A five year retrospective study on maternal and perinatal outcome in pregnancy after cardiac surgery

Background: Pregnancy is a hypercoaguable state with physiological haemodynamic changes occurring during pregnancy. There is a progressive increase in intravascular volume in second trimester of pregnancy and increase in cardiac output. Pregnancy makes a significant impact on cardiovascular system. It is important to evaluate and study the effect of pregnancy on women with surgically corrected heart conditions so as to preempt potential complications.Methods: This is a retrospective study of patients with prior history of cardiac surgery and their pregnancy outcomes in a tertiary center of Southern India over a period of five years from January 2011 to December 2016.Results: In this study, descriptive statistical analysis was done in 87 women with pregnancy following cardiac surgery. 58.6% were nulliparous. Around 52% had associated obstetric risk factors. The most common cardiac surgery in this population was Mitral valve replacement (40.2%) and Atrial septal defect closure (37.9%). Women belonged to NYHA class I in 90.8% of cases. 58.6% had vaginal delivery and 36.8% had caesarean section. 6 women had postpartum haemorrhage which was medically managed, and 6 women needed ICU care.74.7% women had term deliveries. 18.4 % of the babies were less than 2.5 kg weight at birth. 13 babies required Neonatal ICU care.Conclusions: Maternal and neonatal outcome mainly depends on the functional cardiac status of women before conception. In this study we emphasize on the importance of multidisciplinary team approach involving cardiologist, obstetrician and neonatologist in the management of women with prior cardiac surgery

Association of metabolic syndrome and lower urinary tract symptoms amongst South Indian postmenopausal women

Background: Women spend one third of their life in menopause. The age related anatomical and physiological changes predispose them to MetS and lower urinary tract symptoms (LUTS). The aim was to study the prevalence of metabolic syndrome (MetS) and lower urinary tract symptoms in postmenopausal women attending menopause clinic, to study the correlation of LUTS and body composition among women with MetS.Methods: 154 post-menopausal women who attended menopause clinic at the Christian Medical College Hospital Vellore, were recruited. MetS was diagnosed using IDF criteria. LUTS were assessed BFLUTS questionnaires. Blood was taken to assess serum fasting glucose and lipid profile. DEXA was performed to assess the whole-body composition.Results: Of 154 postmenopausal women, 64% had MetS and 43% of women had a total LUTS score > 5. 90% of women had filling symptoms,57% had incontinence,17% had voiding symptoms,14 % had quality of life issues and 6 % had sexual symptoms. However, there was no statistical significant difference between two groups in correlating the variables of MetS with LUTS (P >0.05). The percentage of total body fat by DEXA scan was significantly greater (P=0.006) in women with MetS (37.32±5.04) when compared to the women without MetS (34.629±3.65).Conclusions: Prevalence of MetS among the study population was 64 %. LUTS were observed in 43% of the patients. There was no significant difference in LUTS in women with MetS and without Mets. However, there was a significant difference in body composition among women with and without MetS

Prevalence of metabolic syndrome among postmenopausal women in South India

Background: As the average life expectancy of women extends 20-30 years after menopause, the medical impacts of changes leading to metabolic syndrome on postmenopausal women are significant. The menopausal state has been noted to be an independent risk factor for the occurrence of metabolic syndrome. This study was conducted to look at the prevalence of metabolic syndrome in postmenopausal women.Methods: A prospective cross sectional study was done and postmenopausal women were assessed for metabolic syndrome using the International Diabetes Federation Criteria.Results: The prevalence of metabolic syndrome was found to be 64%. Women with metabolic syndrome had a higher systolic blood pressure and larger waist circumference, however did not differ in terms of diabetes and dyslipidemia. There was no significant difference with regards to frequency and severity of menopausal symptoms between women with and without metabolic syndrome.Conclusions: The increased prevalence of metabolic syndrome in postmenopausal women may be directly due to ovarian insufficiency and indirectly due to metabolic consequences of central fat redistribution with estrogen deficiency

High dietary diversity is associated with obesity in Sri Lankan adults: An evaluation of three dietary scores.

Background: Dietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults. Methods: Six hundred adults aged > 18 years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24 hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25 kg.m−2 is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity. Results: Mean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non-obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population. Conclusion: Our data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items

Outcome of radiotherapy for pituitary adenomas

AimThe aim of this study was to analyze the outcome and toxicities and its correlation to patient related and treatment related factors.BackgroundPituitary adenomas are treated by radiation therapy (RT) as one of the modalities along with surgery and medical therapy. RT to pituitary adenomas is a challenge due to adjacent dose limiting structures such as optic apparatus and hypothalamus.Materials and methodsBetween January 2004 and December 2010, 94 patients treated for pituitary adenoma with RT who had hospital records of a minimum follow-up of 1 year were included in the analysis. Tests of correlation were done with regards to treatment factors.ResultsMale preponderance was noted in our patient population. Nonfunctioning and functioning tumors were equal in number in this series. Hypopituitarism was associated in 58.5% of patients prior to RT. Radiological tumor progression was seen in one patient (1/94) who had a nonfunctioning tumor. Among functioning tumors, biochemical remission was seen in 93.6% of patients at a median follow-up of 6 years.ConclusionsVisual complication was seen in 5.3% of patients and worsening or new onset hypopituitarism was seen in 6.4%. Conventional 3-field technique was associated with significantly more visual complication compared to Stereotactic Radiation Therapy (SRT) technique. Doses ≤50.4[[ce:hsp sp="0.25"/]]Gy showed a trend of reduced rate of visual and endocrine complications with no compromise in efficacy

Comparison of Monitored Anesthesia Care with Propofol Versus Dexmedetomidine for Awake Craniotomy: A Retrospective study

Background Anesthetic agents used for awake craniotomy should be safe, short-acting, titratable, and provide an adequate level of sedation and analgesia, along with facilitating adequate neurological assessment during the functional testing. Our study aims to review the efficacy and safety profile, along with the potential for neurophysiological monitoring, of two commonly used anesthetic regimens, i.e., propofol and dexmedetomidine

Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study

Background and Aims: Epidural catheter migration is a well-described complication in the obstetric population, though its significance in the non-obstetric surgical population is not known. The purpose of this study was to explore the incidence of epidural catheter migration in a non-obstetric adult surgical cohort, assess the factors associated with migration and analyse complications among patients with and without catheter migration. Methods: In this single-centre, prospective, observational study, the acute pain services team collected data over 12 months on consecutive, adult non-obstetric surgical patients who received an epidural catheter for postoperative pain management. Details of epidural catheter insertion, fixation, migration and complications were collected from the first to the fourth postoperative day. Results: Of the 510 patients recruited, epidural catheter migration was noted in 233 patients (45.7%), of which 152 (65.2%) migrated outwards and the rest migrated inwards. Also, 72 (30.9%) and 86 (31.05%) complications were noted in the groups with and without catheter migration, respectively. The most frequent complications noted were inadequate analgesia, unilateral sensory block, motor block and hypotension in both groups. We did not find any correlation between the frequency of epidural catheter migration and demographic factors. Conclusions: Epidural catheter migration is a sizeable postoperative occurrence in non-obstetric surgical patients. Factors that might play a role in catheter migration could not be established in this study. There is an almost similar frequency of complications noted among patients with and without catheter migration, with the most common being inadequate analgesia in both groups

A Survey on Factors Influencing the Work–Family–Health Balance of an Interventional Radiologist

Aim: Burnout and stress-related health disorders are on the rise among physicians. The aim of this study is to report the results of a survey on factors affecting the work–life balance of interventional radiologists (IR)

A five year retrospective study on maternal and perinatal outcome in pregnancy after cardiac surgery

Background: Pregnancy is a hypercoaguable state with physiological haemodynamic changes occurring during pregnancy. There is a progressive increase in intravascular volume in second trimester of pregnancy and increase in cardiac output. Pregnancy makes a significant impact on cardiovascular system. It is important to evaluate and study the effect of pregnancy on women with surgically corrected heart conditions so as to preempt potential complications.Methods: This is a retrospective study of patients with prior history of cardiac surgery and their pregnancy outcomes in a tertiary center of Southern India over a period of five years from January 2011 to December 2016.Results: In this study, descriptive statistical analysis was done in 87 women with pregnancy following cardiac surgery. 58.6% were nulliparous. Around 52% had associated obstetric risk factors. The most common cardiac surgery in this population was Mitral valve replacement (40.2%) and Atrial septal defect closure (37.9%). Women belonged to NYHA class I in 90.8% of cases. 58.6% had vaginal delivery and 36.8% had caesarean section. 6 women had postpartum haemorrhage which was medically managed, and 6 women needed ICU care.74.7% women had term deliveries. 18.4 % of the babies were less than 2.5 kg weight at birth. 13 babies required Neonatal ICU care.Conclusions: Maternal and neonatal outcome mainly depends on the functional cardiac status of women before conception. In this study we emphasize on the importance of multidisciplinary team approach involving cardiologist, obstetrician and neonatologist in the management of women with prior cardiac surgery