Diorganotin(IV) complexes with 2-furancarboxylic acid hydrazone derivative of benzoylacetone : synthesis, X-ray structure, antibacterial activity, DNA cleavage and molecular docking

Two new diorganotin(IV) complexes, Me2SnL and Ph2SnL, have been synthesized from the reaction of Me2SnCl2 and Ph2SnCl2 with the hydrazone H2L [H2L \ubc (Furan-2-yl) (5-hydroxy-3-methyl-5-phenyl-4,5- dihydro-1H-pyrazol-1-yl)-methanone] derived from furan-2-carbohydrazide and benzoylacetone. The new compounds have been characterized by elemental and spectroscopic analyses. The crystal structures of the monohydrate form of the ligand and of the Me2SnL derivative have been also determined by X-ray crystallography. Experimental evidences confirm the existence of the hydrazone ligand exclusively in cyclic form in both solution and solid state. On coordination to tin the hydrazone undergoes a ring opening reaction and a doubly deprotonation to act as a tridentate ligand via imine nitrogen and enolic oxygens. The tin atom in the complexes is five coordinate with geometry between square-pyramidal and trigonal-bipyramidal. The in vitro antibacterial activity of ligand and its complexes has been evaluated against Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria. The interaction between compounds with bacterial DNA was also studied by molecular docking. Our findings indicate that diphenyltin(IV) complex, by binding to DNA via minor groove to TATA sequence in genes upstream, has good activities along with the standard antibacterial drugs. Our agarose-gel electrophoresis experiments show that the ligand exert DNA cleavage, while Me2SnL and Ph2SnL did not

Longitudinal retinal changes in MOGAD

OBJECTIVE: Patients with myelin oligodendrocyte glycoprotein antibody (MOG-IgG) associated disease (MOGAD) suffer from severe optic neuritis (ON) leading to retinal neuro-axonal loss, which can be quantified by optical coherence tomography (OCT). We assessed whether ON-independent retinal atrophy can be detected in MOGAD. METHODS: Eighty MOGAD patients and 139 healthy controls (HC) were included. OCT data was acquired with 1) Spectralis spectral domain OCT (MOGAD (N=66) and HC (N=103)) and 2) Cirrus HD-OCT (MOGAD (N=14) and HC (N=36)). Macular combined ganglion cell and inner plexiform layer (GCIPL) and peripapillary retinal nerve fibre layer (pRNFL) were quantified. RESULTS: At baseline, GCIPL and pRNFL were lower in MOGAD eyes with a history of ON (MOGAD-ON) compared with MOGAD eyes without a history of ON (MOGAD-NON) and HC (p12 months ago (p<0.001). The overall MOGAD cohort did not exhibit faster GCIPL thinning compared with HC. INTERPRETATION: Our study suggests the absence of attack-independent retinal damage in MOGAD. Yet, ongoing neuroaxonal damage or oedema resolution seems to occur for up to 12 months after ON, which is longer than what has been reported with other ON forms. These findings support that the pathomechanisms underlying optic nerve involvement and the evolution of OCT retinal changes after ON is distinct in MOGAD. This article is protected by copyright. All rights reserved

Retinal optical coherence tomography in neuromyelitis optica

BACKGROUND AND OBJECTIVES: To determine optic nerve and retinal damage in aquaporin-4 antibody (AQP4-IgG)-seropositive neuromyelitis optica spectrum disorders (NMOSD) in a large international cohort after previous studies have been limited by small and heterogeneous cohorts. METHODS: The cross-sectional Collaborative Retrospective Study on retinal optical coherence tomography (OCT) in neuromyelitis optica collected retrospective data from 22 centers. Of 653 screened participants, we included 283 AQP4-IgG-seropositive patients with NMOSD and 72 healthy controls (HCs). Participants underwent OCT with central reading including quality control and intraretinal segmentation. The primary outcome was thickness of combined ganglion cell and inner plexiform (GCIP) layer; secondary outcomes were thickness of peripapillary retinal nerve fiber layer (pRNFL) and visual acuity (VA). RESULTS: Eyes with ON (NMOSD-ON, N = 260) or without ON (NMOSD-NON, N = 241) were assessed compared with HCs (N = 136). In NMOSD-ON, GCIP layer (57.4 ± 12.2 μm) was reduced compared with HC (GCIP layer: 81.4 ± 5.7 μm, p < 0.001). GCIP layer loss (-22.7 μm) after the first ON was higher than after the next (-3.5 μm) and subsequent episodes. pRNFL observations were similar. NMOSD-NON exhibited reduced GCIP layer but not pRNFL compared with HC. VA was greatly reduced in NMOSD-ON compared with HC eyes, but did not differ between NMOSD-NON and HC. DISCUSSION: Our results emphasize that attack prevention is key to avoid severe neuroaxonal damage and vision loss caused by ON in NMOSD. Therapies ameliorating attack-related damage, especially during a first attack, are an unmet clinical need. Mild signs of neuroaxonal changes without apparent vision loss in ON-unaffected eyes might be solely due to contralateral ON attacks and do not suggest clinically relevant progression but need further investigation

Diagnosis and management of glomus tumors of the hand

Aim and Background: Glomus tumors are hamartomas that account for 1 to 5 of all soft tissue tumors of the hand. These tumors are usually benign. However, malignant degeneration can sometimes occur. They are usually characterized clinically by paroxysmal pain. Herein, we present our experience with 8 patients diagnosed with glomus tumors treated within the past 10 years. Materials and Methods: Eight patients who were diagnosed with glomus tumor of the hand were treated. Excruciating pain upon palpating the tumor was present in all the patients. Imaging studies such as magnetic resonance imaging were obtained but were only marginally helpful in locating and defining the surface topography for tumor resection. Meticulous dissection in a bloodless field and use of an operating microscope from the start of the operation were used for complete removal. Results: Complete excision of the tumor with free margins was confirmed in all 8 cases. However, 1 of the patients had recurrence of the tumor, which presented 4 weeks postoperatively. No other recurrence was observed during the follow-up period (1 to 10 y). The postoperative course in all patients was uneventful except for deformed fingernail formation in 3 of the patients. Conclusions: Glomus tumor is a rare disease; we encountered only 0.26 cases in our patients (3014 patients referring for hand surgery) during a 10-year period. Imaging studies are not very helpful. Preoperative marking of the maximum point of pain helps the surgeon somewhat to locate the tumor clinically. We believe that a bloodless operation field and magnification are essential prerequisites for successful surgery. We also note that pain alleviation and no pain recurrence 2 months after surgery clinically signify a cure. The possible development of permanent nail deformity should be anticipated and must be discussed with the patient preoperatively. © 2010 by Lippincott Williams & Wilkins

L-carnitine treatment in patients with mild diastolic heart failure is associated with improvement in diastolic function and symptoms

Objectives: L-Carnitine is a crucial component of activated fatty acid transport. The aim of this study was to evaluate the effect of L-carnitine on patients with a history of mild heart failure and diastolic dysfunction. Methods: Twenty-nine patients with a history of NYHA functional class II symptoms and ejection fraction >45 with documented grade 1 diastolic dysfunction on echocardiogram were randomized in blinded fashion to receive 1,500 mg of L-carnitine daily for 3 months in comparison to a no treatment group (31 patients). Baseline echocardiographic and follow-up measurements of diastolic parameters were assessed after 3 months. Results: Important parameters of diastolic function improved in the L-carnitine group only: left atrial size (3.6 ± 0.4 cm before treatment vs. 3.4 ± 0.5 cm after treatment, p = 0.01); isovolemic relaxation time (127 ± 26 ms before vs. 113 ± 24 ms after treatment, p = 0.007); septal mitral E' velocity (0.064 ± 0.01 m/s before vs. 0.074 ± 0.01 m/s after treatment, p = 0.01), and lateral mitral E velocity (0.082 ± 0.01 m/s before vs. 0.091 ± 0.02 m/s after treatment, p = 0.006). Dyspnea also significantly improved in L-carnitine-treated patients. Conclusion: In patients with a history of diastolic heart failure, important indices of diastolic function and symptoms appear to improve with L-carnitine treatment. © 2010 S. Karger AG, Basel

