Study of maternal and neonatal outcome in teenage pregnancy

Background: Teenage is a period of transition from childhood to adulthood. According to WHO, the period of teenage extends from 11-19 years. The objective of the present study was to find out the incidence and to evaluate the effect of pregnancy in teenage girls (13-19 years) and its maternal and neonatal outcome.Methods: Prospective observational cohort study, the duration from 1st January 2016 to 31st July 2017.Results: 216 teenage patients were studied; however medical termination and abortions were excluded as the study includes both maternal & neonatal outcome. 3944 pregnant patients were admitted for delivery and abortion related care. Out of this, pregnant adolescents were 216. Proportion of adolescent pregnancy was 5.47%. 170(78.7%) were booked, 32 (14.81%) were unmarried, while 50 (23.1%) were literate. Primigravida were 189 (87.5%) & multigravida was 27 (12.5%).39 (18.05%) were Anemic, Preterm labour occurred in 14 (6.5%) & PROM occurred in 41 (18.9%) patients. Preeclampsia and Eclampsia occurred in 27 (12.5%) and 14 (6.5%) respectively. There were 176(81.48%) normal vaginal deliveries.36 (16.66%) had Lower Segment Caesarean Section; commonest indication being Cephalopelvic disproportion (25%) & 4(1.85%) were instrumental deliveries 53 (24.3%) babies required admission at Neonatal Intensive care unit. Low Birth weight babies were 15 (28.3%).Conclusions: - Early ANC registration and good antenatal care with effective intrapartum & postpartum monitoring along with contraceptive advice on discharge help reduce maternal and neonatal morbidity & mortality associated with teenage pregnancy. However, it is evident that teenage pregnancy rates could be reduced by effective measures like sex education in schools, community-based programs, widespread awareness about contraception

The maternal and perinatal outcomes in heart disease in pregnancy in a tertiary care hospital

Background: The incidence of cardiac diseases in pregnancy ranges from 1 to 3%. Pregnancy in women with heart disease is associated with considerable mortality and morbidity. Thorough prenatal care and team approach involving obstetricians, cardiologists, anaesthesiologists and neonatologists can improve the maternal and fetal outcome in these women. Rheumatic heart disease is still the leading cause of maternal heart disease during pregnancy in developing countries. Methods: Between February 2022 and August 2022, a retrospective research at the RL Jalappa Hospital in Kolar was carried out. Out of 764 deliveries made at the facility throughout the study period, 30 singleton pregnancies complicated with heart disease admitted department of obstetrics and gynaecology at different periods of gestation. The maternal and perinatal outcome was thus noted. Results: Out of 764 deliveries, 30 women were found to have been complicated with heart disease. Overall incidence was 3.9%.  Rheumatic heart disease was the most common heart disease seen among them. The most common congenital heart disease present was atrial septal defect (ASD). The most common cause for LSCS was fetal distress. 93.3% of the babies delivered were shifted to NICU, with the most common cause being, preterm and low birth weight. No maternal mortality seen, though 1 neonatal mortality present due to extreme low birth weight. Conclusions: A multidisciplinary team approach including obstetrician, cardiologist, pediatrician and anesthesiologist is needed in the cases of pregnancy with heart disease to determine the mode of delivery, timing of delivery, change in anticoagulant drugs in pregnancy, type of anesthesia, care of neonate, and follow-up of mother for better maternal and fetal outcomes

Tuberculous meningitis masquerading as acute ischemic stroke in young adult

Tubercular meningitis (TBM) constitute 5% of all cases of extra pulmonary tuberculosis but a presentation leading to an ischemic stroke in a young adult is a rare clinical entity. In a case of TB vasculopathy, vasculitis, venous thrombosis and aneurysm may be the underlying events leading to a stroke. Stroke in TBM is seen in the tubercular zone which encompasses internal capsule, thalamus and caudate nucleus. Inflammatory mediators like TNF alpha, Interferon gamma and vascular endothelial growth factor have been implicated in the pathogenesis of arteritis. Imaging modalities like MRI show lesions which are usually bilateral in the territory of the perforating vessels. We report a case of 24 year old Asian male who presented with complaints of headache, projectile vomiting and altered sensorium. On examination his Glasgow Coma Scale (GCS) was 10/15, with left oculomotor and left facial nerve palsy, and hypotonia of all 4 limbs with bilateral plantar reflexes being mute. Contrast MRI of brain showed acute infarct, meningeal enhancement and basal exudates. He was started on Anti-tubercular therapy and steroids, but had a poor clinical outcome, due to his late presentation

A study to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II

Background: The acute metabolic complications of diabetes consist of diabetic ketoacidosis (DKA), hyperosmolar non-ketotic coma (HNC), lactic acidosis (LA), and hypoglycemia. All of these are associated with significant morbidity and mortality. These can easily be prevented by early recognition and prompt management. Therefore, this study was conducted to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II.Methods: This observational, analytical study was conducted on 100 patients aged more than 18 years admitted in the ICU with acute complication of Diabetes mellitus Type II. Medical history was recorded. Physical examination and investigations were done and recorded.Results: The mean age of the study population was 55.26±13.13 years. Hypoglycemia was more common (63%) than DKA (37%). Fever and sweating had the overall highest incidence (and were more in patients with hypoglycemia) while stupor, nausea and abdominal pain had the lowest incidence (and were more in patients with DKA). On examination, only one patient of DKA was drowsy. Mean temperature, pulse and respiratory rate were higher in the patients having DKA while blood pressure was higher in patients having hypoglycemia.Conclusions: It can be effectively concluded from the present study that DKA and hypoglycaemia have a broad spectrum of clinicopathological features. But the incidences vary widely. This may help in early recognition of the impending complication and thereby enabling prompt management of the same, reducing the associated morbidity and mortality. 

Tumor Size Processing using Smart Phone

This paper presents the tumor processing from MRI images using the computational features available on a mobile device (smart phones). The MRI images are pre-processed using dithering and median filtering and then transmitted to the mobile computing device. Dithering which converts gray scale image to black and white image but with gray scale visual rendition leads to the reduction in the size of the image being transmitted. The dithered images are filtered using median filter to improve the PSNR. From these transmitted images the Region of Interest (ROI) is selected using image measurement application present(in built) in mobile device. Tumor size is so computed is compared with that of obtained from existing automated algorithms. DOI: 10.17762/ijritcc2321-8169.15027

Mental Well-Being of Older Adults and Access to Healthcare During the COVID-19 Pandemic in Karnataka, India

Introduction: While older adults face inequalities and discrimination based on their age in everyday lives, COVID--19 pandemic has further multiplied their sufferings. They are at higher risk of morbidity and mortality due to not only COVID-19 but also other chronic underlying health conditions. It is possible that healthcare seeking of older adults can be delayed with imposition of restrictions on their movement on one hand and diversion of healthcare system's focus on COVID-19 management on the other. We attempt to understand how COVID-19 restrictions affected the mental well-being and access to healthcare of older adults in Karnataka, India. Methods: A unique online survey was conducted in Karnataka, India during June 2020. The survey was open to older adults above 50 years. A total of 300 older adults participated in the online survey. The survey was circulated through personal and professional contacts, and social media applications. Results and Conclusion: The findings show that nearly 81% older adults reported a poor quality of life and 20% suffered from depression. Nearest healthcare facility for nearly half the respondents was more than one-kilometre away from home, making them dependent on transportation to access healthcare facility. Experience of COVID-19 restrictions among older adults varied based on interactions with other factors such as gender, working status, and living arrangements. The chapter argues that blanket strategies followed currently increased the vulnerability of older adults and it is important to ensure that tailored strategies are developed based on the current pandemic experience to prepare for future

Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV). The disease is often more severe in adults than children.  Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity & importance of early administration of antivirals, especially in adult pox, to tackle the complications of disease and get a favourable outcome

Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of ?motility? (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes