A Review From Historical To Current-Celastrus Paniculatus

Celastrus paniculatus is commonly known as “Malkangani”, widely distributed in the Maldives, Australia, China, Cambodia, Malaysia, Taiwan, Nepal, Thailand as well as in the Pacific Islands and all over India mainly Maharashtra, Orissa and Andaman and Nicobar group of Islands on an altitude of 1800m. It climbs up to over 10m. The leaves are ovate or elliptic in shape with dentate margin. Seeds are ellipsoid or ovoid, yellowish-brown in color and grow inside the capsules. Celastrus paniculatus (Malkangni) is used in Ayurveda as a nervine tonic, tranquilizer and diuretic and in rheumatism, gout, leprosy and asthma. Different Parts of Celastrus paniculatus after extraction and fractionation give different active constituents such as sesquiterpene esters-malkanguinol, malkangunin, sesquiterpene alkaloids-celapanin, celapanigin, alkaloids-celastrine, paniculatine, fatty acids-oleic acid, palmittic acid, linoleic acid and stearic acid, crystalline substance tetracasanol and sterol. Different pharmacological activities are anti-rheumatic, anti-fungal, nootropic activity, antimalarial activity, anti spermatogenic effect, anti-anxiety and anti-atherosclerotic effect. In the present review, our target is to search, bring together and compile the data of Celastrus paniculatus, which have less side effects and very valuable for the treatment of rheumatism. Related information is procured from various scientific publications using online, seek out engines such as Google scholar, Pubmed and Science Direct. A total of 200 articles was reviewed out of which 55 articles are selected to review for the description of the plant, parts used, chemical constituents, traditional uses and for reported activities.

Flood Frequency Analysis for Burhi Gandak River Basin

The study is aimed at finding the best distribution to match the steam flow and calculation of magnitude and frequency of flow. In the current study, we have used several statistical distributions to find the best fit distribution for stream flow and used flood frequency analysis techniques to find the magnitude and frequency of stream flow and non-exceedance probability of peak discharge. The study has been performed at Sikandarpur and Rosera gauging sites of BurhiGandak River. Historical (50 years) maximum annual peak discharge data of each station are used for statistical analysis for estimating maximum peak discharge in 5, 10, 25, 50, 100 year return period. In this study, Lognormal distribution, Galton distribution, Gamma distribution, Log Pearson Type III distribution, Gumbell distribution, Generalised extreme values distribution have been considered to describe the annual maximum stream flow. Flood frequency analysis methods were used for estimating the magnitude of the extreme flow events and their associated return periods. For both Sikandarpur and Rosera stations, Log Pearson type III distributions showed the lowest value of K–S and Chi-square test statistic. The annual probable peak discharge for 5, 10, 25, 50, and 100 years return period is calculated for each distribution. The most suitable distribution for both the stations is found to be the log-Pearson type III distribution.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Neck Swellings

Introduction: Neck swellings are commonest incidentalfindings that are present in all age groups. Objective of thecurrent research was to study the diagnostic accuracy offine needle aspiration cytology in neck swellings keepinghistopathology as gold standard.Material and methods: This is a prospective study conductedfrom January 2017 to December 2017 comprising of 70 casesof neck lesions who underwent FNAC at Adesh HospitalBathinda. Histopathological diagnosis was considered asgold standard. Efficacy of FNAC was determined in termsof sensitivity, specificity, Positive predictive value, NegativePredictive value and diagnostic accuracy.Results: Sensitivity, specificity, Positive predictive value,Negative Predictive value and diagnostic accuracy were83.33%, 100%, 100%, 98.46% and 98.57%.Conclusion: FNAC should be treated as a first-line diagnostictest for neck swellings. As maximum number of cases ofhead and neck lesions are nonneoplastic, FNAC can avoidunnecessary surgeries.

Plasma ghrelin levels after laparoscopic sleeve gastrectomy in obese individuals

Background & objectives: Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods: The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results: A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions: These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.

Effect of roscovitine on developmental competence of small follicle-derived buffalo oocytes

