TOTAL FLAVONOID QUANTIFICATION AND TO STUDY ANTIBACTERIAL POTENCY OF EXTRACTS OF BUTEA MONOSPERMA FLOWERS, NIGELLA SATIVA SEEDS AND VITEX AGNUS CASTUS LEAVES

Objective: An attempt has been made to develop a method for quantitative estimation of flavonoids in the crude extract of Butea monosperma flowers, Nigella sativa seeds and Vitex agnus castus leaves. Antibacterial activity is attributed to various phytochemicals present in these plants.Methods: The amount of total flavonoids was analysed using aluminium chloride colorimetric assay using rutin as standard. Plants studied were subjected to hydromethanolic extraction by using soxhlet apparatus. Flavonoids in extracts were quantified by U. V at a wavelength of 415 nm Antibacterial activities of extracts were evaluated on various bacterias like E. coli, P. aeruginosa, S. aureus, S. pneumonie, P. acne. The in vitro antibacterial activities of these extracts were compared against standard drugs such as gentamycin, ampicillin, chloramphenicol, ciprofloxacin, norfloxacin.Results: Flavonoid content in the crude extract of Butea monosperma flowers, Nigella sativa seeds and Vitex agnus castus leaves was found to be 2.58 %w/w, 0.92% w/w and 1.6 % w/w respectively. The antibacterial study found that activity of Vitex extract against P. acne was better than the standard drugsConclusion: In the present study an attempt has been made to standardize the plant material in terms of its flavonoid content and the study indicated that this extract individually or in combination with other herbal drugs can be useful in treating diseases caused by the organisms mentioned above

EVALUATION OF STABILITY OF HERBAL ANTI-ACNE GEL FORMULATION

Objective: The present study was aimed to evaluate the physical and chemical stability of prepared gel formulations at various intervals for a period of one year.Methods: The amount of total flavonoids was analysed using aluminium chloride colorimetric assay using rutin as standard. Gels were dissolved in distilled water and then analysis was carried out and flavonoids quantified by U. V at a wavelength of 415 nm.Results: Flavanoid content were examined at various time intervals and rate of drug degradation was calculated graphically and by using arrhenius equation. The shelf life of the prepared gel F1, F2, F3, and F4 was found to be 291.76, 460, 184 and 148.39 d.Conclusion: In the present study an attempt has been made to evaluate the shelf life of herbal gel formulations and to generate scientific database for formulation and evaluation of herbal products

Unsuspected multiples myeloma presenting as bilateral pleural effusion – a cytological diagnosis

<b>Background:</b> Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. <b>Case Presentation:</b> A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin&#x2032;s Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type). <b>Conclusion: </b> Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age

Interrupted mattress versus continuous subcuticular versus stapler: a comparative study on wound closure outcomes in primary caesarean section with Pfannenstiel incision

Background: Aim of the study was to compare the suture techniques using interrupted mattress and continuous subcuticular and stapler in terms of wound closure time; pain in stitch line on post-operative day 3, 5 and 7 and patient satisfaction. Methods: All patients fulfilling the inclusion criteria, were divided into 3 categories (interrupted mattress, subcuticular and staples) by random selection. Assessment parameters being skin closure time; induration and discharge on day 4 and 8; pain score using visual analogue scale on day 3, day 5 and 7; wound gaping and Patient satisfaction in terms of cosmesis using Likert’s scale after 4-6 weeks. Results: The skin closure time in mattress, subcuticular sutures and staples are found to be 8.891±1.343; 11.390±1.438 and 1.518±0.502 respectively. Pain on day 3, 5 and 7 were: severe pain was maximum seen in staples group (n=21) as compared to 7 patients in subcuticular group and 6 in mattress group. Wound complications were seen least in mattress group. One patient (1.20%) had wound gaping in mattress group, 3 (3.65%) of the patients in subcuticular group and 5 (6.17%) in staples group had wound gaping. Patient dissatisfaction rate was higher in staples group (8.64%) as compared to 6.09% patient in subcuticular group and 4.8% in mattress group. Conclusions: The mattress suturing technique has least wound related complications and most patients satisfaction. Staples are quick in application and subcuticular technique gives a good scar, but is associated with similar complications as staples.

A community based study of NCD risk factors among adult population in Dehradun, India

Background:&nbsp;A Non-Communicable disease (NCD) is one which is non-infectious and non-transmissible among people. NCDs account for leading causes of death and disease burden worldwide. To decrease the burden of NCDs experts stress on the importance of prevention and control with respect to modifiable risk factors. The World Health Organization's World Health Report 2002 identified tobacco use, alcohol consumption, overweight, physical inactivity, high blood pressure and high cholesterol as the most important risk factors for NCDs.(1) &nbsp;Aims &amp; Objectives:&nbsp;1. To know the prevalence of risk factors leading to NCDs in the study population. 2. To know the socio-demographic correlates associated with risk factors of NCDs. 3. To suggest appropriate recommendations regarding modifiable risk factors of NCDs in study population.&nbsp;Material &amp;&nbsp;Methods:&nbsp;A Cross-sectional study, Community-based study among 18+ population in field practice areas of Community Medicine Department, SGRRIM&amp;HS, Dehradun. Sample Size: 300 each in urban and rural, total 60.&nbsp;Results: The prevalence of Smoking was 11.3%, Smokeless tobacco use 10.5%, Alcohol use 13.2%, Unhealthy diet 99.5%, Low physical activity 0.8%, High BMI (? 25 kg/m2) 51.2%, above normal waist-hip ratio 57.0%, Raised blood pressure 58.5% and raised blood sugar 25.2%.&nbsp;Conclusion:&nbsp;Smoking is significantly associated with age, sex and occupation. Raised blood pressure is significantly associated with age, sex and social class

Effect of peribulbar block on emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia

Background: Strabismus surgery in children may be associated with a high incidence of emergence agitation that may be related to pain and visual disturbances. The objective was to evaluate the effect of peribulbar block on the incidence of emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia.Methods: Fifty-six healthy children aged 2–10 years, undergoing strabismus surgery under general anaesthesia, were recruited. Children were randomly allocated to receive fentanyl 2 μg/kg (Group F) or peribulbar block (Group PB) with 0.3 ml/kg of 0.25% bupivacaine + 2% lignocaine. The primary outcome of the study was incidence of emergence agitation; secondary outcome measures were time to first rescue analgesia, the incidence of oculocardiac reflex and vomiting.Results: Of 52 children, 14/25 (56%) children in Group F developed emergence agitation compared with 3/27 (11.11%) in group PB (p = 0.001). Postoperatively, the paediatric anaesthesia emergence delirium scores showed significantly lower emergence agitation in the PB group with a median (IQR) of 0.00 (0.00–2.00) compared with group F (5.5 (0.75–8.75) at all time intervals (p = 0.003 Mann–Whitney test). Pain scores were comparable between groups (group F 48% vs. group PB 25.9%). The time to first rescue analgesia was increased in group PB (126.875 ± 38.22 min vs. 88.08 ± 28.48 min in group F). The oculocardiac reflex occurred in 7/25 in Group F compared with 1/27 in Group PB (p = 0.015). There was no difference in the incidence of postoperative vomiting (24% in Group F vs. 22% in Group PB).Conclusion: Use of peribulbar block in children undergoing strabismus surgery under desflurane anaesthesia was associated with reduced incidence of emergence agitation and oculocardiac reflex but did not significantly increase the time to first analgesic or the incidence of pain and vomiting. A sub-tenon block may be safer and provide better operating conditions and equal analgesia.Keywords: agitation, children, anaesthesia, strabismus surgery, peribulbar bloc

Influence of Epidural Ropivacaine with or without Dexmedetomidine on Postoperative Analgesia and Patient Satisfaction after Thoraco-Lumbar Spine Instrumentation: A Randomized, Comparative, and Double-Blind Study

Study Design This was a prospective, randomized, and double-blind study. Purpose Thoraco-lumbar spine surgery is associated with severe postoperative pain and can cause chronic pain. We aimed to compare the impact of epidural ropivacaine with and without dexmedetomidine on postoperative analgesia after thoracolumbar spine instrumentation wherein an epidural catheter was placed by the surgeon intraoperatively. Overview of Literature Very few studies have reported the use of epidural dexmedetomidine in spine surgeries. When used via the epidural route, dexmedetomidine is safe and efficacious and is associated with reduced rescue analgesia consumption, increased duration of analgesia, reduced pain scores, but not with major hemodynamic adverse effects. Methods Total 60 American Society of Anesthesiologists I–III adult patients aged 18–65 years who were scheduled to undergo thoraco-lumbar spine instrumentation were randomly allocated into group RD (epidural ropivacaine+dexmedetomidine) or group R (epidural ropivacaine plus saline). We aimed to compare the total rescue analgesic consumption on postoperative day 0, 1, and 2. Moreover, we studied the time to first rescue analgesia with visual analogue scale score <4 and the overall patient satisfaction scores. Results There was no difference between the demographic characteristics of the two groups. The mean value of total rescue analgesia consumption was 162.5±68.4 mg in the RD group and 247.5±48.8 mg in the R group. The mean time to first rescue analgesia was 594.6±83.0 minutes in the RD group and 103.6±53.2 minutes in the R group. The mean patient satisfaction score was 4.2±0.7 in the RD group and 3.2±0.6 in the R group. No patient had any respiratory depression or prolonged motor blockade during the postoperative period. Conclusions This study demonstrated the superior efficacy, in terms of postoperative analgesia and patient satisfaction scores, of epidural ropivacaine plus dexmedetomidine over that of ropivacaine alone in patients undergoing surgery for thoraco-lumbar spine

Validation of a noninvasive aMMP-8 point-of-care diagnostic methodology in COVID-19 patients with periodontal disease

Objectives: The aim of this study was to validate an active matrix metalloproteinase (MMP-8) point-of-care diagnostic tool in COVID-19 patients with periodontal disease. Subjects, Materials, and Methods: Seventy-two COVID-19-positive and 30 COVID-19-negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP-8 (aMMP-8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse-based kit for general disease activity. In COVID-19-positive patients, the kits were run again once the patients turned COVID-19 negative. Results: The overall (n = 102) sensitivity/specificity of the mouthrinse-based kits to detect periodontal disease was 79.41%136.76% and that of site-specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746-0.869 (p < .001) and 0.740-0.872 (p < .001) (the aMMP-8 mouth rinse and site-specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP-8 mouth rinse test (p = .302) and aMMP-8 site-specific test (p = .189) once the subjects recovered from COVID-19. Conclusions: The findings of the present study support the aMMP-8 point-of-care testing (PoCT) kits as screening tools for periodontitis in COVID-19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user-friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.Peer reviewe

Survey on worldwide trauma team activation requirement

PURPOSE : trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level. METHODS : A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. RESULTS : The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income. CONCLUSIONS : The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.http://link.springer.com/journal/68am2022Surger

Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery

Background and Aim: Intrathecal (IT) neostigmine has been used as an adjunct to spinal anesthesia. The purpose of this study was to determine whether a combination of low-dose neostigmine IT would enhance analgesia of a fixed dose of fentanyl IT, in patients undergoing unilateral total knee replacement (TKR) surgery with spinal anesthesia. Settings and Design: Forty-five patients scheduled for unilateral TKR were randomized to one of the three groups (n = 15) and prospectively studied using placebo-controlled, double-blinded design. Materials and Methods: A 19-G epidural catheter was introduced through the L3-L4 interspace with patient in the sitting position, followed by spinal anesthesia administration through the L3-L4 interspace. Fifteen milligrams of hyperbaric bupivacaine (3 ml) plus the test drug (0.5 ml) was administered IT. The test drug was normal saline (0.5 ml) in group I; fentanyl 20 mcg (0.4 ml) and normal saline (0.1 ml) in group II; and fentanyl 20 mcg (0.4 ml) and neostigmine 1 mcg (0.1 ml) in group III. Characteristics of sensory and motor block, heart rate, and blood pressure were recorded intraoperatively. Postoperatively, pain scores, postoperative nausea and vomiting (PONV) scores, and sedation scores, and postoperative analgesic dose were recorded. Results: Forty-five patients were enrolled in this study and 43 patients were subjected to statistical analysis. Overall 24-h visual analog score in group III was significantly less than in those who received fentanyl alone (P = 0.00). The durations of complete analgesia and effective analgesia were longer for all patients in group III compared with group II (P < 0.05) and group I (P < 0.005) patients. The total number of epidural top ups (rescue analgesia) required was less in group II (P < 0.05) and group III (P < 0.005) patients, compared with the control group. The incidence of nausea and vomiting was not increased in group III patients. Conclusions: The addition of 1 mcg neostigmine IT increased the duration of analgesia and decreased the analgesic consumption in 24 h in TKR. There was no increase in the incidence of adverse effects