Platelet profile of patients with gestational diabetes

Background: Aim was to evaluate the differences in platelet count and platelet indices between pregnant women with gestational diabetes mellitus (GDM) and apparently healthy pregnant women.Methods: A cross-sectional study was performed with 68 pregnant women with GDM (cases) and 68 apparently healthy pregnant women (controls) after 24 weeks of gestation. The study groups were compared in terms of demographic, clinical and laboratory characteristics including platelet count and platelet indices.Results: Mean platelet volume (MPV) (p=0.002*) and platelet distribution width (PDW) (p=0.010*) were significantly increased in pregnant women with GDM compared to the apparent healthy pregnant women (p<0.05). MPV was well correlated with PDW (p=0.00). Conclusions: The platelet indices on CBC testing can aid in identification of GDM, and can help to prevent various complications associated with GDM. The clinical relevance of these platelet indices needs further studies

Evaluation of neonatal admission to neonatal intensive care unit in a tertiary care hospital in Kashmir

Background: Neonatal period is the most unguarded period which influences the survival and overall wellbeing of a child. Many illnesses affecting the neonates lead to morbidities and mortality among them. According to 2015 Global health observatory (GHO) data, neonatal deaths constitute roughly 45% of all under five deaths. Worldwide, neonatal mortality rate has seen a steady decline by 47% between 1990 and 2015 from 36 to 19 per 1000 live birth. India contributes to nearly 25% of the mortality around the world.Methods: This descriptive retrospective study was carried out at LallaDed hospital, only tertiary care obstetrics and gynaecology hospital of Kashmir valley from August 2020 to January 2021. The study was conducted with records of the neonates who were admitted to NICU of this hospital during the above mentioned time period. The data regarding gestational age, sex, mode of delivery, birth weight, Apgar score at birth, indication for admission and outcome was recorded.Results: The total number of NICU admission during this time period was 252. The mode of delivery was FTVD in 144 (57.1%) and LSCS in 108 (42.9%). The number of preterm babies was 175 (69.4%) and number of term babies was 77 (30.6%). Among the admitted neonates, 141 (56%) were male and 111 (44%) were female babies. The birth Apgar score 0 minutes was 8 in 24, 7 in 75, 6 in 130 and 4 in 23 babies.Conclusions: This study identified RDS and MAS among the most common reasons for NICU admission. Early neonatal period is the major contributor to neonatal mortality which is influenced by birth weight and Apgar score. Understanding causes of neonatal mortality, education and training of medical and para medical staff and implementation of interventions regarding neonatal resuscitation will play major role in decreasing the neonatal NICU admission and mortality thereof.

Evaluation of maternal admission to intensive care unit in a tertiary care hospital of Kashmir valley

Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity

Humidified high flow nasal cannula oxygen therapy in acute bronchiolitis

Background: Bronchiolitis is a major cause of morbidity and leading cause of hospitalization, mostly in early childhood without coexisting illnesses. Traditionally dry oxygen is provided at 100% concentration via low flow nasal prongs. However, the latest studies have revealed that oxygen therapy via heated, humidified, high flow nasal cannula (HFNC) allows the delivery of high inspired gas flows which is better than the traditional one. Methods: All previously healthy children between 1 and 24 months of age with an established clinical diagnosis of moderate to severe bronchiolitis (clinical severity score ≥4) were enrolled for study. The patients were divided into two groups: Patients in Group 1 received HFNC oxygen therapy (HFNC group) while those in Group 2 received conventional oxygen therapy (non-HFNC group). The patients were randomized in each arm by simple randomization. Outcome parameters measured were duration of hospital stay, duration of pediatric intensive care unit (PICU) stay, oxygen saturation (SPO2), respiratory rate, adverse event (respiratory failure), need for intermittent positive pressure ventilation or continuous positive airway pressure. Results: Out of 100 patients studied, 50 received HFNC oxygen and 50 received conventional oxygen. There was early and better improvement in SPO2 and respiratory rate (p&lt;0.001), decreased length of hospital stay (p&lt;0.001) and PICU stay (p&lt;0.01) among the patients in HFNC group as compared to non-HFNC group. The most common adverse event during the hospital course was respiratory failure which was seen among 4 patients in non-HFNC group and none among HFNC group developed such complication. Conclusion: The use of HFNC oxygen therapy in infants hospitalized with acute bronchiolitis reduces PICU and hospital stay as well as the potential complications which will substantially reduce the hospital cost

Electrocardiographic pattern in hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of poor pregnancy outcome and complicate ~6-11% of all pregnancies. When diagnosed during pregnancy, hypertension disorders escalate the maternal risk of placental abruption, cerebrovascular accident and disseminated intravascular coagulation, as well as fetal risk of intrauterine growth restriction, intrauterine death and prematurity. Interpretation of the ECG is an important component in the assessment of cardiovascular adaptations during pregnancy. Methods: In this study, 105 pregnant women (gestational age &gt;20 weeks) with hypertensive disorders of pregnancy (HDP) in the range of 18 to 45 years of age were recruited and compared with the equal number of age matched normotensive pregnant women. ECG parameters were compared with those of normotensive pregnant women. Results: There was left axis deviation in 28.6% in HDP group as compared to 10.5% in control group, while as 71.4% and 84.8% had normal axis in HDP and control group respectively, 4.85% in control group had right axis deviation there was statistical significant difference between the two (p&lt;0.05). There was statistically significant difference between the two groups in ECG characteristics of T wave flattening or inversion in lead III, T wave in lead V1, V2 and V3, (p&lt;0.05). The mean QTc interval was found to be 440.28±43.62 msec in HDP women and 417.42±21.74 msec in normotensive control pregnant women and there was statistically significant difference between the two groups (p=0.000). Conclusions: ECG abnormalities seen in patients with hypertensive disorders of pregnancy (HDP) include left axis deviation, T wave abnormalities, an alteration of ventricular repolarization as evidenced by prolongation of ECG parameters, such as QTc

Neutrophil-lymphocyte ratio as inflammatory marker for clinical prediction and disease severity evaluation of preeclampsia

Background: Pre-eclampsia (PE) is a multisystem disorder that complicates 4-6% of pregnancies and constitutes a major source of morbidity and mortality worldwide. About 10-15% of maternal deaths are directly associated with PE and eclampsia. The aim of this study is to compare the neutrophil-lymphocyte ratio (NLR) values of mild and severe PE with the healthy normotensive pregnant women, in order to study the predictive role of NLR for PE and whether the NLR value has significant difference between normotensive pregnancy, severe and mild PE. Method: A cross-sectional study conducted from January to July 2022 after proper informed consent and ethical clearance. The study population included 194 pregnant women divided into three groups (97 normotensive, 55 mild PE, 42 with severe PE). All the study participants were statistically compared in respect to NLR and the baseline data including age, parity and gestational age. Results: Maternal NLR in mild PE group was statistically increased when compared to normotensive healthy women (p&lt;0.05). Similarly, NLR was significantly higher in severe PE group when compared with normotensive pregnancy group (p=0.00). A statistically significant positive correlation was also seen between SBP (systolic blood pressure) and NLR in PE group (p&lt;0.05). Conclusions: NLR can be used as an inflammatory marker for clinical prediction and disease severity evaluation of PE but further cohort studies are required to determine and establish its role

