Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review.

Autoimmune hepatitis (AIH) is a rare autoimmune liver disease that mostly affects women in their reproductive years, leading to impaired fertility. Nonetheless, the majority of women with well-controlled AIH have a favorable prognosis for pregnancy. This case report describes a 29-year-old pregnant woman with cirrhosis secondary to AIH who presented with severe thrombocytopenia. Her labs showed a decline in her platelet counts from 28 × 109/L before pregnancy to 20 × 109/L during pregnancy. Her abdominal ultrasound showed liver cirrhosis secondary to AIH and splenomegaly. Throughout pregnancy, various scans were performed to monitor the fetal well-being, which showed normal results. She was on a medication regimen that included nadolol of 80 mg/kg/day, prednisolone of 5 mg/kg/day, and azathioprine of 50 mg/kg/day. Due to a breech presentation, the patient was scheduled for a cesarean section. She received two courses of dexamethasone at 20 mg/day for four days within two weeks of delivery. On the day of her scheduled C-section, tranexamic acid of 1 g TID for two days was administered, and she received platelet transfusions of 12 units both before and after the procedure, with an additional 6 units administered during the procedure. Despite proper management, her platelet count remained consistently low. However, she successfully delivered a healthy baby, and the overall condition of the patient was stable.

Framework for obstetrics and gynecology department change management in response to COVID-19 pandemic: A tertiary center experience.

Coronavirus (cov) disease 2019 pandemic caused by severe acute respiratory syndrome cov 2 has imposed significant demands on healthcare systems across the world. These demands were more significant on obstetrics and gynecology (obgyn) patients, who required services that had to continue despite the closure of other services. This paper describes the change management of an obgyn department at a tertiary health-care center. That experience resulted in a complete management shift in the institution and the formation of an infectious disease epidemic plan for respiratory infections. Description of the change management performed, difficulties encountered, and achievements obtained can assist other departments change management when they face similar situations.

Maternal and Fetal Outcomes in Pregnancies affected by Bone and Soft Tissue Tumors.

Objective This study was aimed to describe perinatal outcome of a cohort of pregnant patients with bone and soft tissue tumors and to compare the current series with our group's previously reported experience. Methods Pregnant women diagnosed before and during pregnancy were identified, retrospectively, for the years 2004 to 2014. Relevant maternal and neonatal data were collected. Results Forty-eight patients were identified. Ten cases were diagnosed during pregnancy. Pelvis, abdomen, and extremities were the most common tumor locations. Osteosarcoma, liposarcoma, and Ewing's sarcoma were the most common histological types and comprise more than 50% of the cases. Metastases occurred in nine cases. Most of the cases (60%) were treated surgically during pregnancy and delivery occurred at term. Chemotherapy was delayed until after delivery. There were no perinatal or infant deaths. Patients presented with advanced maternal disease in 18% in previous report (1983-2003) versus 40% in present report (2004-2014). Metastases were present in 40% and maternal death rate was approximately 20% in both cohorts. Conclusion Pregnant women with bone and soft tissue tumors are candidates for standard surgical management during pregnancy. Other treatments, such as chemotherapy and radiotherapy must be evaluated for each woman on a case-by-case basis. Iatrogenic prematurity was common in our findings.

Severe hypoglycemia in peritoneal dialysis patients due to overestimation of blood glucose by the point-of-care glucometer.

Although overestimation of blood glucose (BG) by certain glucometers in peritoneal dialysis (PD) patients has been reported, awareness of this problem by healthcare providers of multiple disciplines and different specialties is probably insufficient. This is a case series of four patients who had severe symptomatic hypoglycemia and normal BG by point-of-care glucometer at a tertiary care center from December 2007 to September 2008. We report four insulin-treated diabetic patients (age = 58.2 ± 16.2 years, 3 men and 1 woman) on PD, who had acute decrease in level of consciousness in the emergency department (n = 1) and the hospital ward (n = 3). While they had their symptoms, they all had normal BG measured by the Accuchek glucometer (7.1 ± 3.3 mmol/L); nonetheless, simultaneous or near-simultaneous laboratory-measured BG levels were very low (2.0 ± 1.3 mmol/L). The mean difference in BG was 5.8 mmol/L (12 simultaneous or near-simultaneous measurements). Three patients had icodextrin-based PD in the night before symptomatic hypoglycemia. The first two patients, whose treatment for hypoglycemia was delayed, remained comatose and died later. The latter two patients were promptly treated with intravenous dextrose and did not have any neurologic sequelae. One of them died later from multiple organ failure. Over-estimation of BG in peritoneal dialysis patients by certain point-of-care glucometers is a serious problem and can be fatal. Increased awareness of this problem for all healthcare providers and use of appropriate glucometers are required.