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Objective. The red rhizome of Angiopteris helferiana has been used widely to treat muscle fatigue, bone pain, and skin infection in Nepal. However, scientific evidence for its bioactive compounds and their bioactivities was lacking till January, 2024. Therefore, we investigated to validate and advance the further use and development. Methods. Column chromatography, including MCI gel CHP20P, Sephadex LH‐20, ODS, and Silica gel, was used for the isolation of compounds from 70% methanol extract of A. helferiana rhizomes. The isolated compounds were evaluated for their TLC‐based antioxidant and antibacterial activity against Staphylococcus aureus, Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa by adopting the agar well diffusion protocol. Furthermore, in silico molecular docking against the penicillin binding protein of E. coli (PBP1b, PBP2, and PBP3 TPd) and ADME toxicity of the isolated compounds was predicted. Results and Discussion. Angiopteroside (1) and osmundalactone (2) were isolated for the first time from the red rhizomes of A. helferiana. The structure of the isolated compounds was elucidated on the basis of spectroscopic (1H‐, 13C‐, and 13C/DEPT‐NMR) and spectrometric (LC MS/ESI and IR) analyses and comparison with reported literature. Both compounds were inactive towards DPPH scavenging activity. Compound 1 showed poor inhibitory activity against E. coli, with inhibition zone range of 2–7 mm. However, both isolated compounds were found to be resistant against S. aureus, K. pneumonia, and P. aeruginosa. Based on in silico molecular docking forecasting, compound 1 revealed the good binding affinity with PBP1b (−6.5 kcal/mol), PBP2 (−5.8 kcal/mol) and PBP3 TPd (−6.1 kcal/mol) compared to positive control meropenem with PBP1b (−6.6 kcal/mol), PBP2 (−6.9 kcal/mol), and PBP3 TPd (−6.6 kcal/mol). Similarly, compound 2 showed weak preference for PBP1b (−4.3 kcal/mol), PBP2 (−4.4 kcal/mol), and PBP TPd (−4.5 kcal/mol). Compounds 1 and 2 were predicted to be safe in terms of hepatotoxicity, cytotoxicity, mutagenicity, and carcinogenicity, with a potential to induce nephrotoxicity similar to that of meropenem. Conclusion. This study successfully isolates two lactones with antibacterial properties and inspires the researcher to further research, development, and formulation. [ABSTRACT FROM AUTHOR]

Background: Bone marrow metastasis is an uncommon yet significant presentation of many non haematological malignancies. Aims: The present study was conducted with the aim of analysing the clinical, haematological and biochemical parameters of the patients with bone marrow metastases and determines the parameters which could possibly indicate the presence of bone marrow metastases. Patients and Methods: Bone marrow aspirate, imprint and biopsy slides of 22 cases with bone marrow metastases were reviewed and the haematological and biochemical data of all these cases were compared with that of 20 controls without any evidence of metastases. Results: The mean values of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and serum lactate dehydrogenase (LDH) were found to be significantly different (P < 0.001) between the cases and controls. MPV <8.1 fL, NLR >3.5 and LDH >452 U/L showed a high likelihood ratio in predicting bone marrow metastases. Conclusion: Parameters such as MPV, NLR and LDH can be used as efficient and easily available methods to predict bone marrow metastasis for a rapid diagnosis. [ABSTRACT FROM AUTHOR]

Ethnomedicinally, more than 2000 plants were found to be used in Nepal. Among them, the red colored rhizome of Angiopteris helferiana and the bark of Saurauia fasciculata have been used widely to treat muscle fatigue, bone pain, fever, postpartum hemorrhage, and thirst by healers in Kaski and Tanahun districts, Nepal. However, scientific evidence towards their traditional uses is lacking till December, 2023. Therefore, we report the phytochemicals, total phenolic content (TPC), total flavonoid content (TFC), total carbohydrate content (TCC), antioxidant and antibacterial activities of A. helferiana and S. fasciculata extracts. Phytochemical analysis indicated that A. helferiana and S. fasciculata extracts were potential sources of chemicals such as phenols, flavonoids, tannins, terpenoids, saponins, and carbohydrates. The TPC, TFC, and TCC of extracts were determined by using an ultraviolet visible spectrophotometer. Among the extracts tested, A. helferiana extracts showed the highest phenolic and carbohydrate contents of 208.33 ± 12.96 mg of gallic acid equivalent/g and 564.16 ± 2.92 mg of D-glucose equivalent/g of dry extract, respectively. Similarly, S. fasciculata revealed the highest flavonoid content of 30.35 ± 0.1 mg quercetin equivalent/g of dry extract. The extract of A. helferiana and S. fasciculata exhibited potent antioxidant activity by scavenging 2,2-diphenyl-1-picrylhydrazyl radicals with an IC 50 of 25.9  µ g/ml and 31.07  µ g/ml, respectively. The antibacterial activity of the A. helferiana and S. fasciculata extract against Staphylococcus aureus, Pseudomonas aeruginosa , and Escherichia coli was determined using an agar-well diffusion protocol that revealed the potential antibacterial activity of A. helferiana against E. coli . The present study will help validate the traditional uses of A. helferiana rhizomes and S. fasciculata barks as a healing medicine and inspire the researcher towards further research, development, and formulation., Competing Interests: The authors declare that they have no conflicts of interest with respect to research, authorship, and/or publications., (Copyright © 2024 Ram Kishor Yadav et al.)

Objective: Placenta percreta is an extremely high-risk obstetric condition often associated with significant maternal morbidity and mortality. To date, there is no consensus on its management. This article aimed to identify an optimum management option to improve maternal outcomes in patients with placenta percreta., Material and Methods: This was an observational study conducted at a tertiary care institute from October 2019 to June 2020. A well-defined plan of preoperative, bilateral, uterine artery catheter placement, cesarean delivery (CD) of the baby followed by uterine artery embolization (UAE), and elective delayed hysterectomy after 2-4 weeks, was made by a multidisciplinary team. Demographic variables such as age, parity, period of gestation, presenting complaints, imaging findings, mode of management, intraoperative findings, blood loss, the requirement for blood and blood products, and complications were noted., Results: We encountered seven cases of placenta percreta over a period of nine months. UAE was performed in 6/7 patients. UAE was not performed in one patient as she presented to the emergency department in shock. Elective delayed hysterectomy was performed after 2-4 weeks in three patients, three patients required emergency hysterectomy (two during CD and one on the seventh postoperative day) and one patient was managed conservatively by leaving the placenta in situ after CD and UAE. Patients who underwent UAE had notably less intraoperative blood loss and requirement of blood and blood products than the patient who could not receive UAE. During cesarean hysterectomy, blood loss was 1,700 mL in embolized (case 4) vs 3,000 mL in unembolized patient (case 7). In embolized patients, the median blood loss during CD (case 1,2,3,5,6) was 200 mL (interquartile range: 165-200 mL) and during delayed elective hysterectomy (case 1,3,5) was 150 mL (range: 125-225 mL). Blood loss in case 2 was 1,000 mL during emergency hysterectomy on the 7 th day of CD and UAE. The blood loss was appreciably higher in patients who underwent immediate cesarean hysterectomy rather than elective delayed hysterectomy., Conclusion: Placenta percreta, if not managed in a preplanned manner, may lead to disastrous maternal outcomes. Prophylactic devascularization during CD and leaving the placenta in situ followed by elective delayed hysterectomy, might be a reasonable management option in most severe cases of placenta percreta.

Background: The COVID-19 pandemic has posed a grave challenge to mankind as it doesn't appear to get controlled in the near future. Worldwide, health care centers are working more than their capacity with the scarcity of medical resources. Cancer patients are considered to be at higher risk of developing life-threatening complications from COVID-19 and at the same time treatment delays can lead to poorer oncological outcomes. Appropriate planning is therefore important to continue with cancer treatment services and simultaneously avoiding the risk of infection to the patients and healthcare staff and not allowing community transmission of viral infection., Methods and Results: We modified our practice measures in cancer patients receiving systemic therapy. Tele-consultations and use of electronic means, providing the best supportive care at or near home, and involvement of local/ family physicians were widely practiced. We minimised in-patient admissions, however, day-care chemotherapies were continued to provide optimum oncology services., Conclusions: Modified oncological practice measures need to be implemented as the pandemic seems to stay for a longer time., (© Journal of the Association of Physicians of India 2011.)

Understanding of molecular regulatory pathways presents a novel therapeutic approach for the treatment of head and neck cancer. These specific check points are becoming the targeted therapeutic approach. In this review, we highlight certain major signaling mechanisms, which are involved in the pathophysiology of head and neck cancer. Also, we discuss the current ongoing trials based on the in vitro success of targeted therapies.