Objective: We aimed to compare the efficacy of gabapentin and levodopa-c for the symptoms of restless leg syndrome in patients of end-stage renal disease (ESRD) undergoing maintenance hemodialysis therapy. Methods: In this observational, cross-sectional study, patients of ESRD on hemodialysis with restless leg syndrome were included after assessment of symptoms and quality of sleep before the treatment by completing two questionnaires: the International Restless Leg Syndrome Study Group (IRLSSG) questionnaire and the Pittsburgh Sleep Quality Index (PSQI) scale. They were randomly divided into two groups. One group was prescribed levodopa-c (110 mg) as a single dose two hours before bedtime for four weeks. The other group was given gabapentin (200 mg) after each hemodialysis session for four weeks. After the treatment, the patients completed the two questionnaires again: the IRLSSG questionnaire and the Pittsburgh Sleep Quality Index.Results: In our study, men were 14 (53.8%), and women were 12 (46.2%). Gabapentin was given to 14 (53.8%) patients, and 12 (46.2%) patients were prescribed levodopa-c. In the levodopa group, the average baseline IRLSS was 24.333 ± 7.936), and the mean baseline PSQI score was 13.583 ± 3.396. After treatment with levodopa for four weeks, the mean IRLSS was 8.666 ± 3.312, and the mean PSQI score was 4.666 ± 2.839; a P-value of 0.00001 was noted. While in the gabapentin group, the mean baseline IRLSS was 26.071 ± 7.936, and the mean baseline PSQI score was 14.857 ± 3.254. After treatment for four weeks with gabapentin, the mean IRLSS was 5.3571 ± 1.392, and the post-treatment average PSQI was 2.992 (SD: 0.916); a P-value of 0.00001 was noted.Conclusion: Both levodopa and gabapentin effectively relieve symptoms of restless leg syndrome and improve the quality of sleep and life in ESRD patients undergoing hemodialysis.

Objective: To determine the frequencies of risk factors and the ultimate outcomes of ccute kidney injury (AKI) among hospitalized patients.Materials and methodology: This prospective, observational study was carried out from September 15, 2018, to March 14, 2019. All admitted patients, both male and female, with AKI, were included. Those with chronic kidney disease (CKD), small size echogenic kidneys (on ultrasonography, performed on admission), and recent history of urological intervention were excluded from the study. All patients were assessed for etiological factors (sepsis, gastroenteritis, surgical, and obstetrical) and outcome (improved, progression to CKD, or expired).Results: Out of a total of 230, most patients were aged between 20-50 years with a mean age of 38.99 ± 7.61 years. Males were 144 (62.61%) and females were 86 (37.39%). About 78 (33.91%) patients were hypertensive while 65 (28.26%) were diabetic. The cause of hospital-acquired AKI was found to be sepsis in most (71.73%, n=165) of the cases, followed by gastroenteritis (10.00%, n=23), surgical (9.56%, n=22), and obstetric (8.69%, n=20) causes. When the outcome was assessed, 10 (4.35%) patients expired, 154 (66.96%) improved completely, while 66 (28.69%) progressed to CKD. Conclusion:This study has shown that sepsis is the most common cause of AKI in patients admitted to the hospital. So we recommend that proper steps should be taken to ensure adequate hospital care for avoiding such outcomes in hospitalized patients, and further decrease mortality.

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Background and Objective: Millions of children receive sedative, anesthetic and analgesic drugs for surgery worldwide. Caudal epidural block with bupivacaine is widely used for perioperative analgesia in children undergoing surgeries under general anesthesia. Current study aims to determine postoperative pain relief and side effects due to caudally administered 0.25% bupivacaine (0.5-1 ml/kg) alone and a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg).Methodology: A randomized clinical trial was conducted at department of Anesthesiology, Shaikh Zayed Hospital, Lahore. Study duration was 1 year and 6 months (February 2015-August 2016). A sample size of 108 patients was calculated using WHO calculator. Non probability consecutive sampling was used. Patients were randomly divided into two groups; Group B was given inj. bupivacaine 0.25% while Group BT received a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg). Patients were observed for sedation score, FLACC pain score and adverse effects in both interventional groups. Data were analyzed using SPSS version 22. Student’s T-test was applied on data. P-value ≤ 0.05 was considered significant.Results: Total 108 patients were included in the study (1:1 randomization). Mean age of patients was 6.41 ± 1.77 y. There were 92 (85.2%) male and 16 (14.8%) female children. Mean sedative scores (p = 0.00) and mean FLACC pain scores (p = 0.000) were significantly lower in bupivacaine tramadol group as compared to bupivacaine group. However, bupivacaine group had more adverse effects as compared to combination of bupivacaine and tramadol group. Conclusion: Caudal epidural with a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg) has high postoperative analgesic efficacy and limited adverse effects as compared to 0.25% bupivacaine alone in children undergone general anesthesia for lower abdominal surgery.

To measure serum neopterin levels in blood donors of the local population and to study its relationship with age and blood group of transfusion-transmitted infection (TTI) negative blood donors.

Objective: To determine different treatment options in patients of Patent Ductus Arteriosus with pulmonary hypertension beyond neonatal period. Study Design: Descriptive cross sectional study. Place and Duration of Study: This study was carried out in Pediatric Cardiology department of Rawalpindi Institute of Cardiology, from Jan 2017 to Jan 2019. Methodology: Patients having PDA with pulmonary hypertension were included in the study. Treatment options were divided into percutaneous catheter device closure, surgical ligation of patent ductus arteriosus and palliative treatment. Any adverse event during the procedure was documented. Stratification was done in regard to gender and age group. Post stratification chi square test was applied and p-value less than or equal to 0.05 was considered as significant. Results: Total number of patients included in the study were 37. Mean age (years) of patients (Mean ± SD) was 19.21 ± 8.76. Mean ± SD pulmonary artery pressure was 56.43 ± 11.55 mmHg. Percutaneous catheter device closure was successful in 24 (64.9%) patients, in 7 (18.9%) patients primary surgical PDA ligation was done, 3 (8.1%) patients were advised palliative treatment and in 3 (8.1%) patients adverse events occurred during percutaneous device closure and were thus referred for surgical ligation. Patent ductus Arteriosus Occlutech device was used in 18 (48.6%) patients, Occlutech VSD device was used in 7 (18.5%) patients and in 1 (2.7%) patient AGA duct occluder was used. Conclusion: In patients with patent ductus arteriosus and pulmonary artery hypertension, percutaneous catheter device closure is a safe and effective procedure.

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OBJECTIVE: To study the impact of nutritional status on induction mortality among pediatric patients suffering from acute lymphoblastic leukemia (ALL). METHODS: This descriptive analytical study was conducted on pediatric ALL patients who completed induction chemotherapy in Pediatric Oncology Department Combined Military Hospital, Rawalpindi, Pakistan from 1st January 2012 to 30th June 2021. All patients of ALL diagnosed on basis of National Comprehensive Cancer Network Clinical Practice Guidelines, aged 1-18 years were included. Patients who left before completion of induction chemotherapy or refused to participate were excluded. Cases were divided into three groups based on nutritional status. Induction chemotherapy was given as per UKALL 2011 protocol. RESULTS: Out of 926 patients diagnosed with ALL, 586 (63.3%) were males and 340 (46.7%) were females. Mean age of patients was a 5.83±3.627 years. Majority of the patients (n=679, 73.3%) were well-nourished; and 161 (17.4%) and 86 (9.3%) were moderately and severely malnourished, respectively. About 49.8% (n=461) patients received standard risk chemotherapy protocol with three-drug induction and 50.2% (n=465) received four-drug induction chemotherapy. Infection was the most common complication in 742 (80.1%) patients. Overall induction mortality was 12.9% (n=119/926) in all patients including 9.54% (n=44/461) in standard-risk and 16.12% (n=75/465) in high-risk patients (p=0.003). Induction mortality was significantly high in malnourished-group (17.8%) and 12.2% in normally-nourished children (p=0.008). CONCLUSION: Nutritional status and risk group at time of diagnosis emerged as predictors of induction mortality among ALL patients. Considerable number of patients died during induction phase of treatment. Malnourished children have a high mortality rate.