ABSTRACT
Nutritional iron deficiency is the main cause of anemia throughout the world. It is especially common in women of reproductive age and particularly during pregnancy. Anemia during pregnancy is associated with adverse perinatal outcomes in the form of preterm birth, stillbirth, small for gestational age babies and increased perinatal mortality. There is persistently high prevalence of anemia in Indian mothers despite a national program in place. Objective: To assess the prevalence of anaemia, its different types and their association with maternal and perinatal outcomes. Methods: This study was conducted on 100 pregnant patients with severe anemia. The study population was divided into 3 groups based on basis of peripheral smear picture i.e. microcytic, macrocytic and dimorphic anemia. These pregnant mothers were followed up until their time of delivery and associations between anaemia types and maternal as well neonatal adverse outcomes were explored. All the data collected was analyzed using statistical computer software (STATA Version 13.0). Result: Microcytic hypochromic anemia was most commonly present (45 patients, 45%). Intrauterine growth restriction was seen in 20% of total study population and out of these, majority were born to mother with macrocytic anemia (32.5%). The same trend was also seen for gestational hypertension with 8.9%. 32.5% and 6.7% patients having gestational hypertension in microcytic, macrocytic and dimorphic anemia groups respectively (p=0.009). A total of 23 patients had low birth weight babies; 65.2% patients with low birth weight babies had macrocytic anemia and this difference was statistically significant (p=0.024). Overall 15% of babies were small for gestational age, out of which 66.7% babies were in macrocytic anemia group. Low Apgar score at one minute after birth was seen in four babies born to mothers having macrocytic anemia and this was a statistically significant relationship (p=0.044). Conclusion: Anemia is increasingly becoming prevalent and is associated with poor maternal and perinatal outcomes. Public health interventions should be made by way of appropriate food fortifications to reduce prevalence of anemia Early diagnosis should be made by appropriate investigations and proper therapy should be started as soon as possible according to type of anemia, in order to prevent adverse maternal and foetal outcomes.
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Background: Literature has substantially advanced our understanding of the action of vitamin D in depression, much is still unknown concerning how vitamin D relates to dimensions of depression. Hence, authors aimed to examine the relationship of vitamin D in patients of depression, its correlation with the severity of depression and different symptom domains of depression.Methods: This Hospital based case control study included 75 patients with depression and 50 controls who were age and gender matched. Beck’s Depression Inventory II was used to assess the severity and symptom domains of depression. Vitamin D levels was assessed using Enhanced Chemiluminescence Technique.Results: Vitamin D deficiency was found significantly (<0.001*) among cases than controls. Significant (0.003*) inverse correlation was observed between severity of depression and vitamin D level.In cognitive symptoms, pessimism, punishment feeling, self-criticism, suicidal thoughts and worthlessness were found significantly higher among vitamin D deficient patients. However, in somatic-affective symptoms, crying, indecisiveness, loss of energy, irritability, concentration difficulty and being tired were the significant by prominent symptoms in vitamin D deficient patients.Conclusions: Vitamin D (<50 nmol/L) was found to be significantly associated with depressive symptoms with cognitive and somatic-affective symptoms being affected by vitamin D deficiency.
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Prostaglandin E2(cerviprime gel), an inducing agent is instilled intracervically or placed high in the posterior fornix of the vagina and may need to be re-in- stilled after 6 h if required. Another alternative is misoprostol (15-deoxy-16- hydroxy-16-methyl prostoglandin E1) which is used in various dosages. Methods: This was a prospective observational study of nulliparous women undergoing labor induction for one year, 100 womens, in a tertiary care center. Participants were then randomly assigned to pre-induction cervical ripening with a dinoprostone vaginal insert (0.5mg) (group I), and with misoprostol (50 microg) intravaginally(group II). Result: From our study observation, maximum patients delivered normal vaginal delivery. Of the vaginal deliveries six (18%) of PGE2 group and five patients(10%) of PGE1 having meconium stained liquor after ARM or spontaneous rupture of membrane, fetal heart was reassuring i.e, no fetal distress was there. The caesarean section rate in both groups nine (18%) and (10%) was statistically insignificant. Mean change in bishop score was also not significant in both groups. Need for oxytocine after 8hrs of induction between both group was significant, 84% in dinoprostone group and 56% in misoprostol group. Gastrointestinal side effects, uterine tacchysystole, uterine hyperstimulation was more common in misoprostol group than dinoprostone group, that is statistically significant. Induction to delivery time was shorter in misoprostol group that is statistically significant. No adverse neonatal outcomes that can directly be related with both drugs. Both agents are equally efficacious in causing cervical repining and almost equal changes in mean bishops. Conclusion: Misoprostol is an excellent labour-inducing agent and can be used liberally for labour induction, unlike PGE2 gel, is comparatively cheaper and is stable at room temperature; thus, it could be an ideal inducing agent in poor resource settings. Local application of misoprostol tablet in posterior vagina is easier method than dinoprostone insertion. Intravaginal insertion of misoprostol tablet is superior to dinoprostone gel in inducing labour and shorter interval between induction and delivery.
