BackgroundDengue is a growing public health problem in Pakistan and acute kidney injury (AKI) is one of the least studied complications of dengue virus infection (DVI). The aim of this study was to determine the frequency, severity and predictors of AKI in patients with DVI and to study the impact of AKI on the length of hospital stay and mortality.MethodsWe retrospectively reviewed medical records of patients aged ≥14 years hospitalized with a primary diagnosis of DVI at Aga Khan University Hospital Karachi between January 2008 and December 2010. Binary logistic regression models were constructed to identify factors associated with the development of AKI and to study the impact of AKI on hospital stays of more than 3 days.ResultsOut of 532 patients, AKI was present in 13.3% (71/532). Approximately two-thirds (64.8%) of these patients had mild AKI and a third (35.2%) had moderate to severe AKI. Independent predictors for AKI were male gender [odds ratio (OD) 4.43; 95% CI 1.92–10.23], presence of dengue hemorrhagic and dengue shock syndrome (DSS, OD 2.14; 95% CI 1.06–4.32), neurological involvement (OD 12.08; 95% CI 2.82–51.77) and prolonged activated partial thromboplastin time (aPTT, OD 1.81; 95% CI 1.003–3.26). AKI was associated with a length of stay ≥3 days when compared with those who did not have AKI (OD 2.98; 95% CI 1.66–5.34). Eight patients (11.3%) with AKI died whereas there were no mortalities in patients without AKI (P < 0.001). Only 5 patients (7%) had persistent kidney dysfunction at discharge.ConclusionsAKI in DVI is associated with neurological involvement, prolongation of aPTT, greater length of hospital stay and increased mortality.

Background: Management of rectal cancer has been evolved significantly in the last few decades, improvement in disease control were achieved with introduction of neoadjuvant chemoradiation followed by surgical excision. Objective: To determine progression free survival and overall survival of the patients with rectal cancer and various factors that affect survival. Methods: We retrospectively collected data of newly diagnosed patients with rectal cancer presented at Aga Khan University Hospital Karachi, from 2009 to 2016. All the patients with early stage or locally advanced rectal cancer who either underwent upfront surgery or received neoadjuvant chemoradiation followed by surgery were included in the study. Results: From 2009 to 2016, 101 patients with newly diagnosed rectal carcinoma were included in the study. Median age 47 years (21-80), 66.3 % (n ¼ 67) were males whereas 33.6 % (n ¼ 34) female. 9.90% (n ¼ 10) have signet ring cell histology while 90.1 % (n ¼ 91) are adenocarcinoma. 59.4 % (n ¼ 60) were stage III, 26.7% (n ¼ 27) stage II and 13.8% (n ¼ 14) were stage I at the time of diagnosis, 47.5% (n ¼ 48) underwent upfront surgery while 52.4% (n ¼ 53) received neoadjuvant chemoradiation. 31 patients who underwent upfront surgery completed adjuvant chemoradiation. 51 patient after neoadjuvant chemoradiation underwent surgery, 2 had disease progression. Of them 7 %( n ¼ 4) of the patients had pathological complete response (CR) while 92.1% (n ¼ 47) had non CR. Median follow up was 3 years (1-5 yrs.), 37 pts. had disease progression. Median time to progression of all patients was 21 months and overall survival of 24 months. In subgroup analysis patient with adenocarcinoma had better PFS (21 vs. 19 months) and OS (24 vs. 21 months) as compared to signet ring histology. Patient who had pathological CR after neoadjuvant chemoradiation had a PFS and OS of 32 months respectively vs. 16 and 18 months who had no pathological CR. Conclusions: Several factors affect survival of rectal cancer patients, our analysis showed that the patients who had pathological complete response and non-signet ring cell histology had better time to progression as that which was reported in international studies.