Sanjay Sarkar

Comparison of Lipid Profiles in Normal Pregnancy and in Pre- Eclampsia: A Case Control Study

Objective: The objective of the study was to compare the changes in lipid profile in normal pregnancy and in preeclampsia. Study Design: A case control study. Method: In this case control study total 180 study subjects were evaluated, 90 normotensive pregnant woman as control group and 90 pre-eclamptic subjects as study group. Fasting venous blood samples were collected and serum levels of triglycerides (TG), Total cholesterol (TC), low density lipoprotein- cholesterol (LDL-C), and Very low density lipoprotein – Cholesterol (VLDL-C), High density lipoprotein cholesterol (HDL-C) were measured. Result: Results showed that in pre-eclamptic group serum triglyceride (212.75 ± 50.29 mg/dl) was increased significantly (p < 0.02) as compared to normotensive pregnant woman (185.60± 40.67 mg/dl). Other parameters TC, LDL-C, VLDL-C and HDL-C were not changed significantly. Conclusion: The findings of the present study are consistent with previous studies, suggesting increased level of serum triglyceride as an important factor in the pathological process of pre-eclampsia.

Echocardiographic Assessment of Left Ventricular Systolic Dysfunction in Chronic Kidney Disease Patients of a Rural Tertiary Medical Care Centre in West Bengal

Objective: To evaluate the prevalence of LV systolic dysfunction in patients with CKD (Hemodialysis naive patients) & assess the severity of dysfunction in respect to stages of CKD. Methodology: This is a cross sectional study conducted at the Medicine Department, B.S. Medical College, West Bengal during the period of one year from 1st May 2012 to 30th April 2013. 50 patients of both sexes and ages above 18 years and below 65 years presenting with chronic kidney disease who did not underwent dialysis, were included in the study. A proforma was designed to collect data containing basic information, history & physical examination and the relevant hematological, biochemical and radiological investigations like Electrocardiography and Echocardiography (2D & M mode). Based on the eGFR value (by Cockroft-Gault equation), Patients were divided in two categories - mild/moderate Chronic Kidney Disease [those with eGFR >30ml/min/1.73m 2 = CKD stages 1-3] (N = 27) and severe Chronic Kidney Disease [those with eGFR <30ml/min/1.73m 2 =CKD stages 4 - 5] (N = 23). And echocardiographic LV systolic parameters were analysed and compared between the two groups. Result: 15% of mild/moderate CKD patients showed low EF & 48% of severe CKD had evidence of low EF. 22% patients with mild/moderate CKD, and 26% with severe CKD had impaired fractional shortening. LVH was 58% among total study population, & it was 33% and 87% among two groups. Among all LVH, 31% was concentric and 69% was eccentric type. Conclusion: Chronic Kidney Disease patients has higher prevalence of left ventricular hypertrophy (LVH) and higher prevalence of systolic dysfunction, which was more pronounced in CKD stage 4-5.

Study of Hematological Parameters in Pregnancy

Objective: To determine the effect of pregnancy on haematological parameters and compare the haematological parameters at different stages of pregnancy. Methods: The study involved 30 healthy pregnant women as the study group and 10 non-pregnant women as control. The age range of these women was 19-37 years. 2.5 ml of venous blood was collected from each pregnant and non-pregnant women and put into EDTA vial. Complete blood count was estimated using automated haematological analyzer. Results: The result showed that study group exhibited statistically significant lower values of haemoglobin, PCV, monocyte and lymphocyte while WBC, eosinophil and ESR were significantly elevated. There was no significant difference in all haematological parameters among the three trimesters. Conclusion: Normal healthy pregnancy may have effect on haemotalogical parameters. So it is essential to monitor these parameters during pregnancy. We also find that trimester of pregnancy have no effect on haematological indices.

Association of serum calcium and uric acid level with hypertensive disorders of pregnancy (pre eclampsia and eclampsia) and there correlation with disease severity

