Complications of Diode Laser in Endourological Procedures in Co-morbid Patients

To determine safety of diode laser by studying post operative complications after endourological procedures in co-morbid patients. A descriptive study. Shalamar hospital, Lahore from June 2009 to June 2012. We studied post-operative complications [up to 3 months] in 3 groups [prostatic obstruction, bladder growths ,urethral strictures] of total180 patients with ASA III and IV. We assessed hematuria, UTI, abdominal pain, suprapubic discomfort, urinary retention, dysuria, incomplete procedure, cardiac or respiratory compromise, fluid overload, mortality, catheterization times and mean postoperative hospital stay In prostate group, mean age was 70.8 +/- 8.6 years and follow-up period was 3 months. Complications were: mild transient haematuria in 65 [100%], creamy urine in 50 [77%], urinary tract infection in 25 [38.4%], dysuria in 16 [24.6%], retreatment required in 06 [9.2%], suprapubic discomfort in 3 [4.5%], TURP syndrome in 1 [1.5%] and significant hemorrhage requiring blood transfusion in 1 [1.5%],. In urethral strictures, the complications were: microscopic hematuria in 80 [100%], urinary tract infection in 52 [65%] suprapubic discomfort in 9 [11.2%], dysuria in 6 [7.4%] mild transient hematuria in 5 [6.2%]. In bladder growths, the complications were: mild transient haematuria in 30 [85.7%], creamy urine in 19 [54.2%], suprapubic discomfort in 18 [51.4%], dysuria in 9 [25.7%], urinary UTI in 8 [22.8%], ablation performed in two sittings in 1 [2.8%]. No mortality in any group. Diode laser is a safe and useful modality in patients with co-morbidities [ASA III and IV]

Dialysis-related factors affecting quality of life in patients on hemodialysis

Treatment modalities for end-stage renal disease affect quality of life [QOL] of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Eighty-nine patients [71.2%] were men, 99 [79.2%] were married, 75 [60.0%] were older than 45 years, and 77 [61.6%] were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 [environment]. There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 [social relationship] of the patients at Mayo Hospital [a public hospital], which was significantly better. Nondiabetic patients had a better QOL in domain 1 [physical health] as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL

Serum trace elements [aluminium, copper, zinc] in hemodialysis patients

Trace element is defined as one that makes up less than 0.01% of body's mass. Those present at micro g/dl in body fluids and at mg/kg in tissues are referred to as trace elements and those found at micro g/dl in body fluids or micro g/kg in tissues are referred to as ultra-trace elements. Although these elements constitute a relatively small amount of total body tissues these are essential for many vital processes. To determine the serum level of trace elements i.e Aluminum [Al], Zinc [Zn] and Copper [Cu] in haemodialysis [HD] patients. Methods: Fifty patients of End Stage Renal disease [ESRD] on [HD] for more than three months from dialysis center of Shalamar Hospital Lahore were included in the study. Patients of acute renal failure, duration less than three months were excluded from the study. Fifteen subjects age and gender matched having normal kidney functions were included as controls. Demographic data was collected in a separate form having age, gender, cause of ESRD, duration of dialysis and viral markers. The major causes of ESRD were diabetic and hypertensive nephropathy. The mean age was 46.10 +/- 16.29 years and predominantly patients were from middle class. Mean duration of dialysis was 24.87 +/- 22.1 months and majority of the patients 40 [74.1%] were on twice weekly dialysis. Mean serum Al level was 65.44 +/- 33.41 micro g/L as compared to controls [13.20 +/- 6.155] which was statistically significant [p<0.001]. Mean serum Zn level was 59.17 +/- 32.51 micro g/L and Cu level was 35.35 +/- 31.52 micro g/L which were significantly [p<0.001] lower than controls [107.53 +/- 13.32, 107.00+11.85 micro g/L]. Duration of the dialysis had negative correlation with serum Zn level. It was significantly [p<0.02] low [44.78 +/- 33.061 micro g/L] when duration of dialysis was more than 30 months as compared to duration less than 30 months [66.36 +/- 30.174 micro g/L]. Serum levels of trace elements were significantly different in ESRD patients. Majority of patients had high Al levels and decreased Cu and Zn level. High serum Al levels in patients were due to intake of Al based phosphate binders. Decreased Zn and Cu levels were due to poor intake and dietary restriction. Duration of the dialysis had negative correlation with serum Zn level