Low platelet counts in pregnancy: an alarm signal for abruption!

Background: Thrombocytopenia, defined as a platelet count less than 150 million/mm3, affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy.Methods: We studied all patients with thrombocytopenia in pregnancy from June 2012 to May 2013. There were 86 patients recruited into the study. Pregnant women with preeclampsia and suspected connective tissue disorder were also screened for thrombocytopenia. All women with platelet count of <1.50,000/µl during the study period were included.Results: Patients were grouped in to mild thrombocytopenia (platelet 100,000-149,999/µl), moderate thrombocytopenia (platelet 50,000-99,999/µl) and severe thrombocytopenia (platelet <49,999/µl. Pregnancy specific cause of thrombocytopenia was in 63 (73.2%) women and non-pregnancy specific were in 23(26.7%) patients.Conclusions: Preeclampsia and HELLP syndrome is more common cause of thrombocytopenia in pregnancy. Abruption can occur in patients with severe thrombocytopenia. Though platelet count is not routinely done in pregnancy it is advisable to do so as it may help in detecting gestational thrombocytopenia or other immune related condition

SYNTHESIS OF NOVEL C-4 DISUBSTITUTED β-LACTAMS THROUGH STAUDINGER CYCLOADDITION REACTION

Synthesis of novel C-4 disubstituted beta-lactam that has N-methyl pyrrole system has been achieved through Staudinger cycloaddition reaction of acid chloride and imine. Interestingly, this reaction has produced a single stereoisomer

Cardiovocal Syndrome: A rare cause of hoarseness in a patient with a history of pulmonary tuberculosis

Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Objective:  To assess the maternal and perinatal outcome in pregnant women with HIV infection and the role of Antiretroviral therapy in reducing complications of pregnancy. Methods: A retrospective analysis was conducted on data from HIV-positive mothers receiving antenatal care at a tertiary care center between February 2015 and January 2020. The study examined various adverse pregnancy outcomes in relation to antiretroviral treatment. Statistical analysis employed chi-square and Fisher’s exact tests to determine differences in distribution proportions of patients on ART versus those not on ART across various antenatal and neonatal complications, with significance attributed to p-values <0.05. Results: A total of 155 patients were found to be HIV positive. Out of this 58 were diagnosed before pregnancy and 97 during pregnancy. Miscarriage was seen in one (0.6%) patient on ART and two (1.2%) not on treatment (p-value 0.6). Sixteen (10.3%) patients underwent medical termination of pregnancy (MTP); all were given HIV-positive status and they were all on ART (p-value <0.001). Anemia was seen in eighteen (11.6%) patients out of which 14(9%) were on ART (p-value 0.01). One (0.64%) woman had thrombocytopenia and she was on ART (p-value 1). Two (1.2%) patients on ART had diabetes mellitus (p-value 0.4). One (0.64%) patient who was on ART developed polyhydramnios (p-value 1).  A total of 8 (5.16%) women had hypertensive disorders; out of which 4(2.58%) were on ART (p-value 1). 11(7.09%) patients who were on ART and 6(3.8%) not on ART had preterm labor (p-value 0.2). 12(7.74%) patients who were not on ART had intrauterine growth restriction (IUGR) and 2(1.29%) on ART had IUGR. A total of 6(3.87%) patients had Intrauterine fetal demise (IUFD), of which 3(1.93%) were on ART and 3(1.93%) were not (p-value 1).  Pre-labour rupture of membranes (PROM) was observed in 2(1.29%) women on ART and 11(7.09%) patients not on ART (p-value 0.004). All women (100%) had CD4 counts more than 500. All (100%) babies delivered at our center received antiretroviral therapy either with oral Nevirepine. Almost half the women (51.6%) had vaginal delivery. Almost one-fourth, 41(26.4%) had a cesarean section. All caesareans were done given obstetric indications. There were no instrumental deliveries. Our study had a total of 122 live births. All 122(100%) babies were exclusively breastfed. None of the babies delivered in our center developed HIV on follow up which was done at 6 weeks and 6 months. Nine (5.8%) patients had infections. None of these women were on ART(p-value < 0.001). Conclusion: HIV infection during pregnancy is associated with various adverse outcomes, but ART plays a crucial role in mitigating these risks and preventing mother-to-child HIV transmission. Initiating ART in all HIV-positive mothers and their infants is essential regardless of HIV status. Keywords: anemia, ART, HIV, MTP, Perinatal outcome,  PROM

Cardiovocal Syndrome: A rare cause of hoarseness in a patient with a history of pulmonary tuberculosis

Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB

Low platelet counts in pregnancy: an alarm signal for abruption!

Background: Thrombocytopenia, defined as a platelet count less than 150 million/mm3, affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy.Methods: We studied all patients with thrombocytopenia in pregnancy from June 2012 to May 2013. There were 86 patients recruited into the study. Pregnant women with preeclampsia and suspected connective tissue disorder were also screened for thrombocytopenia. All women with platelet count of &lt;1.50,000/µl during the study period were included.Results: Patients were grouped in to mild thrombocytopenia (platelet 100,000-149,999/µl), moderate thrombocytopenia (platelet 50,000-99,999/µl) and severe thrombocytopenia (platelet &lt;49,999/µl. Pregnancy specific cause of thrombocytopenia was in 63 (73.2%) women and non-pregnancy specific were in 23(26.7%) patients.Conclusions: Preeclampsia and HELLP syndrome is more common cause of thrombocytopenia in pregnancy. Abruption can occur in patients with severe thrombocytopenia. Though platelet count is not routinely done in pregnancy it is advisable to do so as it may help in detecting gestational thrombocytopenia or other immune related condition

An Architecture to Secure (UAV) Cluster Communication

UAVs are being increasingly used in military and commercial areas alike. They often carry sensitive information making them vulnerable to cybersecurity attacks. Potential security vulnerabilities may also exist in the modules used for functioning of the drone, for example, by launching a GPS spoofing attack or WIFI attack, adversaries can get hold of important information. RF signals are used to control UAVs, but this does not work for clusters. Hence, we use wireless networking for UAV clusters. We use the WIFI module for this, but this, too, has vulnerabilities. In this paper, we have attempted to strengthen the security layer for UAV communication by exploring various security threats

Cooling to reduce the pain associated with vaccination: a systematic review

Background: Vaccine injections are the most common cause of iatrogenic pain in childhood and a cause of anxiety in adulthood. Skin cooling techniques, including icepacks and vapocoolants, may provide pain relief during intramuscular injections. Objective: To identify the effects of skin cooling techniques on pain associated with immunisation. Methods: MEDLINE (Ovid), CINAHL, EMCARE, INFORMIT and Scopus were searched for randomised controlled trials (RCTs) investigating the use of skin cooling techniques on pain associated with vaccination. Study and intervention details, outcomes measures and results were extracted and risk of bias assessed using the Cochrane Risk of Bias tool. Due to heterogeneity of studies, a narrative synthesis was performed. Results: Thirteen trials were included, involving 689 paediatric and 829 adult participants. All studies used vapocoolant or ice as one of the interventions. Comparator groups included topical EMLA cream, breastfeeding, distraction techniques and tactile stimulation. Vapocoolant reduced vaccination-related pain in all adult studies and six paediatric studies however the use of ice packs in paediatric patients was not effective. Conclusion: The use of cooling techniques reduces pain associated with vaccinations in adults. Paediatric studies show mixed results for vapocoolants and an inability for ice to decrease vaccine-injection pain. Larger RCTs are required to determine the most effective administration techniques and optimise the analgesic effects of skin cooling

59 Prognosis of cervical cancer when diagnosed during pregnancy

Objectives: Cervical cancer (CC) occurs in 0.1–12 per 10,000 pregnancies. Management of these patients is largely based on case reports and expert opinion. While data suggests that pregnancy does not adversely affect oncologic outcomes, timing and treatment modality are often impacted by pregnancy. In non-pregnant patients diagnosed with CC the mean reported recurrence rate is 5–10%. We report treatment patterns as well as obstetric and oncologic outcomes in patients undergoing treatment for CC in pregnancy. Methods: Following IRB approval, a retrospective review of all patients with cervical cancer during pregnancy who delivered at our institution between 2009 and 2023 was performed. Data on demographics, histology, stage, treatment, obstetric and oncologic outcomes were analyzed using descriptive statistics. Results: We identified 19 patients who met the inclusion criteria. Mean age at diagnosis was 30.6 years, mean parity was 2.2 (range 0–5). The majority (79%) identified as Hispanic, 10.5 % as black and 10.5% as non-Hispanic white. One patient was diagnosed prior to pregnancy, 10 (53%) were diagnosed prior to 20 weeks and 8 (42%) after 20 weeks gestation. Seventeen patients were diagnosed with stage I disease, one patient with stage II and one patient with stage III. Fourteen patients delivered viable infants at an average gestational age of 37w3d. Cancer was the most common indication for delivery (57%) and 43% delivered for OB indications. Sixteen of 19 patients were treated during pregnancy or at delivery, 5 were treated prior to EGA <22 weeks. 15/17 stage I CC patients were treated withradical hysterectomy, one was treated with LEEP in pregnancy and laparoscopic hysterectomy after delivery and one was treated with postpartum pelvic radiation. Patients with stage II and III CC were treated with chemoradiation. 15/19 patients are NED at median FU of 33 months. Four of 19 (21%) patients had disease recurrence. 18% (3/17) with stage I disease recurred. Two patients died of disease. Conclusions: Cervical cancer recurrence rates are significantly worse in patients with cancer during pregnancy, despite most patients presenting with stage I disease