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Leptin, the prototype adipokine, exerts immunomodulatory actions being implicated in inflammatory responses during sepsis. Clinical evidence regarding its role in sepsis has been contradictory, while free leptin has not been studied. Our aim was to jointly investigate circulating total leptin, its soluble receptor (sOBR), and free leptin, as well as their kinetics in critically ill patients with sepsis regarding their diagnostic and prognostic value.

In a prospective study, serum total leptin, sOBR and free leptin index (FLI) were determined in 102 critically ill patients with sepsis within 48 hours from sepsis onset and one week after enrollment, and in 102 age and gender-matched healthy controls.

Upon enrollment, total leptin, sOB-R and FLI were significantly higher in septic patients compared to controls and they were positively correlated with sepsis severity scores, while they presented a significant decrease during the first week (p<0.001). The decrease in total leptin and sOB-R was significantly higher in patients with sepsis compared to septic shock and in survivors compared to nonsurvivors at 28 days (p<0.001). Higher serum total leptin was independently associated with survival at 28 days (enrollment HR 0.86, p=0.03; one week after HR 0.77, p<0.001). Higher kinetics of total leptin (but not FLI) was independently associated with survival after adjustment (HR 0.48, p=0.001).

Higher circulating total leptin and its higher kinetics during the first week from sepsis onset independently predict 28 day survival in critically ill patients. Free leptin did not present any additional diagnostic and prognostic value in sepsis.

Higher circulating total leptin and its higher kinetics during the first week from sepsis onset independently predict 28 day survival in critically ill patients. Free leptin did not present any additional diagnostic and prognostic value in sepsis.

COVID-19 is associated with elevated levels of inflammatory cytokines. We present the characteristics and outcomes of patients treated in the intensive care unit (ICU) with immunosuppressive drugs, either tocilizumab or anakinra compared with controls.

A Single-center observational prospective study on ICU invasively ventilated COVID-19 patients. The primary outcome was the clinical improvement at day 28. A Bayesian framework was employed and all analyses were adjusted for confounders.

Sixty-one consecutive invasively ventilated patients were included, nine (14∙7%) received tocilizumab and 15 (24∙6%) received anakinra. Over the first seven days, tocilizumab was associated with a greater decrease in C-reactive protein (p<0∙001). After adjusting for confounders, the probability of clinical improvement at day 28 compared to control was 7∙6% (OR, 0∙36 [95% CrI, 0∙09-1∙46]) for tocilizumab and 40∙9% (OR, 0∙89 [95% CrI, 0∙32-2∙43]) for anakinra. At day 28, the probability of being in a better clinical category was 2∙5% (OR, 2∙98 [95% CrI, 1∙00-8∙88]) for tocilizumab, and 49∙5% (OR, 1∙00 [95% CrI, 0∙42-2∙42]) for anakinra.

In invasively ventilated COVID-19 patients, treatment with anakinra was associated with a higher probability of clinical improvement compared to tocilizumab; however, treatment with either drug did not result in clinically meaningful improvements compared with controls.

In invasively ventilated COVID-19 patients, treatment with anakinra was associated with a higher probability of clinical improvement compared to tocilizumab; however, treatment with either drug did not result in clinically meaningful improvements compared with controls.Null.Null.Null.Null.Null.Urology has been separated from its parent generic specialty at different times during the last 150 years in different countries. In Pakistan, from 1947 to 1970s, urology was part of surgery and was done by general surgeons. There were only two urology units from late 1950s to early 1960s. The actual rise of urology started with the introduction of trans-urethral resection of prostate (TURP) in 1980s with the introduction of endourology. Use of cystoscopy and retrograde ureteropyelography was in vogue much before TURP. The second era of modern endourology began with the introduction of percutaneous nephrostomy, ureteroscopy along with ESWL, and percutaneous nephrolithotomy in late 1980s and 1990s. Renal transplantation started in 1979 from living-related donors in public sector hospitals. Now, there are 19 centres in the country performing regular renal transplantions. read more Urology has undergone a dramatic change during the new millennium. There have been sub-specialties in urology, like paediatric urology, endourology, reconstructive urology, uro-oncology, laparoscopic and robotic urology. At present, there are 11 specialised kidney centres and institutes of urology in the country and 25 recognised urology centres for FCPS. More such centres and replication of the SIUT model is expected in Pakistan. Key Words Urology, Endourology, Transplantation, Pakistan.Long-term caregiving is a difficult job, risking mental health of involved individuals. This study was planned to document magnitude of the problem at Pak Emirates Military Hospital, Rawalpindi, with an aim to improve quality of life in caregivers and patients alike. From January to June 2019, caregivers accompanying haemodialysis patients were selected using consecutive sampling technique. Those unwilling were excluded. Psychological burden was assessed using Zarit Burden Interview (ZBI) questionnaire. There were 98 caregivers, including 71 (72.45%) males and 27 (27.55%) females, aged 33.13 ± 9.98 years. There was little/ no burden in 27 (27.55%) caregivers; 52 (53.06%) had mild to moderate, 18 (18.37%) had moderate to severe and 3 (3.06%) had severe psychological burden. Mean ZBI score was 30.00 ± 12.57. Males had lower scores than females (28.01 ± 11.18 vs. 35.22 ± 14.65, respectively; p= 0.026). Gender of caregivers significantly predicted ZBI scores; while their age, job status, education, monthly income and duration of caregiving did not. Key Words Caregivers, Chronic kidney disease, Haemodialysis, Long-term care, Psychological burden.Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words Atresia, Neonates, Bowel segments, Anastomosis.A descriptive cross-sectional survey was done from January to June 2018 in welding shops of Rawalpindi city, Pakistan. The objectives of the study were to determine the frequency of topical ocular anesthetic use among welders and to assess the knowledge and practices of welders regarding safety measures. One hundred and fifty-eight welders from age group of 20 years and above, having welding work experience of more than one year, were included in the study. The sampling strategy was non-random convenient sampling. A pretested structured questionnaire was used to collect data. Topical ocular anesthetic use among welders was found to be 45.6%. Statistically significant association was found between knowledge and practices of welders regarding their safety measures (p less then 0.05). On binary logistic regression, work experience was found to be the strongest predictor of good knowledge (OR = 4.15, 95% CI = 1.45 - 12.15) and practices (OR=10.46 95% CI = 2.92 - 37.51). Key Words Welder, Topical anesthetic abuse, Knowledge, Practices, Perceptions.Hypersensitivity pneumonitis (HP) is a rarely diagnosed interstitial lung disease with variable manifestations. It results from repeated inhalation of certain antigens, e.g. mold, avian antigen, etc. in susceptible patients. The diagnosis is made by exposure history, relevant clinical presentation, and specific radiologic features. It is treated by avoidance of triggers and use of corticosteroids. We report a 7.5-year girl with HP. She was admitted for cough and severe respiratory distress. Key Words Hypersensitivity pneumonitis, Antigen, Allergy, Child.Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. link2 Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with β-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words Rhabdomyolysis, β-haemolytic Streptococci, Creatine phosphokinase, Liver function tests.Sulphamate drugs, widely prescribed for various systemic conditions, are reported to have rare ocular adverse-effects, usually within weeks of initiation of treatment. Medical and drug history in such cases are of pivotal importance in reaching a proper diagnosis. This study reports three cases, which developed topiramate-induced ocular side effects. In one of the cases, although the angles were narrow in both eyes, yet intra-ocular pressure (IOP) was not high. Also, in the third case, there were no macular striae. link3 Topiramate was immediately withheld and all cases were improved without any permanent ocular damage. Key Words Sulphamate, Topiramate, Angle closure glaucoma, Myopia.To optimise the diagnosis and treatment of primary renal leiomyosarcoma, we present our experience with a similar case and review the literature. A 49-year woman was incidentally found to have a palpable mass in the right kidney. CT scan revealed an enhancing, heterogeneous, 6×7×9 cm right renal mass. On suspicion of renal carcinoma, a right radical nephrectomy was performed. The pathological diagnosis was primary renal leiomyosarcoma. After 40 months of regular follow-up, local recurrence was found, and she had liver metastases. She died of cachexia due to tumor metastasis, and the survival period was just 44 months. With unobvious clinical manifestations, preoperative imaging and postoperative pathological examination might be helpful for an accurate diagnosis. Radical nephrectomy to completely remove the tumor is recommended, and the combination of neoadjuvant or postoperative therapy should also be considered. Key Words Renal neoplasms, Leiomyosarcoma, Diagnosis, Therapy.