Background Periampullary carcinoma includes a group of malignant neoplasm arising in the pancreas or in or near the ampulla of vater. Main modalities of treatment in patients with obstructive jaundice due to periampullary carcinoma: resection of the tumor with bilioenteric anastomosis, palliative surgical bypass and stent insertion. Aims and objectives To nd out results, morbidity and mortality to various modalities of treatment to all operable and non operable case of obstructive jaundice due to periampullary carcinoma following proper diagnosis by clinical, radiological and other investigation procedures Materials and methods This is a prospective study on patients presented with obstructive jaundice due to periampullary carcinoma with special reference to its management, admitted in different surgical units of Nootan Medical College & Research Centre, Visnagar from the month of August 2019 to July 2022 suspected due to peri-ampullary carcinoma. Results and discussion Twenty eight cases studied in regard to their incidence of age, sex, religion, occupation, their clinical features, investigations different etiological factors of obstructive jaundice due to periampullary carcinoma and their management. Maximum numbers of obstructive jaundice due to periampullary carcinoma were found to be due to carcinoma head of pancreas, Most of the patients present late and curative resection was not possible in them 24 out of 30 patients were operated out of which 10 had denitive surgery and in 14 palliative surgeries were done. Conclusions Most of the patients' present late and curative resection was not possible in them. Surgical palliation is a better alternative in those patients when nonsurgical palliation is not available

Quadruplets are set of four off springs born at one birth. Quadruplets occurring more frequently as assisted reproduction technique but spontaneous conception and delivery of 4 male live fetuses are something rare case to be reported. Improved MCH care in high risk obstetric cases with team work and Obstetric ICU/HDU and NICU. We report a case of 28 year old multiparous woman presented at around 10 week of amenorrhea with positive pregnancy test. After evaluation she was found to carry 4 live fetuses. She was managed conservatively till 34 week of gestation with regular ANC monitoring. Caesarean section was performed when labour pain was started for obstetrical complications and successful delivery of 4 healthy live male children of 1.75, 1.5, 1.5, 1.2 kg. Entire delivery was possible in Obstetric HDU set up and level 3 NICU setup. This case is unique due to SPONTANEOUS conception of quadruplet pregnancy with regular ANC checkups and delivery at centre with obstetric ICU back up & team work. We followed this case for entire post natal period and infant age of all Children.

Anaemia during pregnancy is allied with maternal and foetal complications like increased risk of intrauterine growth retardation, prematurity, low birth weight, and maternal and infant mortality. The agent iron isomaltose 1000 (Fur-IV) combines iron and isomaltose 1000 for slow, controlled release to reduce the risk of free iron toxicity and provide flexibility and convenience for high dose administration. Iron isomaltoside has been shown to be effective in the treatment of IDA in many treatment groups compared to intravenous iron sucrose and FCM. : It is a prospective interventional study which is conducted to observe an increase in hemoglobin levels in obstetric and gynecological department patients suffering from IDA in whom oral iron preparation was ineffective or in case of clinical need to supply iron rapidly via single infusion of iron isomaltoside 1000. Each patient in the study received 500 mg single intravenous infusion. After this, patient was followed up and haemogram was repeated after 15 and 30 days of infusion while investigation for serum ferritin and serum iron was repeated after 30 days. Average Hb concentration in increased by 30.86% to 9.88 g/dL after 30 days of infusion. There is statistically significant difference between baseline values and post infusion 30 days values for serum ferritin and serum iron (p-value <0.0001 for both).IV iron isomaltoside administration was well tolerated in patients with gynecological IDA who were intolerant or unresponsive to oral iron therapy or who required rapid iron administration.