Penerapan pijat Kaki Dan Rendam Air Hangat Campuran Kencur Untuk Mengurangi Edema kaki Pada Ibu Hamil Trimester III

One of the problems that often experienced by pregnant women in third trimester is edema in the legs. Leg edema can cause cramps at night. One treatment to reduce leg edema is by implementing foot massage and Warm Water Soak with Kencur. This study was carried out to find out whether foot massage and Warm Water Soak with Kencur culd be implemented to reduce leg edema. This research was a case study with 2 primigravida mothers experiencing leg edema as participants. The instrument being used was an observation sheet. The interventions given to the participats were foot massage and Warm Water Soak with Kencur, that were applied for 10 minutes once a day for 5 days. The results showed that after the intervention the edema dispeared both in case 1 and case 2. In conclusion, the implementation of foot massage and Warm Water Soak with Kencur was effective in reducing leg edema in third trimester pregnant women. Thus, health wokers are expected to be able to implement and teach foot massage and Warm Water Soak with Kencur to pregnant women experiencing leg edema Keywords: edema, Kencur, foot massage, Warm Water Soak with AbstrakKetidaknyamanan yang sering muncul pada ibu hamil trimester III salah satunya edema pada kaki. Dampak dari edema kaki dapat mengakibatkan kram pada malam hari perasaat berat. Sehingga edema kaki harus ditangani salah satunya dengan pijat dan rendam air hangat campuran kencur. Karya tulis ilmiah ini bertujuan untuk mengatasi edema kaki. Metode yang digunakan yaitu berupa studi kasus pada 2 ibu primigravida yang mengalami masalah edema kaki. Instrumen berupa lembar observasi pengukuran edema dengan menggunakan pitting edema. Intervensi dengan menerapan pijat kaki dan rendam air hangat campuran kencur, dilakukan selama 10 menit diberikan satu kali dalam sehari selama 5 hari. Hasil menunjukan sebelum intervensi pada kasus 1yaitu 6mm pada kasus 2 yaitu 8mm. Setelah dilakukan intervensi pada kedua kasus sudah tidak mengalami edema. Kesimpulannya adalah pijat kaki dan rendam air hangat campuran kencur efektif untuk mengurangi edema kaki pada ibu hamil trimester III. Saran bagi tenaga kesehatan, diharapkan dapat menerapkan maupun mengajarkan terapi pijat kaki dan rendam air hangat campuran kencur pada ibu hamil yang mengalami edema kakiKata kunci : edema,kencur,pijat kaki, rendam air hangat

Role of Vascular Ultrasonography in Patients with Leg Swelling

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.

Characteristics of the Wells Score and Associated Factors of Pulmonary Embolisms in Inpatients with Deep Venous Thrombosis

Objective: To evaluate the characteristics of the Wells score and associated factors of acute pulmonary embolisms (PE) in surgical-based inpatients’ with acute deep venous thrombosis (DVT), at Songklanagarind Hospital.Material and Methods: Acute DVT inpatients in the departments of surgery, obstetrics-gynecology and orthopedics; from 2010 to 2016, were extracted from medical records, and retrospectively reviewed. The Wells score was calculated for risk stratification in terms of low, moderate, and high probability. Finally, the associated factors of acute PE were assessed.Results: There were 278 inpatients diagnosed with acute DVT in the surgery (n=142), obstetrics-gynecology (n=101, and orthopedics (n=35) wards. The numbers of low, moderate and high risk probability were 4 (1.0%), 141 (51.0%) and 133 (48.0%), respectively. We identified four factors that were significantly different between the three specialties comprising of: “paralysis, paresis, or recent plaster immobilization of the lower extremities”, “recently bedridden or underwent a major surgical procedure”, “leg edema” and “active cancer”. Regarding the surgery service, patients with acute PE experienced a higher rate of bilateral DVT than those who did not—28.0% and 8.0%, respectively.Conclusion: The low-risk probability determined by Wells score had low incidence of acute DVT in in-patient department settings. Acute bilateral DVT was more significantly associated with acute PE in the surgery service.

Real World Use of Narsoplimab in a Case of Severe HSCT-TMA

Introduction: Hematopoietic stem cell transplantation (HSCT) offers a curative approach for hematologic malignancies. However, endothelial injury from HSCT activates the lectin pathway of complement, resulting in complications such as thrombotic microangiopathy (TMA). HSCT-TMA causes significant mortality. Incidence is reported up to 39%, although lack of consensus on diagnostic criteria results in under-recognition. Risk factors for HSCT-TMA include calcineurin inhibitors (CNI), conditioning, and infection. There is currently no approved treatment for HSCT-TMA. Narsoplimab is a monoclonal antibody that inhibits MASP-2, the effector enzyme of the lectin pathway. We report a patient with late-onset HSCT-TMA who was successfully treated with narsoplimab via a compassionate use program. Methods and Results: A 60-year-old woman with de novo acute myeloid leukemia t (9;11) (p22; q23) who achieved first complete remission (CR1) with minimal residual disease positivity confirmed by flow cytometry (0.04%) underwent matched related allogeneic HSCT from her sister. Patient was cytomegalovirus (CMV) seropositive and blood group O, whereas donor was CMV seronegative and blood group B. Patient received induction with 7+3 and HiDAC consolidation, achieving CR1. Conditioning regimen was Bu4Flu with graft versus host disease (GVHD) prophylaxis of mini methotrexate and tacrolimus. Letermovir was used for CMV reactivation prophylaxis until Day +100. Post-transplant maintenance therapy with azacitidine 36 mg/m 2 was administered by four 5-day cycles (de Lima Cancer 2010). Patient achieved completed donor myeloid CD33 chimerism at Day +30, but donor lymphoid CD3 chimerism was not complete until Day +239. Tacrolimus was discontinued at Day +180. Patient initially had red cell aplasia but achieved transfusion independence by 6 months post-transplant. Circa achieving complete donor CD3 chimerism, patient developed extensive skin and gastrointestinal-overlap GVHD requiring admission for high-dose steroid therapy and resumption of tacrolimus. Onset of GVHD precluded stopping CNI. Patient became steroid refractory and ruxolitinib was added for immunosuppression with resolution of symptoms. Four weeks later, patient developed CMV reactivation and started induction therapy with valganciclovir, during which time she became red cell-transfusion dependent. Patient required 3 weeks induction and 10 days maintenance to clear CMV viremia. Subsequently, she reported dark red urine with evidence for hemoglobinuria without viruria, bilateral leg edema unresponsive to diuretic therapy, and rising serum lactate dehydrogenase (LDH). Evaluation revealed negative direct antiglobulin test, schistocytes on peripheral blood smear (~5/hpf), elevated sC5b-9 levels of 334 ng/mL (72-244 ng/mL), and elevated random urine protein of 124 mg/dL indicative of end organ damage. LDH was modestly elevated 302 IU/L (84-246 IU/L) and haptoglobin was elevated. Based on clinical symptoms and lab results, she was diagnosed with late-onset HSCT-TMA on Day +282 (9 months) using published diagnostic criteria proposed by Cho (2010) and Jodele (2014). The patient's clinical symptoms worsened with severe leg edema - which impeded her ability to walk - and red cell and platelet transfusion dependency. With no approved therapies, compassionate use of narsoplimab was requested for this clinical course of HSCT-TMA. Treatment commenced on Day +309. Patient received a total of 21 doses of narsoplimab 370 mg administered twice weekly on an outpatient basis. All infusions were well tolerated. No adverse events were noted with narsoplimab. Peripheral counts, LDH, anemia, thrombocytopenia and sC5b-9 normalized with reduction in proteinuria, reflecting resolution of HSCT-TMA by dose 19 (10 weeks of treatment); two additional doses were administered (Figure 1). Narsoplimab was given concomitantly with tacrolimus. Patient became transfusion independent and leg edema resolved. Conclusions: This report presents a real-world case study of HSCT-TMA treated with narsoplimab via compassionate use. HSCT-TMA resolved after 10 weeks of treatment, as evidenced by peripheral counts, normalization of LDH and sC5b-9, reduction in urinary protein reflecting improvement in renal function, and improvement in clinical symptoms. Narsoplimab was effective in this complicated case despite several risk factors for poor outcomes. Figure 1 Figure 1. Disclosures Pantin: Omeros Corporation: Honoraria. Billy: Omeros Corporation: Current Employment. OffLabel Disclosure: Off-label use of azacitidine for post-transplant maintenance therapy

Successful Surgical Intervention of Strangulated Ileus with a Simple Cut of the External Iliac Vein without Vein Reconstruction

A 67-year-old woman with epigastralgia was referred to our hospital. The patient had undergone hysterectomy, bilateral oophorectomy, omentectomy, and radical pelvic and para-aortic lymph node dissection for her ovarian cancer 6 years before. Despite the gastrointestinal decompression therapy under the presumed diagnosis of adhesive ileus, computed tomography scans taken 3 days after the onset of epigastralgia showed marked dilatation of the small intestine and an oval high-density mass, that is, thrombi, in the right femoral vein. Aggravation of ileus with the thrombi in the femoral vein made us to treat the patient with surgery. Intraoperative findings showed that the terminal ileum was strangulated by a gap between the exposed right external iliac vein and artery presumably formed by pelvic lymph node dissection. Distal ileum strangulated by the gap, however, showed no ischemic change with no surgically available peritoneum left around the external iliac vein. To prevent the pulmonary embolism and the recurrence of this type of ileus due to both the thrombi and the persistent gap, we released the strangulated ileum with a simple cut of the external iliac vein without vein reconstruction. The patient recovered uneventfully and was discharged on the 13th day after operation. The patient has been well with nominal right leg edema. In this situation, that is, internal hernia caused by external iliac vessels with thrombi in the femoral vein and no leg edema, a simple cut of the external iliac vein without vein reconstruction is a feasible treatment option.

Case Report: Risperidone Induced Peripheral Edema

Risperidone is the first line of treatment for bipolar disorder, atypical depression, and Schizophrenia. We present a 55-year-old male with a history of schizoaffective disorder with bipolar type I presented with aggressive behavior and suicidal ideation. Our patient was treated with low-dose Risperidone; after that, he gradually developed leg pain and edema. His leg pain hampers his ambulation, which is clinically improved after a week of medication discontinuation; however, his leg edema did not resolve completely. In addition, we evaluated our patient's compliance with an empathic verbal interview that shows edema and leg pain hampers his quality of life. We have found that not informing edema as one of the possible side effects increases medication non-compliance in our case. There are several case reports about the side effect of Risperidone (such as leg edema) in combination with other medications, but there is no recommendation about patient counseling of forthcoming leg edema and mobility issues.

A Systematic Review of Elective Laser Therapy during Pregnancy

Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.

Lancisi’s Sign: Giant C-V waves with Severe Tricuspid Regurgitation in Isolated Tricuspid Valve Prolapse

IIntroduction Isolated tricuspid valve prolapse (TVP) is a rare finding on transthoracic echocardiography. Right atrial enlargement or prominent ” v ” waves as a consequence of hemodynamic changes in severe tricuspid regurgitation (TR) are rarely seen with isolated TVP. Here is a case of isolated prolapse of anterior tricuspid leaflet presenting with giant C-V waves also known as Lancisi’s sign. Case Report A 66-year-old male presented with increasing exercise limitation and leg edema in recent months and was complaining about the persistent pulsation at his neck and elevated jugular venous pulse with prominent systolic pulsation that represents giant C-V waves, also known as ‘Lancisi’s sign’ consequence of severe TR due to isolated prolapse of the anterior leaflet.The patients’ symptoms resolved completely after tricuspid valve replacement. Discussion TVP is best defined at parasternal short axis view with more than 2 mm atrial displacement (AD) of leaflet/leaflets. TVP can also be detected from four chamber view with more than 2 mm AD or in right ventricular inflow view with more than 4 mm AD. As a consequence of TVP, the physiological jugular venous waveform alters due to severe TR.During severe TR; retrograde blood flow through right atrium during ventricular systole restrains x descent and produces a fusion of c and v waves that appears as a large pulsation in physical examination called as ‘Lancisi’s sign’ Conclusion ‘Lancisi’s sign’ is defined as a large visible systolic neck pulsation as a consequence of the c-v waves fusion by preventing x descent during severe TR.