Updated recommendations for the diagnosis and management of osteoporosis: a local perspective

Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis-after excluding secondary causes-or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate [in the absence of contraindications] is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures

Incidence of complications after cardiac surgery, single unit experience

The objective of this study was to determine the incidence of complications after cardiac surgery in a single unit. This was an observational study. This study was conducted in the department of Cardiac surgery of Civil Hospital Karachi, Dow University of Health Sciences Karachi, over the period of 1 year. This being a prospective, observational study, therefore all patients undergoing cardiac surgery were included in this study, only exclusions being those patients who had redo or reopen procedures. Any complications that took place were noted in the proforma. This study was based on proforma that included patients profile, pre operative investigations, operative data, included date of surgery, type of surgery [whether coronary, valvular or others]. Both intra and post operative complications, like cardio vascular complications, respiratory complications, neurological complications, renal implications, infective complications and miscellaneous complications were noted and entered in the proforma. Over the period of one year, 312 patients have their cardiac surgeries in the department of cardiac surgery, Civil Hospital, Karachi. Over all rate of complications were 118 [37.8%], cardiovascular complications were in 65 patients, neurological in 8 patients, respiratory in 27 patients, renal in 5, infective in 10, and miscellaneous complications in 3 patients. There were two [.6%] mortalities in our study group. This study concludes that cardiac surgery is not free of complications. Therefore it must be done with care and with all the possible supportive measures. The incidence of complications in our unit is about the same as in other renowned centers of the world, but central nervous system complications were less as compared to others, probably related with younger age group of patients in our study