Case Series - Osteochondromas at Rare Locations.

Introduction: Osteochondromas are very common. They are typically seen in long bones and rarely seen in smaller bones. Some of the rare presentations include flat bones, the body of pelvis, scapula, skull, and small bones of the hand and foot. Their presentation also varies according to the site of presentation. Case Report: We have included five cases of osteochondromas occurring at rare locations with variable presentations and their management. We have included one case of metacarpal, one case of skull exostosis, two cases of scapula exostosis, and one case of fibula exostosis. Conclusion: Osteochondromas can rarely occur at unusual locations. It is important to thoroughly evaluate all patients presenting with swelling and pain over bony regions to accurately diagnose osteochondromas and manage accordingly.

Design, synthesis and chemical stability of indolizine derivatives for antidiabetic activity.

Prodrugs of metformin were synthesized with the goal of enhancing biological activity of metformin. They were synthesized by combining metformin with 2-substituted indolizine (C7-C12). The synthesized prodrugs were characterized by IR, 1H NMR, 13C NMR, and mass spectroscopy. The chemical hydrolysis of C7-C12 was carried out at pH 1.2, 6.8, and 7.4. All compounds showed encouraging chemical stability at pH 1.2 and 6.8, whereas mild hydrolysis was shown at pH 7.4. Further prodrugs were screened for antidiabetic activity using a streptozotocin-induced model in rat. These derivatives showed substantial results. Among them C8 showed significant activity in the reduction of streptozotocin-induced blood glucose in rats when compared to that of metformin, indicating the effectiveness of prodrug.

Shoulder Injury Following Overzealous Manipulation in Adhesive Capsulitis by Untrained Professional Managed with Shoulder Arthroscopy.

Introduction: Adhesive capsulitis of shoulder is a commoner condition in middle aged population and is classified into primary and secondary types based on etiology. Treatment options depend on stages of disease which ranges from physical therapy, non-steroidal anti-inflammatory medications, intra-articular steroid injection, hydro-dilatation therapy, manipulation under anesthesia, and arthroscopic capsular release. However, the condition is generally mismanaged by untrained professionals in the periphery center leading to complications. We report one such case, which was then managed arthroscopically. Case Report: A 58-year-old female patient presented to our outpatient department with a severe painful left shoulder following overzealous manipulation by untrained professional and she was diagnosed with severe traumatic capsulosynovitis with a subscapularis tear, biceps tendon subluxation, and shoulder subluxation. We managed patient arthroscopically with extensive capsulosynovectomy, biceps tenotomy, and upper subscapularis repair. Postoperatively, she was immobilized for 6 weeks and was put on proper rehabilitation program. At the 2-year follow-up, the patient had an excellent outcome and had complete pain-free movements at the left shoulder with significant increase in pre-operative constant shoulder score of 12-82. Conclusion: ?Overzealous manipulation shoulder in frozen shoulder patients has serious complications and has to be avoided and therefore has to be done by trained professional gently under anesthesia. Shoulder arthroscopy plays a pivotal role in managing such complications successfully.

Clinical Spectrum, Molecular Characterization, Antifungal Susceptibility Testing of Exophiala spp. From India and Description of a Novel Exophiala Species, E. arunalokei sp. nov.

Introduction: Exophiala spp. are important opportunist pathogens causing subcutaneous or even fatal disseminated infections in otherwise both immunosuppressed and healthy individuals but there are no systematic studies on the isolates of Exophiala species from India. Methods: Twenty-four isolates of Exophiala species were retrieved from the National Culture Collection of Pathogenic Fungi (NCCPF) and identified phenotypically and by molecular methods (ITS region sequencing) followed by antifungal susceptibility testing (AFST) as per CLSI-M38A3 guidelines. A review of the literature of cases from India was performed up to 1st January 2021 using the Medline and Cochrane database. Results: E. dermatitidis (n = 8), E. jeanselmei (n = 6), E. spinifera (n = 6), E. mesophila (n = 1), E. oligosperma (n = 1), E. xenobiotica (n = 1) were identified and the sequencing of ITS, ß-tubulin and ß-actin revealed a novel species, E. arunalokei sp. nov. (n = 1). The ITS sequence phylogram of E. jeanselmei revealed that the majority (83%) formed a separate cluster close to type A while majority (75%) of E. dermatitidis were type B. The MIC50 (mg/L) of amphotericin, itraconazole, voriconazole, micafungin, caspofungin, anidulafungin, and posaconazole, was 1, 0.25, 0.125, 0.12, 0.125, 0.062, and 0.062, respectively. Sixteen more cases were identified on the literature review and a significant association of E. dermatitidis with history of surgical procedures (p = 0.013), invasive disease (p = 0.032) and of E. mesophila with tuberculosis (p = 0.026) was seen. Conclusion: This, to the best of our knowledge is the first study from India elucidating the molecular and clinical characteristics of Exophiala species and the first Indian report of human infection due to E. xenobiotica and E. arunalokei.

