Hospital outcomes of obstetrical-related acute renal failure in a tertiary care teaching hospital.

Management of obstetrical acute renal failure remains a challenging task. We present data of 100 cases of obstetrical -related acute renal failure of 3-year duration (2007-2009) from Department of Nephrology & Hypertension, Lady Reading Hospital, Peshawar, Pakistan. The study is aimed to look at overall mortality and relationship of oliguria/anuria at presentation to dialysis dependency and renal cortical necrosis (RCN). Evaluation of comorbidity to dialysis dependency and RCN was also considered. While 91 patients required hemodialysis, 9 were managed conservatively; 57 were dialysis dependent whereas 43 remained dialysis independent on discharge; 47 patients had oliguria, 30 had anuria, and 23 had an output of >800 mL per 24 h on admission. RCN was seen in 30 cases, all biopsy confirmed; among these, 26 cases (86.67%) were associated with oliguria/anuria and dialysis dependency right from the beginning (p < 0.0001). However, four (13.33%) with RCN had output >800 mL per 24 h but remained dialysis dependent. Our data showed that out of 30 patients who presented with anuria, only 10 patients (33.33%) were dialysis independent on discharge, whereas out of 47 oliguric patients, 21 patients (44.6%) were dialysis independent upon discharge. Thus dialysis dependency does not correlate with anuria or oliguria at presentation (p = 0.133). Mortality of 7% was recorded; 23% were discharged with normal renal function. Septicemia, operative interventions, retained product of conception, post-partum hemorrhage, and RCN remained important comorbid conditions with regard to survival and dialysis dependency.

Ocular emergencies.

OBJECTIVE: To describe clinical data about ocular emergencies (OE) and their management. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted from 1st January, 2000 to 31st December, 2002 at the Department of Ophthalmology, Khyber institute of Ophthalmic Medical Sciences, Lady Reading Hospital, Peshawar. MATERIAL AND METHODS: A comprehensive analysis of the computer record available for admitted ocular emergencies was undertaken in terms of gender, age, etiology, procedure performed and hospital stay. RESULTS: Ocular emergencies (1961) were 18.49% of total admissions. Male to female ratio was 2:1. Non-traumatic ocular emergencies were 1058 (53.95%) with male to female ratio of 1.47:1. In the non-traumatic ocular emergencies, majority (67.2%) were 40 years or above. Traumatic ocular emergencies were 925 (47.16%) with male to female ratio of 2.77:1. Majority (83.78%) of traumatic ocular emergencies were below 40 years and 562 (60.75%) below 20 years of age. Only 150 (16.21%) cases were 40 years and above. Corneal ulcers (44.51%) and glaucoma (24.38%) were the most common non-traumatic ocular emergencies, whereas, open globe injuries (73.4%) were leading the traumatic ocular emergencies. Total surgical procedures performed were 1382 (13.7% of total major ophthalmic surgery). Average stay in hospital was 5.5 days. CONCLUSION: Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions.

Hyphaema due to blunt trauma.

OBJECTIVE: To study the causes, clinical presentation, complications and visual outcome of hyphaema following closed globe injury. DESIGN: Prospective study. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan, from May, 1996 to June 1997. PATIENTS AND METHODS: All cases of hyphaema, due to closed globe injury, were included and history of patients was recorded on a comprehensive proforma designed for this purpose. All cases were admitted for at least 5 days. Ocular examination included checking visual acuity (VA), intraocular pressure (IOP), slit lamp and fundus examination. Patients were treated accordingly and followed up for 90 days. RESULTS: Thirty-six eyes of 36 patients with hyphaema were included in our study. Out of this, 88.89% were males and 11.11% females while 86% were 20 years of age or below. Almost 91.66% presented with primary hyphaema, 44.44% received trauma with stone and 27.77% with tennis ball while playing cricket. Trauma during playing was noted in 66.66% of cases. Almost 62% of cases were having visual acuity in the range of CF to perception of light with good projection. IOP was raised initially in 41.66% cases. Only 33.33% needed surgical intervention. Secondary glaucoma was present in 13.88% and 5.55% had corneal blood staining. Majority of patients (75%) improved to VA range of 6/6 to 6/12 and 19% patients in our study ended up with legal blindness in the affected eyes. CONCLUSION: Traumatic hyphaema is more frequently found among children and young male. Angle recession, traumatic cataract and maculopathy were common co-morbidities. Secondary glaucoma and corneal staining were the main complications. Nearly 1/5th of patients ended up with legal blindness in the affected eyes.