An appraisal of microbiological spectrum in Acne Vulgaris from a tertiary care teaching institution.

Background: Acne vulgaris is one of the most common skin disorders in puberty. The widespread and indiscriminate use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. Aim: The study aimed to analyze the microbiological spectrum in acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Dermatology, MSDS Medical College, Fatehgarh among the patients seeking care for acne vulgaris with pustular and nodulocystic skin lesions in the Dermatology OPD of a rural medical school from western Uttar Pradesh. Patients with pregnancy or endocrinal problems like hirsutism, menstrual dysfunction or adrenal dysfunction and those taking drugs or contraceptives were excluded. The samples were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2-7 days . Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Aerobically, Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acne and Micrococcus spp were detected in 44%, 47%, 1% and 46% of samples respectively whereas anaerobically these were 39%, 21%, 34% and 1% respectively. Propionibacterium acne Staphylococcus epidermidis and Staphylococcus aureus were more sensitive to rifampin (almost 90%) compared to other drugs. Neomycin was found to be least sensitive. Conclusion: The study highlighted the need to discourage antibiotics' abuse. Rifampin is a suitable antibiotic for acne patients, but to achieve a better result, combination of rifampin with other antibiotics should be tried. It is also suggested that studies with bigger sample size on evaluation acne vulgaris treated by rifampin should be undertaken.

An evaluation of bacteriological quality of drinking water from the catchment area of a tertiary care teaching hospital.

Background: It is well-appreciated that many communities in developing countries face severe public-health problems relating to drinking-water. The supply of safe water is important to protect the health of the community people. Aim: The study aimed to evaluate the bacteriological quality of drinking water from various active sources of water utilized in the catchment area of a tertiary care teaching hospital. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Community Medicine, MSDS Medical College, Fatehgarh during 2013-14. Randomly selected 100 active water sources which were being used for drinking purpose and a fairly good number of people using that water source for drinking purpose were included in the study. National Environmental Engineering Research Institute (NEERI) guidelines for drinking water quality assessment were adopted. Culture and bacteriological tests of drinking water were performed as per standard protocols. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Out of one hundred water samples collected, fifty one, twenty seven and twenty two samples of water were collected from municipal tap water, government hand pump and water cooler respectively. Almost half of the samples were found to be unsatisfactory. E. coli was found to be responsible for 26% of samples whereas Pseudomonas in 20% of collected samples. E. coli and Klebsiella tested positive with Methyl Red whereas Pseudomonas sp. and Klebsiella tested positive with Citrate test reagent. E. coli showed positive result with Indole reagent whereas Klebsiella tested positive with Urease. Regarding mix population organisms, Escherichia coli, Klebsiella Sp. and Pseudomonas Sp. were found to be positive in 3 samples whereas Klebsiella Sp. and Pseudomonas Sp. were found to be positive only in 1 sample Conclusion: The study highlighted unsafe nature of current active sources in the study area with regard to drinking water purpose which are not fit for consumption of water. Surveillance of water sources and regular bacteriological assessment of all water sources for drinking is recommended on regular basis.

Clinical study of otological manifestations among children with cleft palate from a tertiary care teaching hospital.

Background: Despite having a well documented relationship of cleft palate with middle ear effusion, little data exists regarding otopathology in Indian children with cleft palate. Objectives: Therefore, the present study was planned with an objective to determine the various otological manifestations that occur in patients with cleft palates seeking care at a tertiary care teaching hospital. Material and methods: The present study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of northern India during June 2012 to May 2014 among 30 cases of cleft palate. On the first visit, history and thorough clinical examination are undertaken. Next, common and special investigations are undertaken to evaluate and assess the status of disease. X-ray mastoids, Pure tone audiometry and Tympanometry were also carried out. Results: The ears are found affected in 86.7%, 60.1% ears had an intact but dull tympanic membrane whereas 16.7% ears had CSOM with a central perforation. On pure tone audiogram (n=18) 33.33% had a hearing loss in one ear and 44.44% had a hearing loss in both ears in the form of a mild or moderate degree of conductive deafness. On tympanogram, 23.3% had an ‘A’ type of tympanogram whereas 44 ears had a `B’ type of tympanogram indicative of recurrent effusions in the middle ear. Majority from this sub-group >80% had associated conductive hearing loss-mild to moderate degrees. Conclusion: Cleft palate individuals should always be evaluated for possible otological manifestations.

