Journal of Diabetology : Official Journal of Diabetes in Asia Study Group, 2023
Introduction: Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility due to ano... more Introduction: Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility due to anovulation. The combination of Curcuma longa (CL) and Emblica officinalis (EO) is known to ameliorate diabetes and, thereby, may resurrect PCOS. The present study aimed to evaluate the effect of this combination prepared by two different methods, independently and with metformin (Met), compared with Met in PCOS on glycaemic control, inflammation, adipokines, and anthropometry. Aim: The aim of the study was to evaluate the effect of the combination of CL and EO, prepared by two different methods, independently and with Met, compared with Met in PCOS. Materials and Methods: PCOS women aged 18–35 years were selected through Rotterdam criteria from a tertiary care teaching hospital setting post-Ethics Committee permission. They were randomized to five groups (eight per group); combination of CL and EO prepared by traditional method (TF- Traditional Formulation), standardized extraction method (PNAE- Pharmanza Nisha Amalaki Extract), standard control Metformin (Met) and their combinations, TF + Met and PNAE + Met for 90 days. Fasting glucose, insulin, lipid profile, reproductive hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], and free testosterone), inflammatory markers (tumor necrosis factor-alpha [TNF-α], interleukin [IL]-6), and adipokines (leptin and adiponectin) were done at baseline and day 90, whereas anthropometry was done monthly. Results: Of 48 randomized women, 37 completed the study. TF and Met groups demonstrated higher weight decrease, whereas TF + Met significantly decreased waist circumference. Blood glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) decreased in all groups except glucose in TF + Met and HOMA-IR in the Met group. Only PNAE decreased free testosterone. TNF-α increased while leptin decreased in all groups. Both TF and PNAE, with Met reduced IL 6, significantly only in PNAE + Met group. Similarly, both TF and PNAE, with Met reduced LH/FSH ratio and significantly increased adiponectin. Two females, each, conceived in TF and PNAE, whereas one was in PNAE + Met group. No adverse events were reported. Conclusion: Both botanical formulations, TF and PNAE, were comparable to Met. The standardized extracts formulation PNAE seems more promising due to administration ease, smaller dose, and consistent bioactives.
The Journal of Obstetrics and Gynecology of India, Jun 8, 2019
BackgroundTransversus abdominis plane (TAP) block is a fascial plane block providing postoperativ... more BackgroundTransversus abdominis plane (TAP) block is a fascial plane block providing postoperative analgesia after lower abdominal surgeries including Cesarean section. Conventionally, it is administered under ultrasound guidance or by blind technique. We studied a novel transperitoneal surgical TAP block for providing safe and effective analgesia after Cesarean section through transverse incision.MethodsA hundred patients who fulfilled the inclusion criteria were included in the study after obtaining informed written consent. They were randomized in two groups: Group A with surgical TAP block and Group B without TAP block as control. Surgical TAP block was administered by transperitoneal route before the closure of peritoneum with 0.25% bupivacaine (dose adjusted with weight of the patient), and visual analogue score was assessed by a blind assessor. Time for rescue analgesia was noted and analyzed with the ‘two independent sample t test.’ResultsThe duration of postoperative analgesia in hours was significantly longer in the TAP block group compared with the control group (5.14 ± 1.63 vs 2.61 ± 0.89, p < 0.001). There was no reported complication of the surgical technique or any adverse effect of the used drug.ConclusionSurgical TAP block via the transperitoneal route is a safe, easy and effective mode of providing postoperative analgesia after Cesarean section. This technique does not need any costly specialist equipment, overcomes the technical limitations of ultrasound-guided TAP block and can be used in obese patients also. It has almost no side effects, and the technique can be easily mastered.
The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the act... more The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the activity of fatty acid desaturase (FADS) enzymes, fatty acid transport proteins (FATP) and fatty acid binding proteins (FABP). In a previous study we have demonstrated region-specific changes in the LCPUFA levels in preeclampsia (PE) as compared to the normotensive control (NC) placentae. AIM To understand the region-specific changes in the mRNA levels and protein expression of biosynthesis enzymes and transporters of LCPUFA in PE and NC placentae. METHODS In this cross-sectional study, 20 NC women and 44 women with PE (23 term (TPE) and 21 preterm PE (PTPE)) were recruited. The samples were collected from four regions of the placentae considering cord insertion as the center (CM, central maternal/basal; CF, central fetal/chorionic; PM, peripheral maternal/basal and PF, peripheral fetal/chorionic). The mRNA levels were estimated using qRT-PCR. Statistical analysis was done using both post hoc least significant difference (LSD) test and Benjamini Hochberg correction in the analysis of covariance. Preliminarily, localization and expression of proteins were studied by immunohistochemistry (n = 3/group). RESULTS The mRNA levels of FADS1, FADS2 and FATP1 were lower in the central regions (CM and CF) of the PE placentae (both TPE and PTPE) as compared to NC. These differences in the mRNA levels were observed by the LSD test and were not significant after the Benjamini Hochberg correction. Preliminary findings of IHC indicate that the protein expression of FADS1 and FATP4 was higher in the basal regions (CM and PM) of the PE placentae as compared to NC. FADS1, FADS2 and FATP4 proteins were localized in the syncytiotrophoblasts, cytotrophoblasts, mesenchymal cells, endothelial cells of the fetal capillaries and extravillous trophoblasts of the placenta. CONCLUSION FADS enzymes are detected in the placentae of Indian women. In PE placentae, there are region-specific alterations in the mRNA and protein levels of LCPUFA biosynthesis enzymes (FADS1 and FADS2) and transporters (FATP1, FATP4 and FABP3) as compared to term NC. These changes were more pronounced toward the basal side and region around the cord insertion.
A very large number of fatty acids play wide range of physiological roles in cellular growth and ... more A very large number of fatty acids play wide range of physiological roles in cellular growth and function in placental as well as fetal growth. However, docosahexaenoic acid (DHA), in addition to its critical role in cellular membranes, is known to act as a ligand for several nuclear receptors and regulates the activity of transcription factor families like peroxisome proliferator-activated receptor, liver X receptor (LXR), retinoid X receptor (RXR), and sterol regulatory element binding protein (SREBP). These transcription factors and DHA are known to regulate the placental and fetal growth and development. The objective of the present study was to examine the fatty acids and transcription factors in the placenta of women delivering low birth weight (LBW) babies. The present study examines the fatty acid and mRNA levels of various transcription factors in the placentae of women delivering normal birth weight (NBW) (n = 38) and women delivering LBW (n = 36). Placental fatty acids were analyzed using gas chromatography. Placental mRNA levels of PPARα, PPARγ, SREBP-1c, LXRα, RXRα, and RXRγ were examined using quantitative real time PCR. Placental DHA levels and mRNA levels of placental PPARγ and LXRα were lower (P &amp;amp;lt; .05 for all) in women delivering LBW babies. There was a positive association of placental PPARγ mRNA levels and placental DHA levels with baby weight (P &amp;amp;lt; .05 for both). Our data suggest that lower placental DHA and transcription factors may have a vital role in the etiology of LBW babies.
Hysterectomy is one of the most commonly performed gynecological procedures. Although the first l... more Hysterectomy is one of the most commonly performed gynecological procedures. Although the first laparoscopic hysterectomy was performed in 1989, this technique accounts for only a few of all hysterectomies performed today. To assess the safety of total laparoscopic hysterectomy through a novel technique that we have evolved, a retrospective analysis of 140 patients with benign uterine pathologies operated at our institute between 2004 and 2007 was performed. All patients underwent total laparoscopic hysterectomy (TLH) using a simple technique. The highlight of this technique was the omission of any vaginal manipulator. The mean operation time was 88.75 ± 52.72 minutes, the mean blood loss 53.80 ± 35.94 ml and the mean hospital stay 2.21 ± 1.12 days. No conversion to open surgery was necessary. Iatrogenic complications were bowel injury (n=1) and vaginal tears (n=3) and were managed laparoscopically. The new method of TLH proved to be reproducible and safe with decreased morbidity and operation time. This can be attributed to the performance of the same standardized steps each time. Our technique provides a safe procedure suitable for routine use in gynecological surgery.
