Testicular cytology in azoospermia

Background: Male infertility is a common problem and needs a minimally invasive method to arrive at the appropriate diagnosis. Alternative to open testicular biopsy the fine needle aspiration cytology of the testis is being increasingly used as a minimally invasive method of evaluating testicular function. Aim of the study: To assess the diagnostic accuracy of fine needle aspiration cytology in determining the causes of azoospermia. To establish that FNAC is cost effective, safe, out-patient investigation with no complications.Methods: Thirty nine patients with azoospermia in the age group of 20-40 years were included in the study. All the cases were subjected for Doppler study to rule out varicocele. Cord block was achieved with 1% lignocaine and aspiration was done with 23 gauge 1.5 inch needle. Smears were made on albuminised slides and stained with Leishman stain. Forresta et al. scoring system was adopted to analyse the smears. In the same sitting testicular biopsy was taken, fixed in Bouin’s fluid, routinely processed and stained with H&E stain.Results: The commonest group with infertility were in the age group 21-30 years. The testicular size was normal in 87.17% of subjects and 12.82% had small testis. Out of 39 subjects with azoospermia 38.46% subjects had varicocele. Varicocele was commonly associated with duct obstruction. The commonest causes observed in cases with azoospermia were; hypospermatogenesis with maturation arrest (4/39,10.25%), duct obstruction (12/39,30.76%), maturation arrest (7/39,17.94%), testicular atrophy (10/39,25.64%) and sertoli cell only syndrome (2/39,5.12%). In the present study diagnostic accuracy was 89.18%.Conclusions: Fine needle aspiration cytology is as informative as biopsy and can be done as a routine procedure. It helps us in ruling out obstructive and non-obstructive causes for azoospermia. In cases where FNAC shows normal spermatogenesis with azoospermia, biopsy and Doppler study is indicated to rule out duct obstruction which can be corrected surgically. It is a simple and cost effective.

Syntheses, Structures and Magnetic Properties of Cyano-bridged Transition Metal Compounds

To investigate the hypotheses, that systematically changing the electronic and relative sizes of tricyanido building blocks will tune magnetic properties of their cluster derivatives, we prepared two new tricyanido pyrazolylborate complexes, [NEt4][(Tp*Me)­Fe(CN)3]­·H2O and [NEt4]­[(Tp*Bn)­FeIII(CN)3]­·H2O·MeOH, and investigated their self-assembly. The new building blocks were prepared, structurally characterized, and their coordination chemistry explored to prepare small molecule-based magnetic materials. Three bent trinuclear ferromagnetic cluster derivatives of {[(Tp*Me)­FeIII(CN)3]2­[NiII(L)2]}·n(solvent) [L = 2,2′-bipyridine or bpy, diethylenetriamine or DETA and tris(2-aminoethyl)amine or tren] stoichiometry were prepared and their properties compared to other magnetic analogues. Another building block, [NEt4]­[(Tp*Bn)­FeIII(CN)3]­·H2O·MeOH, was also used to prepare two linear trinuclear derivatives of {(Tp*Bn)­Fe(CN)3}2­­MII(DMF)4]}­×2DMF (MII = Mn, Ni) stoichiometry. Under similar synthetic conditions two tetranuclear derivatives, {[(Tp*Me)­FeIII(CN)3]2­­[NiII(DMF)4]2[OTf]2}­×2DMF and {[(Tp*Me)FeIII(CN)3]2­[NiII(bpy)2]2­[ClO4]2}­×3MeCN­­×2H2O×MeOH were obtained. Systematic alter­ation of the reaction conditions also allowed for the isolation of a new hexanuclear analogue, {[(Tp*Me)FeIII(CN)3]4­[NiII(DMF)3]2}­­×4DMF­×H2O, and octa- and nonanuclear ones, {[(Tp*Me)FeIII(CN)3]4­[NiII(tren)]4­­[ClO4]4}·7H2O­·4MeCN and {[(Tp*Me)­FeIII(CN)3]6­[NiII3(MeOH)8]3}­­×3H2O­×8MeOH, respectively. Each of these clusters display ferromagnetic coupling of their paramagnetic nickel (S = 1) and iron (S = ½) spin centers. Overall, we find that magnetic interactions may be predicted using molecular orbital symmetry arguments and that the electronic and magnetic properties of cluster derivatives (ten total) are directly related to those of the chosen building blocks. Slow magnetic relaxation is generally seen for polynuclear analogues when the magnetic anisotropy axes are parallel

Undergraduate teaching in COVID-19 pandemic: an experience at tertiary care centre

Background: COVID-19 outbreak has taught us to opt for technologies, which have not been used before. There is lot of information available on the internet for learning, but undergraduate students of medicine need continuous guidance. The best platform would be live online teaching which includes student centred learning and observing appropriate COVID-19 social distancing. Aims and objectives of the study was to highlight various positive and negative impacts of COVID-19 on medical education.Methods: The students included in the study are from second MBBS with total number of 200. Time table was planned and everyday two live lectures across their subjects of study were taken. The classes were carried out using the Cisco Webex software. The students were able to ask questions and cleared doubts during and at the end of each class. The feedback of the session was collected by structured format and observations recorded.Results: In the present study the advantages of online classes based on student observations were: learning at ease, flexible environment, no delay in classes, and no peer distraction. In the present study the disadvantages were: eyes are getting strained, network issues, concentrate for long time, disturbances at home and no practical knowledge. In the present study, improvements and suggestions offered were to provide recorded videos or power point presentation, case based discussions, assignments and revision classes to be increased.Conclusions: The present study had several limitations. The study was conducted during the first phase of the COVID-19 pandemic at a Government Institute where most students belong to middle class. Despite these limitations, we believe the study provides relevant insights into the challenges facing online medical education in a time of healthcare crisis

Study on the acceptance, complications and continuation rate of post-partum family planning using the post placental intrauterine contraceptive device among women delivering at a tertiary care hospital

Background: Post placental intrauterine contraceptive device use in India showed that most women were satisfied with their choice of immediate insertion of an IUCD and the rates of complications were relatively low. The large proportion of women accepting the method to limit future childbearing indicates the important place post placental IUCD hold. This study was done to evaluate the acceptance of intrauterine contraceptive device as an immediate family planning method following delivery. The complications associated with it were identified and continuation rates were assessed.Methods: Women admitted for delivery in a tertiary care hospital were included in the study. Only women who fulfilled the medical eligibility criteria were included in the study.Results: A total of 4209 women were counseled of which 780 (18.5%) women accepted the method, 3429 declined. Out of the 780 cases, 764 came for follow up, and 16 were lost to follow up, spontaneous expulsion was seen in 2 (0.2%) cases, removal was done on request in 1 case and continuation was seen in 761 (97.56%) women.Conclusions: The Post placental intrauterine contraceptive device is safe to insert immediately after delivery. It has good acceptance with minimal expulsion and very high continuation rates

Meckel-Gruber syndrome: a case report with review of literature

Meckel Gruber syndrome is an autosomal recessive disorder, characterized by a combination of renal cysts or cystic renal dysplasia, developmental anomalies of the central nervous system, hepatic dysgenesis and polydactyly. It is a rare syndrome with highest incidence in Gujarati Indians and Finnish population. We report a case of Meckel Gruber syndrome in non Gujarati Indian which was diagnosed on fetal autopsy

A study of placental morphology and correlation with colour doppler ultrasonography, maternal and neonatal outcome in high risk pregnancies

Background: The placenta has multifaceted roles in foetal development and survival. Determination of placental abnormalities is very much essential in preventing intrauterine and perinatal morbidity and mortality. The aim of present endeavor was to study the placental histology and correlate with colour flow doppler ultrasonography, maternal and neonatal outcome.Methods: A prospective comparative study was conducted in 50 antenatal women of >28 weeks gestation. Out of these, 25 cases of high risk pregnancies which included pregnancy induced hypertension, preeclampsia, intrauterine growth retardation (IUGR) and anaemia of chronic disease. Other 25 normal antenatal cases were taken as controls. All the women were subjected to colour doppler ultrasonography and study of placental histology done and results were correlated to maternal and neonatal outcome.Results: The Doppler flow was abnormal in 44% of high risk groups. Abnormal histological changes were seen in all the high risk cases (100%). The mean diameter of the placenta (20.69 cms) and the mean birth weight in high risk group (2.34kgs) were comparatively less than that of control group. Abnormal histological changes were maximally found in high risk groups of abnormal Doppler in comparison to control group. Perinatal mortality (2.22%), Apgar score (90.9%), IUGR (4.44%) are higher in cases with abnormal histology of placenta compared to normal cases.Conclusions: Placental abnormalities correlate well with the factors causing high risk pregnancies and the subsequent maternal and foetal outcomes. Placental examinations may help in better understanding of the mechanisms of placental dysfunctions that may contribute to more effective therapeutic strategies in the future

TO ASSESS THE POTENTIAL OF CURCUMIN AGAINST GUT MICROBIOTA-INDUCED ALTERATION IN CHOLINE METABOLISM IN C57BL/6J MICE

Objective: The present study was focused on assessing the antimicrobial activity of curcumin against Providencia rettgeri, a gut microbe, which was further corelated to the effect of curcumin on choline metabolism and its role in preventing atherosclerosis and on the evaluation of potential of curcumin on the inhibition of conversion of choline to trimethylamine (TMA), and further its conversion to trimethylamine-N-oxide (TMAO) in liver.Methods: The minimum inhibitory concentration of curcumin was determined using Cup-plate method. The estimation of trimethylamine was performed using high performance thin layer chromatography (HP-TLC) technique. Estimation of blood serum parameters were performed using kits supplied by Span-diagnostics for estimation of triglycerides, total cholesterol and high density lipoprotein (HDL) cholesterol. All surgical procedures on animals including blood withdrawal and isolation of livers were carried out in accordance with CPCSEA guidelines.Results: The minimum inhibitory concentration of curcumin was found to be 10 µg/ml. There was a significant increase (p<0.001) in the mean triglyceride, total cholesterol, low-density and very low-density lipoprotein, along with a significant decrease (p<0.001) in high-density lipoprotein in choline-fed mice. Also, there was significant decrease (p<0.001) in the mean triglyceride, total cholesterol, low-density and very low-density lipoprotein, along with a significant increase (p<0.001) in high-density lipoprotein cholesterol in choline-fed mice treated with curcumin. Further, there was a decrease in the Flavin mono-oxygenase (FMO3) activity in the mice livers treated with curcumin by 21.57%.Conclusion: It was concluded that curcumin has the potential to inhibit gut microbiota thus prevention the conversion of choline to trimethylamine, has serum lipid lowering effect in female C57BL/6J mice and has an inhibitory effect on hepatic FMO3 thus preventing the conversion of trimethylamine to trimethylamine-N-oxide

Analysis of the variations in price of anti-glaucoma eye preparations available in Indian pharmaceutical market

Background: The aim of the study was to analyze the percentage cost variations among different brands of the commonly prescribed anti–glaucoma drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of each eye drop was calculated. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for anti-glaucoma eye preparations marketed in india was found to be eye drop timolol maleate (0.5%) of 5 ml:263.63, eye drop dorzolamide (2%) of 5 ml:9.77, eye drop pilocarpine (2%) of 5 ml:160.40, eye drop Betaxolol (0.5%) of 5 ml:56.54, eye drop Latanoprost (50 mcg/ml) of 2.5ml:135.88, eye drop Brimonidine tartarate (0.15%) of 5 ml:183.9, eye drop Levobunolol (5 mg/ml) of 5 ml:32.38.Conclusions: Glaucoma is the most common ocular disease and eye drops are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy

Study of the cost variation analysis of anti-epileptic drugs available in different brands in Indian pharmaceutical market

Background: The aim of this study was to analyze the cost ratio and percentage cost variations in different brands of the commonly prescribed anti-epileptic drugs available in Indian pharmaceutical market.Methods: The maximum and minimum price of each brand of the drug given in Indian rupees (INR) was noted by using CIMS January to April 2020 edition and drug today April to June 2020 volume  1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of one bottle in case of 100 ml syrup and 10 tablets/capsules was calculated in case of oral drugs and the cost of one 1 vial or ampoule was noted in case of injectable drugs. At last the cost ratio and percentage cost variation of various brands was compared.Results: After calculation of cost ratio and percentage cost variation for each brand of anti-epileptic drug tablet clonazepam (2 mg) shows highest cost ratio and percentage cost variation as 10.41 and 941.66, carbamazepine (200 mg SR tablet) shows lowest cost ratio and percentage cost variation as 1.09 and 9.32.Conclusions: Epilepsy is the most common neurological disorder and epileptic drugs are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. There is a wide difference in the cost of different brands of anti-epileptic drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy

Comparative study of conventional Pap smear and liquid based cytology as a screening method for cervical cancer

Background: Pap smear is the conventional screening procedure for cervical cancer. Liquid based cytology has been developed as a cost effective alternative as it has a short screening time, better morphology and clean background while also providing residual material to test for HPV DNA. Therefore this study is undertaken to know the role of Liquid-based cytology in evaluating pre-malignant and malignant lesions of cervix. Objectives of current study were to study the distribution of various cervical lesions on liquid-based cytology and compare them with conventional Pap smears. To know the role of liquid-based cytology in evaluating pre-malignant and malignant lesions of cervixMethods: This study included 200 women attending to gynaecology OPD and the samples were taken for both conventional cytology and liquid based cytology. The smears were studied in detail and were interpreted as per The Bethesda system 2014 of reporting pap smears and results are recorded and compared.Results: The commonest cervical lesions on pap smears by liquid-based cytology are NILM-reactive changes (N=92, 46%), NILM Candida infection is seen in 9 cases (4.5%) and trichomonas vaginalis infection in 5 cases (2.5%). Unsatisfactory smears on LBC is less when compared to conventional smears as the coefficient of correlation is significant with p value of 0.000422 (<0.05). The number of cases with a diagnosis of ASCUS is reported more in liquid-based cytology (9 cases) when compared to conventional Pap (8 cases). The number of cases with diagnosis of HSIL, SCC is reported more in liquid based cytology (7 cases) when compared to conventional Pap (4 cases). Epithelial cell abnormality were easily diagnosed on LBC smears with significant p value of 0.002414 (<0.05).Conclusions: Liquid-based cytology has advantages of fewer unsatisfactory smears and better detection of epithelial cell abnormalities when compared to conventional Pap smears. LBC is better for the screening of premalignant and malignant lesions of cervix even though it is costly