Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study.

BACKGROUND: The expanding horizons of the application of Segmental Thoracic Spinal anesthesia in day-to-day anesthesia practice prompted us to perform this study in a large subset of healthy patients with the aim of determining the feasibility, safety, advantages, and complications of this mode of anesthesia. MATERIAL AND METHODS: The prospective observational study was conducted from April 2020 to March 2022, 2.146 patients with symptoms of cholelithiasis and planned for laparoscopic cholecystectomy were included in this study, and 44 patients from this study were excluded due to pre-defined exclusion criteria. The patients belonging to ASA lIl, lV, severe cardiovascular or renal disability, on beta blockers, coagulation anomaly, spinal deformities, or previous spine surgeries were not included in the study. The patients exhibiting allergy to local anesthetics, requiring more than two attempts for the procedure, patchy or inadequate effects after spinal anesthesia, or change in the plan of surgery intraoperatively were also excluded from the study. All other patients were given subarachnoid block at T10-T11 intervertebral space with 26G Quincke needle and Inj. Bupivacaine Heavy (0.5%) 2.4 mL with 5µg of Dexmedetomidine. Intraoperative parameters, number of attempts, the incidence of paresthesia during the procedure intraoperative and postoperative complications, and patient satisfaction were evaluated and recorded. RESULTS: Spinal anesthesia was successful in 2,074 patients and was achieved in a single attempt of procedure in 92% of patients. The incidence of paresthesia during needle insertion was 5.8%. Hypotension was observed in 18% of patients, bradycardia (13%), and nausea (10%) in a few patients, with shoulder tip pain in only 6% of patients. The majority of patients (94%) were "very satisfied" with the procedure. There were no episodes of any adverse event during the postoperative period. CONCLUSION:  Thoracic spinal anesthesia is a regional anesthesia technique practically feasible for healthy patients undergoing laparoscopic cholecystectomy with a manageable incidence of intraoperative complications and no evidence of any neurological complications. It has the advantage of providing manageable hemodynamics, minimal postoperative complication, and an acceptable degree of patient satisfaction.

Assessing impacts of COVID-19 on aquatic food system and small-scale fisheries in Bangladesh.

COVID-19 is now a major global health crisis, can lead to severe food crisis unless proper measures are taken. Though a number of scientific studies have addressed the possible impacts of COVID-19 in Bangladesh on variety of issues, problems and food crises associated with aquatic resources and communities are missing. Therefore, this study aimed at bridging the gap in the existing situation and challenges of COVID-19 by linking its impact on aquatic food sector and small-scale fisheries with dependent population. The study was conducted based on secondary data analysis and primary fieldwork. Secondary data focused on COVID-19 overview and number of confirmed, recovered and death cases in Bangladesh; at the same time its connection with small-scale fisheries, aquatic food production, demand and supply was analyzed. Community perceptions were elicited to present how the changes felt and how they affected aquatic food system and small-scale fisheries and found devastating impact. Sudden illness, reduced income, complication to start production and input collection, labor crisis, transportation abstraction, complexity in food supply, weak value chain, low consumer demand, rising commodity prices, creditor's pressure were identified as the primary affecting drivers. Dependent people felt the measures taken by the Government should be based on protecting both the health and food security. Scope of alternative income generating opportunities, rationing system, training and motivational program could improve the situation. The study provides insight into policies adopted by the policy makers to mitigate the effects of the pandemic on aquatic food sector and small-scale fisheries.

Brachytherapy Localization Radiographs with Conventional Diagnostic X-Ray Machine.

With conventional diagnostic X-ray machines with over couch X-ray tubes, it is not possible to obtain anteroposterior (AP) and lateral (Lat) radiographs without changing the posture of the patients. In an old 300 mA X-ray machine with a fluoroscopy screen (12.4 kg) (1995 model), by substituting the screen with suitable counterweight and making provision to take the hoist pillar up to the edge of the wall, we could get isocentric setup for a hospital stretcher kept near the chest stand. This setup provided acceptable AP-Lat radiographs for brachytherapy localization using "Perspex jig" (Nucletron, Netherlands) and field check radiographs in head and neck, esophagus patients for treatment planning.

Design of a highly selective quenched activity-based probe and its application in dual color imaging studies of cathepsin S activity localization.

The cysteine cathepsins are a group of 11 proteases whose function was originally believed to be the degradation of endocytosed material with a high degree of redundancy. However, it has become clear that these enzymes are also important regulators of both health and disease. Thus, selective tools that can discriminate between members of this highly related class of enzymes will be critical to further delineate the unique biological functions of individual cathepsins. Here we present the design and synthesis of a near-infrared quenched activity-based probe (qABP) that selectively targets cathepsin S which is highly expressed in immune cells. Importantly, this high degree of selectivity is retained both in vitro and in vivo. In combination with a new green-fluorescent pan-reactive cysteine cathepsin qABP we performed dual color labeling studies in bone marrow-derived immune cells and identified vesicles containing exclusively cathepsin S activity. This observation demonstrates the value of our complementary cathepsin probes and provides evidence for the existence of specific localization of cathepsin S activity in dendritic cells.

Racemization free protocol for the synthesis of N-tert-butanesulfinyl ketimines.

A general and robust racemization-free protocol for the synthesis of a variety of N-tert-butanesulfinyl ketimines is reported. Reaction progress was monitored by (1)H NMR using the nonperturbing internal standard diglyme, and ketimines were formed in good to high yields in either THF or CPME (cyclopentyl methyl ether) as solvent with heating to reflux.

High stereoselectivity in chelation-controlled intermolecular Heck reactions with aryl chlorides, vinyl chlorides and vinyl triflates.

Highly stereoselective chelation-controlled Pd(0)-catalyzed beta-arylations and beta-vinylations of a five-membered chiral, pyrrolidine-based vinyl ether were achieved using aryl- and vinyl chlorides as substrates, yielding quaternary 2-aryl/vinyl-2-methyl cyclopentanones in 89-96% ee under neutral reaction conditions.

Selective terminal heck arylation of vinyl ethers with aryl chlorides: a combined experimental-computational approach including synthesis of betaxolol.

Reaction conditions have been developed for palladium-catalyzed terminal (beta-) arylation of acyclic vinyl ethers with high regioselectivity using inexpensive aryl chlorides as starting materials and the P(t-Bu)3 releasing preligand [(t-Bu3)PH]BF4 as the key additive. This swift and straightforward protocol exploits non-inert conditions and controlled microwave heating to minimize handling and processing times and uses aqueous DMF or environmentally friendly PEG-200 as the reaction medium. The selectivity for linear beta-product in PEG-200 is slightly higher than in aqueous DMF. DFT calculations support a ligand-driven selectivity rationale, where the electronic and steric influence of bulky P(t-Bu)3 ligand provides improved beta-selectivity in the essential insertion step also with electron-rich aryl chlorides. A tentative computational rationalization of the improved selectivity in non-methylated PEG is discussed. Finally the synthetic methodology was used to provide efficient access to linear p-[2-(cyclopropylmethoxy)ethyl] phenol from p-nitrophenyl chloride, a key intermediate in the synthesis of the beta-adrenergic blocking agent Betaxolol.

A rapid microwave protocol for Heck vinylation of aryl chlorides under air.

In modern high-throughput chemistry, the overall workflow is a crucial factor and much work is devoted to speeding up the process of chemistry development. Since automated microwave-based synthesizers are known to streamline the compound production and to accelerate slow organic transformations, this technology was implemented for Heck reactions with sluggish aryl chlorides. Furthermore, homogeneous palladium-catalyzed Heck vinylations of aryl chlorides can be performed under air under optimized conditions. Based on this finding, controlled microwave heating was utilized to accelerate model reactions down to 30 min employing a mixture of ionic liquid and 1,4-dioxane as solvent.