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BackgroundNecrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition.MethodsA retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020.ResultsAmong 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients.ConclusionNecrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.

Objectives Assess the clinical utility of an Endoscopic Integrated Multipoint Laser System (EMLS) to otology. This is an emerging technology from automotive engineering that may offer the ability to accurately measure anatomy and pathology using an endoscope while undertaking ear surgery. Patients Simulated otology patients were used incorporating the Phacon Temporal Bone synthetic models and Kyoto Kagaku Ear Examination Simulator models to allow assessment of the EMLS technology in evaluating external ear and middle ear pathology, e.g., perforation or prosthesis sizing. Intervention Eight otolaryngology resident and fellows at a tertiary university teaching hospital were given training in EMLS and reviewed simulated anatomy and pathology within the models including tympanic membrane perforation, ossicular discontinuity, and a cochleostomy. Main outcome measure Variance in measurement was assessed in relation to those made manually by an independent surgeon using surgical calipers (0.1 mm). Results The 8 participants produced 47 mean measurements. The mean difference from independently made manual measurement was 0.294 mm (standard error of the mean 0.033). Maximum variance was 0.98 mm and minimum 0.01 mm. Conclusion Use of an integrated endoscopic laser measurement tool allows reliable, easy-to-obtain measurements to be obtained within a simulated otological surgical environment. Translation of the technology to a thinner delivery system through a rigid endoscope offers further promise for routine use in a clinical setting.

Globally the SARS-CoV-2 pandemic has posed significant challenges in the delivery of clinical care, in part owing to the lack of an evidence base for treatment and formalised patient care pathways. Guidelines have been published on the technical protocol for surgical tracheostomy in SARS-CoV-2 patients [2], however it is important to also focus on the pre-operative referral process. In order to make assertions on whether tracheostomy may have aided weaning, it would be necessary to implement formal, standardised methods of patient selection and record variables that may allow eventual patient prognostication. With a view to address this issue we have established a COVID-19 tracheostomy referral pathway based on work by The British Laryngological Association (BLA) and multidisciplinary stakeholders at Barts Health NHS Trust (see online Appendix 1) [3].

Objective: CHARGE syndrome presents with a collection of congenital anomalies affecting multiple organs. Ear and temporal bone anomalies, including hearing loss are highly prevalent.We present an a...

COVIDTrach is a UK multidisciplinary collaborative project that aims to evaluate the outcomes of tracheostomy in COVID-19 patients. It also examines the implementation of national guidance in COVID-19 tracheostomies and the incidence of COVID-19 infections amongst those health care workers involved in the procedure. An invitation to participate in an online survey tool (REDCap) was disseminated to all UK NHS departments involved in tracheostomy in mechanically ventilated COVID-19 patients via the Federation of Surgical Specialty Associations, it’s subsidiary organisations and the Intensive Care Society. To date 78 hospitals have submitted 564 COVID-19 tracheostomy cases. Fifty-two percent (n=219/465) of patients who had undergone tracheostomy and were still alive had been successfully weaned from mechanical ventilation at the point of completing the survey. The all cause in-hospital mortality following tracheostomy was 12% (n=62/530), with 3% of these (n=2/62) due to tracheostomy related complications and the remaining deaths due to COVID-19 related complications. Amongst 400 cases submitting data two weeks after the tracheostomy, no instance of COVID-19 infection amongst operators was recorded. FFP3 masks or Powered Air Purifying Respirators were used by operators in 100% of tracheostomies and a face visor or hood with face shield was available in 99% of cases. This interim report highlights early outcomes following tracheostomy in mechanically ventilated COVID-19 patients. Future reporting from COVIDTrach will include more detailed analysis at later timepoints using comparator groups in order to provide a more comprehensive assessment of tracheostomy in COVID-19.

A new series of 2,6-diarylpiperidin-4-one N(4′)-cyclohexylsemicarbazones were synthesized from the corresponding 2,6-diarylpiperidin-4-ones (1–9). The synthesized compounds [2,6-diarylpiperidin-4-one N(4′)-cyclohexylsemicarbazones (10–18)] were confirmed by their spectral analysis such as FT-IR, 1H NMR, 13C NMR, HMBC, HSQC, HOMOCOSY and NOESY. Shielding differences between the syn α and anti α carbons with respect to C = N has been discussed in detail. Conformational analyses reveal that the compounds 10–18 exist in chair conformation with the diequatorial orientation of bulky aryl substituents. In vitro antibacterial and antifungal activities of compounds 10–18 and the anticancer activity of 3-methyl-2,6-bis(4-tolyl)piperidin-4-one N(4′)-cyclohexylsemicarbazone (12) in HEp-2 cell line are reported. Compound 12 is found have promising antibacterial, antifungal and anticancer activities.

N-Cyclohexylcarbamoyl-3-isopropyl-2,6-bis(phenyl)piperidin-4-one (1) and N-Cyclohexylcarbamoyl-3,3-dimethyl-2,6-bis(4-fluorophenyl)piperidin-4-one (2) were synthesized and characterized by IR, 1H NMR, 13C NMR, HOMOCOSY, NOESY, HSQC and HMBC. Single crystal X-ray diffraction study was performed for 1 and 2. Both the compounds (1 and 2) crystallized in triclinic crystal system with P-1 space group. From the XRD analysis results it is observed that the conformation of the heterocyclic ring in 1 and 2 is twist boat. The computational study was performed and the structures were optimized using DFT–B3LYP with the 6-31G basis set. Hirshfeld surface analysis was also carried out and the contributing intermolecular interactions which stabilizes the crystal structures are quantified. It exemplifies the predominant contribution of van der Waals interaction in the packing of both the crystal structures. Cyclic voltammetric studies were also performed and discussed. From the CV analysis it is observed that 2 exhibit the high specific capacitance value even at higher scan rate.

A series of N -cyclohexylcarbamoylpiperidin-4-ones were synthesized by the addition reaction of corresponding piperidin-4-ones with cyclohexylisocyanate in benzene. The structure and stereochemistry of the synthesized N- cyclohexylcarbamoyl -2, 6-diarylpiperidin-4-ones, were established on the basis of their analytical and spectral data (IR, 1 H and 13 C NMR). 2D NMR spectra (HOMOCOSY, HSQC, HMBC and NOESY) were also recorded to analyze the stereochemistry. In the IR spectra of synthesized compounds, the characteristic absorptions due to ring and amide carbonyl functionalities were observed which evidences the formation of N- cyclohexylcarbamoyl-2, 6-diarylpiperidin-4-ones. NMR spectral results are in line with the proposed structure of the compounds synthesized. Conformational analysis was carried out from the extracted coupling constants and NOESY spectral results. The synthesized compounds were evaluated for their antibacterial and antifungal activities.

This article reports the single-crystal X-ray diffraction dataset of some isobutyl-1,2,6-triaryl-4-(arylamino)-1,2,5,6-tetrahydropyridine-3-carboxylate (1-3) derivatives with Hirshfeld surface analysis. Pictorial representations of intramolecular hydrogen bonding in 1-3 with the characteristics of Resonance Assisted Hydrogen Bonding (RAHB) are presented. The data corresponding to the Hirshfeld surface analysis is given.

A new set of compounds which are intra-molecularly hydrogen bonded have been synthesized and analyzed with special reference to Resonance Assisted Hydrogen Bonding (RAHB). The structure and stereochemistry of the synthesized compounds (1–10), were established on the basis of their analytical and spectral data (IR, 1H, 13C NMR, HOMOCOSY, NOESY, HSQC and HMBC). The structure in the solid state for 5, 9 and 10 is clearly established by single crystal X-ray diffraction analysis. Spectral and single crystal X-ray structural study confirms the flattened boat conformation of the heterocyclic ring which is analyzed with the help of dihedral angles and the mean plane deviations. Hirshfeld surface analysis is carried out and the packing interactions are discussed. The prevalent intramolecular hydrogen bonding is well proved by XRD analysis and the type of hydrogen bonding is classified as S(6), and the resonance assistance for the hydrogen bonding is also quantified and discussed explicitly. Antimicrobial studies were performed for the synthesized compounds against some Gram positive and Gram negative bacterial strains and some fungal strains and the results are summarized.

An efficient synthetic route with good overall yields to synthesize alkyl 2-(3-alkyl-2,6-diarylpiperidin-4-ylidene)hydrazinecarboxylates (7–14) is reported. All the synthesized compounds were characterized by their analytical and spectral (IR, 1H, 13C and 2D NMR) data. Single crystal X-ray structural analysis of compound 7, evidences that the configuration about C N double bond is syn to C5 carbon (E-form) and exists in normal chair conformation with equatorial orientations of all the substituents.

Background:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.

Objectives/Hypothesis To demonstrate construct validity of the ovine model as a tool for training in endoscopic sinus surgery (ESS). Study Design Prospective, cross-sectional evaluation study. Methods Over 18 consecutive months, trainees and experts were evaluated in their ability to perform a range of tasks (based on previous face validation and descriptive studies conducted by the same group) relating to ESS on the sheep-head model. Anonymized randomized video recordings of the above were assessed by two independent and blinded assessors. A validated assessment tool utilizing a five-point Likert scale was employed. Construct validity was calculated by comparing scores across training levels and experts using mean and interquartile range of global and task-specific scores. Subgroup analysis of the intermediate group ascertained previous experience. Nonparametric descriptive statistics were used, and analysis was carried out using SPSS version 21 (IBM, Armonk, NY). Results Reliability of the assessment tool was confirmed. The model discriminated well between different levels of expertise in global and task-specific scores. A positive correlation was noted between year in training and both global and task-specific scores (P

An efficient and multifunctional three component synthetic protocol was developed to synthesize ethyl 6-amino-4-aryl-5-cyano-2-propyl-4H-pyran-3-carboxylates from ethyl 3-oxohexanoate, malononitrile and corresponding aldehydes (1a–11a) using K2CO3 as a catalyst under water solvent in good yields. The derived compounds have been analyzed by IR and NMR (1D and 2D) spectra. Single crystal X-ray structural analysis of 2a, evidences the flattened-boat conformation of pyran ring and the phenyl group is nearly perpendicular to the pyran ring.

1,3-Dimethyl-2,6-diphenylpiperidin-4-one N(4′)-cyclohexylsemicarbazone (DDPCS) has been synthesized and characterized by IR, 1H NMR and 13C NMR spectral analysis. IR and NMR spectra of compound DDPCS have been simulated by computational method using DFT-B3LYP with the 6–31 G basis set. Single crystal X-ray diffraction analysis has been performed and it evidences the configuration about C=N double bond is E and the chair conformation of the heterocyclic ring. The N H••••O intermolecular hydrogen bonding in the crystal structure forms an eight membered pseudo ring with the R22 (8), Etter's graph set. The computational, spectral and X-ray structural results exemplifies the chair conformation of the heterocyclic ring with the equatorial orientation of bulky groups. The calculated vibrational frequencies of the normal modes accorded well with the experimental values. Hirshfeld surface analysis was also carried out and discussed in detail. The synthesized compound was screened for its in vitro antimicrobial activity.

A new series of 2,6-diarylpiperidin-4-one N(4′)-cyclohexyl thiosemicarbazones (13–23) were synthesized by corresponding 2,6-diarylpiperidin-4-ones (1–11) reaction with cyclohexyl thiosemicarbazide (12). The chemical structures were confirmed by means of IR, one and two dimensional NMR, Mass spectra and single crystal X-ray diffraction analysis. Compounds 13–23, exist in chair conformation with equatorial orientation of all the substituents at piperidine ring except the methyl group at C-5 of compounds 21–23 oriented at axial disposition to stabilize the chair conformation. Single crystal X-ray structural analysis of compound 18, evidences that the configuration about C N double bond is syn to C-5 carbon (E-form). All the synthesized compounds were screened their biological activity.

A series of isobutyl 6-amino-4-aryl-5-cyano-2-methyl-4H-pyran-3-carboxylates (1–9) have been synthesized by the multicomponent reaction (MCR) between isobutyl ethylacetoacetate, aryl aldehydes and malononitrile using BF3:OEt2 as catalyst. The derived compounds have been analyzed by IR and NMR (1D and 2D) spectra. Single crystal X-ray structural analysis of 1, evidences the flattened-boat conformation of pyran ring.