Clinical spectrum of elderly-onset inflammatory bowel disease in India

Background/Aims@#Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India. @*Methods@#A cross-sectional retrospective analysis of a prospectively maintained database of patients diagnosed with IBD was conducted at 2 centers in India. The clinical spectrum of elderly-onset IBD including demographic profile (age and sex), clinical presentation, disease characteristics (disease behavior and severity, extent of disease), and treatment were recorded and compared with adult-onset IBD. @*Results@#During the study period, 3,922 (3,172 ulcerative colitis [UC] and 750 Crohn’s disease [CD]) patients with IBD were recorded in the database. A total of 186 patients (4.74%; 116 males [62.36%]) had elderly-onset IBD (69.35% UC and 30.64% CD). Diarrhea, blood in stools, nocturnal frequency and pain abdomen were the commonest presentations for UC, whereas pain abdomen, weight loss and diarrhea were the most frequent symptoms in CD. For both elderly onset UC and CD, majority of the patients had moderately severe disease. Left-sided colitis was the commonest disease location in UC. Isolated ileal disease and inflammatory behavior were the most common disease location and behavior, respectively in CD. 5-Aminosalicylates were the commonest prescribed drug for both elderly onset UC and CD. Thiopurines and biologics were used infrequently. Prevalence of colorectal cancer was higher in elderly onset IBD. @*Conclusions@#Elderly onset IBD is not uncommon in India. Both the elderly onset UC and CD were milder, with no significant differences in disease characteristics (disease extent, location and behavior) when compared to adult-onset IBD. Colorectal cancer was more common in elderly onset IBD.

Effects of the COVID-19 pandemic on semen quality in male partners of infertile couples: a hospital-based observational study / 亚洲男科学杂志(英文版)

The effects of the coronavirus disease 2019 (COVID-19) pandemic on male fertility have received considerable attention because human testes contain high levels of angiotensin-converting enzyme-2 receptors, through which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can enter. Early studies showed decreases in semen quality during and after recovery from COVID-19. However, no semen quality studies have examined the effects of widespread subclinical and mild disease, as well as changes in lifestyle, psychosocial behavior, intake of dietary supplements, and stress. This cross-sectional study compared semen quality parameters in male partners of infertile couples between men who underwent semen analysis before the COVID-19 pandemic (prepandemic group) and men who underwent semen analysis during the pandemic period (pandemic group); the analysis sought to clarify the overall effects of the pandemic. No participants in the pandemic group had experienced clinically overt disease. Among the 239 participants, mean body weight (P = 0.001), mean body mass index (P < 0.001), median sperm concentration (P = 0.014), total sperm count (P = 0.006), and total percentages of motile (P = 0.013) and abnormal cells (P < 0.001) were significantly greater in the pandemic group (n = 137) than those in the prepandemic group (n = 102). Among abnormal cells, the percentages of cells with excess residual cytoplasm (P < 0.001), head defects (P < 0.001), and tail defects (P = 0.015) were significantly greater in the pandemic group than those in the prepandemic group. With the exception of morphology, the overall semenogram results were better in the pandemic group than those in the prepandemic group.

Inflammatory bowel disease (IBD)-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD

The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and its relation with disease activity. Methods: A cross-sectional study was conducted between June 2021 and December 2021. Patients with IBD were asked to complete the IBD-disk and a visual analogue scale of IBD daily-life burden (scored from 0–10, score >5 indicative of high burden). The internal consistency of IBD-disk, correlation with IBD daily life burden and disease activity (assessed by partial Mayo score and Harvey Bradshaw Index in patients with ulcerative colitis [UC] and Crohn’s disease [CD], respectively) and diagnostic performance of IBD-disk to detect high burden were analyzed. Results: Out of the 546 patients (mean age 40.33±13.74 years, 282 [51.6%] males) who completed the IBD-disk, 464 (84.98%) had UC and the remaining (n=82, 15.02%) had CD. A total of 311 patients (291 UC and 20 CD; 56.95%) had active disease. The mean IBD-disk total score and IBD daily life burden were 18.39±15.23 and 2.45±2.02, respectively. The IBD-disk total score correlated strongly with the IBD daily life burden (ρ=0.94, P30 predicted high IBD daily-life burden. Conclusions: The IBD-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD and can be applied in clinical practice. (Intest Res, Published online)

