Utilization of Antenatal services and concerning factors: A community based study

Background: Antenatal and post natal care are important component of maternal mortality rate. Antenatal facilities provided to mothers form the base of their future outcome. The services provided to mothers are still poor in India. A proper and effective program implementation is depending on understanding of basic factors that affect maternal and child health services utilization. Considering all these facts, it is important to study the maternal health service utilization pattern among the beneficiaries living in urban area of Jabalpur and factors responsible for their under utilization. Material & Methods: A prospective study was carried out in urban area of Jabalpur district of Madhya Pradesh. Cluster sampling technique was used to select 396 Antenatal females in the 36 different clusters. Information about socio demographic factors and ANC services utilization was recorded. Results: This study showed that 50.50% of women were registered within 12 weeks of pregnancy, 58.80% women received four or more antenatal visits, 23.99% women consumed hundred and more Iron Folic Acid (IFA) tablets and 96.21% received 2 doses of Tetanus Toxoid (TT) injections. Only 22.72% women had complete ANC service utilization. Conclusion: Utilization of Antenatal Care (ANC) services was poor in the urban areas of Jabalpur district even though the physical accessibility was adequate. ANC services utilization is significantly associated with level of education of mother, education of husband, occupation of mother, type of family and time of registration of pregnancy.

Study of audio vestibular dysfunction in type2 diabetes mellitus

Background: Improved quality of life is prime concern of management of diabetes, which is affecting vast population in later years. Audio vestibular function monitoring and care in the diabetics is part of such concern. Materials and methods: A cross sectional investigation was carried out, of type 2 diabetes patients at different stages of disease and therapy to evaluate audio vestibular dysfunction profiles. Results: Hearing loss (HL) was fairly common even in mild early disease while, tinnitus and vertigo too, occurred in all age, gender, disease duration and therapy categories of diabetics. Some 39% of patients bearing tinnitus or vertigo had normal audiograms. Aged males were found to have more exaggerated prevalence of audio vestibular problems than females. Insulin therapy in presumably, patients of long standing disease had lower prevalence of vertigo. Conclusion: Findings imply, more complex relation of audio vestibular complications to diabetes than, to glycemic status or duration of disease. Monitoring of such complications from the earliest, may alone, bring understanding of their pathogenesis and proper prevention and management.

Clinical profile of pregnancy related acute renal failure: An experience at a tertiary level hospital in Mumbai

Background: Pregnancy-related acute renal failure (ARF) can be caused by any of the disorders leading to ARF in the general population. We aimed to study the clinical profile of pregnancy related acute renal failure, management and clinical outcomes. Materials and methods: After obtaining ethical committee’s approval, a prospective observational study was carried out on hospitalized patients in our hospital from 1st August 2007 till 30th September 2008, where all pregnant females referred to nephrology unit were enrolled. Results: A total of 41 patients were included in the study in which oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Respiratory system involvement was associated with increased mortality. No correlation between serum creatinine level and mortality was observed. Neonatal deaths were seen in 2.43% of patients while IUFD was seen in 19.51% of patients. Conclusions: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. More than two organ involvement was associated with higher mortality and majority of the patients were treated conservatively. Maternal and fetal mortality were high, 17.07% and 2.43% respectively.

Ankle Brachial Index as a Predictor of Coronary Artery Disease in Diabetic Patients.

