Clinical efficacy of medicinal leech therapy in treating third- and fourth-degree hemorrhoids / Eficácia clínica da hirudoterapia no tratamento de hemorroidas de terceiro e quarto graus

Abstract Objectives Hemorrhoids are characterized by bleeding, mucous discharge, itching, pain, and prolapse. This condition is known as bawaseer in Unani medicine, and Hirudinaria granulosa has been used for its treatment in Irsal-e Alaq, or medicinal leech therapy (MLT), for centuries. Hirudinaria granulosa with antithrombotic and antiinflammatory action is used in the treatment of chronic venous disease and hemorrhoids. The present study was aimed to investigate the efficacy of MLT in third and fourth-degree hemorrhoids. Methods A single-centre prospective, clinical trial with a pre and postanalysis design was conducted at the hospital of the National Institute of UnaniMedicine. Twenty male and female patients, with a mean age of 38 years, presenting moderate symptoms assessed with the colorectal evaluation of clinical therapeutics scale (CORECTS) questionnaire were included in the study. Hirudinaria granulosa were applied around the pile mass for 15 minutes weekly, for 4 weeks. The efficacy of the treatment was measured by an objective and subjective assessment using the CORECTS. Results When analyzed by the clinician, MLT reduced the symptoms' severity score in the following domains: pain (55% improvement; p < 0.001); anorectal itching (30% improvement; p < 0.10); and bleeding (10% improvement; p < 0.7963). Significant improvement (p < 0.001) was reported in the CORECTS score in relation to pain (44.09% improvement; p < 0.001), itching (38.55% improvement; p < 0.001), swelling (44% improvement; p < 0.001), bleeding (17.28% improvement; p < 0.007), discomfort (34.01% improvement; p < 0.001), and wellbeing (32.35 % improvement; p < 0.001), giving an average overall opinion on the therapy of 4/10. Conclusion The results of the study albeit smaller in sample size show that MLT is an effective and safe therapeutic option in reducing the symptoms of 3rd and 4th degree haemorrhoids.

Resumo Objetivos As hemorroidas são caracterizadas por sangramento, secreção mucosa, prurido, dor e prolapso. Esta condição é conhecida como bawaseer namedicina Unani, e a Hirudinaria granulosa tem sido usada para seu tratamento na Irsal-e Alaq, ou hirudoterapia, há séculos. A H. granulosa, devido à sua ação antitrombótica e antiinflamatória, é utilizada no tratamento de doenças venosas crônicas e hemorroidas. O presente estudo teve como objetivo investigar a eficácia da hirudoterapia em hemorroidas de terceiro e quarto graus. Métodos Este ensaio clínico prospectivo e unicêntrico com delineamento pré e pósanálise foi conduzido no hospital do National Institute of Unani Medicine. Foram incluídos no estudo 20 pacientes de ambos os sexos, com média de idade de 38 anos, que apresentavam sintomas moderados avaliados pelo questionário colorectal evaluation of clinical therapeutics scale (CORECTS). Espécimes de H. granulosa foram aplicadas em volta da área afetada por um período de 15 minutos semanais, durante 4 semanas. A eficácia do tratamento foi medida por uma avaliação objetiva e subjetiva usando o questionário CORECTS. Resultados Quando analisada pelo clínico, a hirudoterapia reduziu o escore de gravidade dos sintomas nos seguintes domínios: dor (55% de melhora; p < 0,001); prurido anorretal (melhora de 30%; p < 0,10); e sangramento (melhora de 10%; p < 0,7963). Melhora significativa (p < 0,001) foi relatada no escore CORECTS em relação à dor (44,09% de melhora; p < 0,001), prurido (38,55% de melhora; p < 0,001), inchaço (44% de melhora; p < 0,001), sangramento (17,28 % de melhora; p < 0,007), desconforto (34,01% de melhora; p < 0,001) e bem-estar (32,35% de melhora; p < 0,001), o que resultou em uma opinião geral média sobre a terapia de 4/10. Conclusão Os resultados do estudo, embora com tamanho de amostra pequeno, mostram que a hirudoterapia é uma opção terapêutica eficaz e segura na redução dos sintomas de hemorroidas de terceiro e quarto graus.

Design And Evaluation Of Buoyant Matrix System Of Nateglinide

The objective of the present study was to develop and optimize a buoyant tablet of Nateglinide to prolong the gastric residence time leading to reduce dose frequency which is an effective drug in the treatment of type II diabetes. The tablets were prepared by wet granulation technique using chitosan as a natural polymer in different ratios with sodium bicarbonate as gas generating agent. The compatibility of Nateglinide and all excipients were confirmed by FTIR spectroscopy. Pre-compression properties of granules are found within the prescribed limits and indicated good flow property. The tablets were evaluated for physical characteristics had shown that all of them comply with specifications of official pharmacopoeias. An optimized tablet formulation (F7) had less buoyancy lag time of 37 sec, total floating time of >12 hrs and higher the drug content of 100.16% and release of Nateglinide was 97.27 % after the end of 12 hours. From the kinetic modeling results, the drug release was Fickian diffusion controlled and followed zero order kinetics.

Pattern of vitamin D among Pakistani pregnant women

Vitamin D deficiency is an emerging health concern around the world, highly prevalent in south Asian population, despite abundant sunlight. In Pakistan, all age groups are vulnerable to Vitamin D deficiency including pregnant women. This systematic review aimed to determine the pattern of Vitamin D deficiency among Pakistani pregnant women as well as exploring the causes and possible interventions that have had a substantial effect on improving the vitamin D level. Three databases [PubMed, Pub Get and Google Scholar], for the present review up to 2016, were used for the identification of published peer reviewed original relevant studies regarding Vitamin D deficiency among Pakistani pregnant women with the keywords Vitamin D or 25-hydroxyvitamin D or 25[OH]D in combination with pregnant women. Five studies were included for the final analysis. Vitamin D deficiency was common and highly prevalent among Pakistani pregnant women and their neonates. The main reasons for this were found to be avoiding sun exposure, quality of diet, and lower intake of calcium. Maternal vitamin D supplementation was found to be a key intervention to improve the maternal and neonatal vitamin D status. These review findings can be emerging in ensuring the adequate vitamin D level for Pakistani pregnant women during pregnancy, ultimately to achieve positive maternal and neonate's health outcomes

Assessment of antimicrobial, antioxidant and cytotoxicity properties of Camellia sinensis L.

The phytochemical screening, antimicrobial, antioxidant and cytotoxic properties of Camellia sinensis were evaluated in the present study. The phytochemical screening revealed the presence of an applicable amount of lycopene, beta-carotenes, flavonoids and tannins in C. sinensis. Among the phytochemicals, tannin was found to be significantly higher in tea plant. The antimicrobial activity of plant extracts against selected bacterial strains namely, Escherichia coli, Staphylococcus aurous, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Marginella morganii and Haemophilus influenzae was investigated. The results showed that the stem part of C. sinensis presented greater antimicrobial potential than the leaf and root. Antioxidant activity [assessed through % inhibition of linoleic acid per oxidation test] was the highest [89.22%] in n-hexane extract of root part as compared to other extracts. Finally, the cytotoxicity analysis [haemolytic activity against human erythrocytes] of plant extract showed the negligible [%] lysis of RBCs ranging from 1.73 to 4.01%. In conclusion, it can be suggested that C. sinensis is the potential source to obtain bioactive phenolic compounds with high antimicrobial and antioxidant properties, which could possibly be exploited for the treatment of various infectious diseases

Knowledge and perception about polio vaccination approval among religious leaders

Objective: To examine the knowledge and perception among religious leaders regarding polio vaccine approval

Methodology: A cross sectional population study was conducted in three districts [Bahawalpur, Bahawalnagar and Rahim Yar Khan]. Sample of size of 120 religious leaders [RLs] was taken by using convenient sampling technique. Descriptive and inferential analysis was carried out

Results: Every 9 out of 10 participants heard about the polio vaccination whereas every 2 out of 10 tend to disapprove it. Several reasons for disapproval were reported, majority [32.26%] of the participants believed that polio vaccine reduces the sexual power and affect the sperm [sterilize] as children grown up this was followed up by the vaccine consist of forbidden [Haram] ingredients [29.03%], its Jews lobby to destroy the muslim generation [22.58%] and it's a plan to reduce the muslim population [16.13%]

Conclusion: Although higher proportion of religious leaders approves the polio vaccination but at the same time misconception exists

Design specifications of ergonomic sofa through sofa makers perception: a case study in Malaysia

Development of ergonomic sofa design is a design process that has the basic framework specification and type of material that is applied on the sofa design. This is due to human consumption that is closely related to ergonomic design of this specification which will affect human physical. To achieve this goal, a survey involving 30 respondents of sofa makers was conducted to get feedback regarding the sofa design specifications. Survey questions emphasize on the basic specifications and material dimensions of sofa materials used. The results of data analysis show that the size of basic dimensions and materials is essential in designing an ergonomic sofa. The survey is very important to find out the basic specifications in the development of ergonomic design through perception of sofa maker.

Homozygous mutations in NTRK1 gene underlie congenital insensitivity to pain with anhidrosis in Pakistani families

Congenital insensitivity to pain with anhidrosis is a rare autosomal recessive disorder presenting with loss of pain sensation, thermal sensation defects, and self-mutilating behavior. In the present study, we recruited two consanguineous pedigree showing pain insensitivity symptoms from Pakistan for clinical and molecular investigations. In family A, one female patient displayed classical CIPA symptoms along with microcephaly and severe intellectual disability. During course of the disease, her right foot was amputated and had remarkable dental degeneration and teeth shedding. In family B, one boy presented with classical symptoms of congenital insensitivity to pain with anhidrosis. Blood was collected from both families for molecular studies. Sequencing with the Ilumina Trusight One Sequencing Panel covering 4813 OMIM genes revealed a known homozygous mutation c.2084C>T; p.P695L of NTRK1 in family A and a novel truncated mutation c.2025C>G; p.Y681X in family B. Protein modeling analysis of both mutations (p.P695L and p.Y681X) predicted loss of the rigidity in tyrosine kinase domain of NTRK1 that led to conformational changes as well as deleterious effect on protein function. The known mutation was reported more than a decade ago in a family from Northern Israel and other non-sense mutation is newly identified. It is interested that most of NTRK1 mutations are associated with this domain. This is first ever report of NTRK1 variants in congenital insensitivity to pain with anhidrosis patients from Pakistan.

Effect of Glutamate on the Vestibulo-Solitary Projection after Sodium Nitroprusside-Induced Hypotension in Conscious Rats

Orthostatic hypotension is most common in elderly people, and its prevalence increases with age. Attenuation of the vestibulo-sympathetic reflex (VSR) is commonly associated with orthostatic hypotension. In this study, we investigated the role of glutamate on the vestibulo-solitary projection of the VSR pathway to clarify the pathophysiology of orthostatic hypotension. Blood pressure and expression of both pERK and c-Fos protein were evaluated in the nucleus tractus solitarius (NTS) after microinjection of glutamate into the medial vestibular nucleus (MVN) in conscious rats with sodium nitroprusside (SNP)-induced hypotension that received baroreceptor unloading via sinoaortic denervation (SAD). SNP-induced hypotension increased the expression of both pERK and c-Fos protein in the NTS, which was abolished by pretreatment with glutamate receptor antagonists (MK801 or CNQX) in the MVN. Microinjection of glutamate receptor agonists (NMDA or AMPA) into the MVN increased the expression of both pERK and c-Fos protein in the NTS without causing changes in blood pressure. These results indicate that both NMDA and AMPA receptors play a significant role in the vestibulo-solitary projection of the VSR pathway for maintaining blood pressure, and that glutamatergic transmission in this projection might play a key role in the pathophysiology of orthostatic hypotension.

Anti retroviral life-saving therapy; a curve fitting approach in Pakistan

Effective implementation of mathematical and statistical models maximizes the likelihood of understanding the trajectory, level and pattern of incurable diseases and their therapies, so that precise demand strategies for costly lifesaving therapies for future, resource allocation and timely intervention could be ensured, a significant concern for less developed countries like Pakistan. The record of monthly number of patients on lifesaving anti-Retroviral Therapy for more than 18 HIV treatment centers in Pakistan was acquired for the period January 2011 to July 2013.A set of eleven curve fitting models namely linear, quadratic, cubic, logarithmic, inverse ,exponential growth model, logistics-curve and compound models was carried out for prediction. After the execution of various curve fitting models by taking the ANOVA approach along with coefficient of determination and the forecast accuracy measures namely, mean percentage error [MAPE], mean absolute error [MAE] and mean square error [MSE] in the selection of final efficient model. Cubic model was selected for forecasting the monthly anti-retroviral therapy cases for all categories i.e. overall, male female and children. On the basis of final selected model 3% increment is expected number of paticuts on anti-retroviral therapy annually in HIV treatment center in all Pakistan. Male patients are expected to increase 14% who will get lifesaving anti-retroviral therapies. While the annually expected reduction of 17% and 42% in female and children cases taking anti-retroviral therapy is expcted in future respectively. The overall number of people on anti-retroviral therapy are expected to increase in Pakistan. Males are expected to have greater risk as compared to female and children in Pakistan

Infant polio immunization; time series modeling towards coverage in Pakistan

Poliomyelitis is a highly infectious disease but preventable by effective vaccines. Children under five year of age affected by this disease as a result a permanent paralysis. To uncover the trend of infant polio immunization coverage through modeling is a significant concern to formulate an adequate vaccination strategies and program after the outbreak of new cases of polio in a recent year in Pakistan. The reported data of monthly infant polio immunization coverage to National Institute of Health, Islamabad, Pakistan from January 2008 to July 2013 for the present study has been taken from Pakistan bureau of statistics with total time series entities 67. National Institute of Health, Islamabad took the record of per month number of doses administered [0-11 months] children by the registered health centre in pakistan. January 2008 - July 2013. Pakistan bureau of statistics [Statistics House]. A set of various short term time series forecasting models namely Box-Jenkins, single moving average, double moving average, single parameter exponential smoothing, brown, Holts and winter models were carried out to expose the infant polio immunization coverage trend. Among the several forecasting models ARIMA models are chosen due to lower measure of forecast errors namely root mean square error [RMSE], mean absolute error [MAE] and mean absolute percentage error [MAPE]. ARIMA [2,1,1], ARIMA [1,0,2], ARIMA [0,1,2] and ARIMA [2,1,1] models are established as an adequate models for the prediction of OPV-0, OPV-1, OPV-2 and OPV-3 respectively. With the exception of OPV-1 the infant polio immunization coverage is expected to rise in Pakistan

HIV/AIDS awareness in Pakistan; binary logistic regression analysis of PDHS-2012-13

Globally 35 million people were living with HIV in 2013 whereas around 78 million people have been infected since the start of the epidemic and 39 million people have died of AIDS- related illness. To examine the factors associated with HIV/AIDS awareness of ever married men and women age 15-49. The secondary data sets are used of Pakistan demographic and health survey [PDHS] of ever married men and women with sample size 3134 and 13558. PDHS 2012-13. The national institute of population studies done this survey with the technical support from ICF International and Pakistan bureau of statistics and the USAID supported the financially. Bivariate and binary logistic regression analysis has been carried out to evaluate the significant socio demographic factors. Every 7 out of 10 ever married men have heard about AIDS, while the situation is much critical for ever married women, 6 out of 10 have not heard about HIV/AIDS. Generally finding revealed that almost both of the respondents have misconception regarding HIV/AIDS transmission. Two binary logistic regression models are executed one for ever married man and other for ever married women. Two models revealed that early age groups have less knowledge about HIV/AIDS; urban has more knowledge compared to rural. Education level, media assess and wealth index have positive association regarding to HIV/AIDS awareness. Socio-demographic aspects such as age, education, place of residence and access to media TV, radio and newspaper, wealth index and occupation are found to be significant varied systematically with the awareness of HIV/AIDS. These statistical outcomes will enhance the capability in disease management and control

