Diagnostic Accuracy of the Government of India Mother and Child Protection Card for Developmental Screening of Indian Children Aged 2-36 Months: A Hospital-based Mixed Method Study

Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2-36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neurodevelopment; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3-93.2) and 90.6% (95% CI 85.2-94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7-9 months, 13-18 months, and 25-36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months.

Comparison of changes in endothelial cell count and central corneal thickness after phacoemulsification and small-incision cataract surgery: A prospective observational study at a tertiary care center of eastern Uttar Pradesh

Purpose: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450�0 cells/mm2, corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state. Methods: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50� Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3rd week, and 6th week after surgery. Results: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40� years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3rd week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification. Conclusion: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts.

Dedifferentiated chordoma: A rare tumor with diagnostic challenge

Chordomas are rare locally invasive malignant bone tumors arising from remnants of embryonic notochord. Dedifferentiated chordoma (DC), a rare subtype, is characterized by the presence of a sarcomatous component in conventional chordoma (CC) which may arise de novo or as a malignant transformation of previously treated chordoma. The presence of dedifferentiation warrants a poor prognosis due to distant metastasis and recurrences. De novo DCs pose a diagnostic challenge especially in small biopsies and at metastatic sites. Here, we report the case of a 45-year-old female presenting with a long history of backache and constipation, finally diagnosed as DC. Radiological as well as histomorphological pictures of the tumor posed diagnostic challenges because they can mimic other tumors occurring in a similar location. We found this case worth reporting as de novo DC is rarely reported in the literature and it has the potential to pose diagnostic as well as therapeutic challenges.

Histological Variants of Leiomyoma: A Great Impersonator posing a Diagnostic Challenge - Three year Study in Delhi NCR

Background: Objectives: Uterine smooth muscle tumours are diagnostically challenging as well as scientifically intriguing with leiomyoma being the most common. On review of literature there are numerous studies on audit of hysterectomy specimens worldwide, however, studies focusing on detailed histopathologi cal analysis of leiomyomas are limited. Thereby, this study was conducted to identify the secondary changes as well as histological variants of leiomyoma, their frequency of occurrence and other associated clinicopathological factors Methods: A retrospecti ve audit of all the hysterectomy and myomectomy specimens was conducted over a period of 3 years (Jan 2016 to Dec 2018) comprising of a total of 155 cases with 388 leiomyomas (LM). The clinical details were retrieved, and histopathological slides reviewed for cellularity, mitosis, atypia, necrosis, any secondary changes or specific variants. Results: On histopathology, 19.1% LM showed degenerative changes and histologic variants were observed in 6.18% LM. Hyaline change was the most frequent degenerative ph enomenon in 82.43% (60/74) while cellular leiomyoma was the most common variant in 37.5% (9/24) LM. Conclusion: Certain histological variants make the differentiation from malignant tumors challenging. A thorough tissue sampling and strict adherence to histologic criteria coupled with a ncillary techniques like immunohistochemistry can help in excluding malignancy in most of the cases. Awareness regarding these is very important amongst youn g pathologists to avoid misdiagnosis and overtreatment leading to unwarranted stress to the patient.

COVID-19 Infection Rate following COVID-19 Vaccination among Healthcare Professionals at a Tertiary Care Public Hospital in City of Mumbai

Background : India launched COVID-19 mass Vaccination campaign after regulatory approval of Covishield & Covaxin vaccines. However, inspite of Vaccination, cases of COVID-19 infection are being reported. Hence, this study is aimed to assess the COVID-19 infection and/or re-infection rate, including breakthrough infections, following vaccination among Health Care Workers at a Tertiary Care Dedicated COVID Hospital. This questionnaire-based survey was initiated following Institutional Ethics Committee approval. We also looked at reasons for Vaccine hesitancy and occurrence of adverse reactions following vaccination, their management and duration amongst the Healthcare Workers. Results : Of 564 Healthcare Workers (HCWs) who consented to participate, only 503 filled in the questionnaire completely. Majority of the HCWs received Covishield vaccine (78.56%). The infection rate postvaccination was 8.28% (with a median of 22 days and IQR of 8-43 days). This infection rate was significantly higher in those who were not vaccinated as compared to the Vaccinated HCWs (OR = 0.10, 95 CI% = 0.05�22, p <0.0001). Breakthrough infection rate was 2.42. Although 58.39% of the participants suffered adverse reactions after vaccination, like myalgia, Fever, Headache, these were mild in nature lasting for an average of 3-4 days. The vaccine hesitancy rate at our hospital HCWs was 6.36%, the main issue being the concerns regarding safety and effectiveness of the vaccines against the COVID-19 infection. Discussion/Conclusion : The infection and Breakthrough infection rates in our study were low and severity of COVID infection post vaccination was mild, not requiring hospitalisation

A STUDY OF IMAGING FINDINGS ON HRCT THORAX IN CORONA VIRUS DISEASE 2019 (COVID-19)

INTRODUCTION : In December 2019, a large outbreak of a novel coronavirus infection occurred in wuhan hubei province, china. The disease caused by the virus, named novel coronavirus disease (COVID-19) by the world health organization (WHO) can be spread through human to human contact. In human coronavirus can cause spectrum of diseases ranging from asymptomatic patient, simple cold cough to severe acute respiratory syndrome ( SARS). HRCT is very useful to see the extent of disease spread in lungs and to assess the severity of infection. It also helps in monitoring the response and therapeutic effectiveness and prognosis. AIMS AND OBJECTIVES: 1]To evaluate the various HRCT thorax Findings in RTPCR confirmed patients of covid-19 infection. 2] To correlate the findings of HRCT of thorax with patient’s clinical symptoms. METHODOLOGY: A retro- prospective clinical study was carried out on patients who were referred for HRCT thorax to the Department of Radiodiagnosis, Sheth L.G. general hospital having signs and symptoms of covid-19 and whose RT PCR report was awaited and who had undergone HRCT thorax and only patients who were RT PCR test positive within 72 hours were taken in the study. Total of 250 patients from May 2020 to January 2021, who confirmed covid-19 diagnosis with RT-PCR were taken. RESULTS In our study we found, the most common initial CT findings in COVID-19 pneumonia are bilateral, patchy or rounded ground-glass opacities that most frequently occur bilaterally and in the lung periphery with a subpleural basal predominance in left lower lobe. Most common finding were patchy bilateral ground glass opacity most commonly associated with inter and intralobular septal thickening giving crazy paving pattern. Consolidation was also seen with or without GGO suggesting infective etiology. CONCLUSION HRCT Thorax may be useful as a standard method for the rapid diagnosis of COVID-19 to optimize the management of severely ill PATIENTS.

Clinical Profile of COVID-19 Illness in Children—Experience from a Tertiary Care Hospital

Objective To detail clinical profle and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (<18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the fu emergency (n=1744), severe acute respiratory infection (SARI) ward (n=825), and non-COVID area (n=350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children>10 y of age with malnutrition and comorbid illness.

Endotracheal tube cuff pressure during laparoscopic bariatric surgery: highs and lows

Gastric calibration tubes (GCTs) are a unique component of bariatric surgery. This study aimed to assess changes in the endotracheal tube (ETT) cuff pressure during laparoscopic bariatric surgery. Methods: This was a prospective observational study consisting of 124 American Society of Anesthesiologists class I–III morbidly obese patients (body mass index > 40 kg/m2 ) undergoing elective laparoscopic bariatric surgery under general anesthesia. The baseline ETT cuff pressure was 28 cmH2O. Cuff pressure, peak airway pressure, and hemodynamic changes were observed during various steps of bariatric surgery. Immediate postoperative complications during the first 24 h were recorded. Results: ETT cuff pressure increased significantly from the baseline (28 cmH2O) after insertion of GCT (36.3 ± 7.3 cmH2O) and creation of carboperitoneum (33.3 ± 3.8 cmH2O). Cuff pressure decreased significantly on GCT removal (24.0 ± 3.0 cmH2O) and release of carboperitoneum (24.7 ± 3.0 cmH2O). Peak airway pressure increased from the initial baseline value of 25.1 ± 3.7 to 26.5 ± 4.5 after GCT insertion, creation of carboperitoneum (32.6 ± 4.4), attainment of reverse Trendelenburg position (32.3 ± 4.0), and subsequent return to supine position 32.5 ± 4.8. Conclusions: The endotracheal cuff pressure significantly varies during the intraoperative period. Routine monitoring and readjustment of cuff pressure are advisable in all laparoscopic bariatric surgeries to minimize the possibility of postoperative complications.

Optimization of HPLC method using central composite design for estimation of Torsemide and Eplerenone in tablet dosage form

Abstract A simple, precise, accurate and robust high performance liquid chromatographic method has been developed for simultaneous estimation of Torsemide and Eplerenone in tablet dosage form. Design of experiment was applied for multivariate optimization of the experimental conditions of RP-HPLC method. A Central composite design was used to study the response surface methodology and to analyse in detail the effects of these independent factors on responses. Total eleven experiments along with 3 center points were performed. Two factors were selected to design the matrix, one factor is variation in ratio of Acetonitrile and the second factor is flow rate (mL/min). Optimization in chromatographic conditions was achieved by applying Central composite design. The optimized and predicted data from contour diagram comprised mobile phase (acetonitrile, water and methanol in the ratio of 50: 30: 20 v/v/v respectively), at a flow rate of 1.0 ml/min and at ambient column temperature. Using these optimum conditions baseline separation of both drugs with good resolution and run time of less than 5 minutes were achieved. The optimized assay conditions were validated as per the ICH guidelines (2005). Hence, the results showed that the Quality by design approach could successfully optimize RP-HPLC method for simultaneous estimation of Torsemide and Eplerenone.

Comparison of Efficacy of Dexmeditomidine and Midazolam for Bloodless Surgical Field during Functional Endoscopic Sits Surgery (FESS) under General Anaesthesia

Objective: A comparative study to evaluate the efficacy of dexmedetomidine to provide bloodless surgical field in comparison to midazolam in Functional Endoscopic Sinus Surgery (FESS). Methods: 60 patients ASA I or II scheduled for FESS were equally randomly assigned to receive either Inj. Dexmedetomidine in dose of 1 g/kg over 10 min in infusion or Inj. Midazolam 0.02 mg/kg. In both groups, the infusion rate was adjusted to maintain the mean arterial blood pressure (MAP) of 65-70 mmHg. The induction was done using propofol (2.5 mg/kg) and atracurium (0.5 mg/kg). After the intubation, maintenance was achieved with O (50%), N O 2 2 (50%), Inj. Atracurium infusion and Sevoflurane. Intraoperative bleeding was estimated by the surgeon using Boezzart's scale for the evaluation of operative field visibility during the surgery. Hemodynamic variables (MAP and HR) were recorded. Results: Better achievement of MAP control is achieved with Dexmedetomidine compared to Midazolam. Overall intra-operative blood loss was more in Midazolam group compared to Dexmedetomidine group. Conclusion: Both Dexmedetomidine and Midazolam are safe and effective in FESS for controlled hypotension, though Dexmedetomidine provides excellent surgeon's satisfaction without severe hemodynamic changes

Role of carbon dioxide laser in the treatment of oral leukoplakia

The aim of the present study is to evaluate the treatment results of carbon dioxide (CO2) laser vaporisation in the well-defined cohort patients with oral leukoplakia. The group consisted of 20 patients. Before treatment, a clinical photograph and an incisional biopsy were performed in all the cases. Also, post treatment results were documented with clinical photographs. The mean follow-up period was 12 months. 18 out of 20 patients treated for cure (90%) achieved local control after one treatment. The remaining 2 patients required (10%) 2nd and 3rd vaporisations. The rate of malignant transformation after CO2 laser treatment is found to be 2.27% which is comparable to the other studies. CO2 laser vaporisation in the treatment of oral leukoplakia lesions is an excellent procedure in not only preventing the local recurrence and the malignant transformation but also in preventing the post-operative dysfunction. It is a time saving procedure with a negligible intra operative bleeding. The wound healing procedure after CO2 laser is extremely good causing the least post procedure morbidity.

Sensitization of hepatocellular carcinoma cells towards doxorubicin and sorafenib is facilitated by glucosedependent alterations in reactive oxygen species, P-glycoprotein and DKK4

Altered glucose uptake and metabolism is the key characteristic of cancer cells including hepatocellularcarcinoma (HCC). However, role of glucose availability in chemotherapeutic outcome of HCC is unclear. Thepresent study investigates the effect of glucose facilitated sensitization of HCC cells towards doxorubicin(DOX) and sorafenib (SORA). In HCC cells, we observed that hyperglycemic culture condition (HG) isassociated with increased sensitivity towards DOX and SORA. P-glycoprotein (P-gp), a transporter involved indrug efflux, was elevated in HCC cells in NG, rendering them less susceptible to DOX and SORA. Further, thisstudy demonstrated that knockdown of dickkopf protein 4 (DKK4), a Wnt antagonist protein, causes enhancedglucose uptake and reduction in P-gp level rendering HCC cells in NG sensitive to DOX and SORA.Moreover, HG elevates the level of intracellular reactive oxygen species (ROS), which regulates P-gp.Alteration in intracellular ROS did not directly affect regulation of DKK4 in HCC cells. Functional assayssuggest that alterations in DKK4 and P-gp level in HCC cells are dependent on glucose availability andchanges in ROS level because of enhanced glucose utilization, respectively. Collectively, the present studyhighlights direct involvement of glucose-induced ROS, DKK4 and P-gp in altering the sensitivity of HCC cellstowards DOX and SORA.

A prospective study of obstetric and gynaecological emergencies in a tertiary care hospital

Background: The management of obstetrics and gynaecological emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. The main aim of the study was to access the burden of surgical emergency and to study the course of management at a tertiary care hospital.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period from January to December 2018.Results: A total of 73 patients presented to our emergency room who required urgent surgical intervention. All patients were resuscitated and surgery was done at earliest possible time. The age of patient ranged from 18 to 45 years.  About 75.8% of female presented with the complaint of acute abdomen, followed by 32.9% with bleeding per vaginum. 16.4% had vomiting, 6.8% with fever and 4.1% with mass per abdomen. In majority of cases a diagnosis of ruptured ectopic pregnancy (34 patients) was made, followed by PPH in 14 patients and 12 cases of rupture uterus. Four cases of torsion of ovarian mass and 3 cases of septic peritonitis were operated. The most common surgery performed was salpingectomy followed by subtotal obstetric hysterectomy. A mortality rate of 8.2% was noted.Conclusions: This study emphasized the great role of timely surgical intervention as lifesaving procedures. Skilled clinicians and immediate intervention in a tertiary care is the main-stay of the emergency case management and are indispensable for decreasing mortality and morbidity.

Routine versus selective use of episiotomy in primigravida: a prospective non-randomized case-control study

Background: Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labour. It is an inflicted second-degree perineal tear. Objective of this study was to determine the possible benefits and risks of the use of selective episiotomy versus routine episiotomy during delivery in primigravida.Methods: This is a prospective non-randomized case-control study designed to analyze and compare the maternal outcomes following routine versus selective use of episiotomy in primigravida. In control group, 122 patients were recruited and mediolateral episiotomy was given in all patients; while in study group, 61 patients were recruited, in whom episiotomy was given selectively.Results: In study group 61 patients were recruited, out of which episiotomy can be avoided in 23 (37.7%) of cases. There was no 3rd or 4th degree perineal tear found in any group. Perineal pain score on 3rd day postpartum was less in study group, as compared to control group on bed rest, sitting, walking and defecation.Conclusions: Selective use of episiotomy can improve maternal outcome by reducing perineal lacerations and those having intact perineum can have the best outcome when episiotomy is given selectively.

Recurrent Peumonia in an Infant With an Esophageal Lung

Esophageal lung is a rare variety of communicatingbronchopulmonary foregut malformation with anomaolouscommunication between an isolated portion of respiratory tissueand esophagus. Children present in early life with recurrentcough and pneumonia. Majority of the reported cases areassociated with other anomalies like tracheoesophageal fistula.We report a case of a 7-month-old girl with right sidedesophageal lung who was misdiagnosed as dextrocardia withright sided pneumonitis

Analysis of transfusion of blood and blood products and their utilization pattern at department of obstetrics of tertiary care hospital

Background: In developing countries, nutritional anaemia and obstetric complications are leading causes of transfusion of blood and blood products. The study was aimed to analyse utilization pattern and to identify the indications of transfusion of blood and blood products in obstetrics and to study outcome and management of pregnancy in patients who required blood and/or blood products.Methods: This retrospective study was carried out at department of obstetrics of tertiary care teaching hospital from September 2018 to November 2018 and data was collected from all patients who had received transfusion of blood and/or blood products for any obstetric cause.Results: A total of 164(6.8%) patients received blood and blood products transfusion. Department of obstetrics utilized maximum units of blood and FFP whereas PRC utilization was second highest. There were 62(37.8%) of patients who had not taken any antenatal care, whereas 64(39.0%) patients had less than 4 antenatal visits. Three most common indications for transfusion of blood and blood products were 63.4% in nutritional anaemia, 17.1% in obstetric haemorrhage and 11.6% in first trimester complications.Conclusions: Three most common indications for transfusion were nutritional anaemia, obstetric haemorrhage and first trimester complications. Majority of patients had inadequate or no antenatal care. Early and regular antenatal care, early diagnosis and management of high-risk pregnancies and obstetric complications, institutional delivery can reduce the rate of transfusion of blood and blood products.

Providing Expressed Breast Milk to Preterm Neonates Admitted in an Extramural Neonatal Intensive Care Unit: Where do we stand?

Provision of expressed breast milk (EBM) to premature neonatesposes a great challenge in extramural Neonatal Intensive CareUnits (NICUs). We conducted a questionnaire-based survey toidentify the various challenges faced by the parents to provideEBM to their hospitalized premature infant. 40 preterm neonates(<34 wk gestation and <1500 g weight) planned to be started onEBM were included in the study. The median (range) durationafter which EBM was received in NICU after the time it was askedfor was 34.5 (13 to 40) hours, and it was received in a clean, sterileand covered container in only 8 (20%) cases. There were multiplehurdles in ensuring early availability of EBM in optimal condition.Sensitization and motivation of families regarding the importanceof ensuring early administration of EBM to their prematurelydelivered neonate may lead to substantial improvement inoutcome of these neonates.

​Instrument Retrieval from Central Incisor – A Case Report

Instrument separation is a very common mishap in routine endodontic practice. Although fractured fragment does not affectthe prognosis of the case, it may affect the subsequent steps in endodontic therapy, such as chemomechanical preparation,obturating root canals. In case of separated instrument, attempts should be made to retrieve the instrument where possible orone should try to bypass the fragment. This case report describes the retrieval of a separated instrument from central incisorof 18-year-old boy

Microsatellite instability in young patients with mucinous colorectal cancers – characterization using molecular testing, immunohistochemistry, and histological features

CONTEXT: The incidence of colorectal cancers (CRCs) in young Indian patients is higher than the international average. CRCs in young patients are commonly of mucinous type and show microsatellite instability (MSI). AIMS: To ascertain the MSI status of mucinous CRCs in patients ≤40 years of age by molecular testing and to correlate this with immunohistochemical (IHC) analysis and tumor histology. SUBJECTS AND METHODS: Archived formalin-fixed paraffin embedded tissue blocks of 30 young mucinous CRC patients were retrieved. MSI testing was done using two mononucleotide markers – BAT26 and NR24. IHC analysis was done using MLH1, MSH2, and MSH6. Histological features of all cases were studied. Data were analyzed using the SPSS software and the Pearson's chi-square test and Fisher's exact test. RESULTS: Eight out of 30 cases (26.7%) showed MSI by molecular testing. IHC identified seven of these cases. Histological features showing a statistically significant association with MSI were the presence of a well-differentiated adenocarcinoma component (P = 0.003), peritumoral lymphocytes (P = 0.002) and tumor budding (P = 0.021). CONCLUSION: The detection of defective mismatch repair (MMR) proteins using IHC for MLH1, MSH2, and MSH6 and molecular testing using BAT26 and NR24 appears to be a good protocol to detect CRCs with MSI. Histology could be useful in identifying cases that require screening for presence of MMR protein defects

Expression and cellular distribution of insulin-like growth factor 1 receptor during window of implantation in infertile women with intramural fibroids

Background: The “window of implantation” (WOI) is a transient but well defined period during which the hostile endometrial lining is transformed to a surface receptive to accept the embryo. Recently, data are beginning to accumulate suggesting negative influence of non-cavity distorting intramural uterine fibroids (NCD-IMF) on endometrial receptivity that may have implications for implantation failure. However, molecular mechanisms underlying infertility associated with NCD-IMF remain unclear. The aim of present study was to examine the expression and cellular distribution of insulin-like growth factor 1 receptor (IGF1R) during WOI in infertile women with NCD-IMF and fertile controls. While, reports are available that support role of IGF1R in mediating adhesive interaction with the implanting blastocyst, the effect of NCD-IMF on IGF1R expression during the WOI is not defined.Methods: Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate messenger RNA (mRNA) and protein expression of IGF1R in midsecretory endometrial biopsies obtained from infertile women with NCD-IMF (n=20) and healthy fertile controls (n=10).Results: As compared to fertile controls, significantly higher IGF1R: i) mRNA levels (1.59 fold up regulation; p=0.044) and ii) immunoscore in the luminal epithelium (8.94±3.13 versus 6.31±1.49; p=0.009) were observed in infertile women with NCD-IMF.Conclusions: Over expression of IGF1R in infertile women with NCD-IMF, during the window of receptivity, may result in altered ability of uterine epithelial cells for blastocyst adhesion and subsequent implantation, which might lead to poor reproductive outcome in these women.