Maternal near miss: a retrospective study in a tertiary care hospital at South India

Background: A maternal near miss (MNM) case is defined as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. MNM situations tend to mirror the causes of maternal death. Hence, review of these cases has been found to help in the assessment of maternal health services. These cases are called as MNM or severe acute maternal morbidity (SAMM) and auditing these cases is called near miss audit (NMA).Methods: A retrospective study of 201 MNM cases over a period of 12 months from January 2023- December 2023. Demographic data were collected from MNM review form and records. Data studied and analyzed.Results: There were 11,340 deliveries and 11,126 live births during the study period out of which 201 MNM cases were studied. Haemorrhage followed by anemia was the most common cause of near miss events. The most common age group affected in the near miss cases in the present study was 20 to 35 years (80%). Majority of the cases were referred from the nearby PHCs and government hospitals.Conclusions: Most maternal deaths are preventable by optimal utilization of existing MCH facilities, identifying the bottleneck in health delivery system, early identification of high-risk pregnancy and therein timely referral to tertiary care centre.

Simple predictors to differentiate acute respiratory infections from acute asthma in children 6 months to 5 years

Background: Acute respiratory infections constitute one of the principal causes of morbidity and mortality in children less than five years of age in developing countries. For logistic reasons, WHO recommended case management is structured towards treatment as pneumonia in preference to acute asthma. It is warned that wheezing can occur during pneumonia and therefore, care must be taken when treating wheezing not to miss treating pneumonia with an antibiotic. Current WHO ARI CASE MANAGEMENT guidelines, in a child presenting with cough and rapid breathing, there is a predilection for over -treatment of pneumonia and under treatment of asthma.Methods: Totally 245 children were included in the study. They were classified into asthmatic and LRI prone with the help of simple predictors.Results: The combination of fever, chest indrawing and persistent tachypnoea after bronchodilator has an excellent specificity of 96.12% in predicting the presence of pulmonary infiltrate. The presence of more than two episodes of similar respiratory distress, previous H/O of nebulization and family H/O asthma, either alone or in combination may point more towards asthma as a cause of cough and respiratory distress.Conclusions: In a child presenting with cough and fast breathing with a previous similar episode, trial nebulization can be given before investigating further for pneumonia.

Prevalence of anaemia and its associated factors among adolescent girls: a community based study

Background: Anemia is a major nutritional problem in adolescent girls in many developing countries. Anaemia prior to pregnancy is likely to affect fetal health and survival and therefore it is necessary to evaluate the nutritional needs in this vulnerable group. To know the prevalence of anaemia and its associated factors among adolescent girls residing in the urban field practice area of S. Nijalingappa Medical College, Bagalkot. Methods: A community based cross sectional study. A field practice areas of the urban health training centers, Department of Community Medicine, S. Nijalingappa Medical College in Bagalkot. 400 unmarried adolescent girls were participants. Systematic random sampling. Data was tabulated in Microsoft Excel 2010 and analyzed by using Open Epi software. Data was collected through predesigned, semi-structured questionnaire through house to house visits. Haemoglobin estimation was done by Sahli’s method and anaemia was classified based on WHO criteria. Results: The prevalence of anaemia was 63.3%. Factors associated with anemia were age, mother’s literacy, SES, type of family, environmental sanitation and tea consumption. Conclusions: Prevalence of anaemia is high and is a major public health problem in this area. Health education and periodical haemoglobin estimation followed by supplementation of iron would help in reduction and prevention of anaemia.

An analysis of adherence to the World Health Organisation guidelines pertaining to drug promotional literature by pharmaceutical firms

Background: Pharmaceutical companies used Drug Promotion Literatures (DPLs) as a major tool to advertise their new products. World Health Organization (WHO) has set some guidelines for promotion of drug literature. Thus, this study aimed to evaluate various DPLs for their accuracy and credibility as per WHO ethical criteria.Methods: This was an observational and cross-sectional study. Total 100 drugs advertisements published in various medical journals were collected from the library of the college. Advertisements were selected based on inclusion and exclusion criteria. The selected advertisements were evaluated based on the WHO ethical criteria for drug promotion.Results: From 100 advertisements, 73 were single drug whereas 27 were fixed drug combinations. Antimicrobials (16%) were the most promoted advertisements. Only 28% of the advertisements carried references to support their claim. Out of which majority (91.78%) were from journal articles. The generic name, brand name, names of active ingredients, manufacturer, distributor and dosage regimen were mentioned in majority of advertisements. Drug interactions (12%), contraindications (22%), precautions (24%) and side effects (22%) were least mentioned in the advertisements.Conclusions: It was observed that none of the advertisement followed all the guidelines laid down by WHO. Pharmaceutical companies should follow ethical regulatory measures to promote their product in various journals. The regulatory authority must ensure the pharmaceutical companies to follow ethical guidelines for publishing various drug promotional literatures.

Evaluation of drug promotional brochures in a tertiary teaching hospital of Kannur, India

Background: Pharmaceutical industries worldwide are heavily involved in aggressive drug promotions. WHO has framed guidelines for ethical drug promotion in 1988. The transparency of pharmaceutical advertisements is important because decision of the physician is likely to be influenced by the claims made by the pharmaceutical companies in the promotional drug brochures and pharmaceutical industries treat their marketing material as “educational material” for doctors. Authors did this study to analyze the information given on drug promotional brochures by the drug companies using ethical criteria of drug promotion by WHO 1988 and to verify the authenticity of the claims given by the pharmaceutical companies in drug promotional brochures.Methods: Cross sectional study extending from 1/8/2012 to 31/7/2013. 612 drug promotional brochures satisfied our inclusion criteria. Drug brochures were analyzed with WHO ethical criteria 1988 and further categorizing the data into type of claims, number and source of references. Validity of journal articles were checked by using a validity measure developed by Cardarelli.Results: Total 612 brochures satisfied inclusion criteria. INN was mentioned in 93.8% of collected brochures. Brand name was mentioned in 100% brochures. Content of active ingredients was mentioned in 92% of brochures. Name of the other ingredients known to cause problem 28.4% of brochures. Dosage form or regimen was mentioned in 23.2% of brochures. Approved therapeutic use mentioned in 65.7% brochures. Side effects and major adverse drug reactions were mentioned in 31.4% brochures. Precautions and contraindications and warnings were mentioned in 30.4% drug promotional brochures. Drug interactions were mentioned in 26.5% brochures. Name and address was mentioned by 69.1% brochures. There were 1144 claims and 739 references. Efficacy claims were 84.88% of the total claims. Main source of reference was from journal articles (74.1%) and among them 49.65% were randomized control trials. Only 47.94 % of the journal references were valid.Conclusions: Brochures were lacking in vital information which included contraindication, warning, precaution, name of the other ingredients known to cause problem hence companies were found violating WHO ethical criteria. Claims were not well supported with references. Less than half of the given journal references were only valid. This study highlights the need of healthcare professionals to remain cautious about promotional material presented by pharmaceutical representatives.

The Prevelence Of Obesity And Overweight Amongst Students And Staff Of Era's Lucknow Medical College & Hospital Lucknow

This study had designed, to explore prevalence of obesity and overweight, on two criteria, Indian and World Health Organization (W.H.O.), amongst students and staff of Era's Lucknow Medical College & Hospital, Lucknow and Era Institute of Health Sciences and Research, Lucknow. As well as, assessment of association of oxidative stress with obesity. MBBS, Nursing and DMLT students as well as Hospital Laboratory Services (HLS) staff had included in this study. Study had carried out in Department of Biochemistry with collaboration of Department of Physiology and HLS. Results of this study had showed that, prevalence of obesity and overweight were high in staff with respect to students. The levels of reduced glutathione (GSH) were decreased in obese with respect to normal; on the other hand Malondialdehyde (MDA) levels were increased in obese with respect to normal.

Analysis of various criteria for identification of severe acute maternal morbidity in a rural tertiary health care centre: A prospective one year study.

Background: Maternal mortality has been the indicator of measurement of maternal health. Over the last decade, identification of severe acute maternal morbidity (SAMM) has emerged as a compliment or alternative to investigation of maternal deaths. A review of causes of SAMM will help to find out the potential problems which in turn will enable women to get the treatment on time. Recent researches have suggested that proper identification of SAMM cases can prove to be a better method to monitor the quality and effectiveness of obstetric care than mortality alone. Although there have been many criteria which have been introduced from time to time to identify these cases, because of vast variation of different level of facilities, these criteria cannot be applied across the regions. WHO has recently come up with certain set of criteria which could be more applicable to low resource settings. Aims & Objective: Present study tried to identify SAMM cases through various criteria and compared the applicability of them in our setup which is resource poor setting catering mainly to a huge rural population. Materials and Methods: It is a prospective study done over a period of one year, from September 2012 to August 2013. All severely morbid pregnant women or who had delivered or aborted within 42days were included. Initial identification of these cases was done on the basis of general criteria and later on other criteria were applied according to the primary obstetric event, clinical features, Lab findings or management provided. A comparison was done amongst all criteria and their individual applicability was checked as per the facility available in our set up. Results: During the study period total 7819 women delivered in the hospital out of which 6498 delivered vaginally and 1321 delivered through caesarian section. Total live births during this period were 5219. The present study found an incidence of severe maternal morbidity/near miss ranging from 5.56 to 40 per 1000 live births. Among 244 women suspected to be SAMM/MNM, 179(73%) met Waterstone’s criteria, 48(20%) met Mantel’s Criteria and 63(26%) met WHO criteria, 20% women met Mantel and Waterstone’s criteria both while 17% met all three criteria. Conclusion: The study of SAMM cases and their identification through suitable criteria can contribute to know its magnitude, as well as to identify most frequent characteristics and clinical conditions which will help to recognize the problems in antenatal services, peripheral health care facilities and referral system. The criteria which are available now cannot be applied uniformly, and need to be tailored to identify more specific criteria according to infrastructure of a particular setting in order to utilize resources effectively.

RECIST Criteria for Tumor Response in the Patients with Breast Cancer Who Had Neoadjuvant Chemotherapy

PURPOSE: This study compared the response evaluation using the WHO (World Health Organization) criteria for patients with breast cancer with that of the RECIST (Response Evaluation Criteria In Solid Tumor) criteria in order to determine the significance of the RECIST criteria in breast cancer. METHODS: Between 2001 and 2005, 42 patients with measurable lesions radiologically receiving neoadjuvant chemotherapy for a breast carcinoma were enrolled in this study. The results were compared using a kappa test as a concordance measure between the two response criteria. RESULTS: With the WHO criteria, the overall response and progression rate were 35.7% (CR 0, PR 15) and 16.6% (PD 7) respectively. On the other hand, the overall response and progression rate using the RECIST criteria were 38.0% (CR 0, PR 16) and 7% (PD 3) respectively. The kappa value as a concordance measure between two response criteria was 0.718. CONCLUSION: The RECIST criteria are comparable to the WHO criteria in evaluating the response of breast cancer patients who have undergone neoadjuvant chemotherapy. A comparison of these results with other studies of more common tumor types supports the implementation of RECIST as the standard criteria for evaluating the treatment response but also for monitoring progression.

Acupunctural Treatment for Hypertension / 全日本鍼灸学会雑誌

We have twice previously reported the results of our preliminary investigation regarding patients with hypertension. Recently, the focus of our interest has been on the blood pressure levels at the time of the third sound of korotkoff. We reported our findings regarding this topic in an oral presentation titled “Evaluation of acupunctural treatment in hypertensive patients” at the 9th Annual Central Japan Block Meeting of the Japanese Society of Acupuncture and Moxibustion Therapy.<br>Since then, we have accumulated further clinical experience regarding hypertensive patients. In this study, we investigated the third sound of korotkoff in patients diagnosed as borderline hypertension according to the WHO criteria for hypertension. The blood pressure during the third sound of korotkoff ranged from 100mmHg to 110mmHg in our patients. This difference in blood pressure noted during the decreasing phase of the blood pressure cycle may serve as a useful prognostic indicator in hypertensive patients.