A UNIQUE CASE OF BILATERAL VOCAL FOLD PARALYSIS FOLLOWING SPINAL ANAESTHESIA

Cranial nerve palsies are potential but rare complications of spinal anaesthesia. Most of the literatures support upper cranial nerve palsies like VI, IV and III cranial nerve palsies. Intrathecal hypotension resulting in tractional injury of the cranial nerves is the likely mechanism of injury. As on date, some cases of unilateral vocal fold paralysis and very little bilateral vocal fold paralysis have been described in case reports. We have described a patient who developed hoarseness and dysphagia 7 days after receiving spinal anaesthesia for fixation of inter-trochanteric fracture femur. The patient was diagnosed with bilateral vocal fold paralysis. He was managed conservatively and exhibited complete spontaneous recovery as has been described in the previously reported cases. Any patient presenting with idiopathic vocal fold paralysis should be enquired about the history of spinal or epidural anaesthesia. If the history is affirmative, then it points towards transient intrathecal hypotension as a potential etiology of the cranial nerve palsy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Charge-transfer interaction of some aromatic hydrocarbons with chloranil

266-268The interaction of different substituted naphthalenes with chlorapil has been studied spectrophotometrially in chloroform Symmetrically substituted naphthalenes give one new absorption band while the unsymmetrically substituted naphthalenes show two new absorption bands. The formation constants for the charge-transfer complexes have been determined using Benesi-Hildebrand's method. Linear plots for hv against ionization potential of the donors have been obtained

Fluorescence studies of the charge-transfer complexes of some substituted benzenes and naphthalenes with chloranil

724-726The charge-transfer complexes of some substituted benzenes and naphthalenes with chIoranil are studied spectrofluorometrically in different solvents. No fluorescence bands are observed for compounds having two charge-transfer bands. The quantum yield of the substituted benzenes-chloraniI complexes are calculated. The dipole moments calculated from solvent shift data show the same trend as calculated from absorption measurements

Ground state dipole moment of the charge transfer complexes of some aromatic hydrocarbons with chloranil from solvent shift data

891-893The ground state dipole moment of charge transfer complexes of chloranil with aromatic hydrocarbons has been calculated as a linear function of solvent shift. Very close values of μ1 and μ2 for multiple charge transfer bands indicate that orientation is not playing a major role. The weak nature of the complexes is manifested by the oscillator strength values. Nevertheless lower energy transition shows a greater overlap

Relative contribution of charge-transfer and electrostatic force in donor-acceptor complexes of <em>pi-pi* </em> type

161-164The analysis of the relative, contribution of charge transfer and electrostatic forces in the 'formation of molecular complexes of different substituted naphthalenes with chloranil (pi-pi* complexes) shows that in nonpolar solvents, the charge-transfer force plays the dominant part. In polar solvents, however, the electrostatic force does have an important contribution

On some megaspores from the triassic of Nidhpuri, India

The paper describes structural features of megaspores from the Middle Gondwana (Middle Triassic) beds of Nidhpuri. These include two species of Srivastavaesporites Bharadwaj et Tiwari viz. S. triassicus sp. nov. and S. major sp. nov.; Grambastisporites nidhpurensis gen. et sp. nov.; Trikonia emarginata gen. et sp. nov.; one species of Mamillaespora Pant et Srivastava, M. sidhiensis sp. nov.; Nidhitriletes spinosa gen. et sp. nov

Kinetics of dispersion of nanoparticles in thin polymer films at high temperature

We report the first detailed study of the kinetics of dispersion of nanoparticles in thin polymer films using temperature dependent in situ X-ray scattering measurements. We show a comparably enhanced dispersion at higher temperatures for systems which are otherwise phase segregated at room temperature. Detailed analysis of the time dependent X-ray reflectivity and diffuse scattering data allows us to explore the out-of-plane and in-plane mobility of the nanoparticles in the polymer films. While the out-of-plane motion is diffusive with a diffusion coefficient almost two orders of magnitude lower than that expected in bulk polymer, the in-plane one is found to be super-diffusive resulting in significantly larger in-plane displacement at similar time scales. We discuss the origin of the observed highly anisotropic motion of nanoparticles due to their slaved motion with respect to the anisotropic chain orientation and consequent diffusivity anisotropy of matrix chains. We also suggest strategies to utilize these observations to kinetically improve dispersion in otherwise thermodynamically segregated polymer nanocomposite films

Percutaneous ethanol ablation in managing predominantly cystic thyroid nodules: An eastern India perspective

Aims: Percutaneous aspiration and ethanol injection (PEI) is effective in managing predominantly cystic (>50% cystic) thyroid nodules with efficacy ranging from 38-85%. We aimed to evaluate efficacy, safety, and factors determining outcomes of PEI in managing simple cystic (purely cystic) vs. complex cystic (having both cystic and solid components) thyroid nodules. Materials and Methods: Predominantly cystic thyroid nodules, without any ultrasonography and/or fine needle aspiration, evidence of malignancy were aspirated ultrasonography guided. Sterile 100% ethanol (50-100% volume aspirated) was injected and reviewed monthly for 3 months and thereafter 3 monthly. Responders were defined as ≥ 50% reduction in nodule volume. Results: Sixty-five patients out of 152 considered underwent PEI. Sixty patients [simple cystic (42) and complex cystic (18)] with mean follow-up of 12.3 ± 2.88 months were analyzed. Response rate of PEI was 78.33% [simple cystic (92.86%) and complex cystic (44.44%) nodules; P < 0.001]. Also, 31.67% patients achieved remission at 1 st month. And, 46.67% patients achieved remission between 1-6-months follow-up. Kaplan Meier analysis showed significantly improved outcomes in patients with simple cystic nodules (P < 0.001). Cox-regression revealed type of nodule (simple cystic vs. complex cystic) to be predictive of outcome (P = 0.034). Complex cystic nodules were 67.6% less likely to go into remission, compared to simple cystic nodules. Baseline nodule size, aspirate, or volume of ethanol injected did not predict outcome. Conclusions: PEI is safe and should be treatment of choice for simple cystic thyroid nodules. PEI for complex cystic thyroid nodules are associated with lower response, increased recurrence, and need for repeated PEI