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Background: Fibrinogen is a glycoprotein produced by the liver that plays a crucial role in blood clotting. Elevated levels of fibrinogen have been associated with an increased risk of cardio vascular disease, stroke and other chronic conditions. Several studies have investigated the relationship between fibrinogen and diabetes mellitus. Furthermore, fibrinogen has been suggested to play a role in pathogenesis of diabetes and its complications by promoting inflammation and endothelial dysfunction. The aim of the study was done to study association of fibrinogen levels and development of complications of diabetes mellitus. Methods: A cross sectional observational study was conducted at medicine department of Dhiraj Hospital, Vadodara. Total of 114 diabetes mellitus patients were studied. The level of fibrinogen as well as presence of various risk factors like smoking, hypertension, obesity, dyslipidemia and different microvascular and macro-vascular complications were assessed. There were no conflict of interest. Results: Of 114 patients smoking, overweight, hypertension, uncontrolled diabetes and dyslipidemia was reported in 54.4%, 30.7%, 41.2%, 28.1% and 60.5% respectively. Microvascular complication like retinopathy, nephropathy and neuropathy was reported in 34.2%, 40.4% and 21.1% patients respectively. Macrovascular complications like coronary artery disease and stroke was reported in 20.2% and 16.7% patients respectively. Average level of fibrinogen was found higher amongst diabetic patients with microvascular as well as macrovascular complications. Conclusions: Serum fibrinogen level was found to be higher among patients with poor glycemic control, dyslipidemia, hypertension and higher BMI. A positive correlation was found between the level of fibrinogen and various complications of diabetes mellitus.

Background: Caesarean delivery rate is rising continuously worldwide and is matter of concern. The Robson’s Ten-group classification system allows critical analysis of caesarean deliveries thereby helps to optimise caesarean section rates. Methods: This study was conducted at GMERS medical college and hospital, Sola, Ahmedabad, Gujarat, India. All patients who delivered between November 2021 and May 2022, were included in the study and were classified in 10 groups according to modified Robson’s classification system. The CS rate and contribution to the overall CS rate was calculated within each group.Results: Total number of deliveries was 836, out of them 242 was CS. The CS rate was 28.94%. The main contribution to overall caesarean rate was 39.67% by group 5, followed by 17.77% by group 1, 10.33% by group 2. CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 88% in nulliparous breech (group 6), 84.95% in previous CS (group 5), 40.62% in multiparous breech (group 7) and least 3.57% in multipara spontaneous labour (group 3).Conclusions: The Robson groups 1, 2, 5 and 6 were found to be the major contributors to the overall CS rate. These groups may be targeted for effective interventions to reduce the CS rate. Reduction of primary caesarean delivery, promoting vaginal birth after CS, and careful assessment of cases before induction of labour in nulliparous women, are likely to be a few effective strategies.

Background: Meconium staining amniotic fluid is associated with lots of adverse outcome and has long been considered to be a bad predictor of fetal outcome. This prospective observational study was undertaken to find out immediate fetal outcome in meconium-stained liquor.Methods: The design of the study was prospective. This study was conducted from July 2021 to December 2021.The study included women with meconium-stained amniotic fluid in labor with gestational age >37 completed weeks.Results: Total 100 cases were enrolled. Majority of the patients (74%) were in the age group of 21-30 years with the mean age being 24.6±2.4 years. Fetal distress occurred in 30% of babies, more in association with thick meconium (15%). Caesarean deliveries were 70%. Apgar scores between 0-3 was seen in 17% babies and 1% at fifth minute, between 4-6 in 21% babies and between 7-10 in 62% babies at first minute of birth. Admission in neonatal ward was 32% with perinatal mortality of 6%.Conclusions: Meconium-stained amniotic fluid was associated with higher rate of caesarean delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission and mortality. It is more commonly associated with pregnancy induced hypertension (PIH), post-datism, oligohydramnios and gestational diabetes mellitus.

Metronidazole, a commonly used antiprotozoal and antibacterial medication is usually a safe and rarely reported to cause serious side effects. Major nervous side effects are peripheral ones, while central toxicity is rare. Following the discontinuation of the medication, clinical improvement is seen in the most cases. A 62 years old female patient was presented to hospital after experiencing the symptoms of an unsteady gait, difficulty in walking, impaired coordination of arms and legs, slurring of the speech, headache, tingling and numbness of both the feet and ascending limb weakness following intake of 400 mg metronidazole TDS daily for 2 months. The motor system examination revealed reduced muscle power, and DTR (Deep tendon reflex) was found to be 2+, except ankle reflex absent, while examination of sensory system showed, decrease pain and joint vibration sense up to the neck with absent planter reflex. The axial magnetic resonance imaging study of the brain showed bilateral symmetric hyperintensity involving both dentate nuclei in FLAIR image. The patient’s clinical conditions, on the other hand was deteriorated even after the discontinuation of the medication, hence injection methylprednisolone was given as an empirical therapy and was proved to be successful, and patient was recovered completely.

Background: Iron deficiency anemia (IDA) is described as decrease in the hemoglobin and/or the amount of red blood cells in the blood due to iron insufficiency in the body. The aim of the study was to measure the efficacy and tolerability of iron sucrose in iron deficiency anemia in pregnant women.Methods: This was the prospective study of 50 pregnant women with iron deficiency anemia (Hb- 5 g/dl to 8 g/dl) between 20-34 weeks of gestation, who were given intravenous iron sucrose as per their requirements and follow up measurement of Hb was done.Results: Mean rise in Hb was seen by 2.2 g/dl. Minor side effects were seen in 6 out of 50 participants. Conclusions: Parenteral iron sucrose therapy can be used effectively and safely in pregnant women with iron deficiency anemia

