Values of different DIC scoring systems in early diagnosis and prognosis prediction of coagulation dysfunc-tion in sepsis patients / 实用医学杂志

Objective To evaluate five types of DIC scoring systems based on sepsis patients,to explore the values of different DIC scoring systems in the occurrence and prognosis of DIC in sepsis patients,and to compare the applicability of different DIC scoring systems for sepsis complicated with DIC.Methods Laboratory indexes and clinical data from sepsis patients who had been hospitalized in Gansu Provincial People's Hospital from December 1,2019 to December 31,2021 were retrospectively analyzed within 24 hours.Five types of DIC scoring systems were used to score,and the difference of diagnostic rate and discharge outcome in sepsis patients with different severity was compared.The ROC curves of five DIC scoring systems were established to evaluate the accu-racy of DIC in sepsis patients.Results The fatality rate of sepsis increased with the severity of sepsis(P<0.05).There were statistically significant differences in discharge outcomes between DIC and non-DIC in the five scoring systems(P<0.05).JMHW,CDSS and part of ISTH were detected in JAAM cases,while ISTH was detected in non-dominant ISTH cases.ISTH,JAAM,JMHW,CDSS,and non-dominant ISTH5 scoring systems were used to diagnose DIC,and absence of full health restoration and death were 3.0,3.8,4.2,3.9,and 3.0 times higher than non-DIC cases,respectively.Conclusion JAAM scoring system has higher diagnostic rate and sensitivity for adult sepsis.CDSS and JMHW scoring systems are more accurate in predicting the prognosis of sepsis patients.

Thrombocytopenia in pregnancy

Thrombocytopenia is defined as a platelet count of <150x109/l. It is the second most common hematological abnormality during pregnancy. We present a case series of thrombocytopenia in pregnancy. The aim of this study was to evaluate thrombocytopenia in pregnancy at tertiary care center, Bhopal and to identify, treat and assess the maternal complications and neonatal outcome. In a year, 10 cases were evaluated out of which the diagnosis of 3 cases was immune thrombocytopenic purpura, 3 cases of gestational thrombocytopenia, 3 cases of thrombocytopenia associated with hypertensive disorders of pregnancy and 1 case of HBV induced chronic liver disease associated with thrombocytopenia.

A study on thrombocytopenia in pregnancy and feto-maternal outcome conducted at tertiary care center Rajkot, Gujarat

Background: Thrombocytopenia is second only to anemia as the most common hematological abnormality encountered in pregnancy. Better antenatal care has led to increased detection. Once diagnosed, it is Important to further evaluate and to determine the cause to optimize management. The objectives were to study feto-maternal outcome in patient of thrombocytopenia in terms of maternal and neonatal complications and to study the causes of thrombocytopenia in pregnancy.Methods: The present study was a hospital-based study carried out from June 2021 to June 2022 at the department of obstetrics and gynecology, PDU medical college, Rajkot, Gujarat. During this period 100 patients in the third trimester of pregnancy with thrombocytopenia were selected randomly.Results: In this study 41% cases were mild thrombocytopenia, 39% with moderate and 20% were severe cases. 50% cases were gestational thrombocytopenia, 31% were cases associated with hypertensive disorders of pregnancy, 8% cases were associated with abruption, 13% cases were associated with IUFD, 2% cases were idiopathic thrombocytopenic purpura (ITP), 8% cases were associated with viral (dengue) and bacterial (malaria) infection, 1% cases were associated with SLE, 1% cases was thrombotic thrombocytopenic purpura (TTP). Maternal complications were encountered in form of DIC in 13% cases, jaundice in 7% of cases, 2% cases were complicated by PPH, 4% cases were complicated by acute kidney injury, 2% cases were associated with sickle cell crisis and 4% cases were maternal mortality. 12% were stillbirth and 5% cases had neonatal mortality.Conclusions: Thrombocytopenia in pregnancy induced hypertension carries a risk for both the mother and her fetus. Thrombocytopenia in pregnancy if timely diagnosed do not cause any mortality, however management of these patients require a multidisciplinary approach and close collaboration between obstetrician, physician, and neonatologist.

