ABSTRACT Objective: The increased incidence of diabetes, hypertension in third world countries has lead to an increase in end stage renal disease which in turn escalates the burden of dialysis on patients and caregivers. Dialysis is associated with many serious physical and mental disturbances. The aim of this study is to highlight the importance of screening for cognitive impairment and depression in End stage renal disease because cognitive impairment can impair the activities of daily living and overall quality of life.   Methods: 150 patients were included in a study after fulfilling the inclusion and exclusion criteria. They were screened for cognitive impairment by using the Montreal cognitive assessment scale, for depression by using Hospital Anxiety and Depression scale and Barthels index for assessment of activities of daily living.  Results: Of 150 patients most were males (56%) and females were (44%) out of which 36.67% males and 32.67% of females were cognitively impaired. Most patients were hypertensive and unemployed.  There was no significant social demographic association observed for cognitive impairment. The patients with cognitive impairment need assistance in feeding, bathing and mobility as compared to patients with no cognitive impairment.   Conclusion: Our study revealed that cognitive impairment is present in patients and it is related with activities of daily living. The presence of depressive symptoms and anxiety is also affecting activities of daily living difficulty in ambulatory hemodialysis patients. Patients especially need help in climbing stairs and minor help in transferring, occasional bladder help, minor help in feeding and minor help during walk.  Key words: Cognitive impairment, End stage renal disease, Dialysis, Activities of daily living.

OBJECTIVE: To determine the frequency of 25-hydroxy vitamin-D deficiency in Patients with multiple sclerosis (MS). METHODS: This cross-sectional study was conducted at Civil Hospital Karachi, Pakistan from January to December 2019. One hundred and sixty five diagnosed cases of MS of either gender, aging 20-55 years, not taking vitamin-D supplements, steroids and could go outside in the sun were selected through non-probability consecutive sampling technique. Patients having history of rickets, parathyroid disease, chronic liver or renal diseases were excluded. Blood sample was taken to measure 25-hydroxyl vitamin D3 levels. A level of <20 ng/ml was considered as vitamin-D deficient. Logistic regression analysis was used to identify determinants. RESULTS: Out of 165 MS patients, 106 (64.24%) were females, 66 (40%) had income between PKR 10000-25000, 51 (30.9%) were illiterate and 12 (7.3%) had graduate level education. Majority (n=101; 61.21%) had relapsing-remitting MS. Mean age of enrolled participants was 32.92±8.19 years and mean duration of MS was 2.17±0.84 years. Ninety-nine (60%) patients had history of adequate sun exposure. Vitamin-D deficiency in MS patients was 55 (33.3%). Female patients with MS had 2.9 times more likely to be vitamin-D deficient compared to male patients (95% CI: 1.3-6.5). Vitamin-D deficiency In MS patients having no or primary level education patients was recorded in 38 (69.1%) patients as compared to 17 (31.9%) case having secondary or higher education (p-value=0.046). CONCLUSION: Vitamin-D deficiency is common in MS patients. Female and less educated MS patients are at a higher risk of being vitamin-D deficient.