Framework for developing a national surgical, obstetric and anaesthesia plan.

Background: Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants. Methods: Development of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance. Results: To date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail. Conclusion: There is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale-up of surgical system-strengthening activities.

Antecedentes: En la actualidad, se reconoce que la atención quirúrgica, obstétrica y anestésica urgente y esencial (surgical, obstetric, and anaesthesia, SOA) es uno de los componentes de la cobertura sanitaria universal y un elemento necesario para el funcionamiento de un sistema de salud. Para mejorar la atención quirúrgica a nivel nacional, se necesita una planificación estratégica que aborde los seis dominios de un sistema quirúrgico. En este artículo, se detalla el proceso para el desarrollo de un plan nacional de cirugía, obstetricia y anestesia (national surgical, obstetric, and anaesthesia plan, NSOAP) basado en las experiencias de los principales proveedores, los funcionarios del Ministerio de Salud, los líderes de la Organización Mundial de la Salud y consultores. Métodos: El desarrollo de un NSOAP incluye ocho pasos clave: (1) apoyo y dependencia del ministerio, (2) análisis de la situación y evaluaciones de referencia, (3) compromiso de los agentes implicados y establecimiento de prioridades, (4) redacción y validación, (5) seguimiento y evaluación, (6) análisis de costes, (7) gobernanza y (8) implementación. Redactar un NSOAP implica definir los déficits actuales en la atención, sintetizar y priorizar soluciones, y proporcionar un plan de implementación y seguimiento con unos costes proyectados para los seis dominios de un sistema quirúrgico: infraestructura, prestación de servicios, personal, gestión de la información, finanzas y gobernanza. Resultados: Hasta la fecha, cuatro países han completado un NSOAP y 23 más se han comprometido con su desarrollo. Las lecciones aprendidas de estos procesos previos de NSOAP se describen con detalle. Conclusiones: Existe un movimiento global para abordar la carga de las enfermedades que precisan cirugía, mejorar la calidad y el acceso a la atención SOA. El desarrollo de un plan estratégico para la aproximación sistemáticamente los déficits en todo el sistema SOA es un primer paso crítico para garantizar la ampliación a nivel nacional de las actividades de fortalecimiento del sistema quirúrgico.

Clinical evaluation of purified Shilajit on testosterone levels in healthy volunteers.

Purified Shilajit, an Ayurvedic rasayana, was evaluated in healthy volunteers of age between 45 and 55 years for its effect on male androgenic hormone viz. testosterone in a randomised, double-blind, placebo-controlled clinical study at a dose of 250 mg twice a day. Treatment with Shilajit for consecutive 90 days revealed that it has significantly (P < 0.05) increased total testosterone, free testosterone and dehydroepiandrosterone (DHEAS) compared with placebo. Gonadotropic hormones (LH and FSH) levels were well maintained.

Efficacy of integrated treatment of UV light and low-dose gamma irradiation on inactivation of Escherichia coli O157:H7 and Salmonella enterica on grape tomatoes.

The study evaluated the efficacy of integrated ultraviolet-C light (UVC) and low-dose gamma irradiation treatments to inactivate mixed strains of Escherichia coli O157:H7 and Salmonella enterica on inoculated whole grape tomatoes. A mixed bacterial cocktail composed of a 3 strain mixture of E. coli O157:H7 (C9490, E02128, and F00475) and a 3 serotype mixture of S. enterica (S. Montevideo G4639, S. Newport H1275, and S. Stanley H0558) was used based on their association with produce-related outbreaks. Spot inoculation (50 to 100 µmL) on tomato surfaces was performed to achieve a population of appropriately 10(7-8) CFU/tomato. Inoculated tomatoes were subjected to UVC (253.7 nm) dose of 0.6 kJ/m(2) followed by 4 different low doses of gamma irradiations (0.1 kGy, 0.25 kGy, 0.5 kGy, 0.75 kGy). The fate of background microflora (mesophilic aerobic) including mold and yeast counts were also determined during storage at 5 °C over 21 d. Integrated treatment significantly (P < 0.05) reduced the population of target pathogens. Results indicate about 3.4 ± 0.3 and 3.0 ± 0.1 log CFU reduction of E. coli O157:H7 and S. enterica, respectively, per tomato with UVC (0.6 kJ/m(2) ) and 0.25 kGy irradiation. More than a 4 log and higher reduction (>5 log) per fruit was accomplished by combined UVC treatment with 0.5 kGy and 0.75 kGy irradiation, respectively, for all tested pathogens. Furthermore, the combined treatment significantly (P < 0.05) reduced the native microflora compared to the control during storage. The data suggest efficacious treatment strategy for produce indicating 5 or higher log reduction which is consistent with the recommendations of the Natl. Advisory Committee on Microbiological Criteria for Foods.

