Medicinal plants used for treating infertility and related disorders of women in India: a systematic review

Assessment of plant medicine for treating infertility and related disorders is making headway universally recent couple of decades to bring out new effective and safe substances as an alternative medicine. Present paper reviews the published literature on plant medicine used for female infertility and related disorders. The 53 research papers or reports shortlisted are based studies under taken in India. Total 459 uses of 202 medicinal plants classified under 84 families. Total 62 trees, 55 shrubs, 79 herbs and 3 climbers are reported. Most used plant parts for making medicine are roots in 111 formulations and leaf in 101 formulations. Medicinal plants used for infertility are 84, while for related disorder like leucorrhoea 79 plants, menorrhagia 53, dysmenorrhea 29, amenorrhea 23 and 22 plants used to regulate menstruation. Additional investigations could be helpful to verify the claims reported using a specific formulations or recipes and which will subsequently result in providing possible the alternative medicine for the treatment of female infertility.

Medicinal plants used during pregnancy, childbirth and postpartum care in India: a systematic review

Use of plant medicine during pregnancy, childbirth and in postpartum care has grown significantly worldwide and is remarkably well-known in different regions of India. Traditional plant medicine has the potential for treating various diseases/ailments and is evidenced by well-known pharmacopeia of India - Ayurveda. This paper reviews the research papers on plant medicine utilization during pregnancy, childbirth and for postpartum care based on information published from India. Total 206 uses of 146 medicinal plants belong to 69 families, of which 125 are herbs, 39 trees, 26 shrubs and 16 climbers. Plant parts used as medicine for treating various disorders during pregnancy, childbirth and postpartum are 75 leaves, 48 roots, 23 seeds, 19 whole plants, 15 fruits, 11 barks, stem and flower 5 each, gum 2, latex 1, while in 24 cases part used is not specified. The use of plants for treating various disorder/ailments during pregnancy, of these most prevalent use is as a tonic (23 uses) which followed by vomiting (10), abdominal pain (9), to facilitate delivery (6) and so on. Use of plants during childbirth, maximum number of plants used to facilitate deliver (32 uses), for labor pain (15), and to induce labor (12). While use of plants for postpartum care, includes (37 uses) for lactation, (10) for haemorrhage, and 7 for abdominal pain.

Patterns and causes of maternal mortality in tertiary care hospital in Maharashtra, India: a 10-year retrospective study

Background: Maternal death is a catastrophe, as death of a mother can the entire family. The aim of present study is to find out major patterns, reasons and complications leading to maternal deaths. Methods: A retrospective study was conducted for last 10 years from January 2013 to December 2022 by studying the records of a tertiary care hospital to study the maternal mortalities and complications leading to death. Maternal deaths were analyzed by considering different facets, such as age at death, gravida, locality of residence, admission death interval and direct and indirect cause/s of death, etc. Results: During the study period, total of 107753 live births and 202 maternal deaths have been recorded. The average maternal mortality rate of last ten years was 187.46/100000 live births. Age wise maternal mortality during the study period was high in the age 19 to 25. Major direct cause of maternal mortality was postpartum hemorrhage, (23%) and major indirect cause observed was anemia (43%). Admission to death interval time indicates that delay in provision of treatment and referral to tertiary care hospital might be the reason responsible for high maternal deaths. Conclusions: Maternal deaths can be prevented by improving the health care facilities, ensuring skilled attendants and required basic medication. This is high time to mobilize universal, national, regional, and community-based commitment to decrease maternal mortalities.

Clinicopathological study of benign and malignant ovarian tumours and the role of HER2/neu and ER expression in these tumours

