyolysis, and lest AKI 2ndry to Malaria, death in patients with AKI,HD, CKD (chronic kidney disease). There have been several important developments in the literature recently regarding the association between acute kidney injury (AKI) and chronic kidney disease (CKD). First, when the National Kidney Foundation promulgated their highly influential Kidney Disease Outcomes Quality Initiative CKD guidelines in 2002, six chapters were devoted to the complications associated with decreased glomerular filtration rate (GFR) including hypertension, anemia, nutritional status, bone disease/disorders of calcium, and phosphorus metabolism, neuropathy Objective: To study the outcomecute kidney injury following chronic kidney disease; systematic review. Methods: This was a prospective observational study from January 2018 to December 2020. Patients visiting department of Nephrology Nawaz Sharif Kidney center Swat, number of patients included study 351. All ages and both sexes were considered. Patients treated elsewhere or who has undergone in this study. Complete medical history, detailed examination like age, sex, diagnosis, and outcome, of AKI, examination under microscope and investigations, and necessary blood investigations were carried out. Results: Three fifty one (351) patients were included in this study. The age distribution showed (75%) patients between 40-95 years and 25(25%) between 32-39 years. Mean age was 43 years with Standard Deviation of ± 35.66. Among 351 patients 162 (45%) patients were male and 189 (55%) patients were female. Duration of symptoms in 24(17%) was <4 months and 112(75%) had >4 months, with mean of 4 months and SD ± 2.315. Total 351 participants AKI 45(12%) postnatal AKI 33(9%) Acute MI 18(6%) AKI 2ndry chemotherapy 15(5.72%) AKI 2ndry to abstractive Nephropathy 55 (14%) AKI 2ndry to sepsis 63 (17%) AKI 2ndry to Drugs (NSAIDS and ARBS) 54 (14%) CKD (chronic kidney disease) 48 (15%) AKI 2ndry to Rhabdomylysis 18(6%) Conclusions: The study concludes that the acute kidney injury following CKD systematic reviewing among patients presenting with AKI,CHD ,AKI sepsis, ,AKI Drugs(NSIAD) in local hospital settings This can be reduced with proper health education in general public regarding prevention of the disease and hence its complications.

FREQUENCY OF COMMON FACTORS INFLUENCING THE GRAFT UPTAKE IN MYRINGOPLASTY AMONG THE TERTIARY CARE HOSPITAL KPK

Introduction: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and /or the ossicular chain. Myringoplasty is a tympanoplasty without ossicular reconstruction. Over the years many methods have been used for closing perforations. Myringoplasty was introduced by Berthold in 1878 but the modern era began only in 1950s with the work of Wullstein and Zoellner. The study aims to analyse the common factors which are predictive of success of myringoplasty in adult patients and to construct and validate a prognostic index that could be used as tool to predict the success of myringoplasty in adults. Objectives: To determine the frequency of common factors influencing the graft uptake in myringoplasty. Materials and Method: In this study, a total sample size was 376, using 4.08% proportion of fourth degree perineal tear, 95% confidence level and 2% margin of error under WHO software for sample size determination. Moreover, consecutive non probability sampling technique was used. Results: The mean age was 40 years with standard deviation of ± 2.63. Sixty two percent of the patients were male while thirty eight percent patients were female. The success rate of myringoplasty was 90% while the failure rate was 15(10%) patients in which 4(25%) patients had medium perforation, 5(33%) patients had large perforation while 6(42%) patients had subtotal perforation. Regarding the causes of perforation among 15(10%) patients, 13(85%) patients had infection while only 2 patients had trauma. Conclusion: The study concludes that infection (85%) was the most common cause of perforation followed by trauma (15%) in the graft uptake in myringoplasty.

Prevalence of Trigeminal Neuralgia in Patients with Chronic Facial Pain in Neurology Lrh Hospital Peshawar.

Background: Trigeminal Neuralgia (TN) consist of brief periodic but severe and chronic facial pain in acial region in single or multiple branches of the trigeminal nerve. Objective: The objective of this study was to find the prevalence of TN in patients with chronic facial pain. Methodology: This cross sectional observational study was conducted at Department of Neurology OPD Lady Reading Hospital, Peshawar. 46 patients with chronic facial pain were selected for the study. All data was taken on a structured Performa and was entered and analyzed using SPSS version 21. Using non probability consecutive sampling after taking approval from Ethical Committee of the hospital, study duration was 10 months from 25-1-2019 to 25-10-2019. Results: Out of 46 patients, there were 18 (39.1%) males and 28 (60.9%) females. The mean age of the patients was 50.67, the Standard Deviation recorded was 11.56. Minimum age was 21 and maximum age was 67. 23. Out of 31 patients diagnosed with TN had history of tooth extraction and 8 had no extraction. Out of 31 patients presented with TN, right side was involved in 24 (52.2%) patients and left side was involved in 7 (15.2%) patients. Mandibular never was more common in the patients with TN which was 37% followed by maxillary nerve 21.7%, and ophthalmic nerve at 8.7%. Majority of the patients 28 (75.7%) belonged to the age group of 40 to 67. Females having TGN were 78% and males were 50%. Right side (52.2%) was more involved than left side. Mandibular division (37%) was more involved than maxillary and ophthalmic division. Conclusion: We conclude that females are more at risk of developing TN than males. Increasing age has a higher chance of developing TN. Right side is more involved than left. Mandibular division is more involved than maxillary and ophthalmic.

Male Subfertility; Challenges and advancement in the andrology clinic at Khyber Pakhtunkhwa, Pakistan

Objective: This study is aimed to discuss the challenges in dealing the infertile male and advances in the treatment of male infertility. Material and methods: The study included infertile male patients who presented to andrology outpatient as primary or secondary infertility between December 2018 and January 2021. The data detailed different aspects of challenges and advances in male infertility treatment. The data analysisone with SPSS. Results: Total 289 patients included, most of them (74%) presented as primary infertility and a quarter presented as secondary infertility. The mean delay in presentation was 6.8 years which were due to treatment from non-andrologist doctors of different specialities (53.9%), hakims (15.2%), quacks (13.8%), gynaecologists (10.3%) and some were reluctant to tell their problem (6.5%). The diagnosis was N.O.A (42.9%), unexplained infertility (24.2%), varicocele (22.8%), OA (6.2%), OAT syndrome (2.7%) and CABVD (1%). Different treatment option opted were vasography plus vasovasostomy or vasoepididmostomy (31.1%), ART (23.9%), MSV (22.8%) and medical treatment (22.1%). Vasography plus vasovasostomy or vasoepididmostomy and medical treatment were the available options provided. There was no ART facility and those who were counseled for referral either their unwillingness or cost resulted in a hurdle in their provision. Conclusion: There are still a number of challenges in treating infertile men. Recently provision of medical and microsurgical treatment at andrology clinic resulted in proper treatment of a large number of infertile men who previously received treatment from un- related facilities.

Effect of COVID -19 pandemic on still births.

Introduction: The COVID-19 pandemic is testing the strength of the strongest medical management in the globe. In developing countries, this contagious disease is quickly spreading in the midst of various endemic medical conditions like HIV, tuberculosis, jungle fever, lack of healthy sustenance, and incessant episodes of rampant contaminations. This happens especially in a setting of frail healthcare systems which may scarcely adapt to the previously mentioned existing medical challenges. Purpose: The objective of this research is to examine the impacts of pandemic of COVID-19 on the stillbirth rates. Methodology: Study was conducted at department of obstetrics and gynecology Unit Gynae C Lady Reading Hospital Peshawar from 1st January 2019 to 31st August 2020. This comparative cross sectional study was carried out at using non probability consecutive sampling technique. Findings: A large number of patients admitted with the diagnosis of stillbirth during 2019 and 2020 were multiparas 57% and 62% respectively. Booking status was 64% during 2019 and dropped to 52% in pandemic year 2020.Percentages of stillbirth due to abruption, placenta previa, gestational diabetes mellitus(GDM), type II diabetes, malpresentation, intrauterine growth restriction (IUGR),obstructed labor, eclampsia, postdates and unknown causes in 2019 and 2020 have been given in the table.

COMPARISON OF EFFICACY OF COMBINATION OF METFORMIN PLUS MODIFIED-RELEASE GLICLAZIDE WITH COMBINATION OF METFORMIN PLUS SITAGLIPTIN IN PATIENTS WITH TYPE-2 DIABETES MELLITUS

Introduction: Diabetes Mellitus (DM) is one of the leading causes of morbidity and mortality around the world and is responsible for 3.8 million deaths per year. Its prevalence had shown an exponential rise worldwide in the last two decades, from 30 million cases in 1985 to 177 million in 2000 Objective: To compare the efficacy of the combination of Metformin plus modified-release Gliclazide with a variety of Metformin plus Sitagliptin in patients with type-2 diabetes mellitus. Methodology: This study was conducted at the Department of Medicine, Lady Reading Hospital Peshawar. The study design was a randomized controlled trial conducted for one year from May 2017 to May 2018, in which 62 patients in each group were observed. All patients with type 2 Diabetes Mellitus with baseline HbA1c ≥ 8% and duration >1 year, either gender with age range 35 to 65 years, were included. All patients were subjected to detailed history and clinical examinations. All patients were randomly allocated in two groups by lottery method. Patients in Group A were subjected to the combination of Metformin (1gm twice daily) with modified-release Gliclazide (60mg), and patients in Group B were subjected to the variety of Metformin (1 gm twice daily) with Sitagliptin (50 mg twice daily). All patients were followed up after three months, and blood samples for HbA1c levels were obtained. The analysis was done in SPSS version 20. Results: The Study showed that the mean age in Group A was 58 years ± 12.78, and the mean age in Group B was 55 years ± 13.12. In Group A, 44% of patients were male, and 56% of patients were female, while in Group B, 45% of patients were male, and 55% of patients were female. Moreover, Group A (Metformin (1gm twice daily) + Gliclazide (60mg) was effective in 45% of patients while Group B Metformin (1 gm twice daily) + Sitagliptin (50 mg twice daily) was effective in 71% of patients. Conclusion: Our study concludes that Metformin plus Sitagliptin is more effective than Metformin plus modified-release Gliclazide.

THE COMPARATIVE STUDY TO DETECT RENAL & URINARY TRACT CALCULI (NEPHROLITHIASIS AND UROLITHIASIS) ON ULTRASOUND AND CT.

Background: Ultrasound is a non-invasive imaging modality, and it is cost effective while CT in invasive that uses ionizing radiations, yet it is difficult on ultrasound to diagnose calculi in ureter hence for evaluation of ureteric calculi CT scan is gold standard modality. Objective: To compare the detection of renal& urinary tract calculi (nephrolithiasis & urolithiasis) on ultrasound and CT. Material and methods: The data bases PubMed, ProQuest, and Google scholar and research gate were searched with the key words: nephrolithiasis on ultrasound and CT, sensitivity, specificity, from 2010 to 2021. For inclusion and exclusion of studies independently screened the titles and abstracts of full and related articles. Articles that had information about nephrolithiasis, urolithiasis at ultrasound and CT and its sensitivity and specificity were included. Results: In total, 28 studies were found on renal & urinary tract calculi at ultrasound and computed tomography. This literature review demonstrates that computed tomography is characterized by high sensitivity and specificity in diagnosing renal, ureteric calculi while ultrasound has low sensitivity and specificity. Conclusions: Ultrasound is the best modality for imaging calculi within the kidney, a well hyper echoic mass with posterior acoustic shadow is identified as stone on gray scale, color Doppler can be used for demarcation of stone. At Color Doppler twinkling artifact appears around the calculi hence it can be differentiated by hyper echoic renal sinuses but this is crucially dependant on the size and anatomical position of the stone. The ultrasonic evaluation either overestimates or misinterprets the calculi size while CT gives an exact measurement, position with authentic sensitivity and specificity. Hence, CT is the gold standard for detection of renal calculi. Recommendation: Ultrasound is a non-invasive imaging modality and it is cost effective while CT in invasive that uses ionizing radiations, yet it is difficult on ultrasound to diagnose calculi in ureter hence for evaluation of ureteric calculi CT scan is gold standard modality.

Delivery of Preconception Counselling Services: The Snags of Health Care Service Providers.

Purpose: This study investigates the difficulties the health care service providers encounter in the quest of rendering preconception counselling services in Ghana. Methodology: The study employed descriptive survey design with the use of both qualitative and quantitative research approaches using questionnaire as the main tool. The study employed simple random sampling to sampled 135 out of 675 health care service providers from 23 health facilities in the Bole District of the Savanna Region in Ghana. The quantitative data obtained for the study was analysed using Statistical Package for Social Solution (SPSS) whilst the qualitative data were subjected to descriptive and narrative discussion. Findings: The study revealed that, health care practitioners need continuous training programme. It also became clear that, there no any clear national guideline or policy on preconception counselling in Ghana. It came to light that, the healthcare service providers face a lot of difficulties to capture women of child bearing age to offer them the services. Inadequate knowledge and expertise to effectively offer the preconception counselling services was also identified as a challenge. Recommendations: The study therefore recommend that the Ministry of Health and Ghana Health Service should come out with a clear policy guideline on preconception counselling and also provide an intensive training for the health care professionals. The health care providers should also be provided with the needed resources to embark on sensitisation and advocacy campaigns to create the awareness for women of childbearing age to appreciate the need for preconception and genetic carrier risk counselling.

Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up. Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

Enrolment and Micro Health Insurance Growth in Cameroon: the case of BEPHA Scheme in the Bamenda Metropolis, Cameroon

Introduction: Micro Health Insurance Schemes such as BEPHA have been envisaged by the World Health Organization as a means to facilitate the achievement of universal health coverage and reduce catastrophic out of pocket payment for health care in the developing countries especially in Sub Saharan African countries including Cameroon. Purpose: The objective of this study was to investigate the effect of enrollment on the growth of Micro Health Insurance schemes in Bamenda. Methodology: The causal and descriptive design was adopted for this study. The study area was the Bamenda Metropolis where the MHIS, BEPHA exists. The subjects of the study consisted of people of both sexes between ages 14 and 70 years in Bamenda 1, 2, and 3 councils who had heard about or were registered members of BEPHA. Questionnaires were administered using random sampling techniques to 400 respondents and 10 staffs of BEPHA were interviewed. Frequencies, percentages and the multiple regression analysis were used to analyze data. Findings: From the ten staff interviewed, 50% of them indicated that enrollment into BEPHA was average while 50% said it was low. The growth of BEPHA was said to be50% (average) by 60% of the staff of BEPHA while 40% of them said it was low. Multivariate regression model analysis results showed that enrollment had a significant positive influence on the growth of BEPHA with an estimated standardized coefficients of (β=0.624; p < 0.05). The study overall revealed that enrollment with BEPHA, determine the variations in the growth of the scheme. Unique contribution to theory, practice and policy: This study recommended that management of the scheme should amend some clauses within the scheme such as non-coverage of chronic health conditions, to attract more enrollment with BEPHA.