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Clinical scenario After a long night on call, a general surgery resident on a vascular surgery rotation meets a radiology resident at the hospital coffee shop, and they begin to [...]

Objective: The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy among women aged 15-49. This paper aims to examine the national and state-level age-specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state-level indicators that may explain variation across states.Design: Cross-sectional, nationally representative household survey.Setting: National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016.Population: The survey covered 699 686 women between the ages of 15 and 49 years.Methods: Descriptive analyses and multivariate logistic regression.Main Outcome Measures: Women who reported ever having a hysterectomy and age at hysterectomy.Results: Age-specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15-29; 3.59% (3.45,3.74) among women aged 30-39; and 9.20% (8.94,9.46) among women 40-49 years. There was considerable variation in prevalence by state. Four states reported age-specific prevalence similar to high-income settings. Approximately two-thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state-level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment.Conclusions: Hysterectomy patterns among women aged 15-49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular.Funding: This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID.Tweetable Abstract: Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women. [ABSTRACT FROM AUTHOR]

The essential oil compositions of leaves and inflorescences of Elsholtzia densa Benth. from western Himalaya were studied and compared using gas chromatography-flame ionization detector and gas chromatography-mass spectrometry. Altogether, forty constituents comprising 83.3-83.7% of essential oil composition were identified. The leaf essential oil of E. densa was characterized by citral (52.2%), geranyl acetate (3.3%) and geraniol (3.1%), whereas the inflorescence essential oil of E. densa was found to be dominated by pinocarvone (51.9%), cis-pinocamphone (5.2%) and citronellyl acetate (3.4%). The essential oil compositions were compared with earlier reports on Elsholtzia spp. from different geographic regions that revealed noteworthy compositional variability. [ABSTRACT FROM AUTHOR]

The influences of cropping seasons, crop maturity stages and wilting period on essential oil composition of Ocimum africanum Lour. var. CIM-Jyoti, grown at foothills agroclimatic conditions of northern India, were studied and compared using gas chromatography-flame ionization detector and gas chromatography-mass spectrometry. Altogether, 28 constituents, forming 91.8-99.1% of the total oil composition, were identified by comparing their retention indices and mass spectral data. The essential oil content was found to vary from 0.38% to 0.66% during different maturity stages with maximal in full bloom stage. Citral (55.0-75.5%), (E)-γ-bisabolene (2.6-9.5%), nerol (1.7-8.9%), geraniol (1.5-6.5%), linalool (1.1-6.0%), β-caryophyllene (0.7-3.2%), α-humulene (0.4-2.7%) and 6-methyl-5-hepten-2-one (≤0.03-2.1%) were identified as the characteristic constituents of the essential oil of O. africanum. Significant variations in the essential oil content and qualitative chemical composition were noticed in different harvesting stages of two cropping seasons. [ABSTRACT FROM AUTHOR]

In this study, the essential oil composition and antibacterial activity of an underexplored population of Cymbopogon martinii (Roxb.) W. Watson was investigated using GC-FID, GC-MS, disc diffusion and micro dilution broth assay. To substantiate the stability of the essential oil profile, the population was grown in the experimental field and its oil was analysed at different growth stages. Altogether, forty-eight constituents, comprising 91.5-96.8% of the total oil composition were identified. Main constituents of the oil were trans-p-mentha-2,8-dien-1-ol (16.6-22.8%), cis-p-mentha-2,8-dien-1-ol (7.2-9.7%), trans-p-mentha-1(7),8-dien-2-ol (9.8-15.8%), cis-p-mentha-1(7),8-dien-2-ol (11.3-18.0%), limonene (10.5-34.8%), isopiperitenol (3.1-5.0%), trans-carveol (3.5-4.5%) and carvone (2.6-3.6%). The oil exhibited wide spectrum, moderate to very good activity against pathogenic bacterial strains (zone of growth inhibition: 9-25 mm; minimum inhibitory concentration, MIC: 125-500 μg/mL). In conclusion, due to high percentage of monoterpene alcohols, the examined oil demonstrated potent antibacterial activity against both Gram-positive and Gram-negative strains. [ABSTRACT FROM AUTHOR]

Objective: In this study, productivity and essential oil quality of rose-scented geranium (Pelargonium graveolens L' Herit. ex Aiton.) varieties, namely CIMAP Bio-G-171, CIM-Pawan and Bourbon were assessed and compared in two locations of north India. Methods: A field experiment was conducted to evaluate the productivity, while the chemical composition of the essential oils was assessed by GC-FID and GC-MS. Result: Yields of fresh leaves and essential oil from CIMAP Bio-G-171 were significantly higher (173.64–174.42 q h-1 and 69.93–79.06 l h-1) than those of CIM-Pawan (158.08–160.56 q h-1 and 55.57–64.46 l h-1) and Bourbon (133.34–139.33 q h-1 and 44.19–48.38 l h-1). Major constituents of the oils were citronellol (20.9–39.5%), geraniol (10.9–26.5%), linalool (2.9–14.2%), isomenthone (7.4–9.4%), citronellyl formate (5.5–9.1%) and 10-epi-γ-eudesmol (5.2–9.0%). Conclusion: The essential oil yields and chemical compositions were substantially influenced by variety and location of growing. The variety CIMAP Bio-G-171 showed improvement up to 58.2–63.4% and 22.6–25.8% in essential oil productivity over the existing prevalent varieties, Bourbon and CIM-Pawan, respectively. [ABSTRACT FROM AUTHOR]

Cymbopogon distans (Nees. ex. Steud.) W. Watson (family: Poaceae) is a perennial aromatic grass widely distributed in tropical and subtropical zones of north-western Himalaya. The essential oil of C. distans has industrial potential for aromatherapy, fragrances and for natural aroma isolates. In view of chemotypic variations and industrial potential of the essential oil of C. distans, the present study was carried out to investigate the variability in chemical composition of p-menthenols chemotype of the C. distans harvested in different seasons during annual growth, and to evaluate the antimicrobial potential of its essential oil against pathogenic bacterial and fungal strains. The major constituents identified in essential oil of C. distans were cis-p-menth-2-en-1-ol (24.5–26.7%), δ-2-carene (19.9–28.2%), cis-piperitol (10.9–23.6%), trans-p-menth-2-en-1-ol (8.4–13.3%) and trans-piperitol (5.4–7.3%). The essential oil showed antagonist activity against nine bacterial strains (MIC: 250–1000 μg/mL) and three fungal strains (MIC: 130–530 μg/mL). Results revealed that the essential oil of C. distans possessed >50.0% of p-menthenols viz., cis-p-menth-2-en-1-ol, trans-p-menth-2-en-1-ol, cis-piperitol and trans-piperitol as major constituents, with a significant antimicrobial potential for pathogenic microbial strains. [ABSTRACT FROM AUTHOR]

BACKGROUND Zingiber montanum (J.Koenig) Link ex A.Dietr. (Zingiberaceae), commonly known as cassumunar-ginger, is a folk remedy for the treatment of inflammations, sprains, rheumatism and asthma. The aim of the present study was to assess the chemical composition, and antibacterial, antifungal, allelopathic and acetylcholinesterase inhibitory activities of the essential oil of Z. montanum originating from India. RESULTS The hydrodistilled essential oil of Z. montanum rhizome was analyzed using gas chromatography-flame ionization detection and gas chromatography-mass spectrometry. A total of 49 constituents, forming 98.7-99.9% of the total oil compositions, was identified. The essential oil was characterized by higher amount of monoterpene hydrocarbons (32.6-43.5%), phenylbutanoids (27.5-41.2%) and oxygenated monoterpenes (11.4-34.1%). Major constituents of the oil were sabinene (13.5-38.0%), ( E)-1-(3',4'-dimethoxyphenyl)buta-1,3-diene (DMPBD) (20.6-35.3%), terpinen-4-ol (9.0-31.3%), γ-terpinene (1.1-4.8%) and β-phellandrene (1.0-4.4%). The oil was evaluated against eight pathogenic bacteria and two fungal strains. It exhibited low to good antibacterial activity (minimum inhibitory concentration: 125-500 µg mL-1) and moderate antifungal activity (250 µg mL-1) against the tested strains. The oil reduced germination (69.8%) and inhibited the root and shoot growth of lettuce significantly (LD50: 3.58 µL plate-1). However, it did not demonstrate acetylcholinesterase inhibitory activity up to a concentration of 10 mg mL-1. CONCLUSIONS The essential oil of Z. montanum can be used as a potential source of DMPBD, terpinen-4-ol and sabinene for pharmaceutical products. The results of the present study add significant information to the pharmacological activity of Z. montanum native to India. © 2017 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Benzaldehyde is one of the most important molecules in the flavour industry. Presently, most of its industrial requirement is met through synthetic route. In this research, leaf essential oil of Prunus persica (L.) Batsch. extracted in different seasons was analysed using GC-FID, GC-MS, and NMR (1H and 13C) techniques. The oil was characterised by higher amounts of benzaldehyde (63.1%-98.3%). The yield of benzaldehyde was higher during rainy (0.45 g/100 g fresh leaves) and autumn (0.44 g/100 g fresh leaves) seasons. In conclusion, leaves of P. persica can be used as a natural source of benzaldehyde for flavour industry. [ABSTRACT FROM AUTHOR]

Introduction: Ventriculo-peritoneal shunts (VPS) are still the mainstay treatment for hydrocephalus in children. It is generally accepted that VPS failure and infection rates are higher for neonates than for older children. We compared our 1-year failure and infection rates in under 3-month-old children compared with older children in our department. Results: We identified 58 children under 3 months of age who underwent VPS insertion between January 2007 and December 2016. They had a 29.3% (17) shunt failure rate over the first year. There were two confirmed shunt infections (3.4%). Discussion: The 1-year shunt failure rate at our institution for VPS insertion in children over 3 months is 26.1% and the infection rate is 4.3% (9). The literature suggests that the outcome for VPS in younger children is worse than for older children. Our work shows similar outcomes for all children compared to those under 3 months at time of VPS insertion alone. Conclusion: Children under 3-months-old undergoing VPS insertion should not automatically expect an increased 1-year failure or infection rate compared with older children. The reasons for this may be as a result of increased subspecialisation, the more widespread use of antibiotic-impregnated catheters and improved neonatal care. [ABSTRACT FROM AUTHOR]

Objectives: To document our experiences, technical procedure and outcomes of carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis. Material and Methods: A total of 49 consecutive patients underwent 53 CEAs (three bilateral, one redo) for severe carotid artery stenosis. There were 39 males and 10 females, with mean age of 63 years. All patients underwent neck Doppler, computed tomography/magnetic resonance angiography/digital substraction angiography and a detailed cardiological evaluation. Antiplatelet drugs were continued perioperatively. Surgery was performed under general anesthesia with propofol cerebral protection, mild hypothermia and continuous electroencephalogram monitoring. The procedure was done under microscope and closure was done using 6-0 prolene. Clinical and radiological follow-up was done. Results: Our mean follow-up was 4.69 years. All patients underwent primary suturing except one redo CEA done with venous patch graft. Three patients required intraoperative shunting. One patient died secondary to myocardial infarction peroperatively prior to carotid manipulation. One patient had stroke within 6 h, secondary to operative site intraluminal thrombus and was re-explored. Two patients had transient postoperative hemiparesis and aphasia while two patients had altered sensorium, all self-limiting, with normal imaging. One patient developed temporary twelfth-nerve paresis. One patient had persistent transient ischemic attack on the follow-up. Thus, the perioperative mortality rate was 1.89% and stroke rate was 1.89%. Conclusions: CEA for severe carotid stenosis is a safe procedure with good protection from ischemic events. Detailed preoperative cardiac evaluation and appropriate patient selection is essential. [ABSTRACT FROM AUTHOR]

Chronic, but not acute, exposure to minimal electroconvulsive shock (ECS) has been shown to decrease vulnerability to neuronal cell death, without itself causing neuronal damage. One potential mechanism for the neuroprotective effect of ECS is the increase in fibroblast growth factor-2 (FGF-2) which occurs after chronic, but not acute, ECS exposure. This raises the possibility that repeated seizures over a period of several days may alter the transcriptional regulation of FGF-2. To test this hypothesis, the present study compared the effect of acute (1 day) vs. chronic (7 days) ECS treatment on levels of mRNA for FGF-2 in rhinal and frontal cortices, hippocampus, and olfactory bulbs. In addition, mRNA for another prominent neurotrophic factor, nerve growth factor (NGF), was assayed concurrently. At 8 h after acute ECS, mRNA levels increased by 60% for FGF-2 and 136% for NGF in rhinal cortex, 32% for FGF-2 and 36% for NGF in frontal cortex, and by 13% for NGF in hippocampus. After 7 days of ECS treatment the respective increases were 72% and 80%, 53% and 38%, and 28%. No increases were observed in olfactory bulbs after either treatment regimen. The peak increases in FGF-2 mRNA were consistently greater after chronic treatment, but the differences from those seen acutely reached significance in frontal cortex only. However, the duration over which mRNA for FGF-2 was elevated did not differ between the acute and chronic ECS groups. NGF mRNA induction was neither enhanced nor prolonged as a result of chronic ECS as compared to acute ECS treatment.These results suggest that chronic ECS treatment may lead to an enhanced rate of transcription of message for FGF-2 but not for NGF, in selected brain regions. At the same time, the results indicate that chronic ECS treatment induces FGF-2 and NGF mRNA expression in a tissue-specific manner and that this induction is maintained over the 7-day treatment period. The sustained increases in mRNAs for these trophic factors may contribute to the neuroprotective actions of chronic ECS treatment. [Copyright &y& Elsevier]

Focuses on evidence-based surgical medicine. Presentation of a clinical scenario of evidence-based surgery; Questions to be answered when critiquing an article comparing surgical interventions; Factors needed to be considered by surgeons before incorporating trial recommendations into their clinical practices.

Examines the association between tamoxifen and the development of hepatocellular carcinoma in women with breast cancer. Case study; Results of animal studies on the side effects of tamoxifen; Risk factors of hepatocellular carcinoma.

This study investigates the variations in the chemical, genetic, and biological activity (antibacterial, antifungal, and antioxidant) profiles of thirteen populations of Ocimum kilimandscharicum Guerke (OK1-OK13) from India. Correlations between chemical composition and the biological activities of O. kilimandscharicum were assessed. The essential oils (EOs) of different populations, extracted by hydrodistillation process were characterised by gas chromatography-flame ionization detector (GC-FID) and gas chromatography-mass spectrometry (GC–MS). The antimicrobial activities of the EOs were evaluated by disc diffusion and micro dilution broth assays. The antioxidant activity of the EOs was determined by ferric reducing antioxidant power (FRAP) assay. The essential oil (EO) content varied significantly among the studied populations (0.15–0.93%). The EO analysis, and subsequent cluster and principal component analyses classified the populations in three distinct chemotypes, namely camphor (52.0–57.2%), linalool (65.2–91.0%), and phenylpropanoid/sesquiterpene. Amplification of genomic DNA using 20 inter simple sequence repeat (ISSR) primers yielded a total of 224 loci, out of which 210 loci were polymorphic in nature, representing 93.75% polymorphism. Pearson coefficient correlation ( r  = 0.32) suggesting low correlation between the distances obtained by molecular markers and EO compositions. The EO of population OK12 showed significant activity against Staphylococcus epidermidis , Enterococcus faecalis , and Staphylococcus aureus . However, EOs of populations OK11 and OK13 showed significant activity against Candida albicans (clinical isolate) and Candida albicans (ATCC), respectively. The EO of OK13 exhibited significant antioxidant activity. In-vitro safety evaluation study revealed that the EOs of most of the populations showed no significant toxicity against peritoneal macrophages cells. It is concluded that chemical and genetic profiles of O. kilimandscharicum varied considerably and these variations determined changes in its biological activities. The observations of this study could pave the way to optimize the use of O. kilimandscharicum populations in relation with its biological properties. [ABSTRACT FROM AUTHOR]

