No abstract

Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.

Rapid AED tapering has the advantage of significantly reducing LTM duration over slow tapering, without any serious adverse events.

Dengue fever is endemic in the Indian subcontinent and can have myriad presentations. The term expanded dengue syndrome (EDS) is used for atypical manifestations in dengue fever. We present a rare case of EDS in a patient with secondary dengue infection who developed rhabdomyolysis induced acute kidney injury (RAKI) along with intracranial and intraorbital bleeds. Patient was successfully managed in our institute and was discharged in stable condition. To the best of our knowledge, this is the only reported case of simultaneous occurrence of these complications in a dengue patient. This case is being presented to make clinicians aware of the spectrum of dengue infection.

Septic cardiomyopathy and mortalityBackground: Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC).Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.Methods: In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echocardiogram and was defined by a new-onset decline in left ventricular ejection fraction (LVEF) of up to 50% or a decline of at least 10% in LVEF relative to baseline in patients with a history of heart failure with reduced EF. Multivariable logistic regression analysis was performed using the R software program (R Foundation for Statistical Computing). Results: Of the 359 patients in the final analysis, 19 (5.3%) had SIC, and eight (42.1%) of these 19 patients and 60 (17.6%) of the 340 patients in the non-SIC group died. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15-18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23-0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24-55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.Conclusions: SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.

Background: To isolate the pathogenic bacteria and to know the antibiotic sensitivity in the community acquired neonatal sepsis. Methods: It was a prospective study undertaken on 300 neonates suspected of community acquired neonatal sepsis admitted in Pediatrics Department of Government Medical College,Amritsar over a period of one year from January2014 to December 2014.All these cases fulfilled the inclusion criteria required for the study.Blood culture of these cases was performed by Mackie and McCartney method and antibiotic sensitivity by Kirley-Baner's disc diffusion method. Results: 227 (79%) cases showed positive blood culture.Gram negative isolates (N=156;65.82%) were more frequent than gram positive isolates (N=81;34.18%). Most common isolate was KlebsiellaPneumoniae (N=77%;32.48%) followed by Staphylococcus Aureus (N=66;27.84%), E.Coli(N=37;15.66%), Pseudomonas Aeroginosa (N=28;11.81%), Acinetobacter (N=14;5.90%), Enterococcus(N=8;3.37%) and Coagulase Negative Staphylococcus Aureus (N=7;2.99%). Both gram negative as well as gram positive isolates showed high resistance to ampicillin and gentamycin. Gram negative isolates were highly sensitive to Polymixin B and Meropenem whereas gram positive isolates were highly sensitive to Linezolid and Vancomycin. Conclusion: Gram negative bacteria were more frequent causes of community acquired neonatal septicemia than gram positive isolates. Both gram positive and negative isolates showed poor sensitivity towards conventional first line antibiotics, rather were mainly susceptible to higher antibiotics. So the knowledge of the pattern of bacteriological isolates and their antimicrobial susceptibility pattern can be very helpful for prompt treatment of such patients, to decrease neonatal morbidity and mortality as well as reducing the emergence of multi-drug resistant organisms.

No abstract

Catamenial epilepsy (CE) is a commonly observed phenomenon among women with epilepsy, the management of which is both hormonal and non‐hormonal. Progesterone therapy has been tried in these patients, as the possible mechanism of CE is withdrawal of progesterone and a higher oestrogen/progesterone ratio in the perimenstrual and periovulatory periods. Here, we describe a 24‐year‐old lady with multiple seizure types since childhood, which were refractory to adequate antiepileptic drug therapy after menarche with catamenial clustering of seizures. She went on to have several episodes of non‐convulsive status epilepticus also with similar periodicity, which would abate only with midazolam infusion, without the need for ventilatory support. She was tried on acetazolamide, progesterone vaginal pessaries, and maximum tolerated doses of antiepileptic medications, but finally responded to intramuscular and oral progesterone, and has been seizure‐free for more than a year.