Splenic hemangioma, a vascular malformation represents the most common benign primary neoplasm of the spleen with fewer than 100 cases reported in literature. Rupture of hemangioma is a life threatening complication occurring mostly in third trimester or puerperium with maternal mortality of 70% and fetal mortality of 90-95%. We herein report the first case of rupture of capillary hemangioma of spleen occurring in mid trimester pregnancy.

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Granulosa cell tumor is a sex cord-stromal tumor of the ovary derived from non-germ elements. These lesions occur most frequently in menopausal or postmenopausal women and its association with endometrial carcinoma is seen only in less than 5% of these cases. We herein report a rare case of adult type granulosa cell tumor of the ovary with coexistent endometrial adenocarcinoma in a 35 year old, married Indian female.

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Wilson's disease, also known as hepatolenticular degeneration, is a rare familial disorder inherited as an autosomal recessive trait with inborn error of copper metabolism leading to toxic accumulation of copper in the body particularly the liver, brain, cornea and kidney. In children, Wilson's disease (WD) presents more often with hepatic manifestations. After the age of 20 years, 75% of cases present with neurological manifestations and 25% with both hepatic and neuropsychiatric manifestations. We present a rare unusual presentation of Wilson disease in 12 year male child who presented with neuropsychiatric manifestation without hepatic involvement.

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Involvement of some individuals in risky behaviors such as unprotected sex, smoking and drug abuse is quite common. This has given rise to concepts such as „risk society‟, „risk and identity‟ and „risk management‟. Risks come in two forms - external and internal. It is important to understand the concept of risk-taking and risk management, especially by the health professionals, because it facilitates the understanding of patients‟ involvement in risk-taking behaviors and could also be helpful when health professionals formulate health policies. This paper discusses a number of reasons why some people engage in risky behaviors, sociological view on risk management and occupational risks, with emphasis on internal risks.

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Introduction: The milieu of tertiary education has always been regarded as a highly stressful environment for students especially for medical students. The study aims to explore the stress level, stressors, and coping strategies among first year medical students in Malaysian public universities and factors contributed to the stress at the end of year. Methodology: A multicenter cross-sectional study involving four Malaysian public universities. The 12-item General Health Questionnaire (GHQ-12), Medical Student Stressor Questionnaire (MSSQ) and Brief COPE inventory were self-administered to measure stress level, sources of stress and coping strategies respectively among the participants. Calculated sample size was 387. Results: Out of 387 selected participants, 359 (92.7%) responded to this survey. This study found that the prevalence (at the end of the year) of distressed first year medical students was 50%. The major stressors across the universities were academic-related issues. The top five coping strategies were religion, active coping, positive re-interpretation, acceptance and planning. University, parent income, academic activities, group activities, and desire related stressors were significant factors contributing to the students' stress (p-value < 0.05). Conclusion: This study found that there was a high prevalence of distressed among first year medical students at the end of year, the major stressors were related to academic and contributing factors of stress were related to university, coping strategy, types of stressor and parent income status. Training first year medical students on adaptive coping strategies, managing stressors, and improving peer-group supports to the students will help to improve this condition.

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Introduction: As the female hormones are emetogenic in nature, females in their reproductive period are more predisposed to Nausea/Vomiting in the non-pregnant, pregnant state as well as in the post operative period. This study was conducted to find the influence of the phase of the menstrual cycle on Post Operative Nausea, Vomiting, the alertness and pain perception, after general anaesthesia, in the postoperative period. Methodology: After obtaining the approval of IEC, the study was conducted on 60 young, healthy and consenting female patients. As per the date of their last menstrual cycle patients were divided into two groups: Group A: Patients in proliferative phase (1 to 14th day); Group B: Patients in luteal phase (15 to 30th day). All the patients had standardized method of general anaesthesia. The assessment of the patients for nausea, vomiting, pain and sedation was carried out using specific scoring systems & visual analogue score (VAS) at 30 min, 60 min, 90min, 2 hrs, 6hrs, 12hrs and 24 hrs post operatively by a blinded impartial observer. Patients were given rescue antiemetic and NSAID, as and when required. Results: 26 patients were allocated to group A and 36 to group B. No statistically significant difference was found, in demographic profile, vital parameters, sedation score, VAS (pain score) and the duration of surgery. Although Group A patients had higher nausea/vomiting score than the group B patients, throughout the post-operative period, the difference was highly significant at 90 min and 12 hours postoperatively. The percentage of patients, having PONV (reflecting incidence), in group A was significantly higher (76.8%) than in group B (32.35%). Conclusion: T he incidence and severity of nausea vomiting in the post operative period is definitely influenced/increased by the Proliferative phase of the menstrual cycle.

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Antimicrobial resistance is one of the biggest challenges faced by public health at the beginning of the third millennium. The global presence of antimicrobial resistance is threatening the continued effectiveness of many current medications. Antibiotic resistance is usually associated with significant morbidity, longer hospitalization, excess costs and mortality. Many factors contribute to the unnecessary use of antibiotics including the phenomenal knowledge boom, direct patient requests, perceptions of patient demand, culture and norms and advertisements and other promotional literature. Self-medication with antimicrobials is often cited as a major factor contributing to drug resistance. The microorganisms employ several mechanisms in attaining multidrug resistance such as they lack of reliance on the glycoprotein cell wall; enzymatic deactivation of antibiotics, decreased cell wall permeability to antibiotics and altered target sites of antibiotic. Efflux mechanisms to remove antibiotics and increased mutation rate are some of the other important mechanism for the antimicrobial resistance. Optimal use of existing antimicrobial agents, using alternative treatment options, reducing the need for antimicrobials by increasing immunity, education of health professionals and patients, antibiotic policies and implementation of infection control measures are the strategies aimed at prevention of emergence and spread of antibiotic resistance.

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