clinical audit on venous thromboembolism prophylaxis of medical patients in west medical ward, Mayo Hospital

To reduce risk of Deep Venous Thrombosis/ Pulmonary Embolism in an acutely ill hospitalized medical patient and the consequent clinical complications. The study was carried out in the West Medical Unit of Mayo Hospital, Lahore from January, 2005 to May, 2005. A total of 100 cases were selected from the patients hospitalized in the ward on the basis of presence of risk factors with no contraindications to heparin prophylaxis, taking into account the age, gender, final diagnosis of the patient, the existing risk factors, the risk stratification, the exclusion criteria, whether heparin prophylaxis was given or not, if given type of heparin administered, and whether patients receiving prophylaxis were monitored or not using Platelet Count, APTT or other monitoring techniques. 19 cases were under Moderate Risk of developing Venous Thromboembolism [VTE] and 81 cases were under High Risk. 7 received Heparin prophylaxis. 3 of them were at Moderate Ri sk and 4 cases at High Risk of developing VTE. All acutely ill medical adult patients admitted should be adequately assessed and screened for presence of Risk Factors and categorized according to the SAVE Risk Stratification. In the absence of Exclusion factors, all cases of High Risk and Moderate Risk should be started on Heparin Prophylaxis as early as possible in hospital admission. The audit should be repeated for re-evaluation after adequate time

Bone mineral density measurement in a medical camp to identify osteopenic and osteoporotic subjects

To identify osteopenic and osteoporotic subjects through bone mineral density measurement. Design: An observational, cross sectional study, carried out in a relatively affluent community, both below and above 40 years of age, in both sexes. Settings: In a medical camp held under the supervision of the medical specialists. Main outcome measures: Bone Mineral Density [BMD] was assessed on all the subjects by SAHARA ultrasound bone densitometer on right calcaneus. Sixty subjects were studied, out of these 35[58.3%] were females and 25[41.7%] were males. The age range was 16 - 80 years with the mean of 46.95 +/- 18.61. Out of sixty subjects 17 were below 40 years and 43 were above the age of 40. Daily milk intake was in the range of 25-750 ml/day with the mean of 166.82 +/- 137.10. Symptoms of difficulty in getting up from floor, bone pains, cramps, body aches and pains were more prominent amongst subjects above the age of 40 years. BMD, in males below 40 years was in the Range of -3.20 +/- 2.80 with the mean of 0.125 +/- 1.66 and in females was in the Range of -2.80 +/- 2.00, with the mean of 0.266 +/- 1.34. In subjects above 40 years, amongst males it was in the Range of -3.00 +/- 3.00, and mean of -0.1720 +/- 1.532 and females in the Range of -3.50 +/- 1.70 with the mean -0.8057 +/- 1.364. In subjects understudy 30/60 [50%] had normal BMD, 20/ 60 [33.4%] were osteopenic and 10/60 [16.6%] were osteoporotic. In patients over 40 years of age 29/43[67.44%] were either osteopenic or osteoporotic. BMD is a simple noninvasive but expensive tool which can help in identifying osteopenic and osteoporotic subjects in both genders. It is expected that the problem is much more in the poor and malnourished community. Early detection of potential and at risk individuals and their timely and appropriate treatment can reduce the stresses of mental, physical and financial nature. Strategies need to be developed to encourage modifications of all risk factors for osteoporosis early in life

Portal hypertension

Portal Hypertension is a common cause of mortality and morbidity in our hospitals. Most of the literature which has originated from Western countries indicate the aetiology of Portal Hypertension as cirrhosis in the majority of patients. Studies from India show that almost one third of patients with portal hypertension have non-cirrhotic portal fibrosis. They are relatively of younger age group, have got massive splenomegaly with features of hypersplenism and near normal liver function tests. Variceal bleeding is a very common presentation. It is possible that similar disease pattern may exist in our population. However, very little work has been done on this subject and it is necessary to find out the incidence of Non-Cirrhotic Portal Hypertension [N.C.P.H.]. Hence a study of the disease in Pakistan is mandatory