Introduction: To evaluate the efficacy of GnRH antagonists in terms of increasing the pregnancy rates in intrauterine insemination (IUI) after controlled ovarian stimulation (COS) when more than one dominant follicle is recruited. Methods: This is a prospective and randomized clinical trial that included 300 couples with primary or secondary infertility that underwent their first or second COS-IUI cycle with recombinant FSH. In all of these patients two or three leading follicles > 14 mm of mean diameter where detected by vaginal ultrasound (US) and were randomized into two groups. In group A the patients received rFSH+GnRH antagonists until the day that the hCG was given, while in group B the patients followed a standard COS received rFSH only. Results: Total amount of rFSH units (620.8+245.1vs 575.5+296.4) and clinical pregnancy rates (31.16% vs 19.15%) were statistically significantly higher in patients who were treated with GnRH antagonists. A similar number of twin pregnancies and miscarriages occurred in both groups. Conclusion: Multiple doses of GnRH antagonists in COS-IUI significantly increase pregnancy rates in multifollicular cycles.

Introduction: Stem cells (sc) are the foundation cells for every organ, tissue and cell in the body. They are self sustaining and can replicate themselves for long periods of time. Stem cells can differentiate into different types of cells. Women below the age of forty and showing ovarian function loss are defined to have premature ovarian failure (POF). It is associated with sex steroid deficiency, amenorrhea, infertility, and elevated serum gonadotropins. Aim: To evaluate the therapeutic potential of autologous Mesenchymal sc (MSC) transplantation in women suffering from POF. Out of 112 high risk patients for POF(cases with amenorrhoea befor the age of forty), diagnosis was confirmed in10 cases. The ten POF patients were scheduled for MSC transplantation at Al- Azhar University Hospitals. MSC preparation from the bone marrow of the iliac crest was laparoscopically injected into the ovaries. Endometrial fractional biopsy was histopathologicaly (HP) and Immunohistochemically (IH) stained and evaluated according to Edessy stem cells score (ESS). Ovarian reserve was evaluated according to Edessy ovarian reserve score (EORS). Results: Showed that after transplantation two cases (20%) (ESS = 5 and 6) resumed menstruation after 3 months, one of them (10%) (Case no 5) (ESS = 6) got pregnancy after 11 months and delivered a healthy full term baby (Zeinab).Ten months after transplantation EORS of patient who developed pregnancy (case no 6) was found to be 7 after being 0 before therapy. EORS of the other menstruating case (case no 10) was 5 after being 0. The 2 menstruating cases showed focal secretory changes after being atrophic endometrium in case 5 and distorted proliferative endometrium in case 10. Conclusion: Stem cell transplantation is a good procedure and regarded as a real and hope to get healthy pregnancy and baby for cases of POF. It showed good clinical, HP and IH outcome.

Introduction: Since the introduction of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE) classification of Mullerian anomalies, various authors have raised major concern about its clinical implications, as specific diagnostic criteria that clearly correlate to pregnancy have not yet been validated in clinical practice by any prospective or retrospectives studies. In this study, we aimed to correlate the ESHRE/ESGE classification with the occurrence of pregnancy, consideringthetwo different definitions of myometrial thickness. Methods: A retrospective study, including an ultra-selected cohort of 79 patients, from January 2010 to March 2014. All women with fertilityproblems, who had an isolated andsuspected uterine malformation, t ultrasound and hysteroscopy, were retrospectively included in this study. Myometrial thickness was defined as the entire myometrial layer, as suggested by the ESHRE/ESGE criteria, or the free myometrial layer, as suggested by Gubbini. Results: We failed to evidence an association between the occurrence of pregnancy in the two most representative classes (U0 and U2), considering the free myometrial layer, and the entire myometrial layer. When we considered the effect of hysteroscopic surgery on the occurrence of pregnancy, we also failed to obtain a statistically significant difference. Discussion: The ESHRE/ESGE classification may be useful in classifying Mullerian anomalies, but it needs to be applied in larger series. However, we think that new parameters and algorithms are needed for a better prediction of pregnancy. We recommendto associate the fundal uterine vascularization to the ESHRE/ESGE criteria to be analysed in further studies.

Background: Intracytoplasmic sperm injection (ICSI) is introduced as a treatment modality for severe male factors infertility. It is an effective form of infertility treatment. Progress in the micromanipulation, now is bringing a new way in the treatment of severe male factor infertility to achieve acceptable rates of fertilization and pregnancy success. Objective: To evaluate the difference between ejaculated and surgically retrieved sperm on intra cytoplasmic sperm injection (ICSI) outcomes. Design: A Correlative study. Setting: Dwarozh- IVF center. Patients and Methods: One hundred twenty patients have been taken in Dwarozh and International infertility centers in Sulaimani, for male infertility indications with normoovulatory female partners of ages less than 38 years, from 1st of September 2010 to 1st of September 2013. We divided patients into two groups: patients with normal ejaculation;group one (G1), and patients with surgically retrieved spermatozoa (normal sperms); group two (G2), all underwent Intracytoplasmic Sperm Injection (ICSI) cycles. Main Outcome Measures: Fertilization, cleavage, biochemical and clinical pregnancy rates. Results: The fertilization rate has been found 72.6% in G1, while in G2 it is 60.4% and a significant statistical difference was observed in fertilization rates between the two groups with a P value of less than 0.01. Also it has been found that in G1, 90.2% of oocytes were cleaved, while in G2, 89% of oocytes were cleaved, no significant statistical difference was observed in cleavage rates between the two groups, with a P value of more than 0.05. It has been found that in G1, pregnancy was positive (+ve) biochemically in 65% of the cases, while pregnancy was positive (+ve) clinically in 45% of the cases. In G2 pregnancy were (+ve) biochemically in 28.3%, while pregnancy was (+ve) clinically in 15% of the cases, with significant statistical differences in both biochemical and clinical pregnancies between the two groups with a P value of less than 0.01. Conclusions: It has been found, with the use of ICSI cycles in the treatment of male factor infertility, there are significant differences in reproductive outcomes between cycles using ejaculated and surgically retrieved sperm. The data show that ICSI is aacceptable treatment option in oligospermic and azoospermic males. Acceptable rates of fertilization, cleavage and pregnancy success can be attainwith ICSI from patients with Azoospemia, reaching levels comparable with those of patients using ejaculated spermatozoa for ICSI.

Objective: Review of patients operated for primary squamous cell carcinoma (SCC) of the vulva in the Department of Gynaecological Oncology, University Hospital of Wales in Cardiff, to determine factors related to recurrence as well as survival of disease. Material/Methods: A retrospective review using details obtained from patients' records. Hazard ratio estimation was carried out with Cox Regression analysis and survival plots were determined using Kaplan-Meier plots. Results: 144 women with primary vulval SCC were operated from 2002-2010. Commonly, radical wide local excision (49.3%) and radical vulvectomy (46.5%) were carried out, apart from ano-vulvectomy (1.4%) and local excision biopsies (2.8%). In 77.1% lympnode dissection was performed and inguinal metastasis was diagnosed in 28.8%, bilaterally in 68.8%. Histologically, 64.4% were moderate/poor differentiation and 30.9% were advanced disease (FIGO III and IVA). The 5-year survival rate (OS) was 61.1%. Stratified by FIGO classification, the 5-year OS for stages IA, IB, II, III and IVA were 72.7%, 86.0%, 50%, 34.4% and 45.5% respectively. Age >70 years was an important prognostic factor (51.9% OS) compared to 71.6% in patients 70 years. Patients with grade 1 disease survived in 72.5%, grade 2 in 58.8% and poorly differentiated cancer in 41.7%. Presence of inguinal metastasis was associated with a 40.6% 5-year OS, absence with 74.7%. Conclusions: Cox regression analysis confirms that age, presence/bilaterality of inguinal lymphnode metastasis, high-grade tumour differentiation, tumour size, FIGO stage and adjuvant therapy are important prognostic factors for 5-year survival.

Objective: To compare outcomes among good-prognosis patients undergoing in vitro fertilization and intracytoplasmic sperm injection followed by embryo transfer (IVF/ICSI-ET) in GnRH-agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) regimens. Methods: Retrospective analysis of 434 IVF/ICSI-ET cycles performed in a private center, in women aged up to 40: GnRH-a (n = 291) and GnRH-ant (n = 143). Pre-gestational, gestational and perinatal outcomes were evaluated. Statistical analysis was performed by unpaired t-test, Mann-Whitney test and Fisher's exact test. Significance was set at p < 0.05. Results: GnRH-a regimen was associated with higher amounts of total oocytes (10.7 ± 5.7 vs 9.3 ± 5.7, p < 0.001), mature oocytes (8.2 ± 4,5 vs 6.8 ± 4.4, p < 0.001) and good quality embryos transferred (1.7 ± 0.8 vs 1.5 ± 0.9; p < 0.05). Rates of fertilization, embryo implantation and live births were also higher in GnRH-a (72.8%, 27.6% and 48.8%, respectively) compared to GnRH-ant (65.3%, 14.7% and 26.6%, respectively; p < 0.0001). There were no significant differences between rates of preterm delivery or low birth weight, comparing the two groups. Conclusion: Our results suggest that the long GnRH-a regimen is the one that offers the best reproductive outcomes among in women aged up to 40 undergoing IVF/ICSI-ET.

Objective: To document the seroprevalence of toxoplasma in pregnant females attending a tertiary care hospital and to study its effect on perinatal morbidity and mortality. Design: Prospective follow-up study. Setting: Queen Mary's Hospital, a tertiary level hospital affiliated to King George Medical University (earlier known as KGMC), Lucknow, Uttar Pradesh, India. Sample: All pregnant women coming to this hospital for antenatal care in the Obstetrics and Gynaecology Dept. Methods: Pregnant females were selected through systematic random sampling. A pre-tested semi-structured questionnaire was administered. Blood sample was drawn to detect IgM and IgG antibodies against toxoplasma. Delivery outcomes were recorded with reference to abortions, still births, delivery of congenitally malformed baby and gestational age at delivery. Main outcome measures: Perinatal outcomes among those positive for toxoplasma antibodies. Results: Out of 260 subjects screened, 23 (8.8%) were IgM positive and 40 were IgG positive (15.4%). IgM sero-positivity was observed more in females aged >30 years, those =3 gravida, belonging to low socio-economic status, Muslims, those predominantly non-vegetarian and those exposed to raw meat. Still births (17.4% vs. 3.8%; p=0.006), congenital abnormalities (8.7% vs. 0.5%; p=0.002) and abortions (17.4% vs. 2.7%; p=0.001) were more common in those positive for IgM antibodies compared to sero-negatives. Conclusions: Toxoplasma infection plays a role in adverse foetal outcome. Socio-epidemiological aspects constitute an important contributing factor for the spread of the disease. All pregnant women should be educated and counselled for Routine serological testing for toxoplasma-specific antibodies.

Introduction: The particularly sorry plight of disadvantaged slum population with ample scope of further research into such areas as vulnerability to health risk and access to treatment, reduced economical choice and social support besides natural disasters and emotional stress of displacement. Material & Methods: An observational (cross-sectional) study was designed on a pre designed and pre tested questionnaire to understand women's fertility and contraceptive behavior and to study Socio behavioral Determinants of Utilization of MCH services. Results: The prevalence of <18 marriage was 78.03%.The teenage pregnancy was as high as 46.36% with 47.90% having parity of 4 or more.And of those not seeking ANC 53.42% did not feel the need for care during pregnancy. A very important finding was that 64.23% had home delivery and of these, 74% did not have any trained birth attendant. Conclusion: Levels of education in the family, caste, affordability (asset-holding) and accessibility were the factors which determined the utilization pattern. In general, those with better levels of education and those with better affordability preferred private practitioners and were willing to travel longer distances to avail health services as there was more awareness, motivation and felt need.

Objective: The primary objective of this study was to quantify the visual improvement and the reduction of corneal curvature achieved through association of Mini Asymmetric Radial Keratotomy (MARK) and Corneal Collagen Cross-linking (CXL). Design: Retrospective clinical trial. Methods: Sixteen eyes (sixteen patients) were included. Computerized corneal topography and Scheimpflug camera equipment were used to measure higher order corneal aberrations before treatment and during follow-up. Outcome parameters, including uncorrected visual acuity and best corrected visual acuity, have been measured as well. Examinations were performed at 3, 6, 12 and 24 months following both MARK and CXL. Results: A sharp reduction of both corneal curvature and corneal aberrations was observed after MARK surgery, followed by a smaller improvement following CXL treatment. Conclusion: The combination of MARK with CXL offers a significant improvement of visual acuity and a reduction of corneal curvature along with the corneal reinforcement provided by CXL.

Objectives: To compare insulin-like growth factor binding protein-1/alpha-fetoprotein (IGFBP-1/AFP) to placental alpha microglobulin-1 (PAMG-1) for diagnosis of premature fetal membranes rupture (PROM). Methods: 220 pregnant women ≥ 37 and <39 weeks gestation studied and classified into two groups; study group (PROM) and control group (no PROM). Examination of the studied women followed by abdominal ultrasound (TAS) and sterile vaginal speculum examination to visualize amniotic fluid leaking and for collection of samples for fern, nitrazine, AmniSure^® and AmnioQuick^® Duo⁺ tests on admission. Results: The sensitivity and specificity of AmnioQuick^® Duo⁺ test to detect PROM was 93.6% and 86.4%; respectively compared to 95.5% and 89.1%; respectively for AmniSureR test, 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. PPV, NPV and accuracy of AmnioQuick^® Duo⁺ test to detect PROM were 87.3%, 93.1% and 90%; respectively compared to 89.7, 95.1% and 92.3%; respectively for AmniSureR test, 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick^® Duo⁺ and AmniSure^® tests had higher sensitivity, specificity, predictive values and accuracy to detect PROM compared to conventional diagnostic tests. Conclusion: AmnioQuick^® Duo⁺ test for detection of IGFBP-1/AFP was rapid, accurate bedside test better than the individual conventional diagnostic tests and has same accuracy and performance like AmniSure^® test.

Objectives: Laparoscopic tubal ligation (LTL) is a surgical procedure done on women as a permanent method of contraception and the most prevalent form of contraception worldwide. Study design: We have prospectively collected and evaluated data for 50 women with previous pelvic or abdominal surgery who underwent LTL in the family planning clinic at our tertiary care referral hospital from October 2007 to July 2009. Results: The mean age of patients was 29 years and mean parity 3.2. The most common previous pelvic or abdominal surgeries were caesarean sections followed by open appendicectomy. Omental adhesions up to abdominal wall and in the pelvis were seen in 10 (20%) patients; adhesions to the bladder were observed in 4 (8%) and perihepatic adhesions in 3 (6%) patients; flimsy peritubal and periovarian adhesions were detected in 16 (32%) patients. Conclusion: In women with previous pelvic or abdominal surgery, keeping in mind the risk of postsurgical adhesions, LTL can be performed safely with low morbidity.

Objective: To evaluate the relation between uK (uterine Killer) cells and unexplained repeated miscarriage (RM). Patients and Methods: Eighty (80) women with unexplained repeated miscarriage and missed miscarriage of current pregnancy were studied. Fetal viability and gestational age of current pregnancy were confirmed by ultrasound, followed by suction evacuation to collect abortus specimens and uterine wall curettage to collect decidua specimens. Abortus specimens were collected for long-term monolayer cell culture and subsequent chromosome analysis using conventional G-banding technique. Decidua specimens were subjected to IHC (Immunohistochemical) staining using monoclonal antibodies specific to CD56⁺ and CD16⁺ expressed by uK cells. Results: CD56⁺ CD16⁺ uK cells was found in 85% (68/80) of studied decidua specimens of women with unexplained repeated miscarriage, 88.5% (54/61) had normal abortus karyotyping and 73.7% (14/19) had abnormal abortus karyotyping. 73.75% (59/80) of studied women with past history of early miscarriage had CD56⁺ CD16⁺ uK cells in their decidua specimens and 66.25% (53/80) of studied women with past history of late miscarriage had CD56⁺ CD16⁺ uK cells in their decidua specimens, the association between early and late miscarriage and CD56⁺ CD16⁺ uK cells in deciduas specimen was significant. Conclusion: CD56⁺ CD16⁺ uK cells were predominant in decidua specimens of studied women with repeated miscarriage. Significant association was found between presence of CD56⁺ CD16⁺ uK cells in studied decidua specimens and unexplained repeated miscarriage.

Introduction: Copper is an indispensable trace element required for health and also plays a very important role in successful pregnancy completion. There is insufficiency of data on serum levels of copper and its relation with serum Iron levels in pregnant women, especially in India. This loco regional pilot study was done, keeping in mind the limited information about inter relation of these two important minerals and to provide further insight about interaction of these. Material and Methods: This cross-sectional study comprising of pregnant women, selected by random cluster sampling was conducted in the Rishikesh (Hill regions of Uttarakhand, India). The duration of the study was from 1^st Dec, to 31^st March 2012. Sixty pregnant women of 18 -35 years age group were included. Serum values of twenty non-anaemic, non-pregnant women volunteers in the age group of 18-35 years with no other accompanying illness were considered as controls. The blood investigations for haemoglobin and serum values of Iron and Copper were done in all these. A Krusskal I-Wallis H test was performed for analysis, followed by a Dunn's test for multiple comparisons and a p- value of <0.05 was taken as statistically significant. Results: The percentage of anemia among pregnant women of present study was 46.62%. In present study 58.3% of the pregnant women were found to have hypercupremia and 71.42 % of the anemic pregnant women had hypercupremia The relatively increased serum copper in iron deficient anaemic mothers could be a compensatory mechanism to counter-act anemia. Conclusions: A thorough biochemical analysis of haemoglobin, iron and Copper during pregnancy would therefore help us access the specific nutrient role and corrective measures thereof to deal with iron deficiency anaemia and successful pregnancy completion.

Objective: The aim of this study was to determine the differences between early maladaptive schemas in women who facedmarital infidelity and those who didn't. In order to determine the contribution of each components having access to extensive information can play a significant role in promoting the marital relationships and reducing the marital infidelity. Methods: The present research is a casual-comparative study. The study sample consisted of all married women who refer to Welfare Divorce Reduce centers in Tehran province because of infidelity. Of these, 120 married women are selected among which 60 women experienced infidelity and 60 of them didn't experience marital infidelity. Data collection toolwas short form of Young early maladaptive schemas. Data analysis was performed by using SPSS software and using statistical descriptions (frequency, tendency to center of index and dispersion index) and statistical analysis method was ANOVA. Results: According to the results of this study, the hypothesis was confirmed. In other words, there is a significant different between the component of early maladaptive schemas in women who had infidelity and those didn't face infidelity in their marriage.So each of the components of early maladaptive schemas can be a predictor of marital dissatisfaction and infidelity. Conclusion: The high level in early maladaptive scheme would decreases marital satisfaction and increase infidelity. It seems that determination of maladaptive schemas traits for each of the couples before marriage can be a contributing factor in improving marital relations. So people who seek to design and implementprevention programs in the family, including infidelity, should consider these factors too.

Objective: To determine whether the Three-Dimensional Ultrasound and Three Dimensional Doppler have a role in detection of Endometrial lesions in woman with post menopausal bleeding. Methods: 36 woman in Zagazig University Obstetrics and Gynaecology Department outpatient clinics were recruited. Three-Dimensional Ultrasound and Doppler were done. Then after one week endometrial sampling was done & histological diagnosis was made. After tabulation, all data were analyzed using statistical procedures were carried with SPSS software. Result: Twenty four patients were negative for atypia or cancer and Twelve patients were positive for atypia or cancer. Mean age was 58.1 years in benign endometrium and 62.2 year in malignant endometrium (p=0.1). The mean BMI was 24 in benign and 31.75 in malignant endometrium (p<0.001). Mean endometrial thickness was 11.1 m.m in benign and 26 mm in malignant endometrium (p<0.001). The mean endometrial Volume was 5.6 cc in benign and 54.8cc in malignant endometrium (p<0.001). The VI was 2.24%and 19.5% in the two groups respectively (p<0.001). The FI was 6.7 and 27.2 in two groups respectively (p<0.001). The VFI was 3.3 and 11.5 in two groups respectively (p<0.001). In this study using endometrial volume, vascularization index percent (VI) %, flow index (FI) and vascularization-flow index (VFI) rather than endometrial thickness provided a greater sensitivity for predicting atypia or malignancy. Conclusion: The Three-Dimensional Ultrasound scanning of endometrial volume (3D-US) and Three-Dimensional Doppler Angiography (3D-DA) of the Vascular Indices (vascularization index percent, flow index, and vascularization-flow index), might predict endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline ultrasound scanning.

Background: In the world, tuberculosis ranks second after HIV of all infectious agents leading cause of mortality and morbidity due to bacterial infections with HIV taking the first spot. India holds the global burden of TB in one fifth with more than 350,000 deaths each year. Though pulmonary TB (PTB) cases, account for the vast majority of the total TB burden, almost 10-15 per cent of total cases are extra-pulmonary infection. Methods: Mycobacterium Tuberculosis complex were detected in 50 clinical sputum samples by using Polymerase chain Reaction (PCR) and BacT/Alert. Results: In our study, 50 sputum clinical samples were taken, out of which 11(22%) were smear positive & 39 (78%) were smear negative. Out of 11 smear positive 10 (90%) were MTB (Mycobacterium Tuberculosis) & 01 (10%) was NTM (Non-Tuberculous mycobacteria) and in 39 smear negative,15 (38.47%) were M. tuberculosis & 02 (5.12%) were NTM and 22 (56.41%) samples were negative by using PCR. By BacT/Alert 3D system, out of 50 clinical samples only 15(30%) samples were positive and 35 (70%) samples were negative for M. tuberculosis complex. Conclusions: It is concluded that result obtained from our study, Mycobacterium tuberculosis complex was detected by PCR from clinical samples has high specificity (99%) and sensitivity (95%) than BacT/Alert 3D system.

Introduction: We conducted a retrospective study at the Wayne County Medical Examiner Office, which examined decedents diagnosed with Fibromyalgia, a disorder of unknown etiology characterized by widespread chronic musculoskeletal pain, concomitant with fatigue, sleep disturbances, and psychological distress. Material & Methods: Over a seventeen year period a total of 54 cases from our database met this criterion. Other criteria in the study included cause and manner of death, post-mortem toxicology results, major autopsy findings, and medical history. Results: Our study revealed that the cause of death in approximately two-thirds of the cases was due to drug intoxication. The most frequent post-mortem toxicology finding was Opioids, such as Morphine, Hydrocodone, Oxycodone, Fentanyl, and Codeine. The most common manner of death was accident. Almost 90% of the decedents were Caucasian females, which contrasted with the demographic diversity of Wayne County, Michigan. Additional findings revealed that the average age was 47 years, and the average Body Mass Index (BMI) could be categorized as obese. Nearly 67% of the cases had a medical history of depression. Conclusion: Our findings suggest that Fibromyalgia might be a psychosomatic symptom of depression rather than comorbidity. Therefore, physicians should further inquire about, and consider treating, depression in patients with chronic musculoskeletal pain while completely avoiding the use of opioids, for opioids have a greater risk of being abused and resulting in death in such patients, as found in our study.

Background: Parkinson's disease comes second comparing to Alzheimer's disease being responsible for nerve destructing diseases; it is a complex and multifactorial disease. Gene associated studies help to identify the genetic factors that introduce the Single Nucleotide Polymorphisms in different genes as genetic risk factors for non-Mendelian Parkinson's disease in diverse populations. We intended to study the association of VDR (Vitamin D Receptor) gene polymorphisms with Parkinson's disease in south western Iranian population. Results: In the present study 150 patients with Parkinson's disease and 160 Healthy controls from an Iranian population were genotyped for two polymorphic sites. The prevalence of VDR polymorphisms in two restriction fragment length polymorphism sites including FokI and ApaI were analyzed in patients and controls. Our data demonstrated no significant association between VDR FokI polymorphism and PD, whereas the ApaI polymorphism showed a significant association with PD in Iranian patient. Also no association between the age at onset, the male-female ratio and the VDR polymorphism in the PD group was detected. Conclusions: In conclusion these results determined that VDR ApaI (TG and GG) genotype might affect development of PD in our study population. There was no association between FokI polymorphism and the risk of PD. Our results were analogous only with American/Hungarian Caucasian race.

Background and Aims: Current advances in the researches on the stem cells has opened new approaches for their apply in tissue engineering and clinical trials. The most common sources of stem cells are adult and embryonic stem cells. Due to ethical issues, embryonic stem cells use in research has been hotly debated. Unlike embryonic stem cells, adult stem cell have not ethical problem for clinical and research. The purpose of present study was to stem cells isolation and proliferation from the human dipose tissue. Materials and Methods: In this study, stem cells were successfully isolated from human adipose tissue by digestion with type I collagenase enzymes. In summary, adipose tissue were digested by type I collagenase enzyme. Subsequently, the cell solution was centrifuged for mature adipocytes and debris elimination and obtained sedimentation was cultured in culture medium contains Dulbecco's Modified Eagle's Medium (DMEM) via 1% penicillin/streptomycin antibiotics and 10% fetal bovine serum (FBS) at 37°C, 5% CO2 and 95% humidity. Results: in this study, ADSCs were successfully isolated and proliferated. Human ADSCs were able to divide in our culture mediums. Conclusion: The results of the current study were suggesting that this adipose-derived stem cell isolation protocol provides an effective and improved method for isolation and proliferation of these cells in order to tissue engineering application.

Objective: To assess the pattern of sales of Psychotropic drugsin India over a period of thirty-six months. Methods: Psychotropic sales by rupees and units over a thirty-six month period were analysed in relation to estimated patient population and population taking treatment. Results: There was an increase in per capita sales over the years. Even though there was a progressive increase in sale amount in all drugs, unit-wise there was a continuous decline in Antipsychotics (AP) and Anxiolytics (AA) in final year. Conventional AP though declining, have substantial share in sales. Similarly older AD accounted for substantial sales. Limitations: Lack of different strengths of various drugs in unitshindered a finer and meaningful analysis. Conclusions: There was a mismatch between need and use of Psychotropic drugs Recommended: Analysis of individual drugs unit-wise to get a view of pattern of use in different parts of the country.

Introduction: In India, almost 150,000 women are diagnosed with breast cancer every year and almost half of patients expected to die of the disease. In India most of patients with breast cancer diagnosed with advanced stage of the disease. As breast cancer treatment is multimodality approach Radiation therapy has significant impact on prevention of local recurrence. So, purpose of the study is to assess 5 year rates of local recurrence following post-operative 2D Radiotherapy treatment planning. Methods and Materials: We have selected 198 patients treated for post-operative 2D Radiotherapy treatment planning from September 2009-September 2010. All patients had undergone surgery in form of mastectomy or modified radical mastectomy. None of the patients with breast conservation surgery had been selected. All patients underwent chemotherapy either Induction chemotherapy following surgery or chemotherapy after surgery. All patients had been treated with 2D conventional Radiotherapy treatment plan with tangential fields and supraclavicular and axillary fields according to histopathology report. Patients were first taken on simulator machine and planning was done with breast wedge in position and fully abducted arm of the patient. Radiotherapy treatment dose was – 45Gy/20#, 2.25Gy/#, 5 days/week, total 4 weeks of treatment. Patients were assessed for acute toxicity every week. Patients were followed every monthly for 2 years, 2 monthly for 3^rd year, 4 monthly for 4^th year up to 5 year. Patients were assessed for Local recurrence up to 5 years. Results: 152 (77%) patients had undergone upfront Surgery. 46 (23%) patients were diagnosed with LABC, and had undergone chemotherapy first for downstage of the disease. After a median follow up of 34 months (range: 9-67 months), out of total 198 patients, 8.6% patients developed local recurrence. In which 6.5% (10 patients out of 152) in upfront surgery group and 15.2% (7 patients out of 46) in LABC group developed local recurrence. So, total 5% (10 patients) in upfront surgery group and 3.5% (7 patients) in LABC group out of 198 total patients developed local recurrence. Conclusion: Local recurrence after treatment of breast cancer with mastectomy+radiotherapy+/-systemic therapy is associated with a significantly higher risk of distant metastasis and death. So, in this retrospective study we have shown comparable results after 2D Conventional Radiotherapy Treatment Planning for prevention of local recurrence. Approach is safe, easy, and feasible, less time consuming and in Indian scenario where patients come in advanced stage of the disease and most of the time death is due to disease itself it is quite suitable approach at our centre. Also, we use hypofractionation regimen of 45Gy/20#, which is also feasible to reduce total treatment time and it has also shown equivalent results.

Background: Interleukin-6 (IL-6), a pro-inflammatory cytokine is involved in various vascular pathologies including stroke. Till date, no studies have been reported for the association between IL-6 gene polymorphisms with the risk of Intracerebral hemorrhage (ICH). Objective: The aim of this present case-control study was to investigate the association between IL-6 (-174 G/C and -572 C/G) gene polymorphisms and risk of ICH in North Indian population. Methods: Genotyping was carried out by using SNaPshot method for ICH patients and 100 age-sex matched ICH free controls. Conditional logistic regression analysis with adjusting multiple demographic and risk factor variables was used to calculate the strength of association between IL-6 (-174 G/C and -572 C/G) polymorphisms and risk of ICH. Results: Hypertension, diabetes, dyslipidemia, smoking and low socioeconomic status were found to be associated with the risk of ICH. The distribution of -174 G/C and -572 C/G genotypes was consistent with Hardy Weinberg Equilibrium (HWE) in the ICH and control subjects. Conditional logistic regression analysis showed a significant association between IL-6 -572 C/G gene polymorphism and the risk of ICH under dominant model (OR=3.7; 95%CI 1.05 to 13.1; p=0.004) and allelic model (OR=2.6; 95%CI 1.1 to 6.2; p=0.01). No significant association was observed for the association between IL-6 -174 G/C gene polymorphism and risk of ICH. Conclusion: Our results suggest that IL-6 (-572 C/G) polymorphism is significantly associated with the risk of ICH in North Indian population. Further prospective studies with large sample size are needed for independent validation.

Introduction: Considered as an end-stage for all cardiovascular diseases, cardiac fibrosis leads to the development of heart failure, thus the ultimate goal is to prevent the progression of fibrosis. Indeed, heart can regenerate itself but to a certain limit based upon the number of resident stem cells which is limited. Thus, stem cells transplantation is considered as a promising therapy. This study aims to examine if MSC transplantation can inhibit the progression of myocardial fibrosis in rat model compared to Colchicine treatment; and if the timing of treatment with MSCs or COL affect the progression of fibrosis. Material & Methods: To induce cardiac fibrosis in 48 female albino rats, Isoproterenol hydrochloride was used. These rats were divided into 2 models: COL-treated group that were treated after 1,2,3 weeks of the last ISO injection by colchicine orally. MSC-treated group that were injected intravenously after 1,2,3 weeks of last ISO injection by MSC. Heart rate and Systolic blood pressure were measured and the levels of Creatine phosphokinase, Lactate dehydrogenase, Matrix Metalloproteinase II and Collagen I were assessed. Moreover, cardiac tissues were examined hitopathologically. Results & Conclusion: MSC were proved to enhance the effect of anti-remodeling of extracellular matrix significantly by modulating the expression of matrix metalloproteinases, which is superior to COL treatment.

Background: Wounds with bare bone, joint and tendons in the extremities have been a formidable challenge to plastic surgeons. Although several skin substitutes are used in West, as both dermal and epidermal analogue, they are expensive and most of them are unavailable in India. It is in this scenario that Healicoll – a type 1 pure collagen as a possible dermal substitute is being investigated. The material ‘Healicoll’ is a type-1 native collagen derived from the bovine source and is bioengineered, biocompatible and biodegradable skin substitute. The advantages of Healicoll have led us to an increase in its use for complex wounds. Medical literature on Healicoll, thus far has only reported its use for superficial burns and ulcers. Materials & Methods: The purpose of this study was to evaluate the advantages of using an inexpensive, easily available, bioengineered skin substitute ‘Healicoll’ for the closure of bare bone, joints and tendon. Results: Healicoll was used in three patients with two patients having undergone surgery involving use of Healicoll for bare bones, joints and tendons after release of contracture following burns and trauma, and one patient was treated with Healicoll as an outpatient procedure for bare bones following electrical burns. The mean hospital stay was 15 days. In all the three cases, a clear neodermis had covered the bones and joints in 5 days time and was ready to support the take of skin graft. Conclusions: Based on our initial experience, Healicoll skin substitute offers an excellent alternative for rapid reconstruction obviating the need for flap cover for wounds that have been difficult to reconstruct.

Background and Objectives: Mycosis fungoides (MF) is the most common type of cutaneous lymphoma accompanied by neoplastic T cells. Histopathological changes after phototherapy could be an effective index for evaluation of treatment. The aim of this study was to compare histomorphological changes in Iranian MF patients before and after phototherapy. Methods: Skin biopsies of 20 diagnosed MF patients in Razi dermatology Hospital of Tehran University of Medical Sciences were evaluated based on major and minor diagnostic criteria using Guitart classification to assess histological features of phototherapy. Result: Of 20 studied patients eight patients were man and 12 were woman. Following phototherapy, major histologic criteria including density of infiltrate, epidermotropism and lymphocytic atypia along with some minor histologic criteria such as lymphocytic infiltrate and intraepidermal atypical lymphocytes were significantly alleviated after treatment (p < 0.05). Conclusion: We find a significant decrease in some important histologic parameter of MF after phototherapy, indicating these features may be important diagnostic parameters evaluating therapeutic effect of phototherapy.

Background: According to the World Health Organization (WHO), acute respiratory infections are a leading cause of morbidity and mortality in infants and children worldwide. The aetiology of many of these respiratory infections remains unknown, highlighting the potential role of unrecognized pathogens. The aim of the present study is to determine the contribution of hMPV, RSV and influenza virus infections to acute respiratory infections in children< 6 years old, during 2004-2013 in northern Greece. Materials and Methods: During 2004-2013, a total of 949 pharyngeal swabs were collected from patients younger than 6 years old, who were presented as Influenza-Like Illness (ILI) or other respiratory infections. The clinical specimens were divided into three age groups (0-6 months-119 specimens, 7 months-2 years-377 specimens, 3-6 years-453 specimens). A real-time one-step RT-PCR protocol with specific primers and probes for matrix protein and haemagglutinin genes was used in order to type and subtype influenza A and B viruses. A multiplex real-time one-step RT-PCR was used to detect hMPV and RSV in the extracted RNA. Results: Influenza viruses were detected in 343 out of 949 specimens, RSV in 82 and hMPV in 50 specimens. Conclusion: Our results show the significant role of these pathogens in childhood respiratory disease. They require constant medical attention as they represent a substantial health care burden among inpatients and outpatients.

Background: The study was conducted to see the association of cervical abnormalities in relation to high risk Human Papilloma Virus (HR-HPV) infection at King Hamad University Hospital, Bahrain. Materials and Methods: It was a retrospective cohort study completed in 3 years at King Hamad University Hospital, Department Pathology Lab and other private Hospitals of Bahrain. Patients of Obstetrics and Gynecology out patient's clinic and other requesting private hospitals were included in this study.A non-probability purposive sampling technique was used for this retrospective review of 160pathology reports and HPV cervista reports. Data was collected from I-Seha and patients Al-care, and was transferred and assessed SPSS-version 22. Results: Tere were 160 cases in total, who were examined for HPV-HR DNA using Cervista molecular testing. Tere were 73 cases were Positive for HPV and 87 cases negative for HPV. The minimum age of patiesnt's was 20 years while the max was 70 years. The mean age was 42.5 years. HR-HPV was detected in (100%) all cervical HSIL cases and in 71% of LSIL cases. Cervical intraepithelial lesion CIN2/3+ was significantly associated with HR-HPV positive cases. Compared to HPV positive cases, here was no cervical intraepithelial lesion (CIN) of any grade found in HR_HPV negative cases. Tere were only four cases with LSIL found to be R-HPV positive, which may be associated with Low-risk HPV infection. Conclusion: Tere was strongest association of cervical neoplastic lesions with high risk HPV to control.

Objective: Our objective was to study the prevalence of thrombocytopenia & erythrocytopenia post renal transplantation in Eastern Indian population. Thrombocytopenia & erythrocytopenia are common phenomena prevailing post transplant rejection. It is found to occur in patients developing HCMV (human cytomegaloviral nephropathy), post transplantation. Whereas in the case of none rejected patients thrombocytopenia is unlikely to occur. Methods: Several methodologies such as the serological cross match, HLA-cross match DSA luminex, renal biopsy including C4d staining, hematological RBC & platelet count monitoring were adopted in the study, along with these the serum creatinine levels of the rejected patients were tested by making use of several biochemical approaches. Statistical analysis of the data obtained from the laboratories, were also done by the software prism 4.1. Results: Out of total population of 30 patients selected randomly, 24 were found to have successful transplants as for them a significant increase in both platelet & RBC count were noticed post transplantation where as for the other 6 patients a significant decrease in the RBC & platelet count was observed post transplantation along with a significant increase in the serum creatinine levels. There was also a significant decrease in the GFR (glomerular filtration rate) which was an indication of some sort of graft dysfunctioning. All the patients were checked for viral nephropathy & the above 6 patients were found to develop HCMV nephropathy. For the above mentioned 6 patients, the presence of C4d marker in their renal peritubular capillaries after performing the immunehistochemical C4d staining was a key indicator of acute antibody mediated rejection. Conclusion: Our study clearly reveals that Thrombocytopenia & erythrocytopenia was quite common in the patients with acute antibody mediated renal transplant rejection. A low RBC & platelet count persisted in them even after transplantation owing to allograft rejection, & HCMV nephropathy. Whereas for the patients with successful transplants events such as thrombocytopenia & erythrocytopenia were nevertheless unlikely.

Oocyte freezing has been considered as an experimental procedure for decade while it would be an important tool to use in IVF routine. In fact, a safe and efficient program would be of substantial benefit for infertile patients and also for women at risk of loosing their fertility due to radio or chemio therapy treatments. Moreover, egg cryopreservation could replace embryo freezing which instead involves important legal and ethical drawbacks. After the initial disappointment due to the low survival rate diverse methods have been developed raising the post thaw recovery. The fertilization and cleavage performance of frozen eggs is now similar to that of fresh sibling oocytes, even though not a great deal is known about the early implantation potential. There is an increased global interest in analyzing intrinsic factors connected to the ability of these embryos to give a live birth. What is clear, up to now is that certain oocyte cryopreservation protocols may affect cell division and thus being associated with low implantation rates. Other freezing methods, instead, seem not to affect the post implantation development and are going to be used in laboratories as an alternative mode to embryo freezing. It would be of immense importance that further randomized studies are carried out which may underline any possible differences between various technical approaches and also to further generate more analytical data on the cumulative pregnancy rates along with long term follow up of the babies born as associated with oocyte cryopreservation.

Ovarian cancer is a devastating disease. The pathogenesis of ovarian carcinomashas always remained unclear. Enough evidence is now available clearly highlighting distal fallopian tube as the site of origin for serous ovarian carcinomas particularly in women with BRCA mutations. The ovaries and fallopian tubes may not be simultaneously involved. After the completion of childbearing, there exists no known physiological benefit of retaining the fallopian tubes. Post-salpingectomy,the ovarian endocrine function remains unaffected. Removal of premenopausal ovaries leads to attainment of early surgical menopause. Prophylactic salpingectomy at hysterectomy for benign reasons or sterilization rules out any subsequent tubal pathology and offers considerable protection against later tumor development. Risk reducing salpingectomy even if the ovaries are retainedare beneficial especially in young women with BRCA mutations.

This review article scrutinizes the role of male and female reproductive hormones on behavioural and psychological levels. Research suggests that estrogen serves as a protective hormone against psychosis in females, and that women are most prone to acute psychotic states during their menopausal years. Estrogen-driven dopamine levels are regulated, as shown by strong evidence that younger females are less likely to experience psychosis than older women. However, higher testosterone levels in males can cause an upsurge of dopamine levels, making younger men more prone to psychosis than older males. The role of other reproductive hormones (such as pregnenolone) on dopamine levels and therefore risk of psychosis is also explored from a psychiatric angle.

Introduction: Studies suggest that exercise therapy may enhance heart rate variability in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. This review addressed the impact of cardiac rehabilitation programs (CRPs) in post CABG patients on the quality of life, in terms of physical function and cardiac risk factors. Methods: OVID, Science direct, Embase, AMED and Cochrane controlled Trial Register were searched for studies published from 2005 up to 2015. Two reviewers assessed the eligibility of each study based on predefined inclusion criteria. Results: Of 35 abstracts reviewed, 9 studies met the inclusion criteria. All studies compared CRPs of different interventions to a control (non-intervention) group. From the selected 9 studies, 6 studies included interventions compared with control groups (usual or standard care) while 3 studies compared two different intervention strategies with groups and included a no-intervention control group. Conclusion: This systematic review concludes that all types of CRPs lead to improvements in the quality of life and reduction of cardiac risk factors in post CABG patients. However, these improvements were quite varied between the 9 studies according to variations in the components of CRPs.

Background: The recent engagement of Game base console is emerging in rehabilitation practice and its overall effectiveness has not been yetsubstantially manifested. Objective: To evaluate the effectiveness of Wii based balance interventions among Multiple Sclerosis people. Data Sources: A systemic search was conducted in the PubMed and Scopus data bases electronically up to February 2014. Study Selection: Randomized and non-randomized control trials with Wii intervention on balance as an outcome measure among people with Multiple Sclerosis were included in this review. Data Synthesis: After screening 57 studies, 7 were selected for full-text screening and 5 were included in this review. Three out of five were RCTs and rest were quasi experimental and 2-point crossover pilot studies. Total of 205 medically diagnosed mild to moderate MS people were in the selected studies with less than 6 expanded disability status scale (EDSS). Total of 13 different outcome measures were used on assessment of balance in Multiple sclerosis individuals and the most common outcomes were Berg balance scale (BBS), Center of Pressured (COP), Four Square step test (FSST), Time up and Go test (TUG). Three out of five studies report statistical significant improvement in the Four Square step test (FSST), Berg Balance Scale (BBS) and center of Pressure (COP) between intervention and control groups of MS. Conclusion: Review of the selected studies indicates that the inclusion of Wii game in balance exercise on Multiple sclerosis people improve static balance more effectivelyas compare to dynamic balance in mild to moderate level of disability. However evidence on the mode selection in Wii, treatment setting and frequency lacking. Further studies with large sample size and more homogenize outcome measure and control setting is recommended for future.

Low Back Pain (LBP) is one of the main causes of disability in the whole world. In most cases, its presentation is considered benign and usually managed quite easily. However, in a low percentage of cases LBP is secondary to a serious pathology. Patients with Multiple Sclerosis (MS), for instance, are often affected also by LBP, and LBP could also be an initial symptom of MS. Moreover, patients with MS can present with a w ide range of clinical symptoms, as the Restless Legs Syndrome – RLS. In these specific cases, the ability to recognize a serious pathology is a key component of the physical therapist practice. Both conditions, nonspecific LBP and RLS, have been found in a patient that was referred with diagnosis of bilateral sciatica.

Objective: Cerebral Hydatid disease (CHD) is very rare manifestation of echinococcosis, representing only 2% of all celebral space occupying lesion even in the countries where the disease in is endemic. The aim of this paper is to describe the characteristic features of cerebral hydatid disease in computed tomography, magnetic resonance Imaging (MRI) and to report a multiloculated cyst (more than 100 loculi) along with its management. Case Presentation: In this paper we have reported a young boy of 20yrs with primary CHD without associated extracranial lesions with focal neurological deficits and intracranial hypertension. The extracranial investigations were found to be negative. CT and MRI of the patient suggested it to be a multiloculated Hydatid cyst. The patient was managed surgically and more than 100 daughter cysts were recovered, antihelminthic medications were given to the patient was discharged successfully. Conclusion: Multilocular Hydatid cyst is a rare SOL of Brain. When present the patient remains asymptomatic for long followed mostly by symptoms of headache and vomiting. Patients may also present with focal deficit or seizures-Surgery remains the mainstay of treatment with careful evacuation of the cysts alongwith the medications for the causative agent (Echinococcus granulosus or multilocularies). Prevention of the disease should be given utmost emphasis.

Signet ringcarcinoma (SRC), a variant of gastric adenocarcinoma, is known to have a poor prognosis, especially when arising in the young population. In this report, two cases of gastric SRC carcinomas with different outcomes are described. The first case is a 49 years old Bahraini lady who presented with abdominal pain and was found to have a gastric ulcerover the lesser curvature on endoscopy and her biopsy showed features ofa poorly differentiated signet ring adenocarcinoma. This patient was managed by a timelysubtotal gastrectomy with adjuvant chemoradiotherapy. The second caseis ofa 34 years old Bahraini male whom presented withmild dyspepsia and in whomSRCwas an incidental finding on initial endoscopic biopsy that was later confirmed by targeted biopsy.This patientwas advised total gastrectomybut died due to delay in appropriate and timely interventions primarily due to his multiple consultations regarding the same matter.

Acute disseminated encephalomyelitis (ADEM) is characterized by Immune mediated inflammation of brain causing and gray matter. ADEM is an which usually follows a viral or bacterial infection, immunizations, and drug or serum administration. One such case is being reported here where a 3 year old girl was brought in status epilepticus as presenting feature of ADEM.

Introduction: IgG4-related disease is now considered to result from an imbalance in the regulatory immune system, and it is diagnosed on the basis of clinical and histopathologic evidence such as the presence of lymphoplasmacytic infiltrates, especially increased IgG4-positive plasma cells and fibrotic sclerosing tissue. Case report: We report herein a 45-year-old male patient with mediastinal mass with IgG4-related disease. IgG4-related disease can involve any organ but the most frequently involved sites include pancreato-hepatobiliary tract, salivary glands, and kidneys, generally manifesting as a mass in one or more sites mimicking a neoplasia. In the thoracic region, IgG4-related disease manifests as interstitial lung disease and fibrosing mediastinitis. Mediastinal lesion in our patient was quite resemble to mediastinal tumor derived from anterior mediastinum. This is the first case with mediastinal mass in a patient with this disease. Conclusion: Although very rare, we should rule out this disease as differential diagnosis in patients with anterior homogeneous density mediastinal mass simulating mediastinal tumor.