Profile of asphyxial deaths in Faisalabad: a 10-year study

Objective: To determine the frequency of violent asphyxial deaths in Faisalabad over a span of a decade; and assessing the age and gender vulnerability. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Forensic Medicine and Toxicology, Punjab Medical College, Faisalabad, from January 2007 to December 2016

Methodology: Cases identified as violent asphyxial deaths according to police inquests and findings of the medico-legal examiners were computed. Age, gender, and cause of asphyxia recorded in predesigned proformas and analysed by SPSS version 12.0

Results: Asphyxial deaths accounted for 7.66% [259 / 3,381] of the medico-legal deaths during the 10-year span. Majority [28.57%] victims belonged to the 20-29 year age group, followed by the 10-19 year age group [20.07%]. Male victims [56%] outnumbered the females [44%] by ratio of 1.3:1. Ligature strangulation was the cause of asphyxia in majority of the victims [40.93%], followed by hanging [28.96%]

Conclusion: Young population between 20-29 years were the predominant victims of violent asphyxial deaths. Homicide due to ligature strangulation was the commonest form of violent asphyxial deaths

Comparative evaluation of conventional medical treatment alone versus conventional medical treatment with amniotic membrane transplantation in infective corneal ulcer

To compare the effect of amniotic membrane transplantation along with conventional therapy and the conventional therapy alone for the treatment of infective corneal ulcer. This study was conducted at Ophthalmology Department, Hayatabad Medical Complex Peshawar. The duration of study was 6 months, i.e., from April 2010 to October 2010, in which a total of 68 patients were included using WHO software for sample size determination. They were divided into two equal groups of 34 each. Non probability purposive sampling technique was used. In this study, mean age was 50 +/- 0.24 years. Forty six [67.6%] patients were male while 32.4% [n=22] patients were female. Conventional Medical Treatment alone was effective in 87% [n=30] cases while Conventional Medical Treatment with Amniotic Membrane was effective in 96% [n=33] cases with a p-value of 0.03. This study showed encouraging results of amniotic membrane trans plantation along with conventional treatment in corneal ulcer in improving both symptoms and signs

Asphyxial deaths: a four year retrospective study in Peshawar

The study provides epidemiological analysis of autopsy record on asphyxial deaths and different methods used to carry it out. It was a retrospective [descriptive] study done at the Department of Forensic Medicine and Toxicology, Khyber Medical College Peshawar. Analysis of autopsy record was done and cases of asphyxial deaths and the cause of asphyxia was noted. The data covers a period from January 2009 to June 2012. A total of 3,265 [males n=2839, Females n= 426] cases were presented for autopsy to Forensic Medicine and Toxicology Department of Khyber medical college Peshawar and 130 deaths were due to asphyxia compared with 2370 deaths due to firearm. Homicide was the most common manner of death. 89 cases were males and 41 were females. Approximate ages of the autopsies conducted were 0-19 years n= [18.2%], 20-40 years n= [64.5%], 41-60 years n= [13%] and 61 or above n=4 [3.0%]. Strangulation was found to be the most common method used. Asphyxial deaths are not as common as firearm deaths in Peshawar. Homicide is the most common method of death. The findings may be helpful for the security agencies in investigation of asphyxial deaths

Effects of season (summer & winter) on electrical characteristics of skeletal muscle membranes of the spiny-tailed lizard, uromastix hardwickii.

This study deals with the observation of changes with temperature variations of the seasons in the muscular electrical excitability in the reptile Uromastix hardwickii. Freshly captured adult animals of both the sexes were used in all the experiments, and the gastrocnemius (skeletal) muscles were dissected out. The muscle samples were digested with digestive fluid (pepsin & Hcl), stirred, settled and supernatant was removed, till whitish fluid having clear cells obtained for patch clamp recording of ionic currents and potentials. Resting membrane potentials and action potentials of reptilian cell membranes were measured in whole cell current mode. The glass microelectrodes, with a tip diameter 2–3 μm and tip resistance 5–6 MW (when filled with intracellular solution) were used in these experiments. The present study was carried out to investigate the electrical characteristics of the skeletal muscles of this species of Uromastix, which are not studied earlier. The average mean values of resting membrane potential, action potential and its durations showed no significant changes with the change in the season, but other components of action potential including threshold potential, after-potential and its duration were found to be increased significantly (P<0.05) in summer as compared to winter. Temperature dependency of these parameters with seasonal variation, are studied for the first time in the gastrocnemius (skeletal) muscles of Uromastix hardwickii. Hence seasonal changes in the components of action potential are invariably associated with changes in environmental temperature, and may be responsible for changes in the activities and homeostasis of these animals; and possibly indicating underlying mechanism of hibernation.

Patient communication in radiology: current status of breaking bad news among radiologists and radiology trainees in Pakistan

Breaking bad news can be an intimidating task for any physician. The aim of this study was to record the practices of breaking bad news to the patients by Pakistani radiologists and trainees. The radiologists and trainees attending the 26[th] National Radiological Conference in October 2010 in Karachi, Pakistan, were surveyed. The response rate was 76%. The respondents included residents [51%], private practicing radiologists [28%], academic radiologists [13%], and other trainees [8%]. Most of the academic radiologists communicated with their patients. The daily frequency of breaking bad news by residents was noted, which was highest in the public teaching hospitals [71%]. For severe abnormalities such as malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very uncomfortable in disclosure of results. Differences in frequency of communication with patients were noticed with both different training levels, and different settings of practice in a developing country

Coverage and causes of non immunization in national immunization days for polio; a consumer and provider perspective study in Peshawar

Polio is a viral disease that may cause paralysis and infant death. Despite ongoing efforts, polio has not been eradicated from Pakistan. The purpose of this survey is to estimate the coverage of polio vaccine during National Immunization Days and to determine the factors associated with lack of immunization. A Cross-sectional survey was conducted in Peshawar, Pakistan, from 1[st] June to 9[th] June 2010. Confidence level of 95% and confidence interval of 4 was used to derive the sample size [for a population more than 20,000]. Parents of 600 children under 5 years were asked about immunization during NIDs of January - May 2010 [5 NIDs]. Questions regarding demographics, income, education, occupation, accessibility to health centers and frequency of visits from health workers was inquired. Knowledge and views on immunization were also asked. 40 health personnel involved in immunization were also interviewed and they were asked about hurdles faced in immunization. 83.7% children were vaccinated in all National Immunization Days, while 94.7% had at least, taken polio vaccine once. 5.3% had not taken polio vaccine during National immunization Days of 2010. Main reasons for not vaccinating were; Vaccinator absent/not visiting home/vaccine not available [63.36%], no awareness [17.4%], Child ill [5.8%], family problem/mother busy [3.3%] and wrong ideas/sterility [3.3%]. Many health personnel [32.5%] considered lack of awareness among people and low accessibility to vaccine as the main hurdles in immunization, besides the poor salaries and incentives. Polio vaccination during National Immunization Days 2010 was a partial success because some pockets of poor children and afghan refugees were poorly vaccinated. In order to eradicate polio, they must be vaccinated

Intrathecal anti-tetanus human immunoglobulin in the treatment of neonatal tetanus

To determine the outcome of tetanus in neonates treated with intrathecal tetanus immunoglobulin in terms of mortality and hospital stay. Experimental study. Paediatric Unit I, Bahawal Victoria Hospital, Bahawalpur, from April 2004 to December 2007. Seventy neonates with diagnosis of neonatal tetanus were included in the study. The neonates with fits due to causes other than tetanus were excluded. Thirty five patients received intrathecal immunoglobulin in addition to standard treatment [group A] while, the other 35 patients received only standard treatment [group B]. The mortality and duration of hospital stay in 2 groups were recorded. In group A, mean duration of hospital stay was 10 days while, in group B it was 13 days [p<0.001]. One patient from group A and 8 patients from group B expired [p=0.026]. The occurrence of refractory fits, repeated apnoeic episodes and high grade fever did not show any statistically significant difference in the 2 groups. Intrathecal anti-tetanus immunoglobulin in addition to the standard improved the outcome of neonatal tetanus in terms of mortality and hospital stay

Inequity in childhood immunization between urban and rural areas of Peshawar

Background: Purpose of this study was to find coverage of vaccines in EPI and compare the factors related to vaccine failure or missed vaccination in urban and rural areas of Peshawar. Methods: This cross-sectional survey was conducted in Urban and rural of Peshawar from 20th to 31st of June 2010. A questionnaire was used to interview parents of 548 children, aged 1 year and below, about demographics, vaccination status, reasons for missed vaccination and views on immunization. Results from both urban and rural areas were compared to find the impact of different factors on immunization failure. Results: The immunization coverage in urban areas was 76.5% while in rural areas it was 48.8%. Causes for non immunization were different in urban and rural areas. In urban areas, lack of awareness and care takers/parents being busy were the main reason for non immunization. In rural areas, in addition to formers, lack of accessibility to health centres and misconceptions about vaccination were major reasons for non-immunization. Parents were more educated in urban areas than rural areas. Conclusion: Rural areas had a lower immunization rates due to lack of awareness, low accessibility and much lower education of parents. Keywords: EPI Pakistan, children, immunization, urban, rural

