We report a case of rhinocerebral mucormycosis in a 31 year old immunocompetent female presenting initially like acute rhinosinusitis with nasal stuffiness, severe headache, vomiting who soon developed isolated right lateral rectus palsy. Computed tomography(CT) scan of the Post-Nasal Spaces(PNS) showed an ill defined expansile heterogenous density mass in the sphenoid with extension into the ethmoids, nasal cavity, optic canal, superior orbital fissure, clivus and right temporal lobe with signal void in Magnetic Resonance Imaging(MRI). The debris and polypoid mucosa obtained on nasal endoscopy revealed mucormycosis on histopathologic examination. The patient was managed with urgent surgical debridement and medical management.

The interaction of baicalein with bovine serum albumin (BSA) was investigated with the help of spec-troscopic and molecular docking studies. The binding affinity of baicalein towards BSA was estimated to be in order of 105 M?1 from fluorescence quenching studies. NegativeΔH° (?5.6670.14 kJ/mol) and positive (ΔS°) ( t 79.96 7 0.65 J/mol K) indicate the presence of electrostatic interactions along with the hydrophobic forces that result in a positiveΔS°. The hydrophobic association of baicalein with BSA di-minishes in the presence of sodium dodecyl sulfate (SDS) due to probable hydrophobic association of baicalein with SDS, resulting in a negativeΔS° ( ? 40.65 7 0.87 J/mol K). Matrix-assisted laser desorption ionization/time of flight (MALDI–TOF) experiments indicate a 1:1 complexation between baicalein and BSA. The unfolding and refolding phenomena of BSA were investigated in the absence and presence of baicalein using steady-state and fluorescence lifetime measurements. It was observed that the presence of urea ruptured the non-covalent interaction between baicalein and BSA. The presence of metal ions (Ag t , Mg2 t , Ni2 t , Mn2 t , Co2 t and Zn2 t ) increased the binding affinity of ligand towards BSA. The changes in conformational aspects of BSA after ligand binding were also investigated using circular di-chroism (CD) and Fourier transform infrared (FT-IR) spectroscopic techniques. Site selectivity studies following molecular docking analyses indicated the binding of baicalein to site 1 (subdomain IIA) of BSA.&2016 Xi'an Jiaotong University. Production and hosting by Elsevier B.V. This is an open access article.

Objective:To describe the audiological, vestibular and radiological profile of patients with migrainous vertigo. Methods: This is a prospective descriptive study of patients who presented with migrainous vertigo in a tertiary care institute over one year.All patients between the ages of twenty to sixty who presented between 2013 and 2014 with migrainous vertigo diagnosed according to Neuhauser’s criteria were included in this study. The diagnostic intervention was audiovestibular tests and magnetic resonance imaging (MRI) of brain with gadolinium. The main outcome measures were types and degree of auditory and vestibular deficits; MRI findings in migrainous vertigo, and whether age at presentation and duration of symptoms affected these findings.Results:Of the 112 patients recruited, the overall female-to male ratio was 1.7: 1. On pure tone audiogram, 18 (16%) patients had sensorineural hearing loss and this was similar in age groups<41 and >40 years. Caloric abnormalities were seen in 64 (61.5%) patients and there was no significant difference in the younger versus older age groups. MRI abnormality was present in 24% and the commonest finding was deep white matter hyperintensities in the brain. In the <41 age group, there were 8/46 with headache < 7 years (17.3%) and 5/9 (55.5%) with headache for >7 years with MRI abnormalities, and this difference was statistically significant (Chi sq 4.14, p=0.041). Conclusions:Both audiological and vestibular abnormalities were seen in migrainous vertigo patients and older age did not appear to be an additional risk factor for the presence of theseabnormalities. Deep white matter hyperintensities were the commonest abnormality found on MRI scans and longer headache duration was associated with higher chances of MRI abnormalities in younger people.
Vestibular Diseases ; Vertigo

No abstract available.
Catatonia* ; Lorazepam* ; Seizures*

Electroconvulsive therapy (ECT) is a time tested treatment modality for the management of various psychiatric disorders. There have been a lot of modifications in the techniques of delivering ECT over decades. Despite lots of criticisms encountered, ECT has still been used commonly in clinical practice due to its safety and efficacy. Research evidences found multiple neuro-biological mechanisms for the therapeutic effect of ECT. ECT brings about various neuro-physiological as well as neuro-chemical changes in the macro- and micro-environment of the brain. Diverse changes involving expression of genes, functional connectivity, neurochemicals, permeability of blood-brain-barrier, alteration in immune system has been suggested to be responsible for the therapeutic effects of ECT. This article reviews different neurobiological mechanisms responsible for the therapeutic efficacy of ECT.
Brain ; Electroconvulsive Therapy* ; Immune System ; Mental Disorders ; Neurobiology ; Permeability ; Therapeutic Uses

No abstract available.
Leg* ; Muscle Cramp* ; Psychomotor Agitation*

No abstract available.

Initially known as CI-581, ketamine was first synthesized in 1962 as a replacement from phencyclidine. It has since been used as an anesthetic and analgesic. In addition, it has bronchodilating, sedative, and amnestic properties, preserving airway reflexes and sympathetic nervous system tone. Since the discovery of ketamine, it has been a major topic of discussion due to controversies regarding its usage in particular sets of patients. In the past 50 years, despite its potential benefits, it is not commonly used because of concerns of “emergence phenomenon,” its use as a substance of abuse, and its systemic side effects. Since 2012, three World Health Organization reviews on ketamine have addressed its international control.Researchers have been studying this wonder drug for a decade worldwide. Many myths of ketamine regarding emergence phenomenon and its use in traumatic brain injury and open eye injury have been disproved in recent times. It is becoming popular in pre-hospital settings, critical care, emergency medicine, low-dose acute pain services, and adjuvant in regional anesthesia techniques. This review highlights the current consensus on the various applications of ketamine in the literature.

Purpose: To compare the efficacy of 0.1% nepafenac and 1% prednisolone acetate eye drop in postoperative inflammation control in micro-incisional cataract surgery. Methods: We conducted a prospective, randomized, comparative, single-blind study. All the patients underwent temporal 2.2-mm micro-incisional cataract surgery. They were randomized into two groups (group A and B). Group A received 0.1% nepafenac eye drops 4 times/day for 4 weeks and group B received 1% prednisolone acetate eye drops in tapering doses for 4 weeks after surgery. Both the groups received moxifloxacin 0.5% eye drops 4 times/day for 2 weeks. Patients were examined on 1st, 7th, and 30th postoperative days and parameters of postoperative inflammation were evaluated and noted at each visit. Results: A total of 200 patients were enrolled in the study. However, five patients lost to follow up, group A had 97 and group B had 98 patients respectively. Results were statistically insignificant in terms of the difference in lid edema, conjunctival congestion, corneal edema, anterior chamber cells and flare between the two groups with p-values >0.05 for each parameter at each visit. However, the difference in mean central macular thickness between the groups was significant (205.713 ± 17.14 vs. 220.984 ± 32.83 in group A and B, respectively, p ≤ 0.001) at 1 month. Also, the mean pain score was significantly lower (p = 0.018) in the nepafenac group at day 7 of surgery. Conclusions Nepafenac is equally effective and non-inferior to prednisolone acetate in suppression and prevention of inflammation in postoperative period.

OBJECTIVES: Hydroxychloroquine (HCQ) 400 mg is approved by the Drug Controller General of India (DCGI) and recommended by the Research Society for the Study of Diabetes in India (RSSDI) clinical practice recommendations 2017 as add-on therapy after metformin and sulfonylurea in Type 2 Diabetes (T2DM) patients. The aim of this observational study is to compare the efficacy and safety of hydroxychloroquine 400 mg and teneligliptin 20 mg when used as add-on therapy in Indian Type 2 DM patients who were inadequately controlled (HbA1c ?7.5%) with metformin 1000 mg and glimepiride 2 mg combination.

METHODOLOGY: This study is a prospective observational study to be conducted in 2 diabetic centres of Patna city between October 2017 and May 2018 involving 180 patients followed up for 6 months. One group (N=90) of patients received hydroxychloroquine 400 mg + metformin 1000 mg + glimepiride 2 mg, the other group (N=90) received teneligliptin 20 mg + metformin 1000 mg + glimepiride 2 mg. Efficacy was assessed by fasting blood glucose (FBG), post prandial blood glucose (PPBG) and glycated haemoglobin (HbA1c) reduction. Safety was evaluated by the number of hypoglycaemic events and changes in serum creatinine levels. Home based glucose monitoring was used to detect the hypoglycaemic events. Patients who had any type of retinopathy/maculopathy were excluded.

RESULTS: Mean age of entire population was 66 ± 8 years with mean 6 ± 2 years of DM with 102 males. Mean body weight was 71 ± 12 kg. Baseline HbA1c was 8.1 ± 0.3 in the hydroxychloroquine group and 8.2 ± 0.2 in the teneligliptin group.

At 24 weeks there were statistically significant reductions in mean HbA1c in the hydroxychloroquine group (1.1 ± 0.3) as compared to the teneligliptin group (0.82 ± 0.3) (P?0.001). The mean FBG and PPBG was 169 ± 18 mg/dl and 232 ± 18 mg/dl respectively in hydroxychloroquine group which was reduced to 121 ± 15 mg/dl and 161 ± 19 mg/dl at the end of 24 weeks. In the teneligliptin group, FBG and PPBG was 171 ± 16 mg/dl and 239 ± 21 mg/dl at baseline, which was reduced to 121 ± 15 mg/dl and 161 ± 19 mg/dl respectively in same period of time (P? 0.005). There were 4 incidences of hypoglycaemic events in the hydroxychloroquine group (4.4%) and 6 in the teneligliptin group (6.67%). No patients required medical assistance for hypoglycaemic events. There was no statistically significant change in body weight in both the groups. No marked changes in creatinine levels were found in patients in both the groups.

CONCLUSION: In conclusion, treatment with hydroxychloroquine 400 mg for 24 weeks reduces glycaemic parameters more aggressively than teneligliptin 20 mg in Indian type 2 diabetes patients.