Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19

Vitamin C, also known as L-ascorbic acid, is an essential vitamin with pleiotropic functions, ranging from antioxidant to anti-microbial functions. Evidence suggests that vitamin C acts against inflammation, oxidative stress, autophagy chaos, and immune dysfunction. The ability to activate and enhance the immune system makes this versatile vitamin a prospective therapeutic agent amid the current situation of coronavirus disease 2019 (COVID-19). Being highly effective against the influenza virus, causing the common cold, vitamin C may also function against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its associated complications. Severe infections need higher doses of the vitamin to compensate for the augmented inflammatory response and metabolic demand that commonly occur during COVID-19. Compelling evidence also suggests that a high dose of vitamin C (1.5 g/kg body weight) in inflammatory conditions can result in effective clinical outcomes and thus can be employed to combat COVID-19. However, further studies are crucial to delineate the mechanism underlying the action of vitamin C against COVID-19. The current review aims to reposition vitamin C as an alternative approach for alleviating COVID-19-associated complications.

Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19

Vitamin C, also known as L-ascorbic acid, is an essential vitamin with pleiotropic functions, ranging from antioxidant to anti-microbial functions. Evidence suggests that vitamin C acts against inflammation, oxidative stress, autophagy chaos, and immune dysfunction. The ability to activate and enhance the immune system makes this versatile vitamin a prospective therapeutic agent amid the current situation of coronavirus disease 2019 (COVID-19). Being highly effective against the influenza virus, causing the common cold, vitamin C may also function against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its associated complications. Severe infections need higher doses of the vitamin to compensate for the augmented inflammatory response and metabolic demand that commonly occur during COVID-19. Compelling evidence also suggests that a high dose of vitamin C (1.5 g/kg body weight) in inflammatory conditions can result in effective clinical outcomes and thus can be employed to combat COVID-19. However, further studies are crucial to delineate the mechanism underlying the action of vitamin C against COVID-19. The current review aims to reposition vitamin C as an alternative approach for alleviating COVID-19-associated complications.

Inheritance Pattern and Association of Qualitative and Quantitative Traits in Cotton (Gossypium hirsutum L.) for Sustainable Breeding Goal

Background: Cotton (Gossypium hirsutum L.) is the most important fiber crop of the world and commonly known as white gold. It plays an important role in the economy of Pakistan. It provides raw material to the local textile industry and generates considerable amount of foreign exchange. The yield of cotton is lower in Pakistan. Knowledge of association among different traits is important for the development of cultivars with better yield and quality characters. Materials and Methods: In this research, two parents (PB-38 and Jambo Okra) and their crosses sown in randomized complete block design with three replications to sort out best performing genotypes for these profitable traits (plant height, number of sympodial branches, number of monopodial branches, leaf type, boll size, boll shape, number of bolls per plant, boll weight, ginning out turn, 100 seed weight and seed cotton yield). Results: Analysis of variance (ANOVA) revealed that parental and their F2 population showed significant differences for all the observed traits. Correlation and inheritance pattern of all characters provides information of association among all traits and percentage of inheritable attributes. Conclusions: The association and inheritance pattern study provide us useful information for effective selection and sustainable breeding programs. Heritability estimations revealed that heritability of traits fluctuate as following order; monopodial branches> ginning outturn>boll weight>sympodial branches>plant height>yield>number of bolls plant-1 with heritable percentages 99%, 90%, 89%, 64%, 60%, 60% and 55% respectively.

Anisometropia and refractive status in children with bilateral congenital nasolacrimal duct obstruction

Objective: To evaluate the state of refraction in children with bilateral congenital nasolacrimal duct obstruction [CNLDO]

Study Design: Descriptive study

Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from April 2014 to April 2016

Methodology: Children with bilateral CNLDO were studied. Patients' refractive status were evaluated by performing cycloplegic refraction, followed by appropriate management plan. The refractive errors of both eyes were noted and compared for any significant anisometropia

Results: One hundred and seventeen [n=117] children with median age [IQR] of 32 [12] months having bilateral CNLDO were enrolled. Children with bilateral CNLDO had insignificant interocular difference in terms of spherical equivalent [SE] and cylindrical refractive errors [p>0.05]. The rate of the anisometropia [>/=1 D difference between the two eyes] was 5.98% [n=7] in children with bilateral CNLDO

Conclusion: Performing cycloplegic refraction routinely in patients with bilateral CNLDO is not as urgent as compared to ones with unilateral CNLDO. Further, avoidance of early surgical intervention in children with bilateral CNLDO will spare the parents from the emotional trauma and positively influence the health economics worldwide

Frequency of vancomycin resistant staphylococcus aureus among clinical isolates of MRSA collected from tertiary care hospitals of Lahore, Pakistan

Objective: To determine the frequency of vancomycin resistant Staphylococcus aureus [VRSA] among clinical isolates of methicillin resistant Staphylococcus aureus [MRSA]. Study Design: Descriptive study. Place and Duration of Study: Department of Microbiology, University of Health Sciences, Lahore from Jul 2014 to Dec 2014

Material and Methods: A total of 240 [n=240] clinical isolates of MRSA were collected by consecutive sampling from different tertiary care hospitals of Lahore. Re-confirmation of MRSA was done by the standard microbiological methods using disc diffusion technique according to Clinical Laboratory Standards Institute [CLSI] guidelines 2014. Minimum inhibitory concentration [MIC] of the vancomycin was done by agar dilution method

Results: It was found that vancomycin inhibited MRSA strains in the range of 1.0-2.0 microg/ml. Ninety percent [90%] of the strains inhibited at 1 microg/ml while 25 [10.41%] strains showed growth at 1 microg/ml which indicates that their MIC was 2 microg/ml. No vancomycin resistant [VRSA] or intermediate strains [VISA] of MRSA were found during the study but there were significant numbers of isolates having >/=1 microg/ml MIC of vancomycin

Conclusion: Vancomycin has until now excellent activity against clinical isolates of Methicillin-resistant Staphylococcus aureus

Germ cell tumor and Takotsubo Cardiomyopathy: A treatment dilemma

Germ cell tumors [GCT] are uncommon malignancies in adult males and comprise less than 1% of male cancers. Due to highly curative nature and productive life years gained after treatment; reduction of chemotherapy related toxicities becomes vital. Cisplatin is the backbone of GCT chemotherapy, and is related to myocardial injury, thromboembolism and vasculitis. Though it should not be replaced with Carboplatin, however in certain circumstances, its use maybe unsafe; especially in cases when patient have prior myocardial infarction. We report a case of Takotsubo cardiomyopathy [TCM] secondary to GCT diagnosis in a young male. This patient presented withsymptoms of myocardial infarction however, coronary angiography was normal and a diagnosis of TCM was made. Though, it is rare but a unique challenge, as whether Cisplatin use would be safe in this particular scenario? On one hand patient had stress related myocardial injurywhile he was also at risk of further Cisplatin induced complications.There are no clear cut guidelines, so after informed consent his treatment regimen was modified to EC [Etoposide/Carboplatin] instead of EP [Etoposide/Cisplatin]. Patient has completed 4.6 years of follow-up without any evidence of relapse. We suggest informed decisions and to weigh the pros and cons of using an inferior regimen, in order to achieve same long term prognosis while preventing any acute complications,in younger patients with curable cancers

Missed opportunities for earlier HIV-testing in patients with HIV infection referred to a tertiary hospital, a cross-sectional study

Introduction: In Malaysia, the prevalence of missed opportunities for HIV-testing is unknown. Missed opportunities have been linked to late diagnosis of HIV and poorer outcome for patients. We describe missed opportunities for earlier HIV-testing in newly-HIV-diagnosed patients. Methods: Cross sectional study. Adult patients diagnosed with HIV infection and had at least one medical encounter in a primary healthcare setting during three years prior to diagnosis were included. We collected data on sociodemographic characteristics, patient characteristics at diagnosis, HIV-related conditions and whether they were subjected to risk assessment and offered HIV testing during the three years prior to HIV diagnosis. Results: 65 newly HIV-diagnosed patients (male: 92.3%; Malays: 52.4%; single: 66.7%; heterosexual: 41%; homosexual 24.6%; CD4 <350 at diagnosis: 63%). 93.8% were unaware of their HIV status at diagnosis. Up to 56.9% had presented with HIV-related conditions at a primary healthcare facility during the three years prior to diagnosis. Slightly more than half were had risk assessment done and only 33.8% were offered HIV-testing. Conclusions: Missed opportunities for HIV-testing was unacceptably high with insufficient risk assessment and offering of HIV-testing. Risk assessment must be promoted and primary care physicians must be trained to recognize HIV-related conditions that will prompt them to offer HIVtesting.