Journal of Diabetology : Official Journal of Diabetes in Asia Study Group, 2023
Introduction: Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility due to ano... more Introduction: Polycystic ovarian syndrome (PCOS) is the commonest cause of infertility due to anovulation. The combination of Curcuma longa (CL) and Emblica officinalis (EO) is known to ameliorate diabetes and, thereby, may resurrect PCOS. The present study aimed to evaluate the effect of this combination prepared by two different methods, independently and with metformin (Met), compared with Met in PCOS on glycaemic control, inflammation, adipokines, and anthropometry. Aim: The aim of the study was to evaluate the effect of the combination of CL and EO, prepared by two different methods, independently and with Met, compared with Met in PCOS. Materials and Methods: PCOS women aged 18–35 years were selected through Rotterdam criteria from a tertiary care teaching hospital setting post-Ethics Committee permission. They were randomized to five groups (eight per group); combination of CL and EO prepared by traditional method (TF- Traditional Formulation), standardized extraction method (PNAE- Pharmanza Nisha Amalaki Extract), standard control Metformin (Met) and their combinations, TF + Met and PNAE + Met for 90 days. Fasting glucose, insulin, lipid profile, reproductive hormones (luteinizing hormone [LH], follicle-stimulating hormone [FSH], and free testosterone), inflammatory markers (tumor necrosis factor-alpha [TNF-α], interleukin [IL]-6), and adipokines (leptin and adiponectin) were done at baseline and day 90, whereas anthropometry was done monthly. Results: Of 48 randomized women, 37 completed the study. TF and Met groups demonstrated higher weight decrease, whereas TF + Met significantly decreased waist circumference. Blood glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) decreased in all groups except glucose in TF + Met and HOMA-IR in the Met group. Only PNAE decreased free testosterone. TNF-α increased while leptin decreased in all groups. Both TF and PNAE, with Met reduced IL 6, significantly only in PNAE + Met group. Similarly, both TF and PNAE, with Met reduced LH/FSH ratio and significantly increased adiponectin. Two females, each, conceived in TF and PNAE, whereas one was in PNAE + Met group. No adverse events were reported. Conclusion: Both botanical formulations, TF and PNAE, were comparable to Met. The standardized extracts formulation PNAE seems more promising due to administration ease, smaller dose, and consistent bioactives.
The Journal of Obstetrics and Gynecology of India, Jun 8, 2019
BackgroundTransversus abdominis plane (TAP) block is a fascial plane block providing postoperativ... more BackgroundTransversus abdominis plane (TAP) block is a fascial plane block providing postoperative analgesia after lower abdominal surgeries including Cesarean section. Conventionally, it is administered under ultrasound guidance or by blind technique. We studied a novel transperitoneal surgical TAP block for providing safe and effective analgesia after Cesarean section through transverse incision.MethodsA hundred patients who fulfilled the inclusion criteria were included in the study after obtaining informed written consent. They were randomized in two groups: Group A with surgical TAP block and Group B without TAP block as control. Surgical TAP block was administered by transperitoneal route before the closure of peritoneum with 0.25% bupivacaine (dose adjusted with weight of the patient), and visual analogue score was assessed by a blind assessor. Time for rescue analgesia was noted and analyzed with the ‘two independent sample t test.’ResultsThe duration of postoperative analgesia in hours was significantly longer in the TAP block group compared with the control group (5.14 ± 1.63 vs 2.61 ± 0.89, p < 0.001). There was no reported complication of the surgical technique or any adverse effect of the used drug.ConclusionSurgical TAP block via the transperitoneal route is a safe, easy and effective mode of providing postoperative analgesia after Cesarean section. This technique does not need any costly specialist equipment, overcomes the technical limitations of ultrasound-guided TAP block and can be used in obese patients also. It has almost no side effects, and the technique can be easily mastered.
