Wound Healing and Ficus hispida Linn. – Overview

INTRODUCTION

Plants have been the major source of drugs in Indian system of medicine and other ancient systems in the world. Earliest description of curative properties of medicinal plants is found in Rig-Veda, Charaka Samhita and Sushrusha Samhita give extensive description on various medicinal herbs. Information on medicinal plants in India has been systematically organized. India has an ancient heritage of traditional medicine.The materia medica of India provides a great deal of information on the folklore practices and traditional aspects of therapeutically important natural products.Indian traditional medicines based on various systems including Ayurveda, Siddha, Unani and Homeopathy^[1].

Wound healing:                                                                                                   

Healing is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area. Healing incorporates both the removal of necrotic tissue (demolition), and the replacement of this tissue.

Wound healing is a complex phenomenon that results in the restoration of disrupted anatomical continuity and disturbed functional status of the skin ^[2] accomplished by several processes which involve fibro genesis, neo-vascularization, wound contraction and epithelization ^[3] .The basic principle of optimal wound healing is to minimize tissue damage and provide adequate tissue perfusion and oxygenation, proper nutrition and moist wound healing environment to restore the ^[4].

Herbal medicines have been the basis of Ayurveda, Unani and Siddha. One of the surveys conducted by the WHO reports that more than 80% of the world’s population still depends upon the traditional medicines for various diseases. In the developed countries 25 percent of the chronic wounds may even lead to multiple organ failure of death of the patients. Wounds are the physical injuries that result in an opening or breaking of the skin and appropriate method for healing of wounds is essential for the restoration of disrupted anatomical continuity and disturbed functional status of the skin ^[5-6].

 

 

CLASSIFICATION OF WOUND

Wounds are classified as open and closed wound on the underlying cause of wound creation and acute and chronic wounds on the basis of physiology of wound healing.

Open wounds:

In this case blood escapes the body and bleeding is clearly visible. It is further classified as: Incised wound, Laceration or tear wound, Abrasions or superficial wounds, Puncture wounds, Penetration wounds and gunshot wounds ^[7].

Closed wounds:

In closed wounds blood escapes the circulatory system but remains in the body. It includes Contusion or bruises, heamatomas or blood tumor, Crush injury etc.

Acute wounds:

Acute wound is a tissue injury that normally precedes through an orderly and timely reparative process that results in sustained restoration of anatomic and functional integrity. Acute wounds are usually caused by cuts or surgical incisions and complete the wound healing process within the expected time frame ^[8].

Chronic wounds:

Chronic wounds are wounds that have failed to progress through the normal stages of healing and therefore entera state of pathologic inflammation chronic wounds either require a prolonged time to heal or recur frequently. Local infection, hypoxia, trauma, foreign bodies and systemic problems such as diabetes mellitus, malnutrition, immunodeficiency or medications are the most frequent causes of chronic wounds ^{[8, 9]}.

PHASES OF WOUND HEALING:

The Inflammatory phase:

The inflammatory phase starts immediately after the injury that usually last between 24 and 48 hrs and may persist for up to 2 weeks in some cases the inflammatory phase launches the haemostatic mechanisms to immediately stop blood loss from the wound site. Clinically recognizable cardinal sign of inflammation, rubor, calor, tumor, dolor and function-laesa appear as the consequence. This phase is characterized by vasoconstriction and platelet aggregation to induce blood clotting and subsequently vasodilatation and phagocytosis to produce inflammation at the wound site ^[10].

Fibroblastic phase:

The second phase of wound healing is the fibroplastic phase that lasts upto 2 days to 3 weeks after the inflammatory phase. This phase comprises of three steps viz., granulation, contraction and epithelialisation. In the granulation step fibroblasts form a bed of collagen and new capillaries are produced. Fibroblast produces a variety of substances essential for wound repair including glycosaminoglycans and collagen. Under the step of contraction wound edges pull together to reduces the defects in the third step epithelial tissues are formed over the wound site ^[11].

