Ultrasound of the abdomen is a commonly requested investigative procedure. By the use of different probes and varying maneuvers, a remarkable range of views can be obtained. Imaging of the liver is done using four views which can identify most pathological conditions. Being aware of the possible artifacts helps in avoiding a wrong diagnosis. Gallbladder (GB) imaging is useful in detecting gallstones and inflammation of the GB. When inflamed, the pancreas enlarges in size and is bulky, with peripancreatic fluid, which is suggestive of acute pancreatitis.

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The cause of infertility is said to be unexplained when there is normal ovulatory function, semen analysis is normal, and tubal patency is established by hysterosalpingography or laparoscopy. Some of the factors that may contribute to the etiology of unexplained infertility are inability to identify the subtle reproductive abnormalities, endocrine/genetic/immunological disorders, minimal/mild endometriosis, and compromised ovarian and natural fecundability that may be less than normal. Prognostic factors in unexplained infertility include maternal age, duration of infertility, and previous obstetric history. The management options depend on various factors such as age of woman, duration of infertility, couples' preferences, and the health-care setting. The options available for treatment include expectant management, clomiphene citrate, super ovulation with intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.

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Polycystic ovarian syndrome (PCOS) is a common cause of infertility and is characterized by clinical features of irregular menstrual cycles, hirsutism, and anovulatory infertility. The diagnosis is made based on the presence of two of three features (oligo/anovulation, hyperandrogenism, and polycystic ovaries on transvaginal ultrasound) according to the Rotterdam diagnostic criteria. Lifestyle modifications to reduce weight and the use of ovulation induction medications form the cornerstone of treatment of anovulatory infertility secondary to PCOS. Clomiphene citrate is the most effective as an agent for ovulation induction. The other therapeutic options include laparoscopic ovarian drilling, ovulation induction with gonadotropins, and in vitro fertilization.

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Adoption is a process by which one makes someone or something that is external, one's own. A couple struggling with infertility may benefit from artificial reproductive technologies. However, this involves a huge investment in terms of finances, health, and emotions. Adoption is an option that should be considered as a viable alternative. The couple is taken through the process only when both the partners are absolutely ready for it. Adoption finds mention in scriptures and has strong emotional and spiritual components. Adoption provides the components of relationship, family, and security to both the couple and the child being adopted.

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Context: While lack of physicians and surgeons in rural India has received wide publicity, minimal attention has been spared for lack of ancillary personnel, such as surgical assistants. Personnel with no formal training often play the role of surgical assistant. This study evaluates the efficacy of "In-service training" of orthopedic surgical assistants in a rural mission hospital. Methodology: A retrospective, one group pre- and post-test experimental study was designed to evaluate the effectiveness of the "In-service training" program for surgical assistants who participated in orthopedic procedures conducted over a 5-year period (2011-2016), at a rural mission hospital. Data were collected from the hospital's Orthopedic Department database from July 2011 to March 2016. All orthopedic surgical assistants included in the study were classified according to their highest educational qualification and duration of "In-service training" program. Initial and final level of competence of each orthopedic surgical assistant after "In-service training" was evaluated. Paired t-test was used for statistical assessment. Results: A total of 1156 orthopedic procedures were carried out from 2011 to 2016. Twenty-eight personnel including nine General Nursing and Midwifery nurses, two Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy doctors, one dentist, one physiotherapist, one MBBS doctor, 12 medical student volunteers and two college graduates participated in "In-service training" program as orthopedic surgical assistants in the rural mission hospital. The participants had no prior training in operation theater technique or orthopedic procedure. Mean initial competence score was 1.00357 (standard deviation [SD] = 0.1889) and mean final competence score was 3.3928 (SD = 0.9165). This difference was statistically significant with P < 0.00001. Conclusions: "In-service training" program at the rural mission hospital increased the competence level of orthopedic surgical assistants. This is a novel method to overcome the human resource deficit in rural health-care sector.

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