Serum anti-Mullerian hormone and homocysteine in premenopausal females with and without cardiovascular disease

Background: The objective of this study is to assess the association of anti-Mullerian hormone (AMH) and homocysteine (Hcy) levels in premenopausal females with and without cardiovascular disease.Methods: A case control study was conducted in premenopausal, menopausal and normal fertile females (n=30) with and without cardiovascular disease in a tertiary care hospital and research centre in central India. Fasting sample obtained was assessed for AMH and Hcy levels. Results were compared and data was analyzed.Results: The levels of AMH and Hcy were significantly altered in premenopausal and menopausal females as compared to normal fertile females. Moreover, there was a weak correlation when intergroup comparison was made between the parameters in females with and without cardiovascular disease.Conclusions: A prospective study with a larger sample size to assess levels of AMH need to be performed to provide insight in premenopausal females for the early detection cardiovascular disease.

Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization

Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.

Awareness Of Driving Safety Measures In General Population Visiting Tertiary Care Hospital

BACKGROUND:Road traffic accident is a preventable global disaster. In developing countries, the existing road safety policies are ineffective in preventing casualties, mainly because of lack of knowledge regarding the same in the general population. The early assessment of awareness of driving safety measures in general population will thus go a long way to help in reducing existing high fatalities. MATERIALAND METHODS: Aclose ended questionnaire based, cross-sectional study was conducted among 200 participants of age 16 years and above with a valid driving license to assess the awareness regarding driving safety measures. The data was collected and analyzed for number, percentage, mean, standard deviation, t test and Chi-square test. RESULTS: 80.8% of the urban population and 60.5% of the rural population were aware of the legal age for driving vehicles. Majority of the participants were aware regarding wearing helmets while driving. Use of seatbelt and prohibition of alcohol intake while driving was comparatively less in rural population. Awareness of prohibition of use of mobile phone while driving and sign of speed limit was observed in 2/3rd of the population. Less than half of the rural population was unaware of the basic traffic signs like stop, no parking, no horn, school ahead, and one way. CONCLUSION:Awareness regarding driving safety measures in general population was comparatively less among rural population than urban. Traffic awareness campaigns in hospitals in association with Regional Transport Office would be one of the beneficial measures to minimize fatalities arising due to lack of knowledge of safe driving measures.

Study of the Relationship between Personality Traits and Academic Performance of Health Science Students

Background: The purpose of the present study was to investigate the relationship between various personality traits and academic performance of undergraduate health science students. Materials & Methods: A total of 400 medical, dental, physiotherapy and nursing students participated in this study. The instrument was “Big Five Inventory Questionnaire”. The questionnaire was validated. The data was collected and analyzed using STATA software. Results: The findings of the study did not shows any correlation between all the personality traits (Openness, Extraversion, Conscientiousness, Agreeableness and Neurotism). Conclusion: Personality traits does not influence academic performance.

Radiation therapy outcomes in muscle invasive urinary bladder cancer: A single institution experience.

INTRODUCTION: To audit the survival outcomes and loco‑regional control in muscle invasive urinary bladder cancer patients treated with external beam radiation therapy (RT). MATERIALS AND METHODS: From November 2008 through December 2011, 50 consecutively diagnosed muscle invasive urinary bladder carcinoma (T2‑4a N0‑2, M0) patients were included in this retrospective study. All these patients received external beam RT to a median dose of 60 Gy (range 30‑66 Gy), and were not suitable for radical surgery due to patients’ preference or medical comorbidities. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to survival. RESULTS: Completion trans‑urethral resection of bladder tumor was done in 38 (76%) patients of the cohort and 47 (94%) had transitional cell carcinoma on histopathology. Clinical stage T2 was diagnosed in 40 (80%) patients. The median follow‑up for the entire cohort was 14 ± 8.9 months (range 1‑36 months). In conclusion, 24 patients (48%) were free of disease, 5 patients (10%) had residual disease, and 13 patients (26%) had died of disease. Two‑year and 3 year overall survival of intact bladder for the entire cohort was 58% and 43.6%, respectively. Cox regression modeling strongly suggested clinical stage (P = 0.01) and RT dose (P = 0.001) as being predictors for overall survival. CONCLUSION: RT shows reliable outcomes and excellent compliance in this advanced disease. Prescribing a higher RT dose could potentially correlate to better intact bladder control rates while maintaining good quality of life in selected patients.

