Search

Background: Hypertensive disorders of pregnancy (HDP) affect approximately 10% of pregnancies and remain a significant contributor to maternal mortality. Current predictive tools lack both cost-effectiveness and diagnostic accuracy. This study aims to develop a cost-effective prediction model for preeclampsia outcomes utilizing the HDP Gestosis score, Mean Arterial Pressure (MAP), and serum homocysteine levels. Methods: Conducted at the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Tiruppur, a tertiary care facility in South India, this retrospective randomized control pilot study involved 60 patients. Patients were categorized retrospectively into low, medium, and high-risk groups based on HDP Gestosis score. Mean arterial pressure at 20-24 weeks gestation and serum homocysteine levels were recorded. Results: Analysis of data from 60 patients revealed varying diagnostic accuracies: HDP Gestosis score alone (71.67%), mean arterial pressure alone (55%), and serum homocysteine levels alone (55%). Serum homocysteine levels demonstrated the highest positive predictive value (96.67%) and were significantly elevated in the preeclampsia group compared to the low-risk group (p<0.0001). The combined GESTO-MAP-H model showed moderate positive correlation (r=0.6) and a cutoff value of 100 exhibited 93.3% sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy in predicting preeclampsia-related complications. Conclusion: While prevention remains a future goal, early prediction and identification of preeclampsia, coupled with timely delivery, are crucial in reducing maternal morbidity and mortality. GESTO-MAP-H emerges as a promising, economical, user-friendly predictive tool, aiding in standardized decision-making to mitigate preeclampsia-related complications. [ABSTRACT FROM AUTHOR]

Introduction: Peri-anaesthetic haemodynamic alterations, such as hypertension and tachycardia, can cause increased bleeding during Functional Endoscopic Sinus Surgery (FESS), impairing the visibility of the surgical field and resulting in scarring, adhesions, and prolonged surgery time. Various strategies involving pharmacological techniques have been used to mitigate these unfavourable reflexes. Alpha-2 agonists, such as Clonidine, are currently being employed to attenuate sympathoadrenal stimulation caused by tracheal intubation and surgery. Ivabradine is a new drug that selectively lowers Heart Rate (HR) by inhibiting cardiac funny current channels. Aim: To compare the effects of premedication with oral Clonidine versus oral Ivabradine on attenuating haemodynamic stress response and improving the quality of the surgical field in FESS. Materials and Methods: The present randomised, placebocontrolled, double-blind study was conducted in the Department of Anaesthesiology and Intensive care at Rajendra Hospital, Government Medical College, Patiala, Punjab, India from April 2021 to December 2022 on 90 American Soceity of Anaesthelogists (ASA) Physical status I and II adult patients (aged 18-60 years) undergoing FESS. Group A (n=30) received oral Ivabradine 5 mg, Group B (n=30) received oral Clonidine 0.2 mg, and Group C (n=30) received oral placebo tablets 2 hours before surgery. Haemodynamic parameters, including HR and Mean Arterial Pressure (MAP), quality of the intraoperative surgical field, postoperative sedation score, Visual Analogue Scale (VAS) score, time to analgesia request, blood loss, and adverse effects, were recorded. Descriptive statistics were used to calculate mean±Standard Deviation (SD) and percentage. Analysis of Variance (ANOVA), Tukey post-hoc test, Kruskal-wallis H test, and Pearson's Chi-square were applied as appropriate. Results: The mean ages were 33.87±12.84, 35.03±12.93, and 40.9±14.46 years for Groups A, B, and C, respectively. The mean weights were 60.5±8.91, 57.83±5.66, and 57.9±5.42 kg, and the mean duration of surgery was 88.67±4.29, 88.8±4.29, and 88.03±3.93 minutes for Groups A, B, and C, respectively. There were no significant differences in terms of gender, ASA score, and type of surgery between the groups. Baseline HR and MAP were comparable among the groups. HR was significantly lower in both Groups A and B compared to Group C at all time intervals (p-value <0.001). Both drugs significantly attenuated tachycardia and hypertension in response to cardiovascular stress induced by laryngoscopy, endotracheal intubation, and extubation. However, Group B showed significantly better control of MAP throughout the intraoperative period and at extubation. The average category scale score, estimated blood loss, and postoperative VAS Score were all significantly lower in Group B than in Group A. Postoperative sedation scores were significantly higher in Group B, and the time to first rescue analgesic was longest in Group B (p<0.05). No significant side effects were observed. Conclusion: Both Clonidine and Ivabradine effectively attenuated the haemodynamic stress response. Clonidine provided better control of MAP, resulting in reduced bleeding, improved operative field visibility, and lower postoperative analgesic requirements compared to Ivabradine. [ABSTRACT FROM AUTHOR]

Aim: Aim of our study was to find the effects of oral L-Arginine on Mean arterial pressure as an add on therapy in hypertensive patients on antihypertensive drugs. Materials & Methods: This was a Randomized clinical trial, registered in Clinical Trial Registry of India (CTRI) Registration number: CTRI/2019/03/018026. All patients with hypertension visiting the Medicine Out-Patient Department (OPD) of Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni, of age between 18-60 years and either gender, were included in the study. Patients on any drug that may affect nitric oxide synthesis or on any other chronic medications other than antihypertensives were excluded from the study. Total 149 hypertensive patients participated in the study and were randomized into Intervention group (I) and Control group (C) of which 74 were in I Group and 75 in C Group. The participants in the I group received standard antihypertensive therapy along with add on L-arginine oral supplementation for 14 days. The participants in the C group received only standard antihypertensive therapy and had followed up similar to that of the participants of I group. Results: The Baseline Mean arterial pressure of I group and C group was statistically non-significant as analyzed by unpaired ttest, whereas in I group there was significant decrease in MAP on 1st, 2nd and 3rd follow up visits compared to C group (Unpaired t-test). Conclusion: The findings of the present study showed that add on L-arginine supplementation at a dose of 3g/d (Gyargin 5gm sachet) for 2 weeks in patients of hypertension resulted in significant decrease in the Mean arterial pressure. [ABSTRACT FROM AUTHOR]

