Progressing haemolysis, elevated liver enzymes, low platelet count syndrome: near miss case

A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine)

Renal Cell Carcinoma Arising from Isthmus of Horseshoe K

The most common congenital renal fusion anomaly is the horseshoe kidney (HSK) occurring in about 1 in 600–700 individuals in the Indian population. HSKs are associated with problems such as renal stones, obstruction of uretero-pelvic junction causing stasis, and infection due to ectopic location of the kidneys, malrotation of the kidneys, and vascular changes. In general, normally developed kidneys have more incidents of renal cell carcinoma (RCC) as compared to HSKs. The major issue arises during surgery of HSK due to their altered anatomy and aberrant blood supply. We present a case of HSK with RCC located in the isthmus of a 43-year-old woman

Renal Cell Carcinoma Arising from Isthmus of Horseshoe K

The most common congenital renal fusion anomaly is the horseshoe kidney (HSK) occurring in about 1 in 600–700 individuals in the Indian population. HSKs are associated with problems such as renal stones, obstruction of uretero-pelvic junction causing stasis, and infection due to ectopic location of the kidneys, malrotation of the kidneys, and vascular changes. In general, normally developed kidneys have more incidents of renal cell carcinoma (RCC) as compared to HSKs. The major issue arises during surgery of HSK due to their altered anatomy and aberrant blood supply. We present a case of HSK with RCC located in the isthmus of a 43-year-old woman

We came, we saw, we cannulated?

Introduction: Despite advances in management of patients with severe acute respiratory distress syndrome (ARDS), mortality due to ARDS still remains high. In patients with refractory gas-exchange abnormalities, extracorporeal membrane oxygenation (ECMO) is considered as salvage therapy that aims to decrease ventilator induced lung injury and provide lung rest. injury and provide lung rest. Methods: We conducted a retrospective study of patients diagnosed with ARDS from October 2010 to September 2012. The aim of the study was to describe the population of patients placed on ECMO for ARDS in our institution. All patients placed on ARDSnet protocol were identified in the electronic patient record. Demographic, laboratory and ventilator data was extracted. Specifically mode of ventilation, use of rescue modalities (which included inhaled epoprostenol, skeletal muscle paralytics and/or use of airway pressure release ventilation (APRV)), Murray score, Oxygenation Index (OI), Alveolar-arterial gradient (A-a) and PaO2/FiO2 ratio (P/F) were tabulated. Survival to hospital discharge was recorded. Results: We identified a total of 149 patients. Of these 87 were managed per ARDSnet protocol, 48 received rescue modalities, and 14 patients were placed on ECMO in addition to rescue therapy after a mean interval of 72 hours. Six of 14 patients were placed on veno-arterial ECMO and the rest on veno-venous ECMO. Table 1 shows the baseline characteristics of these patients. Table 2 depicts the etiology of ARDS among our patient population. Mortality was higher in the ARDS group treated with rescue modalities (other than ECMO) compared to the group placed on ECMO as additional rescue therapy (77% vs. 50%; p = 0.3243). The ECMO group had a survival advantage despite higher A-a gradient, PaO2/Fio2 ratio, Oxygenation Index and Murray Score in the ECMO group (Table 1). Conclusion: Patients with ARDS placed on ECMO had an absolute reduction in mortality of 27% when compared to other rescue modalities. However this did not reach statistical significance due to the small sample size. We believe that ECMO is an important rescue modality in the right clinical setting. Treating physicians should consider ECMO as a treatment modality for severe ARDS patients

Prediction of adverse maternal outcome in women with preeclampsia using fullPIERS model: observations from a tertiary care hospital

Background: Globally about 10% of pregnancies are complicated by preeclampsia (PE) and other hypertensive disorders of pregnancy. PE is associated with higher near miss maternal morbidity and mortality. PIERS (Preeclampsia Integrated Estimate of Risk Scoring) model was designed for monitoring of women with preeclampsia and to do the risk stratification for improving the management. Objectives: This study was undertaken to analyze the adverse maternal outcome using fullPIERS risk prediction model in women with preeclampsia. Methods: It was a prospective cohort study over a period of one year. Women with PE, who gave consent were enrolled. All were subjected to fullPIERS calculator for predicting the risk of adverse maternal outcome after obtaining the predictor variables. Results: The number of obstetric admissions in our hospital during the period were 13,351. Of them 1389 (10.3%) women had PE. Amongst 150 enrolled women with PE, fullPIERS score of 35 gave the maximum performance in predicting adverse maternal outcomes. 36.6% women in our cohort experienced an adverse maternal outcome, including one maternal death. The relative risk for predicting adverse maternal outcomes in women with fullPIERS score of ≥ 35 was 4.6[95% CI (2.5-8.4)] and AUC for ROC was 0.854;[95% CI (0.78-0.91)]. Conclusion: In women with PE, fullPIERS score ≥ 35is significantly associated with adverse maternal outcome