Retrospective study of maternal near misses in a tertiary care institute

Background: Traditionally, the analysis of maternal deaths has been the criteria of choice for evaluating women’s health and the quality of obstetric care. The objective of the study was to determine the (Maternal near miss incidence ratio) frequency of maternal near miss and to study the demographic profile, etiology and lifesaving interventions done in near miss cases.Methods: A retrospective study was conducted in department of Obstetrics and Gynecology in Chirayu medical college, Bhopal. This is a tertiary care institution and a referral hospital. The study was done during a period of one year from August 2014 to August 2015. During this period 1500 antenatal patients were admitted; of which 30 patients with potentially life threatening conditions were diagnosed; who met WHO 2009 criteria for near miss; along with clinical/laboratory evidence for the same, were selected for the study.Results: The Maternal near miss incidence ratio was 20/1000 live births in our study. In our study 53.3% were in 21-25years age group with a mean age of the patients was 26.3 + 5 years. 93.3% were unbooked, 66.6% were primigravidas, 73.3 % were term patients, 60% were low income group, 73.3% were urban residents, and 76.7% were antenatal cases. In our study 60% patients presented with bleeding PV, 56.3% presented with PPH, 13.3% presented with ecclampsia and 26.7% had pregnancy with jaundice. All patients required ICU for monitoring and interventions as multiple blood transfusions (60%), dialysis (13.3%), liver function monitoring (26.7), encephalopathy (3.3%) and DIC monitoring (20%). 6.7 % required ventilator and 13.3% were managed for multiorgan failure in our study. 26.6 % were managed with uterine packing and MRP, 16.7% were managed with uterine balloon temponade and post-partum hysterectomy in 16.7% cases and internal iliac ligation was done in 13.2% cases in our study. Cesarean section was done in 16.7% cases, 66.6% had vaginal delivery and 16.7% underwent hysterectomy due to haemorrhage and post-partum endometritis in our study.Conclusions: The study concludes that maternal near miss could be an important tool to assess maternal morbidity burden. We can utilize our knowledge of maternal near miss cases to reduce maternal mortality by identifying preventable factors and doing vigilant timely interventions

Maternal and fetal outcome in jaundice complicating pregnancy: a prospective study

Background: The objective of the study was to study maternal and fetal outcome in pregnancy complicated with jaundice.Methods: 30 antenatal patients with clinical /laboratory evidence of Jaundice were selected for study in period between august 2014 to august 2015.Results: The peak age of incidence in our study was 21-25 years (66.6%) and majority were primigravida (66.6%). All cases were in third trimester of pregnancy, 93.3% were unbooked, 73.3% were term, 60% were of lower socioeconomic status and 73.3% were urban. All patients presented with jaundice at time of admission. Pruritus was most common presenting symptom present in 60% of patients. Other presenting complaints were nausea, high BP, abdominal pain and petechiae. Viral Hepatitis was most important cause of jaundice in this study found in 46.7% of cases. Preeclampsia and ICP were other causes of jaundice in this study. Hepatitis B was the most common cause of acute hepatitis (26.7%) and incidence of hepatitis E was 13.3% in our study. Maternal mortality was found in 1 case of hepatitis E complicated with hepatic encephalopathy and coagulopathy. 2% of these patients developed FHF. All patients were kept in ICU for intensive monitoring. PPH was most common maternal complication in 60% of patients. There was 1 maternal death in our study. Of 30 patients, 12 had spontaneous onset of labour. All delivered vaginally of which 8(26.7%) were preterm of which 2 died, 4(13.3%) were IUFD, 12 (40%) had fetal distress with meconium stained liquor, 5 (16.6%) had PROM, 2 (6.7%) had fetal growth restriction and 2 (6.7%) delivered uneventfully.Conclusions: Jaundice in pregnancy results in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and careful management

Pyocolpos at puberty: a very rare entity

This is a case report of a 12 year girl who reported with a H/O incomplete bladder evacuation & burning in micturition since one month, urinary incontinence once only. She had no abdominal pain or fever & had not attained menarche. The stature was short, thelarche attained 4 months back. No bulge in abdomen. Other general examination features normal. Urine examination was normal. USG suggested hematocolpos with imperforate hymen. On this basis local examination was done. Imperforate hymen with otherwise normal external genitalia found. Pubic & axillary hair absent. Preoperative diagnosis was imperforate hymen & hematocolpos with ? androgen insensitivity syndrome. She could not afford serum DHEAS levels. With this diagnosis it was worrisome to think that patient had attained menarche (cryptomenorrhoea) with androgen insensitivity as pubic & axillary hair had not appeared even after the presumed menarche, which should have appeared well before menarche. Her short stature was also not expected to change after menarche. Hymenotomy under GA done, 490 ml of mucopurulent discharge was drained. Postoperative period uneventful. Now she is expected to have a growthspurt, adrenarche & menarche. In prepubertal girls with urinary complains, the possibility of imperforate hymen with hematocolpos/pyocolpos should be considered as differential diagnosis. Incorporating an examination of external genitalia into routine practice of clinicians caring for children can prevent the significant delay in the diagnosis of imperforate hymen

A COMPARATIVE ANALYSIS OF VITAMIN-C CONCENTRATION IN COMMERCIAL FRUIT JUICES AND FRESH FRUITS OF NEPAL WITH EFFECT OF TEMPERATURE

Objective: It was aimed to determine the best storage temperature for fruits to achieve the highest quality of vitamin-C and to compare vitamin C concentration between commercial fruits juices and fresh fruit juices in by using Spectrophotometry and Titrimetric method Methods: Titration involved the redox reaction between iodine and vitamin C. As the iodine was added during the titration, the ascorbic acid was oxidized to dehydroascorbic acid, while the iodine was reduced to iodide ions. The Spectrophotometric method involved the coupling reaction of 2,4 dinitrophenylhydrazine (DNPH) dye with Vitamin C. The samples were analyzed using UV-Vis-Spectrophotometer at 521 nm. Results: Titrimetric and spectroscopic methods were performed for fresh and marketed fruits comprising of apple, grapes, lemon, orange. The maximum amount was found in lemon and orange whereas apple and grapes contained lesser amount of Vitamin C. The stability of marketed fruit juices made up of apple, grapes, lemon, orange were analyzed by storing them on the freeze at 0 °C and 10 °C and on the hot air oven at 20 °C, 30 °C, 40 °C, 50 °C for 72 h and estimated by both Titrimetric and Spectroscopy method. UV-Spectroscopy method showed that, at freezing condition up to 10 °C temperature, degradation was too low but when the temperature reached 50 °C the extent of degradation was more, showing 24.56% apple juice, 10.89% orange juice,12.70% grapes juice and 50% orange juice were degraded in 100 ml sample. Similar results were observed by analysing the samples with titration technique. Conclusion: A new analytical method was developed to address the content of vitamin C in fruits consumed in the local market of Nepal along with the best possible storage of fruit juice to yield the maximum amount of nutrients

Auditing of prescriptions in relation to diarrhea in children below 5 years of age: a multicenter study

Background: This study was planned to determine the prescribing pattern of drugs in children below 5 years of age suffering from diarrhea by different categories of doctors in the city of Jaipur (Rajasthan).Methods: This observational retrospective study was conducted in the Pediatric Outpatient Department of SMS Medical College and other hospitals in Jaipur (Rajasthan). In this study, 300 prescription (10% of total prescription) of the children aged below 5 years, suffering from acute diarrhea, were randomly selected.Results: As alone, norfloxacin was noted in 49.2% prescriptions followed by ofloxacin in 24.6% out of 61 prescriptions. In combination, the most common antimicrobial (77.78%) prescribed was norfloxacin with either metronidazole or tinidazole.Conclusions: Antimicrobials should be prescribed rationally for pediatric patients suffering from diarrhea to avoid potential adverse events and increased cost of the treatment . Regular prescription audits in hospitals should be undertaken to promote rational use of drugs

Reducing AIDS-related stigma and discrimination in Indian hospitals

People living with HIV/AIDS in India, as elsewhere, face stigma and discrimination in a variety of contexts. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services. Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against people living with HIV/AIDS. This report presents the findings which noted that despite variation among the hospitals in their action plan accomplishments, overall the intervention process was associated with improvements among healthcare workers in HIV knowledge, attitudes toward people living with HIV/AIDS, and certain practices with respect to HIV counseling and testing and confidentiality

Continuum of care for HIV-positive women accessing programs to prevent parent-to-child transmission: Findings from India

This study examined the efforts of PPTCT programs in different cities in India to offer women a continuum of care, and shows that the programs have both strengths and shortcomings. The government launched a national treatment program that offers antiretroviral therapy (ART) to HIV-positive women, children below 15 years of age, and men. However, since the start-up of the ART program there have been concerns about limited access to and utilization of these services by women and children. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, better equip PPTCT providers to inform and counsel women about these topics, and engage NGOs in the community that have outreach services to maintain contact with women over time and link them and their families to a continuum of care

FEASIBILITY OF SUBSTITUTING COCOPEAT WITH RICE HUSK AND SAW DUST COMPOST AS A NURSERY MEDIUM FOR GROWING VEGETABLE SEEDLINGS

Not AvailableThe present study reports the feasibility of partial substitution of coir dust in cocopeat production with sawdust and rice husk as a nursery media. Compost was produced by mixing different ratios of raw coir dust, saw dust and rice husk following ICAR-IIHR protocol. The chemical analysis of compost samples showed that among different treatments, substitution with 25% rice husk i.e.,T5 (75% Raw coir dust + 25% Rice husk) recorded lowest C/N ratio (37.13), phenols and tannins (155 mg/100gm) at 30 days of composting. Further the effect of these composts were studied on germination and survival rate of tomato, chilli, cabbage, cauliflower and brinjal crops along with the application of 5% soil less mycorrhiza in pro trays. The highest germination percentage and seedlings survival were observed in T5 (75% Raw coir dust + 25% Rice husk) in all the vegetables. The study showed that substitution with 25% rice husk produced the best compost for nursery media and produced intact plugs of seedlings of different vegetables compared to other treatmentsNot Availabl

Reducing stigma and discrimination in hospitals: Positive findings from India

People living with HIV (PLHIV) in India face stigma and discrimination in a variety of contexts. Stigma and discrimination against HIV-positive people is common in hospitals and acts as a barrier to seeking and receiving critical treatment and care services. Three New Delhi hospitals, SHARAN, and the Horizons Program collaborated on an operations research project to assess responses to hospital-based stigma and discrimination against PLHIV. A baseline survey to measure HIV/AIDS-related attitudes, knowledge, and practices was conducted in 2000 with a random sample of 884 health workers from four departments: medicine, STD and skin, obstetrics and gynecology, and surgery. Based on this assessment, hospital managers and senior representatives of doctors, nurses, and ward staff developed action plans to improve the situation. As noted in this research summary, hospital managers who used a checklist to assess their facilities’ policies and practices took action to improve staff safety and reduce AIDS-related stigma. Findings suggest that the actions taken, including education, training, policy formulation, and involvement of AIDS NGOs, contributed to improved knowledge, attitudes, and practices among health workers

A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO)

Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). We then compared clinically significant electrolyte and acid-base abnormalities in the first 72 hours post-transplant. The primary outcome, acute hyponatremia, was experienced by 53% of 68 participants in the Plasma-Lyte-148 group and 58% of 69 participants in the standard fluids group (odds ratio 0·77 (0·34 - 1·75)). Five of 16 secondary outcomes differed with Plasma-Lyte-148: hypernatremia was significantly more frequent (odds ratio 3·5 (1·1 - 10·8)), significantly fewer changes to fluid prescriptions were made (rate ratio 0·52 (0·40-0·67)), and significantly fewer participants experienced hyperchloremia (odds ratio 0·17 (0·07 - 0·40)), acidosis (odds ratio 0·09 (0·04 - 0·22)) and hypomagnesemia (odds ratio 0·21 (0·08 - 0·50)). No other secondary outcomes differed between groups. Serious adverse events were reported in 9% of participants randomized to Plasma-Lyte-148 and 7% of participants randomized to standard fluids. Thus, perioperative Plasma-Lyte-148 did not change the proportion of children who experienced acute hyponatremia compared to standard fluids. However fewer fluid prescription changes were made with Plasma-Lyte-148, while hyperchloremia and acidosis were less common