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Alzheimer’s disease (AD) consists of 60-80% of all dementia cases, thus is recognized as the commonest form of dementia. The current challenge to clinicians and researchers in the field of AD is development of treatment plans that can target the progression of pathology at molecular level as well newer diagnostic techniques for early detection and prevention of AD. This could be achieved by enhancing our understanding of the underlying pathophysiology of AD. This is systematic and concise review of various pathophysiological mechanisms contributing to AD. Legitimate indexing portals and search websites were used to carry out the literature search for this article. A combination of MeSH terms and Boolean operators were used. Obtained research articles were carefully assessed first by reading title and abstract and finally by reading the whole text. A set of inclusion and exclusion criteria were used to select the reference articles.: In our literature search 75 articles were obtained from PubMed, Google scholar and Cochrane Library after removing duplicate records. These were screened using titles and abstract. 23 articles were excluded from the study as per the exclusion criteria. Full text of 52 articles were read. 7 articles were excluded, 45 were studied thoughrouly and 30 were referenced during the writing of this review.Various risk factors – old age, diabetes, smoking, mutation etc contribute to Aβ plaque accumulation due to cleavage of APP protein by α and ϒ secretase. Aβ plaque further contributes to accumulation of neurofibrillary tangles, neuroinflammation and oxidative stress. This together with disturbance in Calcium homeostasis and excitotoxicity at glutamate receptors contribute to neurodegeneration and synaptic toxicity.

To find out the adverse effects of prolonged mobile phone radiation on the users’ eyes. : A convenience sample of 200 adults visiting our out-patient’s services with 20/20 vision was randomly recruited for this study. The ipsilateral eye on the preferred side during talking was considered as the preferred side and the other as non-preferred side. All participants underwent Schirmer’s test (S1T), Tear film break-up time (TBUT), central corneal thickness (CCT) and central macular thickness (CMT) measurements for comparison on both the sides. The approximate cumulative duration of the talk time (hours/day) while keeping the phone over the ear was recorded.: The mean age of participants was 25.1+5.4 years and 124 (62%) preferred to use the right ear for telephonic conversations. The TBUT (19 + 2.7 vs. 20 + 3 seconds), Schirmer’s (21.5 + 2.8 vs. 22.6 + 2.5 mm), p : Mobile phone use affects the tear fluid dynamics (TBUT and S1T) and the corneal thickness of the eye. Thus, any of the radiations or thermal effect or both from the mobile phones can affect the eye and its structures. Further studies are needed to address these consequences.

“During the COVID-19 pandemic, the “Opportunity to Reform Assessment” Webinar was a global event that was urgently needed. The Department of Physiology, All India Institute of Medical Sciences Rishikesh, India, hosted a faculty engagement webinar for people interested in medical education and evaluations on July 21, 2021. The objective of the webinar served both to disseminate the knowledge and to receive feedback and gather inputs on online assessments. This webinar should help prestigious medical experts, including faculty from all cadres involved in teaching, and result in improvements for planning and implementing future assessments during pandemic-like situations. Additionally, this webinar should assist in the discussion of the issues in conducting online formative and summative assessments in different medical institutions, as well as to raise solutions to the current challenges of the COVID-19 era within a certain timeline.

Background: Patients with psychiatric disorders are at an increased risk of developing cardiovascular disease, reducing life expectancy. Autonomic dysfunction has been linked to this increased risk; many studies have found reductions in heart rate variability (HRV). Only a few studies have systematically explored the relationship between obsessive–compulsive disorder (OCD) and autonomic function, and they have found contradicting results. The present study is intended to explore comprehensive autonomic functions in OCD patients and compare them with healthy controls. Methods: A total of 18 OCD patients meeting Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) criteria were enrolled to undergo comprehensive autonomic function testing, and the results were compared with 25 age- and sex-matched healthy controls. Results: Time-domain parameters of HRV such as standard deviation of the RR intervals, coefficient of variance of RR intervals, standard deviation of differences between adjacent RR intervals, root square of the mean of the sum of the squares of differences between adjacent RR intervals, and percentage of number of RR interval differences ≥ 50 ms were significantly lower in OCD patients, indicating lesser parasympathetic tone. Frequency-domain parameters such as total power and very low frequency were significantly lower in OCD patients, indicating a significant decrease in autonomic tone. Nonlinear parameters such as dispersion of points perpendicular to the line of identity and dispersion of points along the line of identity were significantly lower in OCD patients, indicating altered vagal and sympathetic tone. In autonomic reactivity tests, the fall in systolic blood pressure during the lying to standing test and change in diastolic blood pressure during the cold pressor test were significantly altered in OCD patients, indicating abnormal sympathetic reactivity. There was no significant correlation between autonomic parameters and the severity of OCD. Conclusion: OCD is characterized by a decreased parasympathetic tone and abnormal sympathetic reactivity compared to normal controls.

