Fall In Hemoglobin Level Research Articles

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study.

Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the yearsand one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had asolitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.

A Comparative Study of Sublingual Misoprostol Versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor.

Objective Misoprostol has attracted low-income low-resource countries for the active management of the third stage of labor. The objective of this study was to compare the efficacy of sublingual misoprostol and intramuscular oxytocin in the active management of the third stage of labor. Study design This was a prospective randomized controlled trial in which a total of 407 healthy pregnant women having singleton pregnancy, cephalic presentation, and normal vaginal delivery were divided into two groups. In the first group (n=203), women received 600 µg misoprostol tablet sublingually, and in the second group (n=204), women received 10 IU of intramuscular oxytocin, within 1 minute of the delivery of the baby during the third stage of labor. Three patients from the first group and four patients from the second group were excluded from the analysis due to traumatic postpartum hemorrhage (PPH). The primary outcome was an incidence of PPH. Secondary outcomes were the duration of the third stage of labor, amount of blood loss, fall in hemoglobin concentration after 48 hours of delivery, need for additional uterotonics, and side effects of the drugs. Data were compared using the chi-square and independent samples t-test. Results The incidence of PPH was 6.5% in the misoprostol group as compared to 2% in the oxytocin group (p=0.026). The misoprostol group also had significantly higher blood loss (293.75±125.8 mL) and a greater fall in hemoglobin level (0.58±0.25 g/dL) as compared to that in the oxytocin group (226.13±98.44 mL and 0.45±0.20 g/dL) (p<0.001). The mean duration of the third stage of labor was significantly higher in the misoprostol group (5.31±2.1 min) as compared to that in the oxytocin group (3.65±1.75 min) (p<0.001). The additional need for uterotonics was recorded in 15% of the study participants in the misoprostol group as compared to 8% in the oxytocin group (p=0.028). The incidence of side effects such as shivering and fever was significantly higher in the misoprostol group as compared to the oxytocin group. No significant difference between the two groups was observed concerning the incidence of nausea, vomiting, diarrhea, and headache. Conclusion Intramuscular oxytocin is a safe and useful alternative to sublingual misoprostol in facilitating the third stage of labor with minimal blood loss, fewer incidences of hemorrhage, and fewer adverse effects.

Evaluation of the Effectiveness of Percutaneous Nephrolithotomy in Supine and Prone Positions: A Prospective Interventional Study from Telangana, India

Introduction: Percutaneous Nephrolithotomy (PCNL) is the preferred method for treating large or complex renal calculi. Despite positive results and apparent benefits over the prone position, there are few randomised trials comparing the supine and prone positions. Aim: To evaluate the effectiveness of PCNL in prone and supine positions in terms of operative time, stone-free rate, hospital stay, postoperative complications, and the level of haemoglobin drop. Materials and Methods: The study was conducted from December 2020 to December 2022, at the Department of Urology, Mamata Medical College in Khammam, Telangana, India. Patients with renal stones diagnosed by Non-Contrast Computed Tomography (NCCT) Kidney Ureter Bladder (KUB) and meeting the inclusion criteria were enrolled. Patient demographic data, operative time, stone-free rate, haemoglobin level drop, postoperative fever, and hospital stay in prone and supine positions were recorded. Statistical tests like chi-square or Fisher-exact test were used to compare proportions, and the student t-test was used to compare means. Results: The overall operative time was 79.50 minutes in the prone group and 66.78 minutes in the supine group (p=0.0213). The average hospital stay was 2.68 days in the prone group and 2.72 days in the supine group (p=0.2432). Fall in haemoglobin levels, size of stones extracted, and stone-free rate at three months between the two groups (p&gt;0.05) showed insignificant relation. Furthermore, there was no significant difference in complications between the two groups (p&gt;0.05). Conclusion: PCNL performed with the patient in the supine position requires significantly less time during surgery. There was no significant difference in terms of stone-free rate, hospital stay, fall in haemoglobin levels, and complications between the supine and prone groups.

Case report on severe splenic injury following colonoscopy with disproportionately stable presentation: A rural hospital perspective

Detection of splenic injury following routine colonoscopy is slowly on the rise. Mostly presenting as left upper abdominal or shoulder tip pain along with a sharp fall in haemoglobin level and hemodynamic instability, sometimes the presentation and initial workup may be vague and falsely reassuring. This is demonstrated in the case of a 72year old male who presented with vague but severe left lower abdominal pain following colonoscopy, during which one caecal polyp was removed and no intraoperative complications were reported. On emergency presentation, abdominal examination was not particularly concerning with only mild left lower tenderness and minimal guarding. Vital signs remained largely normal and blood counts were reasonable. Close to being discharged, patient demonstrated brief hypotension post ambulation which was easily reversed with a fluid bolus. Upon surgical review, a high index of suspicion prompted further investigation which revealed an unsuspected complication necessitating urgent laparotomy and splenectomy. Splenic injury is slowly becoming an increasingly reported complication following colonoscopy. While many cases present with typical features, others may only display subtle signs of deterioration, and warrant a high degree of suspicion. Rural doctors should be aware of and able to recognise this potentially fatal complication to ensure timely successful management.

The effect of experience on the outcomes of total laparoscopic hysterectomy surgery: 1295 cases.

To reveal the effect of surgeon's experience on the outcomes of the total laparoscopic hysterectomy (TLH) surgery. Design: Retrospective case series. A tertiary care university hospital. 1295 cases with an indication for hysterectomy. Total laparoscopic hysterectomy. All cases were grouped according to the surgeon's experience. For 30 different surgeons, their first 20 operations constituted Group A, 21st-50th operations Group B, 51st-100th operations Group C, and their operations after the 100th surgery Group D. Demographic data and post-operative results were compared between the groups. There were no statistical differences in terms of demographic data and major complications. A statistically significant decrease was observed in the post-operative fall in hemoglobin level and the duration of hospitalization in the groups with increased experience (p = 0.021, p < 0.001, respectively). There wasn't an increase in uterine specimen weight with increased experience (p = 0.267). We obtained that the peak value in the learning curve cannot be evaluated according to the operation time or complication rates. Although the complication rate seems unaffected by surgical experience, concerns about complications may decrease as experience increases. Since the trend of minimally invasive surgery will continue increasingly in the next century because of higher patient comfort, all gynecologists should gain competence in endoscopic surgery.

Association between use of low-dose aspirin on hemoglobin levels and serum iron homeostasis in patients with acute coronary syndrome or ischemic stroke

Background: Association between low-dose aspirin (LDA) and possible covert effects on hemoglobin (without overt bleeding) has been inconsistent. The current study was planned to assess the effects of LDA on hemoglobin level and serum iron status over a period of 6 months in nonanemic patients with acute coronary syndrome (ACS) or ischemic stroke. Methods: This was a hospital-based open cohort prospective study conducted on newly diagnosed patients with ACS or ischemic stroke discharged on secondary prophylaxis of LDA (&lt;162 mg/day) The study period was 6 months of patient recruitment and 6 months of follow-up. Results: Out of originally recruited 81 patients, 52 were followed up for the entire 6 months. The mean age was 61.8 ± 8 years. In 43 (82.6%) patients, the hemoglobin level had a fall at 6 months from the baseline level. Male patients had a significant fall in hemoglobin levels while as females had an insignificant change. Anemia was detected in 20 (38%) cases at the end of 6 months. The incidence of anemia was 0.38 cases/180 days. A fall in serum ferritin was observed in 30 patients and a rise was observed in 22 patients. At the end of 6 months, serum ferritin fell to &lt;20 μg/L in five patients, out of which two patients had serum ferritin &lt;15 μg/L. Conclusion: The study provided insight about the effect of LDA on the hemoglobin level and serum iron profile among the patients who were started on LDA for the secondary prophylaxis.

THE ROLE OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING ELECTIVE CAESAREAN SECTION IN A TERTIARY CARE CENTRE

Introduction: The reduction of maternal mortality is one of the indicators under Goal 3- Ensure healthy lives and promote well-being for all at all ages of Sustainable Development Goals. It seeks to reduce global MMR to less than 70 per 100 000 live births by 2030. A leading cause of maternal mortality is Post-partum Haemorrhage (PPH). Hence, it is imperative that any improvement in maternal mortality rate must address the issue of Post-partum Haemorrhage. Post-partum Haemorrhage (PPH) is dened as the amount of blood loss in excess of 500 ml following the birth of the baby (World Health Organization). The clinical denition, which is more practical, states, any amount of bleeding from or into the genital tract following the birth of the baby up to the end of the puerperium, which adversely affects the general condition of the patient evidenced by the rise in pulse rate and falling blood pressure, is called Post-partum Haemorrhage. Aim: The present study is aimed to determine the clinical efcacy of tranexamic acid in reducing blood loss during elective caesarean section in Patna Medical College and Hospital, Patna. Type of study: Prospective study Study period: 1 year (January 2020 to December 2020) Materials and Methods: This is a prospective study conducted in Obstetrics and Gynaecology department at Patna Medical College and Hospital, Patna. 100 female patients scheduled for elective caesarean section are enrolled for the present prospective study, which was carried out from January 2020 to December 2020. The patients were randomly divided into 2 groups. 50 patients received 1g intravenous tranexamic acid 10 rd minutes before skin incision in addition to active management of 3 stage of labour and the other 50 patients were kept under the active rd management of 3 stage of labour only. Result: In the present study, the amount of blood loss was found to be signicantly low (mean 537 ml) in the tranexamic acid group as compared to the control group (608 ml), the difference was statistically signicant (p-value 0.001). The mean fall in haemoglobin level was also less (0.61 mg/dl) in the group which received the tranexamic acid as compared to the control group (1.07 mg/dl), the difference was statistically signicant (p- value 0.001). Postpartum haemorrhage (blood loss more than 1000 ml) was observed in 1 patient in the control group and no case of PPH was observed in the study group. Conclusion: To reduce blood loss following caesarean section, TXAmay be safely recommended in addition to Oxytocin.

Correlation of Nutritional Status with Haematological Profile in Undergraduate Medical Students

Background and Aim: Anaemia is a major global health problem affecting all sections of the population. Adolescents are vulnerable to malnutrition and anaemia. Considering the ever rising burden of anaemia in our country, the present study was carried out to detect prevalence of anaemia in undergraduate medical students and to evaluate correlation between nutritional status and anaemia. Correlation between gender and anaemia was also analysed. Methods: Study was carried out in 60 students of I MBBS. Complete blood count was processed on automated haematology analyser. A peripheral blood smear was studied for cell morphology. Dietary history was taken by providing questionnaire and Body mass index (BMI) was calculated using standard protocol. Results were analysed using SPSS. Results: Anaemia was detected in 23.33% students with higher prevalence in female students (44%). Anaemia and its severity were significantly associated with gender. Overall 43.33% students were found to be malnourished. 19.23% of malnourished students were anaemic. 26.47% students with normal BMI were also found to be anaemic. There was no significant association of BMI with anaemia. Variations in values of red cell indices were detected in 08 non-anaemic students, leukocytosis with monocytosis in 01 non-anaemic student and thrombocytosis in 03 anaemic female students. Conclusion: Medical students should be regularly screened for anaemia. Dietary history should be combined with BMI for complete nutritional assessment. Education of students regarding consumption of balanced diet is necessary to prevent nutritional anaemia. Red cell indices should be used to detect anaemia even before fall in haemoglobin levels. Keywords: Anaemia, Body mass index, Haemoglobin, Red cell indices, RDW, Diet.

EP.TH.30Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D, and Parathyroid Hormone Levels: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb

Abstract Introduction There is little data on the effect of One Anastomosis Gastric Bypass (OAGB) on Haematinics, Vitamins D, and Parathyroid Hormone levels. It is further unclear if an OAGB with a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200). Methods We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit. Results A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46±10.98 years and 276 (67.3%) were females. The mean preoperative weight and the Body Mass Index (BMI) were 139±29.96 kg and 49±8.14 kg/m2 respectively. With OAGB-200 there was a significant increase in anaemia rates at 1 and 2-years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150 there was a significant fall in haemoglobin levels at 1 and 2-years but the increase in anaemia rate was only significant at 2-years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2-years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only. Conclusion Both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate, and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.

Comparison of Standard Percutaneous Nephrolithotomy with Mini-Percutaneous Nephrolithotomy for Removal of Renal Stones in Adults

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P &gt; 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.

Robotic-Assisted Hysterectomy for Benign Indications of Uteri Less Than Fourteen Weeks Size Versus More Than Fourteen Weeks Size: A Comparative Study.

