Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy

Introduction Mitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Methods A total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. Results The mean age was 25.5 ± 3.6 yrs in group 1 and 25.7 ± 3.5 yrs in group 2. There was no difference in characteristics –primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p < 0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75 ± 601.8 gm vs. 2641.70 ± 580.6 gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. Conclusion Percutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.

Maternal and fetal outcome in operated vs non-operated cases of congenital heart disease cases in pregnancy

Objectives To study pregnancy outcomes in operated vs non-operated cases of congenital heart disease cases during pregnancy. Materials and methods A total of 55 patients of congenital heart disease who delivered in the authors unit in last 10 years were taken in this retrospective study. These were divided into two groups Group 1:29 (52.7%) patient who had no cardiac surgery and Group 2: 26(47.2%) who had cardiac surgery to correct their cardiac defect before pregnancy. All patients were evaluated for cardiac complications and outcome during pregnancy. Obstetric complications, mode of delivery and fetal outcome was compared in the two groups using statistical analysis. Result The commonest lesion was atrial septal defect (ASD) seen in 22(40%) patients followed by ventricular septal defect (VSD) in 16(29%) .Congenital valvular disease 8(14.5%) and patent ductus arteriosus in 4(7.2%) cases. The mean age was 25.9 ± 3.15 years in Group 1 and 26.3 ± 4.53 years in Group 2. The baseline characteristics were similar in the two groups. There was no difference in cardiac complications, NYHA deterioration and need of cardiac drugs in the two groups. Obstetric complications and mode of delivery were also similar in the two groups.Mean birth weight was 2516.65 ± 514.04 gm in Group 1 and 2683.00 ± 366.00 gm in Group 2 and was similar. APGAR < 8, stillbirth rate and other neonatal complications were also similar in two groups. Conclusion The maternal and fetal outcome was excellent in patients with congenital heart disease and was similar in unoperated and operated cases.

Esthetic and Functional Rehabilitation through Early Placement of PRF Augmented Dental Implant in Maxillary Aesthetic Zone.

Implants placed shortly after tooth extraction have proven to be a predictable treatment modality. The number of surgical appointments and length of surgical phase are reduced, thereby preserving hard and soft tissue configuration. However, there are some limitations to early implant placement. These include a probable lack of soft tissue closure over the extraction site, difficulty in matching the diameter of the implant with that of the extraction socket, partially or totally missing bony housings, and possible accompanying periapical and/or periodontal infection.This clinical report presentsearly dental implant placement with PRF augmentation in maxillary esthetic zone.

Spot urine sample for estimating sodium intake of a population.

McLean R, Williams S, Mann J. (Department of Human Nutrition; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago; Department of Preventive and Social Medicine; Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.) Monitoring population sodium intake using spot urine samples: Validation in a New Zealand population. J Hum Hypertens 2014;28:657–62.

Challenges in scaling up successful public health interventions: Lessons learnt from resistance to a nationwide roll-out of the weekly iron–folic acid supplementation programme for adolescents in India.

Anaemia, a major public health problem globally, affects an estimated 1.6 billion people.1 It has effects on the physical and mental health, as well as the productivity of people, particularly those in the vulnerable groups.2,3 The National Family Health Survey (NFHS)-3, 2005–06 estimated that 56% of women and 30% of men in India in the age group of 15–19 years were anaemic.4 Anaemia among people in the age group of 15–24 years was reported to be more common in the rural than urban areas, and among families belonging to the lower socioeconomic strata (Table I). Iron deficiency anaemia is one of the most prevalent micronutrient deficiencies globally and in India.5 About 60% of adolescents in the age group of 10–17 years have been reported to consume less than 50% of the recommended dietary allowance of iron, according to the 2012 National Nutrition Monitoring Bureau (NNMB) multistate survey.6 The low iron content of a typical Indian diet, along with the high prevalence of worm infestation, is the cause of the high prevalence of anaemia in India.7 The various strategies for the

Role of norepinephrine in the regulation of rapid eye movement sleep.

Sleep and wakefulness are instinctive behaviours that are present across the animal species. Rapid eye movement (REM) sleep is a unique biological phenomenon expressed during sleep. It evolved about 300 million years ago and is noticed in the more evolved animal species. Although it has been objectively identified in its present characteristic form about half a century ago, the mechanics of how REM is generated, and what happens upon its loss are not known. Nevertheless, extensive research has shown that norepinephrine plays a crucial role in its regulation. The present knowledge that has been reviewed in this manuscript suggests that neurons in the brain stem are responsible for controlling this state and presence of excess norepinephrine in the brain does not allow its generation. Furthermore, REM sleep loss increases levels of norepinephrine in the brain that affects several factors including an increase in Na-K ATPase activity. It has been argued that such increased norepinephrine is ultimately responsible for REM sleep deprivation, associated disturbances in at least some of the physiological conditions leading to alteration in behavioural expression and settling into pathological conditions.