Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Antioxidant mediated defensive potency of Caesalpinia bonducella nut on Acetaminophen-inebriated spleen and cardiotoxicity: Implications on oxidative stress and tissue morphology in an In vivo model

Overdosing on medications can be unintentional or deliberate. Acetaminophen (APAP) is a widely used over-the-counter analgesic and antipyretic drug. APAP overdose can induce spleen and cardiotoxicity apart from hepatotoxicity. Bonduc nut is well-known for its medicinal and therapeutic properties. More scientific data is necessary to be therapeutically relevant. This study examined the effects of Bonduc nut extract (BNE) on APAP-induced spleen and cardiotoxicity in Wistar albino rats. The rats were divided into five groups of six rats each. In vitro assays were carried out to analyze antioxidant activity and free radical scavenging activity in aqueous, ethanol, and methanol solvents in Bonduc nut powder. Total phenolic content, DPPH, catalase, and peroxidase activity were used to test antioxidant activity. The rats were euthanized after the study period to examine antioxidant parameters such as superoxide dismutase, catalase, reduced glutathione, and glutathione peroxidase, as well as lipid peroxidation and histopathology of the spleen and heart tissues. Results suggest that compared to other solvents aqueous has better Invitro antioxidant ability and the same extract significantly increased the antioxidant and reduced lipid peroxidation followed by restoring the tissue morphology in APAP-induced spleen and cardiotoxicity. The outcome of the study revealed that aqueous BNE has a significant protective efficacy against APAP-induced spleen and cardiotoxicity in Wistar albino rats.

Supplementation of Madhuca longifolia Seed oil augments diclofenac-induced organ toxicities: A biochemical and histopathological approach-Supplemenntary data

Diclofenac medication has been extensively used for anti-inflammatory, anti-pyretic, and analgesic actions. Its abiding usage and overdose have induced toxicity and harmful effects on the liver, kidney, and gastrointestinal tract. The research aims to scrutinize the protective effect of Madhuca longifolia seed oil against diclofenac-induced toxicity in female Wistar albino rats. A period of 10 days of study was aimed at 7 groups; Group 1 was assigned as normal control. Group 2 has been administered diclofenac (50 mg/kg b.w. /day, i.p.) only on the last two days of each study period. Group 3 and Group 4 have been pre-treated with 1 mL, and 2 mL of Madhuca longifolia seed oil, respectively, and diclofenac was induced as per Group 2. Group 5 was treated with the standard drug silymarin and diclofenac. Group 6 and Group 7 were given 1 mL and 2 mL of Madhuca longifolia seed oil alone. After the study period, parameters like liver enzyme markers, renal enzyme markers, and antioxidants were measured, and tissue samples were analyzed for histopathological changes. The results proved that pre-treatment of 1 mL of Madhuca longifolia seed oil has efficacy against diclofenac-induced toxicity.

Supplementation of Madhuca longifolia Seed oil augments diclofenac-induced organ toxicities: A biochemical and histopathological approach

Diclofenac medication has been extensively used for anti-inflammatory, anti-pyretic, and analgesic actions. Its abiding usage and overdose have induced toxicity and harmful effects on the liver, kidney, and gastrointestinal tract. The research aims to scrutinize the protective effect of Madhuca longifolia seed oil against diclofenac-induced toxicity in female Wistar albino rats. A period of 10 days of study was aimed at 7 groups; Group 1 was assigned as normal control. Group 2 has been administered diclofenac (50 mg/kg b.w. /day, i.p.) only on the last two days of each study period. Group 3 and Group 4 have been pre-treated with 1 mL, and 2 mL of Madhuca longifolia seed oil, respectively, and diclofenac was induced as per Group 2. Group 5 was treated with the standard drug silymarin and diclofenac. Group 6 and Group 7 were given 1 mL and 2 mL of Madhuca longifolia seed oil alone. After the study period, parameters like liver enzyme markers, renal enzyme markers, and antioxidants were measured, and tissue samples were analyzed for histopathological changes. The results proved that pre-treatment of 1 mL of Madhuca longifolia seed oil has efficacy against diclofenac-induced toxicity.