Hypertension is an established risk factor for dementia, and the prevalence of hypertension and dementia is rising. Current tests to diagnose cognitive dysfunction at an early stage lack sensitivity and specificity. Recently event-related potentials (ERPs) have gained much attention in diagnosing cognitive dysfunction and are independent of the education status of the subject. This study was done to find any cognitive deficits in the hypertensive population with electrophysiological evidence, which might open the doors for the need to screen the population at an earlier stage so that the population can be prevented from dementia. Some 31 middle-aged (18-65 years) hypertensives were compared with 31 age, sex, education, and handedness matched normotensives about cognition by neuropsychometric test battery including Hindi Mini-mental Status Examination (HMSE), Hindi Montreal Cognitive Assessment (MoCA), choice reaction time (CRT), and auditory event-related potentials. Hypertensives and normotensives differed significantly concerning P300 potentials' latency (Fz and Cz P300 latencies: p-value: 0.001), and this change was correlated well with the duration of diastolic blood pressure (BP) (r-value: 0.670). The remaining tests, HMSE, Hindi MoCA, and CRT, were dependent on the education status of the patient. The effect of hypertension on cognitive impairment is evident and can be proved early in its pre-clinical stage using ERPs. Early identification can help in specifying high-risk individuals. ERPs have great potential in screening and diagnosing and can also help in assessing cognition as a reliable tool to show the effect of treatments/interventions on cognitive defects.

Background: Tests like auditory P300 event related potential, neuro-psychometric pen pencil Montreal Cognition Assessment Test (MOCA) and Choice reaction time have been used as indexes of cognitive function. Thus this study has been planned with the aim to evaluate cognitive ability of a normal adult to nd out normative data and its, variation with age and gender in Uttarakhand region of India. Materials and Method: This cross-sectional study was carried out in the department of Physiology of AIIMS, Rishikesh on 52 healthy with ages ranging from 20 to 40 years, equal number of male & female volunteers with the ability to understand test procedures. Following tests were performed in the given order for uniformity during 11-1 pm timing of a day: 1. Event Related Potential-P300 2. Neuro-psychometric assessment (Hindi Montreal Cognitive Assessment -HMOCA test) and 3. Choice Reaction Time. Results and Conclusion: Mean of P300 Latency is 310 ± 37.14 msec, mean of P300 Amplitude is 14 ± 7.5 uv (from Cz electrode site), mean of Montreal Score is 24.81±3.25, and mean of CRT is 584.5 ±84.06 ms in all the subjects. All the parameters are better in younger age group. All the parameters are better in male except MOCA score

PRCIS Yogic pranayama and diaphragmatic breathing are potential adjunctive therapies for patients with glaucoma; however, they are not substitutes for medicine or eye drops. PURPOSE Currently, medical or surgical lowering of intraocular pressure is the only therapeutic approach for treating primary open-angle glaucoma. Intraocular pressure maintenance is influenced by autonomic activity (sympathetic and parasympathetic). "Yogic pranayama" and "diaphragmatic breathing" are exercises that can affect autonomic activity by stimulating a wakeful hypometabolic state of parasympathetic dominance. We aimed to assess the effect of yogic pranayama and diaphragmatic breathing on intraocular pressure to determine whether it can be recommended for individuals with established glaucoma in combination with glaucoma medication as an adjuvant therapy. MATERIALS AND METHODS In this prospective, randomized trial, 90 patients with primary open-angle glaucoma (180 eyes, age: above 40 y) were assigned to either the control or yogic pranayama and diaphragmatic breathing exercise group. In the latter group, yogic pranayama and diaphragmatic breathing were practiced daily for 6 months. We measured the intraocular pressure at presentation and subsequently after 1, 3, and 6 months. RESULTS Compared with the wait-list group, the yogic pranayama and diaphragmatic breathing exercise group had significantly lowered intraocular pressure (right eye: 20.85±3.39 to 14.90±2.86 mm Hg; left eye: 20.30±4.12 to 14.25±3.85 mm Hg; P

Purpose: The purpose of the study was to compare the choroidal thickness in normal population and hypertensive patients and to assess the possible effect of hypertension on choroidal thickness using Spectral Domain Optical Coherence Tomography (SD-OCT). Methods: This was a comparative cross-sectional study. A total of 68 eyes of 34 individuals in the age group of 40–60 years were included in both the hypertensive group and control group. Individuals with refractive error beyond ± 3 D and posterior segment pathology were excluded. The choroidal thickness was measured at the sub-foveal region, 500 μm nasal and 500 μm temporal to the fovea on SD-OCT with enhanced depth imaging (EDI) mode. Systolic blood pressure (SBP), Diastolic blood pressure (DBP), and Mean arterial pressure (MAP) were recorded in all individuals. Duration of hypertension was also noted in hypertensive individuals. Results: The choroidal thickness at all locations was significantly lower in the hypertensive group (subfoveal, nasal, temporal and mean choroidal thickness 253.24 ± 63.96 μm, 249.35 ± 63.57 μm, 250.01 ± 63.37 μm, 250.87 ± 63.38 μm, respectively) as compared to the control group (subfoveal, nasal, temporal and mean choroidal thickness 301.25 ± 55.79 μm, 298.97 ± 57.07 μm, 299.49 ± 55.06 μm, 299.90 ± 55.50 μm, respectively). The choroidal thickness in the hypertensive group also had a significant negative correlation with the SBP (Spearman correlation coefficient, rho = –0.35, P = 0.003) and the duration of hypertension (rho = -0.25, P = 0.037). Conclusion: The study demonstrated decreased choroidal thickness in systemic hypertensive subjects as compared to age-matched healthy individuals. The choroidal thickness in hypertensive subjects also had a significant but weak negative correlation with SBP and duration of hypertension.

To study the effect of refractive errors on pattern visual evoked potential (VEP) recordings in the pediatric population.This cross-sectional observational study assessed 240 eyes of 120 participants attending the outpatient department of a tertiary care center in North India. Participants were between 8 and 18 years of age; 30 participants each were recruited into four groups, namely emmetropia, myopia, hypermetropia, and amblyopia. They were then subjected to pattern reversal VEP, with P-100 amplitude and latency recorded for each participant.The emmetropic group in this study provided normal values of P-100 parameters, namely P-100 latency and P-100 amplitude with readings of 115.78 ± 10.19 ms and 11.11 ± 4.08 μV, respectively. P-100 amplitude was significant compared to P-100 latency in detecting the presence or absence of a specific type of refractive error. It was found that there was a significant association between severity of myopia and P-100 latency (both unaided and aided) with P0.05. The severity of hypermetropia showed a significant association with P-100 amplitude (unaided) (P0.05). Receiver operating characteristics analysis revealed P-100 amplitude to be a good predictor of refractive error and the cut-offs were calculated.The P-100 parameters of the pediatric Indian population were comparatively higher than conventional values. P-100 latency seemed to better correlate with myopia, while hypermetropia correlated with P-100 amplitude. P-100 amplitude appears to be the most significant predictor of the presence of refractive error in an individual.

Purpose: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. Methods: A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value

The topic of maternal Chromium (Cr) levels in Gestational Diabetes Mellitus (GDM) has remained controversial; some studies have found lower levels of Cr in GDM population, whereas others found no significant changes in Cr status in GDM. Therefore, this systematic review and meta-analysis was aimed at qualitatively and quantitatively synthesizing past studies to find the relationship of maternal Cr levels with GDM. The study protocol was registered at International prospective register for systematic reviews (PROSPERO) (ID CRD42021272979). Strict adherence to the Preferred Reporting Items for Systematic review and Meta-analysis checklist, 2009 was followed during the entire study. Random-effect model for calculation of distribution of true effect sizes was used for the meta-analysis with a confidence interval (CI) of 95%. The pooled Standard Mean Difference of control and GDM groups were compared using Z statistics with a

