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Background and Aims: Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann-Whitney U test was used to compare continuous variables. Results: NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31-1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000). Conclusion: US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR. Keywords: Adductor canal block, analgesia, anterior cruciate ligament reconstruction, bupivacaine, genicular nerve block, nerve block, postoperative pain, Author(s): Sandeep S. N. Sujatha [1]; Kapil Gupta [2]; Sushil Guria [1]; Priyanka H. Chhabra (corresponding author) [1] INTRODUCTION Arthroscopic anterior cruciate ligament reconstruction (ACLR) is an ambulatory procedure. An [...]

Background: Hepatic encephalopathy (HE) severe complication of liver cirrhosis with high mortality. Few studies have found zinc deficiency in liver cirrhosis and HE patients and found it as a precipitating factor for the development of HE. This study was done to measure the serum zinc level in patients with liver cirrhosis with HE and a correlation was obtained between serum zinc level with grades of HE. Material and Methods: A cross-sectional observational study was done on 150 patients with liver cirrhosis with HE at a tertiary care center in Jharkhand. All cases were evaluated by history taking, clinical examination, and a questionnaire and classified into different WHC grades of HE and CPC classes of cirrhosis. Routine blood investigations, imaging studies, and morning serum zinc levels were done for all patients. Results: Majority of patients with liver cirrhosis with HE had zinc deficiency. There was a statistically highly significant (P < .00001) association between low serum zinc levels and WHC grades of HE. The serum zinc levels in different classes of cirrhosis showed highly significant differences (P < .00001). The mean serum zinc level was significantly low in patients who died (35.56 ± 11.65 vs 48.36 ± 10.91, P < .0001). The study revealed a strong positive correlation (r = .88, P = .048) between serum zinc and serum albumin levels. Conclusion: Serum zinc is deficient in patients with liver cirrhosis and HE. Zinc deficiency is significantly associated with higher severity of cirrhosis and higher grades of HE. All patients with liver cirrhosis with HE and hypoalbuminemia should be evaluated for zinc deficiency.

Background & Aims: Anatomical variations in the branching pattern of arch of aorta are significant for diagnostic, surgical, and interventional procedures of the thorax and neck, and failure to recognize these patterns may have fatal outcome. Hence the present study aims to determine the percentage and type of aortic arch variations. Materials & Methods: This cross-sectional study was conducted on 30 formalin-fixed stillborn human fetuses of 35 weeks gestational age and above, in the Department of Anatomy, RIMS, Imphal, Manipur from 2018 to 2020. stillborn human fetuses were collected from the Obstetrics and Gynecology Department of RIMS, Imphal, Manipur, after taking due consent from parent. Fetus with gross abnormality and weighing less than 2.5 kg were excluded. whereas above 2.5 kg weight fetuses were included. The variations in the branching pattern of aortic arch were observed, noted and photographed. The variations were according to the classification by vicurevic et al., 2012. Results: The classical pattern of three branches of the arch of aorta were seen in 23 (76.66%) cases in the present study. In the remaining 7 (23.33%) cases, two different types of variations were observed with four and two branches arising in five and two cases respectively. Conclusion: Knowledge of normal anatomy and frequency in the variations in the branching pattern of the arch of aorta in the present study can be of significance for clinicians.

Microplastic waste in aquatic environments can lead to the mortality of large marine creatures, as it increases the risk of entanglement, strangulation, and starvation. Even though micro- and nano-plastics pose a hidden threat, researchers still know little about them. The food source is an essential factor in gut microbial diversity. A well-balanced intestinal microbiome impacts animal development and health. According to research, microplastics (MPs) like polyethylene (PE) and polystyrene (PS) affected the gut microbiota of Artemia sp., increasing their genetic diversity. Therefore, the present study examined the negative impacts of MPs within the gastrointestinal tract of Artemia sp., the primary protein source of fish. A comprehensive literature review showed that microplastic contamination and its additives impair environmental and aquatic health. The findings of this research show that MPs alter the gut microbiota of Artemia, which in turn affects fish and, ultimately, human health via a cascade of impacts.

Abstract Non-Hermiticity has emerged as a new paradigm for controlling coupled-mode systems in ways that cannot be achieved with conventional techniques. One aspect of this control that has received considerable attention recently is the encircling of exceptional points (EPs). To date, most work has focused on systems consisting of two modes that are tuned by two control parameters and have isolated EPs. While these systems exhibit exotic features related to EP encircling, it has been shown that richer behavior occurs in systems with more than two modes. Such systems can be tuned by more than two control parameters, and contain EPs that form a knot-like structure. Control loops that encircle this structure cause the system’s eigenvalues to trace out non-commutative braids. Here we consider a hybrid scenario: a three-mode system with just two control parameters. We describe the relationship between control loops and their topology in the full and two-dimensional parameter space. We demonstrate this relationship experimentally using a three-mode mechanical system in which the control parameters are provided by optomechanical interaction with a high-finesse optical cavity.

Background and Aims: Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor-sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)-guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: This randomised, double-blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US-guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US-guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24-h morphine consumption. The Chi-square test was used to test the statistical significance between categorical variables. Independent t-test or Mann–Whitney U test was used to compare continuous variables. Results: NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31–1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24-h morphine consumption was also comparable in both groups (P = 1.000). Conclusion: US-guided GNB has an analgesic efficacy similar to US-guided ACB for patients undergoing arthroscopic ACLR.

