Introduction: Vitamin D deficiency occurs during pregnancy all over the world because of lifestyle modifications, less sun exposure, sunscreen application and reduced amount of vitamin D in diet. At present, there are very limited number of studies regarding the prevalence of vitamin D deficiency during pregnancy and its effects in the newborns in the North Eastern region of India. Aim: To estimate serum vitamin D levels in pregnant women and newborn and correlation between maternal and newborn hypovitaminosis D. The study also assess the association of maternal vitamin D levels with the outcomes of early neonatal period. Materials and Methods: A prospective cohort study was conducted in Assam Medical College and Hospital (AMCH), Dibrugarh, Assam, India, in the Obstetrics and Gynaecology Department over a period of one year (1st July 2019 to 30th June 2020). Seventy pregnant women attending antenatal ward, labour room of AMCH were recruited. The 25-hydroxy vitamin D level was assessed in the maternal and cord blood. Delivery details and foetal parameters were recorded. Primary outcome was to assess the correlation between maternal and cord blood vitamin D level and secondary outcome was to assess the association of maternal vitamin D level with demographic characteristics, economic and obstetrical characteristics, newborn characteristics and perinatal outcome. Analysis of Variance (ANOVA), chi-square test and Fischer’s- exact test, Pearson’s correlation coefficient (r) were used for statistical analysis. Results: Out of 70 participants, majority of the pregnant women (61.43%) were vitamin D deficient, 22.86% were vitamin D insufficient and 15.71% had sufficient vitamin D levels. Maternal vitamin D level was significantly associated with maternal age (p=0.0043) and socio-economic status (p=0.0417). There was a significant positive association between the vitamin D level of the mother with the birth weight (p<0.001), birth length (p=0.0001), head circumference (p=0.0003) and chest circumference (p=0.001) of the newborns and also a positive correlation was found between the vitamin D level of the mother and the cord blood (r=0.984). There was a significant association between the vitamin D level of the mother and perinatal outcomes such as Neonatal Intensive Care Unit (NICU) admission (p=0.0169) and Respiratory Distress Syndrome (RDS) (p=0.0029). Conclusion: The study shows that there is a high prevalence of vitamin D deficiency during pregnancy in North Eastern part of India and it has a significant role in foetal development and perinatal outcomes.
Introduction: Submitral left ventricular aneurysm is a rare but well recognized entity. The aneurysm can attain a large size often distorting and compressing left atrium and left ventricle from behind. The aneurysm may develop as a complication of myocardial infarction, trauma, previous operation or infection. Mitral regurgitation is a common association. Case Report: The patient Mr. Gollo Tado, a 23 years old male from Arunachal Pradesh was admitted to GNRC Heart Institute, Guwahati with history of palpitation and dyspnoea on exertion, which was more on walking since last four years. Following an accident in 1997 he had chest pain, cough and haemopatysis which were the initial symptoms. The patient is nonalcholic, normotensive, non‐diabetic and non‐vegetarian. On examination his cardiovascular system revealed hyperdynamic precordium, epigastrric pulsation present. Apex beat was present in 7th inter costal space lateral to anterior axillary line. SI soft S2 normal, early diastolic murmur in 4th left parasternal area, systolic murmur at apex. No focal neurological deficit. Bio‐chemical parameters were within normal limit. Chest X‐ray showed cardiomegaly, Echocardiography revealed moderate AR, mild Mr. A large cystic mass posterior to heart, pushing it anteriorly compressing the left atrium and distorting the mitral valve—Submitral Aneurysm (Fig. 1). Coronary angiography‐coronaries normal, LV angio–mild mitral regurgitation. There is opacification of another chamber behind LA with calcification of its wall—Submitral Aneurysm LVEF‐30%. Severe aortic regugitation (Fig. 2). He was taken for operation on 1st November, 2000. Standard Cardiopulmonary bypass was instituted to him with successful delivery of aortic root cardioplegia. Left atrium was opened and the neck of the aneurysm was found calcified along with annulus of the mitral valve and the wall of the aneurysmal in places. Mitral valve was excised and blood was sucked out from the aneurysmal cavity and mouth was closed with dacron patch and mitral valve replacement was done with 27 mm on ‐ X valve (fig. 3, 4, 5 & 6). Meticulous deairing and haemostasis were done before come off bypass. Post‐operatively had several episodes of ventricular arthythmias, which were controlled by injection xylocard. After satisfactory recovery he was discharged on 12th post‐operative day. Discussions: Our patient possibly developed the aneurysm following trauma. The patient became symptomatic following trauma to the chest sustained 3 years back while lifting a heavy log of wood. Presence of heavy calcification on the wall of the aneurysm may also suggest its traumatic origin. The aneurysm was very large (size 10.8 cm) compressing the left atrium and the left ventricle from behind. Coronary arteries were normal but left ventricle was with severe dysfunction. Severe aortic regurgitation was an unusual associated finding in our case. In a few reported cases of repair of Submitral Aneurysm, mitral valve was preserved while in others the mitral valve was replaced with a prosthetic valve ...
Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degrees with an onset, or first recognized, during pregnancy. About 15-45% of babies born to diabetic mothers can have macrosomia. This prospective case control study was conducted in the department of Obstetrics and Gynaecology of Gauhati medical college and hospital, Guwahati, Assam during the period of 2013-2015. A total of 160 patients were included in the study. 100 patients without any glucose abnormality were taken as control and 60 patients with gestational diabetes mellitus were included in the study as cases. In this study it was found that mean birth weight in GDM cases is more than normoglycemic control. The overweight and obesity group (BMI>25) have maximum birth weight. In this study it was found that the fasting blood glucose level is maximum in mothers with baby birth weight >3.5 kg.
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