Coverage and causes of missed Haemophilus influenzae type B vaccination in urban and rural areas of Peshawar

Haemophilus influenza type b [Hib] is a major cause of morbidity and mortality in Pakistan. Hib vaccine was introduced in 2009 in EPI programme. The purpose of this study was to find out the coverage and factors associated with non-immunization of Hib in urban and rural areas of Peshawar. Data was collected through random sampling in Peshawar University, Peshawar Saddar, Hashtnagri, Naway Kalay and Pawaka from 9th to 19th of June 2010. A questionnaire was used to interview parents of 600 children aged 1 year and below about demographics, Hib vaccination status, reasons for missed vaccination and views on immunization. Pearson's Chi-square test was used for statistical testing, and p<0.05 was considered significant. Completely vaccinated children were 64.2%, 25% not vaccinated at all, and 11% were incompletely vaccinated. The reasons for not vaccinating were lack of awareness [26%], family problem/mother busy [18%], centre too far [16.9%], wrong ideas [12.2%], fear of reaction [5.4%], child illness [8.1%] and miscellaneous causes [13.7%]. Low Hib vaccination coverage in Peshawar is mainly due to low awareness among people, poor economic conditions and illiteracy

One stage emergency resection and primary anastomosis of sigmoid volvulus

To evaluate the safety of single stage resection and primary anastomosis [RPA] in cases of viable sigmoid volvulus, in terms of anastomotic healing and complications. Observational study. Surgical Unit, Hayatabad Medical Complex [HMC], Postgraduate Medical Institute, Peshawar, from November 2006 to October 2008. Study included all patients presented and admitted in Surgical Unit, HMC, with sigmoid volvulus during the above mentioned period. Resection and primary anastomosis was done without defunctioning stoma formation or on-table colonic lavage. Manual decompression was carried out pre-operatively. Patients excluded, had serious co-morbid conditions in whom colostomy was done instead of primary anastomosis. Patients were followed-up for one month after surgery. A total of 30 patients were admitted during the study of 2 years duration, out of which there were 21 male and 09 female patients, with male to female ration of 2.4:1. Only 1 patient and anastomotic leak while 4 patients had superficial wound infection. One patient died due to comorbid condition. Abdominal wound dehiscence or postoperative abdominal abscess was not observed in any case. Single stage resection and primary anastomosis is a reliable current treatment modality for the emergency surgical management of sigmoid volvulus and has low morbidity and mortality. On-table colonic lavage and proximal defunctioning colostomies are unnecessary with this technique

Complicated Jejunal diverticula as surgical emergency: experience at a tertiary care hospital in Peshawar, Pakistan

Diverticula of small intestine are rare. Jejunal diverticula can be single or multiple. Diverticula in the jejunum tend to be large and multiple. Clinically they may be asymptomatic or may give rise to symptoms like pain, flatulence and borborygmi, may produce malabsorption syndrome or may present in emergency with different acute pathologies like perforation, haemorrhage, obstruction, enterolith formation and inflammation. The Objective was to see the pattern of complications in jejunal diverticula presenting as a surgical emergency. This descriptive study was conducted at Surgical Units of the 3 tertiary care Hospitals of Peshawar, for 7 years from January 1, 2002 to December 31, 2008. Study included all patients presenting to and admitted in Surgical Unit, Hayatabad Medical Complex, Peshawar with complicated jejuna diverticula during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of investigation were recorded. Uncomplicated jejuna diverticula were excluded from study. The operative findings and the type of complication were recorded. Ten patients were admitted during 7 years of study. Out of all patients 9 were male and 1 was female. Eight out of 10 patients presented with perforation of diverticula while 1 patient had severe inflammation of diverticulum causing pain, ileus and acute abdomen. One patient had acute pain due to adhesion formation. It is seen that complicated jejunal diverticulae are quite rare and the most common complication is perforation. Inflammation and adhesion are other complications with which jejunal diverticula presented during this study

