Description and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in North-Eastern Bihar: A retrospective study.

Background: Hypertension is one of the most common medical disorders complicating pregnancy. In India, high blood pressure contributes to 7.1% of maternal deaths. This study was carried out to describe the characteristics and pregnancy outcomes of patients presenting with eclampsia or pre-eclampsia to a secondary care hospital in rural India. Methods: Patients diagnosed with pre-eclampsia or eclampsia between January 2018 and April 2021 were identified and included in the study. Medical records were searched and general patient characteristics, obstetrical history, information about the antenatal period, mode of delivery and outcomes were documented and analysed. Results: Among the 3651 women who delivered in this hospital during this time period, 2.3% (n = 83) presented with eclampsia and 1.9% (n = 71) with pre-eclampsia. More than 50% of the women delivered by lower segment caesarean section among both the eclamptics and pre-eclamptics. The stillbirth rate among those with either pre-eclampsia or eclampsia was 1 per 1000. The number of low birth weight babies born to those presenting with eclampsia (66.7%) was significantly more than those presenting with pre-eclampsia (48.6%). Eclampsia/pre-eclampsia accounted for 21% of all maternal deaths with a case fatality rate of 2.6%. Conclusions: This study identified that in this setting the patients presenting with eclampsia were much higher than those presenting with pre-eclampsia which is in stark contrast to the status even in developing countries. This could be an important finding indicating poorer health-seeking behaviour among the population and will need more studies on various interventions to change this status.

Aggressive natural killer-cell leukemia: classical presentation of a rare disease.

Aggressive natural killer-cell leukaemia is a rare aggressive form of natural killer-cell neoplasm. We report a case of a 40-year-old male who presented with jaundice, raised blood counts,generalised lymphadenopathy and hepatosplenomegaly. The diagnosis was established by flow cytometric analysis of bone marrow aspirate. The patient, however, succumbed to his illness within 2 weeks of starting chemotherapy. To the best of our knowledge, this is the third reported case from India.

Enteropathy associated T cell lymphoma-monomorphic variant, presenting as bilateral ovarian masses.

Enteropathy associated T cell lymphoma (EATL) is a rare type of T-cell lymphoma, often associated with a history of celiac disease. It usually arises in the jejunum, but can involve other gastrointestinal tract sites such as stomach and colon. Monomorphic variant of EATL often occurs without a history of celiac disease, has variable histologic evidence of enteropathy, and is usually CD56 +. We report a case of EATL in a 49-year-old female presenting as bilateral ovarian masses. The morphology and immunophenotypic features were compatible with monomorphic variant of EATL.

Primary intravascular large B-cell lymphoma of pituitary.

A 68-year-old retired nurse, who was a known hypertensive on medication, presented with prolonged fever of 2-month duration without any clinical evidence of infection. On examination she had altered mental status. She also had other nonspecific complaints such as sleep disturbances, loss of weight, etc. On investigation, she was found to have anemia, thrombocytopenia, raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) values. She also had electrolyte imbalance. Radiological evaluation of brain showed mass lesion in the sella turcica, suggestive of pituitary adenoma. Biochemical evaluation showed hypopituitarism. Trans-sphenoidal biopsy was done. Based on histopathological and immunohistochemical findings a diagnosis of intravascular large B-cell lymphoma (IVLBCL) of pituitary was made. Our patient's condition deteriorated rapidly and she succumbed to her illness before therapy could be initiated. We are reporting this case because of the rare subtype of large B-cell lymphoma presenting at an extremely unusual primary site.