Total phenolic and flavonoid content, antioxidant effects and antidiarrheal activity of balacaturbhadrika churna – an Ayurvedic preparation

485-492Balacaturbhadrika churna (BC) is an important pediatric preparation in Ayurveda. It is used to treat various diseases of gastro-intestinal tract particularly diarrhea in children. Free radicals cause oxidative damage in the intestine and are correlated with its diseases. In the current study, total phenolic and flavonoid contents of BC extracts were determined and their antioxidant evaluation in various in vitro models was carried out. Procedures mentioned in The Ayurvedic Formulary of India were followed to prepare in-house BC; alcoholic (BCAL) and aqueous (BCAQ) extracts were prepared and tested by standard procedures. BCAL was tested for antidiarrheal activity in castor oil induced model. The ethanolic extract showed better antioxidant activity in many of the models as compared to aqueous extract. The present study showed substantial amounts of flavonoids and phenolics in churna extracts. BCAL showed significant antidiarrheal activity against the tested model. The potential antioxidant and antidiarrheal activities displayed by Balacaturbhadrika churna extracts could be attributed to these contents

Total phenolic and flavonoid content, antioxidant effects and antidiarrheal activity of balacaturbhadrika churna – an Ayurvedic preparation

Balacaturbhadrika churna (BC) is an important pediatric preparation in Ayurveda. It is used to treat various diseases of gastro-intestinal tract particularly diarrhea in children. Free radicals cause oxidative damage in the intestine and are correlated with its diseases. In the current study, total phenolic and flavonoid contents of BC extracts were determined and their antioxidant evaluation in various in vitro models was carried out. Procedures mentioned in The Ayurvedic Formulary of India were followed to prepare in-house BC; alcoholic (BCAL) and aqueous (BCAQ) extracts were prepared and tested by standard procedures. BCAL was tested for antidiarrheal activity in castor oil induced model. The ethanolic extract showed better antioxidant activity in many of the models as compared to aqueous extract. The present study showed substantial amounts of flavonoids and phenolics in churna extracts. BCAL showed significant antidiarrheal activity against the tested model. The potential antioxidant and antidiarrheal activities displayed by Balacaturbhadrika churna extracts could be attributed to these contents

Quantitative estimation and evaluation of anti-inflammatory activity of macromolecules of Boswellia serrata

The present study was aimed to isolate and perform qualitative analysis of macromolecules present in Boswellia serrata followed by evaluation of their anti-inflammatory activity by in-vitro IL-6 ELISA study. The oleo gum resin of B. serrata was pretreated with hexane, methanol and the obtained residue was extracted with water and the final dried powder was taken for macromolecule analysis. The macromolecules which comprise of polysaccharides, mucilages and proteins were quantitatively estimated and evaluated for their anti-inflammatory activity by in-vitro IL-6 ELISA study. From the current study, it was found that the macromolecules present in B. serrata majorly comprise of polysaccharides and mucilages with moderate quantity of proteins. The quantitative analysis of polysaccharides, mucilages and proteins were found 35.91%, 34% and 14.29%. From the in-vitro IL-6 ELISA study, it was found that the macromolecules showed 82.63% inhibition of IL-6. The identified macromolecules from B. serrata showed significant anti-inflammatory activity by inhibition of IL- 6 and further need to confirm by in vivo study to qualify B. serrata macromolecules as a promising anti-inflammatory agent

Quantitative estimation and evaluation of anti-inflammatory activity of macromolecules of Boswellia serrata

940-943The present study was aimed to isolate and perform qualitative analysis of macromolecules present in Boswellia serrata followed by evaluation of their anti-inflammatory activity by in-vitro IL-6 ELISA study. The oleo gum resin of B. serrata was pretreated with hexane, methanol and the obtained residue was extracted with water and the final dried powder was taken for macromolecule analysis. The macromolecules which comprise of polysaccharides, mucilages and proteins were quantitatively estimated and evaluated for their anti-inflammatory activity by in-vitro IL-6 ELISA study. From the current study, it was found that the macromolecules present in B. serrata majorly comprise of polysaccharides and mucilages with moderate quantity of proteins. The quantitative analysis of polysaccharides, mucilages and proteins were found 35.91%, 34% and 14.29%. From the in-vitro IL-6 ELISA study, it was found that the macromolecules showed 82.63% inhibition of IL-6. The identified macromolecules from B. serrata showed significant anti-inflammatory activity by inhibition of IL- 6 and further need to confirm by in vivo study to qualify B. serrata macromolecules as a promising anti-inflammatory agent

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery:a systematic review and meta-analysis

Background - Postcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint. Methods - A systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API). Results - We identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p 70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported. Conclusion - Haemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS

Use of gentamicin-collagen sponges in closure of sternal wounds in cardiothoracic surgery to reduce wound infections.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Are antibiotic implants like gentamicin-collagen implants useful in preventing sternal wound infections (SWIs)? Altogether, more than 484 papers were found using the reported search; of these, 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that most randomized controlled trials (RCTs) have been performed with gentamicin-collagen sponges for sternal closure. Two out of four RCTs showed a significant benefit of the implant in a reduction in superficial and deep SWIs in routine and emergency cardiac surgery. One RCT showed a significant reduction in superficial infections in 2005, a follow-up trial by the same group in 2009 showed a reduction in deep infections as well. Another group has shown a reduction in deep and superficial SWI with gentamicin implant, in an RCT on 800 patients, however have not published details of the complete trial. The third trial on 542 patients showed no benefit of the implant, but was not adequately powered. However, the most recent multicentre RCT conducted on 1052 patients showed no benefit of gentamicin-collagen sponges in elective surgery (coronary artery bypass grafting and/or valve surgery) in high-risk patients with diabetes, obesity or both. Concerns were raised that gentamicin sponges dipped in saline 1-2 s prior to application may have lost the gentamicin into the saline, thereby reducing their efficacy and that some surgeons may have been unfamiliar with wound closure with sponges. However, these were robustly refuted by the authors. One RCT showed that gentamicin sponges may cause increased sternal rebleeding if used in double layers. Coagulase-negative staphylococci were predominantly isolated from infected wounds in all the trials except the one from USA, where infections were polymicrobial. Gentamicin resistance among common pathogens causing SWIs can vary from 15 to 80%. Gentamicin-collagen is unlikely to reduce SWIs in high-risk patients and polymicrobial infections

Surgery and Tuberculosis

PURPOSE OF REVIEW: Tuberculosis (TB) remains a global emergency and continues to kill 1.7 million people globally each year. In the UK, figures for TB are increasing especially in urban areas. There have been advances in imaging techniques as well as increasingly invasive medical interventions in both the diagnosis and treatment of this complex disease. Surgery continues to play an evolving and more challenging role in TB management as minimally invasive procedures can be increasingly used in diagnosis and treatment. Open surgical procedures continue to prove an important adjunct in the management of multidrug-resistant TB (MDR-TB) and the complications of TB. RECENT FINDINGS: Since the peak of surgical treatment for TB in the 1950s, surgery is currently mainly reserved for 'difficult-to-diagnose' or indeed 'difficult-to-treat' cases of TB. Improved diagnostics, medical imaging and invasive medical interventions have all enabled alternatives to early surgical intervention. As improving minimally invasive surgical techniques provide diagnostic and treatment options, older methods of surgically managing complex TB have been revisited. To date most of the studies are retrospective and observatory but large studies and meta-analyses are showing the continued role surgery has to play in the treatment of TB. SUMMARY: This review will focus on new diagnostic imaging techniques and medical interventions which may become increasingly available in both developing countries and in the Western world. It will also highlight the continued role of minimally invasive video-assisted thoracoscopic surgery as well as open surgery in managing TB and MDR-TB. © 2012 Lippincott Williams & Wilkins, Inc

Tracheal bronchus: a challenge for anaesthesiologists

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. The incidence of tracheal bronchus is approximately 0.1-2%. The presence of congenital anomaly of the central airway can be of great significance to anaesthesiologist and though a rare anomaly it can still be a challenge for proper positioning of DLT and establishing OLV in the hands of junior anaesthesiologists. We report a case with tracheal bronchus arising from right tracheal wall diagnosed when we had difficulty in placing the left DLT. Identification of tracheal bronchus on the chest radiograph and CT-scan of chest before surgery is useful. We do strongly recommend as in other reports, giving the patient an alert card indicating the diagnosis of tracheal bronchus

Quantitative estimation and evaluation of anti-inflammatory activity of macromolecules of Boswellia serrata

940-943The present study was aimed to isolate and perform qualitative analysis of macromolecules present in Boswellia serrata followed by evaluation of their anti-inflammatory activity by in-vitro IL-6 ELISA study. The oleo gum resin of B. serrata was pretreated with hexane, methanol and the obtained residue was extracted with water and the final dried powder was taken for macromolecule analysis. The macromolecules which comprise of polysaccharides, mucilages and proteins were quantitatively estimated and evaluated for their anti-inflammatory activity by in-vitro IL-6 ELISA study. From the current study, it was found that the macromolecules present in B. serrata majorly comprise of polysaccharides and mucilages with moderate quantity of proteins. The quantitative analysis of polysaccharides, mucilages and proteins were found 35.91%, 34% and 14.29%. From the in-vitro IL-6 ELISA study, it was found that the macromolecules showed 82.63% inhibition of IL-6. The identified macromolecules from B. serrata showed significant anti-inflammatory activity by inhibition of IL- 6 and further need to confirm by in vivo study to qualify B. serrata macromolecules as a promising anti-inflammatory agent