Spontaneous adrenal hemorrhage of pregnancy is an acute hemorrhage into the adrenal gland in pregnancy in the absence of trauma, tumor or decoagulant therapy. This can have catastrophic consequences on the mother and the baby and if the hemorrhage involves both the adrenal glands the risk is aggravated because of the high incidence of resulting adrenal insufficiency. We report a case of spontaneous bilateral adrenal hemorrhage in pregnancy resulting in adrenal crisis. A 26 year old primigravida presented at 32 weeks of gestation initially with right sided infrascapular pain and one month later with similar pain in the left side associated with high blood pressure. Imaging with ultrasound and MRI was suggestive of bilateral adrenal mass probably hemorrhage; 2 days following the second episode of pain she developed drowsiness and hypotension and a diagnosis of primary adrenal insufficiency was confirmed by a low serum cortisol and high ACTH. She stabilized with hydrocortisone therapy and the fetus was closely monitored. At 37 weeks she had a normal vaginal delivery under steroid cover. Repeat MRI abdomen 3 months after delivery showed resolution of the hemorrhage but biochemically she continued to be cortisol insufficient at 1 year of follow up. Prompt diagnosis of adrenal hemorrhage in pregnancy and treatment of adrenal insufficiency along with close fetal monitoring usually results in good perinatal outcome in spontaneous adrenal hemorrhage of pregnancy.

Background: Self-medication is a common practice in developing countries and its prevalence is attributed to less healthcare facilities, reduced economic burden, and easy availability of drugs and local medicines. With the onset of COVID-19, self-medication has increased due to fear and stigma surrounding the disease and hospitals being considered hotspots of infection. Methods: This is a cross-sectional study and data was collected from 478 participants using a semi-structured, self-reporting online questionnaire. Responses were tabulated and analysed with the help of SPSS (V25). Results: The prevalence of self-medication had risen to 84.5% in lieu of the COVID-19 pandemic. 80.8% of all males and 86.6% of all females who responded to the form used self-medication. Elderly people were found to have self-medicated the most. 71% of the participants self-medicated as they were anxious about contracting the disease. 50.2% reported using home remedies. Most frequently used allopathic drugs among the respondents were Vitamins and other dietary supplements (51.7%). Treatment by self-medication was found effective by 91.6% of the participants. Conclusion: Self-medication cannot be overlooked as it is most often suitable, cheap and effective. Awareness regarding the proper use of selfmedication is necessary, especially during the COVID-19 pandemic as it can lead to drug interactions, microbial resistance or serious adverse effects.

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Article Info A study was conducted to assess the therapeutic medicine usage pattern in commercial layers in Namakkal district. The data for the period 2016-17 was collected during the months of December 2016 to February 2017 from 60 commercial layer farms selected randomly from four blocks of Namakkal district by using multistage random sampling technique. The sample commercial layer farms were classified into three groups; small (up to 50,000 birds), medium (50,001-2,00,000 birds) and large (2,00,001 and above birds). Of the 60 farms surveyed, 29 (48.34 per cent) farmers were using medicines mainly for therapeutic purpose, 20 farmers (33.33 per cent) were using medicines for therapeutic and prophylactic purpose and remaining 11 (18.33 per cent) were using medicines for prophylactic purpose. Drugs were administered mostly through drinking water (39 farms-65.00 per cent) and next preferred route was through feed (15 farms-25.00 per cent). Most of the farmers (46) purchased medicines based on veterinarian advice (76.67 per cent) and 23.33 per cent of the (14) farmers who had been doing business for the long time were using medicines on their own. Most of the farmers (46) purchased medicines based on veterinarian's prescription (76.67 per cent) and 23.33 per cent of the (14) farmers were using medicines on their self-prescription. All the 60 farms were administering medicines at morning hours (100.00 per cent) and none of the farmers were administering the medicines in the evening hours.