Borderline tumors of the ovary: a clinicopathological study

Objective: To report experience with borderline ovarian tumors [BOTs] in a developing country like Pakistan with limited resources and weak database of health system

Methods: Patients with BOTs managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2004 to 2014 were included and reviewed retrospectively. Data was recorded on histopathological types, age, CA-125, stage of disease, treatment modalities and outcomes

Results: Eighty-six patients with BOT were included with a median age of 35 years. Forty-two [49%] patients had serous BOTs and 43 [50%] had mucinous BOTs, while one [1%] had mixed type. Using FIGO staging, 80 patients had stage I; two patients had IIA, IIB and stage III each. Median follow-up time was 31.5 months. All patients had primary surgery. Seventy [81%] patients underwent complete surgical resection of tumor. Forty-three [50%] patients had fertility preserving surgery. Seventy-three [85%] patients remained in remission. Recurrent disease was observed in 13 [15%] patients. Median time to recurrence was 22 months. On further analysis, age above forty years, late stage at diagnosis and incomplete surgery were significantly associated with invasive recurrence

Conclusion: Despite a low malignant potential, relapses may occur in patients above forty years of age, incomplete surgery and staging information and advanced stage at presentation. Fertility sparing surgery should be considered in young patients. Complete excision of tumor and prolonged follow-up are advised because recurrence and transformation to invasive carcinoma may occur

Unani treatment for the removal of renal and vesicle calculi [Hisat-e-Kulia wa Masand] - a case report

Hisat-e-Kulia wa Masana [Renal and vesicle calculus] is a hard mass, formed from the crystals that aggregated on the inner surfaces of the kidney. This is a case report of a 57 years old male OPD patient of Shifa-ul-Mulk Memorial Hospital for Eastern Medicine, Hamdard University with lumbar pain. The patient had a history of recurrent lower urinary tract infection accompanied by frequent urination and its urgency, difficulty in voiding, small amount of urinary stream. Patient was a known case of diabetes and ischemic heart disease. Physical examination revealed mild tenderness in left lumbar region. According to laboratory examination profile, blood urea [38 mg/dl] and creatinine [0.8 mg/dl] were within normal limits; however, hemogram demonstrated reactive neutrophilie leukocytosis. Renal ultrasound showed single calculus measuring 0.4 cm in left kidney while urinary bladder showed multiple calculi [largest ranging from 0.7 and 0.8 cm] along with enlarged prostate weight [38.3 g]. The patient received polyherbal decoction of Unani codded formulation NU-08 and Hab-e-Rasoot [1 tablet twice a day] for 21 days. This treatment was successful and resulted in excretion of one tiny and one large stone [1 cm] through urination. This was further confirmed by ultrasound?

Evidence Based Assessment of Intermediate State of the Body by Using Scientific Approach of Modern and Conventional Knowledge

There are two states of the human body either health or disease which may co-exist, however, there is an intermediate state between extremes of absolute health and total disease with variation in severity of illness. This core concept of Unani medicine regarding states of the body [Ahwal-e-Badan] was initiated by Jalinoos [Galen] who introduced intermediate state and explained its causes further more notion of intermediate state expanded by Ibn Sina who delineated the states of the body ranging from health to disease. According to him the stages of health and disease are radiant health, not absolute health, neither healthy nor diseased, potential illness, slight ill health and absolute disease. The idea of these states of the body now recognized globally. According to World Health Organization [WHO] only 5% of world population is healthy, 20% have various diseases and 75% are living in [Sub Healthy State [ or ] Gray State of Health]. The objectives of this study was to re-defining intermediate state, reconsidering the signs and symptoms, set the laboratory investigations, relating it to the ancient theory of temperament and to established preventive measures. Healthy subjects male [n=13] and females [n=13] between 19-26 years of age were interviewed and examined by random sampling method, using a validated questionnaire which included complete history, general physical and systemic examination, body mass index [BMI] calculation and temperamental assessment. Biochemical analyses of complete blood count and erythrocytes sedimentation rate, lipid profile, liver function test and fasting blood glucose were performed. Temperature [°F], pulse [beats/min] blood pressure [mm Hg], are respiratory rate were measured following standard procedures. The percentages of normal and low BMI were 33.3% whereas high and obese were 16.7%. In both genders, there was a positive correlation between [BMI] and laboratory investigation's remarks and advises. This study revealed the concept of Unani Medicine that, besides the states of health and disease there is also various intermediate state in which one is neither totally sick nor healthy. The role of six essential factors such as Hawa-e-Muheet [Atmospheric air], Makool wa Mashroob [Food and drinks], Harkat wa Sukoon-e-Badani [Physical activity and response], Harkat wa Sukoon-e-Nafsani [Mental activity and response], Naum wa Yaqza [Sleep and wakefulness], Ehtibas wa Istifragh [Retention and elimination] is much more than just the mere avoidance of disease?

Clinical efficacy and safety of cupping therapy

In Unani System of Medicine, since centuries cupping therapy [Al Hijamah] has been an integral part of regimental therapy to treat various human diseases. The present study focuses on the therapeutic effect of wet cupping therapy [combination of suction and controlled medicinal bleeding] against various diseases. It is the oldest form of alternative medicine in which a suction is created locally on the skin, physicians consider that this act trigger blood flow in order to support healing process

The patients [n = 65] aged between 20-65 years, enrolled in this study after obtaining their informed consents at Eastern Specialist Clinic, Karachi

They were clinically assessed and diagnosed on the basis of their past history, clinical observation and temperamental assessment grouped into: chronic constipation, dyspepsia, knee joint pain/arthritis, migraine, shoulder pain/muscular spasm/cervical pain, sciatica, stress/anxiety/depression and varicose vein. The cupping therapy was applied on the back and front of the body over different points [5-6] for a period of 3-5 minutes comprising 3-10 sessions with an interval of 15 days. The wet cupping was effective in 72% of patients which showed improvement in their corresponding symptoms in order of chronic constipation > migraine > sciatica > shoulder/ cervical/muscular pain > varicose veins > dyspepsia > knee joints pain > tress/anxiety depression. The relief from symptoms depended on temperamental evaluation and its effectiveness appears to be: Sanguineous temperament harr [hot] and ratb [moist] > phlegmatic temperament band [cold] and ratb [moist] > bilious temperament harr [hot] and yabis [dry] > melancholic temperament, barid [cold] and yabis [dry]

It is concluded that wet cupping therapy is effective against diseases of various origins and its efficacy is dependent on temperament and severity of the disease

Scientific bases of Al-Hijamah or cupping therapy in Unani medicine with modern techniques for the treatment of diseases related to uric acid, creatininie, liver enzymes and lipid profile

The present study, describes the effect of cupping therapy on variations observed and assessed in the biochemical parameters such as total cholesterol, triglycerides [TG], low density lipoprotein [LDL], glutamate pyruvate transaminase [GPT], alkaline phosphatase [ALP], total bilirubin, direct bilirubin, urea, creatinine and uric acid before and after cupping therapy. Wet cupping therapy was undertaken in patients having 4 hrs fasting and after taking consent. The first session of wet cupping therapy was performed on both genders [n=69] aged between 20-65 years for 20-25 minutes on their first visit to the clinic followed by the second session after 1 week and all the biochemical parameters were recorded. Different symptoms were assessed considering biochemical parameters. Results of blood samples before and after 10 days of wet cupping treatment was statistically analyzed by applying paired t-test in this study. The values of serum total cholesterol and triglycerides were significantly lower except that of LDL. Thus, the results indicate that cupping therapy of 2 sessions is effective against high cholesterol and triglycerides levels but not for LDL indicating that probably more sessions are required. Regarding temperament the cupping therapy was most effective in patients having temperament sanguineous harr [hot] and ratb [moist] temperament and phlegmatic temperament i.e. barid [cold] and ratb [moist] whilst moderate improvement in bilious temperament harr [hot] and yabis [dry] and least in melancholic temperament that is barid [cold] and yabis [dry] was evident

Effect of different doses of Manuka honey in experimentally induced mouse typhoid