Intrinsic Capacity of Rural Elderly in Thar Desert using World Health Organization Integrated Care for Older Persons Screening Tool: A Pilot Study

Integrated Care for Older Persons (ICOPE) screening tool helps to address declines in physical and mental capacities in older people. In India, majority of the older population resides in rural areas and there is a paucity of studies that demonstrates the utility of the ICOPE screening tool in India. Thus, a cross-sectional study was conducted to demonstrate the feasibility of using the World Health Organization ICOPE screening tool in a rural population. Comprehensive geriatric assessment of intrinsic capacity revealed cognitive decline in 31.5% (n = 142) participants, diminished mobility 52.1% (n = 235) participants, eye problems in 49.4% (n = 223) participants, and hearing loss in 68.3% (n = 308) participants. Gender difference was statistically significant with mobility limitation (P = 0.005; ?2 = 7.95) and feeling of pain (P = 0.001; ?2 = 15.64), being more in females than males. This tool seems suitable in identifying the intrinsic capacity of the rural elderly.

To compare Gross & Ferguson and Mitchell-Banks repair techniques in children with congenital inguinal hernia.

Aims: To compare operating time, early complication(s) and outcome of Gross & Ferguson and Mitchell-Banks repair techniques in children with congenital inguinal hernia. Materials and Methods: A prospective randomized study including boys aged 1-12 years, was conducted over one year. The patients were allocated in two interventional groups based on the repair viz. Gross and Ferguson and Mitchell-Banks group. After hernia repair, the patients were followed up on the day of surgery and at one week for early complications. Results: Fifty patients were enrolled. Mean operating time in Mitchell-Banks technique was significantly more than Gross and Ferguson technique (p=0.00012). The incidence of fever in two groups was similar. Scrotal edema was statistically significant in MB group on both Post-Operative Day -1 and 7 (p=0.023 and p=0.034). No patient in either group had wound infection or scrotal hematoma on POD-1. One subject (2%) had scrotal hematoma in MB group on POD-7. A total of 12 subjects (24%) had Surgical Site Infection on POD-7. There was statistically higher incidence of SSI on Day-7 in GF group (32%) as compared to MB group (16%) (p=0.018). Conclusion: GF technique had lesser operating time, less incidence of scrotal edema and hematoma though higher rate of surgical site infections. In this respect, GF technique can be used as a simple and safe procedure.

A Clinical Comparative Study of Dexmedetomidine with Fentanyl as an Adjuvant to Intrathecal Hyperbaric Bupivacaine for Vaginal Hysterectomy.

Currently only few local anaesthetics are used for intrathecal administration, like bupivacaine, lignocaine, ropivacaine and tetracaine. Opioid analogues have been used as additive in spinal anaesthesia to improve the onset of action, to prolong the duration of block and to improve the quality of intraoperative and postoperative analgesia. Fentanyl is a partial agonist on μ-opioid receptors and Dexmedetomidine is a α2-agonist. Intrathecal dexmedetomidine when combined with spinal bupivacaine prolongs the sensory block by depressing the release of C-fibers transmitters and by hyperpolarization of post-synaptic dorsal horn neurons.1 We compared the effects of adding Dexmedetomidine and Fentanyl as an adjuvant to intrathecal hyperbaric bupivacaine for vaginal hysterectomy.METHODSA total of 100 patients of age 35 to 65 yrs. of body mass index (BMI) within normal range (18.5 to 24.9 Kg/m2) posted for vaginal hysterectomy were divided into two equal groups (Group 1 and 2) in a prospective, randomized, double-blind fashion. In Group 1 (n=50), (2.5 ml) Hyperbaric Bupivacaine + (0.5 ml) Dexmedetomidine (5 mcg) and in Group 2 (n=50) (2.5 ml) Hyperbaric Bupivacaine + (0.5 ml) Fentanyl (25 mcg) were used. Total volume injected intrathecally was 3.0 ml. We observed the effect on onset of sensory and motor blockade, maximum level of sensory and motor blockade, haemodynamic effects during intraoperative period (for 120 min), effect on overall duration and quality of analgesia during postoperative period using VAS score and any side effects.RESULTSWe observed that mean time to achieve sensory block and motor block/ Bromage-3 was shorter in dexmedetomidine group. There was no statistically significant difference for the onset of sensory and motor block in dexmedetomidine and fentanyl group (p value > 0.05). The sensory and motor block were more prolonged in dexmedetomidine group than fentanyl group showing significant difference among the two groups (p value<0.001). Overall duration of analgesia was significantly longer in dexmedetomidine group than fentanyl group showing significant difference among the two groups (p value <0.001).CONCLUSIONSIn our opinion adding Dexmedetomidine 5 mcg to Bupivacaine 12.5 mg not only provides rapid onset, profound analgesia with good relaxation for surgery but also prolongs the duration of sensory and motor blockade. The overall effect and duration are superior to addition of 25 mcg of Fentanyl.

Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience

Background/Aims@#Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD. @*Methods@#This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points. @*Results@#Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI 50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m2 at week 12 (P=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (P<0.001 and P=0.006 respectively). @*Conclusions@#EEN appears to be an effective and well tolerated therapy for induction of remission in anti-TNF refractory adult CD. More data from prospective trials with larger number of patients is required.

Topical corticosteroid misuse: observational study to evaluate pattern of abuse and adverse drug reactions

Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse.

Effect of health seeking interval on outcome in swine flu cases attended a tertiary care hospital in southern Rajasthan region of India

Background: Swine flu influenza is an infection by H1N1 type of swine influenza virus. Swine influenza virus or swine-origin influenza virus (SIV or S-OIV) is a strain of the family of influenza viruses that’s endemic in swine (pigs). Early diagnosis and treatment is key approach to control the morbidity and mortality associated with swine flu which can be achieved by improving health seeking behaviour of community. Understanding of behaviour of community is essential for planning strategies for prevention and control. Aim of this study is to establish a relation between healthcare interval and outcome of swine flu.Methods: A complete data of all the patients visiting swine flu OPDs, swine flu wards and ICU were maintained for year 2015. Each patient visiting either the swine flu OPD or the swine flu ward, who was suspected clinically to be H1N1 positive were tested for real time PCR. Data was collected in a standardized pre-structured questionnaire.Results: Out of 1247 samples tested for rt-PCR, number of patients found to be swine positive was 491 (39.37%). Total 267 patients were admitted in swine flu ward and ICU, out of them 62 was expired. Clinical care intervals of more than 5 days from onset of symptoms to swab collection, diagnosis and admission were more in female and rural population. Mean duration between onset of symptom to hospitalization, swab collection and diagnosis was significantly higher in deceased patients than survived.Conclusions: Early presentation to healthcare facility is associated with better prognosis and outcome. After patient report to the health care setup, early sample collection and diagnosis help to reduce mortality.

A clinico-epidemiological profile of patients with influenza A H1N1 attending a tertiary care hospital in southern Rajasthan region of India

Background: Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses). Swine flu cases resurfaced in month of January 2015 in Southern region of India which are continuation of pandemic 2009. Aim of this study is to summaries the clinical and epidemiological factors associated with swine flu as well as to estimate the burden of Influenza A H1N1 (Swine Flu) cases.Methods: A complete data of all the patients visiting swine flu OPDs, swine flu wards and ICU were maintained for year 2015. Each patient visiting either the swine flu OPD or the swine flu ward, who was suspected clinically to be H1N1 positive were tested for real time PCR.Results: Out of 1247 samples tested for rt-PCR 491 (39.37%) cases were identified as positive for H1N1. Maximum swine positivity was seen in the age group of 16-30 year i.e. 147 (29.94%). Overall swine positivity was significantly (<0.001) higher in females than male and extremely statistically significant (p<0.0001) higher in rural areas than urban. Cough was the most common clinical symptoms affecting 469(95.52%) patients followed by fever (92.26%) and breathlessness 402(81.87%).Conclusions: Our study will help epidemiologist and clinician to identify epidemiological factors and clinical picture of swine flu.

