The optimization and microwave assisted extraction of stem bark of Terminalia arjuna, quantitative estimation of the marker compounds arjunic acid and arjunolic acid using HPTLC and the evaluation of free radical scavenging activity has been performed in this study. The central composite design was used for optimization and the values of parameters for optimized batch of microwave assisted extraction were 1000W (Power), 3 minutes (Time) and 1/120 (Solid/solvent ratio). The solvent system to carry out the HPTLC was toluene: acetic acid: ethyl acetate (5: 5: 0.5) and quantitative estimation was done using standard equations obtained from the marker compounds. The in-vitro free radical scavenging activity was performed spectrophotometrically using ascorbic acid as standard. The value of estimated percentage yield of arjunic acid and arjunolic acid was 1.42% and 1.52% which upon experimentation was obtained as 1.38% and 1.51% respectively. The DPPH assay of the different batches of microwave assisted extraction and marker compounds taken suggested that the marker compounds arjunic acid and the arjunolic acid were responsible for the free radical scavenging activity as the batch having the maximum percentage yield of the marker compounds showed best free radical scavenging effect as compared to standard ascorbic acid. The IC₅₀ value of the optimized batch was found to be 24.72 while that of the standard ascorbic acid was 29.83. Hence, the yield of arjunic acid and arjunolic acid has direct correlation with the free radical scavenging activity of stem bark extract of Terminalia arjuna and have potential to serve as active lead compounds for free radical scavenging activity.
Acetic Acid ; Ascorbic Acid ; Microwaves* ; Terminalia* ; Toluene

Four patients with shoulder problems that were traumatic in etiology presented to us with delays in seeking care ranging from 6 to 12 weeks due to the coronavirus disease 2019 (COVID-19) lockdown. The care of three cases (a 3-month-old neglected anterior shoulder dislocation with a greater tuberosity fracture in a 30-year old man, a 3-month-old neglected anterior shoulder dislocation in a 17-year old boy, and a 2-month-old neglected greater tuberosity fracture in a 31-year old man) was delayed due to the lockdown and the ensuing travel restrictions, while that of one case (a 6-week-old fracture–dislocation of the proximal humerus in a 55-year-old woman) was delayed because the patient was undergoing treatment for COVID-19 at the time of injury. This report intends to present the exceptional circumstances around these cases. The unique treatment challenges and their outcomes are also described to advise the surgeons of the nuances and difficulties in treating these injuries.

Introduction: Various treatment modalities are available butno consensus has been reached for optimal treatment oflateral third clavicle fractures. Precontoured locking plateswith broad lateral end for multiple screws fixation is a newlydesigned plate for lateral third clavicle fractures. Theobjective of our study was to analyse the functionaloutcomes as well as complications of this technique in asignificant number of cases with long follow-up duration.Materials and Methods: Forty-six patients with distal thirdclavicle fractures were treated by precontoured clavicularlocking plate with broad lateral end. Functional outcomeswere assessed on the basis of Constant-Murley ShoulderOutcome Score and University of California, Los Angeles(UCLA) Shoulder Rating Score, active shoulder range ofmotion, time for fracture union and coraco-claviculardistance.Results: The mean Constant-Murley score was 92.56±4.47(range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coracoclaviculardistance at final follow-up was 10.52±1.13 mm(range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm(range 9.6 to 11.2 mm) in normal side. Mean UCLAShoulder Rating Score was 32.55±2.12 (range: 27-34) forinjured side and 33.46±1.88 (range: 31- 35) on normal sidewith p value 0.58. No major complications that necessitatedrevision of surgery occurred in our study.Conclusion: This newly designed plate seemed extremelyuseful in successful union of lateral third clavicle fractures,with reduced rate of complications like fixation failures,iatrogenic rotator cuff injury, AC joint osteoarthritis andsub-acromial bursitis, with good functional out

Procedures involving complex surgical techniques in rats, such as placement of abdominal aortic graft require extended duration of surgical anesthesia, which often can be achieved by repeated administrations of xylazine-ketamine combination. However such repeated anesthetic administration, in addition to being technically challenging, may be associated with potential adverse events due to cumulative effects of anesthesia. We report here the feasibility of using urethane at low dose (~1/10 the recommended anesthetic dose) in combination with a xylazine-ketamine mix to achieve an extended duration of surgical anesthesia in rats. The anesthesia induction phase was quick and smooth with an optimal phase of surgical anesthesia achieved for up to 90 minutes, which was significantly higher compared to that achieved with use of only xylazine-ketamine combination. The rectal temperature, heart rate and respiratory rate were within the physiological range with an uneventful recovery phase. Post surgery the rats were followed up to 3 months without any evidence of tumor or any other adverse effects related to the use of the urethane anesthetic combination. We conclude that low dose urethane can be effectively used in combination with xylazine and ketamine to achieve extended duration of surgical anesthesia up to 90 minutes in rats.
Anesthesia* ; Animals ; Heart Rate ; Ketamine* ; Rats* ; Respiratory Rate ; Transplants ; Urethane* ; Xylazine*

Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Aspirin ; therapeutic use ; Atrial Fibrillation ; complications ; drug therapy ; Brain Ischemia ; etiology ; prevention & control ; Dabigatran ; therapeutic use ; Dipyridamole ; therapeutic use ; Female ; Guideline Adherence ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; therapeutic use ; Practice Guidelines as Topic ; Primary Prevention ; statistics & numerical data ; Pyrazoles ; therapeutic use ; Pyridones ; therapeutic use ; Rivaroxaban ; therapeutic use ; Stroke ; etiology ; prevention & control ; Ticlopidine ; analogs & derivatives ; therapeutic use ; Warfarin ; therapeutic use

Methods: Hospital records of spinal tuberculosis patients treated at a single center over a period of 5 years were retrospectively reviewed. A diagnosis of spinal tuberculosis was based on standard clinical, radiological, microbiological, and histopathological evidence. Patients were treated in accordance with the “middle-path” regimen; surgery was reserved for selective indications. Results: A total of 1,652 patients were included. Their median age was 32.4 years, with 53% being male. Axial pain (98%) was the most common presenting symptom; 19% of patients had neurological deficit. Lumbar spine (37%) was the most common site of involvement, with a paradiscal pattern (82%) of involvement predominating. Multi-level involvement was seen in 19% of patients; skip lesions were noted in 2.8%. Transpedicular biopsy was performed in 667 patients; at least one tissue test was diagnostic of tuberculosis in 65% of patients. Forty-four patients had drug resistance to rifampicin. Surgery was required in 10.5% of patients. The “middle-path” regimen was associated with high compliance and significant improvements in pain (Visual Analog Scale score) and function (36-Item Short Form Health Survey). Conclusions Our findings confirm the widespread prevalence of spinal tuberculosis and describe various epidemiological characteristics of a large sample of spinal tuberculosis patients. Adoption of the “middle-path” regimen is associated with high compliance and favorable outcomes in spinal tuberculosis.

Meghalaya, (in India), in the region of the mega-biodiversity hotspots, is home to a plethoraof wild mushrooms. The present study concerns the exploration of the order Agaricales,which includes rare gilled mushrooms considered endangered under IUCN A4c criteria, dueto the declining habitat. Electron microscopy of the gill sections revealed an abundance ofclamp connections, hyphal cell walls, cystidia, and basidia. This rare species which belongsto the family Cyphellaceae, exhibits morphological and molecular differences from theCyphella spp. Phylogenetic analysis revealed that it formed a clade under the genusCampanophyllum of the order Agaricales, confirmed by both Neighbor Joining (NJ) andBayesian phylogenetic analysis. Being nutritionally potent along with its efficient antioxidantvalue, the fungal extract shows significant rise of two-fold in the antimicrobial activity alongwith the commercial antibiotics. The compound, Phenol, 2, 4-bis (1, 1-Dimethylethyl) (2, 4-DTBP) showed in ample range in the fungal extract along with aliphatic hydrocarbons,terpene, alcohol and volatile organic compounds on further characterization in GCMS. Thepresent study indicates the endangered Campanophyllum proboscideum could be a richsource of natural antioxidants and an effective pharmaceutical agent.

Meghalaya, (in India), in the region of the mega-biodiversity hotspots, is home to a plethoraof wild mushrooms. The present study concerns the exploration of the order Agaricales,which includes rare gilled mushrooms considered endangered under IUCN A4c criteria, dueto the declining habitat. Electron microscopy of the gill sections revealed an abundance ofclamp connections, hyphal cell walls, cystidia, and basidia. This rare species which belongsto the family Cyphellaceae, exhibits morphological and molecular differences from theCyphella spp. Phylogenetic analysis revealed that it formed a clade under the genusCampanophyllum of the order Agaricales, confirmed by both Neighbor Joining (NJ) andBayesian phylogenetic analysis. Being nutritionally potent along with its efficient antioxidantvalue, the fungal extract shows significant rise of two-fold in the antimicrobial activity alongwith the commercial antibiotics. The compound, Phenol, 2, 4-bis (1, 1-Dimethylethyl) (2, 4-DTBP) showed in ample range in the fungal extract along with aliphatic hydrocarbons,terpene, alcohol and volatile organic compounds on further characterization in GCMS. Thepresent study indicates the endangered Campanophyllum proboscideum could be a richsource of natural antioxidants and an effective pharmaceutical agent.

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention.