Malaria

Banning cigarette smoking in public places in India has had some positive effects, but it has not been as effective as expected in reducing smoking rates. What do you believe is the main reason the ban has not achieved its full potential?

Lower abdominal pain *Chief Complaints* Abdominal pain. *History* Postmenopausal for 12 years. No history of post menopausal bleeding. Complaints of abdominal pain . No other complaints *Vitals* Vitals were stable. Pulse 88/ min. BP-120/86 mm Hg. *Physical Examination* Per abdomen there was mass palpable around 20 weeks size of gravid uterus ...mostly on left side mobile from side to side. No guarding/ rigidity/ tenderness. No free fluid. Per vaginal examination . Uterus was palpable separate from the mass and was senile. Mass was around 14*15 cm. Mobile . *Investigations* CA 125 was 5645 Ultrasound solid cystic mass arising from left ovary. Uterus was senile. Right ovary normal. Minimal free fluid in abdomen. CECT revealed same findings *Diagnosis* Complex left ovarian neoplasm *Management* Laparotomy was done. There was 18*14 cm mass arising from left ovary lobulated appearance. No surface excrescences. No surface growth. Other ovary was cystic around 3*3 cm. . Uterus senile. Hysterectomy with bilateral salpingo ovariotomy done.

F.52 yrs. Struggling to breathe Noisy breathe-wheezing Violent coughing 4 days.

F.47yrs. Slowly growing soft tissue swelling at posterior part of left ankle. Pain at moving joint. 3 months

M.ch.11yrs Limping right.