Efficacy of Ropivacaine for Sub-Arachnoid Block in Patients with Recent History of Scorpion Sting: A case series.

Failure of sub-arachnoid block (SAB), due to resistance to bupivacaine after a recent scorpion sting can lead to multiple block attempts and subsequent conversion to general anaesthesia. We report this case series of 10 patients with successful SAB with newly launched 0.75% hyperbaric ropivacaine, in patients with recent scorpion sting. Thus, intrathecal hyperbaric ropivacaine may be considered as the local anaesthetic agent of choice in patients with scorpion sting to prevent failure of SAB.

Efficacy of intertruncal and corner-pocket approaches of ultrasound-guided supraclavicular block in terms of ulnar nerve blockade: A randomised controlled study.

Background and Aims: The incidence of ulnar nerve sparing has declined with the corner-pocket approach of the supraclavicular block (SCB), however, it continues to persist. A recent technique of SCB, the intertruncal approach, separately blocks each trunk of the brachial plexus. Thus, we hypothesised that the intertruncal approach results in a complete ulnar nerve blockade. Methods: Eighty-eight patients were randomised to undergo SCB using an ultrasound (USG)-guided corner-pocket or intertruncal approach and were compared primarily regarding the complete sensory and motor blockade of the ulnar nerve and all four nerves (ulnar, radial, median and musculocutaneous nerves) at 15 min. Secondary objectives included time required for block performance, patient discomfort score, time to readiness for surgery and duration of sensory blockade of the ulnar nerve. Continous data were compared using an independent t-test, and categorical data were compared using the Chi-square test. Results: The proportion of participants with complete sensory (30/44 vs. 14/44, P < 0.001) and complete motor (22/44 vs. 7/44, P < 0.001) blocks in the ulnar nerve and all four nerves at 15 min was significantly higher in the intertruncal group. Block performance time and patient discomfort score were higher in the intertruncal group (P < 0.001). The total duration of sensory blockade in the ulnar nerve was more in the corner-pocket group (P < 0.001). Conclusion: USG-guided intertruncal approach is superior to the corner-pocket approach of SCB regarding a complete ulnar nerve blockade.

Palladium-Catalyzed Directed Aldehyde C-H Arylation of Quinoline-8-carbaldehydes: Exploring the Reactivity Differences between Aryl (Pseudo) Halides.

We have developed a method for Pd-catalyzed direct C-H arylation of quinoline-8-carbaldehydes with either aryl iodides or aryl diazonium salts for the synthesis of aryl quinolinyl ketones. Aryl iodide substituted with an electron-donating group favors the reaction, whereas aryl diazonium salt substituted with an electron-withdrawing group showed excellent reactivity. A range of aryl quinolinyl ketones were synthesized in good-to-excellent yields, with very good functional group tolerance. Our methodology was successfully applied to synthesize highly potent tubulin polymerization inhibitors and can be easily scaled up to a gram scale.

Copper(II) mediated ortho C-H alkoxylation of aromatic amines using organic peroxides: efficient synthesis of hindered ethers.

Synthesis of hindered alkyl aryl ether derivatives (R-O-Ar) remains a huge challenge and highly desirable in organic and medicinal chemistry because extensive substitution on the ether bond prevents the undesired metabolic process and thus avoids rapid degradation in vivo. Herein, we report an unprecedented hindered alkoxylation of picolinamide attached aromatic amines using economic copper salt and organic peroxide to get highly desirable α-tertiary alkyl aryl ethers.

The Positive Predictive Values of the Breast Imaging Reporting and Data System (BI-RADS) 4 Lesions and its Mammographic Morphological Features.

The Breast Imaging Reporting and Data System (BI-RADS) is a comprehensive guideline to systematize breast imaging reporting, and as per its recommendations, any lesion with likelihoods of malignancy greater than 2% is deemed as suspicious and tissue diagnosis is recommended. The aim of the study is to determine the positive predictive value (PPV) of BI-RADS categories 4a, 4b, and 4c for malignancy and association of mammographic morphological features of BI-RADS 4 subgroups with malignant outcomes. We retrospectively reviewed all the patients undergoing mammography with BI-RADS score of 4 followed by biopsy from May 2019 to April 2020. The predictive values of BI-RADS 4 subcategories and morphological features with malignancy are performed taking histopathology report as the gold standard. The PPV of BI-RADS subcategories 4a, 4b, and 4c for malignancies were 34, 89, and 97%, respectively. BI-RADS 4c patients tend to be older (50.2 ± 12.2 vs. 44.6 ± 10.3 years) with larger mass (44 ± 16 vs. 32.9 ± 16.8 mm) at presentation than 4a. Postmenopausal state (P = 0.03) and older age (P = 0.019) were significantly associated with malignancy. There is no meaningful difference observed in the predictability of BI-RADS category 4c lesions among different breast density patterns. The overall higher PPV for BI-RADS 4a and 4b reflects subjectivity in subcategory assignments of BI-RADS 4. In patients, less than 40 years with the BI-RADS 4a category on mammograms may undergo supplementary imaging with MRI which may downscale the lesion classification in turn reducing unnecessary biopsy and surgery.

Cutaneous and cardiac metastases in carcinoma of anterior tongue.

Distant metastases in squamous cell carcinoma of the head and neck are uncommon, and the incidence rises with neck node metastasis. The lung, liver, and bones are the common possible sites for distant metastasis. Cutaneous and cardiac metastases are extremely rare situations with aggressive behaviors and present in the late course of the disease. Here, we report a case of anterior tongue cancer with cutaneous, bone, cardiac, lung, and soft tissue of right suprascapular area metastases after a gap of 2 years of follow-up of completion of treatment with radical surgery and adjuvant concurrent chemoradiation therapy. The present case developed such type of aggressive distant metastases without any locoregional recurrence and died within 6 months of diagnosis of distant metastases.

Visible Light-Promoted Photocatalytic C-5 Carboxylation of 8-Aminoquinoline Amides and Sulfonamides via a Single Electron Transfer Pathway.

An efficient photocatalytic method was developed for the remote C5-H bond carboxylation of 8-aminoquinoline amide and sulfonamide derivatives. This methodology uses in situ generated •CBr3 radical as a carboxylation agent with alcohol and is further extended to a variety of arenes and heteroarenes to synthesize the desired carboxylated product in moderate-to-good yields. The reaction proceeding through a single electron transfer pathway was established by a control experiment, and a butylated hydroxytoluene-trapped aryl radical cation intermediate in high-resolution mass spectrometry was identified.

Recurrence of Plexiform Ameloblastoma as Acanthomatous Ameloblastoma: A Rare Case Report.

Ameloblastoma is an uncommon locally invasive benign odontogenic tumor arising from the odontogenic epithelium. It is a slow-growing tumor with locally aggressive nature, and posterior mandible is the most common location. The recurrence rate is high even after en bloc resection. Acanthomatous ameloblastoma is one of the rare variants of ameloblastoma and is usually seen in older age group. Here, we present a case of acanthomatous ameloblastoma in a 46-year-old female who previously diagnosed and treated for a case of plexiform ameloblastoma 17 years back. This is the first case to be reported among ameloblastoma with different histopathological variants at recurrence.

Perioperative sildenafil therapy for children with ventricular septal defects and associated pulmonary hypertension undergoing corrective surgery: A randomised clinical trial.

BACKGROUND AND AIMS: Sildenafil is known to reduce pulmonary artery pressure but its role in the perioperative period has not been well studied. We aimed to evaluate the efficacy of sildenafil in controlling post-operative pulmonary hypertension in children with pulmonary hypertension undergoing surgeries for correction of ventricular septal defect. METHODS: The patients were divided randomly into two groups of thirty each. Group 1 (placebo) received pre-operative placebo and post-operative sildenafil (0.5mg/kg every 6 hrs) while Group 2 (sildenafil) received pre- and post-operative sildenafil (0.5mg/kg every 6 hrs). RESULTS: In the Group 1, systolic pulmonary artery pressure reduced from 81.63 (±12.1) mmHg preoperatively to 79.26 (±11.29) mmHg pre-cardiopulmonary bypass (CPB) and 56.76 (±11) mmHg (with 10 minutes post-CPB), whereas in Group 2, it reduced from 83.3 (±12.1) before surgery to 68.9 (±11.3) mmHg pre-CPB and after CPB, to 42.2 (±7.6) mmHg (P = 0.001). The mean pulmonary artery pressure decreased from 60.63 (±10.5) mmHg to 42.13 (±8.3) mmHg in the Group 1 whereas it reduced from 54.36 (±10) mmHg to 31.36 (±6.5) mmHg in Group 2 (P = 0.001). The reductions in pulmonary artery/aortic ratio and Intensive Care Unit stay were statistically significant No adverse effects were recorded. CONCLUSION: The use of perioperative sildenafil has a statistically significant reduction in the mean pulmonary artery pressure without any adverse effects.

