Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.

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A 40-year-old female presented to the neuro physician with complains of headache, giddiness, vomiting and loose stools and altered sensorium since past one day. On examination, deviation of angle of mouth towards right, weakness of left upper and lower limbs, GCS 8/15 and an extensor plantar reflex was seen.CT scan showed bilateral diffuse cerebral oedema. Suspecting a cerebrovascular stroke and increasing intracranial tension, the patient was intubated and started on Inj. Mannitol (150 ml i.v. Q4H) and antibiotics. As the patient was intubated, she was sedated using Inj. Midazolam till fifth day of treatment, when she was extubated. Inj. Dexomethasone (8 mg iv QD) and intravenous fluids were also started. The patient was extubated on fifth day and was started on Inj. Enoxaparin 60 mg subcutaneously BD on sixth day.On the eighth day of treatment (day 3 on enoxaparin) patient complained of sudden development of abdominal pain. This was accompanied by tachycardia and sudden fall in blood pressure. The general surgery department was consulted for the above complaints. On examination, the patient was found to have extreme tenderness, and a vague mass was felt in the right iliac fossa, suprapubic region and left iliac fossa with positive Carnett's sign and Fothergill sign. Repeat complete blood count, ultrasonography abdomen and pelvis, and CT scan abdomen and pelvis were advised.Blood count reports showed a drop in haemoglobin level from 14.6 gm% at the time of admission to 7.1 gm% on the fourth day of enoxaparin treatment. Platelet count which was 353,000 cells/cu mm on admission had fallen to 252,000 cells/cu mm on the day of pain and then fell to 183,000 cells/cu mm the next day. The ultrasonography abdomen and pelvis showed a focal thick walled heterogeneous pelvic collection in the infra-umbilical region.CT scan abdomen and pelvis showed a large (15.3 cm 3 x 12.2 cm 3 x 7.4 cm 3 ) collection, approximately 720 ml, heterogeneous hyper dense collection in the right infra-umbilical anterior abdominal wall, proximally limited to the rectus sheath in epigastric region. Inferiorly extended to preperitoneal space of abdominal cavity crossing the mid line and extending to left side. There was extension into suprapubic region posterior to pubic symphisis and in prevesical region. Compression of bowel loops and bladder was also seen. The reports were suggestive of a Grade III rectus sheath haematoma [Table/ Fig-1].Fluid aspiration cytology report from the infra-umbilical region showed few scattered polymorphs with abundant red blood cells in the background with no evidence of malignant cells. Keywords: AbSTRACTRectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the...

Spontaneous extradural hematoma is a well-documented but fairly rare condition, which can be associated with conditions such as vascular malformations, sickle cell disease, metastasis to the skull, infectious diseases of the skull, coagulation disorders, and use of anticoagulants. Of these, very few cases are of life-threatening extradural hematomas in adults, where hypofibrinogenemia is the cause of bleed, without any history of trauma. In this report, we have discussed the management of such a patient.

Background: Burns due to accidents are a common cause of morbidity and mortality in the Indian sub-continent. The causes being preventive, warrant a better understanding of the epidemiology to know the seriousness of the situation, implement better medical care and prevent such accidents. Aim was to study the morbidity and mortality related to percentage of burns.Methods: This is a retrospective observational study where patients admitted with burns 2013 and 2015 were evaluated. Data with respect to sex, age, percentage of burns, air-way burns, mode and cause of burns, cause of death and length of hospitalization were analyzed.Results: 65.3% of the patients were females and 34.7% males, with a male: female ratio of 0.53:1. A total mortality of 43.71% was seen. Maximum patients belonged to age group 21-40 years which also constituted 28.74% (highest) of the above total mortality. More than 50 % mortality was seen in patients with more than 41% burns. Air way burns were present in 41.31% of the cases; of which 85.51% of cases did not survive. Death due to hypovolemic shock (42.47%) was the main cause of death in the initial 4 days of admission; whereas septicemic shock (57.53%) from the 5th day onward.Conclusions: Morbidity and mortality due to burns is still very high in India, especially in young adults of age groups 21- 40 years. A higher case load for females as seen, being nearly double in in relation to males. Better fluid resuscitation regimens with adequate control of infection is the need of the hour to bring down the mortality. Female sex and more than 41% burns predicts higher mortality. Involvement of the respiratory tract, also predicts higher mortality and may be taken as a reliable indicator of the severity of burns. In the present scenario, we should stress more over the prevention of burns, to easily make available affordable and cheap medical care for the patients and to minimize post burn disability as much as possible.