Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients.

OBJECTIVES: Pulmonary embolism (PE) is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs) were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG) analysis and D-dimer in predicting PE in cancer patients. METHODS: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs) were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE) and CTPA negative (PE excluded). Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. RESULTS: Of the total of 104 individuals who had CTPAs, 33 (31.7%) were positive for PE and 71 (68.3%) were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030). Clinical prediction rules showed good sensitivities (88-100%) and negative predictive values (93-100%). An alveolar-arterial (A-a) gradient > 20 had 100% sensitivity and negative predictive values. CONCLUSIONS: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

Bone mineral density level by dual energy X-ray absorptiometry in rheumatoid arthritis.

OBJECTIVE: To observe the level of bone mineral density by Dual Energy X-ray Absorptiometry in rheumatoid arthritis patients. METHODS: The observational study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from January 2011 to December 2014. Bone mineral density was measured from the femoral neck, ward's triangle and lumbar spine, in patients 25-55 years of age, who were diagnosed with rheumatoid arthritis. All the cases were assessed for bone mineral density from appendicular as well as axial skeleton. Data was collected through a designed proforma and analysis was performed using SPSS 21. RESULTS: Of the 229 rheumatoid arthritis patients, 33(14.4%) were males. Five (15.1%) males had normal bone density, 14(42.4%) had osteopenia and 14(42.4%) had osteoporosis. Of the 196(85.5%) females, 45(29.9%) had normal bone density, 72 (37.7%) had osteopenia and 79(40.30%) had osteoporosis. Of the 123(53.7%) patients aged 30-50 years, 38(30.9%) had normal bone density, 59(48.0%) had osteopenia, and 26(21.1%) had osteoporosis. Of the 106(46.3%) patients over 50 years, 12(11.3%) had normal bone density, 27 (25.5%) had osteopenia and 67(63.2%) had osteoporosis. CONCLUSIONS: Osteoporosis and osteopenia were most common among rheumatoid arthritis patients. Assessment of bone mineral density by Dual Energy X-ray Absorptiometry can lead to quick relief in the clinical symptoms with timely therapy.

Adverse fetomaternal outcome among pregnant overweight women.

OBJECTIVE: To compare the adverse fetometernal out come in overweight and normal weight pregnant women. METHODS: This comparative cohort study was conducted from 1(st) October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI (25 - 29.9 Kg/m(2)) were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. RESULTS: The age range was between 30 to 45 years with mean age of 30±4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia (27% versus 9% in controls), PIH (24% versus 8% in controls), gestational diabetes mellitus (22% versus 5% in controls), prolonged labour (4% versus 6% in controls), Caesarean section (44% versus 16% in controls), Wound infection (3% versus 2% in controls) and Postpartum Hemorrhage (5% versus 2% in controls). P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth (13% versus 2%), Early neonatal death (11% versus 1%), shoulder dystocia (5% versus 1%) and NICU admission (47% versus 10%). Results were statistically significant except shoulder dystocia. CONCLUSION: We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome.

An unusual presentation of endobronchial Hodgkin's lymphoma.

Endobronchial involvement of Hodgkin's lymphoma is a rare presentation of the disease. However, it needs to be considered in patients presenting with non-resolving pneumonia in the setting of Hodgkin's disease. In such cases, clinicians need to ensure adequate and multiple biopsies as patients may have co-existent pulmonary infection and disease involvement. A 16 years old patient reported with a history of relapsed Hodgkin's disease, with bilateral pulmonary infiltrates, that failed to resolve after empiric antibiotic therapy. Positron Emission Tomography (PET) scan was performed demonstrating equivocal uptake in left upper lobe. Bronchoscopy revealed a necrotic endobronchial mass. Initial biopsy only revealed necrotic inflammatory debris, however, since the patient continued to lose weight, repeat biopsy was performed which demonstrated CD 30 positive Hodgkin's lymphoma cells.

Bone mineral density in patients with chronic backache.

OBJECTIVE: To evaluate the association of bone mass density with chronic backache. METHODS: The case-control observational study was conducted at Bone Mass Density Assessment Unit, Liaquat University of Medical & Health Sciences Jamshoro from January 2011 to December 2013. Adult patients of either gender having chronic backache were studied alongside subjects without backache who served as the control group. Bone mass density of all patients was measured at the lumbar spine (L1-L4) and hip using a dual-energy X-ray absorptiometry scan. Association of chronic backache with age, gender, body mass index and bone mass density was assessed by performing multiple regression analysis. RESULTS: Of the 482 subjects in the study, 162(33.6%) were cases and 320(66.3%) were the controls. Overall age range was 20-78 years with a mean of 48.5±12.36. The mean age of the controls was 38.87±13.55, while for the cases it was 36.26±9.41. Bone mass density in the cases was significantly low compared to the controls (p-0.028). CONCLUSIONS: Severity of chronic backache could be predicted by low bone mass density.

Impact of Training on General Practitioner's Knowledge, Attitude and Practices Regarding Emergency Contraception in Hyderabad.

OBJECTIVES: To elaborate the impact of family planning training on general practitioners' knowledge, attitude and practices regarding emergency contraception. METHODS: A cross sectional survey involving 270 general practitioners was conducted in Hyderabad from 1(st) Oct to 31(st) Dec 2010. Participants were divided into two groups on the basis of attending family planning training course after graduation and were interviewed face to face. Data was noted on questionnaire asking their knowledge, attitude and practices regarding emergency contraception. Data was analyzed on SPSS version 11. Student t-test was applied to compare the proportions among two groups. RESULTS: Out of 270 general practitioners, male & female participants were 132 (48.9%) and 138 (51.1%) respectively. Mean experience as private general practitioner was 7.48 + 7.6 years. One third of the participants 84 (31.1%) have attended five days training course on family planning in the past, while 186 (69.9%) did not have any training. Source of training was government institutes 46(17%) and non government organization in 38 (14.1%) cases. Significant positive difference was noted on emergency contraception knowledge, attitude and use in group who attended family planning training. CONCLUSION: Educational intervention has a positive impact on health care provider's knowledge, attitude and practices of emergency contraception.