Systemic lupus erythematosus in pregnancy - intricate, but wieldy

Systemic Lupus Erythematosus (SLE) predominantly afflicts young women in reproductive age. In this context, it is only rational that pregnancy and its outcome becomes an imperative concern for the lupus patients and their health care providers. Queries regarding the risk of disease flares during pregnancy, chance of fetal loss, and the safety of various drugs are often raised. However the present day availability of effective treatment regimens has meant that many patients achieve protracted remissions and better disease control. Indeed, a high proportion of lupus patients, with professional care, can thus look forward to a successful pregnancy.1 This article reviews the contemporary concepts regarding SLE and pregnancy, especially regarding the fertility rate, optimal timing of conception, risk of disease flares during lupus pregnancy, pregnancy course, fetal outcome, safety of various drugs used for disease control during pregnancy and lactation, and contraceptive advice

Diagnosis and management of obstetric cerebral venous thrombosis: a stringent challenge

 Cerebral venous thrombosis is an uncommon but serious neurologic disorder in young adults with a peculiarly high preponderance for females. Diagnosis is frequently overlooked or deferred due to its subacute or lingering onset and the wide spectrum of clinical symptoms. Headache is the most frequent symptom occurring in up to 95% of all cases. One must consider stroke in all cases of neurological deterioration in pregnancy and puerperium. Imaging plays a primary role in diagnosis with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) having proven to be the best both for diagnosis and follow-up of these women. Current therapeutic measures used include the utilization of anticoagulants such as dose-adjusted intravenous heparin or body weight adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure. Recurrence in future pregnancy is usually low

Bracing the Emergency Department for the COVID-19 Era

The COVID-19 pandemic in a matter of few months has wreaked havoc across the globe. However as per the WHO, the worst may not be over yet and COVID-19 is going to stay with us for a long time. The coronavirus is highly contagious, and in the current scenario containment measures in the form of lockdowns and curfew may only be useful in transiently flattening the curve and not disease elimination. The absence of an effective vaccine and/or treatment, means that morbidity and mortality associated with COVID-19 is going to increase in the foreseeable future. For the emergency physicians (EPs) working on the frontlines, the battle may have just begun. Any patient coming to emergency room (ER), with COVID-19 related symptoms or otherwise, could be a potential source for the spread of coronavirus infection in the hospital. With most of the ER’s being overcrowded, the place itself will act as amplifier which could lead to a catastrophe. Ever since the beginning of this pandemic, our focus has completely shifted to only COVID-19 related symptoms which is proving detrimental for the other non-COVID emergencies. We hereby put forth certain possible solutions which may be useful for the smooth functioning of our emergency departments (EDs)

Red Cell Distribution Width (RDW) Index as a Predictor of Severity of Acute Ischemic Stroke: A Correlation Study

Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs).  The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3-13.5), moderate stroke was 13.8 (13.5-14.4) and with severe stroke was 15.4 (15.1- 15.6) (p < 0.001). The median (IQR) RDW in the patients with minor stroke on the basis of NIHSS score was 13.4 (13.2 – 13.6), moderate stroke was 13.8 (13.5-14.3), and moderate to severe stroke was 14.7 (14.5-15.3) and with severe stroke was 15.5 (15.1-15.7) (p < 0.001). The median RDW in patients who were alive was 13.8 (13.5 -15.1) and in patients who expired was 15.5 (14.5 -15.7) (p = 0.048). Conclusion: Based on the findings of this study, RDW index has statistically significant correlation with the severity of AIS. So it can potentially be an important parameter to predict the prognosis of AIS patients

Cardiac disease in pregnancy: still an arduous conundrum for the obstetrician

Cardiac diseases, complicating about 1 percent of all pregnancies, account for significant maternal morbidity and mortality by being the leading cause of obstetrical intensive care unit admissions and of indirect maternal deaths. Of late, there has been observed a changing pattern in heart disease, the etiology having shifted from primarily rheumatic to predominantly congenital (75–82%), with shunt lesions preponderating (20–65%). Counseling and management of women of childbearing age with suspected cardiac disease ought to commence prior to conception; they should be managed by interdisciplinary teams; high risk patients must be treated in specialized facilities, and diagnostic procedures and interventions should be executed by mavens with profound expertise in the cardiovascular diseases and proficiency in treating pregnant women. This article provides a comprehensive review on management of cardiac disease in pregnancy to assist obstetricians in tackling this mystifying medical situation effortlessly, attaining a favorable feto-maternal outcome

Different Faces of HIV in a Single Patient

Opportunistic infections (OIs) are a major cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. The most common opportunistic infection is tuberculosis, followed by candidiasis, infections causing diarrhoea, and pneumocystis carinii pneumonia (PCP). We hereby report the case of a 34-year-old male with clinical stage-IV acquired immunodeficiency syndrome (AIDS) who had multiple OIs including visceral leishmaniasis (VLs) an uncommon co-infection in the Indian scenario. This patient also had features of multiple pulmonary infections-bacterial, mycobacterial and fungal, a rare clinical problem in HIV

Red Cell Distribution Width (RDW) Index as a Predictor of Severity of Acute Ischemic Stroke: A Correlation Study

Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs).  The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3-13.5), moderate stroke was 13.8 (13.5-14.4) and with severe stroke was 15.4 (15.1- 15.6) (p < 0.001). The median (IQR) RDW in the patients with minor stroke on the basis of NIHSS score was 13.4 (13.2 – 13.6), moderate stroke was 13.8 (13.5-14.3), and moderate to severe stroke was 14.7 (14.5-15.3) and with severe stroke was 15.5 (15.1-15.7) (p < 0.001). The median RDW in patients who were alive was 13.8 (13.5 -15.1) and in patients who expired was 15.5 (14.5 -15.7) (p = 0.048). Conclusion: Based on the findings of this study, RDW index has statistically significant correlation with the severity of AIS. So it can potentially be an important parameter to predict the prognosis of AIS patients

Pattern of hepatitis B and C infection among gravid women and their newborns in a tertiary care infirmary in India

Background: The objective is to determine the prevalence of the hepatitis B and C virus among pregnant women, to assess impact of maternal hepatitis B virus (HBV) or hepatitis C virus (HCV) carrier status on pregnancy outcomes and to gauge the risk factors associated with them. Antenatal clinic attenders and women undergoing termination of pregnancy over three years.Methods: The study was conducted in Gian Sagar Medical College & Hospital, Patiala, Punjab, India. Hepatitis B antigen and Hepatitis C virus antibody testing of sera from specimens sent to the hospital laboratory for routine serological testing. The results were then linked to risk information, obstetric complications and pregnancy outcome.Results: Overall HBsAg and anti-hepatitis C antibody prevalence was 1.2% (33/2031). Increased risk of transmission was associated with sexually transmitted diseases and previous surgical procedures. High rates of preterm labor pains, CD (27.27%), and non-reassuring fetal heart rate patterns and meconium stained liquor were found in the seropositive patients.Conclusions: Maternal hepatitis B and C carrier status is an eminent risk factor for adverse pregnancy outcome.