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Corona virus disease 2019 (COVID-19), A new health crisis expanded all over the world is caused by the Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) This highly contagious disease, as concluded from genome studies, originated in bats In December 2019, it passed on to humans in Wuhan, Hubei province, China After a few months, the infection was spread to about 109 countries Total 113,702 confirmed cases globally and 4, 012 deaths were registered on March 10, 2020 On 11 March 2020, COVID-19 was declared a pandemic by WHO The disease is transmitted by inhalation or contact with infected droplets having an incubation period range from 2 to 14 days Fever, cough, sore throat, breathlessness, fatigue, malaise, etc are some of the major symptoms of the disease Diagnosis involves Reverse transcription-polymerase chain reaction from a nasopharyngeal swab or oropharyngeal swab, a chest computed tomography scan, and other collective symptoms At present no vaccine, antiviral drug, therapy is documented, only preventive measures like hand washing, maintaining distance from other people, and not touching one's face, use of masks is recommended In this critical situation, researchers are highly focused to combat this problem This review article mainly emphasizes on the occurrence, causes, mode of action, updated statistical data, and preventive measures taken by the government for control of COVID-19

Background: Migraine is a common disabling brain disorder. Headache accounts for 4.4% of all consultations in general practice, approximately 5% of all medical admissions to hospital, and approximately 20% of neurology outpatient consultations. Hence, the present study was undertaken for assessing the MRI findings in patients with migraine. Subjects and Methods: A total of 5 patients with migraine headache were included in the present study. Complete demographic details of all the patients were obtained. Thorough clinical examination was carried out and routine hematological and other biochemical investigations were also done. Patients underwent MRI investigations. Imaging was performed using a head coil with patient in a supine position. All the MR imaging examination were performed on a Seimen’s Avento 1.5 Tesla Magnet MR System, slice thickness was 4-5mm with an inter slice gap of 0.5mm. MR imaging findings were compiled as per proforma and subjected to analysis using SPSS software. Results: Out of 5 migraine patients, significant abnormal MRI findings were present in 40 percent of the patients. One patient showed T2and T2 FLAIR Hyperintensities in subcortical white matter in frontal region. In the second patient with migraine, MRI finding revealed an area of diffusion restriction in left basal ganglia region which was hypointense on T1, T2 FLAIR and Hyperintense on T2 consistent with chronic infarct. Conclusion: Migraine headache patient occasionally have abnormal MRI findings to explain their headaches. Neuroimaging of headache sufferers in the general population yields few findings of clinical importance.

Background: Biliary disorders are one of the common problems routinely seen in clinical practice. Ultrasound (USG) is an initial investigation and Magnetic resonance cholangiopancreatography (MRCP) is a relatively new technique, which has gained popularity because of its excellent diagnostic capabilities in the evaluation of biliary obstruction. Aims: The aim of our study was to know the cause and grade of obstruction in case of clinically suspected biliary obstruction and to evaluate and correlate the accuracy between MRCP and Ultra sonography. Material and Methods: This prospective cross sectional comparative study was conducted in the department of Radiology, Government medical college and Rajindra hospital, Patiala. 50 patients with suspected biliary obstruction with clinical and laboratory features suggestive of obstructive jaundice who were referred for USG, followed by MRCP were studied. Results: Most common disorder observed was choledocholithiasis 16 (32%), followed by carcinoma gall bladder with 7 (14%) cases, periampullary carcinoma with 6 (12%) cases, cholangiocarcinoma and benign stricture with 5 (10%) cases each, carcinoma head of pancreas with 4 (8%) cases, postoperative stricture with 3 (6%) cases and choledochal cyst and cholangitis with 2 (4%) cases each. The overall sensitivity, specificity, positive predictive value and diagnostic accuracy of MRCP in diagnosing biliary obstructive disease was 98%, 100%, 100% and 100%respectively as compared to 60%, 100%, 100%and 97% of USG. Conclusion: Ultrasound is considered the primary screening investigation modality of choice However, owing to its low sensitivity in most of the benign stenosis and distal common bile duct disease, where the clinical and laboratory suspicion is strong, MRCP is highly accurate, non-invasive, sensitive, non-ionizing and superior diagnostic modality in establishing diagnosis of obstructive biliary pathologies.

Introduction: Investigation of male infertility is assuming greater importance with male factors implicated as the cause in up to half of the infertile couples. This prospective cross-sectional study aims to establish the role of transrectal and scrotal ultrasonography in male infertility. Besides routine investigations trans rectal and scrotal ultra sonography was performed to detect testicular and post-testicular etiology or abnormality. Aims: The aim of this cross-sectional study was to determine the role of transrectal and scrotal ultrasonography in the evaluation of male infertility and to compare the findings of ultrasonography with clinical and surgical findings. Material and Methods: The prospective cross-sectional study was carried out on 50 patients visiting the ultrasound section of Rajindra Hospital; Patiala with complaint of infertility over the span of 2 years. All the patient undergoes transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated. Results: Ultra sonographic findings of scrotum in 50 patients reveals 24 cases of varicocele, 7 cases of epididymal cysts, 8 cases of hydrocele, 3 cases of epididymitis, 2 cases of cryptorchidism, 2 cases of testicular microlithiasis and 1 case of bilateral testicular cyst. Apart from the patient who had cryptorchidism, the testis of all the patients were normal in size, site, shape and echo pattern. The clinical palpation when compared to ultrasound was found to be have a sensitivity of 58.33% and a specificity of 92.31%. The positive predictive value was found to be 87.50% and negative predictive value 70.59%. Conclusion: Trans rectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and substantially more pathological conditions can be detected on ultrasound compared to clinical palpation.

Introduction: Spine is the most common site of skeletal tuberculosis.Radiographic manifestations of tuberculous spondylitis include intraosseous and paraspinal abscess formation, subligamentous spread of infection, vertebral body destruction and collapse, and extension into the spinal epidural space. Significant instability and deformity of the spine can result, mandating prompt diagnosis and treatment to prevent permanent neurologic damage. Objective: This is a prospective and descriptive study to evaluate the role of MRI in spinal tuberculosis and various spectrum ofits manifestations. Materials and Methods: This prospective study was on 25 patients of either age or sex with clinical suspicion of spinal TB over a period of 2 years and subsequently went MR Imaging and features were correlated with other investigations and histopathological diagnosis in few patients. Results: Thoracic spine was the most common site of involvement.Vertebral body wedge collapse or compression fracture was seen in 64 % of patients. Posterior element involvement was found in 10 out of 25 cases. Prevertebral & paravertebral collections were seen in88% of cases. Epidural soft tissue component was seen in 56% of cases. Conclusion: MRI is the best diagnostic modality for spinal TB and to demonstratethe various associated manifestations which help in assessing the extent and severity of the disease and thus inearly and correct management planning.

Background: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that selectively affects the optic nerves and spinal cord and generally follows a relapsing course. Therapeutic plasma exchange (TPE) appears to be effective in patients with central nervous system inflammatory demyelinating disease who do not respond to first-line corticosteroid treatment. Objective: We represent a retrospective review of the use of TPE in the treatment of an acute attack of NMO in five patients who failed to respond to initial immunomodulatory treatment. Materials and Methods: We evaluated the effect of TPE on the degree of recovery from NMO. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics Mobile Collection System plus) by femoral or central line access and scheduled preferably on alternate-day intervals from 8 to 10 days. Both subjective and objective clinical response to TPE was estimated, and final assessment of response was made at the time of the last TPE in the series. Results: All patients were severely disabled before the initiation of TPE and they were female; with the mean age of these patients was 52.5 years (range = 36-69 years), the median age of NMO diagnosis was 49.4 years (range = 35–65 years), and the median duration of disease was 2.6 years (range = 0–5 years). Out of five patients, three had a history of bilateral optic neuritis, and all patients were anti-against protein aquaporin-4antibody positive. Totally 24 TPE procedures were performed on five patients, the mean time of start of TPE in the acute attack was 18.6 days. Patients were severely disabled at the initiation of TPE (range = expanded disability status scale 6.5–9), and improvement was observed early in the course of TPE treatment in most patients. Conclusion: The present study provides clinical support for the importance of TPE in refractory acute attack in NMO. However, with new diagnostic technologies and increasing clinical awareness, we may see a more improved ways of TPE in these patients in the future; hence, TPE is more effective modality of treatment as it also removed the antibodies.

Patients presenting with asymptomatic neck masses to surgical OPD can have many differentials, ranging from the simplest reactive lymph nodes to aggressive malignant masses. Bilateral neck masses in a patient can be due to infective lymph nodes, salivary gland pathology, solid - cystic lesions of the neck and malignancies. Based on the anatomical site of the lesion, clinical examination still remains the first step in characterising the lesion into solid, cystic, pulsatile, non pulsatile, response to cough impulse and so on. Imaging is always a mandatory next step for the confirmation of diagnosis and to know about the morphology of the lesion with finer details. USG, CT and MRI are indispensable tools in assessing neck masses with equivocal findings on clinical examination and particularly in asymptomatic individuals where there is lack of history and thus diagnosis becomes a challenging task. One such entity is bilateral Chemodectomas where imaging plays a pivotal role in the diagnosis. We report a case of bilateral neck masses in an asymptomatic female patient which on imaging was diagnosed as a case of bilateral carotid body tumours and referred to higher centre for further management.

Introduction: Focal liver lesions are defined as solid or liquid-containing masses foreign to the normal anatomy of the liver that may be told apart from the latter organ using imaging techniques. They can have a number of etiologies including congenital, neoplastic and infectious and inflammatory conditions as well as trauma and miscellaneous entities. The data was analyzed to compare between ultrasonography (USG) and computed tomography (CT) findings in these cases. Aims and Objectives: To evaluate the role of ultrasound and computed tomography in diagnosis of focal hepatic masses and compare the ultrasound and CT findings of focal hepatic masses and correlate with histopathological and surgical findings. Material and Methods: USG and CT were performed on 40 focal hepatic mass patients. The diagnostic value of ultrasound was compared to those of CT. Final diagnosis was made after correlation with surgical findings, serological findings and histopathological examination. The data collected was analyzed statistically. Results: Final diagnosis of focal hepatic masses was simple cysts (n=5), polycystic liver (n=1), metastasis (n=22), hydatid cysts(n=5), hemangioma (n=6), hepatocellular (n=11), focal nodular hyperplasia (n=1), abscess (n=16), cholangiocarcinoma (n=1). The sensitivity, specificity positive and negative likelihood ratio were 84.38%, 67.74%, 2.62 and 0.23 respectively, for USG and 100%, 97.14%, 35 and 0 respectively, for CT. Conclusion: USG and CT are the modalities having comparable specificity and sensitivity, CT being slightly more accurate than USG in evaluation of focal hepatic lesions in atypical cases. USG is useful in follow-up cases.

Cysticercosis due to its extensive study is known to be one of the common tropical diseases. The spectrum of the disease extension and involvement has been updated continuously and every time case reports have come with new conclusions as the disease is seen worldwide. Disseminated cysticercosis by itself is a rare complication of cysticercosis with involvement of skeletal, ocular and tongue muscles. Pulmonary and cardiac involvements are rare and there are hardly few cases worldwide. Surprisingly we could identify such tiny cysticerci in the lung parenchyma, cardia and thyroid apart from other known dissemination sites .Isolated pulmonary cysticercosis have been reported but simultaneous involvement of other unusual sites is a rarity. Most of diagnosis in our case is by MRI and some by USG.Hence we report MR and USG imaging of such a case of disseminated cysticercosis involving all the possible rare sites in a single young Indian male patient who presented with history of seizures. This documentation and reporting will add up to the few cases reported previously, some of which are in isolation.

Endometriosis is a common gynaecological condition, the pelvis being the most common site. Extrapelvic sites including intestinal tract, urinary tract, omentum, thorax, surgical scars and umbilicus are less common sites and are difficult to diagnose. Majority of extrapelvic cases occur at surgical scar sites. Occurrence of umbilical endometriosis in a patient without any previous surgical history is a very rare condition. So, we are going to report the case of a primary umbilical endometriosis in a 40 years old nulliparous female presented with complaints of pain abdomen associated with bleeding per vaginum and cyclical bleeding from umbilical region since 2 months.This paper summarises the topic of umbilical endometriosis and discusses the radiological and clinical implication of this unusual condition.

Introduction: Healthcare associated infections (HCAIs) pose a significant risk to patient's health with increasing morbidity and mortality. A large portion of HCAI can be prevented by hand hygiene, but adherence to hand hygiene has been found to be very low. Methodolgy: This study was conducted to assess the rate of hand hygiene compliance during 'my five moments of hand hygiene' as per the WHO guidelines in our intensive care units and to implement multimodal intervention strategies to improve hand hygiene compliance. Results: The average compliance amongst all HCWs in both ICUs was 45.7% before sensitisation which increased to 85.4% after sensitisation using multimodal strategies. Conclusion: Multimodal Intervention strategies such as the one we employed had a good impact in improving compliance in our ICU and these improvements can be easily duplicated in healthcare settings across the country.

Aim: The aim of this study was to analyze the retrospective experience related to the indication, complication and outcome of Therapeutic Plasma Exchange (TPE) in Myasthenia gravis (MG). It is a well known autoimmune disease characterized by antibodies against the acetylcholine receptor (anti-ACHR) on the post synaptic surface of the motor end plate. Plasma exchange is the therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence. Materials and Methods: A total of 35 patients of MG were submitted to a total of 41 cycles and 171 session of TPE. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics) by Femoral or central line access and schedule preferably on alternate day interval. Immediate outcome was assessed shortly after each session and overall outcome at discharge. Results: Total of 110 patients of MG who were admitted to our hospital during the study period of two years. 35 (31.8%) patients had TPE performed with mean age of 32 years (M:F = 2:1). The mean number of TPE session was 4.2 (SD±1.2), volume exchange was 2215 ml (SD±435); overall incidence of adverse reaction was 21.7%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 78.3% of patients. Conclusion: TPE may be considered as one of the treatment options especially in developing countries like ours as it is relatively less costly but as effective for myasthenic crisis as other modalities.

Historically, psychotic disorder has been associated with viral infection. Herpes simplex infections and Epstein-Barr virus (EBV) among other viral infections have been implicated in psychotic disorder. Of note in this case report is psychotic disorder that occurred following reactivation of herpes simplex infection in a background of mannose-binding lecithin (MBL) deficiency, childhood EBV infection, and severe psychosocial stress. Herpes simplex encephalitis (HSE) remains a significant cause of morbidity and mortality despite advancement in its treatment with intravenous acyclovir. Many studies have reported psychiatric and neurological manifestation of herpes simplex infection following primary or reactivated infection, while others suggest milder clinical course of herpes simplex encephalitis in a background of immunosuppression. Another contributory factor to psychotic disorder in this case is childhood EBV exposure which has been reported to increase the risk of psychosis in adolescence and adulthood. This case report describes a 15-year-old female with MBL deficiency who presented with psychosis caused by reactivated herpes simplex infection and had good clinical recovery. Based on childhood Epstein-Barr virus exposure and psychosis in adolescence (current case), she is at increased risk of psychotic disorder in adulthood, which underscores the importance of long-term monitoring.

Cholecystitis and cholelithiasis are frequently met surgical conditions in North India. The presence of bacteria in bile at the time of surgery or invasive diagnostic procedures predisposes to complications like septicaemia. Aim of this study was to study the bacteriological profile - aerobic & anaerobic in the bile of patients undergoing cholecystectomy. The present study included 50 patients admitted in the department of general surgery undergoing cholecystectomy with preoperative diagnosis of biliary tract disease. Details of the operative findings were recorded. The bile from gallbladder was cultured for the presence of aerobic and anaerobic bacteria. The bacteriological examination of the bile yielded positive culture in 16 out of 50 cases (32%). Aerobic bactobilia was seen in 15 out of 16 patients (93.75%). Anaerobic bactobilia was seen in 4 out of 16 patients (25%). The infection was mostly due to single microorganism. In 9 out of 16 cases (56.25%) the growth was purely aerobic. E.Coli was the most commonly isolated aerobic bacteria (36%).

Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p

Keloids are well-defined fibrous tissue overgrowths extending beyond the original defects. The purpose of our study was to compare the efficacy of liquid nitrogen cryosurgery alone with liquid nitrogen cryosurgery and intralesional triamcinolone acetonide combination. Study on 60 clinically diagnosed lesions of keloids from 21 patients was conducted to compare the efficacy of liquid nitrogen cryosurgery alone. The statistical analysis shows synergistic action of cryosurgery and corticosteroids may offer promise in the treatment.

Background: Prospective analysis of 500 cases of vaginal discharge in tertiary health centre of Punjab. Objective: To study the prevalence of Sexually transmitted infections (STIs) in 500 outpatient of 15 - 49 years age group with vaginal discharge and to evaluate the various factors influencing pattern of STIs. Method: All cases were subjected to cervical cytology, HIV ELISA, rapid plasma reagen (RPR) test for syphilis and Gram’s staining, Giemsa staining and wet mount study of vaginal discharge. Results: Prevalence of STIs was found to be 58% and majority of infection was caused by G. vaginalis, Candida and Trichomonas. Pap smear showed koilocytosis in 5.6%, mild dysplasia in 1.8% and carcinoma cervix in 1.2% cases. Conclusion: Vaginal discharge is a common gynaecological complaint and STIs are significant cause of vaginal discharge.

A study was conducted on 100 cases of Acute abdomen admitted in surgery department of Govt Medical college and Rajendra Hospital, Patiala, India. Study group included patients with different abdominal emergencies, e.g. gastrointestinal perforation, intestinal obstruction, acute appendicitis, acute cholecystitis, pancreatitis etc. Out of these, three cases were positive for HBsAg alone, one for anti Hepatitis C-Virus (HCV) alone and one was positive for both HBsAg and anti HCV.

Olanzapine is a novel antipsychotic effective in reducing positive and negative symptoms of schizophrenia and with a safe side-effect profile. Premarketing trials, however, included only a few elderly patients. Further data are needed regarding the effects of olanzapine in the elderly and those with comorbid medical illness. In this pilot study, 11 hospitalized patients (age range 60-85 years) who manifested symptoms of psychosis related to schizophrenia and schizoaffective disorders were treated with olanzapine (dose range, 5-20 mg/day). Efficacy and safety were assessed by the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI), Extrapyramidal Symptom Rating Scale (ESRS), Mini-Mental State Examination (MMSE), Calgary Depression Scale For Schizophrenia (CDSS), EKG, physical examination, and various laboratory tests. Seven patients responded to treatment and all of them showed improvement in both positive and negative symptoms, with greater reduction in positive symptoms. Treatment was discontinued in 2 patients whose symptoms showed no improvement or worsened. The CGI showed significant improvement in 9 patients, remained the same in 1, and worsened in 1 patient. ESRS showed significant reduction from baseline to final visit. Of the 10 patients who cooperated for MMSE, 9 had improved scores. The CDSS showed significant reduction in scores from baseline to final visit. No significant changes were noted in laboratory tests, prolactin levels, EKG, and physical examination. Concomitant administration of lorazepam, carbamazepine, divalproex sodium, and lithium carbonate caused no adverse consequences. The reduction of positive and negative symptoms, lack of significant extrapyramidal symptoms and other side effects, and lack of any significant drug interaction suggest that olanzapine may be a safe and effective antipsychotic medication in the elderly.

Conventional medicine is medicine that is practiced by doctors and by health professionals who work with them, including physical therapists and psychologists. Complementary and alternative medicine is a group of different medical and health care systems, practices and products that are not presently considered to be part of conventional medicine. This study aimed to assess the usage of conventional versus complementary and alternate medicine (CAM) among older adults above 60 years. The study was conducted in selected area of district Mohali. A quantitative approach with comparative research design was adopted. By purposive sampling technique, 150 older adults were selected. Checklist was used to collect data from selected village. Study findings revealed that older adults above 60 years were using CAM in common cold 147 (98%), headache 142 (94.7%), body ache 132 (88.0%), joint pain 138 (92.0%), loose motion 144 (96.0%) and constipation143 (95.3%) more than conventional medicine for management of common cold 136 (90.7%), headache 123 (82.0%), body ache 117 (78.0%), joint pain 109 (72.7%), loose motion 112 (74.7%) and constipation 116 (77.3%). Thus there was significant comparison between conventional versus complementary and alternate medicine (CAM) for management of minor ailments.

Background To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. Methods Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. Results The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006). Conclusions This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.

Introduction: Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. The cumulative gene frequency of hemoglobinopathies in India is 4.2%. The carrier state for β-thalassemia in India varies from 1% to 17% with an average of 3.2%. The present study was undertaken to find out the burden of hemoglobinopathies and spectrum of this disorders among the blood donors. Materials and Methods: The study includes 975 students between 18 and 25 years who donated blood, were screened for β-thalassemia trait and related hemoglobinopathies by high-performance liquid chromatography (HPLC) using Bio-Rad variant. Samples were also run on a hemato analyzer for red cell indices and peripheral smear for red cell morphology. Results: A total of 41 donors showed abnormal hemoglobin fractions in HPLC. Out of these, 32 (3.3%) were diagnosed with β-thalassemia trait, 8 (0.8%) with Hb-D Punjab and 1 (0.1%) with Hb-S trait. The frequency of β-thalassemia trait in the student from different geographical regions varied from 0.8% to 4.44%, being the highest in those from Punjab and frequency of β-thalassemia trait in different caste groups varied from 0 to 4.74%, being the highest in the student from Jatt Sikh community. Conclusions: A universal approach of screening for β-thalassemia trait should be included as a part of standard blood testing among the college students, premarital and of the extended family of thalassemics. Population group with high gene frequencies requires screening programs as well as increased awareness and education program to control the birth of thalassemia major.

Pemphigus vulgaris is an autoimmune disorder that involves intraepithelial blistering and sores of skin and mucous membrane. It generally correlates with the levels of circulating autoantibodies; their removal seems a reasonable therapeutic approach. Therapeutic plasma exchange is hypothesized to remove pathogenic autoantibodies and has been used in refractory or severe cases. It may be considered for rapid control of severe or recalcitrant pemphigus vulgaris and should be combined with use of concomitant immuno-suppressive.

The frontal lobes of the brain are notoriously "silent": Benign tumors such as meningiomas that compress the frontal lobes from the outside may not produce any symptoms other than progressive change of personality and intellect until they are large. We present two cases with symptoms suggestive of depressive episodes, which on further investigations showed space occupying lesions suggestive of frontal meningiomas.

Interferon therapy for hepatitis C can result in renal complica-tions as interstitial nephritis, minimal change disease andimmune complex glomerulonephritis [1]. We present the caseof a 42-year old man infected with chronic hepatitis C whodeveloped focal and segmental glomerulosclerosis (FSGS)after treatment with pegylated interferon alfa 2a and ribavirin.A 42-year-old man reported with incidental detection ofhepatitis C virus infection (anti-HCV positive) at the time ofdonation. His risk factors included surgery for fracture tibia,bloodtransfusionsandfrequentuseofinjectionspossiblywithreusable needles and syringes for joint pains. His physicalexamination was unremarkable. His baseline laboratoryinvestigationsshowedhemoglobin13g/dL,meancorpuscularvolume (MCV) 87 fl, white blood cell count 4000/cumm,platelet count 3,00,000/mm

Objectives: The relationship between genitourinary infections and preterm labour (PTL) is known for ages but still the scenario in developing countries is projecting the same picture as prevalent 2-3 decades earlier. We undertook a study to find out the prevalence of genitourinary infections and PTL with the help of simple laboratory tests so as to enable the various health workers to diagnose and treat them early with the assistance of simple and cost-effective diagnostic methods. Patients and methods: A retrospective study was undertaken in the department of Obstetrics and Gynaecology/ Microbiology, Government Medical College and hospital, Patiala which comprised of 500 cases in PTL between 28-37 weeks of gestation and 500 normal term cases for comparison. All the cases were subjected to microbiological analysis for bacterial (aerobic), fungal and protozoal examination by two high vaginal swabs and urine samples for routine examination, bacteriological examination, culture and antibiotic sensitivity. Statistical analysis was carried out using chi square and student ‘’t’’ test. Results: In the intervention group (Group A) of 500 cases of PTL the frequency of genital tract infection, urinary tract infection (UTI) and combined genitourinary infection (GUI) was 44%, 30% and 16% respectively as compared to 10%, 6% and 0% in the Group B, suggesting a statistically significant relationship of prevalence of genital as well as urinary tract infection in patients with preterm labour. The most common causative organisms of UTI were, Escherichia coli (14%) and Klebsiella pneumoniae (12%), while Gardnella vaginalis (16%) and Candida albicans (14%) were found to be commonly associated with genital tract infection. The number of low birth weight babies was significantly higher in intervention group than in the normal group. Conclusions: Integration of a simple infection screening programme into routine antenatal care may reduce the incidence of preterm labour and improve perinatal outcome especially among the rural population of developing countries. Key words: Preterm labour; genitourinary infections; intrauterine infections; bacterial vaginosis. DOI: http://dx.doi.org/10.4038/sljog.v32i3.3984 SLJOG 2010; 32(3): 57-64

Objectives : Examination of pregnant women in the first trimester with transvaginal ultrasonography with the aim to study various fetal development markers, e.g., gestation sac, yolk sac, fetal heart motion, CRL length, and fetal anatomy in both normal and abnormal pregnancies. Comparative evaluation of transvaginal ultrasonography vis-ΰ-vis transabdominal scanning in the study of first trimester of pregnancy and its complications. To assess the relative merits and demerits of transvaginal ultrasonography in comparison with the transabdominal technique. Materials and Methods : The study will be conducted on 50 females patients during the first trimester of pregnancy. The study population will consist of both normal and abnormal pregnancies. These patients will be included on the basis of suspicion of or proven pregnancy of duration up to 12 weeks from LMP. The evaluation of the patients will include the following: Record of patients obstetrical history and clinical examination, record of pregnancy test and relevant investigations, ultrasonic examination of pregnancy. (a) Transabdominal ultrasound scanning will be done with moderately distended bladder by using real time scanners with low frequency probe (3/3.5 MHz); (b) transvaginal sonography will be done with the real-time sector scanner using high-frequency endovaginal probe (5/7.5 MHz), after the patient voids urine. Relevant images will be taken by using the multiformat automatic camera. Results and Conclusions : In the study of 46 normal intrauterine pregnancies, TVS showed additional information in 36 patients (78.3%) as compared to TAS, in detection of gestation sac, yolk sac, double bleb sign, or better visualization of embryonic anatomy. In the abnormal pregnancy (n=17), TVS provided more information in 11 cases (64.9%), which included detection of embryonic demise, yolk sac, double bleb sign, or subchorionic hemorrhage. Regarding ectopic gestations (n=7), TVS gave additional information in 5 cases (71.4%) which included detection of ectopic fetal pole, yolk sac, decidual cast, adnexal mass, and fluid in cul de sac. In two cases, both TAS and TVS gave equal information. However, in 2 cases TAS demonstrated the extent of intraabdominal fluid better than TVS. The other advantages of TVS over TAS are that there is no need for the patient to have uncomfortably full bladder and time is saved from having to wait for bladder to fill. Thus, the potential preoperative patient can be kept fasting. TVS is also superior in obese patients, in patients with retroverted uterus and it also bypasses obstacles such as bone, gas filled bowel, and extensive pelvic adhesions. The limitations encountered with TVS were limited manoveuribility of probe and because of the unorthodox position and angle of the transducer, correct orientation was difficult initially.

Patients who have chronic lower gastrointestinal bleeding with negative conventional work-ups should undergo superior mesenteric arteriography to look for arteriovenous malformations. Once the diagnosis is made, treatment is immediate conventional right hemicolectomy. Six patients with arteriovenous malformations described in this report have had no recurrence of rectal bleeding in one to five years.

In this study in Bahrain increased maternal age, high parity, consanguinity and a history of 2 or more previous abortions were found to increase the risk of congenital malformation.

A review of 583 perinatal deaths at the Ministry of Health hospitals in Bahrain, during the years 1985-1987 revealed a perinatal mortality rate of 19.6 per 1,000 total births. Lethal congenital malformations accounted for 145 (24.9%) deaths. Of the 438 normally formed infants there were 42.2% antepartum, 115 (26.3%) intrapartum and 138 (31.5%) early neonatal deaths; in 82.7% of cases the death was considered to be unavoidable. The population of Bahrain for 1986 according to the Central Statistics Organization (1) was 435,065, the majority of which was served by the Ministry of Health Maternity Service with approximately 10,000 deliveries per annum. The Ministry of Health provides maternity services through one main maternity hospital and 2 peripheral hospitals with consultant obstetric care. In addition to these, there are 3 maternity units run by midwives. High risk cases are usually delivered in the main hospital as there is a neonatal intensive care unit attached to it. The latter also acts as a referral centre for all sick babies in Bahrain. An analysis of the causes of perinatal deaths is an effective way of assessing the efficiency of maternity services. The objective of this study was to identify and improve the various factors influencing perinatal mortality in Bahrain.In Bahrain, the Ministry of Health (MOH) medical facilities, which included 1 main maternity hospital, 2 peripheral hospitals, and 3 maternity units under the direction of midwives, reported 29,644 births during January 1985-December 1987. 355 of these were stillbirth and 228 infants died within the 1st week which made up a perinatal mortality rate of 19.6/1000 births. The leading causes of perinatal deaths included, in descending order, low birth weight, mainly due to prematurity (29.3%); congenital malformations (24.9%); mechanical problems, especially cord complications (12%), antepartum hemorrhage, most caused by abruptio placentae (9.1%), and preeclampsia (9.1%). Of the 438 normally formed infants that died, 185 (42.2%) of these were antepartum, 115 (26.3%) intrapartum, and 138 (31.5%) postpartum. 45 (10%) of the normally formed infants that died weighed above the 10th percentile for their gestational age and there were no maternal complications. The researchers classified 101 of all the infant deaths (17.3%) as avoidable perinatal deaths--70% due to poor patient compliance, 28% due to medical mismanagement, and 2% due to a combination of these factors. The MOH must emphasize health education and regular prenatal visits for pregnant mothers. Health practitioners need to reevaluate present prenatal and intrapartum clinical methods and to routinely screen for diabetes and other possible high risk factors.

The maternal mortality in Bahrain during the 10-year period, 1977-1986, was 33.9 per 100,000 livebirths; the second 5-year period showed a significant reduction (26.9) compared to the first 5-year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.