Curcumin (diferuloylmethane), an active ingredient of turmeric, is known to have multiple activities, including an antioxidant property, and has been suggested to be of use in treatment of several diseases. The present study has been undertaken to investigate the protective effect of curcumin against lead-induced neurotoxicity in rats. Exposure of rats to lead (50 mg/kg po) for 45 days caused an increase in lipid peroxidation (LPO) and a decrease in reduced glutathione (GSH) levels in cerebellum, corpus striatum, hippocampus and frontal cortex as compared with controls. Lead levels were significantly increased in these rats. Activity of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) decreased in all the brain regions following lead exposure. Interestingly, cotreatment with curcumin (100 mg/kg po) and lead (50 mg/kg po) for 45 days caused a significant decrease in LPO with concomitant decrease in lead levels in all the brain regions as compared with those treated with lead alone. A significant increase in reduced glutathione (GSH) levels, SOD and CAT activities was also observed in all the four brain regions in rats simultaneously treated with curcumin and lead. The results suggest that curcumin may prevent lead-induced neurotoxicity.

Turmeric has been in use since ancient times as a condiment and due to its medicinal properties. Curcumin, the yellow colouring principle in turmeric, is polyphenolic and major active constituent. Besides anti-inflammatory, thrombolytic and anticarcinogenic activities, curcumin also possesses strong antioxidant property. In view of the novel combination of properties, neuroprotective efficacy of curcumin was studied in rat middle cerebral artery occlusion (MCAO) model. Rats were subjected to 2 h of focal ischemia followed by 72 h of reperfusion. They were pre-treated with curcumin (100 mg/kg, po) for 5 days prior to MCAO and for another 3 days after MCAO. The parameters studied were behavioural, biochemical and histological. Treatment with curcumin could significantly improve neurobehavioral performance compared to untreated ischemic rats as judged by its effect on rota-rod performance and grid walking. A significant inhibition in lipid peroxidation and an increase in superoxide dismutase (SOD) activity in corpus striatum and cerebral cortex was observed following treatment with curcumin in MCAO rats as compared to MCAO group. Intracellular calcium levels were decreased following treatment with curcumin in MCAO rats. Histologically, a reduction in the infarct area from 33% to 24% was observed in MCAO rats treated with curcumin. The study demonstrates the protective efficacy of curcumin in rat MCAO model.

We report the five year outcomes of a two-stage approach for infected total hip replacement. This is a single-surgeon experience at a tertiary centre where the more straightforward cases are treated using single-stage exchange. This study highlights the vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age of 68 years (42 to 78) were reviewed prospectively. Functional status was assessed using the Harris hip score (HHS). The mean HHS improved from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively. Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all, 19 patients died during the period of the study. This represented a one year mortality of 0.8% and an overall mortality of 15.2% at five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach. The reason for the high rate of mortality in these patients is not known.

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The neuroprotective potential of ethanol:water (1:1) extract of rhizomes of Acorus calamus (AC–002) has been investigated in middle cerebral artery occlusion (MCAO)–induced ischaemia in rats. A significant behavioural impairment in Rota–Rod performance and grid walking was observed in rats, 72 hours after MCAO as compared to sham–operated animals. These rats also exhibited an increase in lipid peroxidation (cortex / 157%, corpus striatum – 58%) and a decrease in glutathione levels (cortex – 59%, corpus striatum – 34%) and superoxide dismutase (SOD) activity (cortex – 64%, corpus striatum – 32%) as compared to sham–operated animals. Ischaemic rats treated with AC–002 (25 mg/kg, p.o.) exhibited a significant improvement in neurobehavioural performance viz. Rota–Rod performance and grid walking as compared to the MCAO group. Interestingly, treatment with AC–002 in MCAO rats significantly decreased malonaldialdehyde levels in cortex as compared to ischaemic rats. A significant increase in reduced glutathione levels and SOD activity was also observed both in cortex and corpus striatum in MCAO rats treated with AC–002 in comparison to MCAO rats. Treatment with AC–002 in MCAO rats also reduced the contralateral cortical infarct area (19%) as compared to MCAO rats (33%). Neurological function score was improved in the AC–002–treated rats as compared to the MCAO group. The results of the present study indicate the neuroprotective efficacy of A. calamus in the rat model of ischaemia.

We report the outcomes of 32 patients diagnosed with macrodactyly. The average age at presentation was 46 months and there was an equal distribution across the sexes, although there was a male predominance in the upper limb and female predominance in the lower limb. There were 20 cases of upper limb macrodactyly and 13 cases affecting the lower limb. Multiple digits were more commonly affected than isolated digits, with an average of 2.5 digits affected. Static disease required significantly fewer operations than progressive disease. The need for repeated procedures must be highlighted in cases of progressive macrodactyly. In the vast majority of cases the functional and cosmetic outcome is good, with good patient acceptance.

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Periprosthetic joint infection is a devastating complication. Orthopaedic surgeons must prevent, anticipate, rapidly diagnose and effectively manage such patients in the multidisciplinary setting. This review discusses current strategies in the management of these patients following total hip arthroplasty.