Background The pathophysiology of hypertension in the immediate postpartum period is unclear. Methods and Results We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. Angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. 77 out of 184 women developed de novo hypertension in the postpartum period and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with development of postpartum hypertension. The antepartum sFlt1/PlGF ratio positively correlated with blood pressures in the postpartum period [highest postpartum systolic (r=0.29; P<0.001) and diastolic (r=0.28, P<0.001)]. Moreover, the highest tertile of the antepartum sFlt1/PlGF ratio was independently associated with postpartum hypertension [OR: 2.25 (1.19, 4.25), P=0.01 in the de novo hypertensive group and 2.61 (1.12, 6.05) in the persistent hypertensive group; P=0.02] in multivariable analysis. Women developing postpartum hypertension had longer hospitalization than those who remained normotensive (6.5 ± 3.5 versus 5.7 ± 3.4 days; P<0.001). Conclusions Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension share similar clinical risk factors as well as a similar antepartum plasma angiogenic profile found in women with preeclampsia. These data suggest that postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia.

Among women admitted for evaluation of preeclampsia, women at risk for adverse pregnancy outcomes have higher soluble fms-like tyrosine kinase/placental growth factor ratio on admission, which continued to rise until delivery. Women with high soluble fms-like tyrosine kinase/placental growth factor ratios delivered sooner than women with low soluble fms-like tyrosine kinase/placental growth factor levels. These data support the hypothesis that targeting angiogenic imbalance in preeclampsia may lead to prolongation of pregnancy.

H ypertensive disorders of pregnancy (HDP) affect 5% to 10% of pregnant women, 1 are the most common medical complication of pregnancy in developed countries, 2 and are a leading cause of maternal and fetal death worldwide. 3 HDP include preeclampsia, gestational hypertension, chronic hypertension, and superimposed preeclampsia. Preeclampsia targets the vascular endothelium causing widespread maternal vascular endothelial dysfunction. Antiangiogenic proteins have been implicated as being pathogenic in the development of the observed vascular endothelial dysfunction. 4Overexpression of soluble fms-like tyrosine kinase-1 (sFlt1), an endogenous vascular endothelial growth factor inhibitor, is associated with preeclampsia-like phenotypes in a rodent model and symptoms diminish with the addition of vascular endothelial growth factor or placental growth factor. [5][6][7] Multiple human clinical studies have established that levels of the sFlt1 and soluble endoglin (sEng) increase in the circulation of pregnant women with preeclampsia. 4,6,[8][9][10] sFlt1 and sEng levels are elevated weeks before the clinical onset of preeclampsia, and the degree of elevation correlates with adverse maternal and fetal outcomes. 8,[11][12][13][14][15][16] Few adverse outcomes occur in the absence of angiogenic factor abnormalities. 17,18 Although previous studies have detected changes in myocardial function in HDP, 19,20 a direct association between preeclampsia biomarkers, including sFlt1 and sEng, has not been described. In other abnormal cardiovascular states such as congestive heart failure, increased circulating levels of antiangiogenic proteins have been associated with development of endothelial vascular dysfunction, myocardial dysfunction, and adverse cardiovascular outcomes. 21Women with HDP have abnormalities in both systolic and diastolic cardiac function that seem before clinical symptoms.19,22 Despite preservation of left ventricular ejection fraction (LVEF), 23 longitudinal muscle fiber shortening is decreased, suggesting the presence of subclinical left ventricular systolic dysfunction. 20 This finding suggests a Abstract-Hypertensive disorders of pregnancy (HDP) are associated with subclinical changes in cardiac function. Although the mechanism underlying this finding is unknown, elevated levels of soluble antiangiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt1) and soluble endoglin (sEng) are associated with myocardial dysfunction and may play a role. We hypothesized that these antiangiogenic proteins may contribute to the development of cardiac dysfunction in HDP. We prospectively studied 207 pregnant women with HDP and nonhypertensive controls and evaluated whether changes in global longitudinal strain (GLS) observed on echocardiography is specific for HDP and whether these changes correlate with HDP biomarkers, sFlt1 and sEng. A total of 62 (30%) patients were diagnosed with preeclampsia (group A), 105 (51%) did not have an HDP (group B), and 40 (19%) were diagnosed with chronic or gestational hype...