Background: Infection of central nervous system (CNS) is most common cause of fever associated with signs and symptoms of CNS disease in children. Viral infections of CNS are more common than other infections. Radiology and pathology go together in understanding etiology causing CNS infections which have similar clinical manifestations making specific diagnosis difficult. The present study aims to study the utility of different neuroimaging patterns in diagnosis of acute CNS infection. Aims include: to study utility and pattern of neuroimaging in CNS infection in paediatric age group, and to study socio-demographic and clinical profile of CNS infection in children.Methods: Prospective observational study in children 1 month-12 years who presented with CNS infection.Results: Total 58 cases were suspected to have CNS infection, which was more prevalent in 1 month-1 year (27.58%), followed by 5-8 year (24.13%), 1-3 year (22.41), >8 year (20.68%) and 3-5 year (5.17%). Neuroimaging was done in all suspected case (58) of CNS infection in which 30 (51.7%) had abnormal neuroimaging where 3(10%) showed pyogenic meningitis, 7 (23.23%) tubercular meningitis (TBM), 4 (13.13%) tuberculoma, 3 (10%) TBM and tuberculoma, 4 (13.3%) viral meningitis, 1 (3.3%) herpes simplex encephalitis (HSE), 1 (3.3%) COVID encephalitis, 4 (13.3%) acute disseminated encephalomyelitis (ADEM) while 2 (6.66%) brain abscess. Correlation between final diagnosis and neuroimaging was 100% in ADEM, brain abscess, tuberculoma, TB spine, HSV followed by TBM (77.77%), pyogenic meningitis (27.27%) and viral encephalitis (26.66%). Clinically diagnosed acute CNS infection was confirmed in 51.72% and wrong in 48.27%.Conclusions: CNS infections were more common in less than 5 years age. Approximately 50% patients had abnormal neuroimaging finding. It was found that neuroimaging was more accurate in early diagnosis, categorization of CNS infection and detection of complications with high sensitivity.

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.

Background: Increased family planning helps to reduce maternal mortality and infant mortality. Unmet need is spacing of birth for younger women and is the limitation of births for older women; both of which can be fulfilled by rigorous counseling. so the present study was conducted to measure the proportion of targeted women adopting family planning methods after postpartum counseling and to find out the type and timing of adoption.Methods: A Non-randomized control trial was conducted. The study was carried out at the postpartum delivery ward of the obstetrics and gynecology department of SSG Hospital. 103 participants in the intervention group and 103 participants in the control group were interviewed.Counseling and leaflet were given to the intervention group. The washout period was kept for one week. In the next week in the control group usual counseling was given by the counselor (standard of care). Second interview of the same participants was done telephonically or home visits after the 6 months to see the adoption of family planning method.Results: Within six months of delivery, acceptance of contraceptive methods was more in intervention group (72.85%) than in control group (48.52%). Condom was the most common type of contraceptive intervention used in both interventional group (51.45%) and control group (36.76%) followed by Copper T use which was 14.21% in interventional group and 8.82% in control group. Majority of the women adopted contraceptives within two months of intervention.Conclusions: Counseling may help in adoption of family planning methods among postpartum women.

The second wave of coronavirus disease 2019 (COVID-19) in India, which commenced in March’21, continues to create a major crisis of medications, hospital beds, oxygen, and Intensive Care Units at very rapid rate which has placed the country on the verge of a humanitarian crisis. While no definite treatment for SARS-CoV-2 has been found, different types of vaccines have been manufactured which have shown some effectiveness in preventing disease progression and severity. The objective of this manuscript is to review the available data from the pandemic and highlight the factors that have contributed to the development of second wave in India which has led to crisis. In this review, using available scientific literature on various indexes such as PubMed, Google Scholar, Medline and news articles- where appropriate, we dive into understanding newer virus variants, vaccines and their effectiveness against new strains, overwhelming burden on the Indian healthcare system and socio-politico-environmental factors responsible for upsurge. The sudden upsurge in the number of cases is multifactorial, which includes virus variants, complacency in following COVID-19 appropriate behaviour, burden over the health care system, various socio-politico-environmental factors. As the definitive treatment is yet to be discovered, vaccination remains at the top.

Background: Depot medroxyprogesterone (DMPA) injection 150 mg intramuscular was used in postpartum women for contraception in this study, once every 3 months. The aim of the study acceptance and compliance of DMPA, observe side effects related to usage of DMPA and establish its effectiveness as a postpartum contraception method.Methods: This is a prospective study carried out at Obstetrics and Gynaecology department over a period of 9 months and follow up was done. Only patients of full term normal delivery and Lower segment caesarean section (LSCS) were included. They were counselled properly and after their willingness for enrolment they were included in study after taken consent.Results: Out of 50 cases selected maximum patients, 48% were in the age group of 26 to 30, 38% were from lower socioeconomic class. Amenorrhoea and irregular spotting were found in 68% and 42%respectively. There was no case of failure of this contraceptive method in this study.Conclusions: DMPA is an effective and safe method of contraception in lactating period. Proper counselling will increase acceptance of DMPA. Awareness in patients regarding its benefits as compared to other contraceptive methods.

Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.

Background: Oligohydramnios has been correlated with increased risk of FGR, meconium aspiration, birth asphyxia, low APGAR scores and congenital anomalies. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality. The aim and objectives of the study was to study the effect of oligohydramnios on fetal outcome in form of FGR, fetal distress, altered APGAR scores, NICU admission and early neonatal morbidity and mortality and to study maternal morbidity in the form of operative delivery and induced labour. Methods: 100 patients in third trimester of pregnancy with oligohydramnios confirmed by ultrasound measurement of AFI were selected randomly after satisfying inclusion and exclusion criteria. Results: Incidence of oligohydramnios and operative intervention for the same was seen more in primipara (52%). Most common causes of oligohydramnios were idiopathic (52%) followed by PIH (25%). Operative morbidity was highest in PIH (60%). Most common indication of caesarean section was fetal distress due to cord compression or FGR. 7% patients had fetoplacental insufficiency on Doppler study. Conclusions: Oligohydramnios demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to high rates of intrapartum complications, perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary operative morbidity is prevented without jeopardizing the fetal well-being.

Background: Dengue fever (DF) and its severe forms - Dengue haemorrhagic fever (DHF) and Dengue shock syndrome (DSS) have emerged as a notable public health problem in recent decades in terms of the mortality and morbidity associated with it. Methods: A cross-sectional prospective study was conducted at PDU Government Medical College, Rajkot during 1st January to 31st December, 2014. All confirmed Dengue cases were admitted in this institute during 2014 included in the study. The data entry was done in Microsoft Office Excel 2007 and analysis was done using the same software and appropriate tests were applied. Results: This study included 145 patients who were admitted to the institute during the calendar year 2014. 62% were males. 69% were in the age group 15-44 yrs. 59% cases were from rural origin. During September to December, 2014, 80% cases were admitted. 74% cases were consulted by doctor before admission at PDU Government Medical College, Rajkot. Fever was present in all the cases i.e. (100%), followed by myalgia (99%), headache (96%), vomiting (78%) and epistaxis (63%). Majority of the cases presented with Classical Dengue fever i.e. (90%) followed by DHF (10%). Most common complication was bleeding from nose and mouth i.e. (66%). No any death due to Dengue was reported during study period. 93% cases were discharged and 7 % cases were DAMA from PDU Government Medical College, Rajkot. Conclusions: The most common age group for Dengue fever was 15-44 yrs. Most of the patients were male and also from rural origin. Most of the cases occurred during the period of September to December, 2014. Fever was present in all the cases and bleeding from nose and mouth was the commonest complication of Dengue. No any death due to Dengue was reported during study period.

Background: Thyroid gland is unique among endocrine organs as it is the largest endocrine gland in the body and the first to develop in the fetal life. There is approximately 4-5% incidence of clinically apparent thyroid lesions in general population. The goal of USG and FNAC diagnosis work up now is to select those patients for surgery who have a high likelihood of harboring malignancy in the nodule. Ultrasonography is the single most valuable imaging modality in the evaluation of the thyroid gland. Indications for thyroid USG include evaluation for palpable thyroid lesion or suspected thyroid enlargement and workup of thyroid lesions discovered incidentally.The present study is undertaken to evaluate the utility of FNAC in preoperative diagnosis of various thyroid lesions and to evaluate the efficacy of in USG and FNAC differentiating between benign and malignant lesions.Methods: A retrospective clinical study, 100patients, in the age group of equal to or above 18 years, with thyroid swellings, referred to the department of ENT, sent for USG and FNAC at radiology and pathology department during the period from July 2014 to July 2016. Results: Out of 100 cases, 6% were malignant, 94% were benign on grey scale ultrasound. Out of 6 malignant cases 2 cases were confirmed malignant by FNAC.Conclusions: High resolution grey scale ultrasound has emerged as initial imaging modality of choice for the evaluation of patients with thyroid enlargement. Ultrasound can detect solitary nodule, multiple nodules and diffuse thyroid enlargement. It can also differentiate solid and cystic lesions.

Background: Chronic suppurative otitis media presents mostly with ear discharge and associated decreased hearing. Tympanoplasty is the established surgery for tympanic membrane perforation. Most commonly used graft material for tympanoplasty is temporalis fascia. Others are fascia lata, tragal perichondrium, tragal cartilage, fat. The objective of the study was to compare the graft taken up and hearing improvement following myringoplasty with use of fat.Methods: Patients of CSOM aged 10 to 65 years old with small central perforation which is dry for at least 3 weeks with normal middle ear mucosa and intact ossicular chain with mild conductive hearing loss. The present study was carried out in Ear, neck and throat (ENT) Department of SCL hospital, Ahmedabad from July 2016 till September 2018 and 25 patients were randomly selected fulfilling the above criteria.Result: The choice of graft affects not only the outcome of surgery, but also determines the complexity of the procedure and the time taken for the same. Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. The results have been quite encouraging.Conclusion: Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. An added advantage of this technique was the excellent post-operative quality of life of the operated patients, assessed in terms of the chronic ear survey and evident by the absence of the usual post-operative complaints following a conventional myringoplasty.

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index 1. Cases with cerebro-placental index

Background: Caesarean section constitutes a major surgical procedure characterized with morbidity even if it is performed a planned procedure. Postoperative infection in obstetrics continues to affect the practice of every surgeon. Infection can cause an increase in patient’s stay in the hospital, create discomfort, cause disfigurement and lead to morbidities to the patient. Thus, preventive measures need to be constantly evaluated and updated and hence authors have to study and analyse prevalence of postoperative infectious morbidities.Methods: The study was conducted in an Urban Based Medical College Hospital in Ahmedabad. It was a retrospective cross-sectional study of 50 cases of patients who suffered infectious complications post caesarean from 1st March 2019 to 31st March 2020.Results: The prevalence rate of surgical site infection in my study is 5.9% whereas of post-operative puerperal sepsis is 0.6%, of post-operative urinary tract infection is 1.09%, of post-operative breast abnormalities is 0.16%. The most common infectious morbidity amongst all was surgical site infection (surgical site) infection and its prevalence was 5.9%.Conclusions: The development of post-operative infection is an important event that can be prevented by taking proper precautions and following prescribed guidelines. There should be specific use of antibiotics in the post-operative period. In the event of early signs of sepsis antibiotics should be administered properly as per culture sensitivity report. The decrease in infection rate also indirectly reduce the health costs involved in treating them post operatively.

Ectopic or extrauterine pregnancy occurring in a case with mullerian defect is very rare and poses diagnostic challenges. Undescended and non-communicating fallopian tubes are extremely rare mullerian anomalies. Here authors present a case of ectopic pregnancy occurring in an undescended non-communicating fallopian tube in a patient with unicornuate uterus with absent horn, which was managed laparoscopically. A 32-year-old lady, diagnosed case of left unicornuate uterus with absent right horn, was referred to us with the suspicion of ruptured ectopic pregnancy. The abdominopelvic ultrasound showed a soft tissue lesion of size 32×24 mm, towards the right lateral pelvic wall near the iliac vessels, with increased vascularity on colour flow doppler. The patient underwent laparoscopy which showed left sided unicornuate uterus with normal left tube and ovary. The right uterine horn was absent. An undescended right ovary and tube were found attached to the peritoneum at the level of pelvic brim along the right lateral pelvic wall. Right sided tubal ectopic pregnancy with rupture was present along with 300-350 cc of hemoperitoneum. The patient was treated with laparoscopic right sided total salpingectomy. In patients with unicornuate uterus and atypical presentation, ectopic pregnancy should be ruled out in an undescended non-communicating fallopian tube. Salpingectomy of incidentally diagnosed non-communicating fallopian tubes is recommended to prevent future ectopic pregnancy.

