A Study of Thyroid Profile and Lipid Profile in Patients with Chronic Kidney Disease with or without Hemodialysis in a Tertiary Care Hospital

Background: Chronic kidney disease (CKD), due to increasing frequency and prevalence, has become one of the leading public health issues. The Kidney Disease Outcome Quality Initiative (KDOQI) defines CKD as kidney injury or a reduction in the glomerular filtration rate (GFR) to <60 mL/minute/1.73 m2 for at least 3 months. This study aims to compare the effects of decreased renal function on thyroid profile and lipid profile in CKD patients. Materials and methods: This is a prospective cross-sectional observational study conducted among the patients attending Outpatient Department/Inpatient Department (OPD/IPD) at the School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, in known cases of CKD, irrespective of the treatment/stage of CKD. All patients of >18 years of age with CKD were included in the study. Result: A total of 200 patients who met the inclusion criteria were included after obtaining detailed informed consent, of which 100 were cases and 100 were controls. The mean age of patients in the study was 47.74 years, with the mean age in patients with CKD 52 years, and the control was 43 years. The mean level of triglycerides (TGs) was significantly higher among the cases, and the high-density lipoprotein (HDL) was significantly lower among cases compared to controls (p < 0.05). Pearson’s correlation between thyroid-stimulating hormone (TSH) with creatinine showed a weak albeit significant positive association (r = 0.200; p < 0.05). Conclusion: Our study shows a higher incidence of alteration in thyroid profile and dyslipidemia among the patients with CKD compared to controls. There is a necessary need to screen routinely for hypothyroidism and dyslipidemia among patients with CKD. Importantly, thyroid hormone levels and their effects on the progression of CKD have not been studied exhaustively.

Enlightenment from the reproductive medicine center summer internship program in Cleve-land Clinic / 中华医学教育探索杂志

The Summer internship program has been successfully carried out in the Center for Reproductive Medicine in Cleveland Clinic for six years (from 2008 to 2013). This program includes lecture, essay writing and experimental research. Until this year, this program has trained 109 stu-dents from United States and all over the world. The students have published 78 articles in SCI jour-nals. This program has a good reputation in the international reproductive medicine education area. The program provides students strong backgrounds of an internship experience, which is helpful to the students when they apply for high level medical school and residency qualification. At present, the students in China have a strong and urgent demand for the similar programs. Some high level medical schools of our country have the personnel and equipment base to carry out these programs. Medical schools can carry out similar programs in our country by using the organization and implementation experiences of Cleveland Clinic to provide high-level Chinese medical students with practice experi-ence out of the course education.

Overview of benign and malignant tumours of female genital tract.

Female genital tract is most common site for tumours in females. The most common type of female genital tract cancers are – cervical, ovarian and endometrial carcinoma. There are other less common tumours including tumours of vagina, vulva and fallopian tubes. The Uterine corpus represents the second most common site for malignancy of the female genital systems. Cervical carcinoma is the second most common cancer in women worldwide. Tumours of the ovary represent about 30% of all cancers of female genital tract. Cancer of the vagina is relatively rare, accounting for about 1%- 2% of gynaecological malignancies. Tumours of the fallopian tube are much less common than the corresponding ovarian neoplasms. In view of major importance of the subject, this review study was undertaken to understand the topic in a better prospective.

A comprehensive review of genetics and genetic testing in azoospermia

Azoospermia due to obstructive and non-obstructive mechanisms is a common manifestation of male infertility accounting for 10-15% of such cases. Known genetic factors are responsible for approximately 1/3 of cases of azoospermia. Nonetheless, at least 40% of cases are currently categorized as idiopathic and may be linked to unknown genetic abnormalities. It is recommended that various genetic screening tests are performed in azoospermic men, given that their results may play vital role in not only identifying the etiology but also in preventing the iatrogenic transmission of genetic defects to offspring via advanced assisted conception techniques. In the present review, we examine the current genetic information associated with azoospermia based on results from search engines, such as PUBMED, OVID, SCIENCE DIRECT and SCOPUS. We also present a critical appraisal of use of genetic testing in this subset of infertile patients.

An update on sperm retrieval techniques for azoospermic males

The use of non-ejaculated sperm coupled with intracytoplasmic sperm injection has become a globally established procedure for couples with azoospermic male partners who wish to have biological offspring. Surgical methods have been developed to retrieve spermatozoa from the epididymides and the testes of such patients. This article reviews the methods currently available for sperm acquisition in azoospermia, with a particular focus on the perioperative, anesthetic and technical aspects of these procedures. A critical analysis of the advantages and disadvantages of these sperm retrieval methods is provided, including the authors' methods of choice and anesthesia preferences.

Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review

We compared pregnancy outcomes following intracytoplasmic sperm injection for the treatment of male infertility according to the type of azoospermia. First, we analyzed our data from 370 couples who underwent intracytoplasmic sperm injection using sperm from men with obstructive azoospermia and nonobstructive azoospermia, and the outcomes were compared to a group of 465 non-azoospermic infertile males. Then, we performed a systematic review of the published data on pregnancy and neonatal outcomes of children born after sperm injection using sperm from men with obstructive and nonobstructive azoospermia. Live birth rates were significantly lower in the nonobstructive azoospermia group (21.4%) compared with the obstructive azoospermia (37.5%) and ejaculated sperm (32.3%) groups. A total of 326 live births resulted in 427 babies born. Differences were not observed between the groups in gestational age, preterm birth, birth weight and low birth weight, although we noted a tendency towards poorer neonatal outcomes in the azoospermia categories. The overall perinatal death and malformation rates were 2.8% and 1.6%, respectively, and the results did not differ between the groups. We identified 20 published studies that directly compared pregnancy outcomes between obstructive azoospermia and nonobstructive azoospermia. Most of these studies were not designed to detect differences in live birth rates and had lower power to detect differences in less frequent outcomes, and the reporting of neonatal outcomes was unusual. The included studies reported either a decrease or no difference in pregnancy outcomes with intracytoplasmic sperm injection in cases of nonobstructive azoospermia and obstructive azoospermia. In general, no major differences were noted in short-term neonatal outcomes and congenital malformation rates between children from fathers with nonobstructive azoospermia and obstructive azoospermia.

Minimal and mild endometriosis negatively impact on pregnancy outcome / Endometriose mínima e leve e seu impacto negativo sobre a gravidez

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

RESUMO O objetivo desta revisão sistemática é apresentar estudos sobre a associação entre as taxas de gravidez e a presença de fases iniciais de endometriose. Estudos relacionados com a infertilidade e estágios mínimos e leves (estágios I,II, American Society of Reproductive Medicine [ASRM]) foram identificados por busca na base de dados MEDLINE, de 1985 a setembro de 2011. Os seguintes termos foram usados como palavras-chave: endometriose, infertilidade, taxa de gravidez; estágio mínimo; estágio leve de endometriose. Entre janeiro de 1985 e novembro de 2011, 1188 artigos foram recuperados; com base no título, 1038 citações foram excluídas e, finalmente, depois de critérios de inclusão e exclusão, 18 artigos foram selecionados para fazer parte desta revisão sistemática. Várias razões têm sido discutidas na literatura na tentativa de explicar o impacto da endometriose mínima no resultado da fertilidade, tais como: disfunção ovulatória, foliculogênese alterada prejudicada, defeito na implantação, baixa qualidade embrionária, ambiente peritoneal inflamatório e hostil e problemas da fase lútea. Apesar de toda polêmica envolvendo o tópico, o maior ensaio clínico randomizado foi publicado por Marcoux et al. Os autores encontraram uma taxa de gravidez estatisticamente significante após a ressecção de lesões superficiais de endometriose. Estágios iniciais de endometriose desempenham um papel crítico relacionado à infertilidade e, provavelmente proporcionam um impacto negativo nas taxas de gravidez em pacientes com endometriose. Outros estudos envolvendo estágios iniciais de endometriose, especialmente ensaios clínicos randomizados, ainda precisam ser realizados.

Unexplained Male infertility: diagnosis and Management

Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. In addition to erectile problems and coital factors, immunologic causes and sperm dysfunction may contribute to such condition. New etiologies of unexplained male infertility include low level leukocytospermia and mitochondrial DNA polymerase gene polymorphism. Contemporary andrology may reveal cellular and sub-cellular sperm dysfunctions which may explain subfertility in such cases, thus aiding the clinician to direct the further work-up, diagnosis and counseling of the infertile male. The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. Extensive literature review was performed using the search engines: Pubmed, Science-direct, Ovid and Scopus.

Nutritional Anemia in the Medical Students.

Background: Nutritional anaemia is very much prevalent and largely undiagnosed among students in Professional Institutes. Various socio-demographic characteristics like age, sex, social class, dietary habits, and infections are the etiological factors for nutritional anaemia. Objectives: To study the nutritional anaemia and its correlates among the MBBS. Medical Students of Rohilkhand Medical College and Hospital, Bareilly in Western U.P. Materials and Methods: The study was done on 100 MBBS students. Haemoglobin estimation was performed by Sahli’s Haemoglobinometer and observations were interpreted as per the WHO criteria. The data was analyzed by SPSS Statistical software. Results: In the present study on 100 Medical students, 32.0% students were anaemic, out of which 44.0% were girls and 20.0% boys. 25.0% students had mild anaemia. Majority (81.8%) of anaemic students were undernourished as per their Body Mass Index. Conclusions: Haemoglobin estimation of students at the time of entrance to Medical Colleges should be done. Iron and folic acid tablets and deworming drugs in therapeutic doses should be provided to anaemic students. The students should be motivated and educated to take balanced diet, rich in green leafy vegetables and fruits as nutritional anaemia is totally preventable.

