Combined protein C and protein S deficiency with pregnancy

A 35 year old female patient, married since 8 years, G6P1L1SA4 was registered with our unit since 8th week of gestation. She was a known case of protein C and protein S deficiency diagnosed 7 years ago (thrombotic profile- protein C: 70% normal: 70-100%, protein S: 55% normal: 70/140%, AT-III: 116% normal 70/140%, factor V leiden: no mutation detected) which was detected on evaluation for her bad obstetric history. ACLA was also positive. She was started on injection low molecular weight heparin 0.6 mg s/c OD, in addition to continuing Tb. Aspirin 75 mg which had been started when the pregnancy was registered. Foleys induction was done at 39 weeks of gestation in view of previous LSCS with pre-eclampsia. Emergency LSCS was done in view of previous LSCS with non-progress of labour. Male child weighing 2.4 kg was born which is doing well. A patient having combined deficiency of both factors protein C and protein S is very rare. Anticoagulation therapy is the cornerstone in the management of patients with inherited coagulation defects

Piloting Upfront Xpert MTB/RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB & DR-TB in Paediatric Population

India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO.Xpert MTB/RIF testing was offered to all paediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India.Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and-November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0-99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8-6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project.Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance