Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity

Electrocardiographic pattern in hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of poor pregnancy outcome and complicate ~6-11% of all pregnancies. When diagnosed during pregnancy, hypertension disorders escalate the maternal risk of placental abruption, cerebrovascular accident and disseminated intravascular coagulation, as well as fetal risk of intrauterine growth restriction, intrauterine death and prematurity. Interpretation of the ECG is an important component in the assessment of cardiovascular adaptations during pregnancy. Methods: In this study, 105 pregnant women (gestational age >20 weeks) with hypertensive disorders of pregnancy (HDP) in the range of 18 to 45 years of age were recruited and compared with the equal number of age matched normotensive pregnant women. ECG parameters were compared with those of normotensive pregnant women. Results: There was left axis deviation in 28.6% in HDP group as compared to 10.5% in control group, while as 71.4% and 84.8% had normal axis in HDP and control group respectively, 4.85% in control group had right axis deviation there was statistical significant difference between the two (p<0.05). There was statistically significant difference between the two groups in ECG characteristics of T wave flattening or inversion in lead III, T wave in lead V1, V2 and V3, (p<0.05). The mean QTc interval was found to be 440.28±43.62 msec in HDP women and 417.42±21.74 msec in normotensive control pregnant women and there was statistically significant difference between the two groups (p=0.000). Conclusions: ECG abnormalities seen in patients with hypertensive disorders of pregnancy (HDP) include left axis deviation, T wave abnormalities, an alteration of ventricular repolarization as evidenced by prolongation of ECG parameters, such as QTc

Neutrophil-lymphocyte ratio as inflammatory marker for clinical prediction and disease severity evaluation of preeclampsia

Background: Pre-eclampsia (PE) is a multisystem disorder that complicates 4-6% of pregnancies and constitutes a major source of morbidity and mortality worldwide. About 10-15% of maternal deaths are directly associated with PE and eclampsia. The aim of this study is to compare the neutrophil-lymphocyte ratio (NLR) values of mild and severe PE with the healthy normotensive pregnant women, in order to study the predictive role of NLR for PE and whether the NLR value has significant difference between normotensive pregnancy, severe and mild PE. Method: A cross-sectional study conducted from January to July 2022 after proper informed consent and ethical clearance. The study population included 194 pregnant women divided into three groups (97 normotensive, 55 mild PE, 42 with severe PE). All the study participants were statistically compared in respect to NLR and the baseline data including age, parity and gestational age. Results: Maternal NLR in mild PE group was statistically increased when compared to normotensive healthy women (p<0.05). Similarly, NLR was significantly higher in severe PE group when compared with normotensive pregnancy group (p=0.00). A statistically significant positive correlation was also seen between SBP (systolic blood pressure) and NLR in PE group (p<0.05). Conclusions: NLR can be used as an inflammatory marker for clinical prediction and disease severity evaluation of PE but further cohort studies are required to determine and establish its role

Comparison of serum electrolytes with preeclampsia severity: a cross sectional study

Background: Preeclampsia is a common complication of pregnancy that put women and their fetuses at significant risk and result in life long sequelae. The pathogenesis of this important disease is complex as such the role of different serum electrolytes is being investigated as they are considered important for blood pressure regulation.Methods: A hospital based cross-sectional study of 100 diagnosed cases of preeclampsia divided into mild and severe according to latest International Society for the Study of Hypertension in Pregnancy (ISSHP) guidelines and equal number of age, parity and gestational age matched women (n=100), that acted as control group, with singleton normal pregnancies. Data was analyzed in SPSS V:26. Statistical tests to find out mean standard deviation and One-way ANOVA test were applied to find the significance of associations.Results: In severe preeclampsia group, the mean values of Na+, K+ and Cl- were 134.50±4.24, 4.28±0.74, 106.48±3.41 meq/l respectively in comparison to control group which had 135.57±3.29, 4.12±0.53, 108.20±3.19 meq/l respectively. Results from one way ANOVA showed that there was statistically significant difference between means of the three groups for systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium and chloride levels with p<0.05. A post hoc analysis was used to distinguish the differences in means of these parameters.Conclusions: Estimation of readily available serum electrolytes of sodium potassium and chloride during the course of pregnancy can help to identify and treat preeclampsia and thus reduce the burden of morbidity and mortality in pregnant women

Stigmatisation in chronic hepatitis B and C infections-time to debunk the myth!

Background: Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The routes of transmission and lack of education among the masses may cause stigmatisation of the affected patients.  The aim of the study was to document the stigmatisation among chronic hepatitis B and C positive patients. Methods: The 242 patients suffering from hepatitis B and C were included in the study. Stigma experienced from relatives, friends, spouse and health care providers was assessed using a semi structured questionnaire. Results: Majority of the patients were males 174 (72%). The 162 (67%) were hepatitis B infected and 76 (32%) were Hepatitis C infected and 4 were dual infected. Male patients were significantly more affected than females in term of changes in lifestyle (86% versus 61%) and changes in relationship with the spouse (89% versus 16%). Significantly more females than males reported feelings of loneliness and isolation (64% versus 30%). Stigma was marked in terms of disease transmission, with 170 (70%) of patients fearing that they could transmit the infection to others. Marital relationships were affected for 52% of married patients. Around 80% unmarried patients were experiencing delay in getting married. Conclusions: Patients comments showed a sense of family and societal discrimination resulting in feelings of disappointment which could be changed by educational interventions, effective patient and family centric awareness and scientific models of approach

