Role of mifepristone in pre-induction cervical ripening: a double blind placebo-controlled study

Background: Mifepristone has been used for cervical priming and labour induction for long with modest success. This double-blind study compares mifepristone with placebo in causing cervical ripening and inducing spontaneous labour in women past their expected date of delivery.Methods: 200 women at 40 weeks gestation received mifepristone or placebo after Bishop score was assessed. 48 hours later, cervical score was rechecked. Improvement in Bishop score was noted as primary outcome measure. Incidence of spontaneous labour, cesarean delivery and meconium staining of liquor during labour was also monitored.Results: 16 women went into labour before 48 hours and 184 were evaluable. Improvement in Bishop score was noted in significantly more women in mifepristone group (82/94 versus 42/90, p<0.0001). Mean change in Bishop score was 3.22 in mifepristone group and 1.61 in placebo group. This advantage in cervical ripening with mifepristone did not translate into better obstetric outcome. The incidence of spontaneous labour (64/94 mifepristone versus 60/90 placebo), cesarean section (4/94 versus 12/90) and MSL (8/94 versus 10/90) was comparable in the two groups and did not reach statistical significance.Conclusions: Mifepristone has a beneficial effect on cervical ripening in term pregnancies but does not offer obstetric advantage in terms of higher rates of spontaneous labour or vaginal delivery.

N‐terminal diproline and charge group effects on the stabilization of helical conformation in alanine‐based short peptides: CD studies with water and methanol as solvent

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137582/1/psc3005.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137582/2/psc3005_am.pd

Gaucher's disease: a case report

Gaucher's disease (GD) is an autosomal recessive disorder, characterized by lack of acid β-glucosidase (glucocerebrosidase) enzyme resulting in accumulation of glucosylceramide in different organs. This enzyme is encoded by a gene on chromosome 1. Accumulation of glucosylceramide in tissues leads to multisystem organ involvement viz. liver, spleen, bone marrow, lungs and central nervous system. It is common in Ashkenazi Jews but rare in India. Around five hundred cases are identified and diagnosed in India. Serum β-glucosidase levels <15% of mean normal activity confirms the diagnosis, enzyme replacement being the only definitive treatment. Here we report a case of Gaucher’s disease

Comparative Study of Colour Doppler versus Non Stress Test as a predictor of Perinatal outcome in PIH and IUGR

Background: Hypertensive disorders and intrauterine growth restriction are common complications encountered during pregnancy. This study was conducted to observe the usefulness of systolic/ diastolic (S/D) ratio in umbilical artery as compared with non-stress test (NST) to predict perinatal outcome in pregnancies complicated with hypertensive disorders and intrauterine growth restriction (IUGR). Methods: It was a prospective observational which was conducted on patients undergoing antenatal visits at the department of obstetrics and gynaecology, Army hospital research and referral, New Delhi from May 2017 to April 2019. NST was started at 32 weeks twice weekly in all patients. All patients were subjected to umbilical artery Doppler velocimetry waveform on weekly basis or every third day in cases of nonreactive NST. Results: Out of 140 patients, 53 patients (37.9%) had PIH and 44 (31.4%) had IUGR. 43 cases (30.7%) had both PIH and IUGR. Among the 140 patients, 40 patients (28.6%) had non-reactive NST and 60 patients (42.9%) of the patients had abnormal doppler. Abnormal doppler and non-reactive NST were associated with APGAR score of less than 7 at 5 minutes in the newborn. Abnormal perinatal outcome was more in abnormal doppler than normal doppler and the finding was statistically significant (p&lt;0.05). Conclusions: Overall sensitivity and diagnostic accuracy of Doppler is better as compared to that of NST in terms of detecting adverse perinatal outcomes

Accuracy of intraoperative frozen section in the diagnosis of ovarian neoplasms: Experience at a tertiary oncology center

BACKGROUND: Epithelial ovarian neoplasms are an important cause of morbidity and mortality in women. The surgical management of ovarian neoplasms depends on their correct categorization as benign, borderline or malignant. This study was undertaken to evaluate the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasms. METHODS: Intraoperative frozen section diagnosis was retrospectively evaluated in 217 patients with suspected ovarian neoplasms who underwent surgery as primary line of therapy at our institution. This was compared with the final histopathologic diagnosis on paraffin sections. RESULTS: In 7 patients (3.2%) no opinion on frozen section was possible. In the remaining 210 patients frozen section report had a sensitivity of 100%, 93.5% and 45.5% for benign, malignant and borderline tumors. The corresponding specificities were 93.2%, 98.3% and 98.5% respectively. The overall accuracy of frozen section diagnosis was 91.2%. The majority of cases of disagreement were in the mucinous and borderline tumors. CONCLUSION: Intraoperative frozen section has high accuracy in the diagnosis of suspected ovarian neoplasms. It is a valuable tool to guide the surgical management of these patients and should be routinely used in all major oncology centers

Role of Brain Angiotensin-II in Development of Experimental Diabetic Nephropathy in Wistar Rats

Abstract The renin-angiotensin-aldosterone system (RAAS) plays a key role in diabetic nephropathy (DN). Angiotensin-II secreted during the RAAS pathway increases nephropathy. It stimulates oxidative stress which can quench nitric oxide. Reduced nitric oxide level aggravates Ang-II-induced vasoconstriction. Ang-II has also emerged as a central mediator of the glomerular hemodynamic changes that are associated with renal injury. Deletion of ACE2 is also noted due to increased Ang-II level which leads to the development of DN. We hypothesize that nephropathy caused by Ang-II in the periphery may be controlled by brain RAAS. ACE inhibitors and ARBs may show the renoprotective effect when administered through ICV without crossing the blood-brain barrier. DN was observed after 8 weeks of diabetes induction through alloxan. Administration of captopril and valsartan once and in combined therapy for 2 weeks, significantly reduced urine output, blood urea nitrogen, total protein in the urine, serum cholesterol, serum creatinine, serum triglycerides, and kidney/body weight ratio as compared to diabetic control rats. Further, combination therapy significantly increased the body weight and serum nitrate level as compared to diabetic control animals. However, increased ACE2 levels in the brain may reduce the sympathetic outflow and might have decreased the peripheral activity of Ang-II which shows beneficial effects in DN

Scrutiny of the mechanism of small molecule inhibitor preventing conformational transition of amyloid-β₄₂ monomer: insights from molecular dynamics simulations

<p>Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is characterized by loss of intellectual functioning of brain and memory loss. According to amyloid cascade hypothesis, aggregation of amyloid-β₄₂ (Aβ₄₂) peptide can generate toxic oligomers and their accumulation in the brain is responsible for the onset of AD. In spite of carrying out a large number of experimental studies on inhibition of Aβ₄₂ aggregation by small molecules, the detailed inhibitory mechanism remains elusive. In the present study, comparable molecular dynamics (MD) simulations were performed to elucidate the inhibitory mechanism of a sulfonamide inhibitor <b>C1</b> (2,5-dichloro-N-(4-piperidinophenyl)-3-thiophenesulfonamide), reported for its <i>in vitro</i> and <i>in vivo</i> anti-aggregation activity against Aβ₄₂. MD simulations reveal that <b>C1</b> stabilizes native α-helix conformation of Aβ₄₂ by interacting with key residues in the central helix region (13–26) with hydrogen bonds and <i>π</i>–<i>π</i> interactions. <b>C1</b> lowers the solvent-accessible surface area of the central hydrophobic core (CHC), KLVFF (16–20), that confirms burial of hydrophobic residues leading to the dominance of helical conformation in the CHC region. The binding free energy analysis with MM–PBSA demonstrates that Ala2, Phe4, Tyr10, Gln15, Lys16, Leu17, Val18, Phe19, Phe20, Glu22, and Met35 contribute maximum to binding free energy (−43.1 kcal/mol) between <b>C1</b> and Aβ₄₂ monomer. Overall, MD simulations reveal that <b>C1</b> inhibits Aβ₄₂ aggregation by stabilizing native helical conformation and inhibiting the formation of aggregation-prone β-sheet conformation. The present results will shed light on the underlying inhibitory mechanism of small molecules that show potential <i>in vitro</i> anti-aggregation activity against Aβ₄₂.</p

Efficacy of MCIMT with Auditory Cueing in order to Augment Functional Motor Recovery of Chronic Hemiparetic Arm

Background: Stroke is a leading cause of functional impairments globally, often resulting in long-term disability and a substantial impact on individuals, families, and caregivers. Learned nonuse, a phenomenon where motor deficits persist after a stroke due to central nervous system suppression, is a significant challenge in stroke rehabilitation. Constraint-Induced Movement Therapy (CIMT) is a well-established neurorehabilitation approach based on behavioural training, which includes repetitive task-specific training, behavioural techniques, and constraining the use of the more affected upper extremity. CIMT has been successful in improving functionality in chronic hemiparetic stroke patients, promoting cortical reorganization and neural plasticity. Method: This study involved 60 stroke survivors aged 20 or older, selected purposively and meeting specific criteria. Participants underwent an 8-week Modified CIMT (M-CIMT) program with auditory cueing for the hemiparetic upper limb. Data collection included pre-test and post-test assessments using the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) to evaluate functional activity. The M-CIMT program comprised warm-up sessions, M-CIMT protocols, and cool-down exercises, conducted five days a week. Results: Following participation in the M-CIMT program, significant improvements were observed in WMFT and MAL scores. The mean pre-test score of 46.60 seconds decreased to a mean post-test score of 16.85 seconds, with highly significant t-values of 14.292 and -51.356 and a p-value of 0.0, indicating a strong correlation between the two datasets. The analysis revealed that M-CIMT effectively enhanced upper extremity function in chronic stroke patients. Conclusion: This study highlights the effectiveness of the Modified CIMT protocol, emphasizing repeated use and a distributed practice schedule, in reducing upper-limb impairment and improving upper-limb use and function in chronic stroke patients. The significant improvement in post-test scores underscores the promise of M-CIMT as a valuable approach for upper extremity rehabilitation following chronic stroke, offering hope for enhanced recovery and improved quality of life for affected individuals. Keywords: Stroke; Rehabilitation; Upper Extremity; Constraint-Induced Movement Therapy; Motor Activit

A review on diabetes associated with psychological disorders among elderly people

People over the age of 65 who have diabetes are more likely to have mental health issues. Chronic illness might have a direct or indirect impact on this outcome. Diabetic complications can also play a role. The goal of this study is to examine the relationship between the various diabetes problems and the mental health issues of depression, anxiety, and cognitive decline in the elderly diabetic population. The following are the materials and procedures used: An outpatient geriatric medicine department conducted cross-sectional research. It has been found that people with Type 1 and Type 2 Diabetes are more likely to suffer from mental health concerns than the general population. Adults with T1D and T2D are at an increased risk of developing a variety of mental health issues, including depression, anxiety, eating disorders, and more severe forms of mental illness. In this review, we examine the prevalence, impact, and available therapies for these issues. Research priorities for adults with T1D and T2D have been highlighted and explored in light of the literature's implications for psychologists

Exploring the Potential of <em>Calotropis procera</em> in Pharmacological Approaches

Medicinal plants have been a source of treatments for many ailments for thousands of years. The WHO estimates that 80% of worldwide population use traditional medicines to treat common health issues. Plant derived bioactive substances constitute 50% of Western medications. The increase in incidents of emerging medical challenges, including post-COVID syndrome, rising multidrug-resistant (MDR), and many more, has raised annual fatalities. To address these issues, novel medications and strategic approaches are urgently required. Designing novel drugs relies on exploring medicinal plants, which have great scope in combating diseases. Calotropis procera is a medicinal plant belongs to Apocynaceae family and subfamily Asclepiadoideae that have been exploring for developing novel drugs. C. procera consists of numerous phytochemicals including flavonoids, terpenoids, cardenolides, steroids and oxypregnanes. Therefore, its phytoconstituents have been used to treat a variety of conditions including cancer, asthma, epilepsy and snake bite. C. procera is reported to have anti-inflammatory, anti-tumor, anthelmintic, antibacterial, antinociceptive and antimalarial properties. Roots, leaves and flower of C. procera have been used in wide range of ethnomedicinal and pharmacological actions including leukoderma, malaria and eczema. Recent ongoing techniques including computational tools using the phytoconstituents of C. procera against various diseases will open up avenues for developing novel drugs