Abstract: Background: Male infertility is a serious problem all over the world. Nutritional deficiency of trace element Zinc (Zn) may play a role in male infertility as Zn plays an important role not only in normal testicular development, but also in spermatogenesis and sperm motility. Deficiency of Zn is associated with hypogonadism and insufficient development of secondary sex characteristics. Objective: The present study was designed to analyze the level of seminal Zn among different groups of infertile patients and to correlate it with sperm concentration, active, sluggish and immotile fractions of seminal parameters, with an objective to establish the role of Zn in male infertility. Setting and Design: The present study was carried out in five- years period from 2004 to 2009. It was a descriptive analytical study with non probability sampling. Materials and Methods: Semen examination of the patients was carried out according to the standardized method of the World Health Organization. Semen Zn was estimated by color 5 Br. PAPS method. Statistical Analysis: All statistical analyses were performed by using SPSS (Version 14.0 for windows) software, by applying student's t-test. Results: The result showed that seminal Zn was 702.92±10.60, 598.48±12.95, 617.54±9.55, 542.29±22.75, 710.36±7.87, 712.06±7.96, 789.36±21.33, and 762.06±8.99 mg/dl in azoospermic, oligozoospermic, asthenozoospermic, oligoasthenozoospermic, teratozoospermic, normozoospermic, polyzoospermic, and proven fathers group, respectively. Conclusions: Decreased concentration of seminal Zn do affect the sperm count, while increased level of seminal plasma Zn causes decreased sperm motility; so, it is suggested that administration of Zn should be very carefully monitored in such patients having low sperm count but normal sperm motility, as adequate seminal Zn is required for normal sperm function.

Abstract: Background: Emergence of high-level aminoglycoside and glycopeptide resistance has significantly contributed to the mortality, particularly in serious enterococcal infections. Objectives: This study was aimed to determine the prevalence of high-level gentamicin resistance (HLGR), high-level streptomycin resistance (HLSR) and vancomycin resistance in enterococcal isolates recovered from patients with bacteremia. Materials and Methods: A total of 110 blood culture isolates of enterococci were recovered from septicemic patients. Routine antibiotic susceptibility testing was performed and screening for ampilcillin, high-level aminoglycoside resistance (HLAR) and high-level vancomycin resistance was done by agar screen method. Results: Out of 110 isolates, Enterococcus faecium accounted for 53% of these isolates, followed by Enterococcus fecalis (33%), Enterococcus casseliflavus (8%), Enterococcus raffinosus (4%) and Enterococcus dispar (2%). Resistance to ampicillin, HLGR, HLSR and HLAR was detected in 58%, 62%, 58% and 54% of the isolates, respectively. No isolate was resistant to vancomycin. Conclusion: This study illustrates the high prevalence of HLAR in enterococci from patients with septicemia in our region, which emphasizes the need to predict synergy between beta-lactams and aminoglycosides for management of enterococcal infections.

Abstract: Background: Psychiatric problems in children are rising and reported cases represent only the tip of the iceberg; large number remains unreported in India. There is limited data on childhood mental disorders and mental health needs in Northern-India. Aims and Objective: The main objective of this research was to study the extent and nature of psychiatric disorders in school children in a defined geographical area and to study their psychosocial correlates. Materials and Methods: In this cross sectional study, Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of 982 students in the age group of 10-15 years from four randomly selected schools in a city of North India. Screening stage was followed by detailed evaluation stage in which children were diagnosed by ICD-10 criteria. Statistical analysis was done by percentage and Chi-square test. Results: The results showed that among 982 students, 199 (20.2%) had psychiatric morbidity. Most of them were in the age group of 13-14 yrs, from middle income group and were second in birth order. No significant sexual preference was found regarding distribution of the disorders. Specific phobia; other non organic sleep disorders like sleep talking, bruxism; tension headache found to be the most prevalent disorders followed by sleep terror, hyperkinetic disorder, pica, enuresis. Conclusion: Epidemiological studies should be started early in childhood and carried longitudinally for development of preventive, promotional and curative programme in the community.

Abstract: Background: Serum nitric oxide (NO) has emerged as a fundamental signal associated with the endothelial dysfunction in type 2 diabetes. Aims: To compare serum nitric oxide level among type 2 diabetic patients along with other biochemical parameters and to compare it with that of normal population in Sikkim. Settings and Design: This prospective study was carried out in the Biochemistry Department in a tertiary care teaching hospital in Sikkim on 50 type 2 diabetics compared to 100 non-diabetics. Materials and Methods: The un-hemolyzed blood sample was collected for estimation of biochemical parameters. Griess reaction was used for indirect assay of stable decomposition products in serum (serum nitrite and nitrate levels) as an index of NO generation. The comparison of different parameters between cases and control was done by using Student's t-test. Results: There was significant difference when age- and sex-matched cases and controls were compared in regard to waist circumference and body mass index. The values of fasting and postprandial serum glucose, and lipid profile between study group and control group differed significantly. The mean serum level of NO in the study and control group was 43.83 ± 11.3 μmoles/L and 58.85 ± 12.8 μmoles/L respectively, and this difference was statistically significant. Conclusion: To sum up, serum NO was observed significantly low in diabetic participants as compared to control, along with difference in other biochemical parameters.

Abstract: Multiple sclerosis (MS) is thought to arise due to an interplay of genetic and environmental risk factors. Vitamin D, besides maintaining bone health and calcium metabolism, is thought to play an immunomodulatory role in the central nervous system. Studies have shown that patients with the highest level of Vitamin D (99-152 nmol/l) had a significantly lower risk of MS than the subgroup with the lowest levels (15-63 nmol/l). Furthermore, populations having a high oral intake of vitamin D had a decreased risk of MS. Hypovitaminosis D is one of the environmental risk factors for MS based on numerous physiological, experimental and epidemiologic data, which can be corrected to provide an effective therapeutic option for this debilitating disease.

Abstract: Background: Breast cancer is a leading cause of death in women. Receptor status is the most important prognostic and predictive marker for breast cancer. Aims: The present study was conducted with an aim to analyze breast cancer of Indian women with discordant receptor status, probably hormone dependent estrogen receptor (ER) positive, progesterone receptor (PgR) negative or ER− negative and PgR+ positive subgroup profile, infiltrating ductal breast cancer (IDC) not otherwise specified. Materials and Methods: Specimens from 100 IDC were grouped into three categories according to hormonal status (group 1: ER+ positive and PgR+ positive, group 2: ER+ positive and PgR− negative or ER− negative and PgR+ positive, group 3: ER− negative and PgR− negative) evaluated prognostic parameters. Statistical Analysis: Statistically significant difference was found between tumor receptor status distribution and menopausal status (P = 0.0235), age of patients (P < 0.001), histopathologic grade (P < 0.001), vascular invasion (P = 0.006), HER-2/neu status (P = 0.004) and Ki-67 proliferation rate (P < 0.001). Results: Group 1 tumors were found exclusively in post-menopausal patients with average age 68.9 years, most of which had intermediate grade II, without vascular invasion, with HER-2/neu status score predominantly 0 or 1+ and lower Ki-67 proliferation rate. Group 2 tumors were found predominantly in younger post-menopausal patients with average age 57.5 years, with vascular invasion found in 23% of cases. Group 3 tumors mostly had higher histopathologic grade, showed the highest percentage of the Ki-67 positive tumor cells and vascular invasion in 30% of the cases. Conclusion: It is concluded that patients with group 2 breast cancer were younger post-menopausal women, with tumors moderately differentiated, HER-2/neu score 0 or 1+ and with lower Ki-67 proliferation rate.

Abstract: Objective: The Cancer Behavior Inventory (CBI), a measure of self-efficacy for coping with cancer, was used to examine the feasibility and impact of a self-management program for women with breast cancer. This controlled clinical trial was conducted on newly diagnosed breast cancer patients, using a time series, block design. Sixty-nine patients were allocated to receive four weekly sessions of the self–management training program, while 78 patients were allocated to the control (usual-care) group. Results: A significant difference was found between the means of the experimental and the control group at post-test (T2; P=.01) and at follow-up (T3; P=.02). The multivariate analyses of the three repeated measures showed significant differences (P=.001; partial eta-squared = 0.092). Pair-wise comparison shows that the differences were significant between baseline (T1) measure and follow-up (T3) measure (P=.01), and between post-test (T2) and follow-up (T3) (P=.03). Conclusion: For women undergoing intervention, the cancer-specific self-efficacy as measured by the cancer-behavior-coping inventory showed improvement over time. The result demonstrated that the self-management program to improve self-care correlates significantly with coping behavior in cancer. A larger and longer study of this efficacy-enhancing intervention is warranted.

