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Purpose: Recommendations from the American Society of Clinical Oncology (ASCO) emphasize the critical need to understand current trends in fertility preservation (FP) among the two sets of primary health care providers involved in oncofertility: the oncologists and the gynecologists. This study is aimed at understanding the health care providers' knowledge, attitudes, and barriers in oncofertility across India. Methods: An 18-item oncofertility survey was designed and directed to 77 oncologists and 214 gynecologists across India. The responses were analyzed by using descriptive statistical methods, and the oncofertility trends between the two groups were studied. Results: The total response rate was 34%, with 49 of 214 oncologists (23%) and 49 of 77 gynecologists (64%) participating in the survey. The awareness of ASCO FP guidelines among oncologists and gynecologists was 53% and 59.5%, respectively. About 48% of oncologists felt knowledgeable about sperm banking, whereas 52% knew about oocyte freezing but not about other options. On the other hand, among gynecologists, 38% reported inadequate knowledge of testicular or ovarian tissue cryopreservation. About 85% of oncologists reported routine referral of cancer diagnosed patients for FP, whereas 75% of gynecologists reported routine FP discussion with patients. Health care providers from both groups perceived the major barriers in oncofertility to be, "financial burden on the patient" (73%-86%) and, "lack of patient awareness" (71%-79.5%). Conclusion: Effective collaboration between oncologists and gynecologists is essential to establish a successful FP program. Economic burden on the patient and lack of patient and physician awareness are limiting factors that need to be overcome.

Maternal mortality in India is an unresolved issue with more than 130,000 deaths every year. Home births remain a strong preference and often the only option for many women in rural locations [1]. Post partum hemorrhage (PPH) accounts for approximately 25---30% of maternal deaths in India [2]. Intervention with an effective drug at the time of delivery by a skilled attendant would be a crucial factor in averting death due to PPH. However, such individuals are not routinely present and many women deliver only in the company of concerned family members who, although they have assisted many times, are not skilled or trained birth attendants. This study tested whether use of 600 mcg of oral misoprostol, administered during the third stage of labor by auxiliary nurse midwives (skilled birth attendants) reduced the incidence of postpartum hemorrhage. Nineteen auxiliary nurse midwives (ANMs) from four primary health centers (PHC), Karnataka, India administered the intervention to 1620 women. The ANMs were responsible for screening and recruiting the study participants, obtaining informed consent, randomization, delivery of the intervention, measuring the blood loss and following the participants during the 6 weeks postpartum. The training of the ANMS included screening for

Road traffic accidents are among the most common cause of death in India. According To WHO statistics it is the 9 th leading cause of death in 2004 and projected to be the 5 th leading cause by 2030 . 1 Among road traffic accidents (RTA) deaths , two wheeler accidents are common , followed by pedestrians. Pedestrian forms the most vulnerable group amo ng road users. The current study was done for a period of five years on fatal Pedestrian’s accidents. The incidence was common among the age group of 41 to 50 years with male predominance. Majority of individual died on spot without receiving any prelimina ry treatment , majority of incidence was seen between 12.00 Noon to 6.00 PM. Externally injuries are common in trunk followed by head and neck. Internally brain involvement was common followed by abdominal viscera. Majority of death were due to head injurie s. The incidence of accidents has been increased with current trend of increased vehicle load on roads and with negligent attitude in following the traffic rules

Trauma is one of the leading preventable causes of death in developin g countries, and is a major health and social problem. Trauma affects generally the young people, and accounts for loss of more years of life, than lost due to cancer and heart diseases put together. In urban life 75% of thoracic trauma follows blunt injur y. Greatest difficulty in their management lies in the timely diagnosis. This is largely due to masking of thoracic trauma by associated injuries like head injury, abdominal trauma and bony injury. In Bangalore, vehicular accidents are one of the most common contributory factors to the chest trauma because of multiplicity of vehicles

