A Prospective Observational Study of Spectrum of Tropical Infections in Pregnancy in a Tertiary Care Hospital in Mumbai, Maharashtra

Background and aims: Pregnancy is associated with several hormonal and mechanical changes in the body. The tropical infections that most commonly affect pregnant females are malaria, dengue, leptospirosis and typhoid. These tropical infections cause many medical complications in pregnancy by causing anemia, thrombocytopenia, bleeding and inflammatory reactions. Therefore, we conducted a study to evaluate the clinical presentation, complications and outcome of tropical infections in pregnancy. Material and methods: The present study was conducted at a tertiary care hospital in Mumbai, Maharashtra over a period of 1½ year (January 2018 to June 2019) after getting approval from Institutional Ethics Committee. In this study, 250 pregnant patients admitted in medicine ward, obstetrics and gynecology ward, and ICU with symptoms and signs of tropical infections and age more than 18 years, who gave written informed consent, were included. Results: The most common age group amongst the study population was 20 to 24 years (41.6%), followed by 25 to 29 years (40%) and 30 to 35 years (18.4%). Most of the study population had gestational age of 1 to 12 weeks (61.6%), followed by 13 to 28 weeks (31.6%) and more than 28 weeks (6.8%). Most of the study population had parity 2 (46.8%), followed by parity 1 (43.2%), parity 3 (6.8%) and parity 4 (3.2%). The most common clinical features amongst the study population was fever (62%), followed by headache (32.8%), nausea (30.8%), pain in abdomen (26.4%) and petechiae (26%). The most common infections amongst the study population were malaria (11.2%), dengue (8%), leptospirosis (6%) and enteric fever (5.2%). The most common medical complications were bleeding due to thrombocytopenia (TCP) (6.8%), followed by serositis (5.2%), ARDS (4.4%), meningitis (2.8%), subconjunctival hemorrhage (2.8%) and encephalitis (1.4%). Complicated infections were seen in 30% of the study population. Conclusion: All pregnant women must be evaluated at primary care centers properly in their antenatal visits for their parity status and any associated risk factors and diseases. By doing this, we can reduce many tropical infections, complications and maternal mortality in early stage of pregnancy.

Study of electrolytes in patients of Dengue in a tertiary care hospital in India

Background: Dengue is a mosquito borne viral infection. It is the most common arboviral disease globally. In the year 2017, India had 1,53,635 cases of dengue with 226 deaths. Electrolyte disturbances reported in dengue infection are hyponatremia, hypokalaemia and hyperchloremia. Considering the serious nature of effects of dyselectrolytemias and high incidence of dengue in India, it is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly.Methods: This study was performed in a tertiary care centre in Mumbai, India. The study was a prospective observational cross-sectional study. 150 Patients diagnosed with Dengue were enrolled for the study. Patients’ demographic data, clinical history, examination findings and investigations including electrolyte values were recorded and analysed.Results: A higher incidence of dengue was seen in young age group among admitted patients (74%). Hyponatremia (45.33%) and Hypokalaemia (10.60%) were more commonly observed than hypernatremia (3.33%) and hyperkalaemia (3.33%). Hypochloraemia (6.66%) was seen slightly more than hyperchloraemia (6.00%). Fever was Present in 98.66%, retro orbital headache in 86.66%, vomiting in 56.00%, joint pain in 69.00%, lethargy in 70.66%, breathlessness in 36.00%, bleeding in 8.66%, abdominal pain /tenderness in 18.00%. 85.00% had low platelet count, 30.66% had low hemoglobin and 36.66% had leucopenia. Haematocrit was found to be less in 27.33% and high in 1.33%.Conclusions: From the above results we concluded that, there is a need to have a degree of suspicion about dyselectrolytemias while managing patients with Dengue. Also, patients need to be subjected to necessary lab investigations early during management so that if abnormalities are found, they can be promptly and appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Acute renal failure in pregnancy at a tertiary level hospital in Mumbai: An epidemiological profile.

Background: To study the clinical profile of pregnancy related acute renal failure, management and outcome in terms of cure, maternal morbidity and maternal – fetal mortality. Methods: This is a prospective observational study carried out on hospitalized patients in our hospital over a period of fourteen months (August 2007 – September 2008) after approval from the ethical clearance committee. Results: A total of 41 patients, with age ranging between 15 – 45 years. The majority of the patients 25 (60.98%) were multigravida and 16 (39.02%) were primigravida. The bimodal frequency pattern were also observed in our study, first between 19 to 24 weeks of gestation and second around 31 to 36 weeks of gestation. The incidence of PR-ARF was about 1 in 270 pregnancies. Sepsis was the commonest cause of PR-ARF (46.34 %) followed by Toxaemia of Pregnancy (31.69%) and Haemorrhage (14.62%). The incidence of septic abortion as a cause of PR-ARF has declined to 7.31%. Oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Conclusion: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. Sepsis was the commonest cause of PR-ARF followed by toxaemia of pregnancy and haemorrhage. Maternal and fetal mortality were high , 17.07 % and 2.43 % respectively.

Adult Unilateral Chorioretinal Atrophy Secondary to Acquired Rubella.

Rubella retinopathy in adults is uncommon. Here we report a case of 25-year-old healthy female who presented with blurring of vision of right eye, and was detected to have chorioretinal atrophy on fundus examination. Detailed investigations of the patient to evaluate the cause of chorioretinal atrophy were done in which her serology against rubella was found strongly positive. This is an uncommon case of acquired adult unilateral rubella retinopathy, which is a rare presentation of rubella infection in adults.

Bilateral Dupuytren’s Contracture.

Dupuytren’s contracture (DC) is painless flexion contracture of ulnar side of palm where fingers bend towards palm and cannot be straightened. It is a fibrosing disorder that results in slowly progressive thickening and shortening of the palmar fascia, leading to the debilitating digital contractures. The prevalence of DC is found to be higher in patients with cirrhotic or noncirrhotic alcoholic liver disease. We report the case of a 56-year-old male chronic alcoholic who presented with distention of abdomen, yellow discoloration of sclera since 1 month and altered sensorium since 1 day. He had bilateral contractures on ulnar side of hands, suggestive of DC.

Adult Coarctation of Aorta with Bicuspid Aortic Valve.

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed with only hypertension as a marker of its presence, because clinical signs can be subtle and overlooked if a complete physical examination is not performed. Here we present a case report of 20 year old young male patient with hypertension who was diagnosed to have Coarctation of Aorta and Bicuspid aortic Valve.Our patient was relatively asymptomatic until he presented with headache and exertional dyspnoea.