bluuebunny/crossref_metadata_2025 huggingface dataset:
Restoration of middle third leg soft tissue defects using a distally based hemigastrocnemius flap
Authors: Elhosiney Alhosiney Salalh eldin , Ayad Wael Mohamed , ElsoudSalim Ahmed Abu
Published: June 2021

Background

Traumatic wounds, burns, tumor resections, and tibial fractures frequently lead to exposure of the tibia. Due to limited mobility and a paucity of overlying skin, flap coverage is generally required even for a small defect in the pretibial area. Soft tissue coverage of these defects is a must as any exposed bone that is not covered by vascularized soft tissue is at risk of osteomyelitis, bone necrosis, and sepsis.

Objective

This study aimed to evaluate the coverage of middle third defects of the leg using an inferiorly based hemigastrocnemius muscle flap.

Patients and methods

This prospective study was carried out at the Plastic, Reconstructive and Burn Department, Al-Azhar University Hospitals. This study included 20 patients with soft tissue defects at the middle third leg.

Results

In our study, 90% of the patients underwent reconstruction with a medial head distally based gastrocnemius flap, while the rest, 10%, underwent reconstruction with a lateral head distally based gastrocnemius flap. The majority of our patients, 65%, did not develop any complications. Unfortunately, 10% of the patients developed graft rejection and 10% developed partial flap necrosis, while 5% developed wound infection, 5% developed hematoma and 5% showed delayed graft take; all of these patients were managed early, and in terms of complications, only 5% of the patients had a hypertrophic scar of the donor site and 5% of the patients had hyperkeratosis. Most of our patients, 90%, were satisfied with the results, with only 10% being unsatisfied with the shape of postreconstructive recipient or donor sites.

Conclusion

The inferiorly based hemigastrocnemius muscle flap based on the vascular bundles between the two heads can be useful for reconstruction of the middle third of the leg. It is a simple technique allowing rapid, durable, and reliable coverage of these defects without sacrificing a nerve or a major vessel to the foot.
A comparative study between the efficacy of tranexamic acid and ibuprofen for treatment of menorrhagia induced by copper T-380A intrauterine device
Authors: Shahin Mohamed Saad , Ahmed Abdullah Khalil , Galal Samir Khamis
Published: June 2021

Background

Menorrhagia is menstrual blood loss, which interferes with a woman's physical, emotional, social, and material quality of life, and which can occur alone or in combination with other symptoms. Ibuprofen is one of the most common NSAIDs used for treatment of heavy menstrual bleeding. Tranexamic acid is the best option for those who experience irregular uterine bleeding and plan to become pregnant in the near future.

Objective

To evaluate and compare the efficacy of tranexamic acid and ibuprofen in controlling menorrhagia induced by copper T-380A intrauterine device (IUD).

Patients and methods

This prospective randomized comparative parallel study between tranexamic acid and ibuprofen for treating copper-IUD-induced menorrhagia included 100 women who attend outpatient clinic at Al-Hussein University Hospital from October 2019 to March 2020.

Results

Mean menstrual days in both group 1 and group 2 decreased significantly from the first month after IUD insertion to 6 months after treatment.

Conclusion

Tranexamic acid as an antifibrinolytic agent and Ibuprofen as an NSAID, at a dosage of 500 mg capsules of tranexamic acid three times a day and 400-mg tablet of ibuprofen three times a day orally, have the same significant effects on copper T-380A IUD-induced menorrhagia. Their effects are on both the volume of blood loss and the duration of menses.
Adolescent trauma
Authors: Fernandes Joanna Preritha , Hazra Darpanarayan , Jyothirmayi Chinta Annie , Abhilash Kundavaram Paul Prabhakar
Published: June 2021

Introduction:

Adolescence is the transitional stage of physical and psychological changes that occur from puberty to adulthood, and disruption in growth at this stage can have long-lasting effects. Our main aim was to profile these injuries treated in the emergency department (ED) and describe the etiology, patterns, and outcomes in such patients.

Materials and Methods:

We conducted a retrospective descriptive analysis of these victims who presented to us from January 2017 to December 2018. Among key factors studied were patient demographics, mechanism of trauma, injury severity, hospital admission status. In addition to descriptive statistics, we utilized univariate and multivariate analyses to help elucidate factors associated with severe injuries.

Results:

The data for a total of 693 patients were analyzed. Among these, 84.5% were male. The mean age was 17.2 ± 1.33 years. Based on their hemodynamic stability, the majority were triaged as priority 2 (49.6%). The most common causes of trauma were road traffic accidents (RTAs) (63.3%), followed by sports related injury (13.7%). Two-wheeler-related incidents accounted for 82.5% of RTA-related injuries. Extremities, face, and head were injured in 51.3%, 25.8%, and 13.5%, respectively. New injury severity score of more than 14 was noted in 82 (13.2%) cases. Approximately half of the study population, 374 (54%), were discharged stable from the ED, whereas 254 (37%) were admitted with 194 (28%) requiring major surgical intervention.

Conclusions:

Most of the traumas related to adolescents are RTAs, followed by sports-related injuries. Male gender and pedestrian-related injuries are independent predictors for high severity of injuries.

The following core competencies are addressed in this article:

Patient care, Systems-based practice, Medical knowledge, Practice-based learning and improvement.
Community surveillance of COVID-19 pandemic
Authors: Anil R. , Kumar B. A. Praveen , Srikanth S. , Priyadarisini N. J. , Janakiraman P. , Devivaraprasad M. , Subramaniyan P. , Nagaraj Chitra
Published: June 2021

Introduction:

COVID-19 is an ongoing pandemic and a global public health crisis. India has been setting up multiple strategies to contain this pandemic. Active community-level surveillance is a vital strategy to prevent, control, and manage the outbreak of COVID-19. This study explores the perspectives and describes budding doctors' field experience who worked in the community surveillance activity during the pandemic.

Materials and Methods:

We used a mixed-method research design wherein 67 medical interns of a tertiary care teaching institute participated in the COVID-19 pandemic surveillance activity were included in the study. Their field experience, perspectives, and opinions were captured using pretested questionnaires, participants' interviews, and focused group discussions.

Results:

More than one-third of medical interns (41.8%) felt that the government could better handle the surveillance process, while around two-thirds (65.6%) were satisfied with their work. Notably, 40 (59%) were not happy/clear with the training and orientation on the job before engaging in surveillance activity. A majority of 47 (70.1%) interns reported inadequate personal protective equipment, which raised the fear of transmission. While they felt that surveillance provided health services close to the community and addressed the public's pandemic concerns, they said the lack of basic training, an inadequate workforce, and resources were detrimental to the response.

Conclusions:

This pandemic has exposed the naive interns to the community health surveillance process's ground realities. This experience has changed their perception of the profession and given them the impetus to become a future workforce. Strength, weaknesses, opportunities, and threats analysis of the surveillance process provided vital inputs to act and prepare for future public health emergencies.

The following core competencies are addressed in this article:

Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, and Professionalism.
Plant-based diet
Authors: Bhatia Vikas , Gopi Gokul , Behera Priyamadhaba
Published: June 2021

The entirety of food and drink that an individual continually expends is called a diet. Proper nutrition – a sufficient, all-around offset diet with regular physical activity, frames the establishment for good health. The majority of the currently prevalent dietary recommendations are based on the health benefits of different individual food products. With the rising concern regarding climate change and evidence highlighting the influence of our nutritional practices on the environment, the time has come to redefine the dietary guidelines and recommendations considering the environmental impact of diet along with the health benefits. Studies have been reliably consistent with demonstrating that an equicaloric diet rich in plant-based products and lower in animal products is beneficial to health and put a lesser burden on the earth. There are five Sustainable Developmental Goals that can be linked with our dietary practices (no poverty, no hunger, good health and well-being, responsible consumption and production, and climate change). A plant-based diet is a suitable solution to the current crisis of noncommunicable diseases and climate change. Moving on to such a dietary practice would require immense changes in the currently prevalent food system with an emphasis on better production and waste management strategies along with improvement in food delivery and consumption practices worldwide. This article brings insight regarding the benefits of a plant-based diet and the need to address the ecological impact of animal-based foods.
Executive health checkup package at All India Institute of Medical Sciences, Bhubaneswar
Authors: Sahoo Bimal Kumar , Taywade Manish , Bhatia Vikas , Patro Binod Kumar , Mohanty Sachidananda
Published: June 2021

Early detectionof a disease leads to relatively simple courses of treatment and prevents life-threatening complications. Many health conditions can be corrected or maybe improved through treatment modalities if they are discovered by health screening facilities. Health screening program such as executive health checkup is convenient, affordable, inexpensive, and vastly beneficial for the patients. Hence, health screening saves lives immensely by early detection of diseases and preventing serious complications. It is an effective component of healthcare. It achieves more positive effects than medical treatment and at a lower cost. Health promotion is aimed at influencing people's social circumstances and lifestyles so that their health is improved (or maintained) and disease is prevented.
First few cases of COVID-19 admitted in a teaching hospital of North Kerala – Insights gained on the clinico-epidemiological presentations, management and patient perceptions on transmission dynamics
Authors: Rahim Asma Ayesha , Muthukutty Sujina V. , Babu Shinas P. , Chandran Praseeda , Hameed M. P. Shahul , Anitha S. P.
Published: June 2021

Introduction:

The first case of COVID-19 in India was confirmed in Kerala on January 2020, with the state effectively crushing the epidemic curve.

Objectives:

This study aims to describe the clinico-epidemiological profile and transmission dynamics of confirmed COVID-19 cases admitted in our health care facility.

Materials and Methods:

A case series study of 19 laboratory-confirmed cases in the early pandemic phase was done (13th March–April 9th 2020). Information on sociodemographic variables, exposure histories, clinical symptoms, and treatment were collected from case records and in-depth telephonic interviews. Descriptive analysis of selected variables was done. Incubation periods and receipt of infection were estimated from patient histories.

Results:

About 78.9% were male, in the age group of 22–86 years (Median-42 years). 18/19 (94.7%) of laboratory-confirmed cases were imported, half of them from UAE. Fever and cough were the predominant symptoms, followed by sore throat, breathlessness, headache, muscle pain, and loose stools with majority (85%) reporting mild symptoms. Five patients were asymptomatic. Mean duration from symptom onset to reporting is 4 ± 4.47 days. Two patients developed complications, one requiring hemodialysis and ventilator support. About 42% of patients had at least one comorbidity. Mean duration of symptom clearance and hospital stay was 6.76 days and 19.41 ± 6.801 days, respectively. Virological clearance was noted in 13.06 ± 7.32 days.

