Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder characterized by persistent hyperactivity, impulsivity, and inattention that impairs educational achievement and/or social functioning. Its diagnosis is made by ascertaining whether the child's specific behaviors meet the diagnostic and statistical manual of mental disorders-IV-revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Comorbidity with psychiatric disorders such as anxiety disorder, depression, oppositional defiant disorder and conduct disorder; and with specific learning disability is not uncommon. Although medication works well in most cases of ADHD, optimal treatment requires integrated medical and behavioral treatment. Methylphenidate (MPH) and atomoxetine are the two drugs being currently prescribed and their efficacy in decreasing the symptoms of ADHD is well documented. Pyschoeducational interventions in school can help increase the successful functioning of affected children and improve their academic performance. Almost half of affected children continue to show significant symptoms of the disorder into adolescence and young adulthood. The family physician can play an important role in detecting this condition early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's academic and psychosocial progress on a long-term basis.

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Backgrounds: Dengue viral infection is one of the most important public health problem in tropical countries. Aim: An outbreak of dengue fever was investigated in a periurban slum area of Chandigarh, India, during September to December, 2002. Materials and methods: Blood samples from 218 patients and 30 apparently healthy contacts were tested for dengue-specific immunoglobulin M (IgM) and IgG antibodies including 80 acute samples collected within 5 days of illness were subjected for virus isolation in newborn mice. The average temperature, rainfall, and humidity of the epidemic year were compared with the number of dengue cases. Statistical analysis: statistical significance was found out using c2-test. Results: A total of 76 cases were positive by either dengue IgM capture assay (n=57) or virus isolation (n=17) or both (n=2). fifteen of nineteen viral isolates subjected for typing by type-specific multiplex reverse transcription-polymerase chain reaction were found to be of dengue virus. High rainfall and humidity with the temperature range from 21oc to 33oc during the months of August and September might have favored the breeding of mosquitoes, thus leading to an increase in the number of dengue cases in October and November, 2002. Conclusion: The present outbreak thus emphasizes the need for continuous sero epidemiological and entomological surveillance for the timely implementation of effective dengue control programme.

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This was a rare case where a patient presented clinically as a case of post abortal sepsis and ultrasound showing the picture of an intramural degenerating fibroid. Her serum and urine both were negative for b human chorionic gonadotropin (bHCG). Patient succumbed to choriocarcinoma 1 month later. Failure to detect urinary and serum bHCG lead to maternal mortality due to the choriocarcinoma. The failure to detect, certain degradation products of HCG which may predominate in gestational trophoblastic neoplasia, by many common HCG testing kits lead to the error of diagnosis. Only 3 of the 7 common commercial serum HCG tests appropriately detects nicked HCG and its free bHCG, DPC immulite assay, being the most sensitive method. Though of rare occurrence, this awareness is important for diagnosis and follow-up of gestational trophoblastic neoplasia and could have been life saving in our case.

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BACKGROUND: Abdominal embolization procedures performed using digital subtraction angiography (DSA) is on the increase in the present-day scenario owing to their diagnostic and therapeutic values. These procedures involve prolonged fluoroscopy times and may tend to impart high radiation dose to patients if adequate radiation safety measures are not taken. AIM: To evaluate radiation dose imparted to patients and the work practices involved therein during abdominal embolization procedures. MATERIALS AND METHODS: Forty-two patients who underwent abdominal embolizations performed using DSA equipment were included in the study. Dose area product (DAP) was measured using DAP meter and values obtained were used for calculating entrance surface dose (ESD). Work practices of personnel involved in conducting the procedure were evaluated based on the choice of field sizes, selection of appropriate fluoro-modes, and optimization techniques. RESULTS AND CONCLUSIONS: The mean ESD values during hepatic embolization, renal embolization, splenic artery embolization and transarterial chemoembolization (TACE) were 1.2, 1.01, 1.19, and 1.03, respectively. No deterministic effects of radiation, such as transient or main erythema, were noticed for a few patients whose doses exceeded the threshold doses.

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Partial patellectomy is advised in treating comminuted fractures of patella when accurate reduction and stable fixation cannot be achieved. Usually, after partial patellectomy, the tendon-to-bone junction requires prolonged protection. One of the effects of the prolonged immobilization is lack of knee flexion. Stiffness of the knee was treated with manipulation under anaesthesia. In order to protect patellar ligament insertion to the patella remnant, a Steinmann pin was put through tibial tuberosity, a metal wire was pulled through the patella remnant and tied firmly to the pin. Gentle manipulation was performed and full flexion of the knee was achieved without damaging bone ligament complex.

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