Background: Ovarian cancers represent the 6th most common cancer among females and are the most common cause of death from gynaecological cancers in the world. The aim is to do clinicopathologic study of ovarian tumours along with evaluation of the expression of estrogen receptor (ER) and human epidermal growth factor receptor (HER2/neu).Methods: A total of 85 cases of ovarian tumors were studied and immunohistochemistry was performed with specific antibodies against ER and HER2/neu as per standard protocol.Results: In present study, surface epithelial tumours were the commonest type comprising 64 cases (75.2%), followed by Germ cell tumours, 17cases (20%) and sex cord stromal tumours, 04 cases (4.8%).Among the surface epithelial tumours , ER‑positive cases were higher in malignant (71.4%) tumours as compared to borderline tumours (33.3%) and benign tumours (7.7%) while Her2/neu positive cases were higher in borderline (66.7%) tumours as compared to malignant tumours (42.9%) and benign tumours (15.3%).Among the germ cell tumours, ER expression was positive in 62.5% cases of mature teratoma while HER2/neu expression was positive in only 12.5% cases of mature teratoma. None of the sex cord stromal tumours showed positive expression of ER and HER2/neu.Conclusions: Positive expression of estrogen receptors is seen predominantly in surface epithelial malignancies and in mature teratoma. It proves the mitogenic role of estrogen in ovarian tumours. Her-2 neu was expressed mainly in malignant tumours. This suggests their carcinogenic role. This also helps in differentiating borderline and malignant tumours.

Comparison of Oral Ivabradine, Oral Metoprolol and Placebo to Attenuate the Stress Response in Nasal and Laryngeal Surgeries: A Prospective, Randomized, Double Blind Study

Introduction: Nasal surgeries like septoplasty, polypectomyand laryngeal surgeries for removal of vocal nodule, cysts etcare commonly performed. Changes in haemodynamics due tolaryngoscopy and endotracheal intubation are likely to persistduring these procedures. These surgeries also require bloodless field. The present study was conducted to evaluate andcompare the efficacy of oral metoprolol tartrate versus oralivabradine versus placebo in attenuation of haemodynamicresponses during laryngoscopy, tracheal intubation andthroughout nasal and laryngeal surgeries.Methods: This was a prospective, randomized, comparative,double blind study. . Patients were randomly allocated bysimple randomization into 3 groups having 30 patients in each.Neither the patient nor the investigator was aware, whichpatient is allocated into which group and were unaware of thedrug being administered as it was given to the patient by aperson not involved in the study. Data collections were carriedout by investigator in a double blind manner. All the patientswere explained about the anesthesia technique and writteninformed consent was taken. Group 1: Oral Ivabradine 5mgtablet was given orally 2 hours before induction of anaesthesia.Group 2: Oral Metoprolol tartrate 50mg tablet was given orally2 hours before induction of anaesthesia. Group 3: Oral placebowas given 2 hours before induction of anaesthesia.Results and Conclusion: We concluded that both the drugscan be used as an effective premedication, to attenuate thesympathetic response to laryngoscopy, endotrachealintubation, extubation and throughout nasal and laryngealsurgeries. However Metopolol was found to have better controlthan Ivabradine in maintaining the vitals at all points andproviding a good hypotensive effect than ivabradine.

In Vitro Evaluation of Carbachol and Endothelin on Contractility of Colonic Smooth Muscle in Hirschsprung’s Disease.

Background: The hypomotility of colon observed in Hirschsprung’s disease (HD) has been attributed to congenital aganglionosis only. So far, it is not clear whether the contractility of colonic smooth muscle in this condition is altered or not. Therefore, the present study attempted to understand the contractile status of colonic segments of HD patients by examining carbachol and endothelin (ET-1) evoked colonic smooth muscle contractions in vitro. Methods: Contractile responses were recorded from strips of colonic segments obtained from HD patients, using organ bath preparations. Cholinergic agonist carbachol and ET-1 along with their antagonists were used to evoke contractile responses. Thereafter, the samples were histopathologically confirmed for HD. Results: Colonic strips of HD did not show any spontaneous contractions but responded to carbachol and ET-1 to a lesser extent. In HD, response of carbachol was blocked by atropine and hexamethonium by nearly 73% and 50% respectively. ET-1 induced contractile responses were blocked by ET-A and ET-B antagonist up to 40%, signifying the possible role of ET-A and ET-B receptors in HD colon contractility. Conclusion: As evidenced by lack of spontaneous contractions and impaired carbachol and ET-1-induced contractile responses, it is concluded that, in addition to aganglionosis, decreased contractility of colonic smooth muscle may contribute to hypomotility observed in patients with HD.

Neonatal surgery: a ten year audit from a university hospital.

Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.

Obstructed Morgagni's hernia.

Morgagni's Hernia is the direct herniation of the intra-abdominal organs through the anterior retrocostoxiphoid diaphragmatic defect. We are presenting a case of obstructed Morgagni's hernia in a five-year-old child. Who presented with colicky abdominal pain, distention of upper abdomen, vomiting with constipation of three days duration.. Morgagni hernia is a rare disease even rarer in pediatric age group, and is usually diagnosed incidentally; presentation of this disease with obstruction had been reported in adult but not in children.

Conservative treatment for round worm intestinal obstruction.

OBJECTIVE: The ascariasis is one of the most cosmopolitan intestinal parasite infections and it can be in inhospitable regions inhabited by human being, but its biggest prevalence is observed in the tropical and subtropical areas. Intestinal obstruction has been estimated to occur in 2 per 1000 ascaris-infected children per year. We are presenting a study emphasizing the conservative treatment for complete intestinal obstruction due to roundworms without sign and symptom of peritonitis and perforation. METHODS: A total of 22 patients of roundworm obstruction partial or complete without signs of and symptoms of peritonitis were admitted in the Department of Pediatric Surgery IMS, BHU Varanasi India in the period form 2003-2005. Patients were put nil by mouth, intravenous fluid, antibiotics, piperazine salt through nasogastric tube and glycerine + liquid paraffin emulsion enemas and were evaluated for duration of hospital stay, rate of conversion to surgical treatment and complications. RESULTS: 19 (86%) patients were treated successfully with conservative line of management. Only 3 patients required surgical intervention. No mortality, complication and mean hospital stay was 4.1 days (range 4-5 days). CONCLUSION: Round worm intestinal obstruction can be effectively treated by conservative line of management.

Spontaneous regression of patent omphalo-mesenteric duct.

We report a one-month-old male child with a patent omphalo-mesenteric duct that regressed spontaneously in the neonatal period and resulted in a Meckel's diverticulum.

Septic induced abortion claiming life of a Nepalese woman.

This is a case report of septic induced abortion done at 16 weeks of gestation outside Kathmandu valley who presented to the emergency department of Tribhuvan University Teaching Hospital (TUTH) with peritonitis and septic shock. The case underwent emergency laparotomy and was treated surgically for perforated ileum and uterus by resection and end to end anastomosis of bowel and subtotal hysterectomy. The patient died after 16 hours of operation due to multiple organ failure (MOF) as a sequelae of septic shock. Unsafe abortion remains one of the major causes of maternal mortality in Nepal. Increasing public awareness about hazards of septic abortion and the provisions of law and decentralizing the trained manpower throughout the country would play a pivotal role in decreasing the incidence of septic induced abortion.

Ivemark syndrome in association with congenital septum transversum defect and pancreatic divisum.

A four-month-old female baby presented with cyanosis and respiratory distress. A provisional diagnosis of congenital posterolateral diaphragmatic hernia was made but on exploration there was a defect in the septum transversum along with features of Ivemark syndrome - asplenia with visceroatrial heterotaxia, malrotation and pancreatic divisum - an association not yet reported in literature. The child did well after operative correction of the hernia. Echocardiography showed situs inversus with dextrocardia with double outlet right ventricle, atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonary stenosis.

Maharishi Amrit Kalash, an ayurvedic medicinal preparation, enhances cholinergic enzymes in aged guinea pig brain.

The effect of orally fed Maharishi Amrit Kalash was examined on the activities of cholinergic enzymes in the guinea pig brain. The activity of the cholinergic enzymes viz. choline-acetyltransferase and acetylcholinesterase enzymes was found to be reduced significantly (P<0.05) in the various regions of CNS of the aged guinea pigs. Oral administration of MAK(500 mg/kg body weight daily) for 2 months significantly increased (P<0.05) the activity of choline acetyltransferase and acetylcholinesterase in the older animals. The present study indicates that this food supplement can be helpful in alleviating the cholinergic deficits in the old age.

Age-dependent variations in mitochondrial and cytosolic antioxidant enzymes and lipid peroxidation in different regions of central nervous system of guinea pigs.