Background:A clinico-epidemiological study helps to plan future preventive measures and management strategies for spinal trauma. This is a 10 years' retrospective review of spinal-injury patients treated at a tertiary health center in the eastern of Nepal to determine clinico-epidemiological aspects of spinal-injury patients in a predominantly rural population of eastern Nepal.Materials and Methods:All medical record files of patients with spinal injury from 1996 to 2005 in the Medical Record Section of BPKIHS (B. P. Koirala Institute of Health Sciences) were studied. The preformed pro forma consisting age, sex, place of living, mode of injury, hospital stay level of injury, site of injury, associated injury, Frankel grading of neural deficit and treatment modality was filled from the record files of patients. These parameters were entered in Excel 8 and analyzed by EPI INFO 2002. Details of 896 patients of spinal injury were recorded in the 10-year period of review.Results:684 (76.35%) male and 212 (23.66%) female patients with mean age of 41.74 ± 16.53 years and 38.56 ± 15.86 years respectively were studied. Two hundred forty-two (27%) patients were from hilly districts of eastern Nepal. Fall from height [in 350 (39%) patients] was the commonest mode of spinal injury. Six hundred thirty-six (71%) patients presented with a neurological deficit. Seven hundred thirty-three (85%) patients were treated conservatively, compared to 163 (15%) surgically treated patients. One hundred forty-six (22%) patients were treated with operative interventions in the last five years.Conclusion:The study shows that the most vulnerable group for spine injury was the group of patients of productive age with late presentation (i.e., injury hospital duration − 41.64 ± 54.24 hours) without proper prehospital management. The treatment modalities have changed (from conservative to surgical) in this part of the world. These specific observations help us in further planning for preventive measures and management in our setting.

Background: Low back pain (LBP) is by far the most prevalent and costly musculoskeletal problem in our society today. Following the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement, our study aims to define outcome assessment tools for patients with acute LBP and the time point at which chronic LBP becomes manifest and to identify patient characteristics which increase the risk of chronicity.

Introduction:  Osteoporosis is a common metabolic bone disease characterized by increased bone fragility, yet underdiagnosed and undertreated. With the increase in longevity of the populace, it is becoming an urgent and serious global epidemic. This being a preventable disease, has no clinical manifestations until there is a fracture. Early diagnosis and treatment are of dire necessity. Hence the aim of our study is to find the prevalence of osteoporosis among adults attending a tertiary care hospital-based on calcaneal quantitative ultrasound. Methods: This descriptive cross-sectional study was done in a tertiary care hospital, from 15th July 2019 to 15th October 2019 after receiving ethical approval from the Institutional Review Committee (Registration number: 2075 / 76 / 119). Convenient sampling was done. Data collection and entry was done in Microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.    Results: Out of 464 participants the overall prevalence of osteoporosis was 38 (8.2%) at a 95% confidence interval (5.7-10.7). Among the participants, 141 (30.4%) were male and 323 (69.6%) were female. The mean age of the participant was 41.02±14.96 years. Osteoporosis was more common in the older age group 11.66 (30.7%) in 60 years above Women were found to be more osteoporotic than men, 3.42 (9.0%) and 2.43 (6.4%) respectively. Bone mineral density and osteoporosis had a bimodal distribution, underweight 5.01 (13.2%) and obese group 5.32 (14.0%) were the two peaks. Conclusions: The prevalence of osteoporosis in our study is high and is consistent with other South Asian studies. Early detection of osteoporosis using calcaneal quantitative ultrasound can be a good screening tool.

Objective To study the association between cardiac function measured by myocardial performance index (MPI), blood pressures and angiogenic factors measured at the time of echocardiography in patients with and without hypertensive disorders of pregnancy (HDP). Methods We prospectively studied 189 pregnant women and evaluated whether changes in cardiac function observed on echocardiography were correlated with higher blood pressures and whether higher blood pressures were associated with antiangiogenic proteins (soluble fms-like tyrosine kinase, sFlt1; soluble endoglin, sEng). Comprehensive echocardiograms, including measurement of MPI, were performed on all patients. sFlt1 and sEng levels were measured using enzyme-linked immunosorbent assay. Results Overall, 189 patients were divided into tertiles based on mean arterial pressure (MAP). The MPI was worst in tertile 3 (0.50 ± 0.15) compared to tertile 1 (0.42 ± 0.10), p = 0.0004. sFlt1 (pg/ml) and sEng (ng/ml) were highest in tertile 3 compared to tertile 1: 15055.37 vs. 1623.01 and 33.06 vs. 8.15, respectively, with p-value <0.001. In crude multivariate regression analysis, MAP was positively correlated with MPI (r = 0.32, p < 0.001), GLS (r = 0.54, p < 0.001), sFlt1 (r = 0.60, p < 0.001) and sEng (r = 0.61, p < 0.001). After adjustment for confounders, these relationships persisted between MAP and MPI (r = 0.31, p = 0.0003), GLS (r = 0.46, p < 0.001), sFlt1 (r = 0.56, p < 0.001) and sEng (r = 0.58, p < 0.001). Conclusion Mean arterial pressure correlates with worsening cardiac function as measured by MPI and serum levels of angiogenic factors. Further studies are needed to evaluate whether a reduction in blood pressure will reverse changes in MPI or reduce levels of angiogenic proteins seen among women with HDP.

A 10 year-old boy had a traumatic extrusion of 10 cm of the distal radius. The segment of bone was replaced after washing it with providine iodine solution and normal saline, autoclaving and dipping in gentamicin solution for 2 hour. At four and half year's follow-up, there was complete incorporation of the segment with almost full functional recovery. We report this case for its rarity and discuss the treatment.