Daidzein attenuated paclitaxel-induced neuropathic pain via the down-regulation of TRPV1/P2Y and up-regulation of Nrf2/HO-1 signaling.

Paclitaxel (PTX) is an anti-microtubule agent, used for the treatment of various types of cancers; however, it produces painful neuropathy which limits its use. Many neuroprotective agents have been introduced to mitigate PTX-induced neuropathic pain (PINP), but they pose many adverse effects. The purpose of this study was to evaluate the pharmacological characteristics of soy isoflavone, and daidzein (DZ) in attenuating PINP. At the beginning of the investigation, the effect of DZ was confirmed through behavioral analysis, as it reduced pain hypersensitivity. Moreover, changes in the histological parameters were reversed by DZ administration along with vascular permeability. PTX administration upregulated transient receptor potential vanilloid 1 (TRPV1) channels and purinergic receptors (P2Y), contributing to hyperalgesia; but administration of DZ downregulated the TRPV1 and P2Y, thus reducing hyperalgesia. DZ increased nuclear factor erythroid-2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), playing a pivotal role in the activation of the antioxidant pathway. DZ also decreased neuronal apoptosis by decreasing caspase-3 and Bcl2-associated X-protein (Bax), while simultaneously, increasing Bcl-2. PTX administration produced severe DNA damage, which was mitigated by DZ. Similarly, DZ administration resulted in inhibition of neuroinflammation by increasing antioxidant enzymes and reducing oxidative stress markers. PTX caused increased in production of pro-inflammatory mediators such as the cytokines production, while DZ inhibited the pro-inflammatory mediators. Additionally, in silico pharmacokinetic and toxicodynamic study of DZ was also conducted. In summary, DZ demonstrated significant neuroprotective activity against PTX induced neuropathic pain.

Fatigue: It Is Not Always in the Head.

Fatigue is a common presenting complaint in patients seen in clinics and same-day emergency care. Although it has a simple presentation, it can be challenging to diagnose and manage, particularly when an underlying medical condition presents atypically as fatigue. Here we present an interesting case of giant cell arteritis (GCA) with only fatigue as the presenting complaint. GCA is the inflammation of medium and large vessels in the body, including the aortic arch and its branches. It typically manifests above the age of 50 with headaches, jaw claudication, temporal tenderness, arthralgia, night sweats, and unintentional weight loss. Early diagnosis and treatment are of paramount importance to prevent complications, particularly permanent blindness.

Anti-nociceptive effects of magnolol via inhibition of TRPV1/P2Y and TLR4/NF-κB signaling in a postoperative pain model.

AIMS: The current study explored the anti-nociceptive activity of magnolol in post-incisional inflammatory nociceptive pain. MAIN METHODS: Preliminary, the anti-inflammatory, antioxidant, and cytoprotective potential of magnolol were confirmed against hydrogen peroxide (H2O2)-induced PC12 cells. Next, an in-vivo model of planter incision surgery was established in BALB/c mice. Tramadol 50 mg/kg intraperitoneal (i.p.) and magnolol (0.1, 1, 10 mg/kg i.p. + 10 mg/kg intra planter) were administered after plantar incision surgery and behavior parameters were measured. KEY FINDINGS: The results indicate that magnolol significantly suppressed post-incision-induced mechanical allodynia, thermal hyperalgesia, and paw edema. Magnolol promisingly inhibited post-incision induces nitric oxide (NO), malondialdehyde (MDA), eosinophil peroxidase (EPO), and neutrophil infiltration. Magnolol strongly attenuated post-incision inducing the release of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and inhibited deoxyribonucleic acid (DNA) fragmentation. Magnolol markedly reverses post-incisional histopathological changes and biochemical composition of the incised paw. Magnolol markedly down-regulated post-incisional increase expression of transient receptor potential vanilloid 1 (TRPV1), purinergic (P2Y) nociceptors as well as toll-like receptor 4 (TLR4), nuclear factor kappa light chain enhancer of activated B cell (NF-κB), cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) while upregulating the expression of inhibitor of nuclear kappa B alpha (IκB-α). SIGNIFICANCE: The present study strongly suggests that magnolol significantly suppressed post-incisional inflammatory nociceptive pain by targeting TRPV1/P2Y and TLR4/NF-κB signaling.

Second-Line Antiretroviral Treatment Outcome in HIV-Infected Patients Coinfected with Tuberculosis in Pakistan.

Background: Tuberculosis (TB) coinfection in human immunodeficiency virus- (HIV-) infected patients is considered a risk of antiretroviral therapy (ART) failure. Coadministration of antitubercular therapy (ATT) with ART is another challenge for TB management. Objective: The study was aimed at investigating contributing factors affecting treatment outcomes in HIV-/TB-coinfected patients. Design: Cross-sectional. Setting. Samples were collected from the Pakistan Institute of Medical Sciences Hospital Islamabad. Subject and Methods. Clinicodemographic and immunovirological factors between the two groups were compared. The Student t-test and chi-square test were applied to compare outcome variables, and logistic regression was applied to determine the effect of TB on virological failure (VF). Main Outcome Measures. TB coinfection did not increase VF even in univariate (p = 0.974) and multivariate analysis at 6 and 12 months of 2nd-line ART start. ARV switching was significant (p = 0.033) in TB-coinfected patients. VF was significantly high in ATT-coadministered patients along with a viral load of ≥1000 (p = 0.000). Sample Size and Characteristics. We recruited seventy-four HIV patients on 2nd-line ART; 33 coinfected with TB were followed for at least 12 months. Conclusion: In HIV-/TB-coinfected patients, CD4 count, CD4 gain, and VF remained comparable to HIV patients with no TB infection. ATT significantly affects the treatment outcome, suggesting drug-to-drug interactions. These factors are important to revisit the therapeutic guidelines to maximize the benefit of dual therapy in resource-limited settings.

Retraction: Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study.

[This retracts the article DOI: 10.7759/cureus.14976.].

Association Between Helicobacter pylori Infection and the Risk of Pancreatic Cancer: A Systematic Review Based on Observational Studies.

Helicobacter pylori (H. pylori) bacterial infection has long been scrutinized as one of the potential risk factors for the development of pancreatic cancer with quite inconsistent and unequivocal data. Little is known about the risk factors involved with this malignancy. In this systematic review, we aimed to examine the relationship between H. pylori infection and pancreatic cancer based on the evidence from the existing observational studies across the world. We searched major electronic databases such as PubMed, MEDLINE, Science Direct, and Cochrane Library. After a careful and thorough screening process, we selected 15 observation studies for this systematic review. Six of 15 studies found a significant association between H. pylori infection and pancreatic cancer. Additionally, four of these studies found a significant relationship between the cytotoxin-associated gene A strain of H. pylori and pancreatic cancer. Based on the evidence from the selected studies, a weak association was observed between H. pylori infection and cancer of the pancreas, especially in European and Asian populations compared to the North American population. The cross-sectional evidence from the case-control studies only suggests the existence of an association but does not provide substantial evidence of the causative relationship. Further large-scale, prospective cohort studies are warranted in the future to understand this contradictory relationship better.

Utility of N-terminal (NT)-Brain Natriuretic Peptide (proBNP) in the Diagnosis and Prognosis of Pregnancy Associated Cardiovascular Conditions: A Systematic Review.

Cardiovascular disease includes many diseases such as heart failure, cardiomyopathy, valvular disease, pericardial disease, peripheral vascular disease, rheumatic heart disease, and vascular disease to name a few. Cardiovascular disease in pregnancy is on the rise especially with women being pregnant at an older age. Brain natriuretic peptide (BNP) could be a factor in determining the severity. BNP is elevated in heart failure. This study will attempt to determine the relationship between BNP and pregnancy outcomes in women with heart failure. A keyword combination search was performed using varying databases. Inclusion and exclusion criteria were implemented and relevant articles were obtained to formulate ideas to support the topic. BNP, the amino acid peptide, is secreted by both atrial and ventricular monocytes. BNP and N-terminal (NT)-pro hormone BNP (NT-proBNP) are elevated in heart failure and seen in pregnant women alike. Within six to 12 weeks it returns to normal levels. Normal levels were shown to have good pregnancy outcomes in that the baby is healthy with normal birth weight and the mother is free of cardiovascular complications, whereas at elevated levels the pregnancy outcome was not favorable. NT-proBNP, when elevated in the pregnant patient, is a predictor of poor pregnancy outcomes, especially in patients with precursors. Testing for this peptide in pregnant women during the early stages of pregnancy could help determine the best course of action for a better outcome.

Exploring the Efficacy of Alirocumab and Evolocumab in Reducing Low-Density Lipoprotein (LDL) Cholesterol Levels in Patients With Familial Hypercholesterolemia: A Systematic Review.

Patients with familial hypercholesterolemia (FH) have an increased risk of having abnormally high low-density lipoprotein cholesterol (LDL-C) levels. One of the main groups of drugs used for FH is statins. However, even with statins, most patients with FH do not achieve their pre-defined therapeutic LDL-C goals. Therefore, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) serve to decrease LDL-C levels in that population. A total of 838 articles were found after searching the databases of PubMed, MEDLINE, and Cochrane Library. After including only full-text peer-reviewed articles published in the last 10 years, 67 articles remained. Thirteen articles were put through the Cochrane bias assessment tool to screen for bias. After a strict quality assessment based on the criteria, eight articles were extracted and included in this systematic review. The data extraction from these studies showed that alirocumab and evolocumab were efficacious in decreasing LDL-C levels and achieving the pre-defined LDL-C goals. Many parameters influenced the strength of the LDL-C reduction: sample size of the population, genetic structure of the patients affected by FH, length of the trial, or baseline lipid-lowering therapy used. Therefore, one must consider several other factors while evaluating the percent reduction of PCSK9i. This review is limited because it did not comment on these drugs' cardiovascular outcomes or mortality benefits. In addition, some of the articles used in this systematic review have small sample sizes and short trial times, limiting the long-term evaluation of these drugs.

Role of Vitamin D Deficiency in Increased Susceptibility to Respiratory Infections Among Children: A Systematic Review.

Vitamin D has several roles in the immune system besides its effects on bone metabolism. Acute respiratory infections are common infections in children. Severe lower respiratory tract infections (LRTIs) even cause death in children, especially in those less than five years of age. Our study aims to examine whether children with vitamin D deficiency are susceptible to respiratory infections and to study the association between vitamin D deficiency and the severity of respiratory infections. We comprehensively searched research articles in PubMed, ScienceDirect, and Cochrane library databases. The main keywords were vitamin D deficiency, respiratory infections, and children. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this systematic review. The initial search showed 16,120 papers. A meticulous screening of research articles using the eligibility criteria and quality appraisal tools was done. Finally, 10 research articles qualified for this systematic review, including eight case-control studies, one randomized controlled trial (RCT), and one cohort study. Seven of 10 research studies reviewed found that children with low vitamin D levels are susceptible to respiratory infections. Five studies discussed the severity of respiratory infections and low vitamin D levels. This systematic review concluded that children with low vitamin D levels are prone to developing respiratory infections. But we could not find a conclusive association between the severity of respiratory infections and low vitamin D levels.

Efficacy of Dengue Vaccines in the Prevention of Severe Dengue in Children: A Systematic Review.

Dengue is a vector-borne disease caused by the dengue virus (DENV) and is a major health concern worldwide, particularly in regions of endemic disease. Dengue usually presents as a self-limited febrile illness. In some cases, more severe forms with hemorrhage and shock can occur, and children are especially prone to develop it. These forms can be lethal without appropriate management, and no antiviral treatment exists today. In the absence of a curative treatment for dengue, its clinical prevention remains essential. One vaccine - the chimeric yellow fever-dengue-tetravalent dengue vaccine (CYD-TDV) - has been approved for use in some populations, and several others are currently in development, including Takeda's tetravalent dengue vaccine candidate (TAK-003). This study is a systematic review of the current literature realized to evaluate the efficacy of the dengue vaccines in preventing severe dengue in children. This review focuses on the vaccines CYD-TDV and TAK-003. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, and Google Scholar were the databases used to find the relevant data. The articles were selected using specific inclusion and exclusion criteria, and quality appraisal was realized with standardized quality assessment tools. Overall, our study shows that the dengue vaccines CYD-TDV and TAK-003 confer protection against severe dengue in children. Some distinctions exist depending on the vaccine type, the age, and the dengue serostatus of patients. While demonstrating encouraging results, this review also emphasizes the need for more in-depth studies about the safety and efficacy of dengue vaccines.

The Impact of the COVID-19 Pandemic on Myopia Progression in Children: A Systematic Review.

Myopia is the most common refractive error among children. The coronavirus disease 2019 (COVID-19) pandemic has affected children's health in many ways. Policy changes due to the COVID-19 pandemic, such as home quarantine and online schooling, have been proposed as causes for the increased risk of myopia progression. During strict home quarantine, children spend less time outdoors and more time using electronic devices which are important risk factors associated with myopia. Our systematic review aims to assess the relationship between myopia progression and these risk factors in children. We did the literature search from PubMed, Google Scholar, and ScienceDirect. A total of 10 research papers were selected for final review using the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. The research articles used had a quality of more than 70%. The quality of these articles was determined using the Joanna Briggs Institute (JBI) tool. Our review included eight cross-sectional and two cohort studies. Most of these studies used questionnaires to assess the risk factors of myopia. Standardized ocular examinations were done in most studies to measure visual acuity, spherical equivalent, and axial lengths. Our study found that the progression of myopia was affected by the reduced time spent outdoors and increased screen time during the pandemic. We also found that children's increased use of electronic devices, such as mobile phones and tablets, has significantly affected myopia progression during the pandemic.

A Systematic Review on Whether an Association Exists Between Adolescent Obesity and Idiopathic Intracranial Hypertension.

Pseudotumor cerebri syndrome (PTCS)/idiopathic intracranial hypertension (IIH) is a clinical presentation appertaining to signs/symptoms of raised intracranial pressure, like headache and papilledema. It is an uncommon but clinically significant cause of morbidity such as permanent vision loss. It is crucial to understand if idiopathic intracranial hypertension (IIH) is on the rise in adolescents, it is probably due to the rising prevalence of obesity worldwide. Our study aimed to find an association between obesity and IIH in adolescents. We utilized Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines to run this systematic review. Many publications related to the topic in the discussion were scrutinized through a comprehensive database search. We filtered them down to a final count of 10 articles after utilizing our inclusion/exclusion criteria and assessing the quality of work. In these final papers, we identified several possibilities to explain the link between obesity and IIH in adolescents. Overweight and obese adolescents were found to have a significantly increased risk of IIH development, with a more severe clinical picture seen in morbidly obese female patients.

A Systematic Review of the Risk of Non-alcoholic Fatty Liver Disease in Women With Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder associated with complications throughout various body organs. Previous studies have shown evidence of liver disease in some women with PCOS. In this study, we attempted to explore the risk of non-alcoholic fatty liver disease (NAFLD) in PCOS women and the specific factors involved in its development. We searched PubMed, PubMed Central, Medline, and ScienceDirect for articles related to the topic, screened those articles according to our inclusion/exclusion criteria, and conducted a thorough quality check using various quality appraisal tools to select articles relevant to our research. The process was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Checklist 2020. We selected 11 high-quality observational studies for our review. Studies from various countries were included, and all studies demonstrated an increased prevalence of NAFLD in PCOS patients compared to healthy controls. Although insulin resistance, obesity, and increased androgens contribute to the increase in the risk of NAFLD in these patients, hyperandrogenism was the most influential risk factor in four of these studies. Two studies explored the degree of NAFLD in these patients using transient elastography (TE). They concluded that PCOS was significantly associated with hepatic steatosis (HS) rather than hepatic fibrosis in most patients. PCOS patients have an increased risk of developing NAFLD, particularly HS, and hyperandrogenism seems to be the main determinant. Therefore, effort should be put into screening and monitoring these patients to manage the disease. TE may be a useful method for monitoring the natural history of NAFLD in these patients, which requires further exploration.

Impact of Hypertensive Disorders of Pregnancy on Stillbirth and Other Perinatal Outcomes: A Multi-Center Retrospective Study.

OBJECTIVE: The aim of the study is to assess the impact of hypertensive disorders of pregnancy on stillbirths and other perinatal outcomes among women in Karachi, Pakistan. METHODOLOGY: This was a retrospective cohort study conducted at two tertiary care hospitals, Aga Khan Hospital (AKU) and Liaquat National Hospital (LNH) in Karachi, Pakistan. The primary outcome variable of this study was stillbirth. Other outcomes assessed in this study included preterm birth, low birth weight, and early neonatal death. RESULTS: Data of a total of 840 women were included in this study; 280 (33.33%) women had hypertensive disorders of pregnancy and 560 (66.67%) were normotensive. Among women who had hypertensive disorders of pregnancy, the adjusted odds ratio (AOR) of having a stillbirth was two times more than that for normotensive women (AOR=2.62, 95% CI=1.46-4.40), four times for low birth weight (AOR=4.23, 95% CI=2.88-6.20), five times for early neonatal death (AOR=5.03, 95% CI=2.40-10.50) and six times for pre-term birth (AOR=5.16, 95% CI=3.42-7.79). CONCLUSION: The current study found that incidence of stillbirth, low birth weight, pre-term birth, and neonatal mortality is higher in mothers with hypertensive disorders of pregnancy than normotensive mothers.

