Hypertensive diseases in pregnancy are a significant cause of morbidity and mortality, particularly in low resource settings (LRS). Pre-eclampsia and eclampsia alone claim up to 50 000 women's lives globally each year, with an estimated fetal case death of 7–25% in African countries.1 Accurate and regular antenatal blood pressure (BP) monitoring is a cost effective means for early identification and management of hypertensive disease in pregnancy. No BP devices suitable for use in LRS have been assessed for accuracy in pregnancy. Aim To evaluate the accuracy of the semi-automatic Omron HEM-Solar BP device in pregnancy and pre-eclampsia according to the British Hypertension Society (BHS) protocol. Methods Pregnant women were recruited from St Thomas' Hospital (UK) and Kimberley Hospital Complex (South Africa). Trained observers took nine sequential same-arm BP measurements from each woman, alternating between mercury sphygmomanometry and the device. Data were analysed according to BHS guidelines, requiring an A or B grade (for both systolic and diastolic pressures) to pass. Results The device achieved an A/B grade in pregnancy (n=30) including five women with pre-eclampsia. The mean difference (SD) between observers and device was −4.0(5.8) mm Hg and −0.1(8.5) mm Hg for SBP and DBP respectively. Conclusion The Omron HEM-Solar can be recommended for clinical use in pregnancy. Low cost, ease of use and solar power make it ideally suited to a LRS for use by skilled and unskilled health workers. It has the potential to facilitate early diagnosis of pre-eclampsia and address the disproportionate burden of maternal and infant morbidity in LRS.
Background: Parkinsonism is a clinical syndrome of akinesia, with or without rigidity, tremor, and postural and gait disturbance. It may be caused by primary degenerative conditions of the brain involving the basal ganglia. We conducted this study with the aim to study the demographic and clinical features of patients with degenerative Parkinsonism presenting to Indraprastha Apollo Hospitals. Methods: A prospective observational study was conducted at Indraprastha Apollo Hospital between September 2014 and June 2016.A total of 80 patients were enrolled for the study after taking an informed written consent. Among the 80 patients, 40 patients were typical Parkinson's disease patients and the other 40 were atypical Parkinsonism patients. Results: In this study we recruited a total of 80 patients which included 40 patients of parkinsonism and 40 patients of atypical parkinsonism. Among the parkinsonism patients, 27 (67.5%) were males, 3 (7.5%) had family history of parkinsonism and 28(70%) were on levodopa-carbidopa therapy. The mean age among typical parkinsonism patients was 66.25±10.55 (mean±SD), mean age of disease onset was 60.64±11.76 and mean duration of the disease was 5.65±4.54. The mean Hoehn and Yahr was 2.54.The mean UPDRS (stage 1-3) was 45.98±21.98 and the mean UPDRS (stage 3) was 31.53±17.39. According to UPDRS part 1-item 4, the mean apathy score was 0.11±0.21), the mean HAMD score in typical Parkinsonism was 6.13±7.66, and mean MMSE score in was 27.75±4.64. Conclusion:Our study demonstrated socio-demographic and clinical presentation of Parkinsonism patients in our setup. Most common comorbid conditions were also identifies.
Introduction 10–15% of maternal mortality global maternal mortality is thought to be attributable to pre-eclampsia, claiming up to 40,000 women's lives each year. In many developing world settings countries, pre-eclampsia is frequently under-detected not only because antenatal attendance is low, but also inadequate training in accurate blood pressure(BP) measurements and poor equipment quality.1 2 3 Objective To determine the prevalence of hypertension in pregnancy and the unmet need for antenatal blood pressure measurement amongst women presenting to hospital in rural and semi-rural sub-Saharan Africa and Pakistan-administered Kashmir. Method Prospective observational study: Antenatal (>20 weeks) and postpartum (<7 days) populations who accessed care at a central referral site served by rural clinics in 5 countries; Ethiopia, Zambia, Zimbabwe, Tanzania, Kashmir. Systematic blood pressures were taken using an automated, validated BP device. Results Data from 926 women (454 inpatients, 472 outpatients, mean antenatal gestational age 32.7 weeks) were analysed. 93/926 (10.0%) had sustained hypertension (>140/90). 282/926 (30.5%) had never had a BP taken in their index pregnancy. Discussion >30% of pregnant or immediately post-partum women had no previous antenatal BP measurement during their pregnancy, either due to insufficient provision of this service or poor uptake. That these were women who had accessed referral level care implies significant levels of undetected pre-eclampsia in the community. Urgent research is needed to establish the optimal way to deliver BP monitoring: Could antenatal BP measurement be improved with the availability of a validated, simple to use BP machine for use by a community health workers or rural clinics?
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