Moderate to severe maternal anaemia in pregnancy and its impact on perinatal outcome in tertiary care hospital

Background: Anaemia is the commonest medical disorder in pregnancy and has a varied prevalence, etiology and degree of severity in different populations. The purpose of this study was to evaluate the prevalence of maternal anaemia in pregnancy and its impact on perinatal outcome.Methods: This was a prospective observational study conducted in department of obstetrics and gynecology JLN Hospital Ajmer, Rajasthan, India from October 2015 to December 2016. Total 325 pregnant women were included in the study who fulfilled the inclusion criteria and found to have moderate to severe anaemia.Results: Prevalence of anaemia in pregnancy was 80% in present study. Perinatal mortality was 13.3% in moderate anaemia and in severe anaemia 42%. In present study maximum 56% of cases were in the age group of 20-25 years, and maximum number of cases were primigravida (33.84%). Out of 225 cases of moderate anaemia only 50 cases (22.22%) had antenatal check-up once or twice. Out of 225 cases of moderate anaemia, 66.66% cases were rural and 33.33% cases were of urban group. Fetal outcome in present study was in form of 49.23% premature birth with 33.12% perinatal mortality.Conclusions: Maternal anaemia in pregnancy is associated with illiteracy, low socioeconomic status, multiparity, inadequate antenatal care and rural geographic area.  Severe anaemia was associated with high perinatal mortality

Leishmania donovani Isolates with Antimony-Resistant but Not -Sensitive Phenotype Inhibit Sodium Antimony Gluconate-Induced Dendritic Cell Activation

The inability of sodium antimony gluconate (SAG)-unresponsive kala-azar patients to clear Leishmania donovani (LD) infection despite SAG therapy is partly due to an ill-defined immune-dysfunction. Since dendritic cells (DCs) typically initiate anti-leishmanial immunity, a role for DCs in aberrant LD clearance was investigated. Accordingly, regulation of SAG-induced activation of murine DCs following infection with LD isolates exhibiting two distinct phenotypes such as antimony-resistant (SbRLD) and antimony-sensitive (SbSLD) was compared in vitro. Unlike SbSLD, infection of DCs with SbRLD induced more IL-10 production and inhibited SAG-induced secretion of proinflammatory cytokines, up-regulation of co-stimulatory molecules and leishmanicidal effects. SbRLD inhibited these effects of SAG by blocking activation of PI3K/AKT and NF-κB pathways. In contrast, SbSLD failed to block activation of SAG (20 µg/ml)-induced PI3K/AKT pathway; which continued to stimulate NF-κB signaling, induce leishmanicidal effects and promote DC activation. Notably, prolonged incubation of DCs with SbSLD also inhibited SAG (20 µg/ml)-induced activation of PI3K/AKT and NF-κB pathways and leishmanicidal effects, which was restored by increasing the dose of SAG to 40 µg/ml. In contrast, SbRLD inhibited these SAG-induced events regardless of duration of DC exposure to SbRLD or dose of SAG. Interestingly, the inhibitory effects of isogenic SbSLD expressing ATP-binding cassette (ABC) transporter MRPA on SAG-induced leishmanicidal effects mimicked that of SbRLD to some extent, although antimony resistance in clinical LD isolates is known to be multifactorial. Furthermore, NF-κB was found to transcriptionally regulate expression of murine γglutamylcysteine synthetase heavy-chain (mγGCShc) gene, presumably an important regulator of antimony resistance. Importantly, SbRLD but not SbSLD blocked SAG-induced mγGCS expression in DCs by preventing NF-κB binding to the mγGCShc promoter. Our findings demonstrate that SbRLD but not SbSLD prevents SAG-induced DC activation by suppressing a PI3K-dependent NF-κB pathway and provide the evidence for differential host-pathogen interaction mediated by SbRLD and SbSLD

Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India

Abstract Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0–36.9) to 40.4% (95% CI 37.5–43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7–35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden

Metabolic distress in lipid & one carbon metabolic pathway through low vitamin B-12: a population based study from North India

Abstract Background Dyslipidemia and hyper-homocysteinemia are the major independent risk factors of cardio vascular disease. Deficiency of folate and vitamin B-12 are associated with both hyper-homocysteinemia and dyslipidemia. The aim of the study is to evaluate the relationship of homocysteine and its associated dietary determinant levels (Folate and Vitamin B-12) with lipids and obesity parameters (WC, BMI, WHR) in North Indian population. Methods The participants were recruited under a major government funded project through household survey covering 15 villages of Haryana, India. Participants were both males and females, between age group 30–65 years, from a north Indian community. Initially 1634 individuals were recruited, of which 1374 were considered for analysis as they were not found to be on any kind of medication for high blood pressure, CAD, diabetes or any other disorder, and had no missing data. 5 mL of intravenous blood sample was collected after obtaining written informed consent from the participants. Homocysteine, folate and vitamin B12 levels were estimated through Immulite 1000 by chemi-luminescence technique. Triglyceride, total cholesterol and HDL-C were estimated by spectrophotometry technique using commercial kits. The values for LDL and VLDL were calculated using Friedwald’s equation. Height, weight, waist circumference (WC), hip circumference (HC) was measured over light clothing. Statistical analysis for data was performed using SPSS 16.0 version. Results All the lipid indices, except HDL, showed a trend of negative correlation with homocysteine after controlling for confounders, though not significant. No association was found between obesity (WC, BMI, WHR) and homocysteine in the present study. Vitamin B-12 deficiency was significantly associated with both hyper-homocysteinemia and low HDL. Folate was found to have significantly reduced risk for high TC & LDL. Conclusions The “hcy-lipid” hypothesis does not seem to be complementing in the present studied population. The population is vulnerable to severe under-nutrition due to the association of vitamin B-12 with HDL, leading to metabolic disturbance in both the pathways; lipid and one carbon metabolic pathway. Co-factors such as ethnicity, cultural practices, and lifestyle & dietary habits must be considered while making public health policies to control diseases

Significant Association of History of Miscarriage with Obesity Among Indian Women of Childbearing Age

The aim of the present study was to understand the effect of history of miscarriage and still birth on the risk for cardio-metabolic risk factors among women from an endogamous population after controlling for potential confounders. A total of 562 premenopausal women (out of a total of 1014 women) were considered for the present cross sectional study. They were categorized into three groups based on their reproductive history that is as those with miscarriages, still birth and controls (women with successful pregnancy without any complications). Somatometric measurements, biochemical profiles and blood pressure were measured using standard techniques. Binary logistic regression analysis revealed that women with history of miscarriages had two fold significantly increased risk for overweight/abdominal obesity after controlling for potential confounder. It becomes equitable to argue that women with history of miscarriage have an increased risk for cardio-metabolic risk factors later in life. Therefore, utilization of adverse pregnancy outcome as an early intervention marker is needed to mitigate the further escalation of cardiovascular diseases later in life that may occur due to age or menopause

Additional file 2: of Metabolic distress in lipid & one carbon metabolic pathway through low vitamin B-12: a population based study from North India

Table S1. Distribution of general characteristics between vitamin B-12 normal & vitamin B-12 deficient groups and folate normal & folate deficient groups. (DOC 108 kb

India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics

Abstract The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care