The role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension

Background: Nearly one third intrauterine death of normally formed singleton fetuses are associated with IUGR coexisting with or without pregnancy induced hypertension (PIH). Abnormal fetal circulation is considered a major factor in fetal growth restriction, both as a cause and an indicator. Doppler ultrasound is a relatively new technique which merits investigations as a screening method for IUGR and PIH as both are associated with placental vascular pathology. The development of Doppler ultrasonographic technology, particularly during last 10 years, has provided an opportunity to obtain both qualitative and quantitative assessment of maternal and fetal hemodynamics using a non-invasive method. Objectives were to assess the role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension.Methods: It was a prospective observational study in which 50 pregnant women were taken as cases with pregnancy induced hypertension and 25 as matched controls without any high-risk factor. All patients were examined for colour Doppler spectral flow analysis. Detailed USG results in the form of maturity by biparietal diameter, head circumference, femoral length, abdominal circumference, liquor, and expected fetal weight were measured and noted. Doppler study of umbilical artery, fetal middle cerebral artery, both maternal uterine arteries and ductus venosus was carried out. Parameters in the form of resistive index (RI), pulsatility index (PI) and systolic/diastolic ratio (S/D) of all four arteries were taken. In ductus venosus waveform, changes in the ‘a’ wave were noted. All participants were followed up from the point of the recruitment up to the time of delivery. At the time of delivery, the mode of delivery, any complications, the Apgar score, weight of the baby, birth asphyxia and admission in NICU were noted.Results: The number of patients with PIH were highest in the age group of 21-25 years [n=31 (62%)]. IUGR of fetus occurred in 74% of the cases with PIH, while no any patients with IUGR fetus among the control group. 92% patients among uterine notches showed abnormal fetal outcome in the form of low birth weight, preterm delivery, LSCS for fetal distress, birth asphyxia or NICU admission of the neonate. Out of total 37 (74%) IUGR cases, 24 (65%) cases had fetoplacental Doppler abnormality. Out of total 6 cases with absent end-diastolic flow (AEDF) 4 cases had abnormal fetal outcome and 2 cases had delivered still-born babies. 20 out of 30 cases had abnormal fetal middle cerebral arterial Doppler (MCA) PI, out of which 19 patients had abnormal fetal outcome. 23 cases had abnormal CPR, out of them 20 (87%) cases had abnormal outcome and only 3 cases had normal fetal outcome. The parameters at the time of delivery are number of cases with delivery before 37 weeks of GA (63.3%), SGA babies (70%), LSCS for fetal distress (43.3%), and NICU admission (43.3%).Conclusions: Examining the maternal vessels using Doppler ultrasound, it is possible to determine the risk of complication developing in the course of pregnancy long before clinical signs of preeclampsia appear, so that therapeutic measures may be undertaken early

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

Background: Lung cancer is the most common cancer worldwide. Hence, timely diagnosis and accurate staging of the carcinoma is critical for the treatment and prognosis. So, this study was performed to evaluate the role of CT scan in diagnosis and staging of lung cancer.Methods: This was a prospective and observational study carried out over one and half years at a tertiary care hospital. The patients found to have abnormalities on chest X-ray suggestive of carcinoma were included in the study. Pre and post contrast CT scans were performed. Individual patient biopsies were done for histopathological staging.Results: Most patients belonged to 41-50 years age group with male preponderance (81.33%). Habit of smoking was prevalent among the lung cancer patients. Almost all masses (92%) showed heterogeneous contrast enhancement on CT. Additionally, there were calcifications, cavitation, hilar enlargement, pleural invasion, mediastinal lymphadenopathy and contiguous bone involvement. Adenocarcinoma was the most common (46.66%) form of cancer followed by squamous cell carcinoma (42.66%). For histopathological diagnosis, majority of patients (73.33%) were diagnosed using CT guided biopsy. In the remaining patients, USG guided biopsy or fibreoptic bronchoscopy were performed. The most common lobe affected by bronchogenic carcinoma was right upper lobe. The most common site of metastasis was pleura (22.66%) followed by bone (17.33%). Majority of the patients (41.33%) presented with TNM stage IV.Conclusions: CT scan as a modality for detection and staging of bronchogenic carcinoma is superior to chest radiograph. CT guided FNAC has a high success rate in evaluation of lung carcinoma.

Case series of mucormycosis occurring in patients of COVID-19

Mucormycosis is an umbrella term used for diseases caused by many non-septate filamentous fungal species which is caused by sub-phylum Mucormycotina. It is an acute opportunistic and aggressive fulminant invasive infection that can occur in immunocompromised patients, such as uncontrolled diabetes, renal failure, organ transplant, long-term corticosteroid and immunosuppressive therapy, AIDS, malignancy and corona virus disease 2019 (COVID 19) infections. Mucormycosis is now third most common invasive mycoses after candidiasis and aspergillosis. The COVID-19 infection is characterised by wide range of disease patterns, ranging from mild to life-threatening pneumonia. Many bacterial and fungal co-infections may exist and may be associated with preexisting morbidity or may develop as a hospital-acquired infection such as ventilator-associated pneumonia. Extensive use of corticosteroids and broad-spectrum antibiotics lead to exacerbation of preexisting disease. The aim of this study is to identify the risk factors along with high index of suspicion, early diagnosis and aggressive management of mucormycosis

Spectrum of Radiological Findings in Leptospirosis on Chest Radiograph and Ultrasonography-Study during Epidemics in South Gujarat Region of India

Introduction: Leptospirosis is an acute generalised infectious disease caused by any of the group of spirochetes of the genus Leptospira. The disease can involve many organs mainly liver, central nervous system, kidneys, skeletal muscle, and lungs. Diagnosis can be done on the basis of epidemiological, clinical and laboratory features. As the disease has varied manifestations, it is frequently misdiagnosed even in areas of high prevalence. A delay in diagnosis can leads to severe form of disease and development of its complications. Aim: To find out involvement of thoracic and abdominal organs in each and every patient with the help of chest radiographs and Ultrasonography (USG) of abdomen and thorax. Also, to put together the radiological spectrum of pulmonary manifestations, and other system involvement in leptospirosis during epidemics in south Gujarat region and their role in early diagnosis and follow up of patients. Materials and Methods: Study was carried out for 3 years. Total 380 patients of suspected leptospirosis were referred during epidemic during months of July to October in year 2008, 2009 and 2010 for confirmation of diagnosis and management. Total 275 patients were confirmed for leptospirosis by serological test (ELISA) during first and second week of illness which was included in our study. All 275 patients were evaluated with chest radiographs and ultrasound of chest and abdomen. Those patients which are clinically suspected for leptospirosis but were serologically negative were excluded. Results: Out of 275 confirmed patients of leptospirosis, 54 patients had signs of pulmonary haemorrhage on chest radiograph (19.65%). Out of these 54 patients 50 (which accounts 92% of pulmonary hemorrhage patients and 18% of total 275 patients) died due to severe pulmonary haemorrhage and respiratory distress. Pleural effusion was diagnosed on X-ray chest in 10 patients but it was found in 68 patients on USG. Signs of acute renal disease were found on USG of abdomen in 124 patients (45%). Hepatic involvement was found in 192 patients while 68 patients had multi organ involvement (24.7%). Changes of acute pancreatitis were noted in 11 patients while 16 patients had pericardial effusion and 198 patients had ascites. Conclusion: Chest radiograph and USG study of each and every patient suspected of leptospirosis has got definite role in confirming different organ involvement and thus helps us in early diagnosis, planning treatment and for judgement of prognosis. As it is non-invasive and easily available procedure, it is also helpful for follow-up after treatment