Background: Several studies have shown potential value of serum Procalcitonin level (SPCT) for diagnosing and differentiating bacterial meningitis (BME) from other, but the results were inconsistent.Methods: Children from birth to 12 years, with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected and cases were classified according to pre decided case definition (based on clinical and laboratory) as bacterial or non-bacterial meningitis (NBME).Results: Out of 4393 admission (2016-17) 60 patients were selected for final study (on basis of case definition) which were equally distributed in both group (BME and NBME) in terms of age and sex (p 0.97). 29/41 (70%) patients of pyogenic meningitis had high level of SPCT which was significant, whereas only 2/19 (10.5%) patients of NBME had high level of SPCT. Although SPCT seems to be the good marker in differentiating between BME and NBME, SPCT level specificity (89%) in the diagnosis of BME was not higher than CSF protein level (94%) and CSF glucose level (94%).Conclusions: Measurement of plasma SPCT levels are of value in differentiating BME & NBME in children. However, SPCT should not be used as single sole diagnostic marker of BME if CSF protein and glucose are available. CSF WBC Count alone should not to be used in diagnosis of BME as specificity is low. This study needs to be validated with a larger sample size and microbiological confirmation of bacterial disease.

Calcifying fibrous tumours are rare benign lesions affecting mostly children and young adults. A 17-year-old female presented with abdominal pain and abdominal distention. Physical examination revealed intra-abdominal mass occupying retro peritoneum and right iliac fossa. Excisional biopsy from peritoneum and mesentery were performed. Histopathologically, it was composed of hypocellular hyalinised collagenized stroma, spindle cells, psammomatous and dystrophic calcification and mononuclear inflammatory cell infiltration. Authors are here in reporting a case of calcifying fibrous tumour and discussing its clinical and morphological features with regard to the literature.

Background: A school is a key location for educating adolescents about health, hygiene and nutrition. Adolescence is period of critical development and transition. These changes have important implications for health. Aims and objectives of the stud was to study the role of WHR in nutritional assessment in adolescent school children and compare it with BMI as an assessment tool and to study nutritional status of municipal and private school.Methods: It was a cross sectional study conducted in 10-17-year-old school children in Ahmedabad, Gujarat. There were 2 private and 2 municipal schools selected randomly by purposive sampling. Child absent or not well on the day of study were excluded.Results: Incidence of obesity is 42.9% and 57.1% in municipal and private school respectively. Incidence of overweight is 47.2% and 52.8% in municipal and private schools respectively. (2.9%) adolescents had BMI range of 25-29.9 which is considered to be overweight. However, the percentage of overweight and obese was raised at 28% and 23.5% respectively when classified as per WHR.Conclusions: The difference between incidence of overweight and obesity in private and municipal schools were not statistically significant. A combination of increase BMI with increase WHR is a stronger indicator of increase health risk.

Background: Thyroid diseases and diabetes mellitus, as comorbid condition these together throw a great burden to medicine and humanity. Considering the ever increasing population of diabetics in our country and the significant causal relationship established by current literature, this study was undertaken.Methods: A thorough clinical history regarding diabetes mellitus (onset, duration), any history of long-term illness, any previous thyroid dysfunction, previous history of any kind of drug therapy, whether the patient was on insulin or oral hypoglycaemic drugs was sought. All diabetic patients were evaluated for thyroid dysfunction by testing thyroid profile (T3, T4 and TSH).Results: In the present study, out of the 100 diabetic patients, 18 (18%) patients had thyroid dysfunction and 82 (82%) patients were found to be euthyroid. The prevalence of thyroid dysfunction more in females as compared to males (68.75% vs 31.25%) and highest in the age group of >60 years. The prevalence of thyroid dysfunction found to be more in patients with HbA1C >7 as compared to patients with HbA1C 1 - 5 years and 08 (44.44%) had duration of diabetes 6 - 10 years. The prevalence of thyroid dysfunction found to be more in patients who had BMI >30 and patients who were on both oral hypoglycaemic agents and insulin.Conclusions: There is a high prevalence of thyroid disorders in patients of type 2 diabetes mellitus which found to be more in Females, Elderly patients, Patients with uncontrolled diabetes and BMI > 30.

Background: Study of the clinical profile and no. of admissions of adolescents admitted in pediatric ward and other than Pediatric ward.Methods: A Prospective Study, conducted during August 2018 to March 2019, at a tertiary care teaching hospital, including age group 10-19 years.Results: Out of 1645, highest adolescents’ admissions 749 (46.37%) were to medical ward, 2nd highest in the Pediatric ward which was 317 (19.6%), followed by general surgical ward which was 312(19.3%). Highest among late adolescents, infectious diseases were still the leading cause of hospitalization of adolescents as it constituted 68.4% (902) of admissions to other than pediatric ward followed by surgical cause[135(10.2%)] followed by accidents [5%(66)].Conclusions: Infectious diseases are more common in adolescents compared to developed countries. The shift in hospitalisation of adolescents from pediatrics to general medicine at about 14 years is illustrated in present study and reflects the need of better implementation of clinical policy on the age divide.

Erosive pustular dermatosis of the scalp (EPDS) has been reported as a rare chronic and progressive non-infectious inflammatory condition of the actinically damaged scalp characterized by crusts, erosions and pustules. It tends to occur on the scalp of older people who have usually been treated for diffuse actinic damage and actinic keratoses. The list of possible differential diagnosis is long and includes tinea capitis, folliculitis decalvans, neutrophilic dermatosis, autoimmune vesiculobullous disorders, malignancy etc. Notoriously difficult to treat, these cases tend to be chronic and progressive. These patients often present after repeated treatment to various scalp dermatosis that doesn’t result in clearing instead persistence and perpetuation of the process. A cross sectional prospective study was conducted in department of dermatology in a tertiary care centre in which six cases of EPDS attending outpatient department from 2017 to 2019 were included. EPDS is more common but under recognized condition, hence less cases are reported till date. Increased awareness of and proper diagnosis of this condition changes the approach towards these patients, protects the scalp from involuntary insults and other precipitating factors that hinders with a better outcome.

Background: India has the maximum number of diabetic patients in the world and this had given the country the dubious distinction of being the “diabetic capital” of the world. It is evident that the urban poor living in slums and slum like areas adopt a more urbanized lifestyle which places them at a higher risk for non-communicable diseases and have poor access to healthcare, partly related to their poor purchasing ability. Women slum dwellers are particularly vulnerable to negative health outcomes. The study was conducted with objectives to assess prevalence, determine factors and know treatment and control status.Methods: This is a cross sectional study conducted among 405 slum women of age 35 years or more in Rajkot city. Interview, anthropometric measurements and selective clinical examinations i.e., blood sugar estimation were done for all participants.Results: In present study, total 64 (15.80%) women were diagnosed with diabetes. A statistically significant association was found between body mass index, remaining busy in household work, walking, practicing healthy habits, parental history, sibling history and diabetes. Out of 64 women who were diagnosed with diabetes, about half i.e., 36 (56.25%) were aware of their diabetic status. Out of those aware, 29 (80.66%) were on treatment. Among those on treatment, about half i.e., 16 (55.17%) had their blood sugar under control.Conclusions: Studied population high prevalence and inadequate control of diabetes.

Background: Antiretroviral therapy is one of the reasons for falling trend of HIV epidemic at present. The clinical efficacy, toxicity and reasons for failure of first line ART is understudied. This study aimed to determine the frequency rates and reasons for discontinuation of first line ART in a cohort of HIV positive adult patients.Methods: Cross sectional study was conducted on 11,968 patients of HIV registered at Victoria Hospital ART centre from 2011 to 2017. Using a structured proforma, relevant information was collected from patients taking first line ART. Descriptive statistics was used for analysing the results obtained.Results: Total 11,968 HIV patients were registered at ART centre during our study period of which only 4,008 patients were taking ART among them, 167 patients were referred for initiation of 2nd line ART. After evaluation 28 were continued on First line,1 opted out, 20 were transferred out,1 discontinued treatment, 17 died, 14 were lost to follow up, 5 were excluded from the study and only 81 patients were started on second line ART. Failure rate of first line ART in our study was 2.02%. Immunological failure followed by clinical failure were the most common reasons for changeover in this study. Tuberculosis was the most common comorbid disease in this study.Conclusions: First line ART is very effective and well tolerated and has a low failure rate. Low CD4 count, anaemia, raised ALP, low albumin were among the factors associated with treatment failure. WHO staging did not correlate with the treatment failure, recommended routine viral load monitoring for assessing treatment failure.

Background: Despite significant progress in improvement of Government health care delivery system over past decade, community is reluctant to accept it because of substandard level of quality. “5S” is one of the strategies used to improve the physical quality and work efficiency of organization. 5S stands for five Japanese words which can be translated in English as Sort, Set in order, Shine, Standardize, and Sustain. Rajkot Municipal Corporation has adopted 5S strategy within its health centers with the aim to improve image of public health care facility among community and thereby to increase coverage of health services. This study was conducted to assess 5S implementation status at all Urban Heath Centers under health department of Rajkot Municipal Corporation, Gujarat, India. Methods: “5S” was implemented by the corporation in campaign mode in 18 Urban Health Centers in July 2014. Campaign included training, baseline assessment, and observing 5S week. A cross sectional study was carried out by personal observation and interview to assess the implementation of 5S campaign. Standard audit check list recommended by the State Quality Assurance Cell, Gujarat was used to evaluate. Results: Overall; all five components of 5S showed significant improvement (p

Background: Any bleeding from the genital tract during pregnancy, after the period of viability until the delivery of the fetus (end of second stage), is defined as antepartum hemorrhage. The World Health Authority defines antepartum haemorrhage as bleeding after 28 weeks of pregnancy. At the country level, the two countries that accounted for one third of all global maternal deaths are India at 17% and Nigeria at 14% in 2013. Maternal health and newborn health care are closely linked. Almost 3 million newborn babies die every year and an additional 2.6 million babies are stillborn. With improvement in medical facilities, early diagnosis, availability of blood transfusion, good anesthesia, proper management of shock and other complication of pregnancy along with liberalization of caesarean section, the rate of maternal morbidity and mortality is gradually on the decline. Methods: This is a prospective study of 100 cases of APH admitted during the period of May 2014 to April 2015 at a tertiary care hospital. Patients in third trimester of pregnancy with APH have been included in this study. Results: In present study incidence of APH is 3.8% and of the 100 sample cases 66 cases were of placenta previa and 34 cases were of abruptio placenta. In the present study 64% were emergency cases. Incidence of APH was 60% in age group 21-30 years of which 70% cases were noted with parity of >2. Ultrasonography was very much helpful in diagnosing placenta previa (93.9%), while most cases (76.4%) of abruptio placenta were diagnosed clinically. At the time of admission 75% patients were anaemic and many required blood transfusion. The perinatal mortality rate of abruptio placenta is 44.1% and placenta previa is 12.1%. Perinatal loss is 22.5% for up to foetus weighing 2 kg, 18.7% for foetus weighing between 2.1-2.5 kg and 27.02% for those ≥2.6 kg. Conclusions: Educating pregnant mothers about the importance of antenatal care and easy accessibility to quality antenatal services would go a long way in bringing down the maternal and perinatal morbidity and mortality related with antepartum haemorrhage. The morbidity associated with placenta previa can be reduced by detecting the condition in the antenatal period by ultrasound, before it becomes symptomatic. Intensive family planning program and awareness of small family norm helps in decreasing cases ofAPH in relation with age and parity. Efforts should be made to reduce the rates of operative deliveries, because there is a greater likelihood of placenta previa in a scarred uterus. There is a lot of scope on further research in the field ofAPH for further reduction in foetal and maternal morbidity and mortality.

Background: Otitis media is very common disease in developing country and if not treated properly can lead to hearing loss and serious neurological complications. Its bacteriology and antibiotic sensitivity varies in different population. Thus knowledge of the microbiological pattern with antibiotic susceptibility is important to deliver efficacious treatment of this disease. So, purpose of the present study was to determine the microbiological profile and antimicrobial susceptibility pattern of isolates from ear discharge in patients of otitis media. Methods: This study was conducted in Department of Microbiology of our institute for duration of one year. A total of 100 patients’ samples visiting ENT OPD were taken who complaining of ear discharge. Identification of organism was done by using standard biochemical reactions and antibiotic susceptibility testing done by using modified Kirby Bauer method as per CLSI guidelines. Results: Majority of the patients were between 21-30 years of age group (28%). The most common organism isolated was Pseudomonas aeruginosa (25.88%), highly sensitive to aminoglycosides and β-lactam + β-lactamase inhibitor (100%) followed by Staphylococcus aureus (21.17%), highly sensitive to aminoglycosides (100%) and fluoroquinolones (72.22%). Conclusions: Knowledge of the pathogenic agents responsible for otitis media and choice of effective antibiotics according to susceptibility pattern will guide the treatment. It also helps in reducing complications of the disease and decreasing emergence of resistance to antibiotics.

