Systematic review of nephrotoxicity of drugs of abuse, 2005-2016.

BACKGROUND: The United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes. METHODS: We conducted a systematic review of published case reports, case series, and cross sectional studies of nephrotoxicities related to drugs of abuse. Literature review was conducted using PubMed/Medline from January 1, 2005 -December 31, 2016 to search for publications related to drug abuse with a defined renal outcome. Publications which reported renal injury in relation to the use of illicit drugs were selected, specifically those cases with raised creatinine levels, clinically symptomatic patients, for instance those with oliguria and proven renal biopsies. RESULTS: A total of 4798 publications were reviewed during the search process and PRISMA flow chart and Moose protocol regarding systematic reviews were followed. 110 articles were shortlisted for the review. A total of 169 cases from case reports and case series, and 14 case studies were analyzed. Renal manifestations of specific illicit drug abuse were included in this review. CONCLUSION: Based on the evidence presented, a wide range of renal manifestations were found to be associated with drug abuse. If the trend of increasing use of illicit drug use continues, it will put a significant percentage of the population at an elevated risk for poor renal outcomes. This study is limited by the nature of the literature reviewed being primarily case reports and case series.

EPIDEMIOLOGY OF CHILDHOOD FRACTURES IN THE CITY OF KARACHI.

BACKGROUND: The epidemiology of paediatric fractures is crucial for developing preventive strategies, but when it comes to developing countries, the urban scenario has rarely been studied in the context of childhood trauma. This study aims to identify the epidemiology of paediatric injuries occurring in the largest and most populated city of Pakistan, Karachi, so that a comparison to data from the developed world can be made, and appropriate precautionary measures can be devised. METHODS: The data from 1,514 paediatric orthopaedic patients treated at the Accident and Emergency department of Jinnah Postgraduate Medical Centre, during the time frame ranging from January 2012 to January 2013 was studied. Survey forms were filled out by the residents on call. RESULTS: The patients' ages ranged from 2 months to 17 years, with males outnumbering females. The mean age of presentation was 8.8±4.6years. The number of fractures was maximal among children aged 5-11 years, after which it decreased in adolescents. Fractures of the radius and ulna were most common (16.9%), followed by the distal radius (14.6%) and humours (12.0%). Patients aged 0-2 years most commonly presented with a fracture of the femoral shaft. Falls on the same plane were responsible for the most fractures (44.2%), followed by falls from a height (21.5%) and road traffic accidents (26.7%).Incidence of fractures peaked in the summer months (p=0.007). CONCLUSION: Adequate precautionary measures and preventive programs need to be inculcated through legislation and a community based effort. In a developing nation however, unless the issues of ignorance, illiteracy and poverty are tackled by the authorities, they will continue to be a maior hindrance.

Automated Versus Manual Blood Pressure Measurement: A Randomized Crossover Trial in the Emergency Department of a Tertiary Care Hospital in Karachi, Pakistan: Are Third World Countries Ready for the Change?

BACKGROUND: Hypertension has proven to be a strong liability with 13.5% of all mortality worldwide being attributed to elevated blood pressures in 2001. An accurate blood pressure measurement lies at the crux of an appropriate diagnosis. Despite the mercury sphygmomanometer being the gold standard, the ongoing deliberation as to whether mercury sphygmomanometers should be replaced with the automated oscillometric devices stems from the risk mercury poses to the environment. AIM: This study was performed to check the validity of automated oscillometric blood pressure measurements as compared to the manual blood pressure measurements in Karachi, Pakistan. MATERIAL AND METHODS: Blood pressure was recorded in 200 individuals aged 15 and above using both, an automated oscillometric blood pressure device (Dinamap Procare 100) and a manual mercury sphygmomanometer concomitantly. Two nurses were assigned to each patient and the device, arm for taking the reading and nurses were randomly determined. SPSS version 20 was used for analysis. Mean and standard deviation of the systolic and diastolic measurements from each modality were compared to each other and P values of 0.05 or less were considered to be significant. Validation criteria of British Hypertension Society (BHS) and the US Association for the Advancement of Medical Instrumentation (AAMI) were used. RESULTS: Two hundred patients were included. The mean of the difference of systolic was 8.54 ± 9.38 while the mean of the difference of diastolic was 4.21 ± 7.88. Patients were further divided into three groups of different systolic blood pressure <= 120, > 120 to = 150 and > 150, their means were 6.27 ± 8.39 (p-value 0.175), 8.91 ± 8.96 (p-value 0.004) and 10.98 ± 10.49 (p-value 0.001) respectively. In our study 89 patients were previously diagnosed with hypertension; their difference of mean systolic was 9.43 ± 9.89 (p-value 0.000) and difference of mean diastolic was 4.26 ± 7.35 (p-value 0.000). CONCLUSIONS: Systolic readings from a previously validated device are not reliable when used in the ER and they show a higher degree of incongruency and inaccuracy when they are used outside validation settings. Also, readings from the right arm tend to be more precise.