Spinal Anaesthesia for Caesarean Section in a Morbidly Obese Parturient: A Case Report

The population of obese individuals is increasing worldwide.Maternal obesity is an important risk factor in pregnancy and problems such as difficulty in endotracheal intubation, risk of aspiration, and hypoxia may occur 2 during generalanaesthesia.A 28-year-old woman (height 1.6 m, body weight 126 kg, BMI 49.2 kg/m ) visited GCS Hospital, Ahmedabad for selective caesarean section at a gestational age of 37 weeks. Patient was diagnosed with PIH. Spinal anaesthesia was selected because of the high possibility of endotracheal intubation failure due to super morbid obesity.Considering the possibility of hypotension, an arterial cannula was placed in the right radial artery for invasive arterial pressure monitoring. After sterile preparation, spinal anaesthesia was performed through the L3–4 interspinous space using a 90 mm 24-gauge spinal needle. During surgery,Blood pressure was maintained between 160/88 and 86/38 mm Hg and heart rate was maintained between 70 and 104 beats/min. The surgery was completed uneventfully. The block level of spinal anaesthesia was maintained at the T8 dermatome level during the operation and was also confirmed at the end of operation.

Waardenburg syndrome: a rare genetic disorder in four generations of a family

Waardenburg Syndrome (WS) is a rare autosomal dominant disorder manifesting with sensorineural deafness, pigmentation defects of the skin, hair and iris and various defects of neural crest derived tissues. A primigravida mother delivered a full term, appropriate for gestational age, 2530 gm female child, by emergency LSCS. Baby was admitted in the NICU in view of features suggestive of Waardenburg syndrome, like white forelock of hair, broad nasal root and hypopigmented patches on the skin for further work up and management. Several members in the family were affected in the last 4 consecutive generations. Our baby was feeding well and discharged home after an uneventful hospital stay. Early diagnosis, detection of findings of hearing loss and the characteristic ophthalmic findings as well as regular follow up is necessary to enable the patient to lead a better quality of life.

Awareness regarding stroke in rural community of Vadodara.

Background and Objectives: Stroke is a principal cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs. This study explored knowledge of stroke warning signs among older adults. Methods: Randomly selected older people (aged ≥ 65) in rural area of Vadodara. Participants completed home interviews. Questions assessed knowledge of stroke warning signs for stroke. Results: Of the whole sample, Less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exclusion. In general, there were considerable gaps in alertness with poorest levels evident in those with primary level education only and in those alive in rural area of Vadodara. Conclusion: Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs must be addressed as one important contribution to reducing mortality and morbidity from stroke.

Metabolic syndrome in an adult rural population of Surat.

Objectives: To evaluate of the metabolic syndrome in a rural population of Surat, a zone located to the South of Gujarat. Methods: Randomly selected adults >20 years were studied using stratified sampling. Metabolic syndrome was diagnosed using Adult Treatment Panel-III (ATP-III) guidelines when any three of the following were present: (1) triglycerides ≥150 mg/dl, (2) HDL cholesterol < 40 mg/dl in men and <50 mg/dl in women, (3) systolic blood pressure ≥130mmHg or diastolic blood pressure ≥85mmHg, (4) fasting plasma glucose ≥100 mg/dL and (5) Truncal obesity (waist circumference more than 102 cm in men and >88 cm in women). Results: Metabolic syndrome was present in 23.6% subjects, 22.9% in men and 24.6% in women (P>0.05). The prevalence increased from 8.1% in the population younger than 30 y to 37.6% in ages more than 60 years. Low HDL was the most common metabolic abnormality in both sexes. The prevalence of obesity (BMI ≥ 30 kg/m2), hypercholesterolemia (≥200 mg/dl) and high LDL cholesterol (≥130 mg/dl) was greater in the metabolic syndrome group than normal subjects (P<0.05). Conclusion: There is a high prevalence of metabolic syndrome in this rural population of Surat. Focus of cardiovascular prevention should be undertaken in this area.