Detection of spontaneous hemoperitoneum in a pregnancy complicated with endometriosis during caesarean section - a case report

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. During pregnancy endometriosis and its related pain symptoms improve due to various metabolic, hormonal, immune and angiogenesis changes that occur in pregnancy. Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious pregnancy complication, which is associated with high rates of maternal and foetal morbidity and mortality. Endometriosis may be a potential risk factor for SHiP. Preformation of IVF on women with endometriosis may be a potential risk factor for SHiP. In gravid females with a history of endometriosis, severe abdominal pain, and a reduction of haemoglobin, physicians should always suspect SHiP because it is a life-threatening condition for both the mother and the baby. We are reporting a case of a primigravida with term gestation, taken up for emergency caesarean section in view of non-reassuring foetal heart rate. Intraoperatively there was evidence of hemoperitoneum and multiple endometriotic lesions on the posterior surface of uterus and Pouch of Douglas, Bilateral ovaries were adherent to the endometriotic growth on the posterior surface of uterus. Postoperatively, patient was stable and was discharged on postoperative day 4

Feasibility of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients Under the TB Control Programme in Two Districts of South India

BACKGROUND:Provider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million). METHODOLOGY/PRINCIPAL FINDINGS:Starting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre (ICTC)--often in the same facility--for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment (ART). Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 (72%) were referred to an ICTC, and 3111 (66%) were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709/5299 (70%) of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 (8.8%) of all registered TB patients were HIV-infected; 177 (37%) were documented to have also received any ART. CONCLUSIONS:With implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation

Consumption patterns of wild edibles by the Vasavas:A case study from Gujarat, India

Abstract Background Wild edibles continue to be a significant contributor to the global food basket in much of the developing world. A consensus has now been formed that information on wild edibles is an important part of ethnobotanical knowledge and hence elucidating region-specific patterns of habitat management and consumption assists policy making with regard to natural conservation, human nutrition, and human health. Using an original data set from Gujarat, India, the present research aims to document the collective knowledge of wild edibles possessed by the local Vasava tribe, as well as the habitat usage and consumption trends of these species. Methods Data were collected using three approaches: key informant interviews to record the local knowledge of wild edibles and methods of collection, village group discussions to quantify past and present consumption trends, and expert interviews to elucidate the reasons for changing consumption patterns. Results Through key informant interviews, 90 species of wild edibles from 46 botanical families were identified along with their Vasavi names, plant parts utilized, habitats, and cooking methods. Of these, 60 species were also used medicinally and 15 carried economic value. Different habitats were preferred for collection at different times of the year. Village group discussions unanimously concluded that the consumption of wild edibles has significantly reduced over time. Expert interviews identified the decreased availability of these species in their natural habitats as the most important reason for their reduced consumption. Conclusion The present study has demonstrated that the Vasavas’ collective knowledge of wild edibles is vast and that these species contribute to their dietary diversity throughout the year. The finding of the present study, namely that anthropogenically managed habitats were often preferred over natural environments for the collection of wild edibles, suggests that conservation efforts should be extended beyond wild and human-uninhabited landscapes

Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Ecological Networks in Urban Forest Fragments Reveal Species Associations between Native and Invasive Plant Communities

Forest fragments are characteristic features of many megacities that have survived the urbanisation process and are often represented by unique assemblages of flora and fauna. Such woodlands are representations of nature in the city—often dominated by non-native and invasive species that coexist with resilient native congeners and purposefully introduced flora. These forest fragments also provide significant ecosystem services to urban society and therefore, understanding their compositional patterns is of considerable importance for conservation and management. In this work, we use a complex network approach to investigate species assemblages across six distinct urban forest fragments in the South Delhi Ridge area of the National Capital Territory, India. We generate bipartite ecological networks using conventional vegetation sampling datasets, followed by network partitioning to identify multiple cliques across the six forest fragments. Our results show that urban woodlands primarily form invasive–native associations, and that major invasive species, such as Prosopis juliflora and Lantana camara exclude each other while forming cliques. Our findings have implications for the conservation of these urban forests and highlight the importance of using network approaches in vegetation analysis

Current status of polyherbal formulation derived from ethnobotanicals

Aim: Polyherbal formulations have been an area of interest for researchers. Ethnobotanicals are evaluated for their effectiveness against diseases as an alternative for synthetic drugs. The present review aimed to discuss the efficacy of the polyherbal formulation.Method: In the present study, all the relevant data collected from classical texts and research articles from various offline and online sources included Scopus, Web of Science, and PubMed, for the current status of the polyherbal formulation. The present review circumscribes the importance of polyherbal formulation.</p

Ecological Networks in Urban Forest Fragments Reveal Species Associations between Native and Invasive Plant Communities

Forest fragments are characteristic features of many megacities that have survived the urbanisation process and are often represented by unique assemblages of flora and fauna. Such woodlands are representations of nature in the city—often dominated by non-native and invasive species that coexist with resilient native congeners and purposefully introduced flora. These forest fragments also provide significant ecosystem services to urban society and therefore, understanding their compositional patterns is of considerable importance for conservation and management. In this work, we use a complex network approach to investigate species assemblages across six distinct urban forest fragments in the South Delhi Ridge area of the National Capital Territory, India. We generate bipartite ecological networks using conventional vegetation sampling datasets, followed by network partitioning to identify multiple cliques across the six forest fragments. Our results show that urban woodlands primarily form invasive–native associations, and that major invasive species, such as Prosopis juliflora and Lantana camara exclude each other while forming cliques. Our findings have implications for the conservation of these urban forests and highlight the importance of using network approaches in vegetation analysis

Efficacy of a biosimilar ranibizumab monotherapy for the treatment of retinopathy of prematurity

Purpose: To evaluate the efficacy of a biosimilar ranibizumab (Razumab) on outcomes of retinopathy of prematurity (ROP) for the first time. Methods: This retrospective study included infants presenting with stage 3+ ROP either in zone 1 or zone 2 posterior or aggressive posterior ROP (APROP). All eligible infants received intravitreal razumab (0.25 mg/0.025 ml) monotherapy. Follow-up was continued monthly till complete retinal vascularization was achieved while retreatment with razumab was given when recurrent neovascularization was noted. In case of no recurrence but incomplete vascularization, laser photocoagulation was done to the residual avascular retina. Results: We included 118 eyes of 59 infants with a median gestational age of 30 weeks and median birth weight of 1250 grams. At presentation, APROP was found in 28 eyes (24%) of 14 babies while stage 3 disease was seen in zone 1 in another 28 eyes (24%) and the remaining 62 eyes (52%) had stage 3 ROP in zone 2 posterior region. Complete resolution of ROP along with complete vascularization was seen in 22 eyes (19%) at a median of 55 days (IQR = 31–56 days) and 42 eyes (35%) showed a recurrent neovascularization at a median of 51 days post razumab (IQR = 42–55 days). The cumulative incidence of recurrence of neovascularization (21%, 95% CI = 14%–29%) peaked at seven weeks and was significantly higher in eyes with APROP (43%, 95% CI = 27%–63%) compared to eyes without APROP (13.4%, 95%CI, 8%-22%) (P < 0.001). Conclusion: Razumab appears to be safe and effective in treating ROP, with about a third requiring reinjection at seven weeks after the first dose

Drimia indica: a plant used in traditional medicine and its potential for clinical uses

Drimia indica (Roxb.) Jessop (Asparagaceae) is a reputed Ayurvedic medicine for a number of therapeutic benefits, including for cardiac diseases, indigestion, asthma, dropsy, rheumatism, leprosy, and skin ailments. The present work aimed to critically and extensively review its traditional uses, phytochemistry, pharmacology, toxicology, and taxonomy together with the mechanisms of action of selected extracts of D. indica. A systematic literature survey from scientific databases such as PubMed, Scopus, and Web of Science as well as from some textbooks and classical texts was conducted. The plant, mainly its bulb, contains various bioactive constituents, such as alkylresorcinols, bufadienolides, phytosterols, and flavonoids. Various scientific studies have proven that the plant has anthelmintic, anticancer, antidiabetic, antimicrobial, antioxidant, and wound healing activities. The present work concludes that D. indica has the potential to treat various diseases, mainly microbial infections. This review also suggests that bufadienolides, flavonoids, and steroids might be responsible for its bioactive potential