Background: The rate of primary cesarean section (CS) is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. Aims: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC) in selected cases of one previous lower segment CS (LSCS). Materials and Methods: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. Results: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. Conclusion: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

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Background: Increased external knee adduction moment during walking alters the joint biomechanics; which causes symptoms in chronic knee osteoarthritis patients. Aims: To assess additional effects of Retro-walking over conventional treatment on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis. Materials and Methods: Thirty chronic knee osteoarthritis patients were randomly assigned into 2 groups. Group 'A' (7 men, 8 women) received conventional treatment. Group 'B' (8 men, 7 women) received conventional treatment and Retro-walking. Pain, assessed through visual analogue scale (VAS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were the primary outcomes and knee range of motion (ROM), hip abductor and extensor strength were secondary outcomes; measured pre-intervention, after 1 week and after 3 weeks of intervention. Results: Two factors analysis of variance for repeated measures was used for all outcomes. At the end of 3 weeks; WOMAC score showed highly significant difference within ( P < 0.0001) and significant difference between groups ( P = 0.040) also by Time × group interaction ( P = 0.024), VAS showed highly significant difference within groups ( P < 0.0001). Knee ROM showed significant difference within groups. Hip abductor and extensor strength showed significant difference by Time × group interaction ( P < 0.05). Conclusion: Retrowalking is an effective adjunct to conventional treatment in decreasing disability in patients with knee osteoarthritis.

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Background: HIV/AIDS has emerged as the single most formidable challenge to public health. School children of today are exposed to the risk of HIV/AIDS. Aims: The study was conducted to determine the knowledge among secondary school students regarding HIV/AIDS and provide suggestions for HIV/AIDS education in schools. Materials and Methods: A cross-sectional study was conducted among students of tenth to twelfth standard in the intermediate schools of Lucknow, India, from July to October 2011. A total of 215 students, both boys and girls, were enrolled in the study. Results: In this study, for majority of the students (85%), the source of information about HIV/AIDS was the television. Regarding knowledge about modes of transmission of HIV/AIDS among girl students, 95.1% of them told that it is through unprotected sex. A total of 75.8% students said that it was transmitted from mother to child. Conclusion: It was observed that the knowledge of the school students was quite satisfactory for most of the variables like modes of transmission, including mother-to-child transmission of the disease. However, schools should come forward to design awareness campaigns for the benefit of the students.

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Background: Cysts of the skin are one of the commonly excised specimens in the surgical outpatient department. A majority of them being clinically diagnosed as sebaceous cysts, their true nature is only discernible on histopathological examination. Closer examination of the type of keratinization involved will throw light into the exact nature of the cyst. Trichilemmal or Pilar cyst is one such entity, which presents in both a non-neoplastic and neoplastic form. Aims: The present retrospective observational study was undertaken to find out the incidence of these cysts in surgical pathology practice in a rural hospital and to enlist the various morphological forms that these cysts may take. Materials and Methods: The histopathology files were reviewed for a period of 6 years for cases coded as pilar cyst. Results: A total of eight cases (5.75%) were identified, which showed features of trichilemmal differentiation. A single case each of proliferating trichilemmal cyst and malignant proliferating trichilemmal tumors were noted. Most of the cases were seen among females on the scalp. Conclusions: Trichilemmal tumor is an uncommon histopathological entity. Many of these lesions may be mistakenly diagnosed due to lack of recognition of the unique type of keratinization.

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Background : Characterization of Plasmodium falciparum diversity is commonly achieved by amplification of the polymorphic regions of the merozoite surface proteins 1 (MSP1) and 2 (MSP2) genes. Aims : The present study aimed to determine the allelic variants distribution of MSP1 and MSP2 and multiplicity of infection in P. falciparum field isolates from Kosti, central Sudan, an area characterized by seasonal malaria transmission. Materials and Methods : Total 121 samples (N = 121) were collected during a cross-sectional survey between March and April 2003. DNA was extracted and MSP1 and MSP2 polymorphic loci were genotyped. Results : The total number of alleles identified in MSP1 block 2 was 11, while 16 alleles were observed in MSP2 block 3. In MSP1, RO33 was found to be the predominant allelic type, carried alone or in combination with MAD20 and K1 types, whereas FC27 family was the most prevalent in MSP2. Sixty two percent of isolates had multiple genotypes and the overall mean multiplicity of infection was 1.93 (CI 95% 1.66-2.20). Age correlated with parasite density ( P = 0.017). In addition, a positive correlation was observed between parasite densities and the number of alleles (P = 0.022). Conclusion : Genetic diversity in P. falciparum field isolates in central Sudan was high and consisted of multiple clones.

