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Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identification of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

Third and fourth degree perineal tears have a considerable bearing on a woman's future continence and quality of life. The RCOG recommends that all symptomatic women or those with abnormal anorectal manometric or endoanal ultrasonographic features should have the option of caesarean birth. We assessed the outcomes of 79 such women with regard to their symptoms, endoanal ultrasound and manometry findings at 6 months after delivery and the mode of delivery in the subsequent pregnancy. Some 85% of the patients were asymptomatic. Five patients (42%) had faecal incontinence and the scarring was the commonest finding on endoanal ultrasound, irrespective of symptoms. The anal manometry showed reduced squeeze and resting pressures in proportionately higher numbers of symptomatic patients. A total of 12 patients underwent a caesarean section in their next pregnancy. Three patients had a repeat third degree tear. Among those who failed to keep the colorectal appointment, we conducted a telephonic questionnaire and found that most women (32 out of 33) were asymptomatic and three women were reluctant to be examined by a male doctor. We recommend appropriate identification, repair, physiotherapy and multidisciplinary follow-up in these patients to improve long-term outcomes.

The cardiovascular responses to tracheal intubation using a jibreoptic bronchoscope or Macintosh laryngoscope were compared in twenty in-patients and twenty day-stay patients. Within these groups patients were randomly allocated to direct laryngoscopic or jibreoptic bronchoscopic intubation. Arterial blood pressure, heart rate and arterial oxygen saturation were recorded before induction and at one-minute intervals untilfour minutes after intubation. In both groups both laryngoscopic and bronchoscopic intubation resulted in a significant rise in blood pressure and heart rate. At no stage was there a significant difference in mean blood pressure in either group, or in heart rate in the day-stay patients, betl'v'een the different methods of intubation. In the in-patients mean heart rate was signijicantly higher in those patients intubated with the bronchoscope at three and four minutes after intubation. Time taken for intubation was significantly longer in those patients intubated with the bronchoscope. In no patient did the arterial oxygen saturation fall below 98%.

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Background: Suicidal ideation (SI) and suicide attempts (SAs) among adolescents are a significant public health concern worldwide. The current study extends previous research by exploring the association between adverse childhood experiences (ACEs) and SI and SAs in a sample of adolescent inpatients as well as identifying specific predictors for increased risk of SI and SAs. Methods: Associations between ACE scores and self-reported SI and SAs were explored in a sample of 154 adolescent inpatients via clinical interview and by analyzing the association between cumulative ACE scores and scores on the Suicidal Tendency scale of a larger personality measure. We also tested for independent relationships between 19 ACEs and SI and SAs to determine unique predictors for suicidality. Results: One-way ANOVA analyses revealed that those who attempted suicide reported significantly more ACEs compared to those who did not attempt suicide. Witnessing violence in the home, school, or neighborhood, and experiences of discrimination increased one’s likelihood to attempt suicide by two to threefold, while sexual abuse, neglect, and physical abuse increased this likelihood by three-to-fourfold. Stepwise linear regression analyses demonstrated that emotional abuse, living with someone who had mental health problems or attempted suicide were most associated with elevated Suicidal Tendency scores on a personality measure. Conclusions: Early identification, education and intervention are imperative to limit or eliminate ACEs from occurring. The impact of cumulative as well as specific ACEs on suicide risk should be closely considered as areas for such intervention. Areas for future research include extending to include more diverse populations such as the LGBTQ community as well as more ethnically and racially diverse populations.

Laparoscopic AAA repair was performed safely, and with at least equivalent outcomes to open repair, in patients unfavourable for EVAR.