Haemoperitoneum from Spontaneous Rupture of Corpus Luteal Cyst in a Case of Dengue with Thrombocytopenia - A Rare Presentation

Dengue viruses are transmitted to humans by infected mosquitoes, mainly Aedes aegypti and albopictus. Dengue illness is clinically characterized by sudden onset of fever, intense headache, retro orbital pain, myalgia, maculopapular rash, minor bleeding manifestations like petechial rashes, gum bleeding, and severe haemorrhagic manifestations like haematemesis, epistaxis & haemoperitoneum. Haemorrhagic manifestations can occur at any stage. Dengue shock syndrome is a dangerous complication with high mortality.1 Increased vascular permeability together with myocardial dysfunction, dehydration contributes to development of shock resulting in multi-organ failure like liver damage, neurological manifestation & corpus luteal cyst rupture. Endothelial dysfunction induced by cytokines and chemical mediators, results in shock. Corpus luteum is a functional cyst developing in luteal phase of ovarian cycle, which regresses spontaneously to corpus albicans when pregnancy does not occur. Being a thin walled vascular structure corpus luteum is prone to haemorrhage even if bleeding is usually contained inside the cyst. Ruptured functional ovarian cyst is a frequent cause of acute pelvic pain in women of reproductive age. Invariably it is self-limiting with conservative management.2 Occasionally it requires surgical intervention, when accompanied by haemodynamic instability, large haemoperitoneum, especially in disturbed coagulation profile,as in our case.Corpus luteal cyst rupture, with consequent haemoperitoneum is a rare disorder in women of reproductive age. The condition should be promptly diagnosed and treated because delayed diagnosis may significantly reduce women’s fertility and lead to intra-abdominal bleeding, which may be life threatening.3 Ruptured corpus luteal cyst in some instances causes massive intra-peritoneal bleed leading to death, especially with bleeding diathesis.4

Moderate Sedation In Spinal Anaesthesia: A Comparative Study Of Equisedative Infusions Of Propofol And Dexmedetomidine

here has been a paradigm shift of focus toward quality of spinal anaesthesia with sedation being an integral aspect of this regional anaesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anaesthesia.Material and Methods: A total of 60 patients of age group 18-50 years of American Society of Anaesthesiologists grade I & II, posted for surgeries under spinal anaesthesia were randomly divided in to two groups (n = 30 each); Group D received infusion of dexmedetomidine 1 μg/kg over 10 min followed by maintenance infusion of 0.5 μg/kg/h. Group P received infusion of propofol 5 mg/kg/h for 10 min followed by the infusionmaintenance of 1.5 mg/kg/h. Level of sedation (using observer’s assessment of alertness/sedation score), onset and recovery from sedation, hemodynamic changes, and overall patient’s satisfaction were assessed.Results: The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001) however intra-operative sedation, and overall patient’s satisfaction was significantly better with dexmedetomidinegroup (p < 0.05). Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs.139.60 ± 3.03 min; P = 0.0013). Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05).Conclusion:Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient’s satisfaction, and post-Operative analgesia could be a valuable adjunct for intra-operative sedation during spinal anaesthesia.

Recurrent Pyrexia, Brucellosis, Underdiagnosis: The Puzzle Triad Untangled By Blood Cultures - The Benchmark Tool Coming To Aid

Introduction: Human brucellosis, a zoonotic disease is common in India. In spite of high prevalence, the disease usually remains under diagnosed or misdiagnosed.Aim: To evaluate & establish the significance of blood culture for diagnosis of brucellosis.Materials & Method: A study of 10 patients of brucellosis diagnosed by blood culture were evaluated retrospectively, for the various clinical & laboratory profiles, during the period of 2014-17. Results: All the ten patients, positive for brucellosis by blood culture were having history of fever. Other clinical presentations were - abdominal pain (n=6,60%), vomiting (n=5,50%), headache (n=1,10 %), generalized body ache (n=1,10%), anorexia (n=1,10%), joint pain (n=1,10%), cough (n= 1,10%), mild splenomegaly (n=2,20%), mild hepatomegaly (n=1,10%), mild to gross hepatosplenomegaly (n=3,30%). In all the cases, Brucella spp. were recovered from patient's blood culture & identified within 7 days of sample collection. The time-to- detection of BACTEC blood culture system (positive indication) was 3-5 days. Conclusion: A high level of clinical suspicion & proper blood culture remains the gold standard for early diagnosis of brucellosis.

Seed maturity indices in Aisandra butyracea - A multipurpose tree species of lower Himalaya.

Fruits of Aisandra butyracea (Roxb.) Lamb. were collected from two sites located at different altitudes in Kumaun Himalaya for analyzing the seed maturity in relation to various fruit and seed characters. The mean seed size (length × width) across the collection dates varied between 186.44±0.05 and 238.17±0.5 mm2 across both the elevations. The fruit colour changed from dark green in the beginning to pale yellow on the maturity. The range of seed moisture content (62.83±1.33 to 63.46±0.89%) coincided with maximum germination. The colour change and seed moisture content appear to be the major indicators of seed maturation in A. butyracea.