The Effect of Tranexamic Acid on Haemoglobin Level During Surgeries Around HIP

Background: The aim is to assess effect of tranexamic acid on haemoglobin level during surgeries around hip.Material & Methods:This was a prospective follow up study conducted in Mahender Reddy Institute of medical sciences, Chevella over a period of two years from June 2020 to June 2022. A total number of 123 patients who underwent hip surgeries by four different surgeons were selected for this study. Proximal femoral nailing (PFN) for intertrochantric fractures by surgeon A, dynamic hip screw (DHS) for intertrochantric fractures by surgeon B, total hip replacements by surgeon C and hemiarthroplasty by surgeon D were included for this study. The patients were grouped as treatment and control group. The treatment group and control group were selected by purposive sampling. In the treatment group, the patients undergoing surgeries around hip joint received single dose of intravenous tranexamic acid 10 mg/kg body weight 10 minutes before skin incision and equal volume of saline was injected in the control group. Intra operative blood loss was calculated by galvanometric method, weighing the sponges used and soiled by blood during surgery and measuring the amount of blood collected in suction apparatus used during the surgery. The haemoglobin level assessed post operatively and compared with preoperative haemoglobin level. The amount of fluid collected in the post-operative drain were also measured. Results:In the treatment group, 11 patients out of 16 had blood loss below 300 ml, and 5 patients had blood loss more than 300 ml. In control group 5 patients out of 15 had blood loss below 300 ml. 10 patients had blood loss more than 300 ml. Among the 25 patients of hemiarthroplasty group, 11 out of 13 patients of treatment group had drain below 100 ml on the first post operative day. In control group only 2 patients out of 12 had drain less than 100 ml. In DHS group, in the treatment group, 10 out of 11 patients had preoperative and post operative haemoglobin difference less than 1mg/dl. In control group, 12 out of 12 patients had preoperative and post operative Hb difference more than 1mg/dl.Conclusions:Tranexamic acid administrated before surgical incision is efficient in reducing bleeding during common surgeries around the hip joint. Especially surgery where more amount of blood loss was expected, like total joint replacement and hemiarthroplasty, the drug had shown significant benefit compared with the control group.

Milk supplementation increases mid-upper arm circumference and haemoglobin level among pregnant women in Kupang, Indonesia: Evidence from a regression discontinuity design

@#Introduction: The high prevalence of chronic energy deficiency (CED) and anaemia among pregnant women in Indonesia is worrying. Nusa Tenggara Timur (NTT) is one of the provinces in Indonesia with the highest prevalence of CED. This study aimed to determine the effect of fortified milk supplementation on changes in mid-upper arm circumference (MUAC) and haemoglobin level among pregnant women. Methods: This quasi-experimental study was conducted in three locations of Community Health Centers in NTT from May to August 2019. Purposive sampling was used to recruit 69 pregnant women who were divided into two groups based on haemoglobin levels; the intervention group consisted of 31 pregnant women with haemoglobin levels below 11 g/dL, and control group consisted of 38 pregnant women with haemoglobin levels above 11 g/dL. Intervention group was provided with fortified milk supplementation, while control group received education about prevention of CED and anaemia. Data were analysed using regression discontinuity design with haemoglobin of 11 g/dL as cut-off. Results: Using regression discontinuity method, we were able to determine the effect of milk supplementation based on haemoglobin levels and confirm the result that milk supplementation significantly increased MUAC by 4.69 cm. Despite no discontinuity found, a positive increase of 0.98 g/dL in haemoglobin level was important to note. Conclusion: Milk supplementation of 300 kcal/day for three months significantly increased MUAC and to some extent, increased haemoglobin level. Thus, it should be considered when planning nutrition programmes to improve the nutritional status of pregnant women.

Microbiological and chest X-ray studies on influenza B virus-associated pneumonia

Introduction: The signs and symptoms of influenza B are commonly ignored. Therefore, very few clinical reports are available. This study is an attempt to evaluate the clinical features and characteristics of influenza B virus-associated pneumonia patients. Objective: The aim of this study is to investigate the microbiological and characteristics of influenza B virus-associated pneumonia patients. Methodology: Patients with <16 years old with a clinical diagnosis of influenza B virus infection and who had chest radiography within 2 days were enrolled. A total of 49 patients were categorised as the pneumonia group by clinical symptoms and chest X-ray (CXR) findings, whereas 107 patients were categorised as the non-pneumonia group based on the laboratory data and normal CXR findings. Results: The study observed that the age of the patients in the pneumonia group was significantly younger than the non-pneumonia group. The white blood cell (WBC) count of the pneumonia group was also higher. However, the haemoglobin (Hgb) level was lower in the pneumonia group. The C-reactive protein (CRP) level of the pneumonia group was also significantly high. The CXR findings revealed that 28.57% of patients had alveolar consolidation, 32.65% had interstitial infiltration and 40.82% had ground glass opacity. Conclusions: High clinical suspicion is required to detect pneumonia in influenza B virus patients. Based on the CXR findings, the study also suggests that patients with pleural effusion and positive bacterial culture need more attention for the severity of clinical outcome. Moreover, critical care should be given to paediatric patients having higher WBC count, higher CRP level and lower Hgb. These parameters would be helpful to differentiate primary pneumonia from non-pneumonic influenza.

Nutritional Anemia in the Medical Students.

Background: Nutritional anaemia is very much prevalent and largely undiagnosed among students in Professional Institutes. Various socio-demographic characteristics like age, sex, social class, dietary habits, and infections are the etiological factors for nutritional anaemia. Objectives: To study the nutritional anaemia and its correlates among the MBBS. Medical Students of Rohilkhand Medical College and Hospital, Bareilly in Western U.P. Materials and Methods: The study was done on 100 MBBS students. Haemoglobin estimation was performed by Sahli’s Haemoglobinometer and observations were interpreted as per the WHO criteria. The data was analyzed by SPSS Statistical software. Results: In the present study on 100 Medical students, 32.0% students were anaemic, out of which 44.0% were girls and 20.0% boys. 25.0% students had mild anaemia. Majority (81.8%) of anaemic students were undernourished as per their Body Mass Index. Conclusions: Haemoglobin estimation of students at the time of entrance to Medical Colleges should be done. Iron and folic acid tablets and deworming drugs in therapeutic doses should be provided to anaemic students. The students should be motivated and educated to take balanced diet, rich in green leafy vegetables and fruits as nutritional anaemia is totally preventable.