Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey

Background: Partograph is an effective, but underutilized tool for monitoring labour. This study examined the influence of hospital policy on the knowledge, attitude, practice and skills of doctors towards partograph plotting.Methods: A cross-sectional survey among doctors posted in labour rooms of tertiary care public teaching hospitals of India was carried out, using self-administered questionnaire to assess knowledge, attitude and practice; and labour case scenarios were provided to assess partograph plotting skills. Chi-square test or Fisher’s exact test were employed to test the significance of association between knowledge, attitude, practice and skills of 150 doctors working in hospitals with (n=3) and without (n=2) policy of routine partograph plotting.Results: The majority of doctors in both groups had correct knowledge about different partograph components. However, doctors working in hospitals with a policy of partograph use, demonstrated significantly better skills using case scenarios for plotting partographs (p<0.01), and a positive attitude towards plotting partograph and its use as a decision support tool (p=0.000) as compared to doctors working in hospitals without a routine partograph plotting policy.Conclusions: Hospital policy of routine partograph plotting may positively influence utilization of partograph in tertiary care public hospitals in India

In vitro induction of tuber formation for the synthesis of secondary metabolites in Chlorophytum borivilianum Sant. et Fernand

Chlorophytum borivilianum Sant. et Fernand an endangered herb is valued for several medicinal properties in its tuberous roots. An efficient and reproducible method for inducing in vitro tubers from stem disc explant has been developed. Stem disc possessing shoot buds were induced to develop multiple shoots in Murashige and Skoog (MS) medium supplemented with vitamins, 3% sucrose, 0.8% agar and 5 mg/L benzylaminopurine (BAP). Healthy regenerated shoots were rooted in MS basal medium containing 3% sucrose (w/v), 0.8% agar supplemented with indole-3-acetic acid (2 mg/L). On further sub culturing, the maximum percentage of tuber formation was obtained in growth hormone free half (½) MS liquid media supplemented with vitamins and 1.5% sucrose after 8 to 9 weeks. The saponin contents of the in vitro and in vivo raised tubers were qualitatively and quantitatively analyzed by highperformance liquid chromatography (HPLC) and liquid chromatography electrospray ionization mass spectrometry (LC-ESI-MS). There was a significant similarity in the saponins in both tubers. The in vitro raised tubers showed similar high metabolite content than in vivo grown tubers which is required for medicinal applications. The rooted plantlets were transferred to peat and sand (2:1) with more than 80% success. This is the 1st report of in vitro tuber formation and secondary metabolites screening of C. borivilianum. This work will give a strong impetus to the pharmaceutical and neutraceutical sectors.Keywords: Chlorophytum borivilianum, tuber formation, saponin, liquid medium, high-performance liquid chromatography (HPLC)African Journal of Biotechnology Vol. 12(20), pp. 2900-2907

Computed tomography texture-based radiomics analysis in gallbladder cancer: initial experience

Aim of the study: To investigate computed tomography (CT) texture parameters in suspected gallbladder cancer (GBC) and assess its utility in predicting histopathological grade and overall survival. Material and methods: This retrospective pilot study included consecutive patients with clinically suspected GBC. CT images, clinical, and histological or cytological data were retrieved from the database. CT images were reviewed by two radiologists. A single axial CT section in the portal venous phase was selected for texture analysis. Radiomic feature extraction was done using commercially available research software. Results: Thirty-eight patients (31 females, mean age 53.1 years) were included. Malignancy was confirmed in 29 patients in histopathology or cytology analysis, and the rest had no features of malignancy. Exophytic gallbladder mass with associated gallbladder wall thickening was present in 22 (58%) patients. Lymph nodal, liver, and omental metastases were present in 10, 1, and 3 patients, respectively. The mean overall survival was 9.7 months. There were significant differences in mean and kurtosis at medium texture scales to differentiate moderately differentiated and poorly differentiated adenocarcinoma (p < 0.05). The only texture parameter that was significantly associated with survival was kurtosis (p = 0.020) at medium texture scales. In multivariate analysis, factors found to be significantly associated with length of overall survival were mean number of positive pixels (p = 0.02), skewness (p = -0.046), kurtosis (0.018), and standard deviation (p = 0.045). Conclusions: Our preliminary results highlight the potential utility of CT texture-based radiomics analysis in patients with GBC. Medium texture scale parameters including both mean and kurtosis, or kurtosis alone, may help predict the histological grade and survival, respectively

