The present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome. MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis. ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (pvalue <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes. ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.
Background and Objectives. Fetal weight evaluation in utero is a significant component in obstetric practices. The present study aims to estimate the fetal weight (EFW) by evaluating two available formulas using ultrasound parameters and comparing them with actual birth weight (ABW) after delivery. The accuracy and efficacy of both EFW formulas in detecting intrauterine growth retardation (IUGR) and macrosomia were also compared in our local sample of the population. Methods. The cross-sectional study included 100 pregnant women aged 20–45 years from the Kamrup district admitted to Guwahati Medical College and Hospital, Guwahati, Assam. The data were analyzed using Microsoft Excel and SPSS version 16. The EFW at term was calculated using Shepard’s formula and Hadlock’s formula. Differences in means are compared using the one-way ANOVA or Kruskal–Wallis test and paired t-test. The accuracy of the two procedures was evaluated using mean absolute error (MAE) and mean absolute percentage error (MAPE). A p value<0.05 was considered significant. Results. The present study included 100 pregnant women aged 21–38 years with term or postterm pregnancies subjected to ultrasonographic evaluation within 72 hours of delivery. The mean (±s.d.) EFW by Shepard’s formula was 2716.05 (±332.38) g and Hadlock’s formula was 2740.44 (±353.23) g, respectively. For Hadlock’s formula, MAE ± s.d. was found to be higher (overall 84.59 ± 76.54) specifically in the weight category less than 2500 (106.42 ± 88.11) as compared to Shepard’s (overall MAE ± s.d = 79.86 ± 64.78, and among ABW < 2500 g, MAE ± s.d = 65.04 ± 61.02). The overall MAPE of Hadlock’s formula was 3.14% and that for Shepard’s formula was 2.91%, and the difference was not statistically significant. Both Shepard’s formula and Hadlock’s formula had a sensitivity of 92.85% in detecting IUGR, but Hadlock’s method had higher specificity (66%), higher PPV (86.67%), and higher NPV (80%). Conclusion. The ultrasonographic evaluation of fetal weight helps predict fetal birth weight precisely and can influence obstetric management decisions concerning timing and route of delivery, thus reducing perinatal morbidity and mortality.
Purpose Death due to acute poisoning is one of the significant health challenges to cope-up. It is imperative to know the death victims’ pattern due to acute poisoning to prepare the relevant preventive and remedial measures. Therefore, the present study aimed to assess the pattern of the dead victims of acute poisoning in a tertiary care centre. Materials and Methods It is a hospital record-based study and conducted in a tertiary care centre. Descriptive statistics to study the distribution of the cases among different age groups, sex, type of poison compounds was computed and analysed using SPSS software version 20. Results The present study detected poisonous substances in 244 (41.8%) cases out of 584 death cases of suspected acute poisoning with the male preponderance of 62.29%. A higher incidence of acute poisoning was noticed among the young age group 21–30 years (33.6%) with 48 (31.6%) cases among males and 34 (36.9%) cases of the female. The Organophosphates (OP) was the main compound found in 151 (61.9%) fatal cases, followed by Carbamate in 45 (18.4%) cases. We also observed a maximum, 76 (36.2%) cases of suicidal victims in the age group of 21–30 years. Children and lower age group were more vulnerable to accidental poisoning as 26.5% cases of accidental death were reported in both the age group of 0–10 and 11–20 years respectively, gradually declining and practically found nil in above 60 years group. These differences of frequencies were found statistically significant (p < 0.0001), χ 2 = 55.1. Conclusion The results suggest due consideration to the young adolescents’ groups without any sexual discrimination to define guidelines for appropriate handling, storage and transportation of the poisonous compounds. Organophosphate’s involvement as the most preferred agent in acute poisoning is to be remembered to help manage poisoning cases.
Background and objectiveIn severe sepsis, increased blood lactate levels are observed indicating impaired oxidative phosphorylation, which secondarily causes hypoxic hypoxia and stagnant tissue hypoxia. Among all other related factors, a high rise of the lactate level in blood may be a useful predictor of sepsis patients' mortality. This study aims to determine the association of consecutive blood lactate levels with the patient's mortality with sepsis admitted in the Critical Care Unit (CCU). MethodsThis prospective study included 50 patient of septicemia at CCU above 18 years in a tertiary care centre. On admission, at 24 hours and 72 hours, blood lactate levels were monitored. Their clinical status was evaluated for 28 days to categorise as survivor and non-survivor. The statistical analysis was made with Microsoft Excel and SPSS version 20. To test the difference in mean blood lactate levels among survivors and non-survivors Student’s t-test was applied. A p-value of less than 0.05 was considered significant. Prior ethical clearance from the institutional ethics committee of human with informed consent from the patients was obtained for data collection.ResultsThe current study included 50 patients of septicemia, 23 were survivors, and 27 were non-survivors after 28 days of follow up. The mean lactate range for the 23 survivors was ranged from 0.43 mmol/l to 5.69 mmol/l, whereas for non-survivors, it was 1.64 mmol/l to 6.14 mmol/l. The mean value of lactate for the survivors and non-survivors during admission, at 24 hours and at 72 hours were 0.9545±0.45798 vs 2.5204±1.51498, 1.2461±1.21360 vs 2.5107±1.63678 and 1.5496±1.66788 vs 2.7904±2.00160. The differences between the mean lactate values between survivors and non-survivors at different time intervals were highly significant.ConclusionA slower rate of lactate clearance during hospitalisation may be a significant factor associated with severe sepsis patient mortality. Thus serial blood lactate levels is a significant predictor of mortality and should be monitored.
Background: Due to high prevalence of Diabetes Mellitus in India, Diabetic nephropathy is on the rise. Diabetic Nephropathy is the leading cause of End stage renal disease and the major factor responsible for renal transplantation. Grey scale ultrasound can detect morphologic renal parenchymal changes late in the disease but the functional haemodynamic changes can be detected early on, by the means of doppler indices such as Resistive Index (RI) and Pulsatility Index (PI). Hence, application of renal doppler can aid in the diagnosis of early nephropathic changes to allow early medical intervention, therefore improving disease prognosis. Methods: Renal doppler ultrasonography was performed in 64 diabetic individuals, in the main renal artery and at the interlobar arteries of both kidneys in the upper pole, interpolar region, and lower pole. RI and PI were obtained for each artery and averaged. The correlation between the Mean RI and Mean PI, each with HbA1c and serum creatinine was checked for every patient using relevant statistical tests. Results: Mean RI and PI in study participants were above the normal range. RI and PI both showed a statistically significant positive correlation with serum creatinine, HbA1c as well as the age of the patient and duration of diabetes mellitus (p<0.001). Conclusions: Evaluation of renal doppler indices while correlating them with laboratory parameters can help slow disease progression. The patient can be provided with medical intervention at the early stage on detection of altered renal indices, hence reducing morbidity and mortality and significantly improving disease prognosis and outcome.
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