Comparative study of neuroimaging features and clinical symptoms in patients with eclampsia

Background: Eclampsia is a life-threatening emergency that remains a major cause for feto-maternal morbidity and mortality. The purpose of our study was to access various computed tomographic scan (CT) findings in eclampsia patients and compare neurological symptoms with radiological findings. Methods: A prospective analytical study was undertaken in department of obstetrics and gynecology, J. K. Lon hospital, Kota during the period of 2019-2020. Women who presented as eclampsia and admitted in indoor wards were included in the study. Data analyzed included various maternal and fetal parameters, CT scan findings and outcome of pregnancy. Results: The incidence of eclampsia was 1.1% of total deliveries. High risk factors associated with eclampsia were primigravida (70%), maternal age (70% in 21-25 years age group), illiteracy (64%), inadequate antenatal care (96%), early gestation (68%). On CT scan findings 52% patients had abnormal CT scan findings of which most common was cerebral edema (57.7%). Parieto-occipital lobe was most common region to be affected. Altered sensorium was found to be significantly associated with abnormal CT scan findings.Conclusions: Eclampsia is a major cause of fetal and maternal morbidity and mortality.  CT scan in eclampsia have significant role in early diagnosis of patients with cerebral pathologies and these CT scan findings were associated with the level of consciousness and number of convulsive episodes.  Thus, CT scan helps in further management of these patients by multidisciplinary approach

A case report on decidual cast following B-lynch compression suture

In case of atonic postpartum haemorrhage (PPH) and traumatic PPH or cervical tear extended deep up to lower uterine segment exploratory laparotomy is the last resort to control PPH. It was a case of 20 years old female admitted in labour room with chief complain of bleeding per vaginum and something coming out of vagina after 6 weeks of post laprotomy for atonic postpartum hemorrhage. Compression sutures were applied and bilateral uterine artery ligation was done at time of laparotomy. After 6 weeks post laparotomy the patient was presented with complain of something coming out from vagina. An examination was performed under short general anesthesia in the operation theater, the mass was removed without any resistance. A provision diagnosis of decidual cast was made which was later confirmed by histopathological report which shows autolytic changes in decidual tissue. Women which are undergoing bilateral uterine artery ligation or compression suture for management of postpartum hemorrhage, should be informed about potential complication. Postoperative follow-up is necessary for any complications

Study of feto-maternal outcome in referred obstetric cases in tertiary care center in Rajasthan: a cross sectional study

Background: Pregnant women are at high risk for life threatening complications throughout the pregnancy and during delivery as well. Most of these complications are unpredictable with routine clinical examination. Skilled medical interventions such as blood transfusion, caesarean delivery, expert surgical team, medicines etc. are required to prevent these complications. Emergency obstetric referral should be carried out to avoid maternal and fetal morbidity and mortality. Aims and objectives of current study were to investigate the pattern of referral in tertiary care center and fetomaternal outcome in referred cases.Methods: This is a observational study conducted in the department of obstetrics and gynaecology, at a tertiary care hospital. Patients are referred from nearby PHCs, CHCs, SDHs and private hospitals. All referred antenatal and intra-natal patients to our center of >24 weeks of gestational age were studied.Results: Majority of them 43% women were of 21-25 year of age, 35% women were of 26-30 year of age group. Out of 76 delivered women, 55% underwent caesarean section and 36.84% were delivered normally. PPH seen in 6.66% patients, maternal deaths reported 2.5%, septicaemia 1.6%, wound gaping in 3.33%, puerperal pyrexia in 5% of patients. 77% neonates were shifted to mother-side, whereas 18% were admitted to NICU.Conclusions: Referral system is an important part of health care system. By providing good antenatal care, availability of blood products, well organized referral center, timely identification and referral of high-risk patients, skilled birth attendants at time of child birth all will help in reducing feto-maternal morbidity and mortality and will help in achieving goal of ideal MMR and NMR.

Severe acute malnutrition: seasonal variations in Southern Rajasthan, India

Background: Malnutrition is India’s one of the biggest health care challenge. India has some of the highest rates of child malnutrition. We performed a retrospective study of children admitted in Malnutrition Treatment Centre to find out any seasonal variations in the prevalence of severe acute malnutrition (SAM) in Southern Rajasthan, India.Methods: In this hospital based retrospective study, data were analysed for all children admitted at malnutrition treatment centre of a tertiary level hospital attached to a medical college from April 2014 to March 2016 to study the seasonal variations in the prevalence of SAM.Results: A total of 30,140 children were admitted during the last two years, out of which under five children other than new born were 4,942 in 2014-15 and 5,972 in year 2015-16. Total 1915 SAM children were admitted in our malnutrition treatment centre (MTC) in last 2 years. Among the under five children 840 (17%) children were admitted with SAM in 2014-2015 and 1075 (18%) in year 2015-2016. The number of SAM admission has increased in 2015-16 from the previous year (p0.05).Conclusions: The prevalence of SAM in admitted patients was high as compared to national and state data and this has increased over the year, but there are no month wise seasonal variations in prevalence of SAM in our children representing Southern Rajasthan, India.

Correlation of liver enzymes with serum ferritin levels in β-thalassemia major

Background: Liver is the earliest site of iron deposition in transfusion dependent β -thalassemia major and iron induced liver injury is the common cause of morbidity. Liver enzymes are raised and indicative of liver injury in transfusion dependant β-thalassemia major patients. Objective of the study was to find out the correlation of serum ferritin with liver enzymes serum glutamic oxalocetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) in thalassemia major children.Methods: Hospital based study of fifty five (55)  children of β-Thalassemia major in the age group of 4-20 years who were regularly transfused and were on oral iron chelators since at least one year were enrolled. Serum ferritin levels and serum SGOT and SGPT levels were estimated and results were correlated.Results: Out of total fifty five (55) children, most were in the age group of 4 to 8 years. Mean rate of blood transfusion in subjects was 157.01ml/kg/year and mean duration of chelation therapy was 2.34 years. Serum ferritin levels were increased in β-thalassemic children with average of 2130.33±859.85ng/ml.  The SGOT and SGPT were also raised significantly (p value <0.05) with mean of 71.37±24.16 IU/L and 62.3 5±25.75 IU/L respectively. The values of SGOT & SGPT becomes highly significant  (p value <0.001) when serum ferritin  becomes more than 2000 ng/ml. Onset of liver enzyme derangement starts at serum ferritin level of more than 1000 ng/ml We found positive correlation between serum ferritin and deranged liver enzymes (Pearson’s bivariate correlation coefficient r = 0.84±84).Conclusions: As soon as the serum ferritin level crosses the value of 1000 ng/ml and number of transfusions are more than 30, derangement in liver enzymes starts occurring in β -thalassemia major.

Myocardial performance index in children with β-thalassemia major

Background: Cardiac complications are the major cause of mortality and morbidity in thalassemic children. Iron deposition inmyocardium is the key factor leading to poor cardiac functions. Myocardial performance index (MPI) by echocardiography (ECHO)can be used for an early recognition of ventricular dysfunctions. Objectives: To assess the MPI in children with β-thalassemiamajor and to establish their relationship with serum ferritin. Methods: Fifty-five children of Thalassemia major in age group of4-20 years who were on regular blood transfusion and on oral iron chelators from thalassemia unit of tertiary hospital were enrolled.After blood transfusion, serum ferritin estimation was done. Two dimensional ECHO with color Doppler was done to estimate thecardiac functions and then MPI by various parameters was calculated. Results: Out of 55 children, most were in the age groupof 4 to 8 years. Mean rate of blood transfusion in subjects was 157.01 ± 21.33 ml/kg/year and mean duration of chelation therapywas 2.34 ± 1.86 years. Mean serum ferritin of subjects was 2130 ± 859.5 ng/ml. Mean ejection fraction was 61 ± 6.2%. Mean MPIof subjects was 0.60 ± 0.14. The MPI was abnormal at all levels of more than 1000 ng/ml serum ferritin (p=0.001). There was apositive correlation between MPI and serum ferritin (Pearson’s bivariate correlation coefficient r=+0.93). Conclusion: In poorlychelated thalassemic children, MPI was abnormally high despite normal ejection fraction, which can be used as an early marker ofventricular dysfunction

