Objective: To study the relationship between history of miscarriage (induced or spontaneous) and current use of modern contraceptive method among women in Pakistan. Study Design: Cross Sectional study. Setting: OPD of MCH, PIMS. Period: July 2019 to December 2019. Material & Methods: A total of 80 married women were enrolled, 40 women who had induced miscarriage (group A) and 40 from spontaneous miscarriage (group B). Data is obtained on predesigned questionnaire. Primary outcome was acceptance of contraception (LARC) after induced versus spontaneous miscarriage. Results: About 51% of women were in the age group of 30–35 years and out of total 80 women, 67 (83%) women had parity of three or above (27 % had parity of three). Out of 66 women who used contraception, 35 (53%) had induced miscarriage (group A) and 31 (46%) had spontaneous miscarriage (group B). Women who belonged to induced miscarriage (group A) faced menstrual irregularity, as the reason of leaving contraception, followed by chronic PID and husband opposition. While in the group B, fertility desire was main reason of discontinuation of contraception. In Group A, 20 (50%) women were willing to use LARC (long acting reversible contraception) after induced abortion to reduce the chances of unwanted pregnancy while in other group B, 15 (37.5%) women were wanted to use LARC and 18 (45%) women were not ready to use contraception due to fertility. Conclusion: High rate of induced abortion due to failed contraception and dis-continuation of contraceptives needs to be addressed by encouraging women to manage the side effects to ensure continuity of contraceptives.

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD. Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad. Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p<0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded. Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.

BACKGROUND AND AIMS Contrast-induced nephropathy (CIN) is a generally reversible form of acute kidney injury that occurs soon after the .administration of radiocontrast media. Several therapies are being used for the prevention of CIN. We aimed to gather the data about protective role of a single oral dose of Allupurinol along with hydration with normal saline as compared with normal saline only in our settings. METHOD Duration of study was 6 months. It was done at Department of Nephrology/Cardiology, Pakistan Institute of Medical Sciences (PIMS), SZABMU, Islamabad. In this randomized controlled trial, a total of 76 (n = 76) adult (age 18–75 years) patients of either gender who were planned to undergo coronary intervention were selected for this study. All the enrolled patients had an eGFR &lt;60 mL/min. Participants were divided into two groups randomly by using random number tables. Patients in group A received a single dose of 300 mg Allopurinol orally 12 h before contrast-based procedure and intravenous normal saline hydration at the rate of 0.5 mL/kg/h in continuous infusion 12 h before and 12 h after contrast-based procedure. Group B received normal saline hydration alone in dose equal to group A. Blood samples were drawn 12 h before procedure. Samples were analyzed for serum creatinine levels. Blood samples were drawn after 48 h and 5 days of procedure for serum creatinine analysis. CIN was assessed in all patients, which was defined as an absolute .increase in .serum creatinine level of &gt; 0.05 mg/dL or a relative increase of &gt; 25% from baseline at 48 h after contrast exposure and compared in both treatment groups. RESULTS Gender distribution was similar in both groups with M:F of 1.71 in group A and 1.53 in group B (P = 0.813). Mean age was 57.6 years ± 7.4 SD in group A, while it was 58.4 years ± 6.5 SD in group B (P = 0.612). There were 63.2% (n = 24/38) patients in group A who were between ≤60 years of age and 36.8% (n = 14/38) had an age &gt;60 years. Mean eGFR at baseline in group A was 53.7 mL/min ± 4.7 SD, and it was 54.8 mL/min/1.73 m2 ± 3.8 SD in group B (P = 0.277). Mean maximal allowable contrast dose (MACD) in group A was 323.3 mL ± 51.7 SD, and it was 313.4 mL ± 0.09 SD in group B (P = 0.445). Mean contrast volume was 55.1 mL ± 5.9 SD in group A, and it was 56.9 mL ± 5.6 SD in group B (P = 0.171). The mean CV/MACD ratio was similar in both groups (0.17 versus 0.19, P = 0.160, Table 7). Contrast-induced nephropathy (CIN) was observed in 5.3% (n = 2/38) patients in group A, while it was observed in 21.1% (n = 8/38) patients in group B as per pour operational definitions (P = 0.042). CIN in both the groups were stratified with respect to age, gender, BMI and baseline comorbids. In patients with baseline uric acid within normal limits, CIN was observed in 3.4% (n = 1/29) patients in group A, while it was observed in 9.7% (n = 3/31) patients in group B (P = 0.334, Table 10). In patients with raised uric acid levels at baseline, CIN was observed in 11.1% (n = 1/9) patients in group A, while it was observed in 71.4% (n = 5/7) patients in group B (P = 0.013). Efficacy of a single dose of Allopurinol dose along with hydration with normal saline was significantly better in patients with raised serum uric acid levels at baseline when compared with normal saline only (P = 0.013). No other significant difference noted across all groups (P&gt;0.05 in all cases). CONCLUSION CIN developed in a significantly lesser number of patients who received a single dose of 30 mg of Allopurinol 12 h before administration of contrast along with saline hydration as compared with patients receiving hydration alone.