The couples of advanced age nowadays are requesting for the promotion of fertility for the first time quite more than what it was before. This is because of career making of men and women, increased divorce, and re-marriage. Physicians dealing with infertility problems are facing a lot of challenges in this regard. The diminished fecundity in advanced age is a routine happening. That is because of diminished ovarian reserve and there may be more aneuploidy in the oocytes or problem with the male gametes, so far as the genetic constitution, fertilizability, and motility are concerned. Research is going on all over the world in this regard, and the present way out is egg donation for elderly women with poor ovarian reserve. Though in a certain percentage of cases, in elderly women, natural conception is possible with or without ovulation induction, in males, usually fertility remain for long, even up to the advanced age, and reproductive assistance in the form of intracytoplasmic sperm injection is required with very poor sperm quality.

Uncivil behavior in the classroom threatens the teaching-learning process. Research to date has focused on nursing student incivility in academia with little research examining the faculty role associated with incivility. Due to the lack of research examining faculty incivility toward nursing students, additional research in this area is indicated. The purpose of this study was to examine the effects of faculty incivility on nursing students' satisfaction with their Bachelor of Science Nursing (BSN) nursing program in a rural Southeastern state. Quantitative data was collected via surveys. Research questions included: (1) What percentage of senior nursing students report experiencing faculty incivility? (2) What is the relationship between faculty incivility and nursing students' ratings of program satisfaction? (3) In what educational settings does perceived incivility toward nursing students occur? (4) How do nursing students respond to perceived faculty incivility? The results of this survey revealed that 35.3% of students had at least one nursing instructor that put them down or was condescending toward them during their educational experience. Furthermore, 20.7% reported that two or more faculty put them down or were condescending toward them. Collectively, the pilot study revealed that over half of the participants reported faculty behaving in a way that was perceived as uncivil. Incivility in the nursing profession has been an on-going problem. The high number (over half) of participating students reporting that they perceived that at least one nursing instructor had put them down or was condescending toward them during their educational experience raises additional concerns for the level of civility in nursing programs and the role modeling that is presented to students. It is imperative that nursing faculty and students interact professionally and establish effective communication patterns.

The Ziziphus jujuba tree is one of the major sources of betulinic acid (BA). After isolation, the bulk structure of the compound was converted to a self-assembled nanofibers (SA-BA) configuration which showed better anti-leukemic efficacy than its bulk form. After internalization in leukemic cells, SA-BA elevated reactive oxygen species (ROS) and pro-inflammatory cytokine secretion which ultimately activated apoptosis pathway. The SA-BA showed potent ameliorative role against acute chemotherapeutic toxicity induced by doxorubicin in human peripheral blood lymphocytes through the mechanism totally opposite to said pathway. Thus, SA-BA showed cell specific distinct effects. It was also revealed that the SA-BA had potent immunomodulatory affected on T cells and macrophages by polarizing the cytokine balance toward Th1 at a slightly higher dose. SA-BA arrested the growth of in vivo cancer by increasing the CD4 ⁺ cells in associated with increased cytotoxic T-cell response. SA-BA was also selectively internalized in folate receptor overexpressing leukemic cells. For this purpose, folic acid (FA) and polyethylene glycol (PEG) were conjugated on the nanostructured of SA-BA. After internalization, the conjugate (FA-PEG-SA-BA) diminished the cellular redox system and generated an excess amount of ROS which induced tumor necrosis factor-alpha-mediated cell death through activation of caspase 8 and 3 cascade system. Throughout all these studies, no toxic effects of the conjugates toward normal cells were observed. Thus, the whole study enlightens the multifunctional role of SA-BA in different aspects of anti-leukemic therapy which may be useful in future treatment policies.