Background: To compare the efficacy of 600mcg of oral misoprostol with 0.2mg of injection methylergometrine for the prevention of post partum hemorrhage. Methods: 200 apparently normal pregnant women were randomized to receive either 600mcg of oral misoprostol (study group) after delivery of baby or 0.2 mg of methylergometrine intravenously (control group) after delivery of placenta. Primary outcome was to know the incidence of post partum hemorrhage in both the groups. Secondary outcome measures were to look for mean blood loss, need for any other uterotonic agents, need for blood transfusion, need for surgical intervention, mean duration of third stage and side effects of both the drugs. Results: Out of 200 cases, two cases were excluded for the final analysis. Incidence of PPH was 9% in misoprostol group & 6% in methylergometrine group which was not significant (p >0.05). There were no significant differences among both the groups in mean blood loss, duration of bleeding, need for further oxytocics and duration of third stage. Shivering was significantly more common in misoprostol group (36% Vs 2% p< 0.0027). Conclusion: Efficacy of 600mcg of oral misoprostol is comparable to injection methylergometrine 0.2 mg intravenously for prevention of post partum hemorrhage. So, in settings where methylergometrine is used routinely for prophylaxis, oral misoprostol can be used with more ease & other advantages over injectables. Significantly more number of patients in misoprostol will have shivering as a major side effect, which should be kept in mind.

Alzheimer's disease (AD) is a neurodegenerative disorder which leads to severe brain damage. The main objective of this work is to diagnosis Alzheimer's disease using Elman Back Propagation (BP) algorithm. In the proposed method, the Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) datasets are obtained from the freely availed database called ANDI. The preprocessing of input images was done by weiner filter. The PET and MR features are extracted using Gray-level Co-occurrence Matrix (GLCM). Finally, the classification was done using Elman Back Propagation Neural Network. The experimental results on dataset validate the efficiency of the proposed method in diagnosing Alzheimer's disease.

To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH).One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe.Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p0.001) and fever (4.2%vs. 1.1%, p0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p0.001) and fever (1.4%vs. 0.4%, p0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns.Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks.

To reduce the many adverse health outcomes associated with intimate partner violence (IPV), high-risk groups need to be specifically targeted in the fight against domestic violence in India. This study aims to examine the prevalence and correlates of IPV in HIV-positive and HIV-negative women from India. A convenience sample of HIV-positive and HIV-negative women responded to questionnaires to assess their experience and perception of violence. Multivariate logistic regression analysis was used to model the association between IPV and age, education, employment status, contraception use, age at first marriage, and HIV status. Although adjusting for age, education, employment status, contraception use, age at first marriage, and HIV status, women who are employed were 3.5 times more likely to suffer IPV (confidence interval [CI] = [1.5, 8.5]), women aged 18 or above at first marriage are 0.3 times less likely to face IPV (CI = [0.1, 0.6]), and women who use contraception are 7 times more likely to suffer IPV (CI = [1.4, 30.2]). Also, HIV-positive women are 3 times more likely to face sexual violence compared with HIV-negative women (CI = [1.1, 7.6]).

A 9 year-old boy presented with a 3-week history of low-grade fever, on and off, and additive arthritis of the lower limb joints with no overt antecedent trauma. Investigations for juvenile idiopathic arthritis (JIA), reactive and tuberculous arthritis were normal. He was started on anti-inflammatory drugs as for seronegative oligoarticular JIA. Since arthritis persisted despite treatment, MRI of the left knee joint was planned prior to an aspiration/synovial biopsy. MRI revealed a partial tear of the anterior cruciate ligament with a significant effusion. On careful re-examination, at this point, he was found to have generalised hypermobility with a Beighton score of 9/9. This had been missed initially, leading to a delay in diagnosis and management. He was managed with careful physiotherapy and lifestyle modification. The left knee effusion resolved within a month. This case is being reported in order to highlight the fact that joint hypermobility syndrome can be misdiagnosed as arthritis.

Posterior reversible encephalopathy syndrome (PRES) is a recently described condition, wherein there is vasogenic oedema, seen on neuroimaging, predominantly over the parieto occipital regions of the cerebrum. Though, as the name implies, the condition is reversible, there may be fatalities and neurological sequelae. We are reporting a 9-year-old female child in whom the typical clinical and neurological findings of PRES were caused by an atypical presentation of acute glomerulonephritis.

Previous studies have shown that the Helicobacter pylori ArsRS two-component signal transduction system contributes to acid-responsive gene expression. To identify additional members of the ArsRS regulon and further investigate the regulatory role of the ArsRS system, we analyzed protein expression in wild-type and arsS null mutant strains. Numerous proteins were differentially expressed in an arsS mutant strain compared to a wild-type strain when the bacteria were cultured at pH 5.0 and also when they were cultured at pH 7.0. Genes encoding 14 of these proteins were directly regulated by the ArsRS system, based on observed binding of ArsR to the relevant promoter regions. The ArsRS-regulated proteins identified in this study contribute to acid resistance (urease and amidase), acetone metabolism (acetone carboxylase), resistance to oxidative stress (thioredoxin reductase), quorum sensing (Pfs), and several other functions. These results provide further definition of the ArsRS regulon and underscore the importance of the ArsRS system in regulating expression of H. pylori proteins during bacterial growth at both neutral pH and acidic pH.

