GCSMC Journal of Medical Sciences

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https://imsear.searo.who.int/handle/123456789/170456

Editor-in-Chief: Dr. Urvesh Shah
ISSN: 2278-7399

Frequency: Half-yearly

Language: English

Open Access Peer-reviewed journal

Web site: https://gcsmc.org/journal.html

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Now showing 1 - 20 of 98

Clinical Correlation of Lactate Dehydrogenase Activity with JAK2V617F and FLT3 Mutations in Myeloproliferative Disorders and Acute Myeloid Leukemia: Indian Population
(GCS Medical College, Hospital and Research Center, 2021-12) Khatri, Helly H; Jethva, Disha D; Thobias, Ashi R; Rathod, Bharati S; Patel, Jayendrakumar B
Background: Lactate dehydrogenase (LDH) play main role in the cell damage.Previous study has shown elevated level in acute leukemia and myeloproliferative disorders. Molecular markers specifically for JAK2V617F mutation in myeloproliferative disorders (MPDs) and FLT3 mutations in acute myeloid leukemia patients (AML) are well known for clinical practice. But, still only few reports have shown the correlation of LDH activity with molecular markers in Hematological Malignancy. Therefore, aim of study is to correlate LDH activity with established specific molecular markers in MPDs and AML. Methods:10 healthy individuals, 50 patients with MPDs and 50 patients with AML were included for the study. Serum LDH was performed by autoanalyser. The JAK2V617F mutations is analyse from blood by Real time PCR and FLT3 ITD/D835 mutations are analysed from blood by PCR-RFLP respectively. Statistical analysis was done by SPSS statistical software. Results: LDH Activity were higher in MPDs and AML as compared with healthy individual. Mean LDH activity was higher in FLT3 ITD/D835 positive mutation and JAK2V617F positive mutation in AML and MPDs respectively was observed. Conclusion: High LDH activity with Positive frequency of FLT3 ITD/D835 mutation in Acute Myeloid Leukemia and Positive frequency of JAK2V617F mutation in Myeloproliferative Disorders were observed.
Severity of Acute Pancreatitis in COVID Pandemic
(GCS Medical College, Hospital and Research Center, 2021-12) Dhabalia, Rahul; Chauhan, Vineet; Kakadiya, Hardik
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19) and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARSCoV-2. Aim: To study severity of Acute Pancreatitis during the covid pandemic as compared to a time period before the pandemic. Methods: A group of 100 patient diagnosed with acute pancreatitis between April 2020 to December 2020 (Group A) were compared with a group of 100 patients diagnosed with Acute Pancreatitis during the similar time frame in 2019 with respect to several parameters indicating the severity and complication rates of Acute Pancreatitis. Results: Revised Atlanta 2012 Grading, Ranson's score and Glasgow Criteriashowed significant difference in severity of acute Pancreatitis between the two groups (p<0.05). Patients with AP during COVID had higher severity as compared to before COVID.Patients with AP during COVID had significantly more ICU admission and significantly higher mortality and transient organ failure as compared to patients with AP before ICU. Conclusion: From the study, it has been found that Covid has impacted the health of the people and had some major issues. As target organs are same in severe AP and severe COVID19, acute respiratory distress syndrome or acute renal failure resulting from the latter can lead to inaccurate severity assessment. Acute pancreatitis in covid pandemic has affected the actions and activities of people.
Ventral and Inguinal Hernia Repair- Polyglactin - 910 better than Polypropylene?
(GCS Medical College, Hospital and Research Center, 2021-06) Parekh, Prujal; Modi, Pankaj; Mehta, Maulik; Suthar, Sweta; Zinzala, Girish; Shah, Kaustubh
Background: Mesh repair has been one of the most popular methods of hernia repair with the lowest recurrence rates as compared to other tissue repairs. With increasing incidence of incisional hernia which is only 2nd to inguinal hernia in incidence, number of surgeries performed for incisional hernia has increased considerably. The mesh fixation has traditionally been done with Polypropylene which are non-absorbable sutures. This study aims to compare the group of patients in which polyglactin-910 was used with patients in which polypropylene was used. Methods: The study is a prospective study conducted over a period of 4 years at the largest tertiary care hospital of Western India. 400 patients were included from which 256 patients had inguinal hernia and the rest 144 had ventral incisional hernias. Two groups were framed from these 400 patients – one in which polyglactin-910 was used (120 patients) and the other in which polypropylene (280 patients) was used. All the patients were followed up for at least 1 year and the complications were compared. Result: Out of 400 patients in 120 patients mesh repair was done with polglactin-910 and rest with poplypropylene, and study was conducted over a period of 4years with results showing incidence of pain 23% with poplypropylene against relatively low incidence with polyglactin-910 of 12%. Another observation was that incidence of sinus formation was 13% with polypropylene and only 0.8% with polyglactin-910. Conclusion: The study concluded that the association of pain and sinus formation was higher with polypropylene
A Case of Paediatric Non-union of Tibia Treated With Tibialization of Fibula
(GCS Medical College, Hospital and Research Center, 2022-12) Vyas, Vaibhav; Shah, Mukesh; Patel, Nishant
Management of non-union with bone gap in tibia is difficult, especially if superimposed by infection of bone. Various modalities have been described for the treatment of gap non-union, with their own advantages and disadvantages. A case of a paediatric patient with traumatic left tibia fracture which was complicated by subsequent osteomyelitis and non-union presented to tertiary care hospital. After failure of different modalities of treatment, to provide union, the patient was managed with tibialization of fibula with fibula strut graft supported by a rush nail
Anaesthetic Management of Patient with Nephropathy and Multiple. Co-Morbid Conditions
(GCS Medical College, Hospital and Research Center, 2022-12) Singh, Aayushi; Chhanwal, Heena; Kacha, Nikhil
Anaesthetic management of a primigravida with chronic kidney disease, IgA Nephropathy and patent ductus arteriosus is challenging. Complications of spinal anaesthesia occurring in such patients are more challenging to treat. Safe anaesthetic management requires adequate preoperative assessment, optimization and planning
Recurrence Developing 21 Years after Treatment of Breast Cancer
(GCS Medical College, Hospital and Research Center, 2022-12) Vagashiya, Vidhi; Mehta, Maitrik; Parikh, Ankita; Shah, Sonal Patel; Suryanarayan, U
Background: Breast cancer is a very common cancer among females. In which most recurrence (around 75%) occurs within the initial 5 years after diagnosis, especially within 3 years. Recurrence after 20 years is very less reported in the last few decades. Case Information: We are presenting a case of a 67-year old female patient presented with pleural based nodules suggestive of lung metastasis followed by brain metastasis. After reviewing history we came to know that the patient was a previously treated case of breast carcinoma treated 22 years back with mastectomy. Conclusion: We report late recurrence of breast cancer occurring 21 years after mastectomy suggesting that possibility of recurrence in carcinoma breast with 21-years latency period although rare should be taken into consideration when making decisions regarding patients who may need long term follow up.
A Comparison of Glasgow Coma Scale Score with “Full Outline of Unresponsiveness Scale” to Predict Outcome of the Patients with Traumatic Brain Injury Presenting to Emergency Medicine Department
(GCS Medical College, Hospital and Research Center, 2021-06) Sangani, Shruti V; Patel, Chirag J; Gosai, Jigarkumar B; Dhusa, Dharmistra; Pathan, Uzma; Parmar, Anjali
Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance
Isolated Extramedullary Relapse in the Gastrointestinal Mucosa of a Patient with T cell Lymphoblastic Lymphoma
(GCS Medical College, Hospital and Research Center, 2022-12) Yadav, Rajan; Parikh, Sonia; Panchal, Harsha; Patel, Apurva
An unusual case of extramedullary relapse in a known case of T cell lymphoblastic lymphoma is presented here. The patient is a 24-year-old girl diagnosed with T cell lymphoblastic lymphoma in June 2020. The patient th showed extramedullary relapse in the gastrointestinal mucosa without bone marrow recurrence whilst on the 6 month of BFM (Berlin Frankfurt Munster) -90 maintenance. Isolated gastrointestinal infiltrate is unusual at presentation or relapse of T cell lymphoblastic lymphoma. While on BFM-90 maintenance, she presented with multiple vomiting and abdominal pain episodes. Upper gastrointestinal scopy revealed multiple gastric ulcers, with morphology and immune-phenotyping identical to her initial T cell lymphoblastic lymphoma. We could not find evidence of leukaemic activity in the blood, cerebrospinal fluid or bone marrow. Several types of leukemic infiltrates have been recognised at post-mortem examination; the fact that makes our case is unique is T cell lymphoblastic lymphoma presenting as an isolated malignant ulcer, which to the best of our knowledge, has not been reported. We conclude that relapsed T cell lymphoblastic lymphoma may present with gastrointestinal infiltration. Further investigations are warranted to establish the same
Dengue and Chikungunya viruses Co infection: A serological based study from tertiary care center, Ahmadabad, India
(GCS Medical College, Hospital and Research Center, 2022-12) Vaghela, Unnati; Patel, Parul C; Sathwra, Nidhi G; Rao, Palak D; Modi, Dhara J
Introduction: Dengue and Chikungunya (CHIK) infections appear to be increasing in all parts of India. Aedes aegypti mosquitoes are common vectors for dengue virus (DENV) and CHIK virus (CHIKV - Chikungunya Virus). In areas where both viruses co circulate, they can be transmitted together. Aim: The present study was undertaken to study the prevalence of dengue–CHIK co infection and compare with monoinfection. Methods: IgM antibody capture ELISA (Enzyme linked immunosorbent assay) for dengue IgM and CHIK IgM and ELISA for dengue non structural protein 1 antigen was performed on serum samples obtained from suspected patients. Results: Out of total 1071 samples from suspected patients for dengue & chikungunya infection, 212 (19.7%) samples were positive for DENV while CHIK IgM antibodies were positive in 145 (13.53%) patients. Total 44 sera were positive (4.10%) for co-infection of dengue and CHIK. Conclusion: Increase in the number of Dengue and Chikungunya infections and their cocirculation is an important public health concern which warrants the implementation of strict control measures
Severity of Deep Vein Thrombosis in COVID Pandemic
(GCS Medical College, Hospital and Research Center, 2021-06) Udwani, Kaashvi; Shah, Apurva G; Jariwala, Henil; Jani, Rushabh
Aim : To study the severity and complication rates of deep vein thrombosis (DVT) during the covid pandemic as compared to a similar time frame before the pandemic. Materials and methods: A group of 80 patient diagnosed with deep vein thrombosis between April 2020 to November 2020 (Group A) were compared with a group of 80 patients diagnosed with deep vein thrombosis during the similar time frame in 2019 with respect to several parameters indicating the severity and complication rates of deep vein thrombosis. Results: Deep vein thrombosis has showed an increased severity since the onset of covid with higher number of patients presenting with acute compartment syndrome requiring surgical intervention and with more number of cases showing extensive venous thrombosis. Complication rate with regards to pulmonary embolism has also showed a rise relating to the rise in patients presenting with extensive DVT.
A Comparison between Objective Structured Practical Examination and Traditional Practical Examination as an Assessment Tool in Biochemistry
(GCS Medical College, Hospital and Research Center, 2021-12) Pradhan, Ramesh; Rathod, Shubhangi; Kharsadiya, Meet; Tamboli, Dhruvin
Introduction: The competency based medical curriculum implemented in 2019 stresses on assessment systems aligned to the teaching-learning process. Assessment drives the learning process, so assessment tools have to be objective, uniform, valid and reliable. Traditional practical examination is more subjective and prone to examiner bias and is suspect to its validity and reliability. OSPE has been advocated as a tool to be used in CBME as it possesses the requisite criteria of an ideal assessment tool. However OSPE is not widely used in our st country. Methods: In this study the performance of 1 MBBS students in traditional practical examination & OSPE was compared & perception of students towards it evaluated. 150 first MBBS students of 2020-21 batch were included. Assessment by traditional and OSPE was conducted on “Blood sugar Estimation”. OSPE was conducted with 2 observer & 3 response stations. Mean was calculated and analysed for statistical significance using MS Excel. A well-structured questionnaire was administered to the same students and a feedback was obtained about the process of OSPE. Results: There was statistically significant difference between the mean scores of traditional format and OSPE (P <0.001). Analysis of students' feedback showed that more students found OSPE better in terms of scoring, passing and catering to psychomotor domain evaluation. Anumber of students felt that OSPE was more useful and comfortable than the conventional pattern of examination. Most students did not find OSPE intimidating and opined that it should be kept as assessment method in internal and university examination. Interpretation & Conclusion: Our study observed OSPE scores to be better than traditional format. OSPE eliminated examiner bias by integration of cognitive, psychomotor and affective domains. Therefore we conclude that OSPE though time and labour intensive, should be introduced and adopted as an assessment tool.
The Study of Rapid Ultrasound in Shock in Patients of Undifferentiated Hypotension Presenting to Emergency Department
(GCS Medical College, Hospital and Research Center, 2022-12) Ginoya, Sonal K; Parmar, Ami; Parikh, Samira
Background: Patients with hypotension or shock usually have high mortality rates, and use of traditional physical examination techniques only may be misleading for rapid diagnosis and treating the same. RUSH (Rapid Ultrasound for Shock and Hypotension) protocol is used in patients with undifferentiated shock to improve accurate diagnosis of shock. Methods: A prospective observational study was done from April to June 2022 at emergency department in 100 patients who presented with hypotension. This included patients who had systolic blood pressure (SBP) of <90 mmHg, along with tachypnoea and tachycardia. Patients RUSH examination was performed. The patients were followed up to document their final diagnosis. Results: In our study, the mean age of patients with hypotension was 58.8±8.7 years with male preponderance of 53%. The hypovolemic shock (40%) was found to be the most common subtype of shock. 86% of patients were correctly diagnosed with RUSH study. The sensitivity, specificity, PPV and NPV of RUSH in shock patients was 36.69%, 25.7%, 26.5%, 87.25% respectively and disease prevalence 31.5% and accuracy 68.75%.Cohens Kappa index was 0.5 showed a moderate agreement of the RUSH protocol in diagnosis of causes of shock with the final diagnosis. Conclusion: This study advocates the use of RUSH protocol in patients presenting with undifferentiated hypotension in the emergency department. It narrows the possible differentials of shock and guides the emergency physician to an early initial therapy, thereby improving the final outcome of patient.
A Study on Clinical Profile and Complications of Acute Pancreatitis at a Tertiary Care Centre, Ahmedabad: A Case-Series
(GCS Medical College, Hospital and Research Center, 2021-12) Parmar, Darshan; Makwana, Rakesh A
Introduction: Acute pancreatitis accounts for 3% of all cases of abdominal pain among patients admitted to hospital in the UK. The prevalence of pancreatitis in India is 2.6-3.2 cases per 100,000. Major causes of acute pancreatitis are biliary calculi and alcohol abuse. Acute pancreatitis may be categorized as mild (interstitial oedematous pancreatitis), moderately severe acute pancreatitis or severe (necrotising pancreatitis). The majority of patients will have a mild attack of pancreatitis. Severe acute pancreatitis is seen in 5–10% of patients, and is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Objective: To study Age, Sex distribution, Etiology, Clinical presentation & complications of Acute Pancreatitis. Methods: Retrospective Observational Study of 10 patients presenting to civil hospital, Ahmedabad OPD/Emergency department with complains of abdominal pain and showing acute pancreatitis on ultrasound or CT scan were included. Results: Out of 10 patients, 40% were from 50-59 year age group, 70% were males, 60% were Chronic Alcoholic, 50% had Pleural effusion, 80% had Ascites and 30% had Pancreatic necrosis. Conclusion: Acute Pancreatitis is common in adult males with Alcohol abuse and second common etiology being Gall stones. Common sequeae include Ascites and Pancreatic Necrosis
Incisional Hernia: A Comprehensive Study on the Incidence and Management of Abdominal Incisional Hernia
(GCS Medical College, Hospital and Research Center, 2021-06) Patel, Dhaval V; Mukadam, Prashant N; Shukla, Vineet V; Vaidya, Apurva P; Patel, Raj R
Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.
Anesthetic Management in A Patient with Myasthenia Gravis Posted for Thymectomy
(GCS Medical College, Hospital and Research Center, 2022-12) Shah, Meet Bhadresh; Chhanwal, Heena; Kheskani, Divya
Myasthenia gravis is an autoimmune disease which causes disorder in transmission at the neuromuscular junction. In patients with myasthenia gravis undergoing surgical procedures administration of general anaesthesia becomes challenging. Overall safe general anaesthesia can be achieved through adequate preoperative assessment and optimization; vigilant intraoperative monitoring of neuromuscular transmission along with adequate dose titrations and by Train of four responses (TOF) guided administration of non depolarising muscle relaxants.
Spinal Anaesthesia for Caesarean Section in a Morbidly Obese Parturient: A Case Report
(GCS Medical College, Hospital and Research Center, 2021-12) Baldaniya, Sanjay; Chhanwal, Heena; Shah, Dhara
The population of obese individuals is increasing worldwide.Maternal obesity is an important risk factor in pregnancy and problems such as difficulty in endotracheal intubation, risk of aspiration, and hypoxia may occur 2 during generalanaesthesia.A 28-year-old woman (height 1.6 m, body weight 126 kg, BMI 49.2 kg/m ) visited GCS Hospital, Ahmedabad for selective caesarean section at a gestational age of 37 weeks. Patient was diagnosed with PIH. Spinal anaesthesia was selected because of the high possibility of endotracheal intubation failure due to super morbid obesity.Considering the possibility of hypotension, an arterial cannula was placed in the right radial artery for invasive arterial pressure monitoring. After sterile preparation, spinal anaesthesia was performed through the L3–4 interspinous space using a 90 mm 24-gauge spinal needle. During surgery,Blood pressure was maintained between 160/88 and 86/38 mm Hg and heart rate was maintained between 70 and 104 beats/min. The surgery was completed uneventfully. The block level of spinal anaesthesia was maintained at the T8 dermatome level during the operation and was also confirmed at the end of operation.
Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury
(GCS Medical College, Hospital and Research Center, 2021-06) Shukla, Vineet V; Mukadam, Prashant N; Vaidya, Apurva P; Patel, Dhaval V
Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.
Comparing the Prognosticative Value of APACHE II and mSOFA Scores in Critically Ill Patients: A Prospective Study
(GCS Medical College, Hospital and Research Center, 2022-12) Ginoya, Sonal, K; Bhabhor, Anjali, Bala; Parikh, Samira
Objective: Several predictive scoring systems measuring disease severity are used to predict outcomes, typically mortality, of critically ill patients in the intensive care unit (ICU). Two common validated predictive scoring systems include acute physiology and chronic health evaluation II (APACHE II) and modified sequential organ failure assessment score (mSOFA). To compare performance of APACHE II and mSOFA score in critically ill patients regarding the outcomes in the form of morbidity and mortality in ICU. Methods: This prospective observational clinical study was conducted on 100 patients over 6 months. For each patient, APACHE II score on day of admission and serial mSOFA scores on day 0, 3, 7 and 10 were calculated and compared. Results: The age of the non-survivors was significantly older than survivors was (57.1±11.76 and 54.28±15.16). [In our study we found that the mean length of ICU stay of non-survivors was (5.41±4.81) & survivors(8.63± 4.81) days.] In our study mortality rate was 40%.The APACHE II score with cut-off point of 23 demonstrated a sensitivity rate of 98.33% & specificity rate of 17.5%, accuracy of 66.00%. Serial mSOFA scores with cut-off of 11 on day0, day3, day7 better differentiated survivors from non-survivors with 98.3% sensitivity, 27.5% specificity and 70% accuracy. Conclusion: Both APACHE II and mSOFA scores can help ICU physicians as a significant predictive marker for mortality in critically ill patients. The serial measurement of mSOFA score in the first week is a better mortality predictor tool than APACHE II score in critically ill patients.
A Study of Clinical Features and Presentation of Patients with Grade I & II Haemorrhoids and Injection Sclerotherapy as a Treatment Modality
(GCS Medical College, Hospital and Research Center, 2021-12) Mukadam, Prashant N; Kothari, Krupali V; Patel, Ashit V; Patel, Utsav V
Introduction: Haemorrhoids are the clinical manifestation of the downward disruption of normal functional architecture known as the anal cushion. A wide variety of treatment options are currently available for haemorrhoidal disease. For grade I & II of haemorrhoids, Minimal Invasive Procedures are done routinely in which Injection Sclerotherapy is included in this study. Methods: 150 patients presenting with Grade I & II haemorrhoids, admitted through the outpatient department, under General Surgery Department at our Hospital, who underwent Injection sclerotherapy between April 2019 to April 2022 were included. Objective: To study clinical presentation of patients with Grade I & II of haemorrhoides & sclerotherapy as a management modality. Results: Male gender and middle age group were predominant risk factors for haemorrhoides & sclerotherapy was found to be cost effective as well as compliant management modality. Conclusion: Injection Sclerotherapy is a day care procedure & is highly effective in treating Grade I and Grade II of haemorrhoids. It is economical, well accepted, well tolerated over other management modalities for haemorrhoids.
Anaesthetic Management of a Patient Presented As Acute on Chronic Ruptured Ectopic Pregnancy Posted for Emergency Laparotomy
(GCS Medical College, Hospital and Research Center, 2021-12) Kalotra, Kaushal, S; Kheskani, Divya; Chhanwal, Heena; Gandhi, Parita
Ruptured ectopic pregnancy is a form of obstetric hemorrhage which is the world leading cause of maternal mortality. A 22 year female admitted with chief complaint of abdominal pain and 2 months of amenorrhea and diagnosed as acute on chronic ruptured ectopic pregnancy. Emergency laparotomy was planned. Proper preanaesthetic check-up was done. There were no other comorbidities; no significant past and family history were present. Intra-operatively, fluid and PCV (patient's blood group was B-ve) replacement was done according to loss. Salphingoophorectomy was done and till then patient was vitally stable but just before closure, sudden hypotension, bradycardia, hemolysis were reported. After suspected blood transfusion reaction, PCV transfusion was stopped; iv line flushed with NS, Inj. Avil, Inj. Dexona and Inj. Hydrocort, Inj. Trenexa were given. Intra operative blood sample was collected and urgent ABGA, CBC, LFT, RFT, S. LDH were sent and patient was kept in OT for 1 hour after normal vitals and then shifted to ICU intubated. Monitoring core temperature, prompt use of measures to avoid hypothermia, using blood warmers, watch for hypocalcaemia, acidosis, and hyperkalemia go a long way in unmasking blood transfusion reactions. During operation, diagnosis becomes still more difficult and uncertain, because even when present, hypotension and oozing are easily attributed to events incident to anesthesia, operation or both. Thus hemolytic transfusion reactions occurring during operation are difficult to recognize early.

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