Evaluation of In vitro and In vivo Antioxidant potential of Morinda reticulata Gamble Tubers in Wistar Albino Rats Subjected to CCl4 and Paracetamol induced Hepatotoxicity

The aim of present study is to explore the antioxidant potential of ethanol and aqueous extracts of Morinda reticulata Gamble by in vitro and in vivo methods.  In vitro antioxidant activity of Benzene, Chloroform, Ethanol and aqueous extracts of  M. reticulata was studied by DPPH, Metal chelating, Super oxide free radical scavenging assay, Hydroxyl radical scavenging assay and Reducing power assay where ascorbic acid was used as a standard antioxidant. Oxidative stress in Wistar rats was induced by two different models using administration of CCl4 (1.5 ml/kg, p.o) and paracetamol (2g/kg) on seventh day of study. Ethanol and aqueous extracts were given twice daily for one week. Silymarin (25 mg/kg, p.o) was given as a standard drug. In in vitro, IC50 values were least with ethanol and aqueous extracts when compared with other extracts. Ethanol extracts exhibited similar free radical scavenging effect as that of standard ascorbic acid.  In vivo antioxidant activity was assessed by the measurement of Melondyaldehyde (MDA), Reduced Glutathione (GSH), Super oxide dismutase (SOD) and Total protein levels were estimated from the liver tissue homogenate. The level of MDA (3.27±2.18) was significantly (p˂0.001) increased whereas decreased level of total protein, GSH and SOD were found in CCl4 and paracetamol control group. Seven days extracts treatments restored these altered parameters in to normal where ethanol extract treatment group showed significant (p˂0.001) result than aqueous extract. HPTLC study showed that presence of six phytoconstituents with corresponding Rf value. The study report concluded that M.reticulata has very good antioxidant effect against CCl4 and paracetamol induced liver damage with oxidative stress. Probable mechanism behind this protection against oxidative damage produced by CCl4 and paracetamol is its phytoconstiuents

Perinatal Idiopathic Hemochromatosis

We report the clinicopathologic features of an infant who died of a rare form of perinatal cirrhosis associated with idiopathic hepatic and extrahepatic parenchymal siderosis. The infant appeared normal at birth but soon became severely ill, following a progressively downhill course associated with hypoglycemia, metabolic acidosis, bleeding diathesis, jaundice, and shock. The infant died at 7 days of age. The manifestations were those of hepatic failure but mimicked sepsis and disseminated intravascular coagulation. Cirrhosis, giant cell transformation, and parenchymal iron deposition characteristic of perinatal idiopathic hemochromatosis, a recently emerging clinicopathologic entity of unknown etiology, were present in this infant. These clinical and pathologic features differ from other neonatal liver diseases in their acute onset immediately after birth, a catastrophic clinical course ending fatally, and the morphologic manifestation of significant iron overload

The raising epidemic of COPD in women

Background: Chronic obstructive pulmonary disease (COPD) represents an important public health challenge that is both preventable and treatable. Although it is more frequently observed in males, the number of females with COPD is on the rise due to either active smoking or passive exposure and biomass fuel combustion.Methods: It is a cross sectional study comprising forty female patients with signs and symptoms of COPD and graded according to Global association for obstructive lung diseases (GOLD) spirometry strategy. For all the enrolled patients, clinical history was taken and investigations like chest X-ray, Spirometry, Six minute walk distance test (6MWD) and BODE index was assessed.Results: The majority of cases (72.5%) belong to fifth to sixth decade. Most of cases were from rural area. 85% of the COPD females were smokers. Among non smokers biomass fuel is major risk factor. COPD is common in patients with smoking history of more than 20 years. Duration of exposure to biomass fuel exceeded 45 years in the COPD subjects. The mean 6MWD was 311 meters suggesting low exercise capacity. Most of the patients with severe COPD have BODE score >7 with poor prognosis.Conclusions: This study recognizes the prevalence of reverse chutta smoking among the COPD females and the risk of biomass exposure in the development of COPD in women, especially from rural areas. Identification and control of the risk factors are important steps in prevention and treatment of COPD.

Comparative study of topical application of nanosilver and human placental extract on wound healing in rabbits

Background: The objective of the study was to study the comparative effect of topical application of nanosilver and human placental extract on wound healing in rabbits.Methods: 12 rabbits were randomly divided into two groups (n=6) and wound healing effect was observed in Excision model. Standard group was treated with topical human placental extract gel and test group was treated with topical Nanosilver cream. The mean percentage of the wound healed ‘within’ the group and ‘in between’ the groups were observed on day 3, 6, 9, 12, 15, 18, 21 and biopsy was done on day 21 for histopathological examination.Results: The mean percentage of wound contracted with Human placental extract vs nanosilver was 29.5 vs 35.7 on day3, 46.2 vs 53.5 on day 6, 61.5 vs 70.2 on day9, 74.2 vs 88.0 on day12, 89.5 vs 97.0 on day15, 96.7 vs 99.9 on day 18 and 99.9 vs 100 day 21 respectively. The mean percentage of the wound contracted when day1 compared to day21 was statistically significant (P value 0.0001) within the groups but in between the groups it was statistically non significant (P >0.05). There was an increase in collagen content and granulation tissue in the histopathological examination in both the groups on day 21.Conclusions: Wound healing effect of the Nanosilver was comparable to that of Human placental extract in excision wound model of rabbit

Drain versus no drain in an uncomplicated elective laparoscopic cholecystectomy- an institutional study

Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstones. Post surgery to keep a subhepatic drain is an issue of debate. A randomised trial was designed to assess the outcome of drain in elective lap cholecystectomy.Methods: A randomized control trial was done from January 2019 to June 2020 among 40 patients. They were randomised into group A: (n=20) in which subhepatic space was drained by an abdominal drain size 28F drain which was brought out through right anterior axillary port (even group) and group B: (n=20) in which there was no-drain at sub hepatic space (odd group). The end points of this study was to compare postoperative pain, fever, wound infection ,hospital stay between the two groups.Results: Mean hospital stay among drain group was 3.95±1.35 days as compared to 2.55±0.60 days among no drain group and the difference was statistically significant (p value =0.001). 8 (40%) patients with drain had port side infection as compared to 1 (5%) patient among no drain group and the observed difference was statistically significant (p value =0.02). Post operative pain abdomen assessed using VAS, and found significant 12 after surgery. The young female patients were unhappy with the drain scar and 3 cases requested for need of plastic surgery corrections also.Conclusions: The routine use of a drain in uncomplicated elective laparoscopic cholecystectomy has no benefit; in contrast, it is associated with longer hospital stay, so better to avoid the drain

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.]

Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis

Background: Global and regional prevalence estimates for blindness and vision impairment are important for the development of public health policies. We aimed to provide global estimates, trends, and projections of global blindness and vision impairment. Methods: We did a systematic review and meta-analysis of population-based datasets relevant to global vision impairment and blindness that were published between 1980 and 2015. We fitted hierarchical models to estimate the prevalence (by age, country, and sex), in 2015, of mild visual impairment (presenting visual acuity worse than 6/12 to 6/18 inclusive), moderate to severe visual impairment (presenting visual acuity worse than 6/18 to 3/60 inclusive), blindness (presenting visual acuity worse than 3/60), and functional presbyopia (defined as presenting near vision worse than N6 or N8 at 40 cm when best-corrected distance visual acuity was better than 6/12). Findings: Globally, of the 7·33 billion people alive in 2015, an estimated 36·0 million (80% uncertainty interval [UI] 12·9–65·4) were blind (crude prevalence 0·48%; 80% UI 0·17–0·87; 56% female), 216·6 million (80% UI 98·5–359·1) people had moderate to severe visual impairment (2·95%, 80% UI 1·34–4·89; 55% female), and 188·5 million (80% UI 64·5–350·2) had mild visual impairment (2·57%, 80% UI 0·88–4·77; 54% female). Functional presbyopia affected an estimated 1094·7 million (80% UI 581·1–1686·5) people aged 35 years and older, with 666·7 million (80% UI 364·9–997·6) being aged 50 years or older. The estimated number of blind people increased by 17·6%, from 30·6 million (80% UI 9·9–57·3) in 1990 to 36·0 million (80% UI 12·9–65·4) in 2015. This change was attributable to three factors, namely an increase because of population growth (38·4%), population ageing after accounting for population growth (34·6%), and reduction in age-specific prevalence (–36·7%). The number of people with moderate and severe visual impairment also increased, from 159·9 million (80% UI 68·3–270·0) in 1990 to 216·6 million (80% UI 98·5–359·1) in 2015. Interpretation: There is an ongoing reduction in the age-standardised prevalence of blindness and visual impairment, yet the growth and ageing of the world’s population is causing a substantial increase in number of people affected. These observations, plus a very large contribution from uncorrected presbyopia, highlight the need to scale up vision impairment alleviation efforts at all levels

Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis

Background: Contemporary data on causes of vision impairment and blindness form an important basis for recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modeling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. Methods: Published and unpublished population-based data on the causes of vision impairment and blindness from 1980 to 2015 were systematically analysed. A series of regression models were fit to estimate the proportion of moderate and severe vision impairment (MSVI; defined as presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60 in the better eye) by cause by age, region, and year. Findings: Among the projected global population with MSVI (216.6 million; 80% uncertainty intervals [UI] 98.5-359.1), in 2015 the leading causes thereof are uncorrected refractive error (116.3 million; UI 49.4-202.1), cataract (52.6 million; UI 18.2-109.6), age-related macular degeneration (AMD; 8.4 million; UI 0.9-29.5), glaucoma (4.0 million; UI 0.6-13.3) and diabetic retinopathy (2.6 million; UI 0.2-9.9). In 2015, the leading global causes of blindness were cataract (12.6 million; UI 3.4-28.7) followed by uncorrected refractive error (7.4 million; UI 2.4-14.8) and glaucoma (2.9 million; UI 0.4-9.9), while by 2020, these numbers affected are anticipated to rise to 13.4 million, 8.0 million and 3.2 million, respectively. Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of MSVI in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness, with a relatively low prevalence of cataract and a relatively high prevalence of AMD as causes for vision loss in the High-income subregions. Blindness due to cataract and diabetic retinopathy was more common among women, while blindness due to glaucoma and corneal opacity was more common among men, with no gender difference related to AMD. Conclusions: The numbers of people affected by the common causes of vision loss have increased substantially as the population increases and ages. Preventable vision loss due to cataract and refractive error (reversible with surgery and spectacle correction respectively), continue to cause the majority of blindness and MSVI in adults aged 50+ years. A massive scale up of eye care provision to cope with the increasing numbers is needed if one is to address avoidable vision loss

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe