Objectives: To determine frequency of left main stem (LMS) and triple vessel coronary artery disease (3VCAD) in patients of Non-ST-elevation myocardial infarction (NSTEMI) and to compare the frequency of LMS and 3VCAD in patients with NSTEMI with or without ST elevation in lead aVR. Methodology: Total 346 patients with NSTEMI having age 30-70 years were included in this descriptive cross-sectional study. The data on demographic details was collected. All patients underwent electrocardiography (ECG) and cardiac specific troponin-I assessment. Patients were categorized as NSTEMI with or without ST-elevation in lead aVR. Coronary angiography was performed in all patients and angiographic findings were noted. Results: Mean age of patients was 51.87±10.03 years. There were 218 (63.01%) males and 128 (36.99%) female patients. 182 (52.60%) patients of NSTEMI had ST elevation in aVR. LMS disease was found in 53 (29.10%) patients with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for LMS disease was 62.35%, 50.57%, 29.12% and 80.49% respectively. 3 VCAD was found in 54 (29.70%) with ST elevation in aVR. Sensitivity, specificity, positive predive value and negative predictive value of ST elevation in aVR for 3VCAD was 77.14%, 53.52%, 29.67% and 90.24% respectively. Conclusion: NSTEMI patients with ST elevation in aVR may have higher chances of having LMS disease or 3VCAD. There is high negative predictive value for ST elevation in aVR to predict LMS disease or 3VCAD.

Objective: To determine the frequency of uremic pruritus in ESRD patients on thrice-weekly maintenance hemodialysis. Study Design: Cross-sectional analytical study Place and Duration of Study: Department of Nephrology, Sir Ganga Ram Hospital, Lahore from 1st Mar 2018 to 15th February 2019. Methodology: Sixty five adult patients on hemodialysis for >3 months duration were included whereas patients on hemodialysis for acute kidney injury duration <3 months and exhibiting clinical or laboratory features of other conditions as chronic skin disease, cholestasis, and malignancies were excluded from the study. Results: The mean age was 48±13.29 years, 46 (70.8%) were males and 19 (29.2%) were females. The mean BMI of patients was 23.73 kg/m2. Thirty one (47.1%) was diabetics and 34(52.9%) was nondiabetics. Hypertension was found in 61(93.9%) while 4(6.2%) were normotensive, 3 (4.6%) were on HD from 6 months to 1 year, while 19(29.4%), 43(66.0%) were on HD for 1 to 3 years and >3 years respectively. Conclusion: The frequency of uremic pruritis in patients on thrice-weekly MHD is 23.1% in our population. Key words: Uremic pruritis, Hemodialusis, End stage renal disease

Background: End-stage renal disease patients getting hemodialysis (HD) frequently report sleep problems. There are various sorts of sleep disorders, generally classified into different categories depending upon initiation of sleep, duration, and continuity of sleep, calmness during sleep, respiration pattern during sleep, and daytime alertness. Sleep abnormalities have a significant and well-documented effect on daily routine activities thereby reducing the quality of life. Objective: To determine the frequency of sleep pattern abnormalities in patients with chronic kidney disease on maintenance hemodialysis. Study Design: Cross-sectional study Place and Duration of Study: Department of Nephrology, Sir Ganga Ram Hospital, Lahore from 24th January 2019 to 24th July 2019. Methodology: Ninety one cases ages between 14-70 years of either gender, having ESRD, and are on maintenance HD for at least 3 months were included. All those patients who were having HD for acute kidney injury were excluded. Sleeping disorders were evaluated using Pittsburgh Sleep Quality Index by a single interviewer. Results: Fifty five (60.4%) were males and 36 (39.6%) were females. The mean age was 51.1±12.1 years, mean BMI was 25.1±5.2, and mean duration of dialysis was 5.1±2.8 years, 74(81.3%) patients had sleep disorders. Among patients having sleep disorders, 38(41.8%) had Insomnia, Narcolepsy in 41(51.6%), Sleep Apnoea Syndrome in 38(41.8%), restless leg syndrome in 35(38.5%) and parasomnia in 17(18.7%) patients. Conclusion: Sleep disorders are common in regular hemodialysis patients affecting 81.3% of individuals. Key words: Chronic kidney disease, Haemodialysis, Sleep disorders

Background: Serum lipid abnormalities are strongly related to cardiovascular as well as all-cause mortality. The most common dyslipidemia among dialysis patients is low HDL followed by hypertriglyceridemia. Total cholesterol and LDL levels are normal. Dyslipidaemia in end-stage renal disease is multifactorial in addition to abnormalities in lipid metabolism, malnutrition, inflammation, low albumin, and inadequate hemodialysis also contribute to premature atherosclerosis. That’s why treatment of dyslipidemia in hemodialysis patients should be individualized. Objective: To determine the frequency of dyslipidemia among patients of end-stage renal disease on thrice-weekly hemodialysis. Study Design: Cross-sectional study Place and Duration of Study: Dialysis Unit, Department of Nephrology Sir Ganga Ram Hospital, Lahore from 1s9th March 2021, to 18th September 2021 Methodology: Seventy two patients having maintenance HD at our center were enrolled. The data included the patient's name, age, gender, duration of maintenance hemodialysis, BMI, HTN, DM, IHD, and smoking status. Fasting lipid samples of patients were collected in serum vials and samples were analyzed in the major laboratory for any lipid abnormality. Results: Forty four (61.1%) patients have dyslipidemia among which 27 (61.4%) were males and 17 (38.6%) were females. The mean age was 47.5±11.5 years. The most common lipid abnormality in our patients was low HDL levels i.e., 56.8% followed by hypertriglyceridemia 6.9%. Total cholesterol and LDL levels are normal in 98% and 100% respectively. Conclusion: The frequency of dyslipidemia among patients of thrice-weekly maintenance hemodialysis is 61.1%. Low HDL is the most common lipid abnormality followed by hypertriglyceridemia 56.8% and 6.9% respectively. Key words: Dyslipidemia, End-stage renal disease (ESRD), Hemodialysis

Objective: To determine the frequency of Arteriovenous Fistula (AVF) Stenosis and Access Recirculation (AR) among Hemodialysis patients. Study Design: Cross-Sectional Study. Setting: Dialysis Unit, Nephrology Department, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore. Period: July 2017, to December 2017. Material & Methods: Eighty-four patients on maintenance hemodialysis fulfilling selection criteria were enrolled in the study. All the patients underwent Doppler ultrasonography for AVF stenosis detection and Peak systolic velocity (PSV) of more than 500 ml/sec predicted 50% or greater stenosis of AVF. A two-needle urea-based method was used for the calculation of AR and the AR value of more than 10% was considered significant. Data were analyzed in Statistical Package for Social Science (SPSS) v23.0. Data were stratified according to age, sex, BMI, hypertension, smoking, and duration of dialysis. Post-stratification, Chi-square was used. P-value ≤0.05 was taken significantly. Results: Among ESRD patients, 60(71.4%) were males and 24(28.6%) were females. 65(77.4%) had hypertension and 21(25.0%) were smokers. Among these patients, 6(8.3%) had AV fistula stenosis, and 10(11.9%) had access re-circulation. Statistically, a significant correlation was only present between AVF stenosis and AR (p-value 0.003) Conclusion: The periodic measurement of AVF stenosis and AR have diagnostic implications in maintenance hemodialysis patients because these are important causes of inadequate dialysis.