Asthma and diabetes have strong relationship; both are cause and effect of each other. Oxidative stress due to bronchial asthma may cause insulin resistance whereas lack of proper insulin can cause defective smooth muscle relaxant. There is no single medicine available that can manage both diseases, rather the mainstay treatment of bronchial asthma causes hyperglycemia. Keeping this problem in focus, in this study the hypoglycemic effect of an indigenous antiasthmatic Ayurvedic drug Shirishadi was evaluated. Pancreatic alpha amylase and glucosidase inhibitors offer an effective strategy to lower the level of post prandial hyperglycemia via control of starch breakdown. For evaluation of hypoglycemic activity of drug, in-vitro alpha amylase and alpha glucosidase enzyme inhibition was calculated. Ethanolic extract of compound showed 76.40% + 0.88% reduction in alpha amylase activity and 63.85% + 0.36% in alpha glucosidase activity with IC50 0.68 mg/ml and 2.89 mg/ml, respectively. This study suggests that the ethanolic extract of Shirishadi polyherbal compound effectively acts as alpha amylase and glucosidase inhibitor leading to a reduction in starch hydrolysis and hence acts as antiasthmatic as well as hypoglycemic drug.

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Background: Obstructed labour is one of the most common preventable cause of maternal and neonatal morbidity and mortality in developing countries. This study was undertaken to assess the incidence, causes and feto-maternal outcomes of obstructed labour. Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital, Patna, Bihar, India over a period of one year from February 2012 to February 2013. The 228 patients diagnosed to have obstructed labour were studied. Results: Out of 2556 deliveries conducted during this period, 228 cases of obstructed labour were found constituting an incidence of 8.9%. Majority of the patients were unbooked (89.47%), between 21-30 years of age (90.35%) and with parity 3 or more. The most common cause of obstructed labour was malposition (45.61%) followed by cephalopelvic disproportion (43.85%) and malpresentation (8.7%). caesarean section was the most common mode of delivery. In 21.92% of cases ruptured uterus was diagnosed pre-operatively among which, 2.63% has scar rupture and in remaining cases rupture was in unscarred uterus due to obstructed labour diagnosed intra-operatively. PPH was seen intra-operatively in 17.54% of cases and bladder trauma in 3.5% of cases. Most common post-operative complications were paralytic ileus (52.6%) followed by severe anaemia (48.2%) and infections (23.68%). Only 0.8% patients developed vesico-vaginal fistula as a late sequela of obstructed labour. The maternal mortality was 3.5% and perinatal mortality was 39%. Conclusions: In present study, the incidence of obstructed labour is very high. Good antenatal care, education of primary health care providers and traditional birth attendants on dangers of obstructed labour and the need for early referral is suggested to reduce the incidence of this condition.

Aims of Study:To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks.Materials and Methods:In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine.Results:Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades.Discussion:The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique.Conclusion:A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.

The consequences of climate change and land subsidence are often related to sea level rise/fall. Mangrove extinction and migration were assessed through palynological studies in two sedimentary cores in order to address climate, Relative Sea level (RSL) and its relation to geomorphology since 8420 cal. yr BP from Kanuru (500 cm deep) and since 5850 cal. yr BP from Machilipatnam (118 cm deep), Krishna delta, India. Four units/nine phases of sediment depositional environment were identified on the basis of marine/terrestrial palynomorphs. In Unit 1, the marine palynomorphs indicate palaeoshoreline in Kanuru from 8420 to 8300 cal. yr BP which is now ~4–5 km from the present-day shoreline, but after a short span a retreat in sea level took place between 8300 and 7040 cal. yr BP. About three to four short-term intermittent rise/fall in RSL were recorded in Unit 2 between 7040 and 3980 cal. yr BP in Kanuru and between 5225 and 3240 cal. yr BP in Machilipatnam. During this period, the diversity of mangroves was more in Machilipatnam and only salt-tolerant mangroves were present in Kanuru. Unit 3 is characterized by non-estuarine sediment deposition since 3920–240 cal. yr BP in Kanuru and since 3240–950 cal. yr BP in Machilipatnam. Unit 4 shows a rise in RSL in both the studied sites which began much earlier in Machilipatnam than in Kanuru. Loss of mangrove diversity and dominance of salt-tolerant mangroves were recorded in Unit 4. Results indicate climate-induced RSL fluctuations highlighting the cooling event of 8.2 ka BP from Kanuru site and duration of intermittent rise/fall of RSL during middle Holocene transgression. The rate of sea level rise during the period was not continuous but interrupted by three to four retreats. At present, the evidence of these are at different depths in both the sites and in other contemporary sites along the east coast of India, suggesting neo-tectonics in the vertical stack of Holocene sediment. The geomorphology of the studied sector is tectonically controlled which may increase deltaic instability in future.

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Background: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective and long-term contraception such as intrauterine device (IUCD) in post-partum women. This study was done to determine the efficacy and safety of Post-Partum Intrauterine Device (PPIUCD) and to compare the outcomes of PPIUCD insertion after vaginal delivery and caesarean section.Methods: This follow up study was carried out in the department of Obstetrics and Gynecology, Dr. R.M.L Hospital, PGIMER, New Delhi over a period of 7 month from January 2016 to July 2016. PPIUCD (cu T- 380 A) insertions were done in 136 women who fulfilled the inclusion criteria. Women having haemoglobin less than 8 gm%, rupture of membranes more than 18 hours, obstructed labour, Uterine anomalies, distorted uterine cavity by fibroid, significant postpartum haemorrhage, coagulation disorders, fever or clinical symptoms of infection during labour were excluded from the study. Post insertion counselling was done, and these women were advised to follow up at 6 weeks and then after 6 months postpartum in the family planning O.P.D. At the follow-up visit, the women were asked for any symptoms of unusual vaginal discharge, irregular or heavy bleeding per vagina, and any expulsions if noticed.Results: Total number of cases that reported for follow up in family planning OPD was 118. Therefore, 18 patients were lost in the follow up. In 58.47% women, there was no complaint. Heavy menstrual bleeding was found in 17.79% women and pelvic pain in 16.10% women. The expulsion rate was 5.08% and IUCD removal was done in 12.71% women. Though, the incidence of expulsion and removal rate was more in vaginal insertions than in caesarean insertions but this difference was not statistically significant, while the incidence of missing threads were found more in intra caesarean insertion (28% vs. 11.76% with p value <0.05). Continuation rate at 6 month was 82.20%.Conclusions: PPIUCD insertion is a safe, convenient and effective method of contraception. Although the expulsion rate and removal rate was more in vaginal PPIUCD insertions, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in our country where most of the women do not come for contraceptive advice after delivery.

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