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Background: Perimenopause refers to the period around menopause (40-55 years). This includes the period before menopause and the first year after menopause. Perimenopausal age is an important stage in a women’s life. Many women are diagnosed with hypothyroidism at midlife. Hypothyroidism - both overt and subclinical are associated with increased risk of CVS diseases. Subclinical hypothyroidism is more important as this stage is usually ignored from treatment point of view and if early intervention is done in SCH worsening of metabolic derangement may be avoided. Objectives: The present study was aimed to know the prevalence of subclinical hypothyroidism and associated dyslipidemia in perimenopausal females. Material and Methods: In our retrospective study we took 100 perimenopausal females (40-55years) who were investigated for thyroid and lipid profile. Atherogenic indices like TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios were calculated from the individual lipid profile parameters. The reference guidelines for lipid profile was according to NCEP ATP III. Result: Subclinical hypothyroidism was found to be present in 18% of perimenopausal females The mean TSH levels were found to be higher in SCH as compared to euthyroid females with a mean value of 7.56±3.54(μIU/ ml). Dyslipidemia was seen in patients with SCH. TSH levels were found to be positively correlated with total cholesterol. Conclusion: We conclude that subclinical hypothyroidism is present in 18% females of perimenopausal age group. Increased TSH levels are associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio and non cholesterol HDL. In perimenopausal women the condition is usually underdiagnosed and ignored but subclinical hypothyroidism in these females should be screened and treated timely to decrease the risk of accelerated atherosclerosis and premature coronary artery disease in them.

BACKGROUND: Himachal Pradesh is a hill state in North India in the Western Himalayas. β-thalassemia is a genetic disorder of hemoglobin inherited in an autosomal recessive manner that results in defective globin production leading to the early destruction of red blood cells. β-thalassemia has long been neglected in Himachal Pradesh due to popular belief that it runs along “Lahore-Gujarat-Punjab” belt in India. Therefore, there is no β-thalassemia testing facility currently in the state. METHODS: To estimate the prevalence of β-thalassemia carriers, we calculated the sample size based on probability proportional to size self-weighing design. In each of 20 selected colleges, 111 students having an age of 18–25 were tested for high-performance liquid chromatography (HPLC) and complete blood count. Some were further tested for the mutations. We computed sensitivity, specificity, positive predictive value (PPV) and negative predictive value, and receiver operating characteristic curve for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) red cell parameters. RESULTS: Of the 2220 students, 57 were found to be β-thalassemia carrier by HPLC. The overall prevalence rate was 2.6% which translates to probable 180,000 β-thalassemia carriers in Himachal Pradesh. Six districts bordering highly endemic Punjab had a higher prevalence. Hemoglobin D-Punjab, Heterozygous-Iran Trait, and raised fetal hemoglobin were found. Thalassemia major and sickle cell disease were not found. Anemic status or MCV/MCH parameters were not found to be reliable predictors of thalassemia carrier status among the healthy populations of HP. The predominant mutation found was IVS 1–5 G > C. CONCLUSION: Popular ongoing strategy for screening with MCV and MCH has low-PPV and can miss upto 37% of true thalassemia carriers. HPLC is better strategy for screening carriers and reduces further spread of thalassemia.

Background: Ectopic pregnancy is the commonest cause of the maternal morbidity and mortality in the first trimester of the pregnancy. The aim of this study was to see the clinical presentation, associated risk factors, mode of treatment and outcome.Methods: Retrospective study conducted in a tertiary care rural hospital. Women with diagnosis of ectopic pregnancy admitted between August 2016 to September 2018 were studied. Medical record files were scrutinized to get the details. Data was analyzed using Microsoft Office Excel (version 2007). Numerical data were subjected to descriptive analysis, with mean±standard deviation (SD) and categorical data as frequency and percentage.Results: Forty cases of ectopic pregnancy were included who were unbooked, non-smokers, married and belonged to rural areas. Eighty percent were in the age group of 20 to 30 years.  Maximum were gravida 3 or 4 with commonest presentation was pain, site was tubal. Laparotomy was done in 95% of women salpingectomy was the commonest surgical procedure done in 32 (80%) women. Salpingoophrectomy was done in one woman and lifesaving hysterectomy in 2 (5%) women for cervical and ruptured interstitial ectopic pregnancy one each. Blood transfusion was required in 28 (70%) women. No mortality was seen.Conclusions: Women of reproductive age group with pain abdomen and menstrual complaints, even without amenorrhoea, ectopic pregnancy should be ruled out. Treating reproductive tract infections / PID and offering contraceptives will decrease the incidence of ectopic pregnancy. Medical and paramedical staff should do the timely referral to higher centres.

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Background: Significant number of induced pregnancies land in caesarean delivery. Cervical assessment is integral to successful outcome of induction of labour. Objective of this study was to study preinduction transvaginal ultrasonographic cervical length and to compare it with Bishop Score in predicting successful labour.Methods: This prospective study was conducted at the department of obstetrics and gynaecology, MMIMSR, Mullana, Ambala on 150 patients. A total of 150 women were studied from January 2015 to June 2016 after taking an informed consent. The sociodemographic particulars were recorded, detailed history was taken and examination performed. Transvaginal ultrasound was done to assess cervical length after evacuation of bladder. Bishop score was then determined by separate observer. The occurrence of vaginal delivery was considered as primary outcome. All statistics collected were entered in statistical software SPSS-15. ROC curves were constructed for both Bishop Score and TVS.Results: The mean gestational age was 38 week 6 days, majority 134 (89.3%) being less than 40 weeks of gestation. The ROC curve for Bishop Score demonstrated better predictability compared to cervical length by TVS. Optimized cut off for Bishop score in addition to TVS was determined by ROC curve to predict successful vaginal delivery, it was ≥ 6 for Bishop score (sensitivity 90.7%, specificity 68.6%, positive predictive value 91.5% and negative predictive value 66.7%) and ≤ 3.0 cm for cervical length on TVS (sensitivity 74.6%, specificity 51.6%, positive predictive value 74.5% and negative predictive value 51.6%). The relation of both cervical length and Bishop score with successful vaginal delivery was found to be statistically significant with p value of 0.0001.Conclusions: The present study indicates that Bishop Score is a better predictor for successful vaginal delivery as compared to cervical length by transvaginal ultrasonography.

NAFLD is characterised by fatty infiltration of the liver, mostly in the form of triglycerides, which exceeds 5% of the liver weight. Insulin resistance impairs the suppression of lipolysis, and this leads to an increased release of free fatty acids from adipose tissue so that more are delivered to and taken up by the liver. This excess amount of free fatty acids can overload the hepatic mitochondrial beta oxidation system, the major pathway of fatty acid oxidation in the liver, leading to the accumulation of fatty acids in the liver. The present hospital-based, observational, analytical and comparative study was conducted on 80 subjects including 50 cases of ultrasonographically diagnosed NAFLD and 30 age and gender matched healthy subjects as controls. In this study, lipid profile was assessed in 50 USG diagnosed cases of NAFLD and 30 controls and the results were analysed statistically. The study found a statistically significant change in lipid levels in patients of Non alcoholic fatty liver disease indicating hepatic steatosis. In the present study, increased levels of cholesterol, triacylglycerides, LDL, VLDL and decreased levels of HDL were found. This study concluded that low fat diet, lifestyle modifications, exercises and yoga could be a potential tool to prevent the progression of NAFLD.

Introduction: Corona disease 2019 (COVID-19) is an airborne viral infectious disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) mutant. Transmission can occur if splashed or sprayed with contaminated fluids in the eyes, nose, or mouth, and, rarely, via contaminated surfaces. Symptoms are slightly variable with the mutants, and the general is fever, cough, headache, fatigue, breathing difficulties, and loss of smell and taste. The co-morbid diseases like cancer, cardiovascular disease, diabetes, hypertension, and chronic respiratory disease & the elderly are more likely to develop severe illnesses. The standard diagnostic method and treatment pattern varies from hospital to hospital, provokes to carry out this project.  Objectives: To assess the drug treatment pattern, antibiotic usage patterns, and cost, determine the antiviral usage pattern and its price. Estimate anti–interleukin-6 receptor monoclonal antibody (Tocilizumab) usage and cost. Methodology: A retrospective observational study was conducted in Sagar Hospitals, Kumaraswamy Layout, Bangalore, for six months after obtaining ethical clearance using a well-designed questionnaire. Results and Discussion: 155 Cases were collected from the medical records department. The most widely used antibiotic was Ceftriaxone, 60.6%, a cell wall synthesis inhibitor, followed by Azithromycin, 59.4%, a protein synthesis inhibitor. The most widely used antiviral was Oseltamivir in 51.6%, Remdesivir in 41.3% of patients, and Favipiravir in 12.3%. Other co-morbid drugs are corticosteroids, immunomodulators, mucolytics, antihistamines, blood thinners, and anti-helminthes. The mean cost of the antibiotics and antiviral are 224 ± 295.73; 1623.28 ± 2047.45. Conclusion: This study showed that in the management of COVID 19, ICMR Guidelines were adopted. The cost of the drugs also played a significant role in selecting treatment regimens, especially antibiotics, antiviral, and immunomodulators. Hence the cost consideration studies may help in Rational drug usage promotion and cost-minimization in disease management.