BackgroundAnaemia is a common disorder. Most health providers in resource poor settings rely on physical signs to diagnose anaemia. We aimed to determine the diagnostic accuracy of pallor for anaemia by using haemoglobin as the reference standard.Methodology/Principal FindingsIn May 2007, we enrolled consecutive patients over 12 years of age, able to consent and willing to participate and who had a haemoglobin measurement taken within a day of assessment of clinical pallor from outpatient and medicine inpatient department of a teaching hospital. We did a blind and independent comparison of physical signs (examination of conjunctivae, tongue, palms and nailbed for pallor) and the reference standard (haemoglobin estimation by an electronic cell counter). Diagnostic accuracy was measured by calculating likelihood ratio values and 95% confidence intervals (CI) at different haemoglobin thresholds and area under the receiver operating characteristic curve. Two observers examined a subset of patients (n = 128) to determine the inter-observer agreement, calculated by kappa statistics. We studied 390 patients (mean age 40.1 [SD 17.08] years); of whom 48% were women. The haemoglobin was <7 g/dL in 8% (95% confidence interval, 5, 10) patients; <9 g/dL in 21% (17, 26) patients and <12 g/dL in 64% (60, 70) patients. Among patients with haemoglobin <7 g/dL, presence of severe tongue pallor yielded a LR of 9.87 (2.81, 34.6) and its absence yielded a LR of 0. The tongue pallor outperformed other pallor sites and was also the best discriminator of anaemia at haemoglobin thresholds of 7 g/dL and 9 g/dL (area under the receiver operating characteristic curves (ROC area  = 0.84 [0.77, 0.90] and 0.71[0.64, 0.76]) respectively. The agreement between the two observers for detection of anaemia was poor (kappa values  = 0.07 for conjunctival pallor and 0.20 for tongue pallor).Conclusions/SignificanceClinical assessment of pallor can rule out and modestly rule in severe anaemia.

Groin swelling in pregnancy can give rise to various diagnostic dilemmas. Inguinal hernia not uncommonly may present for the first time in pregnancy because of increase in intraabdominal pressure. It is 10 times less frequent in women than in men. The reported incidence is 1 in 3000. The other differential diagnosis including femoral hernia, enlarged lymph nodes, vascular aneurysm and subcutaneous lipoma. Congestion of the pelvic and iliac veins may give rise to round ligament varicosities mimicking inguinal hernia. The distinction between the two is difficulty clinically as symptoms and signs are similar. Ultrasound has proved to be a useful tool for differentiating round ligament varicosities from an inguinal hernia. The characteristic ultrasound picture includes a prominent venous plexus with dilated draining veins and typical bag of worms appearance. Round ligament varices require close monitoring during pregnancy as it can lead to rupture of varices or acute variceal thrombosis in peripartum period. This case highlights the potential difficulty in diagnosing inguinal swelling clinically in pregnancy. Ultrasonography can however clinch the diagnosis and prevent unnecessary surgery and its associated morbidity. Bilateral inguinal swelling is gravid state is not a common occurrence is obstetric practice. Bilateral round ligament varicosities may be mistaken for inguinal hernias in gravid patients because these conditions have similar presentations. It is very critical to differentiate between varicosities and hernias to avoid performing unnecessary surgery.

Introduction: Integrated counseling and testing centers (ICTC) provide an excellent opportunity for activities to prevent parent to child transmission of HIV/AIDs. This study was carried out to find the HIV seroprevalence among antenatal clinic attendees and to analyze the utilization of ICTC services in a rural institute of India. Method: A retrospective analysis of utilization of ICTC services by pregnant women over 8 years at a tertiary care medical institute of central Maharashtra was done. Pre-test counseling, HIV testing and Post-test counseling was done by trained staff of ICTC centre . Single dose oral Nevirapine (200 mg) was given to seropositive women during active labour. Nevirapine syrup 200 mg/ kg body weight was administered to newborn. Analysis of outcome of seropositive pregnancies and exposed babies was done. Results: Out of new antenatal attendees 26,487 pregnant accepted pre-test counseling and 25,740 (97.17%) were tested for HIV. 144 women were found positive with seroprevalence rate of 0.44 %, 3.5% opted for pregnancy termination, 15.73 % delivered vaginally and 85.39 % underwent caesarean section. All the mother-baby pairs received nevirapine prophylaxis. 27 exposed babies were tested at 18 months of age and 2 were found to be positive. Conclusion: PPTCT centers act as excellent venues to impart information, education and counseling to expectant mothers and 100 % counseling rates and excellent testing rates can be achieved. With proper sensitization of health care providers almost all mother baby pairs can be administered the antiretroviral drug at the appropriate time.