Background: Worldwide stroke is the second major cause of mortality and the fourth prominent cause of disease load after coronary heart disease and all types of malignancy. Greater than 3/4th of these cases are in low-priced and middle-priced nations. Several epidemiological studies have shown that alcohol consumption is a risk factor for stroke. The correlation between alcohol consumption and stroke involves various processes. For excessive alcohol consumption, GGT (gamma glutamyl transferase) is used as a marker. The study aims to see whether serum GGT level is an independent risk factor for stroke in young and elderly patients who do not have a history of alcohol intake. Material and Method: The study is an analytical cross-sectional comparative hospital-based study done in the Department of Medicine, RIMS, Ranchi from November 2019 to April 2021. A total number of 100 cases including both sexes who presented with the first episode of stroke have been compared with 100 age–sex-matched healthy control subjects without any cerebrovascular or cardiovascular disease meeting inclusion and exclusion criteria. Analysis of data is done by SPSS software and R studio software. Result: Serum GGT is lower in the age group of 40–60 years (24-hour GGT mean 50.70 U/L+SD 16.86) than the age group of 60–80 years (24-hour GGT 65.89 U/L+SD59.04) with a P value of 0.005. This is also true in 48-hour GGT (48.02 U/L+SD16.02) in 40–60 years compared to 57.94 U/L+SD42.81 in 60–80 years with a P value of 0.001 and 72-hour GGT (44.80 U/L+SD16.98) in 40–60 years compared to the mean (56.16 U/L+SD43.82) in 60–80 years with a P value of 0.001. This suggests that serum GGT level is significantly lower in the 40–60 years age group with a P value < 0.01. The serum GGT level in the case population is mean 58.30 (U/L) + SD43.87, and that in the control group is mean 17.48 (U/L) + SD4.32 with P value < 0.001. This implies an increased level of serum GGT level in stroke patients. Conclusion: Serum GGT level is independently correlated with stroke even in the presence of other risk factors for stroke such as diabetes mellitus, hypertension, and dyslipidemia. Serum GGT level is more in hypertensive, dyslipidemic, and ischemic stroke patients than in non-hypertensive, non-dyslipidemic, non-ischemic stroke patients, but serum GGT level cannot predict the outcome (survival or death) in stroke patients.

Abstract Remote meta selective C–H functionalization of aromatic compounds remains a challenging problem in chemical synthesis. Here, we report an iridium catalyst bearing a bidentate pyridine-pyridone (PY-PYRI) ligand framework that efficiently catalyzes this meta selective borylation reaction. We demonstrate that the developed concept can be employed to introduce a boron functionality at the remote meta position of phenols, phenol containing bioactive and drug molecules, which was an extraordinary challenge. Moreover, we have demonstrated that the method can also be applied for the remote C6 borylation of indole derivatives including tryptophan that was the key synthetic precursor for the total synthesis of Verruculogen and Fumitremorgin A alkaloids. The inspiration of this catalytic concept was started from the O–Si secondary interaction, which by means of several more detailed control experiments and detailed computational investigations revealed that an unprecedented Bpin shift occurs during the transformation of iridium bis(boryl) complex to iridium tris(boryl) complex, which eventually control the remote meta selectivity by means of the dispersion between the designed ligand and steering silane group.

Abstract Facile conversion of CO2 to commercially viable carbon feedstocks offer a unique way to adopt a net-zero carbon scenario. Synthetic CO2-reducing catalysts have rarely exhibited energy-efficient and selective CO2 conversion. Here, the carbon monoxide dehydrogenase (CODH) enzyme blueprint is imitated by a molecular copper complex coordinated by redox-active ligands. This strategy has unveiled one of the rarest examples of synthetic molecular complex-driven reversible CO 2 reduction/CO oxidation catalysis under regulated conditions, a hallmark of natural enzymes. The inclusion of a proton-exchanging amine groups in the periphery of the copper complex provides the leeway to modulate the biases of catalysts toward CO2 reduction and CO oxidation in organic and aqueous media. The detailed spectroelectrochemical analysis confirms the synchronous participation of copper and redox-active ligands along with the peripheral amines during this energy-efficient CO 2 reduction/CO oxidation. This finding can be vital in abating the carbon footprint-free in multiple industrial processes.

In this study, we investigated von Willebrand factor (VWF)-related parameters in 30 patients with stable coronary artery disease (CAD) and 50 patients without CAD. In both groups, the following were measured: the VWF antigen level (VWF:Ag); the VWF ristocetin cofactor activity (VWF:RCo); the VWF collagen-binding activity (VWF:CB); and VWF-mediated platelet adhesion. Platelet adhesion was measured in whole blood at a shear rate of 1300 s−1 using a microfluidic chamber with a collagen-coated surface. VWF:Ag and VWF:RCo were found to be the same in both groups of patients. However, VWF:CB was found to be lower in patients with CAD compared with patients without CAD, with values of 106.7% (82.1; 131.6) and 160.4% (112.5; 218.1), respectively (p < 0.001). The decrease in platelet adhesion after GPIb inhibition was more pronounced in patients with CAD compared with patients of the control group, with recorded values of 76.0% (60.6; 82.1) and 29.3% (0.0; 60.4), respectively (p < 0.001). After adjusting for traditional risk factors, the odds ratio for CAD was found to be 0.98 (95% CI, 0.97–0.99; p = 0.011) per 1% increase in VWF:CB activity, and 1.06 (95% CI, 1.03–1.09; p < 0.001) per 1% decrease in GPIb-mediated platelet adhesion. The findings presented in this paper indicate a possible critical role played by complex VWF–collagen-platelet interactions in the development of CAD.