Ultrasonography in Patients with Suspected Acute Appendicitis

Background

To evaluate the usefulness and limitations of graded compression ultrasonography in the diagnosis of clinically equivocal cases of suspected acute appendicitis at the setting of mid zonal military hospital of India.

Methods

A prospective study, graded compression ultrasonography with self localization was carried out with 3.5 MHz convex, 5 MHz convex and 7.5 MHz linear transducers (Wipro GE) in 69 clinically equivocal suspected cases of acute appendicitis. With maximal compression the anteroposterior diameter of appendix was measured from outer to outer wall. The main criterion for diagnosing appendicitis was demonstration of a non compressible appendix with anteroposterior dimension of 7mm or more.

Result

Sonologically 36 (52%) cases were diagnosed as appendicitis. Anteroposterior outer diameter of inflamed appendices ranged from 7mm to 21mm (mean 10.5mm). 30 (83%) of 36 patients could accurately self localize the point of maximum tenderness. There were 01 false positive and 04 false negative cases. Sensitivity and specificity were 89.7% and 96.6% respectively. Positive and negative predictive values were 97.2% and 87.8% respectively. Alternative diagnoses were offered in 33 (47.8%) cases. Amongst these 33 cases, 14(42.4%) had abdominal pain of unknown origin. Gynaecologic, urologic and gastrointestinal aetiologies were established in 10(30.3%), 07(21.2%) and 02(6%) cases respectively.

Conclusion

Graded compression ultrasonography superadded with self localization is an accurate means of diagnosing/excluding appendicitis in clinically equivocal cases of acute appendicitis and it is of great value in establishing alternative diagnoses.Key Words: Ultrasonography, Acute appendicitis     

Laboratory assessment of the molluscicidal and cercariacidal activities of Balanites aegyptiaca

Objective

To assess the molluscicidal and cercariacidal activities of aqueous extracts of Balanites aegyptiaca (B. aegyptiaca) against Ethiopian Biomphalaria pfeifferi (B. pfeifferi), Lymnaea natalensis (L. natalensis) and Schistosoma mansoni (S. mansoni) cercariae.

Methods

Extracts of seeds, endocarp, mesocarp, and fruit of B. aegyptiaca were tested for their activities against adult B. pfeifferi and L. natalensis. The cercariacidal activity of the seeds of the plant was also evaluated against S. mansoni. Bioassays were carried out following the methods recommended by WHO. Snail mortalities were compared between each plant part and snail species, and LC₅₀ and LC₉₀ values for the plant parts tested were computed. The cercariacidal activity of the plant was assessed by exposing the mice to the cercariae pre-exposed to aqueous extract of B. aegyptiaca seeds.

Results

For the molluscicidal activities of seeds, endocarp, mesocarp and whole fruit, the LC₅₀ values against B. pfeifferi were 56.32, 77.53, 65.51 and 66.63 mg/L, respectively, while the respective LC₉₀ values were 77.70, 120.04, 89.50 and 97.55 mg/L. Similarly, the LC₅₀ values for the seeds, endocarp, mesocarp and whole fruit against L. natalensis were 80.33, 92.61, 83.52 and 87.84 mg/L, respectively, while the respective LC₉₀ values were 102.30, 138.21, 115.42 and 127.69 mg/L. B. pfeifferi were found to be more susceptible to B. aegyptiaca than L. natalensis. S. mansoni cercariae exposed to 15 mg/L of extract of seeds were incapable of infecting mice. The mean egg load of tissue was reduced in mice infected with the cercariae exposed to 5 and 10 mg/L of the extract.

Conclusions

The aqueous extracts of different parts of B. aegyptiaca exhibited reasonable molluscicidal activity against B. pfeifferi and L. natalensis, as well as cercariacidal activity against S. mansoni cercariae. However, comprehensive laboratory evaluation is recommended prior to field tests of the plant parts since their impact on other aquatic biota is not known.     

A study on traditional medicinal plants of Uthapuram,Madurai District,Tamilnadu, South India

Objective

To record the medicinal plants of Uthapuram Village, Madurai district, Tamilnadu, South India for the first time and the usage of these medicinal plants to remediate the diseases among the peoples.

Methods

Explorative field trips were made to the village for about twelve months from April 2012 to May 2013 to survey the medicinal plants and collect the information from the villagers.

Results

From this study 52 species of valuable medicinal plants belonging to 36 families were recorded and their ethnomedicinal values were collected from the village peoples.

Conclusion

This study focuses the importance, utilization and conservation of the medicinal plants among the people.     