A study on the phytoaccumulation of waste elements in wetland plants of a Ramsar site in India.

Some wetland plant species are adapted to growing in the areas of higher metal concentrations. Use of such vegetation in remediation of soil and water contaminated with heavy metals is a promising cost-effective alternative to the more established treatment methods. Throughout the year, composite industrial effluents bringing various kinds of heavy metals contaminate our study site, the East Calcutta Wetlands, a Ramsar site at the eastern fringe of Kolkata city (formerly Calcutta), India. In the present study, possible measures for remediation of contaminated soil and water (with elements namely, Ca, Cr, Cu, Pb, Zn, Mn, and Fe) of the ecosystem had been investigated. Ten common regional wetland plant species were selected to study their efficiency and diversity in metal uptake and accumulation. Results showed that Bermuda grass (Cynodon dactylon) had the highest total Cr concentration (6,601 ± 33 mg kg( -1) dw). The extent of accumulation of various elements in ten common wetland plants of the study sites was: Pb (4.4-57 mg kg( -1) dw), Cu (6.2-39 mg kg( -1) dw), Zn (59-364 mg kg( -1) dw), Mn (87-376 mg kg( -1) dw), Fe (188-8,625 mg kg( -1) dw), Ca (969-3,756 mg kg( -1) dw), and Cr (27-660 mg kg( -1) dw) indicating an uptake gradient of elements by plants as Ca>Fe>Mn>Cr>Zn>Cu>Pb. The present study indicates the importance of identification and efficiency of metal uptake and accumulation capabilities by plants in relation to their applications in remediation of a contaminated East Calcutta Wetland ecosystem.

Sepiapterin reverses the changes in gastric nNOS dimerization and function in diabetic gastroparesis.

BACKGROUND: We have demonstrated previously that in vivo supplementation of tetrahydrobiopterin (BH4); a co-factor for neuronal nitric oxide synthase (nNOS) significantly restored delayed gastric emptying and attenuated nitrergic relaxation in diabetic rat. In this study, we have investigated whether supplementation of sepiapterin (SEP), a precursor for BH4 biosynthesis via salvage pathway restores gastric emptying and nitrergic system in female diabetic rats. METHODS: Diabetic rats (streptozotocin-induced) were supplemented with BH4 or SEP (20 mg kg⁻¹ body weight). Gastric nitrergic relaxation in the presence or absence of high glucose and SEP were measured by electric field stimulation. Gastric muscular strips from healthy or diabetic female rats were incubated in the presence or absence of high glucose, SEP and/or methotrexate (MTX). Nitric oxide release was measured colorimetrically by NO assay kit. The expression of nNOSα and dimerization was detected by Western blot. KEY RESULTS: In vitro studies on gastric muscular tissues showed that MTX, an inhibitor of BH4 synthesis via salvage pathway, significantly decreased NO release. In vivo treatment with MTX reduced both gastric nitrergic relaxation and nNOSα dimerization. Supplementation of SEP significantly attenuated delayed gastric emptying in diabetic rats. In addition, SEP supplementation restored impaired nitrergic relaxation, gastric nNOSα protein expression, and dimerization in diabetic rats. CONCLUSIONS & INFERENCES: The above data suggests that supplementation of SEP accelerated gastric emptying and attenuated reduced gastric nNOSα expression, and dimerization. Therefore, SEP supplementation is a potential therapeutic option for female patients of diabetic gastroparesis.

Chemical leucoderma: a clinico-aetiological study of 864 cases in the perspective of a developing country.

BACKGROUND: Chemical leucoderma, often clinically mimicking idiopathic vitiligo and other congenital and acquired hypopigmentation, has been increasing rapidly in incidence in developing countries such as India. OBJECTIVES: This study attempts to detect clinical and epidemiological patterns of chemical leucoderma. METHODS: Detailed history-taking, especially of exposure to contributory chemicals, clinical examination, relevant investigations, data recording and analysis were done. RESULTS: In a total of 864 cases of chemical leucoderma, 65.6% cases started de novo and vitiligo patches were pre-existing in the remaining cases. Patches were limited to the contact area in 73.7% but had spread to remote areas in 26.3% cases. The face (41.1%) and scalp (5.9%) were the commonest and least involved sites. Confetti macules were seen in 89% and pruritus was complained of in 21.8%. Aetiological agents identified were hair dye 27.4% (21% self-use; 6.4% not self-use), deodorant and spray perfume 21.6%, detergent and cleansers 15.4%, adhesive bindi 12%, rubber chappal 9.4%, black socks and shoes 9.1%, eyeliner 8.2%, lipliner 4.8%, rubber condoms 3.5%, lipstick 3.3%, fur toys 3.1%, toothpaste 1.9%, insecticides 1.7%, 'alta' 1.2%, amulet string colour 0.9%. Therapeutic response was much better in 'pure' chemical leucoderma (73.4%) than in those with co-existing vitiligo (20.9%). CONCLUSIONS: Chemical leucoderma, a disease of mostly industrial origin in developed countries, may be induced by common domestic products in developing countries. Diagnosis and differentiation from other causes of hypopigmentation can be done confidently by following the clinical criteria as proposed. The therapeutic response of chemical leucoderma is better than that of vitiligo.

Effect of Sahaja yoga meditation on auditory evoked potentials (AEP) and visual contrast sensitivity (VCS) in epileptics.

The effect of Sahaja yoga meditation on 32 patients with primary idiopathic epilepsy on regular and maintained antiepileptic medication was studied. The patients were randomly divided into 3 groups: group I practiced Sahaja Yoga meditation twice daily for 6 months under proper guidance; group II practiced postural exercises mimicking the meditation for the same duration; and group III was the control group. Visual Contrast Sensitivity (VCS), Auditory Evoked Potentials (AEP), Brainstem Auditory Evoked Potentials (BAEP), and Mid Latency Responses (MLR) were recorded initially (0 month) and at 3 and 6 months for each group. There was a significant improvement in VCS following meditation practice in group I participants. Na, the first prominent negative peak of MLR and Pa, the positive peak following Na did not register changes in latency. The Na-Pa amplitude of MLR also showed a significant increase. There were no significant changes in the absolute and interpeak latencies of BAEP. The reduced level of stress following meditation practice may make patients more responsive to specific stimuli. Sahaja Yoga meditation appears to bring about changes in some of the electrophysiological responses studied in epileptic patients.

Targeting of liposomal andrographolide to L. donovani-infected macrophages in vivo.

Despite the rapid development in medicinal and pharmaceutical technology, the targeting of drugs to phagocytic cells in macrophage-related diseases still remains a major unsolved problem. By using the mannosyl-fucosyl receptors on macrophages, attempts were made to target antileishmanial drugs encapsulated in mannosylated or fucosylated liposomes to treat experimental leishmaniasis in the hamster model. Mannosylated liposomes were found to be more potent in delivering antileishmanial drugs to phagocytic cells. Liposomes loaded with an indigenous drug, andrographolide, a labdane diterpenoid isolated from Indian medicinal plant Andrographis paniculata, were prepared and tested against experimental leishmaniasis in a hamster model. Mannosylated liposomes loaded with the drug were found to be most potent in reducing the parasitic burden in the spleen as well as in reducing the hepatic and renal toxicity. In addition, mannosylated drug-loaded liposome-treated animals showed a normal blood picture and splenic tissue histoarchitecture when compared with those treated with free drug or regular liposomal drug. Such a drug-vehicle formulation may be considered for clinical trials.

Evaluation of the in-vivo activity and toxicity of amarogentin, an antileishmanial agent, in both liposomal and niosomal forms.

The antileishmanial property of amarogentin, a secoiridoid glycoside isolated from the Indian medicinal plant Swertia chirata, was examined in a hamster model of experimental leishmaniasis. The therapeutic efficacy of amarogentin was evaluated in free and two different vesicular forms, liposomes and niosomes. The amarogentin in both liposomal and niosomal forms was found to be a more active leishmanicidal agent than the free amarogentin; and the niosomal form was found to be more efficacious than the liposomal form at the same membrane microviscosity level. Toxicity studies involving blood pathology, histological staining of tissues and specific enzyme levels related to normal liver function showed no toxicity. Hence, amarogentin incorporated in liposomes or niosomes may have clinical application in the treatment of leishmaniasis.

