In the present study, the isolated compound Punicaflavone (PF) from the methanolic flower extract of Punica granatum (Linn.) was subjected to toxicity assessment in Wistar albino rats. Sub-acute toxicity studies were carried out by oral administration of the PF from Punica granatum (Linn.) for a period of 28 days at different dose levels of 50, 100 and 200mg/kg body weight. No major changes in body and organ weight, behavioural, haematology and histology were observed at the end of 28 days of daily oral administration. Biochemical parameters such as the levels of Glucose, Protein, Urea and Creatinine in serum were found to be well within the normal limits. Histopathological examination of the major vital organs (heart, liver and kidney) revealed no significant pathological alterations in the treated group of rats. The sub-acute toxicity studies of the PF showed no mortality and no symptoms of toxicity or behavioral changes at the maximum dose (1000mg/kg). The results indicate that the PF is safe up to a dose of 1000 mg/kg.

A study was conducted to assess effectiveness of structured teaching programme on knowledge regarding psycho social interventions for the caregivers on caring the mental health needs of mentally ill inmates. The study was conducted in Shivamoga Beggar Relief and Rehabilitation Centre. Total samples were 10. Non probability purposive sampling technique was used. A structured questionnaire was used as an instrument to measure the level of knowledge of caregivers. It was seen that the pre - test mean (6.8+_2.7) was lesser than post – test mean (23.7+_1.9). Here p value is (<0.001*) which is highly significant. The study revealed that the 60% samples had poor knowledge and 40% of them had average knowledge in pre- test. But in post-test 80% of samples had excellent knowledge and 20 % had good knowledge. The study concludes that structured teaching programme was effective in improving the knowledge of caregivers regarding psycho social interventions. We have performed Fishers exact test to know the significant association between knowledge and selected demographic variables. We observed that there is no significant association between knowledge and selected demographic variables.

Intravenous induction agents Propofol and Thiopentone are commonly used in obstetric anesthesia. We in the present study tried to compare the effects of Propofol and thiopentone on hemodynamics, Heart rate in the pregnant ladies undergoing Cesarean sections. Methods A total of 60 patients were included in the study. They were randomly divided into two groups. Propofol group (n=30) and Thiopentone group (n=30). The dosage was calculated to body weight 5mg/Kg for thiopentone and 2.5mg/Kg for Propofol. The mean induction time in Propofol group was 20.95 seconds and Thiopentone group as 26.5 seconds. There was smooth induction in 86.67% of the patients of Propofol group and 13.33% had disturbed induction. In the Thiopentone group, 76.67% had smooth induction and 23.33% had disturbed induction. No induction failure was encountered in this study and all patients were unconscious after 45 seconds. The total duration of surgery in propofol group was 70 ± 20 minutes and in thiopentone group was 85 ± 27. The time to extubation in Propofol group was 8.5 ± 2.60 and Thiopentone group was 7.0 ± 3.56. The Arterial Blood gas analysis after surgery shows average values of PaO2 in Propofol group and 87.5 ± 2.1 and thiopentone group 88.6 ± 1.8 and PaCO2 in propofol group 38.6 ± 2.05 and thiopentone 38.4 ± 2.5 mmHg. The mean SBP at the baseline of Propofol group was 124.05 ± 10.5 mmHg, while for Thiopentone group it was 124.05 ± 10.5 mmHg. The mean DBP at the baseline in propofol group was 76.5 ± 10.2 and thiopentone group was 78.8 ± 6.8. The heart rates were 80.5 ± 7.8 beats/min and 83.5 ± 8.8 beats/min in propofol and thiopentone group. The mean changes at the time of induction in heart rate of propofol group were 18 beats/min and the mean change of heart in thiopentone group was 23 beats/min. The mean SBP change during induction in Propofol group was -2.8mmHg and DBP change was -2.0 mmHg. In thiopentone group SBP change was -2.55mmHg and DBP change was -1.3 mmHg. Conclusion: Propofol has rapid actions and does not have any adverse effects on the CVS. The amount of pain produced due to propofol was also lesser compared to the thiopentone group and the induction was smooth in propofol group compared to thiopentone group and overall outcomes of Propofol were better than the Thiopentone group. Therefore propofol appears to better induction agent than thiopentone for obstetric anesthesia

Suxamethonium is the drug of choice for muscle relaxation for endotracheal intubation with its rapid onset and short duration of action. The newly introduced non-depolarizing drug rocuronium has got rapid onset and intermediate duration of action. The aim of the present study was to compare the intubating conditions of rocuronium bromide with suxamethonium chloride. Aim: To compare the onset and duration of action of Rocuronium Bromide and Suxamethonium Chloride. Methods: it is prospective randomized controlled study carried on 90 adult patients with age groups of 20-60 years of either sex. They were posted for elective surgery in MGM’s Hospital Aurangabad. They were randomly divided into two groups of (n=45) each. Group I (R) patients received rocuronium at the dose of 0.9mg/Kg and Group II(S) patients received suxamethonium at the doses of 1.5mg/Kg. Results: In Group I (R) group there were 14 (31%) male patients and female were 31 (69%). In group II (S) there were 14 (31%) male and female were 31 (69%). In group II (S) suxamethonium showed acceptable intubating conditions in 100% of cases at 60 sec out of which 93.24% were excellent. In rocuronium group I(R) 100% cases had acceptable intubating conditions at 60 seconds out of which 77.7% excellent and 22.3% had good intubating conditions the P values were significant. In both the groups there was no significant difference jaw relaxation as well as vocal cord movements. There was the significant difference in response to intubation in Rocuronium group 6 (13%) patients had a mild cough on intubation whereas no patient in suxamethonium group II had any cough. In the Group I 24% patients had slight diaphragmatic movements on intubation and in group II 11% had diaphragmatic movements. There was no significant rise in HR difference in group I and group II preoperative, post muscle relaxant, 0 minutes after intubation, 5 minutes after intubation, and 10 minutes after intubation. Conclusion: Rocuronium bromide at the dose of 0.9 mg/Kg produces excellent and good intubating conditions in patients although slightly inferior to that provided by the Suxamethonium 1.5mg/Kg but there is more hemodynamic stability with rocuronium then suxamethonium. Therefore Rocuronium bromide may be considered as safe and good alternative to suxamethonium for endotracheal intubation. Hence rocuronium bromide can be used for a rapid sequence of induction and intubation if there is no prediction of difficult intubation

The principle of the minimally invasive technique is to implant specific bony plate which is fixed across fractures via small incisions of the skin, muscle, and periosteum. The aim of the study was to find the functional outcomes in patients treated with proximal humerus fractures with a minimally invasive technique using locking compression plates. Methods: The cross-sectional study was conducted in the Department of Orthopedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar. A total of 39 patients were included in the study. The patients were selected using the inclusion criteria and they underwent operations under general anesthesia followed by early mobilization and follow up at the intervals of 3 months, 6 months and 12 months to evaluate functional outcomes according to Constant-Murley criteria. Results: The fractures were classified according to the NEER/AO/ASIF classification of fractures of the humerus. The type A fractures were found in 20 out of 39 patients 51.28% A1 fractures were in 8 patients A2 in 5 patients and A3 in 7 patients and 19 fractures were type B 48.72% and B1 and B3 had in 7 patients each and B2 had 5 patients. The mean Constant-Murley score was 89.25 points at the end of one year follow up in 2 part fractures. According to Constant-Murley score, 85% had an excellent outcome, 10% had a good functional outcome and 5% had moderate outcomes. All the fractures were united on an average time of 19 weeks (14-24). In the Three-part fractures, the average Constant-Murley score at the end of one year was 81 points. The Constant-Murley score showed 78.94% had excellent outcomes, 15% had a good functional outcome and 5.26% had a moderate outcome. Conclusion: Within the limitation of the present study it can be concluded that minimal invasive plate osteosynthesis with locking compression plate is a good technique for the treatment of proximal humerus fractures. It provides good stability, functional outcomes and minimal post-operative complications

Optimal management sequence for the primary tumor and the liver in synchronous colorectal liver metastases (SCLM) is still controversial. Except reviews, studies comparing the 3 surgical approaches are infrequent. The present study aimed to describe the surgical management of patients operated of SCLM. In particular, we compared short-term outcomes and survival according to the surgical strategy. A multicentric retrospective study was conducted on 125 patients with SCLM. Surgical strategy was defined as classic (colorectal first approach), combined and reverse (liver-first approach). Between 2008 and 2013, 87 patients completed the classic strategy, 24 combined strategy and 14 reverse strategy. The 3 groups were comparable regarding pre-operative data. Liver metastases involvement was significantly higher in reverse group. Severe cumulative postoperative morbidity was 39.2%, similar between the 3 strategies. Ninety-day mortality was higher in combined group (12.5%, p>0.05). Failure rate of liver first approach was 17%. The 3-year overall survival (OS) was 73% in classic group, 78% in combined group and 93% in reverse group. The 3-year disease free survival (DFS) was 29%, 30% and 19% for classic, combined and reverse strategy respectively. There was no significant difference with regard to OS and DFS between 3 groups. We demonstrated that liver first approach is safe and feasible with acceptable perioperative and survival outcomes despite initially worse prognostic criteria. Reverse strategy can be applied to a vast majority of patients independently to the liver tumor burden and should be considered progressively as a reference in the management of SCLM

The objective of the study was to observe the various clinical features, histopathological and immunofluorescence findings in patients with autoimmune vesiculobullous disorders. The overall M: F ratio of autoimmune vesiculobullous disorders in the study was 1: 1.4. Trunk was the most common site of involvement in all types of autoimmune vesiculobullous disorders. Overall trunk was the most common site of onset of lesions in autoimmune vesiculobullous disorders but in pemphigus vulgaris mucosal onset is more common than trunk and extremities. Incidence of autoimmune vesiculobullous disorder was 0.11% of the total number of patients attending the skin OPD. Pemphigus vulgaris constituted the most common subtype of autoimmune vesiculobullous disorder in this study, followed by pemphigus foliaceus. Pemphigus group of diseases were most common in the 4th decade while bullous pemphigoid was most common in the 7th decade. Histopathological examination showed features typical of each subtype of autoimmune vesiculobullous disorder.

The study was conducted to determine the Etiological basis of dizziness in patients attending ENT clinics in Pakistan. It was a prospective, multicenter, observational, non-interventional, cross - sectional study conducted in five cities across Pakistan, between August, 2014 and March, 2015. The study population included male and female patients attending the outpatient clinics of ENT departments. The patient population was of 18 years of age or older presenting with dizziness. Based on the initial screening patients were diagnosed as vertiginous or non-vertiginous. Patients’ written authorization to use or disclose the patient’s personal or health data was obtained. Benign Paroxysmal Positional Vertigo was the commonest diagnosis (67%) followed by Meniere’s disease (16%) in patients who presented with vertigo attending outpatient departments in ENT Clinics. At baseline visit, 38.3% of the patients were categorized as moderately handicapped. Medication was offered to three quarter of the patient population (69%), while rest of the patients were offered maneuver and medication both (20.8%) and only maneuver (3.5%). DHI was used at the baseline visit and post treatment as well. It was observed in the study that the DHI score was significantly improved in all diagnosis groups after the treatment. At the end of four weeks majority of the patients were categorized mildly handicapped (91.3%). Majority of the patients diagnosed as BPPV were prescribed anti-vertiginous medicines (70%) followed by anti-emetics and pain killers. Amongst the patient reporting with dizziness the commonest diagnosis was Benign Positional Paroxysmal Vertigo followed by Meniere’s disease. Based on pre and post-treatment DHI scores, medication and medication with maneuver helped the patients presenting with dizziness in improvement of Quality of Life.

Family planning is widely acknowledged as an important intervention towards achieving Sustainable Development Goals (SDGs) three (4) and five (5) as it has proven to reduce maternal and child mortality. Family planning can prevent unwanted pregnancies and unsafe abortions. The aim of this study was to determine various factors that influence the uptake of modern family planning among women of reproductive age in South-eastern Nigeria. The study used data obtained from Nigeria Demographic and Health Survey (NDHS) 2013. Factors considered were drawn from the dataset. Analysis was carried out using Stata version 12.1. Multivariate logistic regression analysis was used to determine relationship between various factors and use of modern family planning methods. Level of significance was set at 0.05. The total number of participants in the study was 2,816. Twelve point fifty seven percent (12.57%) of the participants were currently using modern family planning methods. The highest proportion of use was 25.57% in Ebonyi State, while the lowest was 16.94 % in Imo State. The only identified predictor of use of modern family planning use was educational status. The women who had at least secondary education were almost twice (1.82 times) more likely to use modern family planning methods than those who had only primary education or less (OR=1.82, 95% CI: 1.4-2.4, P<0.001). Measures should be taken to increase female literacy, as this will most likely lead to improved uptake of modern family planning among the respondents.

Blunt abdominal trauma presents a challenge for diagnosis because it may be associated with multiple organ injuries thus physical examination alone may result in an improper diagnosis. Ultrasonography is one of the important tools in the examination of such patients. The aim of the present study was to determine the accuracy of Focused Assessment Sonography for Trauma [FAST technique] in blunt abdominal trauma patients. Methods: The study involved 120 Abdominal trauma patients admitted to Prathima Institute of Medical Sciences and Hospital. Every patient was examined by abdominal sonography in those patients who required urgent management because of serious injuries were excluded from the study. All the patients based on clinical assessments were suspected of abdominal trauma. The sonographies were done using the FAST technique “Focused Assessment Sonography for Trauma" in which six areas of the abdomen were examined. Results: Out of the 120 patients 94 were diagnosed as positive after abdominal sonography out of which 73 were confirmed as positive by CT, DPL, and explorative laparotomy and remaining 21 were found to be negative. Similarly out of 24 diagnosed as negative by sonography 2 were found to be positive by CT, DPL, and explorative laparotomy. The mean sensitivity in all patients was found to be 97.33% with 95% Confidence Interval ranging from 90.70% - 99.68%, the specificity was 53.33% 95% CI 37.87% - 68.34%, the positive predictive value PPV was 77.66% range 71.73% - 82.64% the negative predictive value NPV was 92.31% range 74.85% - 97.98%, the overall accuracy was 80.33% and range was 72.64% - 87.44%. Conclusion: within the limitations of the present study it can be concluded that abdominal ultrasonography with FAST technique is fairly reliable and accurate method of evaluation in blunt abdominal trauma. Abdominal ultrasonography is a valuable tool after clinical examination of the patients with blunt abdominal trauma. It has a relatively high negative predictive value that prevents the patients from undergoing unnecessary tests after blunt abdominal injuries.

Consumption of thermoxidised and photoxidised palm oil diets is known to be harmful to tissues in the body including the reproductive system. It is not known which of these two forms of the commonly consumed vegetable oils is less harmful to reproductive function. Fifteen male Wistar rats weighing 80-125g and aged 19 to 23 weeks were randomly divided into control, thermoxidised palm oil (TPO) and photoxidised palm oil (PPO) diets-fed groups of five rats per group. Control group was fed on plain rat feeds while the other two groups were fed on TPO diet or PPO diet accordingly for 13 weeks. Results demonstrated a significantly lower seminal pH in the PPO-fed than in the TPO-fed group (P<0.01) and control (P<0.05). Sperm motility was significantly reduced in the PPO-fed compared with TPO-fed groups (P<0.05). The viability of sperms was significantly decreased in PPO-fed rats compared with the TPO-fed group (P<0.05) and control (P<0.01). Sperm count was significantly lower in PPO-fed compared with TPO-fed group (P<0.01). Percentage of sperms with morphological defects was significantly higher in the PPO- than in the TPO-fed groups (P<0.01). Serum testosterone concentration was significantly decreased in PPO-fed compared with TPO-fed group (P<0.001). Serum luteinizing hormone (LH) level was significantly decreased (p<0.001) in PPO-fed group compared with control and TPO-fed groups. Serum concentration of follicle stimulating hormone (FSH) was significantly decreased (p<0.001) in PPO-fed group compared with control and TPO-fed groups. In conclusion, chronic consumption of PPO diet has greater deleterious effects on male reproductive function than TPO diet

Fistula in Ano is a simple anorectal condition, however, has the potential to cause high morbidity. The usual line of surgical treatment for simple fistula in ano includes fistulotomy with marsupialization and fistulectomy. The present study was aimed to determine the overall outcomes after treatment of patients with fistulotomy with marsupialization and fistulectomy and compare the results in terms of post-operative complications and recurrences. Methods: The study involved 70 patients diagnosed with simple fistula in ano. Patients with morbid medical conditions and those diagnosed with complex fistulas were excluded from the study. The Clinical examination included perineal inspection, palpation, digital rectal examination and proctoscopic evaluation. The patients were then randomly divided into two groups. The group I patients underwent fistulectomy and the group II underwent fistulotomy with marsupialization. The patients were operated under general or regional anesthesia. The anorectal examination was done to verify the findings of the clinical examination. The patency of the tract was checked using the probe to the external opening. Seventy patients diagnosed with simple anal fistula were involved in the study. The mean distance of external fistula opening in group I was 2.6 ± 0.54 cms and the mean distance in group II was 2.5 ± 1.05. The duration of symptoms in group I and group II was 7.60 ± 2.9 and 8.85 ± 3.2 weeks respectively. The mean duration of surgery in group I was 12.5 ± 2.2, was 9.95 ± 1.25 in group II. Post-operative healing of the wounds was earlier in group II 4.06 ± 0.95 as compared to group I 5.15 ± 2.5. The mean VAS score was calculated on the 3rd postoperative day in both the group of patients. In group I the mean VAS score was 2.25 and the mean VAS score in Group II was 2.25. No patient in the study developed the wound infection and none had other complications. Conclusions: Within the limitations of the present study it can be concluded that fistulotomy with marsupialization and fistulectomy are equally effective in terms of the outcomes of treatment of simple fistula in ano. Although fistulectomy requires longer post-operative healing and the mean VAS scores were higher in the fistulectomy group then compared to fistulotomy group. No recurrence and occurrences of complications were noted in both the groups.