The Helicobacter pylori ArsS-ArsR two-component signal transduction system, comprised of a sensor histidine kinase (ArsS) and a response regulator (ArsR), allows the bacteria to regulate gene expression in response to acidic pH. We expressed and purified the full-length ArsR protein and the DNA-binding domain of ArsR (ArsR-DBD), and we analyzed the tertiary structure of the ArsR-DBD using solution nuclear magnetic resonance (NMR) methods. Both the full-length ArsR and the ArsR-DBD behaved as monomers in size exclusion chromatography experiments. The structure of ArsR-DBD consists of an N-terminal four-stranded β-sheet, a helical core, and a C-terminal β-hairpin. The overall tertiary fold of the ArsR-DBD is most closely related to DBD structures of the OmpR/PhoB subfamily of bacterial response regulators. However, the orientation of the N-terminal β-sheet with respect to the rest of the DNA-binding domain is substantially different in ArsR compared with the orientation in related response regulators. Molecular modeling of an ArsR-DBD-DNA complex permits identification of protein elements that are predicted to bind target DNA sequences and thereby regulate gene transcription in H. pylori.

The main objective of this study was to identify factors associated with variation in the rate of acute postpartum hemorrhage (PPH), defined as blood lossor= 500 mL within 2 hours of delivery, observed in a randomized clinical trial of misoprostol for the prevention of PPH, conducted in rural India. Although the women in the misoprostol group had a significantly lower probability of having a PPH, we also noted a reduction in the rate of PPH in the placebo group over the course of the study. We hypothesized that this was due to the changing skills of the auxiliary nurse midwives (ANMs) over the course of the study.We conducted a post-hoc analysis examining variation in PPH rates over the duration of the trial among the women randomized to the placebo arm (n = 808). Descriptive, correlation analysis and generalized estimating equations (GEE) were used to predict PPH rates. With no direct measure of ANM skills, we used proxy measures, including: (1) the ANM's point of entry into the study (original ANMs at the initiation of the trial were less skilled than replacement ANMs); (2) the study duration, representing exposure of the ANM to ongoing training and monitoring; and (3) duration of the second stage of labor as a measure of improved delivery practices.As the study duration increased, the duration of the second stage of labor decreased (-0.12, p = 0.001) and as the duration of the second stage of labor decreased, the rate of PPH decreased (0.0282; 95% CI 0.0201-0.0363). For each 10-minute increase in the duration of second stage labor increased PPH odds by 7.1% and each 30-day duration of the trial decreased PPH odds by 3.4%. Additionally, a patient delivered by an original ANM was 3.14 times more likely to have a PPH compared to a patient delivered by a replacement ANM.Declining PPH rates were associated with improved skills and delivery practices that decreased duration of the second stage of labor. These improvements appeared to be consistent with the introduction of the more skilled replacement ANMs as well as ongoing training and monitoring for all ANMs over the duration of the trial.

Postpartum haemorrhage is a major cause of maternal mortality in the developing world. Although effective methods for prevention and treatment of such haemorrhage exist--such as the uterotonic drug oxytocin--most are not feasible in resource-poor settings where many births occur at home. We aimed to investigate whether oral misoprostol, a potential alternative to oxytocin, could prevent postpartum haemorrhage in a community home-birth setting.In a placebo-controlled trial undertaken between September, 2002, and December, 2005, 1620 women in rural India were randomised to receive oral misoprostol (n=812) or placebo (n=808) after delivery. 25 auxiliary nurse midwives undertook the deliveries, administered the study drug, and measured blood loss. The primary outcome was the incidence of acute postpartum haemorrhage (defined asor =500 mL bleeding) within 2 h of delivery. Analysis was by intention-to-treat. The trial was registered with the US clinical trials database (http://www. clinicaltrials.gov) as number NCT00097123.Oral misoprostol was associated with a significant reduction in the rate of acute postpartum haemorrhage (12.0% to 6.4%, p0.0001; relative risk 0.53 [95% CI 0.39-0.74]) and acute severe postpartum haemorrhage (1.2% to 0.2%, p0.0001; 0.20 [0.04-0.91]. One case of postpartum haemorrhage was prevented for every 18 women treated. Misoprostol was also associated with a decrease in mean postpartum blood loss (262.3 mL to 214.3 mL, p0.0001). Postpartum haemorrhage rates fell over time in both groups but remained significantly higher in the placebo group. Women taking misoprostol had a higher rate of transitory symptoms of chills and fever than the control.Oral misoprostol was associated with significant decreases in the rate of acute postpartum haemorrhage and mean blood loss. The drug's low cost, ease of administration, stability, and a positive safety profile make it a good option in resource-poor settings.

Objective: To compare (1) visual estimation of postpartum blood loss with estimation using a specifically designed blood collection drape and (2) the drape estimate with a measurement of blood loss by photospectrometry. Methods: A randomized controlled study was performed with 123 women delivered at the District Hospital, Belgaum, India. The women were randomized to visual or drape estimation of blood loss. A subsample of 10 drape estimates was compared with photospectrometry results. Results: The visual estimate of blood loss was 33% less than the drape estimate. The interclass correlation of the drape estimate to photospectrometry measurement was 0.92. Conclusion: Drape estimation of blood loss is more accurate than visual estimation and may have particular utility in the developing world. Prompt detection of postpartum hemorrhage may reduce maternal morbidity and mortality in low-resource settings.

The commonest cause of maternal deaths worldwide is postpartum bleeding, and the great majority of such deaths take place in developing countries such as India where women frequently do not deliver their children in a hospital setting. The major cause is uterine atony, which can be prevented by administering a uterotonic agent such as oxytocin. Such treatment remains impractical for much of the developing world, where women giving birth are cared for by untrained attendants. In addition, injected uterotonic agents must be stored in the cold and require active management of the third stage of labor. Orally administered misoprostol, a prostaglandin E 1 analogue, is a comparatively inexpensive alternative to oxytocin that has proved to be effective and safe, does not need to be refrigerated, and has a long shelf life. The investigators report a trial, conducted in rural India, which compared a single oral dose of 600 μg of misoprostol (n = 812) with placebo (n = 808) for preventing acute postpartum hemorrhage, defined as 500 mL or more within 2 hours after delivery. Medication was administered within 5 minutes of cutting the umbilical cord. The rate of acute severe bleeding (1000 mL or more within 2 hours) also was estimated. The actively treated women and placebo recipients were similar with respect to demographic, clinical, and perinatal features. The overall incidence of acute postpartum hemorrhage was 9.2%, occurring in 6.4% of misoprostol-treated women compared to 12% of placebo recipients, a highly significant difference (P < 0.0001). The relative risk for actively treated women compared with the placebo group was 0.53 (95% confidence interval, 0.39-0.74). All but 2 of 10 women with acute severe postpartum bleeding had received the placebo. Overall mean blood loss was lessened by misoprostol (214 versus 262 mL; P < 0.0001). Actively treated women were less likely to require transfer to a higher-level facility, blood transfusion, and surgical interventions. There were no group differences in delayed postpartum bleeding or infection. Rates of neonatal fever, vomiting, and diarrhea did not differ in the two groups. Oral administration of the prostaglandin analogue misoprostol is an effective, safe, inexpensive, and easily administered means of limiting the risk of postpartum bleeding in areas where medical resources may be scarce.

a John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA b J. N. Medical College, Belgaum, Karnataka, India c Department of Obstetrics and Gynecology, University of lllinois at Chicago, Chicago, IL, USA d University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA e Global Network for Women's and Children's Health Research, National lnstitute of Child Health and Human Development, Rockville, MD, USA

It is well-known that India's economic reforms were set off by balance of payments crisis of 1991. At the time the banking system both commercial and cooperatives suffered from lack of competition, low productivity, high cost of intermediation, narrow capital base, etc. The financial sector reforms were necessarily set to alter organizational structure and ownership pattern, as well as, to infuse competition. After a decade, the RBI in its Report on Currency & Finance, 2001-02 had taken a review and observed that the financial sector reforms had brought about marked improvement in the financial, health of commercial banks in terms of assets quality, capital adequacy and profitability. The cooperative banks, to which the reforms were initiated little later, did not show much improvement in any of these areas.