Effect of epidural analgesia on the duration of labour and pains: a comparative study

Background: Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of Epidural Analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Objective of this study was to study the effect of epidural analgesia on the duration of labour and pains.Methods: The present study was conducted on 60 women in the department of obstetrics and gynecology at Topiwala National Medical College, Mumbai during a period from October 2014 to January 2017. The women requesting EA were assigned as the study group (Group A - 30 cases) and women not receiving EA were included in the control group (Group B - 30 cases).Results: The duration of active phase of first and second stage of labour was found to be prolonged in patients who received EA as compared to control group. An increase in number of caesarean sections and requirement of oxytocin augmentation was found to be more in Group A as compared to Group B. There was no statistically significant difference in Apgar score of newborns at 1 min and 5 min in both the groups. The patients demanding epidural drug had better pain relief during labour. In Group A, 17% of patients and in Group B, 7% of patients had nausea and vomiting. Other side effects were minimal.Conclusions: Epidural analgesia is not a totally free of disadvantages, it is the most effective mode of pain relief available compared with other techniques. The addition of patient-controlled epidural analgesia and innovations using new technologies enhance patient satisfaction

Antibacterial, antioxidant, and phytochemical analysis of Piper longum fruit extracts against multi-drug resistant non-typhoidal Salmonella strains in vitro

Most bacteria are becoming resistant to almost all of the currently recommended drugs, leading to difficulty in their treatment. The present study focused on evaluating the therapeutic potential of Piper longum fruit extracts in terms of bactericidal, antioxidant and phytochemical evaluation by conducting antibacterial sensitivity tests against four multidrug-resistant Salmonella strains (Salmonella enterica subsp. arizonae, Salmonella Newport, Salmonella enterica ser. Typhi, and Salmonella enterica ser. Paratyphi) obtained from the Institute of Microbial Technology (IMTECH), Chandigarh. The Agar Well Diffusion method and the Minimum Inhibitory concentration (MIC) methods were performed to implement the anti-sensitivity test of crude extracts of the plant. The present study showed that the MIC of the P. longum  was between 0.25-0.0625mg/ml, which was lowest in the aqueous extract at 0.5mg/100µl, and the highest in the methanol extract (1mg/100µl). The Minimum Bactericidal Concentration (MBC) was lowest in aqueous (0.5mg/100µl) and highest in methanol plant extract (1mg/100µl). The methanol extract had the maximum antibacterial potency, whereas the aqueous extract had the lowest. The antioxidant capacity of the plant extracts was determined using a DPPH assay. Methanol plant extract revealed the highest antioxidant power (81.92%) and the lowest was found in the aqueous extract (62.84%). The GC-MS approach identified active bioingredients, important botanicals including caryophyllene, eicosane, and piperazine (potent antibacterial agent) as naphthyridine (having antimicrobial, anticancer, and anti-inflammatory activities), among others. The unique aspect of the study was the effectiveness of P. longum against Salmonella strains that are resistant to multiple antibiotics. This suggests that P. longum can be a great source of novel antibacterial compound for the development of herbal formulations

Prediction of preterm delivery with a novel bedside test

Background: Preterm birth occurs in 7 to 12 % of all deliveries but account for 85% of perinatal morbidity and mortatity. Hence, there is a need for a reliable test to predict the onset of preterm labour. One such test is detection of phosphorylated insulin like growth factor binding protein 1 (phIGFBP- 1) in cervical secretion with a simple bedside kit that is recently commercialized Actim Partus kit.Methods: This was a prospective study carried out at a tertiary hospital over a period of 2 years from October 2006 to November 2008. Women between 28 to 37 weeks with intact fetal membranes, who presented with threatened preterm labour were included and followed up till delivery. Time interval between test and delivery, weeks of gestation at the time of delivery, labour and delivery details as well as neonatal outcome were documented. Diagnostic accuracy of the test was determined by sensitivity, specificity, positive and negative predictive value.Results: It was found that this test was extremely sensitive in prediction of preterm delivery and negative test results implied low chance of preterm delivery as in the patients with positive test result the average time of prolongation of pregnancy was less than 24 hours and in patients with negative test result it was more than 7 days which was statistically significant (P value = 0.001). The need for NICU and perinatal morbidity was significantly less in patients with negative test result.Conclusions: There is a role of detection of cervical IGFBP-1 test in the management of women presenting with suspected preterm labour which allows us to focus on patients who are more likely to deliver preterm and also to reduce perinatal mortality and morbidity

A study on cardiotocography for predicting fetal prognosis in high-risk pregnancy

Background: The admission cardiotocography (CTG) in high-risk obstetrics patients for continuous monitoring of fetal heart rate (FHR) has become crucial in the modern obstetric practice. It is not only a good screening and inexpensive test but also non-invasive, easily performed and interpreted. Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology, Pannadhay Rajkiya Mahila Chikitsalaya at RNT medical college, Udaipur from April 2022 to September 2022. A total of 100 high risk obstetrics patients were subjected to cardiotocography (CTG). The Women eligible for the study were those who had gestational age ≥32 weeks with cephalic presentation in first stage of labour with singleton fetus in vertex presentation and categorised as high-risk during the time of admission. Results: A total of 100 high risk obstetric patients were subjected to CTG. Out of these common high-risk factors in our study consisted of postdated pregnancy (21%) followed by pre-eclampsia (19%), oligohydramnios (16%) cord around neck (13%). Majority of them (47%) fall under 20-25 years and constituted by primigravida (59%).  CTG was reactive in (65%), non-reactive in 25% of cases and 10% patients had suspicious tracings. The incidence of neonatal intensive care unit (NICU) admission, fetal distress and APGAR score less than 7 was significantly higher with suspicious and nonreactive CTG than reactive CTG. Conclusions: CTG test is a simple, non-invasive screening test should be used in high risk pregnancy as admission test. The heavy load of constant monitoring and adverse perinatal outcome can be reduced by CTG monitoring in high-risk obstetrics patients

Correlating multi-functional role of cold shock domain proteins with intrinsically disordered regions

Cold shock proteins (CSPs) are an ancient and conserved family of proteins. They are renowned for their role in response to low-temperature stress in bacteria and nucleic acid binding activities. In prokaryotes, cold and non -cold inducible CSPs are involved in various cellular and metabolic processes such as growth and development, osmotic oxidation, starvation, stress tolerance, and host cell invasion. In prokaryotes, cold shock condition re-duces cell transcription and translation efficiency. Eukaryotic cold shock domain (CSD) proteins are evolved form of prokaryotic CSPs where CSD is flanked by N-and C-terminal domains. Eukaryotic CSPs are multi-functional proteins. CSPs also act as nucleic acid chaperons by preventing the formation of secondary structures in mRNA at low temperatures. In human, CSD proteins play a crucial role in the progression of breast cancer, colon cancer, lung cancer, and Alzheimer's disease. A well-defined three-dimensional structure of intrinsically disordered re-gions of CSPs family members is still undetermined. In this article, intrinsic disorder regions of CSPs have been explored systematically to understand the pleiotropic role of the cold shock family of proteins

Topological and system‑level protein interaction network (pin) analyses to deduce molecular mechanism of curcumin

Curcumin is an important bioactive component of turmeric and also one of the important natural products, which has been investigated extensively. The precise mode of action of curcumin and its impact on system level protein networks are still not well studied. To identify the curcumin governed regulatory action on protein interaction network (PIN), an interectome was created based on 788 key proteins, extracted from PubMed literatures, and constructed by using STRING and Cytoscape programs. The PIN rewired by curcumin was a scale-free, extremely linked biological system. MCODE plug-in was used for sub-modulization analysis, wherein we identified 25 modules; ClueGo plug-in was used for the pathway’s enrichment analysis, wherein 37 enriched signalling pathways were obtained. Most of them were associated with human diseases groups, particularly carcinogenesis, inflammation, and infectious diseases. Finally, the analysis of topological characteristic like bottleneck, degree, GO term/pathways analysis, bio-kinetics simulation, molecular docking, and dynamics studies were performed for the selection of key regulatory proteins of curcumin-rewired PIN. The current findings deduce a precise molecular mechanism that curcumin might exert in the system. This comprehensive in-silico study will help to understand how curcumin induces its anti-cancerous, anti-inflammatory, and anti-microbial effects in the human body

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Modeling signaling pathways leading to wrinkle formation: Identification of the skin aging target

Background: In the present scenario, wrinkle formation, prominent sign of skin ageing, is one of the most demanding areas of research. This burgeoning research demand to reduce, delay and restore the effects of skin ageing has led to the study of various signaling pathways leading to wrinkle formation. Wrinkles appear on skin due to influence of intrinsic and extrinsic factors on mitogenic reactions and signal transduction pathways. Aim: The aim of the present study is to analyze each protein involved in the signaling pathway leading to dilapidation of collagen and an attempt has been made to compare different signal transduction pathways to identify a common target for skin ageing. Methods: In the present work, bioinformatics tools have been used to extract information from already existing experimental data. The statistical techniques are used for further analysis and make useful predictions for skin ageing. Results: Stressors like UV irradiation, osmotic stress and heat shock have been reported to activate epidermal growth factor receptor, interleukin 1 receptor, tumor necrosis factor receptor, platelet-derived growth factor receptor and platelet activation factor receptor signaling pathways, which lead to the production of matrix metalloproteinases, collagen degradation and, consequently, wrinkle formation. When all the five signaling pathways were modeled, the c-jun part of the AP-1 transcription factor was found to be a common intermediate protein involved in all the signaling cascades. Moreover, it shows differential expression in the skin on response to stressors. Conclusion: We proposed c-jun to be the most potent target for drug designing against wrinkle formation