SANKHAHOLI (( Evolvulus alsinoides Linn.)): A REVIEW

ABSTRACT: The Sankhaholi (Evolvulus alsinoides Linn.) of family  Convolvulaceae which is commonly known as sankhpushpi, in traditional system of medicine including Unani Medicine. It is a perennial herb with a small woody branched root stock which contains alkaloids: shankhapushpine and evolvine. Fresh plant of sankhholi contains volatile oil. It also contains a yellow neutral fat, an organic acid and saline substances. Therapeutic uses of Sankhaholi Evolvulus alsinoides Linn, mentioned in the Unani Medicine are Alexiteric (Mufarreh), Cardiac  tonic  (Muqawwi-e Qalb), Brain tonic  (Muqawwi-e Dimag), Digestive (Hazim)  Musaffi-e- Khoon (Blood purifier),General tonic (Muqawwi-e-am), Diuretic (Mudirr-e-Baul), Anti Inflammatory (Muhallil-e-waram), Hypoglycemic (Dafa-e-Ziabitus), Antihypertensive (Dafye Imtella). It is also used in headache, asthma, hyperlipidemia etc. The present article reviews the pharmacological actions and therapeutic uses of Sankhaholi ( Evolvulus alsinoides Linn.) present in Unani literature supported with the available clinical and animal studies.Keywords: Sankhaholi Evolvulus alsinoides Linn. Sankhpushpi, Unani Medicin

Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Post-auricular leech therapy reduced headache & migraine days in chronic migraine

Background: Migraine is an exceedingly common disorder that causes substantial pain, disability and societal burden. Unfortunately, conventional treatments are insufficient, inadequate, or associated with significant risks, such as overuse, abuse or addiction. The Unani system of Medicine has been treating migraine since centuries. Leech therapy (Irsale Alaq) has been employed successfully in severe persistent headache, mania and insomnia since decades. Aim: The purpose of our study was to evaluate the impact of post auricular leech therapy in migraine and to collect data to warrant further clinical trials. Methods: We conducted a case series on 7 patients who had failed conventional oral treatments for the migraine. After informed consent, post auricular leech therapy was done.  Patients were asked to keep detailed headache calendars, documenting the number of headache days, migraine days, the intensity of headaches/ migraines and analgesic usage. We compared these parameters before and after 2 months of therapy. Results: We observed a reduction in the number of headache & migraine days and amount of painkillers used without any adverse effects. (P≤ 0.01) Improvement in quality of life was also observed. Discussion: We reviewed the literature related to the medicinal leeches (Hirudo medicinalis), used for the treatment in these cases. Leech saliva contains certain potent anesthetic, anti-inflammatory and vasodilator substances, suggesting plausible mechanisms of action in these cases. Conclusion: The preliminary findings indicate the safe and potential therapeutic role of leech therapy. So further trials should be carried out to explore the therapeutic potential of this therapy in chronic migraine. Keywords: Chronic Migraine, leech therapy, hirudo medicinalis, headache, Unani Medicine, complementary Medicine

Antibacterial activity of phyto-mediated silver nanoparticles developed from Melia azedarach

BACKGROUNDː Nanoparticles formed by plant extracts present a good alternative of existing antibiotics to compete with the resistant strains of bacteria. Antioxidants present in plants synthesize the nanoparticles from metal salt and also cap them.METHODSː In the present study, Melia azedarach fresh leaves were extracted with water. These extracts were reduced by adding silver nitrate (AgNO3) solution separately. Plant extract in different concentration was used to develop nanoparticles with constant strength of salt solution. Color change of extracts represented the development of silver nanoparticles due to reduction of silver ions to form silver nanoparticles. Absorbance of reaction mixtures were determined by UV Vis spectrophotometry. Further antimicrobial activity of these nanoparticles was tested against Borditella pertussis and Xanthomonas axonopodis by agar well diffusion method.RESULTSː Maximum absorbance was noticed between 400-500 nm. EDX analysis proved the presence of silver ions and SEM analysis showed size and shape of nanoparticles (105 nm). Silver nanoparticles developed from water extract of M. azedarach exhibited maximum inhibition zones (25.4±0.36) and (47.2±0.25) against Borditella pertussis and Xanthomonas axonopodis respectively.CONCLUSIONSː The conclusion was established that silver nanoparticles from M. azedarach revealed enhanced antibacterial activity with comparison to pure plant extract and silver nitrate solution and can be used in different antibacterial products.</p

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI