Outcomes of Dialysis Among Patients With End-Stage Renal Disease (ESRD).

Background Dialysis-associated morbidity and mortality among end-stage renal disease (ESRD) patients has been increasing, despite the advancement in pharmacological treatment and dialysis technology. The aim of this study was to determine the outcomes of dialysis among ESRD patients presenting at the nephrology department of Jinnah Postgraduate Medical Centre (JPMC).  Methodology This cross-sectional study was conducted during the year 2015-2016, including 105 ESRD patients. Data were collected through a structured questionnaire inquiring about patient's demographics and hemodialysis details. The outcomes in terms of survival and death within one month of dialysis were also recorded. The statistical analysis was carried out using SPSS version 21.0 (IBM Corp, Armonk, NY). Results Gender distribution showed that most of the study patients were males (58.1%). The mean duration of ESRD was 7.65 ± 3.69 months while the mean duration of hemodialysis was 36.5 ± 5.65 hours. Among the comorbid conditions, hypertension (69.5%) and diabetes (64.8%) were the most prevalent, followed by renal stones, chronic pyelonephritis, and chronic nephritis. The outcomes indicated mortality among 16.2% of patients; all deceased ESRD patients had diabetes (p < 0.05). Moreover, the duration of hemodialysis was significantly associated with the outcomes of dialysis (p < 0.05). Conclusion In conclusion, a considerable mortality rate was observed among ESRD patients undergoing hemodialysis. Moreover, patient survival was better with the increased duration of dialysis.

Assessment of Prescriptions in the Endocrinology Department of a Tertiary Care Hospital in Pakistan Using World Health Organization Guidelines.

BACKGROUND: It is essential to follow World Health Organization drug prescribing indicators to ensure rational prescribing in every health care setting. OBJECTIVE: To evaluate the prescriptions in the endocrinology department, according to the World Health Organization (WHO), recommended Ghana guidelines for diabetes management and rational therapy. METHODS: Concurrent and retrospective study design was used. The prescriptions of 100 diabetes patients were assessed for the type of medicine, dosage form, number of drugs, diabetes type, and deviation from standard guidelines. RESULTS: In a total of 100 prescriptions, the pattern was reported as injections (31%), antibiotics (18%), and metformin (31.1%). Half of the prescriptions were according to WHO guidelines. The number of drugs per prescription was reported at 5.2. A 70% rational approach was followed in prescribing. 81% of drugs were prescribed from the Essential Drug List (EDL) of the WHO. However, the National Essential Drug List (NEDL) was followed by 27%. The percentage of drugs on generic names was 0.7%. Eighty-four patients showed net improvement in health; 16 patients showed higher glycemic range at the time of discharge. CONCLUSION: The conclusion of the present study indicates that WHO Ghana guidelines were not followed up to the mark to improve the overall health status of diabetic patients and rational prescribing.

Knowledge, attitude and practices amongst the Pakistani females towards breast cancer screening programme.

OBJECTIVE: To assess the knowledge, attitude and practices amongst Pakistani females towards breast screening programmes. METHODS: The descriptive cross-sectional study was conducted from June 2013 to July2014 at Mayo Hospital, Lahore, and comprised attendants and patients who visited out-patients department and/or were treated as in-patients. The questionnaire contained 25 open and close-ended questions regarding knowledge and attitude, along with 7 questions regarding practices. Data was analysed using SPSS 17. RESULTS: There were 1184 women with a mean age of 32.7±8.6 years. The mean score was 12.7±4.9. Positive family history of breast cancer was reported by 156(13.2%) women; 420(35.5%) believed advancing age was a risk factor; 1041(87.9%) never had breast self-examination; 1106(93.4%) never had a clinical breast examination; and 1171(98.9%) never had screening mammogram. CONCLUSIONS: The knowledge and practices regarding breast cancer screening, breast self-examination and mammogram among women were not good. The knowledge about breast cancer risk factors was very poor and showed an alarming attitude towards practices.

Mechanical characteristics of hardened concrete with different mineral admixtures: a review.

The available literature identifies that the addition of mineral admixture as partial replacement of cement improves the microstructure of the concrete (i.e., porosity and pore size distribution) as well as increasing the mechanical characteristics such as drying shrinkage and creep, compressive strength, tensile strength, flexural strength, and modulus of elasticity; however, no single document is available in which review and comparison of the influence of the addition of these mineral admixtures on the mechanical characteristics of the hardened pozzolanic concretes are presented. In this paper, based on the reported results in the literature, mechanical characteristics of hardened concrete partially containing mineral admixtures including fly ash (FA), silica fume (SF), ground granulated blast furnace slag (GGBS), metakaolin (MK), and rice husk ash (RHA) are discussed and it is concluded that the content and particle size of mineral admixture are the parameters which significantly influence the mechanical properties of concrete. All mineral admixtures enhance the mechanical properties of concrete except FA and GGBS which do not show a significant effect on the strength of concrete at 28 days; however, gain in strength at later ages is considerable. Moreover, the comparison of the mechanical characteristics of different pozzolanic concretes suggests that RHA and SF are competitive.

Effects of different mineral admixtures on the properties of fresh concrete.

This paper presents a review of the properties of fresh concrete including workability, heat of hydration, setting time, bleeding, and reactivity by using mineral admixtures fly ash (FA), silica fume (SF), ground granulated blast furnace slag (GGBS), metakaolin (MK), and rice husk ash (RHA). Comparison of normal and high-strength concrete in which cement has been partially supplemented by mineral admixture has been considered. It has been concluded that mineral admixtures may be categorized into two groups: chemically active mineral admixtures and microfiller mineral admixtures. Chemically active mineral admixtures decrease workability and setting time of concrete but increase the heat of hydration and reactivity. On the other hand, microfiller mineral admixtures increase workability and setting time of concrete but decrease the heat of hydration and reactivity. In general, small particle size and higher specific surface area of mineral admixture are favourable to produce highly dense and impermeable concrete; however, they cause low workability and demand more water which may be offset by adding effective superplasticizer.

Strength development of high-strength ductile concrete incorporating Metakaolin and PVA fibers.

The mechanical properties of high-strength ductile concrete (HSDC) have been investigated using Metakaolin (MK) as the cement replacing material and PVA fibers. Total twenty-seven (27) mixes of concrete have been examined with varying content of MK and PVA fibers. It has been found that the coarser type PVA fibers provide strengths competitive to control or higher than control. Concrete with coarser type PVA fibers has also refined microstructure, but the microstructure has been undergone with the increase in aspect ratio of fibers. The microstructure of concrete with MK has also more refined and packing of material is much better with MK. PVA fibers not only give higher stiffness but also showed the deflection hardening response. Toughness Index of HSDC reflects the improvement in flexural toughness over the plain concrete and the maximum toughness indices have been observed with 10% MK and 2% volume fraction of PVA fibers.