Diabetic retinopathy (DR) is a microvascular complication associated with diabetes mellitus. Pregnancy is a major risk factor for DR in diabetic women. Recent evidenced suggests that in course of DR functional changes including damage of pre-ganglionic and ganglionic cells in retina precede structural microvascular changes. A number of studies in the past have highlighted the role of pattern visual evoked potential (VEP) in detecting such functional changes. However, the study of VEP changes in diabetic pregnancies remains unexplored. This case series has the objective of exploring VEP changes in symptomatic OVD cases, who had no signs of DR on fundoscopy. We present two cases of overt diabetic women who complaint of straining of eyes, headache, and difficulty in reading during pregnancy. Complete ophthalmic examination was done in both the cases followed by a VEP test. VEP test was done as a part of a research project. The ethical clearance for the project was obtained from the Institute’s Ethics Committee before the commencement of the study. Fundoscopic examination in both cases revealed that the retina was within normal limits with no signs of retinopathy. In Case 1, P100 latency was increased for the left eye and was normal for the right eye during the first visit. While P100 latency was increased for both left and right eye during the second visit. There was a substantial increase in P100 latency for both eyes in second visit as compared to first visit. In Case 2, P100 latency was increased for both left and right eye and amplitude decreased for the left eye. This is a case series consisting of symptomatic overt diabetic pregnant women who had increased P100 latency despite no signs of retinopathy in fundoscopy. The previous studies have reported that multiple follow-ups with ophthalmoscopy may not be cost-effective in diabetic pregnant women. VEP provides a window for detection of early functional changes that may help identify at risk patients for follow-up and early intervention.

Background: The World Health Organization and the World Bank's "World Report on Disability" reported that over 1 billion people have various kinds of disability worldwide while Indian Census 2011 reported about 26 million in India. The United Nations Convention states, "The Rights of Persons with Disabilities (PwD) include accessibility to Information, Transportation, Environment, Communication Technology and Services". Objective: This article takes forward the reason of making the "EasenAccess" (EnA) Android-based app to empower PwD with wheelchair-accessibility information, communication sentences and sending SOS signals with location. Methods: A survey of 25 most frequented places in New Delhi by common people and tourist with chosen 12 parameters in comparison the Government of India's survey of 100 most important buildings nationally. Results: A statistical analysis and recommendations about areas for improvement, for the Government of India. Conclusions: EasenAccess helps millions of PwD to enable them with freedom of movement for employment and socio-economic activities to lead an independent lifestyle. EasenAccess increases government's access to information about lacunae, gives them an easy way to tabulate the places where more accessibility needs updating, and helps the government in facilitating information flow to the PwD. Implication for Rehabilitation The Rights of Persons with Disability Act in 2016 covers both the concepts of Universal Design of products, environments and programs; and accessibility. We are exploring with them the ways technology can help bridge the gap between rehabilitation and accessibility. In the higher income countries such as the UK or USA, it is normal for a person to receive training when being given a wheelchair to prevent future injuries. Frequently, even with this, training people develop upper limb injuries, due in part to the high, repetitive loads needed to push a wheelchair. This training is given as part of a package of rehabilitation, which also normally includes adaptations to people's living environments, which will enable them to use their wheelchair indoors. In Accessible Routes from Crowd-based Cloud Services (ARCCS) many NGOs have been able to develop sensors, which are themselves part of the Internet of Things, which when attached to a mobility device extend the ability of that device. Users can interact with the sensor data on their mobile phone via an app. They can also add geo-tagged photo or voice notes to annotate their journey. These can then be shared with other users of the ARCCS system. The system has been developed with a range of wheelchair users and other stakeholders. For example, one such initiative by the Government of India is called "Street Rehab". The aim of Street Rehab is to co-develop a new system for delivering a service for wheelchair users, which puts everyday activities at the heart of the rehabilitation process. To do this, a clear understanding of user needs, available technology and the accessibility of the city are all required. The first step is to understand the current accessibility of Delhi, the next to map this with the rehabilitation and livelihoods requirements of the wheelchair and tricycle users. This approach has led to the development of novel sensors and a data processing chain, which can automatically identify features of the sidewalk or surface, for example, drop curb, camber, and rough terrain. These classifications are then used to help with increasing localization of the person. In addition, the sensors can be used to identify how the pushing techniques of people, who self-propel their wheelchair. They have developed these sensors, as mobile phones alone, while useful if secured in a fixed position, are not adequate when loosely placed in bags or pockets. The aim is to find practical solutions for those who use mobility aids in India to access the services and places they wish to without risk of injury. Injuries can occur due to toppling out of a mobility device, being hit by a vehicle or developing an injury over time due to the demand of pushing/cycling the mobility device. EasenAccess can be a synergistic platform for all such future community based rehabilitation approaches. It can also help compile and collate data for accessibility gaps and rehabilitation issues encountered. EasenAccess app can thus help create an emerging framework, which puts the experience of the wheelchair user at the center but with a clear connection to people who can implement policy change on a broad scale.One that includes local people who will be advocates for creation of accessible maps, and local NGOs to provide hubs of training. These can be linked to a series of YouTube videos and supported via a messaging service, for example, local WhatsApp groups or social media groups, for example, a Facebook Page. With infinite possibilities, as illustrated above, EasenAccess app can create a new technological paradigm for convergence of Accessibility and Rehabilitation.

We report a case of a 55-year-old known hypertensive female who presented with features suggestive of dementia, which, on further workup unveiled background dyslipidemia and type 2 diabetes mellitus. An magnetic resonance imaging of the brain revealed findings suggestive of Binswanger's disease. This is a discussion of this unusual disease and its presentation and the differentials of this presentation which may be encountered in general clinical practice.

Context: Wholesale vegetable market is a rich source of generation of organic dust as loads of fruits and vegetables are loaded and unloaded here daily. Thus, regular workers are exposed to this organic dust for a considerable period of time depending on their work schedule. This study was planned to determine the microbial status of organic dust and to explore its association with pulmonary functions in the workers of wholesale vegetable market in Rishikesh. Materials and Methods: It was a cross-sectional exploratory/observational study. Thirty-five apparently healthy adult males were selected from vegetable market having no history of any chronic illness. Smokers and alcoholic were excluded from the study. The same number of age- and sex-matched controls with the same exclusion criteria were recruited from workers not working in the vegetable market and also not exposed to any other kinds of organic dust. Microbial culture of air in the vegetable market was done. It was compared with the microbial status of air in the working place of controls. Pulmonary functions of all the workers were performed with the help of digital spirometer (Helios 401). Results: Bacterial and fungal concentration was found to be significantly higher in the air of vegetable market as compared to air in the workplace of controls (such as coagulase-negative staphylococci >25 colony-forming unit (CFU) at incubation temperature vs. 10–12 CFU at incubation temperature, significant growth of Mucor, Aspergillus niger, and Candida nonalbicans in vegetable market as compared to workplace of controls). Pulmonary function parameters (percentage forced expiratory volume in 1st s (FEV1), percentage predicted forced expiratory flow in mid-half of expiration, and FEV1) of workers exposed to organic dust in vegetable market were also significantly lower (P < 0.05). Conclusion: Exposure of organic dust is associated with compromised pulmonary functions and there is a need of formulation of safety guidelines.

Memory is formed on the basis of sensory stimuli perceived. Vision and Auditory sense are the most common modes to form visual and auditory memory. This study was planned to find the preferred sense route for the formation of memory, between the two genders.In the present cross sectional experimental study, 40 male and 40 female subjects between 18-20 years of age were tested for visualauditory memory.Results: The results suggested statistically significant higher scores of ‘Memory Test’ in women in comparison to men (F479 3.312, p=0.001). The mean score for memory subtests was best for blackwhite pictures followed by colored pictures, visual words, visual digits, auditory digits and auditory words in that order in men, whereas in women, mean score was best for colored pictures followed by blackwhite pictures, auditory words, auditory digits, visual words and visual digits.It may be concluded that in men visual sense and in women auditory sense are more effectual for the formation of memory.

Background & Objectives : HRV is one of the most promising and popular markers of cardiac autonomic activity. It is a non invasive technique having significant diagnostic, clinical and research application. Rapid weight gain is associated with increased cardiac sympathetic tone in humans. There is a lack of autonomic imbalance studies involving young obese individuals. This study is an effort to assess the effect of obesity on cardiac autonomic activity using Heart Rate Variability in young adults in normal weight and obese subjects. Methods: 140 young adults 18-25 years were categorized into BMI based, normal and obese groups. Raw data for HRV analysis was a ‘lab chart recording’ of heartbeat signal from a pulse transducer in a resting subject for 5 min. at 1000 samples/sec. Results: There was a significant (pInterpretation & Conclusion: In Obese group, study showed a statistically significant reduction in parasympathetic activity and a statistically significant increase in sympathetic activity. There was a shift in the sympathovagal balance towards sympathetic predominance among obese young adults in contrast to normal young adults.

Background Cognition can be defined as all mental activities that are involved in acquisition, processing, storage and retrieval of information. Purpose There is paucity of the data related to cognitive function amongst healthy adolescent age group which limits our ability to distinguish and compare cognitive changes that occur across the adult lifespan in female and male subjects separately and can provide some help to understand dementia related conditions. Methods Cognitive function was assessed in 100 healthy subjects of each sex of 17–20 years by using ‘Montreal Cognition Assessment Test’, a 10 minutes: 30-points test which is used in assessing a wide range of cognitive abilities on 7 subscales : 1) Visuospatial Skills, 2) Language, 3) Memory, 4) Attention, 5) Mathematical ability, 6) Abstraction, and 7) Orientation. Results Overall score (Male: 25.16 ± 1.8, Female: 25.72 ± 1.8) of cognition functions was statistically significantly higher in female adolescents (p=

Background: Antiphospholipid antibody syndrome (APAS) is regarded as the most frequently acquired risk factor for thrombophilia. The obstetric manifestations of APAS include early or late pregnancy losses and complications like preeclampsia and fetal growth restriction. Its timely diagnosis and treatment can improve maternal and neonatal outcome. Aims: To study the pregnancy outcome of patients with APAS treated with heparin and aspirin. Settings and Design: This was a retrospective study of pregnancy outcome in 42 consecutive women with APAS, treated with heparin and aspirin. Materials and Methods: The case records of 42 diagnosed cases of APAS with pregnancy, over a 3-year period, were studied. The pregnancy outcome in this group was compared before and after treatment with heparin and low-dose aspirin in terms of abortions, intrauterine deaths and live birth rate. The outcome of the present pregnancy in terms of fetal and maternal complications was analyzed. Results: The mean age and average parity of women with APAS were 30.1±4.1 years and 3.2±1.2, respectively. Among the treated patients of APAS, 13 (30.9%) had preeclampsia and 9 (21.4%) had intrauterine growth restriction (IUGR). There were 2 (4.7%) intrauterine deaths, 4 (9.5%) missed abortions and 3 (7.1%) abruptio placentae. Women with APAS had a live birth rate of 4.6% before treatment and 85.7% in the index pregnancy after treatment. Conclusion: Treatment of pregnant women with APAS results in marked improvement in the live birth rate (4.6-85.7%). However, complications like preeclampsia and IUGR occur even after treatment, requiring strict monitoring and timely delivery.

Reactive oxygen species (ROS) levels in semen are believed to play both physiological and pathological roles in male fertility. The study was aimed to find the clinical significance of ROS levels in infertile Indian men. This pilot study included 33 idiopathic infertile men and 18 proven fertile controls. ROS levels in the washed sperm were measured using chemiluminescence assay and expressed as 10(6) cpm per 20 million spermatozoa. Sperm count, percent sperm motility, and percent normal sperm morphology were found to be significantly (P < 0.0001) reduced in infertile men compared with the controls. Median (minimum, maximum range) ROS levels of the infertile group [24.90 (6.89, 44.71)] were found to be significantly (P < 0.0001) elevated compared with the fertile controls [0.167(0.15, 2.78)]. No significant correlation was seen between ROS levels and semen parameters. Elevated ROS levels in the idiopathic Indian infertile men may be one of the underlying reasons for impaired fertility. Therefore measurement of seminal ROS levels may be used in Indian infertile men for better understanding of the aetiology and selection of antioxidant regimen in the treatment of male infertility. However, large studies may be urgently warranted to find out the role of antioxidants in ROS elevated Indian infertile men through randomised, controlled clinical study.

Accurate transmission of information coded in the sperm genome is vital to the pre- and post-natal development of the offspring. Recent advances in reproductive biology have proposed evaluation of sperm DNA integrity as an important assessment tool to infer the presence of DNA strand breaks, numerical abnormalities in sperm chromosome complement, and alterations in the epigenetic regulation of the paternal genome. Oxidative stress (OS), characterized by increased free radicals, may lead to the production of apurine sites, apyrimidine sites, oxidation of nucleotides of sperm genome. This study was performed to assess the impact of OS on DNA integrity in sperms. 52 infertile men [oligozoospermic-13, asthenozoospermic-15, teratozoospermic-19, oligoasthenoteratozoospermic-5] and 20 fertile controls were investigated for products of lipidperoxides as malondialdehyde; antioxidants such as superoxide dismutase, catalase and glutathione in seminal plasma by biochemical methods. DNA integrity of the sperms was analyzed by visual scoring method in which the comets were graded into 4 categories (A-D) on the basis of their tail length indicative of increasing levels of DNA damage. Significant increase in DNA damage (higher number of sperms in group D) in cases (oligozoospermic (O)-20%, asthenozoospermic (A)-24%, teratozoospermic (T)-28%, OAT-43%) as compared to controls (8%) was found. Increased malondialdehyde levels, abnormal sperm morphology and higher DNA damage were observed in the cases. The antioxidants superoxide dismutase, catalase and glutathione had a positive association with sperm count and motility while a negative association with the percentage of dead sperms and abnormal morphology was observed. This study highlights the influence of low antioxidants on sperm genome integrity and indicates sperm DNA integrity as a better and more reliable prognostic tool for infertility evaluation than simple quantitative and morphologic evaluation of spermatozoa.

Aim: To compare the efficacy of glyceryl trinitrate (GTN), dinoprostone and misoprostol for preinduction cervical ripening in primigravida at term. Methods: Sixty-five term primigravida, each with an unfavorable cervix (Bishop score ≤5), were randomized to receive GTN (0.5 mg perivaginally, n = 21), dinoprostone gel (0.5 mg intracervically, n = 21) and misoprostol (50 µg perivaginally, n = 23) for a maximum of two doses, 6 h apart. Statistical analysis included paired t-tests to compare pre- and post-treatment Bishop scores, one-way analysis of variance (anova) tests to compare quantitative variables and chi-squared tests to compare the proportion of subjects achieving favorable Bishop scores. Results: Baseline Bishop scores were similar in the GTN (3.4 ± 0.9), dinoprostone (3.4 ± 1.0) and misoprostol groups (3.2 ± 1.2). The final outcome was favorable (Bishop score >6) in a greater proportion of subjects in the misoprostol (n = 18, 81.8%) and dinoprostone (n = 14, 66.7%) groups compared with the GTN group (n = 11, 55%). In subjects with a severely unfavorable cervix (Bishop score ≤3), treatment with misoprostol led to a favorable response in 61.6% of patients compared with 45.6% in the misoprostol group and 33.3% in the GTN group. A significant improvement was noted in the Bishop score of all three groups (P

To compare the efficacy and tolerability of sublingual misoprostol with those of intramuscular 15-methyl-prostaglandin F2alpha (15-M-PG F2alpha) for cervical dilation prior to vacuum aspiration (VA) in first-trimester pregnancy termination.Sixty pregnant women requesting pregnancy termination between the 9th and 12th week were randomized to receive 400 microg of sublingual misoprostol or an intramuscular injection of 125 microg of 15-M-PG F2alpha 2 h prior to vacuum aspiration. Baseline cervical dilation prior to vacuum aspiration was measured using Hegar's dilators. Other variables assessed included procedure duration, intraoperative blood loss, and associated adverse effects. Patient acceptability was assessed by questionnaires completed at the time of discharge from the hospital.Mean cervical dilation at vacuum aspiration was significantly greater in the misoprostol group than in the 15-M-PG F2alpha group (8.8 vs. 7.6 mm; P0.01), and preoperative adverse effects were significantly less frequent in the sublingual misoprostol group (P0.05). However, procedure duration and intraoperative blood loss were similar in both groups. The acceptability rates were 93.3% in the sublingual misoprostol group and 76.6% in the 15-M-PG F2alpha group, respectively; however, 6.6% patients in the sublingual misoprostol group thought that the tablets had an unpleasant taste.Sublingual misoprostol appears to be an effective alternative to intramuscular 15-M-PG F2alpha for cervical dilation prior to vacuum aspiration in first trimester pregnancy. In addition, misoprostol is inexpensive and convenient to use and has higher patient acceptability rates.

Objective: To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor. Method: One hundred twenty low risk pregnant women at term with spontaneous onset of labor were included in the study. The women were randomized to receive either two tablets of misoprostol (200 μg/tablet) sublingually or 1 ml of methylergometrine (200 μg) intravenous injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were: need for additional oxytocic drugs, blood loss ≥500 ml, change in hemoglobin levels and side effects. Results: Postpartum hemorrhage as defined by hemorrhage ≥500 ml occurred in 3.1% of the women in the sublingual misoprostol group but none of the women in the methylergometrine group (P>0.05). There was a need for additional oxytocic drugs in 5.0% and 8.3% after methylergometrine and misoprostol, respectively (P>0.05). The change in hemoglobin levels at 24 h postpartum were 0.8 and 0.7 gm% in methylergometrine and misoprostol group, respectively(P>0.05). In the misoprostol group, 6.6% women developed fever ≥38 °C and 21.6% had shivering while in methylergometrine group none experienced these side effects. However, the incidence of other side effects like nausea, vomiting, headache and giddiness were similar in both groups. Conclusion: Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.

A multicentre study to assess the status of prenatal diagnosis of fetal malformation in India was conducted. Questionnaires were sent to the teaching hospitals and to centres in the private sector involved with ultrasonography in all the four zones. Data were obtained from 13 centres. Basic level I scans were performed on all pregnant women in 64% centres, whereas level II or targeted scans were performed as routine in 42% centres. Obstetricians performed level II scans in only 35% of cases while rest were performed by radiologists. Malformations of the central nervous system were commonest, accounting for 35-69% of all malformations, followed by genitourinary and gastrointestinal malformations. Malformations of the cardiovascular system were detected in 9.3% as abnormal four chamber view and outlet tract abnormalities, subsequently confirmed on fetal echocardiography. Invasive prenatal diagnosis by fetal blood sampling, chorion villus sampling and amniocentesis for chromosomal analysis of malformed fetuses was performed at 40% centres. At the All India Institute of Medical Sciences, approximately 11,042 ultrasound scans were performed by obstetricians as routine in all pregnant women. A total of 543 malformations were detected accounting for a 4.9% incidence of structural anomalies. A total of 98 cardiovascular malformations were detected in high and low risk pregnant women on fetal echocardiography. No database or registry exists in India to give an actual insight into the problem of congenital malformation and their prenatal diagnosis. It is important to train obstetricians in level I and II ultrasonography, to recognise centres and institutions at national and regional level, and to integrate a network of diagnostic testing. Close liaison between geneticists, radiologists, pediatric surgeons, pediatricians and obstetricians is a must for prenatal diagnosis and management of fetal malformations.

Objective: To evaluate the role of ultrasound-guided aspiration (UGA) as an alternative therapeutic modality in patients with cystic lesions of ovary (CLO). Methods: Forty-six patients (age 14–65 years) of CLO were managed by UGA. Patients suspected of having malignancy either clinically or on ultrasound were excluded. The aspiration was done transvaginally (11 patients) or transabdominally (35 patients). All aspirates were subjected to cytological examination. Patients have been followed up for 10–48 months. Results: The cyst size varied from 4 to 30 cm and the volume aspirated ranged from 30 to 1600 ml. There were no procedure-related complications. No further intervention were required in 33 (71.7%) patients. Re-aspiration was required in six (13%) and, to date, seven patients (15.3%) have been operated on for recurrence or persistence of lesion. Recurrence rate was not influenced by cyst size or volume aspirated. Mucinous or hemorrhagic aspirate correlated significantly with a higher risk of recurrence. Conclusion: Ultrasound-guided aspiration is a simple, safe and effective alternative to surgery in management of selected patients with CLO. Simple unilocular cysts can be safely aspirated, but it should not be carried out in patients with multilocular cysts. If the aspirate is hemorrhagic or mucinous, the patient should be considered for surgical intervention.

We describe a case of a vesico-vaginal fistula in a 32-year-old lady presenting with true urinary incontinence. There was a 1.5 x 1.5 cm deficit in the bladder wall and the left ureteric orifice was very close to the edge of the defect. For a successful transvaginal repair, we used a mobilized vaginal flap to bridge the defect in the bladder wall. This avoided the mobilization of the bladder wall and also prevented the left ureteric orifice from getting entrapped in the suture line. Adjacent wall of vagina was mobilized and stitched over the first layer to achieve water tight repair. Her post operative period was uneventful. The repair healed well and she was discharged in a good condition.

I am Professor & Head of the Department of Physiology of a medical college in Dehradun. A few years back, my second daughter was born and it was a difficult pregnancy experience since I had to undergo premature labour due to my problem of 'pregnancy induced hypertension'. While I was recovering from my problem, I attended an evening outdoor party. Perhaps the cold evening was a little too cold for my feeble body so later I had an attack of labyrinthitis induced vertigo. doi: 10.5214/ans.0972.7531.200102

Chronic idiopathic thrombocytopenic purpura (ITP) is defined according to the criteria of the American Society of Hematology (ASH) as idiopathic thrombocytopenia lasting more than 6 months (Cines a...