RESUMO
Anticonvulsant hypersensitivity syndrome (AHS) is a rare condition that needs to be seriously recognized and diagnosed. However, it is difficult to diagnose it since its clinical manifestation mimics other common infectious and neoplastic diseases. AHS manifests as skin rash that is preceded by fever accompanying internal organ involvement, with the liver being mostly affected. AHS is a condition that develops secondary to anticonvulsant exposure like phenytoin, phenobarbitone, carbamazepine, and lamotrigine. A defect in epoxide hydroxylase leading to the accumulation of toxic metabolites of aromatic anticonvulsant is hypothesized to play a role in developing AHS. This report presents a case of a 49-year-old epileptic Asian female, who complained of persistent high-grade fever followed by generalized maculopapular rash, high liver enzymes, and pancytopenia. The patient had unremarkable past history and systematic review. The patient went through various investigations to rule out infections and systematic diseases and all investigations were normal. After excluding every possible cause, the patient was diagnosed with AHS secondary to lamotrigine usage for one month.
RESUMO
BACKGROUND: The rate of cesarean section (CS) births has been rapidly increasing in Saudi Arabia during the last two decades. Using the Robson Ten Group Classification System (TGCS) to classify and analyze the causes of the high CS rate. OBJECTIVE: To assess the increasing rates of CS by the implementation of the Robson TGCS on all CS births in our chosen population. STUDY DESIGN: An observational, cross-sectional study conducted among all deliveries at the King Abdul-Aziz Medical City (KAMC), Jeddah, Saudi Arabia during most of 2018. Over the study period, 3168 births were enrolled in the study. RESULTS: The analysis of 3168 births, where 870 women gave birth through CS, resulted in a CS rate of 27.5%. The three major TGCS which contributed to the CS rate were group 5, 2 (divided into 2A and 2B), and 3. Class 5 (Previous CS, single cephalic, ≥37 weeks) contributed the most to the CS rate by 36.5%. Followed by Class 2 (divided into 2A; nulliparous, singleton, cephalic, ≥37 weeks, induced labor and 2B; nulliparous, singleton, ≥37, pre-labor CS) which contributed by 12.9%. Class 3 (multiparous (no previous CS), singleton, ≥37 weeks, spontaneous labor) was the third-highest contributing group by 9.2%. Women who gave birth spontaneously and vaginally were 1403 (44.3%) where women whose labor was induced were 1286 (40.6%). CONCLUSION: The CS rate in KAMC was 27.5%. After classifying these patients according to the TGCS, Class 5 had the largest percentage of patients going for CS (36.2%). While they are individually low together, Robson classes from Class 1 to 4 (which are considered as low-risk classes) were responsible for 37.8% of the patients going for CS. Since the previously mentioned groups are considered low-risk they should be targeted by health institutions to reduce the CS rate. Improved education of nulliparous and multiparous women who never underwent a CS to prevent nonmedically indicated CS is in order, to preclude repeated CS births in the future and further increase the CS rate.
