E The transversus abdominis plane (TAP) block provides anaesthesia to the anterior abdominal wall. It can be performed using landmark techniques via the Triangle of Petit or using ultrasound guidance. It is an effective tool in postoperative pain management for patients undergoing anterior abdominal wall surgery. It produces a significant reduction in postoperative pain scores, thereby reducing opioid consumption and the incidence of associated side-effects. Cardiopulmonary exercise (CPEX) testing provides a non-invasive method of assessing combined pulmonary, cardiac and circulatory function. It quantifies patient’s functional ability to respond to the increased metabolic demands of major surgery and is commonly used to assess mortality risk preoperatively. The use of CPEX testing to predict postoperative complications is not fully defined. We report the case of a patient with poor functional capacity and a CPEX test indicating high risk, who underwent uneventful intra-abdominal surgery with the use of bilateral TAP blocks.

COPD is a preventable and treatable disease with some extra- pulmonary effects that may contribute to the severity in individual patients Its pulmonary component is characterized by airflow limitation that is progressive and not fully reversible. There is an abnormal inflammatory response of the lung to noxious gases and particles, most commonly cigarette smoke 3. Airflow obstruction is defined as post-bronchodilator FEV1/FVC ratio (where FEV1 is the forced expiratory volume in one second and FVC is the forced vital capacity) of less than 0.7 If FEV1 is ≥ 80% predicted, a diagnosis of COPD should only be made in the presence of respiratory symptoms 4.

Another potential mechanism responsible for pathogenesis of pre-eclampsia is placental hypoperfusion which in turn releases various factors that trigger endothelial activation / dysfunction. Nitric oxide, disordered endothelin metabolism, thromboxane/prostaglandin imbalance, cellular fibronectin, inflammatory cytokines (TNF-α, IL-6, IL-1α, and IL-1β) and other factors such as lipid peroxides and reactive oxygen intermediateshave all been implicated in mediating the endothelial cell injury12. This is well-supported by the fact that pre-eclampsia commonly occurs in pre-existing metabolic (diabetes, hypercholesterolemia), renal, vascular disorders (hypertension) and connective tissue disorders that result in poor placental circulation. In cases of multiple gestation or increased placental mass, it is not surprising for the placenta to become under perfused. However, majority of the pre-eclamptic women do not suffer from any underlying medical conditions. In these women, lack of placental cytotrophoblast invasion of uterine spiral arterioles and arrest of arteriolar remodeling results from failure of pseudo-vascularization of the invasive cytotrophoblasts13. Deregulation of angiogenesis-related gene products such as vascular endothelial growth factor (VEGF), angiopoietin and ephrin family proteins, placental growth factor (PlGF) and their receptors have been implicated in this process14.Shallow placentation leads to reduced placental perfusion and subsequent ischemia.

Aim: Self-medication (SM) is proportionately increasing in both urban and rural communities. The prevalence and pattern of SM use is not well established; hence a cross-sectional survey was undertaken which recruited a sample size of 200 participants randomly from the coastal regions of south India. Method: Each participant underwent a face-to-face interview with the help of a structured questionnaire; data collected was analyzed using descriptive and inferential statics in SPSS. Result: SM use was reported by 71% of the subjects, which ranged from a frequency of at least one time to a maximum of 5 times and above. Lack of time (41.5%), minor illness (10.5%) and quick relief (10%) was cited as the most common reason for SM use. The majority of the participants (93.5%) were not aware about the side effects of SM. Findings revealed females and people living in urban areas are more likely to use SM than males and people in rural areas (P<0.001). Conclusion: There may be a larger role for a training programme to empower people about safety and side effects of SM use, to achieve a greater sense of self control

Background: Radioiodine therapy (RAI) is commonly used as a definitive treatment for hyperthyroidism. However, there is no agreement on the regime or the dose of RAI used and success rate is quite variable. In addition, the literature on the factors governing the success of the initial dose is conflicting. Objective: We have adopted a standard 550 MBq dose for all patients with hyperthyroidism. The aims of our study were (1) to assess the success rate of this regime in terms of cure of hyperthyroidism and (2) to evaluate the role of pre-treatment factors including age, gender, use of antithyroid medication prior to RAI, aetiology of hyperthyroidism and free thyroxine levels at diagnosis, as predictors of response to RAI. Patients and methods: The study is a retrospective analysis of 584 patients treated at this center over a 14-year period. All patients received a fixed 550MBq dose following withdrawal of antithyroid medication for 7 days. Repeat dose was administered if patients remained hyperthyroid at the end of one year after the initial dose. Success rate in terms of cure of hyperthyroidism was calculated. The association of pre-treatment factors and failure to respond to the first dose of RAI was studied using univariate and multivariate analyses. Results: Mean age was 56 years (range 20-90 years) with female preponderance (82%). Of the 478 patients in whom the aetiology could be ascertained by the criteria used, 344(72%) patients had Graves’ disease and 134(28%) patientshad toxic nodular disease. At the end of one year 545(93%) patients were either hypothyroid (411(70%)) or euthyroid (134(23%)) and were considered to be cured, while 39(7%) patients remained hyperthyroid and required further doses of RAI. Free thyroxine level at the time of diagnosis was the only pre-treatment factor, which independently influenced post-RAI outcome and a higher free thyroxine level predicted a lower cure rate. Conclusion: A standard 550MBq dose of RAI has a low failure rate when used for the treatment of hyperthyroidism. In our experience, only high free thyroxine levels at diagnosis were associated with a lower cure rate.

However, in everyday practice, management of carriers with PNALT may be paradoxically more difficult than that of patients with abnormal ALT levels. Indeed, it is not always so easy to ascertain in the single case whether it should be considered as healthy subject or true patient. Several topics to date remain unresolved: Should these ‘seemingly healthy’ people undergo routine liver biopsy? Is antiviral treatment justified in ‘asymptomatic’ subjects with persistently normal liver biochemistry? Is long-term follow-up needed in this setting, and how long it should last?2 Liver biopsy provides helpful information on liver damage, as it may reveal the presence of advanced fibrosis or cirrhosis. Without a biopsy, it is impossible to clinically distinguish true ‘healthy’ carriers from those with CH.4 On the other hand, it is difficult to recommend routine biopsy for all  HCV-PNALT .4 The decision to perform a biopsy should be based on whether treatment is being considered, taking into account the estimated duration of infection, probability of disease progression, willingness to undergo a biopsy, motivation to be treated, and availability of non-invasive tools to assess liver fibrosis.12 The recently developed  transient elastography has improved our ability to non-invasively define the extent of fibrosis in HCV persons