Epidemiological determinants and clinical profile of eclampsia: a case control study

Background: The incidence of eclampsia has reduced considerably in the developing countries due to good antenatal care and increased awareness within the population. To determine the magnitude of the problem, to assess trends and to identify risk factors and risk groups, it is worthwhile to periodically review this problem.Methods: A study using one control for each case of eclampsia was conducted among women who were admitted at Burdwan Medical College and Hospital between July 2014 and June 2015. Cases were women with a confirmed diagnosis of eclampsia. Eclampsia cases were identified by daily monitoring of all new admissions to Eclampsia ward of Burdwan Medical College and hospital. After strict exclusion criteria, a total of 500 eclampsia cases were studied along with same number of controls for identifying the epidemiological determinants.Results: Maternal age at extremes (<20 and >30 years) was identified as a risk factor of eclampsia. Nulliparity has been identified as a risk factor for eclampsia in present study. About 74.6% mothers were nulliparous. Most of the patients 66.6% were admitted during the antenatal period i.e. presented with antenatal eclampsia. 62.2% of them were at between 34-37weeks of gestational age during admission.Conclusions: Authors observed increased eclampsia risk among women with a prior history of pregnancies complicated by hypertensive disorders. Positive personal histories of hypertensive disorders of pregnancy and family history of hypertensive disorders are well known risk factors of eclampsia. Our findings point to public health and clinical measures that may be taken to potentially attenuate the incidence of eclampsia and mitigate associated maternal-fetal complications resulting from the disorder.

Isolation, identification, and antibiogram studies of Salmonella species and Escherichia coli from boiler meat in some selected areas of Bangladesh.

Background: The present study was carried out for the isolation, identification of Salmonella and Escherichia coli from broiler meat samples (leg muscle, breast muscle and drumstick) which were collected from different upazilla markets of Mymensingh, Gazipur, and Sherpur districts during the period of January 2015 to May 2015. Methods: A total of 60 samples were subjected to bacterial isolation and identification by using cultural, biochemical, and polymerase chain reaction assays. Results: Using standard bacteriological techniques E. coli was isolated from 50 (83.33%) samples and Salmonella spp. from 18 (31.66%) samples. Furthermore, the isolates were subjected to antibiogram studies by disk diffusion method using eight commonly used antibiotics. Antibiogram studies revealed that gentamicin, ciprofloxacin, and norfloxacin were highly sensitive against all the isolated bacteria, whereas most of the isolates were resistant to amoxicillin, erythromycin, and tetracycline. Out of all the isolates, 5 isolates of E. coli and 3 isolates of Salmonella were found multidrug resistant. Conclusions: The study revealed the presence of multidrug resistant Salmonella and E. coli in broiler meat sold in live bird market of different upazilla.

Learning curve, diagnostic yield and safety of single balloon enteroscopy.

Background: Single balloon enteroscopy (SBE) is a recently developed diagnostic modality to assess small bowel mucosa. The data on learning curve of SBE is scanty. We aimed to assess the learning curve, diagnostic yield and safety of SBE Methods: All patients who underwent SBE at our centre from December 2007 to December 2010 were included retrospectively. The clinical details, enteroscopy findings and procedure related details were obtained for each patient from a prospectively maintained database. The extent of small bowel visualised with increasing number of procedures by a single endoscopist (Endoscopist A) who performed most of the procedures was used to estimate the learning curve using locally weighted regression curve. The diagnostic yield and complications rates of SBE were also estimated. The study was approved by the institute review board and ethics committee. Results: Ninety SBEs were performed in 84 patients (age: 42+15 years, 27.4% females). 57 procedures were performed (32 antegrade and 25 retrograde) by endoscopist A. There was gradual improvement in the extent of small bowel visualised during the first 15 procedures via antegrade route followed by flattening of curve. The retrograde route showed no definite trend towards improvement during the procedures performed. The overall diagnostic yield of SBE was 32.1%. There was no complication except for mild self-limiting abdominal pain in one patient. Conclusions: SBE via antegrade route has a higher success rate and better learning curve than the retrograde route. SBE is a safe procedure and helps in establishing a diagnosis in one-third of the patients examined.

Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis.

Introduction The changing antimicrobial sensitivity pattern of causative organisms poses a therapeutic challenge in treating patients with acute cholangitis. We therefore evaluated the microbial profile and sensitivity pattern to antibiotics in patients with acute bacterial cholangitis. Methods Data of patients above 18 years of age with acute bacterial cholangitis seen between January 2004 and March 2007 were retrospectively analyzed. The study was continued prospectively from April 2007 to December 2008. Data on clinical features, etiological and microbial profile and therapy, and patient outcomes were analyzed. In the prospective group, the antibiotic susceptibility patterns of organisms grown on bile and blood culture were also obtained. Results One hundred and eighty-five patients with acute cholangitis were studied. Choledocholithiasis (62.7%) and malignancy (29.2%) were the main predisposing factors. Bile culture was positive in 88 of 95 patients, and blood culture was positive in 47 of 178 (26.4%) patients. Bile cultures were predominantly polymicrobial (69.5%) in contrast to blood cultures (2.2%). E. coli was the predominant isolate in blood and bile. No growth was seen on anaerobic bile or blood cultures. The prospective group showed high resistance of E. coli to third generation cephalosporins and ciprofloxacin. Conclusions Changing antimicrobial sensitivity patterns requires a revision of empiric antibiotic therapy policy in cholangitis.

Distinguishing Crohn’s disease from intestinal tuberculosis – a prospective study.

Background: Distinguishing Crohn’s disease (CD) from intestinal tuberculosis (ITB) is clinically challenging but important for prognostication and patient management. Methods: Patients with diagnosis of CD and ITB were prospectively enrolled in the study from January 2006 to October 2007. The patients were followed up for further 15 months to ascertain that the diagnosis had not changed. Clinical, laboratory, serological [IgG anti Saccharomyces cerevisiae antibody (ASCA)], endoscopic and histologic features were compared between the ITB and CD patients. The ASCA titers were estimated in 100 healthy controls. Patients were diagnosed as ASCA positive when their ASCA titers were three standard deviations above mean of controls. Results: Thirty patients with CD (age 33.9 + 15.2 years, 70% males) and thirty with ITB (age 35.1 + 12.2years, 53.3% males) were included in the study. Features commoner in CD were longer duration of symptoms (p<0.001), blood mixed stool (p=0.006), presence of longitudinal ulcers (p=0.005) and skip lesions (p=0.008) on colonoscopy and more number of colonic segments involved (p=0.004). Anorexia was commoner in ITB patients (p=0.008). Positive ASCA was commoner in CD (30%) than ITB (10%) but did not reach statistical significance (p=0.1). Conclusions: A combined evaluation of clinical features, endoscopy, histology and response to treatment is the key to differentiate between CD and ITB.

Molecular adsorbent and re-circulating system.

The molecular adsorbent recirculating system (MARS) is a non-biological artificial liver support system. Used for almost a decade, there are only two randomized controlled trials on the efficacy of MARS till date. A number of uncontrolled studies have documented a marked improvement in the biochemical parameters of patients after MARS. Although MARS seems to be an effective and promising tool in the management of liver failure, its cost needs to be reduced to enable it use in a member of indications.