Effect of double dose plateletpheresis on target yield and donor platelet recovery

Abstract Introduction The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. Objective The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. Methods The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. Results The mean platelet yield in the SDP was 4.09 ± 1.15 × 1011 and in the DDP, 5.93 ± 1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ± 1.08 × 1011 and for the DDP, 7.94 ± 0.77 × 1011. The collection efficiency was 71.93 ± 25.14% in the SDP and 72.94 ± 16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. Conclusion The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Deformity Correction with Interbody Fusion Using Lateral versus Posterior Approach in Adult Degenerative Scoliosis: A Systematic Review and Observational Meta-analysis

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°–40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group.

Visual outcome after manual small-incision cataract surgery by viscoexpression technique

Purpose: Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9� million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. Methods: This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Results: Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. Conclusion: This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.

Vector and rodent surveillance for Orientia tsutsugamushi in north India

Background & objectives: Scrub typhus or chigger borne typhus, caused by Orientia tsutsugamushi is an emerging vector-borne disease as large numbers of cases have been reported in various tropical countries. It is transmitted to humans through bites of infected chiggers (larval mites). The knowledge about the vector, its distribution, density and habitat are important so as to understand the epidemiology of scrub typhus in a given area. To control rickettsial infections, regular rodent-vector surveillance should be planned in areas where the disease transmission is occurring and it will also help to strengthen the existing entomological data related to the vector of scrub typhus in northern India. Methods: In the present study, rodent-vector surveillance was planned for one whole year, covering both mite active and non-active seasons (October 2019–December 2020) in selected areas of Chandigarh and Punjab in north India. Rodent tissues and mites were also examined for the presence of O. tsutsugamushi by nested PCR for 56 kDa gene and real-time PCR for 47 kDa outer membrane protein gene. 18S gene PCR was performed for molecular identification of mites. Results: In the surveillance, three types of ectoparasite, viz. mites, fleas and ticks were obtained in rodents. All mites found were of Laelapidae family. None of the pooled rodent tissue samples as well as mite samples were found positive for O. tsutsugamushi by nested PCR for rickettsial DNA. Interpretation & conclusion: In the present study, we did not get any evidence of carriage of O. tsutsugamushi in either mites or rodents collected and sampled in selected regions in Chandigarh and Punjab. We need to strengthen the entomological surveillance over a broader region and increase the frequency of trapping rodents to increase clarity on vector-reservoir dynamics in this geographical region.

Comparison Of Oral Midazolam,Oral Dexmedetomidine And Oral Midazolam Ketamine Combination For Premedication In Paediatric Surgery

Background: Children especially age group <10years undergoing operation may experience preoperative anxiety & may be uncooperative. This uncooperative behavior of children may be observed at the time of separation from parents, venipuncture or mask application. Untreated anxiety may lead to difficult induction, greater rescue analgesic needs, emergence delirium (ED), behavioural & postoperative psychological effects. An atraumatic premedication, calm separation from parents can minimize these problems and a smooth induction of anaesthesia can be achieved.Method : Prospective randomized double blind active controlled study was conducted in Government medical college & hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. 75 ASA I & II subjects aged between 2 to 5 year weighing less than 15 Kg posted for elective paediatric surgery under general anaesthesia at tertiary care centre were selected. They were randomly allocated into 3 groups Group M ,Group M K & Group D with 25 subjects in each group using computer generated randomization list. Oral premedication was given in each group 30 minutes before surgery. Baseline heart rate, SBP and RR measured before administering premedication and at 10 minutes intervals up to 30 to 45 minutes after premedication. Sedation & anxiolysis score at induction[S1] was significant higher inResults: Group M K& Group D [p Value <0.05] compared to Group M. Sedation at the time of separation from parents [S2] was better in Group M K & Group D compared to Group M[p Value <0.05]. Sedation during Mask Acceptance[S3] was better in Group M K & Group D compared to Group M[p Value <0.05].Wake up Behaviour [when the patient recovers from anaesthesia at end of surgery [S4] ] was assessed & Subjects were more Sedated[post anaesthesia] in Group D when compared to Group m & Group M K[p Value <0.05]. Time taken for maximum change in vital parameters was more in Group D followed by Group M K and Group M respectively p Value 0.001].There was significant changes in Vital parameters in Group D compared to Group M & Group M K .Bradycardia p Value 0.00044] & Hypotension [p Value 0.01]was more significant in Group D when compared to Group MK &Group M Oral Midazolam (0.2mg/kg)Conclusion: & Ketamine (2mg/kg) combination & oral Dexmedetomidine (0.5 g/kg) both provide satisfactory sedation levels & offers significant ease of separation from parents with satisfactory mask acceptance in children<10 years compared to oral Midazolam alone.