Conclusions:

Epidemiological findings from these cases aided in prompt public health responses across the districts in Kerala.
Characteristics and outcomes of patients receiving high flow nasal cannula therapy prior to mechanical ventilation in COVID-19 respiratory failure
Authors: Hansen Christopher K. , Stempek Susan , Liesching Timothy , Lei Yuxiu , Dargin James
Published: June 2021

Background:

Treatment strategies for acute hypoxic respiratory failure secondary to coronavirus 2019 disease (COVID-19) had significant variation early in the pandemic. We sought to determine if patients treated with high flow nasal cannula (HFNC) prior to mechanical ventilation had differing outcomes compared to those treated only with conventional oxygen.

Methods:

This was a prospective, observational study of patients with COVID-19 admitted to a tertiary care medical center with a diagnosis of acute hypoxic respiratory failure. Adult patients with a positive polymerase chain reaction test for COVID-19 who required mechanical ventilation were included.

Results:

A total of 91 patients met the inclusion criteria for our study. The mean age was 68.4 years (standard deviation [SD] ± 12) and 58% were male. The mean initial partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio was 152 (SD ± 65) and was not significantly different between the HFNC group and the conventional oxygen strategy group (P = 0.95). The observed mortality rate was 30% in the HFNC group versus 52% in the conventional oxygen strategy group (P = 0.05). The multivariate odds ratio of mortality for patients on HFNC was 0.375 compared to a conventional oxygen strategy (95% confidence interval 0.122–1.151, P = 0.09).

Conclusions:

While HFNC appears to be safe as the initial treatment strategy for COVID-19 associated respiratory failure, HFNC did not result in a statistically significant difference in mortality compared to a conventional oxygen strategy. Further studies are needed to confirm these findings.
Colonic perforation revealed by massive subcutaneous emphysema
Authors: Diop Sylvain , Giabicani Mikhael , Legriel Stéphane
Published: June 2021

We present the case of an 82-year-old woman admitted in the intensive care unit with a septic shock caused by a liver abscess. She underwent an emergency laparotomy for abscess drainage and microbiological sampling. In the early postoperative period, she developed a massive subcutaneous emphysema (SE) extending from the abdomen to the head, without obvious cause. A surgical complication was suspected; thus, the patient underwent a second laparotomy which revealed a perforated peritonitis. SE is a rare presentation of perforated peritonitis, which should be known by critical care physicians in order to avoid a misdiagnosis of this life-threatening pathology.
The association of ABO blood groups and trauma outcomes
Authors: Sauder Michael W. , Wolff Timothy W. , LaRiccia Aimee K. , Spalding M. Chance , Pandya Urmil B.
Published: June 2021

Background:

There is currently a lack of understanding regarding the link between ABO blood types with outcomes of traumatically injured patients. The purpose of this study was to determine the association of ABO blood types with outcomes in traumatically injured patients separated by injury type.

Methods:

This retrospective study evaluated trauma patients at an urban, Level 1 trauma center from January 1, 2017, through December 31, 2017. Patients were excluded if they were pregnant or <16 years old. Recorded outcomes included: ABO blood group, mortality, Injury Severity Score (ISS), race, injury type, mechanism of injury, and complications. Data analysis was performed using descriptive statistics including Chi-squared, Kruskal–Wallis, and F-test calculations.

Results:

A total of 3779 patients were included in this study. No significant differences were present in mean age or ISS between blood types. In patients with penetrating injuries, blood type O was associated with a significant increase in mortality (P = 0.017), red blood cell transfusion (P = 0.027), and massive transfusion protocol (MTP) (P = 0.026) compared to non-O blood types. In patients with blunt injuries, blood type AB was associated with a significant increase in mortality rate compared to non-AB blood types (P = 0.03).

Conclusion:

ABO blood type is connected with an underlying process which affects trauma outcomes, including mortality. Blood type O is associated with increased blood transfusion, MTP, and mortality during the initial hospitalization following a traumatic penetrating injury, while blood type AB is associated with increased mortality during the initial hospitalization following a blunt traumatic injury.
A Recurrent Hibernoma in Neck
Authors: Chandanwale Shirish , Khan Rumaanah , Dharwadkar Arpana , Randive Ruchi
Published: June 2021

Lipomatous lesions are very commonly encountered in clinical practice. Although they are commonly encountered in the third and fourth decades, they can occur at any age. Clinically, they present as slowly painless growing mass commonly in subcutaneous tissues. Clinically and radiologically, they are difficult to differentiate from other lipomatous lesions. The four morphological variants have been identified. Hibernoma cells are key to diagnosis. Hibernomas do not have malignant potential or metastatic ability. However, local recurrence is known to occur and is extremely rare. Wide local excision with negative margins is the key to prevent further recurrence.
Rapid Prototyping Technology for Silicone Auricular Prosthesis Fabrication
Authors: Manju V , Babu Anna Serene , Krishnapriya V. N. , Chandrashekar J
Published: June 2021

Context:

Three-dimensional printing technologies have been used recently for patients with maxillofacial deformities who seek esthetic prosthesis. The aim of the present study was to assess the accuracy, surface texture, marginal adaptation, patient satisfaction, and ease of fabrication of silicone auricular prostheses fabricated by the rapid prototyping technology (RPT) when compared to the conventional method (CM).

Materials and Methods:

A pilot study was conducted on five patients who had partial auriculectomy defects. Ear prostheses fabricated by CM and RPT were compared. RPT include the fabrication of prostheses by the duplication of polymer model fabrication or by injecting silicone to mold obtained by Vacuum casting method (VCM). The prostheses were evaluated by 15 randomly allotted trained independent observers based on the Likert Scale. The patients performed a self-rating assessment followed by a report from the clinician and technician.

Statistical Analysis:

The scores for each of the dimension were analyzed using the ANOVA. The cost, time, and quantity of silicone material were expressed in means for three fabrication methods.

Results:

Prostheses fabricated by RPT yielded superior scores in terms of accuracy, texture, and marginal fit; the vacuum casted prostheses being more precise. The patient perspective was in favor of RPT though not significant statistically. Time for fabrication and number of patient visits were less for rapid prototyping methods than CM.

Conclusion:

The present study demonstrated the potential benefits of digital method in the fabrication of auricular prosthesis using RPT in the field of maxillofacial rehabilitation.
Tobacco Consumption Patterns and Coping Behavior during the COVID-19 Lockdown
Authors: Sujatha S. , Shwetha V. , Vaishnavi P. , Sreekanth P. , Nagi Ravleen
Published: June 2021

Background:

During the COVID-19 pandemic, millions of Indians were self-quarantined generating exceptional challenges and stress for all people and more so among regular tobacco users. Tobacco use is known to be detrimental to lung and immune function, thus suppressing the body's ability to combat infections including the novel coronavirus, COVID-19. This study was intended at surveying the stress, tobacco consumption patterns, and the coping behavior during the COVID-19 pandemic.

Methodology:

Seven hundred and twenty-nine current tobacco users aged 18 years and above participated in the questionnaire study on stress due to COVID-19, tobacco consumption patterns during lockdown, years of tobacco use, prior quit attempts, thoughts of quitting currently, and means of purchasing and coping behavior. The data were subjected to statistical analysis.

Results: The

average Fagerström Test for Nicotine Dependence score was 6, and males had higher scores than females. 68.4% of tobacco users reported increased use, 5.07% decreased use, and 26.4% no change in tobacco use during the lockdown. Causes for increased tobacco use were stress (62.1%), being alone and restrictions in movement (21.6%), and boredom (16.3%), while the fear of contracting COVID infection and becoming severely ill has motivated few (31.6%) to decrease tobacco use. 50.9% wanted to quit, the thought of quitting tobacco was more among men (54%) as compared to women and was higher among smokers as compared to smokeless tobacco users.

Conclusion:

Tobacco users appear to be affected by stress related to the COVID-19 pandemic, with majority of them increasing the consumption.
The Use of Vaginal Lubricants and Ultrasound Gels Can have Deleterious Effects on Sperm Function
Authors: Soriano María José , Botella Inmaculada Molina , Sadeghi Sara , Rios Andrea Palomar , Balasch Sebastià , Luján Saturnino , Pellicer Nuria , Rubio José María
Published: June 2021

Context:

Some vaginal lubricants and ultrasound gels are known to be detrimental to sperm function and therefore could negatively affect fertility.

Aims:

The aim of the current study was to develop a sperm motility index (SMI) to test the sperm toxicity of ultrasound gels and vaginal lubricants used in reproductive medicine.

Settings and Design:

Two ultrasound gels (Aquasonic® and Kefus®) and five vaginal lubricants (Vaginesil™, Velastisa®, K-Y Jelly®, Control®, and Durex®) were studied. Three different concentrations (1%, 5%, and 10%) of each lubricant were tested.

Subjects and Methods:

SMI was calculated dividing the percentage of progressively motile sperm in each tested gel by that in the control at 0.5, 1, 2, and 24 h of incubation at 5% of CO2 and 37°C. SMI values <0.75 indicate sperm toxicity.

Statistical Analysis Used:

The main outcome measured was SMI for each concentration and time of incubation.

Results:

Only Durex® did not show any deleterious effect on sperm quality. The rest of lubricants presented different degrees of toxicity. Vaginesil™ resulted in toxic for all concentrations and incubation periods (SMI < 0.12). Control® and Velastisa® presented toxicity at 10% after 2 h, while K-Y Jelly® showed toxicity at 10% from 1 h of incubation. Regarding ultrasound gels, Aquasonic® showed toxic effects after only 0.5 h (SMI = 0.70 ± 0.15), while Kefus® showed slightly toxic effects after 2 h (SMI 0.69 ± 0.07).

Conclusions:

SMI is an accurate tool to evaluate sperm toxicity. One of the main strengths of the article is the inclusion of representative semen samples and known products used worldwide. This study has a relevant clinical translation since it highlights the importance of evaluating the possible sperm toxicity of simple products used in reproductive medicine.
The Spectrum of Chromosomal Abnormalities and Endocrine Profile of Male Infertility with Nonobstructive Semen Abnormality
Authors: Singhal Paresh , Pendkur Ganesh , Parihar Rituraj Singh , Singh Sharanjit , Chakrabarty Barun Kumar , Raghavendra S. K.
Published: June 2021

Background:

Primary infertility is a common occurrence which affects approximately 15% of couples who desire to begin their family. Chromosomal abnormalities are well-established causes of pregnancy loss but may also have a role in explaining the cause of male infertility, especially with nonobstructive semen abnormalities. Hence, awareness regarding safety of artificial reproductive technology in these individuals due to underlying sperm aneuploidy is required.

Aims:

The aims of the study are to determine the prevalence of chromosomal abnormalities in primary infertile males with nonobstructive semen abnormalities and correlate with their endocrine profile.

Study Design:

A case–control study, in which 100 males with primary infertility and non-obstructive semen abnormalities were evaluated for chromosomal abnormality and hormonal profile; and were compared with 50 healthy males with normal semen analysis and at least one biological child.

Materials and Methods:

Blood T-lymphocytes were cultured using RPMI-1640 medium for obtaining metaphases and chromosomal analysis.

Statistical Analysis:

SPSS software and Student's t-test were used. A p < 0.05 was considered statistically significant.

Results:

Azoospermia (81%) was the most common nonobstructive semen abnormality. Overall prevalence of major chromosomal abnormalities and polymorphic variants was 16% and 7%, respectively. Klinefelter syndrome was the most common sex chromosomal numerical abnormality seen in 6.17% of cases with azoospermia. All healthy control males had 46, XY karyotype. Higher levels of follicle-stimulating hormone and luteinizing hormone and lower levels of testosterone along with testicular volumes were observed in infertile males with abnormal karyotype (p < 0.05).

Conclusion:

Primary infertile males with nonobstructive semen abnormality have high frequency of chromosomal aberrations, which justify the requirement of cytogenetic testing in these patients.
Persistent Idiopathic Prolactin Elevation Merits Macroprolactin Estimation
Authors: Gautam Krishnaprabha , Cherian Kripa Elizabeth , Jose Arun , Aleyamma T. K. , Kapoor Nitin , Paul Thomas Vizhalil
Published: June 2021

The prevalence of hyperprolactinemia ranges from about 0.4% in an unselected adult population to as high as 9%–17% in women with reproductive disorders. It may cause infertility in about 11% of the oligospermic males. Rarely, the cause of persistently elevated prolactin remains obscure even after thorough work up. Macroprolactinemia is biologically inactive, high-molecular-weight form of prolactin resulting from its binding to immunoglobulin G, causing a decrease in its clearance. We report the case of a 35-year-old female, detected to have hyperprolactinemia on multiple tests, during routine work up for primary infertility. Secondary causes for the same were ruled out. A magnetic resonance imaging (MRI) of the brain excluded a prolactinoma. This prompted an estimation of prolactin levels after polyethylene glycol precipitation which showed a decrease to 5.58 ng/mL, with <40% recovery, confirming the presence of macroprolactin. Thus, persistently elevated prolactin levels in the background of negative neurological imaging necessitate the estimation of macroprolactin.
Reduced Angiopoietin-2 as a Predictive Biomarker for Clomiphene Citrate Resistance in Polycystic Ovary Syndrome
Authors: Rajendiran Luxmipratha , Nandeesha Hanumanthappa , Chitra Thyagaraju
Published: June 2021

Background:

Even though angiopoeitin-2 and interleukin (IL)-23 are known to be altered in polycystic ovary syndrome (PCOS), their association with clomiphene citrate (CC) resistance has not been studied.

Aim:

The objective of the study was to investigate whether angiopoietin-2 levels are associated with inflammation and CC resistance in PCOS.

Settings and Design:

This study was conducted in a tertiary care hospital.

Materials and Methods:

Eighty-one women diagnosed with PCOS and on treatment with CC were enrolled in the study. Angiopoeitin-2 and IL -23 were analyzed in all the subjects.

Results:

Angiopoietin-2 was significantly reduced (P = 0.018), and body mass index (BMI) (P = 0.049) and duration of infertility (0.006) were significantly increased in PCOS women with CC resistance compared to those who are sensitive to CC. In CC resistant PCOS, IL-23 predicts reduction in angiopoietin-2 levels (P = 0.010). Among angiopoietin-2, IL-23, BMI, and duration of infertility, we found that angiopoeitn-2 (P = 0.020) and duration of infertility (0.036) can predict resistance to CC therapy among PCOS subjects.

Conclusion:

We conclude that reduced angiopoietin-2 levels predict CC resistance in women with PCOS.
Observable Protective Activities of Quercetin on Aluminum Chloride-Induced Testicular Toxicity in Adult Male Wistar Rat
Authors: Olanrewaju John Afees , Akinpade Toluwani Gabriel , Olatunji Sunday Yinka , Owolabi Joshua Oladele , Enya Joseph Igbo , Adelodun Stephen Taiye , Fabiyi Sunday Oluseyi , Desalu Ayodele Babajide
Published: June 2021

Background:

Aluminum chloride (AlCl3) present in many manufactured consumable is considered as a toxic element.

Aim:

Our study evaluates the toxic effects induced by AlCl3 on the testes as well as the therapeutic tendency of Quercetin (QUE) agent as an antioxidant.

Setting and Design:

In the department of Anatomy of Medical School.

Methods and Materials:

Thirty-two male Wistar rats weighing approximately 170 ± 10 g were assigned into four groups with eight each, fed with rat chow and water ad-libitum. Group A served as control and was given distilled water throughout; Group B was given only QUE (200 mg/kg body weight) for 21 days; Group C was given only AlCl3 (300 mg/kg body weight) for 14 days; and Group D was given AlCl3 (300 mg/kg body weight) for 14 days followed with QUE (200 mg/kg body weight) for 21 days. Substance administrations were done orally.

Statistical analysis:

One-way analysis of variance was used to analyze the data, in GraphPad Prism 6.0 being the statistical software.

Results:

AlCl3 significantly reduced the relative organ (testes) weight, correlating the decrease in sperm count, sperm motility and sperm viability. Furthermore, there was a decrease in luteinizing hormone with an increase in follicle-stimulating hormone which accounted for a significant reduction in testosterone level that plays a great role in spermatogenesis, following AlCl3 treatment. The cytoarchitecture of the testes showed degenerative changes in the seminiferous tubules and leydin cells, nitric oxide synthases immunoreactivity was intense in the seminiferous epithelium of rat in Group C.

Conclusion:

These suggest that QUE antioxidant property could reverse the decrease in sperm status, hormonal effects, and functional deficit induced by aluminum chloride on the testes of Wistar rats.
Impact of Intrauterine Administration of Human Chorionic Gonadotropin before Intrauterine Insemination in Infertile Women
Authors: Wadhwa Leena , Rani Anupama
Published: June 2021

Background:

Implantation is the rate-limiting step in the success of both intrauterine Insemination (IUI) and in vitro fertilization cycles. Numerous interventions that target various local signals have been tried to improve the implantation and clinical pregnancy rate (CPR). The most significant of these signals is human chorionic gonadotropin (hCG) which acts as immunomodulator and improves implantation by decidualization of the endometrial stromal cells, trophoblast invasion, proliferation of uterine natural killer cells, stimulation of endometrial angiogenesis, and maintenance of progesterone secretion by the corpus luteum.

Aim:

The aim of the study is to evaluate the effect of intrauterine hCG administration before IUI on CPR.

Settings and Design:

A prospective parallel randomized control study was done from September 2017 to February 2019.

Materials and Methods:

A total of 200 eligible women planned for IUI were randomly divided just before IUI into 2 groups. A computer-generated randomization list with block size of 10 with 1:1 allocation was used to randomize the patients. Experimental group received 0.5 ml containing 500 IU hCG, on the other hand control group received 0.5 ml of normal saline 2–3 min before IUI in single sitting. The main outcomes were CPR, miscarriage rate, and ongoing pregnancy rate.

Statistical Analysis:

It was performed using statistical software version SPSS 17.0.

Results:

Patient's demographic and baseline characteristics were comparable in both the groups. CPR in experimental group was significantly high compared to control group (26% vs. 9%, P = 0.002). Ongoing pregnancy rate was also significantly higher in experimental group (23%) compared to control group (7%) (P = 0.003). No significant difference in miscarriage rate was seen between the two groups. No cases of ectopic pregnancy, ovarian hyperstimulation syndrome, or multiple pregnancy were reported.

Conclusion:

Intrauterine hCG administration is a simple procedure that can be used to improve pregnancy outcome in IUI cycles.
Marital Duration, and Fertility-Related Stress as Predictors of Quality of life
Authors: Bose Swarnali , Roy Bharati , Umesh Shreekantiah
Published: June 2021

Context:

Infertility is a global public health issue, and the current data suggest that the problem is growing. Various infertility-related issues are responsible for poorer mental health and well-being in couples with primary infertility.

Aim:

The present study aimed to understand the gender differences of psychological factors related to infertility in couples with primary infertility. Furthermore, an attempt was also made to understand gender-specific associations that could interact with the fertility-related quality of life (FertiQoL).

Settings and Design:

This cross-sectional hospital-based study included 100 married couples with the diagnosis of primary infertility, irrespective of the cause of infertility. The study was conducted at Infertility centers in the Eastern region of India.

Subject and Methods:

One hundred men and women (n = 100 couples) with the diagnosis of primary infertility were recruited in the study. The fertility problem inventory and FertiQoL were used to measure the couples fertility-related stress and FertiQoL, respectively.

Statistical Analysis Used:

Descriptive statistics, independent t-statistics, Pearson correlation, linear regression, and mediation analysis were conducted.

Results:

A significantly higher social and sexual concern of infertility and “need for parenthood” were found in women. Men had a significantly better quality of life compared to women. Significant negative predictors of quality of life were noted for both men and women separately. Fertility stress was a significant mediating factor between marital duration and global FertiQoL in men. However, women showed a direct negative association between marital duration and FertiQoL.

Conclusions:

The study provides important insights into the couple's experiences with various infertility problems that may potentially be addressed during psychotherapy or during infertility counseling.
Hydrogen Peroxide Has Adverse Effects on Human Sperm Quality Parameters, Induces Apoptosis, and Reduces Survival
Authors: Pujianto Dwi Ari , Oktarina Mona , Sharma Sharaswati Ida Ayu , Yulhasri
Published: June 2021

Background:

One of the causes of male fertility disorders is the exposure of oxidative stress on the human sperm. Understanding the mechanism of disturbance is important to develop a better treatment for infertile or subfertile patients.

Aims:

The aim of this study was to analyze the effects of hydrogen peroxide (H2O2) on human sperm quality parameters and cell survival.

Settings and Design:

This study used an experimental design.

Materials and Methods:

Sperm cells from 15 donors were washed in a Percoll gradient and dissolved in Biggers, Whitter, and Whittingham medium. Cells were incubated with H2O2 at various concentrations from 0 to 250 μM for 2 h. Sperm viability was examined by eosin assay, sperm kinetic by computer-assisted sperm analyzer, sperm penetration by cervical mucus penetration assay, and membrane integrity by hypo-osmotic swelling test. Sperm capacitation, apoptosis, and cell survival were analyzed using western immunoblotting.

Statistical Analysis Used:

One-way ANOVA on SPSS 21 combined with post hoc LSD test was used to analyze differences among the groups. A P < 0.05 was considered significant.

Results:

Sperm viability and kinetic were significantly reduced at H2O2 concentrations of 200 and 250 μM. H2O2 reduced sperm capability to penetrate cervical mucus and also damage cell membrane integrity at all concentrations used. H2O2 significantly inhibited sperm capacitation, indicated by reduced total tyrosine phosphorylation. H2O2 exposure stimulated activation of caspase 3 and significantly reduced phosphorylated AKT at all concentrations used.

Conclusions:

H2O2 comprehensively inhibits sperm qualities related to the capacity to fertilize oocyte, stimulates caspase activity, and inhibits cell survival.
Assessment and Establishment of Correlation between Reactive Oxidation Species, Citric Acid, and Fructose Level in Infertile Male Individuals
Authors: Shemshaki Golnaz , Murthy Ashitha S. Niranjana , Malini Suttur S.
Published: June 2021

Background:

Biochemical complexity of seminal plasma and obesity has an important role in male infertility (MI); so far, it has not been possible to provide evidence of clinical significance for all of them.

Aims:

Our goal here is to evaluate the correlation between biochemical markers with semen parameters, which might play a role in MI.

Study Setting and Design:

We enlisted 100 infertile men as patients and 50 fertile men as controls to evaluate the sperm parameters and biochemical markers in ascertaining MI.

Materials and Methods:

Semen analyses, seminal fructose, citric acid, and reactive oxidation species (ROS) were measured in 100 patients and 50 controls.

Statistical Analysis:

Descriptive statistics, an independent t-test, Pearson correlation, and machine-learning approaches were used to integrate the various biochemical and seminal parameters measured to quantify the inter-relatedness between these measurements.

Results:

Pearson correlation results showed a significant positive correlation between body mass index (BMI) and fructose levels. Citric acid had a positive correlation with sperm count, morphology, motility, and volume but displayed a negative correlation with BMI and basal metabolic rate (BMR). However, BMI and BMR had a positive correlation with ROS. Sperm count, morphology, and motility were negative correlations with ROS. The machine-learning approach detected that pH was the most critical parameter with an inverse effect on citric acid, and BMI and motility were the most critical parameter for ROS.

Conclusion:

We recommend that evaluation of biochemical markers of seminal fluid may benefit in understanding the etiology of MI based on the functionality of accessory glands and ROS levels.
Catch Me While You Scan
Authors: Singh Sweta , Rout Prashanta Kumar , Ayyanar Pavithra
Published: June 2021

Primary ovarian pregnancy is rare, accounting for 0.5%–3.0% of all ectopic gestations. It was earlier diagnosed by the classical Spiegelberg's criteria. Ultrasonographic diagnostic criteria have now been described for preoperative diagnosis. We report a case of primary ovarian pregnancy in a 30-year-old woman, where the diagnosis was made preoperatively, and discuss the challenges in diagnosis and management for optimal patient outcomes.
Effect of Endometrial Thickness and duration of Estrogen Supplementation on In Vitro Fertilization-Intracytoplasmic Sperm Injection Outcomes in Fresh Ovum/Embryo Donation Cycles
Authors: Patel Jayesh Amrutlal , Patel Azadeh Jayesh , Banker Jwal Manish , Shah Sandeep I. , Banker Manish
Published: June 2021

Background:

There is no consensus regarding optimal endometrial thickness and duration of estrogen supplementation in embryo transfer cycles, at present.

Aims:

To observe the effect of endometrial thickness and/or duration of estrogen supplementation on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes in fresh ovum/embryo donation cycles.

Settings and Design:

This was a retrospective observational study. The study was conducted from January 2015 to November 2017.

Subjects and Methods:

Nine hundred and fifty seven fresh blastocyst transfer cycles in the recipients of oocyte/embryo donation regardless of reproductive history and diagnosis conducted at Nova IVF Fertility, Ahmedabad, Gujarat, India. Of these, 315 women had single embryo transfer (SET), while 642 had double embryo transfer (DET). Only fresh blastocysts derived from oocytes of young donors (≤30 years) and transferred in a uniform hormone replacement therapy (HRT) cycle were included. The effect of endometrial thickness and duration of estrogen on live birth rate (LBR) and other IVF/ICSI outcomes were analyzed.

Statistical Analysis:

Univariate logistic regression.

Results:

A significant improvement in LBR was noted in the recipients with each millimeter increase in endometrial thickness starting from 6 mm after transfer of either single (odds ratio [OR] = 1.3, P = 0.003) or double (OR = 1.14, P = 0.0218) blastocysts. Lower LBR was observed in recipients having SET and who received estrogen supplementation of <10 days (OR = 0.72; P = 0.02). Implantation rate and clinical pregnancy rate also improved significantly with endometrial thickness, but there was no change in clinical abortion rate and ectopic pregnancy rate.

Conclusions:

After minimizing the possible oocyte factor by including only donor oocytes and that of COH using a uniform HRT protocol, LBR improved with each millimeter increase in endometrial thickness starting from 6 mm. Shorter duration of estrogen supplementation (<10 days) reduced the chances of live birth in recipients after transfer of a single blastocyst.
Spontaneous Ruptured Bilateral Tubal Ectopic Pregnancy Following Natural Conception
Authors: Iwe Amobi Bobbie Chukwujioke , Nwafor Johnbosco Ifunanya , Asiegbu Obiora Godfrey , Adebayo Joshua Adeniyi , Uche-Nwidagu Bridget Nkiruka , Ali Vincent Chidiebere
Published: June 2021

Ectopic pregnancy complicates 0.25%–2% of all pregnancies and is one of the most common causes of first-trimester maternal mortality in developing countries due to late diagnosis. Spontaneous ruptured bilateral tubal ectopic pregnancies are extremely rare, with very limited data on its occurrence in the literature. In a spontaneous conception, the preoperative diagnosis is difficult to make but an important one to consider at surgery for presumed unilateral tubal ectopic pregnancy because missing the diagnosis can lead to mortality. We report a case of a 38-year-old multipara with a history of amenorrhea of 8 weeks and 2 days and complaints of vaginal spotting of 4-day duration and sudden onset of abdominal pain of 4 h before presentation. On admission, a preoperative diagnosis of ruptured left tubal ectopic pregnancy was made following ultrasound findings of left adnexal mass and hemoperitoneum. However, both fallopian tubes were found to harbor ectopic gestational sac with bleeding rents on the tubal walls at surgery. She subsequently had exploratory laparotomy and bilateral salpingectomy with good outcome. In low-resource settings, ectopic pregnancy is associated with poor maternal outcome due to late presentation. Diagnosis of ruptured bilateral tubal ectopic pregnancy is difficult before surgery. Therefore, examination of both tubes at laparotomy for ectopic pregnancy should be routine and mandatory to avoid missing the diagnosis.
Effectiveness of Saptamrita Loha on Panduroga (iron deficiency anemia) in children an open-label prospective clinical trial
Authors: Hiremath Virupaxayya , Kulkarni Reena
Published: June 2021

Introduction:

Panduroga is a systemic disorder that presents with pallor; it is correlated to anemia. Iron deficiency is the most common nutritional deficiency on the globe that contributes to the highest incidences of anemia. Oral iron therapy is the treatment in iron deficiency anemia (IDA), which is associated with adverse reactions such as gastrointestinal irritations on long-term usage. Saptamritaloha is a frequently prescribed herbo-mineral drug from Ayurveda pharmacopeia in the context of eye disorders and it is also used to treat Panduroga. Hence, Saptamritaloha was subjected to a safety and efficacy trial. The aim of the trial was to evaluate the effectiveness of Saptamritalohavati in children with Panduroga (IDA).

Materials and Methods:

An open-label, controlled, prospective clinical trial in children aged 12–16 years was conducted over a period of two months. Assessment was done based on changes in clinical features and complete blood count analysis before and after therapy. The changes were assessed using paired and unpaired t test, Friedman test, and Wilcoxon sign-rank test.

Results:

A total of 43 children (22 in the study group and 21 in the control group) were registered in the trial, out of whom 20 in each trial and the control group completed the study. The present study shows that Saptamritaloha is effective in improving the clinical features and hematological parameters significantly and the results were comparable with the standard control used, namely Dhatriloha. The mean improvement in hemoglobin (Hb) was 1.17 g% in the trial group during the course of treatment (P < 0.001). No adverse drug reactions were noted in the study.

Discussion:

Saptamritaloha vati increases Hb and red blood corpuscles (RBC), packed cell volume (PCV), and mean corpuscular hemoglobin concentration (MCHC) by virtue of its ingredients. The herbal ingredients in the formulation, namely Triphala (group of three drugs, namely Haritaki [Terminalia chebula Retz.], Bibitaka [Terminalia bellirica (Gaertn.)Roxb], Amalaki [Phyllanthus emblica L], Yashtimadhu [Glycyrrhiza glabra L], Madhu [Honey], and Ghrita [Ghee]), possess Tridoshashamana, Anulomana, and Rasayana property, which aids in better bioavailability, drug absorption and also minimizes the gut irritation after oral iron usage.

Conclusion:

Saptamritaloha is effective in the management of Panduroga in children.
Effect of Ayurveda treatment modalities in motor disabilities of children with cerebral palsy
Authors: Uppinakuduru Shailaja , Raj G. R. Arun , Rao Prasanna N. , Jyothsna Mangala , Mallannavar Vijayalaxmi , Subrahmanya Nayan K. , Sagar Kannan
Published: June 2021

Background:

Cerebral Palsy (CP), is umbrella term which encompasses a broad spectrum of neurological impairments which requires multiple line of treatment. Ayurveda interventions for improving the motor disabilities can contribute in bringing out a better result in this condition.

Objective:

To evaluate the effect of Ayurveda treatment modalities in motor disabilities of children with cerebral palsy (CP).

Materials and Methods:

A single-centered, open-labeled, prospective, clinical trial was conducted at a tertiary care teaching hospital attached to Ayurveda Medical College located in district headquarters. Overall, 15 subjects affected with CP were administered with Ayurveda treatment modalities that are inclusive of Udwarthana (dry powder massage), Sarvanga Abhyanaga (oil massage), Sarvanga Parisheka (pouring of warm liquid over a desired body part), Shirodhara (pouring of warm liquid over the head), Upanaha (warm poultice), Matra Basti (medicated enema), and Karnapoorana (administering warm oil into the ear canals) for a period of 15 days. The subjects were assessed before and after treatment for spasticity, muscle power, and range of movements of joints. The data were collected by using a case report form designed for the study. Such collected data were tabulated and analyzed by using Statistical package for social sciences (SPSS, version 20) by using an appropriate statistical test.

Results:

The intervention was found to be effective in reducing spasticity as well as in improving the movement of joints at P < 0.05.

Conclusion:

Holistic Ayurveda treatment modalities can be beneficially implemented for treating spasticity in children with CP.