Anemia In Pregnancy: Risk Factors And Adverse Maternal And Perinatal Outcomes In Tertiary Care Hospital

BACKGROUND: Menstruation is an important milestone event in a girl's life with the beginning of reproductive life. Still, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions, particularly in rural areas leading to ignorance of adolescent girls regarding menstrual hygiene practices and its scientific facts. AIMS AND OBJECTIVES:1. To find out status of menstrual hygiene practices among adolescent girls. 2.To find out association between different socio-demographic factors and menstrual hygiene. MATERIALANDMETHOD:Across sectional study was conducted between March 2017 to September 2017 among 400 adolescent girls (10-19 years) of rural area of Katihar. Data were collected from 273 girls, who have achieved menarche, on a pre tested and pre designed questionnaire after taking parental consent and was analysed using MS Excel and Epi info 7. RESULT:Menarche was found to be achieved by the girls in age group 10-16 years, mostly in the age group 12-13 years (69.59%). Among 273 respondents, 82(30.04%) girls were aware about menstruation prior to menarche and the source of information was mostly sister (54.95%) followed by friends (19.05%) and mothers (15.75%). In my study, only 31 (11.36%) girls used sanitary pads during menstruation. Majority of them (95.24%) were using soap and water to clean external genitalia while more than half of girls (69.60%) did not possess a covered toilet. Menstrual hygiene was taken care mostly by those girls, whose mothers were literate (77.42%). Around 260 (95.23%) of the participants followed one or the other cultural restrictions and majority (76.15%) were avoiding religious functions. CONCLUSION:In our study, hygiene during menstruation is not satisfactory hence there is a need to educate the adolescent girls about healthy and hygienic practices during menstruation to prevent the reproductive tract infections.

Acute liver failure secondary to chronic lymphocytic leukemia

Chronic lymphocytic leukemia is an indolent malignancy of lymphocytes commonly seen in elderly. Dissemination of malignancy is a rare cause of acute liver failure and has rarely been reported. Here we describe the case of a sixty five year old male presenting with acute liver failure. He is a diabetic with no known history of seropositive hepatitis, drug intake or any addictions. Bone marrow and liver biopsy suggestive of chronic lymphocytic leukemia. He eventually succumbed to his illness.

Deep vein thrombosis in patient with pulmonary tuberculosis: a rare and interesting causative link?

Pulmonary tuberculosis is a devastating disease affecting millions of people in developing countries such as India. Many complications of this disease are known, however only few of its hematological complications have been reported. Discovery of its unknown thrombogenic potential is one such disturbing new entity. Tuberculosis can induce a hypercoagulable state and can lead to thromboembolic complications and deep vein thrombosis. Here we report an interesting and rare case of 20-year-old male, newly diagnosed case of Pulmonary Tuberculosis presenting with complaints of acute onset right lower limb swelling and pain. He was diagnosed with thrombosis of external iliac vein. All possible causes for a provoked deep vein thrombosis were evaluated for and ruled out. The patient was started with first line anti tubercular treatment-rifampicin, isoniazid, pyrizinamide, ethambutol along with anti-thrombotics injection enoxaparin and warfarin and followed up for 6 months. He made complete recovery of both his pulmonary and limb disease.

Brucellosis - A Major Differential For Juvenile Idiopathic Arthritis

Brucellosis is a Gram-negative, aerobic zoonotic infection acquired by Brucella species and transmitted from animals to humans through the ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols. Usually, the disease remains undiagnosed due to lack of awareness and inadequate reporting and is a challenging health problem in tropical countries. We report a case of 16-year-old male presenting to us with chronic inflammatory symmetric polyarthritis misdiagnosed as juvenile idiopathic arthritis but later found to be suffering from brucellosis on reevaluation. Through this case report, we would like to highlight the possibility and advantage of the high degree of suspicion for an infectious etiology responsible for arthritis in the background of autoimmunity and would also like to emphasize on the possibility of Brucella inducing a false-positive response for young patients presenting with arthritis.

