Ziauddin University Hospital Research Articles

Comparative safety and efficacy of low dose ketamine and opioids for acute pain management at the emergency department

Background: Pain is a complex phenomenon for which many pharmacological agents have been discovered and utilized for pain relief. Ketamine is a more preferred pain reliever over opioids in the emergency department (ED). The aim of this study was to compare the safety and efficacy of low dose ketamine (LDK) with morphine (opioid) for pain relief among patients presenting to the ED.
 Methodology: A prospective, cohort study was conducted over a sample of 280 patients presented with acute pain to the ED, Ziauddin University Hospital, Karachi. These patients were then divided into two groups via simple random sampling with randomization being assured using an online randomizer software tool. The 1st group (n=140) was given 0.2 mg/kg of LDK while 0.1 mg/kg of intravenous morphine (opioid) was given to the 2nd group (n=140). The pain intensity was measured using the Visual Analogue Scale (VAS) from admission to 60 mins, the records were taken after every 15 mins. The adverse events (AE’s) were also recorded for both groups. The data was then analyzed using SPSS Version 21 & Microsoft Excel 2016.
 Results: Out of 280 patients enrolled in the study, there was male majority i.e. 76.07% while the remaining were females with the mean age of 29±7 years. Within 15 minutes of initial dose administration in both groups, a marked reduction in pain intensity was observed. Reduced respiratory rate, pruritus and decreased O2 saturation were common AE’s observed, which were comparatively higher among patients receiving morphine as compared to ketamine.
 Conclusion: The efficacy of morphine (opium) and LDK is similar in alleviating pain in an emergency setting, however, LDK is visibly safer than its opioid counterpart and thus may be used as a safer alternative.

OVARIAN CANCER: MOST FREQUENTLY SEEN GYNAECOLOGICAL MALIGNANCY IN ZIAUDDIN HOSPITAL, NORTH NAZIMABAD

Background: The prevalence of genital tract malignancies is rising worldwide making it one of the most common malignancies in females after breast cancer. Despite cervical cancer being the most commonly occurring cancer globally, a multitude of studies in Pakistan have identified ovarian cancer as the most commonly occurring malignant tumor. The morbidity and mortality rates from genital tract tumors are considerably higher in developing countries. In developed countries, screening tests for early diagnosis of a malignancy followed by effective treatment are readily available. The objective of this study is to study the pattern and relative frequency of the malignancies involving the genital tract among women admitted to Ziauddin Hospital in 2015. Methods: The study is a retrospective, observational analysis of the case files of female patients admitted into Ziauddin University Hospital, North Nazimabad. The patients coming to the OPD have been followed for the last 3 years to check for the suspected presence of a genital tract malignancy. Results: A total of 55 patients over the last three years were confirmed to have some form of genital tract malignancy. Ovarian cancer accounted for 49% of the outcome, with around 23.6% of the cases diagnosed at stages 3 and 4. Endometrial cancer was the second most common cancer, with 27.2% being diagnosed at stage 1. Cancers of the cervix and vulva accounted for 3.6% and 1.8% respectively. No cancer of the vagina was documented. Conclusion: The most common genital tract malignancy in female patients at Ziauddin University Hospital is ovarian cancer, in contrast to the vast majority of developing countries where cervical cancer is the leading cause of genitourinary malignancies.

TYPE II DIABETES MELLITUS: A WARNING SIGN FOR DEPRESSION

Background: People with type 2 diabetes compared to those without seem to have more chances of developing depressive symptoms. Diabetes leads to depression or vice versa, remains an unsolved puzzle. Diabetes and depression together leave deep psychological and physical imprints on their victims leading to functional limitation, poor quality of life and raised mortality rate. Diabetic patients should be warned by the physicians to keep a watch for the development of depressive symptoms in them. The study aimed to investigate the relationship between type 2 diabetes mellitus and depression. Methods: The cross sectional study was conducted at Ziauddin University Hospital over a period of six months. Sample size of 100 was taken. Details of participant’s demographics along with Body Mass Index were recorded. Questionnaires were filled by researchers. SRQ 20 depression scale was used to diagnose depression. Data was entered and analyzed by version 20 of SPSS. Results: Different demographic and social variables were assessed in this study. 100 patients with HbA1c <6.5% were taken and 100 with ≥ 6.5%. 73 (36.5%) patients out of the total sample were depressed, almost from the good glycemic control group. Only a quarter of patients that had normal HbA1c levels became depressed however 48% patients with poor glycemic control suffered depression. Conclusion: Research concludes that co-morbid diabetes and depression is not a rare finding. Risk factors must be ruled out and the chances to develop depression should be identified at an earlier stage before complications worsen the condition.

Complications Associated with Permanent Internal Jugular Hemodialysis Catheter: A Retrospective Study.

IntroductionA significant increase in patients with end-stage renal disease has been observed currently in our community. Kidney transplantation is the most promising cure but the problem is that large numbers of people are not good candidates for transplantation. Hemodialysis is the next appropriate medication for such patients and for patients with end-stage renal disease, who have no chance for transplantation. Morbidity and mortality are the consequences of vascular access complications. Local data related to the complication rate of permanent hemodialysis catheters is not available. The current study examines the complication rate in people due to permanent intrajugular hemodialysis catheterization.Materials and methodsThe study has been conducted in Dr Ziauddin University Hospital, Karachi. The dataset consists of 212 patients who had gone through jugular catheterizations for hemodialysis at this hospital from the year 2014 to the year 2015. A descriptive method has been chosen for obtaining appropriate results. Complications have also been categorized as early or late.ResultsComplications have been detected in around 24% of the patients from the dataset. Among these complications, infection has the highest percentage (around 13%) while 4% percent of patients have a failed puncture. The others have venous thrombosis, catheter thrombosis, hematoma, wrong canulation, and hemothorax and pneumothorax problems.ConclusionThe study concludes that the placement of a permanent hemodialysis catheter in the internal jugular vein has a low complication rate. In addition, the method is safe and easy. So, it can be said that the internal jugular vein is a reliable and preferred route for hemodialysis catheterization.

Detection of Transition Zone in Bowel Obstruction via Curved Multiplanar Reformations with Multidetector Computed Tomography.

ObjectiveWe conducted this study to determine the added value of curved multiplanar reformations (CMPR) and multiplanar reformations (MPR) of multidetector computed tomography (MDCT) scan in the visualization and localization of the zone of transition in patients with intestinal obstruction.Materials and methodsA total of 100 patients with suspected bowel obstruction were evaluated in a retrospective cross-sectional study from September 2016 to September 2018 at Dr. Ziauddin University Hospital, Clifton Campus. All patients underwent multidetector computed tomography (CT) scans with oral and intravenous contrast before surgical exploration. CMPR and MPR were acquired at the time of examination in each patient in addition to routine axial images. The CT scans were analyzed by two independent, experienced radiologists skilled at detecting the zones of transition in patients with bowel obstruction using the axial images alone, followed by axial images along with MPR, and then MPR plus CMPR. Patient data were masked to the radiologists. The CT scan findings were compared with surgical findings to determine the accuracy of CMPR in detecting the zone of transition between distended and collapsed bowel loops. The added CMPR showed high accuracy in the diagnosis of intestinal obstruction with a remarkable advantage over the conventional axial images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Cohen’s kappa statistics were obtained to show the measure of agreement between the two readers. McNemar’s test was also applied to determine the homogeneity.ResultsTwo radiologists, one with two years of experience and the other with five years of experience were 80% and 81% accurate, respectively, in identifying the zones of transition using axial images alone. Using axial images plus MPR, their accuracy was 88% and 92%, respectively. Using MPR plus CMPR, their accuracy was 96% and 98%, respectively. The accuracy of MPR plus CMPR views was significantly increased when compared to the accuracy using axial images alone. CT findings were compared to surgical findings in terms of diagnostic performance. The kappa value of 0.6 indicates moderate association and substantial agreement between two radiologists. McNemar’s test showed homogeneity in the number of valid cases.ConclusionCMPR is an important and accurate technique for evaluating intestinal obstruction in addition to MPR as it helps in better localization of the zone of transition and in determining the cause of obstruction. This insight provides guidance for the appropriate treatment.

