The article aims at investigating the current scenario of internationalization of higher education (IoHE) in Kerala, particularly in the area of inbound student mobility. It analyses the issues of foreign students enrolled in different programmes across the state. The study includes the in-depth analysis of the current challenges faced by Kerala in the era of growing internationalization trends worldwide. Notably, these challenges encapsulate a larger picture of IoHE in India which makes this article relevant in a broader context. The conducted study enables further policy suggestions which may prove to be useful for the state authorities and lawmakers.
Introduction. Severe preeclampsia in early stages can be detected by isolated thrombocytopenia, which makes it difficult to diagnose it in time and carry out the necessary therapeutic measures. As a rule, the diagnosis of severe preeclampsia can be declared with a detailed clinical and laboratory researches, and it increases the risks for the mother and the embryo. However, if there are no clinical symptoms of preeclampsia except of thrombocytopenia, there is a problem of differential diagnosis between thrombocytopenia, which has the same symptoms as preeclampsia and gestational thrombocytopenia, which is a physiological peculiarity and does not require any medical interventions and restrictions. Nowadays there are no screening methods for differential diagnosis of these conditions. Objectives. To estimate the possibilities of determing the level of neutrophil extracellular traps (NETs) during the differential diagnosis of preeclampsia and gestational thrombocytopenia. Materials and methods. The comparative analysis of the level of NETs was carried out in three groups of pregnant women. Group 1 included patients with severe preeclampsia (n = 45), group 2-patients with gestational thrombocytopenia (n = 44) and group 3 consisted of healthy pregnant women (n = 44). Results. The research revealed significant increase in the level of NETs in the group of patients with preeclampsia (15.26 %,) compared with the groups of healthy patients (7.65 %, p = 0.001) and patients with gestational thrombocytopenia (7.04 %, р = 0.002). There were no significant differences in the level of NETs between the groups of healthy patients and patients with gestational thrombocytopenia. Conclusions. A significant increase of the level of NETs among the patients with severe preeclampsia allows us to consider the method of calculating the level of NETs among patients with thrombocytopenia which can be detected after the 20th week of pregnancy, if there are no other laboratory and clinical signs of preeclampsia as a screening method for early diagnosis of this complication.
Inherited metabolic disorders have a specific place among cases of sudden deterioration of the newborn’s condition. Therapies have been developed for some of these disorders. Accurate verification of the diagnosis is extremely important for choosing an optimal treatment strategy. However, treatment is not always successful due to the rapid progression of symptoms. We report a case of citrullinemia diagnosed in a newborn in Vidnoye Perinatal Center.
Thrombocytopenia is the second most frequent hematological complica-tion of pregnancy after anemia. Among all thrombocytopenia during pregnancy, the most common is gestational thrombocytopenia. Gestational thrombocytopenia is not accompanied by coagulation disorders, has a minimal risk of bleeding, for both a mother and her fetus. Nevertheless, according to modern concepts, thrombocytopenia is a contraindication for performing obstetric neuroaxial blockades only on the basis of quantitative count of platelets, without taking into account coagulation status. These contraindications are derived from the general surgery and traumatology practice due to the high risk of developing epidural hematoma, but do not take into account the features, including physiological hypercoagulation, of pregnant patients. Refusal of the patient to perform a neuroaxial blockade during delivery on the basis of only counting the number of platelets often leads to an unreasonable increase in the risk / benefit ratio for both the mother and the fetus. Analysis of the research results indicates a change in attitude towards this problem towards a more loyal approach, taking into account the assessment of the coagulative status of a particular patient.
According to the results of systematic reviews of WHO, maternal mortal-ity associated
with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has in-creased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirm-ing the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta.
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