Study on the Essential Oil of Aerial and Sub-Aerial Parts of Cymbopogon Flexuosus (Nees Ex Steud) Wats.

Cymbopogon flexuosus (Nees ex Steud) Wats commonly known as, East Indian lemongrass a widely grown essential oil plant in the world belongs to the family Poaceae and comprise of 140 species worldwide, found abundantly in tropics and sub-tropic regions of Asia, Africa and America. In India, 45 species are recorded of which the economic importance is C.winterianus, C.flexuosus, C.martinii, C.nardus, C.citratus, C.pendulus, C.jwarancusa and C.khasianus. Aerial and sub-aerial parts of C. flexuosus collected from Himavath Gopala hills, Karnataka, India, were subjected to hydrodistillation for extraction of essential oil. GC and GC-MS analysis were performed to know the chemical composition of the oil. Among the 39 compounds identified in aerial parts of the plant the major compounds were citral (64.98%), 1,7-octadien-3-ol (10.97%), dimethyl oxatricyclo nonanone (9.44%), nerol (2.85%), verbenol (1.77%) and caryophyllene oxide (0.71%). In sub-aerial parts of the plant 33 compounds were identified. The analysis of sub-aerial parts showed a different chemical profile compared to aerial part and possessed citral as the major compound of upto 30.47%. Other compounds in sub-aerial part are Eudesmol (17.82%), Elemol (14.16%), dihydro isopropyl methyl azulene (11.08%), .-cadinene (1.88%), junipene (1.36%), hydroxyalloaromadendrene, juniper camphor (1.12%) and elemene (1.04%)

A clinical study of tramadol as an analgesic in labour

Background: Labour is a painful event, may be the most painful event that women has even experienced. It is unpleasant disturbing and extremely unbearable for many.Methods: The clinical trial was conducted from July 2016 to June 2017 at Karnataka Institute of Medical Sciences, Hubballi. 200 parturients which included both primigravidae and multigravidae in labour at term were alternatively divided into two groups. The study group (n = 100) received 50mg-100mg of Tramadol and control group (n = 100) received no analgesic at the onset of active labour. Degree of pain relief, type of delivery, duration of labour, maternal and foetal morbidity were noted.Results: Pain relief in stage I was grade I (no pain) in 24% V/s 2%, grade II (mild pain) in 62% V/s 40%, grade III (moderate pain) in 13% V/s 56% and grade IV (severe pain) in 1% V/s 2% in study and control groups respectively (p < 0.001). Pain relief in stage II was grade I (no pain) in 8% V/s 0%, grade II (mild pain) in 47% V/s 7%, grade III (moderate pain) in 33% V/s 49% and grade IV (severe pain) in 12% V/s 43% in study and control groups respectively (p < 0.001). Duration of labour was significantly shorter in study group as compared to control group. There was minimal maternal morbidity in study group and no significant difference in the incidence of foetal morbidity in both the groups.Conclusions: Tramadol is an effective and safe labour analgesic. Besides it also shortens the duration of labour

Glove balloon uterine tamponade for post-partum haemorrhage: indigenous, readily available, cheap, easy to learn and practice, yet effective

Background: Postpartum haemorrhage (PPH) is still a nightmare in obstetrics. It is the leading cause of maternal mortality and morbidity accounting for one quarter of the maternal mortality worldwide. In a simple language, we can say PPH is allowing the delivered woman to bleed till death. Uterine atony is the cause in 80% of cases.Methods: This study is conducted in a tertiary care and teaching hospital between May 2019-2020. There were 5400 vaginal and 2100 caesarean sections conducted in our institute in the study period. 20 patients who underwent vaginal delivery and 12 patients of caesarean section had PPH. Only one patient had unsuccessful glove tamponade who underwent stepwise devascularisation for her survival. Hence the success rate of glove tamponade in our institute is found to be 95% (n=19).Results: We chose glove as it is simple, safe, least invasive, rapidly made without any expertise, non-irritant, doesn’t rupture easily, doesn’t slip and cost effective. We have manually tried out the capacity of the glove and found to be enormous, of 10 litres. After a successful insertion of glove tamponade, it is left in situ for 24 hours in our study.Conclusions: In this era of advanced medical services, it is annoying to say women still die of postpartum haemorrhage. Timely intervention (medical or surgical) in the golden hour can bring back many mothers back to life.

Pregnancy emerged thrombocytopenia: maternal and fetal outcome

Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.Methods: It is a prospective observational study done in a tertiary care centre.Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good

A study of maternal and fetal outcomes in critically ill obstetric patients

Background: Pregnancy related morbidity is becoming a nightmare in Indian women. Some of these women end up in mortality and a few of them narrowly escape death. Critical care should be and is an authenticated part of obstetric practice. This study is an effort initiated to understand the risk of maternal morbidity, to investigate the contributing factors, foetal outcome, to study the adverse event, cause of maternal death and remedial measures.Methods: All the obstetric cases admitted in Intensive care unit in a government institute in Maharashtra during January 2018 to June 2019 were analyzed prospectively. The indications for transfer into intensive care, risk factors, co morbidities if any were studied. Maternal and fetal morbidity and mortality were included in the study.Results: During the study period, there were 10, 208 deliveries. There were 12 maternal deaths and 98 critically ill patients became morbid. Anemia is found to be a major pre-existing contributing factor (25.5%) and an important risk factor making pregnancy become critical. DIC is found to be a major reason for ICU admission (39.1%), 72.7% needed mechanical ventilator and 60.1% needed ionotropic support.Conclusions: Anemia is a major problem still existing in our country. Gestational hypertension is another leading cause of critical illness in pregnancy. Identification of patients who are going downhill, timely referral to higher centers and appropriate management can improve both the maternal and the fetal outcomes

Effect of sUV-B on Essential Oil from Aerial and Sub-Aerial Parts of Cymbopogonflexuosus(Nees Ex Steud) Wats.

The effect of supplemental Ulatraviolet-B (sUV-B) radiation on essential oil yield and chemical composition were analysed in Cymbopogonflexuosus (Nees ex Steud) Wats. The exposure to sUV-B radiation for different intervals of time (15min, 30min and 1hr) showed increased percentage of essential oil in aerial parts of the plant. There was no significant variation was observed in essential oil percentage of sub-aerial parts.Theanalysis of essential oils was performed through Gas chromatography (GC) and Gas chromatography - Mass Spectroscopy (GC-MS),which indicated high citral (isomer of geranial and nearl) production in aerial part,an important compound in perfumery and pharmaceutical industry. The increase in citral percentage in UV treated plants ranged from 67.83% to 81.80% compared to control which showed 65%. The sub-aerial part of the control plantpossessed higher percentage of citral (30%)and sUV-B treated plants showed either one of the isomers in varying percentages.Neral (14.73%) and Junipene (52.70%) in sub-aerial part of sUV-B treated plants were found in higher percentages

Comparison of Foley’s catheter with PGE2 gel and Foley’s catheter with PGE2 gel with extra amniotic saline infusion for labour induction

Background: Induction of labour is initiation of uterine contractions before the onset in order to vaginally deliver the foetoplacental unit. Common reasons for induction of labour are post-term and hypertensive disorders of pregnancy. The purpose of this study was to compare the efficacy of Foley catheter with intra cervical PGE2 gel and Foley catheter with PGE2 gel with extra amniotic saline infusion for induction of labour.Methods: The clinical trial was conducted from November 2016 to April 2017 at Karnataka Institute of Medical Sciences, Hubballi. 80 pregnant women which included both primigravidae and multigravidae were alternatively divided into two groups. Group 1 received Foley’s and PGE2 gel and group 2 received Foley’s, PGE2 gel and extra amniotic saline infusion for induction of labour.Results: Both groups were comparable with respect to maternal age, gestational age and indication for induction. There was no significant difference in the mean pre-induction Bishop score between two groups. In both the groups there was significant improvement in the Bishop score after 6 hours of induction. But progress in group 2 was greater than group 1(P <0.05). The mean time from induction to delivery in group 2 was shorter and was statistically significant(P<0.05). There was no difference in mode of delivery, neonatal and maternal morbidity and mortality between 2 groups.Conclusions: The present study showed that Foley’s with PGE2 gel with extra amniotic saline infusion is better for labour induction though both groups appear to be effective agents

Maternal outcome in obstetric ICU and HDU: a study from a teaching hospital in South India

Background: The management of critically ill obstetric patients presents a unique challenge. Dedicated High Dependency Unit (HDU) and Intensive Care Unit (ICU) for obstetric patients are widely available in India. The data regarding obstetric critical care is invaluable in formulating policy decisions. The objective is to study the profile of cases admitted to obstetric HDU and ICU and to evaluate maternal outcome and co-morbid conditions.Methods: This was a prospective observational study between January 2017 and June 2018.Results: Total number of obstetric admissions was 7966. Total admissions to obstetric ICU were 60. ICU cases accounted for 0.7% of all obstetric admissions and 1.1% all deliveries. Obstetric cases formed 1.6% of total ICU admissions. Number of admissions to HDU was 576. HDU cases accounted for 7.2 % of all obstetric admissions. HDU utilization rate was 11.32%. Hypertensive disorders of pregnancy (n=22, 33.3%), obstetric haemorrhage (n=18, 30%), septic abortion (n=2, 3.3%) were the most common conditions necessitating admission.Conclusions: Hemorrhage was the most common indication for admission to HDU. Delayed identification and referral were the important obstacles. There is a need for early booking at peripheral centres. Introduction of obstetric ICU and multidisciplinary approach has brought down the incidence of maternal mortality in present centre

Essential Oil Studies and RAPD Markers in sUV-B Treated Cymbopogon Flexuosus (Nees Ex Steud) Wats

The wild plants of Cymbopogon flexuosus (Nees ex Steud) Wats were subjected to sUV-B treatment to analyze essential oil variation and DNA polymorphism. Significant difference in essential oil yield and citral content was observed. Plants treated with sUV-B for different intervals of time (15min, 30min, 1h, 1.5h, 2.0h, 2.5h, 3.0h, 3.5h and 4.0h) along with control were subjected to RAPD analysis with 10 random decamer primers. Five primers (OPA-01, OPA-09, OPY-18, OPY-09 and OPG-10) produced polymorphism generating 57 amplicons, of which 27 were polymorphic and 30 were monomorphic in nature. Primer OPA-01 showed highest polymorphism (60%) and OPA-09 showed lowest polymorphism (12.5%). High genetic similarity was observed in treatment with 1.5h and 2.5h and least genetic similarity in treatment with 3.5h and control plants. Dendrogram constructed on genetic similarity coefficient showed two clusters viz., cluster I and II. The study indicates the significant variation at intraspecies level with respect to essential oil yield, citral content and DNA polymorphism in sUV-B treated plants which can be further exploited for developing high yielding chemotypes in C. flexuosus