Improvement in the pattern of advice of investigations following rationalization campaign

To assess the magnitude of change in advising pattern of laboratory and radiological investigations during and after campaign emphasizing rational use of these tests. Comparative cross sectional study. Combined Military Hospital Peshawar, Twenty seven months. The laboratory investigation analysis were Blood Glucose, Thyroid Function Tests, Liver Function Tests [LFT], Renal Function Tests [RFT] and Cardiac Markers and radiological tests were X-Rays Chest, Skull, Wrist and Plain Abdomen, Obstetric Ultra Sound [USG] and CT Scan. The awareness was done by Lectures, handouts, feedback advice on test reports and personal communications to the Medical Officers, Nursing Officers and Paramedical Staff. The data was analyzed through Quarterly Returns, records of laboratory and radiology retrieved from Hospital Information System and departmental registers. In some laboratory investigations there was a significant improvement in the advisory pattern e.g. blood glucose fasting instead of random, ALT instead of whole LFT, electrolytes not included in every RFT and abolishing of AST and LDH from cardiac marker profile and TSH only as screening test. In Radiology there was improvement in the rationality of X-Ray chest, X-Ray skull, X-Rays wrist and obstetric USG. CT scan data could not be compared because CT Scan equipment became out of order during the study. There was also reduction in expenses incurred on irrational investigations. A dynamic ongoing process of awareness and realization campaign for medical professionals is required in any public sector medical institute for cultivating a culture of rational use of investigations

Frequency of placenta accreta on doppler studies in patients with previous caesarian section

To determine frequency of placenta accreta in patients with previous Caesarian section on Doppler ultrasound examination. A descriptive study. The study was conducted in Radiology Department CMH / MH Rawalpindi which is a tertiary care hospital from April 2006 to February 2007. All patients who were pregnant and had previous LSCS were included in our study. The patients were included on the basis of Non-probability convenience sampling. Patients who had all previous normal deliveries were not included in our study. The method adopted on Doppler ultrasound studies placenta accreta in patients with previous caesarian section was confirmed in the first trimester if sac was low lying and attached to anterior wall of uterus with little or no myometrium between sac and bladder. In the second and third trimester visualization of multiple irregular vascular spaces/ sinuses within placenta and visualized vascular bundles leaving the placenta and reaching lower part of bladder was diagnostic of accreta. We found the frequency of placenta accreta in patients with previous caesarian deliveries to be 3% [3/100] in CMH / MH Rawalpindi which is almost consistent with other studied performed in Pakistan and abroad. Out of 100 selected patients 3 were given suspicion of accreta on Doppler studies and confirmed to have accreta by our obstetrician and hysterectomy was done. Placenta accreta is a life threatening condition with increase risk to mother morbidity and mortality. Doppler ultrasound is a reliable radiological technique to diagnose placenta accreta

Diagnostic accuracy of doppler ultrasound in comparison with venography in the diagnosis of varicose veins of the legs

To determine the diagnostic accuracy of Doppler ultrasound in the diagnosis of varicose veins of legs using venography as gold standard in picking up deep vein thrombosis. Prospective validation study. Place and Duration of study: Six months, 01 Apr -30 Sep 2006 at Radiology Department, Combined Military Hospital, Quetta. Fifty cases were included in study, fulfilling the inclusion and exclusion criteria. The patients sampled were referred by surgeons from out patients department. The sensitivity of Doppler was 75%, specificity 100% and accuracy 98% in picking up deep venous thrombosis [DVT]. For the detection of incompetent perforators/reflux disease, at spheno-femoral junction the sensitivity of Doppler ultrasound was 85.7%, specificity 95% and accuracy 94%. At spheno-popliteal junction the sensitivity of Doppler ultrasound was 70%, specificity 100% and accuracy 76%. Patients with varicose veins of legs should be evaluated first with Doppler ultrasound. Venography remains the examination of choice when absolute determination of the presence and extent of thrombus is needed, for the determination of the reflux disease level in obese patients, in patients with severe leg edema or in patients in whom results of Doppler ultrasound is equivocal or negative in the settings of high clinical suspicion