Effect of epidural analgesia on the duration of labour and pains: a comparative study

Background: Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of Epidural Analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Objective of this study was to study the effect of epidural analgesia on the duration of labour and pains.Methods: The present study was conducted on 60 women in the department of obstetrics and gynecology at Topiwala National Medical College, Mumbai during a period from October 2014 to January 2017. The women requesting EA were assigned as the study group (Group A - 30 cases) and women not receiving EA were included in the control group (Group B - 30 cases).Results: The duration of active phase of first and second stage of labour was found to be prolonged in patients who received EA as compared to control group. An increase in number of caesarean sections and requirement of oxytocin augmentation was found to be more in Group A as compared to Group B. There was no statistically significant difference in Apgar score of newborns at 1 min and 5 min in both the groups. The patients demanding epidural drug had better pain relief during labour. In Group A, 17% of patients and in Group B, 7% of patients had nausea and vomiting. Other side effects were minimal.Conclusions: Epidural analgesia is not a totally free of disadvantages, it is the most effective mode of pain relief available compared with other techniques. The addition of patient-controlled epidural analgesia and innovations using new technologies enhance patient satisfaction

Prediction of preterm delivery with a novel bedside test

Background: Preterm birth occurs in 7 to 12 % of all deliveries but account for 85% of perinatal morbidity and mortatity. Hence, there is a need for a reliable test to predict the onset of preterm labour. One such test is detection of phosphorylated insulin like growth factor binding protein 1 (phIGFBP- 1) in cervical secretion with a simple bedside kit that is recently commercialized Actim Partus kit.Methods: This was a prospective study carried out at a tertiary hospital over a period of 2 years from October 2006 to November 2008. Women between 28 to 37 weeks with intact fetal membranes, who presented with threatened preterm labour were included and followed up till delivery. Time interval between test and delivery, weeks of gestation at the time of delivery, labour and delivery details as well as neonatal outcome were documented. Diagnostic accuracy of the test was determined by sensitivity, specificity, positive and negative predictive value.Results: It was found that this test was extremely sensitive in prediction of preterm delivery and negative test results implied low chance of preterm delivery as in the patients with positive test result the average time of prolongation of pregnancy was less than 24 hours and in patients with negative test result it was more than 7 days which was statistically significant (P value = 0.001). The need for NICU and perinatal morbidity was significantly less in patients with negative test result.Conclusions: There is a role of detection of cervical IGFBP-1 test in the management of women presenting with suspected preterm labour which allows us to focus on patients who are more likely to deliver preterm and also to reduce perinatal mortality and morbidity

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Assessing Growth-Promoting Activity of Bacteria Isolated from Municipal Waste Compost on <i>Solanum lycopersicum</i> L.

Rapid urbanization and population growth are stressing the present agricultural systems and could threaten food security in the near future. Sustainable development in agriculture is a way out to such enormously growing food demand. Plant growth-promoting bacteria (PGPB) are considered pivotal to providing adequate nutrition and health to plants and maintaining soil microbial dynamics. In the present study, municipal solid waste composts (MSWC) were studied for the presence of PGPB and their growth-promoting characteristics such as ammonium production, siderophores production, phosphorus solubilization and potassium solubilization, IAA (indole acetic acid), and HCN production. Four promising isolates were chosen and identified through 16S rRNA sequencing as Bacillus sp. strain L5-1, Bacillus pumilus strain EE107-P5, Bacillus sp. strain LSRBMoFPIKRGCFTRI6 and Bacillus sp. strain LPOC3. The potential of isolates is validated using Solanum lycopersicum (tomato) and was found to improve its growth significantly. The findings indicated the presence of potential Bacillus strains in MSWCs, and these composts can be utilized as biofertilizers for urban agricultural practices. However, studies concerning their impact on other crops’ growth and health are still underdeveloped. Since MSWCs might carry hazardous metals or chemicals, their evaluation for the safe application on the crops should also be assessed

Modulating the Ubiquitin&ndash;Proteasome System: A Therapeutic Strategy for Autoimmune Diseases

Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease associated with the central nervous system (CNS). Autoimmunity is caused by an abnormal immune response to self-antigens, which results in chronic inflammation and tissue death. Ubiquitination is a post-translational modification in which ubiquitin molecules are attached to proteins by ubiquitinating enzymes, and then the modified proteins are degraded by the proteasome system. In addition to regulating proteasomal degradation of proteins, ubiquitination also regulates other cellular functions that are independent of proteasomal degradation. It plays a vital role in intracellular protein turnover and immune signaling and responses. The ubiquitin&ndash;proteasome system (UPS) is primarily responsible for the nonlysosomal proteolysis of intracellular proteins. The 26S proteasome is a multicatalytic adenosine-triphosphate-dependent protease that recognizes ubiquitin covalently attached to particular proteins and targets them for degradation. Damaged, oxidized, or misfolded proteins, as well as regulatory proteins that govern many essential cellular functions, are removed by this degradation pathway. When this system is affected, cellular homeostasis is altered, resulting in the induction of a range of diseases. This review discusses the biochemistry and molecular biology of the UPS, including its role in the development of MS and proteinopathies. Potential therapies and targets involving the UPS are also addressed

Modulating the Ubiquitin–Proteasome System: A Therapeutic Strategy for Autoimmune Diseases

Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease associated with the central nervous system (CNS). Autoimmunity is caused by an abnormal immune response to self-antigens, which results in chronic inflammation and tissue death. Ubiquitination is a post-translational modification in which ubiquitin molecules are attached to proteins by ubiquitinating enzymes, and then the modified proteins are degraded by the proteasome system. In addition to regulating proteasomal degradation of proteins, ubiquitination also regulates other cellular functions that are independent of proteasomal degradation. It plays a vital role in intracellular protein turnover and immune signaling and responses. The ubiquitin–proteasome system (UPS) is primarily responsible for the nonlysosomal proteolysis of intracellular proteins. The 26S proteasome is a multicatalytic adenosine-triphosphate-dependent protease that recognizes ubiquitin covalently attached to particular proteins and targets them for degradation. Damaged, oxidized, or misfolded proteins, as well as regulatory proteins that govern many essential cellular functions, are removed by this degradation pathway. When this system is affected, cellular homeostasis is altered, resulting in the induction of a range of diseases. This review discusses the biochemistry and molecular biology of the UPS, including its role in the development of MS and proteinopathies. Potential therapies and targets involving the UPS are also addressed

Assessment of Heavy Metal Distribution and Health Risk of Vegetable Crops Grown on Soils Amended with Municipal Solid Waste Compost for Sustainable Urban Agriculture

Rapid urbanization is one of the key factors that leads to defragmentation and the shrinking of agricultural land. It further leads to the generation of an ample amount of municipal waste. Several technologies have emerged in the past for its utilization, and in this regard, composting is one of the conventional approaches gaining popularity in modern agriculture. To overcome the possible criticality of intense urbanization, the concept of urban agriculture is taking shape. Municipal solid waste compost (MSWC) has been popularly explored for the soil amendments and nutritional requirements of crops. With this, the assessment of soil pollution (due to the heavy metals presently found in MSWC) is a required step for its safe application in agriculture. The present study aims at assessing the utilization of MSWC (in different ratios) to amend the soil and its impact on the growth and yield of brinjal (Solanum melongena), tomato (Solanum lycopersicum), and okra (Abelmoschus esculentus). The study also explored the uptake of heavy metals by plants and their risk to human consumption. The findings suggested that MSWC amendments upgraded the physio-chemical properties of soil, including organic matter (OM) and micronutrients, and increased the heavy metal concentrations in soil. Heavy metal analysis underlined the presence of several heavy metals both in soil and crops. Total metal concentration in soil increased with increased MSWC dosage. Concerning metal uptake by crop plants, 25% of MSWC was found to impart metal concentrations within permissible values in edible parts of crops. On the contrary, 50%, 75%, and 100% compost showed higher metal concentrations in the crops. A Health Risk Index (HRI) of less than 1 was found to be associated with soil amended with 25% MSWC. Our study implies that MSWC significantly improved the growth and yield of crops, and it can be considered an alternative to chemical fertilizer but only in a safer ratio (≤25%). However, further studies are required, especially on field conditions to validate the findings regarding metal accumulation