1. Entry by Droplet Infection2. Day 5 – Inflammation & Immune Response3. Alveoli fill with Fluid4. Oedema collapses Alveoli5. Day12 – Hypoxia & Resp

Failure

Dr Yung of HongKong University hasIsolated the corona virus from

CIVET CAT

Prof Vikramasinghe Director, Astrobiology,Cardiff University says

Virus came from OUTER SPACE

Lancet

Developing a Drug for SARS

Contributions from

The VIII World Congress

on

EndometriosisFebruary, 2002

AETIOPATHOLOGY

• Identification of Candidate Gene - Treolar• Endometriosis develops from reflux of specific

cell types, altered by peritoneal environment & not from eutopic endometrium

- Redwine &Taylor• Tumour Necrosis factor-a in peritoneal fluid - Lebovic• Decreased macrophage recruitment & Impaired

Phagocytosis - Kharfi et al

DIAGNOSIS

Search for a specific Diagnostic Marker

• Serum CA-19-9 and CA-125 may be useful

- Harada

• Endometrial Biopsy & Aromatase assay

- Deenadayalu

TREATMENT

• No benefit with Post op Interferon-a2b or GnRHa

- Randomized Trial by Acien

• Surgery during Luteal phase doubled the incidence of Recurrence compared to Proliferative phase

- Schweppe

ENDOMETRIOSIS & INFERTILITY

• Controlled Ovarian Stimulation & IUI and IVF result in acceptable Pregnancy rates

- Dmowski • IVF is the most effective Treatment

- Rickles• Laparoscopic excision of Endometrioma has no

effect on IVF results

- Marconi

GANGA & JAMUNABorn in May 2000 to aNepali Gurkha couple

CRANIOPAGUSIncidence: 1 in 2 millionSeparated successfully at

S’pore Gen Hospital

82 Hrs of Surgery + 17 Hrs To patch up Openings in Skull

usingSTEALTH computerised system to guide Vascular

Anastamosis

NeurosurgeonsKieth Goh

And Chumpon Chan

Source: Readers Digest April 2003

The Cochrane Review August 2000

• Comparison of Continuous EFM & Intermittent Auscultation in Labour

• 9 Trials: >18,000 Mothers• Conclusion: No short term or long term benefit

of continuous EFM in Labour• Increased incidence of Caesarean Section & Assisted vaginal Deliveries• Recommendation: Reduce or Abandon

Continuous EFM in low risk cases

“Yes we’re all cousins,

That’s what I believe,

Because we’re children

Of Adam and Eve…

But we’re kissing cousins”

Elvis Presley

song, 1964

EUTHANASIA

• PASSIVE : Withdrawal of Life Support

• ACTIVE : Through Direct Action

• PHYSICIAN-ASSISTED : By providing Information or Means

• INVOLUNTARY : With disregard to person’s wishes

“Doctor Death”Philip Nitschke

Demonstrating his “Death Machine”

which generates COIn Sydney

on 31 May 03

EUTHANASIA

• Some states in US & Australia allow passive euthanasia

• Netherlands first in the world to legally sanction – April 2003

• Belgium & France to follow• Applies to continuous, unbearable & incurable

pain• On request voluntarily, independently &

persistently• Second opinion must be taken

Second Opinions

•Second opinion is Patient’s Right

•Opinion only after review of History, All records & Physical Examination

From the book,

“Second Opinions” by E Groupman of Harvard Medical School