Thromboprophylaxis; pregnant women with high body mass index

Maternal obesity [body mass index, BMI >/= 30kg/m[2]] is a global health problem. Significant evidence is available that it is directly associated with an increased risk of venous thromboembolic events in pregnancy and puerperium. This study aims to assess our current management protocols for thromboprophylaxis and to improve them according to guidelines recommended by The Royal College of Obstetricians and Gynecologists [RCOG]. Retrospective study. September 2005 to December 2006. In this study we did a retrospective first audit cycle to evaluate the existing thromboprophylaxis management in women with high BMI [>/= 30] in our hospital. The aim was to check our compliance with RCOG recommendations and to introduce change in accordance with RCOG guidelines. In first loop of audit cycle 120 pregnant women with BMI of more than 30 were evaluated.52 [43.3%] of them had no objective assessment done during antenatal period with no instructions regarding thromboprophylaxis. 3 of these patients developed Deep vein thrombosis [DVT]. Change in practice was introduced based on findings of first loop of audit. In re-audit 120 pregnant women were reviewed with BMI of >/= 30. Ninety eight[81.6%] women received Thromboprophylaxis, 22 [18.3%] did not receive thromboprophylaxis, none of them had any thrombotic or embolic complications. Detailed objective assessment of obese pregnant women for thromboprophylaxis should be implemented in our clinical practice according to the recommendations of NICE and RCOG guidelines

Musculoskeletal injuries by bone setters

To highlight, evaluate and analyze the complications associated with the treatment of fractures, joint dislocations and limb deformities by bone setters in a suburban population of district Kasoor. Prospective descriptive study. This study was conducted at the Department of Trauma and Orthopaedics, Central Park. Medical College based at Bhatti International Teaching Hospital, Kasoor. This was a six month prospective study involving eighty six [86] consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. Eighty six patients with complications associated with previous treatment by bone setters were seen 62.7 [%] were male while 37.2 [%] were female. The age range from 4 months to 76 years [mean 34 years]. out of eighty six patients, 15 [17.4%] patients had non union, 21 [24.4%] had malunion, 9 [10.4%] had avascular necrosis, 15[17.4%] had chronic osteomyelitis, 4[4.6%] patients had gangrene, 8[9.3%] had contractures, 2[2.3%] had persistent dislocations, 4[4.6%] had Leg ulcers and 8[9.3%] had wound infections. The major reasons for going to bone setters were the perceived low cost of treatment [45%], pressure and advice from the elders and friends [38%], fear of surgery [5%] and assumption of faster healing by the bone setters [12%]. The methods used by the bone setters include splintage, bandage, plaster, stretching, massage and suturing. Bone setters create very difficult problems for orthopaedic surgeons. Many patients develop complications and loose their limbs due to inappropriate treatments. Awareness programs regarding inadequate treatment given by bone setters are necessary and their Patronization should be discouraged to avoid these types of complications