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Background: Takotsubo cardiomyopathy (TC) or transient left ventricular apical ballooning syndrome is an acute cardiac syndrome characterized by transient wall motion abnormalities extending beyond a single epicardial vessel in the absence of significant obstructive coronary artery disease. Aim: This study was to describe the clinical characteristics of TC in North America. Materials and Methods: We identified 10 patients who met the Mayo Clinic criteria for TC using our Electronic Medical Records. We also conducted a systematic review of case series of TC that were done in North America by searching the MEDLINE database. We identified 11 case series that met our eligibility criteria. Results: Our systematic review included 620 patients. Chest pain and ST segment elevation were the cardinal features of this syndrome, but the prevalence was lower than in the European and Asian cohort (50% and 39% as compared with 80% and 70%, respectively). Classic precipitating emotional or physical stress was described in > 80% of patients. Cardiac biomarkers were found to be elevated in >90% of our patients. Conclusions : TC is a worldwide problem and clinical presentation appears to be similar in North American, European, and Asian countries. However, fewer patients in our cohort presented with typical chest pain and electrocardiography (ECG) changes, which might suggest ethnic variations in the syndrome or perhaps a more aggressive diagnostic approach in North American countries.

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Background: Children with adenoid hypertrophy have been shown to harbor pathogenic bacteria in the nasopharynx despite antibiotics. Removal of the adenoid is associated with a reduction in the bacterial count. Aims: The study was done to determine the bacteriology of the adenoid tissue in chronic adenotonsillitis and adenoid hypertrophy, and determine the antibiotic sensitivity of potential pathogens. Materials and Methods : This is a descriptive study conducted on 100 patients aged between three and twelve years who underwent adenotonsillectomy/adenoidectomy. After adenoidectomy, the specimen along with the swab taken from the surface of the adenoid was sent for microbiological examination. After 48 and 96 hours, the microbial growth was identified and the antibiotic-sensitivity pattern of the isolate was studied. Results: Aerobic organisms grew in 93% of the specimens and anaerobic organisms in 68%, whereas 7% had no growth. The surface was predominated by commensals and the pathogens were mainly found in the core. The predominant pathogens were Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus species. The organisms were resistant to penicillin but showed sensitivity to co-amoxiclav and ciprofloxacin. Co-amoxiclav and ciprofloxacin should be considered as the first line of medical treatment for adenotonsillar diseases. Conclusions: Infection is the main cause of adenoid hypertrophy. Amoxicillin with potassium clavulanate and ciprofloxacin should be considered as the drugs of choice for all adenotonsillar diseases.Early and prompt treatment of adenoid hypertrophy with appropriate antibiotics will avoid unnecessary exposure to repeated antimicrobial therapy, thereby maintaining the beneficial effects of the normal adenoid flora.

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Background: Data about the health-related quality of life (HR-QOL) of people living with HIV/AIDS (PLHA) after the implementation of free antiretroviral treatment in India are scarce. Aim: The study was to describe the HR-QOL and gender differences of PLHA in rural India. Materials and Methods: Cross sectional study of 120 PLHA who came to the outpatient department in a rural district hospital. Assessment of the HR-QOL was performed through interviews using a validated structured questionnaire from the Medical Outcome Study HIV Health Survey. Linear regression with robust standard errors was used for multivariable analysis. Results: Domains related to social and daily activities such as cognitive, role and social functioning had lower HR-QOL scores than domains related to physical health. Men had higher scores of HR-QOL in health transition, perceived HR-QOL, health distress, social functioning and role functioning. In multivariable analysis, factors associated with poorer HR-QOL were female sex, lower levels of education and being widowed or separated in women. Conclusions: HR-QOL of PLHA in rural India is poor, especially in widowed or separated women and people with lower levels of education. There is an urgent need of implementing programmes for improving the HR-QOL of HIV infected women in rural India.

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Background: The values such as participation/empathy, communication/sharing, self-awareness, moral integrity, sensitivity/trustfulness, commitment to ongoing professional development, and sense of duty linked to the practice of the medical professionalism were defined by various professional oaths. Aims: The aim of this study was to evaluate how these values are considered by the students of the degree course of medicine. Materials and Methods: Four hundred twenty three students (254 females, 169 males) taking part of the first, fourth, and fifth years of the degree course in medicine were asked to answer seven questions. Pearson's Chi-square, Wilcoxon rank sum test, and Kruskal-Wallis test were used for the statistical analysis. Results: The survey showed a high level of knowledge and self-awareness about the values and skills of medical profession. In particular, the respect, accountability, and the professional skills of competence were considered fundamental in clinical practice. However, the students considered that these values not sufficiently present in their educational experience. Conclusions: Teaching methods should be harmonized with the contents and with the educational needs to ensure a more complex patient-based approach and the classical lectures of teachers should be more integrated with learning through experience methods.

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Background: Carotid ultrasonography is a useful diagnostic tool for assessing carotid disease. It is highly reliable, has no radiation risk, and has no risks when compared to conventional angiography. Aim: The study was to determine the common carotid artery (CCA) intima-media thickness (IMT) in the normal adult Sudanese so as to create standards for defining abnormalities. Materials and Methods: In 440 participants, the intima-media thickness was obtained sonographically in the supine position at the point of 1 cm section distal to the carotid bulb. Due to ethnic variations, participants were divided into a five ethnic groups according to their geographic distribution in Sudan. Results: The ranges of IMT found in the study were from 0.04 cm to 0.07 cm in carotids. Ethnically, males and females from West and East of Sudan show the highest IMT (0.070 ± 0.00 cm and 0.065 ± 0.01 cm) for CCA while males and females from the South of Sudan show the lowest IMT (0.055 ± 0.01 cm and 0.058 ± 0.004 cm). Conclusion: Mean carotids' IMT was slightly higher in females compared to males. No significant differences were found between IMT and different ethnics but significance was noted among participants' age and IMT of both sexes.

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Background: Variations concerning the origin and course of the suprascapular artery are numerous and present important clinical implications. Aim: In the present study the origin and course of the suprascapular artery are investigated in a sample of Greek (Caucasian) origin. Materials and Methods: The anatomy and course of the suprascapular artery were carefully examined in 31 adult human cadavers (16 male and 15 female). Results: Anomalous origin of the suprascapular artery from the third segment of the subclavian artery was observed in the right side of only one female Caucasian specimen (1/62 = 1.6%). The suprascapular artery and the suprascapular nerve passed together under the superior transverse scapular ligament through the suprascapular notch, whereas the suprascapular vein was absent. Conclusion: According to the available literature, this type of variation in the origin of the suprascapular artery is considered rare. This variation is clinically important, since it is related to the creation mechanism of suprascapular neuropathy and has also obvious surgical implications. The variation is embryologically enlightened and has an interesting ontogenic aspect.

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Background: Quality control (QC) in diagnostic microbiology is a matter of effective, efficient, accurate reporting in the expected turnaround time. Major stages of the analytical "standard operational procedures" where QC could be easily affected include organism identification and antibacterial susceptibility testing. Aim: The objective of this experiential technical note is to provide an evidence base to highlight the value of internal QC program in evaluating the effectiveness and efficiency of a laboratory's standard operational procedures; and the competences of individual scientific/technical staff. Materials and Methods: This report is based on four different scenarios requiring internal QC, including cases that are not reported within the turnaround time of standard operational procedures. Small-scale evaluations of (i) internal QC program, (ii) ciprofloxacin vs. moxifloxacin susceptibilities, and (iii) calibrated dichotomous susceptibility vs. directed susceptibility testing were performed. Results: The internal QC program identified sources of discrepancies in laboratory results. Evidence base for decision on new methodology and antibiotic testing were developed. For instance, it is observed that calibrated dichotomous susceptibility gives greater annular radius than directed susceptibility ( P < 0.01). Conclusions: Internal QC program continues to be valuable means of identifying discrepancies, and vetting new ideas. This report presents evidence base to reaffirm that the need for internal QC is ever present.

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Background : Microdialysis is a specific and local sampling method to collect free molecules from the extracellular fluid, however, there are no reports on time delay issues of microdialysis applications. Aims : This study was to check the time gap between the start of target molecule changes in detected fluid and corresponding stable concentration formation in the sampled dialysate. Materials and Methods : A designated microdialysis system for free calcium ion was set up in vitro and perfused with saline. The dialysate was diluted synchronously, and collected in a vial every 10 min. The free calcium concentration [Ca++] of the sample was measured by an atomic absorption spectrophotometer. A signal-switching method was introduced to mimic the target molecule [Ca++] changes in the detected fluid, standard calcium solution and saline. Results : There was a notable lag in dialysates [Ca++] for both uprising and down going course in spite of instant switching between the detected fluids. The recovery time (RT) of the microdialysis system was extrapolated to be 20 min for [Ca++] detection. Conclusions : With 10 min sampling interval, [Ca++] time delay of the microdialysis system existed, and could not be estimated precisely beforehand. The signal-switching method was applicable for RT calibration in vitro with a dedicated microdialysis system.

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