Background: In India, despite improvements in access to health care, social inequalities are gross in both rural and urban areas. Many middle and lower socio economic class families are crushed under debts at the time of hospitalization due to lack of health insurance. Health financing is an important part of broader efforts to ensure social protection in health. However "health insurance" is still an unknown word for most rural people. So this study was undertaken with the objective to assess the awareness about Health Insurance in rural areas and to describe the sociodemographic characteristic of respondents. Methods: A cross sectional community based study was done with sample size of 290 households estimated by using 25% national coverage according to Public Health Foundation of India. The study was conducted between July 2014 to August 2014. 290 families were covered from two Primary Health Centres which come under field practice area of our medical college. A pretested semi structured questionnaire was used to collect data. Data was entered in excel sheet and analysed using SPSS version 17 software. Results: Among 290 respondents 72.5% were in age group of 26-45 years, 69.4% were female, 82.1% belonged to below poverty line, 72.4% were from nuclear family and about 81% of respondents were aware of Health Insurance. Conclusions: Awareness about Health Insurance among rural population was satisfactory. Attention for implementation of health insurance policies has to be paid more importance than only awareness.

Varied presentation of infectious diseases like the rheumatic fever is on the rise especially in rural areas where a great proportion of communicable diseases are undiagnosed and untreated. Keen clinical examination and early treatment with minimal laboratory aid reduce healthcare expenditure in low socioeconomic regions. An 18-year-old adolescent girl presented with acute onset of motor tic for 2 weeks which progressed to vocal tic in a span of 6 weeks. As per the initial presentation, the patient was worked up as a case of Transient Tic Disorder and later as Tourette Syndrome. All the test results including Rheumatic Heart Disease workup were negative. But the patient developed Pure Chorea 2 weeks after this. The patient was treated on a presumptive diagnosis of Rheumatic Chorea and is now in remission for 6 months. Even though tics and other movement disorders can be associated with Rheumatic chorea, it is seldom to present as pure tic disorder at the first encounter and in relatively uncommon age group making this case special. Rather than early referral to movement disorder center, detailed observation of disease progression can prevent unnecessary work up.

Background: Several interventions have been used to reduce the rate of preterm birth and prolonging gestation in a twin pregnancy and routine usage of cervical cerclage in twin pregnancy conceived after intra-cytoplasmic sperm injection (ICSI) procedure has found to be beneficial.Methods: Prospective case series studies, series of expectant mothers with twin pregnancy conceived by ICSI were studied under tertiary care hospital setting. A total of 108 cases with twin pregnancy were included during a period of 2016 to 2019. Obstetric profile of all the cases was taken; cervical cerclage procedure was done at 14-16 weeks of gestation (McDonald method) after a normal nuchal translucency scan and a double marker test. Pregnancy outcome parameters like abortion, preterm labour/delivery, premature rupture of membranes (PROM), and mode of delivery, gestational age at delivery, birth weight and neonatal complications were assessed.Results: Mean age of the mothers was 30.61±4.45 years, rates of the pregnancy outcome parameters were abortion 0%, preterm labour 11.1%, premature rupture of membranes (PROM) 9.3%, mean gestational age at delivery was at 34.56±1.71 weeks. Neonatal outcome parameters were mean birth weight was at 2279±470 grams, 77.8% of the neonates had normal APGAR scores. The rates of NICU admission was 28%, RDS– 24.1%, 3.7% had sepsis and 92.6% of neonates survived and 7.4% died.Conclusions: In ICSI twin pregnancies with normal cervical measurements, prophylactic cervical cerclage is effective in prolonging pregnancy and preventing preterm delivery and thereby minimizing neonatal morbidity and mortality.

Lemierre’s syndrome is characterized by thrombophlebitis of the internal jugular vein with resulting systemic septic emboli. Most cases occur following an oropharyngeal infection and have been historically caused by the bacterial pathogen Fusobacterium necrophorum. However, infection from other pathogens is becoming more common in recent years. Our case is special in the sense that Lemierre’s syndrome was caused by staphylococcus aureus after influenza infection. A 23-month-old male presented with complaints of left neck swelling and recurrent fever for one week, following influenza A infection. The child was ill-appearing with fever, tachycardia, tachypnea, and erythematous swelling on the left cheek. Laboratory results revealed elevated inflammatory markers. Computed tomography (CT) scan of the neck showed loculated fluid collection suggesting an intra parotid abscess with poor visualization of the internal jugular vein (IJV). Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Due to high clinical suspicion of Lemierre’s syndrome, a doppler ultrasound was obtained which showed a left IJV thrombus. CT scan of the chest after the clinical suspicion showed multiple bilateral pulmonary nodules suggesting septic emboli. He was treated with antibiotics and a six-week course of the anticoagulant with a resolution of his thrombus. Though historically, Lemierre’s disease is caused by Fusobacterium necrophorum, other causative organisms such as methicillin-sensitive Staphylococcus aureus are increasingly being recognized. Lemierre’s disease can present as a complication of influenza. A high index of clinical suspicion based on the location of the abscess helped us delineate diagnostic tests and treatment.

STUDY OBJECTIVE:We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined 'low dose' spinal and epidural (CSE). DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia -'GROUP T' and 60 of who underwent a delivery without labour analgesia -'GROUP C'. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. 'Low dose' labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: 'Low dose' labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.