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Osmotic demyelination syndrome (ODS) is well known to be associated with the rapid correction of hyponatremia. However, there is limited literature on its link to persistent or corrected hyperglycemic states in diabetic patients. We report two young patients with ODS and hyperglycemia. Neuroimaging and blood tests indicated central pontine and extrapontine myelinolysis with a hyperglycemic hyperosmolar state (HHS). These unusual cases provide insight into the neurologic complications of hyperglycemia. Keywords: Central pontine myelinolysis, hyperglycemia, neuroimaging, normal sodium, osmotic demyelination syndrome, Author(s): Manisha Gupta (corresponding author) [1]; Ramesh Gurjar [2]; Arpit Agrawal [1]; Abhijeet Kumar Kohat [1]; Abhishek Kumar [3] Introduction Extrapontine demyelination and central pontine myelinolysis (CPM), known as osmotic [...]

Byline: Arpit. Agrawal, Abhijeet. Kohat, Chandradev. Sahu, Shalabh. Agrawal, Anam. Fatima To the Editor, Syringobulbia (SB) denotes a longitudinally oriented fluid-filled cavity within the brainstem. It is usually associated with [...]

Background: Acute kidney injury (AKI) is prevalent in patients with acute stroke. Although AKI is linked to poor clinical outcomes, data about its incidence and effect on stroke outcomes is limited. Methods: This was a prospective observational study carried out at a single tertiary care center that analyzed the data of 204 consecutive subjects with acute ischemic stroke and intracerebral hemorrhage. Considering serum creatinine at admission as the baseline, AKI was defined as a rise in serum creatinine value of 0.3 mg/dl over 48 h or a percentage increase of at least 50% from baseline over 7 days during hospitalization. The primary outcome was to measure the prevalence of AKI in patients with acute stroke. Secondary outcome measures were all-cause mortality, duration of hospital stay, need for dialysis, and comparison of outcomes in ischemic and hemorrhagic stroke. For both the stroke subtypes, we employed a multivariate logistic regression model, with AKI and hospital mortality being the outcomes. Covariates included gender, age, ventilatory requirement, duration of hospital stay, and National Institutes of Health Stroke Scale score at admission. Results: There were 144 cases of ischemic stroke with 12 deaths (8.3%) and 60 cases of intracranial hemorrhage (ICH) with 22 deaths (36.7%). The mean age was 55 years, 72.6% were males, and AKI complicated 34% of ischemic stroke and 66.7% of ICH hospitalizations. AKI was linked to increased hospital mortality from ischemic stroke (odds ratio [OR] 27.21, 95% CI 3.39-218.13) and hemorrhagic stroke (OR 5.12, 95% CI 1.29-20.28) in multivariate analysis stratified by stroke type. Conclusions: AKI complicates stroke frequently and increases hospital mortality. Additional studies are required to assess if the association is causal and if remedies to prevent AKI would decrease mortality. [ABSTRACT FROM AUTHOR]

Abdominoscrotal hydrocele (ASH) is a relatively rare variant of hydrocele in both adult and pediatric populations. The incidence among adults is <1% of other types of hydroceles, which are different from most cases related to persistent processus vaginalis. It presents as a dumbbell-shaped cystic collection with cross-fluctuation in the abdominoscrotal region and the inguinal canal acting as the rod connecting two masses. The abdominal swelling could be retroperitoneal or intraperitoneal. Clinical examination can lead to a suspected diagnosis of ASH, but confirmation relies on ultrasonography and computed tomography. Spontaneous resolution of ASH has been unlikely, and hence surgical intervention is recommended. In this study, we present three cases with ASH who underwent surgical repair using different methods. [ABSTRACT FROM AUTHOR]

Byline: Arpit. Agrawal, Chintan. Prajapati, V. Vishnu, M. Padma Srivastava, Vinay. Goyal, M. Singh, Ajay. Garg, Manmohan. Singh Sir, Chronic venous sinus thrombosis can present with different symptoms. Headache, transient [...]

Byline: Arpit. Agrawal, Tanvi. Dhawale, Varinder. Kaur, Gouri. Passi Congenital kyphoscoliosis associated with myotonic dystrophy type 1 (DM 1) is a rare combination and carries challenges of surgical as well [...]

Byline: Abhishek. Juneja, Kuljeet. Anand, Jyoti. Garg, Arpit. Agrawal Sir, We report a case of a 60-year-old right-handed male patient who presented with a sudden inability to speak and swallow. [...]

While metallic glasses exhibit exceptionally high strength, their relatively low ductility, accompanied by catastrophic failure caused by the formation of shear bands, is the major obstacle to using these materials in practical applications. Despite discovering some methodologies for improving the near-zero ductility of metallic glasses, overcoming this deficiency is still the most active field of research in designing and fabricating bulk metallic glasses. This work utilizes computational studies at the atomistic scale to demonstrate that adding graphene to metallic glasses is a superior method to improve their ductility. Our results show that the graphene layers in metallic glass-graphene composites will enhance the ductility by activation of three deformation mechanisms, including (i) confining the space for shear band formation, (ii) retarding the propagation of embryonic shear bands, and (iii) increasing the resistance of the metallic glass matrix against shearing during the nucleation and propagation of shear bands. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation stimulates sympathetic system causing transient increase in heart rate and blood pressure which may be detrimental in patients with cardiovascular and cerebrovascular comorbidities. Intravenous dexmedetomidine given preoperatively prevents these unfavorable changes caused by endotracheal intubation. Aims and Objectives: The aims of this study were to compare effectiveness of nebulized dexmedetomidine and intravenous dexmedetomidine given preoperatively in blunting hemodynamic response (HR) to intubation. Materials and Methods: One hundred and twenty ASA I and II patients (either gender between 18 and 60 years) undergoing elective surgeries under general anesthesia were randomized into two equal groups in this prospective and comparative study. Thirty minutes before induction, Group IV received dexmedetomidine 0.50 µg/kg (diluted with normal saline [NS] to 50 mL) as slow IV infusion and nebulization with 5 mL NS, while Group N received nebulization with dexmedetomidine 1 µg/kg mixed with NS up to 5 mL along with 50 mL NS given as slow IV infusion. HR and mean arterial pressure (MAP) were noted at different intervals until extubation. Sedation score using Ramsay Sedation Scale (post-administration of drug) and adverse effects were noted. Comparison of HR and MAP was done using unpaired "t" test (P=0.05). Results: IV dexmedetomidine and nebulized dexmedetomidine given preinduction were comparable in reducing stress response to intubation. The sedation score in both groups was comparable post-administration of drug. The incidence of hypotension was significantly more in IV group. Conclusion: Nebulized dexmedetomidine was equally efficacious in blunting HR to intubation as IV dexmedetomidine with fewer side effects making its administration safer for maintaining hemodynamic stability. [ABSTRACT FROM AUTHOR]

Herein, an improved synthetic strategy to linear tetraquinanes is reported via a [3+2] cycloaddition and ring‐rearrangement metathesis as key steps. The linear tetraquinanes reported earlier were synthesized in a nine step sequence with an overall yield of 9 % while the same tetraquinanes are now prepared in four steps with a 3‐fold increase in overall yield of 29 %. Failure of the conventional [3+2] cycloaddition using allyltriisopropylsilane was overcome by using microwave irradiation (MWI) conditions which is performed for the first time for this purpose. The strategy reported here does not involve any protection and deprotection steps and can be helpful for the synthesis of polyquinane based natural products and synthesis of medicinally important targets. [ABSTRACT FROM AUTHOR]

A short synthetic sequence to a linear triquinane is reported involving [3+2] cycloaddition, oxidative cleavage of double bond using ruthenium catalyst followed by decarboxylation. By this methodology, norbornene double bond can be easily cleaved to obtain the linear triquinane unit. This methodology is useful for the synthesis of natural and non-natural products having fused cyclopentane ring systems. [ABSTRACT FROM AUTHOR]

A nine-step synthetic sequence to linear tetraquinanes involving [3+2] cycloaddition, chemoselective allylation, and ring-rearrangement metathesis as key steps is reported. A chemoselective allylation of 7-ketonorbornene was realized for the first time by using indium powder and allyl bromide. By this method, norbornene ketones can be selectively allylated in the presence of a cyclopentanone moiety to give good yields of monoallylated Barbier-type products. [ABSTRACT FROM AUTHOR]

Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P<0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field. [ABSTRACT FROM AUTHOR]

Background: Children undergoing surgical procedures can experience significant anxiety and distress during the perioperative period. The use of sedative premedication may help to reduce anxiety, minimize the emotional trauma, and facilitate a smooth induction of anesthesia. Midazolam is most commonly used as a premedication agent in children. Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist that provides sedation, anxiolysis, and analgesic effects without causing respiratory depression. Aims and Objectives: The aim of the study was to compare intranasally administered dexmedetomidine and oral midazolam for premedication in pediatric patients undergoing cochlear implant surgeries. Materials and Methods: This prospective randomized controlled study included 60 ASA Grade I and II patients between 1 and 6 years of age who underwent cochlear implant surgeries under general anesthesia. Patients were divided into two groups. Group A received 1µg/kg intranasal dexmedetomidine and Group B patients received 0.5 mg/kg oral midazolam 45 min before induction. The pediatric separation anxiety was assessed using the pediatric separation anxiety scale (PSAS) while shifting the patient to operating room (OR) and mask acceptance was assessed by the attending anesthesiologist using mask acceptance scale (MAS) in OR who is blinded to the drug given. Heart rate (HR) and oxygen saturation were monitored till the end of procedure was noted on a pre-structured proforma. Results: The mean PSAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.10±0.31 (P=0.000). The mean MAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.13±0.35 (P=0.000). Mean HR (P>0.05), systolic blood pressure (P>0.05), and diastolic blood pressure (P>0.05) were comparable between both the groups. There was a statistically significant association seen between sedation grade and the groups (P=0.000), showing that groups are dependent on the sedation group. There was a statistically significant association seen between wake up behavior grade and the groups (P=0.000), showing that groups are dependent on the wake up behavior grade. Conclusion: Intranasal dexmedetomidine is an effective and safe alternative for premedication in view of parental separation, mask acceptance, hemodynamic stability, and sedation for the children undergoing cochlear implant surgeries under general anesthesia. [ABSTRACT FROM AUTHOR]