Chromatographic finger print analysis of steroids in Aerva lanata L by HPTLC technique

Objective

To determine the chemical profile and steroids composition of the medicinally important plant Aerva lanata (A. lanata) L.

Methods

Preliminary phytochemical screening was done by the method as Harborne described. HPTLC studies were carried out as Harborne and Wagner et al described. The Ethyl acetate-ethanol-water (8: 2: 1.2) was employed as mobile phase for glycosides.

Results

The desired aim was achieved using Chloroform-acetone (8: 2) as the mobile phase. The methanolic extract of stem, leaves, root, flower and seeds of A. lanata showed the presence of 30 different types of steroids with 30 different Rf values from 0.04 to 0.97. Maximum number (11) of steroids has been observed in leaves followed by root (10).

Conclusions

HPTLC profile of steroids has been chosen here to reveal the diversity existing in A. lanata. Such finger printing is useful in differentiating the species from the adulterant and act as biochemical markers for this medicinally important plant in the pharma industry and plant systematic studies.     

Comparison of pre-operative bilirubin level in simple appendicitis and perforated appendicitis

Background

Delay in diagnosis and treatment of perforated appendicitis may cause life-threatening complications.The aim of this study was to determine and compare pre-operative total and direct bilirubin levels incases of simple and perforated acute appendicitis in order to improve the clinical decision making.

Methods

This prospective observational study included eighty patients who underwent open appendectomy,during a one-year period from March 2010 to March 2011 in the surgical department of Hazrat-e-Rasool AkramHospital, an academic teaching hospital in Tehran- Iran. Pre-operative total and direct levels of bilirubin werecompared in two groups of histologically proved appendicitis (simple and perforated), each including 40 patients.

Results

Eighty patients who underwent open appendectomy including 70% men and 30% women with a meanage of 34±11 years in Group I (perforated appendicitis) and 47.5% women and 52.5% men with a mean age of33±14 in Group II (simple appendicitis) were included in this study. The mean bilirubin levels were higher forpatients with perforated acute appendicitis compared to those with a non-perforated simple appendicitis(1.04±05 mg/dl vs 0.7±0.1 mg/dl) and this difference is highly significant (p<0.01).

Conclusion

Assessment of preoperative total bilirubin is useful for the differential diagnosis of perforatedversus acute simple appendicitis and total bilirubin should be used as an independent parameter in the early diagnosisof appendix perforation     

Ethnomedicinal plants used in the treatment of skin diseases in Hyderabad Karnataka region,Karnataka, India

Objective

To document traditional medicinal plants knowledge used in treating skin diseases at Hyderabad Karnataka Region.

Methods

The information on the use of medicinal plants in the treatment of skin diseases was gathered from traditional herbal healers and other villagers through interviews.

Results

A total of 60 plants species belonging to 57 genera and 34 families were found useful and herewith described them along with the method of drug preparation, mode of administration, probable dosage and duration of treatment. Several new findings on the traditional rural practices were reported.

Conclusions

The present study revealed that the Hyderabad Karnataka rural people is primarily dependent on medicinal plants for treating skin diseases.     

Malaria in Pregnancy

Background

Malaria in pregnancy contributes to low birth weight and increased infant mortality.

Methods

The study included 416 pregnant women reporting with fever and the impact of malaria on pregnancy was assessed.

Result

The study revealed that the protozoal infection affects second trimester more commonly. It increases the chances of abortions, intrapartum foetal distress and meconium stained amniotic fluid.

Conclusion

Malaria is an important cause of feto-maternal morbidity during pregnancy.Key Words: Malaria in pregnancy, Plasmodium     

Research and applications: Leveraging biodiversity knowledge for potential phyto-therapeutic applications

Objective

To identify and highlight the feasibility, challenges, and advantages of providing a cross-domain pipeline that can link relevant biodiversity information for phyto-therapeutic assessment.

Materials and methods

A public repository of clinical trials information (ClinicalTrials.gov) was explored to determine the state of plant-based interventions under investigation.

Results

The results showed that ∼15% of drug interventions in ClinicalTrials.gov were potentially plant related, with about 60% of them clustered within 10 taxonomic families. Further analysis of these plant-based interventions identified ∼3.7% of associated plant species as endangered as determined from the International Union for the Conservation of Nature Red List.

Discussion

The diversity of the plant kingdom has provided human civilization with life-sustaining food and medicine for centuries. There has been renewed interest in the investigation of botanicals as sources of new drugs, building on traditional knowledge about plant-based medicines. However, data about the plant-based biodiversity potential for therapeutics (eg, based on genetic or chemical information) are generally scattered across a range of sources and isolated from contemporary pharmacological resources. This study explored the potential to bridge biodiversity and biomedical knowledge sources.

Conclusions

The findings from this feasibility study suggest that there is an opportunity for developing plant-based drugs and further highlight taxonomic relationships between plants that may be rich sources for bioprospecting.     

Antibacterial activities of selected medicinal plants in traditional treatment of human wounds in Ethiopia

Objective

To evaluate the activity of selected Ethiopian medicinal plants traditionally used for wound treatment against wound-causing bacteria.

Methods

Samples of medicinal plants (Achyranthes aspera, Brucea antidysenterica, Datura stramonium, Croton macrostachyus, Acokanthera schimperi, Phytolacca dodecandra, Millettia ferruginea, and Solanum incanum) were extracted using absolute methanol and water and tested for their antimicrobial activities against clinical isolates and standard strains of wound-causing bacteria using agar well diffusion and micro titer plate methods.

Results

Most of the plant extracts had antibacterial activities, among which Acokanthera schimperi and Brucea antidysenterica inhibited growth of 100% and 35% of the test organisms, respectively. Methanolic extracts had higher activities compared with their corresponding aqueous extracts. The most susceptible organism to the extracts was Streptococcus pyogens while the most resistant were Escherichia coli and Proteus vulgaris.

Conclusions

This finding justifies the use of the plants in wound healing and their potential activity against wound-causing bacteria. Their toxicity level and antimicrobial activity with different extraction solvents should further be studied to use them as sources and templates for the synthesis of drugs to control wound and other disease-causing bacteria.     

Antibacterial efficacy of the seed extracts of Melia azedarach against some hospital isolated human pathogenic bacterial strains

Objective

To investigate the antibacterial potential of the polar and non-polar extracts of the seeds of Melia azedarach (M. azedarach) L. (Meliaceae) against eighteen hospital isolated human pathogenic bacterial strains.

Methods

Petrol, benzene, ethyl acetate, methanol, and aqueous extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were evaluated. Disk diffusion method was followed to evaluate the antibacterial efficacy.

Results

All extracts of the seeds demonstrated significant antibacterial activity against tested pathogens. Among all extracts, ethyl acetate extract revealed the highest inhibition comparatively. The present study also favored the traditional uses reported earlier.

Conclusions

Results of this study strongly confirm that the seed extracts of M. azedarach could be effective antibiotics, both in controlling gram-positive and gram-negative human pathogenic infections.     

Protection of cadmium chloride induced DNA damage by Lamiaceae plants

Objective

To analyze the total phenolic content, DNA protecting and radical scavenging activity of ethanolic leaf extracts of three Lamiaceae plants, i.e. Anisomelos malabarica (A. malabarica), Leucas aspera (L. aspera) and Ocimum basilicum (O. basilicum).

Methods

The total polyphenols and flavonoids were analyzed in the ethanolic leaf extracts of the lamiaceae plants. To determine the DNA protecting activity, various concentrations of the plant extracts were prepared and treated on cultured HepG2 human lung cancer cells. The pretreated cells were exposed to H₂O₂ to induce DNA damage through oxidative stress. Comet assay was done and the tail length of individual comets was measured. Nitric oxide and superoxide anion scavenging activities of lamiaceae plants were analyzed.

Results

Among the three plant extracts, the highest amount of total phenolic content was found in O. basilicum (189.33 mg/g), whereas A. malabarica showed high levels of flavonoids (10.66 mg/g). O. basilicum also showed high levels of DNA protecting (85%) and radical scavenging activity.

Conclusions

The results of this study shows that bioactive phenols present in lamiaceae plants may prevent carcinogenesis through scavenging free radicals and inhibiting DNA damage.     

Evaluation of aqueous and ethanol extract of bioactive medicinal plant,Cassia didymobotrya (Fresenius) Irwin & Barneby against immature stages of filarial vector,Culex quinquefasciatus Say (Diptera: Culicidae)

Objective

To evaluate aqueous and ethanol extract of Cassia didymobotrya leaves against immature stages of Culex quinquefasciatus.

Methods

The mortality rate of immature mosquitoes was tested in wide and narrow range concentration of the plant extract based on WHO standard protocol. The wide range concentration tested in the present study was 10 000, 1 000, 100, 10 and 1 mg/L and narrow range concentration was 50, 100, 150, 200 and 250 mg/L.

Results

2nd instar larvae exposed to 100 mg/L and above concentration of ethanol extract showed 100% mortality. Remaining stages such as 3rd, 4th and pupa, 100% mortality was observed at 1 000 mg/L and above concentration after 24 h exposure period. In aqueous extract all the stages 100% mortality was recorded at 1 000 mg/L and above concentration. In narrow range concentration 2nd instar larvae 100% mortality was observed at 150 mg/L and above concentration of ethanol extract. The remaining stages 100% mortality was recorded at 250 mg/L. In aqueous extract all the tested immature stages 100% mortality was observed at 250 mg/L concentration after 24 h exposure period. The results clearly indicate that the rate of mortality was based dose of the plant extract and stage of the mosquitoes.

Conclusions

From this study it is confirmed and concluded that Cassia didymobotrya is having active principle which is responsible for controlling Culex quinquefasciatus. The isolation of bioactive molecules and development of simple formulation technique is important for large scale implementation.     

Hypoglycemic effect of Brassica juncea (seeds) on streptozotocin induced diabetic male albino rat

Objective

To evaluate the hypoglycemic effect of Brassica juncea (seeds) on streptozotocin induced diabetic male albino rats.

Methods

Hypoglycemic activity of Brassica juncea (seeds) aqueous extract at a dose of 250, 350 and 450 mg/kg body weight was evaluated. Adult male Swiss albino rats of six numbers in each group was undertaken for study and evaluated.

Results

The serum insulin levels were recorded a significant depletion in all groups, short term as well as long term diabetic animals, when compared to that of normal animals. A significant dosage dependent augmenting effect of the seed extract on the serum insulin was recorded in both short term as well as long term groups.

Conclusions

The aqueous seed extract of Brassica juncea has potent hypoglycemic activity in male albino rat.     

Post-prandial paradoxical filling of gall bladder in patients with acute hepatitis: Myth or reality?

Background

A minority of patients of acute hepatitis may exhibit edematous GB walls with no visible lumen despite fasting and may also exhibit paradoxical GB response in the post-prandial state.

Methods

Patients of acute hepatitis underwent routine upper abdominal sonography after overnight fasting. Patients who demonstrated contracted GB with edematous and coapted walls without any visible lumen despite overnight fasting were studied in the post-prandial phase after having breakfast. Serial ultrasonography was carried out at 10–15 min interval for an hour and changes in GB morphology was noted at each stage.

Results

A total of 77 patients of acute hepatitis underwent USG of hepatobiliary system between Sept 2008 and Aug 2009. Contracted gall bladder with edematous and coapted walls without any visible lumen despite overnight fasting was noted in 11 patients and were studied in the post-prandial phase. Post-prandial paradoxical filling of GB was observed in all such cases. Serial post-prandial ultrasonography demonstrated onset of filling of GB as early as 10–15 min post-prandial. Maximal GB distension was observed between 30 and 60 min. USG at 60 min post-prandial showed slight reduction in GB volume. As the GB distended in the post-prandial state, the lumen became increasingly visible with marginal reduction in wall thickening.

Conclusion

We have observed transient paradoxical filling of GB on serial USG in early post-prandial state, in a subset of patients of acute viral hepatitis who had contracted GB with coapted walls in the initial USG after overnight fasting.     

Performance factors of mobile rich media job aids for community health workers

Objective

To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms.

Design

A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject).

Measurements

Error rate per case and task, protocol compliance.

Results

A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p=0.001) and increases protocol compliance 30.18% (p<0.001).

Limitations

Medical cases were presented on human patient simulators in a laboratory setting, not on real patients.

Conclusion

These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries.     

Daily Fetal Movement Count Chart : Reducing Perinatal Mortality in Low Risk Pregnancy

Background

A reduction or cessation of fetal movements (FMs) is frequently reported by pregnant women resulting in anxiety and concern. Formal counting of FMs by the pregnant woman could possibly identify the fetuses at risk.

Methods

A prospective study was carried out over 500 booked cases after introducing daily fetal movement count (DFMC) Chart in the ninth month of pregnancy. Prior ultrasound (USG) was done in all cases. DFMC chart was used to record number of fetal movements perceived by patient for one hour after food (breakfast, lunch, dinner). Fetal movements were considered satisfactory if the count was three or more on each occasion.

Result

During the study period, no fetus was lost after introduction of DFMC chart in the 250 cases that were given DFMC chart and delivered in our hospital (Nil perinatal mortality). This was compared with 250 booked cases that were not given DFMC chart but had normal ultrasound done after completion of eight months of pregnancy and followed up. Five intrauterine deaths occurred in the ninth month in control group (2% perinatal mortality). In the DFMC chart group, 15 patients were admitted with decreased fetal movements. Out of these, 12 were discharged after monitoring for three days and three cases were delivered.