Background: BP monitoring is mandatory in all newborns to find out the cardiac as well as renal diseases. Premature infants have a limited ability to auto regulate cerebral blood flow when compared to full-term infants and hypotension is a major concern in them. Measures should be taken to detect neonatal hypotension and hypertension as earlier as possible and thereby they can be managed well. Aim: To determine the normative distribution of blood pressure in healthy newborns in the tertiary care setting in 1st 48 hours of life. To find out the factors affecting blood pressure in healthy newborn and to find out relationship between blood pressure distribution and anthropometric measurements of neonates. Materials and Methods Study design: This is a descriptive cross sectional study was conducted in the post-natal ward of DR.SMCSI Medical College Hospital, Karakonam, Kerala, India. Study population: Newborns in the postnatal ward after physical examination including modified Ballard assessment and APGAR score at 1 and 5 minutes were selected for the study. Study size: Study consisted of 400 Newborn. Study tools and Data collection procedure: Blood pressure measurements were taken at age 0–24 hours and 25-48 hours, three times at five minutes interval to get average values. BP measurement was performed with the neonate in the supine position, either awake or quiet or during sleep. The newborn was left for 10-15 min after the application of appropriate size cuff to the right arm to ensure quietness [12] . The automatic cuff inflation and deflation by the instrument rendered display of the BP values (systolic, diastolic and MAP) on the screen. Values are disregarded if any movement occurred during the measurement. The entire procedure was repeated twice as a standardization procedure for deriving on a single valid measurement. Weights of infants were measured by placing the baby naked on an infant’s weighing scale and length of the newborn was measured using an Infantometer. Results: The mean SBP, DBP and MAP for term babies in the first 24 hours of life were 70.7±14 mmHg, 39.1±11 mmHg and 49.6±11 mmHg respectively. For preterm, the corresponding values were 70.1±21 mmHg, 36.5±12 mmHg and 47.7±13.8 mmHg respectively. A significant positive correlation (p value<0.05) was observed between heart rate and blood pressure values of newborns both at 0-24 and 25- 48 hours of life. Conclusion: The normative distribution of mean arterial pressure in the term neonates in the first 48 hours of life was 49±9 mmHg. The normative distribution of mean arterial pressure in the preterm neonates in the first 48 hours of life was 47±13 mmHg. All three parameters (SBP, DBP, and MAP) were lower in preterm neonates compared to term neonates. DBP and MAP values significantly rose with increase in the birth weight of neonates at 0- 24 hours. Blood pressure values of neonates are also influenced by gestational diabetes mellitus and use of antenatal steroid. Maternal age and maternal BMI were found to have a significant influence in the blood pressure values of their babies. [ABSTRACT FROM AUTHOR]

Background: To evaluate the performance of the Fetal Medicine Foundation (FMF) preterm preeclampsia (PE) screening algorithm in an indigenous South Asian population., Methods: This was a prospective observational cohort study conducted in a tertiary maternal fetal unit in Delhi, India over 2 years. The study population comprised of 1863 women carrying a singleton pregnancy and of South Asian ethnicity who were screened for preterm pre-eclampsia (PE) between 11 and 14 weeks of gestation using Mean Arterial Pressure (MAP), transvaginal Mean Uterine Artery Pulsatility Index (UtAPI) and biochemical markers - Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor.. Absolutemeasurements of noted biomarkers were converted to multiples of the expected gestational median (MoMS) which were then used to estimate risk for preterm PE < 37 weeks using Astraia software. Women with preterm PE risk of ≥1:100 was classified as as high risk. Detection rates (DR) at 10% false positive rate were calculated after adjusting for prophylactic aspirin use (either 75 or 150 mg)., Results: The incidence of PE and preterm PE were 3.17% (59/1863) and 1.34% (25/1863) respectively. PAPP-A and PlGF MoM distribution medians were 0.86 and 0.87 MoM and significantly deviated from 1 MoM. 431 (23.1%) women had a risk of ≥1:100, 75 (17.8%) of who received aspirin. Unadjusted DR using ≥1:100 threshold was 76%.Estimated DRs for a fixed 10% FPR ranged from 52.5 to 80% depending on biomarker combination after recentering MoMs and adjusting for aspirin use., Conclusion: The FMF algorithm whilst performing satisfactorily could still be further improved to ensure that biophysical and biochemical markers are correctly adjusted for indigenous South Asian women., (© 2021. The Author(s).)

Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine's criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Prospective observational study was conducted in a tertiary care hospital of India over 8 months to measure blood pressure (BP) in healthy term and preterm neonates using oscillometric method and explore the associations with gestational age and birth weight. Consecutive BP measurements were taken by standard oscillometric method on 1617 neonates on day 4, 7 and 14 of life. Mean birth weight was 2.7 ± 0.46 kg, and mean gestational age was 38.2 ± 2.12 weeks. The mean arterial pressure (MAP) on day 4, 7 and 14 were 59.3 ± 7.33, 63.2 ± 6.55 and 66.4 ± 6.13 mmHg, respectively. Larger and mature newborns had significantly higher BP than those who were smaller and premature. Birth weight more strongly correlated with MAP than gestational age. Predictive equations linking MAP with gestational age and birth weight were deduced, which can be used for judicious fluid inotrope management., (© The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)