Relevance of multi?disciplinary team approach in diagnosis and management of Stage III NSCLC

Lung cancer is reported as the leading cause of cancer?related mortality worldwide. Non?small cell lung cancer (NSCLC) constitutes 80%�% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.

Cryptosporidiosis, a public health challenge: A combined 3D shape-based virtual screening, docking study, and molecular dynamics simulation approach to identify inhibitors with novel scaffolds for the treatment of cryptosporidiosis

Cryptosporidiosis is a neglected tropical disease caused by the protozoan parasite Cryptosporidium parvum. Limited therapeutic options, limitation in in vitro parasite culture, and lack of a reliable animal model of parasite for replication of in vivo life cycle and drug testing demand alternative methods for drug development. The in silico methods of drug discovery prove a crucial process in such conditions.Recent research reported a limited number of small molecules for drug development. Purine nucleotide biosynthesis in Cryptosporidium species is dependent on the IMPDH (CpIMPDH) enzyme, so distortion of parasite IMPDH has been pursued as a compelling strategy for curbing Cryptosporidium infection due to its different kinetics from the host enzyme. Our study's primary aim was to discover novel ligand molecules with noticeable activity against Cryptosporidium parvum IMPDH. For this purpose, we selected 18 previously discovered ligands to understand the interaction feature between ligand and receptor, and their shape and electronic features are employed as a template for shape-based virtual screening of the ZINC database (drug-like subset) search approach via Schrodinger-2019 (Maestro 11.9). The obtained hits were subsequently subjected to structure-based screening, quantum polarized ligand docking (QPLD), and molecular dynamics simulations to fetch potential small molecules with the highest binding affinity for CpIMPDH protein. Further ligand binding energy and pharmacokinetic analysis were also taken into consideration as filtering criteria for selecting the most promising drug-like compounds. On this experimentation analysis, three top-ranked (ZINC24855054, ZINC58171263, and ZINC08000072) molecules were found to have appropriate pharmacokinetic properties along with surpassing in silico inhibitory potential towards the CpIMPDH compared to known inhibitors. The molecular docking and molecular dynamics simulation analysis results satisfactorily confirmed the inhibitory action. Therefore, these new scaffolds deduced by the presented computational methodology could recommend lead molecules for designing promising anti-cryptosporidial drugs targeting CpIMPDH protein.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM扴 PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.

Cost of National Vector Borne Disease Control Programme in North India

Background & objectives: Despite significant resources being spent on National Vector Borne Disease Control Programme (NVBDCP), there are meagre published data on health system cost upon its implementation. Hence, the present study estimated the annual and unit cost of different services delivered under NVBDCP in North India. Methodology: Economic cost of implementing NVBDCP was estimated based on data collected from three North Indian States, i.e. Punjab, Haryana and Himachal Pradesh. Multistage stratified random sampling was used for selecting health facilities across each level [i.e. subcentres (SCs), Primary Health Centres (PHCs), community health centres (CHCs) and district malaria office (DMO)] from the selected States. Data on annual consumption of both capital and recurrent resources were assessed from each of the selected facilities following bottom-up costing approach. Capital items (equipment, vehicles and furniture) were annualized over average life span using a discount rate of 3 per cent. The mean annual cost of implementation of NVBDCP was estimated for each level along with unit cost. Results: The mean annual cost of implementing NVBDCP at the level of SC, PHC and CHC and DMO was ? 230,420 (199,523-264,901), 686,962 (482,637-886,313), 1.2 million (0.9-1.5 million) and 9.1 million (4.6-13.5 million), respectively. Per capita cost for the provision of complete package of services under NVBDCP was ? 45 (37-54), 48 (29-73), 10 (6-14) and 47 (31-62) at the level of SC, PHC, CHC and DMO level, respectively. The per capita cost was higher in Himachal Pradesh (HP) at SC [? 69 (52-85)] and CHC [? 20.8 (20.7-20.8)] level and in Punjab at PHC level [? 89 (49-132)] as compared to other States. Interpretation & conclusions: The evidence on cost of NVBDCP can be used to undertake future economic evaluations which could serve as a basis for allocating resources efficiently, policy development as well as future planning for scale up of services.

Variability in Management Practices and Surgical Decision Making in Spinal Tuberculosis: An Expert Survey-Based Study

Methods@#Seventeen fellowship-trained spinal TB experts representing different geographical regions of India completed an online survey consisting of questions pertaining to the conservative management of spinal TB (antitubercular therapy) and 30 clinical case vignettes including a wide spectrum of presentations of spinal TB with no or minimal neurological deficit. The variability in the responses for questions and case wise variability with respect to surgical decision making was assessed using the index of qualitative variation (IQV). The average tendency to operate (TTO) was calculated for various groups of respondents. @*Results@#High variability was observed in all questions regarding conservative spinal TB management (IQV > 0.8). Among the 30 case vignettes, 14 were found to have high variability with respect to surgical decision making (IQV > 0.8). With respect to levels of fixation, all but two cases had poor or slight agreement. Younger age and practice in a government or tertiary care teaching hospital were factors associated with a higher TTO. @*Conclusions@#Significant variability was detected in treatment practices for the management of spinal TB among experts. Most of the case vignettes were found to have significant heterogeneity with respect to surgical decision making, which reflects a significant lack of consensus and lacunae in literature.

Placenta Accreta - Diagnosis and Management

Placenta accreta is a potential grievous obstetric condition that calls for a multidisciplinary timely management. Placenta accreta refers to placenta that is firmly adherent to the myometrium.1 Three types of adherent placental attachments are, placenta accreta (the uterine decidua is absent and the chronic villi attaches to the myometrium directly), placenta increta (the chronic villi invades into the myometrium), and placenta percreta (the villi penetrate the myometrium up to the serosal layer).2The incidence of placenta accreta has increased ten-fold in the past 50 years.3 It can lead to excessive bleeding, haemorrhagic and neurogenic shock, sepsis, uterine inversion, or need for hysterectomy.4Previous obstetrics interventions like caesarean deliveries are the largest risk factor for the placenta accreta, or previous dilatation and curettage or previous manual removal of placenta. Increasing maternal age and parity, as well as other uterine surgeries also have increased risks. When placenta accrete is suspected, a multidisciplinary team with expertise should be there to take care of such cases. Although ultrasound and magnetic resonance image (MRI) may or may not indicate clearly an invasive placenta, the final diagnosis is made intra-operatively and is supported by histopathological examination.4Placenta accreta is associated with high morbidity and mortality of the mother and the foetus and has high demands on health resources. Antepartum haemorrhage may occur in such cases if there is associated placenta previa. MRI is the best modality for diagnosis when there is suspicion of placenta accreta clinically.

Intrathecal Chloroprocaine Plus Fentanyl and Levobupivacaine Plus Fentanyl in Infraumbilical Surgeries in Adults

Background: The changing trend from an inpatient to outpatient has urged us to use short-acting local anesthetic with adjuvantssuch as opioids to intensify sensory block without affecting sympathetic blockade in spinal anesthesia. This study was designedto compare the safety and efficacy of 25 µg fentanyl as an adjuvant to either 10 mg levobupivacaine or 40 mg chloroprocaineintrathecally.Materials and Methods: In this prospective, randomized, clinical trial, 60 patients of 18–60 years were randomly divided into twogroups of 30 each, to receive either 4 ml of 1% chloroprocaine (40 mg) plus 25 µg fentanyl (Group C) or 2 ml of 0.5% isobariclevobupivacaine (10 mg) plus 25 µg fentanyl (Group L) intrathecally. Patients were monitored for 24 h for sensory and motor blockcharacteristics as a primary outcome and post-operative analgesia, hemodynamics, and side effects as a secondary outcome.Results: Onset of sensory block and time to maximum sensory block were rapid in Group C (2.53 ± 1.20 min and 4.40 ± 1.45 min)as compared to Group L (4.43 ± 1.12 min and 8.10 ± 0.83 min) (P < 0.001). The maximum sensory block was T4 in Group C and T6in Group L. Maximum Bromage score was 2 in both groups but achieved earlier in Group C as compared to Group L (P < 0.001).Duration of sensory and motor block was significantly prolonged in Group L (264.47 ± 29.97 min and 173.80 ± 31.47 min)as compared to Group C (101.50 ± 10.30 min and 75.93 ± 10.41 min). The total duration of analgesia was also prolonged inGroup L (259.83 ± 29.60 min) as compared to Group C (96.50 ± 9.84 min). Patients remained hemodynamically stable and nosignificant side effects and complications were noted.Conclusion: Chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with theadvantages of faster block resolution.