Road traffic accidents; prediction in Pakistan

To determine the trend of road traffic accidents [RTAs] and forecasting their incidence is an emerging to take safety measures so that general public health related morbidity and mortality can be minimized. The data for present study has been taken from Pakistan bureau of statistics [statistics House]. January 2002-2003 to December 2011-2012. A set of eleven curve fitting models namely linear, quadratic, cubic, logarithmic, inverse, exponential growth model, logistics-curve ,and compound models were carried out for prediction. Under the descriptive analysis, the annual average number of fatal and non-fatal accidents is 43.3% and 56.7% respectively. In provinces Punjab contributes to a high rate of total number of accidents, while Khyber Pakhtunkhwa, Sindh and Baluchistan placed second, third and fourth respectively. Under the curve fitting estimation, the cubic model was selected for predicting the annual traffic road accident for all categories i.e. [i] Total Number of Accident [ii] Fatal Accident [iii] Non-Fatal Accident [iv] Killed People [v] Injured People and [vi] The Number of Vehicle Involved. Rising trend in all categories are expected in Pakistan. The traffic road accident is expected to rise in Pakistan

Perianal fistula; evaluation of the Perianal fistula by MRI: our experience

MRI is increasingly used nowadays in the evaluation and management of Perianal Fistula. To assess the role of MRI in the detection and classification of Perianal Fistula and correlation of preoperative MRI findings with the findings on surgery. Prospective study. Department of Radiology King Khalid Civilian Hospital Tabuk Kingdom of Saudi Arabia. Two years between February 2013 and February 2015. 60 patients were referred from surgical department for evaluation of Perianal fistula by MRI during the above mentioned period. MRI was performed in 48 Patients. [42 males and 6 Females] using variety of MRI sequences. Fistulas were classified according to SJUH [St James's University Hospital classification MR imaging based grading system] and MRI findings of individual MRI sequence used were correlated with operative findings. Most common fistula was Grade 1 [37.5%].In majority of the cases internal opening was found at 6 O clock position. Post intravenous contrast enhanced Axial and coronal oblique [CE FST1WFSE] Fat suppressed T1 weighted Fast spin echo and Axial and coronal Fat suppressed T2W FSE sequence [FST2WFSE] showed the highest Accuracies 98.13% and 97.06% respectively in diagnosis of anorectal fistulae. MRI should be used as a first line imaging modality in the preoperative assessment of Perianal fistula. Findings on Axial and coronal oblique CE FST1WFSE, axial and coronal oblique FST2WFSE showed the excellent agreement with the surgical findings. By using MRI as the first line imaging modality in the evaluation of Perianal Fistula one can percept best possible surgical management resulting in prevention of residual/ recurrence disease and complications such as fecal incontinence

TB knowledge and perception; trends: evidence from Pakistan

To uncover the trend regarding TB knowledge and perception of its transmission as well as underlining the socio demographics aspects associated with TB cure among the reproductive venerable women. Quantitative frame work along with inferential analysis have been carried out by using the Pakistan Demographic and Health Survey 2006-07 and 2012-13 of ever married women. Trend regarding TB awareness and its cure and treatment have been changed over time by 4.31% and 4.49% respectively in PDHS 2012 compared to PDHS 2006. Whereas an adequate knowledge of TB transmission thought air when coughing and sneezing remain constant after equating the two surveys. To understand the functional relationship of variables multinomial logistic regression analysis was carried out separately for PDHS 2006 and PDHS 2012. Two models revealed that early reproductive age group 15-19 of ever married women believed that TB cannot be curable compared to their counterparts upper age groups 45-49. Illiterate ever married women are more pronounced [OR=5.38 and OR=10.30] that TB is an incurable infectious disease compared to women having higher educational degree in PDHS 2006 and PDHS 2012 respectively. Location and geographical area of residence, wealth index, and media exposure have positive association about TB knowledge of cure and treatment. Although the awareness level improved but it still needs to launch some massive and wide-ranging awareness programme regarding an adequate knowledge of various diffusion modes of tuberculosis by utilizing all media modes predominantly television. Potential struggles are obligatory where the subordinate literacy rate and limited health care settings meticulousness in remote areas, so that the illness and death due to TB can be minimized

Sexually transmitted infections; trends and differentials

Objectives: This study aimed to uncover the trend regarding knowledge about sexually transmitted infections [STIs] among Pakistani women of reproductive age 15-49 as well as evaluating the socio demographic differentials associated with STIs knowledge

Design: The secondary data sets are used of Pakistan demographic and health survey [PDHS] of ever married women with sample size 10023and 13558

Period: PDHS 2006-07 and PDHS 2012-13

Setting: The national institute of population studies done this survey with the technical support from ICF International and Pakistan bureau of statistics and the USAID supported the financially

Methods: Descriptive frame work along with bivariate analysis was performed to understand the trend regarding STIs knowledge and evaluate the significant socio demographic factors respectively

Results: The awareness regarding STIs and knowledge to use always condom during sex to reduce the risk of getting HIV/AIDS after equating the two PDHS has improved over time just by 3.85% and 6.50% respectively in PDHS-2012-13 compared to PDHS 2006-07. Early age group [15-19] women have sufficient lack of knowledge about STIs. Urban has more knowledge regarding STIs compared to rural. Education, wealth index and media awareness have positive association with STIs knowledge

Conclusions: Socio demographic differentials such as age, education, location and geographical area of residence, media access, wealth index and women occupation are found to be statistically highly significant with respect to sexually transmitted infections knowledge. These statistical outcomes will enhance the capability in disease management and control

HIV/AIDS awareness; long distance truck drivers

Objectives: to examine the awareness regarding HIV/AID and sexual behavior among long distance truck drivers [LDTDs] in Bahawalpur division

Study design: a cross sectional population study

Setting: three districts [Bahawalpur, Bahawalnagar and RYK]

Data: sample of size of 120 LDTDs is taken by using convenient sampling technique

Methods: descriptive and inferential analysis carried out

Results: every 6 out of 10 LDTDs have heard aboutHIV/AIDS and believed that sexual intercourse is a major mode of its transmission. The use of condom before sex is seldom among truckers. Exactly half of LDTDs have only one sexual partner while nearly quarter [23.3%] of the respondents currently having two sexual partners. Over half [54.2%] of truckers made payment for sex with commercial sex workers [CSWs] and only 3.3% did so with their helper/conductor. Two models are executed separately to explore the association of trucker's knowledge about HIV/AIDS [Model 1] and those who paid for sex [Model 2]. Pearson chi-square analysis exhibits that respondents having age group 25-30 year, those with native of Punjabi language, those who manage to earn more than 15,000 Pakistani rupees per month, those having secondary level of schooling and those watching TV has higher knowledge regarding HIV/AIDS. LDTDs with age thirty years and over, Saraiki speaking, monthly income less than 10,000, illiterate, unmarried, watching TV and remain away from home during current trip a week are found to be more prone to pay for sex to CSW

Conclusions: the awareness of HIV/AIDS and knowledge of its transmission through sexual contact is high among LDTDs but still public health strategies are needed to promote the knowledge of all possible transmission modes of HIV/AIDS and use of condom before sex, ultimately to improve health outcomes

Clinical study of primary hyperlipidaemia and the role of Kalonji [nigella sativa] and Saboos-e-Asapghol [plantago ovata] in its management

Lipid disorders comprise the most prevalent serious disorders in industrialized nations and are a rapidly growing problem in developing nations. The growing prevalence of obesity, type 2 diabetes mellitus, hyperlipidaemia and metabolic disorders are important risk factors for atherosclerosis. To cure the hyperlipidaemia several synthetic drugs of better efficacy are being introduced in the modern system of medicine. But most of the medications induce adverse side effects. Therefore search for safe and effective lipid lowering drugs was the main motivating factor behind this study. In Unani System of Medicine many drugs [single drugs as well as compound formulations] are used for the purpose of reducing body weight and treating the obesity. Saboos-e-Asapghol [Plantago ovata] and kalonji [Nigella sativa] are among these medicines. Their efficacy has also been proved pharmacologically and documented as good hypolipidemic. A clinical study was carried out in Ajmal Khan Tibbiya College Hospital on 60 patients of primary hyperlipidaemia. The diagnosis was made on inclusion and exclusion criteria. The Unani formulation Sufoof-e-Kalonji [Nigella sativa] 2 gm and Saboos-e-Asapghol [Plantago ovata] 4 gm twice daily before meal were given for 90 days

The combination of drugs was found to be significant in lowering the lipid level and in increasing the level of serum HDL-cholesterol, in patients of primary hyperlipidaemia. Therapeutic responses were evaluated through follow up observations at 45th day interval. The results were analyzed statistically and results were encouraging

Effect of Vestibulosympathetic Reflex and Baroreflex on Expression of pERK in the Nucleus Tractus Solitarius following Acute Hypotension in Conscious Rats

Control of blood pressure is maintained by the interaction between the arterial baroreflex and vestibulosympathetic reflex during postural changes. In this study, the contributions of vestibular receptors and baroreceptors to the maintenance of blood pressure following acute hypotension were compared in terms of phosphorylated extracellular regulated protein kinase (pERK) expression in the nucleus tractus solitaries (NTS). Expression of pERK in the NTS was measured in conscious rats that had undergone bilateral labyrinthectomy (BL) and/or sinoaortic denervation (SAD) 5, 10, 20, and 40 min following acute hypotension induced by sodium nitroprusside (SNP) infusion. Expression of pERK increased significantly in the NTS in the control group following SNP infusion, and the expression peaked at 10 min after SNP infusion. The number of pERK positive neurons increased following SNP infusion in BL, SAD, and BL+SAD groups, although the increase was smaller than in control group. The BL group showed a relatively higher reduction in pERK expression than the SAD group, and the pERK expression in the NTS was localized to the caudal portion of the nuclei in the BL and SAD groups. These results suggest that the vestibular receptors may play a key role in maintaining blood pressure following acute hypotension; thus, the vestibular system may contribute to compensate for orthostatic hypotension.

27G Quincke spinal needle for spinal anaesthesia in Caesarean section: A study of 50 cases.

Background: Post dural puncture headache (PDPH) is a serious complication of spinal anaesthesia and incidence is more particularly in parturient. Aims & Objective: The present study was designed to investigate the use of 27 Gauge (G) spinal needle for spinal anaesthesia in Caesarean section in terms of success and PDPH rate. Material and Methods: We included total 50 female patients of aged 20-40 years old, were administered spinal anaesthesia with 27G Quincke spinal needle for Caesarean section by same investigator having enough experience. Redirections and attempts for lumbar puncture, success rates of spinal anaesthesia and PDPH were recorded. Results: We succeeded in 49 patients (98%) to administer spinal anaesthesia. The mean attempt and redirections for lumbar puncture were 1.1 and 1.24 respectively. We found PDPH in 1 patient (2%), which was mild in severity and subsided within two days. Conclusion: Spinal anaesthesia using a 27G Quincke spinal needle, in experienced hands can have successful spinal block with reduced PDPH rates in patients undergoing Caesarean section.