Objective: To assess the safety as well as efficacy of desmopressin monotherapy alone and in combination (desmopressin + oxybutynin) in treating nocturnal urinary incontinence among children with 7 to 13 years. Methods: This randomized controlled trial has been carried out in National Institute of Child Health from September 2018 to March 2019 with the utilization of convenient sampling technique. Data has been collected after taking ethical approval and informed consent of the Parents with complete confidentiality. The sample size was 84 and equal number of patients was divided in two groups. Group-I was given desmopressin at monotherapy at a dose of 0.2 mg and Group-II was given desmopressin and oxybutynin at the dose of 0.2 mg desmopressin and 5 mg oxybutynin patients were diagnosed on the basis of history. Routine lab investigation included Urine DR and ultrasound abdomen. Results: In this study significant differences between two groups were found with respect to socio economic status, lack of education of parents (P Less than 0.05). The frequency, urgency and incontinence of this ailment was significantly controlled by combination therapy (desmopressin + oxybutynin) as compared to desmopressin as monotherapy (P Less than 0.05) as patient was followed after one, two and three monthly basis. Conclusion: Desmopressin combination with oxybutynin is more effective as compared to monotherapy treatment. The affectivity of the combination therapy was very high with least side effects and all the children recovered from the condition at third month of treatment. Furthermore, headache was observed to be common with monotherapy and loss of appetite was observed with combination therapy. doi: https://doi.org/10.12669/pjms.36.6.1957 How to cite this:Kazi A, Moorani KN, Zehra S, Zaidi IH. Comparative response of Desmopressin versus Combination Therapy (Desmopressin + Oxybutynin) in Children with Nocturnal Enuresis. Pak J Med Sci. 2020;36(6):---------.   doi: https://doi.org/10.12669/pjms.36.6.1957 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To assess the correlation between inferior vena cava(IVC) diameter and central venous pressure (CVP) in critical patients admitted in ICU. Study Design and Setting: The cross-sectional pilot study was conducted at Radiology Department of PNS SHIFA Hospital. Methodology: 18-80 years patients were included and patients with severe orthopnea, unable to lie in supine position, morbid obese, pneumothorax, mass in mediastinum, tricuspid regurgitation and intra-cerebral bleeds were excluded. Results: The mean age of 50 patients was 41.44±16.73 years. Mean measurement of CVP was considered as 10.41±4.18 mm. Mean diameter of IVC was 12.65±2.22 mm. The study results showed weak negative correlation between the CVP and IVC (r= - 0.110, p=0.04). It was also predicted that patients with age =50 years showed weak negative correlation between the CVP and IVC (r=-0.290, p=0.034). Similarly, in patients with age >50 years there was strong negative correlation between CVP and IVC (r=-0.680, p=0.045). The study results also showed that in male patients there was weak negative correlation between the CVP and IVC i.e. (r=-0.045, p=0.048). However, in female patients there was moderate positive correlation (r=0.685, p=0.001). Conclusion: Weak negative correlation was found between inferior vena cava diameter on ultrasonography and central venous pressure measurement among critically ill patients.

Nocturnal enuresis is one of the commonest developmental problem specially in our country. It can cause emotional family stress and social isolation of child. According to WHO if condition persist after six years of age, it should be consider as pathological. Exact cause of this condition is not known but is common in lower socio economic people due to lack of awareness about the impact of this disease on the psychology of the children. Different modalities of treatment comprising of non-Pharmacotherapy as well as pharmacotherapy are being tried but relapse rate still persist. In non-pharmacotherapy: Psychotherapy, toilet training and alarm therapy has been tried but in pharmacotherapy, monotherapy that is desmopressin and imipramine and combination of therapy that is desmopressin + oxybutynin and desmopressin + imipramine has been tried. Multiple studies are available but relapse rate till exist. Combination therapy (desmopressin + oxybutynin) is being tried in various Tertiary care Hospital of Pakistan and results are encouraging.