Background: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist. Objectives: To examine the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for Caesarean section. Design: Prospective cohort study. Subjects: All women who underwent Caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria. Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. Results: The overall cumulative incidence of post dural puncture headache was found to be 20.35 % but was significantly higher in patients in whom the quincke type of needle was used than in those whose spinal anaesthetics were administered using the pencil point needle (24.2% and 4.5% respectively: p=0.042). Conclusions: The incidence of post dural puncture headache can be significantly reduced in the obstetric population at the Aga Khan University Hospital if the pencil point spinal needle was to be routinely used. We recommend that the Quincke needles should not be used in the obstetric population at the Aga Khan University Hospital.

Objective: To determine to mean change in levels of Triglycerides (TG), Total cholesterol (TC), High-Density Lipoprotein Cholesterol (HDL-C), and low-density lipoprotein (LDL-C) in critically ill patients at admission,18 hours and 42 hours after admission. Study Design: Cross-sectional study Place and Duration of Study: Department of Chemical Pathology & Endocrinology, Armed Forces Institute of Pathology Rawalpindi (AFIP), in collaboration with Military Hospital Rawalpindi (MH), Combined Military Hospital Rawalpindi (CMH) and Armed Forces Institute of Cardiology Rawalpindi (AFIC) Pakistan, from Mar to Sep 2016. Methodology: A total of Fifty patients admitted to intensive care units of MH, CMH and AFIC for coronary artery disease(CAD), sepsis, burns and cancer were included in the study. Patients on lipid-lowering drugs and post-surgery patients were excluded.TC, HDL-C, LDL-C and TG were analysed on ADVIA 1800 (SIEMENS, Germany). Results: Fifty patients were included with mean age of 48.12±2.26 years. Parametric analyses revealed significant increase in serum TG levels during hospitalization in critically ill patients in various disease groups (Mean±SD at admission, 18 hours and 42 hours): TG (CNS disorders 1.35±0.18, 1.78±0.24 and 1.22±0.17; CVS 1.92±0.21, 2.15±0.28 ,2.32 ±0.20; sepsis 1.55±0.18,1.38+0.24,1.54+0.17; malignancies 1.24±0.31, 1.28+0.42,1.35+0.30; renal disorders 1.39+0.35,1.82+0.47,1.08+0.33; (p<0.05). TC decreased in sepsis, CVS and cancer patients while increasing in CNS and renal disorders. HDL-C and LDL-C decreased in all diseases as an acute stress response. Conclusions: During critical illness, TG and LDL-C may change significantly; therefore, they should be monitored and interpreted with extreme care if requested to be performed within the course of the disease.

Introduction: Chronic kidney disease (CKD) increases the risk for adverse cardiovascular events including heart failure (HF) and death. Left atrial size is an easily quantified metric that provides prognostic information in non-CKD populations. Hypothesis: We hypothesized that left atrial size would be an independent risk marker for incident HF and death in individuals with CKD. Methods: The Chronic Renal Insufficiency Cohort (CRIC) is a large, multicenter, multiracial cohort study established to understand the progression of cardiovascular and renal disease among individuals with CKD. We evaluated echocardiograms among participants without a history of heart failure. The left atrial area was measured in the apical 4-chamber view and indexed to body surface area (LAAI). Cox proportional hazards models were constructed to assess the risk between left atrial size and incident HF and death. Results: Among the 2960 CKD participants without known heart failure, higher tertiles of LAAI were associated with older age, Hispanic ethnicity, a history of stroke, myocardial infarction, atrial fibrillation, higher systolic blood pressure, hypertension, diabetes, and lower eGFR (P<0.005 for all). The median left ventricular ejection fraction was 55% across LAAI tertiles. Over a median [IQR] follow-up of 6.6 [5.7-7.6] years, 344 participants developed HF and 472 died. An increase in LAAI was a strong risk marker for the development of heart failure after multivariable adjustment (Table 1). LAAI was modestly associated with all-cause death after controlling for demographics and clinical variables; however, additional adjustment for echocardiographic variables and cardiac biomarkers rendered the association non-significant. There was no significant interaction between LAAI and sex or race for either outcome. Conclusion: Among adults with CKD, LAAI is a stronger marker of risk for incident HF than death.