Antimicrobial Agents Based on Metal Complexes: Present Situation and Future Prospects.

The rise in antimicrobial resistance is a cause of serious concern since the ages. Therefore, a dire need to explore new antimicrobial entities that can combat against the increasing threat of antibiotic resistance is realized. Studies have shown that the activity of the strongest antibiotics has reduced drastically against many microbes such as microfungi and bacteria (Gram-positive and Gram-negative). A ray of hope, however, was witnessed in early 1940s with the development of new drug discovery and use of metal complexes as antibiotics. Many new metal-based drugs were developed from the metal complexes which are potentially active against a number of ailments such as cancer, malaria, and neurodegenerative diseases. Therefore, this review is an attempt to describe the present scenario and future development of metal complexes as antibiotics against wide array of microbes.

Evaluation of the anticancer potential of secondary metabolites from Pseudevernia furfuracea based on epidermal growth factor receptor inhibition.

UHPLC/ESI/MS/MS profiling followed by bioactivity guided isolation of Pseudevernia furfuracea (P. furfuracea) extract yielded two polyphenolic molecules, Methyl haematommate (PF-1) and Atraric acid (PF-2). These molecules were evaluated for bioactivity against five cancerous cell lines. The results revealed that atraric acid showed significant activity against ovarian cancer cell line (PA-1) having GI50 at 16.42 µg/mL and moderate activity against the breast cancer cell line (MCF-7), having GI50 at 64.35 µg/mL. The results were further supported by in silico molecular docking studies of atraric acid with the epidermal growth factor receptor (EGFR) tyrosine kinase protein. The study revealed that atraric acid has the capacity to act as a potential EGFR inhibitor via occupying the ATP binding pocket of EGFR and making favourable electrostatic interactions and van der Waals interaction with its key residues. Our results highlight P. furfuracea and its polyphenolic compound, atraric acid as a promising candidate for ovarian cancer management.

A Mini-Review on Lichen-Based Nanoparticles and Their Applications as Antimicrobial Agents.

Biological entities such as green plants, fungi, and lichens are now a days persistently explored for the synthesis of nanoparticles. Lichen-based nanoparticles are also becoming increasingly popular owing to their biocompatibility, eco-friendliness, and cost-effectiveness. The lichen-based metal nanomaterials, particularly synthesized using green chemistry approaches, have turned out to be great substitutes to conventional antimicrobial therapies. Many scientific reports established the significant antimicrobial properties exhibited by the lichen nanoparticles. Therefore, the present mini-review summarizes an overview of lichen-based nanomaterials, their synthesis, their applications, and the molecular mechanism of their potential as broad spectrum antimicrobial agents for biomedical applications.

Vesico-vaginal fistula presenting as overactive bladder in a case of Gellhorn pessary for vault prolapse.

An 81-year-old woman with early dementia was on a regular follow-up for change of Gellhorn pessary every 6 months for vault prolapse. She presented with frequency and urgency for 10 months duration 5 years into conservative management. Her symptoms did not improve on anticholinergics and lifestyle modifications. She underwent an opportunistic change of pessary under general anaesthesia coincidental to scalp wound debridement. On removal of the pessary, a gush of urine was noted followed by confirmation of a large vesico-vaginal fistula (VVF). In the initial period of follow-up, she was reviewed by the urogynaecology team and considered to be a poor surgical candidate for a major surgical procedure and was offered conservative measures with incontinence pads and possible indwelling catheter. Serious complications like fistulae can still occur despite well-managed pessary treatment. Earlier presentation with overactive bladder symptoms masked the VVF resulting in delayed diagnosis.

Novel use of laparoscopic-guided TAP block in total laparoscopic hysterectomy.

BACKGROUND: Transverse abdominis plane (TAP) block is a peripheral nerve block designed to anaesthetise the nerves supplying the anterolateral abdominal wall (T6 to L1). We introduced laparoscopic TAP block at Ninewells Hospital in 2014 and present a retrospective study assessing its efficacy. To our knowledge, there is limited study done on laparoscopic-guided TAP block whilst there are abundant literatures available on ultrasound-guided TAP block. AIMS: To evaluate the efficacy of laparoscopic-guided TAP block as postoperative analgesia following total laparoscopic hysterectomy (TLH). METHODOLOGY: A retrospective study was done between November 2014 to October 2016 (24 months) comparing patients who had TLH with TAP block (Group 1; n = 45) and patients who had TLH without TAP block (Group 2; n = 31) in our gynaecology unit. Patients were identified from theatre database. Data was collected from clinical portal and medical notes. The data included demographic information, BMI, METS score, intra-operative opiates use, post-operative pain scores, opiate requirements and use of patient-controlled analgesia (PCA), total dose of opiates used and day of discharge. The outcomes were analysed using means, odds ratios (OR), Mann-Whitney U-test and Fisher's exact or Chi-square test with 95% confidence interval (CI). RESULTS: Patients in Group 1 were older (mean age of 64.4, range 38-87) when compared to Group 2 (mean age of 49.3, range 37-81). Group 1 and 2 had comparable mean BMI (30.34 vs. 30.02) and METS score (6.77 vs. 7.76). Mean post-operative pain scores were lower in Group 1 within 4 hours, in periods of 4-12 hours, 12-24 hours and 24-48 hours post-op. Smaller proportion of patients in Group 1 required opiates post-operatively in all periods as compared to Group 2. This was statistically significant in the periods of 12-24 hours post-op (OR 0.31, 95% CI 0.11-0.82; p = .01). PCA use was significantly lower in Group 1 (OR 0.02, 95% CI 0.0014-0.46; p = .01). Group 1 had lower mean total dose of opiates used (27.182 mg, range 0-102 mg) than Group 2 (59.452 mg, range 0-240 mg), which was statistically significant (p < .0001). Average post-op hospital stay was 1.3 and 1.8 days in Group 1 and 2, respectively. CONCLUSION: Laparoscopic-guided TAP block delivered as post-operative analgesia following TLH results in reduced opiate requirement at post-operative period 12-24 hours, reduced PCA use and lower total dose of opiates used.

Outcome of gestational diabetes mellitus from a tertiary referral center in South India: a case-control study.

BACKGROUND: Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women. STUDY DESIGN: A case-control study with 286 cases and 292 age-matched controls was conducted for a period of 11 months (August 2007-June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India. MATERIALS AND METHODS: Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed. STATISTICAL ANALYSIS: Univariate analysis was done by means of t test, Odd's ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant. RESULTS: The frequency of induction of labor was significantly higher than spontaneous labor (OR = 1.84, P = 0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR = 1.66, P = 0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR = 2.3, P = 0.007). Hypoglycemia was the most common neonatal complication (OR = 11.97, P < 0.001) and nine babies of diabetic mothers were macrosomic (OR = 5.2, P = 0.02). CONCLUSIONS: Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.

Knowledge and practice profile of obstetricians regarding epilepsy in women in Kerala state, India.

PURPOSE: To assess the knowledge of obstetricians about concerns of women with epilepsy. MATERIALS AND METHODS: We surveyed 97 obstetricians (teaching hospitals-43, private hospitals-32, and community health centers-21) using knowledge of women's issues and epilepsy (KOWIE) questionnaire II with additional questions. RESULTS: The mean duration of practice of the surveyed obstetricians was 12.4 ± 10.7 years and 94% were female doctors. Most of them were well informed about the teratogenic effects of AEDs (91%), need to continue antiepileptic drugs (AEDs) during pregnancy (95%), and the role of folic acid and vitamin K during pregnancy (95%). They agreed AEDs decrease the efficacy of oral contraception and it was safe for the woman to breast-feed the baby while on AEDs. Only 1/3(rd) of them knew that steroid hormones could alter seizure threshold or that AEDs could predispose to osteomalacia. Fewer doctors knew that WWE could have increased sexual dysfunction (29.9%) or infertility (26.8%). The knowledge did not vary according to years of practice or practice settings. CONCLUSIONS: Obstetricians were well informed about the fetal complications of antenatal AED exposure, but were under informed of other complications such as osteomalacia, sexual dysfunction, and infertility.

Acupressure to reduce labor pain: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of acupressure administered during the active phase of labor on nulliparous women's ratings of labor pain. DESIGN: Randomized controlled trial. SETTING: Public hospital in India. SAMPLE: Seventy-one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 30-minute period (acupressure group), 71 women to receive light touch at SP6 on both legs during the same period of time (touch group) and 70 women to receive standard care (standard care group). METHODS: Experience of in-labor pain was assessed by visual analog scale at baseline before treatment, immediately after treatment, and at 30, 60 and 120 minutes after treatment. MAIN OUTCOME MEASURE: Labor pain intensity at different time intervals after treatment compared with before treatment. RESULTS: A reduction of in-labor pain was found in the acupressure group and was most noticeable immediately after treatment (acupressure group vs. standard care group p < 0.001; acupressure group vs. touch group p < 0.001). CONCLUSION: Acupressure seems to reduce pain during the active phase of labor in nulliparous women giving birth in a context in which social support and epidural analgesia are not available. However, the treatment effect is small which suggests that acupressure may be most effective during the initial phase of labor.

Determinants of gestational diabetes mellitus: A case control study in a district tertiary care hospital in south India.

OBJECTIVE: To study the determinants of Gestational Diabetes Mellitus (GDM). DESIGN: Case-control study. SETTING: Sri Avittom Thirunal Hospital, Thiruvananthapuram district, Kerala, South India. PARTICIPANTS: 300 GDM women as cases and 300 age-matched controls. STUDY VARIABLES: Sociodemographic characteristics, pre-pregnancy Body Mass Index (BMI), menstrual history, obstetric history, infertility history, family history of diabetes in first degree relatives, recurrent urinary tract infection (UTI), and moniliasis. STATISTICAL ANALYSIS: T-test, Fishers Exact Test, Chi square test, Adjusted Odds Ratio with 95% CI. RESULTS: Pre-pregnancy BMI >/= 25 (P < 0.001, OR = 2.7), irregular menstrual cycle (P = 0.006), treatment for infertility (P = 0.001, OR = 3.3), family history of diabetes (P = 0.001, OR = 4.5), history of diabetes in mother (P = 0.003), previous pregnancy losses (P = 0.04), past GDM (P = 0.035), prematurity (P = 0.01), pre-eclampsia (P = 0.04), polyhydramnios (P < 0.001, OR = 6.0), UTI (P < 0.001, OR = 3.2), and moniliasis (P < 0.001, OR = 7.6) were significantly associated with present GDM. CONCLUSION: Early identification of women at risk of GDM and prompt treatment is recommended to prevent complications.