Health education as a tool to quit tobacco use among non-teaching staff in a medical college of North Karnataka: an interventional study

Background: Non-teaching staff working in medical institutes forms a formidable workforce and an important sector with respect to public health point of view. Nothing much is known about their tobacco habits and quit patterns.Methods: An interventional study was conducted for the period of two months among 258 non-teaching staff in a medical college in north Karnataka. A self-administered questionnaire followed by intervention in the form of health education about the harms of tobacco was given to the participants. Further, follow-up was conducted after a week and at the end of one month using the same questionnaire to study the quit rate among the tobacco users. Appropriate statistical tests were used to analyze the results.Results: Among 258 consented participants, 98 (38%) were using tobacco in any form. Smoking forms of tobacco use was seen in 17 (17.35%), smokeless forms in 61 (62.24%) and dual smoking and smokeless forms in 20 (20.41%) participants. Among tobacco users, only 30 (32.60%) actually attended the intervention. First follow-up was attended by 26 (86.67%) but none of them had quit tobacco. Second follow-up was again attended by same 26 participants. Among them, 3 (11.54%) participants had quit tobacco.Conclusions: Tobacco consumption among the study participants was high. Compliance for health education to quit tobacco was poor among study participants. Similarly, tobacco quit rate among those who attended the intervention and the two follow up sessions was very poor.

Mortality profile of confirmed cases of swine flu attending a tertiary care center of Udaipur region of Rajasthan, India

Background: Mortality profile is an analytical tool used to identify the various factors responsible for poor outcome of disease and it can also use to evaluate quality and efficiency of healthcare providers. The aim of this study is to summarise the clinical and epidemiological factors as well as to identify the risk factors associated with mortality among swine flu cases.Methods: It is a cross-sectional, descriptive, hospital-based study conducted on 62 deceased patients due to swine flu reported at Maharana Bhupal Government Hospital, Udaipur, Rajasthan during the outbreak of influenza A H1N1 in the year 2015. A standardized pre-structured questionnaire with consent was filled by help of bed head tickets and by interview of attendants of deceased patients.Results: Deaths were higher among age group of 31-45 years (35.48%). Case fatality rate for male patients (13.88%) was higher. Mortality was highest in females of rural background 27(43.55%). Majority of deceased patients (70.97%) had delay of 4-7 days in admission after onset of symptoms. Diabetes, cardiovascular diseases and pregnancy was the major risk factors for poor outcome.Conclusions: Delay in diagnosis and admission may be the reason for higher mortality rate. The most common co morbid illness was Diabetes mellitus, cardiovascular diseases (Ischemic heart disease, Rheumatic heart disease, Hypertension) and pregnancy.

A Comparative Study of End Results of Various Methods of Treatment of Fractures of Distal Radius

Background: Distal end radius fractures are the commonest fractures occurring in upper extremity that account for 17% of all upper limb injuries. Many treatment methods for displaced distal radius fractures are available. The aim of this study to evaluate the fracture patterns of distal radius fractures & compare the results of different methods of treatment of fracture distal end radius. Materials & Methods: This prospective study was conducted in RBM Hospital, Bharatpur, Rajasthan. A total of 50 patients with fractures of the distal end radius who attended the outpatient or emergency in our hospital were included in our study. Functional outcomes were assessed at final follow up visit using “Demerit point rating system” of Gartland & Werley. Results: Our study showed that the mean age was 45.50 years with the youngest patient being 20 years old and the oldest being 70 years old. The mode of injury was fall in 30 cases (60%) and road traffic accidents in 20 cases (40%). The minimum duration of follow-up was 18 weeks and maximum of 54 weeks. Comparison of clinical and functional results by Chi square test showed significant associated with treatment types (P<0.05) in our study. Conclusion: We concluded that the treatment choice should be based on the fracture type, the patient’s characteristics, the patient’s demands and last but not least on the treating surgeon’s experience and preference.

