Pramukhswami Medical College

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

BACKGROUND: Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods. OBJECTIVES: To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings. METHODS: Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence-based definitions and diagnostic methods. RESULTS: The 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence-based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library. CONCLUSIONS: The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical. Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common. These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts. The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings. Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.

CONTEXT: There is growing body of evidence that use of computers can adversely affect the visual health. Considering the rising number of computer users in India, computer-related asthenopia might take an epidemic form. In view of that, this study was undertaken to find out the magnitude of asthenopia in computer operators and its relationship with various personal and workplace factors. AIMS: To study the prevalence of asthenopia among computer operators and its association with various epidemiological factors. SETTINGS AND DESIGN: Community-based cross-sectional study of 419 subjects who work on computer for varying period of time. MATERIALS AND METHODS: Four hundred forty computer operators working in different institutes were selected randomly. Twenty-one did not participate in the study, making the nonresponse rate 4.8%. Rest of the subjects (n = 419) were asked to fill a pre-tested questionnaire, after obtaining their verbal consent. Other relevant information was obtained by personal interview and inspection of workstation. STATISTICAL ANALYSIS USED: Simple proportions and Chi-square test. RESULTS: Among the 419 subjects studied, 194 (46.3%) suffered from asthenopia during or after work on computer. Marginally higher proportion of asthenopia was noted in females compared to males. Occurrence of asthenopia was significantly associated with age of starting use of computer, presence of refractive error, viewing distance, level of top of the computer screen with respect to eyes, use of antiglare screen and adjustment of contrast and brightness of monitor screen. CONCLUSIONS: Prevalence of asthenopia was noted to be quite high among computer operators, particularly in those who started its use at an early age. Individual as well as work-related factors were found to be predictive of asthenopia.

With the objective of assessing the level of awareness about the various aspects of biomedical waste and disposal practices by the medical practitioners this study was conducted. It was a cross sectional study. 30 hospitals with more than 30 beds minimum were randomly selected from Sabarkantha district, Gujarat. The doctors and auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the existence of the law related to biomedical waste but details were not known. Doctors were aware of risk of HIV and Hepatitis B and C, whereas auxiliary staff (ward boys, ayabens, sweepers) had very poor knowledge about it. There was no effective waste segregation, collection, transportation and disposal system at any hospital in the district. There is an immediate and urgent need to train and educate all doctors and the staff to adopt an effective waste management practices.

Background and objective The recent pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. The infectiousness and the quick spread across the world make it an important event in everyone's life, often evoking fear. Our study aims at assessing the overall knowledge and perceptions, and identifying the trusted sources of information for both the general public and healthcare personnel. Materials and methods This is a questionnaire-based survey taken by a total of 1,246 respondents, out of which 744 belonged to the healthcare personnel and 502 were laypersons/general public. There were two different questionnaires for both groups. The questions were framed using information from the World Health Organization (WHO), UpToDate, Indian Council of Medical Research (ICMR), Center for Disease Control (CDC), National Institute of Health (NIH), and New England Journal of Medicine (NEJM) website resources. The questions assessed awareness, attitude, and possible practices towards ensuring safety for themselves as well as breaking the chain of transmission. A convenient sampling method was used for data collection. Descriptive statistics [mean(SD), frequency(%)] were used to portray the characteristics of the participants as well as their awareness, sources of information, attitudes, and practices related to SARS-CoV-2. Results The majority (94.3%) of the respondents were Indians. About 80% of the healthcare professionals and 82% of the general public were worried about being infected. Various websites such as ICMR, WHO, CDC, etc., were a major source of information for the healthcare professional while the general public relied on television. Almost 98% of healthcare professionals and 97% of the general public, respectively, identified 'Difficulty in breathing" as the main symptom. More than 90% of the respondents in both groups knew and practiced different precautionary measures. A minority of the respondents (28.9% of healthcare professionals and 26.5% of the general public) knew that there was no known cure yet. Almost all respondents from both the groups agreed on seeking medical help if breathing difficulty is involved and self-quarantine if required. Conclusion Most healthcare professionals and the general public that we surveyed were well informed about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the same. There is a high trust of the public in the government. There are common trusted sources of information and these need to be optimally utilized to spread accurate information.

BACKGROUND: Knowledge acquisition and skill maintenance are important in learning neonatal resuscitation. Traditionally this is taught by using low fidelity mannequins. Technological advancement enabled a move towards high fidelity mannequins. In a low resources setting, it is incumbent to ensure reasonable cost benefit ratio before investing in technology. METHODS: A randomized control trial was conducted in 101 undergraduate students who were assigned to conventional Resusci(®) Baby Basic or SimNewB group over a period of 3 days. The lectures were the same for both groups but the hands on training was on different mannequins. There were five experienced and accredited teachers who were standardized for training the students. Both the groups received a written test and a Megacode before and after the training, and 3 months later a post-test. RESULTS: The baseline written exam score (p = 0.07), Megacode assessment score (p = 0.19) and sex distribution (p = 0.17) were similar in both groups. Both groups showed significant improvement in the written exam score as well as in the Megacode assessment score at post-test and 3 months (retention) period. However there was no significant difference in the "improvement" between both the groups with respect to written exam (p = 0.38) or Megacode assessment (p = 0.92). Further the post-test and 3 month scores were comparable for the skills as well as content components suggesting that the skills were retained in 3 months with an opportunity of self learning them. CONCLUSIONS: Due diligence is a caveat before contemplating the acquisition of high fidelity mannequins by educational centers for neonatal resuscitation.

The Department of Physiology of Pramukhswami Medical College at Anand, Gujarat, India, started using problem-based learning in a modified way along with didactic lectures to improve students' understanding and motivate them toward self-directed study. After the didactic lectures were taken for a particular system, clearly defined short clinical problems related to that system were given to the students in the tutorial classes. Each tutor was assigned three to four groups of five to six students each. Problems were accompanied with relevant questions so as to streamline the thought processes of the first-year undergraduates. The tutor then facilitated the study process, and the students discussed among themselves to derive their solutions. At the end of the sessions, feedback was taken from the students through a planned questionnaire on a three-point scale. Of a total of 278 students over a span of 3 yr from 1999 to 2002, 74.4% of students favored a judicious mixture of didactic lectures and case-oriented problem solving in tutorial classes to be an efficient modality in understanding a system under study, and 84% of students stated the mixture of didactic lectures and case-oriented problem solving to be beneficial in relating a clinical condition to the basic mechanism; 82% of students believed that this module helped with better interactions among their batch mates, and 77.2% of students hoped to perform better in the university examination due to this new teaching/learning modality. They also expressed that this gave them ample motivation to do self-directed learning. It may therefore be concluded from the results of the present study that it is possible to have a problem-based learning module in the form of case-oriented problem-solving tutorials coexistent with the traditional didactic lecture module in the first year of medical education under a conventional curriculum.

INTRODUCTION: This is an attempt to find the species prevalence of various dermatophytes in patients with dermatophytosis in our hospital in Baroda. MATERIAL AND METHODS: Two hundred and sixty clinically suspected cases of dermatophytosis were subjected to mycological studies. RESULTS: One hundred and fifty seven cases (60.38%) were positive for fungus in direct microscopy while 116 (44.62%) were culture positive. Tinea corporis was the most common clinical presentation followed by tinea cruris. Young adults in the age group of 16-30 yrs were mainly affected. The male to female ratio was 1.57:1. Trichophyton rubrum (73.27%) was the most common isolate, followed by Trichophyton mentagrophytes (17.24%), Epidermophyton floccosum (7.75%) and Trichophyton violaceum (1.72%). CONCLUSION: Trichophyton rubrum was the predominant fungus found in this area of Gujarat, followed by Trichophyton mentagrophytes, Epidermophyton floccosum and Trichophyton violaceum.

BACKGROUND: Azithromycin has demonstrated in vitro and in vivo activity against Plasmodium falciparum, but small treatment studies have given mixed results. METHODS: Participants with fever and with both a blood smear and a rapid diagnostic test positive for falciparum malaria were randomly assigned to groups that were treated with either azithromycin or chloroquine or to matched groups receiving a placebo. After an interim analysis, open-label combination therapy with both drugs was initiated. RESULTS: At day 28, 5 (33%) of 15 participants in the azithromycin-treated group had remained free of fever, compared with 4 (27%) of 15 in the chloroquine-treated group. All subsequently enrolled participants then received combination therapy with azithromycin and chloroquine. In 61 (97%) of 67 participants, resolution of fever and parasitemia had occurred by day 7, and, through day 28, no clinical or parasitologic relapse had occurred in them. CONCLUSIONS: Resolution of parasitemia was inadequate with monotherapy with either azithromycin or chloroquine, but combination therapy provided substantially improved clinical and parasitologic outcomes. The combination of azithromycin and chloroquine may be an effective alternative treatment for falciparum malaria and deserves further study.