Phenotypic and molecular characterisation of Sporothrix globosa of diverse origin from India.

Sporotrichosis is one of the neglected tropical diseases causing subcutaneous chronic granulomatous lesion by thermally dimorphic fungi belonging to Sporothrix species. Sporothrix brasiliensis, Sporothrix mexicana and Sporothrix globosa are the common pathogenic species. In Asian countries, S. globosa constitutes nearly 99.3% of all Sporothrix species. We studied 63 cases of sporotrichosis of geographically diverse origin from India and Sporothrix isolates were characterised for its growth in different media, temperatures, ability to assimilate sugars and antifungal susceptibility profile. Molecular characterization was performed by sequencing of the calmodulin (CAL), beta tubulin (BT) and translational elongation factor 1-alpha (TEF-1α) and typing by fluorescent amplified fragment length polymorphism (FAFLP). In patients who presented with fixed (49.2%), lymphocutaneous lesions (23.8%), in 26.9% the details were not known, none had systemic dissemination. All the isolates tested were Sporothrix globosa and that could grow up to 35 °C and unable to grow at and beyond 37 °C. The assimilation of sucrose, ribitol and raffinose helps in identifying S. globosa. Sequences of CAL or BT or TEF-1α can differentiate S. globosa from other species in the complex. FAFLP results exhibited low genetic diversity. No correlation was noted between genotypes and clinical presentation, or geographic distribution. Itraconazole, terbinafine and posaconazole showed good in vitro antifungal activity against S. globosa whereas fluconazole and micafungin had no activity. S. globosa of Indian origin is relatively less pathogenic than other pathogenic Sporothrix species as it does not cause systemic dissemination and in the diagnostic laboratory, incubation of the cultures below 37 °C is essential for effective isolation.

Elevated plasma levels of P-selectin glycoprotein ligand-1-positive microvesicles in patients with unprovoked venous thromboembolism.

Essentials PSGL-1+ microvesicles (MVs) may be important in venous thromboembolism (VTE). We measured plasma levels and parental origin of PSGL-1+ MVs in patients with unprovoked VTE. VTE patients had higher plasma levels of PSGL-1+ MVs than healthy controls. The PSGL-1+ MVs originated mainly from monocytes and endothelial cells. SUMMARY: Background Microvesicles (MVs) express antigens from their parental cells and have a highly procoagulant surface. Animal studies suggest that P-selectin glycoprotein ligand-1-positive (PSGL-1+ ) MVs play a role in the pathogenesis of venous thromboembolism (VTE). Objective The aim of this study was to determine plasma levels, the cellular origin and the morphological characteristics of PSGL-1+ MVs in patients with unprovoked VTE. Methods We conducted a population-based case-control study in 20 patients with a history of unprovoked VTE and 20 age- and sex-matched healthy controls recruited from the general population. Plasma levels, the cellular origin and the morphological characteristics of PSGL-1+ MVs were evaluated using flow cytometry, electron microscopy and confocal microscopy. Results Plasma levels of PSGL-1+ MVs were associated with increased risk of VTE. The odds ratio per one standard deviation increase in PSGL-1+ MVs was 3.11 (95% confidence interval [CI], 1.41-6.88) after adjustment for age and sex, and 2.88 (95% CI, 1.29-6.41) after further adjustment for body mass index. The PSGL-1+ MVs originated mainly from monocytes and endothelial cells determined by double staining with markers of parental cells using flow cytometry and transmission electron microscopy. Scanning electron microscopy of PSGL-1-labeled plasma-derived MVs displayed dominantly spherical vesicles that varied between 50 and 300 nm in diameter. Conclusions Increased plasma levels of PSGL-1+ MVs are associated with the risk of unprovoked VTE. Large population-based prospective studies are required to validate our findings.

Antiurolithiatic activity of natural constituents isolated from Aerva lanata.

