Anti-avian influenza virus H[9]N[2] activity of aqueous extracts of Zingiber officinalis [Ginger] and Allium sativum [Garlic] in chick embryos

In the present study, anti-Avian influenza virus H9N2 activity of aqueous extracts [5, 10, 15, 20, 25%] of Zingiber officinalis and Allium sativum was evaluated. Embryo-toxicity was evaluated by histopathological scoring of Chorio-allantoic membrane of chick embryos. Cytotoxicity of extracts was determined by MTT assay on Vero cells. Aqueous extract of ginger had antiviral activity at 10, 15, 20 and 25% while garlic had activity at 15, 20 and 25%. Histopathological scoring of chorio-allantoic membrane for aqueous extracts [5, 10, 15, 20, 25%] of ginger [0.66+/-0.57, 1.33+/-0.57, 1.66+/-0.57, 2.66+/-0.57, 3.66+/-0.57, respectively] and garlic [1.00+/-0.00, 1.33+/-0.57, 2.00+/-0.00, 2.33+/-0.57, 3.66+/-0.57, respectively] was concentration dependant. MTT assay revealed cytotoxicity of both plants was also concentration dependent. Extracts of ginger [5, 10, 15, 20, 25%] had lower cytotoxicity [71, 59, 28, 22, 0 % cell survival, respectively] as compared to garlic [61, 36. 20, 11, 3% cell survival, respectively]. Overall results revealed that concentration of aqueous extract of ginger [10%], showing antiviral activity against H[9]N2, was less toxic to vero cells [> 50% cell survival]. It is insinuated that ginger may have anti- Avian influenza virus H9N2 potential and its active compounds needs further investigations

Rationalization of routine crossmatched blood arrangement for caesarean deliveries and analysis of risk factors requiring blood transfusion

Objective: To assess the incidence of blood transfusions required in Caesarean section [CS] and evaluate the rationale of routinely arranging cross matched blood for every patient

Study Design: A chart review retrospective descriptive study

Place and Duration of Study: This study was conducted at the Anesthesia Department of Combined Military Hospital [CMH], Lahore, from June 2011 to May 2013

Patients and Methods: In this retrospective study we reviewed all singleton CS performed using data from blood bank registry and all CS patient's charts obtained from the Records Department of the hospital. Clinical variables including demographic characteristics, estimated blood loss, indications for CS, preoperative haemoglobin and indications for transfusion were gathered. Patients transfused with blood had their medical records reviewed by two reviewers to confirm accuracy and identify risk factors for haemorrhage

Results: A total of 6250 caesareans deliveries were performed over the study period. Out of these 381 patients were transfused [6.09%]. Blood typing and screening was done for 3260 cases [52%] and blood was arranged for 2320 [37%]. Among blood receiving patients 250 patients [65.62%] were emergencies. Ninety eight patients [25.72%] were primigravida. Indications for transfusion mentioned in the charts were preoperative anaemia [18.37%], repeat caesarean sections [39.37%], placenta previa [6.56%], severe preeclampsia [17.06%], failed progress in labor and other rare causes [18.37%]

Conclusion: Transfusion risk in patients undergoing routine CS is low. Factors indicating risk for transfusion include preoperative anaemia, repeat caesareans, severe preeclampsia, obstructed labor and placenta previa. In the absence of these risk factors routine arrangement of the blood does not enhance patient care

Antioxidant and nutraceutical value of wild medicinal Rubus berries

Nutritional quality and antioxidant capacity of three edible wild berries [Rubus ellipticus Smith, Rubus niveus Thunb, Rubus ulmifolius L.] from Lesser Himalayan Range [LHR] were evaluated. Their edible portion was assayed for moisture, fats, ash, carbohydrates, proteins, fibers, essential minerals [Ca, P, Mg, K, Na, Cl, S, Mn, Zn, Fe, Cu, Se, Co, Ni] and DPPH free radical scavenging activity was applied to determine the antioxidant potential. The fruit of Rubus ulmifolius L. [blackberry] possessed the highest values of energy [403.29 Kcal], total protein [6.56g/100 g], Nitrogen [N] content [1500mg/100g], K [860.17mg/100g], Ca [620.56mg/100g], Zn [17.509mg/100g] and the strongest antioxidant activity [98.89% inhibition]. While the raspberries [Rubus ellipticus Smith, Rubus niveus Thunb.] exhibited more significant contents of dietary fiber [5.90g/100g], carbohydrates [86.4 g/100 g] and Fe [4.249mg/100g]. Significant variation was observed among the tested samples in all the investigated features. The combination of bio elements and active antioxidants clearly showed the applicability of these berries as a nutraceutical supplement

Feasibility and safety of transabdominal chorionic villus sampling

Chorionic Villus Sampling [CVS] is the technique of choice for prenatal diagnosis prior to 12 weeks gestation. The objective of this study was to determine the feasibility, and pattern of complications following first trimester Trans-abdominal Chorionic Villus Sampling [TA-CVS]. This was a descriptive study conducted in the Obstetrics and Gynaecology Department Military Hospital [MH] Rawalpindi from Jan 2007 to July 2008. Couples at risk of giving birth to a child with genetic disorder were identified and counselled. Trans-abdominal Chorionic Villus Sampling was done using double needle technique under ultrasound guidance. Immediate and late complications were followed up. Data was analysed using SPPS-10. On 200 cases chorionic villus sampling was done as an outdoor procedure. Most common indication was thalassaemia trait 75 [37.5%]. Most procedures were done between 12-13 weeks. All placental positions including 104 [52%] posterior and 71 [35.5%] anterior were approachable. Most aspirations were easy, however, in 30 [15%] the aspiration was difficult. Overall success rate was 100%. In 158 [79%] of the cases sample yield was good. One [0.5%] patient had vaginal bleeding and three [1.5%] had placental haematoma formation. Most patients [84%] experienced mild pain during the procedure. The procedure related miscarriage occurred in 2 [1%] patients while another patient developed this complication after 6 weeks. First trimester TA-CVS is an accurate and safe invasive prenatal diagnostic procedure. Placentas in almost any position can be approached without any significant risk to mother and the foetus.

Efficacy of cervical cerclage in sonographically shortened cervix in women at moderate risk of preterm delivery

To compare the efficacy and safety of cervical cerclage following objective shortening of cervix by endovaginal ultrasound with elective cerclage in women at high risk of midtrimester miscarriage or preterm delivery. Quasi experimental. Place and Duration of study: Military Hospital Rawalpind., January 2005 to July 2008. Material and Cases of elective cerclage were matched for maternal age, previous history of single mid trimester loss or preterm delivery or preterm rupture of membranes before 34 weeks with women who had selective cerclage if cervical length became < 25mm. All patients were followed up till delivery and outcomes in the two groups were assessed in terms of duration of gestation and neonatal survival. 23 cases of elective cerclage were matched to 24 cases of selective cerclage. Transvaginal ultrasound indicated cerclage was performed in 50% of the control group due to decrease in cervical length. There was no significant difference in the number delivering before 25 weeks 2[8.6%] versus 3[12.4%], those delivering at gestation>35 weeks 17 [73%] versus 16[66.6%][p=0.94]. Neonatal survival was also similar 18[78%] versus 19[79%] p=0.96. Cervical length as measured by TVS is the best available technique for predicting preterm labour. In women deemed moderately high risk on the basis of history, sonographic cervical length indicated cerclage appears to reduce cerclage rates without comprising pregnancy outcome

Rising caesarean section rate; making sense of it is it unavoidable?

Compare indications for caesarean section in Military Hospital Rawalpindi in the year 1999 with the year 2005, six years apart, with an aim to identify areas where caesarean section rates could be decreased. Prospective Survey of caesarean section using information provided by doctors/midwives entering data in labour ward /theater registers. The study was designed as a process evaluation. Indication for caesarean section, parity, previous caesarean section, emergency / elective, labour / pre labour, presence of previous caesarean section scar, induced or spontaneous labour were noted. Data was plotted into 2 separate classifications and indications compared across the 2 years 1999 versus 2005. Statistical significance was calculated and value of <0.05 was considered significant. Overall section rates rose from 16.9% to 34.6% which showed almost doubling of rates in a span of 6 years. The chief contributors to rising rates were as follows. Caesarean section rate rose from 132 [2.2%] to 355 [4.6%] for previous one Caesarean section [p<0.001], from 172 [2.9%] to 383 [5%] for previous >1 caesarean [p<0.001], that for nullipara increased from 203 [3.3%] to 632 [8.3%], prelabour or induced labour [p<0.001] and for dystocia from 150 [2.5%] to 490 [6.4%] which was again significant [p<0.001]. Increase in section rate for antepartum haemorrhage, diabetes, previous infertility and intrauterine growth restriction was insignificant. A decrease in the number of caesarean sections may be achieved by reducing the number of primary caesarean section and/or encouraging more patients to take a trial of scar. A decrease in induction rates may also lead to lowering of caesarean section rates