ASSESSMENT OF DENTAL FLUOROSIS IN CHILDREN OF JAIPUR DISTRICT, RAJASTHAN, INDIA

Objective: The objective of the present study was carried out to explore the potential association between fluoride concentration in drinking water and severity of dental fluorosis (DF) in the children.Methods: The study of dental fluorosis (DF) in the children (6-14 years old) was conducted in the two blocks (a) Jamwaramgarh block ;Heerawala, Palera ,Nayabas, Saipur and Birasana, (b) Amber block; Jugalpura, Chitanukalan, Sunder ka bas, Peelwa and Sirsali of Jaipur district, Rajasthan, India of the study villages. Total 150, children were surveyed. The role of fluoride (F) levels in drinking water in the etiology of dental fluorosis (DF) and the cases of dental fluorosis (DF) in both dentitions and teeth were also assessed using DEAN'S classification. The fluoride (F) concentration in source of drinking water was estimated by fluoride (F) ion specific electrode (Thermo Scientific Orion Star A329, USA).Results: The F concentration in (Tube well and Hand pump) water ranges from 0.7 to 15.0 parts per million (ppm) in Jamwaramgarh block and 1.40 to 5. 10 parts per million (ppm) in Amber block. Prevalence of dental fluorosis (DF) 27 (36%) in Jamwaramgar block and 26 (34.66%) in Amber block out of 75 children were examined in each block. Significantly increase in levels of F in drinking water is positively correlated with dental fluorosis.Conclusion: This study finding has shown the relation of dental fluorosis (DF) to high fluoride (F) levels in drinking water sources. A higher fluoride (F) levels in source of drinking water is a major risk factor for dental fluorosis. In view of the severity of the problem the intake of calcium rich foods and defluoridation techniques may help reducing risk of dental fluorosis (DF) in the children.Â

A Comparative Study of Energy Contents in Mosquito Vectors of Malaria and Dengue Prevailing in Jodhpur City (Thar Desert) of Rajasthan State, India

Background: Transmission of malaria and dengue in the desert part of India is mainly caused by Anopheles ste­phensi and Aedes aegypti respectively. The maintenance and transmission of the pathogens that cause malaria and dengue are dependent on the physiology of the mosquito vectors. We aimed to measure the energy contents in the mosquitoes transmitting malaria and dengue in the desert part of the country. Methods: Immature stages of mosquitoes were collected from six different larval habitats situated in Jodhpur City of Rajasthan state, India. The immature stages of both the mosquitoes were collected once in fortnightly from each loca­tion. Quantitative estimations of the lipid, glucose, and glycogen of the laboratory-reared and field collected An. stephensi and Ae. aegypti were made by spectrophotometric method. The energy contents of the larvae, pupae, fe­males, and males were estimated in triplicates on six different occasions. Results: The lipid content of laboratory-reared larvae, pupae and female mosquitoes of An. stephensi and Ae. aegypti was found to be lower than their conspecific field-collected specimens. Whereas, the glycogen content in the la­boratory-reared larvae, pupae and female mosquitoes of An. stephensi and Ae. aegypti was higher than that of their conspecific field-collected specimens. The glucose content in all the stages of the laboratory-reared An. stephensi was lower than their conspecific field-collected specimens except in few cases. Conclusion: The higher amount of lipid in field-collected mosquitoes may be because of the availability of food in the natural habitat and adaptation of mosquitoes. Mosquitoes living in desert climate are physiologically better equipped to survive in the desert environment

Predictability of STOP-Bang Questionnaire and Epworth Sleepiness Scale in Identifying Obstructive Sleep Apnoea against Polysomnography: A Cross-sectional Study

