Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension

Background: Pre-eclampsia is not totally a preventable disease. It is found more related to chains of social ills such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However, some specific “high-risk” factors leading to pregnancy induced hypertension (PIH) may be identified in individuals which include and not limited to young and elderly primigravida, multiple pregnancy, diabetes, Rh incompatibility, new paternity, pre-existing vascular or renal disease, family history of hypertension, pre-eclampsia and eclampsia, obesity, thrombophilia. Low dose aspirin given in 2nd trimester in these high-risk women is anticipated to prevent the development of PIH.Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynecology, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13th to 28th weeks were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group having placebo.Results: Protienuric hypertension was high in control group who did not receive aspirin. Low dose aspirin significantly reduces PIH in high-risk group (3.48% in case versus 23.52% in control). Low dose aspirin was not associated with significant increase in placental bleeding. Low dose aspirin was generally safe for the fetus and new born infant with no evidence of an increased likelihood of bleeding.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

Five-year girl with advanced lupus nephritis and insulin dependent diabetes mellitus

Systemic Lupus Erythematosus (SLE) and Insulin Dependent Diabetes Mellitus (IDDM) are two common auto immune disorder occurring in children which can involve the renal system. The condition when occurs simultaneously in a child and its effects and follow up on the kidneys and its management have been mentioned here. A five-year-old girl was presented with low grade fever, dryness of mouth and bilateral pain over knee joints over four months. She had facial puffiness, mild bilateral pedal edema, and ascites on admission. She was treated immunosuppressive medications following a renal biopsy and insulin for IDDM

Demographic variation of electrolyte imbalance in a tertiary care pediatric intensive care unit

Background: Electrolyte imbalances are common in critically ill paediatric patients. When present, they can significantly affect the outcome. Critical care provision through Paediatric Intensive Care Units (PICU) is aimed at maintaining 'homeostasis' in the body which is vital for the organ's support and optimal function. This involves fluids and electrolytes balance.Methods: This prospective observational study was conducted in the PICU, SCB MC and Hospital, Cuttack during November 2015 to October 2017. includes Children admitted to PICU (Based on consensus guidelines for PICUs in India, Indian Society of Critical Care Medicine (Pediatric Section) and Indian Academy of Pediatrics (Intensive Care Chapter).Results: Percentage of male children was 65.9%, with male to female ratio 1.9:1, showing male dominance. Most electrolyte imbalances were seen in age group of 1 to 5 years (67.06%). Abnormal serum electrolyte was seen in 37.91% in our study. SIADH was observed in 43.5% of euvolemic hyponatremic patients. SIADH was observed in 27.8% of hyponatremic patients. Respiratory disorder was the most common attributing factor for SIADH followed by CNS disorder.Conclusions: The present study showed high incidence of electrolyte abnormalities in patients admitted to pediatric intensive care unit. Though at times symptoms of electrolyte disorder is indistinguishable from symptoms of primary pathology, so a close monitoring and correction of electrolyte abnormalities is necessary for better outcome. SIADH is recognizable and common cause of electrolyte imbalance in PICU. Thus, this study recommends early routine monitoring of serum electrolytes in all patients admitted to PICU.

A study of mortality and morbidity profile of electrolyte imbalance in critically ill children with special importance to mechanical ventilation

Background: Electrolytes imbalance is not uncommon in critically ill children. The outcome of critically ill child is dependent on various factors like the underlying disease, fluid and nutrition, which are responsible for electrolyte homeostasis in tandem with renal function and many others. In this study authors look into morbidity and mortality associated with dyselectrolytemia with special importance to children on mechanical ventilation.Methods: This prospective observational study was conducted in the PICU, SVPPGIP (SCB MC and Hospital), Cuttack during the period November 2015 to October 2017. Includes children admitted to PICU (Based on consensus guidelines for PICUs in India, Indian Society of Critical Care Medicine (Pediatric Section) and Indian Academy of Pediatrics (Intensive Care Chapter).Results: Mortality distribution in electrolyte abnormality patients is 27.9% (around 3 times higher than normal electrolyte patients). 25% hyponatremic patients and 31.25% hypernatremia patients expired, 30.76% hypokalemia patients, 32.72% hyperkalemia patients expired. Morbidity distribution in electrolyte imbalance population was 85.27%, with more than 7 days of stay in PICU. Amongst the mechanical ventilated patient, 54.23% patients having potassium disturbances were associated with significant mortality and morbidity. No such significant relation exists between mechanical ventilation and dyselectrolytemia of sodium and calcium.Conclusions: Early recognition with a thorough understanding of common electrolyte abnormalities and their prompt management definitely pose an implication on the final outcome of the patient. Aggressive and strict adherence to correction of in particular to potassium before weaning is necessary for successful weaning from ventilator.

Rising trend of Non-Communicable Diseases in India

The 21st century has witnessed multiple public health emergencies (viz. Fukushima nuclear disaster, the Ebola outbreak in West Africa, civil wars, natural calamities, etc.), which are mostly associated with many adverse consequences locally, nationally, and internationally. (1,2) Simultaneously, an unexpected rise in the global magnitude of noncommunicable diseases (NCDs) has also been observed. The Lancet Commission on Global Health 2035 foresees that the threat of pandemics, antimicrobial resistance and noncommunicable diseases will represent the greatest threats to global public health in the future. (3) The disease burden in India is changing. While communicable diseases remain a significant threat, non-communicable diseases (NCDs) are also posing threat to country’s public health and wellbeing.

Prevalence of Alcohol Consumption among Adults & Elderly- a Community based Study in Uttarakhand

Background: Alcohol is one of the leading causes of the death and disability globally. About two billion people worldwide consume alcoholic beverages and about one-third (nearly 7.6 million) are likely to have one or more diagnosable alcohol use disorders. In India, the economic returns from alcohol override public health issues with the situation being one of “getting less and losing more”. Aims & Objectives: To find out the prevalence of alcohol consumption in relation to socio-demographic characteristics among adults and elderly population of Uttarakhand. Methods and materials: This is a cross sectional study. In this study we included four different geographic settings (urban, rural, town and slum) of Uttarakhand. A simple random methodology was adopted. Results: Out of 400 participants interviewed, alcohol consumption was reported higher in 30-49 years age group (45%), married (38%), employed (58%), males (72%), residing in rural areas (43%). Conclusion: In Uttarakhand percentage of alcohol consumption is higher among middle age group (30-49 year). Males are more alcoholic than females.

Cancer scenario in India and its comparison with rest of the world and future perspectives

Cancer remains the scourge of mankind, lets us not delude ourselves. Despite recent advances in molecular biology and very advanced techniques leading to early detection of malignant tumours and despite newer drugs and use of nanotechnology an adjunct measures for targeted therapy, cancer remains the most deadly enemy and killer of mankind. Thus cancer remains the single most factor for increase mortality and morbidity of human being as well as for entire nation, impacting its manpower and economy. It is this vicious cycle that needs to be controlled, broken and irradiated which at present appears to be a herculean tasks although not an impossible one.

Prevalence of Hypertension and Risk Factors associated with it in Subjects attending Health Camp in Rishikesh, Uttarakhand

Background: One of the most important causes of death in the world is hypertension and its epidemic seems to be growing. By the year 2025, around 1.5 billion adults will be living with hypertension. Aim & Objectives: To find prevalence of hypertension in subjects attending a health screening camp at SPS government hospital, Rishikesh and to identify various risk factors related to hypertension. Material & Methods: A cross-sectional study was conducted among subjects attending a health screening camp at SPS Government hospital, Rishikesh. The camp was conducted for seven days period, from 11th October- 17th October, 2017. All subjects that attended the health camp and were either 30 years old and/or above were included in this study. An informed written consent was taken from all subjects that consented to participate in this study after explaining to them the purpose of the study. A questionnaire that was predesigned, pretested, structured was used to obtain demographic data, personal data and history of hypertension in the family, behavioural aspects, including, use of tobacco, alcohol and dietary habits. Blood pressure (BP) and anthropometric measurements were also recorded in this study. Total of 207 people attended the health camp, from which 196 agreed to participate in study. Results: Out of total of 207 people that attended the camp, 196 people gave their consent to participate in the study. In this study, out of 196 subjects 66 (33.7%) were found to be hypertensive. Risk factors like increasing age, family history of hypertension, increased BMI and waist hip ratio, use of tobacco and alcohol and increased blood sugar levels were found to be associated significantly with hypertension. Conclusion: There is high prevalence of hypertension in Rishikesh. Efforts are required to regularly screen for blood pressure at the community level to help tackle this iceberg disease.

Do We Need to Change the Outlook?

Family Medicine is a complex branch by virtue of its nature. Broad in its perspective, it involves high proportion of poorly differentiated problems along with overlapping biological, psychological, and social factors.(1) EBM (Evidence Based Medicine) which originated in second half of 19th century, roused greater interest among health professionals especially during last decade (1). With time as medical knowledge grew, EBM was internationally accepted as gold standard for decision-making and standard for medical practice. It facilitated clinicians in providing up-to-date scientific evidence which in combination with clinical expertise was utilized in medical practice to achieve best possible outcomes (2). Evidence-based practice guidelines and EBM approaches are recognized as the core of today’s scientific thinking with randomized controlled trials (RCTs) being regarded as fundamental research response of EBM for healthcare (3). However, the most troubling aspect of EBM is that it provides the restricted view of evidence. As advocated since 1990s, it was based on the notion that medical practice was subjective and evidence should rather be prioritized on hierarchical system. To promote greater reliance on published literature, RCTs were introduced as a powerful tool for measuring effectiveness and safety of treatments. It argued that clinical judgment and mechanistic reasoning are less reliable forms of evidence in medicine (4,5). Despite EBM era, they still continues to exert influence, resulting in confusion and controversy.

Utilisation of Maternal Health Services and its Predictors in Slum Population.

Introduction: The particularly sorry plight of disadvantaged slum population with ample scope of further research into such areas as vulnerability to health risk and access to treatment, reduced economical choice and social support besides natural disasters and emotional stress of displacement. Material & Methods: An observational (cross-sectional) study was designed on a pre designed and pre tested questionnaire to understand women’s fertility and contraceptive behavior and to study Socio behavioral Determinants of Utilization of MCH services. Results: The prevalence of <18 marriage was 78.03%.The teenage pregnancy was as high as 46.36% with 47.90% having parity of 4 or more.And of those not seeking ANC 53.42% did not feel the need for care during pregnancy. A very important finding was that 64.23% had home delivery and of these, 74% did not have any trained birth attendant. Conclusion: Levels of education in the family, caste, affordability (asset-holding) and accessibility were the factors which determined the utilization pattern. In general, those with better levels of education and those with better affordability preferred private practitioners and were willing to travel longer distances to avail health services as there was more awareness, motivation and felt need.

Prevalence of domestic accidents in the rural field practice area of a medical college in Bangalore, Karnataka.

Domestic accidents are worldwide health problems. A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 5419 individuals were selected from 30 clusters (villages) using cluster sampling technique. Of the 5419 study population, 50.9% (2748) were males and the rest were females. The prevalence of domestic accidents in the rural community was found to be 9.6% (522 individuals who had sustained domestic accidents), was found to be more in females compared with males, which was statistically significant with P-value =0.0077 (Z value =9.09). Falls 43% (225) was the most common type of domestic accidents. The most common place of occurrence of domestic accidents was 46% (243) kitchen, most frequent site of injures in domestic accidents was upper limbs.

Morpho-anatomy of Solanum pseudocapsicum

Morpho-anatomical features in leaves, stems and unripe fruits of Solanum pseudocapsicum L., Solanaceae, were investigated by histological methods. Anatomically the plant may be characterised by the presence of uniseriate trichomes, anomocytic stomata, calcium oxalate needles in leaves while presence of oval to circular compound starch grains, angular vessels, vertically upright, uni-biseriate rays and intraxylary phloem with differentiation of internal cambium abutting marginal pith cells and protoxylem in transverse view. Development of distinct internal cambium may be considered as a characteristic feature for S. pseudocapsicum. Intraxylary secondary phloem was composed of sieve tube elements, companion cells and axial parenchyma cells.

KAP Study About Carbonated Drinks Among Medical and Nursing Students at Teaching Hospital.

To assess the knowledge, attitude and practices of students regarding carbonated drinks, a cross sectional study was conducted at Himalayan Institute of Medical Science (H.I.M.S.), Dehradun. The study subjects comprised of medical and nursing students at HIMS. A total of 137 students were randomly selected and included in the study. A self administered pre-tested structured questionnaire was introduced for the purpose of the study. Maximum of the medical students responded gastritis (27.14%) specifically as the important ill-effects associated with the consumption of the carbonated drinks for long period of time followed by teeth and bone diseases (22.85%) and about 28.57% of the them were not aware of the ill-effects of the same at all. About 39.65% of the nursing students responded gastritis followed by diarrhoeal diseases (36.2%) as the ill-effects for the same. A holistic approach should be incorporated to combat the problems associated with the consumption of carbonated drinks.

Diffuse interstitial skeletal hyperostosis (DISH) in type 2 diabetes.

A 58 years type 2 diabetic woman, school teacher by profession, presented with backache, neck pain and generalised weakness since last few months. Pain was mild with stiffness and neck pain was particularly associated with extension of the neck towards back. There was no focal neurological deficit on central nervous system examination. X-ray of lumbo- sacral spine showed prolific osteophytes and new bone formation in the body of lumbar vertebrae. Cervical X-ray showed 'Melting candle-wax' appearance at the anterior to the cervical vertebrae. In view of clinical and radiological association the case was diagnosed as DISH syndrome. It is being presented for its rarity.

Practice of prelacteal feeding in a rural community.

In India breast feeding in rural areas appears to be shaped by the health beliefs of a community, which are further influenced by social, cultural and economic factors. One of such tradition is prelacteal feeding which is widely prevalent since ancient times. The present study was aimed to find out the practice of prelacteal feeding and various factors which influence this practice. The study on analysis showed that 45% (90) mothers gave prelacteal feeds to their newborns in the form of sugar water, gur water or cow's milk. Sugar water was common amongst mothers belonging to nuclear family (49%) whereas gur water was given mostly by joint family mothers (75.70%). Parity and family type had no significant effect on this practice, however the effect of literacy was found to be significantly related to the practice.