ObjectivesThis study was conducted to evaluate the feasibility of robotic hysterectomy for benign indications in patients with small size (<14 weeks) versus large size (>14 weeks) uterus.MethodsThis prospective study was conducted in a single centre from August 2018 to January 2020 in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences, Rishikesh (Uttarakhand). Surgical outcomes of 216 patients who underwent a robotic hysterectomy in our institution for benign indications were analysed. Women opting for definitive surgical management by minimally invasive technique were divided into two groups according to the size of the uterus less than 14 weeks (group 1) versus more than equal to 14 weeks (group 2). Data collected in both groups included intra-operative and post-operative parameters, length of hospital stay and morbidity if any.ResultsThe demographic profile was comparable in both groups. The mean estimated blood loss was 180.78 ±68.0 ml (range, 10-340 ml) in group 1 and 253.49 ±57ml (range, 60-360 ml) in group 2 (p-value < 0.0001). However, the fall in haemoglobin level after 24 hours of surgery was not statistically significantly different between the two groups. The total duration of surgery in group 1 was 97.86 ± 12.0 minutes (range, 78-132 minutes) and in group 2 was 116.60 ± 15.4 minutes (range, 97-156 minutes), the difference being statically significant (p-value < 0.0001, 95% CI 103±2.1). Console time in group 1 was 43.84 ±6.0 minutes (range, 34-57 minutes) and in group 2 53.22 ±5.5 minutes (range, 44-66 minutes), the difference being statistically significant (p-value < 0.0001, 95% CI 46.57±0.97). There was no difference observed in terms of intra-operative and post-operative complications between the two groups.ConclusionThe total duration of surgery and estimated blood loss were directly proportional to the size of the uterus. However, complication rate, hospital stay and requirement of post-op analgesia were comparable in both groups. Robotic surgery in a larger uterus is a feasible option in terms of better surgical outcomes and postoperative course. Thus, robotic hysterectomy in women with a large uterus is a suitable approach in the narrow region of the pelvis.

Effect of intramyometrial injection of epinephrine during abdominal myomectomy

Objective: To assess the effectiveness of intramyometrial injection of epinephrine inreducing blood loss in abdominal myomectomy and to compare it with pericervicaltourniquet.Methods: Randomized controlled study carried on sixty patients suffering fromsymptomatic uterine fibroids and counseled for abdominal myomectomy. The patientswere randomized into 3 groups of twenty each: control, tourniquet and epinephrinegroups. A comparative analysis of the intra and postoperative outcomes of thesegroups was performed assessing the duration of operation, the blood loss and theblood transfusion rate.Results: The epinephrine group had a statistically significant lower values of the fall inhaemoglobin level and a significantly lower mean operative blood loss than thetourniquet and the control groups. Furthermore, the mean duration of operation wassignificantly shorter in the epinephrine group.Conclusion: Intramyometrial injection of a solution of bupivacaine (50 ml of 0.25%) plusepinephrine (0.5 ml of 1 mg/ml) is very effective in reducing intraoperative bleedingduring abdominal myomectomy. This solution is significantly more effective than usingFoley's urethral catheter as a pericervical tourniquet. However it offers no additionalbenefits over using a pericervical tourniquet regarding the need for blood transfusion.

Increased Bleeding Risk with Phosphodiesterase-5 Inhibitors after Left Ventricular Assist-Device Implantation

Purpose Phosphodiesterase-5 inhibitors (PDE5I) are frequently implemented after left ventricular assist device implantation (LVAD) to improve right heart hemodynamics. No prospective study has yet evaluated the net benefit of off-label long-term PDE5I on clinical outcomes and their potential risks. We aimed to evaluate the impact of PDE5I on bleeding risk as well as severity and type of bleeding according to The Bleeding Academic Research Consortium (BARC) classification after LVAD implantation. Methods We retrospectively reviewed the database of our heart failure unit to identify adult patients who received a durable LVAD at our institution from December 2010 through May 2019. Patients were included in the analysis if they were discharged on oral PDE5I after LVAD implantation. Patients were excluded if they had received biventricular assist-devices, in case of postoperative death during the index hospitalization, follow-up interruption or follow-up in an affiliated hospital. Major bleeding was defined as fatal bleeding, and/or symptomatic bleeding in a critical area or organ, and/or bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells. All non-major bleedings were considered minor bleedings. Results The analytic cohort included 109 patients. Seventy-five patients (69%) received long-term PDE5I therapy and thirty-four (31%) did not receive PDE5I. At 12 months 19 (17%) patients experienced cumulatively 28 bleeding events (26 events in patients on PDE5I, 2 not on PDEI5) leading to 27 red blood cell transfusions (all in the PDE5I group). Patients on PDE5I had higher bleeding rates (23% vs. 6%, p = 0.03) and more bleeding events per patient (0.32 vs. 0.06, p = 0.03). Most events concerned major bleeding (24 events, 85.7%) and 50% non-gastrointestinal bleeding. BARC Type 2 had the highest incidence and was more frequent in the PDE5I group (19 vs 3%, p = 0.03). Hospitalizations for bleeding and their duration were numerically higher for PDE5I (0.28 vs 0.03 hospitalizations, p = 0.07 and 2.4 vs. 0.2 days, p = 0.07, respectively). Conclusion Long-term PDE5I treatment after LVAD increases the risk of bleeding at 12 months after LVAD implantation. The role of off-label PDE5I in LVAD patients remains unclear and should be further clarified in contemporary patient and device cohorts.

Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications.&lt;/p&gt;

Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D and Parathyroid Hormone Levels: a Comparison Between 150 and 200 cm Bilio-Pancreatic Limbs.

There is little data on the effect of one anastomosis gastric bypass (OAGB) on haematinics, vitamin D and parathyroid hormone levels. It is further unclear if an OAGB with a bilio-pancreatic limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200). We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit. A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46 ± 10.98 years and 276 (68.1%) were females. The mean preoperative weight and the body mass index (BMI) were 139 ± 29.96 kg and 49 ± 8.14 kg/m2 respectively. With OAGB-200, there was a significant increase in anaemia rates at 1 and 2 years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150, there was a significant fall in haemoglobin levels at 1 and 2 years but the increase in anaemia rate was only significant at 2 years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2 years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only. We found that both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.

Safety of High-Dose Unfractionated Heparin for Prophylaxis of Venous Thromboembolism in Hospitalized Obese Patients.

Optimal dosing of unfractionated heparin (UFH) for thromboprophylaxis in the obese patient population is uncertain because of their high-risk, prothrombotic state and a complexity of pharmacokinetic considerations. Literature on the appropriateness of the use of a higher dose UFH regimen remains unclear and inconsistent. To evaluate the safety of the use of 7500 units every 8 hours (high-dose) of subcutaneous UFH compared with the use of 5000 units every 8 hours (standard-dose) of subcutaneous UFH for thromboprophylaxis in obese patients (defined as BMI ≥30 kg/m2). In a retrospective cohort study, 326 adult patients were included, with a BMI ≥30 kg/m2, who were admitted to a large, urban academic medical center between September 1, 2015, and September 1, 2018. Patients received either high-dose or standard-dose UFH for at least 48 hours. The primary end point was the incidence rate of bleeding events, defined as a ≥2-g/dL fall in hemoglobin level or receipt of transfusion of 2 or more units of packed red blood cells (pRBCs) from the start of the UFH order. The incidence rate of bleeding was significantly higher in those who received high-dose UFH (43%) compared with those who received standard-dose UFH (29%; P = 0.008). No significant difference was found between venous thromboembolism event rates. High-dose UFH was associated with an increased bleeding event rate compared with standard-dose UFH in patients with a BMI ≥30 kg/m2. This raises safety concerns about the appropriateness of utilizing this regimen in this population.

Editors' note: Low hemoglobin and hematoma expansion after intracerebral hemorrhage

To corroborate previous reports that lower hemoglobin levels may be associated with hematoma expansion (HE) and poor functional outcomes after intracerebral hemorrhage (ICH), Drs. Roh et al. queried their single-center prospective ICH registry of 256 patients. After adjustment for known predictors of HE, each 1 g/dL fall in hemoglobin levels was associated with a 20% higher odds of HE and 24% higher odds of severe disability (modified Rankin Scale score 4–6) at 3 months. Mediation analysis demonstrated that HE contributed to the poor long-term outcomes seen in patients with lower admission hemoglobin levels. Yu et al. address important unmeasured confounders—notably, coagulopathy—which could have also contributed to adverse radiographic and clinical outcomes. However, as Dr. Roh responds, patients in this study were excluded if there was evidence of coagulopathy secondary to systemic disease. Furthermore, the investigators adjusted for the use of therapeutic anticoagulation, irrespective of coagulation studies. Ultimately, both groups agree that these results warrant replication in further studies. To corroborate previous reports that lower hemoglobin levels may be associated with hematoma expansion (HE) and poor functional outcomes after intracerebral hemorrhage (ICH), Drs. Roh et al. queried their single-center prospective ICH registry of 256 patients. After adjustment for known predictors of HE, each 1 g/dL fall in hemoglobin levels was associated with a 20% higher odds of HE and 24% higher odds of severe disability (modified Rankin Scale score 4–6) at 3 months. Mediation analysis demonstrated that HE contributed to the poor long-term outcomes seen in patients with lower admission hemoglobin levels. Yu et al. address important unmeasured confounders—notably, coagulopathy—which could have also contributed to adverse radiographic and clinical outcomes. However, as Dr. Roh responds, patients in this study were excluded if there was evidence of coagulopathy secondary to systemic disease. Furthermore, the investigators adjusted for the use of therapeutic anticoagulation, irrespective of coagulation studies. Ultimately, both groups agree that these results warrant replication in further studies.

A COMPARATIVE STUDY OF ASSESSMENT OF ROLE OF TRANEXAMIC ACID IN CONTROLLING BLOOD LOSS IN ORTHOPAEDIC SURGERIES: A RANDOMISED CONTROL TRIAL.

Aim: to study the role of Tranexamic Acid in Controlling Blood Loss In orthopaedic surgeries.&#x0D; Material &amp; Methods: 50 patients were included in the study during the study period. Patients were randomly allotted to 2 groups of equal participants. The first group (Group A) received Tranexamic Acid. The second group (Group B) was given Normal saline as placebo. The Total Blood Loss ( intra operative + post operative ) and Fall in Haemoglobin levels were measured post-operatively at 24 and 72 hrs of post-operative period.&#x0D; Result: The group A had showed significantly reduced total blood loss and fall in Haemoglobin, thus, requiring fewer blood transfusions. No complications were observed.&#x0D; Conclusions: the present investigation concluded that Tranexamic acid can be effective in reducing blood loss and subsequent fall in haemoglobin.&#x0D; Keywords: Tranexamic acid, Bleeding, Major Orthopaedic surgeries.

Predictive Factors for Muscle Injury After Posterior Lumbar Spinal Surgery

The aims of this study were to evaluate the risk factors for muscle injury in patients undergoing posterior lumbar spinal surgery and the clearance of postoperative biochemical changes following lumbar fusion and secondarily to evaluate the timing for monitoring postoperative biochemical serum levels and potential clinical correlation. The study prospectively enrolled 39 patients with degenerative disease of the lumbar spine. Biochemical markers (creatine phosphokinase [CPK], creatinine, and hemoglobin) were analyzed in 5 predefined stages. All relevant clinical data were collected. Rhabdomyolysis (RML) was defined as a postoperative 5-fold increase of the baseline CPK value. Patients from the lumbar fusion group had the highest postoperative CPK ratio. Overall, the rate of RML was 43.6%. CPK and creatinine activity reached their maximum on the first postoperative day in 69.2% and 87.5% of patients, respectively. Lumbar fusion (P= 0.005), surgical time >270 minutes (P= 0.028), and fall in hemoglobin levels >3 g/dL (P= 0.034) were identified as independent factors associated with higher risk of RML. The risk of RML increases with prolonged and invasive surgery with higher bleeding potential. Knowing the clearance of postoperative biochemical changes permits a standardized strategy with measurements in precise intervals, thereby avoiding unnecessary costs. The clinical significance is still undetermined.

The Clinical Significance of a 'Crazy-Paving' Pattern on Chest Radiology.

A crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground-glass attenuation associated with interlobular septal thickening and intralobular lines. It was initially described as a pathognomonic sign of pulmonary alveolar proteinosis. However, it can be also found in many other diffuse acute and chronic lung diseases including diffuse alveolar haemorrhage (DAH), a rare and life-threatening clinical syndrome which can be caused by many conditions, the most frequent of these being capillaritis associated with systemic autoimmune diseases.In this case report, we describe an 82-year-old female patient with acute respiratory failure and bilateral pulmonary infiltrates with the characteristic crazy-paving pattern. The final diagnosis was isolated DAH induced by microscopic polyangiitis. The patient was treated with IV high dose prednisolone and cyclophosphamide and was mechanically ventilated. Nevertheless, her clinical status progressively deteriorated and she died after 3 days from acute respiratory distress syndrome.LEARNING POINTSA crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground-glass attenuation associated with interlobular septal thickening.The presence of a crazy-paving pattern together with a progressive fall in haemoglobin levels suggests diffuse alveolar haemorrhage (DAH).A panel for collagen vascular diseases and vasculitis should be immediately performed in patients suspected of having DAH.