Acute right lower limb deep venous thrombosis due to pressure from large adenomyotic uterus-laparoscopic management

A 48-year lady came with abnormal uterine bleeding with 22 weeks size adenomyotic uterus compressing on right common iliac, external iliac and femoral vein leading to acute deep venous thrombosis (DVT). She had history of severe anaemia secondary to menorrhagia with multiple blood transfusions and medical management with tranexamic acid and oral and intrauterine progesterone for 2 years. She presented with right leg swelling and discoloration for 1 day, and a doppler ultrasound confirmed an extensive DVT. Limb saving procedure was taken up immediately with right femoral vein catheterization and venoplasty followed by heparin infusion and thrombolysis for total 48 hours. After 12 hours of stopping heparin drip total laparoscopic hysterectomy was done in view of continuous bleeding and to decrease pressure on iliac vessels. Post-operative heparin infusion started in 8 hours and patient was discharged in stable condition 48 hours post-surgery. Histopathological examination confirmed adenomyosis with weight of specimen being 1.5 kg.  Large uterine fibroids are a well-known cause of DVT and/or pulmonary embolism (PE). However, reports of large uterine adenomyosis causing DVT secondary to pelvic compression are scanty

Clinical analysis of maternal and fetal outcomes in COVID-19 pregnant women undergoing cesarean section in a tertiary care center in Hyderabad, India

The outbreak of coronavirus disease 2019(COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading globally at an accelerated rate. A serious public health threat, it has caused a major impact on health care systems with a significantly high mortality and morbidity. Physiological changes and immuno-compromised state make pregnant women vulnerable during infectious disease outbreaks and hence need a more cautious approach. With this report we aim to share our experience regarding clinical characteristics, management and outcomes of 10 diagnosed COVID-19 pregnant women undergoing cesarean section at Medicover hospital, a tertiary-care center in Hyderabad, India between July to September 2020. All 10 pregnant women were referred in their third trimester with diagnosis of COVID-19. 2 out of 10 patients had severe COVID-19 and were managed in the ICU. All patients underwent emergency cesarean sections and none of the infants were infected with COVID-19. At discharge, all patients and the newborns were in a clinically stable condition. Effective management strategies incorporating integrated team approach, early cesarean section and low-threshold for mechanical ventilation has been shown to be associated with favorable outcomes for mothers diagnosed with COVID-19 and their infants. Also, the present data does not support any evidence of vertical transmission of SARS-CoV-2 virus in those manifesting during the third trimester of pregnancy

Febrile morbidity post laparoscopic myomectomy for symptomatic large submucous myoma in an adolescent girl

The occurrence of post-operative fever after myomectomy without an apparent infectious cause has been reported in various studies. We here in report a case of an 18-year girl with abnormal uterine bleeding and severe anemia resulting from a large 5 cm submucosal fibroid. She underwent laparoscopic myomectomy. Surgery was uneventful. Post-operative she had fever of 100.4°F which lasted for 48 hours. Antibiotic coverage was continued for 48 hours. Her urine culture and hemogram were negative for infection. Early postoperative fever is most commonly caused by inflammatory changes rather than infectious causes. Large submucous fibroids can be managed by laparoscopy with excellent clinical outcomes and minimal morbidity

Treatment dilemma in an adolescent girl with idiopathic intracranial hypertension presenting with abnormal uterine bleeding and severe anemia

Abnormal uterine bleeding (AUB), specifically heavy menstrual bleeding (HMB) is a frequent complaint for adolescents. Idiopathic intracranial hypertension (IIH) is a syndrome of raised intracranial pressure, in the absence of any evidence of an intracranial space occupying lesion. Female sex, obesity and polycystic ovarian disease are known risk factors associated with IIH. This case report depicts the unusual case of an 18-year-old girl with IIH who presented with HMB for 28 days with severe anemia with Hb of 5.5 gm%. Urgent ophthalmic and neurological review was taken in view of IIH. Prompt treatment of AUB was done with blood transfusion, hemostatics, and orally administered iron supplements. Despite medical treatment for AUB, patient continued to bleed and hence after multidisciplinary discussion and informed consent she was started on low dose progesterone. Symptoms improved rapidly and she was discharged in a stable condition with tapering doses of medication and regular follow- up advice. Treatment of AUB in adolescents with IIH is a dilemma for physicians. To date, there is no direct evidence suggesting either implantable or oral contraceptives as a cause for IIH but few studies have closely linked oestrogen containing oral contraceptive pills and some levonorgestrel implants in IIH and hence these should be avoided

Traumatic Brain Injury Induces Genome-Wide Transcriptomic, Methylomic, and Network Perturbations in Brain and Blood Predicting Neurological Disorders.

The complexity of the traumatic brain injury (TBI) pathology, particularly concussive injury, is a serious obstacle for diagnosis, treatment, and long-term prognosis. Here we utilize modern systems biology in a rodent model of concussive injury to gain a thorough view of the impact of TBI on fundamental aspects of gene regulation, which have the potential to drive or alter the course of the TBI pathology. TBI perturbed epigenomic programming, transcriptional activities (expression level and alternative splicing), and the organization of genes in networks centered around genes such as Anax2, Ogn, and Fmod. Transcriptomic signatures in the hippocampus are involved in neuronal signaling, metabolism, inflammation, and blood function, and they overlap with those in leukocytes from peripheral blood. The homology between genomic signatures from blood and brain elicited by TBI provides proof of concept information for development of biomarkers of TBI based on composite genomic patterns. By intersecting with human genome-wide association studies, many TBI signature genes and network regulators identified in our rodent model were causally associated with brain disorders with relevant link to TBI. The overall results show that concussive brain injury reprograms genes which could lead to predisposition to neurological and psychiatric disorders, and that genomic information from peripheral leukocytes has the potential to predict TBI pathogenesis in the brain

Giant placental chorioangioma presenting as severe polyhydramnios: a case report

Chorioangiomas are the most common non-trophoblastic, benign, vascular tumour of the hemochorial placenta. Small chorioangiomas are usually symptomless, and of no clinical significance while giant ones more than 4 cm in diameter may be complicated by polyhydramnios, foetal cardiomegaly, hydrops fetalis, and foetal growth restriction. We present a case of a 32-year-old primigravida referred to us at 30 weeks of gestation with large placental chorioangioma causing polyhydramnios which was treated by amnioreduction twice over 1 month. On referral the tumour size was about 56 mm size with severe polyhydramnios with amniotic fluid index of 57 cm, with breathlessness and pain abdomen. After relevant investigations and informed consent, she was taken up for caesarean section. 2 litres of clear liquor drained. She delivered a live female baby weighing 1.2 kg with Apgar score of 7 and 8. Patient stood the operation well. Gross and microscopic examination of the placenta confirmed the diagnosis of chorioangioma. Chorioangioma should be considered as differential diagnosis in cases of hydrops fetalis or polyhydramnios. Doppler ultrasound is the method of choice to detect chorioangioma and its vascularity. Giant chorioangiomas complicating pregnancy can be managed conservatively with close surveillance, foetal monitoring and timely intervention to prevent maternal and foetal morbidity and mortality.

Reynolds number dependence of length scales governing turbulent flow separation with application to wall-modeled large-eddy simulations

This article proposes a Reynolds number scaling of the required grid points to perform wall-modeled LES of turbulent flows encountering separation off a solid surface. Based on comparisons between the various time scales in a non-equilibrium (due to the action of an external pressure gradient) turbulent boundary layer, a simple definition of the near-wall ``under-equilibrium" and ``out-of-equilibrium" scales is put forward (where ``under-equilibrium" refers to scales governed by a quasi-balance between the viscous and the pressure gradient terms). It is shown that the former length scale varies with Reynolds number as lp Re^(-2/3). The same scaling is obtained from a simplified Green's function solution of the Poisson equation in the vicinity of the separation point. A-priori analysis demonstrates that the resolution required to reasonably predict the wall-shear stress (for example, errors lower than approximately 10-15% in the entire domain) in several nonequilibrium flows is at least O(10) lp irrespective of the Reynolds number and the Clauser parameter. Further, a series of a-posteriori validation studies are performed to determine the accuracy of this scaling including the flow over the Boeing speed bump, Song-Eaton diffuser, Notre-Dame Ramp, and the backward-facing step. The results suggest that for these flows, scaling the computational grids () such that / lp is independent of the Reynolds number results in accurate predictions of flow separation at the same ``nominal" grid resolution across different Reynolds numbers. Finally, it is suggested that in the vicinity of the separation and reattachment points, the grid-point requirements for wall-modeled large eddy simulations may scale as Re^4/3, which is more restrictive than the previously proposed flat-plate boundary layer-based estimates (Re1) of Choi and Moin (Phys. Fluids, 2012) and Yang and Griffin (Phys. Fluids, 2021).Comment: 21 pages, 17 figures. Submitted to AIAA Journal for publication consideratio