Obesity and dementia are both associated with an increased risk of Alzheimer's disease (AD), and underlying neurodegenerative changes. Review articles provide evidential support that obesity and dementia result in an early old-age memory crisis. Obesity triggering vascular dementia decreases not only blood supply to the brain, but also increases fat cells that damage the brain white matter leading to loss of cognitive and intellectual behaviour. Adipocyte-secreted proteins and inflammatory cytokines explain the association between obesity and increased risk of dementia. Late-life elevated body mass index (BMI) confers a lower risk of having dementia. The hormone leptin explained the mechanism for the reverse association. Future studies need to reveal the linkage between adiposity and excess risk of dementia and AD.

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

Background and Objectives:Hepatitis C and chronic kidney disease (CKD) are major global health problems and are highly prevalent in Pakistan. There is limited information on prevalence of hepatitis C in patients with CKD not yet on dialysis. The objective of this study was to determine the frequency of hepatitis C in hospitalized chronic kidney disease patients at a tertiary care center in Pakistan.Methods:The study design was cross-sectional in nature. Patients between ages of 20-80 years with CKD not previously on renal replacement therapy and who were admitted to nephrology ward at a tertiary care facility were included. Hepatitis C was tested using 3rd generation enzyme linked immunosorbent assay (ELISA). Hepatitis C RNA was tested by polymerase chain reaction (PCR) in patients with positive ELISA.Results:A total of 180 patients were included in the study. Mean age of patients was 48.7±14.9 years. Of all patients, 105 (58.3%) were males and 75 (41.7%) were females, 152 (84.4%) had hypertension, 113 (62.8%) had diabetes mellitus and 26 (14.9%) had known cardiovascular disease. Mean eGFR of patients was 11.4±9.4 ml/min/1.73 m2. Of all patients with CKD, 49 (27.2%) had hepatitis C test positive by ELISA. Hepatitis C PCR testing was done in 39 patients with hepatitis C ELISA positive status and 29 (74.4%) tested positive. Risk factors and clinical characteristics of patients with and without positive hepatitis C antibody by ELISA were similar.Conclusion:A significant proportion of hospitalized CKD patients have hepatitis C. Strict universal infection control measures should be implemented in nephrology wards to prevent transmission of hepatitis C infection.

Sugar-sweetened beverages containing caffeine are widely used among humans nowadays and can have negative consequences on the overall health. Our study aims to discuss the effects of these sugar-sweetened beverages (SSB) and how they can impact the health in different ways particularly on the brain. Some of the mechanisms by which soft drinks can exert adverse effects include an increase in glutathione-6-dehydrogenase level, increased levels of gamma-aminobutyric acid (GABA), glutamate and dopamine alteration in brain waves on electroencephalography (EEG) eventually leading to stroke and dementia. They can increase the oxidative stress by a decreasing monoamine oxidase and acetylcholine esterase and antioxidants such as glutathione and catalase. The sleep quality and duration of sleep is also significantly affected by their increased consumption. Also, the consumption of sodium benzoate (found in beverages) on impairing memory, motor coordination, affecting reduced glutathione (GSH), increasing the malondialdehyde (MDA) level in the brain and producing attention deficit hyperactivity disorder (ADHD) in children is emphasized. Finally, we will highlight how diet drinks can also be harmful and the maternal consumption of chocolate or soft drinks during pregnancy and postnatal period can be linked to cognitive impairment and child obesity.

Diabetes Mellitus and Hypertension are leading causes of chronic kidneydisease (CKD). There is limited data on frequency of retinopathy attributed to diabetes mellitusor hypertension in CKD patients in local population. Objective: to determine the frequency ofdiabetic and hypertensive retinopathy in patients with CKD not on hemodialysis or peritonealdialysis. Study Design: Cross Sectional. Setting: Nephorology ward at Sharif Medical CityHospital. Period: 6 Month. Methods: All patients between ages of 20-80 years with CKD notpreviously on renal replacement therapy (hemodialysis or peritoneal dialysis) who were admittedto nephrology ward at tertiary care facility over a 6 month period were included. Fundoscopicexamination was performed by a qualified ophthalmologist after dilating pupils. Results: A totalof 124 patients were included in the study. Stage V CKD was present in 85.7%. Diabetes Mellituswas present in 84 patients (67.7%). Of these patients, 39 (46.4%) had diabetic retinopathy. Nonproliferativediabetic retinopathy, proliferative diabetic retinopathy and macular edema werefound in 27 (69.1%), 4 (10.2%) and 9 (23.1%) patients respectively. Hypertensive retinopathywas present in 51 (49.5%) out of 103 (83%) hypertensive patients. Of these patients, 16 (31.3%)had grade I, 21 (41.2%) had grade II, 11 (21.6%) had grade III and 3 (5.8%) had grade IVhypertensive retinopathy. Conclusion: A significant proportion of patients with advanced CKDhave retinopathy. Patients with CKD and diabetes or hypertension should be encouraged toundergo a complete eye examination