Cholangiocarcinoma

In your experience, what is the biggest barrier to effective diabetes management in India?

A 61-year-old female have recurrent episodes of severe UTI every 6 months for the past 7-8 years. She is on continuous medication for 5 years. Now her urologist has diagnosed the cause as narrowing of urethral stricture and has suggested for surgical measures - OIU procedure. What is your opinion on this? Should she go for surgery or wait for some time after discontinuing the medicine to check if the episode occurs again.

Osteoarthritis (OA) is one of the most common forms of arthritis and is a leading cause of disability, especially among older adults. 10-15% of people over 60 years old are affected by OA & it represents a significant public health concern due to the large aging population and increasing prevalence of risk factors like obesity, physical inactivity, and urbanization. Check few facts about OA and share your opinion.

Fibroid uterus *Chief Complaints* Noticing mass per abdomen. Heavy menstrual bleeding *History* 45 year old para 2 previous 2 normal vaginal deliveries presented with history of heavy menstrual bleeding for 6 months with usage of 7-8 pads/ day and passage of clots . Also she had complaints of noticing mass in lower abdomen. Patient complaint of generalised weakness, lassitude, fatiguebility. *Vitals* Pulse 106/ min. BP 124/90 mmHg *Physical Examination* Per abdomen examination revealed uterus irregularly enlarged to 20 weeks size of Gravid uterus with multiple fibroids. Mobile from side to side. No tenderness Per vaginal examination cervix long os parous and uterus enlarged with multiple fibroids palpable *Investigations* Patient had severe anemia HB of 6 gm % she had received blood so now hb was 10 gm% Ultrasound revealed multiple fibroids indenting the endometrium *Diagnosis* Multiple fibroids in uterus *Management* Patient underwent hysterectomy. OT findings were uterus irregularly enlarged to 20 weeks size with fibroids. Bilateral fallopian tubes and ovaries normal Patient is fine post op

Baby is having these lesions all over the body for 10 days Itching & high grade fever from last 3 days These lesions appeared Suddenly over the night in morning, mother is saying / suspecting Mosquito bite