The effect of a healthy lifestyle program on the elderly's health in Arak.

Background: Increasing life-expectancy and decreasing birth rate have led to an increase in the elderly population worldwide so that the aging population is considered one of the biggest public health concerns in the present century which demands more attention to this vulnerable group. Therefore, the present study was done to determine the effect of a healthy lifestyle program on elderly's health in Arak. Materials and Methods: This quasi-experimental intervention study was carried out on 60 elderly citizens of Arak. The participants attended four instructional classes on nutrition, exercise, sleep hygiene, life skills, and personal hygiene over one month and they were followed for three months after the intervention. Data were collected through standard quality of life questionnaire (SF-36) and Katz standard ADLs in the elderly questionnaire before and three months after the completion of the study .Results: The average age of the participants was 67.61 ± 5.02 years. In terms of gender, the majority of the participants (60%) were male. In terms of quality of life before the instructional intervention, 13.3% of the participants were in low level, 30% in average level, 41.7% in good level, and 15% in the high level of quality of life. However, after the intervention, the majority of the participants were in good (38.3%) and high (45%) levels of quality of life which showed significant differences before and after the instructional intervention (P < 0.001). Moreover, there was a significant difference between Katz ADLs in the elderly before and after the intervention (P < 0.001). Conclusion: The comparison between the quality of life and ADLs in the elderly before and after the intervention showed that continuing instruction for the elderly based on a regular healthy lifestyle program is effective and holding different instructional classes for this population, that is often ignored, seems necessary. The findings of this study can help design proper instructional guidelines on healthy lifestyle in the elderly.

Comet assay: A prognostic tool for DNA integrity assessment in infertile men opting for assisted reproduction.

Background & objectives: The growing concern on transmission of genetic diseases in assisted reproduction technique (ART) and the lacunae in the conventional semen analysis to accurately predict the semen quality has led to the need for new techniques to identify the best quality sperm that can be used in assisted procreation techniques. This study analyzes the sperm parameters in the context of DNA damage in cytogenetically normal, AZF non deleted infertile men for DNA damage by comet assay. Methods: Seventy infertile men and 40 fertile controls were evaluated for the semen quality by conventional semen parameters and the sperms were also analyzed for DNA integrity by comet assay. The patients were classified into oligozoospermic (O), asthenozoospermic (A), teratozoospermic (T), oligoasthenoteratozoospermic (OAT) categories and infertile men with normal semen profile. The extent of DNA damage was assessed by visual scoring method of comets. Results: Idiopathic infertile men with normal semen profile (n=18) according to conventional method and patients with history of spontaneous abortions and normal semen profile (n=10) had high degree of DNA damage (29 and 47% respectively) as compared to fertile controls (7%). The O, A, T and OAT categories of patients had a variably higher DNA damage load as compared to fertile controls. Interpretation & conclusions: The normal range and threshold for DNA damage as a predictor of male fertility potential and technique which could assess the sperm DNA damage are necessary to lower the trauma of couples experiencing recurrent spontaneous abortion or failure in ART.

Antioxidant levels in blood and seminal plasma and their impact on sperm parameters in infertile men.

Excess reactive oxygen species (ROS) beyond the scavenging capacity of antioxidants leads to DNA damage and oxidation of lipoprotein components at the cellular and subcellular level. The oxidative stress (OS) adversely affects sperm function by altering membrane fluidity, permeability and impairs sperm functional competence. In the present study, the OS status in seminal plasma and blood serum in infertile men and its relationship with spermatozoa parameters have been investigated. Four groups of infertile men viz., oligozoospermic (n = 15), asthenozoospermic (n = 17), teratozoospermic (n = 19), and oligoasthenoteratozoospermic (n = 9), and healthy fertile controls (n = 40) have been analyzed for superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA) in seminal plasma and blood serum. Significant correlation between blood serum SOD and sperm count has been observed in patients (p = 0.018) and controls (p = 0.021). Similarly, significant correlation between blood serum GSH and sperm progressive motility in patients (p = 0.036) and controls (p = 0.029) is observed. The low seminal MDA is associated with increase in sperm progressive motility in patients (p = 0.039) and controls (p = 0.028). Positive correlation is found between increased seminal MDA levels and abnormal sperm morphology in both patients and controls (r = 0.523, p = 0.029; r = 0.612, p = 0.034 respectively). Correlations between blood SOD and sperm count and between blood GSH levels and progressive motility suggest that these can be important biochemical markers in assaying the sperm count and motility. A negative correlation of motility with seminal MDA indicates that sperm membrane lipid peroxidation affects the fluidity and thus mobility of sperm axoneme. This affects functional competence of the sperm and acts like a biological safeguard. The results of the present study suggest the prospects of using the blood serum and seminal plasma antioxidants as a valuable tool to evaluate the sperm reproductive capacity and functional competence.

Role of reactive oxygen species in the pathogenesis of mitochondrial DNA (mtDNA) mutations in male infertility.

Infertility affects about 15 per cent married couples half of which may be attributed to men with low sperm motility (asthenozoospermia), low sperm count (oligozoospermia) or abnormal sperm morphology (teratozoospermia). As mitochondria are the energy source for initiation, differentiation and function of the germ cells, mutation in mitochondrial genome can impair the formation of mature spermatozoa. Mutations in mitochondrial genome are identified in patients with fertility problems. However, mitochondria are also both the source and target of reactive oxygen species (ROS). ROS are normally generated at low levels by human spermatozoa in order to perform its physiological function. However, if the generation of these reactive free radicals overwhelm the antioxidant defense system, this can lead to oxidative stress, which is characterized by mitochondrial and nuclear genome damage. So both ROS and mtDNA mutations are considered to be the major aetiological factors in a variety of human diseases including male infertility. Identification of novel mutations in mtDNA of infertile patients with supraphysiological levels of ROS are considered to be important to gain better understanding of the aetiology of idiopathic infertility. Early detection and prompt antioxidant therapy can prevent ROS induced DNA damage. This has far reaching impact if such men opt for assisted reproductive technology (ART)/in vitro fertilization.

[Effects of age, gender, body composition on cardio respiratory fitness in students aged 8-11 years using the FFMI-FMI regression model]

Age, gender, body composition and genetic background affect cardio respiratory fitness. In children, the variability of physiological responses to exercise yield different interpretations of the effective parameters. The aim of the present study was to investigate the effect of age, gender, body composition on cardio respiratory fitness of students of Semnan city aged 8-11 years, using the FFMI-FMI regression model. This cross-sectional study was performed on 685 students [347 boys and 338 girls]. Subjects were selected via a multi-level cluster sampling. After adjustment for differences in age, gender and body mass using the FFMI-FMI regression model, i.e. Fat free mass index [FFMI], [dividing fat free mass to squared stature] was predicted by fat mass index [FMI] [dividing fat mass to squared stature] subjects were categorized into 3 groups: The Normal, the Solid [higher than normal FFM group] and the Slender [lower than normal FFM group]. The 20 m Shuttle run test used to estimate maximal oxygen uptake [VO[2] max] as an index of cardio respiratory fitness, expressed in absolute values. There was a positive significant association between age and VO[2] max [P<0.05]. The solid group had higher values, while the slender group had lower values in VO[2]max. Boys had better cardio respiratory fitness than girls in. There are significant direct positive associations between age and body composition and VO[2] max

Evaluation of nuclear DNA damage in human spermatozoa in men opting for assisted reproduction.

