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Introduction More than 80 million people have been infected with coronavirus disease 2019 (COVID-19) infection worldwide till date with more than 17,00000 fatalities. Although COVID-19 commonly affects respiratory system in the form of cough and dyspnea, a neurotropic presentation has been described in one-third of patients. Objective We report an atypical case of COVID-19 with mild symptoms who presented to our hospital with features suggestive of severe Guillain-Barré syndrome (GBS). Discussion The mechanisms by which severe acute respiratory syndrome coronavirus 2 causes neurologic damage are multifactorial, including direct damage to specific receptors, cytokine-mediated injury, secondary hypoxia, and retrograde travel along nerve fibers. The pathogenesis of GBS secondary to COVID-19 is not yet well understood. It is hypothesized that viral illnesses-related GBS could be mediated due to autoantibodies or direct neurotoxic effects of viruses. Conclusion In this ongoing era of pandemic, it is very important for the clinicians to be aware of association of GBS with COVID-19, as early diagnosis and treatment of this complication could have gratifying results. It is also very important to differentiate GBS from critical illness neuropathy and respiratory distress secondary to COVID-19 itself, as treatment to the above conditions is quite different and inability to correctly diagnose could lead to significant increase in morbidity and mortality.

Purpose The timely management of cancer surgery suffered due to COVID-19 and nationwide lockdown. Continuing cancer surgery was a challenge faced by all. We present our experience on cancer surgery in a cancer centre with high volume of patients and limited resources during early pandemic. Methods We retrospectively analysed our operation theatre database on surgery and anaesthesia from 1st April to 30th June 2020. Results A total of 457 surgeries were done—complex major, major, intermediate and minor surgeries constituted 43%, 25%, 12% and 20%, respectively. Median age of patient was 50 years, and 76% were below 60. The median ASA class was I (I–IV), and 97% were ASA I and II. The median Eastern Cooperative Oncology Group score was 0 (0–3), and 92% had score 0 and 1. Major cases done under regional anaesthesia were 30.7%. Median length of intensive care unit stay was 1 (1–6) days, and length of hospital stay was 7 (7–15) days. Clavien–Dindo Grade II complication in patients above 60 years was 16.4% and below 60 years was 17.6% (p = 0.76). 10% in ASA I compared to 26% of ASA II (p = 0.00) and 15.9% with ECOG 0 and 1 compared to 30.9% with ECOG 3 and 4 (p = 0.01) had grade II complication. Four (1%) patients had Grade ≥ III CD complication. Covid testing was undertaken in 52% patients pre-operatively, and there was no positive case in post-operative period. Conclusions Adopting and implementing institutional policy catering to limited resource available at our centre, we facilitated cancer surgery.

Captive maturation and spawning in Penaeus monodon are currently induced by unilateral eyestalk ablation, a method that removes the gonad-inhibiting hormone (GIH) secreted from the eyestalk. However, unilateral eyestalk ablation creates physiological complications in the brooder due to the unintended removal of other hormones secreted by the eyestalks. Here we studied the effect of gih silencing by long hairpin RNA on the reproductive physiology of P . monodon . We observed 3–5 fold enhanced expression of the androgenic gland hormone (AGH) transcript in males, but no effect on vitellogenin expression in females. In the destalked animals, however, positive effect on the maturation indicator transcripts was seen in both the sexes, and surpassed the efficiency of the silencing treatment. There were indications of active spermatogenesis in histological sections of both the gih silenced and destalked males, but no changes at histological level in the females. We also observed a significantly higher rate of molting and associated mortality in the gih silenced animals at the end of the experiment. Our results suggest that eyestalk ablation is still the most efficient technique to induce maturation in P . monodon . Although gih silencing could be a potential alternative to eyestalk ablation, further research is needed to enhance its efficiency over eyestalk ablation by using tissue specific and/or inducible promoter for lhRNA expression. It is also evident that females need to be fairly large in size for these interventions to succeed. Statement of relevance Induction of captive maturation has been a challenge for shrimp industry. The seed production is often hampered by the low abundance and high price of naturally collected broodstock. Collection of natural brooders also has the intrinsic problem of WSSV infection. Also, genetic improvement of this highly preferred species is difficult unless the reproductive cycle is closed. For all these reasons it is important to study the reproductive physiology and endocrinology of this species and ways to manipulate it in order to induce captive maturation. The present study utilizes the RNA interference mechanism to silence the gonad-inhibiting hormone gene to see its effect on maturation.

Background and Objectives: The EuroQol five-dimensions – 3-level (EQ5D) is a versatile quality of life (QOL) instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analog scale. It can be used to calculate quality-adjusted life years. We aimed to evaluate the validity, reliability, and responsiveness of an Odia version of EQ5D and to study the QOL of cancer patients in our part of the country as cancer treatment in India still focuses largely on longevity due to scarcity of resources. Materials and Methods: The EQ5D tool was translated into Odia language in collaboration with the EQ group. This tool and the World Health Organization-5 (WHO-5) questionnaires were administered to 155 surgical outpatients and 150 cancer patients in two hospitals of Eastern India. The convergent and discriminant validities (construct validity), concurrent validity, reliability (test-retest method of administering the tool to a part of the population after 7–14 days), and the internal consistency (Cronbach's alpha) were measured using preestablished hypotheses. The data from the cancer patients were analyzed separately. Results: The QOL worsened with age and was worse in cancer patients proved that the tool had good construct validity. The Anxiety Depression dimension had good correlation with all the dimensions WHO-5 (rho > 0.4) indicating a good concurrent validity. Internal consistency and reliability of the tool were good (Cronbach's alpha > 0.7). Cancer patients had a poor QOL (mean EQ5D index 0.37SD 0.4) with male patients, patients with Grade II cancer or referred for pain care services and those with living spouses reporting worse QOL. Conclusions: The Odia version of the EQ5D has good reliability and validity for the measurement of health status in cancer and outpatient department patients. Cancer patients in this part of the country have a poor QOL and may need a closer look at pain management and improved societal support systems.

Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT). They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014.

Background and Aims: Breast cancer surgery can be carried out as day-care procedure to increase patient turnover, decrease disease progression and financial burden. The present study was carried out to assess the role of dexmedetomidine in breast cancer surgery as a day-care procedure. Methods: This prospective randomised, double-blind study was carried out on 100 patients screened for day-care breast cancer surgery. They were divided into two groups of 50 each; who received either normal saline (Group NS) or 0.6 μg/kg/h dexmedetomidine (Group D) infusion from 10 min before induction until skin closure. All patients were given general anaesthesia. The incidence of discharge, post-operative pain (POP), average rescue analgesia (fentanyl) required and side effects were noted. Statistical analysis was performed using Student's t-test and Chi-square test. Results: Incidence of discharge in group NS was 60% compared to 88% in Group D (P = 0.001). Average rescue analgesia requirement by group NS was 136.07 ± 43.06 μg, whereas it was 77.5 ± 29.86 μg in Group D (P = 0.01). The incidence of POP in 6 h and within 2 h of expected discharge time in Group NS was 56% and 28%, respectively, and in Group D, it was 8% in both the periods (P < 0.001 and 0.01). Side effects such as post-operative nausea, vomiting and bleeding were encountered in eight and two patients, respectively, in Group NS and two and one patients, respectively, in Group D. Conclusion: Dexmedetomidine as an anaesthetic adjuvant makes breast cancer surgery feasible on day-care basis.

Objective: Cartap hydrochloride poisoning is an uncommon poisoning encountered in India. The aim of this study was to assess the characteristics, severity, management, and outcome of patients with Cartap poisoning, treated with N-acetylcysteine (NAC) in intensive care unit (ICU) of a tertiary referral hospital.Methods: This is a retrospective study where 11 cases of Cartap poisoning admitted to hospital ICU between 2011 and 2016 were identified from the case records. The demographic data, mode of ingestion, time to treat, ingested dose and severity of poisoning, presenting features, duration of mechanical ventilation (MV), dose of NAC used, complications, and outcome were noted.Results: Patients were scored as moderate or severe cases of poisoning. Severe cases consumed >10 g, underwent gastric lavage > 4 hrs, and took Cartap concomitantly with alcohol or in empty stomach. Duration of MV varied from 68-94 hrs in severe cases and 12-48 hrs in moderate cases. Average dose of NAC in severe case was 11.19 g and moderate case was 8.89 g. The most common presenting symptoms were vomiting, altered sensorium, and breathlessness. Severe cases had more complications, and the most common complication was hypotension followed by seizures. Survival was 100%.Conclusion: 50% of Cartap poisoning cases had good survival outcome. Severity of poisoning depends on amount of Cartap ingested, time taken for gastric lavage, and concomitant administration of alcohol. Duration of MV and dose of NAC and complications encountered correlates with the severity of poisoning.

Objective: Endogenous production of glutamine may be reduced during critical illness. The shortage of glutamine is reflected as a decrease in plasma concentration, which is a prognostic factor for outcome in sepsis. Therefore, we have studied the effect of enteral or parenteral glutamine therapy on biochemical parameters and the hospital stay of critically ill patients.Methods: A total of 66 critically ill patients aged 18-70 years, admitted to central and medical intensive care unit of a tertiary care hospital were randomly divided into three equal groups; 22 in each group: Group 1 (control group) received no glutamine, Group 2 received oral glutamine 0.5 g/kg/d for 5 days, and Group 3 received parenteral glutamine 0.5 g/kg/d by intravenous infusion for 5 days. All patients received glutamine-free tube feed throughout the study period. Total leukocyte count (TLC), total lymphocyte count, total protein and serum albumin, serum lactate, and sequential organ failure assessment (SOFA) score were recorded on each day for 7 days and were compared.Results: Decrease in the TLC and increase in lymphocyte count was most evident in Group 3 compared to Groups 2 and 1 which was statistically significant. Decrease in serum lactate and increase in serum protein and albumin was maximum in Group 3 compared to Groups 1 and 2 which was statistically significant. The mean duration of hospital stay of Group 3 was the least followed by Groups 2 and 1 which was statistically not significant. There was an improvement in SOFA score in all the three groups.Conclusion: Parenteral glutamine in a dose of 0.5 g/kg/d was more potent than oral glutamine in improving the biochemical parameters. The duration of hospital stay was similar in all the groups after treatment.