Incidence of venous thromboembolism in cancer patients treated with cisplatin based chemotherapy - a cohort study

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals.Results: The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4±10.7years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 - 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 - 6.8) compared to the control group.CONCLUSION: A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens

Clinical outcome of post placental IUD CuT380 insertion in terms of expulsion

Background: Insertion of an intrauterine contraceptive device (IUD) immediately after delivery has been recommended by the World Health Organization (WHO), as one of the safe and effective methods of temporary contraception. In the immediate post delivery period the women are highly motivated and need an effective method for contraception so that the child can be brought up with a relaxed mind without the worry of unintended pregnancy. This approach is more applicable to our country where delivery may be the only time when a healthy woman comes in contact with health care personnel. However, immediate post-partum IUD insertion may have disadvantages as well. The risk of spontaneous expulsion may be unacceptably high.Methods: After taking approval from hospital ethical committee, all women planning vaginal delivery desiring IUD, admitted through OPD and emergency were evaluated in detailed on design Performa Performa include patient’s identity, age, parity, gestational age, no of alive children, outcome and timings of insertion. Informed consent was obtained. With aseptic precautions IUD was inserted with kellys forceps in the uterine cavity up to the fundus, then cervix was examined for thread (that should not be visible at cervix if proper insertion done). The procedure was performed by myself. Patients were followed at 6week by examining the threat of IUD. All the information was recorded by myself. Follow up was done by taking patients contact number.Results: In our study, out of 300 cases, 63.67% (n=191) were between 18-30 years of age while 36.33% (n=109) were between 31-40 years of age, mean+sd was calculated as 29.49+4.62 years, mean gestational age was calculated as 38.53+0.94 weeks, mean parity was calculated as 3.49+1.06 paras. Frequency of expulsion in post placental intra uterine device cuT 380 insertions reveals in 8.67% (n=26).Conclusions: We concluded that the frequency of expulsion in post placental intra uterine device cuT 380 insertions is not significantly higher and appears to be safe and effective method of contraception.

Determine the frequency of peripartum hystrectomy in placenta previa

Background: Peripartum hysterectomy is one of the life saving procedure performed after vaginal delivery or caesarean birth or in the immediate postpartum period in cases of intractable haemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the haemorrhage. The objective of the study was to determine the frequency of peripartum hysterectomy in placenta praevia.Methods: The study was cross-sectional. It was conducted at the Department of Obstetrics and Gynaecology, Punjab Medical College and affiliated Hospital, Faisalabad. Study was carried out over a period of six months from October 2010 to March 2011. Total 130 cases of placenta praevia undergone caesarean section were included in this study. In cases of primary postpartum haemorrhage conservative management was done first in the form of intramuscular syntometrine (Oxytocin 5 IU/ergometrine 0.5 mg). Intravenous infusion syntocinon (40 IU in 500ml 0.9% saline over 4-6 hours).Results: Mean age of the patients was found to be 30.9±6.7 years. Distribution of cases by gestational age shows, 52 (40.0%) patients had gestation of 28-36 weeks and 78 (60.0%) patients had gestation of 37-41. Mean gestational age was observed 37.5±3.4 weeks. Parity distribution was as follows: 76 (58.5%) patients had parity 0-3, 34 (26.1%) patients had parity 4-6 and 20 (15.4%) patients had parity > 6 with mean parity of 3.2±1.9. Conservative management was done in 129 patients (99.3%). Peripartum hysterectomy was found to be in 1 patient (0.7%).Conclusions: Placental pathology is the leading cause of postpartum hemorrhage and the main indications of peripartum hysterectomy. Timely operation minimizes the morbidity and mortality

Knowledge attitude and practices of undergraduate students regarding first aid measures

OBJECTIVES: To assess knowledge, attitude and practices of first aid measures in undergraduate students of Karachi. METHODS: A cross-sectional study was carried out at six colleges of Karachi, three of which were medical colleges and three non-medical colleges. Knowledge was assessed regarding various emergency situations with the help of a questionnaire. The target population size was 460, based on 50% prevalence and 95% confidence interval. The eventual sample size achieved was 446. RESULTS: A total of 446 students were interviewed. Seventy eight students (17.5%) had formal First Aid (FA) training. The mean number of correct answers of students with FA training was 10.3 (+/- 3.5) as opposed to 8.58 (+/- 4.0) in those without FA training (p \u3c 0.001, 95% CI) with a mean difference of 7.84%. The mean number of correct answers by medical students with FA training was 11.2 (+/- 2.9) as opposed to 7.2 (+/- 3.43) by non-medical students (p \u3c 0.001, 95% CI) with a mean difference of 18.14%. Students having received formal first aid training scored better than those who had not (p \u3c 0.001). CONCLUSION: First aid training programmes should be introduced at school and college level in developing countries to decrease the early mortality and morbidity of accidents and emergencies

Incidence of Venous Thromboembolism in cancer patients treated with Cisplatin based chemotherapy \u2014 a cohort study

Abstract Background Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents. Methods Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals. Results The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4\u2009\ub1\u200910.7\ua0years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 \u2013 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 \u2013 6.8) compared to the control group. Conclusion A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens