Introduction: Non-invasive selection of developmentally human oocytes may increase the overall efficiency of human assisted reproduction. Morphologic abnormalities in the oocyte are relevant for determining its developmental fate. The objective is to evaluate the influence of MII oocyte morphology on intra cytoplasmic sperm injection (ICSI) outcomes. Material and Methods: 132 patients undergoing ICSI cycles and having female factors of infertility and unexplained infertility. Couples having male factors of infertility were excluded. A total of 1200 oocytes were retrieved from 132 ICSI cycles, of which 1056 MII oocytes were evaluated. The criteria for morphological evaluations were: (i) Normal MII oocytes showing clear cytoplasm with uniform texture and homogenous fine granularity, a round or ovoid first polar body with a smooth surface, and perivitelline space of normal size. (ii) MII oocytes with extra cytoplasmic abnormalities (first polar body and perivitelline space abnormalities). (iii) MII oocytes with cytoplasmic abnormalities (dark cytoplasm, granular cytoplasm, inclusion body and presents of vacuoles). (iv) MII oocytes with combined abnormalities. Result: From 1056 MII oocytes, 180 (17.04%) had normal morphology while 876 (82.95%) had at least one demonstrable morphological abnormality. Cytoplasmic abnormalities were observed in 516 (58.9%) of the oocytes. Extra cytoplasmic abnormalities were observed in 104 (11.87%) while combined abnormalities were responsible for the remaining 256 (29.22%). There were no significant differences in fertilization, cleavage, and embryo quality between the groups but there was a highly significant difference in implantation rate which was higher in the group of normal oocytes morphology than abnormal oocytes morphology, oocytes with cytoplasmic, extracytoplasmic and combined abnormality 11.11%, 7.33%, 9.03%, 2.3%, and 4.34% respectively. Conclusion: MII oocyte morphology did not affect fertilization, cleavage, and embryo quality, but affecting implantation rate.

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Background: Analysis of positive and negative symptoms of schizophrenia has been increasingly needed for a systematic management plan. Unfortunately, this type of study was lacking in Bangladesh. Aims: The study aims were to find out the predominant symptom pattern and associating factors in schizophrenia. Methods: This was a cross sectional, analytical and descriptive study done in a tertiary care hospital with a sample size of 78. The SCID-I and pre designed socio demographic questionnaire was applied. Positive and negative symptoms were assessed by using the Positive and Negative Symptom Scale (PANSS). Statistical analysis was done through SPSS version 17. Results: Among 78 patients, schizophrenics with positive symptoms (57.7%) were predominant over schizophrenics with negative symptoms (42.3%). Delusion (64.1%) and blunted affect (55.1%) were the most frequent positive and negative symptoms respectively. Negative symptoms were significantly associated with poverty, unemployment and lack of education. Limitations: Single centered cross sectional study with small sample size. Conclusions: Schizophrenic patients with positive symptoms visit clinicians more readily than those with negative symptoms.

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Objective: Habitual squatting in humans is associated with modifications of ankle especially the neck of the talus (squatting facets) and its trochlear surface (trochlear extensions) that characterize the strong pressure and traction forces on ankle joints in state of hyperdorsiflexion. Present study was done to find out variations and incidences of various types of modifications of neck of talus thoroughly and to determine regional peculiarities of these modifications in Indians. Material and Methods: 300 dry (150 right and 150 left) adult tali were taken for present study. Each talus was examined for the presence of various patterns of articular facets on neck of talus and extensions of its trochlear surface. Statistical analysis of data was performed by using Fisher exact test with 95% confidence limits. Results: Lateral squatting facet was found in 136 tali (45.3%). Incidences of medial, combined & continuous gutter like squatting facets were 7.7%, 3.3% & 4.3% respectively. Lateral and medial extensions of trochlear surface were found in 22.3% and 23.7% respectively. Conclusions: Modifications of the neck of talus (squatting facets and trochlear extensions) are result of prolonged squatting positions which is common habit of Indian population and incidences of these variations can be used as an anthropological marker for racial and regional diff erentiation of unidentified bones.

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Introduction: There is increasing awareness and facilities provided by various government and non government organizations regarding antenatal care and safe delivery practices but it is still a public health concern due to high maternal and perinatal mortality. The aims of present study is to assess the availability of manpower which provided services to the mothers in the peripheries, role of demographic characteristics, educational status, common pregnancy complications and there maternal and fetal outcome along with the hospital stay. Material and Methods: It was a retrospective study carried out in the Teerthanker Mahaveer Medical College. All the patients who were admitted through casualty were analysed with respect to Age, parity, Socioeconomic status, antenatal check-up, reason for referral from periphery, maternal and fetal condition at the time of admission, mode of delivery, maternal and fetal outcome along with NICU admission & hospital stay. Result: It has been observed that most of the patients with poor obstetrical outcome are multiparous or grand multiparous with low socio economic status not receiving any antenatal care. The common obstetrical emergencies came out were PIH (18%), obstructed labor (10.3%) followed by APH (8.2%), fetal mal-presentation (7.5%) and anemia (7.2%). Conclusion: Illiteracy and ignorance of female regarding healthcare requirements came out to be a major contributor of poor pregnancy outcome. Early diagnosis and management of high risk pregnancies is one of the measures which can reduce poor pregnancy outcomes. It is to be emphasized that majority of the maternal death from pregnancy are preventable by sample priority intervention. Co-ordination between healthcare providers at gross root level to tertiary care centre is the need of time. Health care providers at PHC and CHC levels should have adequate knowledge of antenatal requirements and importance of immunization. There must be referral of high risk cases for their early and timely management. There must be adequate transport facility and systematic referral system as well as provision of immediate management of referred cases at tertiary care centre. So it is high time for urgent strategic planning and investment for upgrading eff ective obstetric and neonatal care.

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Background: There was an increasing trend for suicide Objective: To examine the trend and relationship between Indian Suicide Rates and Human Development Index (HDI). Method: Trends of Suicide rates and HDI values were evaluated by moving averages time series analysis (ARIMA Model). S. Rate and HDI were subjected to Pearson Correlation Coefficient and Spearman's ρ. Results: There was an increasing trend for both the parameters with minor exceptions in suicide rates. Significant correlation between suicide rates and HDI values were found. Conclusion: The notion that suicide and development were related found support. It warrants further analysis into contribution of individual components of HDI.

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Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcification plays central role. A pivotal role in the inhibition of calcification is played by fetuin-A. The measurement of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: The study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a significant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a significant increase in hs-CRP, homocysteine and only those with CVD had significantly decreased fetuin-A in relation to CKD patients. The study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: The combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be effective for discrimination of CVD patients from other ESRD or CKD patients.

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Introduction: Blastocystis hominis (B. hominis) is an obligate anaerobic protozoan found in the human large intestine, and is the most common eukaryotic organism reported in human fecal samples. Method: Multiple stool samples from 460 children (53.9% male and 46.07% female) were collected and examined for the presence of Blastocystis hominis in Parasitology Laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh during the period of 9th January to 28th December, 2011. Among them, 255 were diarrheal patients (56.47% male and 43.53% female). Direct microscopy was done for each of the samples and each sample was cultured in vitro for 48 hours and observed again for the presence of the pathogen. The aim of the study was to develop a sustainable technique to identify the pathogen. Results: In culture, several morphological forms were observed. Through microscopy, various morphological forms were clearly observed. Within 5679 tested samples, 795 samples (0.14%) were positive for B. hominis. As multiple forms were observed in the same sample, the most prevalent was cyst (0.125%) whereas least prevalent was granular (0.0072%). The highest percentage for all the morphological forms was observed in age group 25-36 months. In direct microscopy from fresh samples, children from 37-48 months showed the highest percentage (22.9%) of infection (p=0.000). In culture, the same age group showed the most infection rate (p=0.000). Among the different morphological forms observed in culture, the highest prevalence of cyst was in age group 37-48 months (p=0.000). The highest prevalence of vacuolar form(5.7%) was observed in the same age group (p=0.015). In contrast, the amoeboid forms were mostly observed in children of 25-36 months (p=0.002). The children aged in between 37 to 48 months are at the most risk of the infection. Conclusion: The sensitivity of direct microscopy was found only 38.46% in respect to in-vitro culture which strongly suggests that in-vitro culture is the gold standard for the diagnosis of this parasite.

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Introduction: Lithium is a therapeutic agent currently used for the treatment of affective disorders controlling a variety of neurotic and psychosomatic manic depressions. The main objective of the present work was to demonstrate the histopathological effects of the therapeutic doses of Lithium on the renal tubules and glomeruli in growing albino rats. Material and Methods: Thirty growing male Sprague - Dawley albino rats were used in this study. The rats were divided into a control group formed of 6 rats and an experimental group formed of 24 rats which received a daily therapeutic dose of 20 mg Lithium/kg body weight by the same route for 7 weeks. The renal cortex in all animals is examined by light and electron microscopes. Blood was collected from the sacrificed animals for serum creatinine, urea, sodium and potassium to access the effect of lithium administration in a therapeutic dose on renal function. Results: The present work revealed that the therapeutic doses of Lithium induced nephrotoxicity in the form of degeneration and necrosis in the renal tubules and glomeruli. Alteration in the cellular fine structure and degenerated cytoplasm and cytoplasmic organelles were found revealing cellular degeneration and necrosis. Glomerulosclerosis and congestion were the predominant effect on the renal glomeruli. Conclusion: Histological and ultrastructrual features of Lithium nephrotoxicity were detected in the current study with therapeutic doses of Lithium.

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Introduction: The ischaemic disorders as a complication of intra-aortic balloon pump counterpulsation (IABP) could be deleterious in critically ill patients with myocardial failure and cardiogenic shock. Tis study is a pilot to predict the length of the descending aorta to select the optimum IABP size for Asian patients. Methods: The somatometric features from 80 Chinese patients were used: gender, age, height, body mass index, body surface area, trans-pyloric plane. Moreover, the aortic length from the origin of left subclavian artery to the orifice of the celiac trunk (LSA-CT) measured from tomographic scan examination. The variables to predict the length from the LSA-CT were studied in four types of predictive statistical analysis: nonlinear regression analysis, tree model, linear regression, and loglinear regression. The model was defined by obtaining the R square. Results: Tere were 59 males (mean age 53.9 years SD 13.2, height 170.8cm SD 4.0) and 21 females (mean age 58.7 years SD 7.8, height 160.2 cm SD 6.8). LSA-CT distance was found to be 279.5 SD 31.34 mm. The length of distance from the jugular notch to trans-pyloric plane was 273.8cm SD 12.5. The body mass index was 25.6 Kg/m2 SD 3.8 and the body surface area 1.8 m2 SD 0.1. The tree model for predicting the distance to the left subclavian artery to the celiac axis was chosen due to obtained an R2 square of 0,829. The comparison between the tomographic values and results of the tree model was realized with a nonparametric test. Wilcoxon signed-rank test showed that the values of computed tomograhy scan did not show a statistically significant difference with the results of the tree model (Z = -0.827 p =0.408). Conclusion: The tree model for predicting the distance from the left subclavian artery to the celiac trunk, could be an accurate guide to choosing an adequate catheter length of intra-aortic balloon pump counterpulsation in Asian patients.

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Background: In most of the centers of developing country no premedication is used in cases of anesthesia in paediatric population. Many centers use oral promethagine on the night before to ensure good sleep. There is dilemma of using premedication with a fear of losing control over baby. There are controversial results regarding the effectiveness of clonidine compared with midazolam as premedication in children. Aim: The aim of this study is to evaluate the efficacy of oral clonidine and midazolam as a premedication and compare to with that of conventional promethagine in pediatric patients. Methods: This prospective randomized controlled study was carried out in Combined Military Hospital, Dhaka, among 90 children aged 2 to 7 years of ASA grade I & II scheduled for elective surgery under general anaesthesia during the period of Jan 2012 to Dec 2013. All the children were randomly divided in three groups, 30 children received only syrup promethagine as per body weight (Group-P, n=30) at night. In the study groups, after the syp promethagine at night in addition they were also given oral clonidine 4 μg/kg mixed with honey (Group-C, n=30) and midazolam 0.5 mg/kg mixed with honey (Group-M, n=30) at 60 and 20 min before separation of baby from parents lap respectively. The protocol of general anesthesia like induction, intubation, maintenance, reversal and postoperative analgesia was the same for all three groups. Patient's sedation status, separation anxiety, venipuncture, mask acceptance, anesthetics requirement, salivation, analgesia, post operative nausea vomiting (PONV) and emergence agitation were recorded by an observer blind of the patient's group. Results: Children characteristics were similar in all three groups. Children who had received clonidine as well as midazolam had more satisfactory sedation upon parent separation and less separation anxiety than promethazine; compared with midazolam & promethazine, clonidine premedication was associated with better mask acceptance; children who had received clonidine had significantly less incidence of salivation and less rescue antisialagogue; children received clonidine were better managed both intra & post operatively and needed less rescue analgesics; children who had received clonidine had significantly less episodes of PONV and also required less rescue antiemetic; incidence of emergence agitation was less in clonidine group in comparison with other two groups. Conclusion: The findings of the study suggest that both midazolam and clonidine are safe and effective as anaesthetic premedication in paediatric population. It can be concluded that oral midazolam premedication is effective as far as sedation is concern but considering multifarious anesthetic function oral clonidine is much superior premedicant. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with clonidine should be considered. We recommend further multi-centre studies with larger samples to validate findings of our study.

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Introduction: Contrary to its name, synovial sarcoma does not arise from the synovial membrane but from multi-potent stem cells and can present in any part of the body. Very few cases of vulval synovial sarcoma have been reported in the literature; we report on such a presentation. These tumors can present as painless lumps, which must be completely excised to give the best prognosis. Therefore the diagnosis of synovial sarcoma should always be kept in mind in the management of vulval masses, especially in young patients.

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Introduction: Benign peripheral nerve schwannomas are uncommon tumours. Extra cranial schwannomas have also been reported from uncommon and unusual sites including breast, pancreas, and gastrointestinal system. Peripheral nerve schwannomas may pose a problem in clinical diagnosis, however an appropriate diagnostic work-up including thorough history and clinical examination, Ultrasonography, magnetic resonance imaging, fine needle aspiration cytology, nerve conduction velocity and electromyography study may all help reaching the correct preoperative diagnosis. The important clinical differential diagnoses include traumatic neuroma, neurfibromas, lipoma, cold abscess and muscle hernia. The definitive treatment of benign peripheral nerve schwannoma is complete enucleation of the tumour mass without damaging the intact nerve fascicles followed by confirmatory histopathological examination. When there is a doubt on histopathology, a positive Immunohistochemical staining with S100 is helpful in confirming a diagnosis of schwannoma. Case presentation: We had 40 years female who had a slow growing swelling over the inner aspect of her right elbow for the last one year; this was followed by pain, tingling and numbness over inner one and half fingers of her right hand for six months. Tinnels sign was positive over the swelling. Her subsequent clinical examination and investigations including a magnetic resonance imaging was suggestive of a benign growth in her right ulnar nerve in the elbow region. Complete enucleation of the swelling was done from the right ulnar nerve in the elbow region and subsequent histopathological examination confirmed it to be a benign cellular schwannoma. Patient recovered successfully after the surgery and paresthesia in the distribution of her right ulnar nerve also improved six weeks after surgery. At her last follow-up six months after surgery, the patient was completely asymptomatic and highly satisfied with the results of surgery. Conclusion: A correct preoperative diagnosis of peripheral nerve schwannomas is possible, and it can be successfully managed with complete enucleation of tumour mass with satisfactory patient outcomes.

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Introduction: On Sudden death of a medical student (20 year old girl) of National Institute of Medical Science autopsy materials along with site of injection were sent to F.S.L. It was informed during investigation that the girl took tetanus vaccine before death. In crime scene investigation Forensic Team observed that it was a case of gross negligence of dispensing wrong injection. Material: Tests were performed on viscera material viz., liver, spleen, kidney, lungs, brain, skin and blood etc. Mystery of suspected death was solved when a new GC-MS application was designed to get the unknown drug and various fragments of extracted material were studied. Method: A new method was developed on gas-chromatography-mass spectrophotometer and TL.C using various solvent systems is explained. Results: Metabolite fragments of vecuronium bromide a muscle relaxant were surprisingly observed in Viscera material, Blood sample and Skin piece from Left cubital fossa from this young girl, whose death is questioned. Conclusion: Structural elucidations of fragments provide a new approach to toxicokinetics. The explanation of fragments obtained were structurally compared with other neuromuscular blocking groups like atracurium and succinyl choline The presence of bromide attached cholest-5-en-Br, hydroxylated cholest-5-en-ol as hydroxylated product, acetylated fragments as cholest-5-enacetate and piperidone-2-one present in visceral samples indicates structural part obtained from vecuronium bromide drug. These metabolites studies makes the case studies highly informative. Beside this new method of extractions, TLC systems and colouring reagents are also explained.

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Introduction: Body dysmorphic disorder (BDD) is excessive concern about physical appearance leading to mental, social & functional distress. Patients seek cosmetic surgery not psychiatry & may remain dissatisfied after surgery. Study includes 100 hair transplant patients. Materials and Methods: From 1^st Jan to 31^st July 2013. Patient's Personal Evaluation, Yale Brown Obsessive Scale, Sheehan Lifestyle Disability Scale & Derriford Appearance Scale were used for evaluation. Patients deformities were corrected with hair transplant and these patients were reassessed. Results: 10 months later to judge the benefit. BDD prevalence in hair loss is 28%, which is higher than rhinoplasty 20.7%. Preoccupation of hair loss on the minds of the patients is much higher than perceived by their doctors. After hair transplant 52% patients considered their baldness has been corrected, 32% patients, had milder perception of their defect but 16% continue to feel that they have less hair than others. Conclusion: The study shows that hair loss patients who display BDD like concerns, can have significant benefit in personal life, social life and work performance after hair transplant. Study also shows that four diff erent psychiatry scales can be used for evaluation and follow up of BDD in hair loss patients.

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Aim: Traumatic injuries related to agricultural production can lead to serious disability and even mortality. Inappropriate use of farm machinery increases the risk for accidents. The objective of this study was to describe the characteristics of "pat-pat-machine"-related work injuries cases treated at the emergency department and to assess injury severity and hospital admissions in the West Black Sea Region of Turkey. Methods: All cases related to injuries caused by work with a "pat pat machine" between June 2003 and June 2010 were included. Information was collected concerning the demographic features of patients, and injury sites, injury types, initial injury severity scores at admission, and clinical features were evaluated. Results: Thirty-nine (73.6%) of the cases were male and 14 (26.4%) were female. The ages of the cases were 5-76 years with a mean age of 38.8 ± 18.3 years. Approximately 19% of the cases were considered slight injuries, 30.2% moderate, and 50.9% severe. In terms of age, a plurality of injuries 24 (45.3 %) occurred among those aged 19-45. The Glasgow Outcome Scale score for 37 patients was five; it was four for 14 patients, and it was three for two patients. Conclusions: Our findings suggest that the "pat-pat machine" is one of the most dangerous agricultural machines, particularly for adults. In rural areas of Turkey, agricultural machines cause serious injuries that require hospitalization.

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Introduction: Malnourished children are about 20% in the developing world. Food insecurity is a key risk factor for child malnutrition Food insufficiency, an extreme form of household food insecurity, can affect physiological mechanisms that are linked to an individual': nutritional status. Food-insufficient children are also more likely to have poorer health status and to experience a range of negative academic and psychosocial outcomes. Methods: We administered a cross-sectional socioeconomic survey to 354 households ir research site, including a validated food insufficiency measurement questionnaire, and obtained anthropometric measurement: from children aged 12 to 24 months. We used chi-square tests to assess the relationship between household food insufficiency an nutritional status of children. Results: Average age of study children was 18 months and standard deviation was (± 3.2 months) The status of household food insufficiency was 56%. The prevalence of underweight, stunting and wasting was 24%, 36% and 8% respectively. The household food insufficiency was significantly (p<.05) associated with underweight and stunting but not witt wasting (p>0.05). Discussion: The study results indicate that food insufficiency is associated with stunting and underweight bu not with wasting in urban slum of Bangladesh. We also found that child malnutrition is associated with mother's education, father': education, monthly family income and people per room.

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Introduction: Superior cerebellar artery is the most constant among the cerebellar arteries and is almost always present, sometimes it can be double, and more rarely, triple. Methods: We report the case of a 72-yr male patient who came to hospital in whom cerebral angiography was performed because of subarachnoid hemorrhage. Results: cerebral angiography showed the unusual presence of an embryonic right posterior cerebral artery, associated with triplication of the right superior cerebellar artery. Conclusion: The tripling of the SCA is seen in only 7% of angiographic abnormalities and rarely is associated with posterior communicating artery aneurysms and embryonic posterior cerebral artery, as in our case.

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Systemic lupus erythematosus (SLE) is a multi-system auto-immune disorder that is characterized by widespread immune deregulation, formation of auto–antibodies, and immune complexes, resulting in inflammation and potential damage to variety of organs. 25-95% it is complicated by neurological or neuropsychiatric symptoms, which is referred to as neuropsychiatric SLE (NPSLE). NPSLE contain both central and peripheral nervous systems, which includes transverse myelitis. We report our experience of concurrent manifestation of transverse myelitis as an initial presentation of SLE, which suggests the common immune-mediated mechanisms of diseases. We here report the case of a 7-year-old girl with SLE who first presented with features of TM. The patient developed ascending weakness starting from low extremities, experienced difficulty in voiding. An initial diagnosis of TM was made on the basis of clinical findings and MRI spine, which displayed T2 weighted high signal intensities at thoracic level. She partially respond to intravenous immunoglobulin therapy, and serological analysis revealed the presence of anti-dsDNA, anti nuclear antibody with decreased level of complements. The diagnosis was revised to acute transverse myelitis resulting from SLE. Additional methylprednisolone pulse therapy led to rapid clinical improvement. This was followed by oral prednisolone and cyclophosphamide pulse therapy. The crossreactivity of auto-antibodies and increased susceptibility to infection owing to immunologic changes associated with lupus may form the basis of the association. Systemic Lupus Erytheromyitis should consider as an etiology of transverse myelitis. Aggressive treatment may alter the course and lead to a better outcome.

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Introduction: Os odontoideum is a rare lesion of the axis. Described as an ossicle, consisting of smooth and separate caudal portions of the odontoid process wherein its etiology has remained controversial. Os odontoideum complicating a possible osteogenesis imperfecta has not been reported before in the literature. Methods: We report the case of a 14-yr male patient presented with progressive weakness of both lower and upper extremities after a head trauma 10 months prior to admission, which presented as transient quadreparesis. Results: Magnetic resonance imaging of cervical spine showing cervicomedullary junction compression. Patient underwent surgical intervention and 3 months post operation, patient was reported to have steady gait and muscle grading of 5/5 on all extremities. Conclusion: Surgical fixation and fusion in patients with instability may prevent catastrophic neurologic insult after minor trauma in the future.

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Introduction: Human papillomavirus (HPV) is a DNA virus which has tropism for epithelial cells, is the major etiological factor for development of cervical precancerous and cancerous lesions. Nearly 100 different types of HPV have been characterized and thereare a large number of other types. HPV infection is one of the most common causes of sexually transmitted disease in both men and women worldwide. It is associated with a variety of clinical conditions that range from innocuous lesions to cancer. Genital HPV types are divided into high and low-risk types, according to the oncogenic potential. Molecular and epidemiologic studies have solidified the association between high risk HPV types (especially HPV-16 and HPV-18) and cervical squamous cell carcinoma. HPV infection is often transient and self-limiting but infection may persists and progress to high grade lesions and cancer. In addition to persistent high-risk HPV infection, other viral factors such as high viral loads, HPV variants, infections with multiple high-risk HPV types and genetic predisposition contribute to the development of cervical cancer. The aim of the present study was to detect HPV DNA and identify high risk HPV genotype among women having cervical intraepithelial neoplasia and carcinoma and to evaluate potential efficacy of prophylactic HPV vaccine. Methods: Cervical swab from histopathologically diagnosed CIN (n=51) and carcinoma (n=39) patients were taken and high risk HPV DNA was detected by HC II assay. Polymerase Chain Reaction was used to identify high risk HPV genotype. Result: HPV DNA was detected in 41 (45.56%) patients by HC II assay. HPV type 16 was detected in 27 (81.82%) followed by type 18 in 3 (9.09%) and type 45 in 2 (6.06%) cases of cervical carcinoma. Among precancerous cases, only type 16 was detected. Conclusion: Knowledge based on HPV prevalence and genotype could be used to predict the efficacy of cost effective prophylactic vaccine, introduction of newer generation vaccine and management of cervical carcinoma.

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Introduction: Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase that plays a pivotal role in cell invasion. Matrix metalloproteinases (MMPs) are implicated as the key players in cancer cell invasion. Hence, the role of FAK in MMP regulation is very important in understanding tumor progression. Materials and Methods: Here, we studied the role of FAK, its association with other signaling kinases and involvement in the α5β1 integrin receptor-mediated regulation of MMP-2 activity and expression in human breast cancer cell line MCF-7. Results: Immuno blot analysis revealed that FN treatment causes phosphorylation of FAK and FAK gets localized at the cell attachment focal point of MCF-7 cells. FN treatment did not change the mRNA status of FAK but enhanced mRNA level of MMP-2 and MT1-MMP, also caused downregulation of TIMP-2. Co-imunoprecipitation and inhibitor studies revealed the association of FAK with α5β1, Paxillin, PI3K and ERK. siRNA studies revealed that FAK is critical in regulation of activity and expression of MMP-2 and downstream signaling kinases. Conclusion: The interaction of α5β1 integrin with FN initiates a signaling cascade with FAK as its central player. FAK gets phosphorylated and in turn associates with tyrosine kinases like PI3K and ERK. FAK also activates PI3K and ERK that serve as very crucial mediators of the signaling pathway leading to induction of MMP-2 activity and resulting invasion of breast cancer cell, MCF-7.

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Introduction: Intra-operative ultrasound provides low cost real time imaging that is simple and rapid to use. In recent years there has been a significant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the approach, and achieving safe maximal resection, thereby improving outcomes for patients with different localization and histology of brain tumors, vascular patology, spontaneous intra-cerebral hemorrhage. Material and Methods: Since 2007 till 2010, in the Institute of Neurology and Neurosurgery, 130 operations with application of 2D iUS have been performed. Starting from March till May 2012, 17 patients went under surgical treatment using the intraoperative ultrasound integrated neuronavigation system. Results: We applied ultrasound neuronavigation system in 17 cases on patients with diverse pathologies, including brain tumors (craniopharyngeoma, corpus callosum and intracerebral glioblastoma, intraaxial glioma), vascular patology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. Application of ultrasound neuronavigation system aids in improving postoperative outcomes for these patients. Conclusions: The integration of 3D US with neuronavigation technology created an efficient and inexpensive tool for intraoperative imaging in neurosurgery. The technology has been applied to optimize surgery of brain tumors, but it has also been found to be useful in other procedures such as operations for aneurysms or arteriovenous malformations. iUS is easy to use and has a rapid learning curve which makes it a useful tool to the neurosurgeons intraoperative armamentarium.

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Background: Proteinuria is recognized as one of the earliest sign of renal function deterioration in chronic smokers. Proteinuria occurs due to alteration in glomerular permeability and later due to failure of reabsorption of filtered protein by the tubular cells. Normally, most healthy adults excrete 20 - 150 mg of protein in urine over 24 hours. However, it is difficult to collect 24 hrs urine samples. Objectives: To advocate the use of PCI (protein creatinine index) in assessment of proteinuria and to compare dipstick result with PCI in the assessment of proteinuria in chronic cigarette smokers. Material & Methods: A total of 30 cigarette smokers and 40 age and sex matched controls were included for the study. A random specimen of urine collected from each cigarette smoker and non- smoker was tested quantitatively by manual sulfosalicylic acid colorimetric method for the estimation of protein concentration. Creatinine concentration in each specimen was measured by modified Jaffe's method and the urinary PCI was calculated. Results: Normal range of PCI which has been established in this study is 50 to 259. Significantly higher amounts of protein were found to be excreted in urine in chronic smokers (9.313 ± 4.003 mg/dl) as compared to healthy non smokers (7.738 ± 2.05 mg/dl). On comparison of PCI between healthy non smoker and chronic smoker subjects, PCI has been found to be significantly elevated in chronic smokers (healthy non smoker- 118.32 ± 56.86, chronic smoker- 180.1 ± 88.23) (p=0.001). Conclusion: PCI of random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria to confirm the advent of kidney damage, avoiding the drawbacks of 24 hrs urine collection.

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Introduction: Cardiovascular disease is one of the common complications of Diabetes mellitus. Serum Cystatin C level has been suggested as a marker for cardiac complications in diabetes. Material and Methods: We studied serum Cystatin C level in Diabetics to find if correlation exists between cardiac complications and elevated Cystatin C levels. Results: A total of 50 diabetics were studied out of whom 25 had cardiac complications and the rest did not have cardiac complications. No significant difference was observed between Serum Cystatin C levels of diabetics with cardiac complications (mean 1.5±0.45) and diabetics without cardiac complications (1.4±0.46) although Cystatin C levels were found to be elevated in diabetic cases. Conclusion: Keeping in view the significant difference (p=0.000) in Cystatin C levels of healthy and diabetic patients, it is reasonable to accept the importance of Cystatin C as an indicator of diabetes and its associated complications.

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Introduction: Inhibition of pituitary gonadotropin secretion in men by testosterone (T) is principally mediated by aromatization to estrogen (E), which inhibits hypothalamic secretion of gonadotropin-releasing hormone (GnRH). Material and Methods: Longitudinal clinical investigation unit-based evaluation of the clinical and biochemical response to E-receptor blockade. Initial monotherapy with 50 mg of clomiphene citrate (CC) daily for a period of 9 months, with diurnal morning peak testosterone and luteinizing hormone (LH) levels evaluated at three-month intervals thereafter. The patient then resumed hormone replacement therapy (HRT) using T cream with adjuvant CC therapy. Main Outcome Measures were Baseline and stimulated T and LH levels; effect on sexual function. Result(S): CC therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. Conclusion(S): Isolated hypogonadotropic hypogonadism (IHH) may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. Reversal of gonadotropin deficiency with CC was found to have a similar biological effect.

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Background: Depression is projected to become the 2^nd worldwide leading cause of disability by 2020. Marriage is one of the principal facets when it comes to interpersonal context of Depression. There is evidence supporting bidirectional casual eff ect between Depression and marital satisfaction. However the phenomenon of marital adjustment and its related variable has not been given much attention in the Pakistan. Aim of the study: The primary objective is to determine the frequency of marital adjustment by using validated Urdu version of Kansas Marital Satisfaction Scale in patients with Depression, who are under treatment at Psychiatry outpatient clinics at tertiary care hospital in Karachi. Method: Patient presenting in outpatient clinic and diagnosed with Depression for at least last 6 months according to ICD-10 criteria by Consultant psychiatrist, who were aged between 15-65 were included. Patients who had documented co morbid of substance use or any unstable serious general medical condition were excluded. The severity of Depression was evaluated by using Urdu validated Hamilton Depression Rating Scale. Marital adjustment is determined by using Urdu validated version of Kansas Marital Satisfaction Scale. Result: Only 8.6% were well adjusted in their marital life, and all were females; most of them were living in nuclear setting, unemployed, severely depressed, educated above intermediate, aged above 30 years, and had duration of illness more than 12 months. The association of marital adjustment and severity of Depression is insignificant. It further revealed to have insubstantial diff erence on KANSAS scale between both genders. The odd ratio of duration of illness was 7.6, which indicated that the longer the duration of illness, the more positively it is interrelated to the marital adjustment. Being employedand above 30 years of age were inversely related to marital satisfaction with odd ratio of 6.1 and 5.4 respectively. However, the correlation between other independent variables and marital adjustment were insignificant in both genders. Conclusion: This study confirms the presence of high frequency i.e. 91.4% of marital dissatisfaction in Depression in both male and females, irrespective of their severity of Depression. No substantial difference was established between both the genders based on KANSAS score. Longer duration of illness, unemployment, and above 30 age have protective effect on quality of marital life.

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Introduction: Current treatments for AML have not changed for several decades and have not resulted in satisfactory outcomes. Modulating the immune system may improve survival in AML patient. Increasing evidence shows that Treg cell may play an important role in immune evasion mechanisms employed by cancer This work was designed to measure the frequency of regulatory cells T cells (Treg(in newly diagnosed adult acute myeloid leukemia patients (AML) and to correlate its percent with cytogenetic study and clinical outcome. Material and Methods: This study was conducted on 50 subjects divided into two groups: 25 AML cases(group 1) admitted to Hematology Unit, Alexandria Main University Hospital, Egypt and 25 healthy subjects(group 2) of matched age and sex. Detection of Treg was done to both groups by Multi-Color Flow Cytometry Kit. Results: Treg value was higher in AML patients at diagnosis compared to healthy controls. No significant difference was present in the percent of Treg between the patients with normal and abnormal karyotype. Patients who achieved complete response after induction chemotherapy had lower Treg percent compared to those with persistent leukemia. Conclusion: From this study we can conclude that higher pretreatment Treg percentage may be a poor predictor to response to induction therapy.

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Nowadays surrogacy is a process practiced in many countries of the world and spark a deep interest in many couples that consider it as the only way to realize their dream to have a family. This article focuses on the increasingconclusion ofinternational surrogacy agreements as a consequence of the different countries' approaches, and aims to provide analysis of the different attitudes shown, specifically, by the Italian, Californian, Indian and English legal system. The article highlights the importance of the protection of human rights of people involved in surrogacy process underlining that,in particular with regard to the unborn child, it will be the best interest of the child to represent the guiding principle.

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Oncofertility is an emerging field, merging oncology and reproductive endocrinology. Any woman facing a cancer diagnosis is devastated especially if she is young. Young women diagnosed with cancer face an additional burden of compromise of future fertility. Oncofertility aims to explore and expand fertility options to address reproductive concerns of young women with cancer diagnosis. This review aims to highlight the available and emerging options for young women diagnosed with gynecological cancers to enable them to realize their dream of parenthood.

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In 1992 a new syndrome was described consisting of syncopal episodes or sudden death in patients with a structurally normal heart and an electrocardiogram characteristic of right bundle branch block with ST segment elevation in leads V1 to V3. Brugada syndrome is an autosomal dominant disorder. It has been shown to be associated with mutations in the gene (SCN5A) that encodes for the sodiumion channel in cardiac myocyte. Over 160 mutations of gene SCN5A have been identified. The incidence of the disease is difficult to estimate, but it causes sudden deaths of 5 per 10,000 inhabitants per year and involved much more frequently in people of Asian ancestry. Diagnosis can be easily made by means of genetic analysis and ECG. Recent data suggest that loss of the action potential dome in the right ventricular epicardium underlies ST segment elevation seen in this syndrome. Right ventricular epicardium is preferentially affected because of the predominance of transient outward current in this tissue. Antiarrhythmic drugs like amiodarone and beta-blockers do not prevent death in symptomatic or asymptomatic individuals. Though Implantation of an automatic cardioverter–defibrillator is the only recently proven effective therapy; Quinidine has been found to decrease Ventricular fibrillation and could prove to be a secured option of implantable cardioverter–defibrillator. However, researcher set focus on gene therapy that may offer an enduring cure in future years. The purpose of this brief review is to record the past highlights that have brought us to our present understanding of Brugada syndrome.

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This article details the principles and practices of the scientific discipline Sexology. The purpose of this article is to provide the reader with an in-depth understanding of Sexology as an academia as well as its professional applications. Sexology is defined as the multidisciplinary scientific study of human sexuality, but few individuals know exactly what a Sexologist does. Often the assumption is solely sex therapy as treatment for sexual dysfunctions, however, the field of Sexology is far more expansive with multitudinous diverse specializations. Sexology covers a broad spectrum of theory and practice and Sexologists integrate many methods, concepts and interventions into their work. Through education, research and therapy, human sexual difficulties maybe successfully resolved through the commitment and dedication of Sexologists.

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