Epithelization phase:

 Epithelial cell migration is one of the vital processes of wound healing. The stem cells of epithelium must detach from the edges of the wound and migrate into wound. Normally dermal basal cells adhere to each other and to the underline basal layer of the dermis. Following mobilization, epithelial cells begin to enlarge and migrate down and across the wound. Transected hair follicles also contribute to the number of migrating epithelial cells. Epithelial cell migrating across wound usually move along the basal lamina or fibrin deposits, this phenomenon is called contact guidance and is an important factor in epithelial migration. Epithelial migration is followed by increased mytosis of epithelium. Recent evidence suggests that a water soluble heatlabile substance called chalone which is secreted at the wound site is responsible for regulation for mytosis. ^[12]

 

Prolifrative phase:

Proliferative Phase (2 days to 3 weeks) includes: Granulation stage: Fibroblasts lay bed of collagenFills defect and produces new capillariesContraction stage: Wound edges pull together to reduce defect. Epithelialization stage: Crosses moist surface cell travel about 3 cm from point of origin in all directions ^[13].

CONTRACTION PHASE:

Wound contraction is caused by the action of differentiated fibroblasts (myofibroblasts) in the granulation tissue, which contain filaments of smooth muscle actin. Contraction of these fibroblasts makes the wound margins move toward the center of the wound^.[14,15] Wound contraction started sooner in ponies than in horses and it was significantly more pronounced in ponies .Additionally, it was significantly more pronounced in body wounds compared with the limb wounds. As a result, second intention wound healing was significantly faster in ponies

than in horses, and significantly faster in body wounds than in metatarsal wounds^.[16] Histology showed that myofi-broblasts were more organized in the wounds of the ponies: the myofibroblasts in the newly formed granulation tissue were transformed into a regularly organized pattern within 2 weeks, in which the cells were orientated perpendicular to the vessels and parallel to the wound surface. This appears to be a more favorable condition for wound contraction to occur. In the horses, myofibroblast organization took much longer. No differences were found in the number of fibroblasts, the amounts of smooth muscle actin and collagen^.[17] Further research was performed to investigate whether the differences in wound contraction between horses and ponies were caused by differences in the inherent contraction capacity of fibroblasts or the local environment of the fibroblasts. It was found that no differences existed in the inherent contraction capacity of fibroblasts from ponies and horses in vitro^.[18] However, the level of Transforming Growth Factor , the most important instigator of wound contraction, was significantly higher in the granulation tissue of pony wounds compared with horse wounds.

 

Remodeling phase:

This phase last for 3 weeks to 2 years. New collagen is formed in this phase. Tissue tensile strength is increased due to intermolecular cross-linking of collagen via vitamin-C dependent hydroxylation. The scar flattens and scar tissues become 80% as strong as the original ^{[19, 20].}

The wound healing activities of plants have since been explored in folklore. Many Ayurvedic herbal plants have a very important role in the process of wound healing. Plants are more potent healers because they promote the repair mechanisms in the natural way. Extensive research has been carried out in the area of wound healing management through medicinal plants. Herbal medicines in wound management involve disinfection, debridement and providing a moist environment to encourage the establishment of the suitable environment for natural healing process ^[21].

 

HERBAL PLANTS FOR WOUND HEALING:

 

 

S.No	Plant Name	Family	Plant part used	Reference
1	Agave cantala Roxb.	Agavaceaae	LF	22
2	Annona squamosa L	Annonaceae	LF	23
3	Aporusa lindleyana	Euphorbiaceae	LF	24
4	Bidens biternata	Asteraceae	LF	25
5	Blumea lacera	Asteraceae	LF	22
6	Calycopterisfloribunda.	Combretaceae	LF	26
7	Chloroxylon swietenia	Rutaceae	LF	27
8	Colebrookeaoppositifolia	Lamiaceae	LF		22
9	Ficus racemosa L.	Moraceae	BK,  LF & FR		28
10	Piper betel L.	Piperacea	LF		29
11	Acacia catechu	Mimosaceae	BK		30
12	Ficus bengalensis L.,	Moraceae	LF		31
13	Datura stramonium L.	Solanaceae	LF		30
14	Ficus religiosa L.	Moraceae	BK		31

 

LF- Leaf, BK- Bark and FR- Fruit

 

REVIEW OF LITRATURE:

Plant Name                      Ficus hispidaLinn.

