Skull Base Osteomyelitis- Marauders of the Skull.

Skull base osteomyelitis is a vicious infection of temporal bone associated with very high morbidity and mortality. But few studies have been undertaken recently for eliciting its increasing incidence. Hence this study aims to describe the clinical profile of skull base osteomyelitis and changes noted in the post-covid period, and encourage a uniform treatment policy globally. This descriptive study was conducted among 140 patients diagnosed with skull base osteomyelitis. Data was collected using semi-structured proforma, HRCT temporal bone findings, microbiological reports, histopathology of granulation tissue, ESR and House-Brackmann grading. Male patients in 61-70 age group were most commonly affected and all patients had uncontrolled diabetes mellitus, usually presenting with nocturnal otalgia, ear canal granulation and cranial nerve palsy. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. Among fungal pathogens, candida albicans were the most common. 29.3% patients had extensive disease according to Thakar et al. staging and on follow up, 43.75% patients showed a satisfactory response. Coronary artery disease and cerebrovascular accidents were the leading cause of death. More atypical organisms, extensive disease and changes in antibiotic sensitivity were noted in the post-covid period. Prolonged treatment with culture sensitive antibiotic is the main stay of treatment. A uniform treatment guideline is needed for proper management of such patients. Level of Evidence 4.

Chemical composition and biological activities of the essential oil from Cleome rutidosperma DC.

Cleome rutidosperma DC, commonly known in Jamaica as 'consumption-weed' is a plant traditionally used in folklore for treating tuberculosis and other infectious and chronic ailments. We evaluate for the first time the chemical composition and biological activities of the essential oil components of the complete aerial parts of this plant. The essential oil obtained by steam distillation (0.02%) was analyzed by a combination of gas chromatography-flame ionization detector (GC-FID), gas chromatography-mass spectroscopy (GC-MS) and retention index (RI). The volatile oil of C. rutidosperma was dominated by oxygenated diterpenes (67.6%); with (Z)-phytol (65.1%) being the single most abundant constituent. C. rutidosperma aerial essential oil exhibited moderate inhibition against the activity of recombinant arylamine N-acetyltransferase (NAT) from Mycobacterium marinum (IC50 22.20 ±â€¯1.80 µg/µL), while, racemic phytol had an inhibition with an IC50 of 22.33 µg/µL ±â€¯0.50 µg/µL, thus accounting for the NAT inhibition imparted by the crude oil. Inhibition of NAT, a key enzyme in mycobacterial growth may be the pathway in which phytol, shown in this study to interact with the active site using in-silico methods, renders its previously demonstrated anti-tubercular properties. The phytol rich essential oil also demonstrated antimicrobial activity against all nine human pathogenic bacteria and the fungus strain assayed, with the most significant inhibitory activity against Bacillus cereus and justifies the need for further evaluation and development of the essential oils from this plant.

Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear.

This study reports the clinical and sonographic outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years and aimed to determine factors associated with re-tear. A total of 69 consecutive repairs were performed in 68 patients with a mean age of 77 years (70 to 86). Constant-Murley scores were collected pre-operatively and at one year post-operatively. The integrity of the repair was assessed using ultrasound. Re-tear was detected in 20 of 62 patients (32%) assessed with ultrasound. Age at operation was significantly associated with re-tear free survival (p = 0.016). The mean pre-operative Constant score was 23 (sd 14), which increased to 58 (sd 20) at one year post-operatively (paired t-test, p < 0.001). Male gender was significantly associated with a higher score at one year (p = 0.019). We conclude that arthroscopic rotator cuff repair in patients aged ≥ 70 years is a successful procedure. The gender and age of the patient are important factors to consider when planning management.

Chemical composition and biological activity of the essential oil from Jamaican Cleome serrata.

The chemical composition of the essential oil obtained from the aerial parts of Cleome serrata by hydrodistillation was analyzed by employing GC-FID, GC-MS and RI. Fourteen compounds comprising 90.4% of the total oil composition were characterized. The main components identified were (Z)-phytol (53.0%) and di(2-ethylhexyl)-phthalate (DEHP) (14.7%). The oil was evaluated for its in vitro antimicrobial activities against nine pathogenic microorganisms using the filter paper disc diffusion method. Moderate antimicrobial activity was observed against five of the pathogens assayed. In addition, the essential oil was tested against the sweet potato weevil, Cylas formicarius elegantulus. Strong knockdown insecticidal activity was observed.

