Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder which can be associated with various solid tumors and can even precede detection of the underlying malignancy. A 54-year-old male presented with migratory asymmetric inflammatory polyarthritis and high-grade fever for 6 months. On evaluation, he was diagnosed to have renal cell carcinoma (RCC). CP as an initial presentation of RCC was not described previously.
Introduction: We studied the effectiveness of a standardized protocol for emergent warfarin reversal in intracranial hemorrhage using prothrombin complex concentrate (Profilnine SD®). Hypothesis: We hypothesized that Profilnine SD® would shorten time to achieve INR less than or equal to 1.4, limit hemorrhage growth and improve outcome at hospital discharge. Methods: Sixty three patients with INR greater than or equal to 1.2 from 2009-2011 (38 on protocol after 2010) were included in this retrospective analysis. Pre-protocol patients received Vitamin K and plasma; post-protocol patients with INR 1.6 – 4 and > 4 received in addition, 25 and 35-50 units/kg of Profilnine SD® respectively. Hemorrhage volumes were measured on consecutive CT scans using MIPAV semi-automated software. Modified Rankin Score (mRs) was calculated at hospital discharge. Results: Twenty three post protocol patients (61%) received Profilnine SD® (median dose 28 units, IQR 25-46). They had similar baseline median INR’s (2.7 Vs 2.3) and a trend towards larger baseline hemorrhage volumes (9.9 Vs 1.6 cc) compared to other post-protocol patients. Despite faster times to INR reversal in Profilnine SD® patients, (7 Vs 16 hrs, p = 0.008), absolute hemorrhage growth (1.6 Vs 3.1 cc) and median mRs at discharge (3 Vs 3) were similar. However, post-protocol patients had significantly lower hemorrhage growth (absolute: 1 Vs 6.3 cc, p=0.01 and relative: 29% Vs 95% p=0.02) and a higher proportion (66 Vs 52%) achieved good neurological outcome (mRs 0-3). Thirteen of 15 eligible post-protocol patients did not get Profilnine SD®. There were no thrombotic complications related to use of Profilnine SD®. Conclusions: Profilnine SD® significantly shortened time to INR reversal. We could not demonstrate improvement in terms of hemorrhage growth or neurological outcome from Profilnine SD® administration, probably due to small number of patients and imperfect protocol compliance. Despite these limitations, implementation of an emergency warfarin reversal protocol did result in less hemorrhage expansion and better outcomes at hospital discharge.
Introduction Around 9% of India’s children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures. Methods This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants’ GMs twice, that is, within 2 months after birth and at 3–5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12–24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12–24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA. Ethics and dissemination G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.