Estimation Of Salivary Superoxide Dismutase Level In Oral Submucous Fibrosis: A Clinical And Biochemical Study

Objective: The objective of the study was to compare the salivary Superoxide dismutase (mU/L) level among stage one patients of Oral sub mucous fibrosis and healthy controls. Study Design and Setting: It was a comparative cross sectional study design conducted at Outpatient clinic of Dental Department at Ziauddin University Hospital from January 2012 till December 2013. Methodology: Eighty histo-pathologically confirmed patients of clinical stage one Oral Sub mucosal fibrosis (OSMF) and eighty healthy controls were matched for age and gender to recruit in the study. Socio demographic information (i.e. age, gender, ethnicity, education and occupation), oral health status, measurement of mouth opening (mm) and Superoxide dismutase (mU/L) were recorded. The study was conducted after the approval granted from the ethical review committee of Ziauddin University Hospital. Data was entered and analyzed using SPSS version 21 (IBM). Result: The standard mean (+/-SD) of Superoxide dismutase (mU/L) in both groups was 4.99 (+/-2.18). The mean of Superoxide dismutase (mU/L) in confirmed cases of oral sub mucosal fibrosis was 3.02 (+/-0.44) which was significantly lower as compared to the control group which was 6.96(+/-1.24) and the calculated p value was 0.001.The strong positive correlation was identified in mouth opening (mm) and superoxide dismutase (0.842). Conclusion: It was concluded that the levels of salivary superoxide dismutase was significantly lower in the sample of OSMF and lower levels of superoxide dismutase (mU/L) was the indication of decrease in mouth opening among the cases of OSMF. Therefore, salivary superoxide dismutase can be used as a biomarker for the early detection as well as successful treatment of OSMF

A novel comparison of Epstein-Barr virus with broad histological spectrum of oral squamous cell carcinoma

Objectives:To evaluate the immunohistochemical expression of Epstein-Barr virus (EBV) in broad spectrum histological subtypes of oral squamous cell carcinoma (OSCC) and to determine the relationship of EBV with clinicopathological parameters of OSCC.Methods:This cross-sectional study included 150 clinically diagnosed OSCC cases from the outpatient of Ziauddin University Hospital from March, 2017 to October, 2018. These were confirmed on histological examination and categorized into conventional squamous cell carcinoma (SCC) and rare variants. Conventional SCC was subcategorized into keratinizing (KSCC), non-keratinizing (NKSCC), and hybrid SCC (HSCC). EBV status was compared among various histological tumor entities and clinicopathological characteristics of OSCC using immunohistochemistry. Chi-square test was used to determine the association of each histological subtype with EBV status with P-value <0.05 considered as statistically significant.Results:Conventional tumor was the most frequent squamous cell carcinoma (n=126; 84%). A significant statistical link of EBV infection was observed with rare histological tumors exhibiting acantholysis (P=0.01), as well as tumors involving buccal mucosa (P=0.03), and habitual smokers (P=0.001).Conclusions:In this study, acantholytic tumor, a rare histological subtype of OSCC, tended to be EBV related. Moreover, OSCC cases bearing EBV infection were more likely smokers favoring buccal mucosa as primary anatomical site for oral cancer.

TRIAL OF LABOR

Objective: To determine the frequency and types of vaginal delivery in womenwith previous one caesarean section and to observe the effect of women age on success ofvaginal birth. Method: A descriptive study was carried out in the department of obstetrics&amp; gynecology, Ziauddin University Hospital Kemari campus Karachi from January 2011 toJanuary 2013. 200 patients with previous one caesarean section for a non recurrent cause wereincluded in the study after fulfilling the inclusion and exclusion criteria. The women selectedwere evaluated and counseled for trial of labor. The frequency and mode of vaginal delivery wasrecorded in cases of successful trial of labor and caesarean section was performed in case offailed trial of labor. Results: Successful vaginal delivery was achieved in 67% of the patients andrepeat emergency caesarean section was carried out in 33% of the patients. Leading indicationfor repeat caesarean section was failure to progress, fetal distress and scar tenderness. Nomaternal and fetal complication occurred. We also observed that patients of less than 30 yearswere more likely to have a successful vaginal delivery (82%) as compared to patients older than30 years (18%). Conclusions: The trial of labor should be encouraged with vigilant monitoringin patients with previous one Caesarean section and is a safe and successful option if carefullyselected and monitored.

MRI An Imaging Tool To Evaluate Cerebral Changes In Victims Of Heat Stroke Presenting With Cerebral Symptoms

Heat stroke usually presents as medical emergency that causes altered cerebral status and deterioration of multiple organ functions. Heat stroke leads to many different physiological changes within the body, some of which result in neurologic dysfunction. The imaging characteristics of neurological changes of heat stroke are not well documented in literature although the pathophysiologic mechanism of neuronal damage is fairly well understood. We conducted a study to evaluate the imaging appearances of human brain after heat stroke on MRI presented with cerebral symptoms. Material and methods: The retrospective study conducted in radiology department of Ziauddin university hospital from May 2015 till July 2016. All the patients with heat stroke presented with neurological deficit were underwent MRI brain, evaluated by two senior radiologists. Results: 56 patients were included in study, 12 female and 44 male, all patients had clinical symptoms of fever and most of them had additional symptoms of altered level of consciousness. Out of 54 patients, 8 patients had normal MRI brain. 6 patients presented with bilaterally symmetrical hyperintense signals on T2WI in thalami and basal ganglia. 2 patients demonstrated focal high signal intensity in pons representing pontine myelinosis, rest of the patients presented with cerebral or cerebellar infarcts. Conclusion:Many cerebral lesions can result as cerebral damage of heat stroke which includes cerebral infarct, white matter changes, haemorrhages and inflammatory reactions, in these clinical scenarios MRI would be imaging modality of choice to evaluate the disease pattern.

TYPE II DIABETES MELLITUS

Introduction: Diabetes Mellitus is a syndrome with disordered metabolismand inappropriate hyperglycemia due to either deficiency of insulin secretion or combinationof insulin resistance and inadequate insulin. Infections constitute the main bulk of cutaneousmanifestations of diabetes mellitus with incidence ranging between 20–50%. Bacteria andfungi can cause infective complications involving skin and nails of the diabetic patients. Themajor share of infections in Diabetes Mellitus is contributed by bacteria. The most commoncausative organisms are Staphylococcus aurous and beta-hemolytic Streptococci. Objective:to determine the frequency of cutaneousbacterial Infections in patients with type II DiabetesMellitis, attending outpatient clinic in a tertiary care hospital. Study Design: Cross sectionalstudy. Setting: Department of Dermatology and Medicine, Dr. Ziauddin University Hospital,KDLB Campus, Karachi. Period: 1st January 2017 till 31st March 2017 over a period of threemonths. Material and methods: Adult patients already diagnosed to be suffering from type 2Diabetes Mellitis presenting with cutaneous manifestations were included in the study. Patientsfulfilling the selection criteria were enrolled after an informed consent. Relevant laboratoryinvestigations were advised where required. Current study targeted bacterial infections onlyand Chi-square test was used to determine P value. Data obtained was compiled, tabulatedand analyzed by SPSS. Result: Total of 302 cases of Type 2 Diabetes Mellitis having somecutaneous manifestations were enrolled. There were 124 (41%) males and 178 (59%) females.Mean age of presentation was 50 ± 11 years, the age range being 30-80 years. The meanduration of diabetes was 8.5 ± 7 years (range being 1-30 years). Unsatisfactory glycemic controlwas present in 205 (68%) patients. Among the enrolled subjects bacterial infections were themost frequently seen skin disease accounting for 79 patients (26%). Among the patients withthese bacterial infections uncontrolled Diabetes was a feature in 61 (77%). The breakup ofbacterial infections (59) in the descending order of frequency stood as follows: cellulitis 22(28%), carbuncle 17 (21%), furuncle 14 (18%), ecthyma 13 (16%), folliculitis 09 (12%), andimpetigo 04 (5%). Conclusion: Cutaneous infections are a common feature in patients withType II Diabetes Mellitis, bacterial infections being the most common.

