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Dixit P, Mishra TK, Nargawe D, Singh S. Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre. Cureus 2023; 15:e45971. [PMID: 37900531 PMCID: PMC10600615 DOI: 10.7759/cureus.45971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the leading causes contributing to morbidity and mortality globally is attributed to eclampsia. Hence, it is vital to comprehensively review each female having eclampsia and to evaluate the factors that govern the outcomes in females with eclampsia. Aim To decode the fetal and maternal outcomes in subjects having eclampsia and to evaluate various factors that govern the outcomes. Methods This retrospective cohort and epidemiological study commenced at the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, in January 2016 till April 2017, and included females that either developed eclampsia in hospital stay duration or presented with pre-existing eclampsia. In included females, various fetal and maternal parameters were assessed along with the outcome of pregnancy. The institutional data records and the database were also used to determine the prevalence and incidence of eclampsia. Baseline maternal parameters were recorded from the already-existing institute data. These included the gestational age (in years), socioeconomic status, educational attainment, parity, gravidity, and the number of weeks of gestation present at the time of delivery. Antenatal care data assessed were blood pressure recordings, any proteinuria documented in the data, and the number of antenatal visits by the subjects. Statistical analysis was performed to assess both parameters. Results In the current investigation, there were 0.34% eclampsia cases among females visiting the institution for deliveries. Incidences of stillbirth were seen in 19.04% and 8% of study participants, respectively. We found 9.52% (n=4) of female infants to have perished from eclampsia. Preterm births, a delayed start to the treatment, and insufficient care were all linked to poor foetal and mother outcomes. The longer the period between the beginning of a fit and delivery, the greater the likelihood of unfavourable results. Seizure onset before or after birth, parity, or subject age had no impact on mother or foetal health. The p-value for statistical significance was kept at 0.05. Conclusion Most of the research participant women, had intrapartum eclampsia, postpartum eclampsia, and antepartum eclampsia, based on the time of the convulsions in relation to the labor. It was highlighted that there was no conclusive evidence linking the date of the fit's beginning to unfavourable results or an elevated risk of complications. Neonatal mortality and stillbirth were observed with vaginal delivery in eclampsia cases. Outcomes in eclampsia can be improved by early treatment initiation, timely and appropriate referral, early disease recognition, and appropriate antenatal care.
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Affiliation(s)
- Pratibha Dixit
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Ratlam, IND
| | - Tarunendra K Mishra
- Department of General Medicine, Government Medical College and Hospital, Ratlam, IND
| | - Devendra Nargawe
- Department of Pediatrics, Government Medical College and Hospital, Ratlam, IND
| | - Sandeep Singh
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
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Vasquez DN, Das Neves AV, Aphalo VM, Vidal L, Moseinco M, Lapadula J, Santa-Maria A, Zakalik G, Gomez RA, Capalbo M, Fernandez C, Agüero-Villareal E, Vommaro S, Moretti M, Soli SB, Ballestero F, Sottile JP, Chapier V, Lovesio C, Santos J, Bertoletti F, Mos FA, Risso-Vazquez A, Esteban-Chacon M, Illutovich S, Chapela S, Loudet CI, Scapellato JL, Intile AD, Estenssoro E. Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study. Hypertens Pregnancy 2021; 40:279-287. [PMID: 34587828 DOI: 10.1080/10641955.2021.1981373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS Multicenter, prospective, national cohort study. RESULTS Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.
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Affiliation(s)
- Daniela N Vasquez
- ICU, Sanatorio Anchorena, City of Buenos Aires, Argentina.,ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, Argentina
| | - Andrea V Das Neves
- ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, Argentina
| | | | - Laura Vidal
- ICU, Hospital Pablo Soria, San Salvador De Jujuy, Jujuy, Argentina
| | | | - Jorge Lapadula
- ICU, Hospital Nacional Prof. Alejandro Posadas, Villa Sarmiento, Bs As, Argentina
| | | | - Graciela Zakalik
- ICU, Hospital Luis Lagomaggiore, City of Mendoza, Mendoza, Argentina
| | - Raúl A Gomez
- ICU, Sanatorio De Los Arcos, City of Buenos Aires, Argentina
| | - Mónica Capalbo
- ICU, Hospital Gral De Agudos José M.Penna, City of Buenos Aires, Argentina
| | - Claudia Fernandez
- ICU, Hospital De Agudos Ramón Madariaga, Posadas, Misiones, Argentina
| | - Enrique Agüero-Villareal
- ICU, Hospital Policlínico Regional Dr. Ramón Carrillo, City of Santiago Del Estero, Santiago Del Estero, Argentina
| | | | | | - Silvana B Soli
- ICU, Sanatorio Julio Corzo, Rosario, Santa Fé, Argentina
| | | | - Juan P Sottile
- ICU, Hospital Zonal Bariloche, Bariloche, Río Negro, Argentina
| | - Viviana Chapier
- ICU, Hospital Español De Mendoza, Godoy Cruz, Mendoza, Argentina
| | | | - José Santos
- ICU, Clínica Colón, Mar Del Plata, Bs As, Argentina
| | | | - Fernando A Mos
- ICU, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | | | | | | | | | - Cecilia I Loudet
- ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, Argentina
| | | | | | - Elisa Estenssoro
- ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, Argentina
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Generating evidence on screening, diagnosis and management of non-communicable diseases during pregnancy; a scoping review of current gap and practice in India with a comparison of Asian context. PLoS One 2021; 16:e0244136. [PMID: 33524025 PMCID: PMC7850625 DOI: 10.1371/journal.pone.0244136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Children born to high-risk pregnancies are more likely to experience adverse health outcomes later in life. As estimated, 15% of all pregnancies are at risk of various life-threatening conditions leading to adverse maternal and foetal outcomes. Millennium Development Goal resulted in the global reduction of maternal death from 390,000 to 275000 in 1990–2015). Similarly, to keep this momentum, the current United Nations Sustainable Development Goal (SDG: 3.1) aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and this can be achieved by addressing high-risk pregnancy contributing to significant mortality and morbidity. In India, gestational diabetes, gestational hypertension, and gestational hypothyroidism were identified as factors contributing to the high-risk pregnancy. This review summarises the commonly used approach for screening, diagnosis, and management of these conditions in the Asian population. It draws a comparison with the current protocols and guidelines in the Indian setting. Methods Electronic search in PubMed and Google Scholar, reference snowballing, and review of current guidelines and protocols were done between January 2010 to October 2019. Published studies reporting Screening, diagnosis, and management of these conditions were included. Articles selected were then screened, appraised for quality, extract relevant data, and synthesised. Results Screening, diagnosis, and management of these three conditions vary and no single universally accepted criteria for diagnosis and management exist to date. In India, national guidelines available have not been evaluated for feasibility of implementation at the community level. There are no national guidelines for PIH diagnosis and management despite the increasing burden and contribution to maternal and perinatal morbidity and mortality. Criteria for diagnosis and management of gestational diabetes, gestational hypertension, and gestational hypothyroidism varies but overall early screening for predicting risk, as reported from majority of the articles, were effective in minimizing maternal and foetal outcome. Conclusion Existing National guidelines for Screening, Diagnosis, and Management of Gestational Diabetes Mellitus (2018) and Gestational Hypothyroidism (2014) need to be contextualized and modified based on the need of the local population for effective treatment. Findings from this review show that early screening for predicting risk to be an effective preventive strategy. However, reports related to a definitive diagnosis and medical management were heterogeneous.
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Machowska A, Landstedt K, Stålsby Lundborg C, Sharma M. Antibiotic Prescribing to Patients with Infectious and Non-Infectious Indications Admitted to Obstetrics and Gynaecology Departments in Two Tertiary Care Hospitals in Central India. Antibiotics (Basel) 2020; 9:E464. [PMID: 32751558 PMCID: PMC7459830 DOI: 10.3390/antibiotics9080464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patients admitted to obstetrics and gynaecology (OBGY) departments are at high risk of infections and subsequent antibiotic prescribing, which may contribute to antibiotic resistance (ABR). Although antibiotic surveillance is one of the cornerstones to combat ABR, it is rarely performed in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients in OBGY departments of two tertiary care hospitals, one teaching (TH) and one nonteaching (NTH), in Central India. Methods: Data on patients' demographics, diagnoses and prescribed antibiotics were collected prospectively for three years. Patients were divided into two categories- infectious and non-infectious diagnosis and were further divided into three groups: surgical, nonsurgical and possible-surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system, and the International Classification of Disease system version-10 and Defined Daily Doses (DDDs) were calculated per 1000 patients. Results: In total, 5558 patients were included in the study, of those, 81% in the TH and 85% in the NTH received antibiotics (p < 0.001). Antibiotics were prescribed frequently to the inpatients in the nonsurgical group without any documented bacterial infection (TH-71%; NTH-75%). Prescribing of broad-spectrum, fixed-dose combinations (FDCs) of antibiotics was more common in both categories in the NTH than in the TH. Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: Antibiotics were frequently prescribed to the patients with no documented infectious indications. Misprescribing of the broad-spectrum FDCs of antibiotics and unindicated prescribing of antibiotics point towards threat of ABR and needs urgent action. Antibiotics prescribed to the inpatients having nonbacterial infection indications is another point of concern that requires action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve antibiotic prescribing practice.
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Affiliation(s)
- Anna Machowska
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden; (A.M.); (K.L.); (C.S.L.)
| | - Kristoffer Landstedt
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden; (A.M.); (K.L.); (C.S.L.)
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden; (A.M.); (K.L.); (C.S.L.)
| | - Megha Sharma
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden; (A.M.); (K.L.); (C.S.L.)
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, India
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Sharma A, Arora M, Goyal AK, Rath G. Spray Dried Formulation of 5-Fluorouracil Embedded with Probiotic Biomass: In Vitro and In Vivo Studies. Probiotics Antimicrob Proteins 2018; 9:310-322. [PMID: 28275899 DOI: 10.1007/s12602-017-9258-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The present study is utilizing the targeted therapeutic approach and antioxidant potential of selected probiotic biomass in mitigating toxic side effects of chemotherapeutic agents. Multicomponent carrier system consisting of 5-fluorouracil (5-FU) and selected probiotic strain with higher free radical scavenging activity was prepared using spray drying technique. Prepared spray dried microparticles were characterized for various physical, pharmaceutical, and biopharmaceutical properties including particle size, moisture content, entrapment efficiency, in vitro drug release, DSC, XRD, cell uptake, histopathology, and pharmacokinetic studies. In addition to the above, optimized formulation was subjected to in vivo targeting efficacy studies using radiographic technique. Optimized formulation meets the necessary physical requirement for pharmaceutical powder. X-ray studies revealed that the prepared spray dried formulations are able to target the colon. Pharmacokinetic endpoints with an extended t 1/2 and lower C max indicate lower systemic toxicity. Intact nature of colonic epithelium in experimental formulation clearly demonstrates the protective role of Lactobacillus rhamnosus in minimizing the harmful consequence induced by 5-FU. Existing outcomes provide the basis for a combination of targeted therapeutic approach with natural antioxidant capacity of potential probiotic strain which could help to mitigate the problems associated with traditional chemotherapy.
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Affiliation(s)
- Anshul Sharma
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
| | - Malika Arora
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
| | - Amit K Goyal
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
| | - Goutam Rath
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India.
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Ahadi SSM, Yoshida Y, Rabi M, Sarker MAB, Reyer JA, Hamajima N. Clinical features, current treatments and outcome of pregnant women with preeclampsaia/eclampsia in northern afghanistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2015; 77:103-11. [PMID: 25797975 PMCID: PMC4361512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Abstract
In Afghanistan, preeclampsia/eclampsia is the second leading cause of maternal deaths following maternal hemorrhage. This study aimed to describe clinical features, current treatments, and outcome among preeclampsia and eclampsia patients in the north region of Afghanistan. This was a retrospective study based on medical records of four center hospitals (one regional hospital and three provincial hospitals) in the north region of Afghanistan. Subjects were 322 patients with preeclampsia/eclampsia, admitted from March 2012 to March 2013. Out of 322 cases, 72.7% were diagnosed as preeclampsia and the rest as eclampsia. Those aged 30-39 years were 41.0% among preeclampsia patients and 29 years and younger were 35.2% among eclampsia patients (p= 0.002). The first delivery was significantly higher (p=0.045) among eclampsia patients (51.1%) than among preeclampsia patients (36.8%). While none died among the preeclampsia patients, 12 out of 88 eclampsia patients died in the hospitals. The causes of the 12 deaths were pulmonary edema (6 patients), renal failure (3 patients), cerebrovascular attack (2 patients), and hemorrhage (1 patient). There were no clinical findings at admission significantly associated with the deaths within the eclampsia patient group. Although the sample size was not large enough, patients admitted to the regional/provincial hospitals at the stage of preeclampsia had a low risk of death. Access at the stage of preeclampsia and improvement in treatments for eclampsia would reduce maternal mortality in Afghanistan.
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Affiliation(s)
- Sayed Shir Mohammad Ahadi
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Department of Obstetrics/Gynecologic, Balkh regional hospital, Ministry of public health, Islamic Republic of Afghanistan
| | - Yoshitoku Yoshida
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mirwais Rabi
- Department of Obstetrics/Gynecologic, Balkh regional hospital, Ministry of public health, Islamic Republic of Afghanistan
| | | | - Joshua A Reyer
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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