Enhancing contraceptive usage by immediate postpartum intra uterine contraceptive device insertion with evaluation of safety, acceptability and expulsion

Background: India’s population which crossed one billion in 2000 is projected to reach 1.53 billion by 2050 making India the most populous country in world. In India 65% of women have unmet need for family planning in the first post-partum year. PPIUCD is highly effective, safe, long-acting, coitus independent and rapidly reversible method of contraception with very few side effects.  Since there is tenfold increase in institutional deliveries due to maternity benefit schemes, postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated and these women would leave the hospital with contraceptive in place.Methods: The present study was a prospective study to assess the acceptance rate of PPIUCD insertion and evaluation of safety of Cu T 380A when inserted within ten minutes of placental expulsion in 100 women delivering at PESIMSR, Kuppam. A specially designed proforma was used to collect the data of women attending hospital between period June 2016 to June 2017.Results: Out of 486 patients who were counselled only 100 women (20.57%) accepted for PPIUCD insertion. The acceptance rate of PPIUCD is 20.57%. Of 100 women who had PPIUCD insertion, 91 were seen at follow up, 76 (78.12%) women were continuing with no complaints and only 15 (16.4%) women developed complications. PPIUCD was found to be safe as there was no reported case of perforation or failure during usage. The complications like expulsion was found to be 1.09%, infection 5.4%, pain abdomen 5.4%, bleeding 1.09% and missing strings 5.4%.Conclusions: PPIUCD was demonstrably safe, having no reported case of uterine perforation. Expulsion rates are low implying more retention rates, thus more effective. Public awareness regarding the concept and advantages of PPIUCD insertion can be improved by mass media approach and creating strategies and training programmes under Government policies

CLOZAPINE, CANCER CHEMOTHERAPY AND NEUTROPENIA - DILEMMAS IN MANAGEMENT

Clozapine is the antipsychotic of choice in the management of treatment resistant schizophrenia. Neutropenia is a rare but serious adverse effect of clozapine. The risk for neutropenia with clozapine is highest in the first 18 weeks of treatment and decreases with time though a few cases were reported after several years of continued therapy. Different protocols that guide the monitoring for neutropenia have been developed; in Australia we follow the protocol implemented through the Clopine® Alert Programme. Despite an increased risk of poor physical health and shortened life span in patients with schizophrenia, the overall incidence of cancer in schizophrenia is not significantly increased. This suggests a discrepancy between cancer risk exposure (e.g., smoking) and cancer incidence in schizophrenia (Goldacre et al. 2005), an association that has been described paradoxical (Hodgson et al, 2010). Nevertheless, these two conditions co-occur (Goldacre et al. 2005). It can create difficulties in management when the patient is clinically stable on clozapine and require chemotherapeutic agents that can frequently cause myelosuppression and neutropenia as it can pose several dilemmas for the clinicians. A systematic literature search identified 11 case-reports (Avnon & Stolerman 1993, Bareggi et al. 2002, Frieri et al. 2008, Goulet & Grignon 2008, Haut 1995, Hundertmark and Campbell 2001, Kolli et al. 2012, McKenna et al. 1994, Rosenberg et al. 2007, Rosenstock 2004, Wesson et al. 1996). The results are summarized in Table 1. Interestingly, Clozapine was successfully continued during chemotherapy treatment regime in most of these cases despite neutropenia (Bareggi et al. 2002, Goulet & Grignon 2008, Kolli et al. 2012, Rosenberg et al. 2007, Rossenstock 2004, Wesson et al. 1996). There is however little guidance to appropriately manage the potential risks under these circumstances (Rosenstock 2004). We present here three cases and discuss three of the dilemmas that clinicians can face under such circumstances- identifying the offending agent, decision to continue clozapine treatment and use of human granulocyte colony stimulating factor (G-CSF)

Psychopathology in never-treated schizophrenia

Abstract The effect of drug treatment and its adverse effects confound studies on symptoms and associated factors in schizophrenia. Knowledge of psychopathology in the untreated state would identify the natural state of the illness and is relevant to understand pathology underlying the illness. We report here symptoms of schizophrenia as measured by Positive and Negative Syndrome Scale in 143 patients with schizophrenia living in the community never treated with antipsychotic drugs. Positive symptoms were more frequent than negative ones. Negative subscale scores correlated negatively with positive subscale scores and positively with general psychopathology subscale scores. Age correlated negatively with negative and general psychopathology subscale scores independent of duration of illness. Duration of illness and the proportion of life spent in psychosis did not correlate with any Positive and Negative Syndrome Scale scores. The factors (negative, positive, anxiety-depression, motor, and excitement) extracted by a forced 5-factor analysis explained 56% of variance. This factor structure resembled that of treated patients reported in most studies except for the identification of a motor symptom cluster. Psychopathology in the never-treated schizophrenia varied in some aspects from descriptions in the treated state. The differences can be said to demarcate the natural features of the illness from medication effects on the relationship of symptoms with one another and to sex, age, duration of illness, and age at onset.

The persistent shadow of the supermassive black hole of M 87

In April 2019, the Event Horizon Telescope (EHT) Collaboration reported the first-ever event-horizon-scale images of a black hole, resolving the central compact radio source in the giant elliptical galaxy M 87. These images reveal a ring with a southerly brightness distribution and a diameter of ∼42 μas, consistent with the predicted size and shape of a shadow produced by the gravitationally lensed emission around a supermassive black hole. These results were obtained as part of the April 2017 EHT observation campaign, using a global very long baseline interferometric radio array operating at a wavelength of 1.3 mm. Here, we present results based on the second EHT observing campaign, taking place in April 2018 with an improved array, wider frequency coverage, and increased bandwidth. In particular, the additional baselines provided by the Greenland telescope improved the coverage of the array. Multiyear EHT observations provide independent snapshots of the horizon-scale emission, allowing us to confirm the persistence, size, and shape of the black hole shadow, and constrain the intrinsic structural variability of the accretion flow. We have confirmed the presence of an asymmetric ring structure, brighter in the southwest, with a median diameter of 43.3−3.1+1.5 μas. The diameter of the 2018 ring is remarkably consistent with the diameter obtained from the previous 2017 observations. On the other hand, the position angle of the brightness asymmetry in 2018 is shifted by about 30° relative to 2017. The perennial persistence of the ring and its diameter robustly support the interpretation that the ring is formed by lensed emission surrounding a Kerr black hole with a mass ∼6.5 × 109 M⊙. The significant change in the ring brightness asymmetry implies a spin axis that is more consistent with the position angle of the large-scale jet

Case Report - Folie a Famille: Delusional parasitosis affecting all the members of a family

Delusional parasitosis (Ekbom syndrome) is an uncommon psychiatric disorder that presents with a delusion of being infested with parasites. Treatment of this condition is difficult as patients with this paranoid disorder reject psychiatric diagnosis and treatment and often consult a dermatologist. Sharing the delusional beliefs of the paranoid patient by other people living in close emotional bonding with him/her could occur. We report here the clinically interesting phenomenon of delusion of parasitosis occurring simultaneously in all the members of a family. There was a pathological bonding between the members of the family who all presented to the dermatologist and rejected treatment. Dermatologists need to be aware of this uncommon clinical picture

Cognitive dysfunction and associated factors in patients with chronic schizophrenia

BACKGROUND: Deficits in neurocognitive function are a hallmark of schizophrenia. They are associated with clinical manifestations and the course of the illness. A study of cognitive dysfunction in Indian patients with schizophrenia is of significance in view of a more benign course and outcome of the illness in this region. AIM: To study cognitive deficits and associated factors in patients with chronic schizophrenia and compare them with those in the normal population. METHODS: We compared 100 patients with chronic schizophrenia with 100 matched normal controls on multiple measures of attention, executive function and memory. RESULTS: Compared to normal individuals, patients with schizophrenia performed poorly in all cognitive tests. Cognitive deficits in patients were related to gender, education, age, duration of illness, and presence of positive and negative symptoms. CONCLUSION: The neurocognitive profile of Indian patients with chronic schizophrenia resembles those of patients in developed countries