Prevalence and determinants of anemia in pregnancy at private hospital of Bareilly District.

Back ground: Anemia in pregnancy continues to be the major public health problem in the world & is the commonest medical disorder in pregnancy that has a varied prevalence, etiology and degree of severity in different populations. Objective: To find out the prevalence of anemia amongst pregnant women and socio-demographic factors associated with anemia in pregnancy. Methods: The present cross sectional study was carried out in obstetric and gynae OPD of one of the private hospital of Bareilly district during the month of Jan.2010 to May2010. Chi square test was applied for statistical analysis. Results: prevalence of anemia was 43.38% Anemia was found to be more prevalent in women age more than 30 years (80.39%), illiterate (49.53%), working (83.82%) & those belonging to Muslim community. Multiparous women (45%), women with poor personal hygiene (48%) and non-vegetarian diet were slightly more anemic as compare to their contrary one. Conclusion: Despite the measures taken to control anemia in pregnancy in the last two decades, the severity of nutritional anemia continues to remain a public health issue of great magnitude, suggesting that these measures have been largely ineffective.

Sperm retrieval techniques for assisted reproduction

Different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE have been developed to retrieve spermatozoa from either the epididymis or the testis according to the type of azoospermia, i.e., obstructive or non-obstructive. Laboratory techniques are used to remove contaminants, cellular debris, and red blood cells following collection of the epididymal fluid or testicular tissue. Surgically-retrieved spermatozoa may be used for intracytoplasmic sperm injection (ICSI) and/or cryopreservation. In this article, we review the surgical procedures for retrieving spermatozoa from both the epididymis and the testicle and provide technical details of the commonly used methods. A critical analysis of the advantages and limitations of the current surgical methods to retrieve sperm from males with obstructive and non-obstructive azoospermia is presented along with an overview of the laboratory techniques routinely used to process surgically-retrieved sperm. Lastly, we summarize the results from the current literature of sperm retrieval, as well as the clinical outcome of ICSI in the clinical scenario of obstructive and non-obstructive azoospermia.

Cell phones and male infertility: a review of recent innovations in technology and consequences

Cell phones have become a vital part of everyday life. However, the health risks associated with their usage are often overlooked. Recently, evidence from several studies supports a growing claim that cell phone usage may have a detrimental effect on sperm parameters leading to decreased male fertility. Nonetheless, other studies showed no conclusive link between male infertility and cell phone usage. The ambiguity of such results is attributed to the lack of a centralized assay for measuring inflicted damage caused by cell phones. Study design, ethics, and reproducibility are all aspects which must be standardized before any conclusions can be made.

Caesarean myomectomy: Prospective study.

Introduction: Contrary to previous belief many studies published now have shown that myomectomy during cesarean section (CS) is a safe procedure with no significant increased risk of intra and postoperative complications. Methods: This prospective study was carried out in antennal mothers from May09 to Sep 10 in a tertiary care hospital of Uttar Pradesh after taking institutional ethical committee approval. Diagnosis of myoma was confirmed by ultrsonography. Only those mothers were included in the study who gave the informed consent to participate in study. Cesarean myomectomy was planned in all mothers having myoma. Operative time, intraoperative haemorrhage and length of hospital stay of mothers having myoma were compared to matched pregnant women with CS alone (28cases). Data were collected on a questionnaire and analyzed by appropriate test of significance. Results: Out of 966 antenatal mothers registered during the study period myoma was detected in 14(1.18%) cases. Mean age mothers of having myoma were 27.08 years and 61.54% were primigravida and only 23.08 % were third gravida. In 61.54% mother’s parity was zero and only 15.39 % mothers were having parity two. Mean haemoglobin was 10.56 gm%. In all cases presentation of foetus was vertex. In 92.3% mothers location of myoma was at anterior wall and subserous and in 7.7% cases it was fundal . Size of myoma was less than 3.0 Cm in 38.50 cases , 3.1 Cm to 5.0 Cm in 23.1% cases and more than 5.1 Cm in 38.4% cases. There was no significant difference in operative time, intraoperative haemorrhage and length of hospital stay in comparison to matched pregnant women with CS alone. Postnatal period was uneventful and complication like PPH was nil in all in cesarean myomectomy cases. Conclusion: caesarean myomectomy can be safely performed in majority of patients with myomas without any serious or life threatening complication.