CONTEXT: Dry eye is a very common as well as under-diagnosed ocular disorder. It is not only troublesome in terms of its symptoms but also imposes a great financial burden. AIMS: To determine the prevalence of dry eye in ophthalmology out-patients at a Tertiary Care Hospital and its association with various clinico-epidemiological factors. SETTINGS AND DESIGN: A hospital-based study at a Tertiary Care Center was conducted including 400 out-patients of age 40 years and above. MATERIALS AND METHODS: Patients were consecutively selected and underwent a routine ophthalmological examination along with tear film break-up time (TBUT) as a screening tool for detecting the presence of dry eye. STATISTICAL ANALYSIS: We performed a descriptive, univariate and multivariable logistic regression analysis to calculate odds ratios and 95% confidence interval. RESULTS: The mean age of the study population was 58.6 years. The overall prevalence of dry eye was found to be 54.3%. An association was found between dry eye prevalence and outdoor workers, participants working indoor using air conditioners, housewives, diabetics, patients who have undergone previous ocular surgery and those with meibomian gland dysfunction. CONCLUSIONS: Dry eye is a very common condition with a high prevalence among the elderly. We recommend the screening of all out-patients by TBUT, which is a simple test to perform and examination of lids for meibomian gland disease, which if present can be treated. Further studies are needed to establish uniform diagnostic criteria for dry eye, which will help to get more concrete prevalence data, as well as its etiological factors.

Objective. To explore the psychosocial problems faced by the parents of children with cerebral palsy (CP) in rural and urban settings. Design. Qualitative research design using focus group discussions (FGDs) was used for the study. Setting. Two FGDs comprising one at a rural tertiary level care hospital and the other at an urban tertiary level care hospital were conducted. Participants. A total of thirteen parents participated in the two FGDs. Main Outcome Measured. Psychosocial problems experienced by the parents of children suffering from CP were measured. Results. The problems experienced by the mothers were associated with common themes such as disturbed social relationships, health problems, financial problems, moments of happiness, worries about future of the child, need for more support services, and lack of adequate number of trained physiotherapists. All the parents had children with problems since birth and most had approached various health care providers for a cure for their child. Conclusions. A wide range of psychosocial problems are experienced by the parents of children with CP. Studies like this can provide valuable information for designing a family centered care programme for children with CP.

AIMS: We have evaluated screen time usage among preschool-aged (≤6 years) children in rural Western India. In addition, we have evaluated various lifestyle factors and their impact on the screen time of these children. MATERIALS AND METHODS: English-medium schools in the locality were chosen based on convenience. A self-report survey requesting family information and screen usage information was distributed to the parents. Daily screen time was categorized as a three-category variable. Ordered logistic regression with multivariable regression was performed to examine the association of risk factors with screen time. RESULTS: = 0.03) on weekends. No association was observed between screen time and mother's occupation. CONCLUSIONS: More than 80% of children exceeded the advised screen time with television and smartphone being the major contributors. This issue has to be dealt with at both individual and societal levels. Increased awareness about the high prevalence of inappropriate use of screen time use within the Indian context is needed to inspire attention and interventions for this emerging public health problem in India.

The traditional education strategy is insufficient to meet the demands of dynamically changing medical science and the fast-growing medical field. The present Competency-Based Medical Curriculum for medical undergraduates in India emphasizes acquisition of a set of competencies for self-directed learning (SDL) through an explicit approach and dedicated teaching hours in the disciplines which gives the opportunity to develop skills for developing lifelong learners. Self-directed learning cuts across all domains of learning and has a significant potential in shaping transformational learning experiences. The concepts of SDL are based on adult learning principles and experiential learning fostering skills for lifelong learning. In view of the paradigm changes in the new curriculum, it is imperative to understand the basic concepts and the methods for effective practice of SDL in the new curriculum. Faculty development for SDL, ensuring the availability of resources, harnessing the power of information technology, and integrating cognitive and affective assessment strategies enhance the effectiveness of SDL. We revisited the literature, and critically summarize our views on the theory-to-practice concepts of self-directed learning. The article discusses the basic concept of SDL, implementation strategies, and evaluation of self-directed learning.

Xanthelasma palpebrarum is the most common cutaneous xanthoma, characterized by yellowish plaques over eyelids - most commonly, over the inner canthus of the upper lid. It is triggered by hyperlipidemia, thyroid dysfunction, and diabetes mellitus. Xanthelasma results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis. Different modalities of treatment, such as simple surgical excision, cryotherapy, chemical peeling with trichloroacetic acid, radiofrequency, and laser, are used in the treatment of xanthelasma palpebrarum. A brief review of current treatment strategies is presented here.

INTRODUCTION: Mental health problems in adolescents are inadequately researched in low-resource settings. We aimed in this study to assess the prevalence of mental health problems and correlates in school children aged 13-17 years and compare differences between urban and rural schools in Anand District, Gujarat. METHODS AND ANALYSIS: A cross-sectional study was conducted in five Gujarati medium higher secondary schools in Anand, Gujarat. Six hundred and ninety-three students with equal distribution of boys and girls belonging to 9th to 12th grades were included in the study. Strengths and Difficulties Questionnaire (SDQ) was used to assess the mental health status of the students, and total difficulties scoring was used to categorise participants into normal (0-15) and high (borderline (16-19) and abnormal (20-40)). Socio-demographic data and Teenage Screening Questionnaire-Trivandrum (TSQ) were used to assess associated medical and psychosocial factors. Clearance was obtained from the institutional ethics committee before conducting the study. RESULTS: 15% participants had a high SDQ score. Girls had more emotional problems, while the rest of the mental health problems were more prevalent in boys. Rural children were found to have more mental health issues. Having an eye problem, scoring <50% in last annual examinations, failure in examinations, difficulties in studying at home and difficulties in relationships were associated with high SDQ score. Keeping physically fit and having friends were associated with normal SDQ score. Logistic regression model revealed that age, receiving punishment in form of more homework and difficulty discussing friends with parents increased odds of high SDQ score, while having friends and after-school entertainment like watching movies decreased odds of high SDQ score. CONCLUSIONS: At least one in eight adolescents in this study was at risk of mental health problems. SDQ self-report questionnaire and TSQ survey may be used as a screening modality to identify at-risk students.

Several preventive strategies to reduce dyslipidemia have been suggested, of which dietary modification features as an important one. Dyslipidemia is a major risk factor for coronary heart disease and strategies to manage dyslipidemia have been shown to reduce the incidence of cardiovascular disease (CVD). Although there are proven pharmacological therapies to help manage this condition, nutritional interventions are a safer option to help prevent and manage dyslipidemia. Addition of almonds in the daily diet has been proposed to beneficially impact the lipid profile. This review critically examines the available evidence assessing the effect of almonds on dyslipidemia in the South Asian (particularly Indian) context. An extensive review comprised of epidemiological studies, clinical trials, meta-analyses, and systematic reviews was conducted from published literature from across the world. Studies examining the effect of almonds on different aspects of dyslipidemia viz. high low-density lipoprotein-cholesterol (LDL-C), low high-density lipoprotein-cholesterol (HDL-C), triglyceridaemia, and high total cholesterol levels have been included. In several studies, almonds have been shown to reduce LDL-C-which is a known risk factor for CHD-and the effect of almonds has been well documented in systematic reviews and meta-analysis of clinical trials. Addition of almonds in the diet has been shown to not only to reduce LDL-C levels, but also to maintain HDL-C levels. This review provides information about the use of this simple nutritional strategy which may help manage known major risk factors for heart disease, such as high LDL-C and low HDL-C levels especially in the context of South Asians.

<b>Research question : </b> What is the level of general awareness and knowledge of people about dog bites and its first aid measure with anti-rabies vaccines? <b> Objectives : </b> 1) To know the general awareness pertaining to rabies in rural community. 2) To study the knowledge of people about dog-bites. 3) To ascertain the first aid measures adopted by people after dog bite. 4) To study the awareness of people regarding anti rabies vaccines &#x0026; health services utilization. 5) To know the opinion regarding control of dog population. 6) To make recommendations based on study findings. <b> Methodology : </b> Study design : cross sectional study. 2) Setting : village surrounding the PSMC, Anand. 3) Participants : total 225 families were contacted in nine villages with 25 families per village. <b> Results : </b> All of the individuals were aware about rabies and 98.6&#x0025; knew about its transmission by dog bite. Only 31.1&#x0025; would like to apply first aid measure and 36.4&#x0025; will visit to doctor and rest either do nothing or adopt some religious practices to prevent the development of rabies. 86.6&#x0025; of individuals were aware about anti-rabies vaccine and 24.4&#x0025; knew that pet dogs need vaccine against rabies. <b> Statistical analysis : </b> The data was analyzed by using &#x2032;Epi-info&#x2032; package.

Appropriate feeding practices are the key contributor to reducing morbidities and mortalities in under-five children. A cross-sectional questionnaire based survey of mothers of children aged less than 5years was conducted in 781 mothers. More than half of mothers (57.5%) started feeding within an hour of birth, 55.9% gave exclusive breastfeeding for six months, 89.1% of the mothers stopped breastfeeding before two years of age, 18.2% of the mothers bottle-fed the babies, and 15.6% had problems during breastfeeding in first 6 months. Early initiation of breastfeeding within one hour of birth promoted exclusive breastfeeding, and breastfeeding for longer duration. Exclusive breastfeeding increased frequency of feeds. Multivariable logistic regression showed that initiation of breastfeeding after an hour of birth (p = 0.035), not providing exclusive breastfeeding for 6 months (p < 0.0001), unemployed mothers (p = 0.035), having two or more kids (p = 0.001), and complementary feeds given by person other than mother (p = 0.007) increased hospitalization. Starting breastfeeding after an hour of birth (p = 0.045), severe malnutrition (p = 0.018), and breastfeeding for < two years (p = 0.026) increased rates of diarrhea. Breastfeeding practices were not optimum and interventions to improve these practices need to be strengthened.

OBJECTIVE: To evaluate the efficacy and safety of pegylated interferon alfa-2b (PEG IFN-α2b) along with the standard of care (SOC) in subjects with moderate COVID-19. METHODS: In this phase 2, randomized, open-label study, adult subjects aged ≥18 years with RT-PCR confirmed COVID-19 with moderate symptoms were randomized in a 1:1 to receive PEG IFN-α2b plus SOC, or SOC alone. The primary endpoint was improvement in clinical status on day 15, measured by the WHO 7-point ordinal scale. RESULTS: Forty subjects were randomized to PEG IFN-α2b plus SOC (n = 20) and SOC (n = 20). Overall, 19 (95.00%) subjects in PEG IFN-α2b plus SOC had achieved clinical improvement on day 15 compared to 13 (68.42%) subjects in SOC (p < 0.05). Overall, 80% and 95% of subjects in the PEG IFN-α2b plus SOC group had a negative RT-PCR result on day 7 and day 14, respectively, compared to 63% and 68% in the SOC group. Adverse events (AEs) were reported for eleven subjects in the PEG IFN-α2b plus SOC group and eight subjects in the SOC group. All reported AEs were mild. CONCLUSION: The significant improvement in clinical status on day 15 is likely due to faster viral reduction compared to SOC with the PEG IFN-α2b treated moderate COVID-19 subjects showing a difference as early as day seven and becoming significant by day 14.

The squamous part of the occipital bone consists of 2 parts, supraoccipital and interparietal. The supraoccipital develops both in cartilage and membrane. At the upper margin the bone lying between the superior and highest nuchal lines known as the torus occipitalis transversus is ossified in membrane by a pair of centres. This part of the supraoccipital represents the original membranous part of the primitive occipital bone of lower animals where the interparietals form part of the parietals. This segment of bone is labelled as the intermediate segment which probably never separates from the cartilaginous supraoccipital. The interparietal bone lying above the highest nuchal lines develops in membrane by 2 pairs of centres, 1 pair for the lateral plate and the other for the medial plate. Each centre consists of 2 nuclei. Failure of fusion between these centres or their nuclei with each other and the supraoccipital may give rise to various anomalies in the interparietal region which are discussed. This is the true interparietal bone which has migrated from the parietals of lower animals during evolution to become part of the occipital bone in man. When it appears as an anomaly in the form of an independent separate bone, the suture between it and the supraoccipital lies at the level of highest nuchal lines. There is no pre-interparietal bone.(ABSTRACT TRUNCATED AT 250 WORDS)