Characteristics and Obstetric Outcomes in Pregnant Women with Acute Hepatitis E Virus Infection in Tertiary Care Hospital of Himachal Pradesh.

BACKGROUND: Hepatitis E Virus (HEV) infection is a major concern regarding morbidity and mortality among pregnant women especially in developing countries. The objective of this study was to determine the characteristics and obstetric outcomes in pregnant women with Acute Hepatitis E Virus Infection in tertiary care hospital of Himachal Pradesh. METHODS: Prospective observational study has been done in the department of Obstetrics and Gynaecology and department of Medicine and Emergency Medicine among all the pregnant women who were sero-positive for hepatitis E viral marker in two consecutive years. Information regarding basic characteristics of pregnant women and obstetric outcome has been collected. RESULTS: Among 30 pregnant women with hepatitis E viral infection, a case fatality ratio of 8.0% for hepatitis E infection was found. 13.3% of the pregnancies ended up as intra uterine death. Most common age group affected was below 25 years. Mode of delivery among 70% of the women was normal vaginal delivery though 30% women delivered prematurely. CONCLUSIONS: This prospective case series of 30 pregnant women with acute hepatitis E viral infection, indicate poor maternal, obstetric and foetal outcome among pregnant women with hepatitis E viral infection.

Hemophagocytic Lymphohistiocytosis Secondary to Acute Hepatitis E Infection: A Rare Association.

Viral infections are commonest cause of secondar y hemophagoc ytic lymphohistiocytosis (HLH) and Ebstein Bar Virus is associated with majority of cases. We report a rare case of HLH associated with acute hepatitis E virus infection.

Diabetes Drug Prescription Pattern and Awareness Among Health Care Providers in Sub-Himalayan Region of India: A Population Based Study.

BACKGROUND: To determine the pattern of diabetic drug prescription and awareness about diabetes among primary health providers in the rural areas of Himachal Pradesh situated in the western Himalayas at an elevation range from 350 meters (1,148ft) to 6900 meters (22,966ft) above sea level. METHODS AND MATERIAL: Study was conducted in 20 rural areas of Himachal Pradesh, located 50 to 400 Km from state capital, at 2200 to 10,000 feet altitude. Non-pregnant diabetic adults were surveyed through 31 diabetic camps. Detailed history, weight, height, waist circumference, body mass index recorded. Fasting or random blood glucose, glycated hemoglobin, lipid profile measured and blood pressure recorded. RESULTS: 894 diabetic patients were included in the study (59.83% male) with the mean age of 52.94±6.78 years. Two in three patients were on oral hypoglycemic agents (OHAs), and one in three on alternative approaches for diabetes control. Among OHAs, sulphonylureas (SU) were the most commonly prescribed oral agents in 76.09% of patients followed by metformin in 23.87%. Glibenclamide was the most commonly prescribed SU in 44.60%. Amlodipine and atenolol was the commonest anti-hypertensive drug prescribed in 77.85% either in combination or as individual drug. Only 10.59% were on lipid lowering therapy. For primary care providers glycemic target was the mainstay of diabetes treatment with little emphasis on blood pressure control and no emphasis on lipid reduction. CONCLUSIONS: Sulphonylureas were the commonest anti-diabetic drug prescribed by the primary care providers followed by metformin. Insulin was prescribed to 2.23% only. Combination of amlodipine and atenolol was the commonest anti-hypertensive drugs prescribed and only 10% of patients were prescribed statin.

High Prevalence of Hypovitaminosis D in Patients Presenting with Proximal Muscle Weakness: A Sub-Himalayan Study.

BACKGROUND: Hypovitaminosis D has emerged as a major public health problem and 25-50% of patients encountered in clinical practice are deficient in vitamin D. This study was conducted to estimate the prevalence of hypovitaminosis D among patients presenting with proximal muscle weakness. STUDY DESIGN: It was a cross-sectional study done on patients ≥18 years presenting in outdoor clinic from May 2008 to April 2013, with difficulty in standing and going up stairs/ diffuse musculoskeletal pains. Proximal muscle weakness due to other causes were excluded through investigations and those taking steroids and/or indigenous drugs were also excluded. Vitamin D levels measured by radioimmunoassay (RIA) in all eligible patients and individuals included in the study were those with hypovitaminosis D (<30ng/dl) and proximal muscle weakness. Patients reassessed after supplementation with vitamin D at 2 and 6 months. RESULTS: 99 patients with hypovitaminosis D associated proximal myopathy included in study. Of these 55 (55.55%) were males and 44 (44.44%) were females. Age ranged from 22 to 82 years with a mean of 52.84 ± 12.6 years. Of 99 patients, 55 (55.55%) were from the rural area and 44 (44.44%) from urban area. Mean duration of symptoms was 22.7 months (range 6-60 months). The level of 25(OH) Vitamin D ranged from 2.0 ng/dl to 35.7 ng/dl with the mean level of 13.18 ± 5.80 ng/dl (males = 12.76± 4.85ng/dl and females = 13.60±6.70ng/dl). Hypovitaminosis D was present in 98.98%. A direct relationship was found between the vitamin D levels (<10 ng/dl) and severity of weakness. Of 83 patients, who reported at the end of two and six months of treatment, 71 (85.54%) patients were able to stand-up from squatting position. CONCLUSION: Muscle weakness is common among vitamin-D deficient individuals. Our study indicates that more focus should be on muscle symptoms in at risk population groups. The vitamin D deficiency related myopathy should not be missed due to its potential reversibility with vitamin D supplementation.

Cushing's Disease presenting as Suicidal Depression.

A case of Cushing disease, who presented with suicidal depression as the main complaint is reported. Prompt diagnosis and early management of the underlying cause of Cushing's disease, not only relieved features of hypercortisolaemia but also remitted depression fully.