Response surface methodology-based optimization of ultrasound-assisted extraction of β-sitosterol and lupeol from astragalus atropilosus (roots) and validation by HPTLC method

Objective: To optimize the ultrasonication method for efficient extraction of P-sitosterol and lupeol from the roots of Astragalus atropilosus using Box-Behnken design of response surface methodology (RSM), and its validation by high performance thin layer chromatography (HPTLC) method. Methods: Ultrasonication method was used to extract β-sitosterol and lupeol from Astragalus atropilosus (roots). RSM was used to optimize the different extraction parameters viz. liquid to solid ratio (10-14 mL/g), temperature (60-80 °C) and time (40-60 min) to maximize the yield of β-sitosterol and lupeol. The quantitative estimation of β-sitosterol and lupeol was done in chloroform extract of Astragalus atropilosus by validated HPTLC method on 10 cm × 20 cm glass-backed silica gel 60F

Analgesic prescribing trends in musculoskeletal disorders

Background: Musculoskeletal disorders like osteoarthritis, rheumatoid arthritis, bursitis, backache, tendinitis, cervical spondylitis etc. are very commonly encountered in orthopaedic practice and are generally treated with various analgesic drugs. There are number of non-steroidal anti-inflammatory drugs (NSAIDs), opiod analgesics and also fixed dose combination (FDC) of analgesics available for the treatment of such disorders with some advantages and disadvantages of these drugs. Since few studies are there on utilization of analgesic drugs in the orthopaedic practice, this study was undertaken to determine the current prescribing trends for these disorders.Methods: It was record based observational study carried out at NKP salve institute of medical sciences, Nagpur. A total of 200 prescriptions of patients reported to orthopaedic outpatient department, with presenting complaints of musculoskeletal disorder and rheumatological conditions like osteoarthritis, rheumatoid arthritis, bursitis, backache, tendinitis, cervical spondylitis etc. were noted for the various analgesic drugs prescribed for these disorders.Results: The common age groups encountered for musculoskeletal disorders were between 41-50 years (26%) and 31-40 years (20%) followed by other age groups. The common conditions for which patient attended orthopaedic outpatient department were low backpain in 42 (21%) and osteoarthritis in 41(20.5%) patients followed by others. Aceclofenac and diclofenac were the most commonly prescribed analgesics in 25 (12.5%) and18 (9%) patients followed by other analgesics. Fixed dose combinations of NSAIDS with other NSAIDS or opoid analgesic were also commonly prescribed. Diclofenac + Paracetamol and Tramadol + Paracetamol were most commonly prescribed combinations in 30 (15%) and 19 (9.5%) patients respectively.Conclusions: As monotherapy aceclofenac and diclofenac were the most commonly prescribed NSAIDS for various musculoskeletal disorders. Also, fixed dose combinations of NSAIDS with other NSAIDS or opoid analgesic were also commonly prescribed. Diclofenac + Paracetamol and Tramadol + Paracetamol were the most commonly prescribed FDCs in our study.

Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease

BACKGROUND: The objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease. METHODS: Retrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer–Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh. RESULTS: A total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer–Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer–Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05). CONCLUSION: Gender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.

Maturation of arteriovenous fistula: Analysis of key factors

The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.

Maturation of arteriovenous fistula: Analysis of key factors

The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.

Treatment of mycosis fungoides with total skin electron beam therapy using modified stanford technique

A retrospective review of three patients with mycosis fungoides treated with total skin electron beam therapy, from the year 2007 to 2009, at the Oncology department, Ziauddin University Hospital

Therapeutic evaluation of kalonji [nigella sativa] in dyslipidemia - a randomized control trial

Dyslipidemia is one of the most common risk factors of cardiovascular diseases. An increased level of cholesterol is responsible for atherogenesis, which ultimately leads to the development of cardiovascular, cerebrovascular, and peripheral vascular diseases. According to a survey report, 36.3% patients are dyslipidemic; therefore, the problem is increasing day by day as a huge cause of morbidity and carries economic burden for society. These days, dyslipidemia is treated using lipid-lowering agents with lifestyle intervention; however, lipid-lowering agents produce various side effects. In Unani system of medicine, several drugs are used as lipid-lowering agents, which are comparatively safe. However, such drugs are still not validated on scientific parameters. Thus, a clinical trial was conducted with the objective to evaluate the efficacy and safety of Unani drugs in the management of dyslipidemia. The study was designed as single-blind, randomized with standard control. Thirty patients of dyslipidemia were selected and randomly assigned to control and test groups, the test group comprising 20 patients and the control group comprising 10. The test group received the powder of Kalonji in the form of capsule [two capsules twice a day] and the control group received Lipotab[R] [two tablets once a day for 60 days]. All the patients were assessed on subjective and objective parameters. The result was analyzed statistically using appropriate statistical tests. The test drug shows significant results on few subjective and objective parameters in comparison to the control drug. Overall, improvement was observed in the test group without any clinically and statistically significant side effects or toxicity. The compliance to the treatment was found good. The study revealed that the comparative analyses of both test and control drugs were not statistically significant, but improvements in subjective and objective parameters were present in both groups

Professional identity [role blurring] of occupational therapy in community mental health in india

The aim of this article is to describe the experience of health professionals who struggle for professional identity [role blurring] whilst working in a community mental health setting nationally [India] as an occupational therapist. The articles which were chosen for this study mostly belong to United Kingdom, United States and Australia, because the nature of occupational therapy in community mental health is somewhat similar in these parts of world compared to India. But due to lack of sufficient research, the author was bound to choose some articles from the late nineties. In this study the author is trying to give focus on few aspects such as inter professional conflicts, professional identity, occupational injustice at worldwide level and some issues at national, departmental and personal level with future recommendation. There still plenty to be done to prevent role blurring which is causing damage towards the identity of occupational therapist in India. Each professional should take it very sincerely and try to maintain professional boundaries, focus on more research and collaborative work, staff education, and professional dignity

Hemorrhagic cardioembolic stroke secondary to a left ventricular thrombus: a therapeutic dilemma

Cardiogenic embolism is a major cause of stroke and often leads to significant morbidity and mortality. Despite the recent advances in our understanding of the pathophysiology of stroke and its risk factors, diagnosis and therapy; some case scenarios still present a real challenge for the treating physicians. We report a case of a 50 year old male patient presenting with multi-territory cerebral infarctions due to a left ventricular mobile thrombus complicated with hemorrhagic transformation at the time of presentation. Gradual introduction of anticoagulation coupled with a multidisciplinary team approach advocating careful daily clinical assessment of the patient and regular echocardiographic and neuroimaging studies have resulted in a better management and achievement of therapeutic goals

psychosocial impact of diabetes in adolescents: a review

Type 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus

Analytical approaches to paclitaxel, an anti cancer domain

Cancer is the uncontrolled growth of abnormal cells in the body. Symptoms of cancer depend on the type and location of the cancer. Paclitaxel obtained from Taxus brevifolia is an effective natural drug used in cancer treatment, so there arises a need of its estimation in biological fluids for the pharmacokinetic studies in clinical trials and in various pharmaceutical dosage forms including nanoparticles, cremophore based formulations and paclitaxel releasing stents. Literature survey reveals many chromatographic methods for estimation of paclitaxel by HPLC, LC-MS-MS and UPLC to get very accurate, precise and robust method with lower run time and higher recovery. An important step in the development of liposome-based formulations is estimation of the free drug concentration in the aqueous solution surrounding liposomes

Comparison of convergence angle of prepared teeth for full veneer metal ceramic crowns

To compare clinically practiced convergence angle values of tooth preparation with recommended values, and also the effect of tooth position and operator experience on convergence angle. Analytical study. The study was carried out at the Dental clinic, The Aga Khan University Hospital, Karachi, from January to June 2007. A minimum of 75 crown preparation dies including 25 dies in each group of teeth [anterior, premolars and molars] were collected retrospectively which were prepared by residents and specialists of operative dentistry. AutoCAD 2007 software was used for measurement of convergence angle. One sample t-test was applied to compare the mean practiced convergence angle values with its recommended values. Two way ANOVA was applied to measure difference in convergence angle values with respect to operator experience and tooth type with the level of significance being a=0.050. Mean reported convergence angle value was 22.72°, which was significantly greater [p < 0.001] than the recommended values. Statistically significant difference in convergence angle was found between anterior vs. molar teeth and between premolars vs. molar teeth [p=0.0001 and p=0.002, respectively]. There was a considerable disparity between the convergent angles values recorded in this study and the recommended guidelines. Measured convergence angle values were greater for posterior teeth as compared to the anterior teeth

assess the practices about initiation of oral maternal feeding after cesarean section under regional anesthesia

Cesarean Section [C-S] is one of the most commonly performed operations in the world.1 Diet and nutrition play a vital role in post operative recovery. The objective of the study was to assess the trends and practices about "Early Initiation of Oral Maternal Feeding after Cesarean Section [C-S] under Regional Anesthesia [RA]" and to analyze it in the context of evidence based medicine [EBM]. The study was a multi center cross sectional survey conducted from August 2009-September 2010. Closed ended self administered questionnaires were filled in by 398 respondents of obstetric specialty. In response to the questionnaire 31.3% of the study participants were in favor of early initiation of maternal feeding 2-4 hours; while 84.6% preferred to delay it up to 6-12 hours; 61.6% had the perception that early start of solid diet may lead to ileus and wound dehiscence; whereas 3.4% feared burst abdomen; while only 35.1% said that it would have no effect on wound. About 57% respondents said that early maternal ambulation after an uncomplicated C-S can help in early recovery, while 43% participants thought that it may lead to hypotension, giddiness and spinal headache. The responses of the participants regarding early initiation of maternal oral feeding after C-S under RA illustrate fears and old conventional trends rather than practices based on scientific evidence. Awareness programs and multi center clinical trials in the local context may change this practice and give them enough experience and confidence. The evidence shows that initiation of early oral maternal feeding [MF] results in greater maternal satisfaction, less gastro intestinal and wound complications and is also cost effective

Clinical spectrum of post-stroke seizures

To determine the characteristics of post-stroke seizures and compare these in early vs. late post-stroke seizures. Observational study. Department of Neurology, Liaquat National Hospital, Karachi, from March to September 2007. All admitted patients aged over 25 years, with diagnosis of post-stroke seizures were included. Those with known epilepsy, sepsis and eletrolyte imbalance were excluded. Age, co-morbid condition, details of seizures and radiological findings regarding type and location of stroke were collected and entered in a pre-formed proforma. Results were described as frequency and mean. Association of variables was determined through chi-square test with significance at p < 0.05. Out of the 50 patients, there were 28 [56%] males and 22 [44%] females with the mean age of 56.86 +/- 15.26 years. Thirty-one [62%] patients had history of hypertension. Early seizures i.e. within 2 weeks were seen in 29 [58%] patients. Generalized seizures were seen more frequently i.e. in 37 [74%] patients. Thirty-one [62%] subjects experienced more than 2 seizures. Forty [80%] had an ischemic stroke including 36 [72%] arterial infarct and 3 [6%] venous infarcts. Intracerebral hematoma was seen in 10 [20%] of subjects. Comparison between early and late onset seizures revealed significant association between ischemic heart disease [IHD], old stroke, hypertension and late onset seizures [p < 0.05]. Post-stroke seizures were more frequent in males, with history of hypertension, and with cortical ischemic strokes. Early seizures, multiple episodes and generalized seizure type were more common. Venous infarcts were chiefly associated with seizures at presentation. History of old stroke, ischemic heart disease, hypertension and hypercholesterolemia showed a strong relationship with the occurrence of late onset seizures

Synthesis and antituberculostic activity of some novel 1,3,4-oxadiazole

A series of 5-[3'-oxo-6'-[substituted aryl]-2',3',4',5'-tetrahydropyridazin-2'-yl methyl]-2-substituted 1,3,4-oxadiazole has been synthesized. Appropriate aromatic hydrocarbon reacts with succinic anhydride in presence of AlCl[3] to yield beta-Aroyl propionic acid [1a]. The corresponding acid is cyclised with hydrazine hydrate to give 6-[substituted aryl]-2,3,4,5-tetrahydro3-pyridazinone [1b]. This intermediate after reaction with ethyl bromo acetate, hydrazinolysed into 3-oxo-6-[substituted aryl]-2,3,4,5-tetrahydropyridazinyl acetohydrazide [1c]. The resulting product was converted into 5-[3'oxo-6'-[substituted aryl]-2',3',4',5'-tetrahydropyridazin-2'-yl methyl]-2-substituted 1,3,4-oxadiazole [Scheme-I]. All the final compounds have been structurally elucidates on the basis of IR, [1]H-NMR, mass spectral data and elemental analysis and screened for antitubercular activity

Complications in craniocerebral aspergillosis of sino-nasal origin in immunocompetent patients

Four immunocompetent patients of craniocerebral aspergillosis of sino-nasal origin who developed complications have been described. They developed intracerebral haemorrhages, multifocal infarctions and intraventricular dissemination of aspergillus infection and 2 patients developed acute hydrocephalus. All 4 patients have been managed by standard therapeutic regimens including both surgical resection followed by antifungal therapy while CSF shunting was done as required. Only one patient survived till the last clinical follow-up. Magnetic resonance angiography along with routine magnetic resonance imaging at the time of initial work-up may be helpful to pick up mycotic aneurysms and vascular occlusions

comparison of red-green color vision deficiency between medical and non-medical students in Pakistan

To investigate the prevalence of red-green color vision deficiency [CVD] among medical and dental students compared with non-medical students. This descriptive, cross-sectional study compared the prevalence of CVD between medical and non-medical Pakistani students. A total of 926 medical and dental students from Baqai Medical University, Karachi, Pakistan were compared with 7288 non-medical students from Nadirshaw Edulji Dinshaw University of Engineering and Technology, Karachi, Pakistan, and Pakistan Air Force [PAF] Public Schools [Muree and Sargodha], Pakistan. Standard Ishihara color vision charts were used, which provided an accurate assessment of CVD. More than 3 mistakes from plates 10-17 identified students as having red green CVD. The study was carried out from September 2003 to December 2008. The overall prevalence of CVD in the study population was 2.75%. They were no significant differences between male students in engineering college versus medical college [2.7% versus 4.4%, p=0.125], or between schools and universities [3.1% versus 3.1%, p=0.930]. A small proportion of the Pakistani population suffers from red-green CVD, more prominent in males. We found no differences between students in engineering college versus medical college, or between schools and universities in different geographical locations within Pakistan

profile of natural sweetener - stevia

The small perennial shrub, Stevia rebaudiana Bertoni is native to valley of Rio Monday in Paraguay. It is one of 150 species of genus Stevia which contains diterpene glycosides e.g. Stevioside, Rebaudioside A, B, C [Dulcoside B], D, E, F, [Dulcoside A], Steviolmonoside, Steviolbioside and Rubusoside in its leaves. All these are responsible for making Stevia about 300 times sweeter than sucrose [0.4% solution]. Stevioside and Rebaudioside A are the abundant glycosides in this plant responsible for the potent sweet taste of the drug. Extract of Stevia leaves have been used for many years as sweetening agent in traditional treatment of diabetes in South America. Several studies demonstrated that Stevia significantly decreases glucose level and increases glucose tolerance in diabetic type II volunteers and experimental animals. Stevioside and Rebaudioside A exert hypoglycemic, insulinotropic [enhance insulin release] and glucogonostatic activities. Organoleptic evaluation of Stevia for sweetener properties demonstrated that it exerts intensively sweet taste superior to most of other sweeteners. Other pharmacological activities such as antihypertensive, anticancer, non-carcinogenic, gastroprotective, antibacterial etc. have been demonstrated by several studies. The present literature survey reveals the phytochemical and pharmacological activities of the Stevia rebaudiana Bertoni

Anti-inflammatory activity of the aqueous extracts of Cassia pumila Lamk

Aqueous extracts of Cassia pumila Lamk obtained by continuous hot percolation were given orally to study their effects on the exudative and proliferative phases of the inflammatory reaction, using the technique of carrageenan-induced rat paw oedema. The anti-inflammatory activity was compared with Indomethacin, The aqueous extracts of leaves of Cassia pumila showed highly significant anti-inflammatory activity