Background : In Morocco, acute aluminum phosphide poisoning (AAlPP) is a serious health care problem. It results in high mortality rate despite the progress of critical care. Aims : The present paper aims at determining the characteristics of AAlPP and evaluating its severity factors. Setting and design: We studied consecutive patients of AAlPP admitted to the medical intensive care unit (ICU) (Ibn Sina Hospital, Rabat, Morocco) between January 1992 and December 2007. Materials and Methods : Around 50 parameters were collected, and a comparison was made between survivor and nonsurvivor groups. Statistical Analysis : Data were analyzed using Fisher exact test, Mann-Whitney U test and Cox regression model. Results : Forty-nine patients were enrolled: 31 females and 18 males; their average age was 26± 11 years. The ingested dose of aluminum phosphide was 1.2± 0.7 g. Self-poisoning was observed in 47 cases, and the median of delay before admission to the hospital was 5.3 hours (range, 2.9-10 hours). Glasgow coma scale was 14± 2. Shock was reported in 42.6% of the patients. pH was 7.1± 0.4, and bicarbonate concentration was 16.3± 8.8 mmol/L. Electrocardiogram abnormalities were noted in 28 (57%) cases. The mortality rate was 49% (24 cases). The prognostic factors were APACHE II (P= 0.01), low Glasgow coma scale (P= 0.022), shock (P= 0.0003), electrocardiogram abnormalities (P= 0.015), acute renal failure (P= 0.026), low prothrombin rate (P= 0.020), hyperleukocytosis (P= 0.004), use of vasoactive drugs (P< 0.001), use of mechanical ventilation (P= 0.003). Multivariate analysis by logistic regression revealed that mortality in AAlPP correlated with shock (RR = 3.82; 95% CI= 1.12-13.38; P= 0.036) and altered consciousness (RR= 3.26; 95% CI= 1.18-8.99; P= 0.022). Conclusion : AAlPP is responsible for a high mortality, which is primarily due to hemodynamic failure.

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Background : Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases. Aims: To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine. Settings and Design : Outpatient gynecological department and open randomized trial. Materials and Methods : One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Statistical Analysis : Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the χ² test. Results: Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13± 1.28; group II, 5.93± 1.26; group III, 5.58± 1.51), (P< 0.001); as well as 30 minutes later (group I, 1.78± 0.89; group II, 2.53± 0.81; group III, 2.23± 0.94), (P< 0.001) and 60 minutes later (group I, 1.2± 0.46; group II, 1.98± 0.83; group III, 1.68± 0.75), (P< 0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed. Conclusions : Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.

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Ragging is any disorderly conduct that has the effect of teasing or handling with rudeness any student, which causes or is likely to cause annoyance, harm or to raise fear in a junior so as to adversely affect the psyche of the junior. Ragging is practiced all over the world, with different nomenclature like hazing, fagging; bapteme in French; doop in Dutch; and Mopokaste in Finnish. The first recorded cases of ragging were in the 8 ^th century BC during the Olympics in Greece. Ragging has been frequently associated with a broad spectrum of physical, behavioral, emotional and social problems among the victims. It independently increases suicide risks. Some of the reasons given by students for ragging are they were also ragged by their seniors; sense of superiority; and introduction. Other factors perpetuating ragging are use of alcohol in hostels and lack of implementation of serious anti-ragging measures by college authorities. Various practical steps to control ragging must include strict role of authorities, ban on alcohol within college and hostels, surprise raids in hostels at night, postings (with accommodation) of wardens in hostels, separate hostels for juniors, presence of college "disciplinary committee" and "cultural committee," strict punishments for those involved in ragging, actions by Medical Council of India (MCI) and University Grants Commission (UGC) against the erring colleges and universities and formulation of anti-ragging laws. Ragging should be declared a public health problem because it involves the physical, mental and social exploitation of not only an individual but also of his/her family and the society as a whole.

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In this report, we describe a patient with drug-induced liver failure who developed endogenous endophthalmitis after liver transplantation. Our patient's clinical course was so fulminant that the eye was lost in less than 1 month, without any response to therapy. Recognition of this infection is important because many patients die of disseminated Aspergillus infection, which may be detected early with bedside funduscopic examination by an ophthalmologist. Probably if the patient had referred to us earlier, it may have been possible to save the eye.

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Background: The objective structured clinical examination (OSCE) is used commonly for assessment of psychiatry trainees but has been used less for teaching. Aim and Setting: This study describes the adaptation of the OSCE method for training purposes in a postgraduate psychiatry training center in India and the initial findings with regard to trainee performance. Materials and Methods : The adapted method was called the objective structured clinical assessment with feedback (OSCAF). The adaptation included several steps - modifying existing OSCE patterns for language and cultural appropriateness, using supervised roleplaying instead of standardized or simulated patients and evolving an assessment method (14-item checklist) that would generate feedback. This exercise was conducted in front of a group of multidisciplinary peers and supervisors. Statistical Analysis: Descriptive statistics and ANOVA were used. Results: Analysis of the performance based on the 14-item checklist assessing common elements of any patient-related interaction in 34 different OSCAF tasks indicated the following: less-than-satisfactory (<75%) performances in the following areas - assuring confidentiality (73.5%), assessing comfort (62%), summarizing (60%), closure (62%) and checking whether the 'patient' had understood what was being communicated (42%). Based on the nature of clinical situations, performances on some specific and difficult OSCAF situations were found to be inadequate and indicated need for further training. Conclusions: We have been able to demonstrate OSCAF to be a convenient, cost-effective training method in psychiatry, with limited demands on resources; however, further refinements in ratings and feedback methods and studies on effectiveness may enhance its utility.

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