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Background: Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. Materials and Methods: A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. Results: The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. Conclusion: The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care. [ABSTRACT FROM AUTHOR]

Background: Video laryngoscopes are commonly used along with Macintosh and McCoy laryngoscopes for Nasotracheal intubation (NTI). The purpose of this study was to evaluate the performance of McCoy, Macintosh, and Truview laryngoscopes during bougie-aided NTI with respect to intubation time, success rate, and hemodynamic changes during the procedure. Methods: Forty-five American Society of Anesthesiologists (ASA) I-II adult patients, with Mallampati grade 1-4, requiring NTI, were enrolled after taking written informed consent. ASA III/IV, restricted mouth opening, and body mass index >30 were excluded from the study. Patients were randomly allocated to intubate with one of the three laryngoscopes (McCoy, Macintosh, and Truview) and the anesthesiologists were well experienced with all of them. The primary outcome was intubation time and secondary outcomes included first attempt success rate, external laryngeal manipulation, Cormack-Lehane (CL) grade, and hemodynamic responses. Results: The intubation time of McCoy, Macintosh, and Truview, was 86.87 ± 15.92, 82.87 ± 16.46, and 79.93 ± 14.53 (mean ± standard deviation) seconds, respectively, which is comparable with Truview being the shortest. CL grade 1 was obtained more in the Truview group (53.3%) compared to the other two groups, while CL grade 3 was obtained in 20% each in McCoy and Macintosh groups. Conclusions: McCoy, Macintosh, and Truview laryngoscopes were comparable in performance during bougie-aided NTI, with Truview having the shortest intubation time and better visualization. [ABSTRACT FROM AUTHOR]

Background: Powered circular saw-related injuries (PCSRIs) are responsible for a sizable proportion of occupational injuries presented to the emergency department (ED). The present study portrays the mechanisms, injury patterns, epidemiological parameters, and outcomes among subjects presenting with PCSRI to the ED. Methods: This retrospective observational study was conducted in the ED of a tertiary care hospital in eastern India. Clinical records of subjects with PCSRI from June 2019 to June 2022 were reviewed. Data pertaining to patients' demographic profiles and the patterns and mechanisms of injury were retrieved. The Modified Hand Injury Severity Score (MHISS) and the Injury Severity Score (ISS) were calculated. Statistical analysis was performed using R version 4.1.0. Results: A total of 175 subjects' data were analyzed. The median age was 34.5 years, and all subjects were men. The mean year of experience of the subjects was 6.2. The most common job category was carpentry (n = 63 [36%]), followed by "do it yourself work" (n = 26 [14.8%]). One hundred twenty-two (69.7%) subjects had hand injuries (HIs), and the left hand was involved in 85 (69.6%) subjects. The index finger was involved in 36 (29.5%) subjects, followed by the thumb (n = 31 [25.4%]). Laceration (n = 155 [88.5%]) was the most common injury pattern. The subjects' mean ISS and mean MHISS were 8.52 and 45, respectively. Conclusion: PCSRI is associated with moderate-to-severe HIs that are most common in occupational settings. Young male carpenters involved in wood and plywood work are more prone to injuries. [ABSTRACT FROM AUTHOR]

Byline: Bikasa. Triapthy, Subrat. Sahoo, Manoj. Mohanty, Mantu. Jain, Sangeeta. Sahoo Spontaneous spinal epidural abscess is rare entity in neonates. These are surgical emergency in which early diagnosis and prompt [...]

Byline: Chitta. Mohanty, Suma. Ahmad, Snigdha. Bellapukonda, Sangeeta. Sahoo Sir, The sudden disruption of oxygen supplies due to damage to medical gas pipeline system (MGPS) during a natural disaster can [...]

