Study of prevalence of heart disease in antenatal mothers along with fetal and maternal outcome from a tertiary care hospital, Salem, Tamil Nadu, India

Background: Incidence of pregnancy in women with heart disease is increasing due to the increasing number of women with congenital heart disease. Although most cardiac conditions are well tolerated during pregnancy, there are some conditions that have adverse fetal and maternal outcome. Objective of this study is to study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management.Methods: This is a prospective observational study carried out in the Department of Obstetrics and Gynaecology at Government Mohan Kumaramangalam Medical College and Hospital during January 2018 to March 2019 for a period of fifteen months. Authors included 149 antenatal mothers with heart disease and analysed the data using percentage analysis through excel software.Results: Incidence of heart disease in pregnancy was observed to be 1.2%. Rheumatic heart disease being 73.8%, congenital being 22.8% and complete heart block was 3.4%. Among rheumatic heart disease mitral stenosis was the most common lesion. Atrial septal defect was the most common congenital heart disease. The mean gestational age of delivery was 37 to 38 weeks. 58% delivered by vaginal route. Most common neonatal complication was prematurity. Pregnancy and neonatal outcome were favorable.Conclusions: Heart disease complicating pregnancy has increased due to late marriage, obesity, hypertension and diabetes. Early referral, regular follow-up and multi-disciplinary approach with tertiary care back-up will bring a favorable maternal and neonatal outcome in patients with heart disease.

Factores epidemiológicos asociados a la referencia temprana al nefrólogo para hemodiálisis crónica en pacientes de un Hospital Público de Perú / Epidemiological factors associated with early referral to a nephrologist to start chronic hemodialysis in patients at a Public Hospital in Peru

OBJETIVO: El objetivo de esta investigación fue establecer la frecuencia de referencia temprana al nefrólogo para el inicio de hemodiálisis (HD) y sus factores epidemiológicos asociados en pacientes con enfermedad renal crónica (ERC) de un hospital público de Perú. MATERIAL Y MÉTODOS: Estudio observacional, analítico, de diseño transversal. El estudio fue llevado a cabo en pacientes que inician HD de un hospital público de Perú. La variable principal fue referencia temprana, definida como todo paciente que recibió indicación de inicio de HD después de 180 días de la primera atención en el servicio de nefrología. Se recolectaron variables epidemiológicas y de laboratorio. Se utilizó modelos lineales generalizados (MLG) crudo y ajustado; y como medida de asociación se calculó la razón de proporciones (PR) con intervalo de confianza (IC) al 95%. RESULTADOS: Se evaluaron 148 pacientes, se encontró referencia temprana en 17% de la población. En el MLG ajustado, los mayores de 60 años tuvieron mayor frecuencia de referencia temprana al nefrólogo PR= 2,17; IC 95% (1.09-4.32); p=0,03. Se encontró menor frecuencia de referencia temprana entre los participantes con anemia severa, PR=0,15; IC 95% (0,02-1,11); p=0,06. CONCLUSIONES: La frecuencia de referencia temprana es baja y debería considerarse como problema de salud pública; se recomienda mejorar los procesos de referencia de las redes de nuestra institución

OBJECTIVE: Our objective was to establish the frequency of early referral to the nephrologist for the initiation of hemodialysis (HD) and its associated epidemiological factors in patients with chronic kidney disease (CKD) in a public hospital in Peru. MATERIAL AND METHODS: We conducted an analytical cross-sectional study in patients who started HD in a public hospital in Peru. Our main variable was early referral, defined as patients who received an indication of onset of HD after 180 days of the first appointment in the nephrology service. We collected epidemiological and laboratory variables. We used crude and adjusted generalized linear models (GLM) and we calculated the proportion ratio (PR) with a 95% confidence interval (CI) as a measure of association. RESULTS: We evaluated 148 patients; we found early referral in 17% of the population. In the adjusted GLM, participants older than 60 years had a higher proportion of early referral to the nephrologist, PR = 2.17; 95% CI (1.09-4.32); p = 0.03. We showed a lower frequency of early referral among participants with severe anemia, PR = 0.15; 95% CI (0.02-1.11); p = 0.06. CONCLUSIONS: The frequency of early referral is low and it should be considered a public health problem. We recommend improving the process of referral in our health care network

Estrategia para la derivación oportuna: experiencia en un centro de referencia en reumatología / Strategy for temely referral: experience in a reference center in rheumatology

Introducción: En los últimos años se ha reconocido la importancia del diagnóstico precoz de la artritis reumatoidea y las espondiloartritis. Aún existen barreras que impiden la derivación precoz de estos pacientes. Objetivo: Evaluar si existe un aumento significativo en el número de derivaciones al Servicio de Reumatología luego de implementar una estrategia de concientización a otros especialistas. Material y métodos: Estudio observacional, retrospectivo. Resultados: Durante el primer período, el servicio realizó un total de 1027 consultas, de las cuales 130 fueron derivaciones. Las consultas efectuadas luego de la implementación del plan de derivación fueron 1199 con 202 derivaciones (17% IC 95 14,7-19); la diferencia entre ambos períodos fue estadísticamente significativa (p 0,003). Conclusión: La implementación de estrategias de derivación fue valiosa, puesto que encontramos un incremento en el número de derivaciones realizadas. Consideramos que estas intervenciones deben perdurar en el tiempo para mejorar el diagnóstico precoz.

Introduction: In recent years, the importance of early diagnosisof rheumatoid arthritis and spondyloarthritis has been recognized. However, there are still barriers that obstruct the early referral ofthese patients. Objective: To evaluate whether there is a significant increase in thenumber of referrals to the department of Rheumatology after implementinga strategy of awareness to other specialists. Material and methods: Observational and retrospective study. Results: During the first period, the service conducted a total of1027 consultations, of which 130 were referrals. Consultations made after the implementation of the derivation strategy were 1199 of which 202 were referrals (17% CI 95 14.7-19); the difference between the two periods was statistically significant (p 0.003). Conclusion: The implementation of this strategy was valuable, since we found an increase in the number of referrals made. Weconsider that these interventions should last over time to improveearly diagnosis.