1
|
George JT, Thomas A, Jaleel R, Paul GJS, John A, Kurien RT, Chowdhury SD, Simon EG, Joseph AJ, Dutta AK. Bile Culture May Guide Antibiotic Stewardship in Acute Bacterial Cholangitis. Dig Dis Sci 2024; 69:1872-1879. [PMID: 38457116 DOI: 10.1007/s10620-024-08289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/09/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Bile cultures are often sent with blood cultures in patients with acute bacterial cholangitis. AIMS To assess the yield of blood and bile cultures in patients with cholangitis and the clinical utility of bile cultures in guiding therapy. METHODS All patients diagnosed with cholangitis, based on the Tokyo 2013/2018 guidelines were recruited retrospectively over ten years. The clinical and investigation details were recorded. The results of bile and blood cultures including antibiotic sensitivity patterns were noted. The concordance of microorganisms grown in blood and bile cultures and their sensitivity pattern were assessed. RESULTS A total of 1063 patients with cholangitis were included. Their mean age was 52.7 ± 14 years and 65.4% were males. Blood cultures were positive in 372 (35%) patients. Bile culture was performed in 384 patients with 84.4% being positive, which was significantly higher than the yield of blood culture (p < 0.001). Polymicrobial growth was more in bile (59.3%) than in blood cultures (13.5%, p < 0.001). E.coli, Klebsiella, Enterococcus and Pseudomonas were the four most common organisms isolated from both blood and bile. Extended spectrum betalactamase producing organisms were isolated in 57.7% and 58.8% of positive blood and bile cultures, respectively. Among 127 patients with both blood and bile cultures positive, complete or partial concordance of organisms was noted in about 90%. CONCLUSION Bile and blood cultures have a similar microbial profile in most patients with cholangitis. As bile cultures have a significantly higher yield than blood cultures, they could effectively guide antimicrobial therapy, especially in those with negative blood cultures.
Collapse
Affiliation(s)
- John Titus George
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India.
| | - Ajith Thomas
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | - Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | - G Jackwin Sam Paul
- Department of Community Medicine, Christian Medical College, Vellore, 632004, India
| | - Anoop John
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | | | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, 632002, India
| |
Collapse
|
2
|
Kumar SE, Jaleel R, Varghese T, Praharaj I, Benny S, Chowdhury SD, Thomas R, Simon E, Joseph AJ, Dutta AK. Fecal calgranulin as a potential screening tool to differentiate inflammatory bowel disease from irritable bowel syndrome. Indian J Gastroenterol 2024; 43:264-266. [PMID: 38261246 DOI: 10.1007/s12664-024-01525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Santhosh E Kumar
- Department of Hepatology, Christian Medical College, Vellore, 632 004, India
| | - Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - Tintu Varghese
- Wellcome Research Unit, Christian Medical College, Vellore, 632 004, India
| | - Ira Praharaj
- Wellcome Research Unit, Christian Medical College, Vellore, 632 004, India
| | - Stephan Benny
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - Sudipta D Chowdhury
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - Reuben Thomas
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - Ebby Simon
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, A Block, 7th Floor, Ranipet Campus, Kilminnal, Ranipet, 632 517, India.
| |
Collapse
|
3
|
Barnaba Durairaj MV, Jaleel R, Pulimood AB. Granulomatous inflammation is less common in delayed-onset Crohn's disease. Trop Doct 2023; 53:113-116. [PMID: 35903927 DOI: 10.1177/00494755221104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crohn's disease (CD) usually affects younger individuals but delayed-onset disease is not uncommon. We studied the epidemiology, demographic profile, and clinical characteristics of patients with delayed-onset CD (disease onset >50 years) and compared them with CD in younger individuals (disease onset 20-40 years) in a tertiary care center in India. The presenting symptoms, site of involvement, and treatment profile were similar, except for weight loss, which was more often noted in young-onset CD. However, granulomatous inflammation on mucosal biopsy was twice as common in young-onset compared to delayed-onset CD. As it is thus seen less often in delayed-onset CD, this may lead to a potential delay in diagnosis and treatment.
Collapse
Affiliation(s)
| | - Rajeeb Jaleel
- Department of Gastroenterology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Anna B Pulimood
- Department of Pathology, 30025Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
4
|
Chatterjee K, Dutta AK, Goel A, Aaron R, Balakrishnan V, Thomas A, John A, Jaleel R, David D, Kurien RT, Chowdhury SD, Simon EG, Joseph AJ, Premkumar P, Pulimood AB. Common polymorphisms of protein tyrosine phosphate non-receptor type 2 gene are not associated with risk of Crohn’s disease in Indian. World J Gastrointest Pathophysiol 2022; 13:114-123. [PMID: 36161231 PMCID: PMC9350595 DOI: 10.4291/wjgp.v13.i4.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple genetic risk factors for Crohn’s disease (CD) have been identified. However, these observations are not consistent across different populations. The protein tyrosine phosphate non-receptor type 2 (PTPN2) gene plays a role in various aspects of host defense including epithelial barrier function, autophagy, and innate and adaptive immune response. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) have been associated with risk of CD in Western countries.
AIM To evaluate the association of PTPN2 gene polymorphisms with risk of CD in Indian population.
METHODS We conducted a prospective case-control study. Patients with CD were recruited, and their clinical and investigation details were noted. Controls were patients without organic gastrointestinal disease or other comorbid illnesses. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) were assessed. DNA was extracted from peripheral blood samples of cases and controls and target DNA was amplified using specific sets of primers. The amplified fragments were digested with restriction enzymes and the presence of polymorphism was detected by restriction fragment length polymorphism. The frequency of alleles was determined. The frequencies of genotypes and alleles were compared between cases and controls to look for significant differences.
RESULTS A total of 108 patients with CD (mean age 37.5 ± 12.7 years, females 42.6%) and 100 controls (mean age 39.9 ± 13.5 years, females 37%) were recruited. For the single nucleotide polymorphism (SNP) rs7234029, the overall frequency of G variant genotype (AG or GG) was noted to be significantly lower in the cases compared to controls (35.2% vs 50%, P = 0.05). For the SNP rs2542151, the overall frequency of G variant genotype (GT or GG) was noted to be similar in cases compared to controls (43.6% vs 47%, P = 0.73). There were no significant differences in minor allele (G) frequency for both polymorphisms between the cases and controls. Both the SNPs had no significant association with age of onset of illness, gender, disease location, disease behaviour, perianal disease, or extraintestinal manifestations of CD.
CONCLUSION Unlike observation form the West, polymorphisms in the PTPN2 gene (rs7234029 and rs2542151) are not associated with an increased risk of developing CD in Indian patients.
Collapse
Affiliation(s)
- Kaushik Chatterjee
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Amit Kumar Dutta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ashish Goel
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Rekha Aaron
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Vijayalekshmi Balakrishnan
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ajith Thomas
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Anoop John
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Rajeeb Jaleel
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - SD Chowdhury
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - AJ Joseph
- Department of Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Prasanna Premkumar
- Departments of Biostatistics, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Anna B Pulimood
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
| |
Collapse
|
5
|
Jaleel R, Kapoor N, Kalra S. Endoscopic intragastric balloon: A novel therapy for weight loss. J PAK MED ASSOC 2022; 72:1444-1446. [PMID: 36156579 DOI: 10.47391/jpma.22-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Endoscopic intra gastric balloon placement provides an alternative method for weight loss in patients who fail to respond to life style modification, diet restriction and pharmacological therapy. Intra gastric balloon (IGB), placement can be used as a temporary measure for weight loss in obesity with or without related complications or bridge therapy in morbid obesity prior to bariatric surgery. Weight loss achieved following IGB implantation depends on the type of balloon, medium, and filling volume used for IGB inflation. This brief review provides an overview of the indications, efficacy and safety of intragastric balloon treatment in patients with obesity.
Collapse
Affiliation(s)
- Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) -632004, India, and Non Communicable Disease Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| |
Collapse
|
6
|
Dhar Chowdhury S, Jaleel R. Cholangioscopy: Has It Changed Management? Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1743183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThe single operator per oral cholangioscope is a catheter-based system that allows for direct visualization of the bile duct and pancreatic duct. The instrument with its improved imaging technique and larger accessory channel allows for high-quality image acquisition and performance of therapeutic and diagnostic procedures within the bile duct and pancreatic duct. There has been an increase in the range of indications for the use of the cholangioscope. The current indications include management of difficult biliary stones, pancreatic calculi, assessment of indeterminate biliary stricture, pancreatic stricture, intra-ductal papillary mucinous neoplasms, and extractions of proximally migrated stents. The use of laser lithotripsy and electro-hydraulic lithotripsy has improved the management of difficult bile duct stones. Direct visualization of biliary and pancreatic duct strictures is helpful in the diagnosis of indeterminate strictures. In this review, we explore how cholangioscopy has changed management.
