ABSTRACT
Background: The main aim of this study is to find out the effect of valproic acid on platelet count and to know the possible risk factors for thrombocytopenia in patients taking valproate (VPA). Methods: On 72 patients having psychiatric indication, a longitudinal observational study was designed and conducted from February 2012 to July 2013 at Department of Psychiatry (out-patient department) of Pt. Jawahar Lal Nehru Memorial Medical College and Dr. Bhim Rao Ambedkar Memorial Hospital, Jail Road, Raipur, Chhattisgarh. Platelet count was monitored and determined using an automatic coulter analyzer. The patients were followed up to 6 months. Statistical tool standard deviation ± was used for statistical analysis. p<0.05 is considered as statistically significant. Results: Total percentage of thrombocytopenia was found to be 12.5%; among that males constitute 9.8% and females 19.04%. The maximum number of cases falls in the age group between 51 and 60 years (55.5%). The major diagnostic group was reported to be consisted of mania (40.4%), followed by resistant cases of schizophrenia (25%) and then bipolar affective disorder (23.6%). The study indicated that maximum patients suffered from mild thrombocytopenia (11.1%) and (1.4%) patients have moderate thrombocytopenia. The mean time from exposure to VPA therapy to the first episode of thrombocytopenia was reported 92 days. Conclusions: Our findings underlined the importance of monitoring platelet counts in patients treated with VPA. This monitoring should be continued indefinitely on monthly basis. The studies indicate that the demands of more vigilant monitoring of patients should occur in age of 50-60 years, and result of entire studies indicates that females were found to be subjected to incidences of thrombocytopenia especially.
ABSTRACT
BACKGROUND: Serous fluid leakage is an unusual but often devastating complication following the placement of a modified Blalock-Taussig shunt using a polytetrafluoroethylene graft. METHOD AND RESULTS: Between September 1994 and September 1999, out of 268 patients undergoing a modified Blalock-Taussig shunt using polytetrafluoroethylene grafts, 10 developed massive pleural effusion or seroma due to a leak from the surface of the shunt. The age of the patients ranged from 9 days to 7 years. There were 7 males and 3 females. Nine patients presented with respiratory distress between 2 and 12 weeks of shunt surgery and one presented with sudden cardiac arrest. The shunt was patent in all the patients. Initial management was conservative. i.e. by pharmacological means and tube thoracostomy. Reoperation was undertaken in 9 patients when conservative treatment failed. All patients survived except one who had a cardiac arrest before any intervention could be carried out. CONCLUSIONS: Patients with serous effusion have significant morbidity and mortality and often require reoperation. The initial management remains conservative but, if unsuccessful, re-exploration can be undertaken as it proved to be uniformly successful in our experience.