Introduction: Rising morbidty resulting from Obstructive Sleep Apnoea (OSA) is an emerging public health concern. The estimated prevalence of OSA in India has been investigated. STOP-Bang and Epworth Sleepiness Scale (ESS) have proven beneficial in identifying sleep breathing disorder. Validity of these questionnaire has been verified against polysomnography in many studies. Aim: To assess the predictive ability of STOP-Bang questionnaire and ESS in identifying OSA and comparing their efficacy with polysomnography. Materials and Methods: The cross-sectional study was conducted in the Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India, from January 2020 to June 2021, among 100 patients with symptoms of OSA. The STOP-Bang questionnaires were administered to the patients, and scoring was done, followed by overnight attended polysomnography. The normality of data was tested by Shapiro Wilk’s test. The values obtained were statistically analysed and to compare the parameters between groups and with in groups for normal data parametric test One-way Analysis of Variance (ANOVA) followed by Tukey’s HSD test, for intragroup Paired t-test. Results: Mean age of the study population was 49.46±6.523 years, 79 were males and 21 females. Total, 79% of the subjects were males, and 21% of the study subjects were females. Among the 100, 65% had OSA as per polysomnography. STOP-Bang questionnaire had a higher sensitivity as compared to ESS in predicting OSA (75.38% for STOP-Bang and 72.31% for ESS). Conversely, the specificity of ESS (82.8%) was found to be greater than STOP-Bang (45.71%). Similar results were obtained for positive predictive value, in which ESS scored 88.6% while STOP-Bang scored 50%. For negative predictive values, ESS again scored higher (65%) than STOP-Bang (61.7%). Similarly, the Likelihood Ratio for a positive result (LR+) of ESS was greater than STOP-Bang (4.2 and 1.3 respectively). The STOP-Bang questionnaire, however, had higher Likelihood Ratio for a negative test (LR-) as compared to ESS (0.5 and 0.3 respectively). Conclusion: Polysomnography is the gold standard to diagnose OSA. For screening OSA, patients with symptoms of sleep disordered breathing, this study found that STOP-Bang questionnaire is better in identifying OSA as compared to ESS

Tillage-based nutrient management practices for sustaining productivity and soil health in the soybean-wheat cropping system in Vertisols of the Indian semi-arid tropics

To achieve higher crop production in a soybean-wheat cropping system, comprehensive knowledge of soil fertility status and its variability is crucial. However, a significant gap exists between the potential and actual productivity of this system in the Vertisols of Indian semi-arid tropics. Therefore, 2 years of field research were conducted to investigate how different crop management practices affect soil fertility in this cropping system. The trial was conducted using a randomized complete block design (RCBD) with five crop management practices: CAO (conservation tillage + organic nutrient and weed management), CAC (conservation tillage + chemical nutrient and weed management), CTC (conventional tillage + chemical nutrient and weed management), OCT (conventional tillage + organic nutrient and weed management), and PoPs (package of practices). Results showed that CAO significantly (p < 0.05) increased soil organic C (6.8 g kg−1), available N (129.5 mg kg−1), P (11.0 mg kg−1), K (232.6 mg kg−1), Fe (9.17 mg kg−1), and Mn (10.48 mg kg−1) at topsoil (0–15 cm) and deeper layers (15–60 cm). In contrast, CAC had significantly (p < 0.05) higher soil availability of Ca (5,072 mg kg−1) and Mg (901 mg kg−1) and Cu (0.84 mg kg−1). On the other side, PoPs resulted in the highest S (10.05 mg kg−1) and Zn (0.85 mg kg−1) availability in the topsoil. Our results evidently suggested S and Zn availability as key indicators of soil health sustenance in the present agroecosystem. Notably, CAC had significantly (p < 0.05) higher system productivity (4.62 t ha−1) than the other treatments, showing a 14.0, 6.3, and 18.2% increase over CAO, CTC, and OCT, respectively. Based on the results, it is recommended that CAC is a better option for achieving higher system productivity, while CAO is the best option for ensuring long-term sustainability of soil fertility. The findings of this study could be useful for farmers and agricultural researchers in designing efficient crop management practices to improve the productivity and sustainability of soybean-wheat cropping system in arid to semiarid ecology