Thrombocytopenia in pregnancy

Background: Thrombocytopenia in pregnancy is defined as platelet count of less than 150,000/µl. It may be inherited or idiopathic, acute or chronic in onset, either primary or associated with other disorders. Gestational thrombocytopenia is the most common type which is diagnosed usually in the last trimester. When there is severe thrombocytopenia, it is usually pathological in origin. The goal of this study was to identify thrombocytopenia in early stages of pregnancy and evaluate the risk factors involved. Aim was the evaluation of thrombocytopenia in pregnancy.Methods: This was a prospective observational study conducted in the Obstetrics and Gynecology Department of a tertiary care centre from 1st January 2020 to 31st December 2020. Data was collected and analyzed by SPSS version 17.Results: In the current study, 71.1% of cases were mild thrombocytopenia and 64.4% were picked up in the third trimester. Out of the 90 cases taken, 64% of the cases were due to the most common cause i.e., gestational thrombocytopenia. The second most common cause of thrombocytopenia was pregnancy induced hypertension which accounted for 18% of the total number of cases. Symptomatic thrombocytopenia of moderate and severe degree was seen in cases of PIH and ITP. 37.5% of the cases had underlying hypertension.Conclusions: Timely identification and management of the cause of thrombocytopenia is crucial in the antenatal group of women. Although it is an incidental finding in most cases, when there is an underlying cause, severity of thrombocytopenia increases tremendously and has dire consequences. Every pregnant woman should undergo complete blood count examination once in each trimester to avoid maternal and fetal complications

Comparison of efficacy and safety of thiocolchicoside and pregabalin in the treatment of acute non-specific low back pain: an open label randomized prospective study

Background: The present study was undertaken to study the efficacy and safety of thiocolchicoside, a centrally acting skeletal muscle relaxant, GABA mimetic drug and pregabalin, an anti-epileptic, GABA mimetic drug in the treatment of acute non-specific low back pain.Methods: The study was carried out at the orthopaedic outpatient department of our hospital. 80 patients were included during the study period of two months. Out of the 80, 40 were given pregabalin 75 mg 1hs and the rest were given thiocolchicoside 8 mg bd by the prescribing doctor. Patients, aged between 18-60 years having non-radiating low back pain for less than 7 days were selected. The data was collected in a proforma which included the patient’s details and the prescribed drugs. The patients were also given notepads to record adverse effects. On day 1, the pain was measured on visual analogue scale. After a week, follow up was done and decrease in pain was measured on the visual analogue scale.Results: There was significant difference between pre and post visual analogue scale score in both the groups with a p-value of less than 0.0001. But the difference between the two groups was not statistically significant (p-value 0.0664). In both the groups, patients did not report any adverse effects. Pregabalin has a slower onset than thiocolchicoside however has better efficacy. In India, where the drug abuse risk is higher, pregabalin is a safer choice as skeletal muscle relaxants (thiocolchicoside) should not be given for more than a week.Conclusions: Pregabalin has better efficacy in treatment of acute non-specific low back pain as compared to thiocolchicoside

Compassionate use of remdesivir in pregnancy: a case series

Coronavirus disease 2019 (COVID-19) has resulted in an unprecedented global healthcare crisis. One special population that poses a challenge is pregnant women with COVID-19. However, there is limited data on treatment options for severe coronavirus disease in pregnancy. Remdesivir, an antiviral drug, is currently being studied as a potential treatment of COVID-19 pneumonia. Nevertheless, pregnant women are also being excluded from various clinical trials for the disease. There are some studies mentioned in the literature which have shown no adverse effects of remdesivir during pregnancy. In this study, we present four serial cases of COVID-19 in pregnant women with moderate to severe symptoms who were treated with remdesivir. All of the them showed positive fetal outcome without any birth defects or malformations. However, further studies are necessary to evaluate the biosafety and effects of remdesivir in pregnant women

Personal Mastery and All-Cause Mortality among Older Americans Living with Diabetes

Introduction: Higher personal mastery is associated with better physical functioning, wellbeing, and longevity among older populations. However, few studies have focused on whether personal mastery is protective against mortality among older adults living with diabetes over time. Methods: A total of 1,779 participants were identified from an off-year survey of the Health and Retirement Study. Proportional Hazard Models were used to evaluate the significance of selected variables in predicting the survival of participants over a 13-year period. Results: A substantial proportion (46.7%) of the diabetic patients had survived by the end of 2016. Adults with lower mastery scores were more likely to die (Hazard Ratio = .94, p \u3c .001). Gender differences in the association patterns between personal mastery and survival were identified. Personal mastery had an independent health-protective effect on the survival of diabetes patients over the study period. With lower educational attainment, the foreign-born female diabetics scored higher in personal mastery measure when compared to their male counterparts. In the face of more severe diabetes comorbidity, foreign-born female diabetics also outlived their male counterparts over the study period. Conclusion: As a crucial psychological resource and a modifiable factor, personal mastery holds a potential for improving the health status among lower SES groups of older adults. Further investigations into the identified gender difference could be applied to break the cycle of poor health among lower Socio-Economic Status groups of older adults

Advanced composites structural concepts and materials technologies for primary aircraft structures. Structural response and failure analysis: ISPAN modules users manual

The ISPAN Program (Interactive Stiffened Panel Analysis) is an interactive design tool that is intended to provide a means of performing simple and self contained preliminary analysis of aircraft primary structures made of composite materials. The program combines a series of modules with the finite element code DIAL as its backbone. Four ISPAN Modules were developed and are documented. These include: (1) flat stiffened panel; (2) curved stiffened panel; (3) flat tubular panel; and (4) curved geodesic panel. Users are instructed to input geometric and material properties, load information and types of analysis (linear, bifurcation buckling, or post-buckling) interactively. The program utilizing this information will generate finite element mesh and perform analysis. The output in the form of summary tables of stress or margins of safety, contour plots of loads or stress, and deflected shape plots may be generalized and used to evaluate specific design

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral

Tofacitinib in a Recalcitrant Case of Alopecia Areata

Alopecia areata (AA) is a non-cicatricial alopecia that is postulated to be a hair-specific autoimmune disease, with genetic factors playing a role in disease susceptibility and severity. The most common form of disease manifests as smooth, discrete, round patches of hair loss and can be referred to as alopecia areata focalis (AF). Tofacitinib is emerging as a promising therapy for severe AA. An increasing number of studies have demonstrated the efficacy of tofacitinib in treatment of alopecia areata. Herein we report a case of recalcitrant alopecia areata in a 14-year-old female treated successfully with oral tofacitinib based therapy