Content uploaded by Debasish Das
Author content
All content in this area was uploaded by Debasish Das on Nov 14, 2022
Content may be subject to copyright.
Among 130 babies, 46.2% were delivered bycaesarean and 2.3% by assisted
mode showing a towering likelihood of caesarean section in diabetic
mothers.
The normal range Cord blood HCT is 50-55%
In our study, 48(37.7%) neonates had HCT between 45%-50%, 35(26.9%)
showed values between 50%-55%,20(15.4%) had values of 55%-60% and
13(10%) had cord blood HCT >60%.
The occurrence of complications was higher in the high cord blood hae-
matocrit group than in the normal group. The commonest problems
encountered in IDM babies were hyperbilirubinemia and hypocalcaemia
(Table 29)
The study is to reinforce the need to improve the knowledge on repro-
ductive health of women with diabetes during gestation and to understand
the underlying mechanisms of adverse foetal and maternal outcomes,
which in turn may lead to strategies for its prevention.
Awareness, proper observation, early detection and felicitous management
of complications as per guidelines would reduce the mortality and
morbidity among babies born to diabetic mothers, using a simple tool like
cord blood hematocrit.
Abstract e91
A CASE OF SPONTANEOUS RETROPERITONEAL HEMATOMA IN AN
OCTOGENARIAN POST RADIAL PERCUTANEOUS CORONARY
INTERVENTION.
Dr. Anindya Banerjee, Dr. Shashikant Singh, Dr. Debasish Das.
Background: Retroperitoneal hematoma (RH) is a rare but devastating
complication of percutaneous coronary intervention (PCI) occurring either
as a consequence of femoral access or spontaneously. (1-3) Its incidence,
derived mostly from North American database cohorts and small sin-
gleecenter reports, ranges somewhere between 0.025% to 0.9%. (4-8)
Although more common in patients undergoing PCI through femoral ac-
cess, in non-femoral access patients RH is more likely if associated with
female sex, valvular heart disease, cardiogenic shock, received circulatory
support, and warfarin therapy. (9) We present an interesting case of an
eighty three year old man who developed RH on day 2 post radial PCI,
managed conservatively and successfully discharged on day 15.
Case report: An eighty-three-year-old man, on follow-up from an outside
hospital for the past 2 years for chronic coronary syndrome (CCS) and
receiving maximal antianginal with little relief, presented to us and was
admitted for coronary angiogram (CAG) and revascularisation. Radial CAG
through right side revealed significant disease in ostio-proximal left
anterior descending artery (LAD) and hence, after detailed heart team
discussion along with patient informed consent PCI was done with
placement of Drug Eluting Stent (DES). The procedure was uneventful,
patient received a total of 8000 units of Unfractionated Heparin (UFH)
during the procedure. Post-procedure patient received 500 0 units UFH 8th
hourly for next 24 hours along with dual antiplatelet therapy (DAPT):
Aspirin and Ticagrelor. On day 2 the patient developed a significant drop in
hemoglobin (Hb) (10.3 to 5.2 g/dl) along with abdominal distension and
pain in the right lower abdomen. Non-contrast computed tomogram
(NCCT) abdomen revealed bulky and heterogenous appearance of right
psoas muscle over an extent of 4.6*5.0*10.7 cm (Ante-
roposterior*transverse*craniocaudal) (Fig 28, Fig 29) esuggestive of
organized hematoma. The patient was investigated for disorders of
bleeding and coagulation with a battery of tests to no avail.
Dual antiplatelet and anticoagulant therapy was stopped with the
continuation of Ticagrelor at 60 milligrams twice a day. The patient
received 2 units of packed cell transfusion after which Hb increased to 9 g/
dl. A repeat NCCT done after 7 days did not reveal any increase in size and
conservative management was continued. The patient was discharged on
day 15 on single antiplatelet (Ticagrelor 60 mg twice a day).
Conclusion: A retroperitoneal hematoma in the immediate post PCI
setting presents a unique and difficult challenge, where in one hand an-
tiplatelet therapy needs to be maintained for stent patency, on the other
hand there remains a risk of further propagation of the hematoma. Hence,
a judicious and well thoug ht treatment along with supportive measures, as
shown in our case, is required for successful management.
Table 29
Events/findings Normal and low PCV group
(below 55%)
High PCV group
(55% and above)
Large birth weight 12% 24%
Birth trauma 0.18% 4%
Congenital heart
lesion/ disease
6.5% 18%
Hypoglycaemia 16% 28%
Hyperbilirubinemia 52% 85%
Hypocalcaemia 15% 50%
Ă
Abstracts Indian Heart Journal 74 (2022) S27eS108
S74
Downloaded for Anonymous User (n/a) at All India Institute of Medical Sciences - Bhubaneswar from ClinicalKey.com by Elsevier on
November 14, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights reserved.