Background & objectives: The lower recovery of competent oocytes in buffalo species limits the commercialization of in vitro embryo production technology in field condition. In this context, pre-maturation of small follicle (SF)-derived oocytes with meiotic inhibition may be a promising alternative to obtain more number of competent oocytes. Thus, the present study was conducted with an objective to enhance the developmental potential of less competent SF-derived buffalo oocytes. Methods: All the visible follicles (used for aspiration) from buffalo ovaries were divided into two categories: large follicle (LF) (follicles having diameter ?6 mm) and SF (follicles of diameter <6 mm). The competence of LF and SF oocytes was observed in terms of brilliant cresyl blue (BCB) staining, cleavage rate, blastocyst rate and relative gene expression of oocyte and blastocyst competence markers. Thereafter, less competent SF oocytes were treated with 0, 12.5, 25, 50 and 100 mM doses of roscovitine (cyclin-dependent kinase inhibitor) to enhance their developmental potential. Results: Based on parameters studied, LF oocytes were found to be more competent than SF oocytes. Pre-maturation incubation of SF oocytes with roscovitine reversibly arrested oocyte maturation for 24 h to ensure the proper maturation of less competent oocytes. A significantly higher number of BCB-positive oocytes were noted in roscovitine-treated group than SF group. Cleavage and blastocyst rates were also higher in roscovitine-treated group. The relative messenger RNA expression of oocyte (GDF9, BMP15, GREM1, EGFR, PTGS2 and HAS2) as well as blastocyst (INF-?, GLUT1 and POU5F1) competence markers was significantly greater in roscovitine-treated group relative to SF group. Again, on comparison with LF group, these parameters depicted a lower value in the treatment group. Interpretation & conclusions: The findings of this study has revealed that pre-maturation incubation of SF-derived oocytes with 25 ?M roscovitine can improve its developmental competence and thus can be utilized to get maximum number of competent oocytes for better commercialization of in vitro embryo production technology in buffalo.

Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.

Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India

Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation.

Medulloblastomas were originally classified under gliomas of the cerebellum until Bailey and Cushing in 1925 named these tumors as medulloblastoma. At present these tumors are classified under primitive neuroectodermal tumor. Surgical excision followed by craniospinal irradiation is the treatment of choice. A 13-year-old-girl operated for posterior fossa medulloblastoma 5 years ago presented with history of headache and vomiting on and off for 4 days in late August 2008. The MRI showed left frontal tumor which on excision was reported as medulloblastoma. Even after optimal treatment reports of recurrence abound in literature. The most common location is in the posterior fossa, followed by spinal, supratentorial, and uncommonly, systemic metastases. We conclude that medulloblastomas are highly aggressive tumor with high local recurrences if the initial excision is incomplete and that recurrence in the supratentorial area although uncommon is still a possibility. This mandates regular follow up of these children till adulthood to catch early recurrences and metastatic disease.

Spontaneous intracystic hemorrhage of the arachnoid cyst: a case report and review of literature.

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. We report a case of a years right handed lady, who presented to the emergency department with the complaints of headache and vomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region. On the fifth day of admission, patient had sudden onset of severe headache associated with loss of consciousness for about 3-4 minutes with neck rigidity. A CT scan of head was repeated, which showed left fronto-parietal cystic lesion with intracystic bleed and SAH. Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid with normal brain surface and there were no evidence of any vascular malformations. Marsupilization of the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst with spontaneous intracranial haemorrhage is reviewed.

Traumatic posterior fossa extradural haematoma.

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH with low GCS or the haematoma of more than 10 ml were subjected to evacuation. Since the volume of the posterior fossa is limited, patients deteriorate early with the development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases. A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury. Vomiting was the most common symptom accounting for 67% of cases followed by transient loss of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%). A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in 27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%.

Postmortem examination in cases of custodial death in India.

Death in custody causes one of the most embarrassing situation for the law enforcement agencies and medicolegal experts. The doctors has to follow the guidelines given by National Human Rights Commission while conducting postmortem examination in such cases and many a times doctors have been blamed for giving a biased opinion under influence to protect the interests of police and jail officials. This paper discusses postmortem examination in cases of custodial deaths and incidence of custodial death in India as well as other parts of the world. The cases of custodial deaths for which autopsy was conducted at AIIMS has also been discussed.

A retrospective analysis of open globe injuries in a tertiary ophthalmological centre in North-East India.

PURPOSE: To evaluate the clinical presentations and surgical outcome in patients with open globe injuries in a tertiary ophthalmological centre in North-east India. METHODS: Case sheets of 79 patients undergoing surgery following open globe injuries at Sri Sankaradeva Nethralaya, Guwahati were studied retrospectively in terms of the type of injury, surgical interventions and final visual outcome. The period of study was from 1994-2005. Results: Injury was mild in 48 (60.8%), moderate in 17 (21.5%) & severe in 14 (17.7%) cases (International Ocular Trauma Classification). 46 (58.2%) cases had only primary repair, 27 (34.2%) had associated lens extraction, 12 (15.2%) had vitrectomy, 2 (2.5%) had retinal detachment surgery, one (1.3%) had intra-ocular foreign body removal, one (1.3%) evisceration.13 (16.5%) cases underwent secondary procedures. Final vision was 6\18 or better in 20 (25.3%), 6\18-6\60 in 14 (17.7%) and <6\60 in 15 (18.9%) cases. 10 (12.7%) cases developed phthisical changes. CONCLUSION: Present analysis reveals that open globe injuries can present in varying severity & though the overall prognosis is grave, prompt surgical intervention can result in better visual outcome.

Dissociation of clinical and laboratory diagnosis in hypothyroidism.

