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Background: Acute leukemia in pregnancy is estimated to occur in less than one in one lakh pregnancies. Management of these patients differs by the trimester in which they present, because of the differential sensitivity of the fetus to chemotherapy during the three trimesters. Because of the rarity of this situation, there is scarcity of data on the management of these patients. Materials and method: We included patients with acute leukemia diagnosed and treated during pregnancy at our institute and reviewed 3 successive patients for this case series. Results and conclusion: Acute leukemia in pregnancy presents a unique challenge for treatment and requires multidisciplinary co-ordination for treatment. When judiciously managed, good outcomes of disease of mother and fetus can be achieved. Our three patients included one in each trimester; the first trimester patient underwent medical termination of pregnancy and has successfully completed treatment. The second trimester patient underwent induction chemotherapy and delivered a healthy baby. The patient diagnosed in the third trimester delivered a pre-term healthy baby during treatment and continues to be on chemotherapy.

Background: Coronavirus disease 2019 (COVID-19) is a pandemic caused by a novel beta coronavirus severe acute respiratory syndrome coronavirus (SARS-CoV-2). The symptoms range from mild to severe in nature. The severity of respiratory symptoms is due to the cytokine storm. The tocilizumab, interleukin-6 inhibitor, can prevent the cytokine release and decrease the mortality. Patients and methods: This is a retrospective observational study of 20 COVID-19 positive cases who received tocilizumab. Results and conclusion: There were 75% males with a mean age of 47.20±9.68 years in our study. 50% had diabetes mellitus, 35% had hypertension, 5% had Chronic kidney disease, 5% had obesity and 5% had hypothyroidism. Mortality was reduced to 65% with tocilizumab administration. There was statistically significant reduction of C- reactive protein (p

This prospective trial investigated the population pharmacokinetics of piperaquine given with dihydroartemisinin to treat uncomplicated malaria in 107 Ugandan children 6 months to 2 years old, an age group previously unstudied. Current weight-based dosing does not adequately address physiological changes in early childhood. Patients were administered standard 3-day oral doses and provided 1,282 capillary plasma concentrations from 218 malaria episodes. Less than 30% of treatments achieved 57 ng/mL on day 7. A three-compartment model with first-order absorption described the data well. Age had a statistically significant effect (P < 0.005) on clearance/bioavailability in a model that accounts for allometric scaling. Simulations demonstrated that higher doses in all children, but especially in those with lower weight for age, are required for adequate piperaquine exposure, although safety and tolerance will need to be established. These findings support other evidence that both weight- and age-specific guidelines for piperaquine dosing in children are urgently needed.

Background: One promising new Artemisinin-based combination therapies (ACTs) is dihydroartemisinin-piperaquine (DHA-PQ). However, the pharmacokinetics of piperaquine and the relationship between drug levels and clinical efficacy are incompletely characteri

Nitin K Sekhri,1,2 Shalvi Parikh,1 Garret M Weber1,2 1Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA; 2Department of Anesthesiology, New York Medical College, Valhalla, New York, USACorrespondence: Nitin K SekhriDepartment of Anesthesiology, Westchester Medical Center, 100 Woods Road, Macy Suite W228, Valhalla, NY 10595, USATel +1 9144937693Fax +1 9144937927Email Nitin.Sekhri@wmchealth.orgBackground: Cerebrospinal fluid (CSF) pressure measurement is routinely performed via a conventional water column manometer. There is increasing interest in using a digital manometer in measuring CSF pressures. The aim of this study is to compare column and digital manometers, in addition to measuring time to acquire the pressure readings.Research design and methods: This prospective study included 27 patients who were referred for a fluoroscopically guided lumbar puncture. Opening pressure and closing pressure measurements were done with a digital manometer and then a traditional water column manometer. The time to obtain each pressure measurement was also recorded and compared.Results: Mean time to obtain pressure reading was significantly lower in the digital manometer group when compared to the water column manometer group (8.1 seconds vs. 42.2 seconds, P

Sickle cell trait (HbAS) is the best-characterized genetic polymorphism known to protect against falciparum malaria. Although the protective effect of HbAS against malaria is well known, the mechanism(s) of protection remain unclear. A number of biochemica

Jean M Whaley,1 Mark Tirmenstein,2 Timothy P Reilly,2 Simon M Poucher,3 JoAnne Saye,4 Shamik Parikh,5 James F List61Bristol-Myers Squibb, Metabolic Disease Discovery Biology, Research and Development, Princeton, NJ, USA; 2Bristol-Myers Squibb, Drug Safety Evaluation, Research and Development, New Brunswick and Princeton, NJ, USA; 3AstraZeneca, Cardiovascular and Gastrointestinal Innovative Medicines Science Unit, Alderley Park, Macclesfield, Cheshire, UK; 4AstraZeneca, Global Safety Assessment, Research and Development, Wilmington, DE, USA; 5AstraZeneca, Cardiovascular, Clinical Development, Wilmington, DE, USA; 6Bristol-Myers Squibb, Global Clinical Development, Research and Development, Princeton, NJ, USAAbstract: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of glucuretic, antihyperglycemic drugs that target the process of renal glucose reabsorption and induce glucuresis independently of insulin secretion or action. In patients with type 2 diabetes mellitus, SGLT2 inhibitors have been found to consistently reduce measures of hyperglycemia, including hemoglobin A1c, fasting plasma glucose, and postprandial glucose, throughout the continuum of disease. By inducing the renal excretion of glucose and its associated calories, SGLT2 inhibitors reduce weight and have the potential to be disease modifying by addressing the caloric excess that is believed to be one of the root causes of type 2 diabetes mellitus. Additional benefits, including the possibility for combination with insulin-dependent antihyperglycemic drugs, a low potential for hypoglycemia, and the ability to reduce blood pressure, were anticipated from the novel mechanism of action and have been demonstrated in clinical studies. Mechanism-related risks include an increased incidence of urinary tract and genital infections and the possibility of over-diuresis in volume-sensitive patients. Taken together, the results of Phase III clinical studies generally point to a positive benefit-risk ratio across the continuum of diabetes patients. To date, data on dapagliflozin, a selective SGLT2 inhibitor in development, demonstrate that the kidney is an efficacious and safe target for therapy, and that SGLT2 inhibition may have benefits for patients with type 2 diabetes mellitus beyond glycemic control.Keywords: type 2 diabetes mellitus, SGLT2, dapagliflozin, mechanism of action

To demonstrate the laparoscopic resection of an anterior abdominal wall endometrioma. A stepwise demonstration of the laparoscopic resection of the anterior abdominal wall endometrioma. A tertiary academic hospital with Minimally Invasive Gynecologic Surgery specialists 39yo G3P3 with a history of endometriosis who presented for consultation for a right upper quadrant pain and a palpable mass. Abdominal wall endometriosis (AWE) is a type of extra-pelvic endometriosis found within the layers of the abdominal wall. The typical triad a patient presents with is cyclic abdominal pain, a palpable mass and history of abdominal surgery. 80-90% of AWE cases are associated with a surgical scar, with the most common being a Pfannenstiel incision. The standard of care for AWE is surgical excision. After our patient underwent consultation with appropriate imaging and counseling, she was consented for surgical intervention with diagnostic laparoscopy and resection of endometriosis. A diagnostic laparoscopy was performed and utilizing palpation from above and visualization from below, the excision was strategically mapped out. An ultrasonic energy device was used to sharply resect the affected tissue. The cycle of palpating from above and dissecting laparoscopically was crucial throughout the case to ensure the entire specimen was removed. Following resection, a small defect in the fascia was noted, which was closed laparoscopically with suture passer device. The pathology was consistent with endometriosis. AWE needs to be considered when patients present with cyclic abdominal pain, a palpable mass and a surgical history. Medical management can be considered for temporary symptom relief but will not reduce the size of the lesion. Surgical excision with 1cm margins is the standard of care for treatment of AWE. AWE involves the fascia in two-thirds of cases, which means a multidisciplinary surgical team will be necessary for fascial defects greater than 3cm if reconstruction or mesh is required. [ABSTRACT FROM AUTHOR]

To demonstrate the principles of rectal shaving for deep infiltrating endometriosis (DIE) involving the rectosigmoid colon. A stepwise demonstration of laparoscopic rectal shaving and closure of bowel serosal defect. A tertiary academic hospital with Minimally Invasive Gynecologic Surgery and Colorectal specialists. A 30-year-old who presented with chronic pelvic pain and history of endometriosis. Preoperative ultrasound showed an immobile uterus with a suspected bowel nodule. DIE is defined by subperitoneal invasion of endometriosis lesions by greater than 5mm. Bowel endometriosis is reported in 3.8-37% of patients with endometriosis and can be less responsive to medical therapy alone. Surgical management of bowel endometriosis depends on the size of the lesion and includes bowel shaving, discoid resection, or bowel resection. After our patient underwent consultation with appropriate imaging and counseling, she was consented for surgical intervention with bowel shaving and possible bowel resection. The patient had a diagnostic laparoscopy, resection of endometriosis, bilateral ureterolysis, significant adhesiolysis and enterolysis, and rectal shaving for advanced-stage endometriosis. A serosal bowel shaving for a <3 cm endometriosis lesion was performed without any defects to the muscularis layer. The bowel serosa was laparoscopically repaired with 3-0 Vicryl suture in a continuous fashion. The final pathology was consistent with endometriosis. Rectal shaving is a safe and conservative approach for most bowel endometriosis lesions and has the fewest complications. The recurrence rate of endometriosis is similar between rectal shaving and resection. Rectal shaving should be performed by a trained specialist and a laparoscopic bowel repair can be performed in a safe manner. [ABSTRACT FROM AUTHOR]

To demonstrate the utility of preoperative sonographic evaluation for deep infiltrating endometriosis (DIE) and correlate ultrasound and intraoperative findings through a clinical scenario. A stepwise demonstration and comparison of ultrasound and intraoperative evaluation of DIE with narrated video footage. A tertiary, academic hospital with an experienced endometriosis sonographer and high-volume MIGS specialist. A 25-year-old presented with chronic pelvic pain and history of endometriosis after failing multiple medical therapies. DIE occurs in 4-37% of patients with endometriosis. Ultrasound is recommended as a first-line imaging for evaluation and has high sensitivity and specificity for DIE. At our institution, same day preoperative ultrasound is performed for patients based on the IDEA group consensus on the systematic approach to sonographic evaluation of endometriosis. This evaluation includes a basic assessment of the uterus and adnexa, soft markers such as sliding sign, and the anterior and posterior compartments of the pelvis. In this patient, ultrasound illustrated an immobile uterus with a 3 cm right ovarian endometrioma and two hypoechoic lesions in the posterior cul-du-sac, indicating adhesive disease and advanced-stage endometriosis. The patient had a laparoscopic resection of endometriosis, right ovarian cystectomy, bilateral ureterolysis, adhesiolysis and enterolysis, rectal shaving, and an appendectomy. Sonographic results correlated accurately with intraoperative findings, and the pathology was consistent with endometriosis. Ultrasound is imperative for assessing patients with suspected or confirmed advanced-stage endometriosis. A structured pelvic ultrasound should be completed in a manner that assesses for uterine and adnexal mobility and endometriosis lesions or nodules in the anterior and/or posterior compartments of the pelvis. This type of evaluation allows for appropriate surgical planning and counseling, especially for advanced laparoscopic procedures. However, there needs to be more specialized sonographic training to improve the accuracy of preoperative sonographic evaluation of endometriosis. [ABSTRACT FROM AUTHOR]