The age-related changes in the activities of antioxidant enzymes of mitochondrial and cytosolic fractions were measured in different regions of the central nervous system (CNS) in 10 and 32 months old guinea pigs. In old animals, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were reduced (p < 0.05) in all the regions of CNS studied but catalase (CAT) declined significantly only in the cerebral cortex, hypothalamus and cerebellum. Glutathione reductase (GRd) activity declined in cerebral cortex and hypothalamus in the cytosolic fractions and only in cerebellum in the mitochondrial fraction. It is concluded that age-related decline in the activities of antioxidant enzymes is both region and enzyme specific. The endogenous lipid peroxide was found to be significantly higher (p < 0.05) in the 32 month old animals whereas, lipid peroxidation after incubating the tissue homogenate in air was found to be lower (p < 0.05). The in vitro mitochondrial lipid peroxidation decreased with age. The results indicate that accumulation of lipid peroxides takes place with ageing but the susceptibility of lipid peroxidation decreases in the older animals.

Effect of Maharishi Amrit Kalash an ayurvedic herbal mixture on lipid peroxidation and neuronal lipofuscin accumulation in ageing guinea pig brain.

The effects of ayurvedic herbal mixture Maharishi Amrit Kalash(MAK) were studied on brain lipid peroxidation, oxygen consumption, and lipofuscin accumulation in 10 months and 32 months old guinea pigs. Brain regions studied were cerebral cortex, hypothalamus, cerebellum and spinal cord. Parameters assessed were lipid peroxidation, oxygen consumption, and lipofuscin accumulation. The endogenous lipid peroxide was found to be increased significantly (P < 0.05) in the 32-month-old animals. Neuronal lipofuscin accumulation in the neurons of cerebral motor cortex, cerebellum and cervical spinal cord was increased (P < 0.05) in the older animals. Oxygen consumption was found to be decreased significantly(P < 0.05) in the 32-month old guinea pigs. Treatment with MAK at a dose of 500 mg/kg body weight daily for two months reduced the lipid peroxidation and lipofuscin pigment accumulation significantly in brain regions and it also helped in restoring the normal oxygen consumption in the older animals. This indicates antioxidant properties of MAK.

Aspiration vs nonaspiration technique of cytodiagnosis--a critical evaluation in 160 cases.

The two sampling techniques were studied in 160 randomly selected cases of superficial swellings in various sites of the body. They were sampled by fine needle aspiration (FNA) and by non-aspiration (NA) (a needle without application of aspiration pressure). Cell samples were cytologically assessed and critically evaluated using five objective parameters. Contamination with blood was more in lymphnode, thyroid and liver lesions in aspiration smears than NA smears and values were statistically significant. Similarly when compared for the degree of cellular trauma and cellular degeneration statistically significant better results were obtained by nonaspiration technique for lymphnode lesions. Regarding amount of cellular material obtained by FNA, statistical significant better results were found for breast lesions only. Statistically significant better maintenance of architecture was observed only for thyroid lesions by NA technique. Better average scores were observed by NA technique for lymphnode and thyroid only. Categorizing all the smears obtained by FNA & NA on the basis of their scores according to predetermined criteria, greater number of diagnostically adequate specimens were obtained by FNA than by NA but the number of diagnostically superior specimens obtained by NA technique was found to be more than that by FNA. The difference was found to be statistically significant. However the number of inadequate smears was also more by NA technique than by FNA technique.

Local steroid therapy in cutaneous hemangiomas.

OBJECTIVES: To evaluate the efficacy of intralesional triamcinolone in enhancing regression in various type of hemangiomas. SETTING: Outpatients department of a teaching hospital Subjects: One hundred and five patients with rapidly growing surface hemangioma. The age ranged from 1 month to 15 months (mean 7 months). INTERVENTION: Intralesional triamcinolone administered at monthly intervals, ranging from single injection to 7 injections (mean 3.6 injections). MAIN OUTCOME MEASURE: Regression of the hemangioma. RESULTS: The overall response rate was 88.6% (excellent 51.4%, and good 37.2%). Maximum response was observed in children below 1 year of age (> 90%), lesions over the face (92.8%) and strawberry hemangiomas (99.9%). CONCLUSION: Intralesional administration of triamcinolone devoid of systemic side effects and an effective initial modality for rapidly growing hermangiomas.