Mahonia leschenaultia (ML) and Mahonia napaulensis (MN) are less known and unexplored medicinal plants of the family Berberidaceae. They are used by the Todas of Nilgiris in their religious and medical practices but chemically less identified. Hence, we decided to do extensive phytochemical analysis to explore the potential of these plant extracts. An ultrahigh performance electrospray tandem mass spectrometry (UHPLC–ESI–MS/MS) method was successfully developed for qualitative analysis of the bioactive components in Mahonia species using Orbitrap Velos Pro mass spectrometer. Sixteen compounds were identified by comparison of their retention times and mass spectra (MS) with authentic standards and reported literature. Multi-stage mass spectra (MS2–8) for the identification of protoberberine and aporphine alkaloids showed the sequential expulsion of all the substituents attached with their basic skeleton followed by CO loss. Eight of the identified compounds (berberine, jatrorrhizine, palmatine, magnoflorine, isocorydine, glaucine, tetrahydropalmatine and tetrahydroberberine) were simultaneously determined by another UHPLC–ESI–MS/MS method under the multiple reactions monitoring (MRM) mode quantitatively using triple quadrupole linear ion trap mass spectrometer. The analytical method was validated for 8 bioactive compounds with overall recovery in the range 98.5%–103.6%(RSD≤2.2%), precise (RSD≤2.07%) and linear (r≥0.9995) over the concentration range of 0.5–1000 ng/mL and successfully applied in ML and MN roots, which suggests the suitability of the proposed approach for the routine analysis of Mahonia species and their quality control.

Curculigo orchioides Gaertn. (family Amarylladaceae) is an endangered rasayana herb which is popularly known as "Kali Musli". The plant is native to India, and holds a special position as a potent adaptogen and aphrodisiac in Ayurvedic system of medicine. It is an important ingredient of many Ayurvedic preparations and is considered to have aphrodisiac, immunostimulant, hepatoprotective, antioxidant, anticancer and antidiabetic activities. Various chemical constituents like mucilage, phenolic glycosides, saponins and aliphatic compounds from the plant have been reported. The plant is also considered as an important component of various herbal preparations of the Chinese and Kampo medicine. The present review is an attempt to enumerate various biologically tested activities and evaluation of different phytochemicals present in this important medicinal plant.

Objective: This study aimed to determine the prevalence of epilepsy in prisoners suffering from substance dependence and the relationship between onset of epilepsy and substance dependence in a prison population. Methods: The present cross-sectional study in a prison population was conducted in Central Jail (CJ), New Delhi, India over a period of 3 months. The convenience sample consisted of 900 subjects. The study group consisted of 450 prisoners taken from the deaddiction ward and the rest were placed in the control group. Physical examination and Mini Mental State Examination (MMSE) of subjects were done to make necessary exclusion. Assessment tools were applied in the order starting from MMSE, Basic Socio-demographic Performa, Present State Examination (PSE), and Addiction Severity Index (ASI). Results: The average ages of study and control subjects were 34.5 + 2.3 years (mean + standard deviation) and 35.6 + 3.6 years respectively. Prevalence of epilepsy among substance using prisoners was 1.4 times higher than in non-substance using prisoners. Alcohol, opioid, and cannabis, either alone or in various combinations, were the most commonly used substances. Subjects suffering from epilepsy were likely to have higher chances of consuming three or more substances than those without problem of epilepsy. Study subjects suffering from epilepsy compared with those without epilepsy performed worse in all parameters. This is indicative of higher severity of psychoactive substance dependence. Conclusion: Findings of high prevalence rate of epilepsy and co-morbid substance dependence highlight the need for better screening among epileptic subjects for substance abuse at entry into prison for effective treatment while in custody, and at follow-up on release. Specialist addiction services for prisoners have a considerable impact in a wellplanned intervention programme for prisoners with substance use and comorbid epilepsy. ASEAN Journal of Psychiatry, Vol. 15 (2): July – December 2014: 153-163.

Rauwolfia species (Apocynaceae) are medicinal plants well known worldwide due to its potent bioactive monoterpene indole alkaloids (MIAs) such as reserpine, ajmalicine, ajmaline, serpentine and yohimbine. Reserpine, ajmalicine and ajmaline are powerful antihypertensive, tranquilizing agents used in hypertension. Yohimbine is an aphrodisiac used in dietary supplements. As there is no report on the comparative and comprehensive phytochemical investigation of the roots of Rauwolfia species, we have developed an efficient and reliable liquid chromatography-tandem mass spectrometry (LC–MS/MS) method for ethanolic root extract of Rauwolfia species to elucidate the fragmentation pathways for dereplication of bioactive MIAs using high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry (HPLC–ESI–QTOF–MS/MS) in positive ion mode. We identified and established diagnostic fragment ions and fragmentation pathways using reserpine, ajmalicine, ajmaline, serpentine and yohimbine. The MS/MS spectra of reserpine, ajmalicine, and ajmaline showed C-ring-cleavage whereas E-ring cleavage was observed in serpentine via Retro Diels Alder (RDA). A total of 47 bioactive MIAs were identified and characterized on the basis of their molecular formula, exact mass measurements and MS/MS analysis. Reserpine, ajmalicine, ajmaline, serpentine and yohimbine were unambiguously identified by comparison with their authentic standards and other 42 MIAs were tentatively identified and characterized from the roots of Rauwolfia hookeri, Rauwolfia micrantha, Rauwolfia serpentina, Rauwolfia verticillata, Rauwolfia tetraphylla and Rauwolfia vomitoria. Application of LC–MS followed by principal component analysis (PCA) has been successfully used to discriminate among six Rauwolfia species.

Objectives: The aims of the study were to investigate whether Sudarshan Kriya (SK), a form of Yoga and related practices can lead to increased Global Assessment of Functioning (GAF) and increased feeling of wellness in patients with substance dependence. Method: This was a 3-month single blind parallel randomized controlled study with sample size of 111 patients which were allocated by simple randomization to two groups. Study subjects were involved in an intensive program of Sudarshan Kriya and practices (SK&P) which they practised daily for 6 weeks. The control subjects were instructed to sit in an armchair with their eyes closed and pay gentle attention to their breath. A period sample of three months consisting of all patients admitted in De-addiction (DAC) ward fulfilling study criteria was taken. Only male patients diagnosed to be suffering from Substance Dependence by ICD-10 (DCR) criteria, aged between 18-65 years were included in this study. The assessment tools were the Basic Socio-demographic Performa, Mini Mental State Examination (MMSE), Severity of Dependence Scale (SDS), Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based clinical interview, Global Assessment of Functioning (GAF) and Psychological General Well Being (PGWB). These assessments were conducted before starting the intervention and six weeks thereafter. Results: In the final analysis, number of participants analyzed in the study group was 55 and in the control group was 56. Majority of subjects were unemployed, married individuals who did not have occupational skills of more than skilled labour level. After six weeks of SK&P, statistically significant improvement in study subject dimensional scores of GAF (48.43+/- 0.08 to 66.77+/-0.14), Anxiety (ANX) (9.64+/-0.52 to 15.66+/-0.38), Depressed Mood (DEP)(7.19+/-0.2 to 9.18+/-0.37), Positive Well Being (PWB)(10.28+/-0.61 to 12.92+/-0.73), General Health (GH)(7.74+/-0.18 to 9.75+/-0.22) and Total PGWB(41.46+/-0.35 to 59.28+/-0.63) were noticed. However, when compared with control subjects, improvement was statistically significant in the case of GAF (p=0.000158), Anxiety (ANX)(p=0.011), Positive Well Being (PWB)(p=0.02), General Health (GH)(p=0.02) and Total PGWB(p=0.05); but not in the case of Depressed Mood (DEP), Self Control (SC) and Vitality. Conclusion: Practicing SK&P helps in improving Global Assessment of Functioning, Psychological General Well Being, General Health (GH) and positive well being of an individual. SK&P also causes significant reduction in anxiety levels of an individual.

Berberis petiolaris Wall. ex G. Don, an unexplored medicinal plant belonging to the family Berberidaceae, is a large deciduous shrub found in Western Himalaya between 1800-3000 m. Chemical profiling of fruit, leaf, root and stem was done by direct analysis in real time mass spectrometry followed by multivariate analysis for discrimination among the plant parts. The bioactive compounds, including magnoflorine, berberine, jatrorrhizine, thalifendine/berberrubine, demethyleneberberine, reticuline, 8-oxoberberine, N-methyltetrahydroberberine, tetrahydropalmatine, tetrahydroberberine and palmatine, were identified by their exact mass measurement and the corresponding molecular formula of each compound. A comparative study of distribution pattern for all these bioactive alkaloids showed qualitative and quantitative variations in different parts of B. petiolaris. Principal component analysis clearly dis-criminated each part of B. petiolaris plant.

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. METHODS: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. RESULTS: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. CONCLUSIONS: Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
Aged ; Aged, 80 and over ; Comorbidity ; Follow-Up Studies ; Fracture Fixation ; Hip Fractures ; Hip ; Hospitals, Military ; Humans ; Hypertension ; India ; Length of Stay ; Lost to Follow-Up ; Mortality ; Postoperative Complications ; Rehabilitation ; Specialization ; Veterans ; Walkers ; Walking

No abstract available.
Herpesvirus 4, Human ; Lymphoproliferative Disorders ; Primary Myelofibrosis

Background: The indications for total knee arthroplasty (TKA) have been expanded to include younger, demanding patients. Some TKA patients expect a return to high-performance activities to restore optimum quality of life. The concept of the medial pivot (MP) TKA is that more natural knee kinematics can be achieved by altering the bearing design. In the present study, we compared the early outcomes of MP TKA with posterior-stabilized (PS) TKA in terms of patient-reported outcomes, function, and performance. Methods: This randomized study was performed in a high volume joint replacement facility of a tertiary care military hospital. We enrolled 40 patients each in the MP group and PS group and assessed knee flexion, patient-reported outcome (new Knee Society Score [new KSS]), patient performance (Delaware Osteoarthritis Profile Score [DOPS]), and function (Forgotten Joint Score [FJS]) at 2 years after surgery. Results: Compared to PS group patients, MP group patients had similar patient-reported outcomes assessed by new KSS (satisfaction, expectation, and activity scales) and FJS. MP knee patients had better performance in the timed up and go test (p < 0.026) and self-paced walk test (p < 0.002) of DOPS. The gain in knee flexion (9.3° ± 14°) compared to baseline was significantly greater in the PS group (p < 0.013). Conclusions When assessed by DOPS, getting up from chair and walking speed were significantly better in MP knee patients than in PS knee patients. However, considering the predictable rollback ensured by cam and post, the PS knee produced better knee flexion. Despite these results, patients were equally satisfied with the two designs.

Background: With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. Methods: This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. Results: TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). Conclusions Screening and RM can reduce 90-day complications in patients undergoing TKA.