Objectives: To assess the comparative as well as collective role of various grey scale (GS) ultrasonography (USG) and color doppler (CD) parameters in distinguishing benign from malignant thyroid nodules. To suggest a scoring system for predicting malignancy in thyroid nodules using this array of parameters. Methods: 140 patients with non palpable thyroid nodules were examined by five GS USG and three CD parameters. The results were compared with histopathological examination and evaluated statistically. Each GS and CD parameter was evaluated individually as well as collectively, comparatively. Total score was calculated by assigning each of these eight parameters a score of 0 to 2. Results: Scoring used in this study showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of 87.5%, 90.6%, 70%, 96.7% and 80% respectively. These parameters were 85.4%, 86.2%, 60%, 96%, 80% for CD and 69.2%, 71.9%, 50%, 85.2% and 64% for GS. Two GS USG features showing p value < 0.05 were poorly defined margins and thick incomplete halo while on CD Resistivity index (RI) was found to be very highly significant (p < 0.0001) and Pulsatility index (PI) was highly significant (p < 0.001). Conclusion: Scoring system proposed in this study proved better than GS or CD individually for predicting malignancy in thyroid nodules. Amongst various GS and CD parameters RI showed highest statistical significance. Overall CD showed better accuracy, sensitivity, specificity than GS USG.

Introduction: Myeloproliferative neoplasms with PDGFRA, PDGFRB and FGFR1 rearrangements are reported to be very rare entities. Myeloid neoplasms with PDGFRB rearrangement have prominent eosinophilia, neutrophilia or monocytosis and presence of t (5;12)(q31~q33;p12-13) or variant translocation. Case Report: We report a 55 years old female patient who presented with eosinophilia along with predominant eosinophil precursors on bone marrow and concomitant isolated del (5q) and PDGFRB gene rearrangement which is an infrequent and rare finding. Conclusion: isolated acquired deletion of the long arm of chromosome 5 (del 5q) also known as 5q- syndrome, is a distinct hematologic disorder reported to be primary myelodys plastic syndrome which is found in females of middle age and usually presents with macrocytic anemia, oval macrocytes, with white blood cell counts normal or reduced, platelet counts normal or elevated and bone marrow exhibitery throid hypoplasia with megakaryocytes showing hypolobated nuclei

Objective: To identify the p53 binding pocket as well as active residues in mdm2 protein, and search for similar (or) better compounds to inhibit mdm2-p53 interactions in comparison to FDA approved drug (Nutlin) by ligand and structure based virtual screening methods, docking, and molecular dynamic simulation studies. Methods: A structure and ligand based virtual screening for mdm2 protein; targeting the key residues involved in their active binding of p53 peptide was conducted after obtaining structurally suitable compounds similar to Nutlin from ZINC database. These compounds are virtually screened onto the mdm2 protein targeting its active binding site where p53 binds. The best compound with highest binding affinity was taken up for further analysis using molecular dynamic simulations for further validating the docking studies and to reveal interactions during the conformational changes Results: We discovered several compounds that are potentially able to block the interaction between active residues of mdm2 and p53 complex, suggesting their capability to act as anti-cancer agents. As proven by our structure based virtual screening studies coupled with semi-flexible and flexible docking studies, compound ZINC59256947 was found to be the strongest inhibitors for mdm2 protein amongst all of those isolates from ZINC database. Conclusion: Our results suggest that, a simple, selective and reliable inhibition assay can be performed to search for novel inhibitors of p53-mdm2 interaction. Therefore this study provides a rationalization to the ability of a ZINC59256947, an isolate from ZINC database with strong binding affinity towards mdm2 protein, for future implications as anti-cancer agent.

Introduction: The brachial artery starts at the inferior border of teres major and ends by dividing into ulnar and radial arteries in cubital fossa region. The radial artery frequently arises at the level of the neck of the radius and runs along the lateral side of the forearm. Case report: During routine teaching for undergraduate medical student of the upper limb, atypical brachial artery bifurcation giving a high origin of the radial and ulnar arteries was found in the right upper limb of a male cadaver. The bifurcation level was proximal to the interchonylayar line. After that, the ulnar artery descends and gives prominent common interosseous artery at the neck of radius. Conclusion: This case report of vascular variability of the upper limb is to alert vascular radiologists and surgeons as well as nephrologist to prepare a modified surgical intervention of arteriovenous fistula in renal haemodialysis. There is always great vascular variability of the upper limb therefore it is important to be aware of anatomical variation and to avoid iatrogenic fault.

Introduction/Aim: Aging of the parahippocampal cortex is accompanied by atrophy. The most common changes include cell number reduction, formation of corpora amylacea in astrocytes, which may represent the basis for the development of cognitive dysfunction. The aim of this study was to detect presence and distribution of corpora amylacea in subpial and subcortical region of parahippocampal cortex during aging process using histochemical analysis as well as to carry out quantification of structural changes in different cortical layers using histochemical and immunohistochemical methods. Material and Methods: Material represents tissue of uncus of parahippocampal gyrus of right cerebral hemisphere of 30 cadavers taken from autopsies carried out at the Forensic Medicine Institute of the Niš Faculty of Medicine. Upon tissue preparation using standard histological procedures, 10 μm thick sections were made and stained with hematoxylin eosin and periodically with acid Schiff's method. The total number of 30 samples, 16 to 93 years of age, was analyzed. Results: During the normal aging process in parahippocampal cortex the number of corpora amylacea localized in subpial region increases, and it is even greater in subcortical white matter, with no significant change in size and shape. Positive reaction to neuron specific enolase, determined by immunohistochemical methods suggests the presence of neural components, while a weaker reaction to glial acid protein and positive one to S100 protein suggests the possibility that the corpora amylacea are astrocyte inclusion. Conclusion: The obtained results indicates that the presence of these structural changes may lead to damage of those brain structures responsible for normal memory function and thus responsible for cognitive changes present in healthy elderly individuals.

Introduction: Chronic exposure of non-ionizing extremely low-frequency magnetic fields (ELF-EMF) is considered as a health hazard due to its adverse effects on human body such as generation of any type of cancer. Stem cells are appropriate models to assess the effects of ELF-EMF on other cell lines and human beings. Materials and methods: Adipose tissue has been known as source of multi potent stromal human mesenchymal stem cells (MSCs) which can be obtained in less invasive method and in large amounts; so adipose-derived stem cells (ADSCs) were used in this study. Effect of ELF-EMF (intensities of 0.5 and 1 mT and 50 Hz) on proliferation rate of hADSCs was assessed in 20 and 40 min per day for 7 days. Trypan blue assay was performed to assess cell proliferation rate. Result: The results shown that 0.5 and 1 mT magnetic fields can promote the proliferation rate of adipose derived hMSCs according to the duration of exposure. Conclusion: These outcomes could approve the effect of ELF-EMF on cancer induction; although the effective mechanisms in this process are still unknown.

Aims & Objectives: To compare the occurrence of hyponatremia in the patients receiving two different Tricyclic Antidepressants (TCAs)–Amitriptyline and Imipramine Methodology: Fifty OPD patients attendingthe Psychiatry outpatient clinic of Mahatma Gandhi Institute of Medical Sciences, Sewagram having diagnosis of Depressive episode as per DSM-IV-TR criteria were included in the study. Patients with normalserum sodium levels before treatment with antidepressant were included in the study. Repeat serum Sodium levels were done after one month of being on treatment. EPI Info-6 software was used to analyze the data. Results: Average serum sodium concentrations of the patients receiving different TCAs before treatment were 139.4+2.45 (Mean+SD). Out of the 44% patients who developed hyponatremia, 45.45% were amongst the Imipramine group and 54.54% were amongst the Amitriptyline group. Although of mild severity only, hyponatremia was more in patients receiving Amitriptyline compared to those receiving Imipramine. Conclusion: Patients receiving Amitriptyline have fairly more chance of developing hyponatremiathan Imipramine receiving patients. Hence precaution should be observed while using TCA group of antidepressants.

Introduction: Toxoplasma infection is considered as the most frequent infection in both animals and humans. It is due to protozoan parasite belonging to phylum of Apicomplexa, Toxoplasma Gondiiwhich can have severe congenital consequences if acquired in pregnancy. Material and methods: In this prospective study, toxoplasmosis seroprevalence was searched in asymptomatic pregnant women attending the central laboratory of university hospital center Hassan II of Fes city between 2010 and 2015. Samples are treated by chemiluminescent microparticle immunoassay. Results: In our study the rate of IgG anti-toxoplasma was 39.7% which is close to other Moroccan cities and different from Europe. Conclusion: The variances in prevalence between different region is related to different factors such as habit of eating, contact with cat and mediocre sanitation and hand hygiene.

The independent practice of clinical psychology has experimented recent changes. Spain has achieved to regulate the current professional situation of the different figures of clinical psychologists mainly in three arms: 1) by authorizing those psychologists who met the required legal criteria to continue with their clinical practice, 2) by creating the Master in General Health Psychology (MGHP) and 3) by maintaining the tasks and public scope for Psychologist Specialized in Clinical Psychology (PSCP) This manuscript aims to summarize the process for the regulation of clinical and health psychology in Spain and to compare it to other European and North American countries. Discussion about the quality, benefits and future ambitions of the MGHP programs have been made.

Objective: to study soluble HLA-G (sHLA-G) in Egyptian acute myeloid leukemia (AML) patients. HLA-G is speculated to be a tumor-driven immune escape mechanism. In addition, it might be a promising target for future immune therapeutic approaches. Methods: Thirty AML patients and 15 healthy controls of matched age and sex were the subject of the study. sHLA-G was done to all patients and controls by ELISA. Results: Statistically significant increase in sHLA-G level was present in AML patients compared to controls, being higher in relapsed cases. HLA-G levels was correlated to bone marrow blast percentages but not affected by age, gender, WBCs or response to chemotherapy. HLA-G had a sensitivity of 100% and a specificity of 62% to detect AML cases. Conclusion: HLA-G may be an additional marker for AML especially relapsed cases

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin^®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin^®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin^®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin^®-ES. Conclusion: HIP (Proferrin^®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store.

Introduction: Pyoderma gangrenosum is arare cause of skin necrosis after surgery. It often appears with extensive ulcerations and scaring with significant aesthetic aftermaths. The pathogenesis is poorly understood but often associated with inflammatory diseases, however post-surgical idiopathic pyoderma gangrenosum can occur. Case Report: We report a case of pyoderma gangrenosum following a bilateral breast reconstruction in a 33-year-old woman, successfully treated with steroids. A week after the surgery wounds started to break down and extensive necrotic ulceration appeared quickly covering both breasts. After dermatopathology evaluation she received antibiotics and prednisone and three months later wounds were completely healed and surgery was not necessary.

Objective: In this study we evaluated the prognostic factors, dosimetry and survival outcome of high grade gliomas receiving radiotherapy with concurrent temozolomide and with or without adjuvant temozolomide. Materials and Methods: Eighty patients with high grade gliomas were treated with concurrent chemoradiation post operatively. 27 patients received 3D Conformal Radiotherapy, 25 received Intensity Modulated Radiotherapy and 28 were treated with Rapid arc. Temozolomide 75mg/m2/d seven days a week was given concurrently with radiation (60Gy in 30 fractions) followed by 6 cycles of adjuvant Temozolomide with a dose of 150mg/m2/d for 5 days in every 28 days. Primary end point was overall survival and secondary end point was effect of radiation technique on overall survival and dose to organs at risk. Results: All patients completed concurrent chemoradiation but only 52 patients completed 6 months course of adjuvant chemotherapy. Median age was 52.5 years; The prognostic factors important for overall survival are at least 6 cycles of adjuvant temozolomide (p<0.0001) and mean dose to normal brain <30 Gy (p-0.022). Median overall survival was 6 months. The median survival for patients who completed 6 months of adjuvant chemotherapy and those who did not was 12 months and 3 months respectively. Survival at 12, 18 and 24 months were 24.5%, 13.2% and 11.3% respectively for patients treated with high precision radiotherapy. One year survival in 3DCRT group was 3.7%. Mean dose to normal brain was 28.7Gy in 3DCRT, 23.9Gy in high precision technique respectively. Conclusion: Reduced doses to normal brain with high precision techniques and improved survival in our patients receiving radiotherapy with concurrent temozolomide & adjuvant 6 cycles of temozolomide.

Background: Tarantula cubensis venom (Theranekron^®) is used as a homeopathic medicine which has shown anti-tumor effects in veterinary medicine. The aim of this study was to assess effect of Tarantula cubensis venom on apoptotic cell death of human cancer cell lines. Methods: HEK293, MCF7 and HN5 cell lines were used. The cells were treated with different concentrations of alcoholic extract of Tarantula cubensis (Theranekron^®) for different periods of time. Cell morphology was studied by light microscopic observation. Cell proliferation was evaluated by MTT assay and death rate was assessed applying trypan blue staining. Apoptosis was assessed by DNA fragmentation, cleaved caspase-3 protein western blotting and ELISA caspase-3 activity assays. Results: Tarantula cubensis venom ruined cell adhesion, reduced cell proliferation, increased cell death rates and caused DNA fragmentation in human cells. An increased caspase-3 cleavage and hyper-activation of caspase-3 was detected in the cells treated with the venom. Results also showed a significantly higher toxicity and apoptosis levels in cancer cell lines MCF7 and HN5 compared with non-cancerous HEK293 cells. Conclusion: We conclude that Tarantula cubensis venom is selectively toxic for human cancer cells via inducing caspase-3- mediated apoptosis.

Introduction: Hypothyroidism is frequently associated with growth failure. In long-standing hypothyroidism the growth hormone (GH) secretory responses to growth hormone-releasing hormone (GRH) and insulin-induced hypoglycemia are decreased. Methods: To investigate whether hypothyroidism of short duration affects pituitary GH release, we measured the serum GH response to synthetic GRH (1-29), 1g/kg body weight, given IV to six athyreotic patients during thyroxine (T4) treatment and one month after stopping T4 (short-term hypothyroid state). This served as a direct measure of pituitary somatotroph function .We also assessed the serum GH response to insulin-induced hypoglycemia in three patients as an indirect assessment of hypothalamic function. Results: We found that basal GH levels remained the same both during (euthyroid state) and after stopping T4 therapy (hypothyroid state). Peak serum GH response to GRH was significantly greater in patients while they were hypothyroid than during T4 therapy when they were euthyroid (p< 0.01). There was no difference in the peak serum GH response to hypoglycemia during and after stopping T4 replacement (30.3 + 8.9 g/L euthyroid-state versus 45 + 14.5 g/L short term hypothyroid-state). Discussion: These results suggest that, in contrast to long standing hypothyroidism, thyroid hormone deficiency of short duration increases somatotroph sensitivity to GRH, perhaps as a result of decreased endogenous hypothalamic IGF-1 release and/or tone.

Introduction: Exfoliative Erythroderma syndrome is a serious, at times life-threatening reaction pattern of the skin characterized by generalized and uniform redness and scaling involving the entire skin and often associated with systemic toxicity, lymphadenopathy and fever. Diffuse Cutaneous Leishmaniasisis observed in anergic patients with a low immune response. Case report: We are presenting a case of a 17-year-old patient diagnosed with Diffuse Cutaneous and Visceral recidivial Leishmaniasis, which clinically presented Erythroderma and skin exfoliation. The most common causes of Erythroderma are Psoriasis, Allergic Dermatitis, Drug Reactions, Lymphoma and Pityriasis Rubra Pilaris. Conversely, Diffuse Cutaneous Leishmaniasis is characterized by the presence of non-ulcerative nodules which resemble Lepromatous Leprosy, scattered in in every part of the body.To the best of our knowledge, the present clinical manifestation of Leishmaniasis has not yet been reported in the literature. Conclusion: In the correct clinical and epidemiological scenario, diffuse Cutaneous Leishmaniasis should be suspected in patients presenting Exfoliative Erythroderma and diffuse nodular lesions.

A report of an unusual and easily missed diagnosis of Henoch-Schonlein purpura in an adult Caucasian male who presented in the emergency department. The patient had widespread rashes, positive urine dipstick (haematuria, proteinuria and ketonuria) and responded well to steroid and fluids treatment in the emergency department. He was admitted to the acute medical unit.

Objective: The main aim of this paper is to examine the relationship between cosmetic surgery and psychological variables such as self-esteem and marital satisfaction along with its components in Iran. Methods: The study had an ex-post facto, pre-post-test design. Using purposive sampling method, a total of 30 married women, who had referred for cosmetic surgery to clinics in Tehran, were incorporated during a six-month period. Data collection instruments included Enrich Marital Satisfaction Scale and Coopersmith Self-Esteem Inventory. The obtained data were analyzed using inferential statistics (analysis of variance for repeated measures, related sample test, and Pearson correlation coefficient). Results: According to the results of this study, some components of marital satisfaction (such as marital relations, financial management, leisure, and sex) and self-esteem of women before and after cosmetic surgery is statistically significant also there is a relationship betwean marital satisfaction and self-esteem, as self-esteem increases, marital satisfaction rises too. Conclusion: Performance of such surgeries always presents risks, and advice should be sought before making any decision about the surgery.

Introduction: Essential hypertension begins due to mutation of specific genes that contribute to the risk of developing hypertension. Genetic contribution was recognized 25 years ago, now formulated from time to time. Some studies have also proven that the hypertension in father had strong contribution in their individual than mother. The aim of the study is to compare the cardiovascular reactivity in male and female subjects with hypertensive and normotensive parents. Materials and methods: This comparative study was conducted in physiology department of Teerthanker Mahaveer medical college and research center, Moradabad. The research work was initiated after taken the ethical clearance from the ethical committee of the college. Three different stressors: cold pressor task, cycling and videogame were used. Total 120 subjects were taken for the study in which 77 were male and 43 were female. Result: Male subjects of normotensive parents had slightly higher HR rate (mean: 76.73/min) compared to the female subjects (mean: 75/min) with p value >0.05. Female subjects of hypertensive parents had higher HR rate (mean: 82.72/min) compared to the male subjects (mean: 73.95/min) with p value <0.001. Conclusion: Male subjects with normotensive parents had higher resting HR, SBP &DBP than Female subjects with normotensive parents, but the difference was significant only in SBP. Female subjects with hypertensive parents group was showing higher resting HR than male subjects with hypertensive parents group, remains higher after stress also with insignificant difference. Thus, subjects with hypertensive parents showing increased CVR to stress are more likely to develop future hypertension, and the risk is greater for male subjects.

Introduction: The confusion around the diagnosis of ‘medically unexplained symptoms’ has lead to a paradigm shift in criteria for diagnosis of somatization disorder. Aims: 1. To compare the socio-demographic variables in patients of somatization disorder 2. To compare the levels of depressive and anxiety scores of patients of somatization disorder along with the severity of disorder. Material and Methods: Somatization patients visiting the psychiatry outdoor of TMMC & RC, were randomly selected and diagnosed as per DSM-IV TR. After obtaining informed consent and applying exclusion criteria, demographic and clinical details were obtained on a self designed Performa. The HAM-A scale and MADRS scale were applied to calculate anxiety and depression scores. Results: The prevalence of somatization disorder was 2.35% in men and 6.7% in women. Females were significantly higher in number. Headache was the chief complaint. The anxiety scores and MADRS scores were highest in patients complaining of chest pain. The HAM-A and MADRS scores increased significantly as number of complaints increased. Female patients and patients belonging to rural background had significantly higher number of complaints. Illiterate patients had a significantly higher duration of illness. Conclusion: Somatization disorder comprises unique group of patients with high co-morbidities and longer duration of illness. It is imperative to identify and clarify severity of this subgroup as treatment decisions need to be modified accordingly.

Dr. Ivan Oransky is a self-proclaimed science watchdog who, together with Adam Marcus, have taken on the world of science in a blaze of public shaming – disguised as science journalism – that has already caused irreparable damage to science, despite the informative nature of those reports. Their portal for launching attacks on the publishing establishment and on scientists is Retraction Watch, a blog that sees monthly traffic in the hundreds of thousands of hits. One of the loudly claimed key tenants of Retraction Watch is to hold science and scientists accountable, and to thus be open and transparent. What is not very known, because Oransky fails to provide a full listing of his own publications, i.e., he does not show equivalent transparency that he expects or demands from others, is that he held a very important role at Elsevier's The Lancet, a premier medical journal that he now aggressively critiques, almost without impunity. That role at The Lancet was primarily to record the death of medical scientists. In the real world, taking care of the dead and the deceased lies in the hands of an undertaker. It is thus very apt that the role of digital undertaker for The Lancet established the necessary credentials that Oransky required to overlook the cadaver he and Marcus wish to create of science, and of scientists’ and publishers’ reputations.

A very few health care providers look after HIV/AIDS people because of their poor knowledge and either their lack of positive attitude or usually both. The rationale of this study was to evaluate the knowledge and attitudes of health care providers (tertiary care hospitals in Lahore, having HIV/AIDS Treatment Facility) towards patients with HIV/AIDS. In this cross sectional study, a random sample of 180 healthcare providers was assessed for their knowledge and attitudes. In the questionnaire of knowledge, items were measured in the form of dichotomous scale. Whereas in the five domains of attitudes, items were measured as a five-point likert scale ranging from strongly disagree to strongly agree. Results were discussed in the outlook of two variables which showed that the presence of negative attitude and lack of awareness increase the level of stigma and discrimination. HIV in our country needs positive attitude of rendering care and effective control measures by creating awareness in the community. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization.