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   2012| January-June  | Volume 2 | Issue 1  
    Online since June 1, 2012

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Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility
Indu Verma, Renuka Sood, Sunil Juneja, Satinder Kaur
January-June 2012, 2(1):17-19
DOI:10.4103/2229-516X.96795  PMID:23776802
Context: Prevalence of hypothyroidism is 2-4% in women in the reproductive age group. Hypothyroidism can affect fertility due to anovulatory cycles, luteal phase defects, hyperprolactinemia, and sex hormone imbalance. Aims and Objectives: To study the prevalence of clinical/sub-clinical hypothyroidism in infertile women and the response of treatment for hypothyroidism on infertility. Materials and Methods: A total of 394 infertile women visiting the infertility clinic for the first time were investigated for thyroid stimulating hormone (TSH) and prolactin (PRL). Infertile women with hypothyroidism alone or with associated hyperprolactinemia were given treatment for hypothyroidism with thyroxine 25-150 μg. Results: Of 394 infertile women, 23.9% were hypothyroid (TSH > 4.2 μIU/ml). After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year. Infertile women with both hypothyroidism and hyperprolactinemia also responded to treatment and their PRL levels returned to normal. Conclusion: Measurement of TSH and PRL should be done at early stage of infertility check up rather than straight away going for more costly tests or invasive procedures. Simple, oral hypothyroidism treatment for 3 months to 1 year can be of great benefit to conceive in otherwise asymptomatic infertile women.
  13,258 1,625 35
Chromobacterium violaceum : A rare bacterium isolated from a wound over the scalp
M Ravish Kumar
January-June 2012, 2(1):70-72
DOI:10.4103/2229-516X.96814  PMID:23776815
Infection due to Chromobacterium violaceum, a large motile gram-negative bacillus, is a rare entity that typically starts with a localized skin infection or localized lymphadenitis after contact with stagnant water or soil. It can progress to fulminating septicemia, with necrotizing metastatic lesions and multiple abscesses in the liver, lung, spleen, skin, lymph nodes, and brain, and result in fatal multiorgan failure. We report a case of a young male with a history of fall from a bike into stagnant water who subsequently developed C violaceum infection at the site of the sutured scalp wound.
  7,286 637 22
Effect of aqueous leaves extract of Ocimum gratissimum on hematological parameters in rats
OE Ofem, EJ Ani, AE Eno
January-June 2012, 2(1):38-42
DOI:10.4103/2229-516X.96807  PMID:23776807
Objective : This study aims to elucidate the effect of Ocimum gratissimum on hematological parameters in rats. Materials and Methods : Thirty male albino Wistar rats were randomly assigned into three groups of ten rats each. Group 1 was control, while groups 2 (LD) and 3 (HD) received 500 mg/kg and 1000 mg/kg body weight, respectively, of the extract orally once daily. Rats in all three groups received normal rat chow and drinking water ad libitum for 28 days. Complete blood count was done using an automatic counter. Results : The HD group had significantly (P<.05) higher red blood cell (RBC) counts, packed cell volume (PCV), hemoglobin (Hb), and platelet counts as compared with the control and LD groups. No significant changes were observed in the total white blood cell (WBC) count of the three groups, but significantly (P<.05) lower lymphocyte and higher neutrophil counts were observed in the HD group compared with the LD group. The mean platelet volume (MPV), platelet-large cell ratio (P-LCR), and platelet distribution width (PDW) were significantly (P<.05) reduced in the HD compared with the LD group. The mean corpuscular volume (MCV) and RBC distribution width-standard deviation were significantly (P<.05) lower in the HD group than in control. No significant changes were observed in levels of mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and RBC distribution width-coefficient of variation among the groups. Conclusion: We conclude that oral administration of O gratissimum increases RBC, PCV, Hb, platelet count, and neutrophils and also leads to a decrease in platelet indices (i.e., MPV, P-LCR, and PDW).
  6,256 717 8
Neonatal sepsis: Role of a battery of immunohematological tests in early diagnosis
Santosh Kumar Mondal, Dipanwita Roy Nag, Ranjana Bandyopadhyay, Debdutta Chakraborty, Swapan Kumar Sinha
January-June 2012, 2(1):43-47
DOI:10.4103/2229-516X.96808  PMID:23776808
Background and Objective : Worldwide, many neonates with sepsis die due to lack of early diagnosis. In this study we attempt to analyze the value of various immunological and hematological parameters, singly and in combination, for the diagnosis of neonatal sepsis, with the aim being to formulate guidelines for the early diagnosis of the condition. Materials and Methods : In this prospective study, 62 patients having clinical suspicion of neonatal sepsis were evaluated with a battery of investigations. Neonates admitted for other causes and without clinical suspicion of sepsis were selected as controls (n=40). The tests included blood culture, hemoglobin level, total and differential blood count, absolute neutrophil count, ratio of immature to total neutrophil count (I/T ratio), micro-erythrocyte sedimentation rate (m-ESR), C-reactive protein (CRP), platelet count, serum IgM level, and plasma fibrinogen level. Patients were divided into proven cases (positive blood culture) and probable cases (negative blood culture). Results : Positive blood culture was seen in 38 cases (61.3%). Raised m-ESR (>8 mm in the first hour) was seen in 63.2% of proven and 66.7% of probable cases. I/T ratio of ≥0.2 was seen in 63.2% and 58.3% of proven and probable cases, respectively. Morphological changes in neutrophils were detected in 68.4% of proven cases and 91.7% of probable cases. Positive CRP test (≥6 mg/l) was found in 84.2% of proven cases and 100% of probable cases. Raised serum IgM, leucopenia, and neutropenia were seen in a small number of patients (11%-37%). Raised fibrinogen level (>400 mg/l) was seen in patients as well as in controls. Conclusions : The four useful tests that we identified were m-ESR, I/T ratio, morphological changes in neutrophils, and CRP; and role of these tests in early diagnosis of neonatal sepis were statistically significant (P<.05). The most sensitive test was CRP (84%) and the most specific test was m-ESR (94%). A combination of three or all of these four tests was highly specific (95%-100%).
  5,982 795 9
Evaluation of acrosome intactness status in male infertility in Mysore, South India
G Sreenivasa, VS Vineeth, P Kavitha, Suttur v Malini
January-June 2012, 2(1):31-33
Background and Objective: The objective of this study is to determine the status of acrosome intactness in different infertile conditions among men who have attended the Mediwave Fertility Research Center, Mysore, South India. Materials and Methods: A total of 70 infertile and 20 control subjects were employed in the study. Infertile subjects were classified into different conditions according to the WHO protocol. The data obtained was statistically analyzed. Results: In the present study, seven different infertile conditions were reported. For the acrosome intactness test, except oligospermia, all other conditions recorded a statistically significant value (P < 0.05) compared with the control group. Conclusions: The present study shows the decreased acrosomal enzyme activity in infertile males compared with fertile males. If diagnosed and treated earlier, it may help in the success of the in vitro fertilization technique.
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Use of Bayesian statistics in drug development: Advantages and challenges
Sandeep K Gupta
January-June 2012, 2(1):3-6
DOI:10.4103/2229-516X.96789  PMID:23776799
Mainly, two statistical methodologies are applicable to the design and analysis of clinical trials: frequentist and Bayesian. Most traditional clinical trial designs are based on frequentist statistics. In frequentist statistics prior information is utilized formally only in the design of a clinical trial but not in the analysis of the data. On the other hand, Bayesian statistics provide a formal mathematical method for combining prior information with current information at the design stage, during the conduct of the trial, and at the analysis stage. It is easier to implement adaptive trial designs using Bayesian methods than frequentist methods. The Bayesian approach can also be applied for post-marketing surveillance purposes and in meta-analysis. The basic tenets of good trial design are same for both Bayesian and frequentist trials. It has been recommended that the type of analysis to be used (Bayesian or frequentist) should be chosen beforehand. Switching to an analysis method that produces a more favorable outcome after observing the data is not recommended.