Morphometry of myenteric neurons in stomach.

The wall of the gastrointestinal tract presents extensive plexuses of nerve fibres and neuronal cell bodies responsible for the modulation of the rhythmic gastrointestinal peristaltic activities, among other functions. One of the most developed ganglionated plexuses of the gastrointestinal tract is the Myenteric plexus located between the inner circular layer and outer longitudinal layer of the smooth muscle tunica. The musculature of fundus, body and pyloric parts of stomach are differently disposed and they perform different functions. Thus the present study was conducted to study the myenteric plexus of all parts of stomach by counting the number of collections of neurons, number of neurons in each collection, diameter and area of the neurons of the plexus. The stomach walls of 1 cm in size were taken from 5 cadavers of medical post mortem cases from Postgraduate Institute of Medical Sciences and Research, Chandigarh and were processed for paraffin sections. 5 and 10 micro thick sections were stained with haematoxylin and Eosin and examined under light microscope. Randomly selected sections were photomicrographed using digital camera and morphometrical analysis was done using Image-Pro Express software. Number of collections of neurons was maximum in fundus with an average of 4.521 and each collection on an average contain 5.27 neurons ranging from 1-31, while body had 3.292 collections containing 1-19 neurons (mean: 3.198), pylorus had 3.883 collections of neurons which contained 1-16 neurons (mean: 4.411). The neurons were classified as small, medium and large according to the size of the area of their cell bodies. In this way, 11.3% neurons were found to be small, 69.5% medium and 19.1% large in fundus, 8.7% small, 80.6% medium and 11.2% large in body and 11.1% small, 74.3% medium and 14.5% large in pylorus.

Horseshoe kidney--a case report.

The congenital anomalies of kidney are important as they may cause renal failure in middle age group. Horseshoe kidney is the most common fusion anomaly. It has been said to occur in every 400 births and is seen in approximately 1 out of 300 pyelographies. A horseshoe kidney was observed in a thirty-two year old male in the archives of the Department of Anatomy, PGIMER, Chandigarh. The kidney was placed at lower level as compared to its normal position. The lower poles were fused to form the isthmus opposite to the L4 vertebra. There was no extra renal anomaly. Relation of structures in hilum was normal on right side while on left side pelvis was anterior to vein and artery. The right and left renal arteries arose as usual as lateral branches of the aorta just below the level of superior mesenteric artery. Two accessory renal arteries originated from the ventral aspect of aorta just above the isthmus. Right kidney was drained by three renal veins directly into the inferior vena cava while the left kidney was drained by a renal vein which had three tributaries outside the hilum. The right kidney appeared normal under the light microscope while in the left kidney, glomeruli were decreased and glomerular space appeared more. Some of the glomeruli appeared atrophied and filled with eosinophilic material. The horseshoe kidney has been estimated to be occurring in 0.25% of the general population and is more common in men.

A reverse phase high performance liquid chromatography method for simultaneous estimation of melatonin, carbamazepine epoxide and carbamazepine simultaneously in serum.

