Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study.

BACKGROUND: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). METHODS: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to mid-gestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg) in early gestation was estimated. RESULTS: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6-2.0]) and SGA birth (aOR: 1.3 [1.2-1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8-2.8] and 2.3 [1.8-3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. CONCLUSION: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders.

Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia.

OBJECTIVE: Pre-eclampsia (PE) is associated with an increased risk of cardiovascular disease later in life. In cases with PE there is a substantial increase in levels of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) and decreased levels of the proangiogenic factor placental growth factor (PlGF). Elevated levels of sFlt-1 are also found in individuals with cardiovascular disease. The aims of this study were to assess levels of sFlt-1, PlGF and the sFlt-1/PlGF ratio and their correlation with signs of arterial aging by measuring the common carotid artery (CCA) intima and media thicknesses and their ratio (I/M ratio) in women with and without PE. METHODS: Serum sFlt-1 and PlGF levels were measured using commercially available enzyme-linked immunosorbent assay kits, and CCA intima and media thicknesses were estimated using high-frequency (22-MHz) ultrasonography in 55 women at PE diagnosis and in 64 women with normal pregnancy at a similar gestational age, with reassessment at 1 year postpartum. RESULTS: During pregnancy, higher levels of sFlt-1, lower levels of PlGF, a thicker intima, a thinner media and a higher I/M ratio of the CCA were found in women with PE vs controls (all P < 0.0001). Further, sFlt-1 and the sFlt-1/PlGF ratio were positively correlated with intima thickness and I/M ratio (all P < 0.0001). At 1 year postpartum, levels of sFlt-1 and the sFlt-1/PlGF ratio had decreased in both groups; however, their levels in the PE group were still higher than in the controls (P = 0.001 and < 0.0001, respectively). Levels of sFlt-1 and the sFlt-1/PlGF ratio remained positively correlated with intima thickness and I/M ratio at 1 year postpartum. CONCLUSIONS: Higher sFlt-1 levels and sFlt-1/PlGF ratio in women with PE were positively associated with signs of arterial aging during pregnancy. At 1 year postpartum, sFlt-1 levels and the sFlt-1/PlGF ratio were still higher in the PE group and were associated with the degree of arterial aging. © 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre-eclampsia.

OBJECTIVE: To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. METHODS: Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. RESULTS: Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CONCLUSIONS: CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.

Status of Serum Iron and Fasting Serum Glucose in Reproductive Aged Women Taking Combined Oral Contraceptive Pill.

The oral contraceptive pill, 'the pill', was introduced in the beginning of the 1960s. Presently, worldwide about 100 million women are current users of combined oral hormonal contraceptives (COC) most frequently used in the western world. Oral contraceptive use has been associated with decreased menstrual blood losses; thus, can independently reduce the risk of anemia and iron deficiency in women. Manufacturers have recently started to include supplemental iron in the non-hormonal placebo tablets of some contraceptives. This study was done to evaluate the status of serum iron and fasting serum glucose in combined oral contraceptive pill users in comparison to non-users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. A total number of 120 reproductive aged women, age ranged from 15-55 years was included in this study. Among them, sixty (60) combined oral contraceptive pill users subjects were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test. The mean±SD of serum iron of control group (Group I) and study group (Group II) were 93.22±17.19µg/dl and 181.57±22.06µg/dl respectively. The mean±SD of fasting serum glucose of control group (Group I) and study group (Group II) were 4.67±0.61mmol/L and 6.61±0.61mmol/L respectively. Serum iron and fasting serum glucose increased in study group in comparison to control group. Result is statistically highly significant (p<0.001). So there from this study it can be concluded that there is significant association of serum iron and fasting serum glucose with oral contraceptives.

Status of Body Mass Index and Blood Pressure in Post-Menopausal Women.

Menopause, in between the age of 45-55 years every woman faces it, that means completely stoppage of menstruation because the decrease level of estrogen from the normal level. In this period the quality life is disturbed due to hormonal imbalance specially estrogen. This study was done to evaluate the changes of body mass index and blood pressure in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh and the period is from January 2021 to December 2021. Total 140 women subjects age ranged between 25-65 years were involved in this study. Among them 70 post-menopausal women (45-65 years) were involved as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). By anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and systolic and diastolic blood pressure by aneroid sphygmomanometer (ALPK2, Japan). Findings were expressed as mean±SD and by unpaired student's 't' test, analytical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. The average (±SD) of systolic blood pressure of control group I and study group II were 118.29±10.00 mm of Hg & 134.00±11.91 mm of Hg respectively. The mean±SD of systolic blood pressure was significantly higher in study group in comparison with control group. The mean±SD of diastolic blood pressure of control group I and study Group II were 79.21±6.46 mm of Hg and 89.00±6.23 mm of Hg respectively. The mean±SD of diastolic blood pressure was significantly higher in study group in comparison with control group. Post-menopausal women with high systolic and diastolic pressure have a chance of development of cardiovascular diseases, stroke. So assessment of these parameters are important for early detection and prevention of complication related to high BMI and Blood Pressure for leading a healthy life.

Study on Body Mass Index and Fasting Serum Glucose in Postmenopausal Women.

Menopause is a normal physiological period that is characterized by the completely stoppage of endometrial cycles in women between the age of 45-55 years due to lack of ovarian follicular function. Several postmenopausal syndromes such as hot flushes, night sweats, vaginal dryness, depression, irritability, headache, and sleep disturbance can occur more frequently in this period which hampers the standard of life. This study was done to assess body mass index and fasting serum glucose changes in postmenopausal women in contrast with reproductive women. This cross-sectional analytical type of study was conducted in the Department of Physiology, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Total 140 women subject's age ranged between 25-65 years were involved in this study. Among them 25-45 years aged 70 (Seventy) reproductive women were involved as control group (Group I) and 45-65 years aged 70 (Seventy) postmenopausal women were taken as study group (Group II). By Anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and fasting serum glucose was measured by GOD-PAP method. Results were expressed as mean (±SD) and by unpaired Student's 't' test, statistical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is notably increase in study group in contrast with control group. The mean±SD of fasting serum glucose of control Group I and study Group II were 4.77±2.04mmol/l and 6.11±1.61mmol/l respectively. In study Group II fasting serum glucose was increased. Due to increased fasting serum glucose caused by lower level of female sex hormones specially estrogen hormone increased chance of cardiovascular diseases in postmenopausal women. Assessment of these parameters are important for early detection and prevention of complication related to high BMI and fasting serum glucose level for leading a better life.

Evaluate the Changes of Body Mass Index and Blood Pressure in Combined Oral Contraceptive Pill Users.

The oral contraceptive pill, 'the pill', was introduced in the starting of the 1960s. Presently, worldwide about 100 million women are current users of combined hormonal contraceptives (COC) most frequently used in the western world. The most frequently used agents are a combination of drugs containing both the estrogen and progesterone. This combination is considered to be highly efficacious, generally considered 99.9% and a use effectiveness of 97.0% to 98.0%. This study was done to evaluate the changes of Body Mass Index (BMI) and Blood pressure ( BP) in combined oral contraceptive pill users in comparison to non- users. This cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. Total number of 120 reproductive aged women, age ranged from 15-55 years was included in this study. Among them, sixty (60) combined oral contraceptive pill users subjects were taken as study group (Group II) and sixty (60) age matched oral pill non users subjects were taken as control group (Group I). Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired students' 't' test and Pearson's correlation coefficient test. The mean±SD of BMI of control group (Group I) and study group (Group II) were 22.50±1.50 kg/m² and 27.64±1.28 kg/m² respectively. In study group (Group II) BMI was increased. Result is statistically highly significant (p<0.001). The mean±SD of systolic blood pressure of control group (Group I) and study group (Group II) were 111.17±8.51 mm of Hg and 127.50±6.14 mm of Hg respectively. In this study the mean±SD of diastolic blood pressure of control group (Group I and study group (Group II) were 75.58±5.05mm of Hg and 87.00±4.89 mm of Hg respectively. In study group (Group II) diastolic blood pressure was increased. Result is statistically highly significant (p<0.001). So the assessment of this parameter is important for early detection and prevention of complication related to combined oral contraceptive pill use for leading a healthy life.

Study on Body Mass Index, Serum Total Cholesterol and Serum Triglycerides in Adult Male Hypertensive Patients.

Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. An estimated 46.0% of adults with hypertension are unaware that they have the condition. In Bangladesh, 21.3 million of the adult population has hypertension and that is 21.0% of total population. About half of them (48.7%) with hypertension are diagnosed and 34.9% are under treatment. One of the global targets for non communicable diseases is to reduce the prevalence of hypertension by 33.0% between 2010 and 2030. This study was done to evaluate the effects of hypertension and to find out the major complications occurring due to hypertension. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. A total number of 120 male subjects, age ranged from 20-59 years was included in this study. Among them, sixty (60) hypertensive subjects were taken as study group (Group II) and sixty (60) ages matched normotensive adult male subjects were taken as control group (Group I). The results were calculated and analyzed by using Statistical package for social science (SPSS). Anthropometric measurements such as height and weight were taken in meter and kilogram respectively. Systolic and diastolic blood pressure were measured by Aneroid Sphygmomanometer (ALPK2, Japan), laboratory analysis of fasting serum total cholesterol by CHOD-POD method, fasting serum triglycerides by GPO-POD method. In this study we found that in study group Mean±SD of body mass index (29.36±2.60, p<0.001), fasting serum total cholesterol (232.05±11.18, p<0.001) and fasting serum triglycerides (180.67±19.44, p<0.001) which were significantly increased with comparison to control group. It's concluded from this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

A Comparative Study of Body Mass Index and Blood Pressure between Sedentary and Non-Sedentary Workers.

