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Despite advances in medical care, we still come across pregnancy in Eisenmenger syndrome. Eisenmenger syndrome represents the severe end of the spectrum for disease in pulmonary artery hypertension associated with CHD. Due to very high maternal and perinatal morbidity and mortality, pregnancy is contraindicated among these women. Current guidelines also recommend that the women who become pregnant should opt for early termination of pregnancy. Here, we present a case series of 11 women of Eisenmenger syndrome and their pregnancy outcome.
Methods:
It was a retrospective analysis of 12 pregnancies among 11 women with Eisenmenger syndrome who were managed in a tertiary care referral centre of Northern India.
Results:
The mean age of these women was 28 ± 4 years (range 22 to 36 years). Almost 80% of them (9/11) were diagnosed with Eisenmenger syndrome during pregnancy. The commonest cardiac lesion was Ventricular Septal defect (54.5%) followed by Atrial Septal defect (27.3%) and Patent Ductus arteriosus (9.1%). Only three women opted for medical termination of pregnancy, rest eight continued the pregnancy or presented late. Pregnancy complications found include pre-eclampsia (50%), abruption (22%), and fetal growth retardation (62.5%). There were three maternal deaths (mortality rate 27%) in postpartum period.
Conclusion:
This case series highlights the delay in diagnosis and treatment of CHD despite improvement in medical care. Women with Eisenmenger syndrome require effective contraception, preconceptional counselling, early termination of pregnancy, and multidisciplinary care.
Drug-induced movement disorders (DIMDs) form an important subgroup of secondary movement disorders, which despite conferring a significant iatrogenic burden, tend to be under-recognized and inappropriately managed.
Objective
We aimed to look into phenomenology, predictors of reversibility, and its impact on the quality of life of DIMD patients.
Methods
We conducted the study in the Department of Neurology at a tertiary-care centre in India. The institutional ethics-committee approved the study. We assessed 55-consecutive DIMD patients at presentation to our movement disorder clinic. Subsequently, they followed up to evaluate improvement in severity-scales (UPDRS, UDRS, BARS, AIMS) and quality of life (EuroQol-5D-5L). Wilcoxan-signed-rank test compared the scales at presentation and follow-up. Binary-logistic-regrerssion revealed the independent predictors of reversibility.
Results
Fourteen patients (25.45%) had acute-subacute DIMD and 41 (74.55%) had tardive DIMD. Tardive-DIMD occurred more commonly in the elderly (age 50.73±16.92 years, p<0.001). Drug-induced-Parkinsonism (DIP) was the most common MD, followed by tardivedyskinesia. Risperidone and levosulpiride were the commonest culprit drugs. Patients in both the groups showed a statistically significant response to drug-dose reduction /withdrawal based on follow-up assessment on clinical-rating-scales and quality of life scores (EQ-5D-5L). DIMD was reversible in 71.42% of acute-subacute DIMD and 24.40% of patients with chronic DIMD (p=0.001). Binary-logistic-regression analysis showed acute-subacute DIMDs and DIP as independent predictors of reversibility.
Conclusion
DIP is the commonest and often reversible drug-induced movement disorder. Levosulpiride is notorious for causing DIMD in the elderly, requiring strict pharmacovigilance.
Tiny drops of millimetre size are known to bounce on a solid surface if the surface is superhydrophobic. Recent experiments show that bouncing can occur even on hydrophilic surfaces under conditions where the drop is supported on a thin cushion of gas preventing it from making contact with the surface. We present a detailed insight into this observation by simulating bouncing dynamics of a drop on a flat solid surface using axisymmetric direct numerical simulations. The dynamics of drop motion is governed by three important dimensionless parameters, namely, Reynolds number, $Re$, Weber number, $We$, and capillary number, $Ca_g$. We generate a phase diagram in the $We\text {--}Re$ plane separating the wettability-independent (non-contact bouncing) and wettability-dependent (contact bouncing) regions. We show that $We=2.14$ is the optimum value of Weber number which can support a gas cushion for the widest range of Reynolds numbers. The phase diagram is further divided into five sub-regions based on the shape of the drop and the gas film beneath it. The simulations can reproduce experimentally reported gas films of ${\sim }1\ \mathrm {\mu }\textrm {m}$ with excellent agreement spatially and temporally. Simulations also reproduce well-known scaling laws for a variety of parameters characterising the gas film. New scaling laws for the radial extent of the gas film as well as time taken for impact are derived. For higher Weber and Reynolds numbers, a bouncing drop captures a gas bubble inside it consistent with simple experiments carried out for water drops bouncing on superhydrophobic surfaces.
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