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Introduction: Ectopic pregnancy means the presence of pregnancy outside the normal uterine cavity. Ectopic pregnancy commonly occurs in the fallopian tube (95 %). Diagnosis can be made by USG, serum hCG, although the 'gold standard' is laparoscopy. Management of the cases depends on the clinical presentation, site of the ectopic and need for future reproductive function and can be medical as well as surgical. Objectives: To determine the incidence of ectopic pregnancy, to assess the percentage of ectopic pregnancy diagnosed with each modality, to identify the factors associated with ectopic pregnancy and to calculate the type of management employed whether medical or surgical. Material and methods: This is a retrospective study where all the cases of ectopic pregnancies from 1 st January 2008 to 31 st December 2013 were included. The data on each patient was obtained and was duly entered in M S Excel and descriptive statistical measures were used for analysis Results: The incidence of ectopic pregnancy in the present study was 0.7%. 33.3% patients were primigravida. 5.5% had history of recurrent abortions, 11% of the patients took treatment for infertility, 27.7% had history of previous LSCS, D&C was done in 13% patients and 31.5% had undergone sterilization. In 83.3% ectopic gestation was diagnosed by ultrasound whereas rest 16.7% was diagnosed by serial serum hCG estimation. 22.2% underwent medical management whereas 89% patients underwent surgical management. Failure of medical therapy and subsequent surgical management was seen in 50% patients. Conclusions: Ectopic pregnancy causes significant morbidity to the mother and hence requires a high index of suspicion so that diagnosis can be made early and also to prevent complications and preserve the future reproductive function of the patient.

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Recent studies using data accrued from global SARS-CoV-2 vaccination efforts have demonstrated that breakthrough infections are correlated with levels of neutralizing antibodies. The decrease in neutralizing antibody titers of vaccinated individuals over time, combined with the emergence of more infectious variants of concern has resulted in waning vaccine efficacy against infection and a rise in breakthrough infections. Here we use a combination of neutralizing antibody measurements determined by a high throughput surrogate viral neutralization test (sVNT) together with published data from vaccine clinical trials and comparative plaque reduction neutralization test (PRNT) between SARS-CoV-2 variants to develop a model for vaccine efficacy (VE) against symptomatic infection. Vaccine efficacy estimates using this model show good concordance with real world data from the US and Israel. Our work demonstrates that appropriately calibrated neutralizing antibody measurements determined by high throughput sVNT can be used to provide a semi-quantitative estimate of protection against infection. Given the highly variable antibody levels among the vaccinated population, this model may be of use in identification of individuals with an elevated risk of breakthrough infections.

Hoagland sign is an early and transient bilateral painless upper eyelid edema observed in patients with Epstein-Barr virus (EBV)-related infectious mononucleosis. This sign can predate the appearance of exudative pharyngitis and cervical lymphadenopathy. Usually, this sign disappears by first week of infection. Here, we describe the occurrence of late onset Hoagland sign in a 14-year old boy who presented to us on 10th day of fever. Hoagland sign appeared after 10 days from symptom onset in our patient. Despite persistence of fever, the presence of Hoagland sign which appeared prior to confirmation of EBV infection was a helpful indicator for stopping antibiotics. In view of tonsillar hypertrophy with potential airway compromise and biochemical parameters suggestive of possible secondary hemophagocytic lymphohistiocytosis, he was initiated on steroids with which defervescence and prompt resolution of symptoms occurred. EBV can present as acute undifferentiated febrile syndrome which might result in inappropriate use of antibiotics. This case highlights the importance of using clinical clues like Hoagland sign to optimize antimicrobial stewardship.