ABSTRACT
Purpose: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID?19?associated rhino?orbital?cerebral mucormycosis (CA?ROCM) with orbital involvement and perform a clinicoradiological correlation. Methods: A cross?sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA?ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs. Results: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter?rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (? 0.621) and 93.70% (? 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively. Conclusion: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.
ABSTRACT
Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.