Background: Teenage or adolescent pregnancy is a major public health problem worldwide. Studies show that teenage mothers are more likely to experience pregnancy-related complications and maternal death compared to adult mothers. Hence, this study was conducted to study the socio-demographic profile and the maternal and fetal outcomes associated with teenage pregnancy and compare it with those of mothers aged 20-30 years.Methods: A cross-sectional comparative study was conducted in Government General Hospital, Guntur from April 2016 to October 2016. 50 adolescent mothers aged <19 years and 50 mothers aged 20-30 years were respectively selected as cases and controls. Data on socio-demographic profile, obstetric complications and fetal outcome was collected using a pre-designed, pre-tested, semi-structured questionnaire by face-to-face interview. Data was analysed by entering it in MS Excel worksheet.Results: Mean age was 18.2 years in adolescent mothers and 23.2 years in controls. Mean age at marriage was 17.3 years in adolescent mothers and 19.9 years in adults. Among teenage mothers 48% were Hindus, 72% upper lower socio-economic class, 88% from rural areas, 32% illiterates, 72% housewives and 32% had consanguineous marriages. Prevalence of under-nutrition (36% vs 14%, p<0.05), PROM (20% vs 4%, p<0.05), PPH (20% vs 4%, p<0.05) was significantly higher in adolescent mothers compared to adults. Prevalence of PIH was significantly lower in adolescent mothers compared to adults (8% vs 28%, p<0.05).Conclusions: Complications like maternal under-nutrition, PROM, PPH, preterm delivery and low birth weight babies were higher in teenage mothers compared to adult mothers. PIH was higher in adult mothers compared to adolescent mothers.

No abstract

No abstract

Cardiovascular involvement is one of the end-organ complications commonly reported in coronavirus disease 2019 (COVID-19). It has also been postulated to be an independent risk factor for increased mortality in COVID-19-infected patients. With such a significant effect of COVID-19 on the cardiovascular system and vice versa, it is pivotal for physicians to observe this association closely for improving management and understanding prognosis in these patients. Here, we present three patients and describe their baseline cardiac risk factors, the cardiac complications they developed in association with COVID-19 infection, and their varying outcomes.

Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.

PURPOSE:Catheter based revascularization is the treatment of choice for a STEMI. Since "TIME IS MUSCLE", any intervention to shorten the time from first medical contact to balloon inflation is felt to have benefit. The ability to perform a 12 lead ECG in the field allows the pre-hospital detection of a STEMI and activation of the STEMI team. However, false activation can result in wasted manpower and increased cost. Prior studies have reported a false activation rate of 12-36%. Reasons for false activation have been investigated, and found to commonly be due to poor quality and mis-interpretation of the 12 lead in the field. What have not been reported are the characteristics and outcome of the group of patients whose STEMI is cancelled. The purpose of this report is to describe who are the cancelled STEMI patients, what was their presenting complaint, where did the activation occur, why was it cancelled and what was their outcome. METHODS:All STEMI activations presenting to a community based Emergency room from January 2015 through December 2019 were reviewed. Data included; site and reason of activation, source and reason for cancellation, co-morbid medical conditions and outcome. RESULTS:During the 5 year interval, a total 418 STEMI cases resulted in activation of the STEMI team by EMS or the ED. Of these 143 were cancelled representing 34.2% of activated STEMI's. Of the cancelled STEMI patients, 107 (75%) were activated in the field and 36 (25%) in the ER. The average age was 67 years (range 25-96). Cardiology was involved with the decision to cancel in 98%. Three chief complaints accounted for 82% of the cases: Chest Pain 44%, shortness of breath 21%, and altered mental status including syncope 21%. Out-of-hospital-cardiac-arrest accounted for 7%. The reasons for cancellation were: a poor quality or false positive ECG 54%, Acute Coronary Syndrome -NSTEMI 34%, Co-morbid medical conditions 12%. The group of cancelled STEMI patients had a mortality of 12.5% after arrival to the ER and before discharge. CONCLUSIONS:The cancelled STEMI patient is not always a false alarm. While they may not be suffering from a coronary occlusion requiring emergent revascularization, many have significant medical conditions requiring emergent care and have a mortality during the index presentation that is 3x higher than the STEMI patients. CLINICAL IMPLICATIONS:The cancelled STEMI patient represents a clinical challenge to the Emergency Room team. An immediate decision needs to be made to continue with or cancel the STEMI. This skill set requires recognition of the common ECG causes for false activation and a focused assessment for significant co-morbid medical conditions. Knowledge of the ECG causes can be used as teaching points to first responders and ER physicians. This has the potential to result in fewer false activations and less wasted manpower.

No abstract

No abstract