Study of Non-Alcoholic Fatty Liver Disease with Special Reference to Liver Enzyme and Radiological Finding

Background: Non-alcoholic fatty liver disease (NAFLD) is a distinct hepatic condition characterized by abnormal fat accumulation in liver cells; histologically resembling alcohol induced liver damage. The term NAFLD is used to describe a wide array of fatty liver changes from simple steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma (HCC), in the absence, of excessive alcohol intake. Methods: 312 suspected patients of NAFLD above the age group of 15 and irrespective of sex were screened during the study. Total 60 patients were selected according to the inclusion and exclusion criteria designed for our study. Further clinical (history, BMI, BP,etc.), biochemical (blood sugar profile, lipid profile, serum transaminases, Serum uric acid etc.), histopathological (liver biopsy) and radiological profiling (USG) was done. Result : Our 60 recruited patients had a mean age of 52.53±11.68 years with 21 (35%) male subjects and 39 (65%) female subjects. We found that fatigue, malaise and abdominal pain were the commonest whereas heart burn as the second commonest complain among the study group. Further clinical examination of 26 (43.3%) patients with RUQ abdominal pain revealed that 14 (53.8%) had abdominal tenderness, 10 (38.5%) had abdominal tenderness with hepatomegaly and 2 (7.7%) had no significant clinical findings. Our study revealed mean BMI to be 27±6.32 kg/m2 with more than half of our patients were pre-obese (33.3%) and obese (28.3%). Lipid profiling revealed 13 (21.7%) patients had hypertriglyceridemia. Serum transaminases revealed 22 (36.7%) and 39 (65%) had raised SGPT/ALT and SGOT/AST levels respectively. Ultrasonographically, 30 (50%) had grade-I, 23 (38.3%) had grade-II and 7 (11.7%) had grade-III fatty liver. Due to low patient compliance, only 3 (5%) had their liver biopsy done which revealed steatosis and dense fibrosis. Conclusion: Current absence of specific treatment further for NASH and NAFL emphasizes the need of healthy diet, yoga and daily exercise in order to control insulin resistance/metabolic syndrome.

Echocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. India alone had 65.1 million diabetics by the year 2013. DM with high BMI & increased central obesity (WHR) have changes in the cardiac geometry evidenced in echocardiography. AIM OF STUDY: Estimation of Body Mass Index (BMI) and Waist Hip Ratio (WHR) & Establish a relationship between obesity, particularly central obesity in type 2 diabetes mellitus patients and cardiac changes with the help of echocardiography.  Methods: 30 Subjects with type 2 DM attending the OPD or admitted in Katihar Medical College indoor department & 30 control patients were also be taken from the same, all of age >40 years. The cases and the controls were examined thoroughly with respect to BMI (>30) & WHR (> 0.85 for females and > 0.95 for males) and echocardiography was done. Results: The cases i.e. type 2 diabetes with high WHR and BMI had highly significant alteration in LV geometry as compared to the controls & had significantly high mean LV mass 189.10grams as compared to 134.04 grams of the controls. There was significant early diastolic dysfunction found in the cases group while no significant difference was found in systolic dysfunction between cases & controls. The incidence of changes in left ventricular geometry was higher in female type 2 diabetic subjects with high waist hip ratio and BMI as compared to males. Conclusions: Form the data of the present study it can be concluded that type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females. Thus, type 2 diabetics with high BMI and Waist hip ratio have higher risk of development of cardiovascular disease, which is higher for female than males.

Evaluation of Hematological Abnormalities in HIV Patients in Kosi Zone of Bihar

Background: Hematological abnormalities are among the most common complications of HIV.  Anaemia is the most common hematological abnormality in HIV patients, and is strongly associated with the progression of the disease, followed by leucopenia and thrombocytopenia. The objective of the study is to find out the magnitude & type of hematological abnormalities and its correlation to CD4 Count.  Methods: The study was done on 80 HIV patients, above the age of 15 yrs, including both males and females, attending ART Centre, at Katihar Medical College, Katihar, Bihar. Various haematological parameters were recorded and studied with respect to CD4 count. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts.  Conclusions: These hematological parameters can be used to assess the severity and progression of HIV as they are directly associated with CD4 count. Anaemia being the single most independent factor associated with high mortality. Aggressive treatment of these haematological abnormalities can lead to substantial decline in morbidity and mortality associated with HIV patients.