Abstract: Background: Contradictory reports about the role of cytokines, particularly interleukins (IL) in atherosclerosis are found in the literature. Objectives: This study was aimed to investigate the association between the levels of cytokines notably IL-4, IL-12, IL-18 and, the atherogenicity and glycemic control in patients with type 2 diabetes mellitus. Materials and Methods: Seventy five patients with type 2 diabetes mellitus (25 males and 50 females) attending diabetic clinic during 1st August 2008 to 30th December 2009 as well as seventy healthy subjects (38 males and 32 female) were enrolled in the study. Fasting serum lipid profile and IL-4, IL-12 and IL-18 levels were determined. Results: The serum lipid profile of diabetic patients was significantly different from healthy subjects, favoring atherogenicity. IL 4, 12, and 18 were significantly higher in diabetic patients compared with healthy subjects. Significant association of high serum IL-18 with poor glycemic control (P < 0.001) assessed by HbA1c, long duration of diabetes and atherogenic index were observed. Conclusions: IL-18 can serve as a predictor for pre-clinical atherosclerosis and poor glycemic control in type 2 diabetes mellitus.

Abstract: Ameloblastic carcinoma (AC) is a rare epithelial odontogenic tumor of the jaws, which exhibits cytological features of ameloblastoma and carcinoma. It has a distinct predilection for mandible. These lesions may initially show histologic features of ameloblastoma that dedifferentiate over time. Others may present with features of epithelial dedifferentiation in ameloblastoma. A case of ameloblastomic carcinoma in a 64-year-old male is reported, who presented with swelling in the left mandible 3 months after the extraction of the left upper molar.

Abstract: Background: Genotoxic carcinogens in cigarette smoke interact with DNA, causing cytotoxicity. Cytogenetic damage therefore seems to be an excellent biomarker for determining the effect of exposure to chromosome-damaging agents in cigarette smoke. Purpose: To study the utility of measurement of frequency of satellite associations (SA) as a biomarker for chromosomal damage using cytogenetic assay in peripheral blood lymphocytes. Materials and Methods: This study was conducted on 30 smokers and 30 nonsmokers drawn from a rural population of South India. Smokers were divided into three groups of ten each based on their smoking index (SI) (group I: SI 300) and the frequency of SAs was studied. Results: The frequency of SAs was significantly greater in smokers than in nonsmokers and the frequency of SAs among the smokers was also seen to increase with increase in SI. Conclusion: The results of this study indicate that the genotoxic effect of cigarette smoke on chromosomes increases with smoking intensity. These findings can be used to support smoking cessation interventions.

Abstract: The muscles of the leg are partitioned into three compartments (anterior, lateral, and posterior) by two intermuscular septa that have separate innervations. Anterior compartment is innervated by the deep peroneal nerve and lateral compartment is innervated by the superficial peroneal nerve. Common peroneal nerve divides into superficial and deep peroneal nerve at the neck of fibula. An unusual finding in the dividing pattern of the common peroneal nerve in the male cadaver on the left side was observed. This finding is of academic interest and clinical significance to the orthopedician operating on the proximal fibula for nerve decompression, high tibial osteotomy, and nerve transfer operations.

Abstract: Background: In patients with advanced obstructive ventilatory disorders, expiration may last for a relatively long time until the end-of-test standards for forced vital capacity (FVC) are satisfied. This may be difficult for both the patient and the technician. The Forced expiratory volume in 3 seconds (FEV3) and Forced expiratory volume in 6 seconds (FEV6) maneuvers are simple, undemanding and easier to perform when compared with FVC; however, their reliability to be used as alternatives for FVC is controversial. Aim: To judge whether FEV3 and FEV6 can be used instead of FVC in detecting airway obstruction in asthmatic patients. Settings and Design: This study was a cross-sectional case-control laboratory-based study. Materials and Methods: The study involved 40 known asthmatic patients and 40 apparently healthy, gender- and age-matched controls. Spirometery was used for assessing pulmonary function according to the American Thoracic Society and European Respiratory Society criteria. Statistical Analysis: A significant difference in the means between the groups was performed using Student's t-test. The receiver operating characteristic (ROC) curves were used to compare efficiency of the studied spirometric measurements on asthma diagnosis. Results: The mean of FEV3 was not significantly different when compared with the mean of FVC (P = 0.352 for asthmatic patients and P = 0.957 for control group). This was also true when the mean of FEV6 was compared with the mean of FVC (P = 0.805 for asthmatic patients and P = 0.957 for control group). The area under the ROC curves of FEV1/FVC%, FEV1/FEV3% and FEV1/FEV6% were also comparable. Conclusion: FEV3 and FEV6 are accurate and reliable alternatives for FVC in assessing airway obstruction of asthmatic patients.

Abstract: Knowledge of variations in arteries and nerves of infratemporal fossa may be helpful in radical neck dissection and in dental procedures to avoid the complications. We present an unusual case in which maxillary artery was found deep (medial) to lateral pterygoid muscle. Lingual nerve originated from two roots: anterior and posterior. Anterior root originated from common trunk and the posterior root directly from mandibular nerve. Inferior alveolar nerve was a continuation of the common trunk. Branches of mandibular nerve formed a loop through which passed the second part of maxillary artery. The clinical significance of the present variations has been discussed.

Abstract: Objectives : To determine the current knowledge and awareness among undergraduate dental students in a rural dental college regarding palliative medicine. Materials and Methods: This cross-sectional observational study was conducted on students of a rural dental college located in western India. They were asked to fill a pre-designed questionnaire. The variables assessed were their knowledge and awareness towards palliative medicine and a dentist role in palliative team. Results : A total of 150 students participated. The male:female ratio was 1:2; mean age of respondent was 20.66 ΁ 1.01 years. On an average, 59.23% were correct and 40.67% were incorrect for knowledge about palliative medicine, while 81.55% were correct and 18.45% were incorrect regarding awareness about oral care in palliative medicine. Conclusion: Results indicate that students had good awareness and perception level about awareness of oral care in palliative treatment.

Abstract: Hyperglycemia and hyperlipidemia are both risk factors for the development of various complications in patients with type 2 diabetes mellitus. Colesevelam hydrochloride is a novel agent that can improve both hypercholesterolemia and hyperglycemia in such patients. It is an orally administered bile acid sequestrant with high capacity for binding bile acids. This drug can offer potential new diabetes treatment along with other drugs.

Abstract: The brachial plexus is a complicated plexus supplying the upper limb. The brachial plexus is of great practical importance to the surgeon. It is encountered during operations upon the root of the neck, and hence it is in danger. Variations in the formation of the brachial plexus are common; and knowledge of the variation of the brachial plexus may be useful for surgeons, for improved guidance during supraclavicular block procedures, and for surgical approaches for brachial plexus. Here we report a case in which the superior trunk of the brachial plexus was found to be absent on the right side during a study on the cadaver-neck specimens in the Department of Anatomy.

Abstract: Background: Argyrolobium roseum is described in texts for its botanical aspects with no mention of its therapeutic uses. Recently, a solvent fraction of this plant has been reported to possess insulin secretagogue activity. Objective: Primary objective of the study was to evaluate the hypoglycemic activity of different fractions of Argyrolobium roseum plant. Secondary objective was to devise a model for detecting its beta-cell neogenesis activity. Materials and Methods: Alcoholic fraction (AR) was studied in fasting, glucose-loaded and streptozotocin (STZ)-treated hyperglycemic rats. For deducing beta-cell neogenesis activity, a sub-lethal dose of STZ, causing delayed death in the animals, was administered. Results: AR in a dose of 200 mg/kg showed hypoglycemic activity in fasting and STZ-treated rats. With sub-lethal dose of STZ, recovery from hyperglycemia was seen. Conclusion: AR of Argyrolobium roseum possesses hypoglycemic and a possible beta-cell neogenesis activity. Further studies are required to confirm its beta-cell neogenesis potential by cytological methods and to establish its role in the treatment of type 2 diabetes.

Abstract: Background: There is a relationship between the intrauterine development, pubertal and adulthood variations, anomalies, and pathology of ovaries. But the entire development spectrum of the ovaries from fetal to menopausal age has not been examined among Indian females. Objectives: This study was conducted with an objective to establish the morphological and morphometric development characteristics of ovaries in local population as a proxy for Indians. Materials and Methods: Thirty ovaries from prenatal embryos and fetuses aged 6 weeks to 40 weeks and 50 postnatal ovaries up to 55 years of age were studied for morphology and morphometry, by doing dissection. Results: Oval shape was predominant in prenatal ovaries (66.68%), followed by rod (20%), almond, and S shapes (6.66% each). Among the postnatal ovaries while almond shape accounted for 72%, the incidence of oval shape was 28%. There was a significant correlation between gestational age and weight of the ovaries both in prenatal (r = 0.56) and postnatal (r = 0.696) specimens studied. Conclusion: Variations in the morphological and morphometric development characteristics of ovaries are common. The findings of this study form an initial database for the local population which may be improved in the subsequent studies.

Abstract: Epidural anesthesia is one of the easier and safer techniques for lower abdominal surgery. It has a very high success rate in the experienced hands, and failure rates are minimal when it is administered by the experienced anesthesiologists. As it is a blind technique, failures can be encountered even by a senior anesthesiologist in many situations and one must analyze retrospectively the various causes responsible for such failures. We report a case of 45-year-old female, weighing 60 kg, who was scheduled for elective vaginal hysterectomy under regional anesthesia. Initial four to five attempts were unsuccessful in establishing the epidural block as the epidural injection encountered bony resistance each time, but subarachnoid block could be achieved with a 23 G spinal needle in the paramedian site of entry in the third attempt. Postoperatively, lumbar and cervical spine X-rays were done which revealed an isolated lumbar spine bony fusion. She was diagnosed as a rare case of isolated lumbar spine fusion without any involvement of cervical spine, other articular joints or any systemic manifestations of diseases like ankylosing spondylitis.

Abstract: Disseminated cryptococcosis is usually detected by cytological examination of fluids and histopathological examination of tissues and confirmed by fungal cultures. Here we report a case of unusual presence of cryptococcal organism engulfed by neutrophils and monocytes in the peripheral smear.

Abstract: As defined by the Standardization Subcommittee of the International Continence Society (ICS), overactive bladder (OAB) is a symptom syndrome characterized by urinary urgency with or without urinary incontinence, usually accompanied by urinary frequency and nocturia but with no proven infection or other obvious pathology.[1] Thus, individuals with neurologic diseases such as multiple sclerosis, spinal cord injury, and myelodysplasia may have neurogenic OAB but they cannot be classified as having characteristic OAB. OAB symptoms are often associated with detrusor overactivity (DO)[2] but can also be associated with other forms of urethrovesical dysfunction. The symptoms of OAB are storage-phase symptoms.[1]

Abstract: DOI: 10.4103/2229-516X.81971 In 2009, the fi rst pandemic of infl uenza of the present century was reported, with its widespread ramifi cations. The last update released by World Health Organization (WHO) on August 6, 2010 reported the spread of laboratory-confi rmed cases of pandemic infl uenza H1N1 2009 in more than 214 countries, including more than 18,449 deaths.[1] As WHO announced H1N1 infl uenza to be in postpandemic phase on August 10, 2010, it is expected that H1N1 2009 virus will circulate as seasonal infl uenza virus for some years to come and localized outbreaks of various magnitude can occur.[2]

Abstract: Sir, Climate change is one of the most critical global challenges of our times. The impacts of climate change range from agricultural damage, further endangering food security, to sea-level rise and the accelerated erosion of coastal zones increasing the intensity of natural disasters, species extinction, and spread of vector-borne diseases.[1] Climate change contributes to the global burden of disease also, and this is expected to grow in the future.[2] The impacts of climate change on human health will not be evenly distributed around the world; the vulnerability of a population will depend on factors such as pre-existing health status, quality and availability of public healthcare, local environmental conditions, and other socio-economic factors.[3]

Abstract: Objective: Dyslipidemia, common in uremic patients subjected to maintenance hemodialysis (HD), represents an independent risk factor for atherosclerosis; but the association between long-term HD and uremic dyslipidemia is not crystal clear The present study was aimed to ascertain any association Materials and Methods: The effects of chronic renal failure (CRF) and HD duration on serum lipids, lipoproteins and homocysteine (HC) were studied in 84 patients suffering from CRF subjected to maintenance HD and were compared with 68 healthy, age-, sex- and race-matched control cohorts Results: Increase in serum free cholesterol (FC), triglycerides, very low-density lipoprotein cholesterol and HC levels, and decrease in esterified cholesterol (EC), EC/FC ratio, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol levels were highly significant (P < 0001) in pre-dialysis patients compared to controls Further disturbances were observed (P < 005) by repeated HD, resulting in further significant increase in FC, and decrease in EC/FC ratio and HDL-C levels after 40 dialysis schedules Conclusion: Levels of HDL-C, plasma FC, and ratio of EC/FC appeared to be clearly altered by HD duration, submitting patients to a greater risk of atherosclerosis due to maintenance HD

Abstract: Concept of bioenhancers or biopotentiators was first time reported in 1929 by Bose. A bioenhancer is an agent capable of enhancing bioavailability and efficacy of a drug with which it is co-administered, without any pharmacological activity of its own at therapeutic dose used. Development and consequent isolation of these molecules, such as piperine and quercetin, is considered as scientific breakthrough. A fixed drug combination (Risorine) of rifampicin, isoniazid, and piperine is the result of this research. It contains almost 60% less dose of rifampicin because of its increased bioavailability and it also prevents resistance. This concept is mentioned as yogvahi in ayurveda and was used to increase the effect of medicines by increasing oral bioavailability, decreasing adverse effects and to circumvent parenteral routes of drug administration. More such useful and economically viable drug combinations can be developed by integrating knowledge of time tested ayurveda with modern methods of research. This review is an account of these bioenhancers, available from the natural resources.

Abstract: Background: Globally, measles is the fifth killer disease among children under five years of age. Despite high immunization coverage in Himachal, outbreaks are occurring. Upon two outbreaks in a hilly district in North India, a case control study was conducted to identify factors contributing to outbreaks and to recommend remedial measures to prevent further outbreaks. Materials and Methods: Factors were reviewed under three heads: program related, health care providers, and beneficiaries related. Cold chain maintenance was determined and responses were compared between workers from study Shahpur and control Nagrota Bagwan blocks. All 69 mothers of age and sex matched children with measles were enrolled. A pre-designed pre-tested data collection instrument was used. For statistical analysis, the odds ratio (OR) and adjusted odds ratio with 95% confidence interval (C.I.) among women of children exposed and unexposed to selected characteristics were calculated. Results: Poor cold chain maintenance and gaps in knowledge of health workers supplemented with beneficiary-related issues precipitated outbreaks in case area. Univariate analysis yielded strong statistical significance to 17 variables. Important statistically significant variables are educational status; OR 27.63 (C.I. 9.46-85.16); occupation; OR 0.35 (C.I. 0.16-0.75); income; OR 5.49 (C.I. 2.36-13.00); mode of transport to health care facility; OR 8.74 (C.I. 2.90-28.23); spread of illness from one person to another; OR 5.60 (95% C.I. 1.40-25.97); first help for sick child OR 2.12 (C.I. 1.00-4.50), and place of visit after recovery; OR 3.92 (C.I. 1.80-8.63). Multiple logistic regression yielded significant association with educational status, drinking water sources, and time taken to reach the nearest health facility. Conclusion: Measles outbreaks were confirmed in high immunization coverage areas. We recommend 2nd dose opportunity for measles (MR) between 5 and 17 years; refresher trainings to workers; mobile access to health care facility, and Information Education Communication activities for social behavioral change in affected areas.