THE EFFECTIVENESS OF KARELA COMPARED WITH VIJAYASAR IN THE MANAGEMENT OF MADHUMEHA

Vijayasar (Pterocarpus marsupium) has been mentioned in Charak Samhita, as a remedy for Madhumeha (Diabetes Mellitus). A study conducted by ICMR (Indian Council of Medical Research) revealed that the hypoglycemic effects of Vijayasar are comparable to that of tolbutamide. Karela (Mormordica charantia) is another herb used in Madhumeha and it is a routinely used vegetable in Nepal. In this study we measured the effectiveness of Karela in patients of Madhumeha and compared with that of Vijayasar. A total of sixty four patients diagnosed with Madhumeha (Fasting Blood Glucose ≥126mg/dl or Post Prandial Blood Glucose≥200mg/dl) were given either Karela or Vijayasar powder two times a day for one month, along with dietary and lifestyle advices and their blood glucose levels were measured before initiating treatment and after one month of treatment. Changes in the subjective complaints of Madhumeha like Prabhutamutrata, Avilmutrata, etc. and appearance of adverse events were also evaluated. Randomization of treatment was done and dosage was titrated on the basis of glycemic control and duration of Madhumeha. The mean reductions in fasting blood glucose and post prandial blood glucose in Karela treated group are 60.83 mg/dl and 79.74 mg/dl respectively and that in Vijayasar treated. Karela is a safe and effective medicine in the management of Madhumeha and it is as effective as Vijayasar

Transaminitis among Patients with Dengue Fever Visiting a Tertiary Care Centre

Introduction: Transaminitis is a condition where serum aspartate transaminase and alanine transaminase increase indicating liver dysfunction. One such disease where liver involvement might be observed is dengue, which is a mosquito-borne viral infection. The aim of the study was to find out the prevalence of transaminitis among patients with dengue fever in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre from 1 November 2022 to 31 March 2023 after obtaining ethical approval from the Institutional Review Committee. Informed written consent was taken before collecting the data. A rapid immunochromatography test was used to confirm dengue infection. Serum aspartate transaminase and alanine transaminase were measured through routine Reitman and Frankel’s enzymatic method. Dengue-confirmed patients from the medical outpatient department, fever clinic, and medical ward of the centre were included in the study. Patients with known prior liver diseases or any other chronic diseases, pregnancy, and patients in the hospice unit were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 442 dengue infected patients, the prevalence of transaminitis was 188 (42.53%) (37.92-47.13, 95% Confidence Interval). The highest frequency of dengue positive was observed among the 18-35 years age group, which was 97 (51.59%) with male predominance 134 (71.27%). Conclusions: The prevalence of transaminitis among patients with dengue fever in a tertiary care centre was found to be lower than other studies done in similar settings

Behavioral effects of perinatal opioid exposure

Opioids are among the world's oldest known drugs used mostly for pain relief, but recreational use is also widespread. A particularly important problem is opioid exposure in females, as their offspring can also be affected. Adverse intrauterine and postnatal environments can affect offspring development and may lead to various disabilities later in life. It is clear that repetitive painful experiences, such as randomly occurring invasive procedures during neonatal intensive care, can permanently alter neuronal and synaptic organization and therefore later behavior. At the same time, analgesic drugs can also be harmful, inducing neuronal apoptosis or withdrawal symptoms in the neonate and behavioral alterations in adulthood. Hence, risk–benefit ratios should be taken into consideration when pain relief is required during pregnancy or in neonates. Recreational use of opioids can also alter many aspects of life. Intrauterine opioid exposure has many toxic effects, inducing poor pregnancy outcomes due to underdevelopment, but it is believed that later negative consequences are more related to environmental factors such as a chaotic lifestyle and inadequate prenatal care. One of the crucial components is maternal care, which changes profoundly in addicted mothers. In substance-dependent mothers, pre- and postnatal care has special importance, and controlled treatment with a synthetic opioid (e.g., methadone) could be beneficial. We aimed to summarize and compare human and rodent data, as it is important to close the gap between scientific knowledge and societal policies. Special emphasis is given to gender differences in the sensitivity of offspring to perinatal opioid exposure

A new class of glycomimetic drugs to prevent free fatty acid-induced endothelial dysfunction

Background: Carbohydrates play a major role in cell signaling in many biological processes. We have developed a set of glycomimetic drugs that mimic the structure of carbohydrates and represent a novel source of therapeutics for endothelial dysfunction, a key initiating factor in cardiovascular complications. Purpose: Our objective was to determine the protective effects of small molecule glycomimetics against free fatty acid­induced endothelial dysfunction, focusing on nitric oxide (NO) and oxidative stress pathways. Methods: Four glycomimetics were synthesized by the stepwise transformation of 2,5­dihydroxybenzoic acid to a range of 2,5­substituted benzoic acid derivatives, incorporating the key sulfate groups to mimic the interactions of heparan sulfate. Endothelial function was assessed using acetylcholine­induced, endotheliumdependent relaxation in mouse thoracic aortic rings using wire myography. Human umbilical vein endothelial cell (HUVEC) behavior was evaluated in the presence or absence of the free fatty acid, palmitate, with or without glycomimetics (1µM). DAF­2 and H2DCF­DA assays were used to determine nitric oxide (NO) and reactive oxygen species (ROS) production, respectively. Lipid peroxidation colorimetric and antioxidant enzyme activity assays were also carried out. RT­PCR and western blotting were utilized to measure Akt, eNOS, Nrf­2, NQO­1 and HO­1 expression. Results: Ex vivo endothelium­dependent relaxation was significantly improved by the glycomimetics under palmitate­induced oxidative stress. In vitro studies showed that the glycomimetics protected HUVECs against the palmitate­induced oxidative stress and enhanced NO production. We demonstrate that the protective effects of pre­incubation with glycomimetics occurred via upregulation of Akt/eNOS signaling, activation of the Nrf2/ARE pathway, and suppression of ROS­induced lipid peroxidation. Conclusion: We have developed a novel set of small molecule glycomimetics that protect against free fatty acidinduced endothelial dysfunction and thus, represent a new category of therapeutic drugs to target endothelial damage, the first line of defense against cardiovascular disease

Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation

Medulloblastomas were originally classified under gliomas of the cerebellum until Bailey and Cushing in 1925 named these tumors as medulloblastoma. At present these tumors are classified under primitive neuroectodermal tumor. Surgical excision followed by craniospinal irradiation is the treatment of choice. A 13-year-old-girl operated for posterior fossa medulloblastoma 5 years ago presented with history of headache and vomiting on and off for 4 days in late August 2008. The MRI showed left frontal tumor which on excision was reported as medulloblastoma. Even after optimal treatment reports of recurrence abound in literature. The most common location is in the posterior fossa, followed by spinal, supratentorial, and uncommonly, systemic metastases. We conclude that medulloblastomas are highly aggressive tumor with high local recurrences if the initial excision is incomplete and that recurrence in the supratentorial area although uncommon is still a possibility. This mandates regular follow up of these children till adulthood to catch early recurrences and metastatic disease

Traumatic Posterior Fossa Extradural Haematoma

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH with low GCS or the haematoma of more than 10ml were subjected to evacuation. Since the volume of the posterior fossa is limited, patients deteriorate early with the development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases. A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury. Vomiting was the most common symptom accounting for 67% of cases followed by transient loss of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%). A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in 27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%. Key words: extradural, haematoma, posterior fossa, traum

IVI sheet VARIATION IN SHORELINE MACROPHYTES AND WATER QUALITY OF BEESHAZARI LAKE, CENTRAL NEPAL: IVI Table

The research has been designed to examine the variation of macrophyte diversity with references to water parameters, which determines the ecological status of Beeshazari Lake (a Ramsar site). Field data were collected in two seasons (monsoon and winter) from 42 plots with 1 m x 1 m quadrat size, laid down at shoreline of the Beeshazari Lake, each plot being 30 m apart from adjacent plot along the lake perimeter for the quantitative analysis of the macrophytes. A total of 42 macrophytes (40 in monsoon and 31 in winter) were recorded during the sampling seasons. Poaceae was the dominant during both seasons, followed by Asteraceae and Euphorbiaceae families during monsoon, whereas Asteraceae and Polygonaceae were found to be dominant during winter seasons. On the basis of growth form, emergent macrophytes were dominant during both seasons. The Shannon-Weiner Diversity Index (SWI) value of macrophytes was higher during the winter (H = 0.98± 0.04) than monsoon (H = 0.97± 0.04). Lemna perpusilla (Importance Value Index, IVI = 22.8) was the dominant species during the monsoon and Azolla pinnata (IVI = 38.2) during the winter. Macrophytes species richness was positively correlated with temperature, pH, DO, and conductivity whereas negatively correlated with TDS during the monsoon season. Further, in the winter season, the richness was positively correlated with pH, DO, TDS, and electric conductivity, whereas negatively correlated with temperature

Anxiety and Depression among Pregnant Women and Mothers of Children Under one Year in Sindupalchowk District.

Background: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk. Methods: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling. Results: Among pregnant women, the study found that 21.3% (95%CI:15.7–28.3) had anxiety and 23.8% (95%CI:17.8–31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7–22.1) had anxiety and 15.2% (95%CI:12.4–18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression. Conclusions: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing