Fagonia cretica: Identification of compounds in bioactive gradient high performance liquid chromatography fractions against multidrug resistant human gut pathogens

@#Plants are alternative source of natural medicines due to secondary active metabolites. Fagonia cretica extracts and Gradient High-Pressure Liquid Chromatography fractionations were checked against multidrug-resistant gastrointestinal pathogens including, Salmonella typhi, Escherichia coli and Shigella flexneri. ESI-MS/MS analysis of bioactive HPLC fractions was performed to elucidate antibacterial compounds. F. cretica extracts exhibited potential antibacterial activity. Twenty-four (24) HPLC fractions were obtained from methanol, ethanol and aqueous extracts of F. cretica. Eighteen (18) fractions showed antibacterial activity, while no activity was observed by the remaining six (6) fractions. HPLC fractions, F1 (25g ± 0.20 mm) and F2 (15f ± 0.12 mm) of aqueous extract exhibited activity against multidrug resistant GI pathogens. Gallic acid, quinic acid, cyclo-l-leu-l-pro, vidalenolone, liquirtigenin, rosmarinic acid and cerebronic acid were identified in F1 fraction of aqueous extract, while succinic acid, cyclo (l-Leul-Pro) and liquirtigenin were identified in F2 fraction of aqueous extract through ESI-MS/MS analysis. F. cretica extracts and HPLC fractions showed potential activity against MDR GI pathogens. Vidalenolone, Cyclo-1-leu-1-pro and Cerebronic acid are first time reported in F. cretica. Further characterization of bioactive compounds from F. cretica may be helpful to elucidate antibacterial therapeutic molecules.

Diagnosis of internal derangement of temporomandibular joint by ultrasonography: our experience

The Temporomandibular Joint [TMJ] is one of the most difficult parts of the body to be visualized clearly by radiograph because of interference from superimposed structures. To compare the US and MRI finding results in diagnosis of TMJ internal derangement [ID] in Iraqi patients. From April to November 2004, 46 patients with temporomandibular [TMJ] disorders were observed in the consultation clinic of the oral maxillofacial surgery department in Al-Kadhimiyia Teaching Hospital. All the patients have symptoms of disk internal derangement [DID.]; pain and many of them have clicking, crepitation, and/or locking. All the patients were examined by Magnetic resonance imaging [MRI] and ultrasound. The results of US were compared with the results of 18 volunteers [18 joints] without symptoms of DID. Our study showed perfect agreement between MRI and US in all the cases. This is considered an important advantage since US, is more available in our hospitals than MRI and also more easy and simple to be performed than MRI and also accepted by the patients than MRI. US may help in the confirmation of the normal disk position in subjects presenting symptoms of normal disk position. US can be used as an alternative method to MRI in the diagnosis of DID. of TMJ

value of early mobilization in patients with osteogenesis imperfecta

Osteogenesis imperfecta is an inherited disorder of collagen maturation which results in abnormal skeletal, ligament, skin, sclera, and dentin formation. Management includes focusing on preventing or minimizing deformities and maximizing the individual's functional ability at home and in the community. Physical therapy including early mobilization after fracture is effective in strengthening muscles which in turn, improves bone density. The theory of set-point proposal, a possible causative mechanism in osteogenesis imperfecta presents a special mechanism of skeletal intermediary organization causing many features of the disease. The minimum effective strain is abnormal in osteogenesis imperfecta, so early mobilization is important in prevention of further fractures of the limbs. The prediction of the role of early mobilization in decreasing the incident of fractures of long bones in osteogenesis imperfecta. This is a prospective study of 42 patients with osteogenesis imperfecta for ten years, they were studied and different methods and treatment used, they were divided into two groups. Group I, included 24 patients which included new patients with new fractures of femur and treated by early mobilization, Group II, included 18 patients treated by immobilization [plaster of paris]. For both groups the commonest age group was [0-2 years]. Male to female ratio was 2:1. Radiological classification mostly thick bone type. Sillence classification, mostly sillence I. In group I surgery was done for 33.3%, traction methods for 66.7%. Follow up for 2.5-3 years was done and 4.2% develop fracture in the same femur while 8.75% developed fracture the contra-lateral femur. In group II all patients treated by immobilization for 4-6 weeks using plaster of pairs, during follow up for same period 16.7% develop fracture in the same femur. And 16.7% developed fracture in the ipsi-lateral tibia. Early mobilization in patients with osteogene imperfecta proved to be a good method in preventing and decreasing the incidence of fractures in different tubular bones

Fournier's Gangrene

Fournier's gangrene is relatively a rare surgical disease. It is a type of necrotizing fascitis involving the genito-perineal region. Both aerobic and anaerobic pathogens lie behind the pathogenesis. In his original description J.A. Fournier thought that it is an idiopathic disease without any obvious etiology. Many controversial issues exist about the pathogenesis and treatment of the disease. To investigate the possible correlation between the clinical outcomes [hospital stay, morbidity, mortality] and the early wound closure. Retrospective analysis was done from 1997-2000, in Al-Kindy Teaching Hospital. Eleven cases were included, with variable age and sex. Several predisposing and triggering factors for the disease were found in our work. Different techniques of surgical treatment were used in wound closure after initial resuscitation and frequent mini debridements, in order to close the defect as early as possible. The outcome of our study, despite different surgical procedures used to close the wounds, was encouraging. Hospital stay, morbidity and mortality were reduced in comparison with other studies. We found that the earlier the wound was closed; a shorter hospital stay, and less morbidity and mortality could be achieved

clinical comparison of prolonged sevoflurance versus isoflurane anesthesia

This study aimed to determine whether prolonged anesthesia with either sevoflurane [S] or isoflurane [I] can produce clinically significant effect on the renal, hepatic and hematologic condition of patients undergoing prolonged orthopedic reconstructive surgeries lasting approximately ten hours. After ethical approval and an informed consent from each patient were obtained before surgery. The patients were classified into two groups according to the anesthetic agent[s], either S group [n = 15] or I group [n = 20]. It was concluded that sevoflurane is at least has comparable effects to isoflurane, and both can be used safely without major hepatorenal or hematological side effects in such type of prolonged surgery

HELLP syndrome: undiagnosed in a case of impending rupture of uterus

A 31-year-old woman, 34 weeks gestation with intrauterine fetal death, and transverse lie with impending rupture of the uterus due to obstructed labor, was scheduled for urgent cesarean section. On preoperative anesthetic assessment, she was diagnosed to have HELLP syndrome based on clinical findings [subsequently confirmed by laboratory results]. She was anesthetized taking the necessary precautions. Her intra and postoperative course is described. The case demonstrates how the anesthetist is often confronted by undiagnosed HELLP syndrome for urgent cesarean section and has limited time for investigations. He should depend on his clinical acumen to diagnose and treat appropriately for a favorable maternal outcome

Effect of Ajmaloon on the baroreceptor-heart rate reflex in anaesthetized rabbits and monkeys.

The effects of a herbal drug, Ajmaloon (Hamdard, India), on the arterial blood pressure, heart rate (HR) and baroreceptor-heart rate reflex were studied in anesthetized rabbits and monkeys. Intravenously administered Ajmaloon produced a dose-dependent hypotensive response in both the species without any significant effect on the heart rate. Only in high doses (200 mg/kg or more). Ajmaloon produced a bradycardia response in rabbits. Even the highest dose (300 mg/kg) of Ajmaloon used in the present investigation did not cause arrhythmia or any other conduction disorder or respiratory distress. Baroreflex SAP-HR curve was shifted to the left of the control following treatment with 100 mg/kg intravenous Ajmaloon in both the species. Loss of tachycardia response to fall in arterial pressure in Ajmaloon treated animals indicated the drug induced suppression of normally existing sympathetic excitatory influence in response to hypotension. Baroreflex regulatory HR response to hypertension remains intact after intravenous administration of 100 mg/kg Ajmaloon, a dose much higher than the prescribed highest oral dose for humans. Intact baroreflex regulation of arterial blood pressure in response to hypertension in Ajmaloon treated mammals suggests that in patients besides lowering the blood pressure. Ajmaloon might not interfere with the normal blood pressure regulatory mechanism through arterial baroreceptors during hypertension.

Pethidine as a regional intravenous anaesthetic agent

Pethidine hydrochloride [100 mg diluted in 30-40 ml saline] was compared with lidocaine hydrochloride [0.5 mg/kg in 5% solution 30-40 ml] for intravenous regional anaesthesia [IVRA] for upper limb surgery. The onset, degree of analgesia need for supplementary analgesia, cardiovascular respiratory changes and motorparalysis during and after release of the tourniquet, the need for post-operative analgesia and any complications due to its use for this procedure were determined. Pethidine hydrochloride provided excellent analgesia in 75.7% of cases comparable to 70% in case of lidocaine hydrochloride. The onset of analgesia was prolonged but of longer duration after release of tourniquet, no cardiovascular or respiratory complications were noticed with the two studied drugs. Poor analgesia was noticed in 9.1% of wrist and fingers operations, which Suggested that the mechanism of analgesia is due to blockage of small nerves or possibly sensory nerve endings and not major nerve trunks at the elbow as has been suggested previously for local anaesthetic. No motor paralysis was noticed. It also has the advantage of prolonged postoperative analgesia. So it could be used safely for the procedure of IVRA