Conclusion

DFMC chart in ninth month of pregnancy helps in identifying at risk fetus in low risk pregnancies in absence of any other adverse factors necessitating early delivery.Key Words: Daily fetal movements count chart (DFMC), Perinatal mortality, Intrauterine death     

Isolation and identification of Salmonella from curry samples and its sensitivity to commercial antibiotics and aqueous extracts of Camelia sinensis (L.) and Trachyspermum ammi (L.)

Objective

To isolate Salmonella from curry samples and to evaluate the drug sensitivity of the food-borne Salmonella and its susceptibility to specific plant extracts.

Methods

Salmonella was isolated from the curry samples by standard microbiological methods and was confirmed by biochemical tests. The antibiotic susceptibility test was conducted by disc diffusion method using commercially available antibiotics such as ampicillin, tetracycline, chloramphenicol, kanamycin, and penicillin. In addition, the susceptibility of the food-borne Salmonella was also evaluated against the aqueous extracts of Camelia sinensis (L.) Theaceae (tea leaves) and the Trachyspermum ammi (L.) Apiaceae ( ajwain or omum seeds).

Results

Out of fifty curry samples, only seven samples were identified to have Salmonella contamination. The Salmonella isolates showed a significant drug resistance pattern except for kanamycin. The plant extracts showed a considerable antibacterial activity against the isolates, indicating the presence of antimicrobial principle which can be exploited after complete pharmacological investigations.

Conclusions

The present study demonstrates the occurrence of Salmonella in the curry samples, and shows significant drug resistance against most of the commercially available antibiotics, except kanamycin. Antimicrobial effect of the plant extracts against the food-bone Salmonella suggests that dietary including medicinal herbs would be one strategy to manage food borne pathogens.     

Low birth weight and incidence of first malaria episode and adherence to malaria treatment protocols in infants in Chikwawa district,Malawi

Background

In Malawi, malaria is a leading cause of infant morbidity and mortality. Low birthweight and fetal anaemia are also a common occurrence. The relationship between birthweight and fetal anaemia and malaria morbidity in infancy is not known.

Objectives

To investigate the relationship between incidence of first malaria episode and birthweight and fetal anaemia and to investigate adherence of health workers to Integrated Management of Childhood Illnesses (IMCI) malaria treatment protocol.

Design

A stratified sample of 561 infants was selected based on low birth weight (LBW, <2.5Kgs), fetal anaemia (FA, Hbcord <12g/dl) and matched controls with normal birth weight (NBW) and no fetal anaemia (NFA). Cases were defined as LBW FA, LBW NFA, and NBW FA.

Results

Cumulative incidence to first malaria episode did not significantly differ between the study groups and the controls. Sulphadoxine-pyrimethamine (SP) was prescribed to the majority of malaria cases (89.3%).

Conclusion

There is no relationship between birthweight and fetal anaemia and first malaria episode. There is good adherence to IMCI guidelines for malaria treatment.     

Platelet Functions in Cardiopulmonary Bypass Surgery

Background

Haemorrhage after Cardio Pulmonary Bypass (CPB) Surgery is a well recognised complication that leads to significant morbidity and mortality. The incidence varies between 5-25% depending upon the clinical situation. Several factors are implicated as causative but none have been precisely proved.

Methods

Our study was an attempt to evaluate the haemostatic defect with particular reference to platelet function abnormalities during cardio pulmonary bypass surgery, in order to reduce the morbidity and mortality associated with post CPB haemorrhage. Flow cytometric evaluation of different platelet glycoproteins like GPIb/IX, GPIIb/IIIa and GMP-140 was done.

Results

The marker expression showed deregulation during surgery which returned to base after bypass was terminated. In contrast, the cases with bleeding showed significant variation. P-Selectin (GMP 140) expression decreased progressively till 3^rd post-operative day showing lack of activation of platelets in cases of severe bleeding.

Conclusion

Longer duration of CPB initiates plasmin generation through heparin, which raises the PAI-1-tPA complex and thereby down regulating the functions of platelets. This suggests a link between duration of CPB, bleeding, platelet dysfunction and fibrinolysis. Hence serial estimations of the levels of GMP-140 and tPA can predict severe bleeding.Key Words: CardioPulmonary Bypass, Platelet dysfunction, flowcytometry, platelet glycoproteins, haemorrhage