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Objective: Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method:A digital survey adapted from the Indian Association of Palliative Care Standards Audit Tool was administered to 250 palliative care centres.Results: Two hundred and twenty-three (89%) palliative care centres participated -26.4% were government-run, while the rest include non-governmental organisations, private hospitals, community-led initiatives and hospices. About 200 centres 'often' or 'always' fulfilled 16/21 desirable criteria; however, only 2/15 essential criteria were 'often' or 'always' fulfilled. Only 5.8% provide uninterrupted access to oral morphine.Significance of the results: Palliative care centres in India are falling short of meeting the essential quality standards, indicating the urgent need for new initiatives to drive national change.

Background: Cognitive deficits among patients with schizophrenia are now recognized as being widely prevalent and one of the most disabling aspects of the illness, as they are associated with poor functional outcomes. Psychotropic medications and benzodiazepines, which are often used in these patients could impact cognition as could the extrapyramidal side-effects. Yet, here are hardly any Indian studies on the subject. The aim of this study was to determine whether cognitive dysfunction among patients with schizophrenia is associated with extrapyramidal symptoms, anticholinergic burden of psychotropic drugs and benzodiazepine dosage Methodology: 40 clinically stable, outpatients suffering from schizophrenia, without any pre-existing neurological disorders between the ages of 18 to 60 years, who had been compliant with medications were selected. Extrapyramidal symptoms (EPS) were assessed using the modified Simpson-Angus scale, anticholinergic burden (ACB) was evaluated using the Anticholinergic burden scale. The benzodiazepine dosage was noted. Cognition was assessed using the Stroop Color and Word Test and the Wisconsin Card sorting test. The correlations between scores on EPS and ACB and neuropsychological tests were carried out using partial correlations controlling for positive and negative symptoms. Results: There were no significant associations noted between extrapyramidal symptoms, anticholinergic burden, benzodiazepine dosage and performance on the neurocognitive tests used. Conclusion: Methodological differences make it difficult to construct comparisons across studies but there is some evidence to support our findings.

We report our experience with an atypical presentation of placenta percreta, presenting as a mass-like bulge in the uterine fundus. A hemodynamically stable young lady status-post preterm delivery at 26 weeks was referred to our center on the third post-partum day after multiple failed attempts at removal of a retained placenta. Magnetic resonance imaging (MRI) showed an atypical fibroid with part of an adherent placenta. Uterine artery embolization was done prophylactically. After a failure at removal under USG guidance, a diagnostic laparoscopy revealed an 8x6 cm highly vascular mass in the fundus extending to the right cornua with intact serosa, possibly placenta percreta. The procedure converted to laparotomy and the mass removed. Histopathology confirmed a placenta percreta. However, the neonate admitted at the referring hospital expired on day 14 due to sepsis. Post-partum adherent placenta in the fundal region on MRI can mimic an atypical fibroid.

Background: It requires detailed research to understand the psychopathology behind DSH attempts. Apart from social factors, psychiatric disorders and individual coping mechanisms can contribute to DSH. This study will be helpful in knowing the prevalence of psychiatric morbidity in these patients. Aims and Objectives: To study the Psychiatric morbidity in patients with DSH. Materials and Methods: This is a retrospective, descriptive study including 42 patients who had history of DSH and were referred to psychiatry department of BARC Hospital, Mumbai. Patients who were below 45 years of age at the time of DSH and above 18 years at the time of study were included. Their socio-demographic data were collected, psychiatric diagnosis were noted from the case files, personality disorders were evaluated using ICD-10 IPDE. Data were analysed using descriptive and analytic statistical methods. Results: 42.86% of the population was diagnosed as having psychiatric disorder. Most common disorder was depression. 7.14% of the patients were diagnosed as having borderline personality disorder. Conclusions: Depression was the most common psychiatric disorder found in our study. Key words: Deliberate self-harm, psychiatric disorders, personality disorders.