Rescue splenic artery embolization in an adult patient of sickle cell disease presented with acute splenic sequestration crisis.

BACKGROUND: Splenic sequestration crisis is a potentially fatal complication of sickle cell disease, mainly seen in young children. Only a few case series describe the acute splenic sequestration crisis in adults and its management, which primarily consists of supportive care and, in some cases, splenectomy. Splenic artery embolization has seldom been described in sickle cell disease. This is probably the first case in which an adult with sickle cell disease presented with an acute splenic sequestration crisis was managed successfully through splenic artery embolization. RESULTS: This 22-year-old female, a known case of sickle cell disease, presented with severe pain in the abdomen and low-grade intermittent fever for two days, secondary to an acute splenic sequestration crisis. The diagnosis of acute splenic sequestration was made based on clinical and blood parameters, ultrasonography, and computed tomography. Even with adequate supportive care and blood transfusions, the patient's condition worsened with a rapid fall in the hemoglobin and total platelet count. Considering splenectomy to be a high-risk procedure for this patient, a decision of rescue splenic artery embolization was taken, which was successful. CONCLUSION: Splenic artery embolization may be considered a lifesaving procedure in patients with acute splenic sequestration, where the risk of splenectomy can be high. Adequate post-procedure supportive care is vital for preventing complications.

Sequential mechanical thrombectomies in acute bilateral middle cerebral artery strokes: A case report and review of literature.

Simultaneous occlusion of both middle cerebral arteries (MCAs) is very rare and usually devastating. Few case reports are available in the literature where bilateral thrombectomy was done simultaneously to remove the clot. High NIH stroke scale with a low level of consciousness can be a clue for the diagnosis. Timely intervention is necessary to decrease morbidity and mortality in these patients. We also reviewed the existing literature where mechanical thrombectomies were done for bilateral MCA stroke in PubMed, Google Scholar, Cochrane, and Embase. Herein, we report a case of 47-year-old female having rheumatic heart disease presented with simultaneous bilateral MCAs occlusion, treated with mechanical thrombectomies successfully.

Congenital brain tumour in a neonate: a therapeutic challenge.

A term neonate with history of ventriculomegaly in the fetal period was diagnosed with a central nervous system tumour after radiological investigations. It was confirmed as an immature teratoma after histopathological examination. He underwent left frontal craniotomy with tumour excision. Intraoperatively, massive haemorrhage (venous bleed) occurred due to the high vascularity of the tumour and led to haemodynamic instability. A massive transfusion protocol was initiated. Despite multiple transfusions and shock management, he succumbed at 2 weeks of life. This case report highlights the importance of antenatal diagnosis and fetal MRI in prognostication and also the possible role of neoadjuvant chemotherapy in reducing tumour vascularity and, hence, bleeding.

Emerging insights into cephalic neural crest disorders: A single center experience.

Objectives: Neural crest cells (NCCs) are transient structures in the fetal life in vertebrates, which develop at the junctional site of the non-neural and neural ectoderm, sharing a common developmental origin for diverse diseases. After Epithelio-mesenchymal (EMT) of the NCCs within the neural tube, delamination of NCCs occurs. After delamination, the transformation of these cells into various cell lineages produces melanocytes, bones, and cartilage of the skull, cells of the enteric and peripheral nervous system. After the conversion, these cells migrate into various locations of the entire body according to the cell lineage. Abnormalities in neural crest (NC) formation and migration result in various malformations and tumors, known as neurocristopathy. Material and Methods: Herein, this case series describes a single-center experience in cephalic NC disorders over the past 3 years, including 17 cases of varying composition (i.e., vascular, dysgenetic, mixed, and neoplastic forms) involving the brain and occasionally skin, eyes, and face of the patients. Results: In our study of 17 patients with cephalic NC disease, 6 (35.3%) patients had vascular form, 5 (29.4%) had dysgenetic form, 4 (23.5%) had mixed form, and 2 (11.7%) had neoplastic form. Brain involvement in the form of vascular or parenchyma or both vascular and parenchymal was seen in all of our patients (100%), skin in 6 (35.3%) patients, eye in 2 (11.7%), and face in 1 (5.9%) patient. Treatment was planned according to the various manifestations of the disease. Conclusion: Neural crest diseases (NCDs) are a rare and under-recognized group of disorders in the literature and may have been under-reported due to a lack of awareness regarding the same. More such reporting may increase the repertoire of these rare disorders such that clinicians can have a high degree of suspicion leading to early detection and timely counseling and also improve preventive strategies and help in developing new drugs for these disorders or prevent them.

Reverse Y stenting in the management of vertebrobasilar junction fenestrated aneurysm: A novel technique.

Fenestrated aneurysm at vertebrobasilar junction (VBJ) is very rare and can occur due to non-fusion of longitudinal neural axis forming basilar artery in the early stage of embryonic life. Due to defects in tunica media and weakness in its wall, these fenestrations are more likely to develop an aneurysm. Various treatment strategies are required for the management of these types of aneurysms including simple coiling, stent-assisted coiling, balloon remodeling technique, and more recently kissing flow diverters. Herein, we report the case of ruptured fenestrated VBJ aneurysm which was managed successfully with novel reverse Y stenting with coiling.

Rare case of duplicated middle cerebral artery and acute ischaemic stroke managed successfully with mechanical thrombectomy.

A man in his early 80s presented with acute onset aphasia and right-sided weakness with an NIH Stroke Scale (NIHSS) of 17. He was last seen normal 9 hours before the presentation. MRI of the brain showed acute infarcts in the left caudate, lentiform nucleus and corona radiata. MRI angiogram (MRA) revealed an occluded left main middle cerebral artery (MCA) and an associated ipsilateral patent duplicated middle cerebral artery (DMCA). Mechanical thrombectomy (MT) was performed, and he was discharged with an NIHSS of 8. In this report, we review and discuss the challenges during the intervention of MCA occlusion in the presence of duplicated MCA, a rare anomaly.

"Shelf Technique" in braided stent (Leo Baby) in wide-necked intracranial aneurysm.

A 42-year-old female presented with sudden onset severe headache without loss of consciousness 4 days back. Non-contrast computed tomography scan of the brain showed subarachnoid hemorrhage, and angiography showed a wide-necked aneurysm in the right middle cerebral artery (MCA) bifurcation, incorporating the superior division of right M2 MCA and another small aneurysm in the inferior division of right M2 MCA. Because of the wide-necked ruptured aneurysm and another in the inferior division of right M2 MCA, braided stent-assisted coiling (Leo baby) with shelving was done to protect both the aneurysms and to protect the superior branch of M2 MCA. The patient tolerated the procedure well and had an uneventful recovery. In this report, we have also reviewed and discussed the challenges, advantages, and disadvantages of the newly discovered shelving technique with a braided stent for wide-necked bifurcation aneurysms.

Osteopetrosis with Arnold Chiari malformation type I.

Osteopetrosis is a rare genetic disorder resulting in increased bone density and decreased bone remodelling. Bone expansion results in the crowding of neural foramina causing cranial nerve compression. Here, we describe a female infant in her mid infancy presented with no eye contact since birth, and abdominal distension for 2 months. On CT evaluation, sclerotic bones with bilateral optic canal narrowing were present. A crowded posterior fossa with Arnold Chiari type I malformation was seen on MRI evaluation, suggesting a rare association of osteopetrosis with Arnold Chiari's malformation.

Chargeability study of disinfectants and the optimization of design parameters of a handheld electrostatic disinfection device for small scale applications.

Apart from aerosols, contaminated surfaces with SARS-CoV-2 virus are the significant carriers of virus transmission. The disinfection and sanitization of the indoor and outdoor places are one among the powerful and effective strategies to avoid the surface-to-human transmission of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) through frequent touch and physical contact. Electrostatic spraying is one of the effective and efficient methods to apply the liquid-based sprays on surfaces to be disinfected or sanitized. This technique covers the directly exposed and obscured surfaces uniformly and reaches to hidden areas of the target. In this paper, the design and performance parameters of a motorized pressure-nozzle based handheld electrostatic disinfection device were optimized and the chargeability of ethanol (C2H5OH), formaldehyde (CH2O), glutaraldehyde (C5H8O2), hydrogen peroxide (H2O2), phenol (C6H5OH) and sodium hypochlorite (NaClO) has been critically investigated. The chargeability indicator for disinfectants was presented in terms of the charge-to-mass ratio. The significant value of the charge-to-mass ratio of 1.82 mC/kg was achieved at an applied voltage of 2.0 kV, the liquid flow rate and pressure of 28 ml/min and 5 MPa, respectively. The experimental results are well aligned to the proposed theoretical context.

Gelation-induced enhanced fluorescence emission from organogels of salicylanilide-containing compounds exhibiting excited-state intramolecular proton transfer: synthesis and self-assembly.

Self-assembly structure, stability, hydrogen-bonding interaction, and optical properties of a new class of low molecular weight organogelators (LMOGs) formed by salicylanilides 3 and 4 have been investigated by field-emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), UV/Vis absorption and photoluminescence, as well as theoretical studies by DFT and semiempirical calculations with CI (AM1/PECI=8) methods. It was found that salicylanilides form gels in nonpolar solvents due to pi-stacking interaction complemented by the presence of both inter- and intramolecular hydrogen bonding. The supramolecular arrangement in these organogels predicted by XRD shows lamellar and hexagonal columnar structures for gelators 3 and 4, respectively. Of particular interest is the observation of significant fluorescence enhancement accompanying gelation, which was ascribed to the formation of J-aggregates and inhibition of intramolecular rotation in the gel state.

Direct and water-mediated excited state intramolecular proton transfer (ESIPT) from phenol OH to carbon atoms of extended ortho-substituted biaryl systems.

In our continuing studies of the generality and mechanistic details of a new type of excited state intramolecular proton transfer (ESIPT), from phenol to adjacent carbon atoms of suitably designed biaryl systems, the photochemical deuterium incorporation at adjacent (proximal) ortho and more distal positions of 2-hydroxy-p-terphenyl (), 2-hydroxy-o-terphenyl (), and 2-(hydroxyphenyl)-9H-fluorene () has been studied in D2O-CH3CN. The observed deuterium exchange in these molecules is entirely consistent with direct and water-mediated (formal) ESIPT processes from the phenol OH to the ring carbons, formally migrating over a range of 2.18-8.12 A (4-10 bonds). These are examples of the longest solvent-mediated ESIPTs reported. Multiple sites of protonation (sites of formal ESIPT) observed requires the intermediacy of a wide-variety of unique quinone methide intermediates. The overall higher deuterium exchange efficiency and greater number of proton transfer sites observed for may be attributed to the enhanced structural rigidity of the proton-accepting ring (a rigid fluorene system).