Objective: To determine the frequency of protein energy wasting among end stage renal disease patients on maintenance hemodialysis. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from May 2019 to Mar 2020. Methodology: Two hundered patients diagnosed with end-stage renal disease on maintenance hemodialysis were included in the study. Protein-energy wasting was assessed using the Malnutrition inflammatory score comprising four x components: medical history, physical examination, laboratory parameters and body mass index. Malnutrition inflammatory score was used to categorize protein-energy wasting. Results: Out of 200 patients with ESRD on maintenance hemodialysis, 73(36.5%) patients had mild, 120(60.0 %) patients had moderate, and 7(3.5%) patients had severe protein-energy wasting. The advanced age group, multiple comorbid (diabetes mellitus, hypertension, ischemic heart disease), and duration of hemodialysis (> 2 years) had a statistically significant association with the protein energy wasting (p-value < 0.05). Protein-energy wasting was also more prevalent in patients with low monthly income (p-value 0.04). Conclusion: Protein-energy wasting is common among patients with end stage renal disease on maintenance hemodialysis.Old age group, multiple comorbid, and duration of hemodialysis are important risk factors.

Objective: To compare the efficacy of Amlodipine with Captopril in the management of patients presenting to the emergency department with uncontrolled blood pressure. Study Design: Comparative prospective study. Place and Duration of Study: Emergency Department, Combined Military Hospital, Malir Pakistan, from Jul to Dec 2021. Methodology: A total of 127 individuals presenting to the Emergency Department with two readings of uncontrolled blood pressure (Systolic blood pressure ≥ 160mmHg and Diastolic blood pressure ≥90mmHg) were included. They were administered a tablet of Captopril 12.5mg per oral and a tablet of Amlodipine 10mg per oral on the turn by turn basis. Patients were observed for 3 hours and monitored for the reduction in blood. The efficacy of medication was judged based on the ability to achieve target blood pressure reduction, which was at least a 20-30% reduction in systolic blood pressure. Results: Out of 127 individuals, 65(51.2%) patients were given a tablet of Captopril 12.5mg orally, and 62(48.8%) were given a tablet of Amlodipine 10mg orally. The mean reduction in systolic blood pressure was 20.73±5.17 in all patients. In addition,target blood pressure reduction was achieved in 35(53.8%) individuals of the Captopril-Group and 33(53.2%) of the Amlodipine-Group, with a total of 68(53.5%) individuals achieving target blood pressure within 3 hours after medication. Conclusion: Both medications were efficient in achieving target blood pressure levels. However, no drug was superior to another in reducing blood pressure in an emergency.

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group. Study Design: Comparative prospective study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020. Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response. Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026). Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections.

Objective: To compare the efficacy and safety of intravenous Insulin infusion versus subcutaneous Insulin in the management of hyperglycaemia in intensive care. Study Design: Quasi-experimental study. Place and Duration of Study: Medical Intensive Care Unit of Combined Military Hospital Malir, from Jul to Sep 2021. Methodology: 68 individuals admitted to the Medical ICU with the blood sugar levels of more than 180 mg/dl were included. Patients on one side of Intensive Care Unit were administered intravenous Insulin infusion, and on the other side were administered subcutaneous Insulin to control blood sugars. Age, gender, previous history of diabetes and use of Insulin and glycosylated haemoglobin were recorded. Efficacy of regimen was judged based on ability to achieve target glucose levels, mean blood glucose levels and total days of ICU stay. Adverse events like hypoglycaemia and hypokalaemia were recorded. Results: Out of 68 individuals, 27 (39.70%) were administered intravenous Insulin infusion, and 41 (60.29%) were administered subcutaneous Insulin. In the intravenous Insulin group, 22 (81.5%) individuals achieved target blood glucose compared to 29 (70.7%) in the subcutaneous Insulin group. The mean blood sugars in the intravenous group were 157.11 ± 25.54 mg/dl, whereas 168.32 ± 30.49 mg/dl in the subcutaneous group (p-value=0.164). The frequency of hypoglycaemia and hypokalaemia was more in the intravenous group than in the subcutaneous group. Conclusion: Optimal blood sugar levels were better achieved with intravenous Insulin than with subcutaneous Insulin. However, the frequency of adverse effects was also more with intravenous Insulin, so better monitoring and management are..............