Sedentary lifestyle are spreading worldwide because of lack of available spaces for exercise, increased occupational sedentary behaviors such as office work and the increased prevalence of television and video devices. Increased incidence of sedentary lifestyle and obesity in developed and developing countries is one of the major risk factors for the development of cardiovascular diseases. This study was undertaken to analyze the differences in anthropometric and cardiovascular parameters in sedentary and non-sedentary male subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. This study consisted 50 male employees of 25-60 years who worked in an office were study group (Group II) and control group Group-I) consisted of 50 male age matched physical laborers. BMI was calculated as weight in kilogram divided by the height in meter square i.e. kg/m². Blood Pressure was measured by indirect auscultatory method with an aneroid sphygmomanometer. Statistical analysis was done by using Student's un-paired 't' test. Values expressed as mean ± standard deviation. P value was taken as significant at 5 percent confidence level. The mean±SD BMI in kg/m² of Group I and Group II were 21.90±2.22 and 29.32±3.13 respectively. The mean±SD systolic blood pressure of Group I and Group II were 112.20±6.79 and 145.10±8.11 and mean±SD diastolic blood pressure of Group I and Group II were 72.80±5.73 and 91.00±5.05 respectively. The BMI and blood pressure were increased in sedentary group compared to non-sedentary group. From the study, it appears that the risk for cardiovascular disease is increased in sedentary workers.

Study on Body Mass Index and Serum Calcium Level in Postmenopausal Women.

Menopause is one of the natural parts of women's life when menstrual cycle stops due to lack of estrogen, which occurs in middle age. Various health problems occur in this period which hampers quality of life. This study was done to evaluate the changes of body mass index and serum calcium level in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. A total number of 140 female subjects age ranged from 25-65 years were included in this study. Among them 70 (seventy) postmenopausal woman (45-65 years) were taken as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). Body mass index was measured by Anthropometric measurements such as height and weight taken in meter and kilogram respectively and Serum calcium level was measured by colorimetric method with O-Cresolftalein-complexone (OCC). Data were expressed as mean (±SD) and statistical significance of difference among the group was calculated by unpaired Student's 't' test. The mean±SD of BMI of Group I and Group II were 23.05±4.43 kg/m² and 29.01±3.12 kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. Serum calcium of Group I and Group II were 10.95±0.77 mg/dl and 7.99±0.55 mg/dl respectively. The mean±SD of serum calcium level was significantly lower in study group in comparison with control group. Post-menopausal women with low serum calcium level have a chance of development of osteoporosis. So, assessment of this parameter is important for early detection and prevention of complication related to low serum calcium level for leading a sound life.

Study of Serum Troponin-I Level in Non-diabetic Hyperglycemic ST Elevation Myocardial Infarction Patients.

The most common cause of premature death in developing countries like Bangladesh is ischaemic heart disease. Cardiac troponin-I (cTnI) is 100 percent tissue specific for the myocardium which has been shown to be a very sensitive and specific biomarker for acute myocardial infarction. As acute myocardial infarction is a stressful condition so, plasma glucose level may also increase in this condition which is stress hyperglycemia and also plasma glucose level may be used for prediction of outcome as it is a cheap and easy available test. The aim of the study is to investigate the impact of the elevation of troponin-I level with plasma glucose level of non-diabetic patients in ST-elevation myocardial infarction. This study which was comparative type of analytical and cross- sectional study carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. Data was collected from Cardiology Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 70 subjects participated in this study and were grouped as normoglycemic ST elevation myocardial infarction- Control group (Group I) and non-diabetic hyperglycemic ST elevation myocardial infarction- Study group (Group II). The results were calculated and analyzed by using SPSS. Serum troponin-I was measured by Fluorescence Immunoassay (FIA) and plasma glucose estimated by GOD-PAP method. Data were expressed in mean±SD and statistical significance of difference among the groups were calculated by unpaired Student's 't' test. The correlation between different parameter was done by Pearson's correlation coefficient test. In this study, the result suggests that there is significant positive association between serum troponin-I and plasma glucose level in study group (hyperglycemic non-diabetic STEMI) in comparison to control group (normoglycemic STEMI). So, by this study we recommend that routine estimation of these parameters is important for prevention of complications related to acute myocardial infarction.

Status of Serum Ferritin Level among Iron Deficiency Anemic Adolescent Girls in Bangladesh.

Adolescence explained as a period of age between 10 to 19 years. This is a major contributing period to build up the health of girls. Ferritin is an intracellular protein that contains iron and releases it in a controlled fashion and it reflects body iron stores and systemic inflammation during adolescent period. It is considered the best single test for the diagnosis of iron deficiency anemia during adolescent because its concentration is directly proportional to total body iron stores in adolescent period. This study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh to evaluate the changes of serum ferritin levels among iron deficient anemic adolescent girls in comparison to healthy adolescent girls in Bangladesh. This was a cross sectional, prospective, analytical type of study. This study ranged from 10-19 years of adolescent girls. Seventy (70) healthy adolescent girls, as control group (Group I). Seventy (70) iron deficiency anemic adolescent girls as study group (Group II). Serum ferritin was estimated by Micro-particle Enzyme Immunoassay Test Kit. Data were expressed as mean (±SD). Statistical significance of difference among the Group I and Group II were calculated by unpaired students 't' test. The mean±SD level of serum ferritin among Group I and Group II were 26.22±4.03µg/L and 13.33±3.18µg/L respectively. Mean values ±SD of serum ferritin significantly lower in (Group II) in comparison with (Group I). Higher numbers of adolescent girls are still suffering from anemia along with low level of serum ferritin in Bangladesh. For combat this situation, immediate, sustainable and long term public health intervention and nutritional supplementation must be required.

Increased carotid intima thickness and decreased media thickness in premenopausal women with systemic lupus erythematosus: an investigation by non-invasive high-frequency ultrasound.

OBJECTIVE: To determine whether high-frequency ultrasound (US) yielding separate assessments of intima and media thickness gives additional information about the vascular morphology compared with the total common carotid artery intima-media thickness (CCA-IMT). METHODS: Using a 22 MHz US instrument, we determined the near-wall CCA-IMT, the intima and media layers, and the intima/media (I/M) ratio in 47 premenopausal women with systemic lupus erythematosus (SLE), 20 healthy women, and 17 postmenopausal women (mean ages 37, 40, and 69 years, respectively). RESULTS: In SLE, the carotid intima was thicker (0.19 ± 0.04 vs. 0.12 ± 0.02 mm), the media thinner (0.45 ± 0.12 vs. 0.68 ± 0.24 mm), the I/M ratio higher (0.45 ± 0.17 vs. 0.20 ± 0.07) (all p < 0.0001), and the CCA-IMT lower (0.64 ± 0.13 vs. 0.80 ± 0.25 mm, p < 0.01) compared to age-matched controls. The SLE patients had a thicker carotid intima compared to the postmenopausal women (0.19 ± 0.04 vs. 0.14 ± 0.03 mm, p < 0.0001) and a similar I/M ratio. CONCLUSION: Separate assessment of carotid artery wall layers demonstrated a thicker intima, thinner media, and a higher I/M ratio in women with SLE compared to healthy controls and indicated an artery wall status in SLE comparable to 30-years-older healthy women. Separate estimates of carotid intima and media layers may be preferable to CCA-IMT in SLE patients.

Clinical course and outcome of snake envenomation at a hospital in Karachi.

INTRODUCTION: Snake envenomation is a frequently reported medical emergency at the Civil Hospital Karachi, Pakistan, [corrected] thus obviating the need to assess the patterns of the clinical course and outcome of snake envenomation cases. METHODS: The demographic characteristics, clinical signs and symptoms, laboratory findings, treatment and outcome of 80 victims of snake bite were recorded. These patients were admitted to the Civil Hospital Karachi between January 2006 and September 2007. The data of all the cases was analysed statistically using the Statistical Package for the Social Sciences version 11.0. RESULTS: The majority of the 80 victims of snake bite were male (80 percent) and 20 percent were female. The mean age of the patients was 33.3 years. The main type of envenomation was vasculotoxic (92.5 percent), and none were neurotoxic or myotoxic. Both local and systemic clinical features of envenomation were present. Bleeding was reported in 43.8 percent of the patients. 71.3 percent of the patients showed coagulopathy of defibrination and the anti-coagulant type. All patients received anti-snake venom. Five (6.3 percent) patients in the study died. CONCLUSION: The most common type of snake envenomation in this part of the province of Sindh is vasculotoxic due to the high inhabitancy of Viperidae. High morbidity and mortality rates can be reduced significantly through patient education on the precautions that need to be taken by farmers and field workers against snake bite. Early referral to a well-equipped health facility is necessary, as the mortality rate was high among those patients who arrived late.