To determine the frequency of hepatitis B and C in patients with prolonged hemodialysis suffering from chronic renal failure. Methods A retrospective study was conducted from January to August 2017 at Tabba Kidney Institute, Karachi. A total of 255 patients on hemodialysis were included in the study by using convenient sampling technique. All the relevant data such as gender, age, duration of hemodialysis and presence of hepatitis B and C were recorded. Data were analyzed using Statistical Package for Social Sciences, version 21 (IBM Corp., Armonk, NY) while binary logistic regression was applied to develop a risk assessment model for the study outcomes. Results The study results showed that 134 (52.5%) patients were on hemodialysis for five years or more, 173 (67.8%) of them suffered from hepatitis B while 124 (48.6%) of them suffered from hepatitis C. The study results further revealed that after controlling for the effects of age and gender, the duration of hemodialysis was significantly associated with both hepatitis B (AOR 1.917, 95% CI 1.111-3.306, p=0.019) and hepatitis C (AOR 2.323, 95% CI 1.395-3.870, p=0.001) among the patients studied. Conclusion The study concluded that longer duration of hemodialysis in patients with chronic renal failure was significantly associated with both hepatitis B and hepatitis C infections in the study population. A myriad of patient and environmental factors can contribute to this finding in patients with chronic renal insufficiency. Therefore, periodic monitoring of liver function tests and routine surveillance for viral hepatitis can help establish an early diagnosis of infection, potentially improving patient outcomes improving patient outcome.

Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study.

Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level <250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level >650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively  (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P <0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin.

Introduction: Iron deficiency is an important cause of anemia in patients with chronic kidney disease (CKD). Anemia develops early during chronic kidney disease (CKD), affects virtually all individuals with stage 5 CKD (GFR <15 ml/min per 1.73 m 2 ), and is associated with increased cardiovascular morbidity and decreased quality of life. Iron deficiency is a common cause of anemia in CKD; the estimated prevalence ranges from 25 to 70%. The causes include decreased intake or absorption of iron; iron sequestration as a result of inflammation; blood loss; and increased iron use for red blood cell production in response to erythropoiesis stimulating agents (ESA). Inadequate production of erythropoietin by the kidney and/or insufficient response to erythropoietin as a result of inflammation contributes to anemia during later stages of CKD.Appropriate management of anemia in CKD often requires both iron and ESA. Thus, assessing

OBJECTIVE: To assess the effectiveness of honey dressing in Fournier's Gangrene against conventional Edinburgh University solution of lime (EUSOL) dressing. METHODOLOGY: This was a prospective experimental study conducted in Liaquat National MedicalCollege and Hospital Karachi for duration of 5 and half years. Total 44 patients having gangrene and no co morbid conditions were included in this study. Patients who had co-morbid conditions like deranged coagulation profile and CVA, who were not willing to participate or loss to follow up were excluded from the study. After getting baseline blood workup (i.e. CBC, S. Creatinine, S. Electrolytes, Urine D/R, C/S and Diabetic workup) done and taking consent, the patients were immediately shifted to operation theatre, the incision and drainage was performed, and the necrotic tissues were debrided. Pus cultures were sent, and patients were started on routine intravenous antibiotics (3 rd generation Cephalosporin and metronidazole). A Dressing of wound was done randomly by honey in Group A and by Eusol in Group B. Patients were discharged after wound was completely healed. The data were obtained and analyzed by using SPSS version 20. Mann-Whitney U-test and chi-square test was applied to find out the significance. A got slough cleared in4.82±0.96 days, on average requiring 3.22±0.75 number of debridement's, complete wound healing and duration of hospital stay being 9.54±0.74 days. The patients in Group B got slough cleared in 8±0.87 days, requiring 5.32±0.72 number of debridement's, complete wound healing and duration of hospital stay 13.68±1.09 days.There was a significant difference in slough clearance, number of debridement's required, time taken for complete wound healing and hospital stay between Group A and Group B (P-value <0.001). CONCLUSION: This study predicted that honey is very valuable in the management of Fournier's gangrene as it ensured early clearance of slough, required lesser number of debridement's, had early wound healing and had relatively shorter duration of stay in hospital than those treated with conventional EUSOL as dressing material RESUTS: The patients in Group