ABSTRACT
Introduction: Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients. Methodology: The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow‑up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in‑hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype). Results: Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss’s kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype. Conclusion: Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.
ABSTRACT
Depletion in vaginal Lactobacilli colonization is associated with poor urogenital health and adverse pregnancy outcomes. Probiotic supplements containing lactobacilli, when administered in adequate amounts, increased vaginal and gut colonization of Lactobacilli, reduced the incidence of bacterial vaginosis and other urogenital infections. Probiotic Lactobacilli reduced preterm births and improved fertility rates in women following in vitro fertilization. Probiotics may also improve implantation rate and live-birth rate in women undergoing IVF. The purpose of this review was to critically analyse the available literature for synthesizing evidence on the use of probiotics and its effect on urogenital and reproductive health in women.
ABSTRACT
Aim: To evaluate the role of hysterosalpingoscintigraphy (HSSG) as a tubal patency test and compare it with hysterosalpingography (HSG) in infertile patients. Objectives: To determine tubal patency with hysterosalpingoscintigraphy and test its accuracy as compared to hysterosalpingography; compare pain scale between hysterosalpingoscintigraphy and hysterosalpingography; determine time taken for the radiopharmaceutical to ascend up the genital tract during hysterosalpingoscintigraphy. Design: Prospective study Place: The study was conducted in the University Hospital setting. Patients and methods: HSSG was performed on 30 patients with 1 mCi technetium 99m labelled sulphur colloid. Sequential static images were obtained at 0, 15 minutes and 30 minutes. The results were compared to findings of hysterosalpingography. Results: Out of the 30 cases evaluated, 50% had bilateral patent tubes, 33.33% had unilateral patent tube, and 16.67% had bilateral blocked tubes. Time taken for sulphur colloid to reach uterus was 3 minutes 45 seconds; tubes 10 minutes 32 seconds; ovaries 25 minutes 48 seconds. All patients marked 0 on pain scale after HSSG while after HSG, 16 patients marked 3 and 14 patients marked 4 on pain scale. The sensitivity of HSSG was calculated to be 69.64%, specificity 75%, positive predictive value 97.5% and negative predictive value 15%. Conclusion: HSSG is easy to perform, with no premedication requirement and no pain in procedure with high positive predictive value (97.5%), but a poor negative predictive value (15%). This test can be used as compliment to other tubal patency test in the work up of infertility.
ABSTRACT
Adolescent boys are recognized as a vulnerable group to substance abuse. The present study has the objective to study the biosocial profile and habit pattern of substance abusers. The study was conducted on 511 male adolescents, students of 10 th to 12 th class from the four intermediate schools of the Doiwala block of Dehradun district. 46.9% students accepted substance abuse. In 75.5% cases, friends were providing the substances. 80.2% substance abusers expressed their desire to quit the habit. The study is indicative of need for developing a supportive environment involving both parents and teachers so that adolescent can decide and sustain with the right choices for healthy life.
ABSTRACT
Increased free radical activity in gestational diabetes (GDM) can lead to a host of damaging and degenerative maternal and fetal complications. Hence antioxidant levels in blood of GDM mothers and cord blood were estimated. Erythrocyte glutathione (GSH), superoxide dismutase (SOD) and thiobarbituric acid reactive substances (TBARS), plasma vitamins C and E and serum total glutathione-S-transferase (GST), protein thiols and ceruloplasmin (Cp) were estimated spectrophotometrically in maternal blood of age matched controls and mothers with GDM and also in cord blood samples of the above. There was a significant increase in the erythrocytic GSH, serum total GST and protein thiols in GDM maternal blood when compared to controls whereas erythrocytic SOD exhibited a marked decrease in GDM cases. The changes in plasma vitamins C and E, Cp and erythrocytic TBARS in GDM were not significantly different from controls. Cord blood levels of protein thiols were also significantly increased in GDM. No significant changes were observed in the serum Cp and GST levels of the same. Hence, elevated glucose levels can induce oxidative stress in GDM mothers.