A rare presentation of common tropical fever, scrub typhus-purpura fulminans, lower limb arterial thrombosis and pulmonary artery thrombosis

Purpura fulminans (PF) is an acute emergency condition manifested as purpuric rash secondary to thrombosis of microvasculature. It is rapidly progressive, can cause thrombosis in large as well as small vessels and tissue infarction. Although it is commonly associated with Meningococcal and Streptococcal infections, here we report this case of PF associated with scrub typhus infection. Our patient presented with generalised body rash and progressed to multiorgan dysfunction. On evaluation, common causes of PF were ruled out and eventually patient came out to be IgM scrub typhus serology kit test positive. Lower limb angiography and pulmonary artery angiography revealed vascular thrombosis. The patient started on IV antibiotics, other supportive managements, anticoagulation. Later the patient improved clinically, skin rash resolved with excoriations but developed gangrenous changes in both lower limbs. Hence the uncommon presentation of scrub typhus infection as purpura fulminans needs early identification and effective treatment to achieve mortality and morbidity benefit.

Effect of vertebral or intraspinal abnormalities on the efficacy of posterior correction surgery for sco-liosis with arthrogryposis multiplex congenita / 中国脊柱脊髓杂志

Objectives:To analyze the effect of vertebral or intraspinal abnormalities on the efficacy of pos-terior corrective surgery for scoliosis patients with arthrogryposis multiplex congenita(AMC).Methods:A retro-spective study was conducted on 30 scoliosis patients with AMC who underwent posterior corrective surgery in the Department of Spine Surgery of Drum Tower Hospital between August 2001 and November 2021.There were 18 males and 12 females with a mean age of 15.9±5.8(6-32)years.The patients were divided into ab-normal group(15 cases)and control group(15 cases)according to with or without vertebral or intraspinal ab-normalities.The types of vertebral or intraspinal abnormalities in the abnormal group were recorded,and the number of fusion segments,operative time and intraoperative blood loss were compared between groups.The complications during follow-up were also collected.The flexibility of major curve was assessed on Bending radiographs,and the main curve Cobb angle,the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL),the sagittal vertical axis(SVA),the thoracic kyphosis(TK),and the lumbar lordosis(LL)were measured on the standing whole spine anteroposterior and lateral X-ray images at pre-operation,postoperative two weeks and two years,and the correction rate of major curve was calculated at 2 weeks after surgery and the final follow-up.Results:There were 10 cases of simple poor segmentation(66.6％),2 cases of poor seg-mentation combined with tethered cord(13.3％),and 1 case of poor segmentation combined with arachnoid cyst,simple hemivertebra,and simple wedge-shaped vertebra(6.7％)each in the abnormal group.There were no significant differences between abnormal group and control group in the number of fusion segments,opera-tive time and intraoperative blood loss(P＞0.05).No complication was observed during operation in the abnor-mal group,and 3 complications were observed during follow-up,including 2 cases with screw misplacements and 1 case with thoracic effusion and the right brachial plexus paralysis;5 cases of complications in the control group were observed,including 1 case with malignant hyperthermia and cardiac arrest during the surgery,3 cases with screw misplacements and 1 with thoracic effusion and screw placement failure.The in-cidence of complications was not statistically different between the two groups(P=0.628).The flexibility of ma-jor curve before operation was not statistically different between the two groups(P＞0.05);The major curve Cobb angle,C7PL-CSVL,SVA,TK and LL at pre-operation,post-operative two weeks and 2 months were not statistically different between groups(P＞0.05);The correction rate of major curve at 2 weeks and 2 months after surgery were not significantly different as well(P＞0.05).Conclusions:Vertebral or intraspinal abnormali-ties have no obvious effects on the efficacy of posterior corrective surgery for the treatment of scoliosis pa-tients with AMC,and there is no significant increase in the incidence of intraoperative and postoperative com-plications.

Coagulopatías por consumo en el paciente con cáncer / Consumptive Coagulopathies in the Patient with Cancer

Introducción: Los trastornos de la coagulación durante el perioperatorio de pacientes oncológicos, son eventos más frecuentes de lo que se conoce en realidad, debido a que un gran número de estos transitan de forma inadvertida. Objetivo: Describir los factores fisiopatológicos que propician la ocurrencia de las coagulopatías adquiridas por consumo durante el perioperatorio del paciente oncológico. Métodos: Se realizó una revisión narrativa, en idiomas español e inglés, se utilizaron como fuente de búsqueda las bases de datos Ebsco, SciElo, Pubmed, Cubmed, Hinary, durante el período de enero a marzo de 2022, y el referenciador Zotero versión 5.0. Resultados: Para comprender qué pasa en el paciente con cáncer en relación con las coagulopatías por consumo es necesario entender la fisiología de los mecanismos de la coagulación. En este sentido, se pueden observar tanto trastornos trombóticos como hemorrágicos, por el incremento del factor tisular que determina la formación de trombina y el fallo de los mecanismos antifibrinolíticos. También, factores como la radioterapia, la quimioterapia y la transfusión de hemocomponentes, aumentan el riesgo de padecerlas. Conclusiones: la coagulopatía por consumo en el paciente oncológico es una entidad multifactorial, compleja y dinámica, en la que se debe pensar y diagnosticar para evitar complicaciones graves en el período perioperatorio.

Introduction: Coagulation disorders during the perioperative period of cancer patients are more frequent events than is actually known, due to the fact that a large number of these go unnoticed. Objective: To describe the pathophysiological factors that favor the occurrence of consumption-acquired coagulopathies during the perioperative period of cancer patients. Methods: A narrative review was carried out, in Spanish and English, using the Ebsco, Scielo, Pubmed, Cubmed, Hinary databases as a search source, during the period from January to March 2022, and the Zotero version 5.0 referer. 96.3. Results: To understand what happens in cancer patients in relation to consumption coagulopathies, it is necessary to understand the physiology of coagulation mechanisms. In this sense, both thrombotic and hemorrhagic disorders can be observed, due to the increase in the tissue factor that determines the formation of thrombin and the failure of antifibrinolytic mechanisms. Also, factors such as radiotherapy, chemotherapy and transfusion of blood components, increase the risk of suffering from them. Conclusions: consumption coagulopathy in cancer patients is a multifactorial, complex and dynamic entity, which must be considered and diagnosed to avoid serious complications in the perioperative period.

Evaluation of the International Society on Thrombosis & Haemostasis scoring system & its modifications in diagnosis of disseminated intravascular coagulation: A pilot study from southern India

Background & objectives: Diagnosis of disseminated intravascular coagulation (DIC) rests primarily on the clinical profile along with supportive laboratory tests. The International Society on Thrombosis and Haemostasis (ISTH) had proposed a scoring system for the diagnosis of overt DIC. However, fibrinogen values which are supposed to be low are often found to be elevated due to the associated inflammation seen in some cases. Moreover, peripheral smear is known to show schistocytes, which is also not included in the score. This study was done to evaluate ISTH scoring system and its modifications in suspected DIC. Methods: Fifty-six patients were enrolled for the present study of whom; in four, fibrinogen assay could not be done. Modifications in the ISTH scoring with the exclusion of fibrinogen, i.e. modified ISTH (MI) score and subsequent inclusion of schistocytes, i.e. modified ISTH with schistocytes (MIS) score, were used. The modified scores were analyzed for diagnostic accuracy parameters and agreement with ISTH score. Results: Amongst 56 cases, 9/52 (17.3%), 22 (39.3%) and 17 (30.4%) were diagnosed as positive for overt DIC by ISTH, MI and MIS scores and mortality was 33, 22.7 and 17.6 per cent, respectively. The sensitivity, specificity, positive and negative predictive values for the MI score were 100, 74.4, 45 and 100 per cent and for MIS score were 100, 86, 60 and 100 per cent, respectively. The agreement between MI score and MIS score with ISTH score was moderate [?=0.502, 95% confidence interval (CI): 0.272-0.732, P<0.001] and substantial (?=0.681, 95% CI: 0.45-0.91, P<0.001). Interpretation & conclusions: In the present study, the calculated mortality was highest by ISTH score. Best agreement was between MIS score and ISTH score. In a resource-constrained setup where fibrinogen assay and therefore ISTH score is difficult, it is suggested that MIS score can be considered.