Study of impact of subclinical hypothyroidism on iron status and hematological profile

Background: Thyroid hormones play an important physiological role to maintain balance of metabolism of entire human body. Erythrocyte abnormalities are frequently associated with thyroid disorder. Subclinical hypothyroidism, often a hidden entity, is associated with iron-deficiency anemia along with other hematological disorders. Thyroid hormones have a crucial role in metabolism and proliferation of blood cells. Thyroid dysfunction has profound effects on blood cells such as anemia, alters RBC indices including MCV, MCHC as well as iron stores. Present study was carried out to investigate and explore subclinical hypothyroid patients, to know the effect of subclinical hypothyroidism on hematological parameters and body iron store.Methods: This retrospective study included 200 newly diagnosed, untreated subclinical hypothyroid, and 200 healthy euthyroid individuals. The hematological parameters and thyroid profile of the subjects were assessed by the mean, standard deviation (SD). Student抯 t-test was used to report our results, with p-value <0.05 considered as statistically significant.Results: In this study we have compared hemoglobin level, red cell indices, serum Ferritin among study group and euthyroid healthy group and found that mean hemoglobin, serum ferritin and RBC indices were significantly depleted in subclinical hypothyroid patient in comparison to euthyroid group. 37 of total 200 [18.22%] newly diagnosed subclinical hypothyroid patients was suffering from Iron deficiency anemia with significant number of patients having hemoglobin level less than 10 gm%.Conclusions: Iron deficiency anemia is quite common in Subclinical hypothyroidism and is often associated with depleted body iron store and complication of getting converted into primary hypothyroidism. As there is no significant clinical manifestation of SCH at earlier stages with anemia it is advisable to routinely investigate it for early detection allowing its early management.

To study the effect of glycemic control and duration of disease on pulmonary function tests and diffusion capacity in type 2 diabetes mellitus.

Background: Type 2 diabetes mellitus is known to cause serious progressive macro and micro vascular complications leading to end organ damage like retinopathy, nephropathy and neuropathy. Pulmonary complications due to collagen and elastin changes as well as microangiopathy has also been demonstrated in type 2 diabetes mellitus but prevalence in most of population is unknown and its possible correlation with duration of disease and degree of glycemic control is not studied more in our population. Aims and objectives: To compare Pulmonary Function Tests (PFT) in type 2 diabetes mellitus with control group and to evaluate possible correlation of PFT with status of sugar control and duration of disease. Methods: Consecutively consenting 120 subjects who satisfied the inclusion criteria were recruited over one year duration. These 120 subjects are categorised into two i.e. healthy volunteers recruited as controls (n=60) and type 2 diabetic patients (n=60). Results: Both group compared and studied with each other. Diabetic patients showed a significant reduction in Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) and pulmonary diffusion capacity for carbon monoxide (DLCO) relative to their matched controls and these values were further reduced in diabetic patients with uncontrolled glycemic status. Conclusion: Our study concluded that lung functions in type2 diabetes mellitus are impaired with restrictive pattern of respiratory abnormality. Duration of diabetes did not influence on pulmonary function and diffusion capacity.

Mechanistic studies on carboxypeptidase A from goat pancreas Part II: Evidence for carboxyl group.

Studies with substrate analogues and the pH optimum indicated the involvement of carboxyl group in the active site of goat carboxypeptidase A. Chemical modification of the enzyme with 1-cyclohexyl-3-(2-morpholinoethyl) carbodiimide methoI -p-toluene sulphonate, a carboxyl specific reagent, led to loss of both esterase and peptidase activities. Protection studies showed that this carboxyl group was in the active site and was protected by ßphenylpropionic acid and glycyl-L-tyrosine. Kinetic studies also confirmed the involvement of carboxylic group because the enzyme modification with water soluble carbodiimide was a two step reaction which excluded the possibility of tyrosine or lysine which are known to give a one step reaction with this reagent.

Mechanistic studies on carboxypeptidase A from goat pancreas Part I: Role of tyrosine residue at the active site.

Chemical modification of carboxypeptidase Ag1 from goat pancreas with Nacetylimidazole or iodine led to loss of enzymic activity. This loss in activity could be prevented when chemical modification was carried out in the presence of β-phenylpropionic acid or substrate NCbz-glycyl-L-phenylalanine, thus suggesting a tyrosine residue at the active site. Chemical modification of tyrosine was confirmed by spectral and kinetic studies. While tyrosine modification destroyed peptidase activity, esterase activity of the enzyme remained unchanged thus indicating non-involvement of tyrosine residue in ester hydrolysis.