Venous thromboembolism [VTE]: risk assessment in hospitalized patients

To determine the number of hospitalized patients at risk for developing venous thromboembolism [VTE] / deep vein thrombosis [DVT], identifying the most common risk factor and to document the use of thromboprophylaxis. Observational and cross-sectional study. Chandka Medical College Hospital, Larkana, from October to December 2011. A total of 170 patients underwent this study and these included 51 [30%] from general medical, and 119 [70%] from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest Physicians- ACCP. Out of 170 patients, 91 were male and 79 female with mean age of 39 +/- 16 years. According to ACCP criteria for VTE risk assessment, 20% [n=34] patients were identified to be at low risk, 20% [n=34] at moderate risk, 47.65% [n=81] at high risk and 12.35% [n=21] at very high risk of developing VTE. The commonest risk factor significantly identified was immobility [54.7%, p < 0.005], followed by advancing age [41.17%, p < 0.005] and obesity [18.23%]. The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% [n=98/119] and in medical patients advancing age 45% [n=23/51]. Only 6 [3.5%] patients received thromboprophylaxis, all were surgical patients of very high-risk category. Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis

Diagnostic validity of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Spontaneous bacterial peritonitis [SBP] is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis [SBP] is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate, so early diagnosis and treatment of SBP is therefore necessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Objectives were to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. This cross-sectional, validation study was conducted from January 2009 to June 2009 at Medical Unit-II, Chandka Medical College Hospital Larkana. All the Patients with cirrhosis and ascites of either gender were included in this study. Paracentesis were performed on admission. The ascitic fluid obtained at bedside was immediately tested with reagent strip Multistixregistered 10 SG. Ascitic fluid was then analysed for PMN cell count. The result of reagent strip was compared with ascitic fluid PMN cell count for determination of sensitivity, specificity, PPV and NPV of the test, while taking ascitic fluid PMN count >/= 250/mm[3] as standard for diagnosis of SBP. Leukocyte esterase dipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative test result. Total ninety four patients were enrolled in this study. Ninety-four Ascitic fluid samples were obtained. SBP was diagnosed in 52 [55.3%] patients, 42 [44.7%] patients were negative for SBP by manual cell count. The sensitivity, specificity, PPV, NPV of leukocyte esterase dipstick test to diagnose SBP were 92%, 95%, 96%, 90% respectively. The leukocyte esterase dipstick test can be used as rapid test for diagnosis of SBP due to its high diagnostic validity

Jaundice with hepatic dysfunction in P.faldparum malaria

To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium [P.] falciparum malaria in adult patients admitted in the hospital. Descriptive study. The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007. This study included 105 adult patients who fulfilled the inclusion criteria. The diagnosis of P.falciparum malaria was confirmed by examination of thin and thick film stained with Leishman's stain. Other laboratory investigations included full blood count, liver function tests, blood urea, electrolytes, serum creatinine, reticulocyte count, blood sugar, viral hepatitis serology and coagulation profile. Patient with significant clinical/biochemical hepatic dysfunction were also subjected to ultrasonic examination of abdomen. On clinical examination, 23% patients were found to be jaundiced. Serum alanine amino transferase [ALT] level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% [p <.0001], thrombocytopenia 91.6% vs. 65% [p <.01], anemia 70.8% vs. 25% [p <.05] and renal impairment 50% vs. 20% [p >.05]. Overall, 5 [4.7%] patients died and mortality rate was high among the patients with bilirubin level >3mg/dl than with normal bilirubin level 4 [16.6%] vs 1 [5%]. Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis [ALT >/= 10 times of normal level]. It indicates severe illness with high frequency of complication and mortality rates

Cornell product index for left ventricular hypertrophy. Does it perform better?

To determine the sensitivity and specificity of Cornell product index for left ventricular hypertrophy with reference to echocardiography. Descriptive study. Medical Unit 111, Jinnah Post-graduate Medical Centre Karachi. June 1998- February 1999. 50 patients with echocardiographic left ventricular hypertrophy [LVH] and 25 normal healthy persons without echocardiographic LVH were included in this study. All patients and control subjects were examined clinically and their ECGs were taken on that same day. Echo LVH was defined if Left Ventricular Mass Index exceeded 118 g/m2 in males and 104 g/m2 in females. Data was preserved and now it is analyzed for Electrocardiographic LVH in view of Cornell voltage and Cornell product index. Sensitivity and specificity was calculated by standard formula and P value derived by chi square test. 50 patients which were included in the study, 21[42%] were male and 29 [58%] were females; while 25 healthy persons without LVH, 12 [48%] were males and 13 [52%] were females. Cornell voltage criterion was having sensitivity of 48% as over-all, 48% in males and also 48% in females. It was 96% specific. Cornell product index was the higher sensitive criteria by scoringing 57% in males, 62% in females and 60% in all patients. Although electrocardiography is less sensitive than echocardiography, but can perform better in certain groups and with improved criterion. Cornell product criterion has the highest sensitivity as compared to other criteria

Diabetes mellitus [diagnosed and undiagnosed] in acute myocardial infarction

To determine the proportion of Diabetes Mellitus [DM] in patients with documented first episode of Acute Myocardial Infarction [AMI], in both genders. A prospective, case control observational study. Emergency Room, CCU and Medical wards of Chandka Medical College Hospital Larkana, Pakistan, from January 2005 to August 2005. 200 patients 100 consecutive males and 100 consecutive females, presenting with definite first episode of AMI. Diagnosis of D.M established on previous history of D.M, medical record and medications used by patient, patients without previous diagnosis of D.M [Undiagnosed], were diagnosed by performing Fasting Plasma Glucose [FPG], once within around 72 hours and 8 weeks later on. Out of 200 patients 49 [24.5%] were known diabetics, 20 [10%] revealed hyperglycemia [suspected diabetics] on routine plasma glucose level and Fasting Plasma Glucose [FPG] petformed within 72 hours of the onset of AMI and on subsequent follow up after 8 weeks, FPG level performed revealed 12 [6%] newly diagnosed definitive diabetics, while 5 [2.5%] revealed Impaired Glucose Tolerance Test [GTT] and 3 [1.5%] were found to be non-diabetics, so that a total 61 [30.5%] were labeled as diabetics. one out of every three patients with AMI had DM, elevated levels of random blood glucose and FPG at the time of admission are not reliable measures to establish the diagnosis of diabetes in cases of AMI and thus follow up measurements after a period of 6-8 weeks are necessary to establish the diagnosis. Awareness in general public regarding deleterious effects of DM should be promoted