Background: Gastric content regurgitation and aspiration are the dreaded complications of securing the airway. Cricoid pressure hinders intubation and causes lower esophageal sphincter (LES) relaxation. A recent study suggests no added benefit of cricoid pressure in preventing pulmonary aspiration of gastric contents. Metoclopramide increases LES tone, prevents gastroesophageal reflux, and increases antral contractions. Hence, we wanted to study the efficacy of metoclopramide for preventing gastric regurgitation during endotracheal intubation (ETI) in patients presenting to the emergency department (ED). Methods: This study was a randomized controlled trial in patients requiring ETI in the ED. The study participants were randomized to receive either metoclopramide (intervention) 10mg/2ml intravenous(IV) bolus or a placebo of normal saline (placebo) 2ml IV bolus 5min before rapid sequence induction and intubation. The outcome of the study was the visualization of gastric regurgitation at the glottic opening during direct laryngoscopy at the time of intubation. Results: Seventy‑four study participants were randomized and allocated to the metoclopramide group (n = 37) or placebo group (n = 37). Gastric regurgitation at the glottis was noted in three study participants (8%) in the metoclopramide group, and six (16%) in the placebo group (odds ratio [OR] ‑ 0.456; 95% confidence interval [CI] of 0.105–1.981; P = 0.295). The study participants who were intubated in the first attempt had less gastric regurgitation compared to ≥2 attempts (OR 0.031; 95% CI of 0.002–0.511; P = 0.015). Conclusion: There was no decrease in regurgitation with metoclopramide as compared to placebo during ETI in study participants presenting to the ED. [ABSTRACT FROM AUTHOR]

Background: Monitoring sodium levels during the correction of hyponatremia is essential. There is cell swelling due to the movement of water from extracellular to intracellular by osmotic effect in hyponatremia. The cellular swelling in a closed space causes increased intracranial pressure (ICP). The raised ICP correlates with the optic nerve sheath diameter (ONSD). So, the research question was whether the ONSD can be used as a guide for the correction of hyponatremia. Methods: It was a prospective observational study conducted on patients with serum sodium below 135 mEq/L presented to the emergency department (ED). The ONSD was measured at the time of presentation and discharge of the patient. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to test the predictive ability of the ONSD to diagnose hyponatremia. Results: A total of 54 subjects were included in the study. The mean sodium level was 109.3 mEq/L at presentation. The mean ONSD on the right side was 6.24 ± 0.71 mm and on the left side was 6.26 ± 0.64 mm at presentation to ED. The mean ONSD on the right side was 5.81 ± 0.58 mm and on the left side was 5.79 ± 0.56 mm at discharge. The ONSD was not able to predict the sodium level measured both by laboratory and POC methods. Conclusion: The ONSD failed to predict the sodium level in patients with hyponatremia during the correction. The change in ONSD did not correlate with the change in sodium level. [ABSTRACT FROM AUTHOR]

Study Objective: To compare the analgesic efficacy of ultrasound-guided selective peripheral nerve block (PNB) and sub-dissociative dose ketamine (SDK) for management of acute pain in patients with extremity injuries presenting to the emergency department (ED).Methods: This prospective, open-label randomized clinical trial was conducted in the ED of a tertiary care Institute. The patients were provided with either ultrasound-guided selective PNB or SDK. The primary outcome was a reduction in pain in numerical rating scale (NRS) by at least 3 points without rescue analgesia. The secondary outcomes were the need for rescue analgesia, adverse events, and patient satisfaction on either arm.Results: A total of 111 patients with isolated traumatic extremity injuries were included in the final analysis. The NRS score was significantly lower in the PNB group compared to the SDK group at 30, 60,120, 180-, and 240-min post-intervention [group ∼ time interaction, F (5, 647) = 21.53, p ≤ 0.001]. All the patients in the PNB group exhibited primary outcome (NRS ≥3 reductions) at 30 min post-intervention compared with 36 (65%) in the SDK group [-1.02(-1.422,0.622)]. Rescue analgesia was required in 10 (18%) patients in the SDK group compared to none in the PNB group [0.663(0.277,1.050)]. The decrease in NRS score from baseline at 30 min was significantly higher in PNB groups compared to the SDK group [-2.166(-2.640, -1.692)]. The most common side effect reported in the SDK group was dizziness 35(64%), followed by nausea 15(27%). None of the patients in the PNB group reported any complications. Patient satisfaction was higher in the PNB group than SDK group.Conclusion: The study provides evidence that ultrasound-guided PNB is superior to SDK in terms of its analgesic efficacy in the management of acute pain due to extremity injuries and is associated with higher patient satisfaction. The need for rescue analgesia was significantly less in the PNB group. SDK was associated with a high incidence of dizziness and nausea. [ABSTRACT FROM AUTHOR]

Background: A blood gas analyzer is a point-of-care (POC) testing device used in the Emergency Department (ED) to manage critically ill patients. However, there were differences in results found from blood gas analyzers for hemoglobin (Hgb) and electrolytes parameters. We conducted a comparative validity study in ED in patients who had requirements of venous gas analysis, complete blood count, and electrolytes. The objective was to find the correlation of Hgb, sodium (Na+), and potassium (K+) values between the blood gas analyzer and laboratory autoanalyzer. Methods: A total of 206 paired samples were tested for Hgb, Na+, and K+. Total 4.6 ml of venous blood was collected from each participant, 0.6 ml was used for blood gas analysis as POC testing and 4 ml was sent to the central laboratory for electrolyte and Hgb estimation. Results: The mean difference between POC and laboratory method was 0.608 ± 1.41 (95% confidence interval [CI], 0.41–0.80; P < 0.001) for Hgb, 0.92 ± 3.5 (95% CI, 0.44–1.40) for Na+, and 0.238 ± 0.62 (95% CI, −0.32–0.15; P < 0.001) for K+. POC testing and laboratory method showed a strong positive correlation with Pearson correlation coefficient (r) of 0.873, 0.928, and 0.793 for Hgb, Na+, and K+, respectively (P < 0.001). Conclusion: Although there was a statistical difference found between the two methods, it was under the United States Clinical Laboratory Improvement Amendment range. Hence, starting the therapy according to the blood gas analyzer results may be beneficial to the patient and improve the outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied. OBJECTIVES: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack- Lehane (CL) grade, and requirement of external laryngeal manipulation. METHODS: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios. RESULTS: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21-0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade. CONCLUSION: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) barrier box is being used by health-care workers for protection against aerosol-transmitted infection. Usually, a Macintosh laryngoscope (MC) or a video laryngoscope (VL) is used for endotracheal intubation (ETI). We aimed to determine the most suitable laryngoscope blade in terms of time to ETI, ease of ETI, and the first-pass success rate. Methods: American Society of Anesthesiologists Grade I and II patients undergoing surgery under general anesthesia were randomized into the MC and the King Vision VL groups in a 1:1 ratio. ETI was performed using either the MC (the MC group) or the King Vision VL (the VL group) with a COVID-19 barrier box. The first-pass intubation success rate, intubation time, and ease of ETI were analyzed. Results: The first-pass success rate was higher in the MC group (P = 0.43). The mean duration of ETI was 33 s and 47 s in the MC group and VL group, respectively. The difference was statistically significant between the groups (P = 0.002). The ease of ETI was comparable between the groups (P = 0.57), and the Cormack–Lehane grade was significantly different between the groups (P = 0.0025). Conclusion: ETI duration was shorter in the MC group than in the VL group. Hence, a MC can be used along with a COVID-19 barrier box by experienced operators for the prevention of aerosol spread. [ABSTRACT FROM AUTHOR]

Background: Basic life support (BLS) is an important component of emergency medical management. Ambulance personnel play a key role in resuscitation to save a life before reaching the hospital. We do not have any published data about the level of knowledge on BLS among the ambulance personnel. Objective: This study was done with the objective to assess the level of knowledge on BLS among the ambulance personnel. Materials and Methods: A cross-sectional study was done in the emergency department (ED) of a tertiary care hospital. Universal sampling was done taking all the personnel of ambulances over the period of one month. Data were collected about the type of vehicle used for ambulance, the number of personnel in an ambulance, educational qualifications, and equipment present in their ambulances. The questionnaire to capture the level of knowledge were based on American Heart Association 2015 guidelines. Result: The total number of ambulance arrivals was 729 times. But data analysis was done from 104 ambulances excluding the repeat arrivals and those who did not give consent. There were 62 type-C and D ambulances, and 42 were type-B ambulances. Total of 210 personnel were there in 104 ambulances. Seventy-nine team leaders did not have any paramedical degrees. Fifty-eight team leaders were trained in BLS before working in an ambulance. In spite of this, 66 (63%) team leaders had poor performance (score of 0 to 4). Conclusion: The level of knowledge on BLS was poor in more than half of the ambulance personnel. They should be trained regularly on providing BLS. [ABSTRACT FROM AUTHOR]

Context: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. Aims: To find out the early impact of "THE MOTOR VEHICLES (AMENDMENT) ACT, 2019". Settings and Design: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. Methods and Materials: Patients studied in two groups – One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). Conclusions: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity [ABSTRACT FROM AUTHOR]

Background: The role of clonidine as an adjuvant to local anesthetic agents in brachial plexus block (BPB) has been extensively studied. However, till date there has been no consensus about the ideal dose of clonidine for this purpose. This study was carried out to evaluate two doses of clonidine-1 and 2 µg/kg, added to 0.5% bupivacaine, with regard to onset and duration of sensorimotor blockade, hemodynamic effects, postoperative analgesia, and adverse effects. Materials and Methods: Sixty adult patients undergoing upper limb surgeries were randomly allocated into two groups. Thirty patients received 1 µg/kg clonidine (group I) and the rest received 2 µg/kg clonidine (group II) added to 30 mL of 0.5% bupivacaine through nerve stimulator-guided supraclavicular BPB. The onset and duration of sensorimotor blockade, hemodynamic variables, duration of analgesia, level of sedation, and adverse effects was assessed. Results: The onset of sensorimotor block was earlier in group II (9.9 ± 4.1 min for sensory block and 13.2 ± 6.7 min for motor block) than in group I (15.9 ± 6.8 min for sensory block and 18.5 ± 7.8 min for motor block). The duration of analgesia was also prolonged in patients receiving the higher dose (21.0 ± 2.96 h vs. 14.9 ± 3.0 h). Although hemodynamics remained comparable in both the groups, incidence of hypotension and bradycardia was higher in group II as compared to group I. The sedation was clinically and statistically more in group II patients (43% vs. 17%). Conclusion: Higher dose of clonidine in BPB hastens the onset, prolongs the duration of sensorimotor blockade and postoperative analgesia without significant hemodynamic alterations. It also causes more sedation, which although ensures patient comfort in most cases, but might be undesirable in certain situations. [ABSTRACT FROM AUTHOR]

Background: Clonidine provides many desirable effects like sedation, analgesia, anxiolysis, and hemodynamic stability and these properties make it a potentially useful anesthetic premedication in the pediatric settings. The aim of this study was to compare oral midazolam (0.5 mg/kg), which is considered gold standard with oral clonidine (5 mcg/kg) as a premedication in pediatric patients. Materials and Methods: Sixty children classified as American Society of Anesthesiologists physical status I, aged between 2 and 12, who were scheduled to undergo an elective surgery, were enrolled for a prospective, randomized, and double blind controlled trial. They received either oral midazolam (Group M) or oral clonidine (Group C) 60 minutes before induction of anesthesia and were submitted to an evaluation of anxiety and sedation scores. We also evaluated secondary outcomes such as palatability, parental separation, effect on hemodynamic status, co-operation during venipuncture and facemask application, postoperative analgesic requirement, and recovery profile. Results: Oral midazolam had better efficacy in the preoperative period as sedative and anxiolytic (P < 0.001), allowed better cooperation during venipuncture and facemask application (P < 0.001), whereas, oral clonidine provided better palatability (P < 0.001), parental satisfaction (P < 0.001), stable perioperative hemodynamics (P < 0.001), better postoperative analgesia (P < 0.001), and night sleep pattern (P< 0.05) without any noticeable side effects (P > 0.05). Conclusion: We conclude that under the conditions of this study, oral midazolam is a better medication than clonidine in children in preoperative period while clonidine is a better medication postoperatively with added advantage of palatability, hemodynamic stability, and no significant side effects. [ABSTRACT FROM AUTHOR]

Here we report a chemical-free, simple, and novel method in which a part from a silver-based anode is controllably used in a straightforward manner to produce silver nanoparticles (Ag NPs) in order to fabricate a controlled assembly of Ag NPs and single walled carbon nanotube (SWCNT) hybrid structures. The attachment and distribution of Ag NPs along SWCNTs have been investigated and characterized by field emission scanning electron microscopy (FESEM). We have achieved the decoration of SWCNTs with different densities of Ag NPs by changing the deposition time, the applied voltage, and the location of carbon nanotubes with respect to the anode. At low voltage, single silver nanoparticle is successfully attached at the open ends of SWCNTs whereas at high voltage, intermediate and full coverage densities of Ag NPs are observed. As voltage is further increased, fractals of Ag NPs along SWCNTs are observed. In addition, a device based on a Ag NPs-SWNT hybrid structure is used for the label-free detection of ssDNA molecules immobilized on it. We believe that the proposed method can be used to decorate and/or assemble metal nanoparticles or fractal patterns along SWCNTs with different novel metals such as gold, silver, and copper and can be exploited in various sensitive applications for fundamental research and nanotechnology. [ABSTRACT FROM AUTHOR]

Limb adorning ornaments (LAO) can exacerbate the local effects of envenoming in case of venomous snake bite. Cultural presuppositions do inhibit victims from removing symbolically/ritually important jewelry even under circumstances that might increase the dangers of envenoming-induced gangrene formation. The recommendation to remove the LAO is usually skipped in guidelines and if at all included the very real hazard is uncommonly documented. We observed 14 cases of snake bite with LAO on the bitten limb with minimal to severe local complications. The possible reasons were discussed with recommendations of proper and timely methods of removal of these ornaments. We suggest inclusion of this concept of 'Remove' in the recommended first aid methods of the guidelines/protocols. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman's disease (RDD) is a rare multisystemic histiocytic disorder, commonly presenting as cervical lymphadenopathy in a young male. Its extranodal form is very unusual. We report a case of extranodal RDD presenting as a large vallecular mass. Management of an airway mass is always a challenge to the anesthesiologist. This problem is accentuated when the mass is due to RDD, as RDD can involve multiple system of the body such as central nervous system, upper respiratory tract, orbit and eyelid, gastrointestinal tract, and skin. Autoimmune phenomenon though rare is also an important concern. Individualized plan based upon thorough evaluation and anticipation is the key for better outcome. [ABSTRACT FROM AUTHOR]

Spintronics aims to develop electronic devices whose resistance is controlled by the spin of the charge carriers that flow through them. This approach is illustrated by the operation of the most basic spintronic device, the spin valve, which can be formed if two ferromagnetic electrodes are separated by a thin tunnelling barrier. In most cases, its resistance is greater when the two electrodes are magnetized in opposite directions than when they are magnetized in the same direction. The relative difference in resistance, the so-called magnetoresistance, is then positive. However, if the transport of carriers inside the device is spin- or energy-dependent, the opposite can occur and the magnetoresistance is negative. The next step is to construct an analogous device to a field-effect transistor by using this effect to control spin transport and magnetoresistance with a voltage applied to a gate. In practice though, implementing such a device has proved difficult. Here, we report on a pronounced gate-field-controlled magnetoresistance response in carbon nanotubes connected by ferromagnetic leads. Both the magnitude and the sign of the magnetoresistance in the resulting devices can be tuned in a predictable manner. This opens an important route to the realization of multifunctional spintronic devices. [ABSTRACT FROM AUTHOR]

We show that electrostatic charging of nanotubes and the consequent repulsion can lead to reversible separation of individual single-walled carbon nanotubes in bundles. Low-energy electron beam irradiation leads to this completely reversible phenomenon. A simple semianalytical model is used to explain the observed separation mechanism. The reversibility of the separation process is attributed to discharging and thermal-fluctuation induced motion of the nanotubes in ambient air. Further, the separation impacts the electrical conductance of small nanotube bundled devices. [ABSTRACT FROM AUTHOR]

Being one of the strongest materials, ternary TiSiN exhibits a very interesting family of binary transition metal nitride and silicide systems. A novel technique to fabricate morphologically fascinating nano and micro structures of TiSiN is reported here. The referred TiSiN films, majorly constituted with cubic TiN phase, are enriched with crystalline nanoparticles, micro‐flowers, and faceted micro‐crystals which possess attractive functionalities toward plasmon mediated optoelectronic applications. Reactivity of titanium to silicon nitride‐based dielectric topping on the substrate at high temperature plays the key role in nitride formation for the demonstrated protocol. The optoelectronic response for these morphologically enriched composite films indicates an influential role of photo‐induced surface plasmon polaritons (SPPs) on their dc transport properties. A plasmonically tuned resistive switching, controlled by the surface morphology in association with the film thickness, is observed under light illumination. Using Drude's modified frequency dependent bulk electron scattering rates and surface mediated SPPs‐electron scattering rates, a generic model is proposed for addressing unambiguously the increased device resistance in response to light. The featured synthesis process opens a new direction toward the growth of transition metal nitrides while the proposed model serves as a basic platform to understand photo‐induced electron scattering mechanisms in metal. [ABSTRACT FROM AUTHOR]

Here we report a novel nitridation technique for transforming niobium into hexagonal Nb2N which appears to be superconducting below 1K. The nitridation is achieved by high temperature annealing of Nb films grown on Si3N4/Si (100) substrate under high vacuum. The structural characterization directs the formation of a majority Nb2N phase while the morphology shows granular nature of the films. The temperature dependent resistance measurements reveal a wide metal-to-superconductor transition featuring two distinct transition regions. The region close to the normal state varies strongly with the film thickness, whereas, the second region in the vicinity of the superconducting state remains almost unaltered but exhibiting resistive tailing. The current-voltage characteristics also display wide transition embedded with intermediate resistive states originated by phase slip lines. The transition width in current and the number of resistive steps depend on film thickness and they both increase with decrease in thickness. The broadening in transition width is explained by progressive establishment of superconductivity through proximity coupled superconducting nano-grains while finite size effects and quantum fluctuation may lead to the resistive tailing. Finally, by comparing with Nb control samples, we emphasize that Nb2N offers unconventional superconductivity with promises in the field of phase slip based device applications. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the clinical case of a 27-year-old man who experienced delayed recovery from anesthesia following ileostomy closure.

The interplay between superconductivity (SC) and ferromagnetism (FM) when embedded together has attracted unprecedented research interest due to very rare coexistence of these two phenomena. The focus has been mainly put into the proximity induced effects like, coexistence of magnetism and superconductivity, higher critical current, triplet superconductivity etc. However, very little attention has been paid experimentally to the role of magnetic constituent on triggering phase slip processes in the composite films (CFs). We demonstrate that less than 1 at.% of magnetic contribution in the CFs can initiate phase slip events efficiently. Due to advanced state-of-the-art fabrication techniques, phase slip based studies have been concentrated mainly on superconducting nanostructures. Here, we employ wide mesoscopic NbGd based CFs to study the phase slip processes. Low temperature current-voltage characteristics (IVCs) of CFs show stair-like features originated through phase slip events and are absent in pure SC films. Depending on the bias current and temperature, distinct regions, dominated by Abrikosov type vortex-antivortex (v-av) pairs and phase slip events, are observed. The results presented here open a new way to study the phase slip mechanism, its interaction with v-av pairs in two dimensions and hence can be useful for future photonic and metrological applications. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation, characterized by massive lymph node enlargement and sometimes associated with extranodal involvement. Even though it is considered as a benign disease, fatalities can occur due to its unusually large size and its location. Our case highlighting a primary extranodal site of vallecula, which is extremely rare and not reported in literature before. It presented with almost complete obstructing the oropharyngeal airway creating a life threatening situation, needed emergency tracheostomy. [ABSTRACT FROM AUTHOR]

The interplay between superconducting fluctuations (SFs) and weak localization (WL) has been probed by temperature dependent resistance [ R ( T )] and magnetoresistance (MR) measurements in two-dimensional disordered superconducting TiN thin films. Within a narrow range of temperature above transition temperature ( T c ), the coexistence of SF-mediated positive MR and WL-led negative MR in different ranges of magnetic fields and a crossover from positive MR to negative MR with an increase in temperature are reported herein. The crossover temperature coincides with a characteristic temperature ( T max ) at which a resistance peak appears in the zero-field R ( T ). The resistance peak and associated magnetoresistance anomalies are addressed using quantum corrections to conductivity (QCC) theory. We show that WL can be accounted for the observed negative MR. By introducing individual coefficients to both SFs and WL contributions, the dominance of one over the other is monitored with respect to temperature. It is observed that just above T c , SFs dominate; with an increase in temperature, the contributions from both become comparable; and finally, at T max , WL takes over completely. The presented approach may be adopted to compare various quantum contributions in two-dimensional superconductors, particularly in the regime where both SFs and WL are pronounced.

Background: Hyperkalaemia in oleander (Nerium oleander) poisoning has been associated with a poor prognosis. Different electrocardiographic (ECG) presentations are possible because of vagotonia and hyperkalaemia., Methods/results: We report a series of three cases of oleander poisoning in which ECG showed unusual hyperkalaemia features, such as bradyarrhythmia, sinoatrial block, atrioventricular block and junctional rhythm., Conclusions: If arterial blood gas analysis or laboratory values indicate hyperkalaemia in oleander poisoning, the hyperkalaemia should be treated immediately, even if the ECG does not show typical hyperkalaemia features., Learning Points: Hyperkalaemia in oleander poisoning is associated with a poor prognosis.Hyperkalaemia should be treated aggressively in oleander poisoning even if the ECG does not show typical features, as mimics other conditions on ECG., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2021.)

Context: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1 st 2019 that permits heavy penalties for traffic rule offenders., Aims: To find out the early impact of "THE MOTOR VEHICLES (AMENDMENT) ACT, 2019"., Settings and Design: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department., Methods and Materials: Patients studied in two groups - One Pre MVA group ( n = 371) and one Post MVA group ( n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded., Statistical Analysis Used: Statistical analysis was done by R version 3.6.1., Results: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly ( P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier ( P = 0.016)., Conclusions: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

The elemental Nb is mainly investigated for its eminent superconducting properties. In contrary, we report of a relatively unexplored property, namely, its superior optoelectronic property in reduced dimension. We demonstrate here that nanostructured Nb thin films (NNFs), under optical illumination, behave as room temperature photo-switches and exhibit bolometric features below its superconducting critical temperature. Both photo-switch and superconducting bolometric behavior are monitored by its resistance change with light in visible and near infrared (NIR) wavelength range. Unlike the conventional photodetectors, the NNF devices switch to higher resistive states with light and the corresponding resistivity change is studied with thickness and grain size variations. At low temperature in its superconducting state, the light exposure shifts the superconducting transition towards lower temperature. The room temperature photon sensing nature of the NNF is explained by the photon assisted electron-phonon scattering mechanism while the low temperature light response is mainly related to the heat generation which essentially changes the effective temperature for the device and the device is capable of sensing a temperature difference of few tens of milli-kelvins. The observed photo-response on the transport properties of NNFs can be very important for future superconducting photon detectors, bolometers and phase slip based device applications.