Introduction: Thalassaemia Major patients require frequent blood transfusion leading to iron overload.Excessive iron gets deposited in vital organs and leads to dysfunction of the heart, liver, anterior pituitary, pancreas, and joints.Our body has limited mechanism to excrete iron, so patients with iron overload and its complications need safe and effective iron chelation therapy.Aim: To assess the efficacy of Deferasirox (DFX) as an iron chelator, with specific reference to reduction in serum ferritin level.Materials and Methods: This is a prospective; observational study done in 45 multitransfused Thalassaemia Major Children receiving DFX therapy at registered Thalassaemia society Raipur Chhattisgarh.DFX was given in an initial dose of 20 mg/kg/day and according to response increased to a maximum of 40 mg/kg/ day.Serum ferritin level was estimated at time of registration and at every three monthly intervals (four times during study period).The primary end point of the study was change in serum ferritin level after 12 months of DFX therapy. Results:The mean serum ferritin before DFX therapy of all cases was 3727.02ng/mL.After 12 months of mean dose of 38 mg/kg/ day of DFX, the mean decline in serum ferritin was 1207.11ng/ mL (drop by 32.38%, p-value <0.001). Conclusion:DFX monotherapy has a good safety profile and effectively chelates total body iron in Thalassaemia major patients.
Background- The occurrence of meconium-stained amniotic uid (MSAF) during labor has long been considered the predictor of adverse fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia, which leads to perinatal and neonatal morbidity and mortality Methods- A Prospective observational study was carried out in Smt. Hira Kunwar Ba Mahila Hospital, Jhalawar attached to Jhalawar Medical College,over one year from January 2020 to January 2021. Total 278 cases taken at random basis having following inclusion criteria Result- MSL is responsible for neonatal morbidity in 15.1% of cases. Rate of neonatal morbidity was higher in thick meconium group (24.9%) as compared to thin meconium group (6.2%) and this difference was statistically signicant. In our study birth asphyxia (5.8%) was the most common complication followed by MAS (4%), Pneumonitis (3.6%) and Sepsis (1.8%). Conclusion- Passage of meconium still remains as an enigma to the obstetrician and equally worries the paediatrician. As shown in the study, thick meconium is associated with increased operative intervention, low apgar score, increased rate of NICU admission and increased risk of neonatal morbidity and mortality as compared to thin meconium.
The study examined the relationship between positive life orientation (PLO) and recovery from a recent myocardial infarction (MI), i.e. heart attack. PLO was defined as a predisposition to selectively focus one's attention on the brighter side of any situation. An 11-item measure of PLO was developed. Seventy male patients of first MI receiving treatment at a local government hospital were interviewed twice, 4-5 days after their first heart attack (time 1) and a month after their first heart attack (time 2). The interview schedule consisted of measures of PLO, perceived recovery, expected recovery, helplessness, personal control and mood state. At time 1 all these measures were administered but at time 2 measures of only PLO, personal control, perceived recovery and mood state were administered. In addition, the attending doctor assessed the patients' medical recovery at time 1. Results showed positive correlation of patients' PLO scores with their medical recovery, perceived recovery, expected recovery, personal control and mood state but negative with helplessness. PLO scores were not influenced by patients' age, education, or income. Patients' scores on PLO at two time points were not significantly different and were positively correlated. Their scores on sense of personal control and perceived recovery increased significantly at time 2. Significant intercorrelations among variables, under study, often reduced to insignificance on partialling out PLO. PLO, thus emerged as an important factor in recovery from MI.
Background: The aim of this study was to compare the efficacy and safety of iron sucrose with oral iron in the treatment of iron deficiency anemia of pregnancy.Methods: An interventional comparative study was conducted at Jhalawar Medical College, Jhalawar involving 80 pregnant women with iron deficiency anemia from March 2016 to August 2016. Inclusion criteria were gestational age between 24-32 weeks with established iron deficiency anemia, with hemoglobin between 7-10g/dl. Target Hemoglobin was 11 g/dl. In intravenous iron sucrose group iron sucrose dose was calculated from following formula: total iron dose required (mg) = 2.4 x body weight in Kg x (target Hb – Patient’s Hb g/dl) + 500. In oral iron, group patient received ferrous-sulphate 335 mg daily BD. Hb level were reviewed at 2, 4, 6 weeks.Results: Change in Hemoglobin level from baseline significantly higher in IV iron group than oral iron group. In IV iron, group mean value of baseline Hb was 8.07±0.610 g/dl and in oral iron group was 8.48±0.741 g/dl. At the end of 6-week mean hemoglobin in IV iron sucrose was 10.66±0.743 g/dl and in oral iron group was 10.08±0.860 g/dl.Conclusions: Intravenous iron sucrose elevates more Hb than oral iron, with less adverse effects.
Background: Eclampsia is a life-threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out the fetomaternal outcomes of eclampsia.Methods: A retrospective epidemiological study was undertaken in the department of Obstetrics and Gynaecology, Jhalawar medical college, Jhalawar during the period ‘September 2018 to August 2019’. Women who presented as eclampsia or developed eclampsia during hospital stay were included in the study. Data analysed included various maternal parameters, fetal parameters, and the outcome of the pregnancy.Results: The incidence of antepartum eclampsia was (0.92%). High risk associated factors were primigravida (65.90%), low maternal age (21-30 years), illiteracy, and inadequate antenatal care. Caesarean section was the mode of delivery in 48 cases (54.54%) most common indication was unfavourable cervix, 80.6% women had antepartum eclampsia and 68.18% women had severe preeclampsia. There was 6.8% maternal mortality, attributed to pulmonary edema and acute renal failure. Perinatal mortality was 14.77% with 8 still births and 5 neonatal deaths. Prematurity complicated 46.66% pregnancies. Thirty neonates were admitted to NICU.Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status, and lack of education. It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities, and multidisciplinary units are available.
Infertility is defined as one year of unprotected intercourse without pregnancy. Sole male factor is responsible in 30% cases of infertility, out of which, 15% is related to genital tract infection including tuberculosis. The Polymerase chain reaction (PCR) technique can accurately diagnose genital Tuberculosis at an early stage. Timely antitubercular therapy can lead to restoration of sperm counts and provide an excellent chance to infertile couples for spontaneous conception. We report a case series of seven cases in which infertility is associated with male genital tuberculosis.
Background: EOH is define as removal of uterus (total or subtotal) at the time of caesarean section or following vaginal delivery within puerperium. Objective of present study was to determine the frequency, demographic characteristics, indications, and maternal outcomes associated with emergency obstetric hysterectomy.Methods: It was a retrospective, observational, and analytical study conducted over a period of eight years, from January 2009 to December 2016. A total of 64 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, SRG Hospital and Jhalawar Medical College Jhalawar (Rajasthan).Results: The incidence of EOH in our study was 0.4 per 1000 following vaginal delivery and 3.5 per 1000 following cesarean section. The overall incidence was 1.03 per 1000 deliveries. Rupture uterus 30 (46.8%) was the most common indication followed by postpartum hemorrhage 23 (35.9%) and morbidly adherent placenta 11 (17.1%). Subtotal abdominal hysterectomy was performed in most of the cases. Maternal mortality was 6.2%.Conclusions: This study concluded the great role of EOH as a life-saving procedure in those cases where medical management has failed.
Early feeding after lower-segment caesarean section (LSCS) leads to reduced postoperative opioid requirements, without increasing gastrointestinal morbidity [1]. Early postoperative feeding has been associated with reduced protein store depletion, improved wound healing, positive psychological impact and hence rapid recovery [2]. Thirty-three patients undergoing elective LSCS under regional anaesthesia were reviewed over 2 months (March 2007–May 2007.) Data collected included time to first food and drink, and patient satisfaction. Fourteen patients were reviewed over a 3-month period (January 2008–March 2008) of re-audit. Data collected included time to first food and drink, and patient satisfaction. Fifty-seven per cent of patients had their first drink in 0–4 h, 21% in 4–8 h and 21% in 8–12 h. Sixty-six per cent of patients had their first solid intake between 12–24 h, 3% in 0–4 h, 6% in 4–8 h and 27% in 8–12 h. These results showed that patients were fasted for prolonged periods after LSCS. Hunger and thirst are commonly encountered after LSCS when patients are allowed to eat only after return of flatus. Results from the 2007 audit showed that patients were fasted for prolonged periods after elective LSCS under regional anaesthesia. Since our first audit, we have introduced departmental guidelines regarding early feeding after LSCS and presented our audit results to midwives and obstetricians. Within 1 year of our audit, we have managed to introduce early feeding in this group of patients, which is reflected in the 2008 re-audit.
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