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Background and Aims:Noninvasive ventilation (NIV) is an emerging popular concept, which includes bi-level positive airway pressure or continuous positive airway pressure (CPAP). In settings with scarce resources for NIV machines, CPAP can be provided through various indigenous means and one such mode is flow inflating device - Jackson-Rees circuit (JR)/Bain circuit. The study analyses the epidemiology, various clinical indications, predictors of CPAP failure, and stresses the usefulness of flow inflating device as an indigenous way of providing CPAP.Methods:A prospective observational study was undertaken in the critical care unit of a Government Tertiary Care Hospital, from November 2013 to September 2014. All children who required CPAP in the age group 1 month to 12 years of both sexes were included in this study. They were started on indigenous CPAP through flow inflating device on clinical grounds based on the pediatric assessment triangle, and the duration and outcome were analyzed.Results:This study population included 214 children. CPAP through flow inflating device was successful in 89.7% of cases, of which bronchiolitis accounted for 98.3%. A prolonged duration of CPAP support of >96 h was required in pneumonia. CPAP failure was noted in 10.3% of cases, the major risk factors being children <1 year and pneumonia with septic shock.Conclusion:We conclude that flow inflating devices - JR/Bain circuit are effective as an indigenous CPAP in limited resource settings. Despite its benefits, CPAP is not a substitute for invasive ventilation, as when the need for intubation arises timely intervention is needed.

Introduction Menstruation is the physical herald to physiologic capacity of conception. Attainment of menarche in a girl brings in a lot of confidence and feminism in a girl. Though the incidence of primary amenorrhea is less than 1%, it accounts for significant amount of psychological trauma. In the present day scenario, there are a lot of investigative and treatment modalities which can at least restore her menstrual functions, if not reproductive, and prevent complications. Aims The objective of this study is to note the various causes of primary amenorrhea and the complete clinical picture and the management done in a tertiary care center like Vanivilas Hospital and Bowring Hospital, Bengaluru. Materials and methods This is a prospective study done in 40 patients of primary amenorrhea presenting to Vanivilas Hospital and Bowring and Lady Curzon Hospital, Bengaluru during a 2 years period. They were investigated and managed. The patients were followed up for their response to treatment. Results Out of the 40 patients studied, Mayer-Rokitansky- Küster-Hauser (MRKH) syndrome (32.5%) and hypergonadotropic hypogonadism (32.5%) were most common. Cryptomenorrhea (17.5%), automatic identification system (AIS) (7.5%) and miscellaneous (4%) were found. Conclusion Evidence of primary amenorrhea is less than 1%. A detailed investigation may lead to treatment in many cases. How to cite this article Anitha GS, Tejeswini KK, Shivamurthy G. A Clinical Study of Primary Amenorrhea. J South Asian Feder Obst Gynae 2015;7(3):158-166.

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Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.