A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome in a tertiary health centre located in central India

Background: A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome was done in a tertiary health centre (RKDF Medical College and Research Centre, Bhopal) located in central India.Methods: This prospective study was carried out in antenatal women in their first trimester attending antenatal OPD in RKDF Medical College and Research Centre, Bhopal, Madhya Pradesh to know the prevalence of thyroid disorder and its association with pregnancy outcome.Results: In this study prevalence of thyroid disorder was 12.4%, subclinical hypothyroidism 7.2%, overt hypothyroidism 3.4%, subclinical hyperthyroidism 1.4%, overt hyperthyroidism 0.4%. Thyroid disorder is responsible for several obstetrical and fetal complication like pre-eclampsia, preterm delivery, abortion, IUGR and low birth weight.Conclusions: Thyroid disorder associated with poor obstetrical outcome and fetal complication. so timely diagnosis and treatment is required. Universal screening should be preferred over high-risk screening because of high prevalence of the disease in India.

A study to compare the efficacy, acceptability and side effect of combined contraceptive vaginal ring with the combined oral contraceptive pills in a tertiary health centre located in central India

Background: A study to compare the efficacy, acceptability and side effect of combined contraceptive vaginal ring with the combined oral contraceptive pills in a tertiary health centre (RKDF Medical College and Research Centre, Bhopal) located in central India.Methods: This prospective randomized comparative trial enrolled hundred women aged between 20 to 40 years seeking for contraception with no contraindication to hormonal contraception. After proper counseling and informed consent, women divided into two groups, study group (50) includes women using contraceptive vaginal ring and control group (50) include women using combined oral contraceptives. The contraceptive efficacy, acceptability, tolerability and adverse events were recorded at each follow-up visit at RKDF Medical College and Research Centre, Bhopal.Results: Vaginal ring and combined oral contraceptives were found to have comparable contraceptive efficacy. In study group no pregnancy reported during study period while one pregnancy reported in control group, which was statistically insignificant. Satisfaction, continuation and recommendation to others were more with vaginal ring which were not significant statistically. Cycle control is superior with vaginal ring. Incidence of adverse effects was same in both groups.Conclusions: Combined contraceptive vaginal ring is an effective and reliable contraception with excellent cycle control, well-tolerated and highly acceptable to most women.

Incidence of Stroke (Infarct and Haemorrhage) and Mortality Rate among Stroke Patients

Background: Infarct and hemorrhage are frequently encountered problem. Assessment of possible hemorrhage in acute stroke before appropriate therapy remains important. Causes, outcome and treatment strategies differ from patient to patient. Aim: To determine the incidence of stroke (infarct and haemorrhage) in patients and mortality admitted to Netaji Subhash Chandra Bose Medical College Jabalpur. Methods: 100 patients of both genders and age > 15 years presenting with stroke were included in the study. All patients had CT scan brain. The results were them compared with clinical diagnosis on case to case basis and precision of clinical diagnosis was as refrained. Results: In current study highest incidence in the age group was 61-70 yrs in 32% cases. In current study the incidence of stroke was much more common in males. Results showed that of the 100 cases studies cerebral infarct was seen in 65% cases, cerebral hemorrhage in 33% cases, and subarachnoid hemorrhage in 1% and cerebral venous thrombosis in 1% cases. The mortality form cerebral infarct was 30 % from intra cerebral hemorrhage was 36%. As a whole out of 100 patient of stroke of all types, 32 patients died within span of 30 days. Conclusion: As the age increases incidence of stroke increases, increased mortality was seen in present study.

Brain–muscle interface: The next-generation BMI.

Spinal cord injuries result in loss of movements below the site of injury because connections between the brain and the muscles are cut. Treatment strategies have focused on restoring connectivity by the application of drugs, or cell or tissue transplants. Brain–machine interface (BMI) devices, on the other hand, aim to improve the quality of life of the patients by using technology to record neural signals directly from the brain and using these signals to control robotic devices, which substitute for the paralysed body part by performing functions such as locomotion and feeding (Jain 2010). BMI devices, which have been successfully demonstrated in rats, monkeys and humans (Chapin et al. 1999; Wessberg et al. 2000; Hochberg et al. 2006), are based on a discovery made nearly three decades ago by Georgopoulos and colleagues. They found that in the primary motor cortex direction of movements is coded in the activity of neurons (Georgopoulos et al. 1983). The firing rate of a neuron coding for the direction of the arm movement is maximum for movement in a particular direction, and decreases as the movement direction shifts away. Neurons in the premotor cortex show a similar directional tuning, except that they discharge before the actual movement takes place, during the movement planning phase. BMI devices record activity of ensembles of neurons, analyse it using mathematical algorithms to predict the intended movement and use the output to generate command signals that control the robotic devices (figure 1A). BMI technology has recently added two new tools to its arsenal, which have the potential to overcome certain technical challenges and make it easier to implement. The first advancement is the use of an individual’s ability to modulate neural activity at will. Practitioners of Indian meditative yoga can control their brain rhythms (Khare and Nigam 2000). Interestingly, control can be achieved at the level of a single neuron. Fetz (1969) showed that monkeys could learn to modulate the firing rate of individual neurons in the motor cortex to obtain rewards, an ability that the Fetz group recently used in a BMI device (Moritz et al. 2008). Previous BMI devices have generally relied on recordings from neurons that actually participate in generating specific movements. In these devices the neuronal activity recorded when the animal is physically doing the task is used to optimize a mathematical algorithm, which is subsequently used to control the robot for mimicking the arm movement. This sequence of optimization is not possible in patients with paralysis, because the devices will be introduced post-injury; no pre-injury recordings of the neuronal activity will obviously be available. Voluntary control over the activity of neurons makes it unnecessary to know a priori the exact contribution of a neuron in the movement generation in order to get a signal suitable for controlling a robotic device. The intra-cortical electrodes can provide stable recordings for many years (Jain et al. 2001; Rajan and Jain, unpublished observations), but cannot be moved easily once placed. Moreover, electrodes often lose the ability to record from the same sets of neurons. This, combined with widespread reorganization of the brain following spinal cord injuries (Jain et al. 1997; Tandon et al. 2009; Kambi et al. 2011), can be especially problematic if recordings from specific neurons were essential for BMI devices. The ability to modulate neuronal activity also provides greater flexibility to the scientists in choosing a site for placement of intra-cortical microelectrodes. Finally, the patients can possibly generate multiple patterns of activities, allowing use of recordings from the same groups of neurons to control different movements, such as feeding and walking, which are normally controlled by different neurons in the brain. The second important technological advancement made by Fetz and colleagues (Moritz et al. 2008) gets rid of the robot as the effector device. Instead of using the brain activity to control a robotic arm, they converted the brain signals into electrical signals, which were used to stimulate the muscles of the paralysed arm. In their study, they first trained monkeys to make rotational movements of the wrist to control a cursor and move it towards a target that appeared on a computer screen, and recorded neural activity from neurons in the motor cortex that controlled the flexor and the extensor muscles of the wrist. In the second step of the training, the position of the cursor was represented as a function of the firing rates of the neurons, which were also available to the monkeys as a visual feedback. The monkeys rapidly learnt to maintain the neuronal activity at a particular level to control the cursor. Post training, muscles of the wrist were reversibly paralysed by injecting a local anesthetic into the peripheral nerves innervating the arm, thus blocking neuronal activity from reaching the arm. In the final testing step, the neuronal activities were converted into proportional electrical currents and used to directly stimulate the paralysed muscles of the arm. Monkeys learnt to precisely control the cursor by increasing or decreasing the neuronal activity, which changed the amount of electrical current delivered to the muscles, and generated the appropriate levels of wrist torque. Moreover, monkeys could independently control the activity of a pair of neurons to specifically stimulate antagonistic pairs of muscles, thus effectively restoring movement of the paralysed arm (figure 1B). Although one could assume that activity of neurons associated with the wrist movement would be more accurate at generating wrist torques, the monkeys were able to control wrist torques by controlling activity of neurons irrespective of their association with the wrist movements. As compared with a BMI device controlling a robotic arm, restoring control of movement in the paralysed arm will reduce the hardware that the patients need to carry around. Use of the natural arm will also make the device less obtrusive and aesthetically more acceptable. In their study, Moritz et al. (2008) were able to produce large ballistic movements by muscle stimulation. It is not clear if a similar device can achieve fine control of complex finger movements as this would require rapid, simultaneous or sequential control of multiple neurons. A detailed understanding of the neural control of individual muscles and the role of sensory feedback in muscle control is necessary.

Terminalia arjuna reverses impaired endothelial function in chronic smokers.

BACKGROUND: Smoking, largely through increased oxidative stress, causes endothelial dysfunction which is an early key event in atherosclerosis. Smoking cessation and antioxidant vitamin therapy are shown to have beneficial role by restoring altered endothelial physiology. The present study was aimed to determine whether Terminalia arjuna, an Indian medicinal plant with potent antioxidant constituents, would improve endothelial dysfunction in smokers. METHODS AND RESULTS: Eighteen healthy male smokers (age 28.16+/-9.45 years) and equal number of age-matched non-smoker controls participated in the study. The baseline brachial artery reactivity studies were performed using high frequency ultrasound according to standard protocol under identical conditions to determine endothelium-dependent, flow-mediated dilation and endothelium-independent nitroglycerine-mediated dilation. The two groups were matched regarding age, body mass index, blood pressure, serum cholesterol, mean resting vessel diameters and post-occlusion flow velocities (all p=NS). While flow-mediated dilation was significantly impaired amongst smokers compared to controls (4.71+/-2.22 v. 11.75+/-5.94%, p <0.005), the nitroglycerine-mediated dilation was similar in the two groups (20.35+/-3.89 v. 19.68+/-3.74%, p=NS). Subsequently the smokers were given Terminalia arjuna (500 mg q8h) or matching placebo randomly in a double blind cross-over design for two weeks each, followed by repetition of brachial artery reactivity studies to determine various parameters including flow-mediated dilation after each period. There was no significant difference as regards vessel diameter and flow velocities between the two therapies. However, the flow-mediated dilation showed significant improvement from baseline values after Terrminalia arjuna therapy but not with placebo (9.31+/-3.74 v. 5.17+/-2.42%, p <0.005). CONCLUSIONS: Smokers have impaired endothelium-dependent but normal endothelium-independent vasodilation as determined by brachial artery reactivity studies. Further, Terrminalia arjuna therapy for two weeks leads to significant regression of this endothelial abnormality amongst smokers.

Degradation of predigested distillery effluent by isolated bacterial strains.

Batch studies were conducted on degradation of anaerobically digested distillery wastewater by three bacterial strains, viz. Xanthomonas fragariae, Bacillus megaterium and Bacillus cereus in free and immobilized form, isolated from the activated sludge of a distillery wastewater treatment plant. The removal of COD and colour with all the three strains increased with time up to 48 hr and only marginal increase in COD and colour removal efficiency was observed beyond this period up to 72 hr. After this period removal efficiency remained fairly constant up to 120 hr. The maximum COD and colour removal efficiency varied from 66 to 81% and 65 to 75%, respectively for both free and immobilized cells of all the three strains. The strain Bacillus cereus showed the maximum efficiency of COD (81%) and colour (75%) removal out of the three strains. An interrelationship between the percent COD and colour removal was carried out by correlation and regression analysis and was justified by high values of coefficient of correlation (r = 0.99) for all the cases. The first order removal rate kinetics was also applied and rate constants were evaluated for COD and colour removal efficiencies.