  4,799 1,007 20
Application of biostatistics in research by teaching faculty and final-year postgraduate students in colleges of modern medicine: A cross-sectional study
AD Gore, YR Kadam, PV Chavan, GB Dhumale
January-June 2012, 2(1):11-16
DOI:10.4103/2229-516X.96792  PMID:23776801
Context: Biostatistics is well recognized as an essential tool in medical research, clinical decision making, and health management. Deficient basic biostatistical knowledge adversely affects research quality. Surveys on this issue are uncommon in the literature. Aims: To study the use of biostatistics in research by teaching faculty and postgraduate students from colleges of modern medicine. Settings and Design: Cross-sectional study in colleges of modern medicine. Materials and Methods: A pretested proforma was used to collect information about the use of biostatistics by teaching faculty and final-year postgraduate students from colleges of modern medicine. The study period was 6 months. Statistical Analysis: Chi-square test, Spearman rank correlation coefficient, and multivariate analysis were used for analysis of data. Results: With this questionnaire, the maximum possible score for appropriate use of biostatistics in research was 20. The range of scores obtained by the study subjects was 1-20 and the median was 11. Appropriate use of biostatistics was independent of sex, designation, and education (P>.05). Spearman coefficient showed low-but significant-correlation between the score and the number of papers presented and published (P=.002 and P=.000, respectively). Conclusions: The study showed that nearly half of the respondents were not using statistics appropriately in their research. There was also lack of awareness about the need for applying statistical methods from the stage of planning itself.
  4,796 848 6
Comparative study of the ocular efficacy and safety of diclofenac sodium (0.1%) ophthalmic solution with that of ketorolac tromethamine (0.5%) ophthalmic solution in patients with acute seasonal allergic conjunctivitis
Navdeep Dehar, Anita Gupta, Gursatinder Singh
January-June 2012, 2(1):25-30
DOI:10.4103/2229-516X.96799  PMID:23776804
Background: Seasonal allergic conjunctivitis (SAC) is the most common and most prevalent of allergic disorders which afflict the ocular surface. Of the several treatments available, ophthalmic non-steroidal anti-inflammatory drugs, are generally very safe and tolerable. Aim: The aim of this study is to compare the ocular efficacy and safety of diclofenac sodium (0.1%) ophthalmic solution with that of ketorolac tromethamine (0.5%) ophthalmic solution in patients with acute SAC. Materials and Methods: Sixty patients with signs and symptoms of SAC were evaluated in an open, randomized, parallel group study. The principle symptoms (ocular itching, burning, discharge, photophobia) and signs (ocular inflammation, lid edema, chemosis, conjunctival mucous, keratitis) were evaluated. Study Design: Patients were randomized into two groups of 30 each. Patients in group A received one drop of diclofenac sodium 0.1% and patients in group B received ketorolac tromethamine 0.5% in both the eyes four times a day for fourteen days. Evaluations were performed at day 0, 3, 7 and 14 of the therapy. At each visit, the signs and symptoms were rated using a scale from 0-3 (mild-1, moderate-2 and severe-3). Results: Significant clinical and statistical reductions in signs and symptoms from baseline were observed in both groups. Diclofenac sodium 0.1% was superior to ketorolac tromethamine 0.5% in reducing ocular itching (P < 0.05) and ocular inflammation (P < 0.05), at the final examination. Conclusion: Diclofenac sodium showed statistically significant better results at day 3 and 7 compared to ketorolac.
  3,959 465 7
Investigating potential sources of transmission of healthcare-associated infections in a regional hospital, Ghana
Daniel NA Tagoe, Kenneth K Desbordes
January-June 2012, 2(1):20-24
DOI:10.4103/2229-516X.96796  PMID:23776803
Background: Recent research has shown that healthcare-associated infections (HAIs) are on the increase despite education. Aims: The aims of this study were to isolate, quantify, and determine antibiotic susceptibility pattern of bacteria on formites at the Central Regional Hospital, Cape Coast, Ghana. Settings and Design: Purposive sampling of likely areas of contamination and contact by patients and healthcare workers was undertaken. Materials and Methods: A total of 100 swabs were taken from door handles, working surfaces, beds and taps from the various wards, consulting rooms, OPDs, laboratory, and surgical theatre. Serial dilution was used in quantifying bacteria, MacConkey and blood agars were used in isolation, and the Kirby Bauer method applied in antibiotic sensitivity testing. Statistical analysis: Data were statistically analyzed using Statview from SAS Version 5.0. The means were separated using double-tailed paired means comparison. Results: Mean bacterial count ranges from least in wards (9.67 × 10 11 ), working surfaces (1.64 × 10 12 ), door handles (1.71 × 10 12 ), and highest in taps (2.08 × 10 12 ). Door handles had the highest isolation (23) and highest number of differential isolates were from working surfaces (7). Of the total bacterial isolates, 46.14% were pathogenic, with S. aureus being the highest (14.42%), while 53.86% were nonpathogenic made up of 45.2% of Bacillus spp. Gentamicin was 100% effective, while 6 of the total 12 antibiotics tested (50%) were 100% resistant in either gram-positive or gram-negative bacteria. Conclusion: There was a high potential of bacterial transmission from the studied surfaces requiring hospital management to monitor and enforce cleaning regimen to prevent HAIs.
  3,969 445 2
Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency
Abdullah Foraih Alanazi
January-June 2012, 2(1):34-37
DOI:10.4103/2229-516X.96803  PMID:23776806
Background: Emergency Medical Services (EMS) provides out-of-hospital acute medical care to different types of serious emergencies. The team of EMS includes paramedics, besides many other staff working in the pre-hospital setting. Although the paramedics are the first responders to the patient in emergency, they face several barriers, which interfere with their efficiency. Aim: However, the magnitude of these obstacles is not known, hence; it was found worthwhile to evaluate the depth of these difficulties. Materials and Methods: A questionnaire that included eight different commonly experienced barriers and four different variables of strength was framed. The questionnaire was served to 140 paramedics in three different regions (Jeddah, Riyadh, and Dammam) of Saudi Arabia. Results: The positive response obtained was statistically significant for traffic congestion (P<0.01; P<0.001), nuisance by bystanders and family members (P<0.001), lack of competence of doctors and the administration in the EMS routines (P<0.05; P<0.01; P<0.001), lack of trust and confidence (P<0.001) lack of independence (P<0.001), patient's resistance (P<0.001), Interference of legal issues and litigation proceedings (P<0.05; P<0.001), paramedic's impression on general public and the family of the patients (P<0.001). Conclusions: The authorities in the hospitals and EMS administration should improve the barriers which interfere with the efficiency of a paramedic and cause gross humiliation to the patients, and the Health authorities should impart proper education and training to the paramedics.
  3,836 530 9
Antimicrobial potential of Dialium guineense (Wild.) stem bark on some clinical isolates in Nigeria
FA Olajubu, I Akpan, DA Ojo, SA Oluwalana
January-June 2012, 2(1):58-62
DOI:10.4103/2229-516X.96811  PMID:23776811
Context : The persistent increase in the number of antibiotic-resistant strains of microorganisms has led to the development of more potent but also more expensive antibiotics. In most developing countries of the world these antibiotics are not readily affordable, thus making compliance difficult. This calls for research into alternative sources of antimicrobials. Dialium guineense is a shrub of the family Leguminosae. Its stem bark is used for the treatment of cough, toothache, and bronchitis. Aims : Despite the acclaimed efficacy of D guineense, there is no scientific evidence in its support. This work was carried out to assess the antimicrobial activity of D guineense in vitro against some clinical isolates. Materials and Methods : D guineense stem bark was collected and 50 gm of air-dried and powdered stem bark of the plant was soaked for 72 hours in 1 l of each of the six solvents used in this study. Each mixture was refluxed, agitated at 200 rpm for 1 hour, filtered using Whatman No. 1 filter paper and, finally, freeze dried. The extracts were then tested for antimicrobial activity using the agar diffusion method. Results : The highest percentage yield of 23.2% was obtained with ethanol. Phytochemical screening showed that D guineense contains anthraquinone, alkaloids, flavonoids, tannins, and saponins. The antimicrobial activity of the extracts revealed a broad spectrum of activity, with Salmonella typhi and Staphylococcus aureusa showing the greatest zones of inhibition (18.0 mm). Only Candida albicans among the fungi tested was inhibited by the extract. The greatest zone of inhibition among the fractions was 16.0 mm. D guineense exhibited bactericidal activity at the 7th and 9th hours against Streptococcus pneumoniae and S. aureus 25923 while the 10th hour against S. typhi and C. albicans. The greatest activity was noted against S pneumoniae, where there was reduced viable cell count after 6 hours of exposure. Conclusion : Stem bark extract of D guineense (Wild.) has the potential to be developed into an antimicrobial agent
  3,762 373 5
Polymorphism of Hassall's corpuscles in thymus of human fetuses
Adil Asghar, M Syed Yunus, A Nafis Faruqi
January-June 2012, 2(1):7-10
DOI:10.4103/2229-516X.96791  PMID:23776800
Background : Hassall's corpuscles (HC) are commonly used as diagnostic features for identifying human thymus and are still present in thymuses undergoing fatty degeneration in young adults. However, few studies have been performed on human fetuses. Aim: A cross-sectional study was done, to study the morphology of HC in human fetuses. Materials and Methods : Twenty-eight thymuses were collected from fetuses of gestational age ranging from 11 to 40 weeks. Thymuses were processed by paraffin embedding methods and hematoxylin and eosin staining. Results : The size of HC varied from very small (100 microns) to very large corpuscles (> 900 microns). A high level of polymorphism was also observed, from round to unusual or odd shapes corpuscles. The degenerated reticulo-epithelial cells represented the starting point in HC formation. The growth of HC was rapid, especially near 28 weeks, and the level of HC polymorphism was significantly greater after 28 weeks of gestation. In advanced stages of gestation, the increase in size of some corpuscles reduced the spaces between them, and some patterns strongly supported the hypothesis that some HC had fused in a single and larger corpuscle. Conclusion : The rapid rise in number and size of HC around 28 weeks of gestation would fit with their role in the negative selection process of thymocytes.
  3,575 517 3
Dosimetric evaluation of 3Dconformal acceleratedpartial-breast irradiation vs. whole-breast irradiation: A comparative study
Ritesh Kumar, Suresh Chander Sharma, Rakesh Kapoor, Rajender Singh, Anup Bhardawaj
January-June 2012, 2(1):52-57
DOI:10.4103/2229-516X.96810  PMID:23776810
Background : Conventional early breast cancer treatment consists of lumpectomy followed by whole-breast irradiation (WBI) therapy. Accelerated partial-breast irradiation (APBI) is also an approach to post-lumpectomy radiation for early breast cancer. Aim : The purpose of this study is to compare two different external-beam APBI techniques using three-dimensional (3D) conformal radiation therapy (3DCRT), with conventional whole-breast irradiation based on the radiation conformity index, dose homogeneity index, and dose to organs at risk. Materials and Methods : WBI treatment plans were compared with two different 3DCRT APBI plans for each of 15 patients (8 with right sided lesions, 7 with left sided lesions). The first APBI plan (APBI 1) used two small coplanar fields conformed to the planning target volume (PTV) using multileaf collimators (MLCs) and wedges, while the other APBI plan (APBI 2) used three non-coplanar fields conformed to the PTV using MLCs and wedges. Results : Both the APBI techniques improved the conformity index significantly over whole-breast tangents while maintaining dose homogeneity and not causing significant increase in dose to organs at risk. Conclusion : Both the 3DCRT APBI techniques are technically feasible and dosimetrically appealing,with better target coverage and relative sparing of normal critical organs
  3,592 386 1
Effect of acute moderate exercise on cognitive P300 in persons having sedentary lifestyles
Naresh Kumar, Manjeet Singh, Sushma Sood, Beena , Sakshi , Prasanta Saha Roy, Joshil Kumar Behera
January-June 2012, 2(1):67-69
DOI:10.4103/2229-516X.96813  PMID:23776814
Background : There are conflicting reports regarding the effect of exercise on cognition. We therefore planned to assess the acute effect of moderate exercise on cognition, studied by event-related brain potential P300, in subjects having sedentary lifestyles. Materials and Methods : Sixty adults (40 males and 20 females) in the age-group of 18-30 years having sedentary lifestyles were included in the study. Baseline P300 was first measured and after that the subjects were divided into two equal age- and sex-matched groups. The test group was subjected to moderate exercise (that is, to achieve 60%-80% of maximum heart rate during exercise, where 100%=200-age) on a bicycle ergometer for 5 minutes, following which postexposure P300 was measured. In the control group P300 was re-recorded 15 minutes after baseline recording, without any intervening exercise. Results : The latency of P300 was found to be significantly reduced after acute moderate exercise in the test group. Conclusion : It appears that acute moderate exercise improves the cognitive brain functions of adults with sedentary lifestyles.
  3,365 471 7
Silymarin, an antioxidant bioflavonoid, inhibits experimentally-induced peptic ulcers in rats by dual mechanisms
Shobha V Huilgol, MG Jamadar
January-June 2012, 2(1):63-66
DOI:10.4103/2229-516X.96812  PMID:23776813
Introduction : Antioxidants are reported to have antiulcer activity. We investigated silymarin, a bioflavonoid antioxidant, for antiulcer potential. Materials and Methods : Pylorus-ligated Shay rats (n=5) were used as the experimental gastric ulcer animal model. The rats, separated into three groups, were administrated silymarin (50 mg/kg), omeprazole (3.6 mg/kg), or saline (5 ml/kg) per orally daily for 5 days prior to ulcerogenic challenge. Nineteen hours after the challenge, the rats were sacrificed and their stomachs isolated. Formed gastric juice was collected for measurement of volume, titrimetric estimation of free and total acidity, and total acid output by the conventional methods. The ulcer index was calculated. Total acid output and free and combined acid quantities were calculated using the acidity value and the volume of formed gastric juice. Results : Silymarin exerted significant (P<.05) antiulcer activity (the ulcer index was reduced to 7.4 ± 1.0 from the control value of 19.8 ± 4.1). Silymarin also significantly reduced free and total acidity, gastric juice volume, total acid output, and combined acid content. The results were analyzed by ANOVA and Newman-Keuls multiple comparison test. Conclusion : This study demonstrates that silymarin has significant antiulcer activity. It perhaps acts by decreasing hydrochloric acid output and increasing buffering power (combined acid).
  3,291 335 5
Biological clocks: The coming of age
Chandrashekhar V Apte
January-June 2012, 2(1):1-2
DOI:10.4103/2229-516X.96788  PMID:23776798
  2,394 443 -
Assessment of nitrosative stress and lipid peroxidation activity in asymptomatic exposures to medical radiation: The bystander effect of ionizing radiation
Marwan S. M. Al-Nimer, Nida H Ali
January-June 2012, 2(1):48-51
DOI:10.4103/2229-516X.96809  PMID:23776809
Background : Adaptive response and bystander effect are two important phenomena involved in biological responses to ionizing radiation. Aims : To determine the bystander effect of ionizing radiation in medical exposures by measuring the serum nitric oxide (NO•), peroxynitrite (ONOO•), and malondialdehyde (MDA) levels. Materials and Methods : Twenty-five medical staff working in the Unit of Radiology and 15 medical staff working in other departments at the Al-Yarmouk teaching hospital in Baghdad, Iraq, were enrolled in the study. Venous blood was obtained from each subject for determination of NO•, ONOO•, and MDA levels. Results : Significantly higher serum NO•, ONOO•, and MDA levels were observed in participants working in the radiology unit as compared with serum levels in those working elsewhere. There was no correlation between the lipid peroxidation activity and ONOO•/NO• ratio. The serum NO• level in subjects working in the x-ray services was significantly higher than that in subjects working in the CT and MRI services. Conclusions : The bystander effect of radiation could be observed in asymptomatic individuals working in the radiology unit and it was particularly well observed in people working in the X-ray services as opposed to CT and MRI services. Determination of serum nitrogen species could be a useful laboratory investigation for assessment of the bystander effect of radiation.
  2,434 321 5

January-June 2012, 2(1):62-62
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