It is important that doctors in the emergency department use terminology that is understood by the patient, as well as emphasising the potential seriousness of the injury. It is possibly better therefore to use informed lay terminology such as 'a break in a bone' rather than more formal vocabulary such 'a fracture' when discussing the diagnosis and treatment options.

A 45 years old gentleman presented to Medical Clinic of Naval Hospital (PNS Hafeez) Islamabad in January 2001 with choreform movements of the body and early dementia of six months duration. He had a strong family history of similar disease, which included his father and two brothers. On neurological examination he had choreoathetoid movements and features of early dementia. His chest was clinically clear and examination of heart and abdomen was normal. Eye examination did not reveal any evidence of Kayser-Fleischer rings (seen in Wilson`s disease). Laboratory investigations showed haemoglobin 13.8 Gm/dl, WBC 7.7 x10e9/L, serum urea 32 mg/dl, serum sodium 139 mmol/L serum potassium 3.8 mmol/L, ASO titre less than 200 IU/ml, serum bilirubin 6 umol/L, ALT 102 U/L, serum alkaline phosphatase 155 U/L, serum caeruloplasmin 42 mg/dl and serum copper 164 mmol/L (WNL). X-ray chest was normal and CT scan brain showed early generalized cerebral atrophy. He was managed with haloperidol (0.5mg) 12 hourly, Procyclidine (kemadrin, 5mg) 8 hourly and Propranolol (Inderal 10mg) 8 hourly. He was discharged from hospital with relative improvement after 2 weeks.

Objective: To compare the estimated glomerular filtration rate (eGFR) assessed through the CKD-EPI equations based on creatinine, Cystatin C and creatinine-Cystatin C levels for estimating kidney function among patients with diabetes. Study Design: Cross-sectional analytical study. Duration and Place of Study: Nephrology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan, from Aug 2020 to Mar 2021. Methodology: A total of 70 patients were recruited. Serum samples were collected for creatinine and Cystatin C levels and 24 hours of urine for creatinine clearance. The eGFR values were calculated using the creatinine, Cystatin C and combined creatinine-Cystatin C CKD-EPI equations and compared with 24 hours of urinary creatinine clearance. Results: A total of 22 (31.4%) patients had early stage, while 48 (68.6%) had late-stage chronic kidney disease (CKD). The highest Spearman correlation coefficient was found for eGFR CKD-EPIcr-cys (rho=0.844), followed by CKD-EPIcys (rho= 0.835) and CKD-EPIcr (rho=0.709). Conclusion: CKD-EPIcr-cys is the most accurate, recommended method of calculating eGFR.

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