ABSTRACT
Background and aims: Pregnancy is associated with several hormonal and mechanical changes in the body. The tropical infections that most commonly affect pregnant females are malaria, dengue, leptospirosis and typhoid. These tropical infections cause many medical complications in pregnancy by causing anemia, thrombocytopenia, bleeding and inflammatory reactions. Therefore, we conducted a study to evaluate the clinical presentation, complications and outcome of tropical infections in pregnancy. Material and methods: The present study was conducted at a tertiary care hospital in Mumbai, Maharashtra over a period of 1½ year (January 2018 to June 2019) after getting approval from Institutional Ethics Committee. In this study, 250 pregnant patients admitted in medicine ward, obstetrics and gynecology ward, and ICU with symptoms and signs of tropical infections and age more than 18 years, who gave written informed consent, were included. Results: The most common age group amongst the study population was 20 to 24 years (41.6%), followed by 25 to 29 years (40%) and 30 to 35 years (18.4%). Most of the study population had gestational age of 1 to 12 weeks (61.6%), followed by 13 to 28 weeks (31.6%) and more than 28 weeks (6.8%). Most of the study population had parity 2 (46.8%), followed by parity 1 (43.2%), parity 3 (6.8%) and parity 4 (3.2%). The most common clinical features amongst the study population was fever (62%), followed by headache (32.8%), nausea (30.8%), pain in abdomen (26.4%) and petechiae (26%). The most common infections amongst the study population were malaria (11.2%), dengue (8%), leptospirosis (6%) and enteric fever (5.2%). The most common medical complications were bleeding due to thrombocytopenia (TCP) (6.8%), followed by serositis (5.2%), ARDS (4.4%), meningitis (2.8%), subconjunctival hemorrhage (2.8%) and encephalitis (1.4%). Complicated infections were seen in 30% of the study population. Conclusion: All pregnant women must be evaluated at primary care centers properly in their antenatal visits for their parity status and any associated risk factors and diseases. By doing this, we can reduce many tropical infections, complications and maternal mortality in early stage of pregnancy.
ABSTRACT
Background: Dengue is a mosquito borne viral infection. It is the most common arboviral disease globally. In the year 2017, India had 1,53,635 cases of dengue with 226 deaths. Electrolyte disturbances reported in dengue infection are hyponatremia, hypokalaemia and hyperchloremia. Considering the serious nature of effects of dyselectrolytemias and high incidence of dengue in India, it is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly.Methods: This study was performed in a tertiary care centre in Mumbai, India. The study was a prospective observational cross-sectional study. 150 Patients diagnosed with Dengue were enrolled for the study. Patients’ demographic data, clinical history, examination findings and investigations including electrolyte values were recorded and analysed.Results: A higher incidence of dengue was seen in young age group among admitted patients (74%). Hyponatremia (45.33%) and Hypokalaemia (10.60%) were more commonly observed than hypernatremia (3.33%) and hyperkalaemia (3.33%). Hypochloraemia (6.66%) was seen slightly more than hyperchloraemia (6.00%). Fever was Present in 98.66%, retro orbital headache in 86.66%, vomiting in 56.00%, joint pain in 69.00%, lethargy in 70.66%, breathlessness in 36.00%, bleeding in 8.66%, abdominal pain /tenderness in 18.00%. 85.00% had low platelet count, 30.66% had low hemoglobin and 36.66% had leucopenia. Haematocrit was found to be less in 27.33% and high in 1.33%.Conclusions: From the above results we concluded that, there is a need to have a degree of suspicion about dyselectrolytemias while managing patients with Dengue. Also, patients need to be subjected to necessary lab investigations early during management so that if abnormalities are found, they can be promptly and appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.
ABSTRACT
Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.