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Background/Objective: Multiple Sclerosis is a common demyelinating disease of the central nervous system. Several studies suggested a link between vitamin D deficiency and multiple sclerosis disease activity, which can be evaluated by magnetic resonance imaging. Thereby, the main objective of the following scoping review is to summarize the magnetic resonance imaging findings assessing the probable effects of vitamin D on MS disease activity. Methodology: PRISMA checklist for systematic reviews and meta-analyses was employed to structure this review. Literature was searched for observational and clinical studies tackling the given matter using several search engines including PubMed, CORE, and Embase. Data was extracted in a systematic manner, and the articles meeting the inclusion criteria were quality-assessed by Jadad scale for randomized clinical trials (RCTs) and Newcastle-Ottawa scale for observational studies. Results: A total of 35 articles were included. Twenty-one (60%) studies noted a statistically significant association between vitamin D and Multiple Sclerosis MRI-detected disease activity. MRI-detected features involved lower contrast-enhancing T1 lesions, lower hyperintense T2 lesions, and a decrease in lesions volume. On the other hand, 40% (14 articles) of the articles did not detect any significant effect of vitamin D on Multiple Sclerosis disease activity. Due to the heterogeneity of the studies involved, meta-analysis was not employed in the given review. Discussion/conclusion: There was an abundance in the number of research studies investigating the relationship between vitamin D and Multiple Sclerosis while highlighting the significant role of MRI in assessing the activity of the disease. Numerous studies found that higher serum vitamin D levels are associated with decreased new active cortical and subcortical lesions and lower lesions volume. These findings highlight the importance of imaging modalities in the various aspects of neurological diseases and encourage further research to focus on the preventive effects of vitamin D on MS patients.

Background: SARS-CoV-causing COVID-19 resulted in mortality, and the clinic-epidemiological profile at the time of admission of patients who died later could provide an insight into pathophysiological consequences due to infection. Method: Retrospective observational study of 64 RTPCR-confirmed COVID-19 non-survivors was conducted from April - June 2021 and January February 2022. Data were analyzed, and a P value

Abstract Background Pneumothorax associated with a steep head-down position in vaginal hysterectomy surgery is rare but can cause life-threatening complications. Case presentation We report a case of a female patient with no obvious lung pathology who suffered intraoperative pneumothorax associated with prolonged steep Trendelenburg position. To the best of our knowledge, this is the first well-documented case of this association. A 53-year-old female, diagnosed as a case of recurrent umbilical hernia with cystocele and rectocele was planned for vaginal hysterectomy with anterior perineorrhaphy and posterior colpoperineorrhaphy along with open mesh repair for umbilical hernia under general anaesthesia. Approximately 90 min after the steep Trendelenburg position, the peak inspiratory pressure increased, while the oxygen saturation decreased. The airway pressures remained continuously on the higher side whole throughout the surgery despite an interrupted propped-up position in between. The patient could not be extubated and shifted to the intensive care unit (ICU) where ultrasonography (USG) of the lung and chest x-ray showed signs of pneumothorax. Intercostal tube drainage (ICTD) was placed, and the patient improved dramatically. It was suspected that a steep head-down position for a prolonged period led to persistently raised airway pressures and the subsequent development of pneumothorax. Conclusions Pneumothorax can develop in rare circumstances even if airway pressures are under the safety range. So, careful monitoring and immediate treatment are necessary to prevent the condition from worsening and anaesthesiologists must be aware of such potential danger.

Background: Methanol poisoning is associated with high morbidity and mortality, due to its toxic metabolites namely formaldehyde and formic acid. Though explicit treatment guidelines exist but management becomes an arduous task when a cluster of cases present in resource limited settings. We describe here an outbreak of methanol poisoning during COVID 19 pandemic, the challenges faced and the outcome.Objectives: To review the clinical manifestations, biochemical parameters, management and outcome of patients of methanol poisoningMethodology: A retrospective analysis of methanol poisoning patients presenting to our hospital during an outbreak.Results: A total of 108 patients presented to our center over a span of 13 days. All had allegedly consumed adulterated alcohol 12 to 96 hours prior to admission. 41had expired en-route to hospital, 20 expired within 6 hours of presentation and 8 were intubated. Among survivors, the most common complaint was visual blurring (n=31) followed by neurological symptoms (n=27). The mean pH and anion gap were 7.06 and 27.2 respectively at presentation and 7.38 and 8.0 respectively on discharge. 30 patients underwent hemodialysis to remove the toxic alcohol and its metabolites. All patients with ocular involvement received injection methylprednisolone 500 mg for 3 days. The overall mortality was 67.5%.Conclusion: Methanol poisoning needs to be recognized early and managed emergently. Delay in seeking medical care substantially increases mortality. In case of inaccessibility to fomepizole and ethanol, dialysis has a pivotal role in management. Methylprednisolone therapy should be considered in all patients with visual complaints to reduce complications.

Background: Caudal anesthesia is a safe and reliable technique for infraumbilical surgeries in pediatric patients. Addition of dexmedetomidine to local anesthetic (LA) in caudal block prolongs the duration of block, but the effect on reducing the concentration of LA drug has not been extensively evaluated. This study was, therefore, designed to evaluate the efficacy of addition of dexmedetomidine to lower concentration of levobupivacaine required for ultrasonography (USG)-guided caudal block. Methods: A total number of 60 children with American Society of Anesthesiologists Grade I and II, aged 2–8 years from both sexes, and undergoing infraumbilical surgeries were recruited in a prospective, double-blinded, randomized controlled study over a duration of 1 year. The study children were allocated into groups A and B (n = 30 each) via computer-generated randomization. Group A children received caudal 0.25% levobupivacaine 0.75 ml/kg with 1 ml of normal saline and Group B children received 0.125% levobupivacaine 0.75 ml/kg with 1 μg/kg dexmedetomidine in 1 ml of normal saline after induction and the insertion of I-gel. Heart rates, blood pressure, and SpO2were monitored perioperatively. Postoperative hemodynamic monitoring; face, legs, activity, cry, and consolability (FLACC) pain score up to 24 h; time to first rescue analgesia; and emergence delirium using Watcha scale and Ramsay sedation score were recorded. Rescue analgesia was administered when FLACC pain score was >4. Any adverse events were noted and documented. Results: The study groups were comparable in terms of demographic characteristics and nature/duration of surgery. The mean FLACC pain scale in Group B was significantly lower compared to Group A. The mean duration of analgesia was statistically prolonged in Group B (P < 0.05) as compared to Group A (1299 ± 145 min in Group B vs. 348 ± 36 min in Group A). Emergence delirium as measured by Watcha scale was significantly lower in Group B (P < 0.05). Perioperative hemodynamic parameters were stable in the two groups, and no clinically significant adverse effects were noted. Conclusion: Addition of 1 μg/kg of dexmedetomidine decreases the effective concentration of levobupivacaine required for USG-guided caudal block, extends the duration of analgesia, and lowers the incidence of emergence delirium among pediatric patients undergoing infraumbilical surgery.

Perioperative analgesia poses specific problems, especially when it comes to neonates and infants. The use of opioid in neonates is usually associated with the risk of delayed extubation and postoperative mechanical ventilation. Regional analgesia including epidural and caudal may be technically challenging or has limitations in a certain group of patients. Ultrasound (US)-guided transversus abdominis plane block (TAP) is gaining popularity as a new technique of regional anesthesia applicable to infants and children. Precise drug administration is a major concern with TAP blocks in pediatric patients, especially infants and neonates. The application of US has enhanced the accuracy of local anesthetic deposition and hence the efficacy of analgesia in TAP block. We, hereby, report a series of five high-risk infants and neonates posted for abdominal surgeries wherein an ultrasonography-guided TAP resulted in satisfactory perioperative analgesia obviating the need of systemic opioids.

Presence of intraoral pathology especially in neonates poses a great challenge during airway management. Epignathus is a rare form of teratoid tumour that arises from the oropharyngeal region. We hereby report a case of a 7-day-old neonate who presented with feeding difficulty secondary to swelling arising from the hard palate. Surgical excision was decided to overcome feeding difficulty and to enable the child to thrive better. In view of anticipated difficult airway, the child was induced with sevoflurane, maintaining spontaneous breathing and intubated with Airtraq optical laryngoscope size 0. The further intraoperative and postoperative period was uneventful.

Background and Aims: The treatment of painful diabetic neuropathy (PDN) in elderly patients is challenging considering the adverse effects associated with long term use of drugs. Pregabalin has been recommended as the first line therapy for relief of neuropathic pain in such patients. However, the occurrence of side effects especially cognitive dysfunction and peripheral edema raised concerns during long term therapy in elderly population. Recently, few studies have highlighted the role of oxcarbazepine, a second generation antiepileptic, in PDN. This prospective, randomized, single-blind, parallel-group study was done to compare pregabaline and oxcarbazepine monotherapy in patients of PDN. Materials and Methods: 150 elderly patients of painful diabetic neuropathy, for at least 6 months of duration with an average baseline pain score ≥ 4 on 11 point numeric rating scale (NRS), were divided into two groups to receive either pregabalin 150 mg/day or oxcarbazepine 600 mg/day. Assessment of pain scores, cognitive functions and quality of life were performed at different time intervals during the course of treatment. Results: Patients in both the study groups showed significant reduction in pain scores from the baseline; however no significant differences in pain scores were noted between the two groups during the course of treatment. The incidence of cognitive dysfunction as measured by BCRS score was significantly more in pregabalin group while no significant changes were noted in oxcarbazepine group. The overall quality of life as demonstrated by SF12 scores was significantly better in both the study groups as compared to baseline. Conclusion: Oxcarbazepine can be used as an alternative to pregabalin in elderly patients with PDN considering the similar degree of pain relief and better cognitive profile.

Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind.