ABSTRACT
India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.
ABSTRACT
Background: Preeclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation which is typically characterized by hypertension, proteinuria, edema and fetal compromise which is a leading cause of intra uterine growth restriction (IUGR). Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) hence determination of NRBC counts is essentially helpful in predicting short term neurodevelopment outcome. Objective of the study Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) in term babies born to preeclamptic mothersMethods: A cross sectional study conducted in a tertiary care hospital to evaluate the significance of cord blood NRBC count in term neonates born with pregnancy complicated by preeclampsia. It included 60 healthy mothers (control group) and 60 mothers with PIH. Collected data was analysed with SPSS software.Results: The nucleated red blood cell in cord blood of newborns in preeclampsia group was significantly higher than in the control group (p value 0.013). IUGR is significantly higher in PIH group (p value 0.008).Conclusions: From the observed data it is concluded that IUGR is an important cause of perinatal morbidity and mortality. The commonest maternal cause for IUGR was pregnancy induced hypertension. The other contributing factors were anemia, lack of awareness (unregistered, unbooked cases) among mothers, poor maternal nutrition and poor weight gain during pregnancy. Infants of preeclamptic women have higher nucleated red blood cell count at birth than control which means that preeclampsia may produce an erythropoietic response in the fetus. The positive correlation between cord nucleated red blood cell counts in preeclamptic patients and control group indicates that may be the hypoperfused placenta plays a role in this correlation.
ABSTRACT
Primary tumours of the heart are rare and the most common benign ones are myxomas. The clinical features are varied and include a myriad of presenting symptoms like embolic, constitutional, cardiac and also symptoms due to obstruction. Right atrial myxomas are very rarely seen when compared with left atrium. Such myxomas independently co existing with Immune Thrombocytopenic Purpura (ITP) is even rarer and we now present one such case in with right atrial myxoma was associated with ITP and was managed surgically. This case emphasises the fact that ITP can co-exist with myxoma and should be borne in mind when treating such patients surgically.
ABSTRACT
New onset diabetes after transplantation (NODAT) is one of the serious side effects of immunosuppressive medications used in renal transplant recipients. Diabetes in transplantation increases the risk of cardiovascular disease and has adverse outcome on graft and patient survival. The aim of this study was to evaluate the incidence of NODAT in renal transplant recipients, the risk factors for the development of NODAT and its effect on graft and patient survival. Total 210 patients underwent renal transplantation from Jan 2010 to June 2016. Mean follow-up period after renal transplantation was 38.14 + 20.12 months. NODAT was defined as two consecutive fasting blood glucose determinations above 126 mg/dL. Thirty five (16.66%) recipients developed NODAT, the duration of onset of NODAT was 4.22 months (range 1 month to 30 months) after transplantation. All of them required insulin treatment. NODAT disappeared in 3(8.57%) recipients with reduction in tacrolimus dose and conversion to everolimus. Cox-Regression analysis was done to estimate the hazard ratio at confidence interval to assess whether the age more than 50 years, deceased donor, induction therapy, graft dysfunction, graft rejection, tacrolimus toxicity, everolimus based immunosuppression, HCV and CMV infection were risk factors for the development of NODAT. Induction therapy and graft dysfunction had 2 fold increased risk of development of NODAT and tacrolimus toxicity had 4 fold increased risk of development of NODAT. Fungal infection (17.14% Vs 2.28%, P value 0.00) was significantly higher in NODAT group compared to recipients without G. Swarnalatha, K.R. Karthik, N. Bharathi, S. Raghavendra, K. Siva Parvathi, A. Deepti, T. Gangadhar. New onset diabetes after renal transplantation: An experience from a developing country – India. IAIM, 2017; 4(7): 74-82. Page 75 NODAT. There was no significant difference in 6 months, 1, 2, 3 and 5 years patient survival or the death censored graft survival of recipients with NODAT compared to patients without NODAT