Assessment of the effect of injection magnesium sulphate on fetal heart rate pattern in patients of eclampsia and preeclampsia

Background: To assess the effect of injection magnesium sulphate on fetal heart rate pattern in severe preeclampsia and eclampsia.Methods: This is a hospital-based prospective observational study. It was conducted in the Dept. of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over period of one year from August 2014 to July 2015.Total 122 patients with diagnosis of severe preeclampsia and eclampsia who received injection MgSO4 were included in the study. Patients who delivered within 1 to 2 hrs of injection MgSO4, had pulmonary edema, respiratory depression, renal insufficiency, patients with recurrent convulsions not controlled by MgSO4 alone, fetus who had abnormal fetal heart rate pattern prior to administration of injection MgSO4, IUD baby, baby of gestetional age <28 weeks were excluded from the study. Fetal heart rate pattern tracings were taken by CTG machine before administration of injection magnesium sulphate. Injection magnesium sulphate was given according to Pritchard Regime. Fetal heart rate pattern after injection MgSO4 were compared with fetal heart rate pattern before injection magnesium sulphate regarding all four parameters fetal heart rate, variability, accelerations and deceleration.Results: Before injection magnesium sulphate mean fetal heart rate was 148.7 bpm+10.78. After 15 minutes mean fetal heart rate was 147.8 bpm+10.32.After 1hour, 2 hour and 4 hour of injection magnesium sulphate mean fetal heart rate was139.1 bpm+9.6,139.2 bpm+9.8 and 137 bpm+9.4 respectively which was statistically significant (p value <0.001). Only patients with good variability were included in the study. After 1 hour of injection magnesium sulphate 16.4%, after 2 hour 23% and after 4 hour 31.1 % developed poor variability i.e. <5. Before injection magnesium sulphate only 4% had no acceleration, after 15 minutes, 1 hour, 2 hour and 4 hour of injection magnesium sulphate 4.9%, 29.5%, 49% and 55% patients had no acceleration respectively. Before injection magnesium sulphate no patient had late deceleration. After 15 min only 2 patients had variable prolonged deceleration. After 1 hour, 2 hour and 4 hour 0%, 4.1% and 6.6% had late deceleration respectively.Conclusions: Maternal exposure to magnesium sulphate in severe preeclampsia and eclampsia is associated with persistent fall in baseline fetal heart rate by approximately 9-11 bpm which appeared at 1 hr of injection MgSO4 but it is within the accepted normal range (110 bpm - 160bpm). Statistically significant patients developed decreased beat to beat variability <5 after 1 hr of injection MgSO4. Statistically significant patients developed absent acceleration. Few patients developed late decelerations but it was not significant

Analysis of Single Nucleotide Polymorphisms on Locus 13q33.1-34 in Multigenerational Families of Cleft Lip Palate using MassArray

BACKGROUND: Cleft lip palate is a common congenital anomaly with multifactorial etiology. Many high-risk markers at different loci were reported to be involved in its etiology. Advanced genetic research led to the discovery of evidence of a new linkage on 13q33.1-34 region at marker rs1830756 in two multigenerational Indian families. However, no further study was reported to confirm or validate this linkage in other families. Hence, the present study was designed.METHODS: Twenty multigenerational families affected by non-syndromic cleft lip palate were selected for the study. Polymorphisms, rs1830756, rs1323672, rs1935135 of FAM155A gene; rs1961495, rs953386, rs1411040 of COL4A1 gene; and rs726449, rs984300 of MYO16 gene were selected. Genomic DNA was isolated and sent for genetic analysis by single nucleotide polymorphism (SNP) genotyping using the MassArray method. Statistical analysis of the genomic data was done by PLINK. Bonferroni correction was applied and haplotype analysis was done using Haploview software.RESULTS: Polymorphisms followed the Hardy Weinberg Equilibrium. In the allelic association, all the polymorphisms analysed showed no statistical significance. Hence, there was no significant difference in the allelic frequencies between non-syndromic cleft lip palate patients and healthy controls. The odds ratio was not more than 1.6 for all the SNPs. Haplotype analysis showed that haplotypes were not significantly higher in non-syndromic cleft patients than in control subjects.CONCLUSION: There is no association between SNPs analysed in the locus 13q33.1-34 with cleft lip palate.KEYWORDS: cleft lip palate, chromosome, polymorphis

Assessment of the effect of injection magnesium sulphate on fetal heart rate pattern in patients of eclampsia and preeclampsia

Background: To assess the effect of injection magnesium sulphate on fetal heart rate pattern in severe preeclampsia and eclampsia.Methods: This is a hospital-based prospective observational study. It was conducted in the Dept. of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over period of one year from August 2014 to July 2015.Total 122 patients with diagnosis of severe preeclampsia and eclampsia who received injection MgSO4 were included in the study. Patients who delivered within 1 to 2 hrs of injection MgSO4, had pulmonary edema, respiratory depression, renal insufficiency, patients with recurrent convulsions not controlled by MgSO4 alone, fetus who had abnormal fetal heart rate pattern prior to administration of injection MgSO4, IUD baby, baby of gestetional age &lt;28 weeks were excluded from the study. Fetal heart rate pattern tracings were taken by CTG machine before administration of injection magnesium sulphate. Injection magnesium sulphate was given according to Pritchard Regime. Fetal heart rate pattern after injection MgSO4 were compared with fetal heart rate pattern before injection magnesium sulphate regarding all four parameters fetal heart rate, variability, accelerations and deceleration.Results: Before injection magnesium sulphate mean fetal heart rate was 148.7 bpm+10.78. After 15 minutes mean fetal heart rate was 147.8 bpm+10.32.After 1hour, 2 hour and 4 hour of injection magnesium sulphate mean fetal heart rate was139.1 bpm+9.6,139.2 bpm+9.8 and 137 bpm+9.4 respectively which was statistically significant (p value &lt;0.001). Only patients with good variability were included in the study. After 1 hour of injection magnesium sulphate 16.4%, after 2 hour 23% and after 4 hour 31.1 % developed poor variability i.e. &lt;5. Before injection magnesium sulphate only 4% had no acceleration, after 15 minutes, 1 hour, 2 hour and 4 hour of injection magnesium sulphate 4.9%, 29.5%, 49% and 55% patients had no acceleration respectively. Before injection magnesium sulphate no patient had late deceleration. After 15 min only 2 patients had variable prolonged deceleration. After 1 hour, 2 hour and 4 hour 0%, 4.1% and 6.6% had late deceleration respectively.Conclusions: Maternal exposure to magnesium sulphate in severe preeclampsia and eclampsia is associated with persistent fall in baseline fetal heart rate by approximately 9-11 bpm which appeared at 1 hr of injection MgSO4 but it is within the accepted normal range (110 bpm - 160bpm). Statistically significant patients developed decreased beat to beat variability &lt;5 after 1 hr of injection MgSO4. Statistically significant patients developed absent acceleration. Few patients developed late decelerations but it was not significant

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine