Background: Intrauterine insemination (IUI) have a low clinical pregnancy rate of 5–13% per cycle. The success of IUI was influenced by the method of preparation and sperm quality. Temperature affects sperm quality. Sperm damage is indicated by the presence of deoxyribonucleic acid (DNA) fragmentation from spermatozoa. Objective: Measuring differences in DNA fragmentation index (DFI) and quality of spermatozoa before and after preparation of the swim-up method at the sperm preparation temperature of 27° and 37°C. Sperm quality measured is concentration, morphology, and progressive motility. Methods: Quasi-experimental laboratory test with pre- and post-test control group design was conducted at the fertility clinic at Dr. Moewardi Hospital. In 20 sperm samples from infertile patients performed the swim-up method at a temperature of 27° and 37°C. Sperm DNA fragmentation was assessed using the chromatin dispersion test (SpermFunc® DNAf). Fragmentation happens if a halo is found <30% of the sperm head volume. Sperm quality assessment based on World Health Organization (WHO) 2010. Data analysis used the Wilcoxon test with a 95% confidence interval and p < 0.05. Results: DNA fragmentation index (DFI) after sperm preparation using the swim-up method at 27°C was lower than 37°C, 17.79 ± 10.88 vs 18.18 ± 12.95, but there was no significant difference (p = 0.765). After sperm preparation using the swim-up method at 27° and 37°C, the sperm concentration was 19.72 ± 13.76 vs 20.55 ± 12.42 (p = 0.512), normal morphology 11.25 ± 5.15 vs 11.6 ± 5.34 (p = 0.626), and progressive motility 82.25 ± 12.77 vs 82.55 ± 11.69 (p = 0.968). Sperm preparation at 27°C has lower DFI, lower sperm quality but without any significant differences. Conclusion: The swim-up method of sperm preparation can be done at room temperature 27°C or 37°C without any significant differences in the DFI and sperm quality.

Introduction: Surgical site infections (SSIs) after major abdominal surgeries are the major causes of morbidity and mortality in our country. SSIs can be prevented by usage of antimicrobial prophylaxis. The appropriate administration of antimicrobial prophylaxis, with respect to choice and timing, is crucial to yield better results and reduce the prevalence of SSIs. Aims: To analyze the time, duration, route, and choice of antimicrobial prophylaxis in major abdominal surgeries at a tertiary care hospital and to assess the prevalence of surgical site wound infections. Methodology: We conducted a descriptive, observational, and cross-sectional study on 100 patients who were administered antimicrobial prophylaxis preoperatively before undergoing major abdominal surgeries. The time, duration, route, and choice of antimicrobial prophylaxis for 18 different types of abdominal surgeries, which included gastroduodenal and gynecological cases, were recorded. These patients were followed up postoperatively for 30 days following the surgery. Incidence of SSIs was also recorded. Results: The prevalence of SSIs in major abdominal surgeries in this study was found to be 7%, which is on the lower limit when compared to similar studies involving major abdominal surgeries conducted in India. This is attributed to proper administration of antimicrobial prophylaxis, with respect to their choice, dosage, and time of administration. The prevalence of SSIs was predominantly seen in elderly groups of patients of advancing age, patients with higher American Society of Anesthesiology (ASA) score, patients undergoing open surgeries, and in prolonged surgical procedures that exceeded their usual duration. Conclusion: This study of antimicrobial prophylaxis for major abdominal surgeries conducted at tertiary care hospitals has shown the prevalence of SSIs as 7%. The prevalence of SSIs is low due to the appropriate choice and timing of administration of antimicrobial prophylaxis.

The severity of ADHD is directly proportional to the social isolation effects implemented to stop the spread of coronavirus disease. This led to series of complications in patients dealing with ADHD, causing school delays. We present a case of an adolescent male suffering from ADHD, whose quality of life is severely decreased after the implementation of social isolation and closure of schools and colleges.

Background: Tumors of salivary glands are rare and constitute only 3% of all head and neck tumors. Pleomorphic adenoma is the most common tumor of the salivary glands. The most common salivary gland to be involved in the parotid gland. Pleomorphic adenoma of the submandibular and sublingual salivary glands is uncommon. Case report: A 14-year-old boy presented with a history of swelling in the left submandibular region for two years, slow-growing & painless in nature. On examination there was a spherical swelling measuring 4×3 cm in the left submandibular region, non-tender, firm, mobile & Bi-manually palpable. Conclusion: Pleomorphic adenoma can be a dilemma to diagnose and treat. Imaging studies with MRI and ultrasonography may be helpful in diagnosis. Total excision of the tumor and gland is recommended treatment.

Aim: To describe a rare case of encephalopathy induced by sulfonamide. Background: Antibiotic-induced neurotoxic side effects can have a multitude of neurologic presentations. Patients with previous central nervous system (CNS) disease, renal disease, and advanced age are at an increased risk. Treatment mainly consists of discontinuation of the offending agent, use of antiepileptic drugs in the case of seizures or status epilepticus, and hemodialysis if necessary. The risk of CNS toxicity can be reduced with dosage adjustments in high-risk populations. Case description: We present to you the case of a 63-year-old male patient, who was diagnosed to develop Bactrim-induced encephalopathy, which is not a common presentation of the neurological side effects of the drug. The patient was treated supportively and educated about his diagnosis to prevent future recurrences and well on to recover well from the episode without any deficits. Conclusion: Sulfonamide-induced encephalopathy is an extremely rare presentation of the neurological side effects of sulfonamide. It should be kept in the differential in relevant cases and treated vigilantly as it is preventable and simpler to treat once correctly identified. Clinical significance: Bactrim is a drug combination of trimethoprim and sulfamethoxazole. It is a drug that is used widely for bacterial infections of varied types. The side effects associated with it are generally due to the sulfa component. Encephalopathy is an extremely rare side effect with about eight cases reported in the literature as of now.

Introduction: Embolia cutis medicamentosa [Nicolau syndrome (NS) or livedoid dermatitis] is a rare adverse reaction developed cutaneously after an intramuscular (IM) or intra-arterial injection (Inj). Case discussion: A 65-year-old female came with complaints of a painful lesion over the left gluteus region and gave a history of diclofenac sodium IM Inj at that site 1 day prior at a local clinic for recurrent oral ulcers. A well-defined violaceous necrotic indurated plaque of 10 × 7 cm with crusting and surrounding erythema and tenderness was noted over the left gluteus. Clinically a diagnosis of necrotizing fasciitis, livedoid vasculitis, and NS was made. Routine investigations showed eosinophilia, thrombocytosis, and reduced serum calcium. Histopathology showed neutrophilic perivascular and periadnexal infiltration with focal denudation of the epidermis suggestive of NS. For treatment of surgical debridement, Inj dexamethasone 4 mg intravenous (IV) for 3 days and pentoxifylline 400 mg orally three times a day (PO t.i.d) was started along with platelet-rich fibrin matrix wound dressing. Conclusion: NS is an uncommon iatrogenic complication and is a forgotten entity; physicians and healthcare workers should be kept informed of this rare entity and should be trained to administer Injs properly.

The need for self-directed learning (SDL) is more now in the lockdown period with the coronavirus disease 2019 pandemic (COVID-19). Online teaching and learning require SDL more than face-to-face teaching. Therefore, curiosity to learn is the first step to learning more, and the first attempt to learn is the need of the hour.