Comparison of determinants of morbidities of late preterms and terms

Background: To compare the determinants of neonatal morbidity in late preterms and terms.Methods: A total of 100 live late preterm (34-0/7 to 36-6/7 weeks) and 100 term infants (37-0/7 to 41-6/7 weeks) admitted in sri guru ram das institute of medical sciences and research were randomly selected to participate in this case control study. The study group include 100 neonates within gestation age of 34 0/7 to 36 6/7 weeks. Equal number of terms between 37 0/7 to 41-6/7 gestation age was taken for comparison. The maternal history including both antenatal and natal history as well as new-born profile was taken.Results: Maternal risk factors have been found to be the major determinants of morbidity in late preterms with PROM (p<0.0001), sepsis and hypertension being significant contributors. Respiratory distress, neonatal jaundice, sepsis has been found to be major morbidity factors in late preterms. The average duration of admission was higher in late preterms than terms.Conclusions: Late preterm infants have higher risks for acute metabolic complications, mortality and long-term disabilities as compared to term infants. Morbidities like respiratory distress, neonatal jaundice, sepsis, hypoglycaemia and hypothermia are more in late preterms due to their immaturity. The risks associated with late preterm birth suggest the need for refinement of obstetric paradigms to extend pregnancy duration if benefits outweigh risk to fetus and mother. There is need to make obstetricians and families aware of complications pertaining to late preterm birth and improving surveillance of high-risk pregnancies.

Comparison of safety and efficacy of Ormeloxifene and Norethisterone acetate in the treatment of heavy menstrual bleeding

Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at some stage of their lives. Medical management is the first line of therapy for menorrhagia (heavy menstrual bleeding: HMB). Progestins have been found to be very effective in the management of heavy menstrual bleeding especially during acute episodes, norethisterone acetate being widely used for the same. Ormeloxifene is a new drug with promising results in managing HMB. The study was undertaken to compare the efficacy, safety and acceptability of Ormeloxifene /Norethisterone acetate in the medical management of heavy menstrual bleeding.Methods: This was a retrospective study conducted from January 2016 till December 2018 in which 98 women of reproductive age group presented with abnormal uterine bleeding without any organic, systematic and iatrogenic causes. The patients were divided into 2 groups. Those wanting contraception along with control of HMB were assigned to Group O and given Ormeloxifene and others were given norethisterone (Group N). The primary outcomes measured were menstrual blood loss assessed subjectively by patients and ultrasonography for endometrial thickness. The secondary outcomes measured were acceptability and side effects of Ormeloxifene and norethisterone.Results: There is a significant reduction in menstrual blood loss as evidenced by the history of patients recorded on follow up and there was a significant reduction in the endometrial thickness as evidenced on follow up scan at the end of 3-4 months. no major side effects were observed with both the drugs.Conclusions: Ormeloxifene in comparison to norethisterone acetate with its effectiveness, significant results, convenient dosages schedule and no major side effects is an effective and safe alternative medical management of HMB.

Comparison of empirical use of low dose aspirin and enoxaprin in the treatment of unexplained recurrent pregnancy loss

Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all those ladies who had taken aspirin in previous pregnancies with no live outcome. Good neonatal outcome was observed with Enoxaparin.Conclusions: Live birth rates did not show significant difference between the two study groups. But empirical use of enoxaparin in patients with no live birth who have taken low dose aspirin in previous pregnancy had shown improved results, so enoxaparin should be used empirically as a first line agent in such cases.

Success of uterine artery embolization in the management of postabortal arteriovenous malformations

Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosis, adenomyosis, genital tract malignancies. Patients who do not have AV malformations on CT angiography.Results: This is a retrospective seven years study between January 2012 to December 2018 during which we received 23 patients who developed arterio-venous fistula following an abortion. The patients had heavy menstrual bleeding. All the patients had taken some hormonal treatment before reporting to us. All these patients underwent CT angiography. After that they all were subjected to UAE. All these patients were followed up to 6 months where they showed improvement in the symptoms.Conclusions: Acquired AVM is rare disorder following an abortion or a caesarean section. Heavy menstrual bleeding is a common symptom often requiring hysterectomy but with the advent of uterine artery embolization by blocking the uterine artery we can conserve the uterus where a lady can have normal menstrual and reproductive functions.

Management of single submucosal fibroid in unmarried females with uterine artery embolization