Management of supratentorial brain abscess

To analyze the management out come of symptomatic supratentorial brain abscess by burr hole aspiration. This descriptive study with 40 cases of symptomatic unilocular supratentorial pyogenic brain abscess was conducted at Department of Neurosurgery, Hayatabad Medical Complex, Peshawar from February 2006 to January 2008. Patients having history of headache for more than 14 days and diagnosed with contrast enhanced CT scan were included in the study. All patients were continued on antibiotic and were followed weekly for 1[st] month then monthly till the CT brain showed abscess resolution or no response to treatment was found. The data was recorded and analyzed using SPSS version13.0. The longest diameter on preoperative CT scan was measured in all patients, which ranged from 2.3cm to 4.1cm, with a mean of 3.39cm +/- 0.5. Male to female ratio was 2:1 and mean age was 12.6 +/- 9.7. Out of 40 patients, 13[32.5%] patients required aspiration only once, 18 [45%] required twice and 9 [22.5%] patients for three times. All patients were followed for period of 3 to 7 months; the mean follow up period was 4.4 months +/- 1.033. The treatment was successful in 95% patients as only two patients [5%] did not show any response to treatment and required further excision. Burr hole aspiration is a reasonably good method to treat symptomatic unilocular supratentorial brain abscess that is larger than 2 cm

Severe diabetic ketoacidosis precipitated by an atypical antipsychotic drug

We report a case of a young Kuwaiti gentleman who presented with severe diabetic ketoacidosis [DKA] associated with atypical antipsychotic drug olanzapine. The current medical literature suggest that atypical antipsychotic drugs, including olanzapine lead to weight gain, insulin resistance, impaired glucose tolerance [IGT], diabetes mellitus [DM] and rarely patient may presents with serious side effects like DKA. Clinicians are urged to monitor the emergence of metabolic risk factors periodically and remain aware of potentially serious effects like DKA in schizophrenic patients taking olanzapine

Risk factors of preseptal and orbital cellulitis

To estimate the frequency and major risk factors of preseptal and orbital cellulitis. A cross-sectional analytical study. The Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from July 2003 to December 2006. All consecutive patients between ages 6 and 40 years, admitted to the institute with the diagnosis of preseptal and orbital cellulitis were included in the study. The patients were divided into two groups. Group I included patients with ages 6-16 years and group II with ages 17-40 years. The clinical features, diagnosis and risk factors were entered on a specially-designed proforma. The risk factors included were trauma, insect bite, localized or systemic infection and postsurgical. Odd ratio and p-values were calculated for potential risk factors. The frequency of orbital cellulitis was 0.1% of total admission. Out of 26 patients, 42.30% patients were in group I and 57 in group II. In group I, insect bite was the most common risk factor identified in 40% of patients with preseptal cellulitis and trauma as a common cause in 50% with orbital cellulitis. In group II, trauma was the leading cause in 50% of patients with preseptal cellulitis and sinusitis as a common cause in 18.1% with those of orbital cellulitis. In both groups the p-values were found insignificant [p > 0.5]. Complications included cicatricial ectropion in 44.4% and orbital abscess in 41.1%. For preseptal cellulitis, insect bite was the most common cause in group I and trauma was the leading cause in group II. For orbital cellulitis, trauma was important cause in group I and sinusitis in group II

Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy

To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections [ESIs] and conservative management in patients with lumbar radiculopathy. Quasi-experimental study. The Postgraduate Medical Institute of Hayatabad Medical Complex, Peshawar, from April 2005 to March 2007. Fifty elective patients fulfilling the inclusion criteria were randomly divided into two groups. Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline in the lumbar epidural space, while patients in the conservative group were treated with bed rest, non-steroidal anti-inflammatory agents, muscle relaxants, and opioids. All the 50 patients in the two groups were regularly assessed at 2 weeks, 1 month, 3 months and 6 months of periods for pain score by the Visual Analogue Scale [VAS], patients satisfaction score and any unwanted side effects. A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group. Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month [p <0.05]. The difference in Visual Analogue Scale [VAS] and patients satisfaction score was non-significant in chronic stages of treatment in both groups [p > 0.05]. Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Frequency of HER-2/NEU receptor positivity and its association with other features of breast cancer

Carcinoma breast is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. In Pakistan it is more common at a young age contrary to the West where it is more common in old age [after 60 years]. The objectives of this cross sectional study were to determine the frequency of HER-2/neu receptor over-expression and its association with some of the features of breast cancer like patient age, ER/PR status, tumour size, histological grade and axillary lymph node involvement. This study was conducted at Surgical C Unit, Postgraduate Medical Institute of Lady Reading Hospital, Peshawar, from January 2007 to December 2007. Study included all patients with breast cancer admitted in Surgical 'C' unit LRH, Peshawar for Modified Radical Mastectomy [MRM]. The resected specimens were sent to histopathologist for immunohistochemical [IHC] studies [HER-2/neu receptor and ER/PR] and detailed histopathological analysis including tumour subtype, size, histological grade and involvement of axillary lymph nodes. Patients refusing HER-2/neu receptor immunohistochemistry were excluded from the study. Name, age, sex, other relevant data, detailed history and clinical examination findings and results of investigation were recorded. Data was analyzed with SPSS version 10 This study included 24 female patients of breast cancer having modified radical mastectomy [MRM]. Age distribution ranged from 32-75 years with a Mean +/- SD of age 48.3 +/- 18.2 years. Fifteen out of 24 patients [62.5%] were >40 years, while nine patients out of 24 [37.5%] were 0.05], number of axillary lymph nodes involved [p > 0.05] and histological grade [p > 0.05]. While, it was significantly associated with tumour size [P < 0.05] and negative ER/PR status [P < 0.05]. Due to high prognostic significance and frequency in Pakistani females with breast cancer, HER-2/neu receptor should be checked in all patients with breast cancer so that the positive cases should have herceptin therapy and benefit from anthracycline based chemotherapeutic agents which can improve survival in these patients