Intra-arterial chemotherapy in refractory and advanced intraocular retinoblastoma

Purpose: To evaluate the efficacy of secondary and salvage intra?arterial chemotherapy (IAC) as a globe salvage treatment modality in advanced and refractory intraocular retinoblastoma. Methods: A retrospective chart review of advanced intraocular retinoblastoma (groups D and E International Classification of Retinoblastoma [ICRB] classification) patients refractory to intravenous chemotherapy (IVC) and undergoing IAC as the secondary and salvage treatment modality between December 2018 and June 2021 was carried out. All patients underwent the IAC procedure by super?selective ophthalmic artery catheterization and with triple?drug chemotherapeutic agents of melphalan, topotecan, and carboplatin. Data were collected about tumor regression, eye salvage, metastasis, and survival outcome at follow?up. Results: Out of 13 patients, 12 patients received secondary IAC after being primarily treated with IVC and focal therapies and one patient received rescue IAC after recurrence following primary IAC. Mean number of IAC cycles administered was 2. Overall, globe salvage rate was 53.84%, with a mean follow?up of 17.53 months (range 6–37 months), three patients had enucleation for residual tumor or tumor recurrence. One patient developed metastasis post enucleation and two patients who were lost to follow?up after enucleation advice for residual tumor developed orbital tumor extension and eventually died of metastasis. Conclusion: Secondary triple?drug IAC following failure of IVC, along with other adjunct treatment modalities might a be a cost?effective option for eye salvage in advanced intraocular retinoblastoma patients who refuse enucleation, with a globe salvage rate of 53.84%. It can also be an effective approach to improve treatment compliance and can help in addressing the barrier of treatment refusal when enucleation is advised.

Rehabilitation Professionals’ Perspectives on Psychosocial Needs of Family Caregivers of Persons with Spinal Cord Injury: A Qualitative Study from India / 가정의학회지

Background@#This study explored the psychosocial needs of family caregivers of persons with spinal cord injuries from the perspective of rehabilitation professionals. @*Methods@#An exploratory qualitative approach was used, and a total of 14 rehabilitation professionals from various backgrounds participated in face-to-face interviews. All interviews were audio recorded, and session notes were added to the existing data and later transcribed. Thematic analysis was used to identify key themes. @*Results@#Nine need themes emerged: informational, psychological, personal care, financial, social support, welfare, vocational, telemedicine, and referral. @*Conclusion@#The findings of this study will aid the design or development of need-based customized psychosocial interventions for family caregivers of persons with spinal cord injuries in India. Multiple stakeholders involved in spinal cord injury management should understand the importance of meeting the needs of family caregivers of persons with spinal cord injuries and the timely delivery of customized psychosocial interventions.

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review / Risco de acidente vascular cerebral perioperatório e monitoramento de autorregulação cerebral: uma revisão sistemática

Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98;p < 0.0001).

Resumo Antecedentes Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. Objetivo Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. Métodos Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. Resultados As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. Conclusão Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54-2,98;p < 0,0001).

Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology

Abstract Introduction: There is a modest relationship between speech perception skills and perceived hearing handicap in individuals with hearing loss. In this study, an attempt is made at linking psychoacoustic results and speech perception skills to understand the subjective handicap and quality of life. Objective: To investigate how speech perception in noise (signal to noise ratio-50), difference limen frequency, temporal modulation transfer function, hearing handicap inventory for adults, and quality of life in auditory neuropathy spectrum disorder differs from sensorineural hearing loss. Further we attempt to discern attributed factors of hearing handicap in auditory neuropathy spectrum disorder and sensorineural hearing loss. Methods: A cross-sectional study with comparative and correlational research designs were utilized. Eighty-four participants were grouped into sensorineural hearing loss (n = 49), and auditory neuropathy spectrum disorder (n = 35) was sub-grouped into mild, moderately severe, and severe. We evaluated signal to noise ratio-50, difference limen frequency, and temporal modulation transfer function. In addition, hearing handicap inventory for adults, and quality of life questionnaires were administered. Results: Mild auditory neuropathy spectrum disorder showed impairment in speech perception and discriminating frequency, which were similar to the severe sensory neural hearing loss. Temporal resolution impairment in auditory neuropathy spectrum disorder mild was significantly higher than in each sub-groups of sensorineural hearing loss. The severity of the hearing handicap in was similar to severe sensorineural hearing loss, quality of life was equally affected in sensorineural hearing loss and auditory neuropathy spectrum disorder. In sensorineural hearing loss, signal to noise ratio-50 was positively related, and quality of life was negatively related to hearing handicap. In auditory neuropathy spectrum disorder, no contributory factors were related to hearing handicap. Conclusion: Mild auditory neural pathology demonstrates impairment in speech recognition and psychoacoustic skills similar to severe cochlear pathology. In sensorineural hearing loss, hearing handicap is predicted from quality of life and speech perception, but none of the contributory factors predicted hearing handicap in auditory neuropathy spectrum disorder.

Carbohydrate profiling & glycaemic indices of selected traditional Indian foods

Background & objectives: Consumption of high glycaemic index (GI) food is associated with a high risk for diabetes. There is a felt need to understand the GI of common Indian traditional foods using standard GI protocols. The present study was aimed to analyse the carbohydrate profile of common traditional Indian food preparation and to determine their GI using standardized protocols. Methods: Twelve food preparations made of millets, wheat, maize and pulses were evaluated for nutrient composition including detailed carbohydrate profiling and tested for GI in healthy volunteers using standard methodology. Capillary blood glucose responses for the test foods containing 50 g available carbohydrates were recorded and compared to the reference food (50 g glucose). GI was calculated from the incremental area under the curve (IUAC) for the test and reference foods. Results: Available carbohydrate content of the food preparations ranged between 13.6 and 49.4 g per cent. Maize roti showed the highest total dietary fibre (7.5 g%). White chick pea ‘sundal’ showed highest resistant starch content (3.95 g%). Amongst the 12 test foods, five fell in the high GI category (finger millet balls, sorghum, pearl millet and maize roti), four in the medium GI category (sorghum idli, wheat dosa, methi roti and adai) and three in the low GI category (broken wheat upma, white peas sundal and white chick peas sundal). Interpretation & conclusions: Merely being a whole grain-based food does not qualify for a lower GI. The method of processing, food structural integrity and preparation could influence the GI. The type and quality of fibre are important than the quantity of fibre alone. Judicious planning of accompaniments using low GI legumes may favourably modify the glycaemic response to high GI foods in a meal.

Association of reproductive risk factors and comorbidities among molecular subtypes of Breast cancer in a Tertiary care Hospital

The reasons for the recently observed increase in the incidence of breast cancer in the Indian population are not clearly understood, but thought to be largely explained by westernization of lifestyles and changes in reproductive behavior, which characterize exposure to hormones. Our aim is to review the reproductive risk factors and comorbidities and evaluate the association between molecular subtypes of breast cancer. A hospital-based analytical case-control study was conducted among the breast cancer cases with controls in a multispecialty teaching hospital for a period of one year. Totally, 130 subjects were recruited and an interview was conducted using a structured questionnaire to obtain demographic and risk factor data, including tissue marker status (ER, PR and HER-2) obtained from case files. Data were analyzed with SPSS-20 version. Results: The highest age group reported in this study was 51- 60 years which has a 3.8 times increased risk compared to other age and the age group of 31- 40 have a decrease risk of 0.33. In this study, the percentage of post menopause (68%) and mothers not breastfeeding (10%) was higher in cases compared to controls and a noted increase in the risk of breast cancer with odds ratio (OR) of 2.745 (p= <0.0001) and 9.08 (p=0.01) respectively. Duration of breastfeeding showed significantly (p=<0.0001)) moderate positive correlation (r=0.549, 0.457, 0.418 and 0.636) for luminal A, luminal B, HER+, and triple negative respectively. This study found that all the reproductive risk factors do not have correlation with a molecular subtype of breast cancer except breastfeeding. Post menopause and breastfeeding were common factors associated with all people and could be modifiable to prevent the occurrence of breast cancer through lifestyle change

Purification and characterization of extracellular alkaline protease from Streptomyces sp. LCJ12A isolated from Pichavaram mangroves

Extracellular protease from culture supernatants of Streptomyces sp. LCJ12A was purified and characterized in thisstudy. The collected supernatant of Streptomyces sp. LCJ12A was purified by ammonium sulfate precipitation anddiethylaminoethyl cellulose chromatography. The molecular weight of the enzyme was 20.1 kDa. Sodium dodecylsulfate-polyacrylamide gel electrophoresis was used to determine the molecular weight of the enzyme. The culture filtrate,partially purified enzyme, and ammonium sulfate precipitate displayed catalysis and stability over pH 3–11.5 and showedoptimal activity at pH 10. The culture filtrate, ammonium sulfate precipitate, and partially purified enzyme were goodbetween 30 and 40°C and the optimum temperature was 35°C. The purified protease exhibited high catalytic activityand stability under different pH and temperature. The partially purified protease from Streptomyces sp. LCJ12A showeda substantial relative activity of 78% with bovine serum albumin (BSA), 43% with gelatin, and 96% relative activitywith casein. Lineweaver–Burk plot was used to calculate the Km and Vmax values for the partially purified protease.The Km values of Streptomyces sp. LCJ12A were 73.5 mM for casein, 44.54 mM for BSA, and 43.45 mM for gelatin.The Vmax values were 500 mM min−1 for casein, 303.03 mM min−1 for BSA, and 270.27 mM min−1 for gelatin fromStreptomyces sp. LCJ12A. The statistical analysis confirmed that compared to the other substrates, casein was significant.

The Study Of Coracoacromial Ligament Morphology And Its Clinical Aspects

Background: The coracoacromial ligament (CAL) as an integral component of the coracoacromial arch, plays animportant role in shoulder biomechanics, joint stability, and proprioception thus maintains static restraint dueto its dynamic interactions with ligaments, muscles and bony elements around the shoulder joint. Age-dependentchanges due to chronic stress and cellular degradation cause thickening and stiffening of the CAL that maycontribute to a spectrum of shoulder pathology from capsular tightness to rotator cuff tear arthropathy andimpingement syndrome.Objectives: This study conducted to observe the different types of CAL and its relationship with coracoacromialveil.Materials and Methods: The study conducted on 50 upper limbs at Bowring & Lady Curzon medical college &research institute and Bangalore medical college & research institute. The upper limbs were dissected at theshoulder joint complex and acromion process and coracoid process were appreciated and coracoacromialligaments were appreciated for their types and morphometry.Results and Conclusion: Four types of CAL were observed in this study. These are Y shaped CAL in 12 (24%) upperlimbs, broad banded in 8 (16%), quadrangular band shaped in 25 (50%) and multiple banded in 5(10

Ultrasound Guided Intra-articular Steroid Injection for Temporo Mandibular Joint Arthritis – A Case Report.

Introduction: Temporo-mandibular joint (TMJ) arthritis isone of the distressing features of many polyarthritic disordersbecause of interference with mastication. Usually bilateraljoint affection may be a part a larger profile of multiplejoint involvements. Yet, it can present as an isolated entity.Establishing analgesia and improving mouth opening are thekey features in the management of the case.Case report: A 23 year old male with no co-morbiditiespresented with restricted and painful mouth opening anddifficulty in mastication for the past two months. He wasdiagnosed as bilateral temporo-mandibular joint arthritis andreferred to us for pain control. Routine investigations werenormal. Ultrasound guided intra-articular temporo-mandibularjoint injection was administered with a combination ofbupivacaine and methylprednisolone bilaterally. There wasa significant improvement in mouth opening and pain scoreVAS < 3 and on a three month follow up, there was no sideeffects and no requirement for further analgesics.Conclusion: We present such a unique case since there is verylittle literature on effectiveness of ultrasound guided intraarticular steroid injection on a case of isolated TMJ arthritisin Indian population.

Two cases of Salmonella breast abscess in pregnancy: a diagnostic challenge

Breast abscess in pregnancy due to Salmonella has been very rarely reported in the literature and most of the cases till now are due to unknown risk factors or in otherwise immunocompromised adults. Localized disease can occur due to bacteremia followed by seeding of bacteria at distant sites. We report two cases of breast abscess in pregnancy cause by Salmonella typhi where drainage of abscess and appropriate antibiotics helped in complete resolution.

Acute kidney injury in a critically ill influenza: a H1N1 infected child

Influenza H1N1 infection is a globally recognized epidemic and is known for several extra-pulmonary complications. Here, for the first time we report a case of a six-year old male child with severe H1N1 infection with acute kidney injury. The child was referred to our center with fever, chills, cough and cold for 2 days. Investigations revealed H1N1 infection with deranged LFT and RFT with anuria. Child was subjected to mechanical ventilation and received higher antibiotics in addition to oseltamivir. The child underwent 13 cycles of hemodialysis and renal profile normalized after a period of 35 days. Our case highlights the importance of recognizing extra-pulmonary complications of H1N1 infection in the pediatric population and the preparation required by healthcare practitioners to reduce the associated mortality.

Efficacy of Electro Acupuncture in Bell’s Palsy – A Clinical Interventional Pilot Trial in Indian Patients

Introduction: Bell’s palsy is an acute peripheral facial neuropathy and is the most common cause of lower motor neuron facial palsy. Various treatment modalities including steroids, physiotherapy, antivirals have been described. We aimed to study the efficacy of electroacupuncture to modify and improve the muscle paralyses. Material and methods: The first twenty patients who were willing for the study were selected. Fourteen sittings of thirty minutes each were done with one chun silver needles and stimulation was electrical and the intensity was adjusted for de qi feeling for the patients. House-Brackmann Classification of Facial Function was used to categorize the patients before and after treatment. Improvement in the score of more than 1 was termed significant relief. Results: Out of the twenty patients 17 had significant improvement of power and three had mild improvement. Three patients had minimal bleeding in a few points which stopped with simple pressure. Watering of the eye stopped in all the cases. The majority of patients were satisfied according to partha patient satisfaction score. Conclusion: To conclude, electroacupuncture has a significant role in early paralytic phase of Bells palsy without many side effects.

Canna indica-chitin-alginate composite beads for the treatment of textile dye effluent containing Rose Bengal dye

Aim: To study the adsorption of Rose Bengal dye used in textile industries by Canna indica-chitin-alginate beads. Methodology: C. indica-chitin-alginate composite beads were prepared using root tubers of Canna indica, chitin from shrimp shells and sodium alginate. Batch adsorption of Rose Bengal dye was carried out with optimized parameters like pH, contact time, adsorbent dosage and dye concentrations. Characterization studies like SEM, FTIR and TGA and reusability of composite beads were also studied. Results: The maximum adsorption of 97.9% was obtained at pH 6, 80 min contact time with the optimized ratio of 1:1:0.05 C. indica-chitin-alginate towards 100 mg l-1 dye concentration. The SEM analysis showed a porous surface morphology whereas FTIR results exhibited the functional groups of Rose Bengal dye and composite beads, proving successful adsorption. Thermogravimetric analysis revealed that the composite beads could withstand a maximum temperature of 300oC. Interpretation: It is inferred from the study that a biosorbent prepared from a commonly available plant and shells of shrimp, which is considered as a waste, can be effectively used in the adsorption of harmful textile dyes from the effluent in an eco-friendly and cost-effective way.

Correlation Of Indirect Immnofluorescence Patterns On Hep2000 With Anti Ds Dna Levels In Patients With Sle

Background: Antinuclear antibody (ANA) detection is very useful in the diagnosis of systemic lupus erythematosus (SLE). Association of specific autoantibodies with the immunofluorescence pattern of ANA in SLE as noted in Western medical literature has been taken as reference all over the world. However, in developing countries like India such research or data correlating the autoantibodies and their ANA Indirect Immunofluorescence patterns is inadequate. Objective: To identify the correlation between Indirect immunofluorescence patterns of antinuclear antibody on HEp–2 cell and serum levels of anti– double stranded DNA (anti–dsDNA) in SLE patients. Material and Methods: Serum samples of 108 SLE patients who were diagnosed by ACR (American College of Rheumatology) classification criteria, attending Rheumatology OPD of a tertiary care hospital during the study period of six months were subjected for ANA testing by Indirect Immunofluorescence (IIF) on HEp–2 cell and anti–dsDNA levels by ELISA. Results: Out of 108 SLE patients who were all positive by ANA in IIF on HEp–2 cell – exhibited predominantly two fluorescent patterns such as homogeneous in 80 (74%) and speckled 28 (26%) and in those with suspected flare–up homogeneous pattern was strongly associated with anti–dsDNA (p<0.05) and speckled pattern was also predominantly associated with anti–dsDNA (p<0.05). Conclusion: In SLE patients showing either homogeneous or speckled pattern in ANA IIF with suspected flare–up had elevated anti–dsDNA levels

ABO incompatibility: its impact on pregnancy and neonate

ABO incompatibility is one of the most common cause of haemolytic disease of fetus and new-born (HDFN). The expression of ABO incompatibility in most of the cases is mild due to the lower expression of A and B Antigens on fetal red cells. ABO incompatibility has affected the first pregnancy and is milder in the subsequent pregnancies.  However, we describe this case with unusually severe form of ABO incompatibility which had an effect not only in her first pregnancy but also in all her subsequent pregnancies, evident as recurrent abortions and both her neonates developed pathological jaundice requiring exchange transfusion. It also emphasizes the fact that ABO incompatibility is not always a benign condition and should be considered in all babies whose mothers have O blood group, even in the presence of a negative DAT. Anticipation of ABO incompatibility not only in the first pregnancy but also in the subsequent pregnancies is necessary. Early diagnosis with cord blood bilirubin can prevent neonatal morbidity.