Anupam Kapur

Takayasu arteritis in pregnancy

In 1908, Mikito Takayasu, a Japanese ophthalmologist, reported the case of a 21-year-old woman with retinal arteriovenous anastomoses, syncope, and absent upper extremity pulses.1 Takayasu arteritis (TA), also known as occlusive thromboaortopathy, is a primary systemic vasculitis of unknown etiology, predominantly affecting women2 during their reproductive years (female to male ratio is 4:1). It has variable geographical distribution with the greatest prevalence in Asians, especially Japan, and the Orient. Optimal management for pregnant patients with this disease has not yet been established. Due to the manifold cardiovascular complications that can occur in the course of the disease, management of pregnancies in TA patients is a challenge for the obstetrician, the rheumatologist and the cardiologist.

Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India

Background & objectives: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. Methods: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. Results: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). Interpretation & conclusions: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Pulse contour analysis guided management of a case of puerperal uterine inversion and hemorrhagic shock – ‘Giving what it takes’

Acute uterine inversion is difficult to diagnose and is associated with significant blood loss and shock out of proportion to the blood loss. Pulse contour analysis guided (Flotrac™/Vigileo™-system Edwards Lifesciences, Irvine, CA, USA) monitoring is a new tool which provides a precise and invaluable insight into the hemodynamics of such delicately poised patients.