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Background:The pathophysiology of an atherosclerotic plaque is mediated by the mechanisms involving thrombus formation and systemic inflammation. While C-reactive protein (CRP) levels are useful in predicting a cardiovascular event in intermediate risk population, the usefulness of routinely measuring fibrinogen in patients with acute coronary syndrome (ACS) is debatable. Also, data on the association of these markers with periprocedural outcomes in patients undergoing percutaneous coronary interventions (PCI) is scarce. Aims: The study aimed to determine whether the levels of fibrinogen and CRP vary across the different spectra of CAD and whether they have any correlation with cardiac Troponin I levels. Materials and Methods: A total of 284 patients with coronary artery disease undergoing percutaneous coronary intervention were included in the study. Complete blood count, serum lipid profile, serum CRP, fibrinogen, and troponin I were measured for all patients. Results: Patients with STEMI had significantly higher levels of CRP as compared to those with unstable angina (USA) and chronic stable angina (CSA). Patients presenting with ACS had significantly higher baseline fibrinogen as compared to those with CSA. A significant positive correlation between CRP and admission Troponin I (r = 0.50; P < 0.05) as well as fibrinogen and admission troponin I (r = 0.30; P < 0.05) was observed. The CRP levels were significantly higher in 15 patients with periprocedural MI as compared to those who did not develop periprocedural MI. Conclusions: The levels of the markers of inflammation and atherothrombosis vary with presentation across varied spectra of CAD with generally higher levels in acute presentation and in those who develop periprocedural MI.
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Background: Labour pain has been described as most severe pain experienced by a female. Labour analgesia is widely practiced in developed countries. Many labour analgesic methods have been introduced to make delivery a pleasurable moment in a women’s life.Methods: This prospective study was performed at the Department of Obstetrics and Gynaecology, Indira Gandhi Institute of Medical Sciences, Patna, India after getting permission from institute ethical committee. 100 pregnant females attending the antenatal clinic were interviewed in their mother language. Information was collected on a questionnaire after an informed consent. The aim of the study was to assess the knowledge, desire and acceptability of pregnant women regarding painless labour.Results: The mean age of the women in the study was 24.98years.56% of women in the study were primigravida whereas 44% were multigravida.66% women belonged to urban area while 34% were from rural area. 10% were illiterate, 35% were educated upto secondary education and 55% were having higher education. Only 24% of the women were having knowledge about painless labour however 87% female were having positive attitude towards epidural analgesia. The correlation between the educational status and knowledge about painless labour was not statistically significant (p0.949). The knowledge and attitude of women regarding painless labour was statistically significant with p value of 0.00001.Conclusions: There is lack of knowledge about labour analgesia among women. Obstetrician and anaesthetist should educate women regarding painless labour. Labour analgesia is standard of care in obstetrics and should be provided to all parturient.
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Background: Pregnancy is associated with several risks toboth mother and fetus. Meconium staining of amniotic fluid isone of the important risk factors associated with neonatalmortality. Thus the aim of this study was to assess theeffectiveness of amnioinfusion in treatment of thick meconiumstained amniotic fluid and compare the results with controlgroup.Materials and Methods: It was a prospective case controlstudy conducted from October 2015 to September 2017, in thedepartment of Obstetrics and Gynaecology, at Indira GandhiInstitute of Medical Sciences (IGIMS), Patna. We included 100cases of thick meconium complicated deliveries. The patientswere categorized as study group who received amnioinfusionand control group who received standard treatment. Eachgroup contained 50 patients.Results: We found that the need for caesarean section waslow in study group. The Apgar score also effectively improvedin the study group compared to the control group at 1 minute, 5minute and 10 minutes interval. Amnioinfusion reduced theincidence of meconium below the vocal cord and meconiumaspiration syndrome. There was also reduction in admission ofinfants to NICU in those cases who received amnioinfusioncompared to control groups.Conclusion: We concluded that transcervical amnioinfusion issimple and effective method that aids in improvement ofperinatal outcomes of those cases complicated with thickmeconium.
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Background Heart rate (HR) reduction is of benefit in chronic heart failure (HF). The effect of heart rate reduction using Ivabradine on various echocardiographic parameters in dilated cardiomyopathy has been less investigated. Methods Of 187 patients with HF (DCM, NYHA II–IV, baseline HR > 70/min), 125 patients were randomized to standard therapy (beta blockers, ACEI, diuretics, n = 62) or add-on Ivabradine (titrated to maximum 7.5 mg BD, n = 63). Beta-blockers were titrated in both the groups. Results At 3 months both groups had improvement in NYHA class, 6 min walk test, Minnesota Living With Heart Failure (MLWHF) scores and fall in BNP, however the magnitude of change was greater in Ivabradine group. Those on Ivabradine also had lower LV volumes, higher LVEF (28.8 ± 3.6 vs 27.2 ± 0.5, p = 0.01) and more favorable LV global strain (11 ± 1.7vs 12.2 ± 1.1, p = <0.001), MPI (0.72 ± 0.1 vs 0.6 ± 0.1, p = <0.001), LV mass (115.2 ± 30 vs 131.4 ± 35, p = 0.007), LV wall stress (219.8 ± 46 vs 238 ± 54) and calculated LV work (366 ± 101 vs 401 ± 102, p = 0.05). The benefit of Ivabradine was sustained at 6 months follow up. The % change in HR was significantly higher in Ivabradine group (−32.2% vs −19.3%, p = 0.001) with no difference in blood pressure. Resting HR < 70/min was achieved in 96.8% vs 27.9%, respectively in the two groups. Conclusion Addition of Ivabradine to standard therapy in patients with DCM and symptomatic HF and targeting a heart rate < 70/min improves symptoms, quality of life and various echocardiographic parameters.
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Background: Ectopic pregnancy is one in which fertilized ovum become implanted in site other than normal uterine cavity. Ectopic pregnancy commonly occurs in the fallopian tube. Ectopic pregnancy is the leading cause of maternal death in early pregnancy. The diagnosis of ectopic pregnancy is complicated by wide spectrum of clinical presentations, from asymptomatic cases to acute abdomen, and hemodynamic shock. There is considerable regional variation in its incidence. Materials and methods: Retrospective analysis of all cases of ectopic pregnancy admitted in IGIMS, Patna was done from January 2014 to December 2016. Results: The incidence of ectopic pregnancy in present study was 2.1%. Majority of patients were multigravida (94.1%) and in the age group of 25-35 years (70.4%). PID was the strongest risk factor found in 35.29%. Other risk factors were tube ligation (23%), LSCS (11.76%), history of abortion/MTP (17.64%). Commonest clinical presentation was pain abdomen (88.23%) followed by amenorrhoea (70.58). bleeding per vagina and adnexal mass was clinical presentation in 64.7% of patients. The site of ectopic was fallopian fallopian tube in all the patients and all patients were managed surgically. Anemia, blood transfusion and wound dehisence was the commonest morbidity seen. No mortality was reported in the present study. Conclusion: The incidence of ectopic pregnancy is on rise. It is a common life threating emergency in first trimester of pregnancy that leads to serious maternal morbidity and also can cause mortality. A high index of suspicion is required for its early diagnosis, so that proper management can be done and the complications can be avoided.