Synovial Sarcoma of Palmar Aspect of Hand and Survival: A Rare Case Report.

Synovial sarcomas of the hand are extremely rare entities than most soft tissue sarcomas. The location at finger is further rarer than carpus of the hand. Synovial sarcoma of the hand/finger initially confused with many diagnoses such as myositis, haematoma, synovitis, tendonitis, bursitis, and other inflammatory lesions and therefore needs careful handling of the case with proper evaluation. We report a case of synovial sarcoma of the palmar surface of the right hand at interface of thumb and index finger in a 22-year-old female. The case was initially misdiagnosed as an abscess/haematoma of the finger 10 years back and treated with wide local excision. Synovial sarcoma was diagnosed on microscopic examination of excised specimen. Patient developed recurrent lesion twice locally. During first recurrence, the patient was treated with wide excision followed by radiotherapy and chemotherapy. Second recurrence was with bony destruction at the same site and below elbow amputation was performed.

Poorly Differentiated Sertoli-Leydig Cell Tumour of Ovary with Heterologous Elements.

Sertoli-Leydig Cell Tumour (SLCT) is included under sex-cord stromal tumour of testis or ovary. Ovarian pathology is an extremely rare entity constituting less than 0.5% of all ovarian neoplasms. Majority of the cases present at younger age group, i.e., 2nd and 3rd decade of life. The clinical presentation depends on either mass effect or excess hormone production. Virillization symptoms are the most common presentation and depend upon the quantity of androgen production. Most of the patients have a unilateral mass without extraovarian spread and present at stage-I. Treatment and prognosis depends on the degree of the differentiation and the stage of the disease. Here, we report a case of SLCT of the ovary in a young female. The patient initially presented with pain abdomen due to mass effect and was treated with conservative surgery followed by adjuvant chemotherapy due to the presence of poorly differentiated pathology with heterologous elements.

Choroidal Metastasis as Initial Presentation in Adenocarcinoma of Lung: A Case Report.

Vision impairment as an initial presentation detecting choroid metastasis in primary lung cancer is rare. Prevention or treatment of visual loss and improvement in quality of life can be achieved by treatment of intraocular metastasis. The survival of the patient in choroid metastasis with lung primary is poor with the median survival being 3.3 months. However, proper treatment may increase the quality of life and survival to an extent. We report a case of adenocarcinoma of lung in a female patient, presented initially with visual impairment as a result of choroidal metastasis and treated with external beam radiotherapy for choroidal metastasis followed by palliative chemotherapy. The patient was survived with improved vision and quality of life since last 12 months of diagnosis.

A Comparative Study on Weekly Versus Three Weekly Cisplatinum Based Chemoradiation in Locally Advanced Head and Neck Cancers.

INTRODUCTION: Head and Neck Cancers constitute around 30% of cancers occurring in India and majority of cases present with locoregionally advanced disease. Cisplatin based concurrent chemoradiation is the most common modality of definitive treatment in these advanced cases. However, it is unclear regarding priority of weekly versus three weekly cisplatin based concurrent chemoradiation schedule in treatment of such advanced diseases. AIM: To evaluate the efficacy in terms of response, locoregional control, and disease status in both the arms, and to compare the acute and late toxicity in both arms. MATERIALS AND METHODS: Thirty untreated patients of locally advanced Squamous Cell Carcinoma of head and neck were randomized into two arms: Arm A (n=15) patients received injection cisplatin 30 mg/m2 weekly along with radiation; Arm B (n=15) patients received injection cisplatin 100 mg/m2 on a three weekly basis along with radiation. Radiotherapy was delivered to a total dose of 66 Gy in conventional fractionation schedule in telecobalt machine. RESULTS: Major toxicities included mucositis, dermatitis, vomiting, neutropenia, and anaemia. There was a trend towards increase in grade-III leukopenia and grade-III dermatitis in arm A compared to arm B, and increase in grade-III mucositis and grade-III vomiting in arm B in comparison to arm A although statistically not significant. Within a median follow-up of seven months, in arm A complete response was 73.33% (11/15) and partial response was 26.67%; whereas in arm B complete response was 85.71% (12/14) and partial response was 14.29%, which was not statistically significant. However, there was a trend towards better efficacy in arm B. CONCLUSION: We conclude that, weekly cisplatin arm is as good as three weekly cisplatin arms. But efficacy is not statistically significant. However, there was a trend of three weekly cisplatin arms towards better efficacy, with comparable haematological and mucosal toxicities.