Zingiber zerumbet (L.) Roscoe ex Sm. (Zingiberaceae), commonly known as bitter ginger, has long been used in traditional herbal medicine for the treatments of inflammations, rheumatism, sprains, colic pain, diarrhea, tonsillitis and various other ailments. The aim of the present study was to assess the chemical composition of the rhizome essential oil of Zingiber zerumbet grown in the foothills of northern India using GC-FID, GC–MS, IR and NMR, and to evaluate the antibacterial and antiproliferative potential of the rhizome essential oil and its major constituent. Altogether, thirty-four constituents were identified representing 98.0% of the essential oil composition. Zerumbone (72.86%), α-humulene (7.09%), camphene (5.04%), humulene oxide I (2.45%), humulene oxide II (1.8%), and camphor (1.41%) were the major constituents. The potential of the rhizome essential oil of Z. zerumbet and zerumbone was tested against nine pathogenic bacterial strains. The results showed that both essential oil and zerumbone, possessed significant antagonist activity against Staphylococcus aureus -96 (MIC: 52.0–166.6 μg/mL), Streptococcus mutans (MIC: 62.5–208.0 μg/mL), and Escherichia coli (MIC: 104.1–208.0 μg/mL). Zerumbone was found more active compared to the essential oil. Moreover, the antiproliferative potential of Z. zerumbet oil and zerumbone was evaluated against various human cancer and normal cell lines (A549, MDAMB-231, A431, K562, WRL-68, COLO-205, HaCaT, and HEK-293). Results showed that, both essential oil and zerumbone possessed antiproliferative activity against tested cell lines, where zerumbone was more competent then essential oil. [ABSTRACT FROM AUTHOR]

The present study was conducted to evaluate the variability in the essential oil yield and chemical composition of Achillea millefolium L. (whole aerial-parts, leaves and inflorescence) grown in the subtropical region of north India during annual growth. The allelopathic, antibacterial, antifungal, and antiacetylcholinesterase activities of the oil were also examined. The essential oil yield varied due to harvesting stages and plant-parts processed (0.10–0.70%). The oils obtained from different stages and plant-parts were analysed using GC-FID and GC–MS. Altogether thirty-nine constituents, forming 93.0–97.8% of the total oil composition were identified. Major constituents of the oils were germacrene D (1.1–46.6%), sabinene (4.0–38.9%), borneol (4.7–24.9%), camphor (0.6–17.6%), α-pinene (0.8–11.7%), artemisia ketone (3.1–12.9%), chamazulene (0.8–9.6%), γ -cadinene (0.3–8.2%), and camphene (0.2–5.7%). Cluster analysis grouped overall compositions into six main groups based on their dominant components. It was observed that season of harvesting and plant-parts affect the essential oil yield and chemical composition of A. millefolium . The chemical composition of the examined essential oil was different from those described from other geographical origins. Moreover, this oil displayed a significant allelopathic activity. [ABSTRACT FROM AUTHOR]

In this study, successfully domesticated Himalayan thyme ( Thymus linearis Benth.) to the subtropical region of north India was evaluated for essential oil yield and chemical composition at different crop durations and harvests. The essential oil content, dry herb yield and essential oil yield varied from 1.64–2.79%, 44.11–52.40 q ha −1 , and 85.57–108.71 l ha −1 , respectively. The resulting essential oil was analysed using GC-FID and GC–MS. Altogether, forty-four constituents, representing 98.0–99.7% of the total oil composition were identified. Major constituents of the oil were thymol (34.3–67.3%), p -cymene (4.0–27.4%), γ-terpinene (4.9–24.4%), thymyl acetate (0.6–5.2%), β-bisabolene (0.8–5.1%), thymol methyl ether (2.4–3.7%), α-terpinene (0.7–3.6%), ( E )-caryophyllene (0.7–2.9%), 3-octanone (0.6–2.3%), α-thujene (0.3–2.3%), borneol (0.5–1.8%), carvacrol (0.9–1.5%), and cis -sabinene hydrate (0.4–1.3%). The essential oil of Himalayan thyme produced in this region fulfilled the criterion set by European Pharmacopeia for common thymes. [ABSTRACT FROM AUTHOR]