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The objective of the study was to document the bladder behaviour in response to rehabilitation intervention in patients with traumatic spinal cord injury (SCI) using urodynamic study (UDS). Additionally, it also aimed to compare the nature of the bladder in a rehabilitated and non- rehabilitated neurogenic bladder of traumatic SCI. Study design: The study adopted a prospective follow-up design. Setting: Department of Physical and Rehabilitation Medicine, Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, Bihar, India. Methods: One hundred and thirty traumatic SCI patients mean age 31.3±7.8 years, 113 males and 17 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Result: There were significant changes in the max. cystometric capacity (p=0.019) after rehab intervention in upper motor neuron (UMN) neurogenic bladders. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity were also found to have significant correlations (p=0.010, 0.010 and 0.013 respectively) in those with UMN neurogenic bladders. However, the volume at the first desire to void did not show significant changes after rehabilitation intervention (p=0.54). Significant decrease in amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In lower motor neuron (LMN) neurogenic bladder significant changes after rehabilitation intervention was found only in the max. cystometric capacity (p=0.015). Conclusion: Based on these findings we conclude that the change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.
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Background: Planter fasciitis is an injury of unknown origin in more than 80% cases. It affects quality of life as well as daily activity of the patients. Various surgical procedures, autologous blood and steroid injection also have been applied without constant success. Platelets rich plasma have been found effective in various orthopedically disorders like osteoarthritis, tennis elbow etc. That is why the present study was designed to compare the efficacy of platelets rich plasma injections and steroidal injections for the treatment of planter fasciitis. Methods: The present interventional study was conducted fromJuly 2016 to June 2018. Study population was divided into groups. Group I included patients (n=40) of a single ultra sound guided platelets rich plasma injection whereas, group II contained patients (n=40) with a single ultra sound guided depomedrol 40 mg injection. Scores of VAS and AOFAS were recorded at the initial level and follow ups after the injections. Follow up examinations were done at 6 weeks, 6 months and 12 months. Results: There was a significant improvement in mean VAS scores of platelet rich plasma group patients (1.8) compare to corticosteroid injection group patients (3.4) after one year of the treatment. However, results showed that steroids failed to show long term decrease in VAS score (p<0.05). Mean AOFAS was significantly increased (64.4) in the steroid group at 6wks as in comparison of platelet rich plasma group (52.2). Conclusion: Findings of the present study showed that improvement in steroid group was faster but benefits were lost in longer run. In contrast, platelets rich plasma was more effective in sustaining the long term beneficial effects.
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Background: Anxiety and depression are commonly found in epileptic patients. However, the etiology behind the mechanism remains multifactorial, mostly because of variability in study settings. In order to fill the knowledge gap, we investigated the prevalence of anxiety and depression among epileptic patients and their correlation with certain demographic variables.Methods: In a Cross Sectional Out Patient Based Study, a total of 147 patients with epilepsy were recruited and evaluated for inclusion and exclusion criterion. Participants who met the inclusion criterion were assessed using standardized scales HARS and HADS rating scale for anxiety and depressive symptoms respectively.Results: 100 participants were included with mean age of 33.63 years for men and 30.16 years for females. 27% showed mild to severe anxiety and 21% had mild to moderate depression. Prevalence of both anxiety and depression was found more among females, singles, participants from urban background and having partial epilepsy. Significantly (p-0.020*) higher anxiety was seen in patients with partial epilepsy than those with generalized epilepsy.Conclusions: Individuals with partial epilepsy are more prone to get affected from comorbid disorder like anxiety and depression, especially females, singles and those from urban domicile.
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Background:To study the incidence of primary postpartum haemorrhage, morbidity and mortality. Methods: Study was carried out in department of obstetrics and gynaecology, Swaroop Rani Nehru and associated Hospital, M..L.N. Medical College Allahabad. All pregnant women who underwent vaginal delivery and those who were admitted within 24 hours of delivery were included in the study .Group allocation was done randomly in three groups. Analysis of study data was done by chi square test. Result:The incidence of primary postpartum haemorrhage was 4%.Maximum incidence was noted in group A (5.8%) and minimum in group C (4.2%) .The morbidity which were related to primary postpartum haemorrhage were anaemia (68%),infection (42%),blood transfusion related complications (26%),DIC(4%), and hysterectomy (3%). 0.3% of patients died of severe postpartum haemorrhage .Management options included intensive therapy ,B-Lynch sutures and hysterectomy. Conclusion: ?