Background: Study of marrow in iron deficiency anemia is very much essential, and it helps to decide whether iron therapy would be of any use or not. Where sophisticated instruments and facilities are not available for measuring iron in the blood by chemical method, this simple technique, is efficient, cost-effective, and result oriented. Aim: The aim was to study the marrow finding in various blood disorders. To establish the fact "old is gold" as "bone marrow iron store by Prussian blue stain" still has its stand in hematology in era of genetic engineering markers study and ferrokinetic study. Materials and Methods: Bone marrow aspiration was performed in 73 patients. Marrow films were stained with hematoxylin and eosin stain, observed and then submitted for Prussian blue stain. Results: In a study of iron deficiency anemia 92.7% of cases received iron store grade in marrow in range of 0-1 (P = 0.001). In megaloblastic anemia, 70% of cases received in the range of 3-4 (P = 0.164), whereas all cases of dimorphic anemia received in the range of 2-3 (P = 0.000) when compared to the normal range of 1-2. Conclusion: Prussian blue stain is simple and helpful technique to see and measure body iron store semi-quantitatively. Furthermore, it helps to decide whether iron therapy would be useful or not.

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Syringomas are common benign neoplasms of the eccrine glands. It, usually, affects adult females with its usual presentation; small smooth skin-colored or yellowish papules with flattened or rounded tops on the face, especially in the periorbital area particularly around the lower eyelid. Eruptive syringoma, a distinctive form of syringoma presents as successive crops of numerous, disseminated papules appearing in atypical sites. There are a few reports of its widespread distribution as eruptive syringoma in the literature. Herein, we report an uncommon presentation in a teenage boy aged 20 years presenting with multiple asymptomatic, skin-colored papules predominantly over the trunk clinically mimicking numerous conditions presenting similarly. Histopathology showed multiple ducts and solid nest or cords of epithelial proliferation within the dermis, embedded in fibrous stroma. Some ducts had comma-like extensions or tadpole-like appearance confirming a diagnosis of eruptive syringomas.

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Neonatal hydrometrocolpos is a rare abnormality and can present as an abdominal mass, urinary tract obstruction, anuria, hydroureteronephrosis, constipation or respiratory distress. Hydrometrocolpos in neonate can be due to imperforate hymen, vaginal atresia, vaginal septum, urogenital sinus or even cloaca. Clinical examination and routine ultrasonography cannot differentiate causes of hydrocolpos in all such cases. Surgical approach depends upon the underlying cause of hydrometrocolpos. We report an unusual case of neonatal hydrometrocolpos in which it was extremely difficult to differentiate urogenital sinus from imperforate hymen or vaginal atresia. The patient underwent magnetic resonance imaging (MRI) which clearly showed the imperforate hymen and was helpful in planning management of the case. Hence, there is the definitive role of MRI in the differential diagnosis of hydrometrocolpos and is equally helpful in making surgical decisions.

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Background: Follicle development is dependent on the interrelationship of many hormones, such as follicle stimulating hormone (FSH) and anti-Mόllerian hormone (AMH). Ovary-specific expression in granulosa cells of growing nonselected follicles makes AMH an ideal marker for the size of the ovarian follicle pool. Thus, the objective was to study the variability of AMH during menstrual cycle and relationship between serum AMH and FSH in infertile women and to observe their relation with antral follicle count (AFC) as to determine, which is a better predictor of infertility. Materials and Methods: This study includes 75 infertile women in aged 30-40 years. Blood samples were taken at day three for serum AMH and FSH levels, and AFC was done. AMH was estimated again on day 14 of the menstrual cycle. Results: Mean serum AMH and FSH were 1.18 ± 0.57 ng/ml and 9.09 ± 2.51 mIU/ml on day three of menstrual cycle. Mean AMH levels on day fourteen was 1.12 ± 0.53 ng/ml, which was not significantly different from day three AMH level. There was a significant inverse relationship between serum AMH and FSH concentration (r = −0.488, P < 0.001). Furthermore, there was a positive correlation between AMH and AFC (r = 0.641, P < 0.001). Conclusion: There was a significant inverse correlation between serum AMH and FSH levels in infertile women and we consider AMH, a better predictor of ovarian reserve as it is relatively stable throughout the cycle. Furthermore, there is was positive correlation between AMH and AFC, denoting reduction of AMH levels in serum is the first indication of a decline in the follicular reserve.

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Charcot-Marie-Tooth disease (CMT) is the most common hereditary neuromuscular disorder. Careful assessment of clinical presentations, mode of inheritance, electrophysiological studies, and genetic analysis form the basis for the diagnosis of CMT. CMT4 is a group of progressive motor and sensory axonal demyelinating neuropathies. It is distinguished from other forms of CMT by autosomal recessive pattern of inheritance, variable clinical manifestations, electrophysiological study, nerve biopsy, and specific genetic studies. Here, we report an interesting case of hereditary neuropathy with recessive inheritance pattern who presented with combined clinical phenotypes of 4B1, 4C, and 4D subtypes. The histopathological study revealed onion bulb appearance suggestive of demyelination and remyelination phenomenon. The overlapping clinical manifestation may create a diagnostic challenge which would be confirmed by specific molecular analysis.

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Background: Despite the remarkable success been made in the prevention and control of Tuberculosis, it remains one of the major public health problems in developing countries. It is the second leading cause of death amongst infectious diseases. Objective: To assess awareness and attitudes of ex/current TB patients (under DOTS) regarding tuberculosis (TB) in Jutpani Village Development Committee (VDC) of Chitwan district, Nepal. Materials and Methods: This was a descriptive cross-sectional study, carried out during July to December 2012 in Jutpani VDC of Chitwan district, Nepal. All (114) the patients of Pulmonary TB undergoing treatment with DOTS therapy including those who had completed the treatment during July 2010 to June 2012 constituted participants of the study. Data were collected through individual interview and analysed by SPSS (16.version). Results: Blood in sputum (80.7%), evening fever (71.9%), and chronic cough (21.1%) were reported as common symptoms of TB. Only 17.5percent were known about the causative organism of TB. Primary immunization (81.5%), avoiding personal contact (54.6%) with the TB patients and use of face masks (12.2%) were the reported preventive measures of TB. Most of the participants had strongly agreed (68.4%) that DOTS is an effective treatment and the treatment should not be discontinued during the course of treatment (61.4%). Out of 14 attitude measurement statements, there were positive agreements amongst more than 60 percent which indicate the affirmative opinions with respect to existing knowledge. Conclusion: Knowledge regarding signs and symptoms of tuberculosis was good amongst participants; however, only few had correct knowledge about the cause, modes of transmission, and prevention of TB. Majority had positive attitude toward the TB prevention and control in accordance with the existing knowledge of TB. Selective approaches need to be employed to create awareness and case identification of tuberculosis in such pocket areas where the tubercular infection persists as a public health problem.

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Context: During emerging adulthood, a person takes on several roles and needs to cope up with psychosocial challenges that are connected to an autonomous personal life. Hence, anxiety and its repercussions, though common in this phase, yet may produce a detrimental effect in their life. Aims: The objective of the study was to examine the contributions of anxiety to hopelessness of emerging adults during their transitional phase from late adolescence to adulthood. Settings and Design: The study involved a correlational design where anxiety, academic difficulty, age, and gender were predictors and hopelessness was the criterion. Materials and Methods: One hundred fifty university students, both men and women, in their emerging adulthood were selected, of which 132 completed the Institute of Personality and Ability Testing Anxiety scale, Beck's Hopelessness scale, and a single-item measuring the presence or absence of academic difficulty. These instruments were administered individually along with demographic details. Statistical Analysis Used: The data were analyzed by means of descriptive statistics, Pearson's product-moment correlations, simple and multiple linear regression analyses. Results: The results revealed that the anxiety along with academic difficulty and gender was found to contribute individually to hopelessness, whereas age was not. A significant combined contribution of anxiety, academic difficulty, and gender to hopelessness was observed. Of the five dimensions of anxiety, low self-control and tension were found to be significant predictors of hopelessness. Conclusions: Findings could be useful for screening the vulnerable persons, and also helpful in designing psychosocial intervention for promoting positive health.

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Background: Role of oral contraceptive pill (OCP) and ormeloxifene (ORM) in dysfunctional uterine bleeding (DUB) is still in an exploring level. Aim: The aim was to observe the improvement of the menstrual bleeding pattern in terms of the amount, regularity, and hemoglobin (Hb) status of the women. Setting: Study was conducted in the Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital, Kolkata a tertiary care teaching hospital. Design: Prospective randomized study with patients having subjective complaints of menorrhagia. Materials and Methods: A total of 36 women was treated with ORM 60 mg and OCP containing 30 μg ethinyl estradiol and 150 μg desogestrel was given to 34 women. Pictorial blood loss assessment chart (PBAC) was applied to assess the amount of bleeding. Statistical Analysis Used: Data were compared using a t-test (paired and unpaired) and Mann-Whitney U-test for numerical variables and McNemar's Chi-square test for categorical variables. Results: The primary outcome showed a comparable PBAC score of ORM in first posttreatment cycle and significantly better in following two cycles (PBAC - postC1: 0.118, PBAC - postC2: 0.016, and PBAC - postC3: 0.04). Group receiving OCP was observed to have good cycle regularity in comparison to ORM (P = 0.006). Hb rise in both groups was almost similar, OCP group revealed an improvement in mean Hb concentration of 0.65 g%, whereas ORM showed a rise of 0.72 g%. Secondary outcomes were adverse reactions, satisfaction level, and poor responders in both groups. Conclusion: ORM is effective in treating DUB in almost in all aspects and can be considered as nonsteroidal option of therapy.

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Infections of the deep spaces of the neck, like the prevertebral abscess, can present with catastrophic consequences due to compromise of air and food passages. The most common causes of the prevertebral abscess in orthopedic practice are tuberculosis of spine, retropharyngeal abscess, infections secondary to foreign body impalement and injury. Early recognition of these conditions is necessary to avert fatal complications. We report a case of a 50-year-old gentleman who presented with symptoms of dysphagia and dysphonia with altered sensorium of 4 days duration. He was diagnosed with septicemia, diabetic ketoacidosis, and an upper motor neuron type of quadriparesis. There was diffuse swelling over the anterior aspect of the neck with magnetic resonance imaging study suggesting a prevertebral abscess with septic discitis of cervical 5 and 6 vertebras. The case is presented along with the literature review discussed as an unusual cause of septic discitis due to Klebsiella manifesting as dysphonia and dysphagia.

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Background: Lifestyle factors are the amendable habits and ways of life that can greatly influence overall health and well-being, including fertility. Infertility is a medico-socio problem, and a large proportion of childless people are confronted with social stigmatization and personal frustration. It has become more socially acceptable to delay fatherhood, but the heritable consequences of this trend remain poorly understood. Advancing paternal age, occupation and lifestyle has been implicated in a broad range of abnormal reproductive and genetic outcomes. Objective: The study presents a preliminary datum about the relationship of age, occupation and verified lifestyle on semen parameters in infertile males of Jaipur (Rajasthan). Materials and Methods: Clinical examination, history of infertility, age, occupation, lifestyle, etc., of 102 infertile subjects were recorded predesigned performa. Results: Based on age subjects were divided into two groups. The respective age of infertile subjects in groups I and II ranged 19-30 years and 31-45 years. A significant (P < 0.05) decline was observed in sperm motility and vitality above the age of 30 years (group II) as compared to below than 30 years (group I) of age. A significant inverse (r = −0.25, −0.20, P < 0.05) correlation were found between sperm motility and vitality to age of group II. In group I, conversely, these parameters was found to be positively correlated with age. Highest prevalence of azoospermia occurs in farmers (66.66%, 50%) in groups I and II. The least azoospermia was found among casual laborers in both high and low age groups. In group, I highest percentage of azoospermia (55.55%) subject were alcoholic, and smoker (50%) and 50% severe oligozoospermia subjects were smokers in both the groups. Conclusion: The age is intimately related to decreasing in sperm motility and vitality, whereas, least effect is observed on sperm count. Occupationally, the highest prevalence of abnormal semen quality is noticed in farmers. Lifestyle of alcohol consumption and smoking further diminishes the semen quality. Our findings may have important implications for men who choose to delay fatherhood and occupationally exposure to solvents and alcoholics.

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Aim: To measure and assess the noise levels produced by different dental equipments. Materials and Methods: Measurement of the noise level was performed in preclinics, clinics, and dental laboratory of different departments of Ahmedabad Dental College and Hospital. The noise levels were determined using a Mini sound meter (CEM USA), which was placed at the dentist's and laboratory technician's ear level and at a distance of 1 m from a main noise source. The level of noise was measured in decibel (dB) while the instruments were at maximum running speed. Results: In dental laboratory, the nosiest dental equipment was gypsum lathe trimmer with the noise level ranging from 87.36 to 98.3 dB. In preclinical area, the sound produced by low-speed air-rotor ranges from 66.68 to 69.28 dB. In clinical areas, the highest noise produced was by high-speed air-rotor (73.36 to 81.8 dB). The noise created by suction pump when in contact with mucosa was in range from 73.1 to 80.32 dB. The noise levels generated during cutting were significantly higher (P < 0.05) than those of noncutting, which was proved in the course of the measurements. Conclusion: At the end of the study it can be concluded that the sound levels are below that causes damage to the human ear (85 dB). However, dental technicians and other personnel working all day in noisy laboratories could be at risk of Noise-Induced Hearing Loss if they did not choose not to wear ear protection.

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Background: The family physician program in the form of a referral system is one the best administrative strategies, especially in rural and low populated regions (under 20,000 people) of Iran in 2006. Objectives: This study was conducted with the aim of general physician's experience as practicing in family physician program. Materials and Methods: This study was a qualitative study using conventional content analysis. The data were gathered by in-depth interview with 12 family physicians working in rural and low populated urban health and treatment center in a province located in west of Iran in 2011. Findings: The findings highlighted that five main themes and 12 subthemes reflected the general physician's experience as family physicians. They were: The physician's lost identity (physician: Belittled and physician: Shattered in the system), the physician left in the system (physician: Extorted and lacking supportive environment), passive and thoughtless practice (learning, a faded element, and scientific practice on the verge of demise), the unstable foundation of the program (insufficient groundwork, lack of comprehensiveness, and the change in the program's nature during practice), and sparks of success (satisfaction with need-based practice, proper distribution of general physicians within the country, and effective management of chronic diseases). Interpretation and Conclusions: The findings indicated serious challenges in family physician program. Ignoring these problems may lead to medical and financial resources wasting. So a permanent progressing program needs solving defects of the valuable program in Iran to improve healthcare in rural and low-populated regions.

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Uterine fatty tumors are rare variants of benign leiomyoma. Lipoleiomyoma, lipomyoma, fibromyolipoma are various synonyms for this lesion. They usually occur in the obese perimenopausal and postmenopausal females in the age group 50-70 years and 90% cases occur in patients older than 40 years. There were only few cases reported in the literature. These lesions are interesting due to the occasional diagnostic confusion with sarcomas and the curiosity regarding its histogenesis. We are presenting three cases of lipoleiomyoma whose age ranged from 40 to 50 years with clinical, radiologic and pathologic correlation. All three cases came with complaints of abnormal vaginal bleeding and found to have intramural heteroechoic nodule in the ultrasonogram.

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Nodular hidradenoma is an uncommon benign adnexal tumor arising from the eccrine sweat glands. It occurs as a slow growing, nodular, solid or cystic, protruding cutaneous mass, which may exhibit serous discharge or ulceration. The lesions are commonly seen in women on head, neck, and limbs. This is a case report of an 85-year-old lady who presented with a slowly progressive nodular protruding mass over the chin. Nodular hidradenoma is an uncommon benign tumor of sweat glands. The clinician and the pathologist should have a strong index of suspicion to detect the lesion. Complete surgical excision is warranted with a close follow-up.

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Clear cell carcinomas (CCCs) are the common renal cell tumors. Sarcomatoid change in the clear cell tumors is uncommon. Not only this sarcomatoid change raises the grade of the tumors thereby adversely affecting the prognosis but it also may pose diagnostic problems. We discuss a case of diabetic female who presented with abdominal mass and polycythemia. She presented with grade IV and stage I CCC with sarcomatoid change. The tumor belonged to stage I. Left sided nephrectomy and splenectomy was done to treat the tumor. Postoperative radiotherapy was done. The patient was followed-up for a period of 2 years, no recurrence was noted. We report this case due to its unusual clinical and histological presentation.

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