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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

Abstract:

The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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Authors: Sujana Dhar, Asis Mazumdar

Abstract:

The effects of global warming on India vary from the submergence of low-lying islands and coastal lands to the melting of glaciers in the Indian Himalayas, threatening the volumetric flow rate of many of the most important rivers of India and South Asia. In India, such effects are projected to impact millions of lives. As a result of ongoing climate change, the climate of India has become increasingly volatile over the past several decades; this trend is expected to continue. Climate change is one of the most important global environmental challenges, with implications for food production, water supply, health, energy, etc. Addressing climate change requires a good scientific understanding as well as coordinated action at national and global level. The climate change issue is part of the larger challenge of sustainable development. As a result, climate policies can be more effective when consistently embedded within broader strategies designed to make national and regional development paths more sustainable. The impact of climate variability and change, climate policy responses, and associated socio-economic development will affect the ability of countries to achieve sustainable development goals. A very well calibrated Soil and Water Assessment Tool (R2 = 0.9968, NSE = 0.91) was exercised over the Khatra sub basin of the Kangsabati River watershed in Bankura district of West Bengal, India, in order to evaluate projected parameters for agricultural activities. Evapotranspiration, Transmission Losses, Potential Evapotranspiration and Lateral Flow to reach are evaluated from the years 2041-2050 in order to generate a picture for sustainable development of the river basin and its inhabitants. India has a significant stake in scientific advancement as well as an international understanding to promote mitigation and adaptation. This requires improved scientific understanding, capacity building, networking and broad consultation processes. This paper is a commitment towards the planning, management and development of the water resources of the Kangsabati River by presenting detailed future scenarios of the Kangsabati river basin, Khatra sub basin, over the mentioned time period. India-s economy and societal infrastructures are finely tuned to the remarkable stability of the Indian monsoon, with the consequence that vulnerability to small changes in monsoon rainfall is very high. In 2002 the monsoon rains failed during July, causing profound loss of agricultural production with a drop of over 3% in India-s GDP. Neither the prolonged break in the monsoon nor the seasonal rainfall deficit was predicted. While the general features of monsoon variability and change are fairly well-documented, the causal mechanisms and the role of regional ecosystems in modulating the changes are still not clear. Current climate models are very poor at modelling the Asian monsoon: this is a challenging and critical region where the ocean, atmosphere, land surface and mountains all interact. The impact of climate change on regional ecosystems is likewise unknown. The potential for the monsoon to become more volatile has major implications for India itself and for economies worldwide. Knowledge of future variability of the monsoon system, particularly in the context of global climate change, is of great concern for regional water and food security. The major findings of this paper were that of all the chosen projected parameters, transmission losses, soil water content, potential evapotranspiration, evapotranspiration and lateral flow to reach, display an increasing trend over the time period of years 2041- 2050.

Keywords: Change, future water availability scenario, modeling, SWAT, global warming, sustainability.

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