Background: Coronary artery disease (CAD) due to atherosclerosis is an epidemic in India. The incidence of coronary artery disease has doubled during past three to four decades. The role of diabetes mellitus (DM) in relation to CAD was believed to be as important as CAD itself. Owing to the similar vasculopathy characteristics, patients with DM were frequently combined with Peripheral Artery Disease (PAD). However of outpatients, clinically suspected of having CAD, the relationship and interaction between DM and PAD remains unknown. Previous investigations have shown that ankle brachial index (ABI) is a quick and useful tool for assessing and evaluating the presence of peripheral arterial disease of the lower extremities. The aim of current study was to determine the relation between ABI with angiographic stenosis and major cardiovascular risk factors in type 2 DM patients with suspected CAD. Materials and methods: A cross sectional study was conducted at a tertiary care centre including 100 consecutive diagnosed cases of diabetes. CAD was diagnosed by a history of angina/ any past history or treatment for CAD/ ECG changes and 2 D echo findings and CAG. Ankle Brachial Index (ABI) was calculated for all patients by using Duplex Colour Doppler and ABI <0.9 was diagnosed as PVD. Statistical Analysis of data was done by using SPSS software ver. 21. Results: About 68.9% of the cases with established CAD proven by angiography had abnormal ABI while 64.1% of the cases with normal coronary angiography had an abnormal ABI thus predicting a future risk of CAD. Mean HbA1c and uric acid levels and number of cases with microalbuminuria Pednekar S, Singh N,James E, Pandey D. Ankle Brachial Index as a Predictor of Coronary Artery Disease in Diabetic Patients. IAIM, 2016; 3(4): 91-96. Page 92 was significantly higher among cases with CAD. About 92.9% of the cases with Triple vessel CAG had Positive ABI which was significantly more as compared to 68.0%, 66.7% and 47.8% of the cases who had Single, Normal and Double vessel CAG respectively. Conclusion: Ankle brachial index is a sensitive, non-invasive predictor of coronary artery disease in diabetic patients. It however needs other markers in association for better specificity for predicting CAD.

Recurrent central serous chorioretinopathy with dexamethasone eye drop used nasally for rhinitis

Central serous chorioretinopathy [CSC] is characterized by serous retinal detachment at the posterior pole. Several factors have been implicated in the pathogenesis, and endogenous or exogenous corticosteroids are thought to play a major role. Here we present a case of a 35-year-old male with complaints of a dark circle in front of his right eye. Fundus examination, optical coherence tomography and fundus fluorescein angiography were performed. The patient was diagnosed with CSC. CSC resolved completely within seven weeks. Four weeks later the CSC recurred and spontaneously resolved over eight weeks. Overall, the patient had three additional recurrences of CSC in the same eye over the next year. A detailed history taking revealed the patient was using 0.1% dexamethasone eye drops nasally for recurrent rhinitis for few days prior to each episode of CSC. This indicates the strong correlation between steroids given by any route and the pathogenesis of CSC

Suspension of the tongue to the digastric tendon following resection of the anterior mandibular arch for oral cancer prevents postoperative tongue fall and avoids the need for tracheostomy.

Background: Resection of the anterior arch of the mandible leads to tongue fall and postoperative stridor because of the detachment of tongue musculature from the mandible. In this article, a simple method of tongue suspension is described which would prevent such complications and the need for tracheostomy. Settings and Design: This study was carried out on patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection at a tertiary centre. Materials and Methods: This study was performed on 32 patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection. Following an appropriate resection of the oral cancer (including the anterior mandibular arch) and neck dissection, a silk suture is used to loop the tongue musculature on either side to the intermediate tendon of the digastric muscle. Result: This technique of tongue suspension was used in 32 patients who required resection of the anterior mandibular arch for oral cancer. Prophylactic tracheostomy was not performed. One patient developed stridor at extubation and required temporary tracheostomy. All other patients could be successfully extubated within 12 h of surgery and none experienced postoperative stridor or sleep apnea. One other patient required temporary tracheostomy for pulmonary toilet as he developed aspiration pneumonitis related to nasogastric feed. Conclusion: This simple method of tongue suspension to the digastric tendon prevents postoperative tongue fall and obviates the need for tracheostomy in most instances.

Sublingual misoprostol: A better choice for cervical priming before manual vacuum aspiration.

Background: Misoprostol is effective for cervical priming before manual vacuum aspiration (MVA). Aim of study was to determine whether sublingual misoprostol with a shorter interval of 2 hours before MVA would be as effective as its standard vaginal administration. Study Design: This randomized control trial included 82 women randomly assigned to receive 400 mcg of misoprostol, either sublingually or vaginally. MVA was performed 2 hours and 3 hours after in sublingual and vaginal group, respectively. Results: Cervical dilatation of 8 mm was achieved within 2 hours in sublingual group. Mean time taken for procedure (14.4 ± 5.3: sublingual group and 16.2 ± 5.7: vaginal group), and blood loss was comparable (12.2 ± 9.7 ml in sublingual group and 13.7 ± 8.5 ml in vaginal group). Conclusion: 2 hour of cervical priming with 400 mcg of sublingual misoprostol before MVA was as good as 3 hours with vaginal administration of the same dose.

Trauma: an unusual aetiology of pulmonary pseudocyst.

Traumatic pulmonary pseudocyst due to blunt chest trauma is rare. It is a clinical entity that manifests itself with minor clinical and major radiological signs. We report a case of a 16-year-old girl, who during an attack by a violent cow sustained a chest impact that resulted in a traumatic pulmonary pseudocyst, confirmed with a computed tomographic (CT) scan of the chest. The patient recovered with conservative management.

Role of simple needle aspiration in the management of spontaneous pneumothorax.

OBJECTIVE: To determine the efficacy of simple needle aspiration in the management of primary spontaneous pneumothorax. Not all patients with pneumothorax require intercostal tube drainage (ICTD). Some patients can be managed conservatively by simple needle aspiration of air from pleural space. It is a cheap and easy alternative to ICTD which can be done on out patient basis. MATERIALS AND METHODS: All patients of spontaneous pneumothorax presenting for the first time were included in this study, after obtaining baseline investigations like chest X-ray, ECG, serum creatinine, blood sugar etc. They were managed by ICTD or simple needle aspiration. Chest X-ray was done 6 hours after the procedure (ICTD), 24 hours after aspiration and prior to ICTD removal or before hospital discharge. Patients who had undergone simple needle aspiration were allowed to go home following a few hours of observation after explaining the warning symptoms and the need for reevaluation after 24 hrs, if prompt follow-up could be ensured otherwise they were admitted along with patients undergoing ICTD. RESULTS: Eighty two patients of spontaneous pneumothorax were included in this study during a-period of 12 months (May- 04 to April - 05). Out of these 40 (49%) patients were managed by ICTD, 42 (51%) patients were subjected to simple needle aspiration. Thirty two (76%) patients responded to simple needle aspiration while the remaining 10 patients required ICTD finally. There were no complications in the patients managed by simple needle aspiration; they had less chest pain and lesser duration of hospital stay. CONCLUSION: Spontaneous pneumothorax may be managed by simple needle air aspiration primarily, unless contraindicated (tension pneumothorax), or in patients requiring mechanical ventilation. For symptomatic patient it is the recommended procedure.

ARDS complicating scrub typhus in Sub-Himalayan region.

Scrub typhus is a febrile illness widely endemic in Asia caused by Rickettsiae tsutsugamushi in which humans are accidental hosts. If there is delay in the initiation of the appropriate antimicrobial therapy patient may present with serious complications. We report three cases that presented in emergency with acute respiratory distress syndrome and history of fever for more than one-week duration. On investigation all the three patients were positive for Weil Felix reaction and showed dramatic response to doxycycline.

Validation and reproducibility of a food frequency questionnaire to assess energy and fat intake in affluent north Indians.

BACKGROUND: India is currently witnessing a sharp rise in noncommunicable disorders such as obesity, diabetes, hypertension and cardiovascular diseases. This rise can be related in part to dietary changes such as increased intake of calories, fat (especially saturated fat) and cholesterol. A simple, accurate and reproducible method to measure these nutrients is essential to study the role of diet in these diseases in epidemiological studies. We aimed to develop and validate a food frequency questionnaire that could be used for this purpose. METHODS: Thirty urban north Indian subjects (age 23-64 years, 16 men) belonging to a high socioeconomic group were studied. The subjects were selected consecutively over a period of 3 weeks from among those participating in an epidemiological survey on cardiovascular risk factors in an affluent population. A 102-item food frequency questionnaire was developed to capture the intake of calories, fat, saturated fat and cholesterol. The results obtained by the food frequency questionnaire were compared with a 5-day diet record. To assess the reproducibility of the food frequency questionnaire, it was re-administered after 3 months to the 23 subjects available. RESULTS: It took the dietician 20 minutes or less to administer the questionnaire. There was good correlation between the nutrient values as calculated by the food frequency questionnaire and 5-day diet record. The correlation for energy intake was 0.80, and varied between 0.55 and 0.69 for unadjusted intake of other nutrients. After adjusting for calories, the correlation varied between 0.45 and 0.68. In general, the food frequency questionnaire overestimated the energy-adjusted nutrient intake by 6%-17%. When intake was classified into quartiles, there was good agreement between the two methods: 43%-100% for calories; 29%-86% for other nutrients for unadjusted intake; 29%-71% for nutrients after energy adjustment. On calculation of intake after re-administration of the food frequency questionnaire, there was a moderate to strong correlation (energy adjusted r=0.49-0.90) between the two evaluations for various nutrients. CONCLUSION: The food frequency questionnaire developed for the assessment of nutrient intake in a north Indian population was easy to administer, showed moderate to good correlation with the 5-day diet record and was reproducible.

Isolated submandibular gland metastasis from an occult papillary thyroid cancer.

A case of an isolated submandibular gland metastasis from a clinically occult papillary thyroid carcinoma is described in a 46-year old lady. Initial surgery was done based on the fine needle aspiration cytology (FNAC) report of adenocarcinoma of the submandibular gland. Histopathologic examination of the specimen suggested a metastatic papillary carcinoma. Occult papillary carcinoma in the thyroid was found by multiple blind FNACs. Subsequently to near-total thyroidectomy, no other site of metastasis was found on radio-iodine scanning.

Early haemodialysis in acute tubular necrosis.

The study was conducted in 35 cases of acute tubular necrosis of varied aetiology. Cases were divided in 2 groups, Group A--17 cases treated conservatively and Group B--18 cases managed by early haemodialysis. Criteria for early haemodialysis were blood urea < 120 mg% and serum creatinine < 7 mg%. Before starting therapy both the groups had comparable biochemical and renal parameters (p > 0.05). Overall mortality was lower in Group B as compared to Group A (22.2% Vs 29.4). Complication events such as uraemic encephalopathy, pulmonary oedema, haematemesis and malena, thrombophlebitis and vomiting were significantly lower in Group B (p < 0.05). Hospital stay was also significantly lower (p < 0.05) in Group B (18 +/- 2.5 days Vs 28 +/- 3 days), this can reduce the cost of treatment also.

Changes in the blood lipid profile after administration of Ocimum sanctum (Tulsi) leaves in the normal albino rabbits.

Administration of fresh leaves of Ocimum sanctum (Tulsi) mixed as 1 g and 2 g in 100 gms of diet given for four weeks, brought about significant changes in the lipid profile of normal albino rabbits. This resulted in significant lowering in serum total cholesterol, triglyceride, phospholipid and LDL-cholesterol levels and significant increase in the HDL-cholesterol and total faecal sterol contents.

Psychopathology of delayed resumption of sexual activity after myocardial infarction.

A total of 300 male cases of myocardial infarction were analyzed to evaluate the effect of myocardial infarction on sexual activity with particular stress on resumption of sexual activity and to determine the factors in cases of delayed resumption. Sexual activity decreased with age and correlated negatively to total sexual activity. 26 per cent cases developed one or other symptoms which occurred during all the phases of sexual activity but were more marked during resolution phase. Sexual activity returned to normal within six months only in 11.33 per cent cases and in the remaining cases resumption was delayed. In 27.8 per cent cases phobia of marked exertion involved in sex act, created by physicians in 12.7 per cent was the factor responsible for the delayed resumption. Quality of sexual activity decreased in 39 per cent cases and it was due to change in position from Male on top to male on bottom position in 31 per cent cases. Counselling for sexual rehabilitation has been discussed.