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Beta-Thalassemia Major (Cooley's Anemia) โ requires chronic blood transfusions leading to Iron Overload (Hemosiderosis/Hemochromatosis).
Mechanism:
\[\text{Each unit pRBC} \approx 200{-}250\,\text{mg iron}\]
Human body has no active iron excretion mechanism โ iron accumulates in organs:
- Liver: Hepatomegaly, cirrhosis
- Heart: Cardiomyopathy, arrhythmias (leading cause of death in thalassemia)
- Endocrine glands: Diabetes mellitus, hypothyroidism, hypogonadism, growth retardation
- Skin: Bronze discoloration
Monitoring: Serum ferritin (target \(<1000\,\mu\text{g/L}\)), MRI T2* (cardiac iron)
Iron Chelation Therapy:
| Drug | Route | Dose | Side Effects |
|---|---|---|---|
| Desferrioxamine (DFO) | SC (8โ12 hr infusion) or IV | \(25{-}50\,\text{mg/kg/day}\) | Auditory/visual toxicity |
| Deferasirox (Exjade) | Oral | \(20{-}40\,\text{mg/kg/day}\) | GI upset, renal toxicity |
| Deferiprone | Oral | \(75\,\text{mg/kg/day}\) | Agranulocytosis |
Curative treatment: Bone marrow/hematopoietic stem cell transplantation.
Ne[3sยฒ3pยน] = Al, Ne[3sยฒ3pยฒ] = Si, Ne[3sยฒ3pยณ] = P, Ar[3dยนโฐ4sยฒ4pยณ] = As. Among these, P has the highest IEโ due to half-filled stability.
Post-cesarean Endometritis is the most common infectious complication after CS (incidence 10โ30% without prophylaxis).
Risk factors: CS (especially emergency), prolonged ROM, prolonged labor, multiple VEs, lower socioeconomic status.
Diagnosis criteria (clinical):
- Fever \(\geq 38.5ยฐC\) on \(\geq 2\) occasions after 24 hours postpartum
- Uterine tenderness (fundal)
- Foul-smelling/abnormal lochia
- Leukocytosis
Gold Standard Treatment: IV Clindamycin + Gentamicin
- Clindamycin: \(900\,\text{mg}\) IV every 8 hours (anaerobic coverage)
- Gentamicin: \(1.5\,\text{mg/kg}\) IV every 8 hours OR \(5\,\text{mg/kg}\) once daily (gram-negative coverage)
- Continue until patient is afebrile for 24โ48 hours
- No oral follow-up needed if responded to IV therapy (ACOG recommendation)
Ampicillin is added if Enterococcus suspected (no response in 72 hours).
If the arithmetic mean of 5 consecutive integers is 12, what is the sum of the least and greatest of these integers?
For 5 consecutive integers, the mean equals the middle (3rd) integer. So the middle integer is 12.
The 5 integers are: $10, 11, 12, 13, 14$.
The least is 10 and the greatest is 14.
Sum $= 10 + 14 = 24$.
In a certain shop, notebooks that normally sell for 59 cents each are on sale at 2 for 99 cents. How much can be saved by purchasing 10 of these notebooks at the sale price?
Normal price for 10 notebooks: $10 \times 59\text{ยข} = 590\text{ยข} = \$5.90$
Sale: 2 notebooks for 99ยข, so 10 notebooks cost $5 \times 99\text{ยข} = 495\text{ยข} = \$4.95$
Savings $= \$5.90 - \$4.95 = \$0.95$
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