Objective: Early diagnosis and treatment decreases the mortality and morbidity of neonatal sepsis(NS). The aim of this study was to find out the level of different inflammatory markers in neonatal sepsis. Methods: Forty two term neonates with non-sepsis (n = 17), clinical (n = 10) and proven (n = 15) sepsis were evaluated. Blood cultures were obtained and ESR, CRP, procalcitonin, IL-6 levels were measured. Statistical analysis was performed to look for association between NS and different inflammatory markers and to compare the strength of association among the markers. Findings: Among the 42 neonates, CRP level was found to be elevated in 27 neonates, ESR in 22 neonates, both procalcitonoin and IL-6 in 24 neonates respectively. Both sensitivity and specificity of procalcitonin and IL-6 were high compare to CRP. Conclusions: Blood culture significantly increases the proven sepsis status among neonates with suspected sepsis. ESR is a poor predictor of NS. Newer inflammatory markers namely procalcitonin and IL-6 were found to have greater value than CRP, but not ESR.

This teaching insight focused on the common misperceptions regarding renal autoregulation (RenAutoreg). The classical model of RenAutoreg is an intrinsic mechanism of a denervated kidney in an in vitro setup. The whole body homeostatic in vivo model of RenAutoreg in a few major texts accounts for the confusion in understanding the intrinsic nature of RenAutoreg first defined originally. RenAutoreg correctly distinguished will provide the basis for appreciating the other intrinsic renal mechanism called glomerulo-tubular balance and also the "second fiddle" role of RenAutoreg in the homeostasis of extracellular fluid/blood volume and arterial pressure.

Background: Pain is reality from womb to tomb as the specific personalized articulated feeling of human beings whether they need respite or not. Objective: To find an optimum primary care approach to pain management. Methods: The investigators pursued a sincere effort to unearth an answer to pain management through their internalized clinical experience of managing the commonest presentation of symptoms at their clinics by hundreds of ailing citizens. Results: Since ancient times, thousands of interventions have been practiced for relief of pain including an array of self-medications and traditional practices. In the era of "Evidence Based Medicine" in this new millennium, all forms of pain managements need scientific evaluation by the application of highest research integrity before they can be adapted as a standard treatment protocol. As the severity of the pain is a grossly subjective, the treatment/drug of choice and/or the methods/dosage should depend on the judgments of objective severity by the health care providers, depending on the objective clinical/ radiological/ pathological/ biochemical criteria and if possible by formulating scoring systems. Rather than managing the pain based on the expressed perception of the severity of pain by the patient as mild, moderate or severe, we have to be innovative in the new paradigm of this nascent pain management scenario. Conclusions: We have to help the budding doctors to grow up not only as a sensible doctor, but also as a great human being, who will give due attention to pain through a holistic tailor-made approach.

Background: In iodine-replete basin of the river Ganga and the Bay of Bengal, we studied iodine nutritional status of school children by goiter prevalence and their urinary iodine (UI), iodine content in edible salt, and the bioavailability of iodine through water and its contribution to iodine nutrition. We also studied consumption pattern of common goitrogenic plants by measuring urinary thiocyanate (USCN), hardness of water (calcium and magnesium salt content) and assessed the effect of concomitant exposure of those environmental factors in goitrogenesis. Methods: 4603 children aged 6-12 years were examined for goiter by palpation, 520 urine samples were analyzed for UI and USCN; iodine content was estimated in 455 household salt and 130 water samples tested both for iodine and hardness. Results: The total goiter rate was 35.9%, median UI was 231 ΅g/l, mean USCN was 0.857 ± 0.48 mg/dl, iodine content in water was 44.7 ± 4.1 ΅g/l, 66.4% of salt samples contained iodine (15 ppm), and water was found to be hard. UI was correlated with both the drinking water iodine content and USCN and the degree of hardness in drinking water was associated with goiter prevalence. Conclusions: The studied population has endemic goitre despite iodine sufficiency. The concomitant exposure of a number of environmental factors, i.e., thiocyanate of cyanogenic plant food, hardness of drinking water, and excess iodine from environmental sources other than iodide salt are likely responsible for the causation and persistence of endemic goiter in the region.

Background: Kasisa is an important iron-containing mineral drug of ayurvedic Rasa Shastra and employs for various therapeutic uses in anemia, hair growth modulator, eye disorders, skin disorders, etc. Objective: In this study, shodhana was done by triturating in lemon juice and calcination was done by traditional heating arrangement with Kanji (sour gruel) method. Both the purified and calcined product of the Kasisa was subjected to histopathological and toxicological study to evaluate the safety of this iron-based ayurvedic medicine. Materials and Methods: Thirty-two adult Charles Foster albino rats of either sex, 16 for each drug (Shodhita Kasisa, Kasisa Bhasma), were taken for the whole study. Toxicological study of the brain, liver, kidney, and spleen was performed. Results: Kasisa Bhasma at higher dose of 100 mg/kg showed some adverse effects in isolated organs of experimental animals, but the extent of damage is minimal compared to Shodhita Kasisa which showed adverse effects at 25-50 mg/kg. Conclusions: Kasisa Bhasma is nontoxic and safer as compared to Shodhita Kasisa. It can be administered at a controlled dose to affect therapeutic efficacy.

Background: Physical activity, health fitness, and academic results are very important goals in student life. However, success lies in academic subjects in educational establishments. Our background reveals the contradictions between two philosophers who approved the importance of physical education (PE) as a component of the curriculum and others who reiterated that PE and sports would never be a component of the curriculum as is the case in Algerian universities. Methods: The research samples were selected by the intentional manner which included sixty students, aged around 18 years. Twenty girls who will pass the baccalaureate, twenty girls of the 1 ^st year department languages, and twenty girls of the 1 ^st year PE and sports for the academic year 2014-2015 were included in the study. They were tested based on the field tests developed by the Canadian Society for Exercise Physiology. Results: Our results confirm that the absence of PE lessons and sport case department languages leads to loss of fitness in the opposite of high-school and students of the Institute of Sports, where the effects return to the absence of the session of physical education and sport. Conclusion: Physical activities are very important in the life of our scholar girls, where the sport practice is a physical as well as a mental effort which is the key to a healthier life.

The knowledge of branches of superior mesenteric artery important for Surgeon and radiologists who deals abdominal diseases. Superior mesenteric artery is second ventral branch of abdominal aorta which arises from 1 cm below coelic trunk, opposite L1 vertebrae and supplies lower portion of duodenum, whole jejunum, ileum caecum, appendix, ascending colon and major portion transverse colon. Actually it is the artery for derivates of midgut. ^[1] Superior mesenteric artery gives inferior pancreatic duodenal artery, middle colic artery, right colic artery and ileo colic artery from its right concave side some ileo-jejunal artery from convex left side. Usually middle colic artery arises from superior mesenteric artery at the lower border of pancreas and immediately enters the root of transverse mesocolon and divides into right and left branch. The right branch anastomose with ascending branch of right colic artery near right colic flexure and left anastomose with ascending branch of left colic. Here we present a case of absence of mid colic artery from superior mesenteric artery and right colic artery shows some extra branches from its proximal part which supplies transverse colon.

Tongue is the most common site for oral squamous cell carcinoma. The various treatment options for carcinoma of anterior tongue are wide excision, hemiglossectomy and primary excisions along with elective neck dissection. Here we show report of a case of carcinoma of anterior tongue.

Here, we report oral artesunate, sulphadoxine and pyrimethamine (sp) induced cardio toxicity case in a female patient. Artesunate is a highly efficacious and relatively safe antimalarial drug. Common adverse reactions to artemisinin derivatives are mild i.e. nausea, vomiting, anorexia and dizziness which are seen in majority of the patients. While serious toxic effects of artesunate are less frequent i.e., neutropenia, anemia, hemolysis, elevated liver enzymes, allergic reactions and cardiac effects. Cardiac effects due to artesunate are very rare. This case recalls the artesunate potential to cause myocardial injury.