Deceased diabetic kidneys are increasingly utilized in transplantation. The relationship of donor's history of diabetes to clinical and histological outcomes was examined. Forty‐nine diabetic deceased donor kidneys (D‐DM) were transplanted into 26 normal (R‐N/D‐DM) and 23 diabetic recipients (R‐DM/D‐DM) and compared to 211 diabetic recipients of normal kidneys(R‐DM/D‐N) and 466 normal recipients of normal kidneys (R‐N/D‐N). Patient survival at 5 years was 89.7% in R‐N/D‐N, 96.2% in R‐N/D‐DM, 80.1% in R‐DM/D‐N, and a 71.6% in R‐DM/D‐DM (P = .008). Death‐censored graft survival at 5 years was 86.3% in R‐N/D‐N, 87.4% in R‐N/D‐DM, 93.5% in R‐DM/D‐N, and 87.5% in R‐DM/D‐DM (P = .24). Multivariable regression analysis showed that compared to non‐diabetic recipients, diabetic recipients had a 2‐ to 3‐fold increased risk of mortality. In this cohort, there was no impact on death‐censored graft survival of diabetic donor status. Only 6 of 26 post‐perfusion biopsies showed evidence of diabetic nephropathy (

Objectives: To identify factors which cause deterioration with worsening ofsymptoms in previously stable heart failure patients. Study design: Descriptive case seriesSetting: Gulab Devi Chest Hospital, Lahore. Duration: 01-04-2017 to 30-09-2017. Patientsand Methods: The study was done on 100 patients diagnosed with LV systolic dysfunctionor cardiomyopathy with LVEF<40%. Patients were examined regarding clinical signs ofdecompensation and detailed history was taken to probe the cause of decompensation. Allinformation was noted down on a pre-defined questionnaire. Mean ± S.D was applied forquantitative data like age and LVEF. Frequency (%) was used for qualitative data like gender.Results: Non compliance to drugs was the most common cause of decompensation (56%),amongst them 73.21% cases were noncompliant due to poor awareness about the importanceof continuing use of medicines. Infection was the second common precipitating factor(51%), where chest infection was the most common cause in 74.51% cases. Other causes ofdecompensation were ischaemia (28%), renal impairment (36%), and arrhythmias (23%) whilemore than one precipitating factors were found in 41% of cases. Conclusion: Multiple factorscan trigger deterioration in patients with previously stable heart failure. Recognition of thesefactors is important for good long term outcome in these patients.

One of the most common injuries during sports is anterior cruciate ligament (ACL) injury. A number of surgical and rehabilitation techniques have been developed. ACL reconstruction is mainstay of treatment. Objective: In this study we are evaluating the outcome of ACL surgery. Design & Setting: Retrospective study Methodology: Data collection of all cases that underwent primary arthroscopic anterior cruciate ligament reconstruction performed. All patients were operated with same surgical technique using quadrupled hamstring autograft. Results: There was an overall male predominance (95.3%). Medical meniscal injury was found in 05 (24%) patients. Lateral Meniscus injury was found in 04(19%) patients. Adjustable length CSF device was used in 12 (57%) patients and fixed-loop CSF device in 9 (43%) patients. Conclusion: At two years, outcome of ACL reconstruction performed by one surgeon using same surgical technique with adjustable CSF device and absorbable tibial screw granted satisfactory clinical results in all patients. Rehabilitation played an important role in return to activities of daily living in all patients at final follow up. Keywords: Anterior Cruciate Ligament, Arthroscopy, Rehabilitation

Objective: To find outthe frequency of cardiogenic shock in patients with ACS Study design: Cross sectional study Methodology:A calculated sample of 240 patients presented with acute coronary syndrome confirmed clinically and/or on the basis of ECG and cardiac markers was taken. In addition to collecting basic demographic details patients were inquired about the presence of risk factors (smoking status, diabetesand hypertension).The collected data was entered and analyzed by using SPSS version 16. Quantitative variable were presented in the form of mean, range and standard deviation. Results:Out of 240 patients, 33 patients (13.8%) were having cardiogenic shock and 207 patients (86.2%) were not. In the patients presented with cardiogenic shock, there were 21 (8.8%) with STEMI, 10 (4.2%) with NSTEMI and 2 (0.8%) with unstable angina. In STEMI there were 14 patients (5.8%) with anterior wall MI, 4 patients (1.7%) with inferior wall MI and 3 patients (1.2%) with lateral wall MI. Conclusion:Frequency of cardiogenic shock in patients presented with ACS was 13.8%. It was more commonin patients presented with ST-segment elevation MI as compared to unstable angina and NSTEMI. In STEMI, anterior wall was more involvement was more predominant. Keywords: ACS, Cardiogenic shock, Unstable angina, NSTEMI, STEMI

Objective: To determine the impact of diabetes on adverse outcomes amongst patients presenting for the first time with acute coronary syndrome. Study design: Cohort Study Methodology: A total of 340 patients were enrolled in this study. At presentation patients were divided in two equal age and gender matched groups with 170 patients in Group-A having diabetes and another 170 being non-diabetics in Group-B. Patients were followed up for period of index hospitalization and all adverse outcomes were noted in both groups as per operational definition. Results: Mean age in Group-A with diabetes was 54±12.7 years whereas in non diabetics it was56±13.12 years. In both groups there was male predominance with approximately 60% males and 40% females. In diabetic group, 38% patients had typical chest pain, 62% patients had dyspnea, 20% patients had cardiogenic shock while in non diabetic group, 20% patients had typical chest pain, 40% patients had dyspnea, 10% patients had cardiogenic shock. In diabetic group, 38% patients had heart failure, 10% patients died while in non diabetics 20% had heart failure and 5% patients died. Conclusion: This study concluded that in hospital adverse outcomes after first episode of acute coronary syndrome were more frequent in diabetic patients as compare to non diabetic patients. Keywords: Acute coronary syndrome, Adverse outcomes, First attack