Clinicohematological profile of patients of sepsis admitted in intensive care unit in a tertiary care hospital in Western India

Background: Sepsis is a life-threatening medical condition triggered due to body's response to an infection. If empirical treatment for sepsis and bacteraemia is held up it will increase chances of mortality as well as duration of stay and cost. Hence, there is a need for risk stratification. So, we planned to study the clinicohematological profile of patients of sepsis admitted to this hospital in ICU.Methods: This was an observational study. A total of 50 patients of sepsis were included. All included participants were subject to CBC, RFT, LFT, RBS, Urine RM, ESR, chest X-ray, USG Abdomen.  Laboratory evaluations were performed in the institutional pathology and biochemistry labs. Data was analysed to assess the clinicohematological profile of the patients of sepsis to identify common factors which if taken care of in time can reduce development to sepsis and the morbidity and mortality related to it.Results: Most common presenting complaint was fever (72%), followed by altered sensorium (58%), vomiting (30%), jaundice (30%) and breathlessness (20%). Most noticed signs were pallor (36%), icterus (36%), edema (6%), reduced air entry (34%) and crepitations (26%). Most common source of the infection were abdomen (28%), urinary tract infection (26%) and community acquired pneumonia (24%).Conclusions: Most common presenting complaints were fever, breathlessness, altered sensorium. Most common source of sepsis were urinary tract infection, lung, and abdomen which if adequately treated in time would aid in reducing the number of sepsis patients and thus will control the morbidity, mortality and cost associated with sepsis

A study of feto maternal outcome in primary caesarean section

Background: Primary caesarean section is defined as caesarean section to be performed in women who have not had previous caesarean delivery. The increase in the rates of primary caesarean section is not only due to increased caesarean section in nulligravida but also due to upward rise in caesarean section rates in parous women. Through this study we aimed to examine the frequency and the indications of primary caesarean section in nulliparous and multiparous women.Methods: A prospective study was carried out in the OBGY department of smt. SCL Hospital, NHL municipal medical college from April 2020 to April 2021. All multiparous women with previous normal vaginal delivery who underwent caesarean section this time were included in this study. Patients with previous caesarean section <28 weeks of gestation, patients who did not give consent were excluded from the study.Results: 92% were 20-30 years and are gravida 2 or 3 patients. 85% patients were booked patients. Most common indication of primary caesarean section in parous women was MSL+FD (31%). Difficulty in delivery of the baby was encountered in 45% of cases. Major cause of admission in NICU was MAS.Conclusions: Primary caesarean section has become a major driver of overall caesarean section rate. Decision making on primary caesarean section should be carefully scrutinized, introducing a diagnostic second opinion for all primary caesarean section. Primary caesarean section in both multigravida and primigravida becomes mandatory in many cases to prevent maternal and feta morbidity

A study of caesarean sections in referred cases

Background: Referral is a coordinated movement of healthcare seekers through the health system to reach a high level of care in a small and often fatal window of time. Even physiological processes like pregnancy and childbirth are not free of complications. The purpose of this study is to understand maternal and foetal outcome in caesarean sections in referred cases.Methods: A prospective study was carried out in the OBGY department of SMT.SCL HOSPITAL, NHL Municipal medical college from April 2020 to April 2021. All referred antenatal and intranatal patients to our tertiary care centre with >20 weeks of gestation who underwent caesarean section with referral note.Results: A total 64% patients were referred from community health center. 63.5% patients were referred due to lack of high-risk management services. 211 patients underwent caesarean section while 69 patients had normal vaginal delivery. Difficulty in delivery of the baby was encountered in 53% of cases due to deep engagement of the fetal head. Major cause of admission in NICU was sepsis (38.6%) followed by prematurity (23.8%).Conclusions: Cesarean section is one of the quickest and most efficient method in the delivery of the baby and thus should in considered in patients in critical situations .The millennium development goals defined by united nation includes one goal (MDG 5) towards improving maternal health which still remains a challenge. Thus, improving knowledge of women regarding good antenatal care and strengthening referral services will play a big role in this

Diffuse neonatal hemangiomatosis presenting as congestive cardiac failure - A case report

Infantile hepatic hemangioma has substantial arteriovenous shunting which may lead to cardiovascular compromise and hydrops fetalis. It may present as hepatomegaly since the entire liver is involved in most cases. As mortality is very high, a high index of suspicion is required to make a diagnosis and common complications arising out it, especially in the presence of cutaneous hemangioma. We present a 2-month-old baby born at term presented with features suggestive of sepsis with multiple cutaneous hemangiomas, and on evaluation, there was congestive cardiac failure, which was initially thought of cardiac origin but subsequently came out to be arteriovenous shunting of blood in liver

DESIGN AND EVALUATION OF BUCCOADHESIVE CONTROLLED RELEASE FORMULATIONS OF PROCHLORPERAZINE MALEATE

Objective: The Purpose of this work was to design mucoadhesive tablets of prochlorperazine maleate to release the drug in buccal cavity for an extended period of time in order to avoid the first-pass metabolism.Methods: Six formulations were prepared using different polymer like Xanthan gum, Locust bean gum, Carbopol 974P NF, HPMC K100MCR, Polyox-WSR301 and Gantrez AN139 as a mucoadhesive and controlled release agents. The formulations were tested for content uniformity, thickness, weight variation, friability, in vitro drug release, in-vitro bio-adhesion, swelling index and residence time.Results: Drug excipient compatibility studies performed using DSC. The DSC studies revealed endothermic peak at 200o–205oC for Prochlorperazine maleate. Similarly endothermic peaks were obtained for separate excipient when heated in the range of 50-300 °C indicating their melting points. There was no separate peak observed when the drug was mixed with the different polymers like Xanthan gum, locust bean gum, Carbopol 974 P, HPMC K100 MCR, Gantrez AN139 and Polyox-WSR301 in ratio (1:1) indicating that no interaction took place between drug and polymers used in the study. Dissolution studies of the tablets of the optimized batch (BDS-6) containing Carbopol 974P (CP) and HPMC K100 MCR showed extended release 90.65% up to 24 hr. The bioadhesive force of optimized formulation is 12.18±.011 gm and the maximum swelling index was observed in 3.87±.0057 h.Conclusion: From the study it can be concluded that formulation BDS-6 containing Carbopol and HPMC K100 MCR give a promising result for sustained release action of PrM. Â

The Isoperimetric Problem in Randers Poincar\'e Disc

It is known that a simply connected Riemann surface satisfies the isoperimetric equality if and only if it has constant Gaussian curvature. In this article, we show that Randers Poincar\'e disc satisfies the isoperimetric equality with respect to different volume forms. These metrics do not necessarily have constant (negative) flag curvature. Thus we show that the Osserman's result \cite{RO} in the Riemannian case can not be extended to the corresponding Finslerian case.Comment: arXiv admin note: substantial text overlap with arXiv:2204.0076

Rheumatoid arthritis-associated interstitial lung disease seen in two generation of females in an Indian family

Interstitial lung diseases (ILDs) or diffuse parenchymal lung diseases (DPLDs) are a group of lung diseases that is distinguished by subacute or chronic inflammation and/or fibrosis. Family history is currently being considered one of the biggest risk factors for ILD. Rheumatoid arthritis (RA) a systemic autoimmune disease has lungs as its most common extraarticular organ involved. Interstitial lung disease associated with it is one of the major causes of mortality along with severe disability. Lung involvement in RA might appear as ILD, pleural effusion, or pulmonary vasculitis. In this case report a 42-year-old female presented with complain of progressive breathlessness, dry cough, chest pain, joint pain since past 10 years. HRCT Thorax of patient suggested it to be ILD of UIP pattern with raised RF, anti CCP and positivity in ANA profile. Patient had a family history with mother being diagnosed with ILD-NSIP pattern. She was suspicioned for RA as she had complained of small joint pains and swellings and was responding well to steroids and HCQ