Therapeutic Uses of Wild Plants by Rural Inhabitants of Maraog Region in District Shimla, Himachal Pradesh, India

The main aim of this study is to document important ethnomedicinal plants from the Maraog region, located in the district of Shimla in Himachal Pradesh, India. A total of 110 medicinal plant species belonging to 102 genera and 57 families were reported from the study site. All of the species were collected from wild habitats. The rural people of the Maraog region were surveyed through interview methods, group discussions, and participatory observations. In the current study, data were collected from 88 informants through the snowball method. A total of 110 plant species were collected from the study area, including 64 herbs, 24 shrubs, 9 trees, 5 climbers, 3 grasses, and 5 ferns. Most of the plant species, reported from the study area, belong to the Rosaceae and Asteraceae families, each contributing 12 plant species, followed by the Lamiaceae family with 6 plant species. The most used part of the plant in the preparation of herbal medications is the leaves, which have been reported in 62 plants, followed by roots in 14 plants, and flowers and other aerial parts in 9 plants. The ethnomedicinal data were analyzed using “Use Value,” a statistical quantitative method, with Artemisia vestita having the highest use value (1.00), followed by Cannabis sativa (0.79), Rhododendron arboreum (0.79), and Datura stramonium (0.71). Older people were found to have a vast knowledge of wild medicinal plants, while the younger generation’s knowledge was lacking. As a result, traditional knowledge about the use of plants as a source of medicine has decreased day-by-day.Therefore, there is a need to document traditional ethnobotanical knowledge. The data could serve as a basis for research by pharmacological and nutraceutical industries for the development of novel drugs

Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography:an international expert consensus

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.]

Structural basis for the redox sensitivity of the Mycobacterium tuberculosis SigK-RskA sigma-anti-sigma complex

The host-pathogen interactions in Mycobacterium tuberculosis infection are significantly influenced by redox stimuli and alterations in the levels of secreted antigens. The extracyto-plasmic function (ECF) sigma factor sigma(K) governs the transcription of the serodominant antigens MPT70 and MPT83. The cellular levels of sigma(K) are regulated by the membrane-associated anti-sigma(K) (RskA) that localizes sigma(K) in an inactive complex. The crystal structure of M. tuberculosis sigma(K) in complex with the cytosolic domain of RskA (RskAcyto) revealed a disulfide bridge in the -35 promoter-interaction region of sigma(K). Biochemical experiments reveal that the redox potential of the disulfide-forming cysteines in sigma(K) is consistent with its role as a sensor. The disulfide bond in sigma(K) influences the stability of the sigma(K)-RskA(cyto) complex but does not interfere with sigma(K)-promoter DNA interactions. It is noted that these disulfide-forming cysteines are conserved across homologues, suggesting that this could be a general mechanism for redox-sensitive transcription regulation

To compare the optimal cytoreduction rate in advanced epithelial ovarian cancer stage III/IV after 3 versus 6 cycles of neoadjuvant chemotherapy

This study aimed to compare the impact of 3 versus 6 cycles of neoadjuvant chemotherapy (NACT) on the optimal cytoreduction in patients of advanced ovarian malignancy during interval debulking surgery (IDS). Thirty patients with advanced-stage IIIc/IV epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer were randomly allocated to receive 6 cycles in the late IDS group versus 3 cycles in early IDS before undergoing interval debulking surgery. A higher percentage of patients achieved optimal cytoreduction in the late IDS group compared to the early IDS group (60 versus 23%) which was statistically significant (p = .010). Giving 6 cycles of NACT before surgery increased the odd of optimal cytoreduction by 10 than giving 3 cycles of NACT which was statistically significant (p = 0.046) Thus, we conclude that administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity.IMPACT STATEMENT What is already known on the subject? Currently, there are no established criteria that would help to determine the number of chemotherapy cycles before debulking surgery in patients with advanced ovarian malignancy. What do the results of this study add? Administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity in cases of advanced epithelial ovarian cancer. What are the implications of these findings for clinical practice and/or further research? We conclude that late interval debulking may be used as a treatment option in the advanced stage IIIc/stage IV. However, the findings need to be studied in a larger study group with a longer follow up period