Monitoring of plasma antiepileptic drugs is useful for better clinical management in epileptic patients, particularly in children. Carbamazepine (CBZ) is one of the commonly prescribed anticonvulsants. The active metabolite of carbamazepine-carbamazepine-10-11 epoxide (CBZ-Epo) also exhibits anticonvulsant effect. The pineal hormone, melatonin exerts an anticonvulsant effect in experimental seizure models and recently has also been used in cases of childhood epilepsy. To facilitate the simultaneous plasma estimation of carbamazepine, carbamazepine epoxide, and melatonin, a new HPLC method was developed. Waters millennium 2010 chromatography manager with a 515 HPLC pump and Waters 24879 dual absorbance UV detector was used. A 25 microlitre of sample and standards were injected, and chromatographic separation was achieved by Merck C18 reverse phase column particle size 5 micro, 250 mm x 4 mm. It was quantitated at UV light 210 nm. The retention times of melatonin, CBZ-Epo, and CBZ were 6.3 min, 7.5 min, and 13.9 min respectively. The Mobile Phase used was water: acetonitrile (70:30), pH 3.0 adjusted with orthophosphoric acid at the flow rate of 1 ml/min. The limits of detection of melatonin, carbamazepine epoxide, and carbamazepine were 800, 500, and 1300 pg respectively.

Osteoarthritic femoral articular cartilage of knee joint in man.

Osteoarthritis is the most common of the various articular disorders affecting man. The present study was conducted to observe the microstructure of osteoarthritic human femoral articular cartilage by light microscopy. Fifteen osteoarthritic cartilage specimens obtained from patients with primary osteoarthritis (52-80 years) undergoing total knee replacement were processed for paraffin sections. 5 m thick sections were observed under light microscope. The articular surface appeared to be very irregular and fibrillated in all the specimens. The cartilage did not show the normal zonation. Various changes seen were different in all specimens and they were not related to age. Most common feature of the osteoarthritic articular cartilage was the presence of large clusters of cells in 60.0% specimens. Detached parts of the degenerating cartilage were present in the joint cavity in the form of loose bodies. The collagen fibres appeared to be coarser and irregular even near the non-fibrillated areas. Numerous tangential, oblique and vertical splits were also observed. Osteoblastic and osteoclastic activity was seen in the subchondral bone and the osteolytic cyst appeared to invade the cartilage from the subchondral bone. Blood vessels from the subchondral bone were also seen invading the cartilage in 20.0% specimens. The various changes seen in the osteoarthritic cartilage could be an effort of cartilage repair but such attempts are severely counteracted by the osteoarthritic wear process.

Bilateral variant origin of pectoralis major.

The variable origin of muscles is not uncommon though the complete or partial absence of the clavicular head of pectoralis major muscle is rare. This paper deals with bilateral partial absence of clavicular head of pectoralis major muscle. The clavicular head was arising only in the middle of medial half of the clavicle and was separated from sternocostal head by a gap of 2.5cm and laterally from the origin of deltoid from clavicle by a gap of 2.5cm. Nerve supply of this muscle was from lateral and medial pectoral nerves as usual. The partial absence of the clavicular head of pectoralis major muscle becomes important in cases of reconstructive surgery as this head is required to cover the lateral acromioclavicular defect and in cases of established facial paralysis.

Post traumatic epilepsy: a review of scientific evidence.

Post traumatic epilepsy is the development of recurrent seizures following head trauma and has a high clinical relevance. Several risk factors including some genetic factors increase the susceptibility of post traumatic epilepsy. The precise mechanisms of epileptogenesis in post-traumatic epilepsy are still poorly understood. Many structural, physiologic and biochemical changes in the brain may account for epileptogenesis. The reactive oxygen species (ROS), especially *OH and excitotoxicity are primarily involved. Antioxidants, like tocopherol, antiepileptic drug zonisamide, condensed tannins, melatonin, adenosine, trans-resveratrol, and some other agents have been proposed to prevent epileptogenic focus formation. The review also discusses various aspects of post traumatic epilepsy, mechanisms of epileptogenesis, and clinical implications.

Modulation of serum concentrations of melatonin by carbamazepine and valproate.

Evidence has accumulated about the involvement of reactive oxygen species (ROS) in epilepsy. The neuromodulator melatonin has been shown to reduce oxidative stress in various animal models due to its free radical scavenging properties. The present study investigated whether carbamazepine and valproate alter serum concentrations of melatonin. Epileptic children were randomly assigned to receive carbamazepine/ valproate monotherapy till 22 patients were recruited in the study. At the tenth day, in the evening, samples were drawn for baseline endogenous melatonin estimation. The patients were then administered exogenous melatonin, and repeat samples were drawn after 30 minutes. Serum levels of melatonin were estimated using Melatonin ELISA kits. The median levels of melatonin were 165.0 pg/ml (Range 50.0-350.0) in CBZ+MEL group and 78.0 pg/ml (Range 13.0-260.0) in the VPA+MEL group. The observed difference in melatonin levels could be attributed to the difference in antiepileptic drugs, additive increase in reactive oxygen species due to disease combined with carbamazepine, or possibly to a difference in melatonin kinetics in conditions of oxidative stress.

Disposition of muscularis propria and nerve elements in the lip of the ileocaecal valve.

The presence of a valve and the concept of a functional sphincter at the ileocaecal junction have been debated in the literature. Twenty four specimens of ileocaecal organ complex including 10cm of ileum and colon were obtained from cadavers from the Departments of Anatomy and Pathology, PGIMER, Chandigarh. 5 micron thick longitudinal sections from the upper lip of the ileocaecal valve were stained with Hematoxylin and Eosin and Silver stain. Sections of the ileum and colon from 5 ileocaecal organ complexes were also prepared and similarly stained. All the sections were viewed under the light microscope. The muscle bundles constituting the muscularis propria in the ileocaecal valve were arranged in two rows and were tapering in size from the base to the apex. The disposition of the muscle fibres was not uniform in all the specimens. The muscle fibers could be traced up to the upper, middle and lower third of the valve in 8 (33.3%), 14 (58.3%) and 2 (8.3%) specimens respectively. Silver stain of these sections revealed large numbers of nerve elements distributed within the submucosa and muscularis propria. The density of nerve elements in the ileocaecal valve was similar in all the sections irrespective of the extent of the muscularis propria and was comparable to the density of nerve elements in the muscularis propria and submucosa of the ileum and colon. The present study shows that the ileocaecal valve has a well developed muscularis mucosa and a proportionate component of the nerve elements.

Variations in branching pattern, shape, size and relative distances of arteries arising from arch of aorta.

Hundred aortic arches were studied in adult cadavers (aged 40-70 years) for variations in the origin of branches at arch of aorta in situ and for observing the lumenal diameters and relative distances between the adjacent branches. Usually described three branches arising at arch of aorta were observed in 77.0% specimens. Two branches arising from arch of aorta, having different branching pattern were observed in 12.0%:--(i) BC trunk; left brachiocephalic which divided into right common carotid and right subclavian (ii) common origin of BC and LCC; LSC. (iii) common origin of BC and LCC; common origin of LSC and left vertebral. While, four branches were observed in 11.0% showing separate openings:--(i) BC; LCC; LV; LSC (ii) BC; thyroid ima; LCC; LSC (iii) BC, mediastinal; LCC; LSC. At the lumenal surface of the arch of aorta the lumenal openings showed a similar pattern corresponding to the arterial branches on the external surface. These openings were oval in shape in 90.0% with the mean maximum anteroposterior diameters being greater than the mean maximum side-to-side diameters (p < 0.001), while they were elliptical in 10.0%. The BC artery showed largest size followed by LSC and then LCC in most of the branching patterns (p< 0.001). The mean transverse distances between adjacent lumenal openings of these branches were significantly greater than the mean vertical distances (p < 0.001). Approximation of LCC to BC trunk was seen in 10.0% specimens. These observations may be important while invading the arch of aorta and its branches by instruments, as all areas are now susceptible to surgical attack.

Lipid peroxidation and antioxidant status in patients with diabetic retinopathy.

Non Insulin Dependent Diabetes Mellitus is responsible for 60% cases of retinopathy in the population and is one of the common cause of blindness. Oxidative stress as measured by the levels of malondialdehyde, superoxide dismutase (SOD), glutathione peroxidase (GPx) and vitamin C was measured in 50 normal controls, 40 diabetics without complications, 22 diabetics with proliferative and 20 with nonproliferative retinopathy respectively. Our finding suggests that lipid peroxidation increases (P < 0.001) with the increase in severity and duration of diabetes. Antioxidants SOD and vitamin C decrease with the progression of the disease, however GPx tends to increase in the later part of the disease.

Mother's use of medication in their children of preschool age.

Self medication by mothers influences the morbidity and mortality in children. The present study evaluates mothers' attitude and practices regarding use of medication in their preschool age children. 976 mothers having at least one child <6 years with history of illness in past 30 days were interviewed according to a predesigned questionnaire. Five hundred and seventy five (58.91%) used medication on their own, most commonly for cough & cold (23.9%). The commonest nonprescribed drugs used were analgesics--antipyretics (34.9%). Inspite of the nonresponse, shortage of money and availability of the drugs without prescription has encouraged self medication. These findings necessitates mothers' education and enforcement of law against selling of non-prescribed drugs.

Bilaterally anomalous formation and distribution of posterior cord of brachial plexus.

Posterior cord (PC) is formed by the union of posterior divisions of upper, middle and lower trunks. During routine dissection variations in the formation and distribution of PC and its branches were observed on both the sides. These variations were: i) prefixed brachial plexus on left side ii) PC on both the sides was formed by the union of posterior divisions of only the upper (C5, 6) and middle (C7) trunks while the posterior division of lower (C8, T1) trunk joined the radial nerve directly and also gave contribution by two roots to left thoracodorsal nerve iii) length of PC varied on both the sides; on right side it was 4cm while on left side it was 1.5cm long. iv) upper subscapular nerve on right side arose from PC far proximal to other branches and on its course communicated with lower subscapular nerve before distributing to subscapularis while on left side it arose from posterior division of the upper trunk (C5, 6) only. v) on left side nerve to teres minor arose directly from axillary nerve trunk instead of arising from its posterior branch. The axillary nerve on both the sides divided into terminal branches before entering the quadrangular space of arm instead after traversing the quadrangular space. vi) the branches of radial nerve, which normally arise in the radial groove, arose in the axilla on both the sides. So in cases of trauma or injury of arm some of these branches may be spared.

Bilateral sternales in relation to body of sternum.

The sternalis muscle on the manubrium sterni and its communication with sternocleidomastoid has been reported by many workers as unilateral or bilateral in both the sexes. The present report deals with bilateral sternales below the angle of sternum in a male cadaver during routine dissection. The proximal attachment of the muscle was from the manubriosternal joint on either side, right being broader than left and was found to be overlapping the lateral part of sternum and adjoining pectoralis major muscle. The muscle was running downwards and laterally and was attached on the cartilage of 6th and 7th ribs appearing to be continuous with rectus abdominis muscle. The muscle was found to be innervated by branches of the corresponding intercostal nerves of these spaces. The sternalis if present could be used for reconstructive surgical operations on the breast.

Pharmacoeconomics.

Pharmacoeconomics focuses on the costs and benefits of drug therapy and pharmacoeconomic evaluations provide a basis for resource allocation and utilization. It is increasingly becoming important for health policy decision-making. A pharmacoeconomic evaluation may be conducted as an economic assessment incorporated into clinical trials. Such trials should compare the new drug/procedure with an older drug or existing intervention. Four techniques are used for economic evaluation, namely, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The choice of the evaluation method depends on the nature of outcomes and the context in which the choices need to be made. Pharmacoeconomics is a young science that will improve with application. Its need is undeniable, especially in developing countries.