Background Inappropriate medication dosing can cause adverse drug reactions or ineffective therapy due to declined renal function in patients with renal insufficiency. This necessitates proper renal dose adjustment. This study was proposed to evaluate medication dosage adjustment in hospitalized chronic kidney disease (CKD) patients. Methods This study included all CKD patients hospitalized between May 1, 2019, and April 25, 2020, at the Institute of Kidney Disease, Peshawar, Pakistan. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula, and dose appropriateness was established by evaluating practice with relevant reference books. Results Of the total 1,537 CKD patients, 231 (15.03%) had evidence of dosing error, which was considered for final analysis. Overall, 1,549 drugs were prescribed; 480 (30.99%) drugs required dose adjustment, of which 196 (40.42%) were adjusted properly and the remaining 286 (59.58%) were unadjusted. The most common unadjusted drugs were meropenem, cefepime, ciprofloxacin, and rosuvastatin, whereas captopril, aspirin, bisoprolol, pregabalin, and levofloxacin had the highest percentage of adjusted drugs. On multivariate logistic regression, the number of drugs requiring dosing adjustments and obstructive nephropathy were found to be statistically significant factors that increased the likelihood of the medication dosing errors: a unit increase in the number of drugs requiring dose adjustment increases 5.241 times the likelihood of dosing error. Similarly, the presence of obstructive nephropathy (OR: 0.383; 95% Cl: 0.153-0.960; p = 0.041) was found to be significantly associated with dosing error after adjustment for potential confounding factors. Conclusion The dosing of more than half of the prescribed drugs that required adjustment in CKD patients was not adjusted, which showed that medication dosing errors were high. This highlights the importance of medication prescription according to guidelines in these patients to improve the outcomes of pharmacotherapy.

Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased recently in Pakistan. Visceral adiposity index (VAI) appears to be a better predictor for metabolic syndrome associated with insulin resistance. VAI has been shown to be linearly and positively associated with diabetes mellitus (DM) in many populations. It is, however, uncertain whether VAI could be associated with T2DM in the Pakistani adult population. Methods: This is a cross-sectional study of 300 outpatients with a newly diagnosed T2DM. Subjects were recruited from Lady Reading Hospital, Pakistan, during the period from April, 2020 to January, 2021. For all study subjects, anthropometric measurements were performed. Blood samples were collected for the assessment of high-density lipoproteins (HDL-C), triglycerides (TGs), glycated hemoglobin (HbA1c), and random blood glucose. Results: Participants with high VAI showed poor glycemic control. The number of patients with poor glycemic control increased across the VAI quartiles. VAI showed significant correlations with TGs (r=0.715, p=<0.001), total cholesterol (TC) (r=0.256, p=<0.001), low density lipoprotein (LDL-C) (r=0.154, p=0.007), uric acid (r=0.205, p=0.019), duration of diabetes (r=0.171, p=0.033), TSH (r=0.163, p=0.007), and random blood glucose (r=0.195, p=0.019). Conclusion: Our data suggest that VAI is significantly and positively correlated with the risk factors of DM such as random blood glucose, uric acid and TSH. The findings of the study do not imply a significant direct association between VAI and DM among the Pakistani adult population. Prospective-large scale studies can help inform an effectiveness of VAI for the prediction of the risk of T2DM among Pakistani population.

Objectives: The objective of this study is to determine the frequency of carotidartery atherosclerosis using color Doppler ultrasound in ischemic stroke patients. StudyDesign: Cross-sectional study. Period: July 2015 to June 2016. Setting: Khyber TeachingHospital, Peshawar. Method: Doppler ultrasonography was done to assess carotid artery statusin patients diagnosed with cerebral infarction. Results: Data comprised of 174 ischemic strokepatients between ages 37-95 years. 111 were males whereas 63 were males. Mean age wasfound to be 64.03±11.71 years. Doppler ultrasound revealed carotid artery atherosclerosis in52.3% (n=91) patients with 57% males and 34% females. Right carotid artery involvement wasfound in 28 patients and left carotid artery involvment in 38 patients. Both carotid arteries wereinvolved in 25 patients. Conclusion: We have concluded that carotid artery atherosclerosis is anindependent predictor for future vascular events. Our study reports carotif artery atherosclerosisin 52.3% patients with ischemic stroke.

Purpose:  To determine the causes and frequency of orbital involvement by systemic disorders and non-ocular trauma at a tertiary Oculoplastic centre. Study Design:  Descriptive cross-sectional retrospective study. Ophthalmology unit Place and Duration of Study:  Department of Ophthalmology, Lady Reading Hospital Medical teaching Institute,  Peshawar from January 2012 and Dec 2016. Methods:  A total of 45 patients were included in this study. Patients’ demographics, clinical cause of orbitopathy and time delay between the problem noticed by the patient and presentation were recorded. Orbitopathy included the presence of corneal and conjunctival changes, optic nerve disorders, proptosis, orbital bone changes and soft tissue swelling of eyelids. The data was analyzed using SPSS software (version 22). The frequency (percentage) and mean ± standard deviation were reported for categorical variables. Results:  Mean age of the patients was 28.89 ± 22.02 years. There were 26 (57.8%) males 19 (42.2%) females. Commonest disorder was Bacterial Infection in 16 (35.6%) patients followed by Thyroid orbitopathy, which was seen in 14 (31.1%) cases. Other causes included Leukemia, Lymphoma, Retrobulbar Hemorrhage, Neurofibromatosis, Neuroblastoma, Maxillary Osteosarcoma, Teratoma and Fungal Infection. Time delay between presentation of orbital swelling and first noticed by patient was 147.02 ± 155.18 weeks in male while in female the time delay was 148.79 ± 146.47 weeks. Conclusion:  The commonest inflammation was due to thyroid, commonest infection was bacterial infection and commonest tumor was leukemia. Imaging and proper workup is important to properly treat any orbital disease. Key Words:  Orbit, Ocular trauma, Neuroblastoma, Orbital lymphoma.

Objective: To determine the frequency of peripheral neuropathy and associated factors among patients with type 2 diabetes mellitus (T2DM), attending a tertiary care hospital via Michigan Neuropathy Screening Instrument (MNSI). Methodology:This cross-sectional study was conducted in the department of endocrinology and metabolic diseaes, Medical Teaching Institute, Lady Reading Hospital Peshawar, from March to December 2019. A total of 365 patients with T2DM were included in the study. All patients were evaluated for peripheral neuropathy using the two sets of MNSI (symptoms and examinations).Results: Mean age of the patients was 49.0±7.52 years. Mean body mass index (BMI) was 28.1±5.21 kg/m 2 , and mean glycated haemoglobin (HbA1c) was 10.1±1.56%. There wew 150 (41.10%) males and 215 (58.90) females. Based on the scoring of MNSI questionnaire, 239 (65.5%) had diabetic peripheral neuropathy (DPN) while using MNSI examination 252 (69.0%) had DPN. By combining both questionnaire and examination, DPN was present in 290 (79.5%) of the study participants. The factors associated with DPN after controlling for potential confounders were age of > 50, high levels of total cholesterol (TC) and low density lipoproteins (LDL). Conclusion:The frequency of DPN was found to be higher in our study population; the burden being high among males. Age, TC and LDL were found to have significant association.