Assessment of lactogenic potential of some traditional herbs

Raval, M.A.,Patel, H.P.,Mishra, S.H. Kyung Hee Oriental Medicine Research Center 2010 Oriental pharmacy and experimental medicine Vol.10 No.2

The entire plant of Leptadenia reticulata (Asclepidaceae) is extensively used as lactogen, traditionally, in veterinary practice. The plants of Dregea volubilis and Pentatropis microphylla (Asclepidaceae) are now used as its substitute and sometimes replace the original drug as traditional lactogen. The lactogenic potential of these drugs was studied in rats using, pup weight, weight of mother, parenchyma percentage, secretary rating, estimation of total protein content and glycogen content of mammary glands tissues as assessment parameters. HPTLC profiles of bioactive extracts were also generated to serve the authentification needs. The results of present studies show that P.microphylla forms a better substitute over D. volubilis.

Assessment of lactogenic potential of some traditional herbs

MA Raval,HP Patel,SH Mishra 경희대학교 융합한의과학연구소 2010 Oriental Pharmacy and Experimental Medicine Vol.10 No.2

The entire plant of Leptadenia reticulata (Asclepidaceae) is extensively used as lactogen, traditionally, in veterinary practice. The plants of Dregea volubilis and Pentatropis microphylla (Asclepidaceae) are now used as its substitute and sometimes replace the original drug as traditional lactogen. The lactogenic potential of these drugs was studied in rats using, pup weight, weight of mother,parenchyma percentage, secretary rating, estimation of total protein content and glycogen content of mammary glands tissues as assessment parameters. HPTLC profiles of bioactive extracts were also generated to serve the authentification needs. The results of present studies show that P.microphylla forms a better substitute over D. volubilis.

Outcomes of Magnetic Resonance Imaging Detected Occult Neck of Femur Fractures: Do They Represent a Less Severe Injury with Improved Outcomes?

Pradyumna Raval,Alistair I.W. Mayne,Phey Ming Yeap,Thomas Barry Oliver,Arpit Jariwala,Sankar Sripada 대한고관절학회 2019 Hip and Pelvis Vol.31 No.1

Purpose: Occult hip fractures in the elderly can be missed on standard radiographs and are a known cause of morbidity. These are generally diagnosed on either magnetic resonance imaging (MRI) or computed tomography scan, depending upon local hospital policy. While there is an abundance of literature on hip fractures in general, little is known about the clinical outcome of patients with occult hip fractures. The aim of this study was to review the demographics, injury characteristics, management and clinical outcome of patients diagnosed with occult femoral neck fractures on MRI. Materials and Methods: Using an existing hospital database, a retrospective analysis of all patients with occult hip fractures diagnosed by MRI scan from 2005 to 2014 was conducted. Results: Sixty-four patients (23 males and 41 females) were included. The mean duration of hospitalisation was 16 days. A significantly higher percentage of patients were discharged to their pre-existing residence compared to National Institute for Health and Care Excellence (NICE) commissioning guidelines (66% vs. 45%). The 30-and 60-day mortalities were 3% and 10%, respectively. Mortality was lower in patients who underwent internal fixation (n=3/31) compared with those undergoing replacement (hemi/total hip arthroplasty) (n=5/12) (P=0.056). Conclusion: Patients with occult hip fractures diagnosed on an MRI scan are more likely to be discharged to their pre-existing residence and have lower mortality rates compared to NICE guidelines and National Hip Fracture Database (NHFD).

Complications following an unnecessary peri-operative plasma transfusion and literature review

Jay S. Raval,Jonathan H. Waters,Darrell J. Triulzi,Mark H. Yazer 대한혈액학회 2012 Blood Research Vol.47 No.4

Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82 year old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction, including hives and voice hoarseness, which caused a 4-week delay in her surgery. This delay and adverse reaction could have been avoided had the principles of evidence based plasma therapy, which we herein review, been followed and if the etiology of the mildly elevated INR been investigated before the day of her surgery.

The impact of suctioning RBCs from a simulated operative site on mechanical fragility and hemolysis

Jay S. Raval,Jonathan H. Waters,Mark H. Yazer 대한혈액학회 2011 Blood Research Vol.46 No.1

Background :Intraoperative cell salvage exerts shear stress upon RBCs, particularly as they are suctioned from the surgical field. Shear stress can result in overt hemolysis or it can cause sublethal injury to the suctioned RBCs. The mechanical fragility (MF) test uses shear stress to measure the extent of RBC sublethal injury. RBCs that have sustained sublethal injury are more susceptible to shear stress induced hemolysis. In this study we suctioned whole blood samples from an artificial surgical field to determine if pre-menopausal female RBCs would demonstrate greater resistance to hemolysis and less sublethal injury compared to that of males and post-menopausal females. Methods :Ten CPD-preserved whole blood units from these 3 donor groups were obtained and samples suctioned at -150 mmHg from a simulated surgical field. The MF test was then performed and the % hemolysis calculated. In addition the MF test was serially performed on these whole blood units during the 21 days of storage. Results :There were no differences in the extent of hemolysis or RBC shear stress resistance after suctioning between the 3 donor groups. During storage the pre-menopausal female RBCs demonstrated higher shear stress tolerance compared to the males or post-menopausal females at all of the time points. Conclusion :Although during static storage pre-menopausal female RBCs in CPD-preserved whole blood demonstrated higher shear stress tolerance, this enhanced resistance was not observed after suctioning from a simulated surgical field.

The top 10 things to know about transfusion medicine before intern year: an evidence-based course for graduating medical students

Alexis R. Peedin,Irina Perjar,Marshall A. Mazepa,Marian A. Rollins-Raval,Yara A. Park,Jay S. Raval 대한혈액학회 2019 Blood Research Vol.54 No.2

BackgroundTransfusion medicine (TM) knowledge varies widely among physician trainees. In addi-tion, there have been few instances in which curricular changes have been meaningfully assessed for TM education in medical school.MethodsWe created and presented a novel lecture to improve TM knowledge for graduating medi-cal students using eight objectives designed to reinforce critical information about blood management. Each objective was coded according to unique color schemes, fonts, and graphics to create visual associations while quickly and clearly presenting complex concepts. The validated BEST Collaborative exam was used to measure changes in student TM knowledge, while a survey was conducted to gauge changes in confidence for each objective. Students were asked to submit anonymous feedback about their experiences. ResultsThe mean student post-course exam score was 50.0%, while the pre-course baseline score was 27.5% (P<0.0001). Mean confidence levels increased significantly for all objectives. Student feedback was universally positive.ConclusionThis study improved knowledge and confidence for graduating medical students by utiliz-ing engaging and visually stimulating presentations to display high-impact TM material. However, further efforts are needed to optimize learning.

In-hospital Outcomes of Aspiration Pneumonia Hospitalizations With Acute Heart Failure: A Nationwide Analysis

Jain Akhil,Raval Maharshi,Srikanth Sashwath,Modi Karnav,Raju Athul Raj,Garg Monika,Doshi Rajkumar,Desai Rupak 대한심부전학회 2023 International Journal of Heart Failure Vol.5 No.4

Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78–1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96–1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30–3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17–1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF. Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78–1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96–1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30–3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17–1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF.

Etiologies and Predictors of 30-Day Readmission in Heart Failure: An Updated Analysis

Jain Akhil,Arora Shilpkumar,Patel Viral,Raval Maharshi,Modi Karnav,Arora Nirav,Desai Rupak,Bozorgnia Behnam,Bozorgnia Behnam 대한심부전학회 2023 International Journal of Heart Failure Vol.5 No.3

Background and Objectives Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions. Methods National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed. Results Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had higher proportion of males (56.3% vs. 53.7%), lowest income quartiles (33.3% vs. 28.9%), Charlson comorbidity index (CCI) ≥3 (61.7% vs. 52.8%), resource utilization including large bed-size hospitalizations, Medicaid enrollees, mean length of stay (6.2 vs. 5.4 days), and disposition to other facilities (23.9% vs. 20%) than non-readmitted. Readmission (30-day) rate was 21.2% (10,370) with cardiovascular causes in 50.3% (HF being the most common: 39%), and non-cardiac in 49.7%. Independent predictors for readmission were male sex, lower socioeconomic status, nonelective admissions, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, anemia, and CCI ≥3. HF-specific readmissions were significantly associated with prior coronary artery disease and Medicaid enrollment. Conclusions Our analysis revealed cardiac and noncardiac causes of readmission were equally common for 30-day readmissions in HF patients with HF itself being the most common etiology highlighting the importance of addressing the comorbidities, both cardiac and non-cardiac, to mitigate the risk of readmission. Background and Objectives Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions. Methods National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed. Results Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had higher proportion of males (56.3% vs. 53.7%), lowest income quartiles (33.3% vs. 28.9%), Charlson comorbidity index (CCI) ≥3 (61.7% vs. 52.8%), resource utilization including large bed-size hospitalizations, Medicaid enrollees, mean length of stay (6.2 vs. 5.4 days), and disposition to other facilities (23.9% vs. 20%) than non-readmitted. Readmission (30-day) rate was 21.2% (10,370) with cardiovascular causes in 50.3% (HF being the most common: 39%), and non-cardiac in 49.7%. Independent predictors for readmission were male sex, lower socioeconomic status, nonelective admissions, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, anemia, and CCI ≥3. HF-specific readmissions were significantly associated with prior coronary artery disease and Medicaid enrollment. Conclusions Our analysis revealed cardiac and noncardiac causes of readmission were equally common for 30-day readmissions in HF patients with HF itself being the most common etiology highlighting the importance of addressing the comorbidities, both cardiac and non-cardiac, to mitigate the risk of readmission.

Formulation and evaluation of microsponge gel for topical delivery of fluconazole for fungal therapy

Nirav Patel,Niyati Padia,Neha Vadgama,Mihir Raval,Navin Sheth 한국약제학회 2016 Journal of Pharmaceutical Investigation Vol.46 No.3

The aim of the present research was to develop Fluconazole loaded microsponge-based topical delivery system for controlled release and enhanced drug deposition in the skin. Microsponges containing fluconazole were prepared by an emulsion solvent diffusion method. The effect of formulation variables (drug: polymer ratio, internal phase volume and amount of emulsifier) and process variables (stirring time and stirring speed) on the physical characteristics of microsponges like Production yield, Mean particle size, Entrapment efficiency were investigated. The effect of internal phase volume and amount of emulsifier on the physical characteristics of microsponges were examined on optimized drug/polymer ratio, stirring speed and stirring time by 32 factorial design. The optimized microsponges were dispersed into a hydrogel and evaluated. In vitro drug release, Ex vivo drug deposition, primary skin irritancy study and In vivo antibacterial activity of fluconazole-loaded formulations were studied. Spherical and porous FLU microsponge particles were obtained. From 32 factorial design, it was concluded that optimized microsponge possess particle size, production yield and entrapment efficiency of 2.45 lm, 77.38 and 92.33 %, respectively. Microspongeloaded gels demonstrated controlled release, no irritancy to rat skin and antifungal activity. An In vivo skin deposition study demonstrated four fold higher retention in the stratum corneum layer as compared with marketed cream. Microsponges-based gel formulations showed prolonged efficacy in mouse surgical wound model infected with Candida spp. Fluconazole was stable in topical formulations and showed enhanced retention in the skin indicating better potential of the delivery system for treatment of primary and secondary skin infections.

Microsurgical Denervation of Spermatic Cord for Chronic Idiopathic Orchialgia: Long-Term Results from an Institutional Experience

Rajeev Chaudhari,Satyadeo Sharma,Shahil Khant,Krutik Raval 대한남성과학회 2019 The World Journal of Men's Health Vol.37 No.1

urpose: Chronic testicular pain remains an important challenge for urologists. At present there are many treatment modali-ties available for chronic orchialgia. Some patients remain in pain despite a conservative treatment. Microsurgical denerva-tion of spermatic cord appears to be successful in relieving pain in patients who fail conservative management. We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treat-ment of chronic orchialgia. Materials and Methods: A prospective study was conducted from January 2007 to January 2016 which included men with testicular pain of >3 months duration, failure of conservative management, persistent of pain for >3 months after treating the underlying cause. Total 48 patients with 62 testicular units (14 bilateral) showed the response to spermatic cord block and underwent microsurgical denervation of spermatic cord. Results: Out of 62 testicular units (14 bilateral) which were operated, complete 2 years follow-up data were available for 38 testicular units. Out of these 38 units, 31 units (81.57%) had complete pain relief, 4 units (10.52%) had partial pain, and 3 units (7.89%) were non-responders. Complications were superficial wound infection in 3 units (4.83%), hydrocele in 2 units (3.22%), subcutaneous seroma in 2 units (3.22%), and an incisional hematoma in 1 unit (1.61%) out of 62 operated testicu-lar units. Conclusions: Idiopathic chronic orchialgia remains a difficult condition to manage. If surgery is considered, microsurgical denervation of spermatic cord should be considered as a first surgical approach to get rid of pain and sparing the testicle.