ABSTRACT
Objectives: Pulmonary embolism [PE] is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules [CPRs] were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas [ABG] analysis and D-dimer in predicting PE in cancer patients
Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms [CTPAs] were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive [patients with PE] and CTPA negative [PE excluded]. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs
Results: Of the total of 104 individuals who had CTPAs, 33 [31.7%] were positive for PE and 71 [68.3%] were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE [68.1 mmHg vs. 71 mmHg, p = 0.030]. Clinical prediction rules showed good sensitivities [88?100%] and negative predictive values [93?100%]. An alveolar-arterial [A-a] gradient > 20 had 100% sensitivity and negative predictive values
Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results
ABSTRACT
To investigate the effect of malarial infection during pregnancy on the newborn. A retrospective cohort study was conducted at The Aga Khan University Hospital [AKUH], Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight [LBW] and intrauterine growth retardation [IUGR] in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period. Pregnant women with malaria had a 3.1 times greater risk of preterm labor [p=0.14]. They were more likely to be anaemic compared to women without malaria [RR=2.9, 95% CI=1.6-5.4] and had a significantly lower mean haemoglobin level [p=0.0001]. Maternal malaria was significantly associated with LBW babies [p=0.001]. The mean birth weight of infants born to pregnant women with malaria was 461 g less [p=0.0005]. No significant association was, however, found between malarial infection during pregnancy and IUGR [p=0.33]. Malarial infection during pregnancy is associated with poor maternal and fetal outcome. It is significantly associated with maternal anaemia and LBW infants. Appropriate measures must, therefore, be taken to prevent malaria during pregnancy, especially in endemic areas