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Labor pain has two components: uterine contractions resulting in visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. Referred pain from uterus is transmitted to a skin area over the vertebrae L3-S2 in the area known as the Michaeli’s rhomboid. During the second stage of labor, there is severe somatic pain in the perineum which is continuous and distressing. The nonpharmacologic techniques of labor analgesia are nothing but traditional methods that have been employed for centuries by various cultures. These can be divided into mind–body interventions, alternative systems of medical practice, manual healing, bioelectromagnetic and physical methods. The mind- body interventions consist of psychoprophylactic methods such as lamaze method, yoga, sophrology, Leboyer’s method, music therapy, biofeedback, hypnosis etc. There are also techniques which activate peripheral sensory perception such as warm water baths, superficial applications of alternate hot and cold packs on the back, back massage, sterile water injections, acupuncture and transcutaneous electrical nerve stimulation. These techniques are cost effective and specially important in areas where there is shortage of staff and nonavailability of personnel to give specialized care.

Omega-3 polyunsaturated fatty acids, probiotics, vitamin C, vitamin D, folic acid and L-methyl folate, broad-spectrum micronutrients, N-acetylcysteine, physical activity, herbs, bright light therapy, melatonin, saffron, meditation, school-based interventions, and transcranial photobiomodulation are reviewed, with a focus on their use for treating mood disorders in children and adolescents. For each treatment, all published randomized controlled trials are summarized.

Wound management is to provide an appropriate environment for the wound to its healing without the breakdown of skin. It is an ongoing treatment process that includes the size, severity, depth, and location of the wound. Carbon-based nanomaterials have greater potential for the management of chronic wound infections as compared to conventional approaches. The physiochemical properties of these nanostructured materials may enable clinicians to develop more advanced approaches for wound healing. The carbon-based nanomaterials have a large surface area, and large surface-to-volume ratio and also exhibit excellent antibacterial, antioxidant, and anti-inflammatory properties which are required for wound healing applications. This review emphasizes wound care management in terms of their healing and dressing by carbon-based nanomaterials. Additionally, a brief introduction of traditional methods of wound care is also discussed with the modern approaches.

Smart nanomaterials are extensively studied for their significance as a nanocarrier towards cancer treatment. Nanomaterial-based drug delivery systems provide improved biocompatibility and stability, precise targeting, enhanced permeability, and controlled release of drugs even in the harsh tumor microenvironment. The recently used smart and advanced nanomaterials, such as mesoporous silica, metal oxides, black phosphorous, polymers, and organic framework, are highlighted in this article. A general approach of drug delivery in cancer cells is also discussed. The incorporation of nanocomposite, nanohybrid as drug delivery system, has led chemotherapy to the next level.

Suicide is a leading cause of death among children and adolescents, and research has shown a significant increase in the rates of emergency department (ED) visits because of suicide ideation and attempts for children younger than 18 years.

Pediatric bipolar disorder (PBD) is a severe and chronic illness. The occurrence of mixed symptoms might add further risk of recurrence of treatment resistance and suicidality. Early recognition and treatment of mixed symptoms might prevent illness progression and development of suicide attempts. This article provides an update on the epidemiology, clinical profile, and treatment of youth with PBD with mixed states. Mixed states in PBD are characterized by higher rates of suicide and more chronic symptoms, and are associated with younger age of onset and greater comorbidity. A careful assessment for mixed states using standardized criteria is essential.

Background: Lymphatic filariasis (LF) is a parasitic disease that causes permanent disability (elephantiasis). Currently used antifilarial drugs are failing to control LF and there is resurgence in some areas. Looking for new antifilarial leads, we found that Calotropis procera plant parts have been used in traditional medicine for alleviating elephantiasis but the antifilarial activity is not known. Objective: In the present study, the antifilarial activity of ethanolic extract (A001) and its hexane fraction (F001) of C. procera flowers was investigated using the human filarial parasite Brugia malayi. Methods: A001 and F001 were tested for antifilarial activity using motility and 3-(4,5-dimethylthiazol-2- yl)-2,5 diphenyltetrazolium bromide (MTT) assays (in vitro) and in the rodent models B. malayi- Meriones unguiculatus and B. malayi-Mastomys coucha. In the rodent models, A001 and F001 were administered orally for 5 consecutive days, and the adult worm burden and course of microfilaraemia were determined. Results: Both A001 and F001 showed microfilaricidal and macrofilaricidal activity in vitro. In animal models, A001 killed ~49-54% adult worms. In M. coucha model, F001 killed 12-60% adult worms in a dose (125-500 mg/kg) dependent manner; A001 and F001 suppressed microfilaraemia till days 91 and 35 post initiation of treatment, respectively. HPTLC revealed 0.61% lupeol, 0.50% β-sitosterol and 1.50% triacontanol in F001. Conclusion: Flowers of C. procera have definite microfilaricidal and macrofilaricidal activities. Whether this activity is due to lupeol, β-sitosterol and triacontanol found in the hexane fraction remains to be investigated. This is the first report on the antifilarial efficacy of flowers of the plant C. procera.

Background/Objectives: Differentiating bipolar disorder (BD) from a borderline personality disorder (BPD) can be diagnostically challenging as symptoms such as, depression, aggression and interpersonal relationships are common to both conditions. Identifying related and unrelated items between BD and BPD may improve diagnostic accuracy since both diagnoses have varying treatments which can be implemented before a behavioral emergency occurs. This study sought to determine which features of BPD, as assessed by the Borderline Personality Features Scale-Child (BPFS-C), are related to BD in youth diagnosed with BD. Methods: Thirty participants (M: 16, F: 14), with BD, aged 7-17 years (mean ± standard deviation, 12.95 ± 3.08 years) met DSM-V criteria for BD I (n=20) and BD II (n=3). The Course and Outcome of Bipolar Youth criteria was used to establish the BD–Not Otherwise Specified diagnosis (n=7). The 24-item self-report BPFS-C was administered to the youth. Two-tailed Pearson correlations were performed to assess associations between scores on the BPFS-C with scores on various psychopathology-related predictor variables while adjusting for age, race and primary BD diagnosis. Results: Higher BPFS-child scores positively correlated with child scores of more severe depression, self-injurious behaviors, and increased impulsive aggression. Conclusion: BPFS-child scores may assist clinicians in identifying youth with BD who may be on the trajectory to developing BPD and thus, implementing targeted psychotherapeutic interventions.

Introduction: The psychopharmacology of aggression in youth is relatively unexplored, even though such maladaptive aggression manifests across many different diagnoses.Methods: This study was a 12-week, open-label trial with divalproex sodium (DVPX) in 24 bipolar offspring 6–18 years of age (mean age = 11.3 years; 17 boys) with mixed diagnoses of major depression, cyclothymia, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The Overt Aggression Scale (OAS) was used to measure aggression in 4-week intervals. We measured serum gamma-butyric acid (GABA) and glutamate levels at baseline and week 12.Results: Seventy-one percent of evaluable subjects were considered responders to DVPX treatment by the OAS. There was a significant correlation between the Young Mania Rating Scale (YMRS) and OAS scores at week 0 (p = 0.036) and week 12 (p = 0.025). Serum DVPX level did not correlate with treatment response.Conclusions: These youths who are at high risk for bipolar disorder experienced an overall decrease in aggressive behavior in response to DVPX. Age or gender did not predict a positive response to DVPX. This study is the first report of treatment efficacy of a mood stabilizer for aggression in youth at high risk for bipolar disorder.

Divalproex sodium is an anticonvulsant that is used extensively in adults with indications for epilepsy, acute mania and migraine prophylaxis. It has been used in children and adolescents as a first-line agent for mania in bipolar disorder. Its efficacy as a mood stabilizer has been established, and there have been studies outlining its efficacy as an agent effective in the treatment of conduct disorder, disruptive behavior disorders, aggression and explosive disorder. Longer-acting formulations are now available that cause less gastrointestinal side effects and can also be taken once a day, thus potentially increasing adherence, an important factor in this patient population. Future directions would include developing a more potent valproic acid formulation with fewer side effects, completing randomized controlled trials to establish the efficacy of divalproex sodium in various other pediatric psychiatric disorders, establishing the relative efficacy of the compound in head-to-head comparisons with other mood stabilizers, examining systematically the value of the compound in multimodal pediatric psychiatric treatment packages, and complete effectiveness trials that demonstrate the short- and long-term effectiveness of the compound in the real world of clinicians. In this drug profile, divalproex sodium and its uses in the pediatric population for psychiatric conditions are reviewed.

ABSTRACTMaladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

A 46-year-old woman was anesthetized for total thyroidectomy. The thyroid was massive, deviating the trachea to the right and causing attenuation of the trachea radiologically. She had symptoms of respiratory obstruction in the supine position. Awake FOB-guided intubation was done in sitting position after airway topicalisation, and the airway was intubated with difficulty with 7.0?mm cuffed orotracheal tube. We describe this case in detail and discuss the significance of careful approach to planning and preparation in the management of such a case.