Role of Dashamula Kashaya and Dhanwantara Taila Yoni Pichu in Sukha Prasava - A Case Series

Pregnancy is one of the most important events in the life of every woman. Antenatal care is essential for diagnosis of high risk cases and for educating the pregnant women about the physiological changes and process of delivery. By these fear is removed and psychology of pregnant women improved. The main objective of antenatal care is to delivery healthy fetus from a healthy mother. The prevalence of the C-section in India was 8.5% in NFHS-3 while data in NFHS-4 showed that it has increased upto 17.2%. Thus, almost 9% has increased over 10 years. In the present scenario incidence of Caesarean section has been increased. When labour is induced with oxytocin or prostaglandin leads to cervical dystocia, uterine inertia are more evident. Acharyas are explained Navama masa garbhini parcicharya for Sukha prasava or Dhatu vriddhi. Basthi which helps in Vata anulomana and softness Kukshi, Kati and Parshwa pradesha. Aim and objective: To achieve normal vaginal delivery without complication and to know the efficacy of Ayurveda treatment modalities in Sukha prasava. Methodology: Oral administration of Dashamula kashya 20 ml second hourly and Dhanwantaram taila yoni pichu till the full dilatation of cervix. Results: There is reduction in duration of first stage of labor. Conclusion: Dashamula kashaya and Yoni pichu with Dhanwantara taila was effective in progress of labor without complication.

Is Mucormycosis an inevitable complication of Covid-19 in India?

ABSTRACT Mucormycosis or black fungus infection is a less common disease but highly fatal infection, infecting the immunocompromised individuals. The site of predilection of the fungus is found to be lungs and brain in addition to its sequestration in sinusoidal spaces. Presently with the ongoing COVID 19 pandemic, the prevalence of this infection is found to be high in the Indian population. The fungus establishes itself by affecting the compromised immune system of an individual and thereby making the individual susceptible to other diseases/ infection. The reasons attributed to the sudden upsurge are steroidal therapeutics abuse, tocilizumab therapy and diabetes mellitus.To avert the cytokine storm, the medical health workers are necessitated to include steroid drugs in COVID 19 treatment protocol however inclusion of these drugs in patients who do essentially require steroids can have their immune system debilitated and permit the invasion of this fungus. According to International Diabetes Federation (IDF), 77 million Indians are known to be diabetic, cautioning the physicians to be vigilante of the impending black fungus infection in the event of COVID19 affliction in such individuals. There is causal relationship between anti-hyperglycemic drugs and weakened immune system and opportunity for the fungus invasion. This review attempts to explain the inter-relatedness of COVID19 infection, its treatment and eventual black fungus infection risk.

A study of correlation of antenatal uterine scar thickness by transabdominal ultrasound with intraoperative lower uterine segment scar grading in elective repeat cesarean delivery

Background: Caesarean section (CS) is the most common obstetric surgery performed world-wide. The objective of this study was to correlate the antenatal sonographic lower uterine segment (LUS) scar thickness in women with previous one cesarean section with intra operative LUS scar grading.Methods: A Prospective observational study was conducted from December 2014 to November 2015. In a tertiary care center. 200 pregnant women from ANC clinic with previous one LSCS were recruited. Transabdominal USG done between 36-38 weeks. LUS thickness was measured from bladder wall-myometrium interphase and myometrium-chorioamniotic membrane inter phase. Intraoperative grading of LUS scar was done. Based on grading of scar participants were assigned into scar dehiscence group (grade III and IV LUS scar) and non-dehiscence group (Grade I and II LUS scar).Results: Mean LUS thickness was 3.41±0.623 mm (range: 2-7 mm). Mean LUS thickness in the scar dehiscence group and non-dehiscence group was 2.98±0.55 mm and 3.48±0.60 mm (P value < 0.05) respectively. A cut off value of 3.5 mm was derived from ROC with sensitivity, specificity, positive and negative predictive value of 92.6%, 54.3%, 24.0%, 97.8%, respectively. The present study reported 27 (13.5%) cases of scar dehiscence.Conclusions: Ultra-sonographic evaluation of LUS thickness correlated significantly with intraoperative LUS appearance. USG evaluation of LUS can be used as a screening test to predict the LUS scar integrity. Risk of dehiscence is increased in women with thin LUS i.e. sonographic LUS thickness of < 3.5 mm and needs to be further evaluated. Women with previous one LSCS with thick LUS i.e. sonographic LUS thickness of > 3.5 mm, can be counselled regarding TOLAC if not contraindicated.

Role of Echocardiographic Systolic Parameters in Pre Eclamptics and Normotensive Women

Introduction: Preeclampsia is a disease unique to pregnancyand it is characterized by progressive hypertension,pathological edema and proteinuria. But till now thehemodynamics of preeclampsia is not properly understoodand is debated. Study aimed to assess maternal cardiovascularfunction using echocardiography in normal and preeclampticwomen.Material and Methods: Our study was a prospective studyon 200 women admitted in the Department of Obstetrics andGynaecology, Chalmeda Anand Rao Institute of MedicalSciences, Bommakal, Karimnagar, Telangana state, India. Allwomen underwent two-dimensional echocardiography at rest.Cardiac systolic parameters were recorded and studied.Results: The studied parameters like Mean Left ventricularend-diastolic volume (LVEDV), Mean stroke volume, Meanaortic root diameter and Mean total vascular resistancewere higher in the Pregnancy Induced Hypertension (PIH)group than the controls and the difference was statisticallysignificant. The Mean left ventricular outflow tract diameterin the Pregnancy Induced Hypertension (PIH) group wasalso higher than the control group, with the difference beinginsignificant.Conclusion: Women with preeclampsia have significantsystolic dysfunction compared to normotensive controls.Blood pressure monitoring alone is insufficient to identifyeffectively.

Use Of Early Labour Room Bubble Cpap In Preterms Born At 28-32 Weeks Of Gestation

Objective: To study the use of early labour room Bubble CPAP in preterm neonates born at 28–32 weeks of gestation and to analyse the outcome in relation to need for mechanical ventilation, duration of hospital stay and mortality at the Neonatal Intensive Care Unit (NICU), Tertiary Care Teaching Government Hospital Kurnool, Andhra Pradesh for a period of 1 Year. Methods : Facility Based Interventional Studied (Randomised Control Study) Participants : Study sample of 109 preterm babies of age 28–32 weeks of gestation Cases : 54 cases, neonates with respiratory distress who were started on CPAP in the labour room within 15 minutes of life. Controls : 55 babies, neonates with respiratory distress who were started on CPAP after 15 minutes to 6 hours of life. In the present study, both the groups(cases and controls) were monitored till they were discharged and the need for mechanical ventilation was noted. Clinical diagnosis of RDS was made based on the time of onset of respiratory distress and clinical examination and respiratory scoring(Silverman Anderson Score) . Chest X–ray and routine investigations were done in all neonates. Duration of CPAP and difference in mortality between the two groups was analysed. Outcome : In the present study, preterm neonates born at 28–32 weeks of gestation who were started on early labour room CPAP vs control group outcome is assessed in relation to need for mechanical ventilation and duration of hospital stay and mortality. Results: It is observed that 16 (29.63%) cases required mechanical ventilation whereas 28 (50.91%) preterm neonatesin the control group needed mechanical ventilation. There was a statistically significant difference between the two groups (p < 0.05). The duration of stay in NICU in neonates with early CPAP was significantly less when compared to the controlled group. 30(76.9%) neonates were discharged within 14 days among cases and 16 (48.48%) neonates among control group. There is no difference in mortality between the 2 groups. Conclusions : The following conclusions could be drawn out of the present study on preterm neonates. 1. The early administration of CPAP in the delivery room in preterm neonates developing respiratory distress decreases the need for mechanical ventilation. 2. The duration of stay in NICU in neonates with early CPAP was significantly less. 3. There is no difference in mortality between the two groups.

A study on role of lipid peroxidation in diabetic patients in Thiruvarur District

Introduction: Insulin affects many sites of mammalian lipid metabolism It stimulates synthesis of fatty acid in liver adipose tissue and in the intestine The insulin has also been reported to increase the cholesterol synthesis The activity of lipoprotein lipase in white adipose is also increased From this point of view, the assessment of various lipid fractions and lipid peroxide in the cases of Diabetes Mellitus may be of some help in the prognosis of patients and in preventing the possibilities of complications or secondary disorders Aim of the study: To study the level of lipid peroxide in IDDM and NIDDM To find out the correlation between Lipid peroxide and Lipid profile in both types of diabetes mellitus Materials and methods: Participants of the study group were selected from the outpatient's population of the Department of Medicine, Government Thiruvarur Medical College, Thiruvarur 100 patients were selected for this study Out of which 50 patients belong to NIDDM and 50 to IDDM group 50 persons served as a healthy control Results: There was a very good positive correlation between MDA and Cholesterol, TGL, LDL, VLDL in both NIDDM and IDDM cases There was a negative correlation between MDA and HDL in NIDDM and IDDM cases Conclusion: In the diabetes mellitus abnormally increased levels of lipid, lipoprotein and lipid peroxides in plasma may be due to the abnormal lipid metabolism The maximum increase in lipid peroxide was found in a group of diabetes mellitus with complication Elevated levels of lipid peroxide in diabetes mellitus may be due to the alteration of function of erythrocytes membrane This inhibits the activity of superoxide dismutase enzyme leading to accumulation of superoxide radicals which cause the maximum lipid peroxidation and tissue damage in diabetes

Clinical study of reconstruction of devastating defects around the elbow region at a tertiary care hospital

Back ground: Devastating defects are those defects where the major structures like bones, joints, nerves, and blood vessels are exposed. These defects may be due to road traffic accidents, train traffic accidents, post burn scar contracture release raw area etc. Skin grafting or simple flaps may not help in these cases making reconstruction challenge. To study the various flap options for the coverage of the elbow defects and its outcomes. Materials and methods: From the period of 2016 to 2017, all patients with elbow defects that required local or locoregional flaps were chosen for the study. Investigations included plain X-ray of the elbow. Hand held Doppler was done for patients in whom the perforator based flaps were selected for reconstruction. Results: In our study (23 patients) were males and (4 patients) were females. The most common cause was the road traffic accident (18 patients). Two patients were due to a post burn contracture release raw area. One of the patients was due to a work place accidental injury. Six patients were due to train traffic accident and of which 5 patients presented with total amputation (stump raw area). The site of the wound played a major role in determining the flap selection. In our series, most of the patients presented with defects over lateral (6 patients) and posterior lateral (7patients) elbow region. Conclusion: Meticulous planning for their construction of devastating elbow defects is necessary to achieve satisfactory results. The choice between different flaps depends on the nature of the defect, availability of donor tissues and the patient’s needs.

Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital

Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired nonmalignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical tracheaoesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi. Clinical study of pedicled sternocleidomastoid muscle flap interposition for cervical tracheo oesophageal fistula repair at a tertiary care hospital. IAIM, 2017; 4(9): 105-109. Page 106 investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.

Odontogenic Keratocyst-A Case Report

Odontogenic keratocyst (OKC) is a developmental, non-inflammatory chronic cyst that may be unilocular or multilocular. Histologic features of OKC are pathognomonic. A 41-year-old male patient presented for emergency evaluation of a buccal gingival swelling in the area of teeth 34 and 35. Incision and drainage were followed 3 weeks later by surgical curettage and guided tissue regeneration using allograft and resorbable membrane. Biopsy of the excised tissue revealed OKC. At 1-year follow-up, the patient was comfortable and complete resolution of the radiolucent pathology was evident. Periodic examination is required because of the high rate of recurrence of OKC.

Prevention of perinatal group B streptococcal infections: A review with an Indian perspective.

Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identifi cation of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

Growth hormone receptor inhibition decreases the growth and metastasis of pancreatic ductal adenocarcinoma

Pancreatic cancer is the only major cancer with very low survival rates (1%). It is the fourth leading cause of cancer-related death. Hyperactivated growth hormone receptor (GHR) levels have been shown to increase the risk of cancer in general and this pathway is a master regulator of key cellular functions like proliferation, apoptosis, differentiation, metastasis, etc. However, to date there is no available data on how GHR promotes pancreatic cancer pathogenesis. Here, we used an RNA interference approach targeted to GHR to determine whether targeting GHR is an effective method for controlling pancreatic cancer growth and metastasis. For this, we used an in vitro model system consisting of HPAC and PANC-1 pancreatic cancer cells lines. GHR is upregulated in both of these cell lines and silencing GHR significantly reduced cell proliferation and viability. Inhibition of GHR also reduced the metastatic potential of pancreatic cancer cells, which was aided through decreased colony-forming ability and reduced invasiveness. Flow cytometric and western blot analyses revealed the induction of apoptosis in GHR silenced cells. GHR silencing affected phosphatidylinositol 3 kinase/AKT, mitogen extracellular signal-regulated kinase/extracellular signal-regulated kinase, Janus kinase/signal transducers and activators of transcription and mammalian target of rapamycin signaling, as well as, epithelial to mesenchymal transition. Interestingly, silencing GHR also suppressed the expression of insulin receptor-beta and cyclo-oxygenease-2. Altogether, GHR silencing controls the growth and metastasis of pancreatic cancer and reveals its importance in pancreatic cancer pathogenesis.

Effect of sleep deprivation on blood glucose and vital data.

Background: The shift work affects human health and performance by disrupting circadian rhythms and by causing numerous alterations in human behaviour. We have taken night shift workers as they were sleep deprived people, comparing with the same variables in same persons during day shift work, to assess, how sleep deprivation (night shift work) impacts on persons health. So we decided to study the effect of sleep deprivation on blood glucose and vital data. Method: 58 normal healthy male volunteers aged ranging from 25 to 45 years were selected from Madras cement factory Limited and tested for Fasting Blood Glucose, Pulse Rate, Respiratory Rate, Temperature, Systolic Blood Pressure, Diastolic Blood Pressure before and After Sleep Deprivation. Results: Mean Fasting Blood Glucose levels after sleep deprivation, when compared to mean fasting Glucose levels after normal sleep is significantly increased (P value < 0.05). The mean Temperature after sleep deprivation, when compared to mean Temperature after normal sleep is significantly decreased (P value < 0.05). The mean Systolic Blood Pressure after sleep deprivation when compared to mean Systolic Blood Pressure after normal sleep is significantly Raised (P value < 0.05)The mean Diastolic Blood Pressure, mean respiratory rate and mean pulse rate after sleep deprivation was not significant (P value > 0.05). Conclusion: This study concludes that sleep deprivation play a role to increase blood glucose levels and blood pressure.The results suggest that sleep deprivation play a role in the etiology of hypertension and diabetes mellitus.

Seroprevalence of chlamydial infection in patients attending STD.

Background: Chlamydial disease has the major scourges of humans. In women severe, sometimes irreversible complications usually present as the first symptom of genital infection. Though contemporary diagnostic methods are reliable for identifying infections there are economic and acceptance issues surrounding certain intervention strategies involving frequent community wide screening for early detection and for mass treatment. So we aimed at the Chlamydial infections in the community. Method: The study population was 150 cases out of which 100 cases were symptomatic patients who are attending STD clinic and 50 were control group. We selected ELISA test by the patella Chlamydia IgG ELISA kit supplied by BIO-RAD agencies, Hyderabad for detecting Chlamydia IgG antibodies after the Ethical Committee approval. Results: The test results were tabulated. Out of 100 test sera collected for chlamydial infections with variety of clinical symptoms, 12 patients have shown seropositivity, 20.83% belongs to the age group of 21-25 years, 17.64 % of them are belongs to rural group,14.18% are females and 16.66% of patients suffers with syphilis. Conclusion: Present study concludes that 12 cases were positive for chlamydial infection. Majority of the patients belong to the age group of 21-25 years and least incidence was seen among the age group less than 20 years and females were affected more than males. Distribution of chlamydial infection was more in rural area than urban and was found to be syphilis than other STD cases.

Persistent fetal bradycardia - a marker for inherited metabolic disorder?

This case report highlights the persistent fetal bradycardia without fetal distress presenting at 29 weeks gestation. Approach to etiological diagnosis is discussed. The neonatal inborn error of metabolism as a cause for this bradycardia is emphasized

Cloning and sequencing of complete tau-crystallin cDNA from embryonic lens of Crocodylus palustris.

tau-Crystallin is a taxon-specific structural protein found in eye lenses. We present here the cloning and sequencing of complete tau-crystallin cDNA from the embryonic lens of Crocodylus palustris and establish it to be identical to the a-enolase gene from non-lenticular tissues. Quantitatively, the tau-crystallin was found to be the least abundant crystallin of the crocodilian embryonic lenses. Crocodile tau-crystallin cDNA was isolated by RT-PCR using primers designed from the only other reported sequence from duck and completed by 5'- and 3'-rapid amplification of cDNA ends (RACE) using crocodile gene specific primers designed in the study. The complete tau-crystallin cDNA of crocodile comprises 1305 bp long ORF and 92 and 409 bp long untranslated 5'- and 3'-ends respectively. Further, it was found to be identical to its putative counterpart enzyme a-enolase, from brain, heart and gonad, suggesting both to be the product of the same gene. The study thus provides the first report on cDNA sequence of tau-crystallin from a reptilian species and also re-confirms it to be an example of the phenomenon of gene sharing as was demonstrated earlier in the case of peking duck. Moreover, the gene lineage reconstruction analysis helps our understanding of the evolution of crocodilians and avian species.

An unusual distribution of glucose-6-phosphate dehydrogenase deficiency of south Indian newborn population.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is seen at a higher frequency in many national and ethnic groups in areas of current or former malaria endemicity. A screening programme undertaken to evaluate the gene frequencies for this deficiency in the highly inbred South Indian population of Karnataka revealed that of the 5140 neonates screened, 7.8% were G6PD deficient with no correlation between the reported level of inbreeding and enzyme deficiency. An interesting finding was the equal number of male (198) and female (207) individuals, with G6PD activity of less than 3 IU. The possible implications of this finding with regard to the expression of G6PD gene is discussed.

Characterization of a variant glucose-6-phosphate dehydrogenase from the south Indian population.

Glucose-6-phosphate dehydrogenase (G6PD) is coded by a gene on the X-chromosome. Earlier studies have shown that the South Indian population has a high incidence of this enzyme deficiency. The electrophoretic mobility, pH optimum and the Km values for G6PD from normal and variant individuals were identical. However, the specific activity of the variant enzyme was 8 times less compared to the value of the normal enzyme. Western blot analysis of partially purified G6PD from normal and variant individuals performed using equal amounts of total protein showed that the variant protein was 3 times less in concentration. Similar analysis performed using protein corresponding to equal enzyme activity units in the normal and variant samples showed that the variant enzyme was 2.25 times less efficient compared to the normal enzyme. RNA dot blot analysis using full length G6PD cDNA probe (PGDT5B, a kind gift from Prof. L Luzzatto) revealed that lymphocytes from normal and variant individuals had equal amounts of G6PD specific mRNA.