Is GABA involved in the development of caffeine tolerance?

Caffeine (10 or 20 mg/kg per day, po)-induced stimulation of locomotor activity (LA) reached its peak following 4 consecutive days of caffeine administration. Caffeine-induced stimulation of LA was restored to the control values following caffeine tolerance after 16 or 12 consecutive days of caffeine treatment at a dose of 10 or 20 mg/kg per day, po. Biochemical studies showed that caffeine in the nontolerant condition reduced GABAergic activity in cerebral cortex, corpus striatum, cerebellum, hypothalamus and pons-medulla; but tolerance to caffeine (10 or 20 mg/kg per day, po) pushed up the GABAergic activity to the control value in all these regions of brain. Further, it was found that muscimol reduced the LA while bicuculline stimulated LA in the caffeine tolerant condition. Thus, from the present study it may be concluded that: (a) caffeine-induced stimulation of LA is dependent on dose and duration of caffeine treatment, (b) development of tolerance to caffeine is dependent on the dosage of caffeine, and (c) the reduction of central GABAergic activity in the caffeine-nontolerant condition pushed up and restored the LA to the control level on the development of tolerance to caffeine.

Factors influencing regeneration from protoplasts of Asparagus densiflorus cv. Sprengeri.

This article describes conditions to optimize the yield of viable protoplasts from callus tissue of Asparagus densiflorus cv. Sprengeri and their subsequent regeneration into plantlets. Callus tissue was initiated by culturing spear sections (5-7 mm) on Murashige and Skoog (MS) medium supplemented with 0.8% (wt/vol) Bacto agar, 3% (wt/vol) sucrose, 0.5 mg/l each of nicotinic acid, pyridoxine-HCl, and thiamine-HCl, 1 mg/l p-chlorophenoxyaceticacid (pCPA) and 1 mg/l 6-benzylaminopurine (BAP). The maximum protoplast yield was obtained in a mixture of 1% (wt/vol) Cellulysin, 0.8% (wt/vol) Rhozyme HP 150 and 0.3% (wt/vol) Macerase, dissolved in cell protoplast wash salt solution with 7 mM CaCl2 .2H2O, 3 mM MES, 0.6 M glucose, and 0.1 M mannitol. First divisions were observed after 3-4 days of initial culture. The plating efficiency was highest (7.8%) in half-strength MS semisolid medium containing 1 g/l glutamine, 0.6 M glucose, 0.1 M mannitol, 0.5 mg/l folic acid, 0.05 mg/l biotin, 2 mg/l ascorbic acid, 1 mg/l α-naphthaleneacetic acid, 0.5 mg/l zeatin, and 0.1% (wt/vol) Gelrite. Protoplast-derived microcolonies and microcalli were cultured on the same medium on which the primary callus culture was initiated. After 10-12 weeks, calli were transferred to shoot regeneration medium containing MS salts, 1 mg/l BAP, 0.5 mg/l pCPA and 0.2% Gelrite. Shoots (3-4 cm) were then transferred to MS rooting medium with 2 mg/l indole-3-butyric acid, and 0.2% Gelrite. Plantlets were obtained within 4-5 weeks.

Detection of rice tungro bacilliform virus in field and glasshouse samples from India using the polymerase chain reaction.

Rice tungro bacilliform virus (RTBV) together with rice tungro spherical virus (RTSV) is the causal agent for the rice tungro disease. A rapid technique was developed to detect RTBV DNA in the crude extract of freshly collected leaf samples by polymerase chain reaction (PCR). This technique can detect the viral DNA in 1000-fold diluted leaf extract. Detection has been possible in samples stored upto 5 days after the collection. This technique may have wide application for the field diagnosis of RTBV infection.

Amarogentin, a naturally occurring secoiridoid glycoside and a newly recognized inhibitor of topoisomerase I from Leishmania donovani.

A MeOH extract of Swertia chirata found to inhibit the catalytic activity of topoisomerase I of Leishmania donovani was subjected to fractionation to yield three secoiridoid glycosides: amarogentin (1), amaroswerin (2), and sweroside (3). Amarogentin is a potent inhibitor of type I DNA topoisomerase from Leishmania and exerts its effect by interaction with the enzyme, preventing binary complex formation.

Brainstem auditory evoked potentials in epileptics on different anti-epileptic drugs.

The effects of anti-epileptic drugs (AEDs) on brainstem auditory evoked potentials (BAEPs) were studied on 32 female patients of epilepsy and 10 age-matched normal healthy females (NS). The patients were divided into 6 groups, those not receiving medication (drug free, DF) and those receiving AEDs: Phenytoin (PHT), Carbamazepine (CBZ), Phenobarbital (PB), a combination of PHT and PB and a combination of CBZ and PB. DF epileptics had shortened were V absolute latency (AL) and I-V interpeak latency (IPL) as compared to NS. Phenytoin and CBZ monotherapy produced a prolongation of wave III AL (by PHT only), wave V AL, wave I-III IPL and I-V IPL, as compared to DF epileptics. Phenytoin monotherapy also prolonged wave III AL and I-III IPL, as compared to NS. When PB in the dosage of 30-60 mg/d was used in combination with PHT the above mentioned changes were not observed. These findings indicate altered neuronal conduction and/or synaptic transmission in epileptics. Anti-epileptic drugs in the dosages studied, with exception of PHT appear to lead towards "normalization" of BAEPs.

Lower environmental temperature: effect of long-term exposure on diazepam-induced changes in brain GABA.

Long-term diazepam (DZ) treatment (5 mg/kg, i.p. for 15-30 consecutive days) reduced GABAergic activity in hypothalamus and cerebellum with the alteration of GABA synthesis and its release process. This long-term DZ-induced inhibition in GABAergic activity in hypothalamus and cerebellum was not altered when DZ-treated rats were exposed (2 h/day) to lower environmental temperature (LET; 12 degrees C) for 7-30 consecutive days. Although repeated exposure to LET did not affect the GABA system in cerebellum and hypothalamus, striatal GABAergic activity was significantly enhanced under similar conditions. This LET-induced (repeated exposure) stimulation in striatal GABAergic activity was prevented when rats were treated with DZ along with repeated LET exposure (2 h/day) under long-term conditions.

Higher environmental temperature-induced change in synaptosomal acetylcholinesterase activity of brain regions.

Exposure of adult male albino rats to higher environmental temperature (HET) at 35 degrees for 2-12 hr or at 45 degrees for 1-2 hr increases hypothalamic synaptosomal acetylcholinesterase (AChE) activity. Synaptosomal AChE activity in cerebral cortex of rats exposed to 35 degrees for 12 hr and in cerebral cortex and pons-medulla of rats exposed to 45 degrees for 1-2 hr are also activated. AChE activity of synaptosomes prepared from normal rat brain regions incubated in-vitro at 39 degrees or 41 degrees for 0.5 hr increases significantly in cerebral cortex and hypothalamus. The activation of AChE in pons-medulla is also observed when this brain region is incubated at 41 degrees for 0.5 hr. Increase of (a) the duration of incubation at 41 degrees and (b) the incubation temperature to 43 degrees under in-vitro condition decreases the synaptosomal AChE activity. Lineweaver-Burk plots indicate that (a) in-vivo and in-vitro HET-induced increases of brain regional synaptosomal AChE activity are coupled with an increase of Vmax without any change in Km (b) very high temperature (43 degrees under in-vitro condition) causes a decrease in Vmax with an increase in Km of AChE activity irrespective of brain regions. Arrhenius plots show that there is a decrease in transition temperature in hypothalamus of rats exposed to either 35 degrees or 45 degrees; whereas such a decrease in transition temperature of the pons-medulla and cerebral cortex regions are observed only after exposure to 45 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Catharanthus alkaloids XXXVII. 16-Epi-Z-isositsirikine, a monomeric indole alkaloid with antineoplastic activity from Catharanthus roseus and Rhazya stricta.

16-Epi-Z-isositsirikine (1) has been isolated from the leaves of Catharanthus roseus and Rhazya stricta and identified through a combination of spectral interpretation and chemical correlation. The compound displayed antineoplastic activity in the KB test system in vitro and the P-388 test system in vivo.

Anticancer indole alkaloids of Rhazya stricta.

The leaves and roots of Rhazya stricta (Apocynaceae) yielded four indole alkaloids. Three of these isolated, vallesiachotamine (1), sewarine (3) and tetrahydrosecamine (4), displayed cytotoxic activity; polyneuridine (2) was not reported previously from this species. Tetrahydrosecaminediol (5), its acetate 6, and didemethoxycarbonyl-tetrahydrosecamine (7) were prepared from tetrahydrosecamine (4) by chemical reactions. The diol 5 was highly cytotoxic.