Fig 29. Transverse CT images demonstrating bulky appearing right psoas muscleĂ
Abstract e92
RELATIONSHIP OF CHEST CT SCORE WITH CLINICAL CHARACTERISTICS
OF 108 PATIENTS HOSPITALISED WITH COVID-19 IN IGIMS, PATNA
BIHAR
Dr. Kaushal Thakur, Dr. Ravi Vishnu Prasad, Dr. Neeraj Kumar.
Background: On Dec 8, 2019, there were reports of several cases of
pneumonia of unknown etiology in Wuhan (Hubei Province, China). The
disease (now termed COVID-19) spread rapidly from Wuhan to other areas.
As of March 15, 2020, there were 80,860 confirmed cases in China, 72,469
cases in 143 other countries, and cases in 6 continents. On January 3, 2020,
this novel coronavirus (now termed SARS-CoV-2) was identified in sam-
ples of bronchoalveolar lavage fluid from a patient in Wuhan and
confirmed as the cause of this disease. During the early stages of this
pneumonia, there were severe acute respiratory symptoms (SARS), and
some patients rapidly developed acute respiratory distress syndrome
(ARDS), acute respiratory failure, and other serious com- plications. On Jan
7, the Chinese Center for Disease Control and Prevention (CDC) identified
this novel coronavirus from the throat swab of a patient. Other coronavi-
ruses cause multiple system infections in various animals, and mainly
respiratory tract infections in humans, such as severe acute respiratory
syndrome (SARS) and Middle East respiratory syndrome (MERS).Most
patients infected by SARS-CoV-2 have mild symptoms and good prognosis.
However, some patients with COVID-19 progressed from severe pneu-
monia to pulmonary edema, acute respiratory distress syndrome, multiple
organ failure, and death.
A confirmed diagnosis of COVID-19 infection requires PCR identification of
viral nucleic acid and lung imaging. Most patients have lung imaging re-
sults indicating bilateral pulmonary parenchymal ground-glass and con-
solidative pulmonary opacities, sometimes with a rounded morphology
and peripheral lung distribution. Notably, lung cavitation, discrete pul-
monary nodules, pleural effusions, and lymphadenopathy are absent.
At present, there is little known about the relationship between imaging
results indicative of pneumonia and the presence of systemic inflamma-
tory mediators in patients with COVID-19. The purpose of this study is to
evaluate the severity of COVID-19 infection by quantifying chest CT results
and to determine the relationship between chest CT scores and systemic
inflammatory mediators in an effort to identify factors that can be used
against the COVID-19 pandemic.
Methods
Study design and participants
Ethical approval was received from the Ethics Committee of Indira Gandhi
institute of medical sciences, Patna Bihar.
A total of 108 patients with COVID-19 were enrolled in the Department of
Covid unit of IGIMS between May 2021 to April 2022. Oral consent was
obtained from patients. All patients with COVID-19 were diagnosed using a
PCR test and all patients met the requirements for admission, all patients
were general or severe according to the fourth edition of the treatment
plan.
Chest CT imaging
Chest CT scores were the average of scores (range: 0 to 10) assigned by two
independent radiologists, each with more than 5 years of experience in
chest CT diagnosis. If the assigned scores differed by more than 1, then a
senior radiologist, with more than 10 years of experience, arbitrated so
that the final assigned scores differed by 1 or less.
According to convention, the lung was divided into five levels, from the
apex to the bottom: suprasternal notch, aortic arch, the tracheal carina,
intermediate bronchus, and apex of diaphragm. The left and right lungs
were scored separately, and each of the 5 lung zones in each patient was
assigned a score according to distribution of affected parenchyma as pre-
viously described.(0, normal; 1,10% abnormality; 2, 20% abnormality; etc.).
The chest CT density was also graded (0, normal attenuation; 1, frosted
glass density; 2, ground-glass attenuation; and 3, consolidation ). Then the
lung parenchyma score was then multiplied by the square of the CT density
Score and points from all zones and added for a final total cumulative score
that ranged from 0 to 900.
Data collection
Demographic and clinical data were collected, including age, gender,
medical history, smoking status, results from a physical examination,
laboratory results, and chest CT results. Patients were divided into three
sub- groups based on chest CT score. The date of disease onset was defined
as the day when symptoms were first noticed.
The validity of all data were checked by two physicians.
Statistical analysis
IBM SPSS Statistics 20.0 was used for data analysis. Data with normal
distributions are presented as the means ±standard deviations (SDs) and
analyzed by Student’s t- test, ANOVA, and a post hoc least significant dif-
ference (LSD) tests. Non-parametric data are expressed as medians and
interquartile ranges (IQRs) and analyzed by the Kruskal-Wallis test with
the Bonferroni correction or the Mann-Whitney U test. Correlations were
deter- mined using Spearman’s rank correlation coefficient. Categorical
Fig 28. Coronal CT images demonstrating bulky appearing right psoas muscleĂ
Abstracts Indian Heart Journal 74 (2022) S27eS108
S75
Downloaded for Anonymous User (n/a) at All India Institute of Medical Sciences - Bhubaneswar from ClinicalKey.com by Elsevier on
November 14, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights reserved.