Background: Hypertensive disorders are the most common medical complications during pregnancy and are associated with high maternal and fetal mortality and morbidity.One way to reduce the impact of arterial hypertension on maternal mortality is to establish the correct diagnosis of preeclampsia, and to proceed with an early intervention when it is diagnosed. The clinical signs are considered to be a late manifestation of a disease. The utility of two biochemical markers like hyperuricemia and hypocalcemia for the diagnostic purposes and for the prognosis remains largely to be explored. Objectives: (1) To determine the role of calcium & uric acid in the pathogenesis of preeclampsia. (2) To determine the serum level of calcium and uric acid & its correlation with the severity with preeclampsia. Study Design: Hospital based cross sectional case control study. Methods: The study was conducted in the Ante Natal Ward in Obstetrics &Gynaecology Department, BankuraSammilani Medical College, Bankura, WB, which serves a rural population where majority of the patients belong to the tribal groups. Mild pre eclamptic patient defined as blood pressure of at least 140/90 mm of Hg. at least on two occasions at least 6 hrs apart accompanied by proteinuria of at least 300 mg per 24 hrs or at least 1+ on dipstick testing. 64 Severe preeclamptic patient defined as having one or more criteria of the following-  BP ≥160/110 mm of Hg at least on two occasions at least 6 hrs apart  Proteinuria of ≥5gm/24hrs or at least 3+ on dipstick testing  Oliguria<500ml/24hrs or Cerebral or visual disturbances or Pulmonary edema or any other features of end organ damage. Statistical Analysis: Students t test, Chi square test and statistical software Medcalc 11.3.0, Q1 Macros 2012. Results: There were no statistical significant difference in age, BMI, or birth weight of the baby between normal pregnant women and women with PIH but preeclamptic patients present early in gestational age and that was statistically significant. The serum calcium level in eclampsia and severe pre-eclampsia were significantly less than normal pregnant woman but there was no significant difference in serum calcium between normal pregnant woman and mild pre-eclamptic woman. The serum uric acid level in eclamptic woman and severe pre- eclamptic woman were significantly more than that of normal pregnant woman but there was no significant difference in serum uric acid between noral pregnant woman and mild pre-eclamptic woman. Conclusion: So the study indicates that hyperuricemia and Hypocalcaemia is significantly associated with Preeclampsia and their level varies with the severity of the disease process. Routine estimation of serum uric acid and calcium level may be useful as diagnostic marker in high risk pregnancies.

Prevalence of Hyper Amylasemia and Acute Pancreatitis in Organophosphate Poisonings

Objective: To determine the frequency of hyperamylasemia and acute pancreatitis following organophosphate poisoning. Methodology: This is a cross sectional study conducted at the Medicine Department, B.S. Medical College, West Bengal during the period of six months from 16th June 2012 to 15th June 20013. All patients of both sexes and ages above 12 years admitted with a positive history of organophosphate poisoning (OP) were included in the study. A special Proforma was designed to enter all the collected data containing the basic information about the patient, history of recent event and the past history, physical examination and the relevant investigations like complete blood count, serum amylase and lipase, alanine aminotransferase (ALT), lactate dehydrogenase (LDH),ultrasound abdomen CT abdomen(where needed). Result: Among 96 patients, hyperamylasemia was found in 30 (31.25%) patients. Acute pancreatitis was seen in 6 (6.25%) patients. Conclusion: Hyperamylasemia is more frequently seen in organophosphate poisoning while six patients proved to have acute pancreatitis as a complication.

Changing Trends in Caesarean Section: Rate & Indications

Objective: The objective of this study is to compare the changes in rate and indication of Caesarean section during 2005 and 2012 after a gap of 7 years. Study Design: Comparative Study. Material and Methods: In this comparative study, 2 years data i.e. of 2005 and 2012 was collected from Hospital record. 2 years data were compared fort Caesarean section rate and trends of indication of Caesarean section. Results: The results showed that in year 2005 the rate of Caesarean section was 13.94% and in year 2012 it increased to 25.68%. In both years the main indication of Caesarean section was previous Caesarean section followed by dystocia and foetal distress. Conclusion: It is suggested to have obstetric audit by inter departmental meetings to assess the intrinsic role of Caesarean section in influencing the standard management guidelines.

Role of Cytological Grading in Breast Cancer Prognosis and its Histo-pathological Correlation

Objective: Breast carcinoma is the most common cause of death in females globally, which should be detected early and treated promptly. This study aims at establishing Fine Needle Aspiration Cytology (FNAC) as an individual parameter in diagnosing & grading carcinoma breast and to correlate cytological grading with the histopathological grading done post-operatively. Materials & methods: We present here, a series of 44 cases, clinically suspected of carcinoma breast, presenting with hard, painful breast lump with or without axillary lymphadenopathy, sent for cytological examination to our department. Aspiration was done, following using 20G needle and smears were stained with Haematoxyline & Eosin, Papanicolau, and May-Grunwald-Giemsa. Results: The stained smear showed highly pleomorphic ductal cells in large number forming dyscohesive sheets & also lying singly. Cells had nuclei with hyperchromasia, irregular nuclear margin, open chromatin & conspicuous nucleoli. The diagnosis of carcinoma breast was offered and cytological grading was done according to Robinsons nuclear grading system in all cases. Urgent biopsy was also however, recommended. The mastectomy specimens of these patients, when grossed & stained with Haematoxyline & Eosin proved the cytological diagnosis conclusive and cytological grading of the tumors concordant in 80% of the cases. Higher cytological grades showed increased nodal metastasis. Conclution: So, early diagnosis & precise grading with the help of FNAC itself can prove to be a very good informative tool & prognostic indicator, leading to commencement of early treatment & can prevent many untimely deaths in future.

Evaluation of Thyroid Hormone Changes in Non-Pregnant, Normotensive Pregnant and Pregnancy with Preeclampsia

Objective: Normal Thyroid hormone level is essential in maintaining the normal fetal development. The objective of the study was to evaluate the thyroid hormone levels among healthy non-pregnant women with normotensive pregnant women and women with preeclampsia. Materials and methods: In these prospective study 90 women in the age group of 19 - 36 are divided into 3 groups consisting of 30 healthy non-pregnant women, 30 healthy normotensive pregnant women and 30 pregnant women with preeclampsia and evaluated for thyroid profile. Results: Serum TT4 and TT3 levels in normotensive pregnant women and preeclamptic women were significantly higher compared to the levels in non-pregnant women. In comparison to the normotensive pregnant women, women with preeclampsia had a non significantly higher TT4 level and significantly lower TT3. In preeclamptic women serum FT4 was marginally raised than in normotensive pregnant subjects but was significantly raised than in nonpregnant subjects. The FT3 level was significantly lower in preeclamptic women than in normotensive pregnant women compared to nonpregnant subjects. TSH levels were significantly higher in both preeclamptic and normotensive pregnant women. Conclusion: The main finding of our study indicates that there is a state of hypothyroidism in normal pregnancy and in preeclampsia and so raised serum TSH occurs. Detection of any changes in thyroid profile in preeclampsia may of health in preventing the development of preeclampsia.

Intrapartum Amnioinfusion in Meconium-stained Amniotic fluid: A Case Control study

Objective- The Aim of this study is to investigate Perinatal outcome and the rate of ceserean section following intrapartam amnioinfusion in women with Meconium Stained Amniotic Fluid (MASF). Method- A total of 100 women at term in labour with meconium stained amniotic fluid were randomised to receive either Transcervical Intrapartum Amnioinfusion with normal saline (50) or routine obstetric care (50). Perinatal outcome and obstetric outcome were recorded and analysed in both groups. Result- The ceserean section rate due to fetal distress was 34% in the control group and 10% in the study group. Respiratory distress of the neonate was significantly less common in the study group than in the control group (p=0.0053). The rate of Meconium Aspiration Syndrome (MAS) was 20% in the control group and 4% in the study study group.(p=0.0433). Conclusion- Amniotransfusion in cases of MSAF significantly improved neonatal outcome and decreases the

Prevalence of Metabolic Syndrome and Its Individual Components in Patients with AMI and Consideration of Obesity Markers among These Patients

Background: Many studies have estimated the prevalence of Metabolic Syndrome (MS) and also its association with type II Diabetes and cardiovascular disease. But its prevalence and association with acute cardiovascular events like Acute Myocardial Infarction (AMI) remained largely unexplored. Objectives: (1) To determine the prevalence of the metabolic syndrome in patients with AMI; (2) To find out the association of the individual component of the metabolic syndrome with AMI. (3) To study the association of obesity markers like waist circumference (WC), Body Mass Index (BMI) and Waist Hip Ratio (WHR) with AMI. Study Design: Hospital based cross-sectional case control study. Methods: The study was conducted in a Medical College of Kolkata, West Bengal. Applying National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria and evaluated subjects for the 5 component conditions of the metabolic syndrome: insulin resistance, abdominal obesity based on waist circumference, hypertriglyceridemia, low HDL cholesterol (HDL-C), and hypertension, as well as the full syndrome, defined by the presence of at least 3 of the 5 conditions. Statistical Analysis: Students t test and Chi-square test. Results: Among the 76 AMI patients, 47.36% male AMI cases and 46.87% of female AMI cases had MS and both are statistically significant when compared with controls. Among the 5 component conditions of MS, 4 components like insulin resistance, hypertension, hypertriglyceridemia and low HDL cholesterol were more prevalent in cases in both the sex groups compared with controls and the results were statistically significant. Only one exception obesity measured by high WC (p>0.05) which was not independently related to MS. Among the component conditions insulin resistance had the highest OR in men and low HDL had the highest OR in women. Among other obesity markers the association of BMI with MI was not statistically significant whereas central obesity measured by WHR of >0.09 were significantly related to MI in both male and female group. Conclusion: The study indicates that prevalence of MS and its individual component conditions are significantly related to AMI. Considering the marker of obesity waist circumference and BMI were not significantly related to AMI whereas WHR is significantly related to AMI. Maybe this is the time when we should look upon to derive the cut off points for obesity with consideration specifically related to Asian Indians.