Novel concepts in male infertility

Extraordinary advances have been achieved in the field of male infertility in the last decades. There are new concepts in sperm physiology and several modern tools for the assessment of spermatogenesis kinetics in vivo. New tests using molecular biology and DNA damage assays allow the clinician to correctly diagnose men so far classified as having idiopathic male infertility. In the field of treatment, microsurgery has increased success rates either for reconstruction of the reproductive tract or the retrieval of spermatozoa for assisted conception. Emerging evidence suggests that life-style and environmental conditions are of utmost importance in male fertility and subfertility. This review discusses several concepts that have changed over the last years, such as the duration of the spermatogenic cycle in humans, Y-chromosome infertility, the reproductive potential of non-mosaic Klinefelter syndrome men, the impact of paternal age and sperm DNA in male infertility, the role of antioxidants in the treatment of infertile men, the predictive factors and techniques for sperm retrieval in non-obstructive azoospermia, and the microsurgical treatment of clinical varicoceles. Whenever possible, levels of evidence are provided as suggested by the Oxford Center of Evidence-based Medicine.

Humor as a learning aid in medical education.

Attention span in a lecture is roughly 15 minutes. After this has been seen that no. of students paying attention begins to drop dramatically leading to loss in retention of lecture material. Objective of present study was to examine the effectiveness of humor when used as an intervention. The present Interventional, Randomized control trial study was carried out on medical students of fourth Semester, of RMCH, Bareilly, which has total ninety students. Class was divided into two groups, Group A and Group B by simple random sampling using lottery method, consisting of 45 students each. For both groups four lectures each were delivered on same topic, with a difference that in group A no intervention used while in group B humor was used as an intervention. Record of class attendance was maintained in both the groups and post lecture tests were conducted. Chi-Square test was applied for statistical analysis. In group B not only the attendance of students increased from class 1 to class 4 but was also more as compared to group A in each class and the difference was found to be statistically significant . Post lecture test scores showed that in group A there was no significant difference in marks obtained by students in class 1 and class 4, however in group B in which humor was used it was observed that in class 4 percentage of students getting marks above 50% increased as compared to class 1. We concluded that humor not only increases interest but also promotes learning.

An update on the clinical assessment of the infertile male

Male infertility is directly or indirectly responsible for 60 percent of cases involving reproductive-age couples with fertility-related issues. Nevertheless, the evaluation of male infertility is often underestimated or postponed. A coordinated evaluation of the infertile male using standardized procedures improves both diagnostic precision and the results of subsequent management in terms of effectiveness, risk and costs. Recent advances in assisted reproductive techniques (ART) have made it possible to identify and overcome previously untreatable causes of male infertility. To properly utilize the available techniques and improve clinical results, it is of the utmost importance that patients are adequately diagnosed and evaluated. Ideally, this initial assessment should also be affordable and accessible. We describe the main aspects of male infertility evaluation in a practical manner to provide information on the judicious use of available diagnostic tools and to better determine the etiology of the most adequate treatment for the existing condition.

Surgical treatment of male infertility in the era of intracytoplasmic sperm injection - new insights

Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility.

Is male infertility a forerunner to cancer?

PURPOSE: The frequency of testicular cancer and male infertility has been increasing in the past several decades. This article examines the relationship between male infertility and testicular cancer, concentrating particularly on causal links. RESULTS: Both of these disorders are associated with testicular dysgenesis syndrome and have also been traced to mutations in genes involving DNA repair and tumor suppression, as well as environmental exposure. CONCLUSION: The identification and examination of these common points of origin supports the integration of testicular cancer screenings into the routine evaluation of infertile men.

Awareness, perception and myths towards swine flu in school children of Bareilly, Uttar Pradesh.

The deadly disease swine flu is, without a speck of doubt, causing a massive havoc among the common people of India and has created fear across the various strata of the society. The objective was to find out the awareness, perception, and myths of school going children of class 9 th to 12 th toward swine flu. The present cross-sectional study was carried out in two randomly selected (using random number table) senior secondary schools of Bareilly among 400 students of class 9 th to 12 th . A total of 200 students were selected from each school. Chi-square test was applied for statistical analysis. Almost all the students (97.75%) have heard about of swine flu and are aware of it as a disease entity. Fever was found to be the main symptom while coughing and sneezing were main way of spread of swine flu known to them. About 97% of the students mention use of mask as most effective way to prevent them from swine flu. Knowledge of availability of medicine was present in less than half of the students. TV was found to be the main source from which they get knowledge (79%), and they are trying to get knowledge (53.2%) of swine flu. Among them, 74% students were taking precaution against swine flu.

Free radicals: Their beneficial and detrimental effects on sperm function.

Free radicals are molecules with one or more unpaired electron(s) commonly found in seminal plasma. Physiologically, free radicals control sperm maturation, capacitation and hyperactivation, the acrosome reaction, and sperm-oocyte fusion. Pathologically, free radicals induce lipid peroxidation, DNA damage and apoptosis of spermatozoa. The present review deals with both the beneficial and detrimental effects of free radicals on sperm function.