Peri-partum Cardiac Failure

The syndrome of peri-partum cardiac failure (PPCF) has beenstudied in 224 women seen in three years in Zaria, in northernNigeria. A very high proportion were rural Hausa patients. Therewas a seasonal peak in July, and the incidence was about oneper cent of deliveries. The risk increased with both age andparity. Symptoms began most commonly in the second week after delivery,and admission was commonest in the fourth. Typical signs ofcardiac failure were found, and pulsus alternans, atrio-ventricularvalvular incompetence, transient systemic hypertension and splenomegalywere common. The chest radiograph showed marked cardiomegaly,and extrasystoles and inverted T waves were often present inthe electrocardiogram (ECG). Hypoalbuminaemia was common. Digoxinand diuretics were rapidly effective, causing a mean, weightloss of 29 per cent in 15 days, resolution of hypertension,and a fall in the cardio-thoracic ratio (CTR) from 61 to 53per cent. During the first year after diagnosis, the CTR became normalin 82 per cent of patients, and the ECG in 60 per cent. PPCFrecurred, again with the same seasonal variation, after 19 percent of subsequent pregnancies. During follow up for two tofive years, 22 per cent of the women became hypertensive, and11 per cent died. The prognosis was worst in those with an arrhythmia,hypertension, sustained cardiomegaly or aged 30 or more. Asymtomatic post-partum hypertension (PPHT) was found in 61per cent of normal Hausa women, with a seasonal peak in May,especially in those with hypertension during pregnancy or labour,and twin pregnancies. Peri-partum cardiac failure may be due to the combined pressureload of PPHT, the volume load from eating the customary sodium-richkanwa, and the cardiovascular demands of heat, both climaticand traditionally self-imposed.     

Prevalence of early stages of chronic kidney disease in healthy army personnel

Introduction: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. Screening and detection of early stages of CKD can help institute interventions that may delay the progression of the disease. One aim was to study the prevalence of early stages of CKD in the Army.Methods: A cross-sectional study ofArmy Personnel in an Army cantt in Central India was carried out. All participants filled a structured questionnaire and anthropometric data was collected. Investigative profile included routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose. Glomerular Filteration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) study equation.Result: A total of 1920 subjects were examined with 731 (38.07%) from Arms and 1189 (6I.93%) from Services. 348 were excluded and of the remaining 1572 subjects, 141 (8.97%) had MAU and 157 (9.99%) had deranged Albumin Creatinine Ratio (ACR). Mean eGFR by MDRD equation was 102 ± 25.84 ml/min/1.73m². Early CKD was seen in 150 (9.54%) with 84 (5.34%) in stage I CKD, 55 (3.5%) in stage II and 11 (0.7%) in stage III. Multiple logistic regression showed BMI > 23, the presence of DM and HTN were independent risk factors for CKD.Conclusion: 9.54 % of healthy army personnel were found to have early stages of CKD. Institution of screening programs can result in early detection of CKD.     

NEONATAL OUTCOME IN MECONIUM STAINED DELIVERIES — A PROSPECTIVE STUDY

This prospective study analyzes the neonatal outcome in deliveries complicated by meconium stained amniotic fluid. In a study of 1000 live born deliveries, meconium staining of amniotic fluid was seen in 50 (5%) deliveries. Out of these, 20 newborns (40%) developed classical signs of meconium aspiration syndrome and were managed according to a predetermined protocol. Multiparity, term deliveries, use of sedatives in mother, intrauterine growth retardation and prolonged labour were some of the risk factors for development of meconium aspiration syndrome in newborns. This study highlights the need for review of management protocol in newborns after meconium staining of the amniotic fluid, including the use of prophylactic antibiotics.KEY WORDS: Amniotic fluid, Delivery, Meconium aspiration, Respiratory distress syndrome     

PLASMID MEDIATED DRUG RESISTANCE IN VIBRIO CHOLERAE 0139 BENGAL

Sixteen strains of Vibrio cholerae were isolated from cases of diarrhoea. Out of these, 12 (75%) were identified as Vibrio cholerae 0139 synonym Bengal and 4 (25%) as Vibrio cholerae El Tor by standard biochemical and serological tests. Modified CAMP reaction in sheep blood agar showed that 0139 produced moderate hemolysis, El Tor produced wider zone of hemolysis whereas Classical Vibrio cholerae produced no zone of hemolysis (CAMP negative). Break point minimum inhibitory concentration (MIC) by agar dilution method showed that all 0139 strains were resistant to ampicillin 8 mg/L, streptomycin 1 mg/L, chloramphenicol 8 mg/L, sulphamethoxazole 32 mg/L and trimethoprim 0.3-128 mg/L, 58.3% were sensitive to gentamicin 1 mg/L, and all were sensitive to norfloxacin 1 mg/L and cefotaxime 1 mg/L. Resistance to trimethoprim, sulphamethoxazole, ampicillin and gentamicin in 5 strains could be transferred to E coli K-12 by conjugation experiment at a rate of 5×10⁻⁶ to 4×10⁻³. Distinct plasmid bands of 35.8 mega daltons could be seen in agarose gel electrophoresis.KEY WORDS: CAMP test, Drug resistance, Plasmid, Vibrio cholerae 0139.