Liver and renal biochemical parameters in preeclampsia: a cross sectional study

Background: Pre-eclampsia is a multisystem disorder of human pregnancy with a genetic predisposition. It occurs more frequently in first pregnancies and leads to elevation in blood pressure and mainly affects maternal renal, cerebral, hepatic and clotting functions. This study evaluated biomarkers of renal and liver function among preeclamptic women. Methods: This was a cross-sectional study conducted among 150 preeclamptic women and 150 normotensive healthy pregnant women in hospital. The baseline data comprising age, gestational age, and blood pressure were obtained. Serum urea, creatinine, and plasma levels of liver enzymes ALT and AST, total protein, albumin, globulin and glucose were measured. Results: The plasma total protein, and albumin in preeclamptic group were significantly decreased (p&lt;0.05) when compared with control. There was statistically significant increase (p&lt;0.05) in urea creatinine, glucose, serum AST, and ALT activities in preeclamptic group. Conclusions: Preeclampsia has harmful effects on renal and liver function as shown by alteration of these parameters

CLINICAL PROFILE AND THE OUTCOME OF COVID-19 IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY: A SINGLE CENTRE EXPERIENCE

Objective: In the present study, we are reporting the clinical profile; and outcomes of COVID-19 in patients with hematological malignancy at tertiary care hospitals. Methods: Data from laboratory-confirmed 40 COVID-19 patients diagnosed between January 1, 2021 and July 31, 2021, were analyzed retrospectively. All COVID-19 patients with hematological malignancy (n=40) were included in the study. Results: In the present study, a total of 40 patients were included. Of 40, 25 (62.5%) were males, and 15 (37.5%) were females. The median age in this study was 43 years (Range, 8–70). Of these 40 patients, acute myeloid leukemia was the most common malignancy 11 (27.5%), followed by acute lymphoblastic leukemia 9 (22.5%) than non-Hodgkin lymphoma 5 (12.5%), plasma cell dyscrasia 4 (10%), chronic myeloid leukemia 4 (10%), chronic lymphocytic leukemia 3 (7.5%), acute promyelocytic leukemia 2 (5%), chronic myelomonocytic leukemia 2 (5%). Mean hemoglobin was (8.04 g/dl), white blood cell count was (10.14×109/l), platelet count was (77.7×109/l) creatinine was (0.86 mg/dl), bilirubin was (1.24 mg/dl). The overall case-fatality rate was 8 (22.5%). Conclusion: Patients with hematological malignancy are immunocompromised, and our study reveals that there is an increased case fatality rate among these patients. Hence, physicians should be aggressive in the management of COVID‐19 patients with hematological malignancy

Antispasmodic and Ca++ antagonist potential of marrubiin, a labdane type diterpene from Phlomis bracteosa

A tricyclic labdane type diterpene was isolated for the first time from ethyl acetate soluble part of Phlomis bracteosa. Its structure was confirmed by x-ray which was found to be marrubiin. When studied in isolated rabbit jejunum, marrubiin caused concentration-dependent relaxation of spontaneous and high K+ (80 mM)-induced contractions, like that caused by verapamil, indicating that marrubiin exhibits spasmolytic activity, possibly mediated through Ca++ channel blocking action

Anti-nociceptive and Anti-inflammatory Activities of Asparacosin A Involve Selective Cyclooxygenase 2 and Inflammatory Cytokines Inhibition: An in-vitro, in-vivo, and in-silico Approach

Triterpenes possess anti-inflammatory and anti-nociceptive effects. In this study anti-inflammatory activities of Asparacosin A were evaluated' using in-vitro cyclooxygenases 1 and 2 (COX-1/2) inhibition assays. Moreover, anti-nociceptive activities were assessed in-vivo by carrageenan-induced paw edema test, xylene-induced ear edema tests, and acetic acid-induced writhing and formalin tests. Additionally molecular docking was conducted to elucidate the binding mechanism of the compound and to correlate the in-vitro findings with the in-silico data. Oral administration of Asparacosin A at the doses of 10, 20, and 40 mg/kg induced significant anti-inflammatory effects (*p &lt; 0.05, **p &lt; 0.01, and ***p &lt; 0.001) in a dose-dependent manner in both models. Asparacosin A also inhibited the human recombinant COX-2 enzyme and caused a dose-dependent decrease in the levels of TNF-α, IL-1β, and PGE2 in the carrageenan-induced paws. Moreover, Asparacosin A displayed significant anti-nociceptive effects (*p &lt; 0.05, **p &lt; 0.01, ***p &lt; 0.001) at the doses of 10, 20, and 40 mg/kg in acetic-acid induced writhing test. However, in formalin test, Asparacosin A (10–40 mg/kg, p.o) produced anti-nociceptive effects only in the late phase, similar to the effect observed with the reference drug celecoxib (50 mg/kg, p.o). Molecular docking was carried out on both COX-1 and COX-2 structures which revealed that Asparacosin A targets allosteric binding site similar to the binding mode of the selective COX inhibitor. In conclusion, Asparacosin A exhibits anti-inflammatory and peripheral anti-nociceptive activities which are likely mediated via inhibition of COX-2 enzyme and inflammatory cytokines. Furthermore, Asparacosin A can serve as a model to obtain new and more selective potent anti-inflammatory and anti-nociceptive drugs