Assessment of left ventricular structural and functional indices by echocardiography in relation to the haemoglobin levels in second trimester of pregnancy.

Background & objectives: Pregnancy is characterized by profound changes in functions of virtually every regulatory system in human body. Blood volume increases progressively from 6 – 8 weeks of gestation & reaches a maximum at approximately 32 to 34 weeks. The increase in plasma volume (40-50%) is relatively greater than that of RBC mass (20 -30%) resulting in hemodilution & decrease in haemoglobin concentration. Thus during pregnancy the mother is under risk of developing nutritional deficiency anaemia. Hence it is decided to determine the impact of altered haemoglobin levels in second trimester of pregnancy on left ventricular hemodynamic functions in present study. Method: In present study subjects were females in the age group of 20 – 30 years with the singleton midterm pregnancy (20 -28 weeks) attending antenatal clinics of New Civil Hospital, Surat whereas the control group comprised of purposive sample (33 healthy subjects) from those attending other outpatient department in reference to comparable age, height & accessibility. Pulse and Blood Pressure was measured by standard techniques and capillary blood was collected for Hb% estimation by cynmethhemoglobin method. Finally, Echocardiography was recorded using MEGAS CVX & MEGAS GPX equipped with ADV4 software from ESAOTE s.p.a Firenze, Italy and the frequency used for Doppler echocardiography was 2.0 -2.5 – 3.3 -5.0 MHZ & sweep time was 2 – 12 seconds. Results: The observations suggest volume overload during pregnancy is a risk factor for left ventricular contractility functions. Interpretation & conclusion: Increased values of stroke volume, cardiac output & cardiac index interpret the result of inability to compensate pressure overload or elevated venous return. Left ventricular diastolic dysfunction in the form of relaxation abnormalities is one of the first changes with left ventricular hypertrophy. The reduction of haemoglobin in second trimester; significantly and negatively correlates with the left ventricular cardiac function. The significant increase in CO and CI reflects a hyperkinetic heart in pregnancy. The increase in percent ejection fraction and percent fractional shortening in the study population can be best explained by Frank- Starling’s law governing the heart.

Karyotypic study of chronic and blastic phase chronic myeloid leukemia patients of Gujarat State.

For present work, 27 clinically diagnosed Chronic Myeloid Leukemia patients were selected, who attended the Out Patient Department of Gujarat Cancer and Research Institute, Ahmedabad. In all these cases relevant history, clinical findings, haematological data and other investigations were noted & bone-marrow samples were obtained for further study, which was done at Genetics Laboratory, B.J. Medical College, Ahmedabad. Samples were cultured, harvested, slides were prepared & photographs were obtained using photomicroscope and Karyotypes were prepared by using conventional cut and paste technique. Cytogenetic evaluation was done to detect the presence of Philadelphia chromosome and/or other chromosomal abnormalities. Out of 27 patients studied, 22 cases were having mild to moderate & remaining 5 cases were having huge splenomegaly. The blood picture showed, 9 were anaemic; 11 having total leukocytic count more than 1 lakh/mm3 ; 8 cases were thrombocytopenic. 25 cases were in chronic and 2 cases were in blastic phase. Cytogenetic evaluation by Karyotypes revealed 13 Ph’ positive cases; 4 Ph’ negative; 3 mosaic & remaining 7 cases came out inconclusive. All relevant parameters including clinical, hematological and cytogenetic were evaluated, analyzed and compared with other similar studies.

Echo doppler assessment of autonomic dysfunctions in second trimester of pregnancy.

For the present study subjects were randomly selected from the females in the age group of 20 – 30 years with the singleton mid-term pregnancy (20 -28 weeks) attending antenatal clinics of New Civil Hospital, Surat. The control group comprised of purposive sample (33 healthy subjects) selected from those attending other outpatient department in reference to comparable age, height & accessibility. The subjects were asked to perform valsalva manoeuvre by forcibly exhaling in an aneroid pressure measuring device (manometer) & maintain a pressure of 40 mmHg for 15 seconds or less formally the patient may be asked to bear down as if having a bowel movement. It is used as a diagnostic tool to evaluate the condition of the heart. Echocardiography was recorded using MEGAS CVX & MEGAS GPX equipped with ADV4 software from ESAOTE s.p.a Firenze, Italy. For Doppler echocardiography the frequency used was 2.0 -2.5 – 3.3 -5.0 MHZ & sweep time was 2 – 12 seconds. Our observations suggests that volume overload during pregnancy is a risk factor for left ventricular contractility functions. Increased values of stroke volume, cardiac output & cardiac index interpret the result of inability to compensate pressure overload or elevated venous return. Left ventricular diastolic dysfunction in the form of relaxation abnormalities is one of the first changes with left ventricular hypertrophy. In our study sample the pregnant females after performing valsalva manoeuvre decreased mean E/A ratio was observed compared to the non pregnant females. It has been suggested that changes in the left atrial pressure may mask or mimic left ventricular diastolic function abnormalities detected by Doppler echocardiography. The valsalva manoeuvre could help better to account for the effect of left atrial pressure on the transmitral flow velocity profile & differentiate between subjects with or without LV diastolic function abnormalities.