Typhoid fever is a major cause of morbidity and mortality in the developing world. Data from World Health Organization [WHO] shows that 21 million cases of typhoid occur globally every year and over 200, 000 die each year; most of them at a very young age. The situation in Pakistan is similar. Typhi and other typhoidal salmonellae have developed resistance to chloramphenicol and other first line anti-typhoid. There is a rapid increase in multi-drug resistance [MDR] throughout the world. There is an urgent need to find out alternative medicine to sort out this problem. This study was conducted to establish preventive as well as therapeutic potential of Manuka honey. A total of eighty pathogen free BALB/C mice between 8 weeks to 12 weeks of age, weighing 25-30 grams were taken and divided into 4 groups. Group A, B and C were infected through oral route with 108 colony forming unit [CFU] of Salmonella typhimurium ATCC 14028 to produce typhoid like disease in mice. Group A, which comprised of 20 mice was further divided in A1 and A2 given Manuka honey at a dose of 15ml/kg and 20 ml/kg respectively. Group B, which comprised of 20 mice was further divided in B1 and B2 was given Manuka honey at dose of 20ml/kg and 25ml/kg respectively. Clinical features of mouse typhoid, like body temperature, respiratory rate, number of stools and general behavior were recorded twice daily. Blood cultures of mice in different groups were taken at different days to evaluate the establishment of infection as well as to observe the therapeutic and preventive potential of Manuka honey in mouse typhoid. Fisher's Exact, Chi- Square and t-test were used to analyze the data. Significant association was observed in the ultimate fate of mice in Group A1 and Group A2 [P<0.001], showing that from a total of 20 mice in both groups, 10 mice fall in Group A1 of which 10 [100%] developed infection as it was not prevented by honey at a dose of 15ml/kg body weight [15.00+0.00] in Group A1 and ten mice fall in Group A2 of which 10[100%] did not developed an infection as it was prevented by honey at a dose of 20ml/kg body weight [20.00+0.00] in Group A2. Significant association was observed in the ultimate fate of mice in Group B1 and Group B2 [p<0.001] showing that from a total of 20 mice in both groups, 10 mice fall in Group B1 of which 10 [100%] had an infection, which was not treated by honey at a dose of 20 ml/kg body weight. Ten mice fall in Group B2 of which 10 [100%] had an infection, which was treated by honey at a dose of 25 ml/kg body weight [25.00+0.00]. Results of the present study suggest that Manuka honey [UMF25+] has a potent anti-typhoid activity in vivo as well. There is an intense need for a carefully designed clinical trial in which this therapeutic potential of Manuka honey should be further evaluated. There is also need for the search of local honeys comparable to Manuka honey as a therapeutic option for typhoid fever.

Clinical evaluation of unani ear drops herbotic for earache

An ear infection [acute otitis media] is most often a bacterial or viral infection that affects the middle ear. Children as compared to adults are more are prone to infections. A study has been conducted on 200 patients with herbal medicine Herbotic and allopathic drug Ofloxacin for the treatment of otitis media. The efficacy of test and control drug was monitored before and after treatment and diagnosed on clinical history, clinical presentation and pathological investigation. This study was a case control, multicenter, prospective randomized authentic allopathic controlled, two arm parallel group clinical trial The data on clinical proforma was gathered between April 2014-March 2015 and subjected to statistical analysis. From the statistical results it was concluded that Herbotic and Ofloxacin are equally effective for the treatment of earache, effect being confirmed by physicians and patients alike

Secondary malignant melanoma in primary mediastinal germ cell tumour

Secondary transformation in Germ Cell Tumours [GCT] is an extremely rare event. We report here a case of malignant melanoma arising in primary mediastinal GCT. A young male presented with new onset dyspnoea and a mediastinal mass. As serum alpha fetoprotein was raised, a diagnosis of primary mediastinal GCT was made. He achieved remission with standard chemotherapy and resection of the mass. After a year, he relapsed with widespread disease which on work-up revealed malignant melanoma. As examination for cutaneous melanoma was unremarkable, a diagnosis of mediastinal GCT with secondary transformation to melanoma was made. Exact origin of melanoma in GCTs is unknown, but these may occur from transformation of dermal elements or de-differentiation of germ cells to melanomas. Before making such a diagnosis, search for primary cutaneous melanoma is mandatory. No clear guidelines exist in literature for the treatment of secondary melanomas, so current management guidelines for cutaneous melanoma may be followed

Microbial spoilage, instability risk of antacid suspension in the presence of commonly used preservative system

Manifestation of microbial spoilage of any product by bacteria and to assess the effectiveness of the antimicrobial preservatives [parabens] used for the prevention and stability purpose. The aim of the present work is to study the effectiveness of preservatives used in the antacid suspensions and to analyze the effect of microbial growth on the quality of respective antacid suspensions. Samples of various antacid suspensions were randomly collected from local market and Government hospital pharmacies. Three different antacid formulations were prepared in the laboratory. All the formulations were preliminarily evaluated on the basis of organoleptic characteristics, pH, viscosity and assay. Efficacy of the preservative system in suspension formulation was determined by inoculating the samples in its final container, with specific strains of bacteria i.e. Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027 and Staphylococcus aureus ATCC 6538, taking samples from the inoculated preparation at specified intervals of time i.e. 0 time, 07 days, 14 days and 28 days, growing it on nutrient agar medium and colony forming units [CPUs] were scored by plate count. At the same time the samples were also subjected to qualitative and quantitative testing. The decrease in CPU and alteration in assay, pH and viscosity was observed in all the formulations except formulation M2 and F3 that showed stability throughout the study period

