h y p o c a l c a e m i a a n d c o m p e n s a t o r y hyperparathyroidism. But with advancing disease, the compensatory mechanism can no more maintain the mineral homeostasis and biochemical a b n o r m a l i t i e s l i k e h y p e r p h o s p h a t e m i a , hypocalcaemia and hyperparathyroidism become obvious at stage 4 CKD. 3,4 Besides, decreased kidney function, lack of adequate storage of vitamin D (25, OH vitamin D / calcidiol) is responsible for decreased calcitriol synthesis and its consequences in CKD. 5 Studies have shown vitamin D deficiencies (20-29 ng/ml) and insufficiency (<20 ng/ml) in CKD, both in pre dialysis and maintenance hemodialysis patients, MJSBH Vol 16 Issue 1 Jan-June 2017 30ABSTRACT Introduction: Abnormalities in mineral metabolism are invariable with progressive deterioration of kidney function in chronic kidney disease (CKD). These abnormalities are documented in CKD on dialysis in our population but not on pre dialysis. So, present study aims to estimate serum vitamin D, calcium and phosphorus in CKD stage 3-5ND. Methods: It was a cross sectional study of established new CKD patients not on dialysis, vitamin D, calcium, phosphate binders and corticosteroids therapy. Blood sample was drawn for estimation of serum vitamin D, creatinine, calcium, phosphorus and albumin and CKD staging done by KDIGO (2012) criteria. SPSS software version 19 was used for data analysis and chi-squared and ANOVA test was applied as the test of significance. Results: Sixty six (51 male and 15 female) CKD patients with a mean age of 54.3±14.8 years were studied. Hypovitaminosis D (<30 ng/ml) was present in 84.8%, with deficiency (<20 ng/ml) in 50% and insufficiency (20-30) ng/ml in 34.8%. Other abnormalities observed were hypocalcemia (60.6%), hypercalcemia (1.5%) and hyperphosphatemia (63.6%) with no difference of corrected calcium, significant difference of serum phosphorus (p<0.001) with hyperphosphatemia in stage 4 and 5 CKD and vitamin D insufficiency in stage 3b, deficiency in stage 3a, 4 and 5 CKD. There was no correlation of serum vitamin D with calcium and phosphorus in different stages of CKD. Conclusion: Present study concludes that hypovitaminosis D, hypocalcemia and hyperphosphatemia is common in our pre-dialysis CKD patients and serum phosphorus raises more with reduction of GFR.

Introduction: Chronic kidney disease is defined as structural or functional damage of the kidney persisting for three or more months. Studies have shown hypertension and diabetes as the leading causes of chronic kidney disease. The aim of this study is to find out the prevalence of end-stage renal disease patients undergoing haemodialysis in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted among 96 patients undergoing haemodialysis from February 13, 2021 to April 4, 2021 in the hemodialysis unit of a tertiary care centre after receiving ethical clearance from the Institutional Review Committee (Reference number: 354). Convenience sampling was done and all patients older than 18 years who were on maintenance haemodialysis on an outpatient basis were included in the study. Data were collected using a self-administered questionnaire. Data were analysed using the Statistical Package for the Social Science version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data and mean with standard deviation for continuous data. Results: Among 96 patients undergoing haemodialysis, the prevalence of end-stage renal disease was 83 (86.45%) (79.60-93.30 at 95% Confidence Interval). The most common underlying condition was hypertensive nephropathy in 34 (40.96%) patients, followed by both hypertensive and diabetic nephropathy in 26 (31.33%) patients. Conclusions: The prevalence of end-stage renal disease in our study was higher when compared to similar studies conducted in similar settings. Early diagnosis and adequate treatment of hypertension and diabetes could be crucial to reducing the prevalence of the end-stage renal disease.

Background: Urinary tract infection (UTI) is one of the most frequently encountered problems owing tosigniÞ cant number of patients needing hospitalization during pregnancy. The incidence of UTI in pregnantwomen is reported to be high up to 7-8%.Methods: This is a prospective study conducted in Valley Maternity Hospital during a period of 6 months(Jan 2011 to June 2011). 520 MSU (Mid stream urine samples) from pregnant women clinically suspected ofurine infection were evaluated by urine dipstick analysis, microscopic and culture method. The isolates wereidentiÞ ed and antibiotic sensitivity pattern was determined by standard protocol.Results: The majority of the patients were in-between the age group of 20-30years- 338cases (65%) and thesepatients usually presented in the Þ rst trimester of pregnancy- 317cases (60.96%). Out of the 520 clinicallysuspected UTI cases, 232 (44.61%) was culture positive. Out of the culture positive cases; Escherichia coli(E.coli) was the most common accounting for a total of 144cases (80%). Nitrofurantoin was found to be the mosteffective drug against the gram negative (Gm-ve) bacteria. Similarly, Ampicillin, Amoxycillin and Cloxacillinwere found to be effective agent against gram positive (Gm+ve) bacteria.Conclusion: Screening for bacteriuria is recommended among all pregnant women at the Þ rst prenatal visit andin the subsequent trimesters of pregnancy.Key words: UTI, Pregnant women, Antibiotics, Culture method.Prevalence of Metabolic Syndrome and its Component inPatients with Acute Coronary Syndrome.Conclusions: Metabolic syndrome is most common and important risk factor in patients of coronary arterydisease. Other risk factors like smoking, obesity, dyslipidemia, hypertension and diabetes were also frequentlyfound. Public awareness to control the risk factors can reduce the prevalence of coronary artery disease in ourcountry.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12928

Introducti on: Diabetes Mellitus is a potent risk factor for Coronary Artery Diseases, but Impaired Glucose Tolerance is increasingly known risk factor for Coronary Artery Diseases. The aim of this study was to correlate blood glucose level in the pati ents with Coronary Artery Diseases with Acute Coronary Syndrome and to determine the relati onship of other risk factors.Methods: This was a cross-secti onal prospecti ve study of consecuti ve pati ents admitt ed in coronary care unit of Bir Hospital and Shaid Gangalal Nati onal Heart Center, with diagnosis of Acute Coronary Syndrome.Results: Total 209 pati ents were enrolled. 90.9% (190) had dyslipidemia, 78.5% were smokers with mean Standard Deviati on of durati on of smoking were 25.35 years. Abnormal waist to hip rati o in male and female are 56.3% and 76.1% respecti vely. 14.4 % (30) had Random Blood Glucose > 200mg%, 17.2 % had Impaired Fasti ng Glucose (110-126 mg% World Health Organizati on); 34.4% had Impaired Fasti ng Glucose (100-126 mg% American Diabeti c Associati on) 28.2% had Impaired Glucose Tolerance (postprandial blood glucose 140-200mg %).19.1% were old diabetes, 21.3% had recent diabetes mellitus, 52.7% had impaired glycemia.93.1% of total pati ents had Glucose Intolerance of any form.Conclusions: Almost all pati ents had diabeti c or glucose intolerance of any form prior to coronary artery disease with acute coronary syndrome. This study consisted with Asian criteria of body mass index and Waist circumference for overweight or obesity.

Introduction: Acute kidney injury (AKI) is the abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. Most patients with AKI recover renal function conservatively yet few require renal support with intermittent Hemodialysis (HD). We conducted a study in a tertiary level hospital to find out the etiology and outcome of the patients presenting with AKI who required dialysis.Methods: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital from Jan 2015 to Dec 2016, i.e. over a period of two years. Consent was taken from both the institution as well as the patients for the evaluation of data. Patients were followed up for at least three months from the time of enrolment. Data were tabulated and analysed using SPSS software.Results: Total 50 patients were included in the study, out of which 67% were male. The mean age of the patients was 54.54 years (SD±18.6). Hypertension was present in 44% and Diabetes in 18% as comorbidities. The commonest etiologies were urinary tract infection (30 %), acute gastroenteritis (24%) and obstructive uropathy (18%). The mean creatinine level at the time of nephrology consultation, maximum level and at the time of discharge were 6.5 (SD ± 2.62), 7.3 (SD ± 2.13) and 2.2 (SD ± 1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD 54% cases. The mean number of intermittent HD used was 3.36. Out of total patients, 68% had complete recovery, 26% died and 6% had persistent renal dysfunction at the end of three months.