Fetomaternal outcome in pregnancy with thrombocytopenia: A prospective study from one of the teaching health-care institutes of Ahmedabad, Gujarat

Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.

Challenges Faced by People Affected with Leprosy During the COVID-19 Pandemic: A Questionnaire Based Study

This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

Cataract surgery in diabetes mellitus: A systematic review

India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Particularly, the early recognition and treatment of diabetic retinopathy or maculopathy before cataract surgery influence the final visual outcome and play a major role in perioperative decision-making. Better understanding of various factors responsible for favorable outcome of cataract surgery in diabetic patients may guide us in better overalll management of these patients and optimizing the results.

Comparative study of lipid profiel on healthy smoker and non smokers.

Background: Smoking is considered to cause heart disease, cancer, stroke and also have close relationship with gastric ulcer, periodontal disease, sudden infant death syndrome, and metabolic syndrome. Aims & Objective: (1) Study the effect of smoking on lipid profile of healthy smokers (2) To compare the lipid profile of both smokers and non-smokers (3)To study the effect of severity and duration of smoking on lipid profile. Material and Methods: The present study “Comparative study of lipid profile on healthy smoker and non-smokers” was carried out at Department of Physiology, Govt. Medical college, Bhavnagar on 100 healthy smokers and non-smokers. Results: The total serum cholesterol, LDL, VLDL and Triglyceride values were higher in smokers as compared to Non-smokers. These values increased with increase in number of Cigarette/bidis smoked. Serum levels of HDL are lower in smokers than the same in non-smokers. Serum HDL levels decrease with increase in number of Cigarette/bidis smoked. Association of HDL had inverse relationship with cigarettes/bidis smoked per day. Increase in duration of smoking adversely affects lipid profile. Bidi smoking has more adverse effects HDL than cigarette smoking although statistically significant results were not obtained. It shows that serum anti-atherogenic HDL-C level is significantly low in chronic smokers irrespective of the number of cigarettes smoked. The serum level of total cholesterol, LDL-C and VLDL-C and TG are significantly increased with the severity of smoking. The results shows that smoking influences the lipid profile adversely hence causing dyslipidaemia in smokers. Smoking results in increase in oxidized LDL-cholesterol level which plays a key role in the development of atherosclerosis, and also raising the cardiovascular disease risk. Conclusion: Tobacco smoking is associated with dyslipidaemia (Increase LDL-C and decrease HDL-C levels), which is atherogenic in nature. As tobacco smoking interacts with other risk factors, the tobacco smokers get additional benefit if these factors are diagnosed and managed adequately. These risk profiles may be helpful in developing preventive cardiovascular strategies for adolescents.

A comparative study of visual reaction time in basketball players and healthy controls.

Introduction:-Reaction is purposeful voluntary response to different stimuli as visual or auditory stimuli. The present study was conducted to measure visual reaction time in 100 subjects, 50 basketball players and 50 healthy controls. Material & Method: - The visual reaction time was measured by the reaction time instrument in healthy controls and basketball players. Simple reaction time and choice reaction time measured. During the reaction time testing, visual stimuli were given for three times and minimum reaction time was taken as the final reaction time for that sensory modality of that subject. The results were statastically analyzed and were recorded as mean+ standard deviation and student’s unpaired t-test was applied to check the level of significance. Result:- The study shows that basketball players shows faster reaction time than healthy controls. Conclusion: - As reaction time gives the information how fast a person gives a response to sensory stimuli, it is a good indicator of performance in reactive sports like basketball.

Malignant myelomatous pleural effusion with good response to combination chemotherapy.

Malignant pleural effusion in myeloma is a rare terminal event with 91 cases reported so far. Majority of the patients survive less than 4 months. We are presenting a short series of four such cases, who had a good clinical response to combination chemotherapy.

Study on clinico-epidemiological profile of HIV patients in eastern India.

In this study, 438 HIV positive patients attending the HIV clinic of Sir Sundar Lal Hospital, IMS, BHU were enrolled. Of these 354 were males (mean CD4 count 179 +/- 9.3 cells/microl) and 84 were females (mean CD4 count 323 +/- 28.26 cells/microl). The mean age of the study subjects at the time of diagnosis was 32.6 years. Heterosexual contact was the commonest mode of transmission in 352 (80.4%) patients followed by blood transfusion in 2.5%.History suggestive of a risk factor for HIV transmission could not be elicited in 62 (14.1%) patients. Among male patients, 71.5% were migrant workers. Fever (70.6%), weight loss (53.3%), chronic diarrhea (43.9%) and cough (40.3%) were the common presenting symptoms. Out of the 438 patients, 66.4% had opportunistic infections at the time of reporting to the hospital. The most common opportunistic infection was tuberculosis (38.8%) followed by oropharyngeal candidiasis (20.3%) and diarrhea (12.7%). CD4 counts of the patients were significantly inversely correlated with the number of symptoms and the number of opportunistic infections (correlation coefficient were -.289 and -.236 respectively).

Simulation of normal, carrier and affected controls for large-scale genotyping of cattle for factor XI deficiency

An insertion mutation within exon 12 of the factor XI gene has been described in Holstein cattle. This has opened the prospect for large-scale screening of cattle using the polymerase chain reaction (PCR) technique for the rapid identification of heterozygous animals. To facilitate such a screening process, the mutant and normal alleles of factor XI gene, represented by 244- and 320-bp PCR amplified fragments, were individually cloned in Escherichia coli using a multicopy plasmid cloning vehicle to generate pFXI-N and pFXI-M, respectively. The authenticity of the inserts was confirmed by nucleotide sequencing. A nested PCR method was developed, by which PCR amplicons generated from primers with annealing sites on the recombinant plasmids and by flanking the insert were used as templates for amplification of the diagnostic products using factor XI gene-specific primers. An equimolar mixture of both PCR amplicons, originating from pFXI-N and pFXI-M, constituted the carrier control while the individual amplicons were the affected and normal controls. The controls were used as references for in-gel comparison to screen a population of 307 cattle and 259 water buffaloes; the frequency of the mutant allele was found to be 0. No DNA size standards were required in this study. The simulated control DNA samples representing normal, carrier and affected cattle have the potential to help in large-scale screening of a cattle population for individuals that are carriers or affected by factor XI deficiency.

Management of bio-medical waste: awareness and practices in a district of Gujarat.

With the objective of assessing the level of awareness about the various aspects of biomedical waste and disposal practices by the medical practitioners this study was conducted. It was a cross sectional study. 30 hospitals with more than 30 beds minimum were randomly selected from Sabarkantha district, Gujarat. The doctors and auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the existence of the law related to biomedical waste but details were not known. Doctors were aware of risk of HIV and Hepatitis B and C, whereas auxiliary staff (ward boys, ayabens, sweepers) had very poor knowledge about it. There was no effective waste segregation, collection, transportation and disposal system at any hospital in the district. There is an immediate and urgent need to train and educate all doctors and the staff to adopt an effective waste management practices.

Serum lactate dehydrogenase in diagnosis of megaloblastic anaemia.

The present study was carried out in 75 patients of macrocytic anaemia categorised on bone marrow examination (into megaloblastic and non-megaloblastic anaemia) to evaluate the efficacy of total serum LDH levels and LDH isoenzyme pattern in the diagnosis of megaloblastic anaemia. 25 healthy adults were taken as controls. From this study it can be concluded that total serum LDH levels more than 3000 IU/L are diagnostic of megaloblastic anaemia. Reversed LDH isoenzyme pattern (LDH1 > LDH2) by chloroform inhibition test is an adjuvant in the diagnosis where total serum LDH levels are between 451-3000 IU/L and it will also differentiate megaloblastic anaemia from haemolytic anaemia.

Combining aspirin with angiotensin converting enzyme inhibitors in heart failure: how safe is it?

The above discussion on the interaction of aspirin and ACE inhibitors seems to suggest that aspirin in high doses may have adverse interaction with ACE inhibitors in patients with heart failure but the data obtained is not sufficient or conclusive to recommended omission of aspirin in patients with heart failure. This raises a query in the mind of the physician whether to use a combination or not? The role of aspirin in the early period after myocardial infarction is well established so is the role of ACE inhibitors. Hence in patients with myocardial infarction and preserved left ventricular function it would not be wrong to administer combination of ACE inhibitors and aspirin. Albeit at a lower dose. In patients with large myocardial infarction or heart failure, warfarin may be an option but still needs to be documented in large trials. As suggested long term use of aspirin after infarction is still ambiguous and may be harmful in patients with heart failure with its anticedent side effects. But long term benefits of ACE inhibitors in heart failure are well documented. Hence if a choice has to be made whether to discontinue either of the two drugs it would be preferable to stop the aspirin. To answer the issue of use of aspirin in patients with heart failure it would be essential to conduct a double blind randomized trial comparing known anti-thrombotic treatment, aspirin and anti-coagulants on mortality in patients with heart failure, especially caused by coronary artery disease. Such a trial is underway at the present and till the results are available it should be left to clinical judgement of the physician whether to administer aspirin in patients with heart failure after weighing the benefits versus risk.

Oral submucous fibrosis in India: a new epidemic?

BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition caused by use of the areca nut. The reported prevalence of OSF in Bhavnagar district during 1967 was 0.16%. We investigated whether the impression of an increase in the incidence of the disease was real. METHODS: A house-to-house survey was conducted in Bhavnagar district, Gujarat state. The use of areca nut-containing products and tobacco was assessed through an interviewer administered questionnaire. The oral examination was done by dentists. The diagnostic criteria for OSF was the presence of palpable fibrous bands. RESULTS: A total of 11,262 men and 10,590 women aged 15 years and older were interviewed for their tobacco habits. Among 5018 men who reported the use of tobacco or areca nut, 164 were diagnosed as suffering from OSF. All but four cases were diagnosed among 1786 current areca nut users (age-adjusted relative risk: 60.6). Areca nut was used mostly in mawa, a mixture of tobacco, lime and areca nut, and 10.9% of mawa users had OSF (age-adjusted relative risk: 75.6). The disease as well as areca nut use was concentrated (about 85%) in the lower (< 35 years) age group. CONCLUSIONS: An increase in the prevalence of OSF, especially in the lower age groups, directly attributable to the use of areca nut products was observed. This could lead to an increase in the incidence of oral cancer in the future.

Investigation into the possible mechanisms involved in altered digoxin levels in diabetic patients.

The present study was undertaken to investigate the possible factors which may contribute to the altered digoxin levels in diabetic patients. The digoxin levels were found to be significantly higher in diabetics (1.74 +/- 0.09 ng/ml) as compared to non-diabetics (0.76 +/- 0.07 ng /ml). There was a positive correlation between digoxin levels and glycosylated haemoglobin levels. All diabetic patients had serum creatinine, urea and potassium levels within normal limits. However, serum TSH levels were found to be significantly higher in diabetics as compared to controls. Serum tri-iodo-1-thyronine (T3) levels were found to be lower in diabetics as compared to non-diabetics. Our data suggests that diabetes-mellitus causes alteration of digoxin levels. One of the causes of this increase in digoxin levels may be a tendency towards mild hypothyroidism associated with diabetes mellitus.

Clinical implications of acute cerebrospinal fluid changes following iophendylate myelography.

Clinical features and serial cerebrospinal fluid (CSF) samples of 50 patients who underwent myelography with iophendylate were studied. Forty two patients (84%) developed one or more features suggestive of meningism lasting for 2-4 days. There was significant rise in the average (mean) CSF counts from 9.81 in the premyelogram sample to 532.6 at the end of 24 hours (p less than 0.001). Both neutrophil and lymphocyte (p less than 000) count increased. At the end of one week, there was significant decrease of total cells in the CSF to 204 (p less than 0.001). Both, neutrophils and lymphocytes decreased. There was significant rise in total proteins in the 24 hours sample, but the fall at one week was not significant statistically. The sugar and chloride values did not change significantly. All CSF samples were negative for bacterial cultures. In conclusion, a significant proportion of the patients undergoing iophendylate myelography develop clinical features suggestive of meningeal irritation and change in the CSF fractions suggestive of meningitis: however these changes are transient and do not warrant institution of chemotherapy or steroids.

Total and free thyroid hormone levels in chronic renal failure.

The levels of serum total thyroxine (TT4), triiodothyronine (TT3), free T3, (FT3) free T4 (FT4) and thyrotropin (TSH) were measured in 127 clinically euthyroid patients with varying grades of chronic renal failure (CRF); and 97 healthy individuals. They were grouped as: Group I containing 93 patients on conservative management; Group II containing 34 patients on regular dialysis therapy; and Group III (normals). Group I patients showed significant decrease in TT3, TT4 and FT3 levels (p less than 0.001) as compared to Group III, whereas FT4 and TSH values in group I were not significantly altered. TT3, TT4 and FT3 levels reduced as the severity of renal damage increased. Variations in TT3, TT4, FT3, FT4 and TSH levels in Group II patients were similar to those in Group I, except for a decrease in TSH levels (p less than 0.05) as compared to normals. Several thyroid function tests are abnormal in CRF patients, however, finding of normal FT4 and TSH levels would indicate functional euthyroid status.