Dengue in pregnancy, maternal and fetal outcome: a case series managed at a Zonal Hospital

Background: Dengue is a vector borne disease with various grades of severity. Pregnancy is a high-risk group and is prone for complications of dengue haemorrhagic fever. The aim of this study was to evaluate the clinical profile of pregnant patients with dengue and to assess the maternal and fetal outcomes of dengue in pregnancy.Methods: All pregnant patients reporting to the hospital with fever and serologically confirmed dengue infection were included in the study. Clinical and laboratory data of patients were collected. The cases were followed up till their delivery to monitor the effect of dengue. An account of the mode of delivery in these patients was made. The neonates were evaluated and followed up till 6 weeks of life.Results: A total 100% patients reported with fever and serologically confirmed dengue infection. 15% had severe thrombocytopenia requiring platelet transfusion. 31% required ICU care and 15% needed mechanical respiratory support due to severe complications of dengue. NICU admission rate was 30% but there was no major neonatal complication or vertical transmission noted. A high index of suspicion should be maintained by the clinician with an aim to identify infection early, start supportive treatment and evaluate for complications. In-patient care should be provided for feto-maternal monitoring.Conclusions: The progression of dengue infection in pregnancy was rapid leading to major complications. Close materno-fetal monitoring and timely obstetric care are essential to ensure a favorable pregnancy outcome

Histological changes in ovaries of mice exposed to butea monosperma: preliminary study / Cambios histológicos en ovarios de ratón expuestos a butea monosperma: estudio preliminar

In Ayurvedic practice Butea monosperma (Palash) is in clinical use for hundreds of years as a contraceptive. Seeds of Butea monosperma are also used as an anthelmitic (Ansani et al., 1979) and antimicrobial (Avirutnant & Pongpan, 1983). Butea monosperma (Fabaceae family) locally known as Palash (Dhak) if given for 3 consecutive days acts as an antifertility agent for which it has been is traditionally used since time immemorial. The objective of the present study was to search the effect of Butea monosperma seeds on the ovary of mice. Observations in the present study were massive degeneration of ova in almost all the follicles, irrespective of the stage of their development. The ova from treated animals showed different stages of necrotic process. Moreover, the arrangement of follicular cells was also disturbed. The Palash seeds in the form of powder when administered orally with distilled water, according to the body weight i.e.2g/Kg, of female mice, for three consecutive days showed notable changes in ovaries. The animals were sacrificed on day next to the last day of treatment and ovaries were extirpated. Ovaries studied histologically after Haematoxylin & Eosin staining showed most of the follicle in immature state with undefined nucleus and nucleoli in the ovum. Others showed degenerative changes in the ovum. Follicles had lost their normal shape and arrangement and organization of granulosa cells. It was conspicuous to find that almost all follicles including graafian follicles of treated ovaries were undergoing degenerative changes simultaneously. The rate of apoptosis in the granulosa cells when studied was found increased in treated cases as compared with control. The study suggests that the disintegration of ova in the ovaries is a specific effect of Butea monosperma seed administration.

En la práctica Ayurvédica Butea monosperma (Palash) se encuentra en uso clínico durante cientos de años como método anticonceptivo. Semillas de Butea monosperma también se utilizan como un antihemético y antimicrobiano. Butea monosperma (familia Fabaceae) conocida localmente como Palash (Dhak) si se administra durante 3 días consecutivos actúa como un agente anticonceptivo que se utiliza tradicionalmente desde tiempos inmemoriales. El objetivo del presente estudio fue buscar el efecto de las semillas de Butea monosperma en ovarios de ratones. Se obsevó degeneración masiva de los óvulos en casi todos los folículos, independientemente de la fase de su desarrollo. Los óvulos de los animales tratados mostraron las diferentes etapas del proceso necrótico. Por otra parte, la disposición de las células foliculares se mostró alterada. El polvo de semillas de Palash, cuando se administra a los ratones, por vía oral en agua destilada, i.e. 2g/Kg peso corporal, durante tres días produce cambios en los ovarios. Los animales se sacrificaron al día siguiente terminado el tratamiento y fueron extirpados los ovarios. Los ovarios se estudiaron histológicamente con HE mostrándose la mayoría de los folículos en estado inmaduro, con núcleo definido y nucléolos en el óvulo. Otros mostraron cambios degenerativos en los óvulos. Los folículos habían perdido su forma normal y la disposición y organización de células de la granulosa. Se encontró que casi todos los folículos incluyendo los folículos mostraban cambios degenerativos de manera simultánea. En los casos tratados, la tasa de apoptosis en las células de la granulosa estaba aumentada, en comparación con el grupo control. El estudio sugiere que la desintegración de los óvulos en los ovarios es un efecto específico de la administración de las semillas de Butea monosperma.

Metabolic syndrome & psychiatric disorders.

The metabolic syndrome, a constellation of symptoms associated with obesity, dyslipidaemia, insulin insensitivity, deranged glucose metabolism and hypertension has been gaining widespread interest due to its immense clinical relevance. We review the metabolic syndrome in terms of its diagnostic criteria and its relationship with severe mental illnesses and psychotropic medications, and the guidelines to manage it.

Carotid endarterectomy under regional analgesia:a retrospective study (1988-1999).

The procedure of carotid endarterectomy is more or less standardized. Controversies persist on many technical issues, one of which is general versus regional anaesthesia. We retrospectively evaluated the influence of regional analgesia on perioperative complications, the hospital stay and the perioperative mortality after carotid endarterectomy in 53 patients. All the patients in the study received deep cervical block regional anaesthesia (Winne's technique) for carotid endarterectomy. Indications for surgery included transient ischaemic haemodynamically significant stenosis. Shunt was used in 7 cases (13.2%). General anaesthesia was supplemented in 2 patients (3.8%). There was no perioperative mortality. Permanent non-fatal neurologic deficit occurred in 1 patient (1.9%) and temporary neurologic Deficit occurred in 1 patient (1.9%). The mean ICU stay was 1.85 (+/-0.82) days and the hospital stay was 5.2 (+/-1.14) days. On the basis of our data we believe that under regional anaesthesia carotid endarterectomy can be performed with acceptable complications and that regional anaesthetic technique is safe and well tolerated by the patients.