THE NEUROPROTECTIVE EFFECTS OF MEDICINAL PLANTS ON ALZHEIMER`S DISEASE: A REVIEW

In the 21st century, the human population is suffering from a neurodegenerative disorder in which neuronal death occurs due to a long-term chronic condition causing substantial major health concerns. When neurons die, they are not regenerated, causing cognitive impairment, i.e., Alzheimer’s disease, Parkinson’s disease, schizophrenia, and dementia. This review concentrates only on Alzheimer’s disease aetiology and various plants having potent neuroprotective activity related to Alzheimer’s disease. The most common aetiology of Alzheimer’s disease is a deposition of APP protein, hyperphosphorylation of Tau protein, a reduction in acetylcholine and oxidative stress, which are discussed briefly. Moreover, pertinent evidence is also discussed for medicinal plants with potent or promising neuroprotective activity related to Alzheimer’s disease

A comparative study of using glibenclamide versus insulin in the treatment of gestational diabetes mellitus and its outcome

Background: Gestational diabetes mellitus(GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. This study aims at determining the efficacy of the glibenclamide versus insulin in achieving the adequate glycemic control and to analyze the maternal and fetal outcomes and to determine the failure rate of glibenclamide, patient compliance and overall cost of the treatmentMethods: This study was carried out for a period of 22 months at Command Hospital Air Force, Bangalore in Dept. of OBG. Women with GDM whose glycemic control was not achieved with medical nutrition therapy with fasting blood sugar (FBS) values >105mg/dl and 2hour post prandial blood sugar (PP) value >140mg/dl were selected and randomized for treatment either glibenclamide or insulin (50 in each group).Results: The age of the patients in this study ranged from 23 to 33 years. The mean age in glibenclamide group was 27.32 (SD ± 2.84) where as in insulin group was 26.30 (SD ± 3.01). The mean plasma glucose level achieved with glibenclamide was fasting -87.62 mg/dl, post prandial -116.44 mg/dl, before lunch - 95.62mg/dl, after lunch -115.80 mg/dl, before dinner-91.96 mg/dl, after dinner - 116.64 mg/dl, 3AM - 84.42 mg/dl and next day fasting - 86.30mg/dl in comparison with insulin where fasting- 85.54 mg/dl , post prandial -114.14 mg/dl, before lunch - 87.08, after lunch -112.82 mg/dl, before dinner-86.76 mg/dl and after dinner - 114.18 mg/dl, 3AM - 81.16 mg/dl and next day fasting was 86.72mg/dl which is statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the group. 4 % percent of patient treated with glibenclamide had treatment failure. The cost of the treatment and compliance was better with glibenclamide.Conclusions: It has been concluded that glibenclamide is effective as insulin in achieving adequate glycemic control with no significant maternal and fetal morbidity and mortality

Sperm recovery and IVF outcome after surgical sperm retrieval in azoospermia: our experience

Background: In the last decade, male factor infertility has been recognized as a significant global problem, which is on an increase. Till date, very few options are available for ameliorating male factor infertility. Development of intracytoplasmic sperm injection has revolutionized the treatment of males with very low sperm counts or with poor quality sperm. However, patients with a diagnosis of azoospermia had no option but to resort to adoption or use of donor sperm. The clinical management of men with azoospermia seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. The older approaches denied such couple the possibility of having own genetic children. Surgical sperm retrieval and intracytoplasmic sperm injection have successfully transformed the treatment of male infertility so that now most of the men can father their own children. The aim of this study is to present the outcome of IVF with surgically retrieved sperm from azoospermic men.Methods: This study was a retrospective analysis of 100 cycles using surgically retrieved sperm. Outcome measures were fertilization rate (FR) and implantation rate (IR) per transfer.Results: Sperm retrieval rate in our study was 76% when Per cutaneous epididymal sperm aspiration (PESA) and Testicular sperm extraction (TESE) are combined. Our data demonstrated similar outcome between the use of epididymal or testicular sperm in men with azoospermic. There was no statistical difference concerning fertilization rate, embryo quality and pregnancy rate between ICSI with surgically retrieved sperm and ejaculated sperms.Conclusions: Surgical sperm retrieval is a feasible and successful procedure. Spermatozoa can be retrieved from the testis in up to 76% of patients, even in cases with severe disorders of spermatogenesis and deranged hormonal profile. Comprehensive genetic counseling is important for infertile couples deciding for surgical sperm retrieval, since genetic disorders, as yet undetected, may be passed on to the following generation with multiplying variety.

Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob’s score

Background: Ovarian malignancy is the most common gynecological malignancy after the cancer of the cervix. A woman's risk at birth of ovarian cancer at some time in her life is 1 % to 1.5% and that of dying from cancer is almost 0.5 %. The most commonly occurring ovarian tumors are of epithelial in origin. It has the highest case-fatality ratio of all gynecological malignancies. Hence the early diagnosis is the most important factor for better prognosis. A clinical evaluation of the patient, followed by ultrasonography and CA-125 is helpful. This study aims to determine the role of Risk of Malignancy Index (Jacob’s RMI) in ovarian tumors for prediction of ovarian malignancy.Methods: This is a prospective cohort study. The present study was carried out at department of OBG, in collaboration with the Departments of Radio diagnosis and Pathology, AHRR, New Delhi. 100 patients meeting the inclusion and exclusion criteria were considered. Detailed clinical history, examination and ultrasonography (Abdomen and pelvis) were done. Estimation of CA125 was done thereafter. Calculated JACOBS RMI score was compared with operative surgical staging and histopathological-cytological examination of the specimen. Data obtained thereafter was analysed using appropriate and relevant statistical software.Results: In present study sensitivity of RMI Score in the pre-menopausal women was 66.7% and in post-menopausal women was 83.3%. Specificity of RMI Score in the pre-menopausal women was 96.3% and in post-menopausal women was 81.8%. The positive predictive value in the pre-menopausal women was 40% and in post-menopausal women was 71.4%. The negative predictive value in the pre-menopausal women was 98.7% and in post-menopausal women was 90%. Diagnostic accuracy in a case of premenopausal women was is 95.2% and 82.4% for postmenopausal women.Conclusions: The present study shows that RMI Score helps in identifying effectively those patients who require Staging Laparotomy and hence referral to Gynecologist Oncologist. Patients with ovarian masses with low risk of malignancy index can be treated by minimal access procedures

Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital

Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision

Role of modified biophysical profile in the management of post term pregnancy

Background: Prolonged gestation complicates 5% to 10% of all pregnancies and confers increased risk to both the fetus and mother. In the west about 18% of all singleton pregnancies persist beyond 41 weeks, 10% (range, 3% to 14%) continue beyond 42 weeks and 4% (range, 2% to 7%) continue beyond 43 completed weeks in the absence of an obstetric intervention. The risks for prolonged and post-term pregnancy include obesity, nulliparity, maternal age >30 years. Apart from these racial and ethnic differences have also been cited to be the reasons for higher risk of prolonged and post-term pregnancy. Post term pregnancies are associated with various maternal and neonatal complications.Methods: A prospective study was carried out at Department of Obstetrics and Gynaecology, Command Hospital, Central Command, Lucknow. 100 patients were selected and divided into two groups and were followed up till the delivery.  Data so collected was subjected to analysis using Statistical Package for Social Sciences version 15.0.Results: Majority of women enrolled in the study were aged above 25 years. Majority of women enrolled in the study were primigravida (67%). The Mean BMI of women enrolled in the study was 24.2±3.43 kg/m2 and the expectant and control groups were matched demographically and anthropometrically. The compromised modified biophysical profile was recorded in 33 (66%) of women in expectant group. Rate of caesarean delivery was 30% in expectant and 46% in control group. In the expectant group, AFD was the most common indication for caesarean section while control group had NPOL as the most common indication for caesarean section. In the expectant group, mean AFI showed a declining trend with increasing gestational age.Conclusions: It was concluded that expectant management using modified biophysical profile (MBPP) does not provide an additional value over prophylactically managed pregnancies. Although cesarean rate and NICU admission rates were lower in expectant group as compared to control group yet the utility of MBPP in expectant management could not be proven and needs further assessment in larger studies or pooled clinical trials