Kingdom                          Plantae Division Magnoliopsida Class Magnoliopsida Subclass  Dilleniidae Order Rosales Family Moraceae Genus Ficus Spcies hispida Botanicalname              Ficus hispida Linn.     Vernacular names Hindi –             Global, Kasha, Kala Umbar, Katgularia & Phalgu. Sanskrit-          Kakodumbarika, Malayuhu, Phalgu & Phanika. Gujarati-        Umbar English Malayalam –    Kaattaththi, Paarakam                                      Photograph of the Ficus hispida Linn. PLANT DESCRIPTION:  A moderate sized tree grows up to 5 meters in height. Leaves opposite, long, with scrubby surfaces, pubescent; receptacles fascicled in the stem, obovoid, hispid, and green turns yellow when ripe. Distribution: Throughout India growing wild in evergreen forests and waste lands. Traditional Uses: According to Ayurveda, it is astringent to bowels; useful in treatment of biliousness, ulcers, erysipelas, vomiting, vaginal complains, fever, inflammations, leukoderma, psoriasis, hemorrhoids, ulcers and leprosy. [32] Chemical constituents: Oleanolic acid, β-sitosterol, triterpenoids, flavonoids, Pharmacological Uses[33-38]: Ghosh R et al., Hypoglycemic activity of ficus hispida (bark) in normal and diabetic albino rats. Indian J Pharmacol 2004; 36: 222-225. Shanmugarajan TS, et al., Cardioprotective effect of ficus hispida linn: On cyclophosphamide provoked oxidative myocardial injury in a rat model. Int J Pharmacol 2008; 1:1-10. Sivaraman D et al., Sedative and anticonvulsant activities of the methanol leaf extract of ficus hispida linn. Drug Invent Today 2009; 1: 23-27. Huong VN et al., A strong anticancer agent isolated from the leaves of Ficus hispida L. Tap Chi Hoa Hoc 2006; 44: 345-9. Vishnoi SP et al., Evaluation of anti-inflammatory activity of leaf extracts of Ficus hispida. Indian J Nat Prod 2004; 20: 27-9. Mandal SC et al., Studies on antidiarrhoeal activity of ficus hispida. Leaf extract in rats. Fitoterapia 2002; 73: 663-667.   REFERENCES 1.          Sachdev Yadav, Mayank Kulshreshtha, Mradul Goswami, Chandana V.Rao and Veena SharmaJournal of Applied Pharmaceutical Science 01 (01); 2011: 38-41 2.           Perumal SR, Ignacimuthu S, Patric RD, Preliminary screening of ethnomedicinal plants from India, Eur Rev Med Pharmacol Sci, 12, 2008, 1-7 3.          Fabricant DS, Farnsworth NR, The value of plants used in traditional medicine for drug discovery, Environ Health Pers, 109 (Suppl 1), 2001, 69-75. 4.          Priya KS, Gnanamani A, Radhakrishnan N, Babu, Healing potential of Datura alba on burn wounds in albino rats, J. Ethnopharmacol., 83, 2002, 193-199. 5.          Steenkamp V, Mathivha E, Gouws MC, Rensburg CEJ, Studies on antibacterial, antioxidant and fibroblast growth stimulation of wound healing remedies from South Afr. J. Ethnopharmacol., 95, 2004, 353–357. 6.          Principe P, Monetising the pharmacological benefits of  plants. US Environmental protection Agency,Washington, D.C. 2005, 1991 7.          Strodtbeck F, Physiology of wound healing, Newborn InfantNurs. Rev, 1, 2001, 43-45. 8.          Kumar B, Vinaykumar M, Govindarajan R, Pushpangadan P, Ethanopharmacological approaches to wound healingexploring medicinal plants of India, J.Ethanopharmacol., 114, 2007, 103-113.  9.          Roberts PR, Black KW, Santamauo JT, Zaloga GP, Dietry peptides improve wound healing following surgery,Nutrition, 14, 1998, 266-269 10.      Li J, Chen J, Kirsener R, Pathophysiology of acute wound healing, Clin. Dermatol., 25,   2007, 9-18 11.      Stadelmalmann WK, Digenis AG, Tobin GR, Physiology and healing dynamics of chronic cutaneous wounds, Am. J.Surg. 176, 1998, 26S-38S 12.      Dr. Tamara et al. 2008, 12 book of pathophysiology basis for phase of wound healing. 13.      Romanian Biotechnological Letters  Copyright © 2008 Bucharest University. . Romanian Society of Biological Sciences Vol. 14, No. 4, 2009, pp. 4597-4605 Printed in Romania. All rights reserved. 14.       Clark RAF: Biology of dermal repair. Dermatol Clin 11:647-666, 1993 15.      Darby I, Skalli O, Gabbiani G: _-Smooth muscle actin is transiently expressed by myofibroblasts   during experimental wound healing. Lab Invest 63:21-29, 1990 16.      Jacobs KA, Leach DH, Fretz PB, et al: Comparative aspects of the healing of excisional wounds on the leg and body of horses. Vet Surg 13:83-90, 198 17.      Wilmink JM, van Weeren PR, Stolk PWT, et al: Differences in second intention wound healing between horses and ponies: Histological aspects. Equine Vet J 31:61-67, 1999 18.       Wilmink JM, Nederbragt H, van Weeren PR, et al: Differences in wound contraction between horses and ponies: the in vitro contraction capacity of fibroblasts. Equine Vet J 33:499-505, 2001 19.      Madden JW, Peacock EE, Studies on the biology of collagen during wound healing. I. Rate of collagen synthesis and deposition in cutaneous wounds of the rat, Surgery, 64, 1968, 288-294. 20.      Prockop DJ, Kivirikko KI, Tuderman L, Guzman NA, The biosynthesis of collagen and its disorders, N.Engl. J. Med.,301, 1979, 13-23. 21.      Purna SK, Babu M, Collagen based dressings/a review.  Burns 26, 2000, 54-62. 22.      Upadhyaya, O.P et al. (1998). Skin treatments of Bihar plants. Pharmaceutical Biology 36, 20–24 23.       Dash, S.S., Misra, M.K., 1999. Taxonomic survey and systematic census of economic plants of Narayana Patna Hills of Koraput Dist., Orissa. Journal of Economic and Taxonomic Botany 23, 473–498. 24.       Bhandary, M.J., Chandrasekhar, K.R., 2003. Herbal treatments for veterinary diseases from the coastal districts of Karnataka, India. Journal of Economic and Taxonomic Botany 27, 648–655 25.      Begum, D., Nath, S.C., 2000. Ethnobotanical reviewof medicinal plants used for skin diseases and related problems in Northeastern India, Journal of Herbs. Spices and Medicinal Plants 7, 55–93 26.      Bhandary, M.J., Chandrasekhar, K.R., 2002. Glimpses of ethnic herbal medicine of coastal Karnataka. Ethnobotany 14, 1–12. 27.      Girach, R.D., Ahmed, A., 1998. Medical ethnobotany of Sundargarh, Orissa, India. Pharmaceutical Biology 36, 20–24 . 28.      Punjani, B.L., 2002. Ethnobotanical aspects of some plants of Aravali Hills in North Gujarat. Ancient Science of Life 21, 268–280. 29.      Sarma, S.K., Bhattacharya, B.K., Devi, B., 2002. Traditional use of herbal  medicine by Modahi tribe of Nalabari district of Assam. Ethnobotany 14, 103–111. 30.      Patil SB, Naikwade NS, Kondawar MS, Magdum CS, Awale  VB, Traditional uses of plants for wound healing in the  Sangli district, Maharashtra, International Journal of Pharm Tech Research, 1(3), 2009, 876-878 31.      Ayyanar M, Ignacimuthu S, Herbal medicines for wound  healing among tribal people in Southern India  Ethnobotanical and Scientific evidences, International Journal of Applied Research in Natural Products, 2(3), 2009,29-42 32.      Kirtikar KR, Basu BD. Indian Medicinal Plants. Periodical Experts, New Delhi, 1975; 2:  2338. 33.      Ghosh R et al., Hypoglycemic activity of ficus hispida (bark) in normal and diabetic albino rats. Indian J Pharmacol 2004; 36: 222-225. 34.      Shanmugarajan TS, et al., Cardioprotective effect of ficus hispida linn: On cyclophosphamide provoked oxidative myocardial injury in a rat model. Int J Pharmacol 2008; 1:1-10. 35.      Sivaraman D et al., Sedative and anticonvulsant activities of the methanol leaf extract of ficus hispida linn. Drug Invent Today 2009; 1: 23-27. 36.      Huong VN et al., A strong anticancer agent isolated from the leaves of Ficus hispida L. Tap Chi Hoa Hoc 2006; 44: 345-9. 37.      Vishnoi SP et al., Evaluation of anti-inflammatory activity of leaf extracts of Ficus hispida. Indian J Nat Prod 2004; 20: 27-9. 38.      Mandal SC et al., Studies on antidiarrhoeal activity of ficus hispida. Leaf extract in rats. Fitoterapia 2002; 73: 663-667.