Background: Iron deficiency anemia (IDA), is defined as decrease in the amount of red blood cells (RBCs) or hemoglobin in the blood due to insufficient iron in the body. We carried out this study to measure the efficacy of iron sucrose in iron deficiency anemia in pregnant women. Methods: In our prospective study 100 patients were included. All of them were having USG maturity between 15-34 weeks. All of them were given iron sucrose IV according to their requirements and follow-up was taken after 4 weeks by measuring Hb level. Results: Hb level improved significantly (2.1 grams) within a short duration of interval. 14% patients suffered from minor side effects. Conclusions: Iron sucrose has been found very useful for correction of iron deficiency anemia in antenatal patients.

Background: Fetal growth restriction is an important and particularly challenging problem for modern obstetricians and paediatricians. The present study is to correlate the importance of Doppler velocimetry and perinatal outcome in cases of growth restricted foetuses by comparing perinatal outcome of control & study groups with normal and abnormal Doppler waveforms. Methods: A study and a control group comprising of 50 pregnant women having growth restricted foetuses in each group was matched for all other confounding factors except for Doppler changes. These patients were followed up and the perinatal outcomes of FGR foetuses having Doppler changes was compared with those having normal Doppler studies. Results: In our study, alteration in both MCA and UmbA Doppler was associated with perinatal morbidity and NICU admissions in 64% and mortality in 28%. Doppler changes showing altered CPR less than 1 had adverse outcome with NICU admission in 61% and mortality in 34%. Alteration in DV Doppler was associated with perinatal morbidity and NICU admissions in 17% cases and mortality in 83% cases, with no pregnancies having a healthy outcome. Among high-risk pregnancies with suspected IUGR, the use of Doppler assessment significantly decreases the likelihood of labor induction, caesarean delivery, and perinatal deaths. Conclusions: Abnormal Doppler waveform changes indicate adverse perinatal outcome of pregnancies with FGR. Doppler study helps to reduce perinatal mortality and morbidity by timely and appropriate interventions.

Background: Objective of current study was to analyze incidence, indications and trends of cesarean birth delivery in our environment. Methods: A prospective study of the cesarean sections performed at V.S. general teaching hospital in Ahmedabad from January 2008 to December 2013 Results: Out of 28,411 total deliveries, 11629 women underwent CS. Each year the CS rate, above 40%, was relatively constant. 72.46% patients were within 20-29 years of age group. 39% patients were from middle to higher socio-economic class. CS in emergency patient was consistently more than 50% and in registered patient around 40%. Maternal indications for CS were twice common to fetal indications. Previous CS and fetal distress were the commonest among maternal and fetal indications respectively. Overall maternal morbidity in CS ranged from 8-10%, commonest being blood transfusion and wound infection. Neonatal morbidity was less than half and neonatal mortality was almost one third in comparison to normal delivery. Rising CS trend was noted in patients with previous CS, fetal distress, oligohydramnios and failed induction. Gradual but constant decline in CS rate was noted among emergency patients, patient with CPD, obstructed labor and PROM. Conclusions: Although to some extent higher CS rate is justifiable due to remarkable reduction in neonatal mortality and morbidity in high risk patients; the CS rate in our environment is still three times higher than WHO recommendation. In controlled environment with experienced staff, careful selection of patients for normal delivery among patients with previous CS, breech presentation and scientific induction of labor may satisfy our concern for mother and newborn safety while keeping the CS rate low.

Background: The present study was conducted to identify pattern distribution of abnormal haemoglobin variants by using HPLC method in a tertiary care hospital, Surat, Gujrat, India.Methods: A cross sectional study of one-year duration was conducted including 9,116 patients screened for the presence of abnormal haemoglobin variants. Blood samples were initially tested for solubility test and run on automated haemoglobin analyzer for complete haemogram. All the suspected and family study cases were processed for HPLC (Bio-Rad Variant II) for conclusive diagnosis. Patients with a history of recent blood transfusion of less than 3 months duration were excluded from the study.Results: A total of 9,116 cases (1390 males, 7726 females) were included in the present study. The age group of patients ranged from 1 month to 95 years. Solubility test and complete haemogram were performed in all the cases. Out of the 9,116 cases, 8409(92.24%)cases had normal HPLC pattern. 492(5.40%)cases were diagnosed as sickle cell trait, 176(1.93%) cases as sickle cell disease, 29(0.32%) cases as β thalassaemia trait, 1(0.01%) case as β thalassaemia major, 2(0.02%)cases as Hb E heterozygous and 03 (0.07%) cases as Hb D Punjab heterozygous. One case of double heterozygous for Hb E-β thalassaemia was also found.Conclusions: HPLC is a rapid, accurate and useful method for diagnosing haemoglobinopathies. It serves as an reliable tool in diagnosing the presence of abnormal haemoglobin variants in suspected cases on routine haematology in developing countries like India, where the resources for detection of haemoglobinopathies are limited. Early diagnosis may help in proper management of patients.

Background: Severe oral submucous fibrosis (OSMF) poses problem with maintenance of oral hygiene,detection of malignancies and maintenance of nutrition. Surgical treatment includes release of fibrous bands with or without reconstruction for the raw area and postoperative physiotherapy.Methods: All cases with OSMF who underwent surgical management at our institute were included in our study. The demographic data, preoperative interincisor distance, local examination was recorded. All patients underwent contrast enhanced computed tomography scan of head and neck to rule out hidden malignancy. All cases underwent OSMF band release with or without reconstruction. All patients were instructed for vigorous mouth opening exercise. All patients were followed upto 6 months and further divided into two groups depending upon whether they followed physiotherapy advice or not.Results: 13 patients of age group 18-47 years were included in our study. Male to female ratio was 1.6:1. Pre-operative mean interincisor distance was 7.5 mm whereas post-operative it was 19.5 mm. Patients who had followed mouth opening exercise were having a mean increase of 15 mm more as compared to those who did not.Conclusions: Even after surgical management of severe OSMF, mouth opening exercise remains the key factor for maintenance of mouth opening.

Background: Osteoporosis (OP) is a silently progressing metabolic bone disease that results in loss of mineralized bone and subsequent fractures with minor trauma. Fracture related pain and physical inability to perform activities of daily living can lead to psychological consequences that impair Quality of Life (QoF). However, much less is known about Indian scenario. Hence, our study becomes imperative. Aim of this study to the drug utilization pattern and to analyze Quality of life of postmenopausal women suffering from osteoporosis.Methods: An analytical cross-sectional study was done on 91 post-menopausal osteoporotic women. Drug utilization pattern was evaluated. Pre-validated QUALEFFO-31 questionnaire was administered to each patient to record patient’s perceived QoL. Scores were calculated according to the algorithm. Higher scores indicated poor QoL. The collected data was analyzed with SPSS software (version 23)and p value ≤0.05 was considered as statistically significant.Results: The mean age group of presenting patients was 56.2±6.6 years. All the patients received Calcium and vitamin D supplements and non-steroidal anti-inflammatory drugs for pain relief. But only 33% of the patients received any one of the bisphosphonates (BP). For analysis, patients were grouped into Group-1(n=60) who did not and Group-2 (n=31) who did receive a BP. QOL analysis showed that pain domain was affected the most. Also, patients in Group 2 reported worse score in all the domains in comparison to Group 1 (P

Background: The objective of the study was to identify various lesions of neck swellings and to study their distributions according to age, sex and site and to find out distribution of malignant, inflammatory and infective lesions in neck swellings.Methods: The prospective study was conducted in the department of ENT, SCL General Hospital, NHL MMC, Saraspur, Ahmedabad from July 2014 to July 2016. All indoor and outdoor 400 patients of SCL hospital presenting with palpable head and neck swellings were referred to the cytology section at SCL hospital for FNAC and included in present study. Results: In our study out of 400 cases, lymph nodes constituted 276 cases with female preponderance. Among the inflammatory lesions, commonest lesion was tuberculosis which comprised of 147 cases followed by 64 cases of reactive lymphadenitis. In thyroid lesions the male: female ratio was 1:18, with maximum incidence in age group of 20-50 years. Total 95 cases were observed, out of which benign thyroid lesions (Bethesda grade II) were most common (92.63%). Salivary gland comprised of 11 cases, Out of 10 benign neoplastic lesions, 9 cases of pleomorphic adenoma and 1 cases of Warthin’s tumor were found.Conclusions: FNAC is a very simple and expeditious procedure which can be carried out without much problem. It reduces the necessities to perform excisions biopsy in many cases. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of neck swellings and can be adopted as an outpatient procedure, thus reducing the cost and time of hospitalization.

Background: Almost every indoor patient requires some form of intravenous (IV) fluids and its infusion rate should be proper as recommended for best treatment outcomes. To overcome the same, a simple, quick and easily applicable new method for drip drop rate calculation is proposed, which is user-friendly at bedside and doesn’t require mathematical skills or help.Methods: Author compared this novel innovative method (IM) of IV fluid drip drop rate method for both regular macro and micro drop infusion set against conventional mathematical calculation method (MC) of infusion in various IV fluid indoor orders and assessed for time-to-initiation of treatment (TI) required and its accuracy. Ten resident doctors and ten nursing staff participated to grade both conventional and novel methods by using pre-printed forms of various parameters like time consumption, comfort level, accuracy and applicability in ward and these both methods were scored on a scale of 1 to 10.Results: Conventional method (CM) required 14.23±1.10seconds, while novel method (IM) required average 3.63±0.73seconds for calculation of drop rate. Average grading for conventional method was 3.63±0.49 and for novel method was 7.84±0.6 out of 10.Conclusions: Novel method of IV fluid drip drop rate formula is easy, quick and superior in comparison to conventional method and it doesn’t require any additional instrumental help. It is good alternative to conventional formula for IV drip drop rate calculation in absence of infusion pump.

Background: Dacrocystitis refers to a series of clinical entities characterized by inflammation of lacrimal sac which leads to obstruction at the level of drainage of lacrimal system. Owing to the initial encouraging results and simplicity of the operation, it is decided that all symptomatic patients with lacrimal drainage obstruction would be treated initially by endoscopic endonasal dacrocystorhinostomy method, irrespective of the level of obstruction. Methods: A total 50 patients were included in the study over a period of 3-4 months. They were subjected to endonasal dacrocystorhinostomy and were evaluated for postoperative complications. Results: Very few complications were seen postoperatively suggesting that this newer technique may be useful. Conclusions: Endonasal dacrocystorhinostomy may prove better in coming years.

Background: Cardiac disease complicates 1-3% of all pregnancies. Of this Rheumatic heart disease constitute 74% and congenital heart disease 26%.Methods: A retrospective study of all patients with cardiac diseases delivered was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according the severity, NYHA classification, type of pathology, the maternal and perinatal outcome was assessed, and the maternal mortality and perinatal mortality was recorded.Results: 84% patients belonged to age group 20-29 years. 8% were teen aged and 4% patients were elderly. 64% patients were either P0+0 or P0+1. 8% patients were P0+3 and 2% patient were P3+0. 74% patients had RHD. 26% had grade I, 40% had grade II, 20% patients had grade III and 14% had grade IV heart disease. The associated complications were anemia 46%, Respiratory tract infection 12%, pregnancy induced hypertension 2% and recurrent rheumatic fever 2%. 48% had normal vaginal delivery, 20% had forceps delivery and 32% had caesarean delivery. One mother died of heart failure. All patients of grade I (100%) had term delivery. 23.07% of grade I, 30% of grade II, 60% of grade III and 100% babies of grade IV mothers were of low birth weight (˂2.5 kg). Babies weighing ˂1.5 kg were seen in 5% grade II, 10% grade III and 42.85% mothers with grade IV disease. 2 of grade IV and each of grade I, II and III died.Conclusions: Feto-maternal outcome can be improved with close supervision of obstetrician and cardiologist throughout the pregnancy by antenatal care, early diagnosis and management.

Background: Pervasive developmental disorder (PDD) affects motor, social and communication function of a child which may lead to affection of global function. Pediatric Evaluation of Disability Inventory (PEDI) is used to assess performances, degree of functional limitations as well as the extent of caregiver assistance. Hence, the need of the study was to quantify the functionality and dependence level in children with PDD. The aim of the study was to quantify the overall functional performance and need for caregiver assistance in PDD.Methods: An observational study was carried out on 12 children (age 6 months - 7.5 years) diagnosed as PDD, taking rehabilitation at pediatric rehab department of SBB college of physiotherapy. After taking consent of primary caregiver PEDI questionnaire was administered by interview method. Demographic details were noted by physiotherapist.Results: The score of functional skills in three domains were self-care (mean 8.58±5.265), mobility (mean 15.58±15.300) and social function (mean 5.42±4.641). The score of caregiver assistance in three domains were self-care (mean 2.75±3.441), mobility (mean 8.83±11.907) and social function (mean 1.50±2.316). Among six domains 12 children had the lowest score in terms of social function for both caregiver assistance and functional skills.Conclusions: Present study concludes that social function is majorly affected in terms of caregiver assistance in children with PDD.

Background: State Government has started a programme “Mission Balam Sukham” to combat the malnutrition with 3 tier approach including Village Child Nutrition Center (VCNC), Child Malnutrition Treatment Center (CMTC) and Nutrition Rehabilitation Center (NRC). Present study was conducted with the objectives to compare the availability of articles present at anganwadies and VCNCs and to know the experience of anganwadi workers running VCNC. Methods: Ten VCNCs from Naswadi block were selected by systemic random sampling and compared with 10 anganwadies as control group from nearby block Sankheda to check the availability of necessary articles. Ten anganwadi workers who ran the VCNCs for 1 month were interviewed about their experience of running VCNC. Results: There were not major differences in availability of articles like weight machine, MUAC tap, IMNCI (Integrated management of neonatal and childhood illnesses) chart, utensils for cooking, soap and water supply, common medicines and food articles between control anganwadies and VCNCs. Some of the articles like referral slips and thermometer were lacking at control anganwadies as well as VCNCs. Anganwadi workers (AWW) did not get enough medicines and functioning weighing scales and proper training before starting the VCNCs. Conclusions: VCNC needs to supply proper medicine stocks, functional weighing scale and other necessary articles to make the programme successful. AWWs also need the proper training to identify and treat the malnutrition at anganwadi centres.

Background: A thorough knowledge of the skin changes, physiological as well as acquired, in neonates is of prime importance for the dermatologist as well as paediatrician.Methods: A total of 430 randomly selected live-born neonates delivered and admitted to the postpartum ward or to the Neonatal Intensive Care Unit and neonates attending the Dermatology Outpatient Department of a tertiary care institute were included in this study after taking written informed consent. A detailed assessment of history was performed and a detailed dermatological examination of each neonate was carried out. Laboratory procedures were performed to confirm diagnosis if required. Data was analyzed using SPSS ver. 20.Results: Most common physiological skin change observed was Mongolian spot (65.35%) followed by Erythema Toxicum Neonatorum (51.63%), Epstein’s pearls (46.97%) and Sebaceous gland hyperplasia (45.81%). Lanugo hair was seen in 16.74% neonates. Among congenital skin lesions, Salmon patch was seen in 15.58% of the neonates whereas congenital melanocytic nevi are seen in 4.19% of the neonates. Diaper dermatitis was the most common acquired skin manifestation seen in 5.81% of cases. Conclusions: Neonates are prone to suffer from a wide range of dermatological problems, physiological as well as pathological. These manifestations are unique to the neonates. A detailed history and awareness of the clinical presentation facilitates the confirmation of the diagnosis.

Background: Tobacco which is most common legally available hazardous substance, most of the new users in India's is school children. For prevention and control of tobacco consumption, legislation lies at the very heart of any effective tobacco control programme. To assess knowledge regarding harmful effects and legislation of tobacco consumption among undergraduate studentsMethods: A cross sectional study carried out among 2000 students in 20 colleges of different streams of Rajkot and Morbi districts during February-March 2016 using self-administered questionnaire. Proportion of male: female was kept 3:1.Results: Knowledge regarding harmful effects of tobacco was present in 95.8% participants. 92.8% students believed that cancer is the harmful effect of tobacco consumption.77.3% students had knowledge that tobacco consumption is the leading cause of death in India. Television was the commonest source of knowledge of harmful effect of tobacco (71.9%). Only 15.9% students had knowledge regarding the penalty for violation of rules of tobacco consumption prohibition.Conclusion: Knowledge regarding harmful effects of tobacco consumption was present in majority of students but it had no association with tobacco consumption habit. Knowledge regarding legislation of tobacco consumption was poor among students.

Background: Blood Transfusion is recognized as one of the eight essential component of comprehensive emergency obstetric care which has been shown to reduce the maternal mortality. 1,2 In developing country like India, efforts should be done to make blood and transfusion services well maintained and quickly available to reduce maternal morbidity from haemorrhage and thus decrease the incidence of maternal mortality. Aims & objectives: (1) To study clinical status of the patients at time of admission. (2) To study the role of antenatal visits in all patients required blood transfusion. (3) To study the effect of blood components on the patients’ health. (4) To screen out the patients of high risk pregnancy and treat them safely. (5) To study causes of maternal mortality. Methods: Retrospective study of requirement of blood transfusion in antenatal and postnatal patients who came in labour room during last 3 month period at tertiary care Centre, Ahmedabad. Results: during the whole study out of 2200 patients 440 patients required blood transfusion among which 70% required due to obstetric hemorrhage and 30% due to severe anemia (less than 7 gm/dl). Major associated complications in the transfused patients were anemia (34%) and PPH (36%). 4 patients expired among them 2 were due to development of DIC and septicemia, 1 due to severe anemia and 1 due to severe PPH. Conclusions: Ensuring a safe supply of blood and blood products and the appropriate and rational clinical use of blood. Strategies made to maximize the haemoglobin (Hb) level at the time of delivery as well as to minimize blood loss. Active management of the third stage of labour is required to prevent avoidable morbidities, such as PPH, Retained product of conception, and vaginal lacerations.

Inguinal hernia repair is one of the most frequently performed surgical procedures in pediatric patients. An inguinal hernia does not resolve spontaneously and must be repaired because of high risk of complications. A retrospective analysis was performed on the hospital records including operative notes of admitted pediatric patients, aged up to 12 years, who underwent inguinal herniotomy. On observation, male affect more than female , right side inguinal hernia more common than left, due to let decent of testis on right side. Early detection and repair of inguinal hernia in pediatric is essential to decrease the potential morbidity and operative complications rate. This needs an increase in popular and pediatric awareness.