Study of role of blood transfusion in obstetric emergencies

Background: Blood Transfusion is recognized as one of the eight essential component of comprehensive emergency obstetric care which has been shown to reduce the maternal mortality.1,2 In developing country like India, efforts should be done to make blood and transfusion services well maintained and quickly available to reduce maternal morbidity from haemorrhage and thus decrease the incidence of maternal mortality. Aims & objectives: (1) To study clinical status of the patients at time of admission. (2) To study the role of antenatal visits in all patients required blood transfusion. (3) To study the effect of blood components on the patients’ health. (4) To screen out the patients of high risk pregnancy and treat them safely. (5) To study causes of maternal mortality.Methods: Retrospective study of requirement of blood transfusion in antenatal and postnatal patients who came in labour room during last 3 month period at tertiary care Centre, Ahmedabad.Results: during the whole study out of 2200 patients 440 patients required blood transfusion among which 70% required due to obstetric hemorrhage and 30% due to severe anemia (less than 7 gm/dl). Major associated complications in the transfused patients were anemia (34%) and PPH (36%). 4 patients expired among them 2 were due to development of DIC and septicemia, 1 due to severe anemia and 1 due to severe PPH.Conclusions: Ensuring a safe supply of blood and blood products and the appropriate and rational clinical use of blood. Strategies made to maximize the haemoglobin (Hb) level at the time of delivery as well as to minimize blood loss. Active management of the third stage of labour is required to prevent avoidable morbidities, such as PPH, Retained product of conception, and vaginal lacerations.

Necrotising fasciitis of the posterior neck crossing the midline: a case report

Introduction and importance: Craniofacial necrotising fasciitis is a complex condition, with high mortality given its propensity to descend via the deep neck spaces into the chest and mediastinum. Management requires optimal antimicrobial therapy with associated aggressive surgical debridement. Presentation of case: A 64-year-old man presented to ENT with a posterior neck swelling. Despite incision and drainage of the swelling following a trial of antimicrobial therapy, it increased in size, with areas of overlying necrosis demonstrated. Based on radiological and clinical findings, a diagnosis of necrotising fasciitis was made. He was taken to theatre for debridement. Intra-operatively, carotid sheath suppuration was noted, after tissue retraction resulted in copious bleeding from the anterior wound bed, requiring vigorous resuscitation and clamping of underlying structures to achieve haemostasis. Senior ENT and vascular surgery involvement was quickly sought to achieve haemostasis, however bleeding from the wound bed was difficult to control. This was due to the significant watershed area at the posterior neck which would not have been amenable to selective vessel ligation. After multiple cardiac arrests, a team decision was taken to discontinue resuscitation. Clinical discussion: Operating in this area of anatomical complexity required input from a number of different specialty teams. Although input from infectious diseases, microbiology, plastic surgery and tissue viability was commendable, there was room for optimising this further. Early patient referral to a tertiary centre where on-site input was available from maxillofacial surgery and plastic surgery would have been beneficial; a set-up commonly seen in regional trauma networks. Conclusion: This case demonstrates the intricacies surrounding a rare occurrence of necrotising fasciitis of the neck crossing the midline. Multi-disciplinary team involvement is imperative and should be encouraged at an early stage

Importance of parenteral iron sucrose therapy in correction of iron deficiency anemia during pregnancy

Background: Iron deficiency anemia (IDA) is described as decrease in the hemoglobin and/or the amount of red blood cells in the blood due to iron insufficiency in the body. The aim of the study was to measure the efficacy and tolerability of iron sucrose   in iron deficiency anemia in pregnant women.Methods: This was the prospective study of 50 pregnant women with iron deficiency anemia (Hb- 5 g/dl to 8 g/dl) between 20-34 weeks of gestation, who were given intravenous iron sucrose as per their requirements and follow up measurement of Hb was done.Results: Mean rise in Hb was seen by 2.2 g/dl. Minor side effects were seen in 6 out of 50 participants.        Conclusions: Parenteral iron sucrose therapy can be used effectively and safely in pregnant women with iron deficiency anemi

Some applications of randomized algorithms for control system design

In this paper a few “difficult” problems related to simultaneous stabilization of three plants (equivalent to a certain problem related to unit interpolation in H∞) have been addressed through the framework of randomized algorithms. These problems which were proposed by Blondel (Simultaneous Stabilization of Linear Systems, Springer, Berlin, 1994) and Blondel and Gevers (Math. Control Signals Systems 6 (1994) 135) concern the existence of a controller

A study of role of doppler in gestational hypertension and perinatal outcome

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index 1. Cases with cerebro-placental index <1 had various complications like preterm delivery, low birth weight, increased chances of still birth, intra uterine death (IUD), increased NICU admission. In this study 31 cases had abnormal uterine artery Doppler which accounts for 62% of total cases, while 38% had normal uterine artery Doppler.Conclusions: Doppler ultrasound can reliably predict any adverse fetal outcome in hypertensive pregnancies and can be a useful tool for decision making in appropriate timing of intervention for delivery

Teneligliptin: a review on cardio-renal safety

Type 2 diabetes mellitus (T2DM) is a well-known risk factor for cardiovascular disease and chronic kidney disease (CKD). Various drugs including DPP4 inhibitors with different pharmacologic profile are being used in patients with type 2 diabetes for improving glycaemic control. Cardiovascular (CV) safety is one of the important aspects while selecting the glucose lowering therapies. In addition, DPP-4 inhibitors differ in their mode of excretion and degree of accumulation, which require dose/frequency modification in patients with impaired renal function. Therefore, understanding the cardio-renal safety profile of DPP4 inhibitors is of great importance. Teneligliptin is a DPP4 inhibitor, approved recently for the management of type 2 diabetes mellitus. The purpose of the present review is to integrate published literature and evaluate the cardio-renal safety of teneligliptin in type 2 diabetic patients. As per the available evidence, teneligliptin has apparently positive effects on CV safety markers like no QT prolongation at clinically relevant dose, small but significant improvement in left ventricular (LV) function, improvement in adiponectin levels and improvement in endothelial dysfunction. These findings support the cardiovascular safety of teneligliptin in T2DM patients. Dual route of excretion makes teneligliptin suitable (no dose adjustment required) for T2DM patients with renal failure. Available clinical evidence suggests that teneligliptin exerts cardiovascular safety in T2DM patients. This drug can be used in T2DM patients with CKD including end stage renal disease patients without any major safety concern

Potts Flux Tube Model at Nonzero Chemical Potential

We model the deconfinement phase transition in quantum chromodynamics at nonzero baryon number density and large quark mass by extending the flux tube model (three-state, three-dimensional Potts model) to nonzero chemical potential. In a direct numerical simulation we confirm mean-field-theory predictions that the deconfinement transition does not occur in a baryon-rich environment.Comment: 14 pp RevTeX, 10 Postscript figures, submitted to Phys. Rev D. (Corrected some typographical errors.

Phase transitions driven by L\'evy stable noise: exact solutions and stability analysis of nonlinear fractional Fokker-Planck equations

Phase transitions and effects of external noise on many body systems are one of the main topics in physics. In mean field coupled nonlinear dynamical stochastic systems driven by Brownian noise, various types of phase transitions including nonequilibrium ones may appear. A Brownian motion is a special case of L\'evy motion and the stochastic process based on the latter is an alternative choice for studying cooperative phenomena in various fields. Recently, fractional Fokker-Planck equations associated with L\'evy noise have attracted much attention and behaviors of systems with double-well potential subjected to L\'evy noise have been studied intensively. However, most of such studies have resorted to numerical computation. We construct an {\it analytically solvable model} to study the occurrence of phase transitions driven by L\'evy stable noise.Comment: submitted to EP

Role of doppler in fetal growth restriction

Background: Fetal growth restriction is an important and particularly challenging problem for modern obstetricians and paediatricians. The present study is to correlate the importance of Doppler velocimetry and perinatal outcome in cases of growth restricted foetuses by comparing perinatal outcome of control & study groups with normal and abnormal Doppler waveforms.Methods: A study and a control group comprising of 50 pregnant women having growth restricted foetuses in each group was matched for all other confounding factors except for Doppler changes. These patients were followed up and the perinatal outcomes of FGR foetuses having Doppler changes was compared with those having normal Doppler studies.Results: In our study, alteration in both MCA and UmbA Doppler was associated with perinatal morbidity and NICU admissions in 64% and mortality in 28%. Doppler changes showing altered CPR less than 1 had adverse outcome with NICU admission in 61% and mortality in 34%. Alteration in DV Doppler was associated with perinatal morbidity and NICU admissions in 17% cases and mortality in 83% cases, with no pregnancies having a healthy outcome. Among high-risk pregnancies with suspected IUGR, the use of Doppler assessment significantly decreases the likelihood of labor induction, caesarean delivery, and perinatal deaths.Conclusions: Abnormal Doppler waveform changes indicate adverse perinatal outcome of pregnancies with FGR. Doppler study helps to reduce perinatal mortality and morbidity by timely and appropriate interventions