How To Approach The Patient Suspected Of Having Acute Appendicitis, Introducing New Criteria: (Two Out Of Three)

Background:Acute appendicitis is the most common cause of acute surgical abdomen.Inspite of the introduction of ultrasonography, computed tomography scanning and laparoscopy in the years 1987-1997 the difficulty in accurate diagnosis of acute appendicitis has remained the same.Our way of reaching a decision for operating in a patient suspected of having acute appendicitis(which will follow) has superiority to other introduced so far approaches. Methods:3046 patients suspected of having acute appendicitis were evaluated during the years 2003-2005 at Shohada Medical Center.We have adopted a 3 point system, giving 1 point each to history, physical examination and laboratory tests if they meet the criteria:   1. Typical history gets 1 point if: an abdominal pain shift from epigastrium or periumbilical area to RLQ accompanying anorexia, nausea and vomiting depending on age.  2. Typical physical findings: RLQ tenderness associated with rebound tenderness, 3. Laboratory tests: leukocytosis between 10,500 to 18,000/mm3 along with normal urinalysis or leukocyturia without presence of bacteria. In pregnancy where leukocyteosis exists shift to the left is considered positive. Each of the criteria gets zero or 1 point if it meets that mentioned above and those who get two or three points will be operated on, otherwise the patient will be observed for 12 hours until his symptoms improve or progress to have two or three point criteria when he or she will be operated on. The results of histopathological examination of appendix have been used for the accuracy of this method. Results: Among 3046 patients, 1241 (41%) were operated on rightaway with diagnosis of acute appendicitis since they had 2 or 3 points on arrival. From these 1213 (97/1%) had acute appendicitis. 1805 (59%) patients who didn't get at least 2 points were observed for 12 hours, during this period 115 (6.4%) patients, who got at least two points were operated on, and 92 (80.5%) patients had non-perforated appendicitis;and the others were discharged since their symptoms improved.None of the patients,who were observed,developed perforation of appendix or peritonitis.Sensitivity and specificity of this method was 100% and 97.1% with positive and negative predictive values of 93.3% and 95.5%.So this method is a safe way of approaching patients suspected of having acute appendicitis. Conclusion:The 2 out of 3 points criteria for approaching the patients suspected of having acute appendicitis provide a nonexpensive, noninvasive,simple,rapid and accurate method for diagnosis of acute appendicitis

How To Approach The Patient Suspected Of Having Acute Appendicitis, Introducing New Criteria: (Two Out Of Three)