FREQUENCY OF CUTANEOUS BACTERIAL INFECTIONS IN PATIENTS WITH TYPE II DIABETES MELLITUS

Introduction: Diabetes Mellitus is a syndrome with disordered metabolismand inappropriate hyperglycemia due to either deficiency of insulin secretion or combinationof insulin resistance and inadequate insulin. Infections constitute the main bulk of cutaneousmanifestations of diabetes mellitus with incidence ranging between 20–50%. Bacteria andfungi can cause infective complications involving skin and nails of the diabetic patients. Themajor share of infections in Diabetes Mellitus is contributed by bacteria. The most commoncausative organisms are Staphylococcus aurous and beta-hemolytic Streptococci. Objective:to determine the frequency of cutaneousbacterial Infections in patients with type II DiabetesMellitis, attending outpatient clinic in a tertiary care hospital. Study Design: Cross sectionalstudy. Setting: Department of Dermatology and Medicine, Dr. Ziauddin University Hospital,KDLB Campus, Karachi. Period: 1st January 2017 till 31st March 2017 over a period of threemonths. Material and methods: Adult patients already diagnosed to be suffering from type 2Diabetes Mellitis presenting with cutaneous manifestations were included in the study. Patientsfulfilling the selection criteria were enrolled after an informed consent. Relevant laboratoryinvestigations were advised where required. Current study targeted bacterial infections onlyand Chi-square test was used to determine P value. Data obtained was compiled, tabulatedand analyzed by SPSS. Result: Total of 302 cases of Type 2 Diabetes Mellitis having somecutaneous manifestations were enrolled. There were 124 (41%) males and 178 (59%) females.Mean age of presentation was 50 ± 11 years, the age range being 30-80 years. The meanduration of diabetes was 8.5 ± 7 years (range being 1-30 years). Unsatisfactory glycemic controlwas present in 205 (68%) patients. Among the enrolled subjects bacterial infections were themost frequently seen skin disease accounting for 79 patients (26%). Among the patients withthese bacterial infections uncontrolled Diabetes was a feature in 61 (77%). The breakup ofbacterial infections (59) in the descending order of frequency stood as follows: cellulitis 22(28%), carbuncle 17 (21%), furuncle 14 (18%), ecthyma 13 (16%), folliculitis 09 (12%), andimpetigo 04 (5%). Conclusion: Cutaneous infections are a common feature in patients withType II Diabetes Mellitis, bacterial infections being the most common.

Assessment of Frequency and Transience Rate for Ventilator-Associated Pneumonia (VAP) in Geriatric Patients in Tertiary Care Settings of Karachi, Pakistan.

To assess the risk factors, frequency and transience rate for ventilator-associated pneumonia in geriatric patients. Cross-sectional, descriptive study. Various campuses of Ziauddin University Hospital and Civil Hospital, Karachi, from April 2016 to May 2017. Critically ill geriatric patients (aged 60 years and above) in intensive care units, were selected who had received mechanical ventilation. Various risk factors, microbial fate, and related clinical outcomes were measured in the selected cohort of 350 patients. It was found that 72% (n=252) of study population was elderly who received ventilation for more than 48 hours with a higher mortality rate of 59.5%. Frequency of VAP was found to be 18% (n=63). A high rate of VAP was observed in geriatric cohort, i.e. n=47 association of age in VAP (p=0.611) in non-significant while mortality values and admission status were significantly associated with VAP (p<0.001). The factual challenge nowadays is to present the real estimate of the clinical consequences of VAP in geriatric cohort. Such studies will help in formulating an optimal institutional policy and rational approach to decrease rates of mortality.

Quantitative Assessment Of The Variations In Thyroid Dimensions In Relation To Increase In Serum TSH In Euthyroids

Objectives: To determine the effect of serum TSH on thyroid dimensions of each lobe and to measure the amount of effect of per unit increase in serum TSH on thyroid dimensions of each lobe in euthyroids. Study Design: It was a cross-sectional study. Setting: The study was conducted at Ziauddin University Hospital, Clifton, Karachi. Methodology: Healthy participants aged 21 years and above were included through convenient sampling. Serum Thyroid stimulating hormone was evaluated and ultrasound of thyroid gland TG of 192 euthyroid participants was performed. Spearman correlation and regression analysis was applied to evaluate the relationship between TSH and TG dimensions Results: Relationship of increase in serum TSH with decrease in light lobe AP dimension was most significant. (r= -0.142 P-Value=0.001) and CC dimension least significant (r= -0.0098 P-Value=0.001). Where as in the left lobe AP dimension decreases significantly with increase serum TSH (r= -0.147 P-value=0.001). 11.7% of total variation in AP dimension, 3.5% of total variation in ML dimension and 6.5% of total variation in CC dimension in right lobe thyroid are because of serum TSH. While 9.5% of the total variation in AP dimension in left lobe is also due to serum TSH. Conclusion: Negative and significant correlation between serum TSH and thyroid dimensions was observed. Serum TSH inversely and significantly affects all the dimensions of the right lobe and only one dimension in the left lobe

Diagnostic Accuracy of Risk of Ovarian Malignancy Algorithm (ROMA) in Post-Menopausal Patients with Ovarian Mass.

To determine the diagnostic accuracy of ROMA in postmenopausal women with history of ovarian mass. Observational study. Dr. Ziauddin University Hospital, Karachi, from May 2014 to June 2015. Two hundred and sixty postmenopausal women of 40-65 years of age with ovarian masses, planned for surgery, were included in the study. Their samples were obtained preoperatively and analysed on Abbot Architect i1000 SR immunoassay analyser for quantitative estimation of tumor markers, i.e. HE4 and CA125. By combination of these two tumor markers, ROMA scores were calculated and studied after histopathological verification of masses. Total number of patients were 260, out of which 122 (46.9%) were diagnosed as having ovarian cancer, while 138 (53.0%) were diagnosed as benign condition. Median ROMA score levels in patients with malignant masses were 95.58 (IQR=44.4) as compared to 20.6 (IQR=14) in benign masses. ROMA had sensitivity 92.6% (CI=86.47-96.04), specificity 78.3% (CI=70.09-83.82), positive predictive value 79% (CI=70.87-84.29), negative predictive value 92.3% (CI=86.02-95.9) and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of ROMA was 85%, based on ROC curve analysis. ROMA had the highest sensitivity in detecting ovarian carcinoma. ROMA is a very useful diagnostic tool for the preoperative stratification of patients with ovarian masses showing 85% diagnostic accuracy. However, there is need of more studies with homogenous laboratory procedures for HE4 and CA125 assays as well as patients, selection criteria, so we can draw firm conclusion about utility of ROMA in clinical setups.

Frequency of Immunisation Status, Complications and Outcome in Children Admitted with Measles in Public and Private Sector Hospitals of Karachi

Objective: To assess the immunisation status, frequency of complications and the outcome in chil- dren admitted with measles in public and private sector hospitals of Karachi.&#x0D; Methods: In this cross-sectional study a total of 382 patients admitted with measles, of either sex from 3 months to 13 years, who presented from March 2016 to March 2017 were included. A total of 265 (69.3%) children were from Ziauddin University Hospital (ZU) and 117 (30.6%) from Abbasi Shaheed Hospital (AS). Non-probability convenient sampling technique was used. Those with con- genital anomalies and chronic medical illnesses were excluded from the study. Detailed history and physical examination was done, and findings entered in a Proforma. Immunisation status of the pa- tients was recorded. All the patients were observed for complications like encephalitis, pneumonia, diarrhea, otitis media, epiglottis, febrile fits and corneal ulcers. Statistical analysis was done using SPSS version 22. Categorical values were compared by chi-square test, p-value of &lt;0.05 was con- sidered significant.&#x0D; Results: A total of 382 were patients admitted with measles, 265 (69.3%) from Ziauddin University hospital and 117 (30.6%) from Abbasi Shaheed Hospital. Overall, 57.4% were completely vaccinated in ZU vs. 32.5% in AS. Despite being completely vaccinated, children in ZU; 152/265 (80%) and in AS; 38/117 (30.6%) had complications with a statistically significant (p&lt;0.0001) difference between private and government sector hospitals. Predominantly, in both hospitals pneumonia was common followed by gastroenteritis. Overall mortality was 13/382 (3.4%) in both hospitals combined.&#x0D; Conclusion: A sizeable number of children admitted with measles in both private and government hospitals were unvaccinated. A significant number developed measles despite receiving two doses of vaccine. Frequency of complications was higher in private versus government hospitals. Mortality from measles was high (3.4%) especially in the unvaccinated.

Comparison of Dosage Requirement of Erythropoietin Stimulating Agent (ESA) in Maintenance of Hemoglobin Concentration in patients undergoing twice weekly versus thrice weekly Hemodialysis in Pakistani Population

Anemia is one of the major complications of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and is associated with left ventricular hypertrophy and also increases morbidity and mortality. Anemia in patients with CKD can be due to two major reasons; iron deficiency or erythropoietin insufficiency. Erythropoietin Stimulating Agent (ESAs) administration is the mainstay in treating anemia if the patient is iron sufficient. However, higher doses of ESAs have been associated with increased cerebrovascular and cardiovascular events. We conducted this study to see how much erythropoietin is required in our setting in iron sufficient patients to maintain hemoglobin(Hb) level and the effect of dialysis frequency on ESA doses. &#x0D; Methods and Findings:&#x0D; A cross-sectional study was conducted at the Department of Nephrology at Ziauddin University Hospital. Patients’ charts were reviewed for Hb levels and doses of ESA to maintain Hb between 10-12 mg/dl. Patients were excluded if they had iron deficiency, malignancy, were on immunosuppressive agents, had renal transplant, and with Hb &gt;12 mg/dl or &lt;10 mg/dl and their ferritin levels, transferrin saturation, hemoglobin concentration, frequency of hemodialysis and ESA dosage were monitored. We also compared these variables between patients undergoing hemodialysis thrice weekly with those undergoing hemodialysis twice a week.&#x0D; A total of 105 patients were analyzed. 24 were excluded as they did not match the inclusion criteria. 81 patients were included in the study. 36 (44.4%) were males and 45 (55.6%) were females. Mean age of the patient was 56.47 ± 11.72 years. The average dose of ESA was 106.91 ± 61.47 for patients undergoing hemodialysis thrice weekly and 183.94 ± 116.71 for patients undergoing hemodialysis twice a week. Significant difference was found to exist between dosage of patients undergoing thrice weekly dialysis versus twice weekly dialysis(p=&lt;0.001).&#x0D; Our study has limitations. First our study only looked at Hb levels, iron stores and dosages of ESA, while other factors like Parathyroid Hormone(PTH) levels and Vitamin B12 were not considered that may have a role in anemia of chronic renal disease. In addition, it was a study limited to one center only and a multicenter trial should be taken to validate the results. We have reported one aspect of dialysis vintage i.e. high ESA dosage requirement&#x0D; Conclusion:&#x0D; We found that patients undergoing hemodialysis three times a week require recommended dosage of ESA; however those undergoing hemodialysis less than three times a week require higher dosage of ESA to maintain Hb level. Here we report significant effect of hemodialysis on ESA dosage to maintain same level of Hb.

Detecting Anatomical Variations of Coeliac Trunk Branching Pattern in the Population of Karachi Using 3D Multidetector Computed Tomographic Angiography (MDCTA)

Objective: To find out the frequency of variations in coeliac trunk branching pattern by Using 3D Multidetector Computer Tomographic Angiography (MDCTA),in patients referred to Radiology Department of Ziauddin University Hospital with abdominal pain, altered bowel habits, kidney or adrenal pathologies&#x0D; Method: For this study, 160 individuals aged 20-60 years, without any abdominal vascular or upper ab- dominal visceral disease who presented to Radiology Department, Ziauddin University Hospital, Clifton Karachi, for abdominal 3D-MDCTA (3-dimensional multidetector computed tomographic angiography) from March 2017 to August 2017 were recruited in this study. It was a cross-sectional study and samples were collected through non-probability convenience sampling technique. Recruitment of study participants was done from patients who were referred to radiology department of Ziauddin University Hospital for abdominal contrast MDCTA examination due to various indications such as abdominal pain, altered bowel habits, kidney and adrenal pathologies. Persons having serum creatinine levels &lt;1.4 mg/dl with no hepatobiliary pathologies, pancreatic or abdominal vascular lesions were included while patient having, abdominal malignancy distorting vascular anatomy, vasculitis and atherosclerosis were ex- cluded from the study. Patients having history of liver transplant or upper abdominal surgeries or those having history of allergic reaction to contrast agents and pregnant ladies were also excluded from the study. Coeliac trunk variations were categorised according to Uflacker's classification into 8 types. Statis- tical analysis was done on SPSS version 20. Data is presented in percentages and frequencies.&#x0D; Results: Classical coeliac trunk (type I) was present in 134 out of 160 (83.9%) individuals while 26 (16.1%) individuals showed coeliac trunk variations. Type II and type V variations were second most fre- quent variations i.e. in 9 (5.6%) individuals each, followed by type VII in 5 (3.6%) individuals. Type III, IV and VI showed variations in 1 (0.6%) individual each. Type VIII was not found in our sample.&#x0D; Conclusion: The present study reports normal configuration of coeliac trunk i.e, classic or type I coeliac trunk in 83.9% individuals and coeliac trunk variations in 16.1% individuals.

Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection.

To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections. Cross-sectional, observational study. Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014. Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement. Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.

BENIGN PROSTATIC HYPERPLASIA;

Objectives: To study the effect of anthropometric measures on benign prostatichyperplasia patients in a subset of Karachi population. Study Design: A cross-sectional study.Setting: Ziauddin University Hospital, Radiology Dept, Clifton. Karachi. Method: 103 benignprostatic hyperplasia patients was carried out. These patients were recruited from a urologyclinic. The study subjects were divided on the basis of Age groups, body mass index groupsand waist circumference groups. Result: Mean prostate volume of BPH patients was foundto be was 62.7 ± 12.5 years. Mean BMI was found to 24kg/m2. Mean waist circumferencewas found to be 73.8cms. Prostate volume was found to be doubled in waist circumferenceof greater than 90cm group. Conclusion: Prostate volume greatly enlarges with advancingage. Waist circumference is the only contributing factor among other anthropometric measureswhich causes growth of prostate volume.

English

Objectives: To study the effect of anthropometric measures on benign prostatichyperplasia patients in a subset of Karachi population. Study Design: A cross-sectional study.Setting: Ziauddin University Hospital, Radiology Dept, Clifton. Karachi. Method: 103 benignprostatic hyperplasia patients was carried out. These patients were recruited from a urologyclinic. The study subjects were divided on the basis of Age groups, body mass index groupsand waist circumference groups. Result: Mean prostate volume of BPH patients was foundto be was 62.7 ± 12.5 years. Mean BMI was found to 24kg/m2. Mean waist circumferencewas found to be 73.8cms. Prostate volume was found to be doubled in waist circumferenceof greater than 90cm group. Conclusion: Prostate volume greatly enlarges with advancingage. Waist circumference is the only contributing factor among other anthropometric measureswhich causes growth of prostate volume.