Predictive factors for intraoperative blood Loss during percutaneous nephrolithotomy

Objective: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy [PCNL] and correlate them with outcome

Study Design: Analytical study

Place and Duration of Study: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016

Methodology: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major > 2 gm/dl. Factors such as age, gender, comorbidities, body mass index [BMI], operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses

Results: Total 305 patients were enrolled in the study. Median age was 37 [27.5-49.1] years with predominantly males [n=217, 71.8%]. Median BMI was 27.3 [24.6-31.4] Kg/m[2] and mean stone size was 2.7 [2.1-3.4] cm. Two hundred and ninety-seven [97.7%] stones were radio-opaque. Operative time was 95 [60-127] minutes. There were 50.8% patients who had moderate drop in hemoglobin [1-2 gm/dl]. Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 [84%] patients. Thirty [9.8%] patients needed blood transfusion. None of the patients required angioembolisation

Conclusion: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL

Comparison of 24 hours urinary citrate levels in urolithiasis patients and healthy controls

To identify the difference in urinary citrate excretion between Stone Formers [SF] and Healthy Volunteers [HV] as a metabolic risk factor, that predisposes to urinary stone formation and to compare levels of urinary citrate in [HV] with reference values. The 24 hours urinary citrate was evaluated in 40 patients treated for renal citrate and declared stone free, and 40 age matched healthy adults taken as controls. Both the groups had a similar living environment, extrinsic factors, diet and similar genetic descent. There was no significant difference in urinary citrate excretion level among stone formers [mean 262 SD 197] and normal volunteer subjects [mean 269 SD 140]. Using the previously defined normal values [200] of urinary citrate in the local population, 55% of stone patients in our study group were hypocitric. While using the same value, 45% of our normal volunteers were also hypocitric. If 320 was taken as normal limit, 70% of the patient's population and 72% of controls were hypocitric. The prevalence of hypocitraturia was similar in the age matched adult groups. Certain intrinsic factors in our local subjects may account for the high prevalence of urolithiasis than in western population. Although the urinary citrate excretion of stone patients is similar to normal volunteers, uniformly low urinary citrate excretion may be a feature as a nation and not a predisposing factor for the lithogenesis. This supports the view that there may be more often prominent influences in stone formers possibly of genetic origin

Bed wetting in School Children of Karachi

To estimate the frequency of primary nocturnal enuresis [PNE] in Pakistani children and to examine the factors associated with it. A randomly selected cross-sectional study was conducted in five elementary schools, one in each of five districts of Karachi. The parents of 5000 children age between 3-13 years were asked to complete a questionnaire which included items about the frequency of daytime wetting and nocturnal enuresis, family history, urinary tract infection, parents and child's own concern about this problem and acquisition of treatments. Over all corrected response rate to the questionnaire was 69% [3395]. Enuresis was present in 9.1% [308]. There were 166 [53.9%] boys and 142 [46%] girls with a median age of 7 years. Only 54% [166] children sought help for their problem of which 26% consulted doctors, 16% visited homeopaths while 11% used hakeems and home remedies. Of the bed wetters, 30% were wet every night, 30% for more than three nights a week and 40% for less than three nights every week. Parents of 68.5% [211] children reported concern for the problem while 69.8% [215] children were also anxious about their enuresis. Among the concerned children group, 22% parents were not concerned about their child's problem. Family history of enuresis was present in 25.6% [79] children. The frequency of enuresis among the school going children in Karachi is 9.1% and is similar to that reported in European countries and other Asian countries including Korea and Taiwan. Enuresis causes concern to both parents and children, but only a small percentage of parents seek medical help for this problem