Vitamin D: Its Deficiency and Effect of Supplementation on Maternal Outcome.

OBJECTIVES: Vitamin D deficiency is on a rise globally and so are the maternal complications related to it. This deficiency can be easily detected and corrected by simple oral supplementation for a better health outcome in pregnancy. METHODS: Antenatal women with no history of Vitamin D intake and first antenatal visit at our hospital between 26 to 28 weeks of gestation or after 34 weeks were tested for levels of Vitamin 25(OH)D. Deficient women (< 30 ng/ml) between 26 to 28 weeks were supplemented and tested again before delivery (Group A). Deficient women after 34 weeks who did not receive supplementation before delivery constituted Group B. Maternal outcome was noted and compared in both the groups. RESULTS: Out of the 189 Vitamin D deficient women included in the study; 105(55.5%) were enrolled in Group A and 84 (44.4%) in Group B. 24 (12.7%) women were severely deficient (<4 ng/ml), 134 (70.9%) were deficient (<20 ng/ml) and 28(14.8%) were vitamin D insufficient (20-30 ng/ml). A statistically significant reduction (<0.001) was observed in vitamin D deficient women after supplementation in group A. 5.7% women developed preeclampsia in group A as compared to 28.5% in group B (p<0.0001). Higher (13%) incidence of gestational diabetes mellitus was observed in group B as compared to group A (6.6%) though the difference was not significant. A significantly higher incidence of preterm labor was observed in group B (p=0.007). CONCLUSION: Vitamin D deficiency is correlated with a higher incidence of preeclampsia, gestational diabetes mellitus and preterm birth. Maternal screening in targeted population and its supplementation is recommended to improve maternal outcome.

Plasma and erythrocyte zinc in pre-eclampsia and its correlation with foetal outcome.

OBJECTIVES: To determine the plasma and erythrocyte zinc levels in women with preeclampsia and eclampsia after 28 weeks of gestation and compare with normal pregnancy and to correlate with the foetal outcome. MATERIAL AND METHODS: 150 antenatal women were divided into Study group A (75 women with preeclampsia or eclampsia); Control group B (75 women with normal pregnancy). Plasma and erythrocyte zinc levels were estimated in both the groups and correlated with the foetal outcome. RESULTS: The plasma zinc levels were significantly low (p < 0.01) in women with severe pre-eclampsia (9.28 +/- 1.63 micromol/l) and eclampsia (9.28 +/- 2.61 micromol/l) as compared to controls (10.63 +/- 1.82 micromol/l). The difference in the erythrocyte zinc levels was not statistically significant in the two groups. There were 4 (5.33%) stillbirths and 8 (10.66%) neonatal deaths in the study group as compared to 2 (2.6%) neonatal deaths in the control group. There was no statistically significant difference in the plasma and erythrocyte zinc levels in infants weighing less than 2500 gm in both the groups.The maternal mortality rate was 1.33% and the overall perinatal mortality rate in the study group was 17.3% as compared to 2.6% in the control group. CONCLUSIONS: Plasma zinc levels were significantly lowered in severe preeclampsia and eclampsia while the erythrocyte zinc levels did not show any significant change. There was no correlation between plasma or erythrocyte zinc levels and intrauterine growth restriction in pre-eclampsia.

Kikuchi's disease--a rare cause of lymphadenopathy and fever.

Kikuchi's disease is a rare, benign, self-limited disorder, characterised clinically by fever and tender regional lymphadenopathy. It has been reported worldwide and is particularly common in people of Asian descent. The cause of Kikuchi's disease is unknown. It predominantly affects young females and can closely mimic several infectious and immunological conditions. Histopathologic features of lymph nodes in Kikuchi's disease are characteristic and permit differentiation of this benign condition from lymphomas, systemic lupus erythematosus and infectious lymphadenopathies. We report a female patient presenting with fever and tender cervical lymphadenopathy. She was being treated for tubercular lymphadenitis and was referred after she developed a transient hepatitis and a skin rash following treatment with anti-tubercular drugs. An excisional biopsy of the lymph node revealed histiocytic necrotising lymphadenitis, consistent with Kikuchi's disease. A brief review of the pathogenesis and differential diagnosis of Kikuchi's disease is presented.

Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn's disease: A cohort study from northern India.

BACKGROUND: Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in the quality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for the comprehensive assessment of the perianal fistula. There is a paucity of data from India on the MRI spectrum of complex perianal fistula in CD. METHODS: A single-centre cross-sectional analysis of patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed. The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula (defined according to the American Gastroenterological Association classification) were recorded. RESULTS: Of total 175 patients with CD who attended the gastroenterology clinic during the study period, 27 (15.42%) (mean age 42±15.5 years, 62.96% females and median disease duration four years) had complex perianal fistula and were included in the analysis. The mean PDAI was 5.48±2.53. The median Van Assche Index was 17 (interquartile range [IQR] 13-19). A majority (96.29%) of the fistulae were trans-sphincteric and four (14.81%) fistulae extended into the supralevator space. All fistulae were active on MRI. Concomitant perianal abscess and proctitis were seen in 59.26% (n=16) and 62.96% (n=17) of patients, respectively. Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy. Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment. CONCLUSION: The cumulative risk of the development of fistulizing perianal CD in a northern Indian cohort was similar to the western populations. Complex perianal fistulae were predominantly trans-sphincteric and commoner in females. MRI evaluation is pivotal for the delineation of fistula anatomy, assessment of disease extent and activity and the evaluation of concomitant perianal abscess and other complications.

Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India.

BACKGROUND/AIMS: Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD. METHODS: Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated. RESULTS: Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD. CONCLUSIONS: Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

To study the prevalence of impaired glucose tolerance in patients with hepatitis C virus related chronic liver disease.

BACKGROUND: Hepatitis C infection is a major cause of Chronic Liver Disease and the prevalence of Diabetes Mellitus is also high. Diabetes has been hypothesised as one of Extrahepatic manifestations of Hepatitis C. AIMS AND OBJECTIVES: The objective of our study was to study the prevalence of impaired glucose tolerance in patients with HCV related liver disease. STUDY DESIGN: The study was a prospective study conducted over a period of one and half year in Dayanand Medical College and Hospital, Ludhiana, Punjab, India. MATERIALS AND METHODS: The study was conducted taking total of 100 Hepatitis C virus positive patients above 40 years of age who had fasting blood glucose levels ≥110mg/dl on two occasions, 24 hours apart. These patients underwent an oral glucose tolerance test. Blood sugar levels were tested at 0 and 2 hours. Based on the findings, patients were classified to have impaired glucose tolerance if levels were between 140-200mg/dl and frank diabetes if the levels were ≥ 200mg/dl. These findings were further assessed according to age, gender, Body Mass Index (BMI) Child Turcott Pugh score and Ultrasonography findings. STATISTICAL ANALYSIS: In our study all the statistical analysis was done using simple z-test and student t-test. The p-values were calculated and the results assessed accordingly. RESULTS AND CONCLUSION: Out of 100 patients, 78 were males and rest females. The mean age of the study group was 55.89±11.22 years. Mean BMI of males was higher than in females (21.98kg/m² v/s 20.13kg/m²). Maximum patients belonged to Child Turcott Pugh class C. Out of 100 patients,80 had cirrhosis on ultrasound. On doing Glucose Tolerance Test, 40 patients were found to have impaired glucose tolerance and one patient to be diabetic. The prevalence increased significantly as age increased and had significant relation with gender. On assessing according to BMI, there was not much significant relation but prevalence was significantly related to severity of disease.