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In this article, we study the following Hamiltonian elliptic system with coefficients:$ \begin{align} \notag \left\{\begin{aligned} -\varepsilon^2\Delta u +c(x)u = b(x) |{v}|^{q-1}v, &\, \, \text{ and } -\varepsilon^2\Delta v +c(x)v = a(x) |{u}|^{p-1}u \quad\text{in } \Omega, \\ u>0, \ v>0 \text{ in } \Omega, &\, \, \text{ and }\quad\frac{ \partial u}{ \partial\nu} = 0 = \frac{ \partial v}{ \partial\nu}\quad \text{on } \partial\Omega, \end{aligned} \right. \end{align} $where $ \Omega $ is a smooth bounded domain in $ \mathbb{R}^n, n\ge 3 $. The coefficients $ a(x), b(x), $ and $ c(x) $ are smooth, positive, and bounded. We study the existence of point-concentrating solutions and the influence of the coefficients on their concentration profiles. As an application of this result, we establish the existence of higher-dimensional concentrating solutions for a class of elliptic systems. [ABSTRACT FROM AUTHOR]

Introduction: Chronically critically ill (CCI) patients often have high costs of care and poor outcomes. Disease management programs offering home care may reduce costs but needs buy-in from informal caregivers. An understanding of caregiver burden in this population is lacking. We aimed to study the caregiver burden, its change over time, and factors affecting it, in post-ICU tracheostomized patients. We compared the caregiver burden among CCI carers to that of palliative caregivers. Methods: Informal caregivers of thirty chronically critically ill tracheostomized patients (CGcci) were administered the Caregivers Burden Scale (CBS) tool at discharge, 2 and 4 weeks after discharge. A one-point assessment of burden was made in 30 caregivers of patients enrolled in Pain and Palliative care clinic (CGpc). Linear mixed models for repeated measures were used to analyze score of CGcci over time and compared to the burden in physical, psychologic, economic, time, and social domains between groups. Results: All 60 caregivers were young (33-35 years), predominantly male, and children of the patients. Both CGcci and CGpc had moderate burden score of 60.5 (14.7) vs 61.5 (13), respectively. Physical burden (11.5 vs 8) was greater in CGcci (p = 0.001) compared to psychologic domain (10 vs 12.5) in CGpc (p = 0.01). Burden score over all domains in CGcci decreased rapidly from 67.5 (8) to 55 (16.5) (p = 0.001) in the first month after discharge. Conclusion: Burden of care among caregivers of tracheostomized chronically critically ill patients is comparable to those of palliative caregivers and reduces significantly with time. [ABSTRACT FROM AUTHOR]

Background: Subanesthetic intravenous (IV) ketamine acts as an analgesic and has opioid-sparing effects, particularly for acute postoperative pain; however, its effectiveness in children is understudied. The primary aim of this study was to evaluate the non-inferiority of subanesthetic IV ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infra-umbilical surgery. Methods: Children aged < 6 years were enrolled in this single-blind study and randomized to receive either subanesthetic IV ketamine (0.3 mg/kg) or caudal 0.125% bupivacaine (1 ml/kg) along with general anesthesia. Postoperative pain was assessed using the FLACC scale at 30 minutes and 1, 2, 3, and 6 h post-operation. Intra- and postoperative opioid consumption, time to extubation, postoperative vomiting, agitation, sedation, and inflammatory markers were also assessed. Results: Altogether, 141 children completed the study (ketamine group: n = 71, caudal group: n = 70) The cumulative proportion of children without significant postoperative pain (FLACC score < 4) in the first 6 h post-surgery was 45.1% in the ketamine group vs. 72.9% in the caudal group (P < 0.001). More children in the ketamine group required an additional dose of intraoperative fentanyl (33.8% vs. 5.7%, P < 0.001) and postoperative tramadol (54.9% vs. 27.1%, P < 0.001). However, postoperative agitation, sedation, and other secondary outcomes were similar between the groups. Conclusions: Subanesthetic ketamine is inferior to caudal bupivacaine for postoperative analgesia in children aged < 6 years undergoing infra-umbilical surgeries; however, other postoperative outcomes are similar. [ABSTRACT FROM AUTHOR]

Background: Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost.Aim: To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies.Methods: It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done.Results: On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10-90%) and 80% (range: 0-90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0-40) and 0% (range: 0-50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89-6.04 mm), which increased to 2.912 mm (range: 0.88-7.07 mm, P = 0.03) at 6 months.Limitations: Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients.Conclusions: Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects. [ABSTRACT FROM AUTHOR]

The prevalence of superficial mycotic infection worldwide is 20-25% of which dermatophytes are the most common agents. Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. Hence, a lack of delayed hypersensitivity reaction in presence of a positive immediate hypersensitivity (IH) response to trichophytin antigen points toward the chronicity of disease. Diagnosis, though essentially clinical should be confirmed by laboratory-based investigations. Several new techniques such as polymerase chain reaction (PCR) and mass spectroscopy can help to identify the different dermatophyte strains. Management involves the use of topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. However, due to the lack of updated national or international guidelines on the management of tinea corporis, cruris, and pedis, treatment with systemic antifungals is often empirical. The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedia while highlighting the lack of clarity of certain management issues. [ABSTRACT FROM AUTHOR]

This paper deals with global compactness and the multiplicity of positive solutions to problems of the type −Δ픹Nu − λu = a(x)|u|2∗−2u + f(x)in 픹N, u ∈ H1(픹N), where 픹N denotes the ball model of the hyperbolic space of dimension N ≥ 4, 2∗ = 2N N−2, N(N−2) 4 < λ < (N−1)2 4 and f ∈ H−1(픹N) (f≢0) is a nonnegative functional in the dual space of H1(픹N). The potential a ∈ L∞(픹N) is assumed to be strictly positive, such that limd(x,0)→∞a(x) = 1, where d(x, 0) denotes the geodesic distance. We establish profile decomposition of the functional associated with the above equation. We show that concentration occurs along two different profiles, namely, hyperbolic bubbles and localized Aubin–Talenti bubbles. For f = 0 and a ≡ 1, profile decomposition was studied in Bhakta and Sandeep [Poincaré–Sobolev equations in the hyperbolic space, Calc. Var. Partial Differential Equations 44 (2012) 247–269]. However, due to the presence of the potential a(.), an extension of profile decomposition to the present set-up is highly nontrivial and requires several delicate estimates and geometric arguments concerning the isometry group (Möbius group) of the hyperbolic space. Further, using the decomposition result, we derive various energy estimates involving the interacting hyperbolic bubbles and hyperbolic bubbles with localized Aubin–Talenti bubbles. Finally, combining these estimates with topological and variational arguments, we establish a multiplicity of positive solutions in the cases: a ≥ 1 and a < 1 separately. The equation studied in this paper can be thought of as a variant of a scalar-field equation with a critical exponent in the hyperbolic space, although such a critical exponent problem in the Euclidean space ℝN has only a trivial solution when f ≡ 0, a(x) ≡ 1 and λ < 0. [ABSTRACT FROM AUTHOR]

A case study of a 32-year-old woman, gravida 2 para 2, presented with multiple, asymptomatic, pedunculated, soft polypoidal growths is discussed. It is mentioned that lesions had gradually increased in number and size over the past 20 years. A clinical diagnosis of linear vulvar acrochordons was considered and in a single sitting by radio-frequency ablation under local anaesthesia, all the lesions were removed.

Background: Venepuncture is an essential component of anaesthesia services. However, this invites pain generating the first negative experience with anaesthesia. Hence, relief of this pain carries considerable importance. Efficacy of ethyl chloride spray although studied, there is no consensus for the best way of application., Objectives: The present study was conducted to find an effective technique/method of ethyl chloride spray application to reduce venepuncture pain., Methods: Adult patients posted for different anaesthesia procedures were randomised into three groups. Venepuncture was done either after installation of distilled water or spray of ethyl chloride either once to twice. Venepuncture pain was assessed with a 0-100 Numeric Rating Scale., Results: The analysis showed significant differences among the groups ( F [2,96] = 66.27, P < 0.05). The twice sprayed group experienced the least pain ([mean ± standard deviation [SD]] 16.67 ± 10.21), lower in the once spray group ([mean ± SD] 27.58 ± 13.24), and the controls had the highest pain score ([mean ± SD] 49.09 ± 11.28). Post hoc Tukey's tests showed all the three groups differed significantly. The effect size was large, and the variability of the spray on the reduction of pain scores is 58% (η 2 = 57.99)., Conclusion: Ethyl chloride spray effectively reduces the pain on venepuncture, especially when the vapocoolant is sprayed twice each over 5 s, and from a distance of 5 cm perpendicular to the skin., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Anesthesia: Essays and Researches.)

Background: Various airway gadgets have been devised to overcome difficult airway scenario in anesthesia practice. It includes simple rigid laryngoscope to complex fiber-optic intubating devices; however, there is weak evidence to support the superiority of one device over the other., Aims and Objective: The ease of intubation, time and the hemodynamic variability between two groups during intubation are considered as the primary outcome measures., Materials and Methods: In this prospective study, 60 patients of either sex undergoing elective surgery who required tracheal intubation were included. All the patients of age between 20 and 50 years with the American Society of Anesthesiologists Classes I and II were divided into the following two groups: Group AT ( n = 30): the intubation was performed using AT laryngoscope and Group-MC ( n = 30); the intubation was performed using MC laryngoscope. The following intubating parameters were recorded: ease of intubation (Grade-I-IV), mean time of laryngoscopy and intubation, Cormack-Lehane grade, and the percentage of glottis opening (POGO) score. The vital parameters such as heart rate (HR) and mean arterial blood pressure (MABP) were recorded only after premedication, and it was taken as the baseline value. These parameters were again recorded at 1 min, 3 min, 5 min, and 10 min after laryngoscopy and intubation. The incidences of sore throat were recorded just before discharge from the recovery room till 24 h of surgery. All these parameters were compared between these two groups using the Student's t -test and Chi-square test., Results: There was no significant difference in age, sex, weight, and Mallampati grading between the two groups. More than 30% of patients in Group AT were intubated without an external aid than the Group MC ( P < 0.05). In Group AT, the mean time of intubation was 13.5 ± 5.72 s when compared to 15.63 ± 7.28 s in Group MC ( P > 0.05). The Cormack-Lehane grade and POGO score were better in the AT group than that of the MC group. The HR at 1 min in Group AT was 101.83 ± 14.50 and in Group MC, it was 108.93 ± 12.86 ( P < 0.05) and after 3 min, it was 98.66 ± 12.60 and 111.53 ± 11.67 ( P < 0.05), respectively. The MABP was 107.17 ± 9.03 in Group AT compared to 116 ± 10.12 in Group MC ( P < 0.05) at 1 min postintubation. The incidences of sore throat were similar in both the groups., Conclusion: The AT laryngoscope is better than MC in terms of the ease of intubation, better glottis view, and hemodynamic stability. However, the incidences of sore throat in both groups were comparable., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Anesthesia: Essays and Researches.)

Competing Interests: There are no conflicts of interest.