Revealing Genome-Based Biosynthetic Potential of Streptomyces sp. BR123 Isolated from Sunflower Rhizosphere with Broad Spectrum Antimicrobial Activity.

Actinomycetes, most notably the genus Streptomyces, have great importance due to their role in the discovery of new natural products, especially for finding antimicrobial secondary metabolites that are useful in the medicinal science and biotechnology industries. In the current study, a genome-based evaluation of Streptomyces sp. isolate BR123 was analyzed to determine its biosynthetic potential, based on its in vitro antimicrobial activity against a broad range of microbial pathogens, including gram-positive and gram-negative bacteria and fungi. A draft genome sequence of 8.15 Mb of Streptomyces sp. isolate BR123 was attained, containing a GC content of 72.63% and 8103 protein coding genes. Many antimicrobial, antiparasitic, and anticancerous compounds were detected by the presence of multiple biosynthetic gene clusters, which was predicted by in silico analysis. A novel metabolite with a molecular mass of 1271.7773 in positive ion mode was detected through a high-performance liquid chromatography linked with mass spectrometry (HPLC-MS) analysis. In addition, another compound, meridamycin, was also identified through a HPLC-MS analysis. The current study reveals the biosynthetic potential of Streptomyces sp. isolate BR123, with respect to the synthesis of bioactive secondary metabolites through genomic and spectrometric analysis. Moreover, the comparative genome study compared the isolate BR123 with other Streptomyces strains, which may expand the knowledge concerning the mechanism involved in novel antimicrobial metabolite synthesis.

Antimicrobial sensitivity patterns of enteric fever in Pakistan: a comparison of years 2009 and 2019.

BACKGROUND: Pakistan is one of the endemic regions for typhoid fever and paratyphoid fever. This study aimed to identify the evolving antimicrobial sensitivity patterns of Salmonella species causing enteric fever and its implications on the clinical prescribing of antimicrobials. METHODS: This was a retrospective descriptive study conducted at a university hospital. Antimicrobial resistance was defined in terms of non-resistant, multidrug resistant (MDR) and extended drug resistant (XDR) as per WHO guidance. Data were collected from the years 2009 and 2019. Chi squared was applied to test for statistical significance (p < 0.05). RESULTS: A total of 200 patients (100 from 2009 and 100 from 2019) were included in the study. Non-resistant enteric fever cases reduced from 100% in 2009 to 44% in 2019, whereas the MDR and XDR enteric fever cases increased to 16% and 40%, respectively (p < 0.05). Cross tabulation carried out for individual drugs showed an independent rise in the sensitivities of individual first-line antimicrobials. CONCLUSION: Antimicrobial resistant enteric fever has become a big challenge for Pakistan. The choice of antibiotic prescription has narrowed down to broader spectrum antimicrobials making it difficult to treat, leading to increased morbidity and mortality.

Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study.

INTRODUCTION: The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life. EBF is considered to be an important practice for enhancing infant health and wellbeing. Breastfeeding offers a wide range of psychological and physical health benefits in the long-term and short-term for young children, infants, and mothers. This study aims to compare exclusive breastfeeding practice among primiparous and multiparous mothers including reasons for discontinuing exclusive breastfeeding and problems faced during breastfeeding. METHODOLOGY: This cross-sectional study was conducted in rural areas of Sindh, registered with the Maternal Newborn Health Registry (MNHR). The study used a systematic sampling technique for the enrollment of study participants. A survey questionnaire was used to collect data from mothers about the practices of EBF. A total of 397 mothers were interviewed and analyzed. RESULTS: Among Primiparous mothers, 14.1% of mothers initiated breastfeeding within one hour of birth, while 22.4% of multiparous mothers, initiated breastfeeding within one hour of birth. The difference between the two is statistically insignificant (p-value=0.234). A high percentage of multiparous mothers exclusively breastfed their infants for six months (63.5%) as compared to primiparous mothers (51.5%). The most common reason for introducing pre-lacteal feed before six months among primiparous mothers is the lack of adequate milk production to fulfill baby needs; this was the case for 35.4% of mothers. On the other hand, the baby remaining hungry post breastfeeding was the major reason among multiparous mothers (44.0%) for introducing pre-lacteal feed before six months. CONCLUSION: This study helped in the identification of issues faced by primiparous and multiparous mothers during exclusive breastfeeding. Interventions for promoting EBF need to be tailored as per the need and challenges of the population.

Frequency of Left Ventricular Hypertrophy Among Patients on Maintenance Hemodialysis by Voltage Criteria and Its Relationship with Biophysical-Chemical Parameters.

Background Among the dialysis population, left ventricular hypertrophy (LVH) is becoming a major cause of cardiovascular death, mainly due to myocardial infarction, heart failure, and arrhythmias. Electrocardiography (ECG) is a cheap and easily available test to detect the presence of left ventricular hypertrophy. The basic purpose of this study was to assess the frequency of left ventricular hypertrophy among the maintenance hemodialysis patients by applying different voltage criteria for the diagnosis of LVH and its relationship with various biophysical and biochemical parameters. Methods A total of 68 patients of end-stage renal disease (ESRD) were included in the study who were on maintenance hemodialysis at the dialysis center of Sughra Shafi Hospital. Baseline characteristics were recorded from the patients' data. Blood samples were drawn and electrocardiographs were taken, both before and after hemodialysis. Results Results showed variability in the detection of left ventricular hypertrophy in the pre- and post-dialysis period, as it was positive for 45%, 21%, and 17% in the pre-dialysis period versus 40%, 32%, and 25% in the post-dialysis period, when the Framingham, Sokolow-Lyon, and Cornell criteria were applied, respectively. The study showed a significant relationship between left ventricular hypertrophy with a high body mass index (BMI), hypertension, and pre- and post-dialysis hypomagnesemia (P <0.05). A significant association was also seen with low serum albumin levels over the past year. Conclusion According to this study, almost half of the dialysis patients were having left ventricle hypertrophy when Framingham criteria were applied. Good control of factors that are significantly associated with the occurrence of left ventricular hypertrophy can reduce morbidity and mortality among dialysis patients secondary to cardiovascular events. In this study, these factors included hypertension, hypomagnesemia, hypoalbuminemia, and high BMI.

Determining the Frequency of Acquired Cystic Kidney Disease in End Stage Renal Disease Patients on Hemodialysis at Dialysis Centre of Tertiary Care Hospital.

Objectives To determine the frequency of acquired cystic kidney disease (ACKD) among patients of end-stage renal disease. Methods This cross-sectional study was conducted at the University of Lahore Teaching Hospital after approval from the ethical review committee. About 150 patients with end-stage renal disease fulfilling the inclusion criteria and undergoing three hemodialysis sessions per week for six months were approached. The patients underwent ultrasonography by the same consultant radiologist and the presence of acquired polycystic kidney disease was noted in the proforma. Data was stratified for age, gender and duration of hemodialysis and the chi-square test was applied. Results The mean age of the study participants was 47.31±9.44 years and males were majority in number with 92 (61.3%). The acquired cystic kidney disease was noted in 20 (13%) participants. There was significant difference noted in different age groups as six (6.5%) patients in the 18-40 age group and 14 (24%) patients in the 40-80 age group have acquired kidney disease (p-value=0.002). No important association between ACKD, age, and gender were found. None of these patients had evidence of renal cell carcinoma, extrarenal cysts, retroperitoneal or intrarenal hemorrhage. Conclusion There was a significant correlation between acquired cystic kidney disease and the duration of hemodialysis, and the chances of the development of acquired cystic kidney disease rise progressively with increasing time on hemodialysis.

An Unusual Presentation of a Patient with Leg Ulcers: A Case Report.

Leg ulcers have been a common presentation in clinics; disruptions in the mechanism of ulcer healing are vascular insufficiency, anemia, metabolic disturbances, neuropathy, and autoimmunity. The term 'non-transfusion-dependent thalassemia' encompasses the milder forms of thalassemia traits that require intermittent or no transfusion at all, and are mostly associated with leg ulcers. We present the case of a 19-year-old female with beta-thalassemia major who presented with non-healing leg ulcers and anemia. The clinical findings and lab evidence suggested hemolytic anemia evidenced by pathologic fractures, hepato-splenomegaly, and normal iron studies. Hemoglobin electrophoresis confirmed beta-thalassemia major with its complications including adrenal insufficiency and pathological fractures, all of which remained well compensated till the second decade of life.