Decoding the maternal factors for low birth weight babies and unveiling its impact on the newborn

Background: Low birth weight is a substantial global health issue with significant consequences to the newborn, family and society. It affects nearly 25 million births worldwide.Methods: This was a prospective study. Total 100 patients included in this study. This study conducted for 6 months. at tertiary health care center.Results: Maternal variables like anemia, hypertension, lack of proper antenatal care and lower socioeconomic status significantly influenced low birth weight in newborns. Clinical intervention such as iron supplementation and proper maternal nutrition, timely management of hypertensive disorders of pregnancy and creating public awareness regarding the importance of antenatal care have shown to impact neonatal outcomes positively.Conclusions: Low birth weight is one of the leading causes of perinatal morbidity and mortality and hence it should be managed in a tertiary health care center with trained obstetricians and with facility of neonatal intensive care unit (NICU).

Left ventricular hypertrophy: hypertensive or hypertrophic cardiomyopathy? What a dilemma! A case report / Hipertrofia ventricular izquierda: ¿cardiopatía hipertensiva o miocardiopatía hipertrófica? ¡Vaya dilema! Reporte de caso

Abstract In the presence of the left ventricle hypertrophy (LVH), the differential diagnosis with hypertrophic cardiomyopathy (HCM) or some phenocopy must be always considered, which can be easily suspected when the hypertrophy is markedly asymmetric. However, when the hypertrophy is homogeneous, especially if the patient has concomitant hypertension, it may be a challenge to distinguish between hypertensive and HCM, although some clinical features may help us to suspect it. In addition, patients with HCM may present with exertional angina due to microcirculation involvement in the setting of the hypertrophy itself or dynamic obstruction in the left ventricular outflow tract, but in some cases, the presence of concomitant coronary artery disease must be suspected as the cause of angina, especially if the patient has an intermediate or high-risk probability of having ischemic heart disease. We present the case of a 46-year-old Afro-American man with poorly controlled hypertension who was found to have severe LVH, and who presented with symptoms of exertional angina during follow-up. We will review the clinical features that can help us in the differential diagnosis in this context.

Resumen Ante la presencia de hipertrofia del ventrículo izquierdo (HVI), siempre se debe considerar el diagnóstico diferencial con la miocardiopatía hipertrófica (MCH) o alguna fenocopia, que puede sospecharse fácilmente cuando la hipertrofia es marcadamente asimétrica. Además, los pacientes con MCH pueden presentar angina de esfuerzo debido a la afectación de la microcirculación en el contexto de la propia hipertrofia o si ésta condiciona obstrucción dinámica al tracto de salida del ventrículo izquierdo, pero en algunos casos debe sospecharse la presencia de enfermedad coronaria concomitante como causa de la angina, especialmente si el paciente tiene una probabilidad de riesgo intermedio o alto de padecer cardiopatía isquémica. Presentamos el caso de un varón de 46 años de afroamericana con hipertensión arterial mal controlada a quien se le detectó una HVI severa, y que durante el seguimiento presentó síntomas de angina de esfuerzo. Revisaremos las características clínicas que nos pueden ayudar en el diagnóstico diferencial en este contexto.

Factores de riesgo aterogénico como predictores de daño microvascular en la retina

Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

Assessment of clinical profile among hypertensive patients, Meru, Kenya

Background: Non-communicable diseases (NCDs) are the leading cause of global morbidity and mortality. Globally, more than 1.28 billion adults are hypertensive and in Kenya, 24% of adult population has elevated blood pressure and 56% of these have never been screened for hypertension. Assessment of clinical profile helps guide the management of hypertensive patients towards obtaining normal blood pressure levels. The aim of this study was to investigate the clinical profile of hypertensive patients at the Meru Teaching and Referral Hospital in Kenya. Methods: A cross sectional survey was conducted and systematic random sampling was used to sample 75 hypertensive patients who participated in the study. The collected data were summarized using frequencies and percentages. Chi square was used to assess the relationship between the participants’ demographic characteristics, clinical profile and hypertension. Statistical significance was set at p?0.05. Results: The average mean age of the participants was 58.53 years and majority were female (52%). Thirty-three (33.3%) were overweight and 24% were obese. The mean body mass index (BMI) for both genders was 26.48±5.24, the mean waist-to-hip ratio (WHR) and waist circumference (WC) was 0.94 and 102.09 respectively with 85.3% of the participants having a substantially increased WHR. Diabetes was the most common comorbidity (70.73%). Of the five clinical profiles assessed (BMI, RBS, WHR, presence of comorbidities and drug used) only the presence of comorbidity was associated with BP levels ?2 (10.01,3), p=0.018. Conclusions: Participants had high blood pressure, BMI, WHR and WC readings as well as several comorbidities.

A study of the incidence of posterior reversible encephalopathy syndrome in patients with eclampsia and their fetomaternal outcome at a tertiary care centre in India

Background: Hypertensive disorders are one of the most crucial and still unsolved problems in obstetrics. Eclampsia is one of the most serious acute complications of pregnancy, and the risk of morbidity and mortality for both the mother and baby is very high. Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition associated with eclampsia that can have severe consequences if not promptly diagnosed and managed. It presents with altered consciousness, acute cortical blindness and convulsions. “Delivery is the ultimate cure of eclampsia” is a traditional belief but it does occur in the postpartum period too.Methods: A retrospective analysis of medical records was conducted for eclamptic patients admitted to the tertiary care center over a specified period. Patients diagnosed with PRES were identified and their clinical characteristics, diagnostic imaging findings, treatment modalities, and maternal and neonatal outcomes were reviewed.Results: This study sheds light on the incidence of posterior reversible encephalopathy syndrome in eclamptic patients at a tertiary care center in India. PRES was more common in primigravidas in the younger age group (20-30 years) and patients who presented with multiple seizures, resulting in higher number of cesarean sections.Conclusions: Early recognition and management of PRES are crucial for improving maternal outcomes. Further research is warranted to refine strategies for timely diagnosis and intervention, ultimately contributing to the reduction of maternal and neonatal morbidity and mortality associated with eclampsia and its complications.

Earthworm Protein Protects Vascular Endothelial Function in Spontaneously Hypertensive Rats via PI3K/Akt/Nrf2 Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the effect of earthworm protein on the expression of phosphatidylinositol 3-kinase/protein kinase B/nuclear factor E2-related factor 2 （PI3K/Akt/Nrf2） pathway in the aorta of spontaneously hypertensive rats （SHR） and explore mechanism of earthworm protein in treating hypertensive vascular endothelial dysfunction （VED）. MethodTen 10-week-old Wistar Kyoto （WKY） rats and fifty SHR rats were selected for a week of adaptive feeding. WKY rats were selected as the normal group， and fifty SHR rats were randomized according to body weight into model， valsartan （8×10-3 g·kg-1·d-1）， and high-， medium-， and low-dose （0.2， 0.1， 0.05 g·kg-1·d-1， respectively） earthworm protein groups. The normal and model groups were administrated with equal volume of double distilled water by gavage. During the drug intervention period， the general situations of rats in each group were observed and their blood pressure was monitored at specific time points every other week before and after administration. After 8 weeks of drug intervention， enzyme-linked immunosorbent assay was employed to measure the levels of angiotensin-Ⅱ （Ang-Ⅱ） and endothelin-1 （ET-1） in the serum of rats in each group. The corresponding kits were used to determine the levels of nitric oxide （NO）， malondialdehyde （MDA）， glutathione peroxidase （GPX）， superoxide dismutase （SOD）， and ferrous ion （Fe2+）. Hematoxylin-eosin （HE） staining was employed to observe the changes in the intima of the aorta. Fluorescence quantitative polymerase chain reaction （Real-time PCR） was employed to measure the mRNA levels of PI3K， Akt， Nrf2， heme oxygenase-1 （HO-1）， and glutathione peroxidase 4 （GPX4） in the aortic tissue. Western blotting was used to determine the protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 in the thoracic aorta. ResultCompared with the normal group， the model group had decreased body mass， increased irritability， severe endothelial damage， elevated blood pressure and serum levels of Ang-Ⅱ， ET1， MDA， and Fe2+ （P<0.01）， lowered NO level （P<0.01）， and down-regulated mRNA and protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 in the aortic tissue （P<0.01）. Compared with the model group， drug intervention caused no significant change in the body mass， calmed the rats， alleviated the endothelial damage， lowered blood pressure and serum levels of Ang-Ⅱ， ET1， MDA， and Fe2+ （P<0.01）， elevated the NO level （P<0.05）， and up-regulated the mRNA and protein levels of p-PI3K （Tyr467/199）， PI3K， p-Akt （Ser473）， Akt， Nrf2， HO-1， and GPX4 （P<0.05）. ConclusionThe earthworm protein can exert antihypertensive effects by ameliorating VED in SHR. Specifically， it may regulate the PI3K/Akt/Nrf2 signaling pathway to inhibit oxidative stress and ferroptosis.