Diagnosis of sperm DNA integrity of semen sample is important for consistently high reproductive efficiency. The conventional parameters of semen analysis take into account morphology, motility, and concentration of spermatozoa in the sample, which are insufficient for evaluation of reproductive potential. Current studies have implicated abnormal organization of genomic material in sperms as a probable cause in 20 per cent cases of male infertility. This is especially important in the era of assisted reproduction technique (ART) when a majority of infertile couples opt for assisted reproduction and in where cases DNA integrity is a better diagnostic and prognostic marker as compared to routine semen analysis. This article reviews and discusses some of the current techniques employed for evaluating chromatin structure or DNA damage in spermatozoa. These different techniques include single cell gel electrophoresis (COMET assay), Terminal tranferase dUTP Nick End Labelling (TUNEL), sperm chromatin structure assay (SCSA), In situ nick translation (ISNT) and acridine orange test. These techniques are independent measure of sperm quality and assist in semen quality assessment by detecting defects in DNA integrity or chromatin structure. The discussed techniques vary in their level of accuracy, cost input, sophistication of analysis and their application depends upon the sensitivity required for analysis. The article also briefly outlines the DNA packaging and the causes of DNA damage in spermatozoa. During chromatin packing 85 per cent of the histones are replaced by protamine while the residual histones act as marker of genes which are expressed in early embryonic development. Among the different aetiological factors observed to be responsible for DNA damage in human spermatozoa increased reactive oxygen species (ROS), oxidative stress is highly correlated with greater DNA fragmentation index (DFI). Oxidative stress leads to single and double strand breaks in sperm DNA. Apoptosis and abnormal chromatin packing also contribute to DNA damage. The significance of chromatin structure studies is more stressed owing to the greater awareness to transmission of genetic diseases because of higher incidence of gene imprinting defects, increased cancer frequency and other congenital and non-congenital defects in children conceived through assisted reproduction techniques.

Necessity of nuclear and mitochondrial genome analysis prior to assisted reproductive techniques/intracytoplasmic sperm injection.

Assisted reproductive technique (ART) has revolutionized the management of severe male factor infertility and in some countries 5% babies are conceived through ART/intra cytoplasmic sperm injection (ICSI). However, the carry-home live birth rate after several ART cycles is low (18-25%) and this is financially, physically and emotionally crippling for the couples. Genetic factors could lead to pre or post-implantation failure and thus explain for low ART success rate. Thus, this study was planned to understand, if infertile men harbour genetic abnormalities which may be iatrogenically transmitted by ART and adversely affect growth potential of embryo. Ninety infertile men underwent semen, cytogenetic, Yq microdeletion and mitochondrial mutation analysis. Of these, 14.4% cases harboured cytogenetic abnormality, and 8.89% Yq microdeletions. A high frequency of mitochondrial mutations was found in 23 men with asthenospermia. It is important to understand that through ART genetic abnormalities are transmitted to offspring, resulting in impaired growth and development potential of embryo and poor take-home live birth rate. Thus, genetic analysis is strongly recommend in all men with idiopathic infertility who opt for ART to counsel couples and provide them with most adapted therapeutics.

Azoospermia factor deletions in varicocele cases with severe oligozoospermia.

BACKGROUND: Varicocele is the most common cause of male infertility. The etiology and pathophysiology of varicocele are multifactorial. When low sperm counts are associated with varicocele, varicocelectomy can partially restore spermatogenesis and fertility. Few recent studies have reported that in some varicocele cases, there may be an associated genetic etiology. Presence of a genetic factor like azoospermia factor microdeletions may lead to irreversible spermatogenic arrest in these cases, but very few reports support these findings. However, it is still not understood why some cases improve after varicocelectomy and why some cases show no improvement in semen parameters postoperatively. AIM: It is important to distinguish varicocele cases from Yq microdeletions as these cases have irreversible testicular damage and thus carry a poor prognosis after varicocelectomy. SETTINGS: Research and Referral tertiary care hospital. Design: Prospective study. MATERIALS AND METHODS: Seventy-two infertile men with varicocele were referred for Yq microdeletion analysis from the infertility clinic of AIIMS and Army Research and Referral Hospital. Genomic DNA was isolated from blood and polymerase chain reaction microdeletion screening was done in these cases to determine the presence or deletion of AZF loci. RESULTS: In this study 7 (9.7%) varicocele cases harbored Yq microdeletion. The sperm count in cases which harbored Yq microdeletion was significantly lower than in cases without Yq microdeletion. CONCLUSION: Varicocele cases with Yq microdeletion do not show improvement in semen parameters post-varicocelectomy. Detection of Yq microdeletion determines prognosis and future management in such cases.