Collapse
Affiliation(s)
| | - Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, India
| |
Collapse
|
7
|
Bharath Kumar C, Goel A, Jaleel R, David D, Zachariah U, Ramachandran J, Eapen CE. Prevalence of Risk Factors for Nonalcoholic Fatty Liver Disease in Middle-Aged and Elderly Patients With Cryptogenic Cirrhosis. J Clin Exp Hepatol 2022; 12:492-502. [PMID: 35535099 PMCID: PMC9077180 DOI: 10.1016/j.jceh.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/22/2021] [Indexed: 12/12/2022] Open
Abstract
Aim of the study To study the prevalence of risk factors for nonalcoholic fatty liver disease (NAFLD) in middle-aged (40-59 years) and elderly patients (≥60 years) with cryptogenic cirrhosis as compared to those with hepatitis B or C virus (HBV or HCV) related cirrhosis. Methods and materials Between August 2013 and December 2014, cases (cryptogenic cirrhosis) and controls (HBV/HCV cirrhosis) above 40 years of age were prospectively recruited and assessed for the cause and prevalence of risk factors for NAFLD. Results One hundred eighteen cases (male-74%; age 55 (40-74) years; median (range); Child's class A:B:C-46:38:16) and 59 controls (male-80%; age 55.5 (40-69) years; Child's class A:B:C-56:30:14) were enrolled. Obesity (53% v/s 39%, P-0.081), diabetes mellitus (DM) (52% v/s 27%; P-0.002), family history of DM (30% v/s 13%; P-0.016), family history of Obesity (21% v/s 3.5%; P-0.002) and metabolic syndrome (65% v/s 44%; P-0.01) were more among cases than controls. Lifetime weight as obese was also longer in cases than in controls (5.9 ± 6.2 years v/s 3.2 ± 5.1 years, P-0.002). On subgroup analysis, in elderly age group, DM (55% v/s 17%, P-0.006), family history of DM (40% v/s 11%, P-0.025), metabolic syndrome (76% v/s 44%, P-0.017) and family history of obesity (19% v/s 0, P-0.047) were more common in cases as compared to controls, where as in the middle-age group, family history of obesity was the only significant factor (22% v/s 5%, P-0.025). Lifetime weight as obese was longer in cases than controls in both middle and elderly age groups. Conclusion Among middle-aged and elderly patients with cirrhosis, there was a higher prevalence of risk factors for NAFLD in those with cryptogenic cirrhosis, compared to those with HBV or HCV cirrhosis.
Collapse
Affiliation(s)
| | - Ashish Goel
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Rajeeb Jaleel
- Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Deepu David
- Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India,Address for correspondence: Department of Gastroenterology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India. Tel.: +91 4162282148.
| | - Uday Zachariah
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Jeyamani Ramachandran
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| | - Chundamannil E. Eapen
- Department of Hepatology, Division of GI Sciences, CMC Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
8
|
Kalra P, John A, Jaleel R, Simon EG, Babji S, Joseph AJ. Prevalence of past hepatitis A infection among Crohn's patients and controls - An examination of the 'hygiene hypothesis', and the need for hepatitis A vaccination. Trop Doct 2020; 51:193-197. [PMID: 33050841 DOI: 10.1177/0049475520961949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our study aimed to determine the prevalence of prior exposure to hepatitis A virus in Crohn's disease patients, whose IgG antibody levels against hepatitis A virus were compared with age and sex-matched controls. All of the 41 cases with Crohn's disease and 43 controls included in the study tested positive for IgG anti-hepatitis A virus antibody, with titres (38.8 IU/ml, 22-63.9; median, IQR) similar to those in controls (40.7 IU/ml, 17.3-66.7; p = 0.75). Environmental sanitation remains poor in India, despite reasonable economic gains as reflected by universal exposure to hepatitis A virus infection. Vaccination against hepatitis A may not be important in patients attending inflammatory bowel disease clinic, owing to natural immunity provided by prior infection. The observed rise in inflammatory bowel disease incidence seems to be increasing despite persistently poor environmental hygiene.