Comparison of biometry formulas and their relationship with axial lengths

The purpose of cataract surgery is mostly to render patient emmetropic. There are many variables involved while achieving this, one of which is correct biometry. Regardless of the procedure involved in biometry, the formulas used also effect the spherical power of the eye post-operatively. Four major biometry formulas [SRK/T, SRK-2, Holladay, and Hoffer-Q] were chosen and were subjected to comparison with each other and their correlation to axial length of the patient's eye noted. Total of 34 patients were chosen, who met the inclusion criteria, and their biometry was done using the respective formula. These patients were followed up for three post-op visits for over a period of 1-1.5 month postoperatively and their spherical errors noted by auto refractometry. This error was later confirmed by subjective refraction. All these patients were operated by a single surgeon with same technique of surgery in all of them i.e. phaco-emulsification. Results showed a statistically significant importance of choice of different formulas [p-value 0.028] while no significant difference in performance of these formulas over same group of axial lengths. Newer generation formulas [Hoffer-Q, SRK/T and Holladay-1] all proved to be equally effective in predicting IOL power in all ranges of axial lengths with no significant difference in their performance

Concept of pott's disease in Unani medicine

Pott's disease is considered to be recognized by Percivall Pott who presented a complete picture of the disease in a monograph published during 1779. However, there are references in the classical books of Unani System of Medicine, which indicate that this disease was already known to the ancient physicians. They had a clear idea about the relationship of respiratory diseases with this deformity and were also convinced that adaba [kyphosis] or destruction of spine may result from the accumulation of viscous humour in that area causing disease. They were also familiar with the connection of the cold abscess with adaba [kyphosis]. Later with the advancement of researches it was found that these cold abscesses are produced due to tuberculous lesion. We have tried to collect all the related information available in Unani medical literature in their original form to prove that Unani physicians were well aware of the pathology of this condition

Role of transvaginal ultrasound in identifying endometrial hyperplasia

Transvaginal sonography [TVS] is one of the diagnostic modalities used to evaluate endometrial pathologies in women with abnormal uterine bleeding. It permits use of high frequency ultrasound waves at greater proximity to the uterus. This study aimed at determining the diagnostic accuracy of TVS in identifying endometrial hyperplasia by comparing with histologic findings in perimenopausal women with abnormal uterine bleeding. This cross-sectional study was conducted in Department of Obstetrics and Gynaecology, Unit II, Fauji Foundation Hospital, from Sep 2011 to Mar 2012. A total of 263 perimenopausal women aged 40-50 years with abnormal uterine bleeding in the form of menorrhagia, metrorrhagia and polymenorrhagia were enrolled. Thickness of the endometrium was first measured by ultrasound and then was later confirmed by sampling of endometrium. The outcome was measured in terms of accurately diagnosing endometrial hyperplasia by TVS and then using histologic findings as gold standard to confirm. The mean age of selected patients was 45.3 +/- 3.2 years. Out of total 263 cases, 129 [49.0%] presented with menorrhagia, 120 [45.6%] presented as metrorrhagia while 14 [5.3%] had polymenorrhagia. The sensitivity and specificity of TVS was 100.0% and 63.7% respectively. Similarly positive predictive value [PPV] and negative predictive value [NPV] were 56.3% and 100.0% respectively. Diagnostic accuracy of TVS in identifying endometrial hyperplasia using histopathology as gold standard was found to be 75.6%. TVS has a moderate diagnostic accuracy in detecting endometrial hyperplasia. Due to the fact that transvaginal ultrasound is safe, acceptable and easily available in most secondary and tertiary care settings and is non-invasive in nature, in our opinion TVS is to be used as a 1st line diagnostic tool in patients who present with abnormal uterine bleeding

Teenage jejunoileal diverticulosis

Presentation of jeujunoileal diverticulosis in young age is virtually unknown. It is associated with middle or old age. It is usually asymptomatic but may present with vague abdominal pain and episodic nausea, vomiting or diarrhoea. It can lead to complications like bleeding, perforation and obstruction. We had 3 cases of jejuno-ileal diverticulosis presenting in their teens. They had resection and anastomosis resulting in improved health