Effect of eclampsia on pregnancy outcome at the tertiary care center

Background: Eclampsia is a common medical and life-threatening emergency condition mainly seen in 5-10% of all pregnancies and that is a major cause of maternal and perinatal morbidity and mortality The aim of the study to find out the fetomaternal outcomes of eclampsia in tertiary care hospital and to analyse the trend of eclampsia and associated epidemiological variables.Methods: This retrospective analytical study was undertaken with 40 clinically diagnosed women with eclampsia in their third trimester of pregnancy in the Department of Obstetrics and Gynaecology, at tertiary care hospital from July 2020 to December 2021. Women who came to the hospital with eclampsia or developed eclampsia during hospital stay were included in our study.Results: In our study, the antepartum eclampsia was in 32 cases (80%), primigravida 27 cases (67.5%), maternal age (21-30 years) 26 cases (65%). Cesarean section was the mode of delivery in 26 cases (65%). NICU admission is required by 20 neonates (50%).Conclusions: Eclampsia is an important cause of maternal and perinatal morbidity and mortality. Providing quality antenatal health care services, increasing awareness of patients about warning symptoms, proper investigations, timely delivery, and proper monitoring in the intrapartum and postpartum period have the potential to improve maternal and perinatal outcomes.

Understanding Health-Seeking Behavior of People with Diabetes during COVID-19 Pandemic: A Facility Based Cross-Sectional Study Conducted in Ahmedabad, India

Objective: The study was conducted to understand health-seeking behavior (HSB) of people with diabetes during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods: A hospital-based cross-sectional study was conducted at All India Institute of Diabetes and Research (AIIDR), Swasthya Diabetes Care in Ahmedabad, India. Data were collected with the help of a structured questionnaire. Response rate was 97%. One hundred thirty-eight participants who visited the hospital during the month of May 2022 were included and interviewed after obtaining informed consent.Results: Of the study participants (n = 138), 43.5% were female, while 56.5% were male. The mean age of study participants was 51.22. Out of 138 participants, 18.1% (n = 25) had type 1 diabetes mellitus (T1D) and 81.9% (n = 113) had type 2 diabetes mellitus (T2D). It was found that 55.7% faced delay in regular checkups, 39.8% used telemedicine to avoid travelling to hospital in fear of getting COVID infection, 7.8% faced delay in consuming medicines due to unavailability of medicines. Regular intake of medicines/insulin altered for 40.5% of study participants. 54.3% of our study participants felt fear while visiting the laboratory to measure their blood glucose level. Conclusions: Uncertainties created by COVID-19 pandemic have affected HSB of people with diabetes in terms of access to healthcare facilities, medicine adherence, laboratory testing, self-management habits. Knowledge shared here can help program planners to identify influencing factors and implement appropriate interventions. This understanding also helps in setting the stage for the formulation of effective diabetesrelated educational programs which might help for future pandemic

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570