Background: Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. Objective of present study was to determine maternal outcome in pregnant women with heart diseases in terms of fetal complication, maternal complication and Mode of delivery.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Government Lalla Ded Hospital, an associated of Government Medical College, Srinagar which is the sole tertiary care referral centre in the valley. 90 women with heart disease which were previously established   or diagnosed during pregnancy were enrolled in the study.Results: In 90 women pregnancies was complicated by heart disease in the study. The prevalence of heart disease amongst all pregnancies found in hospital was 4.3%. The principal cause of cardiac lesion was Rheumatic heart disease (RHD) (56.6%) while congenital heart disease was seen in 13.3%. Among the women who had RHD, mitral stenosis seen in 21 (23.3%) was most common lesion and Multiple cardiac lesions 21 (24.4%) women. Among the women with congenital cardiac disease, mitral valve prolapse was most common constituting 5 (5%) cases. Cardiomyopathy was the most common constituting 7 (7.3%). Heart failure developed in 10 (11.1%) whose NYHA class changed from class I/II to class III/IV. Majority of the women delivered by caesarean section 33 (36.7%) while (35.6%) had a normal vaginal delivery with spontaneous onset of labour. 7% had assisted instrumental vaginal delivered.  9% women had first trimester abortion. There were 4 maternal deaths. 85.6% live births were observed in these women. No baby had congenital heart disease.  72.8% babies born weighed more than 2kg.Conclusions: This study concluded that pre- pregnancy diagnosis, counselling, appropriate referral, antenatal supervision and delivery at equipped centre improve the pregnancy with heart disease outcome for both mother and baby.

Background: The recurrent pregnancy loss (RPL) is defined as two and more failed pregnancies as documented by ultrasound and histopathological examination and suggested some assessment after each loss with a thorough evaluation after three or more losses. RPL is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are few evidence based diagnostic and treatment strategies.Methods: 150 Non pregnant females were taken as both cases and controls in the study. All the pregnancy losses were documented by ultrasound or histological examination after uterine curettage. The control group consisted of women with no RPL with at least one live birth. These two groups were matched on the basis of age and BMI. All the women underwent following examinations, viz. Hysterosalpingography, karyotype of both partners, serum TSH, FT4, prolactin and antibodies for APLA. In addition blood sample were taken for fasting serum glucose and serum insulin level later insulin resistance was calculate using three parameters Fasting insulin > 20IU/ml. Diagnostic of Insulin Resistance. (2) Fasting glucose / Fasting insulin. A ratio of < 4.5 being diagnostic of insulin resistance. (3) HOMA IR.        FG (mg/dl) x FPI (IU/ml) FG (mmol/l) x FPI (IU/ml)------------------------------------ OR -----------------------------------                                             405 22.5Where 1 mmol/l = 18mg/dl, A value of > 4.5 being diagnostic of insulin resistance.Results: 150 patients were enrolled in this study among which 75 were selected as cases and 75 as controls after fulfilling inclusion and exclusion criteria with mean age cases group was28.4+2.37 years and 29.1+2.70 years in control group mean miscarriage rate in study group was 3.17+83 and control group with 0.35+0.48 with statistically significant difference. Mean fasting glucose (96.5+ 7.86) mg/dl, Fasting Insulin (14.1±5.91) IU/ml. Mean Glucose Insulin ratio (8.1±3.39), HOMA-IR (3.4 ±1.51) in the study group and in control group mean fasting glucose was (87.1+11.49) mg/dl, Fasting Insulin (6.9 ± 4.99) IU/ml. Mean Glucose Insulin ratio (17.8 ±11.44), HOMA-IR (1.5 ±1.27) respectively with statistically significant difference.Conclusions: In women with recurrent pregnancy loss fasting insulin and insulin resistance are higher than those in women without spontaneous abortion. The most sensitive parameter for calculating insulin resistance was found to be fasting insulin followed by HOMA – IR and followed by fasting glucose/fasting insulin ratio. It is therefore important to recommend a fasting insulin and fasting glucose level while evaluating a case of recurrent pregnancy loss to assess for insulin resistance.

Background:The interest in cardiac conduction system has focused primarily on its role as a predictor of mortality and coexistent cardiovascular diseases particularly hospitalised patients. Objectives: The study was undertaken to study the association of cardiac conduction defects with underlying cardiovascular diseases and various risk factors. Methodology: The study was conducted from 1st March 2012 to 31st august 2013 and included cases >20yrs of age presenting to OPD or admitted in SMHS hospital and showing some form of cardiac conduction defect on a standard 12 lead ECG. A total of 1710 cases were studied. A thorough medical history and meticulous physical examination was done and relevant investigations ordered to find out the presence of underlying cardiovascular diseases and risk factors Results: Of the 1710 cases, 990(57.9%) were males and 720(42.1%) were females. Most of cases were seen in the age group of 70-79yrs (25.7%). Risk factors including Hypertension was found in 1095(64%) cases, Coronary Artery Disease(CAD) in 445(26%), dyslipidemia in 429(25%), diabetes in 410(23.9%) and gout in 51(2.9%) cases. 1270(74%) cases were smokers, 632(36.9%) were having sedentary life style and 496(29%) cases were obese/overweight. Conclusion: Hypertension, smoking, CAD, obesity and sedentary life style are the major risk factors.

Introduction: Low back ache is the most common problem seen in orthopedic clinic. Low backache with lumbosacral radiculopathy remains the most challenging musculoskeletal problem for its therapeutic management. In around 90% patients, the cause of low back with radiculopathy is a prolapsed disc. Epidural steroid injections are used in the management of patients with subacute or chronic low backache with radiculopathy, not responding to conservative treatment. The aim of study was to check the efficacy of epidural steroid injection in patients of subacute or chronic low backache with radiculopathy due to herniated disc. Material and Methods: The study was conducted over 100 patients reporting to our OPD with chief complaints of LBA with radiculopathy, not responding to conservative treatment. Maximum of three epidural steroid injections were given with two weeks of interval in between. The patients were assessed before and after the procedure and assessment was done using VAS scoring system. Results: In our study, 80% patients got a significant improvement in symptoms according to VAS scoring system. Out of them, 70% improved with only a single dose of ESI, 20% with the second dose and the remaining 10% after third dose. Also the procedure was found to be more effective in treating patients of subacute low backache with radiculopathy rather than the chronic one. Conclusion: ESI is a safe, cost effective and minimally invasive method of treating patients of subacute or chronic LBA with radiculopathy due to herniated disc. The procedure decreases analgesic use and allows early return to work.

Background: Coronary artery disease is often asymptomatic in diabetic patients until the onset of myocardial infarction or sudden cardiac death . . Coronary artery CT angiography can detect Coronary artery disease with high specificity and sensitivity. Aims &objectives: To evaluate the prevalence of coronary artery disease by CT angiography in type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additive risk factors for coronary artery disease. Methods: This hospital based observational study was conducted from March 2013 to August 2014 at GMC Srinagar. This study was carried out among Type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additional risk factors for coronary artery disease. Total of 52 patients with Type 2 diabetes patient underwent Cardiac CT. Results: Mean age of study population was 57.08 ±9.33 years..34 were males and 18 were females. 65.39% of total patient who underwent CT Angiography had plaque in coronary arteries while 34.61% have no plaque and normal coronary vessels. 19.23% patients have significant stenosis defined by luminal narrowing more than 70%. There was statistically significant relation between those who have patient significant stenosis and nonsignificant stenosis with regards to mean age, BMI, duration of diabetes , HDL ,LDL ,total cholesterol ,TG, HbA1c and coronary calcium score. Conclusion: Asymptomatic diabetics with additional risk factors have high prevalence of atherosclerotic plaques with 19% having obstructive CAD .The timely detection of CAD can help in optimizing treatment.