Correlation of intra partum electronic fetal monitoring with neonatal outcome

Background: The importance of fetal monitoring during labour has been realized since long. The stress of uterine contractions may affect the fetus adversely especially if the fetus is already compromised, when the placental reserves are suboptimal, or when cord undergoes compression as in those associated with diminished liquor amnii or iatrogenic uterine hyperstimulation due to injudicious use of oxytocin. Even a fetus which is apparently normal in the antenatal period may develop distress during labour. Hence fetal monitoring during antepartum and intrapartum periods is of vital importance for timely detection of fetal distress so that appropriate management may be offered.Methods: This study was a prospective observational study included 100 patients of more than 34 weeks period of gestation were divided into two groups. Patients in labour were analyzed on an Electronic Monitor. Delivery conducted was either by vaginal route, instrumental or by caesarean section depending upon the fetal heart rate tracings and their interpretations as per the case. At the time of delivery umbilical cord blood was taken for the pH analysis. All new born babies were seen by the paediatrician immediately after the delivery and 1 and 5 minute APGAR score assessed for the delivered baby. The various EFM Patterns obtained were compared with the neonatal status at birth using the parameters already mentioned. The false positives and false negatives if any were tabulated. Data so obtained was analyzed statistically thereafter. Statistical Package for Social Sciences (SPSS) Version 13.0 was used for the purpose of analysis.Results: Results revealed that among the 50 subjects of the case group, 7 subjects showed the absence of the beat to beat variability, 12 subjects showed early deceleration, 32 subjects showed late deceleration, and 6 subjects showed the presence of variable deceleration. No significant association of beat to beat variability, early and variable deceleration could be established with meconium staining/NICU admissions/low APGAR. A significant positive association between persistent late deceleration with MSL, APGAR <7 at 1 min, and Instrumental/LSCS delivery was seen. A significant positive association between any CTG abnormality and APGAR at 1 min, type of delivery, and meconium staining was seen.Conclusions: EFM should be used judiciously. Cardiotocography machines are certainly required in the labour room. Equally important is the proper interpretation of the CTG tracings so that unjustified caesarean sections can be minimized, at the same time picking up cases of fetal distress in time which is likely to improve fetal outcome

Foetal umbilical artery doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and foetal growth restriction

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome.Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out.Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates.Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention

The comparative and prospective study on efficacy and functional outcome of autologous platelet rich plasma injection vs hydrodissection in adhesive capsulitis of shoulder

Background: Adhesive capsulitis of should is also called frozen shoulder which describes a chronic, indolent pathological process in which the body forms excessive adhesions across the glenohumeral joint which in turn leads to pain, stiffness, and loss of range of movements which compromises the quality of life. The objective of the study was to evaluate the efficacy and functional outcome of autologous PRP injection and hydrodissection in adhesive capsulitis of shoulder.Methods: After excluding the patients who failed to satisfy the study protocol, the remaining 100 patients are divided equally into two groups namely group A (n=50) who receive autologous PRP injection and group B (n=50) who receive hydrodissection for adhesive capsulitis of shoulder. Both group participants are followed up pre-procedurally and post-procedurally at the end of 1st, 6th and 12th month for pain relief and range of movements. The improvements in pain and range of movements are charted in terms of VAS and DASH scoring system.Results: The statistical analysis were done for 46 patients in group A and 45 patients in group B which showed a statistical improvement in pain and range of movements (p&lt;0.001 for VAS score and p&lt;0.01 for DASH score) in group A who received autologous platelet rich plasma therapy. Autologous PRP therapy improves the functional quality of life with a long term outcome.Conclusions: For adhesive capsulitis of shoulder, autologous PRP therapy remains functionally superior than hydrodissection as autologous PRP is a constructive procedure by rejuvenating the degenerative tissues.

Modified Electromagnetic Actuator for Active Suspension System

Active suspension is a type of suspension systems which can vary its damping value in order to adjust the spring firmness in accordance with the road conditions. Real Active Suspension incorporates an external actuator which helps in raising or lowering of vehicle chassis independently at each wheel. Generally, the actuators that are used for active suspension are Hydropneumatic, Electro-hydraulic or Electromagnetic actuators. A new concept of two-way electromagnetic actuation with the help of magnetic damping is proposed in this paper, which can extend its arm on both sides to facilitate active suspension mechanism in both humps and potholes. This increases the ride quality while maneuvering not only in humps, but also in dumps. It also describes about the comparison of spring materials, sophisticated design, construction and working principle of newly proposed actuator. Catia V5 software has been used to design and simulate the actuator model, different spring materials are analyzed and their shear stress and deflections are compared