Effect of discrete (individual) and mixed (bulk) genomic DNA on genetic diversity estimates and population structure in Teak (Tectona grandis L. f.).

Teak (Tectona grandis L.f.), a paragon timber tree of tropical deciduous forests of Central and Peninsular India, is highly prized for its wood colour, decorative grains, durability and lightness. An experiment was carried out to compare the genetic variation detected and genetic relationships inferred in five teak populations via 10 genomic DNA samples per population each of either single seed or bulk of 3- or 5- seeds with the help of ISSR markers. The genomic DNA of single seed exhibited higher number of polymorphic loci, per cent polymorphism, nei’s genetic diversity and shannon Information Index than the bulk genomic DNA of 3- or 5- seeds. The bulking of genomic DNA of 3- and 5- seeds using Nei’s genetic distance coefficient revealed similar genetic relationships, which were at variance with those in single seed treatment. Mantel’s correlation test among the genetic distance matrices of single seed sampling, 3-seed bulk and 5-seed bulk sampling also confirmed the trend. Since the bulking of genomic DNA did not generate compatible estimates of diversity parameters and genetic relationship of five populations from its single seed sampling, we recommend strict guarding of identities of genotypes within the collected samples for obtaining precise estimates and drawing accurate conclusions about the genetic diversity and clustering of populations.

relationship between uterine artery two-dimensional color Doppler measurement and pregnancy outcome: a prospective observational study

Background: the purpose of the study was to evaluate the role of uterine blood flow parameters measured by uterine artery two-dimensional [2D]-power color Doppler [PCD] ultrasound in predicting fertility outcomes in women undergoing IVF-ET cycles

Methods: in this prospective observational study, a total of 188 infertile women who underwent IVF-ET cycles were investigated. Uterine artery 2D-PD measurements were taken during early follicular phase and on day of trigger. Pulsatility Index [PI], Resistant Index [RI], Peak Systolic Velocity [PSV], and Systolic/Diastolic ratio [S/D] were measured. Statistical correlation was sought between the doppler parameters and fertility outcomes

Results: the pregnancy rate was 40.43% [76/188]. The women who conceived [n= 76] [Group A] were found to have mean age of 31.2+/-3.9 years whereas the nonpregnant group of women [n=112] [Group B] had mean age of 31.45+/-4.25 years. The mean PI measurements subsequently during early follicular phase and on the day of hCG trigger between group A and group B were comparable [2.09+/-1.15 versus 1.9+/-0.95; p=0.385 and 1.86+/-1.12 versus 2.03+/-1.0; p=0.192, respectively]. No significant changes in the uterine artery PSV values and S/D values and RI were noted during the cycle

Conclusion: uterine artery doppler evaluation in women undergoing IVF cycles was not predictive of the pregnancy outcomes

An Observation of Risk Factors Associated with Patients with Ischemic Stroke.

Background: Objective: our study was to observe the risk factors in different age group of patients with ischemic stroke. Methods: A total of 120 patients of ischemic stroke were considered on the basis of detail clinical history, laboratory findings and CT Scan/MRI. Results: Data was analyzed by using MS-Office software. Conclusion: Major risk factors associated with ischemic stroke was hypertension, smoking, alcohol consumption, diabetes mellitus, dyslipidemia and obesity.

Primary Broad Ligament Pregnancy: A Case Report

Primary broad ligament pregnancy is a rare form of extrauterine pregnancy with a high maternal and perinatal mortality. Early diagnosis is important to prevent life threatening hemorrhage but can be missed on antenatal ultrasonography. The diagnosis is usually established during laparotomy. We present a case of 22 year old female with ectopic gestation in broad ligament which was missed on ultrasonography and diagnosed during surgery.