Ruptured tubal pregnancy in an undiagnosed heterotopic pregnancy

Heterotopic pregnancy is rare obstetrical emergency the diagnosis of which is usually delayed. A high degree of suspicion is required to diagnose to reduce maternal morbidity and mortality. At the same time salvage of the intrauterine pregnancy can be done

ECMO: a lifesaving modality in ARDS during puerperium

Acute respiratory distress syndrome (ARDS) is an uncommon condition encountered in pregnancy. The incidence of ARDS in pregnancy has been reported to be 1 in 6229 deliveries with mortality rates to range from 24% to 39% in pregnant patients. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. In critically ill patients where both cardiorespiratory support is required, Extracorporeal Membrane Oxygenation (ECMO) can be used to help maintain the vital functions. ECMO is a temporary cardio respiratory or respiratory support in critically ill patients who are unresponsive to conventional management.  In present case a young female with post-partum ARDS was successfully managed with extra corporeal membrane oxygenation (ECMO)

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infection (UTI) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against Gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (double-disk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates

Ruptured tubal pregnancy in an undiagnosed heterotopic pregnancy

Heterotopic pregnancy is rare obstetrical emergency the diagnosis of which is usually delayed. A high degree of suspicion is required to diagnose to reduce maternal morbidity and mortality. At the same time salvage of the intrauterine pregnancy can be done

Radiological Evaluation of Ovarian Dermoids -A Reterospective Study of 28 cases in a Tertiary Care Centre of North India

Background: Ovarian Dermoids are the most common ovarian neoplasm. It comprise for approx 15-20% of all ovarian neoplasms. They usually occur during reproductive age group, typically in 2nd -3rd decade. These are slow-growing tumors containing elements from multiple germ cell layers and are easily diagnosed with Ultrasonography (USG) and better characterized by CT and MRI.Aim and objective:To do Radiological Evaluation of Ovarian Dermoids using imaging data of different Radiological Modalities.Materials and methods: Data of Radiologically diagnosed cases of Ovarian Dermoids was collected from USG, CT and MRI wings of Department of Radiodiagnosis BPS GMC W Khanpur Sonipat Haryana over a period of two yrs (2017-2019). Imaging data were evaluated by at least two Radiologists. Histocytopathological findings were taken into consideration wherever available. Data was collected, complied and analyzed statisticallyResults: Total 28 female cases were evaluated in age range of 21-70 with mean, median & modes age as 32, 26.5 and 23 yrs respectively showing predominance of reproductive age group. The lesions are seen predominantly on right side and 3/28 (10.71%) showed bilateral lesions. Most of the patients presented with lower abdominal pain (seen in 12/28, 42.8%); 8cm being the average size of lesions. Complication as torsion seen in 3/28 (10.71%) cases. 3/28 patients were found to be pregnant along with having Dermoid lesions. The lesions were characterized further on USG, CT and MRI. The lesions were readily diagnosed on each modalities based on typical imaging features with most of the lesions diagnosed incidentally on sonography (24/28) done as routine abdomino-pelvic scanning.Conclusion: Ovarian Dermoids can be diagnosed readily on USG with typical imaging features and complicated cases can further be better characterized on CT & MRI

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Summary Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development