Symmetrical Peripheral Gangrene – A Rare Clinical Manifestation of Hodgkin’s Lymphoma

Symmetrical peripheral gangrene (SPG) is a cutaneous manifestation of a wide array of infective and noninfective etiological factors and occurs due to hypoxemia, vasoconstriction, primary endothelial damage and/or decreased cardiac output. It is a devastating complication of underlying septicemia and disseminated intravascular coagulation (DIC) with a high mortality rate and commonly requiring amputation of the affected limb in those who survive. We here describe a case that presented with fever, cough, blackish discoloration of fingers and generalized lymphadenopathy. Investigation revealed anemia, leukocytosis, coagulopathy and positive D-dimer test. Fine-needle aspiration cytology (FNAC) showed evidence of Hodgkin’s lymphoma.

Deformation Characteristics of Hand Movement During Grasping / 医用生物力学

Objective Based on the multi-camera digital image correlation (DIC) method, the dynamic deformation characteristics of human hand during grasping were studied. Methods A continuous four-camera DIC system was established to measure surface strain of the skin on the back of the hand during grasping process, and then through the connection between skin, joints, bones and muscles, the regular pattern of muscle deformation could be known indirectly. Results Four grasping postures (medium cylinder, lateral pinch, index finger extension, power sphere) were measured. It was found that the increases of strain magnitude were different at different positions on back surface of the hand under different grasping postures, and the maximum principal strains were between 0.1 and 0.3. The movement characteristics for each muscle group of the hand under different grasping postures were obtained through analysis. Conclusions This method has the characteristics of non-contact, full field, intuitive results, which provides a new way for in vivo measurement of dynamic deformation during grasping.

Temporal Hemostasis with Kampo Medicine for Bleeding Due to Enhanced Fibrinolytic Type of Chronic Disseminated Intravascular Coagulation : A Case Report / 日本東洋医学雑誌

A 74-year-old woman presented to our clinic with a history of vascular-and stent-graft insertion for aortic dissection developed a tendency to bleed from a palmar wound due to chronic disseminated intravascular coagulation (DIC). Initially, she sustained the palmar wound due to a fall. On the second day after the injury, she experienced continuous bleeding and consulted the orthopedic department of a general hospital, where her dressing was changed. On the third day after injury, she sought consultation at our clinic. The clot and wound remained intact even 12 days after the injury. Therefore, the clot was removed and the bleeding was stopped surgically. On the same day, 5 hours after the surgical treatment, the patient presented to our clinic because of continuous bleeding. She was then administered kyukikyogaito and kamikihito to stop the bleeding. Her laboratory findings revealed thrombocytopenia, and additional inspection was performed. The bleeding stopped on the next day. On the third day after administration, the bleeding remained controlled and an additional inspection revealed DIC. In the cardiology hospital, the cause of tendency to bleed of chronic DIC was pointed out as being due to a leakage at the end of the stent-graft. Kampo medicine was thought to be useful for temporal hemostasis for bleeding due to chronic DIC.

Layered dissolving microneedles as a need-based delivery system to simultaneously alleviate skin and joint lesions in psoriatic arthritis

Psoriatic arthritis (PsA) is a complicated psoriasis comorbidity with manifestations of psoriatic skin and arthritic joints, and tailoring specific treatment strategies for simultaneously delivering different drugs to different action sites in PsA remains challenging. We developed a need-based layered dissolving microneedle (MN) system loading immunosuppressant tacrolimus (TAC) and anti-inflammatory diclofenac (DIC) in different layers of MNs,

Effect of fatigue load on internal mechanical properties of the intervertebral disc / Efecto de la carga de fatiga en las propiedades mecánicas internas del disco intervertebral

SUMMARY: Lumbar disc herniation is considered to be the main pathological factor for the common clinical disease of low back pain. Biomechanical factor is an important cause of lumbar disc herniation, so it is urgent to analyze the stress/strain behavior of intervertebral disc under different loading condition. Slow repetitive loading is considered to be an important factor of spine and disc injuries, and the effect of fatigue load on internal displacement in the intervertebral disc was investigated by applying the optimized digital image correlation technique in this study. The first finding was that fatigue load had a significant effect on the displacement distribution in the intervertebral disc under compression. Superficial AF exhibited the largest axial displacements before fatigue load, while it exhibited the smallest axial displacements after fatigue load. Inner AF exhibited slightly smaller radial displacements than outer AF before fatigue load, while it exhibited significantly greater radial displacements than outer AF displacements after fatigue load. The second finding was that fatigue load had a certain effect on the internal displacement distribution in the flexed intervertebral disc under compression. Middle AF exhibited the smallest axial displacements before fatigue load, while deep AF exhibited the smallest axial displacements after fatigue load. The radial displacement distribution did not change before and after fatigue load, as the radial displacement in outer AF was the smallest, while the radial displacement in inner AF was the largest. The third finding was that with the increase in fatigue time and amplitude, the Young's modulus of the intervertebral disc increased significantly. This study can provide the basis for clinical intervertebral disc disease prevention and treatment? and is important for mechanical function evaluation of artificial intervertebral disc as well.

RESUMEN: La hernia de disco lumbar se considera el principal factor patológico para la enfermedad clínica común del dolor lumbar. El factor biomecánico es una causa importante de hernia de disco lumbar, por lo que es urgente analizar el comportamiento de esfuerzo / tensión del disco intervertebral bajo diferentes condiciones de carga. La carga repetitiva lenta se considera un factor importante de lesiones de columna y disco, y en este estudio el efecto de la carga de fatiga sobre el desplazamiento interno en el disco intervertebral se investigó mediante la aplicación de la técnica de correlación de imagen digital optimizada. El primer hallazgo fue que la carga de fatiga tuvo un efecto significativo en la distribución del desplazamiento en el disco intervertebral bajo compresión. El AF superficial exhibió los desplazamientos axiales más grandes antes de la carga de fatiga, mientras que exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. El AF interno exhibió desplazamientos radiales ligeramente más pequeños que el AF externo antes de la carga de fatiga, mientras que exhibió desplazamientos radiales significativamente mayores que los desplazamientos AF externos después de la carga de fatiga. El segundo hallazgo fue que la carga de fatiga tenía un cierto efecto sobre la distribución del desplazamiento interno en el disco intervertebral flexionado bajo compresión. El AF medio exhibió los desplazamientos axiales más pequeños antes de la carga de fatiga, mientras que el AF profundo exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. La distribución del desplazamiento radial no cambió antes ni después de la carga de fatiga, ya que el desplazamiento radial en la FA externa fue el más pequeño, mientras que el desplazamiento radial en la FA interna fue el más grande. El tercer hallazgo fue que con el aumento del tiempo de fatiga y la amplitud, el módulo de Young del disco intervertebral aumentó significativamente. Este estudio puede proporcionar la base para la prevención y el tratamiento clínico de la enfermedad del disco intervertebral, y también es importante para la evaluación de la función mecánica del disco intervertebral artificial.

Pregnancy emerged thrombocytopenia: maternal and fetal outcome

Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.Methods: It is a prospective observational study done in a tertiary care centre.Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good.

Review of Pathogenesis of COVID-19: Considerations

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a primary target on the human respiratory system. Coronavirus disease was first discovered in Wuhan, China in December 2019 and has currently become a global pandemic. A lot is still unknown about COVID -19 pathogenesis. Prompt assessment, adequate follow up, test and retest of recovered cases to corroborate immune related considerations will go a long way to understand the pathogenesis

Surgical Strategy for Mitral Valve Infective Endocarditis with Concomitant Cerebral Hemorrhage and Disseminated Intravascular Coagulation Syndrome : Decompressive Craniotomy before Open-Heart Surgery / 日本心臓血管外科学会雑誌

