Antifungal Activity of Neem Leaf Extract With Eucalyptus citriodora Oil and Cymbopogon martini Oil Against Tinea Capitis: An In-Vitro Evaluation.

Introduction Tinea capitis, often known as ringworm of the scalp, is a fungal infection that affects the scalp, eyelashes, and eyebrows. It is generally caused by dermatophytes from the genera Trichophyton and Microsporum. Trichophyton tonsurans and Microsporum canis are the main etiological agents responsible for most of the cases of tinea capitis globally. Tinea capitis commonly manifests as itchy, scaly patches of hair loss. Tinea capitis is the prevailing dermatophyte illness among children globally. Methods An in-vitroevaluation study was conducted to assess the antifungal properties of ethanolic extracts of neem leaves and the oils of Eucalyptus citriodora and Cymbopogon martini, both individually and in combination. The agar-well diffusion method and the M38-A2 microbroth dilution method were employed to evaluate the antifungal efficacy against pathogenic dermatophyte strains, namely Microsporum canis and Trichophyton tonsurans. The fully mature green leaves were treated with ethanol to make the neem leaf extract. Additionally, high-performance liquid chromatographic analysis was carried out to determine the contents of the terpenoids. Fluconazole, an antifungal drug, is used as a standard. Results The findings demonstrated an overall inhibition of the growth of dermatophytes at a minimal inhibitory concentration of 187.5 and 375 µg/ml for neem leaf extract and 0.625 to 2.5 µl/ml for selected herbal oils, whereas it was 0.25 µg/ml and 0.50 µg/ml for positive control against Microsporum canis and Trichophyton tonsurans, respectively. Conclusion The phytochemical investigation of the ethanolic extracts in neem leaves revealed the presence of terpenoids, which are known for their significant biological activity. The study's findings demonstrated the therapeutic capabilities of neem leaf extract in combination with the oils of Eucalyptus citriodora and Cymbopogon martini for managing the tinea capitis infection. A broader and improved antifungal spectrum was seen when neem leaf extract and oils were combined. Therefore, it can be developed into a suitable formulation for the management of tinea capitis.

Sinus rhythm activation signature indicates reentrant ventricular tachycardia inducibility and approximate isthmus location.

BACKGROUND: Sinus rhythm activation time is useful to assess infarct border zone substrate. OBJECTIVE: We sought to further investigate sinus activation in ventricular tachycardia (VT). METHODS: Canine postinfarction data were analyzed retrospectively. In each experiment, an infarct was created in the left ventricular wall by left anterior descending coronary artery ligation. At 3 to 5 days after ligation, 196-312 bipolar electrograms were recorded from the anterior left ventricular epicardium overlapping the infarct border zone. Sustained monomorphic VT was induced by premature electrical stimulation in 50 experiments and was noninducible in 43 experiments. Acquired sinus rhythm and VT electrograms were marked for electrical activation time, and activation maps of representative sinus rhythm and VT cycles were constructed. The sinus rhythm activation signature was defined as the cumulative number of multielectrode recording sites that had activated per time epoch, and its derivative was used to predict VT inducibility and to define the sinus rhythm slow/late activation sequence. RESULTS: Plotting mean activation signature derivative, a best cutoff value was useful to separate experiments with reentrant VT inducibility (sensitivity, 42/50) vs noninducibility (specificity, 39/43), with an accuracy of 81 of 93. For the 50 experiments with inducible VT, recording sites overlying a segment of isochrone encompassing the sinus rhythm slow/late activation sequence spanned the VT isthmus location in 32 cases (64%), partially spanned it in 15 cases (30%), but did not span it in 3 cases (6%). CONCLUSION: The sinus rhythm activation signature derivative is assistive to differentiate substrate supporting reentrant VT inducibility vs noninducibility and to identify slow/late activation for targeting isthmus location.

Recurring SARS-CoV-2 variants: an update on post-pandemic, co-infections and immune response.

The post-pandemic era following the global spread of the SARS-CoV-2 virus has brought about persistent concerns regarding recurring coinfections. While significant strides in genome mapping, diagnostics, and vaccine development have controlled the pandemic and reduced fatalities, ongoing virus mutations necessitate a deeper exploration of the interplay between SARS-CoV-2 mutations and the host's immune response. Various vaccines, including RNA-based ones like Pfizer and Moderna, viral vector vaccines like Johnson & Johnson and AstraZeneca, and protein subunit vaccines like Novavax, have played critical roles in mitigating the impact of COVID-19. Understanding their strengths and limitations is crucial for tailoring future vaccines to specific variants and individual needs. The intricate relationship between SARS-CoV-2 mutations and the immune response remains a focus of intense research, providing insights into personalized treatment strategies and long-term effects like long-COVID. This article offers an overview of the post-pandemic landscape, highlighting emerging variants, summarizing vaccine platforms, and delving into immunological responses and the phenomenon of long-COVID. By presenting clinical findings, it aims to contribute to the ongoing understanding of COVID-19's progression in the aftermath of the pandemic.

Symptoms 6 months following SARS-CoV-2 infection in Nepali women.

In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome.

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India.

BACKGROUND: There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. METHODS: Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). RESULTS: Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. CONCLUSIONS: Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.

Role of activation signatures in re-entrant ventricular tachycardia circuits.

INTRODUCTION: Development of a rapid means to verify the ventricular tachycardia (VT) isthmus location from heart surface electrogram recordings would be a helpful tool for the electrophysiologist. METHOD: Myocardial infarction was induced in 22 canines by left anterior descending coronary artery ligation under general anesthesia. After 3-5 days, VT was inducible via programmed electrical stimulation at the anterior left ventricular epicardial surface. Bipolar VT electrograms were acquired from 196 to 312 recording sites using a multielectrode array. Electrograms were marked for activation time, and activation maps were constructed. The activation signal, or signature, is defined as the cumulative number of recording sites that have activated per millisecond, and it was utilized to segment each circuit into inner and outer circuit pathways, and as an estimate of best ablation lesion location to prevent VT. RESULTS: VT circuit components were differentiable by activation signals as: inner pathway (mean: 0.30 sites activating/ms) and outer pathway (mean: 2.68 sites activating/ms). These variables were linearly related (p < .001). Activation signal characteristics were dependent in part upon the isthmus exit site. The inner circuit pathway determined by the activation signal overlapped and often extended beyond the activation map isthmus location for each circuit. The best lesion location estimated by the activation signal would likely block an electrical impulse traveling through the isthmus, to prevent VT in all circuits. CONCLUSIONS: The activation signal algorithm, simple to implement for real-time computer display, approximates the VT isthmus location and shape as determined from activation marking, and best ablation lesion location to prevent reinduction.

Modulated Ultrathin NiCo-LDH Nanosheet-Decorated Zr3+-Rich Defective NH2-UiO-66 Nanostructure for Efficient Photocatalytic Hydrogen Evolution.

Defect engineering through modification of their surface linkage is found to be an effective pathway to escalate the solar energy conversion efficiency of metal-organic frameworks (MOFs). Herein, defect engineering using controlled decarboxylation on the NH2-UiO-66 surface and integration of ultrathin NiCo-LDH nanosheets synergizes the hydrogen evolution reaction (HER) under a broad visible light regime. Diversified analytical methods including positron annihilation lifetime spectroscopy were employed to investigate the role of Zr3+-rich defects by analyzing the annihilation characteristics of positrons in NH2-UiO-66, which provides a deep insight into the effects of structural defects on the electronic properties. The progressively tuned photophysical properties of the NiCo-LDH@NH2-UiO-66-D-heterostructured nanocatalyst led to an impressive rate of HER (∼2458 µmol h-1 g-1), with an apparent quantum yield of ∼6.02%. The ultrathin NiCo-LDH nanosheet structure was found to be highly favored toward electrostatic self-assembly in the heterostructure for efficient charge separation. Coordination of Zr3+ on the surface of the NiCo-LDH nanosheet support through NH2-UiO-66 was confirmed by X-ray absorption spectroscopy and electron paramagnetic resonance spectroscopy techniques. Femtosecond transient absorption spectroscopy studies unveiled a photoexcited charge migration process from MOF to NiCo-LDH which favorably occurred on a picosecond time scale to boost the catalytic activity of the composite system. Furthermore, the experimental finding and HER activity are validated by density functional theory studies and evaluation of the free energy pathway which reveals the strong hydrogen binding over the surface and infers the anchoring effect of the ultrathin layered double hydroxide (LDH) in the vicinity of the Zr cluster with a strong host-guest interaction. This work provided a novel insight into efficient photocatalysis via defect engineering at the linker modulation in MOFs.

Pathophysiology to advanced intra-articular drug delivery strategies: Unravelling rheumatoid arthritis.

Rheumatoid arthritis (RA) is one of the most prevalent life-long autoimmune diseases with an unknown genesis. It primarily causes chronic inflammation, pain, and synovial joint-associated cartilage and bone degradation. Unfortunately, limited information is available regarding the etiology and pathogenesis of this chronic joint disorder. In the last few decades, an improved understanding of RA pathophysiology about key immune cells, antibodies, and cytokines has inspired the development of several anti-rheumatic drugs and biopharmaceuticals to act on RA-affected joints. However, life-long frequent systemic high doses of commercially available drugs are currently a limiting factor in the efficient management of RA. To address this issue, various single and double-barrier intra-articular drug delivery systems (IA-DDSs) such as nanocarriers, microparticles, hydrogels, and particles-hybrid hydrogel composite have been developed which can exclusively target the RA-affected joint cavity and release the precisely controlled therapeutic drug concentration for prolonged time whilst avoiding the systemic toxicity. This review provides a comprehensive overview of the pathogenesis of RA and discusses the rational design and development of biomaterials-based novel IA-DDs, ranging from conventional to advanced systems, for improved treatment of RA. Therefore, this review aims to unravel the pathophysiology of rheumatoid arthritis and explore cutting-edge IA-DD strategies exploiting biomaterials. It offers researchers a consolidated and up-to-date resource platform to analyze existing knowledge, identify research gaps, and contribute to the scientific literature.

An assessment of serum magnesium levels in critically ill patients: A prospective observational study.

Background: A specific magnesium level is essential to be maintained to ensure appropriate neuromuscular excitability and cardiac function; an increase or decrease in its levels usually leads to critical abnormality. Hypomagnesemia in critically ill patients has many potential ramifications and is found to be an important factor in hindering their recovery. Thus, the study aimed to assess the serum magnesium levels in critically ill participants and explore its effect on their condition. Methods: A prospective observational study was conducted for 21 months, from February 2019 to October 2020, among all critically ill participants admitted to the medical intensive care unit (ICU) of a tertiary care hospital. The Acute Physiology and Chronic Health Evaluation II score questionnaire was used to determine the severity of their condition and blood samples were collected within 24 h of their ICU admission for analysis. Results: One hundred participants were enrolled, of which 40% were between the age group of 46 and 65 years and 71% were males. Among all participants with hypomagnesemia, 52% were diabetic, 19% had a history of alcohol use disorder, and 27% had normal calcium and potassium levels. Hypomagnesemia significantly correlated with a longer duration of ICU stay among participants. Conclusion: A significant correlation was observed between hypomagnesemia and increased ICU length of stay and mortality but not the duration of mechanical ventilation. Monitoring and appropriate supplementation of serum magnesium is recommended to limit further comorbidity and mortality in the critical care setting.

Correlation relationships of the reentrant ventricular tachycardia circuit.

INTRODUCTION: A quantitative analysis of the components of reentrant ventricular tachycardia (VT) circuitry could improve understanding of its onset and perpetuation. METHOD: In 19 canine experiments, the left anterior descending coronary artery was ligated to generate a subepicardial infarct. The border zone resided at the epicardial surface of the anterior left ventricle and was mapped 3-5 days postinfarction with a 196-312 bipolar multielectrode array. Monomorphic VT was inducible by extrastimulation. Activation maps revealed an epicardial double-loop reentrant circuit and isthmus, causing VT. Several circuit parameters were analyzed: the coupling interval for VT induction, VT cycle length, the lateral isthmus boundary (LIB) lengths, and isthmus width and angle. RESULTS: The extrastimulus interval for VT induction and the VT cycle length were strongly correlated (p < 0.001). Both the extrastimulus interval and VT cycle length were correlated to the shortest LIB (p < 0.005). A derivation was developed to suggest that when conduction block at the shorter LIB is functional, the VT cycle length may depend on the local refractory period and the delay from wavefront pivot around the LIB. Isthmus width and angle were uncorrelated to other parameters. CONCLUSIONS: The shorter LIB is correlated to VT cycle length, hence its circuit loop may drive reentrant VT. The extrastimulation interval, VT cycle length, and shorter LIB are intertwined, and may depend upon the local refractory period. Isthmus width and angle are less correlated, perhaps being more related to electrical discontinuity caused by alterations in infarct shape at depth.

Halide Tunablility Leads to Enhanced Biomechanical Energy Harvesting in Lead-Free Cs2SnX6-PVDF Composites.

The main challenges impeding the widespread use of organic-inorganic lead halide perovskites in modern-day technological devices are their long-term instability and lead contamination. Among other environmentally convivial and sustainable alternatives, Cs2SnX6 (X = Cl, Br, and I) compounds have shown promise as ambient-stable, lead-free materials for energy harvesting, and optoelectronic applications. Additionally, they have demonstrated tremendous potential for the fabrication of self-powered nanogenerators in conjunction with piezoelectric polymers like polyvinylidene-fluoride (PVDF). We report on the fabrication of composites constituting solvothermally synthesized Cs2SnX6 nanostructures and PVDF. The electroactive phases in PVDF were boosted by the incorporation of Cs2SnX6, leading to enhanced piezoelectricity in the composites. First-principles density functional theory (DFT) studies were carried out to understand the interfacial interaction between the Cs2SnX6 and PVDF, which unravels the mechanism of physisorption between the perovskite and PVDF, leading to enhanced piezoresponse. The halide ions in the inorganic Cs2SnX6 perovskites were varied systematically, and the piezoelectric behaviors of the respective piezoelectric nanogenerators (PENGs) were investigated. Further, the dielectric properties of these halide perovskite-based hybrids are quantified, and their piezoresponse amplitude, piezoelectric output signals, and charging capacity are also evaluated. Out of the several films fabricated, the optimized Cs2SnI6_PVDF film shows a piezoelectric coefficient (d33) value of ∼200 pm V-1 and a remanent polarization of ∼0.74 µC cm-2 estimated from piezoresponse force microscopy and polarization hysteresis loop measurement, respectively. The optimized Cs2SnI6_PVDF-based device produced an instantaneous output voltage of ∼167 V, a current of ∼5.0 µA, and a power of ∼835 µW across a 5 MΩ resistor when subjected to periodic vertical compression. The output voltage of this device is used to charge a capacitor with a 10 µF capacitance up to 2.2 V, which is then used to power some commercial LEDs. In addition to being used as a pressure sensor, the device is employed to monitor human physiological activities. The device demonstrates excellent operational durability over a span of several months in an ambient environment vouching for its exceptional potential in application to mechanical energy harvesting and pressure sensing applications.

Dissecting Parameters Contributing to the Underprediction of Aldehyde Oxidase-Mediated Metabolic Clearance of Drugs.

We investigated the effect of variability and instability in aldehyde oxidase (AO) content and activity on the scaling of in vitro metabolism data. AO content and activity in human liver cytosol (HLC) and five recombinant human AO preparations (rAO) were determined using targeted proteomics and carbazeran oxidation assay, respectively. AO content was highly variable as indicated by the relative expression factor (REF; i.e., HLC to rAO content) ranging from 0.001 to 1.7 across different in vitro systems. The activity of AO in HLC degrades at a 10-fold higher rate in the presence of the substrate as compared with the activity performed after preincubation without substrate. To scale the metabolic activity from rAO to HLC, a protein-normalized activity factor (pnAF) was proposed wherein the activity was corrected by AO content, which revealed up to sixfold higher AO activity in HLC versus rAO systems. A similar value of pnAF was observed for another substrate, ripasudil. Physiologically based pharmacokinetic (PBPK) modeling revealed a significant additional clearance (CL; 66%), which allowed for the successful prediction of in vivo CL of four other substrates, i.e., O-benzyl guanine, BIBX1382, zaleplon, and zoniporide. For carbazeran, the metabolite identification study showed that the direct glucuronidation may be contributing to around 12% elimination. Taken together, this study identified differential protein content, instability of in vitro activity, role of additional AO clearance, and unaccounted metabolic pathways as plausible reasons for the underprediction of AO-mediated drug metabolism. Consideration of these factors and integration of REF and pnAF in PBPK models will allow better prediction of AO metabolism. SIGNIFICANCE STATEMENT: This study elucidated the plausible reasons for the underprediction of aldehyde oxidase (AO)-mediated drug metabolism and provided recommendations to address them. It demonstrated that integrating protein content and activity differences and accounting for the loss of AO activity, as well as consideration of extrahepatic clearance and additional pathways, would improve the in vitro to in vivo extrapolation of AO-mediated drug metabolism using physiologically based pharmacokinetic modeling.

Valproate overdose leading to hyperammonaemic encephalopathy.

Sodium valproate is a commonly prescribed anticonvulsant medication; however, it can cause uncommon side effects such as hyperammonaemia and encephalopathy. We present the case of a male in his early 50s brought to the emergency department after being found collapsed by his wife, with an empty bottle of sodium valproate tablets. The patient developed hyperammonaemic encephalopathy due to sodium valproate overdose and was treated with supportive care and renal replacement therapy. This case highlights the importance of recognising the potential complications of sodium valproate and its prompt treatment.

Microplastic contamination in Indian rural and urban lacustrine ecosystems.

This study investigates the microplastics (MPs) pollution of the lacustrine ecosystems of Tamil Nadu, South India. It examines the seasonal distribution, characteristics and morphology of MPs and assesses the risk posed by MPs pollution. MPs abundance in the 39 rural and urban lakes studied varies from 16 ± 2.69 to 118.17 ± 22.17 items/L (water) and 19.50 ± 4.75 to 156.23 ± 36.41 items/kg (sediment). The water and sediment of urban lakes show average MPs abundances of 88.06 items/L and 115.24 items/kg respectively, while the rural lakes exhibit average MPs abundances of 42.98 items/L and 53.29 items/kg. The results demonstrate that study areas with more residential and urban centers with higher population density and larger discharge of sewage have greater MP abundance. Urban zones have greater MP diversity integrated index (MPDII = 0.73) than rural zones (MPDII = 0.59). Fibres are the dominant group and polyethylene and polypropylene are the most commonly found polymers, possibly gaining entry through land-based plastic litter and urban activities in this region. The weathering index values, 50 % of MPs exhibit high degree of oxidation (WI >0.31) with an age of >10 years. SEM-EDAX results reveal that the weathered MPs from urban lakes have a wider variety of metal elements (Al, Cr, Mn, Co, Ni, Cu, Zn, As, Sr, Hg, Pb and Cd) than those from rural lakes (Na, Cl, Si, Mg, Al, Cu). Though PLI shows low risk (<10) in terms of abundance, PHI reflects pollution status III (10-100) and IV (100-1000) in rural areas and IV and V (>1000) in urban areas based on the toxicity score of the polymer. Ecological risk assessment shows minor risks (<150) at present. The assessment indicates the risk posed by the MPs to the lakes studied and emphasizes the necessity for best MP management practices in future.

Seasonal and spatial variations in the distribution pattern, sources and impacts of microplastics along different coastal zones of Tamil Nadu, India.

We investigated spatiotemporal variations of microplastics (MPs) in Coromandel Coast, Palk Bay, Gulf of Mannar, and West Coast of Tamil Nadu, India. MPs abundance varies from 37 ± 1.52 to 189 ± 9.02 items/kg in sediment and 23 ± 15.25 to 155.25 ± 4.16 items/L in water. Highest abundance in monsoon by riverine inflow transports plastic waste to the ocean. MPs sizes 0.5-1 mm are dominant in summer with 16 polymers, while 3-4 mm dominates the monsoon with 23 polymers. Carbonyl Index shows high MP oxidation (>0.31), unrelated to spatiotemporal changes. SEM-EDAX shows weathered MPs carrying hazardous metals. High MP diversity (MPDII = 0.77) of Coromandel Coast points to many sources of pollution and the need for immediate control measures. Pollution load values indicate low degree of MP pollution (<10), polymer hazard index shows level III (10-100) and IV (100-1000), and ecological risk assessment shows minor risks (<150) at present.

Lateral Boundaries of the Ventricular Tachycardia Circuit Align With Sinus Rhythm Discontinuities.

BACKGROUND: Sinus rhythm electrical activation mapping can provide information regarding the ischemic re-entrant ventricular tachycardia (VT) circuit. The information gleaned may include the localization of sinus rhythm electrical discontinuities, which can be defined as arcs of disrupted electrical conduction with large activation time differences across the arc. OBJECTIVES: This study sought to detect and localize sinus rhythm electrical discontinuities that might be present in activation maps constructed from infarct border zone electrograms. METHODS: Monomorphic re-entrant VT with a double-loop circuit and central isthmus was repeatedly inducible by programmed electrical stimulation in the epicardial border zone of 23 postinfarction canine hearts. Sinus rhythm and VT activation maps were constructed from 196 to 312 bipolar electrograms acquired surgically at the epicardial surface and analyzed computationally. A complete re-entrant circuit was mappable from the epicardial electrograms of VT, and isthmus lateral boundary (ILB) locations were ascertained. The difference in sinus rhythm activation time across ILB locations, vs the central isthmus and vs the circuit periphery, was determined. RESULTS: Sinus rhythm activation time differences averaged 14.4 milliseconds across the ILB vs 6.5 milliseconds at the central isthmus and 6.4 milliseconds at the periphery (ie, the outer circuit loop) (P ≤ 0.001). Locations with large sinus rhythm activation difference tended to overlap ILB (60.3% ± 23.2%) compared with their overlap with the entire grid (27.5% ± 18.5%) (P < 0.001). CONCLUSIONS: Disrupted electrical conduction is evident as discontinuity in sinus rhythm activation maps, particularly at ILB locations. These areas may represent permanent fixtures relating to spatial differences in border zone electrical properties, caused in part by alterations in underlying infarct depth. The tissue properties producing sinus rhythm discontinuity at ILB may contribute to functional conduction block formation at VT onset.

Major complications following central neuraxial block - A multi-centre observational study in Maharashtra (MGMM CNB Study).

Background and Aims: Major complications of central neuraxial block (CNB) are rare and their incidence in India is not known. This information is essential for explaining risk and medico-legal concerns. The present multi-centre study in Maharashtra was conducted to provide insight into the characteristics of rare complications following this popular anaesthetic technique. Methods: Data were collected from 141 institutes to study the clinical profile of CNB. Incidence of complications like vertebral canal haematoma, abscess, meningitis, nerve injury, spinal cord ischaemia, fatal cardiovascular collapse, and drug errors was collected over one year. Complications were reviewed by audit committee to assess causation, severity, and outcome. 'Permanent' injury was defined as death or neurological symptoms persisting for more than six months. Results: Spinal anaesthesia (SA) was the most frequently used CNB in 88.76% patients. Bupivacaine and an adjuvant were used in 92.90% and 26.06% patients, respectively. Eight major complications (four neurological and four cardiac arrests) were reported in patients receiving SA. In seven of eight instances, SA was responsible or contributory for complication. The pessimistic incidence of complications (included cases where CNB was responsible; contribution was likely, unlikely and could not be commented) was 8.69/lakh and optimistic incidence (included cases where CNB was responsible or contribution was likely) was 7.61/lakh. 'Pessimistically' and 'optimistically' there were three deaths including one death due to quadriplegia following epidural haematoma after SA. Five out of eight patients recovered completely (62.5%). As only eight patients had complications of different types, it was difficult to establish statistical correlation of major complications with demographic or clinical parameters. Conclusion: This study was reassuring and suggested that the incidence of major complications following CNB was low in Maharashtra.

A Case Report of Oral Malignant Melanoma: A Silent Killer.

Melanoma of the oral cavity is a rare malignant tumor that develops from a malignant melanocytic or de novo from melanocytes within the normal mucosa or skin and appears blue, black, or reddish-brown. Oral mucosal melanoma has a higher proclivity for metastasis and attacks tissue more aggressively than any other malignant tumor in the mouth. Intestinal melanoma of the head and neck is an uncommon type of cancer that should be counted among the deadliest. Malignant melanoma of the oral cavity accounts for only 0.2%-8.0% of all reported melanoma, although accounting for 1.3% of all malignancies. Because most melanotic mucosal lesions are painless at first, the diagnosis is sometimes delayed until the ulcer or growth causes symptoms. Early detection is critical for effective therapy and the only way to improve survival and prognosis in patients with oral malignant melanoma due to its poor prognosis. To avoid oral melanomas, every single colored lesion identified in the oral cavity should be treated with suspicion and adequate inquiry because a colored lesion might expand, and it should be referred for a biopsy to avoid poisoning. This article shows how the oral clinic is important in the diagnosis of oral ulcers and argues that early detection is necessary to enhance patient outcomes.

Herb-Induced Liver Injury by Ayurvedic Medicine With Severe Lactic Acidosis: A Case Report.

Lactate is the basic blood parameter in the arsenal of an intensivist when managing a critically ill patient. A 62-year-old male presented with nausea and vomiting. He had been using an Ayurvedic medication, Insulin Management Expert (IME-9), for his type 2 diabetes mellitus and was found to have severe lactic acidosis that was resistant to initial fluid resuscitation and Ayurvedic medicine-induced liver injury. He required admission to critical care for organ support and ultimately recovered. Because current literature on the adverse effects of this Ayurvedic medication, particularly hepatotoxicity, is limited, causality was determined using the adverse drug association tool Roussel Uclaf Causality Assessment Method (RUCAM), which determined this as a probable cause with a strong score of seven. As a result, our case adds a vital gear to the wheel of current research literature.