Treating the torn rotator cuff: current practice in the UK.

INTRODUCTION: The aim of this study was to characterise current rotator cuff repair activity in the UK with emphasis on the management of rotator cuff tears in the elderly population (over 70s). METHODS: A one-page web-based survey was created. All British Elbow and Shoulder Society (BESS) members and surgeons who listed the shoulder as an area of specialist interest on the website http://www.specialistInfo.com/ were invited to complete this. RESULTS: A total of 103 surgeons completed the survey; most (n =89, 86%) were BESS members. They had spent a median of 10 years (range: 9 months - 30 years) in consultant practice and performed an annual median of 200 (range: 0-1,000) arthroscopic shoulder procedures. For rotator cuff repair the favoured method was arthroscopic for 47 consultants (46.5%), open or mini-open for 41 (40.6%) and both for 13 (12.9%). The annual median number of arthroscopic and open cuff repairs was 20 (range: 0-250) and 12 (range: 0-100) respectively. The longer the time in practice, the fewer the reported number of arthroscopic cuff repairs (r(s)=-0.22, p=0.027) and the greater the number of open and mini-open cuff repairs (r(s)=0.33, p=0.001). In the management of a full-thickness rotator cuff tear in a patient over 70 years of age, 27 (26.7%) would perform an open or mini-open repair, 43 (42.6%) an arthroscopic repair and 22 (21.8%) would not attempt a repair. CONCLUSIONS: Surgeons performing a higher volume of arthroscopic cuff repairs annually were more likely to repair cuff tears and they predicted significantly better outcomes of cuff repair for both pain and shoulder movement. Our results reflect the existing conflicting evidence regarding the indications for and methods of treatment of rotator cuff disease.

Chemical composition and antimicrobial activity of the essential oils from Cleome spinosa.

Five different essential oil extractions of the aerial parts of Cleome spinosa Jacq. were examined. The oils obtained by hydrodistillation of the whole aerial parts, aerial parts without flowers (fruit, leaves and stem), flowers, fruits and leaves have been examined by GC-FID and GC-MS. The chemical profiles of the oils reveal the dominance of oxygenated sesqui- and diterpenes, with the exception of the fruit oil, which contained a high content of fatty acids. The most abundant compounds from the whole aerial parts were (Z)-phytol (31.3%), integerrimine (5.5%) and incensole (4.0%). The major compounds from the aerial portion without flowers were caryophyllene oxide (10.5%), (-)-spathulenol (7.5%) and Z-phytol (6.9%). In the flower oil, the main components were 7-alpha-hydroxy manool (23.8%), incensole (9.2%) and sclareol (8.7%). The chief constituents in the fruit oil were tetradecanoic acid (40.6%), (Z)-phytol (6.58%) and sclareol (4.5%). In the leaf oil, (Z)-phytol (19.5%), 7-alpha-hydroxy manool (6.8%) and caryophyllene oxide (4.36%) were the predominant compounds. Antimicrobial activity of the oil obtained from the whole aerial part was evaluated against nine microbial strains using a filter paper disc-diffusion method. The volatile oil showed moderate action against seven of the eight bacteria strains used, with significant inhibitory activity against Streptococcus pyogenes Group A when compared with the standard antibiotics, ampicillin and gentamicin. The fungus, Candida albicans was less sensitive to the essential oil. The oils showed moderate insecticidal activity against Cylas formicarius elegantalus, but possessed no antioxidant activity as indicated by the DPPH method. This represents the first report on the chemical composition of the essential oils from C. spinosa found in Jamaica and the in vitro antioxidant, insecticidal and antimicrobial potential of the oil from the aerial parts.

Sesquiterpene and acyclic diterpenes from Hyptis verticillata Jacq.

From the methanolic extract of the plant Hyptis verticillata Jacq, was isolated five compounds: the novel compounds cadina-10(15)-en-3-one and 3,7,11,15-tetramethylhexadec-1-en-3-ol and the known compounds 3,7,11,15-tetramethylhexadec-2-en-1-ol, 7,11,15-trimethyl-3-methylenehexadecane-1,2-diol and myo-inositol. All structures were established by spectroscopic means.

Abietane diterpeniods from Hyptis verticillata.

Seven abietane diterpenoids were isolated from the roots of Hyptis verticillata (Labiatae). One is a novel natural product, 7-acetoxy-16-benzoxy-12-hydroxyabieta-8,12-diene-11,14-dione (1), while the other six known compounds are 11,14 dihydroxy-12-methoxyabieta-8,11,13-triene-7-one (2), 11,14-dihydroxy-12-methoxy- 18(4-->3betaH) abeo-abieta-4(19),8,11,13-tetraene-7-one (3), 7-acetoxy-12-methoxyabieta-8,12-diene-11,14-dione (4), royleanone (5), 7,6-dehydroroyleanone (6) and 7-acetoxyhorminone (7). All structures were elucidated by spectroscopic and mass spectrometric means.

Malignancy larynx presenting solely as pharyngo-cutaneous fistula.

Malignancy larynx usually presents early, the common symptoms being hoarseness, pain thorat, cough and irritation of throat. An advanced malignancy is likely to be complicated by a pharyngo-cutaneous fistula. However it is an occurrence towards the end stage of the disease. Here we present a case of malignancy larynx primarily presenting as pharyngo-cutaneous fistula without any other symptoms.

Angiolymphoid hyperplasia with eosinophilia - A case report.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a distinctive vascular tumor presenting as isolated or grouped papules or plaques or nodules over skin in head and neck. We, hereby, present a case of ALHE affecting the base of tongue-a rare site of involvement.

Biological activity and chemical composition of the essential oil from Jamaican Hyptis verticillata Jacq.

The chemical composition of the essential oil obtained by hydrodistillation from the aerial parts of Hyptis verticillata Jacq. was elucidated by a combination of GC and GC-MS analyses. The oil was dominated by the sesquiterpenoids cadina-4,10(15)-dien-3-one (15.1%) (1) and aromadendr-1(10)-en-9-one (squamulosone) (30.7%) (2). The oil exhibited chemosterilant activities against the cattle tick, Boophilus microplus Canest., and toxic action against adult Cylas formicarius elegantulus Summer, the most destructive pest of sweet potato (Ipomoea species).

Radiological diagnosis of abductor denervation after hip surgery.

A case of total hip arthroplasty through a direct lateral approach is described. The patient had a markedly positive Trendelenburg test at follow-up. Radiographs showed features consistent with the denervation of the gluteus medius. This was confirmed on CT scan. The standard post-operative radiograph following a total hip replacement may suggest denervation of the gluteus medius.

Investigation of plants used in Jamaican folk medicine for anti-bacterial activity

We have started a systematic scientific study of folklore medicinal plants currently used as alternative medicine in Jamaican society. In this initial study, extracts of plants widely used by the islanders are studied for antibacterial activity against five common pathogens; Streptococcus group A, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa and Escherichia coli. These studies revealed that 25 percent (approximately) of the plant extracts had antimicrobial activity against at least one of the microbes used. Subsequent to these observations, extracts from Mikania micrantha were examined in detail. This led to the isolation of two sesquiterpenoids, mikanolide and dihydromikanolide, with activity against S. aureus and C. albicans. The results suggest that traditional folk medicine could be used as a guide in our continuing search for new natural products with potential medicinal properties.(Au)

Acaricidal and insecticidal activities of cadina-4, 10 (15)-dien-3-one

The novel assingment of 13C and 1HNMR data for cadina-4,10(15)-dien-3-one obtained from Hyptis verticillata is presented. The study revealed that cadina-4,10(15)-dien-3-one possesses chemosterilant activities against the economically important cattle tick, Boophilus microplus, and toxic action against adult Cylas formicarius the most destructive pest of sweet potato (I pomoea sp.) (AU)

Urine nickel concentrations in nickel-exposed workers.

Electrothermal atomic absorption spectrometry was employed for analyses of nickel concentrations in urine samples from nickel-exposed workers in 10 occupational groups and from non-exposed workers in two control groups. Mean concentrations of nickel in urine were greatest in workers who were exposed to inhalation of aerosols of soluble nickel salts (e.g., workers in nickel plating operations and in an electrolytic nickel refinery). Less marked increases in urine nickel concentrations were found in groups of metal sprayers, nickel battery workers, bench mechanics and are welders. No significant increases in mean concentrations of nickel were found in urine samples from workers who performed grinding, buffing and polishing of nickel-containing alloys or workers in a coal gasification plant who employed Raney nickel as a hydrogenation catalyst. Measurements of nickel concentrations in urine are more sensitive and practical than measurements of serum nickel concentrations for evaluation of nickel exposures in industrial workers.