The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the act... more The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the activity of fatty acid desaturase (FADS) enzymes, fatty acid transport proteins (FATP) and fatty acid binding proteins (FABP). In a previous study we have demonstrated region-specific changes in the LCPUFA levels in preeclampsia (PE) as compared to the normotensive control (NC) placentae. AIM To understand the region-specific changes in the mRNA levels and protein expression of biosynthesis enzymes and transporters of LCPUFA in PE and NC placentae. METHODS In this cross-sectional study, 20 NC women and 44 women with PE (23 term (TPE) and 21 preterm PE (PTPE)) were recruited. The samples were collected from four regions of the placentae considering cord insertion as the center (CM, central maternal/basal; CF, central fetal/chorionic; PM, peripheral maternal/basal and PF, peripheral fetal/chorionic). The mRNA levels were estimated using qRT-PCR. Statistical analysis was done using both post hoc least significant difference (LSD) test and Benjamini Hochberg correction in the analysis of covariance. Preliminarily, localization and expression of proteins were studied by immunohistochemistry (n = 3/group). RESULTS The mRNA levels of FADS1, FADS2 and FATP1 were lower in the central regions (CM and CF) of the PE placentae (both TPE and PTPE) as compared to NC. These differences in the mRNA levels were observed by the LSD test and were not significant after the Benjamini Hochberg correction. Preliminary findings of IHC indicate that the protein expression of FADS1 and FATP4 was higher in the basal regions (CM and PM) of the PE placentae as compared to NC. FADS1, FADS2 and FATP4 proteins were localized in the syncytiotrophoblasts, cytotrophoblasts, mesenchymal cells, endothelial cells of the fetal capillaries and extravillous trophoblasts of the placenta. CONCLUSION FADS enzymes are detected in the placentae of Indian women. In PE placentae, there are region-specific alterations in the mRNA and protein levels of LCPUFA biosynthesis enzymes (FADS1 and FADS2) and transporters (FATP1, FATP4 and FABP3) as compared to term NC. These changes were more pronounced toward the basal side and region around the cord insertion.
A very large number of fatty acids play wide range of physiological roles in cellular growth and ... more A very large number of fatty acids play wide range of physiological roles in cellular growth and function in placental as well as fetal growth. However, docosahexaenoic acid (DHA), in addition to its critical role in cellular membranes, is known to act as a ligand for several nuclear receptors and regulates the activity of transcription factor families like peroxisome proliferator-activated receptor, liver X receptor (LXR), retinoid X receptor (RXR), and sterol regulatory element binding protein (SREBP). These transcription factors and DHA are known to regulate the placental and fetal growth and development. The objective of the present study was to examine the fatty acids and transcription factors in the placenta of women delivering low birth weight (LBW) babies. The present study examines the fatty acid and mRNA levels of various transcription factors in the placentae of women delivering normal birth weight (NBW) (n = 38) and women delivering LBW (n = 36). Placental fatty acids were analyzed using gas chromatography. Placental mRNA levels of PPARα, PPARγ, SREBP-1c, LXRα, RXRα, and RXRγ were examined using quantitative real time PCR. Placental DHA levels and mRNA levels of placental PPARγ and LXRα were lower (P &amp;amp;lt; .05 for all) in women delivering LBW babies. There was a positive association of placental PPARγ mRNA levels and placental DHA levels with baby weight (P &amp;amp;lt; .05 for both). Our data suggest that lower placental DHA and transcription factors may have a vital role in the etiology of LBW babies.
Hysterectomy is one of the most commonly performed gynecological procedures. Although the first l... more Hysterectomy is one of the most commonly performed gynecological procedures. Although the first laparoscopic hysterectomy was performed in 1989, this technique accounts for only a few of all hysterectomies performed today. To assess the safety of total laparoscopic hysterectomy through a novel technique that we have evolved, a retrospective analysis of 140 patients with benign uterine pathologies operated at our institute between 2004 and 2007 was performed. All patients underwent total laparoscopic hysterectomy (TLH) using a simple technique. The highlight of this technique was the omission of any vaginal manipulator. The mean operation time was 88.75 ± 52.72 minutes, the mean blood loss 53.80 ± 35.94 ml and the mean hospital stay 2.21 ± 1.12 days. No conversion to open surgery was necessary. Iatrogenic complications were bowel injury (n=1) and vaginal tears (n=3) and were managed laparoscopically. The new method of TLH proved to be reproducible and safe with decreased morbidity and operation time. This can be attributed to the performance of the same standardized steps each time. Our technique provides a safe procedure suitable for routine use in gynecological surgery.
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