The relationship between sensorineural hearing loss (SNHL) and Diabetes mellitus has been known since more than 150 years. The pathophysiology of diabetes related hearing loss is speculative. Hearing loss is usually, bilateral, gradual onset, affecting higher frequencies. This study aims at knowing the prevalence of SNHL in DM and its relation to age, sex, duration of DM and control of DM. A total of 50 type 2 diabetics of age group 30-65 years were involved in the study. FBS, PPBS, HbA1c of all the subjects were done and later subjected to PTA. The type and severity of hearing loss was noted. Occurrence of SNHL was later compared with age, sex, duration, and control of DM. Sensorineural hearing loss was found in 66 % of type II diabetic patients and 34 % were found normal. Out of 50 diabetes mellitus patients, 33 patients had SNHL. All cases of SNHL detected were of gradual in onset and no one had hearing loss of sudden onset. Normal hearing was found in 34 % of patients, whereas 54 % of patients had mild hearing loss and 12 % of patients had moderate hearing loss. Association of hearing loss of DM patients with sex of the patient is insignificant. However there is significant association between older age group, longer duration and uncontrolled DM with that of SNHL. In subjects with HbA1c more than 8 and duration of diabetes mellitus more than 10 years prevalence of SNHL is more than 85 %, which is statistically significant. Sensorineural hearing loss in diabetes mellitus is gradually progressive involving high frequency thresholds. Hearing threshold increases with increasing age duration of diabetes and also high level of HbA1c greater than 8 %.

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The prevalence of obesity during pregnancy is rising. Elevated BMI is a significant risk factor for adverse maternal and fetal outcomes, including primary postpartum haemorrhage (PPH). Addressing the issues surrounding obesity in pregnancy presents many biological, social and psychological challenges. BMI is an easily measured and modifiable anthropometrical risk factor and should be recorded in all pregnancies. BMI should be proactively managed prior to and during pregnancy. All women should be educated as to the risks of an elevated BMI during pregnancy and those at risk should have access to specialist medical and surgical support if required. Our aim was to investigate the associations between elevated BMI and adverse maternal and fetal outcomes including PPH, and to explore the psychological challenges of having an elevated BMI during pregnancy.

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A 46-year-old woman attended the gynaecology clinic complaining of right iliac fossa pain and dyspareunia of 18 months duration. Her symptoms were gradually worsening. She had a history of hysterectomy and left salpingoophorectomy for menorrhagia caused by fibroids. The patient had a body mass index of 29. Bimanual pelvic examination revealed right adnexal fullness which was confirmed on ultrasound scan to be an ovarian cyst. After appropriate counselling a right oophorectomy was planned. The procedure was performed through a transverse suprapubic incision. During the operation the abdominal wall was held apart with a self-retaining retractor. It was not necessary to open the retroperitoneal space because the ovary was lying adherent to the vaginal vault peritoneum. The procedure was uneventful. In the immediate postoperative period she complained of pain in the right anterior and medial aspect of the thigh. She also showed signs of significant intraperitoneal bleed and developed mild haematuria. Repeat exploratory laparotomy was performed to stop haemorrhage. On the fourth postoperative day she fell down when attempting to walk. She described pain and numbness in the right anterior thigh extending from the inguinal crease and distally to the knee and slightly below the knee on the lateral border. Following recovery from surgery a specialist neurological examination showed weakness of right hip flexion and knee extension, absence of the right knee jerk, and anaesthesia over the anterior and medial aspects of the right thigh. A right femoral neuropathy, presumed secondary to the surgical procedure, was diagnosed. Peripheral neurophysiological studies showed acute denervation of the right vastus lateralis with a marked loss of motor units confirming the clinical diagnosis. The patient started physiotherapy and was treated with amitryptiline and tramadol for her pain. After 8 months there was appreciable improvement in her symptoms. She was started on gabapentin and remains under follow up in a pain clinic.