Fine needle aspiration cytology [FNAC] and neck swellings in the surgical outpatient

Fine Needle Aspiration Cytology [FNAC] is a simple, quick and inexpensive method that is used to sample superficial masses like those found in the neck and is usually performed in the outpatient clinic. It causes minimal trauma to the patient and carries virtually no risk of complications. Masses located within the region of the head and neck, including salivary gland and thyroid gland lesions can be readily diagnosed using this technique. The objective of this descriptive study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with neck swellings coming to Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar. This study included patients with neck swellings presenting to the Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2007 to December 2007. Patients below 18 years of age were excluded. Patients' data were recorded. Samples of FNAC were sent to the cytologist and results recorded. Frequency of various pathologies was determined. The study included 50 patients with neck swellings. There were 16 male and 34 female patients with an age range of 15-55 years. Tuberculous lymphadenitis was the commonest diagnosis [36%] followed by reactive/non-specific lymphadenitis [18%]. Other pathologies were malignant neoplasms [14%], cysts [10%], benign neoplasms [8%] and sialadenitis [6%]. FNAC was inconclusive in 8% of cases. Carcinomas metastatic to lymph nodes were the most common type of malignancy followed by lymphoma and thyroid gland carcinoma [Papillary Carcinoma]. It is concluded that tuberculous lymphadenitis is still the commonest condition in patients presenting with neck swellings followed by non-specific lymphadenitis and malignant neoplasms especially metastatic carcinoma. FNAC is an easy and suitable tool for the assessment of patients with neck swellings in the outpatient clinics. Although its diagnostic accuracy is limited as compared to tissue biopsy but it is a good test for both screening and follow-up

Midazolam with bupivacaine for improving analgesia quality in brachial plexus block for upper limb surgeries

To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. Randomized controlled clinical trial. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2005 to June 2007. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 micro g.kg-1. Hemodynamic variables [heart rate, noninvasive blood pressure, oxygen saturation], pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A [p < 0.001]. Pain scores were significantly lower in group B for 24 hours postoperatively [p < 0.001]. Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine [0.5%] in combination with Midazolam [50 micro gúkg-1] quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine [0.5%] in equal volume

Iron status and hemoglobin level on chronic renal insufficiency

To correlate the iron status and hemoglobin levels in pre End Stage Renal Disease [ESRE] patients with various degrees of chronic renal insufficiency. A cross sectional analytical study. Department of Physiology, BMSI, JPMC, Karachi, in collaboration with Department of Nephrology, JPMC, Karachi and the above mentioned departments. The study included 120 subjects, distributed into four groups with 30 subjects in each group. There were 15 male and 15 female subjects in each group. First group [control] comprising of normal subjects with Creatinine Clearance above 90 milliliters per minute [Cr. Cl > 90 mI/mm] and remaining three groups i.e., group 11 [Cr. Cl 60-90 mI/mm], group Ill [Cr. Cl 30-59 mI/mm], and group IV [Cr.Cl 15-29 mI/mm] comprising of patients with increasing severity of the renal insufficiency. Their hemoglobin, serum ferritin, serum iron and Total Iron Binding Capacity [TIBC] were analyzed and statistically compaied. As compared to control group. there was a 6.85%, 11.46%, 29.09% decrease in hemoglobin levels in males while 5. 13%, 9.24% and 24.24% decrease in females, when subjects of group II, III, and IV were taken into consideration. Similarly there was 2.82%, 783%, and 12.37% decrease in serum iron, 1.31%, 1.79% and 2.24% rise in Total Iron Binding Capacity [TIBC] and 1.78%, 11.79% and 29.47% decrease in serum ferritin levels in corresponding groups in the same order. The rate of decrease in hemoglobin level corresponds with the rate of deterioration in renal function; however the rate of change in iron profile is by and large within normal limits and hence is not very significant