ENHANCEMENT AND VALIDATION OF WOUND HEALING ACTIVITY WITH HERBAL GEL FORMULATED FROM SUB-FRACTION OF BUCHNANIA LANZAN SPRENG. BARK EXTRACT

Objective: The scheme of the present study is to formulate and evaluate herbal gel prepared from sub- fraction of Buchnania lanazan bark extract to augment its wound healing activity. Methods: Ethyl acetate fraction of Buchanania lanzan bark (Et- BLB) was sub-fractionated by column chromatography using (7:3 methanol: chloroform) solvent system, phytochemical test for Et- BLB and F1- 4 (ethyl acetate sub-fractions 1, 2, 3 & 4 of methanolic extract of BLB); in particular total flavonoid and phenolic content to demonstrate existence of anti-oxidant activity. In-vivo wound healing supporting study mediated by carrageenan induced paw edema as anti inflammatory activity. Herbal gel was formulated incorporating one of the active sub-fractions essentially F4 in two concentrations (1% & 5%). Carbopol 934, propylene glycol 400, methyl paraben & quantity sufficient distilled water was used to prepare herbal gel; then tri-ethanolamine was added to get neutral pH (6.8 - 7) & gel was evaluated for its spreadability, pH, colour, consistency & appearance. Excision & incision models were used to validate and to review enhancement competence of wound healing activity; employing percent wound contraction & tensile strength of wounded skin as parameters. Reference standard used was framycetin sulphate cream. Results: Total phenolic and flavonoid content of F4 was showing highest flavonoid and phenolic content 83.3 mg/g and 77.8 mg/g respectively. Prepared gel was reddish brown in colour with satisfying spreadability, acceptable appearance along with homogeneity and negligible irritation. Excision and incision animal wound model, groups treated with F4 5 % gel and reference standard exhibited significant increase in percentage of wound contraction as well as up growth in tensile strength with 177 g (P<0.05) and 181.2 g (P<0.01) respectively. Conclusion: Data from both the models revealed that 5% gel of F4 showed significant & enhanced wound healing

METABOLIC SYNDROME ASSOCIATED COMPLICATIONS

Metabolic syndrome (MetS) is characterized by a cluster of disorders like obesity, insulin resistance, glucose intolerance, hypertension and dyslipidemia. All these disorders are responsible for the development of secondary morbid and co-morbid conditions. The current review focuses on the molecular pathogenesis of secondary late complications associated with metabolic syndrome including cognitive impairment, depressive disorder, neuropathy, arthritis and colorectal cancer.Â

Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour

Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature

Measurement of cervical length using transvaginal sonography for prediction of preterm labour

Background: Preterm labour and delivery cause major health burden to the society due to high perinatal morbidities and mortality and long-term health implications and also affects maternal. An effective and objective way for predicting preterm delivery is measurement of cervical length by transvaginal sonography as it allows better quality and accurate visualization of uterine cervix. Cervical length (<25 mm) is good and accurate cervical biometry for prediction of preterm birth. The objective of this study was to measure cervical length by transvaginal sonography for predicting preterm labour and fetal outcome.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology, at SVPIMSR hospital, Ahmedabad from July 2018 to December 2019 in 150 antenatal women to assess cervical changes (cervical length, dilatation of internal OS, funnelling etc.) between 16 to 24 weeks of gestation and these cases followed till delivery and results were analysed.Results:150 antenatal women who fulfilled the selection criteria were studied using transvaginal ultrasound between 16-24 weeks of gestation, out of them 36 (24%) women delivered preterm babies. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) recorded in this study were 80.5%, 94.73%, 82.85% and 93.91% respectively.Conclusion: Transvaginal sonography is the most useful and better, safe, accurate, most effective, less expensive, objective and acceptable technique for assessing cervical length in all antenatal women and predicting the preterm labour when assessed between 16 -24 weeks of gestational age

Role of diagnostic hysterolaparoscopy in the evaluation of infertility

Background: Infertility has become nowadays not only a medical, but a social problem as well. None of the laboratory findings alone is conclusive in diagnosing infertility. Diagnostic hysterolaparoscopy is an accurate method of assessing and treating infertility. Direct visualization of abdominal and pelvic organs in hysteroscopy and laparoscopy allows a definite diagnosis where clinical examination and less invasive techniques such as ultrasound, SSG and HSG fail to identify the problem. The main objective of study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centers.Methods: A prospective hospital based study was carried out in two tertiary care centers (Sheth V.S. General Hospital and Smt. S.C.L. Municipal Hospital) over a period of 2 years from July 2013 to June 2015. Hysterolaparoscopy was done in 300 patients. Women aged 20-40 years with normal hormone profile without male factor infertility were included.Results: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 35% of the cases, significant hysteroscopy findings were noted in 17% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesions (12%) in primary and secondary infertile patients respectively, on hysteroscopy, intrauterine septum was found as the commonest abnormality in both the groups.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions and subseptate uterus, which are usually missed by other imaging modalities

Increased Physical Activity and Reduced Pain with Spinal Cord Stimulation: a 12-Month Study

International Journal of Exercise Science 13(3): 1583-1594, 2020. The purpose of this study was to assess changes in pain and physical activity after replacing a traditional spinal cord stimulation (SCS) implantable pulse generator with a next generation SCS in patients for whom traditional SCS was no longer providing adequate relief of low back and/or leg pain. Subjects (n = 19) who reported that they were no longer receiving adequate relief from traditional SCS were implanted with a next generation SCS. Eighteen additional patients who were receiving relief from traditional SCS were also followed as a control. Both groups (next generation, traditional) were assessed for low-back and limb pain (visual analog scale) and daily physical activity (wearable accelerometer) at baseline and three, six, nine and 12 months following the SCS implant. Relative to baseline, next generation SCS subjects exhibited reductions (p ≤ 0.05 for all) in low-back pain (average reduction of 22%) at every time point, in leg pain (average reduction of 23%) at every time point except six months and increased physical activity (average increase of 57%) at three, six and nine months. As expected, there were no changes in pain or physical activity in the traditional SCS subjects (p ≥ 0.1). In conclusion, pain decreased, and physical activity increased in patients receiving a next generation SCS. Physical activity may serve as an objectively measured marker of pain

The Summer Of The Pivot: Prioritizing Equity In Remote Instruction Through A Multidisciplinary Community Of Practice Initiative At A Canadian University

This article is about the multidisciplinary Community of Practice (CoP) initiative that was implemented in the summer of 2020- summer of the pivot- at a Canadian post-secondary institution to prepare faculty, staff, and students for remote teaching and learning while navigating pandemic conditions created by COVID-19. The CoP as a case study using Critical Theory as a theoretical framework examines the experiences of a collective group of faculty and staff from different disciplines leading a multidisciplinary university-wide initiative and the implications of the approach for promoting effective pedagogies for teaching and learning remotely. Findings based on feedback from workshop attendees, reflections from the CoP facilitators, and comments forwarded to senior administrators about the impact and the effectiveness of the program indicate positive results. It is recommended that although the CoP initiative was originally conceived as a response to the summer of the pivot, it should become an integral approach to promoting dialogue and innovative strategies to advance equitable practices in higher education by cultivating community networks. The findings serve to continue constructive dialogues and discussions about how universities can transition, pivot, and mobilize innovatively and creatively to prioritize equitable teaching and learning conditions that challenge the status quo. This requires a long-term commitment by higher education institutions to break away from historically normalized practices and invest in innovative ways to identify and meet the needs of various stakeholders

A hospital based retrospective study of thyroid disorders on obstetric and perinatal outcomes

Background: The study was undertaken in pregnant women to understand and analyze the obstetric and foetal outcomes of thyroid disorders.Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5 mIU/ml in first trimester and above 3 mIU/ml in second and third trimesters were evaluated for free T3, free T4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery.Results: Total no of pregnant women screened were 904 over a period of 1 year from 15 March 2019 to 14 March 2020, of which 115 had abnormal thyroid functions, thereby the prevalence of thyroid disorders being 12.72%. Of the 115 patients with thyroid disorders, 112 were hypothyroid and 3 were hyperthyroid. Among the 112 hypothyroid cases, 48 were known cases and 64 were new cases. The total cases of subclinical hypothyroidism were 88, prevalence being 9.73% and overt cases were 24, prevalence being 2.65%; 3 cases were overt hyperthyroid, prevalence being 0.33%. 66% of subclinical hypothyroidism were TPO positive and 34% of overt hypothyroidism were TPO positive (p<0.05). Out of 115 abnormal thyroid function patients, 92 patients delivered in our hospital. There were 15 abortions, 13 spontaneous and 2 terminations of pregnancies; 7 patients have delivered outside and 1 patient lost follow up.Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and foetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients

Pregnancy outcome in patients with fibroid: a retrospective study

Background: Fibroids are benign smooth muscle cell tumour of the uterus. In some patients of pregnancy associated with fibroid, it does not affect the outcome of pregnancy. On the other hand, various complications have been reported. The aim of our study was to evaluate the outcome in antenatal women with fibroids.Methods: This retrospective study was conducted at tertiary care center, obstetrics & gynecology department over a period of eighteen months between June 2018 to November 2019. Total 26 pregnant patients with >3 cm fibroid was included in the study. They were followed during antenatal period. Maternal age, parity, size of fibroid, complications during pregnancy, labour, and delivery, mode of delivery and indications of cesarean section were noted.Results: Out of 26 patients, 15 (57.6%) were between 26-30 years of age group and 16 (61.53%) were multigravidas. Normal vaginal delivery occurred in 8 (33.33%), while 16 (66.66%) delivered by caesarean section. There were 9 (34.61%) patients who had no complication whereas 17 (65.38%) had some complication. Pain was present in 8 (30.76%). PROM and preterm labour were present in 3 (18.75%) and 5 (19.23%) respectively. PPH was present in 2 (7.69%).Conclusions: Pregnant patients who have fibroids are to be carefully screened in the antenatal period, so as to have a regular follow up. The widespread use of ultrasonography has facilitated diagnosis and management of fibroids in pregnancy. The site and size of fibroid is very important to predict its effect on pregnancy

A study of feto-maternal outcome in case of premature rupture of membrane at a tertiary care center

Background: Premature rupture of membranes is the rupture of the fetal membranes in the absence of uterine contraction or before the onset of labor. When this occurs before 37 weeks of gestation, it is termed as preterm premature rupture of membranes. Management depends upon gestational age and the presence of complicating factors. An accurate assessment of gestational age and knowledge of the maternal, fetal and neonatal risks are essential to appropriate evaluation, counselling, and care of patients with PROM. The purpose of the study is timely diagnosis and appropriate management of the cases of PROM and PPROM to improve maternal and neonatal outcomes. Methods: A Prospective study was performed at the department of obstetrics and gynecology, at a tertiary care center from August 2020 to December 2021. A clinical data sheet was made for recording all information about the pregnant women after taking their consent. And their maternal and neonatal outcomes were recorded. Results: a total of 150 cases of PROM and PPROM were taken during our study out of which 53.33% belong to the younger age group, 43.33% were primi gravida, 66.66% belonged to the lower socioeconomic class, 25.33% had a previous history of abortion followed by dilatation and evacuation, rate of cesarean delivery was 34.66% and rate of NICU admission of neonates was 15.78% and 57.87% babies had low birth weight and rate of stillbirth was 1.97%. whereas 34.66% of cases had various complications related to PROM. Conclusions: Individualized management of PROM cases depending on the gestational age and risk of complications and antibiotic coverage is the best way to achieve a good fetomaternal outcome