The Lost Years 1918-1935

The article covers the last 17 years of Komitas’s life. Constantinople Armenians who took care of Komitas, on the advice of Dr. Vahram Torkomian, seeing no improvement in Komitas’s mental health, while he was treated at Hopital de la Paix in Istanbul, decided to send him to Paris, hoping for better treatment and outcome. The article describes Komitas’s medical care, both psychiatric and physical until his death in 1935 when Komitas was in custodial care in Paris sanatoriums. It describes and analyses the findings from Komitas’s medical files at Ville- Evrard and Ville- Juif Hospitals. It reviews the psychiatric consultations, and explains the medical terms used at the beginning of the 20th century and its implications for psychiatric diagnosis used in Western psychiatry of today. Finally it describes his death due the bone infection in his foot and his funeral arrangements. Սույն հոդվածը նկարագրում է Կոմիտասի կյանքի և հիվանդության փարիզյան շրջանը մինչև իր մահը 1935 թ․ հոկտեմբերին։ 1918 թ. Զինադադարից հետո Կոմիտասի ընկերները բժիշկ Վահրամ Թորգոմյանի խորհրդով նրան բուժման նպատակով ուղարկում են Փարիզ։ Կոստանդնուպոլսի Լա Բե հիւանդանոցում Կոմիտասի առողջությունն անփոփոխ էր մնում, և լավացում չէր արձանագրվում։ Հոդվածն անդրադառնում է Փարիզի Վիլ Էվրար և Վիլ Ժուիֆ բուժական հաստատություններում Կոմիտասի բժշկական խնամքին։ Վերլուծության են ենթրկվում բժշկական թղթապանակը, բժշկական խորհրդատվությունները, համեմատվում են քսաներորդ դարասկզբին գործածված բժշկական ախտորոշիչ եզրույթները՝ ներկայիս գործածվող տարբերակների հետ։ Քննարկվում են նաև նրա ոտքի ոսկորի հիվանդությունն ու ֆիզիկական հյուծման պատճառով մահվան պարագան, ապա նաև թաղման կազմակերպումը։

Bone infection: a clinical priority for clinicians, scientists and educators

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.

Fabrication of Chitosan Based Antibacterial Implant for Multibacterial Bone Infection

Despite advancements in medicines and novel surgical methods, osteomyelitis is still a complex and difficult to treat multi-bacterial bone infection. It generates in tissue necrosis along with rupturing of bone in chronic cases leading towards limited vascularity at infection site, local treatment might not show accountable level of antibiotic at infection site. The present research aims towards development and evaluation of bio-degradable implant of Ciprofloxacin hydrochloride to treat local osteomyelitis. Chitosan is widely investigated biodegradable polymer with hydroxyl moiety which is active and can be altered chemically to develop biomedical and therapeutic dosage forms. Here this active group was modified using epichlorohydrin & crosslinked Chitosan matrices were used as carrier to formulate different Ciprofloxacin implant. In vivo parameters and in vitro study was conducted for optimized batch. The formulation having 40% drug loading (EC4) was found to be optimum when all evaluation parameters were tested. The concentration of Ciprofloxacin Hydrochloride (HCl) in bone and surrounding tissues is much higher than minimum inhibitory concentration (MIC) even after a month. After observing the water uptake and extended release of drug from all formulations the drug loading was found to be higher. The present work concluded that, the highly branched chitosan remarkably reduce the percent (%) drug release up to a month which could be useful in the treatment of osteomyelitis.

Anaerobic osteomyelitis

The prevalence and role of anaerobic bacteria in bone infection were investigated in this prospective study on 134 cases with pyogenic osteomyelitis. Specimens were inoculated immediately in the operating theatre or in the ward and incubated under aerobic and anaerobic conditions without using transport media. Anaerobic organisms were isolated from 39 of the 134 cases [29%] of all types of pyogenic osteomyelitis. The total number of aerobic and anaerobic isolates was 224, of which 50 were anaerobes [22%]. Syringe-aspirated specimens were better than swab specimens for the isolation of anaerobes. Anaerobes were mostly isolated from osteomyelitis cases of long duration

519 Outcomes of Management with Ilizarov Frames in Bone Infection: An Observational Study

Aim The successful treatment and eradication of bone infection requires a multifaceted approach and may recur even after excision if resultant bone void is not managed effectively. This paper aims to review the clinical effectiveness of antibiotic-impregnated bone void filler and current empirical antibiotic guidelines. Method We report a retrospective study of 18 patients with chronic osteomyelitis following injury or surgery managed via Ilizarov Ring Fixator (IRF). All patients were managed by IRF stabilisation procedures with debridement, microbiological sampling, and bone void filling with antibiotic-impregnated biocomposite material, in addition to culture-specific systemic antimicrobial therapy. Results Patients were followed up for a mean of 15.9 months. Infection was eradicated in 94.1% of patients in a grossly comorbid demographic. Comorbidities associated with increased risk of osteomyelitis were noted in 72.2% of patients. Anaerobic bacteria were identified in culture for four (22.2%) of the 18 patients. Conclusions We detected a higher than suspected growth of anaerobes in our samples, suggesting the need for metronidazole in empirical antibiotic treatment. This study would suggest that the use of STIMULAN® may be preferable in this National Health Service from a cost-effect perspective, as our results are comparable to those using other bone void fillers.