A comparative histological analysis of early and late graft dysfunction in different time zones following living donor liver transplantation

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3–6), 3 and 4-late (6–12 and > 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.

DELAYED PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN POSTPARTUM PERIOD

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological entity which presents with diverse neurological symptoms ranging from headache, seizure, visual symptoms with altered consciousness and focal signs. The hallmark of this condition is its reversibility. The etio- pathogenesis is attributed to vasogenic cerebral oedema seen in occipital and parietal lobes of brain. We hereby present this case of a multiparous lady presenting with altered sensorium postpartum. Characteristic findings on imaging helped us to form the diagnosis of PRES in this patient

Effect of isotonic exercise on cardiovascular parameters in medical students with parental history of hypertension – An institutional study

Background: Hypertension (HTN) is one of the most common and a high-risk factor for cardiovascular disease. Aims and Objectives: This study aims to identify students who are at risk of developing HTN with positive parental history of HTN and to compare the effects of isotonic exercise on cardiovascular parameters among the students with and without positive history of parental HTN. Materials and Methods: A total of 50 students participated in the study out of which 21 students had positive history of parental HTN with at least one parent having history of HTN and 29 students had negative history of parental HTN. Baseline pulse rate (PR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the participants were recorded. Then, all the participants performed Harvard step test for 3 min. The SBP, DBP, and PR were measured immediately after stopping the exercise and after 3 min and after 5 min of stopping the exercise. Data were statistically analyzed using unpaired t-test and ANOVA. P < 0.05 was considered statistically significant. Results: PR recorded after 3 min of stopping of exercise was significantly higher in the participants with positive parental history of HTN than the other group. SBP recorded immediately and after 3 min and after 5 min of stopping exercise was significantly higher in the participants with a positive history of parental HTN as compared to the other group. However, no statistically significant difference was observed in DBP between the two groups. Conclusion: Students with positive parental history may have relatively higher risk of developing HTN in future as an exaggerated blood pressure response to exercise was observed in them in this study.

An interprofessional interventional approach to improve the mental well-being of medical students for better academic performances

Background: Medical students are the future doctors who are the primary caregivers for the society. High level of stress can obstruct the learning of medical students by impairing their concentration, problem solving, and decision-making skills. Improving mental well-being of medical students will ensure community safety. The stakeholders need to realize positive role of mental well-being on academic performance of students. This will not only benefit the students as well as the society as a whole. Aim and Objective: The present study was innovatively planned to determine the impact of the motivational sessions on relieving perceived stress and anxiety of the students along-with impact of such sessions on motivation for learning. Materials and Methods: An interventional cross-sectional study was designed for 2nd year MBBS students. A module comprising of eight sessions for improving mental well-being of undergraduate students was designed by an interprofessional team comprising a medical teacher, clinical phycologist, psychiatrist, and medical students. The pre-validated scales used were Hamilton Anxiety Rating Scale (HAM-A) to assess anxiety level, Perceived Stress Scale to assess perceived stress, and Motivated Strategies for Learning Questionnaire to measure the types of learning strategies and academic motivation of college students. Results: About 64% (n = 46) of the participants were male and 36% (n = 26) were female students. The present study showed no significant association between the gender and stress. It was seen that number of students with high perceived stress before the session were reduced by as much as 72.41% and that of students with highest motivation for learning strategies doubled from 18 to 36 (100% improvement).The difference in means of HAM-A scores in post-test and pre-tests is highly significant (P = 0.01). The students were very much satisfied with the mode and content of the module. They expressed that these sessions made them feel thought of and cared for. Conclusion: It is strongly recommended to apply this interprofessional interventional approach to improve the mental well-being of medical students for better academic performances.

Perceptions of Undergraduate Medical Students towards Online Learning in a Medical College in the National Capital Region (NCR), India

Background: Since the COVID-19 pandemic hit the globe, it has not been possible to conduct traditional classroom teaching in view of the closure of schools and colleges in our country since March 2020. Hence, it is important to study the highlights, demerits, and bottlenecks in the implementation of online education from a student’s perspective. Methods: The present study was carried out to assess perceptions regarding virtual classroom among undergraduate students of a tertiary medical college in U.P. A pre-designed, semi-structured questionnaire was used. Study was conducted through an online survey. Data was analyzed with the help of SPSS version 21. Results: A total of 377 participants were included in the study. More than half of the participants (54.9%) preferred a mixed mode of learning which includes both online and offline learning. Lack of interaction with teachers (66.3%) and fellow students (57.6%) and lack of quiet space at home to listen to online classes (44%) were a few of the perceived demerits of online classes. Internet speed was found to be one of the most challenging issues faced in online learning (78.5%). Conclusion: Students’ perception of the blended learning mode was positive. They were, however, less enthusiastic about online learning than they were about conventional classroom learning.

ROLE OF REAL TIME PCR (RT-PCR) IN CLINICAL DIAGNOSIS FOR COVID-19 REVIEW

The pandemic of Coronavirus Disease 2019 (COVID19) has compelled scientists to create highly reliable diagnostic tools quickly in order to successfully and properly diagnose this pathology and thereby prevent infection transmission. Even though structural and molecular properties of the severe acute respiratory syndrome coronavirus 2 (SARSCoV2) were previously unknown, private research institutes and biomedical firms quickly developed numerous diagnostic procedures beneficial for making a correct detection of COVID19. Rapid antigen or antibody testing, immunoenzymatic serological tests, and RT-PCR based molecular assays are the most frequently used and validated procedures now available. The PCR has grown in popularity in molecular diagnostics to the point where it is still considered the gold standard for finding nucleotides from a variety of sources becoming an indispensable tool in the research lab. Because of its improved speed, sensitivity, reproducibility, and lower likelihood of carry-over contamination, real-time PCR has gained greater popularity. Currently, five different chemistries are employed to detect PCR product during real-time PCR. The self- fluorescing amplicons, DNA binding fluorophores, 5? endonuclease, neighbouring linear and hairpin oligoprobes, and self-fluorescing amplicons are all detailed in depth. We also go through the problems that have hampered the development of multiplex real-time PCR and the importance of real-time PCR in nucleic acid quantification.

ROLE OF DNA REPAIR IN AGING AND MALIGNANCY

DNA repair enzymes are proteins that detect and repair physical damage to DNA induced by radiation, ultraviolet light, or reactive oxygen species. The repair of DNA damage prevents the loss of genetic information, the creation of double-strand breaks, and the formation of DNA crosslinks. The time-dependent reduction of functional properties is known as aging. Mitochondrial malfunction and the buildup of genetic damage are two common factors of aging. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair machinery isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair enzymes isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. The large number of alterations per cell, which can reach 105, has been identified as a driving mechanism in oncogenesis. These findings show that abnormalities in the DNA repair pathway contribute to the senescence as well as cancer. Nucleotide excision repair (NER), base excision repair (BER), double-strand break repair, mismatch repair (MMR), are all major DNA repair processes in mammalian cells. BER excises mostly oxidative and alkylation DNA damage, NER removes bulky, helix-distorting lesions from DNA (e.g., ultraviolet (UV) photodimers), MMR corrects replication errors

REVIEW ON STRUCTURE, PATHOGENECITY, TRANSMISSIBILITY AND EPIDEMIOLOGY OF HUMAN PATHOGENIC CORONAVIRUSES

Coronaviruses cause animal and human respiratory and bowel infections. They have not been deemed highly pathogenic to humans until the outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003 in Guangdong province, China. Coronaviruses (CoVs) are large, enveloped, positive-sense, single-stranded RNA viruses that can infect both animals and humans. Coronaviruses didn't just appear recently. They are large family of viruses that have been around for a long time. Formerly, coronaviruses (CoVs) were seen as relatively harmless respiratory pathogens to humans. However, two outbreaks of severe respiratory tract infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) caused high pathogenicity and mortality rates among human populations as a result of zoonotic CoVs crossing the species barrier. Now the recent detection of the 2019 novel coronavirus (COVID-19), added a new member in corona virus family.The novel coronavirus (COVID 19) is one of the member of coronavirus family which infect human. Scientists have divided coronaviruses into four sub- groupings, called alpha, beta, gamma and delta. Seven of these viruses can infect people. The four common coronaviruses are-229E(alpha), NL63(alpha), OC43(beta), HKU1(beta). The three less-common coronaviruses are- MERS-CoV(beta), SARS-CoV(beta), SARS-CoV-2. Our main target is to describe the the structure, Pathogenecity, Transmissibility and Epidemiology of above mentioned subgroups of corona viruses in our review

A PATH TO EFFECTIVE E-LEARNING IN MEDICAL EDUCATION: BARRIERS AND THEIR SOLUTION

Online learning in medical education is a relatively new concept and one which is rapidly expanding. Recently, due to the global widespread of COVID-19 pandemic, e-learning became the mainstreaming mode of teaching all over the world. Thus, it is critical to assess and work upon the potential challenges, drawbacks and barriers of effective implementation of successful e-learning. The general barriers to e- learning are often encountered as institutional or teaching method norms and technological drawbacks and behavior change in both the learner and the instructor is essential for successful implementation of e- learning in medical education. Although online course delivery has probably eliminated certain barriers that exist in face-to-face classrooms, such as geographic location, transportation issues, architectural and physical impediments, and social contexts which lead to inaccessible learning environments. Thus, it is the responsibility of the medical educators and administrators to look into these challenges and incorporate the solutions which can make begin a new era of better teaching-learning mode of education in medical education in the future This review article analyzes the prominent barriers to e-learning and solutions amongst medical educators to the implementation of online learning in medical education.

Association of different patterns of expression of beta-catenin and cyclin D1 with pathogenesis of breast carcinoma

Background: Beta-catenin and cyclin D1 have attracted considerable attention in recent studies as potential proto-oncogenes in many human cancers especially colonic cancer. Beta-catenin plays multiple roles within the cell such as canonical Wnt signaling where cyclin D1 has been identified as one of its target genes. The role of beta-catenin and cyclin D1 in breast cancer has been evaluated in many studies but not established yet. Materials and Methods: The expression of beta-catenin and cyclin D1 was evaluated in 82 cases of breast carcinoma (BCa) and 32 cases of ductal carcinoma in situ(DCIS) by immunohistochemistry (IHC). Their relationship with clinicopathological features was also investigated. Statistical analysis was done to establish an association. Results: Abnormal expression of beta-catenin (ABE) was seen in 80.2% cases of invasive ductal carcinoma (IDC) and 47% cases of DCIS, while the cyclin D1 positive expression rate was 60.9% and 50%, respectively. In the cases showing ABE, cyclin D1 positivity was 88.1%. ABE showed significant association with high-grade BCa. The most common pattern of ABE was loss of membrane with nuclear positivity which is associated with worst prognosis. In addition, ABE in cases of BCa and DCIS showed concordant patterns. Conclusion: Therefore, an association exists between ABE and cyclin D1 in BCa and its precursor lesions implying that Wnt/beta-catenin oncogenic pathway may have a definite role in breast carcinogenesis and can be used for targeted therapy. Also, different patterns of beta-catenin expression may have prognostic and predictive value.

Megaloblastic anemia and non-vegetarian diet – Is there a changing trend?

Background: According to various studies, non-vegetarians are not at an inherent risk of developing megaloblastic anemia, a common deficiency of Vitamin B12. However, recent trends of the consumption of non-vegetarian food in the processed form as well as changes in cooking methods may gradually change the trend of the occurrence of megaloblastic anemia in nonvegetarians. Very few studies have been conducted on the same in a non-vegetarian population. Objectives: The objective of this study was to study the prevalence of megaloblastic anemia in a non-vegetarian population. Materials and Methods: The study was conducted on 100 non-vegetarian adults after due approval of the institutional ethics committee. The patients were evaluated on the basis of their hematological profile including peripheral smear examination and indices. Results: About 29% of total patients presented with features suggestive of megaloblastic anemia, of which 72% of patients agreed to predominantly be consuming non-vegetarian food from processed sources such as fast-food outlets at an average frequency of 3 weeks. Conclusion: There is a changing trend of megaloblastic anemia in the non-vegetarian population. Processing of food and change in conventional cooking practices along with the recent decline in home cooking of meat seem to be the major factors putting the non-vegetarians at a risk of developing megaloblastic anemia.

Seroepidemiology of transfusion-transmitted infections among blood donors at a tertiary care center in Navi Mumbai, Maharashtra

Background: Blood is precious as well as scarce lifesaving medication. Proper screening of transfusion-transmitted infections (TTIs) such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malarial parasite (MP) with appropriate methods is needed to ensure that the donated blood is made innocuous for transfusion. Objective: The aim of the study was to estimate the prevalence of TTI and their epidemiological aspects in blood donors in a hospital-based blood bank in Nerul, Navi Mumbai. Materials and Methods: A retrospective study of the total of 4708 donors was carried out from January 2015 to December 2018 year. Screening of HIV was done using the fourth-generation enzyme-linked immunosorbent assay (ELISA) and for hepatitis B surface antigen (HbsAg) and HCV by the third-generation ELISA kit. Testing for syphilis was done with rapid plasma reagin and MP was tested with rapid card test. Results: Voluntary donors were 4702 (99.9%) while replacement constituted for 6 (0.12%) number of cases. Among 4708 donors, 4079 (96%) were male and 629 (4%) were female. Among 66 (1.4%) transfusion transmitted diseases (TTD)-positive donors, the highest number of donors 28 (42%) belongs to 18–27 years of age group while the lowest 5 (2%) belonged to 48–57 years. Overall prevalence of HIV, HbsAg, HCV, syphilis, and MP was 0.08%, 1.1%, 0.2%, 0.04%, and 0.02%, respectively. Conclusion: The prevalence of TTD was more in males, in 18–27 age groups, and in voluntary donors. The most common TTI was HBV, followed by HCV, HIV, syphilis, and MP, respectively.

Nasal carriage of methicillin-resistant Staphylococcus aureus among health-care workers at a tertiary care hospital in Northern India

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to all beta-lactam antibiotics, including penicillins, cephalosporins, carbapenems, and betalactamase inhibitors. MRSA remains a public health problem globally. MRSA infection increases morbidity, risk of mortality, increased financial burden, and loss of productivity. A major source of MRSA in the hospital environment can be asymptomatically colonized health-care workers (HCWs). Objectives: The aim of the study is to screen nasal swabs collected from HCWs of our hospital for colonization with S. aureus and detect methicillin resistance among them. Materials and Methods: In this cross-sectional study, consenting HCWs were consecutively enrolled. Nasal swabs were collected aseptically from study participants and processed using standard microbiological protocols for the recovery of S. aureus and MRSA. Methicillin resistance was detected by cefoxitin disc diffusion method according to the CLSI guidelines. Results: Out of a total of 184 HCWs studied, the prevalence of S. aureus carriage in anterior nares was 14.6%. The overall MRSA prevalence was 3.8%. Highest carriage rates for MRSA were found in laboratory technicians (7.1%) followed by nursing staff (4.4%). The ophthalmology department had the highest MRSA carriage rate of 22%. Conclusions: Our findings demonstrate that nasal carriage of MRSA among HCWs is relatively low in this study compared to other Indian studies done in tertiary care centres. Further studies are needed to evaluate the incidence of infections due to MRSA in this population.

Impact of fluidic parameters during phacoemulsification on the anterior vitreous face behavior: Experimental study

Purpose: To evaluate the eff ect of different aspiration flow rates (AFR) and bottle heights (BH) on vitreous face (AVF) during phacoemulsifi cation. Methods: Experimental study in 20 porcine eyes. Transzonular viscodissection was performed between the posterior capsule(PC) and AVF to dissect out the Berger's space. Triamcinolone acetonide was injected into this space to aid visualization with ultrasound B-Scan(USG). Realtime USG was performed during phacoemulsifi cation. Eyes were divided randomly into–Group I: Low parameters(AFR = 20 cc/min, BH = 90 cm, vacuum = 400 mmHg),and Group II: High parameters (AFR = 40 cc/min, BH = 110 cm, vacuum=650 mm Hg). Results: 15 eyes were analysed (8 in Group I; 7 in Group II). In all eyes, forward and backward movement of the PC was seen when going from foot position 0 to 1, or on occlusion break. Amplitude of these movements was much greater in Group II compared to Group I. There was no PC rupture in either group. In 2 of the 7 eyes in Group II, USG showed a sudden, spontaneous dispersion appearance of sono-opaque echoes in the vitreous cavity alongwith disappearance of the well-defi ned, crescentic stained space despite an intact PC. This suggests rupture of the AVF, leading to dispersion of the triamcinolone into the entire vitreous cavity. No AVF rupture was seen in Group I. Conclusion: We report a rarely described entity of AVF rupture with intact PC. The use of high AFR and BH may have clinically invisible detrimental consequences to the anterior vitreous face.

Current role of optical coherence tomography angiography: Expert panel discussion

Optical coherence tomography (OCT) angiography is a promising technique that provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging and offers several advantages over conventional angiography to visualize the chorioretinal vasculature in a rapid and noninvasive manner. However, as with any evolving imaging technique, there are ongoing challenges in terms of need for new equipment, limitations of imaging capability and software processing techniques, as well as in understanding the implications of the imaging and its correlation with pathophysiology of the retina and choroid. This expert panel discussion is structured to provide an insight into the current state of OCT angiography.

Cervical cancer screening in rural India: Status & current concepts

Cervical carcinoma is one of the most common and dreaded diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of cervical cancer in the villages. Various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol's iodine, visual inspection with magnification devices-magnavisualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. In the present review, feasibility of different screening methods has been assessed to find out the most suitable mode applicable at the rural level. Single lifetime screening particularly of high-risk women along with analysis of cost-effective tumour markers such as Argyrophilic nucleolar organizer regions (AgNOR) counts to discriminate high-risk dysplasia cases appears to be an appropriate approach in fighting against cervical cancer.

Incidentally detected asymptomatic hepatitis C virus infection with significant fibrosis: Possible impacts on management

Background and Aims: Liver biopsy may be considered in patients with hepatitis C virus (HCV) infection to assess the severity of liver injury and stage of fibrosis, thereby guiding therapeutic decisions. In addition, advanced stage also necessitates surveillance for hepatocellular carcinoma. The aim of this study was to assess whether transaminase (alanine transaminase [ALT]) levels and RNA titers correlate with the histological activity index (HAI) and fibrosis (F) stage in asymptomatic patients with incidentally detected HCV (IDHCV). Patients and Methods: Retrospective evaluation of liver biopsies was done in 113 patients with IDHCV, diagnosed during routine screening. Decision of liver biopsy was made on the basis of age, genotype, acceptable clinical, hematological, and biochemical profiles, and willingness of the patients to undergo treatment. Serum ALT levels, HCV RNA titers, and genotypes were correlated with HAI and F stage. Results: Genotyping was done in 77 of the 113 patients, of which genotype 3 was seen in 43 and genotype 1 in 25 patients. A higher fibrosis stage (Ishak's >F2) was noted in 23.8% of the biopsies. Serum ALT showed a significant correlation with the HAI score on liver biopsy (P = 0.01) but not with the stage of fibrosis (P = 0.52). HCV RNA titers did not reveal any correlation with HAI score or fibrosis stage. Conclusion: Serum transaminases and HCV RNA titers are poor predictors of disease severity and fibrosis. Since HCV shows a slow disease progression, higher stage may predict a worse prognosis irrespective of the low viral RNA load. Liver biopsy may help guide therapeutic decisions in IDHCV infection.

Measurement of Cellulolytic Potential of Cellulase Producing Bacteria

The bioconversion of cellulose and hemicellulose to soluble sugars is important for global stabilization and for a sustainable human society. Here, hundreds of cellulolytic bacteria were found in soil, compost and animal waste slurry of our environment. Bacillus spp. are aerobic cellulolytic bacteria. Here, two Bacillus strains 2414, 2579 (T) and their mixed culture utilized for measuring the cellulolytic potential. The capability of cellulolytic potential was analyzed by enriching the basal salt media with Whatman no.1 filter paper as a substrate for cellulose degradation. Here, Cellulose-degrading potential of Bacillus strains was measured by measuring the diameter of a clear zone around the colony and its hydrolytic value on cellulose Congo-Red agar media. The extracellular cellulase activities ranged from 0.08233 to 0.44 IU/mL for FPase and 0.243 to 0.595 IU/mL for endoglucanase assay. The maximum activities range of β-glucosidase or cellobiase activity was 0.6 to1.5 1U/ml. The maximum xylanase activities value Bacillus cellulolysticus 2579 (T), Bacillus subtilis 2414 and their mixed culture were 12.0,11.5 and 12.5 unit/mL, respectively. All the enzymes were stable at an optimum pH range value of 3.0-7.0 and temperature range of 30˚C-50˚C. The maximum filter paper degradation percentage was estimated to be 71.76% by mixed culture after 48hrs of incubation period, it was observed that the maximum filter paper degradation was done by mixed culture than Bacillus strains. Biodiesel production was estimated by following the EN-14103 method and ester content was calculated on the basis of response factor with a minimum set value of ester content will be 96.5%.

Variations in Placental Attachment of Umbilical Cord.

Background: Our study aims to evaluate the variations in umbilical cord attachment to placenta by dissection method. Methods: Placentas for this study were obtained from the OBG Department and collected by the Department of Anatomy SRMS IMS. The placentas were washed, cleared, dissected and site of placental attachment to umbilical cord were observed. Variations in the type of insertion were noted. Result: Majority of the placentas showed central and eccentric attachments of the cord. Few abnormal placentas were observed with velamentous and marginal insertions of the umbilical cord. Conclusion: Abnormalities in the placental attachment of the umbilical cord can result in various complications of pregnancy and adversely affect the fetal outcome as well. Knowledge of the variations in attachment of the umbilical cord is very significant and of extensive use to obstetricians as well as anatomists. Frequently abnormal cord insertions may be associated with intrauterine growth retardation, preterm labour and congenital abnormalities.

Parenting in Children and Adolescents with Psychosis.

Need and Purpose of review: Psychotic symptoms appear in children and adolescents in the most crucial years, during the individual’s career development. The challenges faced by parents of psychotic children are in dealing with their disruptive behaviours, negative symptoms, cognitive deficits, delusions and hallucinations. This paper presents an overview of the childhood psychosis and how parenting can be done effectively for this population. Methods: Articles were retrieved from the Medline, Cochrane database, Google Scholar, Medscape; using the search terms ‘parenting and childhood psychosis’, and ‘childhood psychoses; and standard textbooks were consulted. Main conclusions: Educating parents how to recognize early symptoms, explaining treatment adherence, side effects of medications along with non-pharmacological measures like dealing with expressed emotions, lowering expectations, enhancing social supports, healthy lifestyle, and making patients independent. Awareness, early identification and effective parenting for psychosis may help bridge the wide gap between scarce skilled mental health professionals, inefficient resources and large paediatric population.