Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of the urinary tract. The primary objective was to find out the prevalence of asymptomatic bacteriuria in pregnancies less than 28 weeks gestation in our hospital and to study the various adverse pregnancy outcomes in the study group.Methods: This was a cross sectional study done over a period of 12 months at this tertiary care centre in Government sector in Trivandrum, Kerala. A sample size was calculated statistically and 400 women with gestational age less than 28 weeks attending the outpatient department were included in this study. A structured proforma, urine microscopy and urine culture and sensitivity were the study tools.Results: Prevalence of asymptomatic bacteriuria in our study population was 8.25%. Commonest pathogen isolated was E.coli in 57.14% cases. Maternal morbidity was higher in women with asymptomatic bacteriuria (24.2%) than those without (12.5%). Fetal morbidity in women with asymptomatic bacteriuria was 24% whereas it was 12.5% in those without it. Preterm labour, preeclampsia and prematurity were the common morbidities noted.Conclusions: Since pregnant women with asymptomatic bacteriuria were at an increased risk of adverse maternal and fetal outcome, routine screening for asymptomatic bacteriuria preferably in the first trimester is highly recommended.

The Kleine-Levin Syndrome, first categorized by Critchley and Hoffman in 1942, consists of periodic hypersomnia and megaphagia associated with abnormal mental states. Though a case of hypersomnia with doubtful megaphagia was described by J. A. Antimoff as far back as 1898, the first two cases definitely belonging to the syndrome lie hidden in a group of five cases reported by Willi Kleine (1925), a psychiatrist of the Kleist Clinic, Frankfurt, under the title of ‘Periodische Schlafsucht’. The patients were adolescent males who showed periodic hypersomnia with eating of excessive food and an unusual mental state. Writing on narcolepsy, a New York psychiatrist, Max Levin (1929), described a boy who exhibited pathological hunger in association with episodes of sleep of unusual duration. ‘The patient would sleep for long periods at the beginning of each attack. His appetite was enormous. He ate large meals and much in between meals. Max Levin rewrote his original case in 1936, and for the first time made specific mention of a ‘syndrome of periodic somnolence and morbid hunger as a new entity in nosology’ and quoted seven cases as ‘good’ examples of the syndrome.

Gilles de la Tourette's syndrome has not been reported outside Europe and America, and all the patients reported have been of the white or negro races (Singer, 1963). Although the condition was described as early as in 1825 by Itard and later differentiated as a syndrome by Gilles de la Tourette (1885), and although the syndrome is an unusual condition with undetermined aetiology, treatment and prognosis (Eisenberg et al., 1959, Kelman, 1965), and Kinnier Wilson (1940) had given the syndrome ‘a sinister’ outlook characteristically ending in insanity, Fernando (1967) could find only 85 cases published in English literature as cases of the syndrome. He rejected 20 cases, and of the 65 ‘proven cases' 50 were from the United States, 13 from Britain, one each from Finland and Canada. Shapiro and Shapiro (1968) commented on the scarcity of the syndrome even in the Western culture. Extensive search in the literature has shown that Gilles de la Tourette's syndrome has not been reported in Asians. This paper presents a detailed report of the first case from India.