Mental Health Status and Its Influencing Factors Among Elderly Hypertension Patients from Rural Areas of Chuxiong and Honghe Prefecture in Yunnan / 昆明医科大学学报

Objective To investigate the mental health status and its influencing factors among elderly hypertensive patients from Rural Areas of Chuxiong and Honghe Prefecture in Yunnan.Methods Multi-stage random sampling method was adopted to select elderly hypertensive patients from rural Yi ethnic areas in Yunnan.Questionnaires were used to collect their basic information and mental health status.Multivariate logistic regression was performed to explore the influencing factors of mental health among the elderly hypertensives.Results 21.82%(209/958)of elderly people with hypertension have poor mental health status in Chuxiong and Honghe Prefecture,Yunnan.Age of 80-89 years(OR = 2.395,P<0.05)and over 90 years(OR = 3.293,P<0.05),as well as physical disability(OR = 2.037,P<0.05),were risk factors for poor mental health.Compared with those who rated their economic situation as very difficult,rating as somewhat difficult(OR = 0.490,P<0.05),moderate(OR = 0.632,P<0.05)and relatively affluent(OR = 0.344,P<0.05),having a spouse(OR = 0.655,P<0.05),received full concern from the offspring(OR = 0.411,P<0.05)and maintain good relationships with offspring(OR = 0.339,P<0.05)were protective factors.Conclusions The mental health status of elderly people with hypertension is relatively poor in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.Special attention should be paid to the mental health of older and physically disabled elderly hypertensives.Economic and mental support from children was crucially important in improving the mental health of elderly hypertensive patients in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.

Research progress on oral lichenoid drug reactions / 口腔疾病防治

@#Oral lichenoid drug reactions (OLDRs) are inflammatory reactions of the oral mucosa caused by the use of specific drugs in sensitive individuals and are classified as oral lichenoid lesions (OLLs). Its clinical and pathological manifestations do not have significant specificity compared to other types of OLL. Various types of drugs have been reported to induce OLDR, including antihypertensive drugs, nonsteroidal anti-inflammatory drugs, hypoglycemic drugs, antipsychotics, and immunosuppressants, among other drugs. Apart from local or systemic administrate glucocorticoids, the most effective treatment measure is to stop using suspicious drugs. Most patients can achieve significant relief from mucosal ulcers and erosion, but white lines may still remain. OLDR has been widely reported in the literature. However, due to a lack of systematic understanding, we do not have a recognized standard for the diagnosis and treatment of this disease. There are still doubts about the causal relationship between related drugs and oral lichen-like lesions. In response to the abovementioned problems, we searched the literature on drug-related oral lichen planus and lichen-like lesions at home and abroad over the past 20 years, most of which were case reports and only a few of which were case-control studies. This article describes the current research status of lichenoid lesions from four perspectives: concepts, suspicious drugs, clinical and pathological manifestations, and treatment prognosis. We hope to provide a theoretical reference for the prevention, diagnosis, and clinical treatment of related lichenoid lesions. A literature review demonstrated that there are still many unclear issues related to the etiology, pathogenesis, clinical diagnosis and treatment, treatment prognosis, and other aspects of this disease, and further clinical and basic research is needed for in-depth exploration.

Clinical value of genetic polymorphism analysis of hypertension drugs for individualized treatment of hypertension patients in the southern Anhui region / 中国临床药理学与治疗学

AIM: To analyze the distribution frequency of gene polymorphisms of β receptor blockers, angiotensin receptor antagonists, angiotensin converting enzyme inhibitors, calcium antagonists, and diuretics in hypertensive patients from southern Anhui province, and provide a theoretical basis for gene detection of hypertension drugs and personalized medication. METHODS: Drug gene testing information from 839 hospitalized patients with hypertension at Yijishan Hospital of Wannan Medical College from July 2021 to April 2023 were collected, and the distribution frequency of each gene locus were analyzed. RESULTS: The genotype frequencies of ACE (I/D) I/I, I/D, and D/D were 42.1%, 46.0%, and 11.9%, respectively. the genotype frequencies of ADRB1 (1165G>C) G/G, G/C, and C/C were 8.3%, 40.0%, and 51.6%, respectively. The genotype frequencies of AGTR1 (1166A>C) A/A, A/C, and C/C were 90.2%, 9.8%, and 0.0%. The genotype frequencies of CYP2C9*3 (1075A>C) *1/*1, *1/*3, and *3/*3 were 91.3%, 8.7%, and 0.0%, respectively; the genotype frequencies of CYP2D6* 10 (100C > T) *1/*1, *1/*10, and *10/*10 were 25.0%, 36.6%, and 38.4%, respectively. The genotype frequencies of CYP3A5*3 (6986A>G) *1/*1, *1/*3, and *3/*3 were 7.0%, 39.0%, and 54.0%, respectively. The frequencies of NPPA (2238T>C) T/T, T / C, and C / C genotypes were 97.9%, 2.1%, and 0.0%, respectively. In addition, there was a significant difference in the genotype distribution frequency of multiple drug related gene loci in southern Anhui compared to other regions in China (P< 0.05). CONCLUSION: The genotype distribution frequency of hypertensive drug related gene loci had certain bias in southern Anhui, and were significant different from other regions in China, indicating that conducting genetic polymorphism testing of hypertensive drugs had certain guiding significance for the individualized application of hypertensive drugs in southern Anhui.

Prevalence, trends, and factors associated with hypertensive crisis among Peruvian adults / Prevalencia, tendencias y factores asociados a la crisis hipertensiva en adultos peruanos / Prevalência, tendências e fatores associados à crise hipertensiva em adultos peruanos

There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.

Pocos estudios se han centrado en la epidemiología de la crisis hipertensiva a nivel poblacional en entornos de recursos limitados. El objetivo de este estudio fue determinar la prevalencia y tendencia, a lo largo del tiempo, de la crisis hipertensiva y los factores asociados a esta condición en adultos. Se realizó un análisis de datos secundarios utilizando la Encuesta Demográfica de Salud Familiar (ENDES) de Perú. La crisis hipertensiva se definió en función de la presencia de presión arterial sistólica (≥ 180mmHg) o diastólica (≥ 110mmHg), independientemente del diagnóstico previo o del uso de medicamentos. Los factores asociados a los resultados se evaluaron mediante regresión logística multinomial, y la tendencia a la crisis hipertensiva se estimó mediante la prueba Cochran-Armitage. Los datos de 260.167 participantes, con una media de 44,2 años (DE: 16,9) y 55,5% mujeres, fueron analizados. La prevalencia de hipertensión fue del 23% (IC95%: 22,7-23,4), de la cual el 5,7% (IC95%: 5,4-5,9) tuvo crisis hipertensiva, con una prevalencia general del 1,5% (IC95%: 1,4-1,6). En el período 2014-2022 se constató una disminución significativa en la prevalencia de crisis hipertensiva, del 1,7% en 2014 al 1,4% en 2022 (p = 0,001). En el modelo multivariable, el sexo masculino, el aumento de la edad, vivir en áreas urbanas, el alto índice de masa corporal y la diabetes autoinformada se asociaron positivamente con la crisis hipertensiva, mientras que mayor nivel educativo, nivel socioeconómico y elevada altitud estuvieron asociadas de manera inversa. Es necesario mejorar las estrategias para el diagnóstico, el tratamiento y el control de la hipertensión, especialmente de la crisis hipertensiva.

Há poucos estudos focados na epidemiologia da crise hipertensiva em nível populacional em ambientes com recursos limitados. O objetivo deste estudo foi determinar a prevalência e a tendência, ao longo do tempo, da crise hipertensiva e fatores associados a essa condição em adultos. Uma análise de dados secundários foi realizada usando a Pesquisa Demográfica de Saúde Familiar (ENDES) do Peru. Crise hipertensiva foi definida com base na presença de pressão arterial sistólica (≥ 180mmHg) ou diastólica (≥ 110mmHg), independentemente de diagnóstico prévio ou uso de medicação. Os fatores associados aos resultados foram avaliados por meio de regressão logística multinomial, e a tendência de crise hipertensiva foi avaliada pelo teste de Cochrane-Armitage. Os dados de 260.167 participantes, com média de 44,2 anos (DP: 16,9) e 55,5% mulheres, foram analisados. A prevalência de hipertensão foi de 23% (IC95%: 22,7-23,4), dentre eles, 5,7% (IC95%: 5,4-5,9) apresentaram crise hipertensiva, com prevalência geral de 1,5% (IC95%: 1,4-1,6). De 2014 a 2022, observou-se queda significativa na prevalência de crise hipertensiva, de 1,7% em 2014 para 1,4% em 2022 (p = 0,001). No modelo multivariável, sexo masculino, idade crescente, residir em área urbana, índice de massa corporal elevado e diabetes autorreferido associaram-se positivamente à crise hipertensiva, enquanto maior escolaridade, nível socioeconômico e altitude elevada associaram-se inversamente. Há necessidade de aprimorar as estratégias de diagnóstico, tratamento e controle da hipertensão arterial, especialmente da crise hipertensiva.