Background: Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis. The location of fibroids, whether submucosal, subserosal, pedunculated subserosal, intramural, or endocavitary, is important because signs and symptoms may be determined by location. Uterine artery embolization (UAE) for many patients is an effective alternative treatment to surgical therapy for fibroid tumors. It is a minimally invasive procedure, which allows for rapid recovery and return to normal activities. Objective of this study was to know the efficacy of minimally invasive technique UAE for reducing symptoms in sub-mucous uterine leiomyoma in unmarried females.Methods: This retrospective analysis was performed on 9 unmarried females with symptomatic single submucosal fibroid diagnosed on MRI with size range of 3.5 cms to 6.5 cms. They presented at Dayanand Medical College and Hospital, Ludhiana, Punjab in a period of 3 years from January 2016-December 2019. Inclusion criteria were unmarried females, single submucosal fibroid diagnosed on USG/MRI. Exclusion criteria was active infection, more than one fibroid in uterus, prior GnRH analogues treatment during the previous 3 months.Results: All patients presented with heavy menstrual bleeding (HMB) and dysmenorrhea, lower abdomen pain was encountered in 3 patients and 2 patients had inter-menstrual bleeding. Recurrent, UTI was there in 1 patient and 1 patient had vaginal discharge. All fibroids belonged to stage 1 FIGO classification. UAE was done and patients were followed for 6 months. Symptomatic success was seen in 100% patients and 77.77% patients expelled the fibroid per vaginally.Conclusions: UAE is alternative method of treatment for submucosal fibroids in unmarried females who do not want to undergo surgery. Proper case selection can give us good results and symptomatic relief.

Study of changes noted in the platelet count in cord blood of neonates born to hypertensive mothers in a tertiary care hospital, Bangalore, India

Background: Hypertensive disorders of pregnancy pose several problems to both mother and newborn. Complications in new-born like intrauterine death (IUD), intrauterine growth retardation (IUGR), perinatal asphyxia, neonatal sepsis and bleeding disorders are associated with toxemia of pregnancy. To decrease the perinatal morbidity and mortality, babies of hypertensive mothers should be carefully monitored and managed. Aim of this study was to establish the changes in total platelet count in umbilical cord blood.Methods: This is a hospital based prospective observational study which included the babies born to mothers having hypertensive disorders of pregnancy, total cases accounting about 158. Detailed clinical history taken including details of labour and clinical examination done.' In all the subjects, 2 ml of umbilical cord blood anticoagulated with EDTA was collected and haematological tests for total platelet count (TPC) count was done.Results: This study shows that the incidence of neonatal thrombocytopenia is 43.67%. The incidence of sepsis among thrombocytopenia group accounts for about 60% in gestational hypertension, 64.2% in pre-eclampsia and 50% in eclampsia group.Conclusions: With respectively, these findings it can be concluded that the incidence of Neonatal Thrombocytopenia is significantly higher in babies born to HDP mothers and it can be taken as a marker to evaluate Sepsis in such a situation in resource limited setting. As less number of studies is available in this area of interest, this study supports the cause.

Utility of screening tools to differentiate beta thalassemia trait and iron-deficiency anemia - do they serve a purpose in blood donors?

Background@#The aim of this study was to estimate the prevalence of the beta thalassemia trait (BTT) and differentiate it from iron-deficiency anemia (IDA) among blood donors. @*Methods@#A total of 1,000 samples from blood donors were subjected to complete hemogram with red blood cell indices. Further, Mentzer index (MI) was calculated for samples with mean corpuscular volume (MCV) below 80 fL and mean corpuscular hemoglobin (MCH) below 27 pg. Samples with Mentzer index ＜12 were subjected to naked-eye single-tube red cell osmotic fragility test (NESTROFT) followed by hemoglobin electrophoresis in positive cases. Serum ferritin was assessed in NESTROFT-negative cases. @*Results@#The prevalence of BTT among blood donors was 3.7% and that of microcytosis among donors was 8.6%. The prevalence of BTT among microcytic donors was 41.8% while that among those with IDA was 11.6%. A value of MI ＜13 was highly sensitive in the diagnosis of BTT. MI ＞13 was found to have both high specificity and high sensitivity for diagnosing IDA. @*Conclusion@#A moderately high prevalence of BTT was observed among blood donors. Presently, no screening program is mandatory for screening of BTT among blood donors. Indices like MCV, MCH, and Mentzer Index were thus found to be effective to screen for BTT and IDA among blood donors, and NESTROFT was a cost-effective mass screening method to differentiate BTT and IDA.

Atrial Myxoma - An unusual cause of ischemic stroke in young

Atrial myxomas are rare primary cardiac tumours with neurological manifestations being reported in 30% of cases. Though a rare cause of ischemic stroke in young patients, considering it as a possibility in absence of any obvious risk factors can help avoid misdiagnosis at early stages. We present a case of left atrial myxoma in a 36-year-old male with no known co-morbidities, showing an unusual clinical presentation of isolated bilateral painless vision loss. With multiple infarcts on Non Contrast Computerised Tomography (NCCT) and a suspicion of Atrial Myxoma on Transesophageal Echocardiography (TEE), patient was successfully managed surgically with confirmation of diagnosis on histopathology.