Background: Acute appendicitis is the most common cause of acute surgical abdomen. Inspite of the introduction of ultrasonography, computed tomography scanning and laparo-scopy in the years 1987-1997 the difficulty in accurate diagnosis of acute appendicitis has remained the same. Our way of reaching a decision for operating in a patient suspected of hav-ing acute appendicitis (which will follow) has superiority to other introduced so far approaches. Methods: 3046 patients suspected of having acute appendicitis were evaluated during the years 2003-2005 at Shohada Medical Center. We have adopted a 3 point system, giving 1 point each to history, physical examination and laboratory tests if they meet the criteria: 1. Typical history gets 1 point if: an abdominal pain shift from epigastrium or periumbilical area to RLQ accompanying anorexia, nausea and vomiting depending on age. 2. Typical physical findings: RLQ tenderness associated with rebound tenderness, 3. Laboratory tests: leukocytosis between 10,500 to 18,000/mm3 along with normal urinaly-sis or leukocyturia without presence of bacteria. In pregnancy where leukocyteosis exists shift to the left is considered positive. Each of the criteria gets zero or 1 point if it meets that mentioned above and those who get two or three points will be operated on, otherwise the patient will be observed for 12 hours until his symptoms improve or progress to have two or three point criteria when he or she will be operated on. The results of histopathological examination of appendix have been used for the accuracy of this method. Results: Among 3046 patients, 1241 (41%) were operated on rightaway with diagnosis of acute appendicitis since they had 2 or 3 points on arrival. From these 1213 (97/1%) had acute appendicitis. 1805 (59%) patients who didn't get at least 2 points were observed for 12 hours, during this period 115 (6.4%) patients, who got at least two points were operated on, and 92 (80.5%) patients had non-perforated appendicitis; and the others were dis-charged since their symptoms improved. None of the patients, who were observed, devel-oped perforation of appendix or peritonitis. Sensitivity and specificity of this method was 100% and 97.1% with positive and negative predictive values of 93.3% and 95.5%. So this method is a safe way of approaching patients suspected of having acute appendicitis. Conclusion: The 2 out of 3 points criteria for approaching the patients suspected of hav-ing acute appendicitis provide a nonexpensive, noninvasive, simple, rapid and accurate method for diagnosis of acute appendicitis

Experience with distal finger replantation: A 20-year retrospective study from a major trauma center

Background and Aim: More than 40 years has passed since the first successfu0l replantation and thousands of fingers have been salvaged. We present our experience with distal finger replantation during 20 years of surgery. From 1990 to 2010, 420 replantations were performed; 64 of 420 cases were distal finger replantations. We discuss the indications, techniques, and outcomes of these difficult cases. Method: The records of 64 patients were reviewed and the demographics, methods of replantation, success rates, and complications were evaluated. Bone shortening was performed and fixation method in this zone was mostly pin fixation. The "Bench Technique" for the amputated part consisted of preparing the artery, vein, and nerve. In zones 1 and 2a, the veins are volar and when incising the skin for dissection, utmost care was taken to save the volar delicate veins and prepare them for outflow. When there was no vein found, dissection was toward finding 2 arteries, 1 for inflow and 1 for outflow. Medicinal leeches were used during the first 10 years. Chemical leeching was used thereafter. Results: Our patients were mostly young male workers and from the industrial sector. Our success rate of 87 was similar to the current literature. The overall complication rate from minor wound infection was 35 and total finger loss was 13. Medicinal leeches had minimal satisfactory results. Chemical leeching was more effective. Conclusions: Our 20-year experience with distal finger replantation showed a success rate of 87. On account of cultural beliefs amputation is not tolerated well in Eastern cultures. Thus, a high rate of single finger replantations is seen. The success rate is similar to that of the literature and cosmetic results are far superior to replantation in other zones. © 2011 by Lippincott Williams & Wilkins

An Easy Solution For The Diverting Loop Colostomy: Our Technique

Background: The loop colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion. We are introducing the use of a full thickness skin bridge under the large bowel instead of a glass rod which alleviates problems such as protrusion of the large bowel, retraction of the bowel into the abdomen after removing the rod and hindering proper application of a colostomy bag over the stoma. Methods: Seventeen patients needing double barrel colostomy for complete diversion of fecal material were selected using loop colostomy with skin bridge. Three patients had Fournier's gangrene and 14 had penetrating rectal injury. Omega loop colostomy with a full thickness skin bridge was performed for fecal diversion. Results: All of the 17 patients had gas passing and full passage of fecal material within 3 days postoperatively. No case of skin necrosis and stitch abscess was encountered. No parastomal hernia or large prolapse was noted until healing was completed and patients were discharged and after at least 8 weeks and in Fournier's gangrene somewhat longer, the loop colostomy was closed without the need for formal laparotomy and without any case of anastomotic leak. Conclusion: In this study we confirmed that diverting loop colostomy using a skin bridge is a safe, rapid and easy to manage colostomy technique which gives complete diversion similar to double barrel colostomy without the need of performing a laparotomy for closure of the colostomy