BACKGROUND: Pashanabheda is used as antiurolithiatic in Ayurveda. In the present study, Aerva lanata (L) Juss. ex. Schult (Amaranthaceae) from Western Ghats of India was selected for isolation of active constituents and screening for antiurolithiatic potentials. OBJECTIVE: Screening of compounds isolated from A. lanata for antiurolithiatic potentials. MATERIALS AND METHODS: Ethylene glycol (0.75% v/v) induced urolithiasis model was used to study the antiurolithiatic activity in male Wistar albino rats. The animals were divided into five groups containing six each. Based on the LD50 of the plant extract (2000 mg/kg b.w) equivalent dose was calculated from their yield. Two isolated compounds (quercetin and betulin) of A. lanata were screened for antiurolithiatic potentials in calculi induced (ethylene glycol 0.75% v/v) male Wistar albino rats by administering 2 mg/kg b.w/day orally as test dose for 28 days. RESULTS: The urine volume was found to be significantly increased from 12.76 ± 0.10 ml to 21.35 ± 0.20 ml in the rats treated by quercetin and 21.50 ± 0.21 ml in rats treated by betulin. Urine microscopy revealed significant reduction (p < 0.001) in the size of calculi and significantly enhanced (p < 0.001) excretion of calcium, oxalate, phosphate, whereas the level of magnesium was increased. SEM of kidney sections has revealed reduction in the calculi in treated animals. Serum analysis has revealed significant reduction in the level of BUN and creatinine in treated rats. CONCLUSION: The isolated quercetin and betulin from A. lanata have shown mild diuretic effect as well as antiurolithiatic effect by significantly reducing the size of calculi in the kidneys and enhancing the excretion of calcium, phosphate, oxalate while maintaining the level of magnesium, which is reported to be one of the calculi inhibiting factors.

Bridgehead Substitution via Putative Norborn-1-en-3-ones: Application in the Synthesis of Complex Molecules.

The base-mediated formation of a bridgehead double bond in a bicyclo[2.2.1]heptane system (anit-Bredt molecules) is described. The synthesis of exocyclic norbornyl enones by Wittig reaction of α-diketones is reported. These enones and their Michael adducts are used as substrates for the generation of transient bridgehead enones and their trapping with MeOH and H2 O. Bridgehead alcohols are easily synthesized from norbornyl enones and are exploited for the diversity oriented synthesis of frameworks of natural and unnatural products.

Improved Rifamycin B Production by Nocardia mediterranei MTCC 14 under Solid-State Fermentation through Process Optimization.

Optimization of various production parameters using response surface methodology (RSM) was performed to assess maximum yield of rifamycin B from Nocardia mediterranei MTCC 14. Plackett-Burman design test was applied to determine the significant effects of various production parameters such as glucose, maltose, ribose, galactose, beef extract, peanut meal, ammonium chloride, ammonium sulphate, barbital, pH, and moisture content on production of rifamycin B. Among the eleven variables tested, galactose, ribose, glucose, and pH were found to have significant effect on rifamycin B production. Optimum levels of the significant variables were decided by using a central composite design. The most appropriate condition for production of rifamycin B was found to be a single step production at galactose (8% w/w), ribose (3% w/w), glucose (9% w/w), and pH (7.0). At these optimum production parameters, the maximum yield of rifamycin B obtained experimentally (9.87 g/kgds dry sunflower oil cake) was found to be very close to its predicted value of 10.35 g/kgds dry sunflower oil cake. The mathematical model developed was found to fit greatly with the experimental data of rifamycin B production.

Superoxide chemistry revisited: synthesis of tetrachloro-substituted methylenenortricyclenes.

An unexpected reactivity of the superoxide ion leading to the synthesis of tetrachloroaryl/vinyl-substituted nortricyclenes through its dual mode of action has been reported. KO2 was found to be superior and the only reagent to perform this kind of reaction over other conventional bases. Addition of the antioxidant BHT (2,6-di-tert-butyl-4-methylphenol) improved the yields of methylenenortricyclenes. A complete deuterium incorporation was observed in the superoxide-mediated reaction in DMSO-d 6. Friedel-Crafts acylation reactions of 3-methylenenorticyclenes yielded 2-propanone-substituted pentachloronorbornenes.

Scalp abscess due to Streptomyces cacaoi subsp. cacaoi, first report in a human infection.

Streptomyces cacaoi subsp. cacaoi, a Gram-positive, branching filamentous bacteria, was isolated from a scalp infection in a patient from Pondicherry, India. Phenotypic tests identified the isolate as a Streptomyces species, but 16S rRNA sequence analysis provided the species identification required for tracking of this emerging pathogen.

Efficacy of low level laser therapy on wound healing in patients with chronic diabetic foot ulcers-a randomised control trial.

UNLABELLED: Foot ulcers are serious complications of Diabetes Mellitus (DM) and are known to be resistant to conventional treatment. They may herald severe complications if not treated wisely. Electromagnetic radiations in the form of photons are delivered to the ulcers in laser form to stimulate healing. This study was conducted to evaluate the efficacy of Low Level Laser Therapy (LLLT) in diabetic ulcer healing dynamics. To determine mean percentage reduction of wound area in study and control groups. SETTINGS: KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. STUDY DESIGN: Randomized-Control Study. METHODS: A total of 68 patients with Type 2 DM having Meggitt-Wagner Grade I foot ulcers of atleast more than 4 weeks duration, less than 6 × 6 cm(2) with negative culture were studied. Patients were randomized into two groups of 34 each. Patients in study group received LLLT with conventional therapy and those in control group were treated with conventional therapy alone. Healing or percentage reduction in ulcer area over a period of 15 days after commencement of treatment was recorded. STATISTICAL ANALYSIS: Unpaired Student T Test and Mann Whitney U test. Mean age of the patients was 50.94 years in control group and 54.35 years in study group (p = 0.065). There was no significant difference between control and study group with respect to mean FBS and HbA1c levels (p > 0.05), suggesting no biochemical differences between two groups. Initial ulcer area was 2608.03 mm(2) in study group and 2747.17 mm(2) in control group (p = 0.361). Final ulcer area was 1564.79 mm(2) in study group and 2424.75 mm(2) in control group (p = 0.361). Percentage ulcer area reduction was 40.24 ± 6.30 mm(2) in study group and 11.87 ± 4.28 mm(2) in control group (p < 0.001, Z = 7.08). Low Level Laser Therapy is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers (DFU).

Successful mating of a human isolate of Arthroderma simii with a tester strain of A. vanbreuseghemii.

An isolate of Arthroderma simii was successfully mated with a tester strain of A. vanbreuseghemii cultured on the plate of simple agar with some hair on it at 27 degrees C. Confirmation of sexual reproduction was made by the detection of hybrids of two parental genotypes. The implications of this result are discussed from the viewpoint of a reevaluation of the species boundaries of dermatophytes.

Different genes can result in different phylogenetic relationships in trichophyton species.

To determine the relationships among Trichophyton species we constructed three phylogenies, based on the nucleotide sequences of the actin, rRNA and DNA topoisomerase II genes. These phylogenies showed several conflicting branch points. For example, strains of T. verrucosum,T. concentricum and T. mentagrophytes var. erinacei were mingled with strains of Arthroderma benhamiae and could not be separated into their own phylogenic groups. In addition, strains of A. vanbreuseghemii, T. tonsurans, T. mentagrophytes var. interdigitale and T. mentagrophytes var. quinckeanum were mingled with strains of A. simii and could not be separated into their own phylogenic groups. T. rubrum and T. violaceum made up a clade, which was phylogenetically related to the A. benhamiae clade or A. simii clade, depending on the gene examined. These findings indicate the need to reevaluate the boundaries among Trichophyton species using an alternative to morphological or molecular biological methods.

Packing, flipping, and buckling transitions in compressed monolayers of ellipsoidal latex particles.

The behavior of monolayers of monodisperse prolate ellipsoidal latex particles with the same surface chemistry but varying aspect ratio has been studied experimentally. Particle monolayers at an air-water interface were subjected to compression in a Langmuir trough. When surface pressure measurements and microscopy observations were combined, possible structural transitions were evaluated. Ellipsoids of a sufficiently large aspect ratio display a less abrupt increase in the compression isotherms than spherical particles. Microscopic observations reveal that a sequence of transitions is responsible for this more gradual increase of the surface pressure. When a percolating aggregate network is used as the starting point, locally ordered regions appear progressively. When it reaches a certain surface pressure, the system "jams", and in-plane rearrangements are no longer possible at this point. A highly localized yielding of the particle network is observed. The compressional stress is relieved by flipping the ellipsoids into an upright position and by expelling particles from the monolayer. The latter does not occur for spherical particles with similar dimensions and surface chemistry. In the final stage of compression, buckling of the monolayer as a whole was observed. The effect of aspect ratio on the pressure area isotherms and on the obtained percolation and packing thresholds was quantified.

Maternal genital bacteria and surface colonization in early neonatal sepsis.

OBJECTIVE: The study was intended to evaluate the role of maternal genital bacteria and baby's surface colonization in early onset neonatal sepsis. METHODS: Babies (born in the hospital of Jawaharlal Institute of Postgraduate Medical Education and Research) who developed clinical signs of sepsis were studied. Swabs were collected for culture from baby's umbilicus, ear, throat in addition to gastric aspirate and blood culture. The genital tract of the mother was also studied for bacterial colonization. The organisms isolated from the maternal genital tract and baby's surface colonization were correlated with those isolated from blood culture by calculating Phi correlation coefficient. RESULTS: Esch coli was the most common organism isolated from maternal genital tract and surface cultures of babies, but Klebseilla-Spp was the most common organism isolated from blood. There was a significant correlation between surface colonization of babies and maternal genital bacteria, so also was baby's surface culture and blood culture. However, correlation between maternal genital bacteria and baby's blood culture was not significant. CONCLUSION: Surface colonizing bacteria and not maternal genital bacteria are important in early onset neonatal sepsis.