Abstractj og_1856 1125..1136Aim: Despite tuberculosis (TB) being a global problem, maternal TB remains an unrecognized and underestimated tragedy, especially in South Asian countries. Therefore, we performed a non-systematic review regarding implications of maternal TB on obstetric and perinatal outcomes in the South Asian context. Material and Methods:We reviewed original studies, both descriptive and analytical, that originated from South Asian countries following an electronic search supplemented by a manual search. Although relevant studies from developed countries were reviewed, they were not included in the tabulation process because those studies had different socioeconomic/epidemiological background. Results: Diagnosis of TB is often delayed during pregnancy, because of its non-specific symptoms, and overlapping presentation with other infectious diseases. Poverty, undernutrition, lack of social support and poor health infrastructure along with complications of TB and need for prolonged medications lead to increased maternal morbidity and mortality. Maternal TB in general (except lymphadenitis), is associated with an increased risk of small-for-gestational age, preterm and low-birthweight neonates, and high perinatal mortality. These adverse perinatal outcomes are even more pronounced in women with advanced disease, late diagnosis, and incomplete or irregular drug treatment. There could be a synergy of TB, socioeconomic and nutritional factors, which might have contributed to adverse perinatal effects, especially in low-income countries. Conclusions: As active TB poses grave maternal and perinatal risks, early, appropriate and adequate anti-TB treatment is a mainstay for successful pregnancy outcome. The current knowledge gaps in perinatal implications of maternal TB can be addressed by a multicenter comparative cohort study.

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The objective of this study was to assess the feasibility and tolerance of diagnostic outpatient flexible hysteroscopy without anaesthesia. Records from 554 consecutive patients were analysed retrospectively. Success rate, reasons for failure, adverse reactions and level of pain were the main outcome measures. Hysteroscopy was successful in 90.5% of patients and well tolerated in 93.3%; 5.4% experienced moderate to severe pain. Inability to negotiate the cervical canal accounted for 47% of failed procedures and poor view for 42%. These results suggest that flexible outpatient hysteroscopy without anaesthesia is a successful and well tolerated procedure.

BackgroundAlthough eponyms are widely used in medicine, they arbitrarily alternate between the possessive and nonpossessive forms. As very little is known regarding extent and distribution of this variation, the present study was planned to assess current use of eponymous term taking "Down syndrome" and "Down's syndrome" as an example.MethodsThis study was carried out in two phases – first phase in 1998 and second phase in 2008. In the first phase, we manually searched the terms "Down syndrome" and "Down's syndrome" in the indexes of 70 medical books, and 46 medical journals. In second phase, we performed PubMed search with both the terms, followed by text-word search for the same.ResultsIn the first phase, there was an overall tilt towards possessive form – 62(53.4%) "Down's syndrome" versus 54(46.6%) "Down syndrome." However, the American publications preferred the nonpossesive form when compared with their European counterpart (40/50 versus 14/66; P < 0.001). In the second phase, PubMed search showed, compared to "Down syndrome," term "Down's syndrome" yielded approximately 5% more articles. The text-word search of both forms between January 1970 and June 2008 showed a gradual shift from "Down's syndrome" to "Down syndrome," and over the last 20 years, the frequency of the former was approximately halved (33.7% versus 16.5%; P < 0.001). The abstracts having possessive form were mostly published from the European countries, while most American publications used nonpossesive form consistently.ConclusionInconsistency in the use of medical eponyms remains a major problem in literature search. Because of linguistic simplicity and technical advantages, the nonpossessive form should be used uniformly worldwide.

ment for the intermediary and abnormal CTG classes was poor, but we disagree with the argument of Ayres-de-Campos et al. to merge these categories. Of course, merging these categories would make life simpler. However, we doubt whether this simplified 'traffic-light-approach (red, orange and green)' also makes it easier, since there is always some doubt about how to act when the light becomes orange. When should we intervene when the CTG traces 'intermediate' and 'abnormal' will be merged in this 'orange' category? Using (existing) cut-off points for intervention (based on ST information) of the abnormal CTG trace will lead to more false positive interventions, whereas cut-off points of the intermediary trace may create a higher false negative rate. In our opinion, the three-category STAN Ò guidelines, as used in the United States, will increase the number of unnecessary caesarean sections (CS) in countries with low CS rates, as in The Netherlands with a CS rate of 15%.Indeed, we found a higher agreement on clinical decisions, which is in agreement with the previous paper by Ayres-de-Campos et al. 4 We do not think that our findings were because of the dichotomous nature of the options (intervention versus no intervention), since intervention may imply many options, such as lowering oxytocin augmentation, amnion infusion, fetal blood sampling, asking a more senior colleague for help, ventouse/forceps delivery or CS. Therefore, the decision not to intervene, requires a great deal of thinking leading to the conclusion that the obtained information was sufficient to refrain from any of the intervention options.In general, we agree with Ayres-de-Campos et al. 1 that classification of the CTG and the subsequent clinical decision making process should not be more complex than actually needed and that there is still a great need for improvement. However, we feel that, rather than simplifying the STAN Ò guidelines regarding CTG classification categories, the solution to the large inter-observer variability may be found in computerised backing of CTG classification. In this way objective additional information (e.g. on poor fetal heart rate variability) is provided by computer quantification, a topic very familiar to Ayres-de-Campos et al.5 j