Clinicopathological study of puerperal sepsis including microbiological profile: at a tertiary health care centre

Background: Puerperal sepsis in developing countries is a major health problem. Antenatal and labour related risk factors play a huge role in causing puerperal sepsis, many of which are modifiable. The aim of the present study is to study the risk factors, clinical features and outcomes of puerperal sepsis in the mother and determine the causative microorganisms involved.Methods: A prospective observational study was conducted at the department of Obstetrics and Gynaecology, Assam Medical college and Hospital from 1st July 2016 to 30th June 2017.Peurperal sepsis cases were identified based on the WHO clinical definition. A total of 88 patients were identified. Information regarding occupation, antenatal care, delivery related events and outcome were recorded on a predesigned proforma. Mothers were followed up till discharge from the hospital.Results: Out of 88 clinically diagnosed patients with puerperal sepsis, common risk factors associated with mortality were young age(p<0.001),primiparity(p 0.005),tea garden workers(p 0.014),few antenatal check-ups and unbooked status (p 0.001) inadequate iron prophylaxis .Among labor related events intrauterine fetal demise (p 0.001), absent membranes on admission (0.001),late presentation (p 0.001) delivery by untrained birth attendant (p <0.001) were significant.24 patients expired due to the disease. Most common isolated in high vaginal swab and blood culture were Klebsiella pneumoniae and CONS respectively.Conclusions: Proper antenatal care and institutional deliveries are the prime and only preventive measure to reduce the burden of puerperal sepsis in our setup

Twin cervical pregnancy: a unique case report

Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level of the internal os. Cervical pregnancy is an infrequent form of ectopic gestation both in naturally conceived pregnancies and even after assisted reproductive technology (ART). It accounts for less than 1% of all ectopic pregnancies. The diagnosis can be missed as a case of incomplete abortion unless an experienced sonologist performs a transvaginal ultrasound. Management options vary and depend on the gestational age at diagnosis, general condition of the patient and woman’s desire to maintain fertility. Medical treatment with methotrexate is the therapy of choice in early gestation with hemodynamically stable patient. Surgical intervention is indicated in late gestation, unstable cases or failed medical treatment. At times hysterectomy is elected as the final path when bleeding does not subside. We present an unique case of twin cervical ectopic pregnancy managed initially conservatively later surgical management was undertaken in view of bleeding

Efficacy of synthetic pyrethroid and propoxur aerosol in the control of German cockroaches (Dictyoptera: Blatellidae) in cookhouses

Background & objectives: A field trial was carried out in cookhouses in an urban area to evaluate theefficacy of synthetic pyrethroid (0.02% deltamethrin + 0.13% allethrin) and propoxur aerosols (2%) inthe control of German cockroaches (Blatella germanica).Methods: A total of six cookhouses were selected by simple random sampling method (two each forthe two insecticide treatments and two for control).Results: It was observed that 89.36–87.8 and 77.95–59.74% reductions were achieved with propoxurand synthetic pyrethroid treatment respectively by first week post-treatment. The reduction in propoxurtreated areas by eight weeks post-treatment was 82.98–76.13%, whereas the reduction in thesame time period in synthetic pyrethroid treated areas ranged from 14.36% to an increase in density bya phenomenal 157.86% in one of the treated sites.Interpretation & conclusion: The study reports the efficacy of propoxur aerosol (2%) treatment oversynthetic pyrethroid (0.02% deltamethrin + 0.13% allethrin) in the control of cockroach infestation incookhouses in urban area

Demographic and clinical factors associated with different antidepressant treatments: a retrospective cohort study design in a UK psychiatric healthcare setting

Objective: To investigate the demographic and clinical factors associated with antidepressant use for depressive disorder in a psychiatric healthcare setting using a retrospective cohort study design. Setting: Data were extracted from a de-identified data resource sourced from the electronic health records of a London mental health service. Relative risk ratios (RRRs) were obtained from multinomial logistic regression analysis to ascertain the probability of receiving common antidepressant treatments relative to sertraline. Participants: Patients were included if they received mental healthcare and a diagnosis of depression with antidepressant treatment between March and August 2015 and exposures were measured over the preceding 12 months. Results: Older age was associated with increased use of all antidepressants compared with sertraline, except for negative associations with fluoxetine (RRR 0.98; 95% CI 0.96 to 0.98) and a combination of two selective serotonin reuptake inhibitors (SSRIs) (0.98; 95% CI 0.96 to 0.99), and no significant association with escitalopram. Male gender was associated with increased use of mirtazapine compared with sertraline (2.57; 95% CI 1.85 to 3.57). Previous antidepressant, antipsychotic and mood stabiliser use were associated with newer antidepressant use (ie, selective norepinephrine reuptake inhibitors, mirtazapine or a combination of both), while affective symptoms were associated with reduced use of citalopram (0.58; 95% CI 0.27 to 0.83) and fluoxetine (0.42; 95% CI 0.22 to 0.72) and somatic symptoms were associated with increased use of mirtazapine (1.60; 95% CI 1.00 to 2.75) relative to sertraline. In patients older than 25 years, past benzodiazepine use was associated with a combination of SSRIs (2.97; 95% CI 1.32 to 6.68), mirtazapine (1.94; 95% CI 1.20 to 3.16) and venlafaxine (1.87; 95% CI 1.04 to 3.34), while past suicide attempts were associated with increased use of fluoxetine (2.06; 95% CI 1.10 to 3.87) relative to sertraline. Conclusion: There were several factors associated with different antidepressant receipt in psychiatric healthcare. In patients aged >25, those on fluoxetine were more likely to have past suicide attempt, while past use of antidepressant and non-antidepressant use was also associated with use of new generation antidepressants, potentially reflecting perceived treatment resistance