Collapse
Affiliation(s)
- Parika Kalra
- Senior Registrar, Department of Gastroenterology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Anoop John
- Assistant Professor, Department of Gastroenterology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Rajeeb Jaleel
- Assistant Professor, Department of Gastroenterology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Ebby G Simon
- Professor, Department of Gastroenterology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Sudhir Babji
- Associate Professor, Department of GI Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - A J Joseph
- Professor, Department of Gastroenterology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
9
|
Abstract
Prolonged indwelling of endoscopically placed biliary plastic stents may lead to complications. We conducted a retrospective analysis of patients who underwent endoscopic retrograde cholangio-pancreaticography (ERCP) at our centre in 2017 and were noted to have retained biliary plastic stents ( > 3 months after an index ERCP). A total of 127 patients had previously placed biliary plastic stents, out of which 45 (35.4%) were retained. The median age of the latter was 52 years (range = 22-79 years) with 27 (60%) patients being men. The median duration of the retained stents was 144 days (range = 94-3292 days). The majority of the patients were asymptomatic. However, 9 (20%) patients had cholangitis, 2 (4.4%) had choledocholithiasis, 2 (4.4%) had cholangitic abscess and 1 (2.2%) developed septicaemia. Fortunately, all these complications could be managed medically and endoscopically. Retention of biliary plastic stents is a problem often overlooked and underestimated in clinical practice. Various measures need to be instituted to create awareness of this entity to prevent undesirable outcomes.
Collapse
Affiliation(s)
- Rajeeb Jaleel
- Assistant Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ebby G Simon
- Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Piyush Gupta
- Endoscopy Fellow, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Itish Patnaik
- Assistant Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepu David
- Associate Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sudipta D Chowdhury
- Professor, Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
10
|
Jaleel R, Khan A. Post-partum haemorrhage--a risk factor analysis. Mymensingh Med J 2010; 19:282-289. [PMID: 20395927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This case control study was done to analyze significance of various risk factors in post-partum haemorrhage (PPH). This study was conducted in the Department of Obstetrics and Gynaecology, Unit V, Dow University of Health Sciences & Lyari General Hospital, Karachi, Pakistan. Study period extended from 1st August 2005 to 31st March 2009. Cases were selected by non-probability sampling and included cases noted in the study unit as well as those admitted with PPH after delivery elsewhere. Controls were selected randomly from patients delivered during same study period who did not have PPH. Cause, type, severity and duration between delivery and onset of PPH were recorded. Amongst the demographic risk factors, age and parity were categorized into sub-groups. Obstetric risk factors were identified for presence or otherwise. Spearman test was used to see bivariate correlation between PPH and various risk factors. P value <0.05 was considered as significant. All the variables which significantly correlated with PPH were entered into logistic regression as cofactors and final risk assessment model was constructed. SPSS version 15 was used for data analysis. Sixty two patients with PPH were studied. Mean age of patients was 28.8 years and controls was 26.8 years (p=0.006). Mean parity of cases was 3.1, while that of controls was 2.15 (p=0.001). Mean Hb was 8.07g/dl in cases and 9.8g/dl in controls (p=0.000). Mean gestational age was equal in both groups. Most frequent cause of PPH was uterine atony, seen in 58.1%, while 17.7% patients had severe amount of haemorrhage. Secondary PPH was seen in 16.1% patients. Majority of events of PPH occurred immediately after delivery. Bivariate analysis of risk factors revealed age more than 35 years, high parity, moderate to severe anaemia, PPH in a previous pregnancy, polyhydramnios, placenta praevia, morbidly adherent placenta and home birth as significant risks. Final logistic regression model included only age >35 years, anaemia, previous history of PPH and home delivery as independent risk factors for PPH. Advanced age, moderate to severe anaemia, PPH in a previous pregnancy and home birth were identified as important risk factors for PPH.
Collapse
Affiliation(s)
- R Jaleel
- Department of Obstetrics and Gynecology, Unit V, Dow Medical College and Lyari General Hospital, Dow University of Health Sciences, Karachi, Pakistan. drriffatjaleel@ yahoo.com
| | | |
Collapse
|