Pre-eclampsia and platelet indices: a cross sectional study

Background: Pre-eclampsia is a complex disease process originating at the maternal- fetal interface that affects multiple organ systems. The exact pathophysiology of preeclampsia is not known but it is considered to be associated with endothelial cell dysfunction, increased inflammatory responses and hypercoagulability. The receptors located on platelets are activated in pre-eclampsia by several proteases plus the vasoconstriction associated with preeclampsia leads to platelet activation which can be evaluated by platelet indices like platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and palteletcrit (PCT). The objective of this study was to compare the platelet count and platelet indices- MPV, PDW, and PCT in patients with pre-eclampsia and normotensive pregnant women.Methods: A cross sectional study which included a total of 204 patients divided into two groups (102 pre-eclampsia and 102 control. The patients were compared for platelet count and platelet indices like MPV, PDW and PCT.Results: The platelet count (PC) was decreased in pre-eclampsia group as compared to control group with statistically significant difference in means between the two groups (p<0.05). The MPV and PDW also showed significant difference between the two groups (p<0.05) with preeclampsia group having increased MPV and PDW values. The PCT value was lower in pre-eclampsia group as compared to control group but it did not reach statistically significant level.Conclusions: In pre-eclampsia patients while as MPV and PDW showed increased value as compared to control group and the difference between the two had statistical significance, platelet count was lower in them and had statistical significance when compared to control group. Therefore these platelet indices and platelet count can be used to predict and prevent complications arising from preeclampsia

Comparison of serum electrolytes with preeclampsia severity: a cross sectional study

Background: Preeclampsia is a common complication of pregnancy that put women and their fetuses at significant risk and result in life long sequelae. The pathogenesis of this important disease is complex as such the role of different serum electrolytes is being investigated as they are considered important for blood pressure regulation.Methods: A hospital based cross-sectional study of 100 diagnosed cases of preeclampsia divided into mild and severe according to latest International Society for the Study of Hypertension in Pregnancy (ISSHP) guidelines and equal number of age, parity and gestational age matched women (n=100), that acted as control group, with singleton normal pregnancies. Data was analyzed in SPSS V:26. Statistical tests to find out mean standard deviation and One-way ANOVA test were applied to find the significance of associations.Results: In severe preeclampsia group, the mean values of Na+, K+ and Cl- were 134.50±4.24, 4.28±0.74, 106.48±3.41 meq/l respectively in comparison to control group which had 135.57±3.29, 4.12±0.53, 108.20±3.19 meq/l respectively. Results from one way ANOVA showed that there was statistically significant difference between means of the three groups for systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium and chloride levels with p<0.05. A post hoc analysis was used to distinguish the differences in means of these parameters.Conclusions: Estimation of readily available serum electrolytes of sodium potassium and chloride during the course of pregnancy can help to identify and treat preeclampsia and thus reduce the burden of morbidity and mortality in pregnant women

Dynamics and determinants of dividend policy in Pakistan (evidence from Karachi stock exchange non-financial listed firms)

This study examines the dynamics and determinants of dividend payout policy of 320 non-financial firms listed in Karachi Stock Exchange during the period of 2001 to 2006. It is also one of the very first examples which try to identify the potential dynamics and determinants of dividend payout in Pakistan by using the well established dividend models in context of emerging market. For dynamic equation we used the extended model of Lintner, Fama and Babiak and ‘Proposed’ model in dynamic setting. The results consistently support that Pakistani listed non-financial firms rely on both the change in dividends and change in net earnings which clearly demonstrate that the firms rely on both current earning per share and past dividend per share to set their dividend payments. However the study clearly shows that dividend tends to be more sensitive to current earnings than prior dividends. The listed non financial firms having the high speed of adjustment and low target payout ratio show the instability to smoothing their dividend payments. To find out the determinants of dividend payout policy dynamic panel regression has been performed. Firstly, profitable firms with more stable net earnings can afford larger free cash flows and therefore pay larger dividends. Furthermore the ownership concentration and market liquidity have the positive impact on dividend payout policy. Besides, the slack and leverage have the negative impact on dividend payout policy. The market capitalization and size of the firms have the negative impact on dividend payout policy which clearly shows that the firms prefer to invest in their assets rather than pay dividends to its shareholders