Author Information:

Ramandeep Singh*

Dept of Pharmacology, Himachal Institute of Pharmacy,  Rampurghat Road, Paonta

Sahib -173025, Himachal Pradesh, INDIA

*Corresponding Author’s Email: ramandeep_pharma@yahoo.com

 Address for Correspondences:

Mr. Ramandeep Singh, Assistant Prof.(Pharmacology) Himachal Institute of Pharmacy,  Rampur ghat Road, Paonta Sahib -173025, Himachal Pradesh, INDIA, Email- ramandeep_pharma@yahoo.com

Mob- +919736922900,  +919017138383

Mucocolpos in a 7 Month old newborn

Abstract

Imperforate hymen is an extreme manifestation of hymenal variation occurring in as less as 0.0014 to 0.1% of infants girls. Female infants with imperforate hymen rarely present with urological complications. We would like to  present  an unusual case of urinary incontinence with hydroureter and hydronephrosis in a 7 month old female child due to a large mucocolpos. This infant was successfully treated surgically.

 Case  Report

A  mother presented to the Uro-Gynaecology Outpatient department with her 7 month old daughter having complaints of urinary incontinence with dribbling of urine and mass in lower abdomen since last 15-20 days. On examination there was a large cystic mass in the hypogastrium which was extending upto the umbilicus. The lower end of masscould not be reached suggesting that it was arising from the pelvis. Ultrasonography showed a large cystic mass arising from the pelvis with a distended urinary bladder, hydroureter and hydronephrosis.(Fig 1). Differential diagnosis of bladder diverticulum, mesenteric cyst, a tuboovarian mass,or an ovarian cyst was made. Cystourethrogram was performed which showed a distended urinary bladder displaced anteriorly due to some mass behind it(Fig 2,3). Detailed gynecological examination was done under anaesthesia which revealed a bulging  IMPERFORATE  HYMEN. It was incised by a cruciate incision and ~1500 ml of straw coloured fluid was drained out.

 Discussion

Ambroise Pare first described Imperforate hymen in 1633.¹  Most distal form of vaginal outflow obstruction is called “imperforate hymen”. During normal embryological development, the central portion of the hymenal membrane disappears, creating the hymenal opening at the level of the vaginal vestibule.(Fig 4). Persistance of the intact hymenal membrance results in the condition of imperforate hymen. The imperforate hymen is a solid membrane interposed between the proximal uterovaginal tract and the introitus. This vertical fusion defect from other vertical fusion defects in that it is not derived from the mullerian system. This vaginal oulet obstruction leads to entrapment of vaginal and uterine secrection above it forming a cystic collection in the pelvis. Large mucocolpos can cause urethral compression anteriorly leading to bladder outflow obstruction,urinary retention with urnary tract infection, hydroureter and hydronephrosis. Most neonates with imperforate hymen are missed at birth, delaying the diagnosis sometimes upto early adolescence when they present with hematometrocolpos. Imperforate hymen may also present with back pain ,urinary retention (37%- 60% of patients ), and constipation.² Physical examination may reveal a lower abdominal mass on plapation, or a pelvis mass on bimanual rectal examination. The diagnosis of imperforate hymen is often established during examination when a distended bluish membrane is observed at the introitus. In the absence of this finding, only imaging study by ultrasound or MRI can establish the level of obstruction. The differential diagnoses of uterovaginal obstruction include disorders of vaginal development, such as a transverse vaginal septum or complete vaginal agenesis.which may be associated with other development anomalies(e.g, Rokitansky- Kuster-Maier-Hauersysdrome).

Prenatal diagnosis of imperforate hymen has also been reported. Fetal diagnosis has occurred as early as 25 weeks` gestation. A thin bulging memebrane separating the labia in association with a distended vagina is apparent on ultrasounography,³ these finding are usually noted during an evaluation for fetal ascites and are thought to result from distal urinary tract obstruction, however they can also be related to reflux of uterine contents through the fallopian tubes. Ascites and bladder outlet obstruction are the most common associated finding in the fetal period.⁴  Intestinal, cardiac and anorectal defects have NOT been reported in conjuction with imperforate hymen. Sometimes polydactyly is associated with imperforate hymen as in Mckusick-Kaufmann sysdrome.⁵

Careful evaluation of the perineum of the newborn is essential. Female neonate has full labia majora under the influence of maternal estrogens. Inspection of the introitus reveals that hymenal membrane is pink and slightly edematous. In the newborn with an imperforate hymen, the membrane is often bulging because of retained mucoid secretions. A vaginal cyst which fills the introitus but is attatched only to one vaginal aspect should be distinguished from imperforate hymen.

Aspirating secretions beyond the obstruction should be deferred because this procedure may result in iatrogenic pyocolpos. Instead, the diagnosis should be confirmed by performing noninvasive imaging studies (Ultrasonography, MRI) to determine the extent of vaginal outflow obstruction and to diagnose other associated anomalies (i.e imperforate hymen and a transverse vaginal septum) can occur.⁶

References :

1. Wall EM, Stone B, Klein BL. Imperforate hymen: a not-so-hidden diagnosis. Am J Emerg Med. May 2003;21(3):249-50.
2. Nazir Z, Rizvi RM, Qureshi RN, Khan ZS, Khan Z. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int. Sep 2006;22(9):749-53.
3. Winderl LM, Silverman RK. Prenatal diagnosis of congenital imperforate hymen. Obstet Gynecol. May 1995;85(5 Pt 2):857-60.
4. Ogunyemi D. Prenatal sonographic diagnosis of bladder outlet obstruction caused by a ureterocele associated with hydrocolpos and imperforate hymen. Am J Perinatol. 2001;18(1):15-21.
5. El-Messidi A, Fleming NA. Congenital imperforate hymen and its life-threatening consequences in the neonatal period. J Pediatr Adolesc Gynecol. Apr 2006;19(2):99-103.
6. Ahmed S, Morris LL, Atkinson E. Distal mucocolpos and proximal hematocolpos secondary to concurrent imperforate hymen and transverse vaginal septum. J Pediatr Surg. Oct 1999;34(10):1555-6.
7. Internet website  available on http://www.embryology.ch/anglais/ugenital/genitinterne06.html#sug

(This reference has been used in legend  4a and 4b)

 

Legends :

Fig 1 :  Ultrasonography showing Hydronephrosis and Hydroureter

Fig 2 : Cystourethrogram showing bladder compressed and displaced anteriorly  due to some mass behind .(both anteroposterior and posteroanterior view)

Fig 3: Cystourethrogram showing a distended urinary bladder extending upto the ribcage of the baby.

Fig 4a: In females, the development of the SUG (urogenital sinus) begins in the 3rd month, at the same time as the formation of the vagina.⁷

1=Genital tubercle   2= Vestibule  2a =SUG : phallic part  2b= SUG : lower  pelvic part of definitive  urogenital sinus   3=Vaginal plate  4=Perineum  5=Rectum  6= Utero-vaginal canal   7 = Urinary bladder  8=Urethra

Fig 4b: The pelvic part of the SUG has shrunk and will be retracted into the phallic part in order to form the definitive vaginal vestibule.⁷

2= vestibule  3a = uterine cavity  3b =uterine cervix  6a= vagina:lower fourth out of endoderm 6b =vagina :upper 3/4th out of mesoderm   9= hymen

 

Author:

 Dr. Baldawa Pratibha S                  

M.S(Obgyn),D.N.B, D.G.O,F.C.P.S,D.F.P,   Assistant Professor .

Correspondence address :

Baldawa Hospital, Budhwar Peth, Near Kasturba Market, Solapur – 413002,

Maharashtra,India.

Phone: (+91) 217- 2324762 (home), (+91) 9745306852 [Mobile].

Email : guptapj@yahoo.com

 

Health Risks Associated with Type 2 Diabetes

From hearing loss to foot numbness, the complications that result from type 2 diabetes vary as much as the patients. Whether you are a man or a woman, Caucasian or African-American, there are subtle differences in the way the disease progresses. Type 2 diabetes is known to quietly attack various groups of people in slightly different ways.

Type 2 diabetes is the most common form of diabetes, affecting millions of people each year. Some groups have a higher risk for developing the disease, including Native Americans, Asian-Americans and Latinos. However, it is India that has developed the world’s largest diabetes population with over 50.8 million people living with diabetes. While India’s government continues to raise awareness to its public, many other countries are facing the widespread epidemic.  Scientists are not completely sure what mechanism causes the disease; they do know that it causes the body’s cells to either not produce or ignore insulin, a naturally occurring hormone made by the pancreas. Without insulin, glucose in the body does not properly break down. That leads to diabetes complications. The list of type 2 diabetes complications is a long one and covers all parts of the body, from head to toe:

• Eye complications – Type 2 patients are more at risk for developing glaucoma, cataracts and retina dysfunction.
• Heart disease – This very real risk is especially prevalent in men with diabetes. Type 2 patients are also at a higher risk for a stroke.
• Mental health problems – Many patients go through stages of anger, denial and depression, especially when initially diagnosed.
• Skin disorders – Having diabetes puts patients at an increased risk of getting bacterial and fungal infections, as well as other diabetes-related skin conditions.
• Sexual dysfunction – Men with diabetes are more likely to suffer from erectile dysfunction and low testosterone.
• Foot problems – Also called neuropathy, diabetic nerve damage can lessen the ability to feel pain, cold or heat. Neuropathy causes poor blood flow.

From the list, it’s easy to see why it is so important for type 2 patients to be vigilant about their health care. At the initial diagnosis, most doctors will recommend a strict diet, a steady exercise regime and medication to stabilize insulin levels. While a new diet and exercise routine might be difficult to establish, the medication aspect of the process could prove to be even more challenging. That’s because of the lingering safety questions surrounding the most popular type 2 diabetes drug, Actos.

Also known as pioglitazone, Actos has been linked to a variety of life threatening side effects, including congestive heart failure and bladder cancer. The drug is known to cause edema, or swelling, which increases the risk for heart failure. Worse yet, recent studies show that those taking the drug for longer than two years have a more than 80 percent chance of developing bladder cancer. It seems that this drug puts already compromised bodily functions at risk for even more damage. In fact, many users of this medication have filed an Actos lawsuit against the drug manufacturer, Takeda.

Today, many doctors are steering their patients to more trusted medications, such as metformin, as a means to control blood sugar levels. Many feel that the risks that Actos presents are far too great for patients who are already struggling with a life-threatening disease.

Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease

 

About the Author:

Dr.Abeezar Sarela

Abeezar Sarela specialises in surgery for diseases of the oesophagus and stomach (often referred to as Upper Gastrointestinal Surgery or Upper GI Surgery or Foregut Surgery). There are three areas of sub-specialisation in this area: (1) surgery for obesity & related diseases such as diabetes (Bariatric & Metabolic Surgery);(2) surgery for cancer of the oesophagus and stomach (Surgical Oncology) & (3) surgery for benign disorders, such as gastro-oesophageal reflux disease, hiatus hernia, achalasia cardia and gastroparesis.

He practices in UK at: St James’s University Hospital, Nuffield Hospital, and Spire Hospital. He also operates in India at Hinduja Hospital, Mumbai

Contact: a.sarela@leeds.ac.uk

Website: http://foregutsurgeon.com/ (Powered by Websites For Doctors)

Waterbirth – Facts vs Myths

Hydrolabour is defined as the use of water during the active phase of first stage of labour. Hydrobirth entails the actual delivery of the baby that is the second and third stage of labour in the pool of warm water.

The equipment used is a disposable inflatable tub about 5 and ½ feet in diameter and two feet tall. The water is maintained at a constant 37* Celsius i.e body temperature which is warm to hot. Monitoring of labour for both patient & baby is just as we do in routine labours.

Patients are admitted early in labour and essentially the entire process of labour remains the same. Due consent is taken for the use of water in labour and delivery. The patient enters the pool of water in the active phase and labours and delivers there.

The baby is born active and calm as the mother holds and brings it out of water after a few seconds of adaptation. The cord is now cut and respiration is established. Placenta delivery may take place in the pool or after shifting the patient out. Episiotomy can be given underwater with local anaesthesia.

The average duration of second stage is shorter and the incidence of instrumentation is lower in patients undergoing Hydrobirth. None of our patients has had any significant 3rd stage complications.

There is absolutely no difference in the neonatal condition at birth or the incidence of neonates requiring resuscitation or other assistance.

 Facts Vs Myths

Myths/ Fears	Scientific Facts
The baby will aspirate water or drown .	There is no attempt to breathe till the cord is cut or exposure to air occurs.
Infection risk to the mother.	Theoretical- never reported in the last 50 yrs.
Infection risk to the baby .	Almost all babies are bathed in most hospitals after birth. We use the same water for our Hydrobirths.
Hygiene?	Disposable equipment available for each patient.
What about Episiotomy & the placenta.	Episiotomy under local anaesthesia can be given underwater. Delivery of the placenta may be done underwater or on the delivery table nearby

So why water?            

• 60% of our body is water!!!
• Water is the essence of life – natural & pure.
• Water is a muscle relaxant it rejuvenates and refreshes.
• Water increases blood supply to the uterus – takes away toxic local hormones.
• Water makes labour more efficient … more progress with lesser number of contractions.
• Gives buoyancy and makes you weightless.
• Results in shorter and less painful labours –without increasing the risk to mother and baby in any way.

In water stress hormones are reduced and pain relieving chemicals or endorphins are released in excess. Also the shock of sudden lights sound and other sensory stimuli to the baby is reduced if the baby goes from water to water to air rather than from water to air directly and these babies are reported to be more balanced and stable individuals who have better adaptive capabilities as adults later on in life.

The subjective reporting of pain relief has us completely stunned and very enthused about what we have seen.

We did not use any drugs or medication to hasten or accelerate these labours which is an important concept of natural birthing.

Benefits of Water Birthing?

1. Water is a muscle relaxant – it aids the passage of the baby through the birth canal.
2. Relives pain.
3. Refreshes & rejuvenates the mother – making her more co-operative
4. Shortens the duration of labour & reduces incidence of artificial instrumentation at delivery (Forceps/Vacuum)
5. Causes weightlessness- overcomes gravity- allows the mother relief and comfort.
6. Gives the baby a smoother medium of transition from the womb to the out side world…..And many, many

Reference Reading:

Cochrane Review : Of more than 40,000 Waterbirths worldwide. No directly attributable fatality and No specific risk above Normal deliveries.

British Medical Journal 1999 : Dr. Gilbert et al. 4032 Waterbirths – Perinatal Mortality 1.2 / 1000 live births. Lower than normal Deliveries.

Choosing Waterbirth : Lakshmi Bertram
Gentle Birth Choices : Barbara Harper
Waterbirth Unplugged : Beverly A Lawrence Beech
Waterbirth Handbook : Eileen Herzberg

www.waterbirth.org
www.waterbirth.com
www.yourwaterbirth.com

About the Author:

Dr. Rajeev Punjabi:  Dr. Rajeev V Punjabi started his Practice in 2000, and spent 4 years performing Sonography in Obst. & Gynaecology, besides working as a Gynaecologist in Mumbai. In July 2003, he joined hands with his colleague from LTMMC, Sion Hospital, Mumbai and long time friend Dr.Sheetal J Sabharwal to start Tulip Women’s Healthcare Centre in Khar(W), Mumbai, India. In October 2003, he performed Mumbai’s First and one of India’s first documented and reported Underwater Deliveries – Hydrobirth successfully. He continues to promote the use of Water in labour and delivery ( Waterbirth ) with great enthusiasm.

You can read more about Tulip and Dr Punjabi at: http://www.tulipwhc.in/ (Powered by Websites For Doctors)

You can also email him at: rvpgynaec@rediffmail.com