Assessment of musculoskeletal function in individuals with haemophilia has been attempted with clinimetric instruments, which use predetermined domains for assessing the same. This study introduces the application of an instrument, the Canadian Occupational Performance Measure (COPM), which is an open-ended questionnaire that allows patients to prioritize their needs and rate their performance in different tasks of daily living as well as their satisfaction in performing them. To study the utility of COPM in evaluating the musculoskeletal functional status of patients with haemophilia and to assess its effectiveness in planning individualized management plans for them. COPM was administered to 67 individuals with haemophilia aged 10-55 years and the data were compared with functional deficits identified through FISH (Functional Independence Score for Haemophilia). A total of 31 performance difficulties in the areas of self-care (62%), productivity (21%) and leisure (17%) were identified by COPM. All eight domains of FISH were identified in COPM as problems in self-care. In addition to these, COPM identified problems in the areas of productivity and leisure. In 78% of the responses on COPM, there was concordance between the performance and satisfaction scores. However, there was discordance between the two in the remaining 22% of responses. COPM is a useful tool for assessment of musculoskeletal dysfunction in haemophilia. It provides a greater insight into the needs of each patient and helps in planning individualized intervention strategies.

Introduction:Mitral stenosis of rheumatic origin still looms large in developing countries like ours. Symptoms of such conditions occur when the severity starts increasing or atrial fibrillation develops. They are mainly because of pulmonary venous and arterial hypertension, low cardiac output, as well as embolic phenomena. Our case deals with a rare complication of this common disease.Case study: 56 yrs old male of known rheumatic heart disease for many years with moderate symptoms was admitted with complain of respiratory distress of acute onset. He was on regular penicillin prophylaxis, diuretic and rate controlling medicines and had been doing well with those. However few days before admission he had sudden shortness of breath which did not respond as well as it had used to be earlier.On admission, he was orthopnoeic, having tachycardia with irregular pulse and normal blood pressure. ECG showed atrial fibrillation with T wave inversion in V 1-3 and inferior leads. TTEcho revealed dilated LA, mildly enlarged RV with evidence of rheumatic involvement of mitral valve whose area by planimetry was 1.36 cm 2 .Transmitral pressure gradient was about 12 mm Hg (mean). There was no clot in LAA. LV function appeared depressed with hypokinesia noted in infero-posterior area. Considering the age and the presentation of the patient, CAG was performed. It revealed 50-60% stenosis with thrombus in mid RCA with distal cut off and minor plaque in proximal LAD (fig-1). J MEDICINE 2016; 17: 43-45 A Rare Presentation of Mitral Stenosis

Dextrocardia with situs inversus are rare congenital anomalies which can be asymptomatic and compatible with normal life. They are characterized by mirror images of all intra-thoracic and intra-abdominal viscera. Our aim is to report an incidental finding of dextrocardia with situs inversus in a neonate with sepsis and also to report other associated anomalies with it. Most cases of situs inversus have been reported either in adults or in cadavers during dissection. Very few in number have been detected in neonates. Here is a one such case report. A day-old term male neonate presented with features of septic shock. Physical examination revealed cardiac apex on the 4th right intercostal space, along the mid-clavicular line. Chest radiograph and abdominal ultrasound confirmed the diagnosis of dextrocardia with situs inversus along with renal agenesis and ectopia.