Complicaciones anestésicas en pacientes con preeclampsia con criterios de severidad / Anesthetic complications in patients with preeclampsia with severity criteria

Resumen OBJETIVO: Describir las complicaciones anestésicas en pacientes con preeclampsia con criterios de severidad. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, transversal y descriptivo llevado a cabo en un centro de atención terciaria de la ciudad de Medellín, Colombia, entre enero de 2016 y enero de 2021. La fuente de información fueron las historias clínicas. Criterios de inclusión: pacientes embarazadas, con preeclampsia con criterios de severidad que recibieron anestesia neuroaxial o general. Criterios de exclusión: pacientes con diagnóstico previo de coagulopatías y con otros trastornos hipertensivos del embarazo no relacionados con la preeclampsia con características graves. Se hizo un muestreo no probabilístico de casos consecutivos y un análisis univariado. RESULTADOS: Se incluyeron 508 pacientes; el 69% finalizaron el embarazo mediante cesárea. El 89.4% recibió anestesia neuroaxial y el 10.6% anestesia general. El 29.9% ingresó a cuidados intensivos, 4.7% tuvo hipotensión, 3.9% requirió soporte vasopresor, 3.7% con vía aérea difícil, 0.98% requirió ventilación mecánica. Una paciente resultó con edema pulmonar y otra con accidente cerebrovascular hemorrágico. El 1.5% de quienes recibieron anestesia espinal tuvo retención urinaria. La frecuencia de anestesia neuroaxial fallida fue del 1.4% para parto y 1.3% para cesárea. No se registraron casos de muerte, meningitis, aracnoiditis, paraplejia, punción de la duramadre accidental o reacción alérgica. CONCLUSIONES: La anestesia neuroaxial sigue siendo la técnica anestésica de elección en pacientes con preeclampsia con criterios de severidad. Las complicaciones anestésicas evidenciadas con más frecuencia fueron el ingreso a cuidados intensivos, hipotensión y requerimiento de soporte vasopresor.

Abstract OBJECTIVE: To describe anesthetic complications in patients with pre-eclampsia with severity criteria. MATERIALS AND METHODS: Observational, retrospective, cross-sectional, descriptive study conducted in a tertiary care center in the city of Medellin, Colombia, between January 2016 and January 2021. The source of information was medical records. Inclusion criteria: pregnant patients, with pre-eclampsia with severity criteria, who received neuroaxial or general anesthesia. Exclusion criteria: patients with previous diagnosis of coagulopathies and with other hypertensive disorders of pregnancy unrelated to pre-eclampsia with severe characteristics. Non-probability sampling of consecutive cases and univariate analysis were performed. RESULTS: Fifty-eight patients were included; 69% terminated the pregnancy by cesarean section. Eighty-nine.4% received neuroaxial anesthesia and 10.6% general anesthesia. 29.9% were admitted to intensive care, 4.7% had hypotension, 3.9% required vasopressor support, 3.7% had difficult airway, 0.98% required mechanical ventilation. One patient had pulmonary edema and one patient had hemorrhagic stroke. Urinary retention occurred in 1.5% of patients receiving spinal anesthesia. The incidence of failed neuroaxial anesthesia was 1.4% for labor and 1.3% for cesarean section. There were no cases of death, meningitis, arachnoiditis, paraplegia, accidental dura puncture, or allergic reaction. CONCLUSIONS: Neuroaxial anesthesia remains the anesthetic technique of choice in patients with pre-eclampsia with severity criteria. The most common anesthetic complications were ICU admission, hypotension, and need for vasopressor support.

Descripción de los factores contribuyentes a las muertes secundarias a trastornos hipertensivos asociados al embarazo en Antioquia, Colombia (2012-2020) / Description of the contributing factors to deaths secondary to hypertensive disorders associated with pregnancy in Antioquia, Colombia (2012-2020)

Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.

Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.

Estados hipertensivos del embarazo y complicaciones materno-perinatales en el Hospital Regional De Ciudad del Este

Introducción: Los estados hipertensivos del embarazo son un conjunto de patologías que puede producir muerte o discapacidad crónica en las madres, en los fetos y recién nacidos. Objetivo: Determinar la frecuencia de los estados hipertensivos del embarazo y las complicaciones materno-perinatales en el Hospital Regional de Ciudad del Este. Materiales y métodos: Estudio transversal descriptivo con muestreo no probabilístico. Se estudiaron a todas las mujeres embarazadas con estados hipertensivos del embarazo o asociado al mismo que tuvieron eventos obstétricos en el Hospital Regional de Ciudad del Este en los años 2018 al 2020. Los datos fueron analizados en el Software Stata 12.0. Resultados: Se estudiaron a 7056 pacientes. Se encontraron 11,9% participantes con estados hipertensivos del embarazo, 55,3% con mayor frecuencia entre los 20 a 35 años, el 71,3% tuvieron control prenatal de mala calidad, se encontraron el 42,8% con preeclampsia. El 65,2% terminaron por cesárea, 27,8% Síndrome de HELLP, el 1,4% presentaron requerimiento de terapia intensiva y 0,6% muerte materna. Con respecto a las complicaciones perinatales se encontraron bajo peso al nacer en 30,2% y muerte del 2%. Conclusión: Se registró alta frecuencia de estados hipertensivos del embarazo con alto porcentaje de complicaciones, mala calidad de control prenatal. Entre las complicaciones perinatales más frecuentes fueron el bajo peso al nacer y la más grave es la muerte.

Introduction: Hypertensive states of pregnancy are a set of pathologies that can cause death or chronic disability in mothers, fetuses and newborns. Objective: To determine the frequency of hypertensive states of pregnancy and maternal-perinatal complications at the Regional Hospital of Ciudad del Este. Materials and methods: Descriptive cross-sectional study with non-probability sampling. All pregnant women with hypertensive states of pregnancy or associated with pregnancy who had obstetric events at the Regional Hospital of Ciudad del Este in the years 2018 to 2020 were studied. The data were analyzed in Stata 12.0 software. Results: A total of 7056 patients were studied. 11.9% of participants had hypertensive states of pregnancy, and among them, 55.3% were found to be more frequent from 20 to 35 years of age, 71.3% had poor prenatal care, and 42.8% had preeclampsia. 65.2% of the participants ended up with cesarean delivery, 27.8% had HELLP syndrome, 1.4% required intensive care and 0.6% ended in maternal death. Regarding perinatal complications, low birth weight was found in 30.2%, and death at birth in 2%. Conclusion: A high frequency of hypertensive states of pregnancy with a high percentage of complications and poor quality of prenatal control was registered. One of the most common perinatal complications were low birth weight, and the most serious was death.

The outcome of preterm births in pregnant women with hypertensive disorders: an observational study

Background: Hypertensive conditions occurring during pregnancy are linked to heightened chances of severe consequences, including preterm birth, intrauterine growth restriction, perinatal mortality and morbidity, acute kidney failure, sudden liver malfunction, excessive postpartum bleeding, HELLP Syndrome, disseminated intravascular coagulation, and seizures.Methods: A prospective hospital-based study was conducted in a tertiary care hospital of eastern Uttar Pradesh, over the period of one year. The total sample size calculated was 235. Data was collected using the structured questionnaire. This study recruited the hypertensive pregnant women with a blood pressure reading of 140/90 mmHg or higher, irrespective of the timing of the blood pressure elevation, who visited the hospital for delivery over the course of one year. Various maternal variables were examined, including age, gestational age, number of previous deliveries, the status of the mother's blood pressure, and the type of delivery.Results: In the present study, the births revealed the following distribution among different hypertensive disorders: chronic hypertension preterm: 100.0% 06 vs. term: 0% 0, eclampsia, preterm: 60.4% 64 vs. term: 39.6% 42, mild preeclampsia, preterm: 55.3% vs. term: 44.7%, severe preeclampsia, preterm: 48.5% vs. term: 51.5%, and gestational hypertension, preterm: 23.5% vs. term: 76.5%.Conclusions: Based on the findings of this study, it was determined that hypertensive disorders play a pivotal role in influencing both the frequency of preterm delivery and the associated complications in infants resulting from premature birth.

Evaluation of serum leptin levels in diabetic and hypertensive subjects resident in Port Harcourt

Background: Diabetes and hypertension which are metabolic conditions are becoming more common and prevalent in the world. Prolonged rise of blood sugar levels, is a hallmark of diabetes, a metabolic condition caused by problems with insulin production, insulin resistance or both while hypertension is the persistent high blood pressure in the arteries. Leptin is a hormone that inhibits appetite, reduces fat storage in adipocytes and aids in the regulation of energy balance hence implicated in diabetes and insulin resistance. Thus, can metabolic state affects its level in the serum. Methods: The study population is two hundred and forty (240) subjects that are residents of Port Harcourt aged between 30-70 years. Sixty subjects were used as the control, sixty subjects were diabetes, the other sixty subjects were hypertensive while the remaining sixty were subjects with both hypertension and diabetic mellitus. An enzyme-linked immunosorbent assay (ELISA) method was used to quantitatively measure leptin levels in the serum sample, glycated haemoglobin were determined quantitatively using sandwich immunodetection and blood pressure was measured using mercury sphygmomanometer. Results: The data generated were statistically analysed using Graph Pad Prism version 9.0.2. The results showed no significant difference in leptin levels in diabetics, hypertensive and subjects having both diabetes and hypertension when compared with the control subjects having none of these metabolic disorders (p =0.4166). Conclusions: Our results shows that leptin levels in the population were relatively within the reference ranges both for males (0.5-12ng/ml) and females (0.5-15ng/ml). It clearly shows that metabolic conditions (diabetes or hypertension) does not affect leptin levels in serum.

Predictive Performance of Triglyceride-Glucose Index on Asymptomatic Multiple Organ Damage in Patients with Newly Diagnosed Hypertension

ABSTRACT Background: Insulin resistance (IR) contributes to the development of hypertension and mediated organ damage (HMOD) through various mechanisms. Objectives: The objective of the study was to assess the diagnostic performance of the triglyceride-glucose (TyG) index, a surrogate marker of IR, in predicting the presence and severity of HMOD in newly diagnosed untreated hypertensive patients from an academic training and research hospital. Methods: The study included 438 patients with newly diagnosed, untreated hypertension. The control group comprised normotensive individuals matched on a 1:1 ratio based on age, gender, body mass index, and smoking using the nearest neighbor method. The presence of HMOD was defined by renal damage (microalbuminuria > 30 mg/day or proteinuria > 150 mg/day), vascular damage (carotid intima-media thickness > 0.9 mm or presence of plaque), or cardiac damage (left ventricular mass index > 95 g/m2 in women and > 115 g/m2 in men). The severity of HMOD was considered as single-, two-, or triple-organ damage. Results: TyG index values were higher in the hypertensive group than the normotensive group. An increased TyG index was independently associated with HMOD (OR: 1.33, p < 0.001). The TyG index exhibited gradually increasing threshold values for distinguishing patients with single-organ HMOD (> 8.8 with 77.8% sensitivity and 74.3% specificity), two-organ HMOD (> 9.1 with 77.6% sensitivity and 71.4% specificity), and triple-organ HMOD (> 9.4 with 71.5% sensitivity and 87.7% specificity). Conclusions: In newly diagnosed hypertensive patients, the TyG index exhibits significant diagnostic performance in predicting multiple-organ damage beyond the presence of HMOD. Since the detection of multiple-organ HMOD requires a multidisciplinary approach, the TyG index can serve as a simple and inexpensive screening tool.

A study on fetomaternal outcome of hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are one of the most common medical disorders seen during pregnancy. Early diagnosis of hypertensive disorders in pregnancy by regular antenatal checkup can help in proper management, thus decreasing the maternal and fetal complications related it. Ensuring timely and effective care requires appropriate use of evidence-based clinical and nonclinical interventions, strengthened health infrastructure, and motivated and competent health care providers. The objective of this study was to study the feto-maternal outcome of hypertensive disorders of pregnancy and complications related to them.Methods: A study was conducted in the department of obstetrics and gynecology at JJ Group of hospitals, Mumbai, India for a duration of 18 months from January 2020 to June 2021. This study had a sample size of 500 antenatal patients. Necessary information such as their detailed clinical, and obstetric history, clinical examination, investigations was noted.Results: In our study, the incidence of hypertensive disorders of pregnancy was 10.2%, being most common in age group of 21-25 years (45.1%) and Primigravida patients (47.1%). The most common type of hypertensive disorder in our study was non severe preeclampsia with incidence of 74.50%. The most common complication was oligohydramnios (11.76%), followed by preterm delivery (9.80%) and IUGR (9.80%). The most common drug used in the management of hypertensive disorder was lobetalol. Most common neonatal complication in PIH group was low birth weight, followed by fetal distress (19.6%), prematurity (9.8%) and IUGR (9.8%).Conclusions: Hypertensive disorders of pregnancy are one of the medical conditions affecting pregnancy. Hypertensive disorders of pregnancy are more prevalent in younger and nulliparous mothers. Early diagnosis and appropriate timely management of hypertensive disorders in pregnant women can prevent the maternal and fetal complications and improve the outcome of pregnancy. These women should be monitored carefully to prevent maternal morbidity and mortality.

A study on fetomaternal outcome of hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are one of the most common medical disorders seen during pregnancy. Early diagnosis of hypertensive disorders in pregnancy by regular antenatal checkup can help in proper management, thus decreasing the maternal and fetal complications related it. Ensuring timely and effective care requires appropriate use of evidence-based clinical and nonclinical interventions, strengthened health infrastructure, and motivated and competent health care providers. The objective of this study was to study the feto-maternal outcome of hypertensive disorders of pregnancy and complications related to them.Methods: A study was conducted in the department of obstetrics and gynecology at JJ Group of hospitals, Mumbai, India for a duration of 18 months from January 2020 to June 2021. This study had a sample size of 500 antenatal patients. Necessary information such as their detailed clinical, and obstetric history, clinical examination, investigations was noted.Results: In our study, the incidence of hypertensive disorders of pregnancy was 10.2%, being most common in age group of 21-25 years (45.1%) and Primigravida patients (47.1%). The most common type of hypertensive disorder in our study was non severe preeclampsia with incidence of 74.50%. The most common complication was oligohydramnios (11.76%), followed by preterm delivery (9.80%) and IUGR (9.80%). The most common drug used in the management of hypertensive disorder was lobetalol. Most common neonatal complication in PIH group was low birth weight, followed by fetal distress (19.6%), prematurity (9.8%) and IUGR (9.8%).Conclusions: Hypertensive disorders of pregnancy are one of the medical conditions affecting pregnancy. Hypertensive disorders of pregnancy are more prevalent in younger and nulliparous mothers. Early diagnosis and appropriate timely management of hypertensive disorders in pregnant women can prevent the maternal and fetal complications and improve the outcome of pregnancy. These women should be monitored carefully to prevent maternal morbidity and mortality.

Clinical profile of patients with hypertensive emergencies in a tertiary care hospital

Background: Hypertensive emergency is defined by systolic blood pressure (SBP) ?180 mmHg and/or diastolic blood pressure (DBP) ?120 mmHg with acute target organ damage. Hypertensive emergencies can be life threatening and fatal unless timely treated. In the present study we aim to study the clinical profile and outcome of patients admitted with hypertensive emergency in the medical intensive care unit in our hospital. Methods: A cross-sectional observational study of all cases with hypertensive emergency admitted in Medical Intensive care unit (ICU) in Government General Hospital, Srikakulam during the study period was conducted. The clinical profile and outcome of the patients were assessed. Results: Out of the fifty patients in the present study, about 36 (72%) were males and 14 were females (28%) and about one third of the patients (36%) belonged to the age group of 60-69 years. Diabetes mellitus (30%) and dyslipidemia (40%) were the commonly encountered comorbidities in the study population. Most frequent presenting symptoms were neurological deficits (50%) followed by dyspnoea (32%) and chest pain (24%). Intracerebral haemorrhage was the commonest target organ damage found in 30% of the patients. Patients presenting with hypertensive emergencies with neurological target organ damage had statistically significant increased chance of mortality (p=0.007). Conclusions: As hypertension emergencies are consequence of uncontrolled hypertension, it is important to educate and bring awareness among public regarding the screening, early detection, and adherence to prescribed medication for hypertension to avoid adverse clinical outcomes.

A cross sectional study of pregnancy outcome in women with recurrent pregnancy loss

Background: Recurrent pregnancy loss occurs in approximately 1-2% of reproductive aged women. Aetiology is unknown in approximately 50% of RPL. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Maternal age and number of previous miscarriages are two independent risk factors. The study was conducted to determine the pregnancy outcomes in women with history of recurrent pregnancy loss.Methods: A hospital based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. The study was carried out during a period of 2 years with effect from September 2019 to August 2021.Results: A total of 116 pregnant women with history of recurrent pregnancy loss were included in the study. The mean age among participants was 30.28±5.48 years. The average number of abortions prior to this pregnancy was 2.53±1.02. About 85.34% had spontaneous onset of labour and nearly equal proportion of (48.27% and 46.56%) of the participants delivered by NVD and CS. Maternal complications were present in 51.72%. Most common were hypertensive disorder (12.06%) and preterm labour (12.06%). Fetal complications were observed in 22.4% of newborn, commonest being low birth weight.Conclusions: Women with history of recurrent pregnancy loss encountered increased adverse maternal complications however fetal complications were similar to that of the general population. The definition, diagnosis and treatment of patients with a history of RPL remains difficult. Increased antenatal surveillance to reduce the risk of pregnancy complications with better screening of the obstetrical history and the necessary investigations to identify a treatable cause associated with previous miscarriages can lead to early prophylactic interventions for a better outcome.