Characterization of the molluscicidal activity of Bauhinia variegata and Mimusops elengi plant extracts against the fasciola vector Lymnaea acuminata

The molluscicidal activity of Bauhinia variegata leaf and Mimusops elengi bark was studied against vector snail Lymnaea acuminata. The toxicity of both plants was time and concentration-dependent. Among organic extracts, ethanol extracts of both plants were more toxic. Toxicity of B. variegata leaf ethanolic extract (96h LC50- 14.4 mg/L) was more pronounced than M. elengi bark ethanolic extract (96h LC50-15.0 mg/L). The 24h LC50 of column purified fraction of B. variegata and M. elengi bark were 20.3 mg/L and 18.3 mg/L, respectively. Saponin and quercetin were characterized and identified as active molluscicidal component. Co-migration of saponin (Rf 0.48) and quercetin (Rf 0.52) with column purified bark of M. elengi and leaf of B. variegata on thin layer chromatography demonstrate same Rf value i.e. 0.48 and 0.52, respectively. The present study clearly indicates the possibility of using M. elengi and/or B. variegata as potent molluscicide.

Tertiary combination of freeze-dried urine of Indian breeds of cow with plant products against snail Lymnaea acuminata

Snail Lymnaea acuminata is the intermediate host of liver fluke Fasciola gigantica, which cause endemic fasciolosis among cattle population of eastern Uttar Pradesh. Control of snail population by molluscicides is one of the effective methods to control fasciolosis. In the present study molluscicidal activity of tertiary combination of freeze-dried urine of different Indian breeds of cow Sahiwal, Geer and Tharparkar with Annona squamosa seed powder, Ferula asafoetida root latex, Azadirachta indica oil and Camellia sinensis leaves have been tested against Lymnaea acuminata. It was noted that the toxicity of tertiary combination (1:1:5) of cow urine kept for 15 days in sunlight or laboratory condition with different plant products were highly toxic against snail L. acuminata. 96 h LC50 of tertiary combinations with Sahiwal urine kept for 15 days in sunlight with A. squamosa, F. asafoetida, A. indica oil and C. sinensis were 35.47 mg L(-1), 37.13 mg L(-1), 33.66 mg L(-1), respectively higher than the Geer and Tharparkar. The toxicity of Sahiwal urine kept for 15 days in laboratory condition with A. squamosa and C. sinensis (96 h LC50 28.28 mg L(-1)) was more potent than the all other combinations. Cow urine in combination with plant product can be used for effective control of snail.

What is integrative oncology and can it help my patients?

Integrative oncology lends itself to the comprehensive practice of gynecologic oncology with multiple tools and interventions that can impact on QoL and survival. However, there remains a paucity of well-designed, well-powered randomized control trials on various CAM modalities for gynecologic cancer patients. The reasons for the lack of level 1 evidence include the nascent state of integrative medicine as a science, the limitations on CAM funding, the relative lack of integration of CAM practitioners into the oncology community, and absence of strict regulation of herbs and supplements by the US FDA. The use of CAM as adjunctive therapies will likely continue given the patient-driven trends to date, and given the evidence for at least safety and potentially efficacy, our patients deserve our willingness to use all possible approaches to improving their outcomes. Continued evolution of our ability to specifically measure and describe QoL will further our ability to hone in on domains most important to patients and their survival and allow practitioners to make patient-specific recommendations. Multimodal programs that include physical activity, stress management, and diet have the potential to address demonstrated deficits in PWB and FWB in ovarian cancer patients which suggests a model of collaborative gynecologic oncology care). Integrative oncology represents a holistic approach to patient care whose goal is maximization of patient quantity and quality of life. Patients can achieve this optimal outcome through the synergy of conventional care, integrative modalities, lifestyle modifications, and supportive care. Refer to Table 4 for a listing of integrated medicine Internet resources.

Anaphylaxis to artesunate?

Artesunate, an artemissin derivative is a highly efficacious and relatively safe antimalarial agent. Common adverse reactions to artemissin derivatives are nausea, vomiting, anorexia and dizziness. More serious but less-frequent toxic effects of artesunate use are neutropenia, anemia, hemolysis, elevated liver enzymes and severe allergic reactions. However, anaphylactic reaction to artesunate is a rare entity. Here, we report a case of anaphylaxis to parenteral artesunate and its successful management in a female patient to whom intravenous artesunate was administered during surgery under general anesthesia.

Bait formulations of molluscicides and their effects on biochemical changes in the ovotestis of snail Lymnaea acuminata (Mollusca; Gastropoda:Lymnaeidae)

The effect of sub-lethal feeding of bait formulations containing molluscicidal component of Ferula asafoetida (ferulic acid, umbelliferone), Syzygium aromaticum (eugenol) and Carum carvi (limonene) on biochemical changes in the ovotestis of snail Lymnaea acuminata were studied. Bait formulations feeding to L. acuminata were studied in clear glass aquaria having diameter of 30 cm. Baits were prepared from different binary combinations of attractant amino acid (valine, aspartic acid, lysine and alanine 10 mM) in 100 mL of 2% agar solution + sub-lethal (20% and 60% of 24h LC50) doses of different molluscicides (ferulic acid, umbelliferone, eugenol and limonene). These baits caused maximum significant reduction in free amino acid, protein, DNA, RNA levels i.e. 41.37, 23.56, 48.36 and 14.29% of control in the ovotestis of the snail, respectively. Discontinuation of feeding after treatment of 60% of 96h LC50 of molluscicide containing bait for next 72h caused a significant recovery in free amino acid, protein, DNA and RNA levels in the ovotestis of L. acuminata.

Double fetus in fetu

Fetus in fetu (FIF) is an extremely rare cause of infantile abdominal mass where a rudimentary, malformed monozygotic-diamniotic twin grows inside the other twin. We describe a male infant with double or twin fetuses in fetu. The diagnosis was made on a computerized tomography (CT) scan of the abdomen and confirmed on surgery. Surgical excision was done and the baby did well post operatively.

Comparison of phenylephrine and norepinephrine in the management of dopamine-resistant septic shock

INTRODUCTION

THIS STUDY AIMS TO COMPARE TWO VASOCONSTRICTORS: - norepinephrine and phenylephrine - in the management of dopamine-resistant septic shock.

MATERIALS AND METHODS

We performed a randomized, prospective, controlled trial in 54 septic shock patients, with persistent hypotension despite adequate volume resuscitation and continued dopamine infusion ~25mug/kg/h. Patients were randomly allocated into two groups to receive either norepinephrine or phenylephrine infusion (n = 27 each) titrated to achieve a target of SBP > 90mm Hg, MAP > 75 mm Hg, SVRI > 1100 dynes.s/cm5m2, CI > 2.8 L/min/m2, DO2I > 550 ml/min/m2, and VO2I > 150 ml/min/m2 for continuous 6 h. All the parameters were recorded every 30 min and increment in dose of studied drug was done in the specified dose range if targets were not achieved. Data from pulmonary arterial and hepatic vein catheterization, thermodilution catheter, blood gas analysis, blood lactate levels, invasive blood pressure, and oxygen transport variables were compared with baseline values after achieving the targets of therapy. Differences within and between groups were analyzed using a one-way analysis of variance test and Fischer's exact test.

RESULTS

No difference was observed in any of the investigated parameters except for statistically significant reduction of heart rate (HR) (P<0.001) and increase in stroke volume index (SVI) (P<0.001) in phenylephrine group as compared to nonsignificant change in norepinephrine group.

CONCLUSIONS

Phenylephrine infusion is comparable to norepinephrine in reversing hemodynamic and metabolic abnormalities of sepsis patients, with an additional benefit of decrease in HR and improvement in SVI.

Combination of molluscicides with attractant carbohydrates and amino acids in bait formulation against the snail Lymnaea acuminata

AIM

Fascioliasis is an important helminth disease caused by Fasciola (F.) hepatica and F gigantica of Asia and Africa. This disease belongs to the plant-borne trematode zoonoses. Human infection has been reported in 51 different countries from 5 continents. One of the possible approaches to control this problem is to interrupt the life cycle of the parasitic trematodes by eliminating the snail.

MATERIALS AND METHODS

Snails attractant pellets (SAP) were prepared from binary combination of carbohydrate + amino acid (20 mM) in 2% agar solution with active molluscicidal component Ferula asafoetida (ferulic acid, umbelliferone), Syzygium aromaticum (eugenol), Carum carvi (limonene). Attraction of snails to different combinations was studied by using clear glass aquaria having diameter of 30 cm. Each aquarium was divided into four concentric zones; zone-3 (central zone), zone-2 and zone-1 (middie zone) and zone-0 (outer zone) had a diameter of 13, 18, 24, and 30 cm, respectively. The behavioral responses of snails to these binary combinations of carbohydrate and amino acid in bait formulation were examined. The fraction of snails that was in contact with the SAP at different times was used as a measure of attraction.

RESULTS

Among all the binary combination of carbohydrate+amino acid+molluscicide after 2h of experiment, highest attraction of snail (54.71%) was observed towards the SAP containing starch+histidine+limolene. Limonene+ starch+histidine containing SAP emerged as the strongest bait formulation (96h LC50 0.74%) against Lymnaea acuminata.

CONCLUSIONS

The present study suggested that the molluscicides of plant origin could be used with varying degrees of success in bait formulation.

Molluscicidal activity of Sapindus mukorossi and Terminalia chebula against the freshwater snail Lymnaea acuminata

The molluscicidal activity of Sapindus mukorossi and Terminalia chebula fruit powder against the vector snail Lymnaea acuminata was time and concentration dependent. The molluscicidal activity of T. chebula fruit powder (96 h LC(50):93.59 mg L(-1)) was more pronounced than that of S. mukorossi fruit powder (96 h LC(50):119.57 mg L(-1)). Ethanolic extracts of S. mukorossi and T. chebula fruit powder were more toxic than their other organic solvent extracts. The molluscicidal activity of ethanolic extract of S. mukorossi fruit powder (24h LC(50):2.75 mg L(-1)) was more effective than the ethanolic extract of T. chebula fruit powder (24h LC(50):124.06 mg L(-1)). The 96 h LC(50) of column-purified fraction of S. mukorossi fruit powder was 5.43 mg L(-1) whereas those of T. chebula fruit powder was 7.49 mg L(-1). Column, thin layer and high performance liquid chromatography analysis demonstrates that the active molluscicidal component in S. mukorossi and T. chebula is saponin (96 h LC(50):1.31 mg L(-1)) and tannic acid (96 h LC(50):1.64 mg L(-1)), respectively. These plants may be used as potent source of molluscicides against the snail L. acuminata.

Behavioural responses of the snail Lymnaea acuminata to carbohydrates and amino acids in bait pellets

Snail control could play an important role in programmes against fascioliasis, especially if the methods used for molluscicide delivery could be improved, such as by the development of bait formulations containing both an effective attractant and a molluscicide, to ensure good levels of contact between the molluscicide and the target snail populations. In a recent study, the attractiveness to Lymnaea acuminata (an intermediate host of the digenean trematode Fasciola gigantica) of potential components of snail-attractant pellets was investigated. Carbohydrates (glucose, maltose, sucrose or starch, each at 10 mM) and amino acids (citrulline, tryptophan, proline or serine, each at 20 mM), were tested in aquaria, with the snails initially placed 22.5, 30 or 45 cm from an agar pellet containing the component under test. Under these conditions, starch and proline emerged as the strongest attractants for L. acuminata, followed by maltose and serine.

Enzyme Inhibition by Molluscicidal Components of Myristica fragrans Houtt. in the Nervous Tissue of Snail Lymnaea acuminata

This study was designed to investigate the effects of molluscicidal components of Myristica fragrans Houtt. (Myristicaceae) on certain enzymes in the nervous tissue of freshwater snail Lymnaea acuminata Lamarck (Lymnaeidae). In vivo and in vitro treatments of trimyristin and myristicin (active molluscicidal components of Myristica fragrans Houtt.) significantly inhibited the acetylcholinesterase (AChE), acid and alkaline phosphatase (ACP/ALP) activities in the nervous tissue of Lymnaea acuminata. The inhibition kinetics of these enzymes indicates that both the trimyristin and myristicin caused competitive noncompetitive inhibition of AChE. Trimyristin caused uncompetitive and competitive/noncompetitive inhibitions of ACP and ALP, respectively whereas the myristicin caused competitive and uncompetitive inhibition of ACP and ALP, respectively. Thus results from the present study suggest that inhibition of AChE, ACP, and ALP by trimyristin and myristicin in the snail Lymnaea acuminata may be the cause of the molluscicidal activity of Myristica fragrans.

Observation of postsoliton expansion following laser propagation through an underdense plasma

The expansion of electromagnetic postsolitons emerging from the interaction of a 30 ps, 3×10¹⁸ W cm⁻² laser pulse with an underdense deuterium plasma has been observed up to 100 ps after the pulse propagation, when large numbers of postsolitons were seen to remain in the plasma. The temporal evolution of the postsolitons has been accurately characterized with a high spatial and temporal resolution. The observed expansion is compared to analytical models and three-dimensional particle-in-cell results, revealing a polarization dependence of the postsoliton dynamics.

Intravenous adrenaline for shock in neonates

Dopamine and dobutamine have been widely used to treat shock with variable success in newborns. In this retrospective data analysis, we report on the use of adrenaline in 20 neonates with birth asphyxia and shock that was refractory to dopamine and dobutamine. We concluded that adrenaline is a safe and effective drug that can be used as an add-on therapy to dopamine and/or dobutamine in newborns with shock secondary to birth asphyxia.

Management of metastatic high-risk gestational trophoblastic neoplasia: FIGO stages II-IV: risk factor score > or = 7

OBJECTIVE

To evaluate treatment of metastatic high-risk gestational trophoblastic neoplasia (GTN), including durable complete response rates to chemotherapy, factors affecting response to therapy, and overall survival.

STUDY DESIGN

Forty women with metastatic high-risk GTN (International Federation of Gynecology and Obstetrics [FIGO] stages II-IV, score > or = 7) completed treatment between 1986 (when EMA-CO became the standard chemotherapy for high-risk disease) and 2009, including 26 who were treated primarily and 14 who were treated secondarily. Patients who had incomplete responses or developed resistance to EMA-CO or other methotrexate-containing regimens were treated with drug combinations employing etoposide and a platinum agent with or without bleomycin or ifosfamide. Adjuvant radiotherapy and surgery were used in selected patients. Clinical response and survival as well as factors affecting outcomes were analyzed retrospectively.

RESULTS

The overall survival rate was 90% (36 of 40): 92% (24/26) for primary treatment and 86% (12/14) for secondary treatment. Twenty-one patients (53%) had durable complete clinical responses to initial treatment, 15 patients (37%) developed resistance to initial chemotherapy but were subsequently placed into lasting remission with platinum-based chemotherapy with or without surgery and 4 patients (10%) died of widespread metastatic disease. Durable complete clinical response to initial chemotherapy was significantly influenced by FIGO stage (II and III, 63%, vs. IV, 31%, p = 0.05) and risk factor score (< 12, 71%, vs. > or = 12, 32%, p < 0.02). Survival was also significantly associated with both FIGO stage (II and III, 100%, vs. IV, 69%, p < 0.01) and score (< 12, 100%, vs. > or = 12, 79%, p < 0.05).

CONCLUSION

The use of EMA-CO chemotherapy as primary treatment and platinum-based chemotherapy along with surgical excision of resistant disease as secondary treatment for patients with metastatic high-risk GTN resulted in a survival rate of 90%. All patients who died had FIGO stage IV and risk factors scores > or = 12.

Cervical epidural anaesthesia for thyroid surgery

BACKGROUND

Cervical epidural anaesthesia is a regional anaesthesia technique which has been used for upper limb surgery, upper thoracic wall surgery, carotid artery surgery and neck dissections. Anaesthesia for thyroid surgery can be complicated due to the altered functional status of the thyroid or its large size.

OBJECTIVE

This prospective study was designed to assess the effectiveness and safety of cervical epidural anaesthesia for thyroid surgery.

MATERIALS AND METHODS

Cervical epidural anaesthesia was attempted in 9 patients and the results compared with 44 patients who underwent thyroid surgery under conventional general anaesthesia with endotracheal intubation. The epidural catheter was placed in the C(7) - T(1) vertebral interspace and 10 - 15 ml of 1% Lignocaine with adrenaline was injected.

RESULTS

The technique of cervical epidural anaesthesia was successfully used in 8 out of 9 patients in whom it was attempted All patients were maintained in a state of conscious - sedation and effective analgesia was obtained in all 8 patients. There were no significant complications especially those related to diaphragmatic function and cardiovascular stability. In contrast patients undergoing surgery under conventional general anaesthesia had complications related to endotracheal intubation, cardiac arrhythmias and hypotension

CONCLUSION

The technique of cervical epidural anaesthesia should be considered in thyroid patients where difficult endotracheal intubation is anticipated and in those in whom alterations in thyroid functional state make them vulnerable to cardiovascular complications under conventional general anaesthesia.

Spatial variability of groundwater depth and quality parameters in the National Capital Territory of Delhi

The groundwater quantity and quality scenario is of much concern in the National Capital Territory of Delhi, India, which necessitates an investigation to envisage the extent of spatial variability of groundwater depth and pollutant concentration levels in this region. Therefore, in this study, an effort was made to generate the spatial variability map of groundwater depth and quality parameters (viz. chloride, electrical conductivity, fluoride, magnesium, and nitrate). Ordinary kriging was used to analyze the spatial variability of groundwater depth and quality parameters, whereas indicator kriging was used to analyze groundwater quality parameters equal to or greater than the pollution threshold values. It was observed that the semivariogram parameters fitted well in the exponential model for water depth and in the spherical model for water quality parameters. The generated spatial variability maps indicated that in 43% of the study area, groundwater depth was within 20 m. The salinity level was higher than 2.5 dS m(-1) in 69% of the study area and the nitrate concentration exceeded 45 mg l(-1) in 36% of the area. The probability maps showed that about 24% of the area had the highest probability (0.8-1.0) of exceedence of the threshold electrical conductivity value and an area of 2% exhibited the highest probability of exceedence of the threshold value of nitrate concentration in the groundwater. The generated spatial variability and probability maps will assist water resource managers and policymakers in development of guidelines in judicious management of groundwater resources for agricultural and drinking purposes in the study area.

The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery

BACKGROUND

Evaluation of the impact of a new robotic surgery programme on perioperative outcomes for endometrial cancer

METHODS

A prospective database of all patients undergoing staging for endometrial cancer during July 2007-July 2008 was collected and analysed. Demographic data and perioperative outcomes were compared between cases performed via laparotomy, laparoscopy and robotics.

RESULTS

Sixty-five patients underwent staging during the time of data collection (LAP-26, LSC-7, ROB-32). No difference in surgical volume in the year before vs. after robotics was identified. Median operative time for robotics and laparotomy was significantly less than for laparoscopy (p = 0.023). There was no significant difference in lymph node yields between the three groups (p = 0.92). Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05). Median hospital stay was 1 day for the minimally invasive groups. Total number of perioperative inpatient days decreased from 331 to 150 in one year. Practice management of endometrial cancer transitioned from a predominantly open approach (5.6% LSC) to robotics (11% LSC, 49% ROB) within 12 months.

CONCLUSIONS

Robotic surgery dramatically altered our management of endometrial cancer and was associated with a significant improvement in several perioperative outcomes when compared to laparotomy and laparoscopy.

Intravenous Adrenaline for Shock in Neonates

Dopamine and dobutamine have been widely used to treat shock with variable success in newborns. In this retrospective data analysis, we report on the use of adrenaline in 20 neonates with birth asphyxia and shock that was refractory to dopamine and dobutamine. We concluded that adrenaline is a safe and effective drug that can be used as an add-on therapy to dopamine and/or dobutamine in newborns with shock secondary to birth asphyxia.

Enzyme Inhibition by Molluscicidal Components of Myristica fragrans Houtt. in the Nervous Tissue of Snail Lymnaea acuminata

This study was designed to investigate the effects of molluscicidal components of Myristica fragrans Houtt. (Myristicaceae) on certain enzymes in the nervous tissue of freshwater snail Lymnaea acuminata Lamarck (Lymnaeidae). In vivo and in vitro treatments of trimyristin and myristicin (active molluscicidal components of Myristica fragrans Houtt.) significantly inhibited the acetylcholinesterase (AChE), acid and alkaline phosphatase (ACP/ALP) activities in the nervous tissue of Lymnaea acuminata. The inhibition kinetics of these enzymes indicates that both the trimyristin and myristicin caused competitive noncompetitive inhibition of AChE. Trimyristin caused uncompetitive and competitive/noncompetitive inhibitions of ACP and ALP, respectively whereas the myristicin caused competitive and uncompetitive inhibition of ACP and ALP, respectively. Thus results from the present study suggest that inhibition of AChE, ACP, and ALP by trimyristin and myristicin in the snail Lymnaea acuminata may be the cause of the molluscicidal activity of Myristica fragrans.