Kidney Centre

To determine the association of fatty liver ultrasound grade with hepatic venous waveform, hepatic vein damping index and portal vein pulsatility index. The cross-sectional, prospective, analytical study was conducted at the Radiology Department of the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, from January 1 to June 30, 2023, and comprised patients who underwent ultrasound scans with a low-frequency curvilinear transducer. Data was collected on fatty liver grade, middle hepatic vein waveform, middle hepatic vein damping index and portal vein pulsatility index. The relationship of fatty liver grades with hepatic vein waveform, hepatic vein damping index and portal vein pulsatility index. Data was analysed using SPSS 27. Of the 45 patients, 26(57.88%) were females and 19(42.22%) were males. The overall mean age was 43.16±11.55 years. Among the patients, 36(80%) had a grade-1 fatty liver, while 9(20%) had a grade-2 fatty liver. Mean middle hepatic vein damping index between grade 1 and grade 2 fatty liver patients was significant (p<0.001). The mean portal vein pulsatility index of grade 1 fatty liver patients was significantly different from grade 2 patients (p<0.001). Fatty liver sonological grade had a moderate and direct relationship with middle hepatic vein damping index (r=0.652), but an inverse relationship was observed between fatty liver sonological grade and portal vein pulsatility index (r=-0.427). Significant correlations existed between ultrasound fatty liver grade and hepatic vein waveforms, hepatic vein damping index and portal vein pulsatility index.

To explore the challenges and opportunities associated with the implementation of formative assessment (FA) practices in medical colleges of Peshawar. A cross-sectional study. Place and Duration of the Study: Four Medical colleges, two private (Rehman Medical College, Northwest School of Medicine) and two public (Khyber Medical College, Khyber Girls Medical College), in Peshawar, Pakistan, from November 2023 to April 2024. This study used a validated questionnaire to gather quantitative information about the challenges teachers face and the present use of formative assessment in the medical college. The sample included four medical colleges, two private and two public sectors, with a total sample size of 258 medical teachers. The data collected were analysed employing descriptive statistics, including frequencies and percentages, which were used to summarise the demographic characteristics and responses to the questionnaire items. The quantitative study revealed that 88.4% (n = 228) of the medical teachers believed that they understood the concept of FA. Similarly, 86% (n = 222) felt they clearly understood the distinction between formative and summative assessments. Additionally, 81.4% (n = 210) considered feedback to be a crucial component of FA. In contrast, 62% (n = 160) believed that FA to be an approach primarily used for grading and certification. Only one-third of participants frequently conducted FA and provided feedback to students, whereas almost half stated they did so only occasionally. About the adding of FA scores in final course, semester, or overall grade,over half of the participants reporteddoing it occasionally, while 28.8% (n = 74) of participants revealed doing it routinely. Despite most of the participants expressing confidence in their understanding of FA, a discrepancy was identified between teachers' perceived understanding and their actual practice of FA. Although many participants acknowledged the significance of FA, the low proportion of teachers who practise it regularly raises concerns about the implementation of this valuable tool in medical education. Formative assessment, Medical colleges, Challenges, Peshawar, Practice, Teacher.

To compare the safety and efficacy of the mid-calyx access (MCA) and the lower-calyx access (LCA) in paediatric percutaneous nephrolithotomy (PCNL). Descriptive study. Place and Duration of the Study: Department of Paediatric Urology, Institute of Kidney Disease, Peshawar, Pakistan, from January 2022 to October 2024. Two hundred paediatric patients divided into two groups (85 MCA and 115 LCA) were retrospectively analysed. Demographic data, stone clearance rates, operative times, blood loss, postoperative complications, and hospital stays were compared. Statistical analysis was performed using the independent t-test and the Chi-square test, with significance set at p <0.05. The mean age was similar between two groups (8.38 ± 3.94 vs. 8.42 ± 3.75 years, p = 0.94), and gender distribution was comparable (lower calyx: 53 females and 62 males; mid-calyx: 40 females and 45 males; p = 0.89). Stone clearance rates were also non-significant (MCA 90.59%, LCA 84.35%; p = 0.19). MCA had significantly shorter operative time (43.0 [41.0, 46.0] minutes compared to 54.0 [50.0, 57.5] minutes; p <0.001) and fewer urinary tract infections (10.59% compared to 21.74%; p = 0.03). Hospital stays were shorter for MCA (1.49 ± 0.22 days compared to 1.91 ± 0.77 days; p <0.001). Other complications, including bleeding, renal injury, and postoperative fever were rare and not significantly different between groups. Both MCA and LCA are safe and effective for paediatric PCNL. MCA offers more advantages, including shorter operative time, reduced urinary infections, and faster recovery, making it a preferable option in selected cases. Mid-calyx approach, Lower calyx approach, Percutaneous nephrolithotomy, Safety, Efficacy.

Background: Distal ureteral stones are frequently managed with semi-rigid ureteroscopy (URS), a procedure that can be technically demanding due to ureteric smooth muscle tone and spasm. Alpha-1A adrenergic receptor blockers such as Silodosin have shown potential in facilitating ureteroscopic access by relaxing ureteral musculature, yet limited data exist on their preoperative use in surgical settings, particularly in South Asian populations. Objective: To compare the mean operative time of semi-rigid URS for distal ureteral stones between patients receiving preoperative Silodosin and those receiving a placebo. Methods: This randomized controlled trial was conducted at the Institute of Kidney Diseases, Peshawar, from December 2023 to June 2024. Sixty adult patients with single distal ureteral stones (11–20 mm) were randomly assigned to receive either Silodosin 8 mg daily or placebo for 10 days prior to URS. Operative time was measured from ureteroscope insertion to removal. Data were analyzed using independent t-tests and subgroup analyses. Results: The mean operative time was significantly lower in the Silodosin group (44.87 ± 3.34 minutes) compared to the placebo group (51.67 ± 5.35 minutes), with a mean difference of –6.80 minutes (95% CI: –9.09 to –4.51; p &lt; 0.001). This effect remained consistent across age, gender, stone size, and laterality. Conclusion: Preoperative Silodosin significantly reduces operative time in semi-rigid URS for distal ureteral stones, suggesting a clinically valuable role in perioperative management. Further large-scale trials are warranted to validate these findings and assess broader outcomes.

Psychosis constitutes a cardinal component of schizophrenia and affects nearly fifty percent of those with bipolar disorder. We sought to molecularly characterize psychosis segregating in consanguineous families. Participants from eight multiplex families were evaluated using standardized testing tools. DNA was subjected to exome sequencing followed by Sanger sequencing. Effects of variants were modeled using in-silico tools, while cDNA from a patient's blood sample was analyzed to evaluate the effect of a splice-site variant. Twelve patients in six families were diagnosed with schizophrenia, whereas four patients from two families had psychotic bipolar disorder. Two homozygous rare deleterious variants in INSR (c.2232-7T>G) and NFXL1 (c.1322G>A; p.Cys441Tyr) were identified, which segregated with severe treatment-resistant psychosis/schizophrenia in two families. There were none, or ambiguous findings in the other six families. The predicted deleterious missense variant affected a conserved amino acid, while the intronic variant was predicted to affect splicing. However, cDNA analysis from a patient's blood sample did not reveal an aberrant transcript. Our results indicate that INSR and NFXL1 variants may have a role in psychosis that requires to be investigated further. Lack of molecular diagnosis in some patients suggests the need for genome sequencing to pinpoint the genetic causes.

Background: Double J (DJ) stent insertion is a vital procedure in urology, used for urinary diversion, drainage, or support during reconstruction. Common indications include urolithiasis, ureteral strictures, pyeloplasty, or other reconstructive surgeries. Despite its benefits, DJ stenting often leads to stent-related symptoms due to its nature as a foreign object. These symptoms are evaluated using the Ureteral Stent Symptom Questionnaire (USSQ). Various medications, such as alpha blockers and antimuscarinics, have been used to mitigate these effects. This study compares the efficacy and side effects of Tamsulosin (alpha blocker), Oxybutynin (antimuscarinic), their combination, and conservative measures. Methods: A total of 216 patients undergoing unilateral 4.7 Fr DJ stenting for urolithiasis or reconstructive procedures were enrolled and divided into four groups (n=54 each): Group A (Oxybutynin), B (Tamsulosin), C (combination), and D (conservative). Patients under 18, with positive urine cultures, bilateral stents, or who declined participation were excluded. Symptom scores were recorded at 1st and 4th postoperative weeks using USSQ. Results: Combination therapy showed the best symptom control at week 1 (83.3%), while Tamsulosin alone was less effective initially (52.3%, p=0.001). At week 4, Oxybutynin and Tamsulosin groups had similar scores (mean: 39 vs. 40.4). Conservative management resulted in higher symptom scores; 5.5% of these patients required further intervention. Patients with constipation, positive cultures, or those treated for urolithiasis reported worse symptoms across all groups. Conclusion: Combination therapy with Tamsulosin and Oxybutynin offers superior relief from DJ stent-related symptoms compared to monotherapy or conservative approaches.

Objective: For liver failure patients, liver transplantation is the only effective therapy option. With higher postoperative survival rates, more focus is required on patient quality of life as a marker of successful liver transplantation. This research evaluates the quality of life following surgery in juvenile liver transplant patients. Methodology: This study was designed as a prospective cross-sectional survey to assess the quality of life of patients. It was conducted at the Pakistan Kidney and Liver Institute and Research Centre (PKLI&amp;RC) over a period spanning from July 2021 to February 2023. Liver transplant recipients, under 15 years, visited OPD at least 6 months after surgery were considered in the study. Quality of life was measured using WHOQOL-BREF. As per scoring guide the scores were converted to 100 sclae. Results: In this study, 41 liver recipients participated in the study. Out of 30 alive, most of the 24(80%) liver transplant recipients were aged between 1 to 10 years. Among them 22(73.3%) were male. Overall mean quality of life and general health was 92.33±11.65 (range 60 to 100), mean physical health score was 79.05±5.22 (range 68.57 to 88.57), mean psychological health was 86.22±5.08(range 76.67 to 96.67), Social relationships was 97.33±6.91 (range 70 to 100) and environment was 88.33±5.51 (range 80 to 100). Conclusions: Liver transplantation leads to an improvement in quality of life as compared to the pre-transplant state. This study will aid in better defining expectations for patients and their families, as well as directing the clinical course following liver transplantation. Transplant teams may also target early interventions.

The emergence of hypervirulent and carbapenem-resistant hypermucoviscous Klebsiella pneumoniae strains presents a significant public health challenge due to their increased virulence and resistance to multiple antibiotics. This study evaluates the antibiotic susceptibility patterns and virulence profiles of classical and hypervirulent K. pneumoniae strains isolated from various clinical samples. A total of 500 clinical samples were collected from patients at the Mardan Medical Complex and Ayub Medical Complex in KPK between July 2022 and June 2024. Among these, 64 K. pneumoniae strains were isolated and subsequently subjected to antimicrobial susceptibility testing (AST) and phenotypic virulence detection. Among the 64 isolates, 21 (32.8%) exhibited hypermucoviscosity, a characteristic associated with increased pathogenicity. Hemagglutination was observed in 35 (54.1%) of the isolates, indicating the presence of surface adhesins that facilitate bacterial adherence to host tissues. A high prevalence of biofilm formation was noted, with 54 (84%) isolates capable of forming biofilms, which are known to protect bacteria from antibiotics and the host immune response. Most isolates (59/64, 92.1%) were resistant against ampicillin, highlighting its limited efficacy against these strains. Conversely, the lowest resistance was observed for tigecycline, with only 15% (10/64) of the isolates showing resistance, indicating its potential utility as a treatment option. The study also found that 38 (59.3%) of the isolates were extended-spectrum beta-lactamase (ESBL) producers, 42 (65.6%) were multidrug-resistant (MDR), 32 (50%) were extensively drug-resistant (XDR), and 13 (20.3%) were resistant to carbapenems. The genetic study revealed biofilm producer and enhancer genes (mrkD, pgaABCD, fimH, treC, wzc, pilQ, and luxS) mainly in the hypervirulent strains. These hypervirulent strains also show a high number of resistance genes. The findings of this study underscore the critical need for the active surveillance of antimicrobial resistance and virulence determinants in K. pneumoniae. The coexistence of high levels of antibiotic resistance and virulence factors in these isolates poses a severe threat to public health, as it can lead to difficult-to-treat infections and increased morbidity and mortality.

Objective: To investigate gender differences in clinical outcomes after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), highlighting insights within a Pakistani healthcare context. Methodology: Conducted over ten months at the Hayatabad Medical Complex, Peshawar, this prospective observational study enrolled 300 AMI patients (150 males, 150 females) treated with primary PCI. Key parameters analyzed included AMI type, demographic characteristics, post-procedure complications, and mortality rates. Statistical analysis was conducted using chi-square tests to examine the association between gender and outcome disparities. Results: The findings revealed that men predominantly presented with STEMI, accounting for higher complication rates and adverse outcomes compared to women. Male patients demonstrated a 22% incidence of major adverse cardiac events (MACE), while female patients showed a 14% MACE rate, predominantly among NSTEMI cases. The age distribution for both genders was centered in the 50-70 age range, with no statistically significant association between gender and overall outcomes (p = 0.582). These results align with international trends yet emphasize the need for gender-sensitive approaches in PCI care within Pakistan. Conclusion: The study underscores notable gender disparities in AMI presentation and outcomes following PCI. Men face higher risks, particularly with STEMI, suggesting a critical need for gender-specific protocols in AMI management. These findings support further multi-center research to enhance gender-responsive healthcare strategies in Pakistan.