Objective: Noninvasive positive pressure ventilation (NIPPV) has been shown to decrease the need for invasive mechanical ventilation (MV) in patients presenting with acute respiratory failure (ARF). We conducted a prospective study to assess if NIPPV use, in a developing country, was associated with clinical and physiological improvements. Design: Prospective observational study. Materials and Methods: Forty patients admitted to a medical intensive care unit during a 2-year period who fulfilled criteria for inclusion formed the study cohort to receive NIPPV. Findings: Baseline (mean ± SD) pH, PaCO ₂ and PaO ₂ were 7.25 ± 0.08, 76.6 ± 20.9 and 79.18 ± 40.56 mmHg respectively. The primary indication for NIPPV was hypercapnic respiratory failure (n = 36, 90%). The success rate with NIPPV was 85%, with 34 of 40 patients weaned successfully. Significant improvements were observed at 1 hour following institution of NIPPV in pH (7.31 ± 0.09, P < 0.001) and PaCO ₂ (65 ± 17.9, P < 0.001). These improvements continued up to the time of weaning (pH 7.38 ± 0.08, PaCO ₂ 54.7 ± 20) and maintained (within 12 h) postweaning from the ventilator (pH 7.39 ± 0.08, PaCO ₂ 51.9 ± 12.4). No significant change in the PaO ₂ was observed during NIPPV; PaO ₂ after 1 h, prior to weaning and after weaning was 90.53 ± 42.85, 84.80 ± 33.76, 78.71 ± 43.81 respectively. Conclusion: This study has demonstrated benefits of NIPPV in avoiding the need for invasive MV in patients presenting with ARF of diverse etiology, with results comparable to developed nations. Increased use of NIPPV in ARF is likely to impact favorably in nations with limited resources.

Background : Varicocele is the most common cause of male infertility. The etiology and pathophysiology of varicocele are multifactorial. When low sperm counts are associated with varicocele, varicocelectomy can partially restore spermatogenesis and fertility. Few recent studies have reported that in some varicocele cases, there may be an associated genetic etiology. Presence of a genetic factor like azoospermia factor microdeletions may lead to irreversible spermatogenic arrest in these cases, but very few reports support these findings. However, it is still not understood why some cases improve after varicocelectomy and why some cases show no improvement in semen parameters postoperatively. Aim: It is important to distinguish varicocele cases from Yq microdeletions as these cases have irreversible testicular damage and thus carry a poor prognosis after varicocelectomy. Settings : Research and Referral tertiary care hospital. Design : Prospective study. Materials and Methods: Seventy-two infertile men with varicocele were referred for Yq microdeletion analysis from the infertility clinic of AIIMS and Army Research and Referral Hospital. Genomic DNA was isolated from blood and polymerase chain reaction microdeletion screening was done in these cases to determine the presence or deletion of AZF loci. Results: In this study 7 (9.7%) varicocele cases harbored Yq microdeletion. The sperm count in cases which harbored Yq microdeletion was significantly lower than in cases without Yq microdeletion. Conclusion : Varicocele cases with Yq microdeletion do not show improvement in semen parameters post-varicocelectomy. Detection of Yq microdeletion determines prognosis and future management in such cases.

Context : Modern life style and affluence lead to changes in people's outlook on various habits, including alcohol intake. Some of them will fall prey to the addictive nature of the drink. Aims: Present study was done to evaluate the responses to comprehensive alcohol expectancy questionnaire (comprehensive effects of alcohol - CEOA) in order to test the tendency towards alcohol intake among the First Year Medical (MBBS) students of our college - that is, to assess the positive or negative reinforcement they would expect if they consumed alcohol. Settings and Design : The study was done by giving a set of questionnaires to be answered by the students. Materials and Methods : Questionnaires of CEOA had 38 responses, in which both negative and positive feelings were represented. All questions were again grouped into four groups of positive and three groups of negative responses. Each question was rated to what degree they agreed, by 4-point Likert-type scale (1 = disagree, 2 = slightly disagree, 3 = slightly agree, 4 = agree). The positive and negative responses were analyzed to group them into agreeing or disagreeing type. Statistical Analysis Used : Analysis of responses by Student 't' test and 2-way ANOVA was done to analyze the results. 'P'< 0.05 was accepted as significant. Results : Results showed that negative expectancies outweighed positives significantly (2.8017 ± 0.58554 vs. 2.3055 ± 0.67604, t = 7.526; P<0.001.). Females rated the negatives more firmly (P<0.001). However, there was no statistically significant difference with respect to different religious beliefs, places of origin or incomes of the respondents. An experience of alcohol had a significant effect on the responses where they had stronger positive expectancy, which is an important point revealed in this study. Conclusions : In this study, we have observed a general acceptance that alcohol could provide positive reinforcement, especially among those who have had a prior experience of intake of alcohol. Thus, this study throws light on whether there is likelihood of youngsters falling into addiction in the later part of their life; hence it can act as a useful predictor for parents, health professionals, social counselors and the society as a whole so that they can take preventive measures against alcohol addiction.

Background : In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study the risk factors associated with maternal deaths. Aims : The study aims to determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums. Materials and Methods : A community-based case-control study was designed, wherein snowball-sampling method was used to identify the maternal deaths (cases) in the community, and circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found. Statistical Analysis : Data on 70 cases and 384 controls that had live births as the outcome of the pregnancy were analyzed. Logistic regression was applied to identify the risk factors. Results: In the study population, most of the deliveries were conducted at home by untrained 'dais.' Cases were mostly illiterate, young, having high parity and no antenatal care taken during pregnancy (P < 0.05) as compared to controls. The distance of health facility from residence was also found to be a significant risk factor for maternal death (P < 0.05). Complications during pregnancy, like jaundice, excessive bleeding and anemia, were also found to be significant. The major causes of maternal death were found to be hemorrhage after delivery, retained placenta and anemia. Conclusions : The study findings suggest that women should be educated about the importance of antenatal registration and regular checkups. Untrained 'dais' should be trained to recognize the obstetric complications at an early stage and refer high-risk cases for adequate management. These preventive measures could help in reducing maternal mortality at the community level.

We report a 10-year-old female child with hypothyroidism and limb muscle pseudohypertrophy (i.e., Kocher-Debre-Semelaigne syndrome) with pericardial effusion. The child presented with generalized swelling, breathlessness and difficulty in walking and in getting up from sitting position (of chronic duration). She had bradycardia, dull facies, marked hypertrophy of both calf muscles and nonpitting edema of legs. Pericardial effusion was detected clinically and confirmed on investigations. Muscle pseudohypertrophy was a striking feature, and hypothyroidism was confirmed on thyroid studies. The response to thyroxine replacement was excellent, with resolution of the pericardial effusion and clinical improvement. The unusual presence of pericardial effusion in Kocher-Debre-Semelaigne syndrome is discussed in the report.

The national family health survey-3 (NFHS-3) reports of declining fertility rate while increasing prevalence of anemia in women and children, since NFHS-2 in 1998-99. The proportion of anemic, stunted and wasted children has also increased since the previous two rounds. NFHS trends show that the status of mother's and child's health indicators is continuing to deteriorate in spite of the many government-run targeted programs, e.g., integrated child development scheme (ICDS), Midday meal program. The only good sign in the findings is the favorable trend in fertility indicators and infant mortality rate. A review of the findings of NFHS surveys, the current government policies and programs targeted upon the improving of health status of women and children in India and of the published scientific literature was conducted. The aim of the review was to understand the health situation of women and children in India and to suggest measures to bring about positive changes in the health status of this population. The analysis suggests that the findings of these successive surveys are not being utilized for the necessary corrective measures. The authors argue that although the NFHS is a useful exercise, in the wake of decentralized planning, the country needs more detailed data focusing on the districts. Synchronization of the ICDS and national rural health mission (NRHM), along with entrusting the responsibility of conducting NFHS to the planning commission, is the other possible solution to tackle the problems of rising anemia and malnutrition in the country.