Visible-Light-Induced Efficient Selective Oxidation of Nonactivated Alcohols over {001}-Faceted TiO2 with Molecular Oxygen.

In the presence of molecular oxygen, a {001}-faceted nanocrystalline anatase TiO2 catalyst enabled the selective oxidation of nonactivated aliphatic alcohols to the corresponding aldehydes or ketones under visible light. The reaction shows excellent conversion and selectivity towards the formation of the carbonyl products without over-oxidation to the corresponding carboxylic acids. The exceptional reactivity of the catalyst is possibly due to the absorption of visible light originating from a stronger interaction of alcohol with the {001} facet, which facilitates the modification of the band structure of TiO2 , thus facilitating the photogenerated hole transfer and subsequent oxidation processes. The experimental results have also been corroborated by first-principles quantum chemical DFT calculations.

Digital Acrometastasis as Initial Presentation in Carcinoma of Lung A Case Report and Review of Literature.

Bony metastases develop in 30% of all the cancers, but out of which only 1% to 3% occurs in the hand. Lung is the most common site for acrometastasis, followed by breast and renal cell cancer. Metastases to the digits are with non-specific presentation. We reported a case of 79-year-old male patient with initial presentation of swelling over left index finger, which was found to be squamous cell carcinoma of finger on histopathological examination. He was subsequently diagnosed as a case of squamous cell carcinoma of lung with acrometastasis.

Squamous cell carcinoma of kidney and its prognosis: a case report and review of the literature.

Primary squamous cell carcinoma of the renal parenchyma is an extremely rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features. Most of the patients are diagnosed at an advanced stage and are with poor outcome. Radical nephrectomy is the mainstay of the treatment. We reported a case of squamous cell carcinoma of the kidney in a 50-year-old female who presented with the right sided abdomen pain. The patient was treated with radical nephrectomy.

Hydroxyeyhyl starch: Controversies revisited.

Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.

Effects of hemodilution on outcome after modified Blalock-Taussig shunt operation in children with cyanotic congenital heart disease.

OBJECTIVE: Cyanotic congenital heart diseases (CCHD) with secondary polycythemia and hyperviscosity state are associated with a reduction in blood flow, stagnation of blood, and thrombosis. Sufficient hemodilution in cyanotic children results in higher blood flow and significant reductions in perioperative blood loss. The aim of this study was to investigate similar beneficial effects of hemodilution in preventing shunt thrombosis and decreasing postoperative blood loss after modified Blalock-Taussig (BT) shunt operations in children with CCHD. DESIGN: Prospective, randomized, controlled study. SETTING: Cardiac center of a tertiary care, referral hospital. PARTICIPANTS: Fifty children with CCHD undergoing modified BT shunt operations. INTERVENTIONS: Patients were randomized into 2 groups. The study group (n = 25) received a calculated amount of 6% hydroxyethyl starch (200/0.5) solution to bring down the hematocrit to 45%, whereas the control group (n = 25) received 5% dextrose solution intraoperatively as per the authors' normal protocol. MEASUREMENTS AND MAIN RESULTS: Effects of hemodilution on shunt patency, postoperative blood loss at 24 hours, blood and blood component usage, and re-exploration rates were recorded. The shunt patency rate was significantly higher in the study group than the control group (100% and 84%, respectively, p < 0.05). Postoperative blood loss at 24 hours was significantly higher in the control group than in the study group (14.4 +/- 11.8 mL/kg and 9.9 +/- 8 mL/kg, respectively, p < 0.05). The number of recipients and the amount of blood and blood components administered were higher in the control group, but they were not statistically significant. The re-exploration rate (for excessive postoperative chest-tube drainage) was significantly higher in the control group than the study group (12% and 0%, respectively, p < 0.05). CONCLUSION: Hemodilution in CCHD patients undergoing modified BT shunt surgery has beneficial effects including improved shunt patency because of higher blood flow through the graft and less postoperative blood loss, which may be attributed to the lower viscosity produced by hemodilution.