AIMS OF THE STUDY: To assess the significance of clinical versus biochemical diagnosis of hypothyroidism using a clinical scoring index and optimize the therapeutic dose of levothyroxine in Indian patients. METHODOLOGY: Three hundred and eighty eight cases of primary hypothyroidism (male:female ratio 1:5.8) were clinically classified as hypothyroid, euthyroid or inconclusive by Billewicz score. TSH estimation was repeated at 6-8 week intervals and appropriate adjustments in levothyroxine dosage made till the TSH was within the normal range. RESULTS: Of 388 biochemically confirmed hypothyroid subjects less than one fourth (21.6%) could be classified as hypothyroid, almost one half were euthyroid (48.4%) and the remaining (29.9%) fell in the inconclusive category according to Billewiz score. Of 227 patients who returned for complete follow up there was a positive correlation of replacement dose with age and initial weight in females, but not in males. Baseline TSH values were not found to have a significant correlation with the initial dose. The mean replacement dose of levothyroxine (T4) in our subjects was 109.4 +/- 24.05 microg/d (range 1.25-3.84 microg/kg). CONCLUSION: Clinical parameters alone fare poorly in establishing an unequivocal diagnosis of hypothyroidism. A biochemical confirmation is mandatory. The replacement done of T4 was found to be independent of the basal TSH level.

Suicide among children and adolescents in South Delhi (1991-2000).

OBJECTIVE: Suicide among youth is of great concern and a subject requires thorough study to formulate prevention strategy. In this paper the incidence and trends of suicide among children and adolescent of South Delhi have been reported. METHODS: A retrospective analysis was carried out on 222 cases of suicidal deaths pertaining to age group of 10-18 years, the postmortem examination on the body of which were conducted in Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi during the period from 1st January 1991 to 31st December 2000. The particular of cases were analyzed according to age group, sex, method used and causes of committing suicide. RESULTS: Out of 222 cases 123(55.4%) were of girls (Female: Male 1.24:1). Commonest age group involved was 15-18 years in both the sexes. Commonest method used for committing suicide was hanging (57% in girls, 49.5% in boys) followed by poisoning (37.4% in girls, 49.5% in boys). CONCLUSION: Methods used to commit suicide are widely available and are difficult to restrict. Therefore, suicide prevention strategy based on risk factors could be more effective rather than limiting the access to methods.

Percutaneous transluminal angioplasty of transplant renal artery stenosis.

Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.

Endoscopic treatment of chyluria using povidone Iodine with contrast agent : a preliminary experience

Objective: To evaluate the safety and efficacy of povidone iodine with contrast agent as a sclerosant for the endoscopic treatment of chyluria. Patients and Methods: From December 1999 to October 2003; a total of 22 patients having chyluria were treated. After their baseline evaluation they were subjected to endoscopic instillation therapy. The scleros-ing agent was prepared by using povidone iodine with contrast agent diluted with sterile water in the ratio of 1:1:3. The side with chylous efflux was identified via cysto-scopy. Using a bulb tip ureteric catheter the sclerosing solution was instilled in the pelvicalyceal system. Unilateral instillation was performed in 13 cases; eight on the left and five on the right side. In the remaining nine cases that had bilateral chylous efflux instillation was performed on both sides in the same session. Fluoroscopy was used to see the complete filling of the pelvicalyceal system. The sclerosing solution was kept in the system for five minutes and the ureteric catheter was then withdrawn. Results: All patients were cured from chyluria in the immediate post operative period. Relapse occurred in three patients; but retreatment by instillation therapy resulted in cessation of chyluria also in these cases. The longest follow up was three years; the shortest two months. Fifteen patients were lost to follow up after nine months. None of the cases but the three mentioned previously had relapse during the follow-up period. Conclusion: Povidone iodine is a very safe and efficacious agent for the endoscopic treatment of chyluria by instillation therapy. Using a contrast agent along with it helps to know; under fluoroscopic guidance; the exact amount of sclerosing agent to be instilled to completely fill the pelvicalyceal system. Thus overfilling of the system is avoided and the complications occurring due to pyelointerstitial backflow of the sclerosant are prevented

Heavy metal toxicity on dehydrogenase activity on rhizospheric soil of ectomycorrhizal pine seedlings in field condition.

The present investigation was carried out to study the toxicity of heavy metals (Zn, Cd, Cu, Ni, Pb and Al) on the dehydrogenase activity of ectomycorrhizal (Suillus leutus, Scleroderma aurantium, Cenococcum graniforme and Boletus spp.) and non-mycorrhizal rhizospheric soil of pine seedlings. The treatment of heavy metals adversely affected the dehydrogenase activity. Inoculation of mixed ectomycorrhizal fungi harbored increased activity of dehydrogenase. It was observed that in absence of ectomycorrhizae, heavy metals drastically reduced the enzyme activity at higher concentration of metals.