A 51-year-old woman presented with a high fever and weakness and was diagnosed with mitral valve infective endocarditis. Medical treatment was unsuccessful, and the patient developed disseminated intravascular coagulation syndrome, multiple cerebral infarctions, and massive cerebral hemorrhage. She was transferred to our hospital for surgical treatment. On admission, she had motor aphasia and right-sided hemiplegia. Echocardiography showed mild mitral regurgitation with a huge mobile vegetation measuring greater than 20 mm on the anterior leaflets. Head CT showed a huge cerebral hemorrhage in the left frontal lobe. Chest radiography revealed severe pulmonary congestion, and laboratory data showed disseminated intravascular coagulation syndrome. Despite medical treatment, the pulmonary congestion worsened. There were concerns that a fatal cerebral infarction would develop, and so urgent open-heart surgery was performed. On the day after the cerebral hemorrhage had occurred, hematoma removal and decompressive craniotomy were performed to reduce the risks associated with cardiopulmonary bypass. Four days after the craniotomy, mitral valve plasty was performed following the complete excision of the infected tissue. Heparin was administered at our normal dosage as an anticoagulant during cardiopulmonary bypass. Postoperative head CT showed no aggravation of the preoperative cerebral lesion. The patient still had symptomatic epilepsy and difficulty performing exact movements with her right hand, but she was able to walk unaided after 1 year of rehabilitation. Generally, early surgery for infective endocarditis is not recommended if the patient has concomitant cerebral hemorrhage ; our strategy may be the safest option for patients in such a serious condition.

A clinical study on fetomaternal outcome in jaundice with pregnancy

Background: Jaundice in pregnancy and pregnancy in women with preexisting liver disease is not very uncommon. However it takes a major toll on health of both mother and fetus, due to increased morbidity and mortality for both mother and fetus, categorizing pregnancy as a high risk one. The distribution of jaundice in pregnancy varies throughout the world, but is seen more in developing countries. The course and outcome of liver disorder in pregnancy is altered due to various hemodynamic, hormonal and immunological changes unique to pregnancy. The hepatic functions during pregnancy are affected by increase in serum estrogen and progesterone levels.Methods: This was a prospective study of 70 cases of pregnancy with jaundice admitted in the department of obstetrics and gynecology at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India. The duration of study was from June 2015 to December 2018. During this period 70 patients were admitted with jaundice in pregnancy. Patients were analyzed with regards to socio demographic profile, investigations, maternal and perinatal outcome.Results: The incidence of pregnancy with jaundice in present study was 0.32%. Most common cause identified was viral hepatitis in 27 cases (38.57%) out of which 23(32.85%) cases being hepatitis E. Followed by HELLP syndrome, pre eclempsia, eclempsia in 24(34.28%) cases. 13(18.57%) cases were belonged to cholestatic jaundice of pregnancy. Rest 6(8.56%) cases belonged to malaria, portal hypertension due to liver disease etc. Out of total 70 patients 53(75.71%) women from rural area, 54(77.13%) patients were from age group of 20-29years.Maximum patients were multigravida i.e. 28 (40%) and 66(94.28%) women coming from lower middle and lower socio economic class. There were 9 maternal deaths, 5 due to DIC. Total vaginal deliveries were 40, 24 patients underwent LSCS, 4 patients had abortion, and 2 expired undelivered. Most common complication was DIC in 16(22.85%) cases and thrombocytopenia in 14(31.67%) cases. 30(42.85%) babies were LBW and 18(25.7%) babies were IUGR.Conclusions: Prompt diagnosis and accurate evaluation and multidisciplinary approach of management in pregnancy with jaundice at a tertiary care center with good NICU is helpful in reducing maternal and perinatal mortality and morbidity.

A clinical observational study in cases of eclampsia

Background: Eclampsia is a life threatening condition and one of the leading causes of maternal deaths worldwide. It is also associated with complications like acute renal failure, DIC, postpartum hemorrhage, etc. and adverse fetal outcomes.  Hence we aimed to study fetomaternal outcomes in cases of Eclampsia.Methods: A total of 75 cases of eclampsia out of 13524 deliveries were evaluated, from 1st January 2016 to 30th June 2017 at RZ Hospital, a government tertiary referral centre. Maternal outcomes were studied for its complications, effectiveness of magnesium sulphate treatment, fetal outcome and mode of delivery.Results: Incidence rate of eclampsia was 0.55%, 62.66% of all cases were primigravida, 76% of cases were in age group of 21-26 years, 84% cases were from lower socio economic status, maternal mortality occurred in 2 of 75 cases. 66.67% of patients were of term pregnancy (37 to 42 weeks). 71%(53) patients delivered vaginally out of which 9 deliveries were spontaneous and 44 deliveries were induced vaginal delivery. 22 patients required caesarean section.Conclusions: Early detection and prevention of pregnancy induced hypertension and pre-eclampsia and other associated risk factors for eclampsia might help to reduce the incidence of eclampsia. Maternal adverse outcomes in this study were magnesium toxicity, acute renal failure (ARF), disseminated intravascular coagulation (DIC) and post partum hemorrhage (PPH) while 92% patients had no complications.

A Study On Etiology And Clinical Profile Of Patients With Thrombocytopenia

BACKGROUND: Thrombocytopenia refers to a reduction in platelet count below 1.5 lakh/microliter. The presence of thrombocytopenia in a hemogram should alert the physician to identify the underlying etiology for the prompt management of the patient. Timely identification and treatment prevent bleeding manifestations, requirement of platelet transfusions/steroids and overall impact on mortality of the patients. AIM OFSTUDY:Analysis to study the etiology, bleeding manifestation, percentage of patients requiring platelet transfusion, length of hospital stay in patients with thrombocytopenia. METHODOLOGY: 100 cases thrombocytopenia both male and female were included in the study. The diagnosis was made on peripheral smear and Hemogram. RESULTS: Dengue fever was the most common cause of thrombocytopenia with 43 cases. Sepsis with 23 cases was the second commonest. Bleeding manifestations were seen in 23% of the study population.100% of the patients with platelet count less than 10,000/microlitre had bleeding manifestations. 26 patients (26%) received platelet transfusion out of which 23 were therapeutic and 3 were prophylactic transfusions. Steroid therapy was given in 11% of patients. Mortality was highest in patients with sepsis induced thrombocytopenia. CONCLUSION:This study shows that Dengue fever is the commonest diagnosis made in patients who are detected to have thrombocytopenia. One fifth of patients with platelet count less than 1,00,000/microlitre tend to have bleeding manifestation, commonest being GI bleed, petechial rash and epistaxis. Majority of the bleeding occurs with platelet count less than 10,000. The proportion of patients receiving therapeutic platelet transfusion was higher compared to prophylactic transfusion.

Study of maternal and perinatal outcome among twin pregnancies with one twin demise

Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy.Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae.Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.

Haemostatic abnormalities in solid malignancies

Background: Though the actual symptoms of any haemostatic abnormalities in patients of solid malignancies are not seen commonly screening in all such cases can guide us to correct those abnormalities in time and improve the outcome. The present study is undertaken with an objective to find out coagulation disorders in patients of solid malignancies and compare their levels according to the stage of the cancer.Methods: A prospective study was undertaken in a tertiary care centre in Maharashtra, India from December 2010 to September 2012. Total 102 cases with malignancies diagnosed on histopathology/cytological examination were tested for BT, CT, Platelet count, PT, APTT, TT and D-dimer levels. These tests were repeated on first postoperative or post chemotherapy day wherever possible. Early and advanced stages of cancer were divided according to the spread of the tumor. Results were compared between the two. DIC cases were also noted.Results: Out of 102 cases studied, haemostatic abnormalities were more common in adenocarcinomas that too in mucin secreting adenocarcinomas. The percentage of cases with increased D-dimer values was higher in the advanced disease compared to early disease. The PT, APTT, TT and platelet count showed statistically significant differences between the early and advanced disease groups. Compared to preoperative values, postoperative values were abnormal but the change was not statistically significant.Conclusions: Screening for coagulation profile in all solid malignancies can help to predict the chances of complication and therapeutic interventions can be done.