Introduction: Medicinal plants, believed to possess hypoglycemic and hypolipidemic potential namely, Gymnema sylvestre, Momorodica charantia, Murraya koenigii, Terminalia arjuna and Trigonella foenum graecum, were analysed for nutritional composition. Methods: Proximate analysis was done following the methods of AOAC. Available carbohydrate, β-carotene and minerals were analysed using spectrophotometer and atomic absorption spectrophotometer, respectively. One-way variance analysis was used to statistically analyse the variations in nutrient contents among the plants. Results: Moisture, crude protein, crude fibre, crude fat, ash, carbohydrate and energy content ranged between 10.86 - 91.81 , 2.81-25.60, 6.22-13.63, 0.48-7.41, 3.27-19.40, 52.87- 68.20 g/100 g and 292.78-400.17 Kcal/100 g on dry weight basis, respectively. Total soluble, reducing, non-reducing sugar and starch varied from 3.02-7.74, 1.74-4.78, 0.65-5.49 and 1.99-19.38 g/100 g, respectively. Neutral detergent fibre, acid detergent fibre, hemicellulose, cellulose and lignin ranged between 22.82-39.68, 1.98-20.69, 8.98- 31.19, 1.21-8.93, 0.72-12.50 g/100 g, respectively. Gymnema sylvestre had the highest concentration of β-carotene (7950 + 0.45 mg/100 g) and iron (37.21 + 0.50 mg/100 g), while Murraya koenigii had the highest copper (2.71 + 0.09 mg/100 g) and calcium concentration (42.76 + 0.43 mg/100 g). Chromium and zinc were highest in Momorodica charantia (2.93 + 0.22 mg/100 g) and Trigonella foenum graecum (3.61 + 0.46 mg/100 g), respectively. Significant difference was observed in the crude protein, crude fat, carbohydrate, energy, acid detergent fibre and lignin content of the medicinal plants.Conclusion: These medicinal plants can be considered as potential sources of protein, fat, dietary fibre, β-carotene and minerals for diabetic and dyslipidemic patients.

Cervico-aural [collaural fi stula] fi stula is rare and it accounts for less than 5% of branchial cleft anomalies. In this paper, we report one such case of a 9 year old girl who was presented to us with two discharging cutaneous openings on the right side; one in the fl oor of the external auditory canal and another in the neck at the junction of the upper 2/3rd and lower third of the sternomastoid muscle along its anterior border.

Abdominal Neoplasms ; diagnosis ; surgery ; Aged ; Diagnosis, Differential ; Hernia, Inguinal ; diagnosis ; Humans ; Inguinal Canal ; pathology ; Lymphangioma ; diagnosis ; surgery ; Male ; Treatment Outcome

Objective: To investigate the antidiabetic activity of hydro-alcoholic extract of Adina cordifolia (Roxb.) leaves (HAEACL) in alloxan induced diabetic rats at 250 and 500 mg/kg doses. Methods:Glibenclamide (10 mg/kg, s.c.) was used as the standard which produced a significant reduction in blood glucose levels. The blood glucose levels of experimental animals were determined at 0, 2, 4 and 6 h after treatment with the plant extract by using glu-oxidase peroxidise reactive strips and glucometer. Results: Treatment with HAEACL at 500 mg/kg dose decreased the blood glucose level significantly. However, the lower doses (250 mg/kg) of HAEACL produced a little decrease in blood glucose level. It showed that there was a dose dependent decrease in blood glucose level in the alloxan induced diabetic rats as compared to the control group. Conclusions: The present study shows that HAEACL possessed significant antidiabetic activity.

Background and Objective: For improving overall care in epileptic patients, careful evaluation of pharmacotherapy, seizure control, quality of life (QOL) and cost effectiveness are helpful but such data are relatively meagre from developing countries. The present study was undertaken to audit all these said factors with different drug combinations comparing older with newer drugs in the setting of a tertiary care epilepsy hospital in India. Methods: Forty patients were divided into four treatment groups, of ten each which were valproic acid + lamotrigine (Group-I), valproic acid+ clonazepam (Group-II), oxcarbazepine + clobazam (Group-III) and phenobarbitone + phenytoin (Group-IV), based on most commonly used dual therapy in local clinical practice. The patients were followed at monthly intervals for six months. Effi cacy was assessed by reduction in seizure frequency, QOL was assessed by using an adapted version of 31- items questionnaire QOLIE-31 (quality of life in epilepsy) and cost effectiveness was calculated as ratio of direct cost of medicine and improvement in quality of life. Results: There was a signifi cant reduction in seizure frequency and improvement in QOL in all four groups at 2nd and 6th months. Cost-effectiveness analysis at the end showed that group-IV paid the least for same improvement in QOL. Conclusion: Older drugs are equally effi cacious as compared to newer in controlling seizure frequency and improving QOL, but are more cost effective.

Background: Surrogate markers simple enough to be used by primary care workers have not been closely investigated by the community experts in rural Uttar Pradesh. We assessed the physical disabilities in activities of daily living (ADL) and unmet need in physical disabilities among rural elderly. Predictors of unmet needs in physical disabilities among the elderly were also identified. Methods: A community based cross-sectional study was conducted among elderly residents of the rural field practice area of a tertiary care centre in rural Uttar Pradesh. Three hundred and thirty five (335) participants aged 60 years and above from 9 villages were selected using the Probability Proportional to Size (PPS) sampling technique. Study tools were the proforma regarding socio-demographic details, socio-economic status and Stanford Health Assessment Questionnaire. Multivariate logistic regression analysis was performed to identify predictors of unmet needs. Results: 185 (55.2%) had physical disability in one or more activity limitation. Gender wise elderly females had more physical disability in one or more ADL categories than elderly males (66.8% vs. 42.0%). Almost one third (32.5%) of subjects had unmet need for one or more physical disabilities. the predictors of unmet needs that were identified in the study were female gender (P = 0.046), elderly aged 70 years and above (P = 0.032), those living alone (P = 0.035), low monthly family income (P = 0.044), financially fully dependent elderly (P = 0.0002), and those having 3 or more physical disabilities (P = 0.033). Conclusions: The findings of the study highlight that large number of needs of the disabled are still unmet. Greater, targeted efforts are needed to identify at-risk elderly people living in the community. These predictors would act as surrogate markers and can be easily used by primary care workers to plan and provide services to the elderly people in rural communities.

Liposomes have been widely investigated since 1970 as drug carriers for improving the delivery of therapeutic agents to specific sites in the body. As a result, numerous improvements have been made to make this technology potential the treatment of certain diseases in the clinics. This review mainly focused on various aspects related to the vesicular system, including method of preparation, stabilization, drawbacks, and applications. Various types of vesicular systems such as liposomes, niosomes, transfersomes, pharmacosomes, and nanoparticle have been discussed briefly along with some other emerging vescicular systems (photosomes, archaesomes, genosomes, cryptosomes, discomes) focusing on cell specific gene transfer, photodynamic therapy and ligand mediated drug targeting. Present applications of the liposomes are in the immunology, dermatology, vaccine adjuvant, eye disorders, brain targeting, infective disease and in tumour therapy. The new developments in this field are of specific binding properties of a drug-carrying liposome to a target cell such as a tumor cell and specific molecules in the body (antibodies, proteins, peptides etc), stealth liposomes which are especially used as carriers for hydrophilic (water soluble) anticancer drugs like doxorubicin, mitoxantrone and bisphosphonate-liposome mediated depletion of macrophages. This review would help researchers working in the area of liposomal drug delivery.

STUDY DESIGN: Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. PURPOSE: The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc. OVERVIEW OF LITERATURE: C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion. METHODS: Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation. RESULTS: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. CONCLUSIONS: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression.
Asian Continental Ancestry Group ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Osteophyte ; Spinal Cord Diseases

STUDY DESIGN: Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. PURPOSE: The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc. OVERVIEW OF LITERATURE: C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion. METHODS: Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation. RESULTS: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. CONCLUSIONS: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression.
Asian Continental Ancestry Group ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Osteophyte ; Spinal Cord Diseases

PURPOSE: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ≥1,000 IU/L as a marker of severe DF. METHODS: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L). RESULTS: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p < 0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST < 1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588–0.714; p < 0.001) for ALT and 0.647 (95% CI, 0.582–0.712; p < 0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF. CONCLUSION: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.
Alanine Transaminase ; Arboviruses ; Aspartate Aminotransferases ; Child* ; Dengue ; Female ; Fever* ; Humans ; Sensitivity and Specificity ; Severe Dengue* ; Transaminases*