Utilization of a Supraglottic Airway Device for Airway Rescue and Tamponade of an Oropharyngeal Hemorrhage After Systemic Thrombolysis for an Acute Ischemic Stroke: A Case Report.

A 39-year-old man presented for mechanical thrombectomy after receiving systemic tissue plasminogen activator (tPA) for a basilar artery occlusion. The anesthesiology team was initially unable to intubate the patient due to oropharyngeal bleeding and a large epiglottis. Two-handed, 2-provider mask ventilation with an oral airway proved difficult. The team successfully placed a supraglottic airway (SGA) through which an oral endotracheal tube (ETT) was advanced over a fiberoptic bronchoscope into the trachea. The SGA remained overnight with the cuff inflated to tamponade the bleeding. The ETT was exchanged over an airway exchange catheter on postoperative day 1 without further airway complications.

Mysterious Mechanisms of Memory Formation: Are the Answers Hidden in Synapses?

After decades of research on memory formation and retention, we are still searching for the definite concept and process behind neuroplasticity. This review article will address the relationship between synapses, memory formation, and memory retention and their genetic correlations. In the last six decades, there have been enormous improvements in the neurochemistry domain, especially in the area of neural plasticity. In the central nervous system, the complexity of the synapses between neurons allows communication among them. It is believed that each time certain types of sensory signals pass through sequences of synapses, these synapses can transmit the same signals more efficiently the following time. The concept of Hebb synapse has provided revolutionary thinking about the nature of neural mechanisms of learning and memory formation. To improve the local circuitry for memory formation and behavioral change and stabilization in the mammalian central nervous system, long-term potentiation and long-term depression are the crucial components of Hebbian plasticity. In this review, we will be discussing the role of glutamatergic synapses, engram cells, cytokines, neuropeptides, neurosteroids and many aspects, covering the synaptic basis of memory. Lastly, we have tried to cover the etiology of neurodegenerative disorders due to synaptic dysfunction. To enhance pharmacological interventions for neurodegenerative diseases, we need more research in this direction. With the help of technology, and a better understanding of the disease etiology, not only can we identify the missing pieces of synaptic functions, but we might also cure or even prevent serious neurodegenerative diseases like Alzheimer's disease (AD).

A Strange Case of Dissociative Identity Disorder: Are There Any Triggers?

We discuss a strange case of dissociative identity disorder, also known as multiple personality disorder. This article describes the case of a 55-year-old Caucasian woman with a history of substance use disorder with seven personalities. The patient describes a couple of triggers for her condition. More research is needed to understand these triggers.

Orbital desmoplastic small round cell tumor in an infant.

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive malignancy that primarily involves the serosal surfaces of the abdomen and pelvis and has a poor prognosis. Orbital involvement is extremely rare. We report the case of a 2-month-old boy who presented with a right infraorbital mass consistent with a DSRCT and causing mass effect and superonasal globe displacement. To our knowledge, this is the first case of orbital DSRCT in an infant.

Liposomal Glutathione Supplementation Restores TH1 Cytokine Response to Mycobacterium tuberculosis Infection in HIV-Infected Individuals.

Cytokines are signaling biomolecules that serve as key regulators of our immune system. CD4(+) T-cells can be grouped into 2 major categories based on their cytokine profile: T-helper 1 (TH1) subset and T-helper 2 (TH2) subset. Protective immunity against HIV infection requires TH1-directed CD4 T-cell responses, mediated by cytokines, such as interleukin-1ß (IL-1ß), IL-12, interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α). Cytokines released by the TH1 subset of CD4 T-cells are considered important for mediating effective immune responses against intracellular pathogens such as Mycobacterium tuberculosis (M. tb). Oxidative stress and redox imbalance that occur during HIV infection often lead to inappropriate immune responses. Glutathione (GSH) is an antioxidant present in nearly all cells and is recognized for its function in maintaining redox homeostasis. Our laboratory previously reported that individuals with HIV infection have lower levels of GSH. In this study, we report a link between lower levels of GSH and dysregulation of TH1- and TH2-associated cytokines in the plasma samples of HIV-positive subjects. Furthermore, we demonstrate that supplementing individuals with HIV infection for 13 weeks with liposomal GSH (lGSH) resulted in a significant increase in the levels of TH1 cytokines, IL-1ß, IL-12, IFN-γ, and TNF-α. lGSH supplementation in individuals with HIV infection also resulted in a substantial decrease in the levels of free radicals and immunosuppressive cytokines, IL-10 and TGF-ß, relative to those in a placebo-controlled cohort. Finally, we determined the effects of lGSH supplementation in improving the functions of immune cells to control M. tb infection by conducting in vitro assays using peripheral blood mononuclear cells collected from HIV-positive individuals at post-GSH supplementation. Our studies establish a correlation between low levels of GSH and increased susceptibility to M. tb infection through TH2-directed response, which may be relieved with lGSH supplementation enhancing the TH1 response.

Differentials and approach to leukocoria.

Leukocoria is an important clinical examination finding as it can be a sign of significant intraocular pathology, with the most common being retinoblastoma and congenital cataracts. The Brückner test is a quick, easy, and inexpensive way to assess the red reflex. When leukocoria is suspected, prompt referral to an ophthalmologist is necessary for further evaluation.