Search results for: venous ulcers

Authors: Bachir Chemani, Rachid Halfaoui

Abstract:

The aim of study was to evaluate pressure distribution characteristics of the elastic textile bandages using two instrumental techniques: a prototype Instrument and a load Transference. The prototype instrument which simulates shape of real leg has pressure sensors which measure bandage pressure. Using this instrument, the results show that elastic textile bandages presents different pressure distribution characteristics and none produces a uniform distribution around lower limb.

The load transference test procedure is used to determine whether a relationship exists between elastic textile bandage structure and pressure distribution characteristics. The test procedure assesses degree of load, directly transferred through a textile when loads series are applied to bandaging surface. A range of weave fabrics was produced using needle weaving machine and a sewing technique. A textile bandage was developed with optimal characteristics far superior pressure distribution than other bandages. From results, we find that theoretical pressure is not consistent exactly with practical pressure. It is important in this study to make a practical application for specialized nurses in order to verify the results and draw useful conclusions for predicting the use of this type of elastic band.

Keywords: Textile, cotton, pressure, venous ulcers, elastic.

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Authors: Thibaud Berthomier, Ali Mansour, Luc Bressollette, Frédéric Le Roy, Dominique Mottier, Léo Fréchier, Barthélémy Hermenault

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Deep Venous Thrombosis (DVT) occurs when a thrombus is formed within a deep vein (most often in the legs). This disease can be deadly if a part or the whole thrombus reaches the lung and causes a Pulmonary Embolism (PE). This disorder, often asymptomatic, has multifactorial causes: immobilization, surgery, pregnancy, age, cancers, and genetic variations. Our project aims to relate the thrombus epidemiology (origins, patient predispositions, PE) to its structure using ultrasound images. Ultrasonography and elastography were collected using Toshiba Aplio 500 at Brest Hospital. This manuscript compares two classification approaches: spectral clustering and scattering operator. The former is based on the graph and matrix theories while the latter cascades wavelet convolutions with nonlinear modulus and averaging operators.

Keywords: Deep venous thrombosis, ultrasonography, elastography, scattering operator, wavelet, spectral clustering.

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Authors: Jakob Renko, Deja Praprotnik, Kristina Martinovič, Igor Karnjuš

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Catheter-related bloodstream infections are a major burden for healthcare and patients. Although infections of this type cannot be completely avoided, they can be reduced by taking preventive measures. The aim of this study is to review and analyze the existing literature on preventive interventions to prevent central venous catheters (CVC) infections. A systematic literature review was carried out. The international databases CINAHL, Medline, PubMed, and Web of Science were searched using the search strategy: "catheter-related infections" AND "intensive care units" AND "prevention" AND "central venous catheter." Articles that met the inclusion and exclusion criteria were included in the study. The literature search flow is illustrated by the PRISMA diagram. The descriptive research method was used to analyze the data. Out of 554 search results, 22 surveys were included in the final analysis. We identified seven relevant preventive measures to prevent CVC infections: washing the whole body with chlorhexidine gluconate (CHG) solution, disinfecting the CVC entry site with CHG solution, use of CHG or silver dressings, alcohol protective caps, CVC care education, selecting appropriate catheter and multicomponent care bundles. Both single interventions and multicomponent care bundles have been shown to be currently effective measures to prevent CVC infections in adult patients in the ICU. None of the measures identified stood out in terms of their effectiveness. Prevention work to reduce CVC infections in the ICU is a complex process that requires the simultaneous consideration of several factors.

Keywords: Central venous access, critically ill patients, hospital-acquired complications, prevention.

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Authors: Grygorii Kostromin, Vladyslav Povoroznyuk

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Chronic venous diseases (CVD) are one of the common, though controversial problems in medicine. It is generally accepted that this pathology predominantly occurs in women. The issue of excessive weight as a risk factor for CVD is still considered debatable. To the author's best knowledge, today in Ukraine, there are barely any studies that describe the relationship between CVD and obesity. Our study aims to determine the association between age, body composition, obesity and CVD in postmenopausal women. The study was conducted in D. F. Chebotarev Institute of Gerontology, National Academy of Medical Sciences of Ukraine. We have examined 96 postmenopausal women aged 46-85 years (mean age – 66.19 ± 0.96 years), who were divided into two groups depending on the presence of CVD. The women were examined by vascular surgeons. For the diagnosis of CVD, we used clinical, anatomic and pathophysiologic classifications. We also performed clinical, ultrasound and densitometry examinations. We found that the CVD frequency in postmenopausal women increased with age (from 72% in those aged 45-59 years to 84% in those aged 75-89 years). A significant correlation between the total fat mass and age was determined in postmenopausal women with CVD. We also observed a significant correlation between the lower extremities’ fat mass and age in both examined groups. A significant correlation between body mass index and age was determined only in postmenopausal women without CVD.

Keywords: Chronic venous disease, risk factors, age, obesity, postmenopausal women.

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Authors: Chongyang Ye, Rong Liu

Abstract:

Elastic compression stockings (ECSs) have been widely applied in prophylaxis and treatment of chronic venous insufficiency of lower extremities. The medical function of ECS is to improve venous return and increase muscular pumping action to facilitate blood circulation, which is largely determined by the complex interaction between the ECS and lower limb tissues. Understanding the mechanical transmission of ECS along the skin surface, deeper tissues, and vascular system is essential to assess the effectiveness of the ECSs. In this study, a three-dimensional (3D) finite element (FE) model of the leg-ECS system integrated with a 3D fluid-solid interaction (FSI) model of the leg-vein system was constructed to analyze the biomechanical properties of veins and soft tissues under different ECS compression. The Magnetic Resonance Imaging (MRI) of the human leg was divided into three regions, including soft tissues, bones (tibia and fibula) and veins (peroneal vein, great saphenous vein, and small saphenous vein). The ECSs with pressure ranges from 15 to 26 mmHg (Classes I and II) were adopted in the developed FE-FSI model. The soft tissue was assumed as a Neo-Hookean hyperelastic model with the fixed bones, and the ECSs were regarded as an orthotropic elastic shell. The interfacial pressure and stress transmission were simulated by the FE model, and venous hemodynamics properties were simulated by the FSI model. The experimental validation indicated that the simulated interfacial pressure distributions were in accordance with the pressure measurement results. The developed model can be used to predict interfacial pressure, stress transmission, and venous hemodynamics exerted by ECSs and optimize the structure and materials properties of ECSs design, thus improving the efficiency of compression therapy.

Keywords: Elastic compression stockings, fluid-solid interaction, tissue and vein properties, prediction.

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Authors: Jawad Al Khaburi, Abbas A. Dehghani-Sanij, E. Andrea Nelson, Jerry Hutchinson

Abstract:

Medical compression bandages are widely used in the treatment of chronic venous disorder. In order to design effective compression bandages, researchers have attempted to describe the interface pressure applied by multi-layer bandages using mathematical models. This paper reports on the work carried out to compare and validate the mathematical models used to describe the interface pressure applied by multi-layer bandages. Both analytical and experimental results showed that using simple multiplication of a number of bandage layers with the pressure applied by one layer of bandage or ignoring the increase in the limb radius due to former layers of bandage will result in overestimating the pressure. Experimental results showed that the mathematical models, which take into consideration the increase in the limb radius due to former bandage layers, are more accurate than the one which does not.

Keywords: Compression bandages, FlexiForce, interface pressure, venous ulcer

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Authors: Lukas Horny, Rudolf Zitny, Hynek Chlup, Tomas Adamek, Michal Sara

Abstract:

An inflation–extension test with human vena cava inferior was performed with the aim to fit a material model. The vein was modeled as a thick–walled tube loaded by internal pressure and axial force. The material was assumed to be an incompressible hyperelastic fiber reinforced continuum. Fibers are supposed to be arranged in two families of anti–symmetric helices. Considered anisotropy corresponds to local orthotropy. Used strain energy density function was based on a concept of limiting strain extensibility. The pressurization was comprised by four pre–cycles under physiological venous loading (0 – 4kPa) and four cycles under nonphysiological loading (0 – 21kPa). Each overloading cycle was performed with different value of axial weight. Overloading data were used in regression analysis to fit material model. Considered model did not fit experimental data so good. Especially predictions of axial force failed. It was hypothesized that due to nonphysiological values of loading pressure and different values of axial weight the material was not preconditioned enough and some damage occurred inside the wall. A limiting fiber extensibility parameter Jm was assumed to be in relation to supposed damage. Each of overloading cycles was fitted separately with different values of Jm. Other parameters were held the same. This approach turned out to be successful. Variable value of Jm can describe changes in the axial force – axial stretch response and satisfy pressure – radius dependence simultaneously.

Keywords: Constitutive model, damage, fiber reinforcedcomposite, limiting fiber extensibility, preconditioning, vena cavainferior.

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Authors: Aman Ahmed Alzubier, Patrick Nwabueze Okechukwu

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Traditionally, Yemini Sidr honey has been reported to cure liver problems, stomach ulcers, and respiratory disorders. In this experiment, we evaluated Yemeni Sidr honey for its ability to protect inflammations caused by acetic acid and formalin -induced writhing, carrageenan and histamine-induced paw oedema in experimental rat model. Hyperpyrexia, membrane stabilizing activity, and phytochemical screening of the honey was also examined. Yemini Sidr Honey at (100, 200 and 500 mg/kg) exhibited a concentration dependant inhibition of acetic acid induced and formalin induced writhing, paw oedema induced by carrageenan & histamine, and hyperpyrexia induced by brewer's yeast, it also inhibited membrane stabilizing activity. Phytochemical screenings of the honey reveal the presence of flavonoids, steroid, alkaloids, saponins and tannins. This study suggested that Yemeni Sidr honey possess very strong antiinflammatory, analgesic and antipyretic effects and these effects would be a result of the phytochemicals present.

Keywords: Anti-inflammatory, Analgesic, Carrageenan, Aceticacid, Histamine, Yemini Sidr Honey

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontraction coupling, viscoelasicity

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Authors: M. Abdul-Rani, K. K. Chong, A. F. M. Hani, Y. B. Yap, A. Jamil

Abstract:

Imaging is defined as the process of obtaining geometric images either two dimensional or three dimensional by scanning or digitizing the existing objects or products. In this research, it applied to retrieve 3D information of the human skin surface in medical application. This research focuses on analyzing and determining volume of leg ulcers using imaging devices. Volume determination is one of the important criteria in clinical assessment of leg ulcer. The volume and size of the leg ulcer wound will give the indication on responding to treatment whether healing or worsening. Different imaging techniques are expected to give different result (and accuracies) in generating data and images. Midpoint projection algorithm was used to reconstruct the cavity to solid model and compute the volume. Misinterpretation of the results can affect the treatment efficacy. The objectives of this paper is to compare the accuracy between two 3D data acquisition method, which is laser triangulation and structured light methods, It was shown that using models with known volume, that structured-light-based 3D technique produces better accuracy compared with laser triangulation data acquisition method for leg ulcer volume determination.

Keywords: Imaging, Laser Triangulation, Structured Light, Volume Determination.

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Authors: C. De Lazzari, E. Del Prete, I. Genuini, F. Fedele

Abstract:

Cardiovascular human simulator can be a useful tool in understanding complex physiopathological process in cardiocirculatory system. It can also be a useful tool in order to investigate the effects of different drugs on hemodynamic parameters. The aim of this work is to test the potentiality of our cardiovascular numerical simulator CARDIOSIM© in reproducing flow/pressure coronary waveforms in presence of two different drugs: Amlodipine (AMLO) and Adenosine (ADO). In particular a time-varying intramyocardial compression, assumed to be proportional to the left ventricular pressure, was related to the venous coronary compliances in order to study its effects on the coronary blood flow and the flow/pressure loop. Considering that coronary circulation dynamics is strongly interrelated with the mechanics of the left ventricular contraction, relaxation, and filling, the numerical model allowed to analyze the effects induced by the left ventricular pressure on the coronary flow.

Keywords: Cardiovascular system, Coronary blood flow, Hemodynamic, Numerical simulation.

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Authors: B. Farahani, R. Fadil, A. Aboonabi, B. Hoffmann, J. Loscheider, K. Tavakolian, S. Arzanpour

Abstract:

Wheelchair users spend long hours in a sitting position, and selecting the right cushion is highly critical in preventing pressure ulcers in that demographic. Pressure Mapping Systems (PMS) are typically used in clinical settings by therapists to identify the sitting profile and pressure points in the sitting area to select the cushion that fits the best for the users. A PMS is a flexible mat composed of arrays of distributed networks of pressure sensors. The output of the PMS systems is a color-coded image that shows the intensity of the pressure concentration. Therapists use the PMS images to compare different cushions fit for each user. This process is highly subjective and requires good visual memory for the best outcome. This paper aims to develop an image processing technique to analyze the images of PMS and provide an objective measure to assess the cushions based on their pressure distribution mappings. In this paper, we first reviewed the skeletal anatomy of the human sitting area and its relation to the PMS image. This knowledge is then used to identify the important features that must be considered in image processing. We then developed an algorithm based on those features to analyze the images and rank them according to their fit to the user's needs. 

Keywords: cushion, image processing, pressure mapping system, wheelchair

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Authors: Elie H. Karam, Antoine B. Abche

Abstract:

It is known that the heart interacts with and adapts to its venous and arterial loading conditions. Various experimental studies and modeling approaches have been developed to investigate the underlying mechanisms. This paper presents a model of the left ventricle derived based on nonlinear stress-length myocardial characteristics integrated over truncated ellipsoidal geometry, and second-order dynamic mechanism for the excitation-contraction coupling system. The results of the model presented here describe the effects of the viscoelastic damping element of the electromechanical coupling system on the hemodynamic response. Different heart rates are considered to study the pacing effects on the performance of the left-ventricle against constant preload and afterload conditions under various damping conditions. The results indicate that the pacing process of the left ventricle has to take into account, among other things, the viscoelastic damping conditions of the myofilament excitation-contraction process. The effects of left ventricular dimensions on the hemdynamic response have been examined. These effects are found to be different at different viscoelastic and pacing conditions.

Keywords: Myocardial sarcomere, cardiac pump, excitationcontractioncoupling, viscoelasicity

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Authors: Sanjay Saraf

Abstract:

The oral cavity can be the site for early manifestations of mucocutaneous disorders (MD) or the only site for occurrence of these disorders. It can also exhibit oral lesions with simultaneous associated skin lesions. The MD involving the oral mucosa commonly presents with signs such as ulcers, vesicles and bullae. The unique environment of the oral cavity may modify these signs of the disease, thereby making the clinical diagnosis an arduous task. In addition to the unique environment of oral cavity, the overlapping of the signs of various mucocutaneous disorders, also makes the clinical diagnosis more intricate. The aim of this review is to present the oral signs of dermatological disorders having common oral involvement and emphasize their   importance in   early detection of the systemic disorders. The aim is also to highlight the necessity of oral examination by a dermatologist while examining the skin lesions. Prior to the oral examination, it must be imperative for the dermatologists and the dental clinicians to have the knowledge of oral anatomy. It is also important to know the impact of various diseases on oral mucosa, and the characteristic features of various oral mucocutaneous lesions. An initial clinical oral examination is may help in the early diagnosis of the MD. Failure to identify the oral manifestations may reduce the likelihood of early treatment and lead to more serious problems. This paper reviews the oral manifestations of immune mediated dermatological disorders with common oral manifestations.

Keywords: Vesiculobullous lesions, Desquamative gingivitis, Nikolsky’s sign, Erythema.

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Authors: Chongyang Ye, Rong Liu

Abstract:

Compression textiles such as compression stockings (CSs) have been extensively applied for the prevention and treatment of chronic venous insufficiency of lower extremities. The involvement of multiple mechanical factors such as interface pressure, frictional force, and elastic materials make the interactions between lower limb and CSs to be complex. Determination of Poisson’s ratio and elastic moduli of CS materials are critical for constructing finite element (FE) modeling to numerically simulate a complex interactive system of CS and lower limb. In this study, a mixed approach, including an analytic model based on the orthotropic Hooke’s Law and experimental study (uniaxial tension testing and pure shear testing), has been proposed to determine Young’s modulus, Poisson’s ratio, and shear modulus of CS fabrics. The results indicated a linear relationship existing between the stress and strain properties of the studied CS samples under controlled stretch ratios (< 100%). The proposed method and the determined key mechanical properties of elastic orthotropic CS fabrics facilitate FE modeling for analyzing in-depth the effects of compression material design on their resultant biomechanical function in compression therapy.

Keywords: Elastic compression stockings, Young’s modulus, Poisson’s ratio, shear modulus, mechanical analysis.

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Authors: Yu Shi, Rong Liu, Jingyun Lv

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Compression textiles with ergonomic-fit and controllable pressure performance have demonstrated positive effect on prevention and treatment of chronic venous insufficiency (CVI). Well-designed compression textile products contribute to improving user compliance in their daily application. This study explored the effects of multiple knitting variables (yarn-machinery settings) on the physical-mechanical properties and the produced pressure magnitudes of tubular compression fabrics (TCFs) through experimental testing and multiple regression modeling. The results indicated that fabric physical (stitch densities and circumference) and mechanical (tensile) properties were affected by the linear density of inlay yarns, which, to some extent, influenced pressure magnitudes of the TCFs. Knitting variables (e.g., feeding velocity of inlay yarns and loop size settings) can alter circumferences and tensile properties of tubular fabrics, respectively, and significantly varied pressure values of the TCFs. This study enhanced the understanding of the effects of knitting factors on pressure controlling of TCFs, thus facilitating dimension and pressure design of compression textiles in future development.

Keywords: Laid-in knitted fabric, yarn-machinery settings, pressure magnitudes, quantitative analysis, compression textiles.

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Authors: S. Jaramillo, Y. Montoya, W. Agudelo, J. Bustamante

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Cardiovascular diseases (CVD) are related to affectations of the heart and blood vessels, within these are pathologies such as coronary or peripheral heart disease, caused by the narrowing of the vessel wall (atherosclerosis), which is related to the accumulation of Low-Density Lipoproteins (LDL) in the arterial walls that leads to a progressive reduction of the lumen of the vessel and alterations in blood perfusion. Currently, the main therapeutic strategy for this type of alteration is drug treatment with statins, which inhibit the enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase), responsible for modulating the rate of cholesterol production and other isoprenoids in the mevalonate pathway. This enzyme induces the expression of LDL receptors in the liver, increasing their number on the surface of liver cells, reducing the plasma concentration of cholesterol. On the other hand, when the blood vessel presents stenosis, a surgical procedure with vascular implants is indicated, which are used to restore circulation in the arterial or venous bed. Among the materials used for the development of vascular implants are Dacron® and Teflon®, which perform the function of re-waterproofing the circulatory circuit, but due to their low biocompatibility, they do not have the ability to promote remodeling and tissue regeneration processes. Based on this, the present research proposes the development of a hydrolyzed collagen and polyethylene oxide electrospun membrane reinforced with medium and high-intensity statins, so that in future research it can favor tissue remodeling processes from its microarchitecture.

Keywords: atherosclerosis, medium and high-intensity statins, microarchitecture, electrospun membrane

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Authors: L. Nekoozad, M. Salehi Barough, B. Salmasian

Abstract:

Introduction: Some parameters should be considered to investigate the chronic effects of radiation absorption in radiation workers. Trace elements are parameters which small changes in them can cause significant effects on live systems. The role of trace element concentration in human health is significant. These elements play an important role in the developing and functioning of the immune system, cellular respiration, and oxidation processes. Considering the importance and necessity of this issue and few studies, measurements of concentration changes of these elements due to the absorbed dose are important. Purpose: This study aimed to determine the biological effects of occupational dose absorption on plasma and erythrocyte concentration of Zn and Cu in the radiology staff of Tehran Oil Hospital. Material and methods: In this analytical-comparative study, 72 people have entered. 36 people (18 males and 18 females) were selected as radiology staff in the diagnostic and therapeutic departments of Tehran Oil Hospital. And 36 people (18 males and 18 females) were selected as general section staff in the same hospital as a control group. Radiology and control groups’ age and sex were matched. 10 ml of venous blood was taken from all people.  An atomic absorption spectrometer was used to obtain zinc and copper plasma concentrations. Levine test was used to compare these results validity. Results: The mean concentrations of copper and zinc were measured as 0.951 and 0.754 mg/L in the plasma phase and 3.2  and 0.401 mg/L in the RBC phase for the radiology group.  Copper and zinc average concentrations, respectively 0.976 and 0.813 mg/L in the plasma phase and 2.906 and 0.476 mg/L in the RBC phase, were measured for the control group. These elements Concentrations in the plasma phase were significantly different from that of the control group, but the concentrations in the red blood cell phase did not show a significant difference compared to the control group. In comparison, a separate comparison between men and women in the experimental and control groups showed a significant difference in the values of the elements mentioned. With a significant increase in samples, a better justification than the available statistical results can be extracted. Conclusions: Within this study results, chronic occupational probabilistic absorption destructive effects (even within the permitted range) on blood trace element concentration have been confirmed.

Keywords: Chronic absorption, atomic absorption spectrometry, radiology staff, trace element concentration.

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Authors: Samar Saadeldin Abdelmotalab Omer, Ikram Mohamed Eltayeb Elsiddig, Amna Beshir Medani Ahmed, Saad Mohamed Hussein Ayoub

Abstract:

Many herbal medicinal products are considered potential anti-hypercholesterolemic agents with encouraging safety profiles, however only a limited amount of clinical research exists to support their efficacy. The present study was designed to compare the antihypercholesterolemic and antioxidant activities of the crude ethanolic extracts of Citrus reticulata fruit peel, Zingiber officinale rhizome and Sesamum indicum seeds. Forty-five rats were used throughout the experiment which are extended for four weeks. These were divided into nine groups, five rats per each group as follows; group 1 was the normal control group (rats only fed standard normal rat diet), group 2 was the hypercholesterolemic control group (rats fed only hypercholesterolemic diet which contained 1% cholesterol plus 10% saturated animal fat added to the normal rat diet), groups 3 and 4 were fed hypercholesterolemic diet in addition to Citrus reticulata ethanolic extract at doses of (250mg/kg (group 3) and 500mg/kg (group 4)) administered daily via oral route, groups 5 and 6 were given hypercholesterolemic diet in addition to Zingiber officinale ethanolic extract at doses of (250mg/kg (group 5) and 500mg/kg (group 6)) daily through oral route, groups 7 and 8 fed on hypercholesterolemic diet in addition to Sesamum indicum ethanolic extract at doses of (250mg/kg (group 7) and 500mg/kg (group 8)) daily orally; and group 9 rats were given hypercholesterolemic diet in addition to atorvastatin (0.18mg/kg) daily via oral route as a standard reference antihypercholesterolemic drug. Blood samples from all groups were drawn from the retro-orbital venous plexus four weeks following treatment after overnight fasting and the lipid profile (total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and triglyceride levels) were measured and the risk ratio (TC/HDL-C) was assessed. The antioxidant activity of the three plants extracts was determined using DPPH free-radical antioxidant assay. Results of in vivo and in vitro antihypercholesterolemic and antioxidant assay respectively, revealed that the three extracts possess comparable antioxidant and antihypercholesterolemic activities.

Keywords: Antihypercholesterolemic effects, Antioxidant activity, HDL, LDL, TC, TGs, Citrus reticulata, Sesamum indicum, Zingiber officinale.

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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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