(a) Define 'pre-eclampsia'. Enumerate the risk factors which may lead to this condition. What are its clinical signs and what are…

Pre-eclampsia. Pre-eclampsia is new-onset hypertension with proteinuria after 20 weeks of gestation in a previously normotensive woman, reflecting placental endothelial dysfunction. High-risk factors include nulliparity, chronic hypertension, renal disease, multiple gestation, personal history of pre-eclampsia, diabetes, autoimmune disease, obesity, family history, and age extremes. NFHS-5’s maternal mortality ratio of 97 per lakh live births and rising maternal complications make early ANC and risk stratification essential. Clinical signs are BP ≥140/90 mmHg on two readings, proteinuria of 300 mg/24h or a positive dipstick, and oedema, often with rapid weight gain. Alarming symptoms suggesting severe disease are severe headache, visual disturbances, epigastric or right upper quadrant pain, hyperreflexia, oliguria, and pulmonary oedema. Management follows WHO/FIGO principles: confirm diagnosis, admit for monitoring, give antihypertensives such as labetalol, nifedipine or hydralazine, and magnesium sulphate for seizure prophylaxis in severe cases. Acute severe hypertension is treated to a target below 150/100 mmHg. Monitor urine output, reflexes and respiratory rate; stop magnesium if respiratory rate falls below 12/min, reflexes are absent, or urine output is inadequate. Definitive treatment is delivery at the appropriate gestational age, with antenatal corticosteroids if preterm and safe; magnesium is continued for 24 hours after delivery, and low-dose aspirin is used earlier in high-risk women for prevention from 12 to 16 weeks where feasible. Severe pre-eclampsia may progress to eclampsia, HELLP or placental abruption, so delivery planning must be individualized.

Ileo-caecal tuberculosis. Ileo-caecal TB usually presents with chronic right iliac fossa pain, a palpable mass, fever, anorexia, weight loss, and alternating constipation and diarrhoea; complications include intestinal obstruction, fistula, abscess and ascites. Diagnosis combines clinical suspicion with colonoscopy and biopsy showing caseating granulomas; colonoscopy may reveal ulcers, strictures or mucosal nodularity, and tissue GeneXpert MTB/RIF gives rapid rifampicin resistance detection. CT/MRI showing thickened ileocaecal wall, mesenteric lymph nodes and “comb sign”, and ascitic fluid ADA when ascites is present support the diagnosis. Mantoux/IGRA may support diagnosis but are not confirmatory. Management is anti-tubercular therapy under NTEP, formerly RNTCP, typically 2HRZE/4HR for new extrapulmonary abdominal TB, with nutritional support, directly observed therapy, and monitoring for hepatotoxicity. In malnourished patients, nutritional rehabilitation is important. Surgery is indicated not only for acute mechanical obstruction or perforation but also for diagnostic uncertainty, non-response to ATT, fistula, abscess, and chronic obstruction; it may involve ileocaecal resection or strictureplasty. Early surgical consultation is needed if obstruction is high-grade, and follow-up should monitor for relapse and drug resistance, especially in diabetic patients. The rising TB–diabetes comorbidity makes glycaemic control and adherence essential.

Epidemic investigation. The objectives are to verify the existence of an epidemic, confirm the diagnosis, determine its extent, identify the source and mode of transmission, implement control measures, formulate and test hypotheses, train field personnel, and communicate findings. Investigation begins with preparation of the field team and notification under IDSP. The first step is to establish that an epidemic exists by comparing observed cases with expected baseline. The diagnosis is verified clinically and laboratory-wise, and a working case definition is fixed. Cases are counted and oriented by person, place and time to describe the outbreak. A line list, attack rates and maps are prepared. Hypotheses about source, vehicle, reservoir and transmission are formulated from the data and tested by analytic studies such as case-control or cohort analysis. Control measures are implemented early and revised as evidence emerges, for example isolation, safe water, vector control, vaccination or food safety action. Finally, findings are reported using the IDSP outbreak response protocol, follow-up is done, surveillance is strengthened, and lessons are documented. This ordered approach converts an outbreak into a controlled public-health response.