Role of ancillary ligands in selectivity towards acceptorless dehydrogenation versus dehydrogenative coupling of alcohols and amines catalyzed by cationic ruthenium(II)-CNC pincer complexes.

An unexpected reversal in catalytic activity for acceptorless dehydrogenative coupling compared to acceptorless alcohol dehydrogenation has been observed using a series of cationic Ru(II)-CNC pincer complexes with different ancillary ligands. In continuation of our study of cationic Ru(II)-CNC pincer complexes 1a-6a, new complexes with bulky N-wingtips [Ru(CNCiPr)(CO)(PPh3)Br]PF6 (1b), [Ru(CNCCy)(CO)(PPh3)Cl]PF6 (1c), [Ru(CNCCy)(CO)(PPh3)H]PF6 (2c), [Ru(CNCiPr)(PPh3)2Cl]PF6 (3b), [Ru(CNCCy)(PPh3)2Cl]PF6 (3c), [Ru(CNCiPr)(PPh3)2H]PF6 (4b), [Ru(CNCCy)(PPh3)2H]PF6 (4c), [Ru(CNCiPr)(DMSO)2Cl]PF6 (6b), and [Ru(CNCCy)(DMSO)2Cl]PF6 (6c) [CNCR = 2,6-bis(1-alkylimidazol-2-ylidene)-pyridine] have been synthesized and the catalytic activities of the new complexes have been compared with their N-methyl analogues for transfer hydrogenation of cyclohexanone and acceptorless dehydrogenation of benzyl alcohol. Furthermore, all complexes have been utilized as catalysts in the dehydrogenative coupling reaction of benzyl alcohol with amines. While the catalytic activities of the new complexes for transfer hydrogenation and acceptorless alcohol dehydrogenation were found to be in line with the previously observed trend based on the ancillary ligands (CO > COD > DMSO > PPh3), for the acceptorless dehydrogenative coupling reaction, complexes containing PPh3 and DMSO ligands performed better compared to complexes containing CO and COD ligands. Based on NMR and mass investigation of catalytic reactions, a plausible mechanism has been suggested to explain the difference in catalytic activity and its reversal during the dehydrogenative coupling reaction. Furthermore, the substrate scope for the dehydrogenative coupling reaction of benzyl alcohol with a wide range of amines has been explored, including synthesizing some pharmaceutically important imines. All new complexes have been characterized by various spectroscopic techniques, and the structures of 4b and 6b have been confirmed by the single-crystal X-ray diffraction technique.

A Prospective Evaluation of Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fracture Patients.

Background Osteoporotic vertebral compression fracture (OVCF) is a common problem in old age, which causes incapacitating pain and leads to significant disability, morbidity, and mortality. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, results in immediate pain relief with decreased morbidity. The primary aim of this study was to evaluate the quality of life (QOL), as denoted by the Roland-Morris Disability Questionnaire (RMDQ) score. In contrast, the secondary aims were determining pain relief using the 11-point Numeric Pain Rating Scale (NPRS) and vertebral height restoration and wedge angle measurements after PVP. Methodology This prospective, longitudinal, interventional study on the efficacy of PVP was conducted among patients with low back pain due to osteoporotic vertebral collapse in a tertiary care institute. Patients with OVCF were managed by PVP and followed at one week, one month, three months, and six months for improvement in QOL by the RMDQ score and pain relief using the NPRS. The pre and post-vertebroplasty wedge angle and vertebral height (anterior, middle, and posterior columns) at one week and six months were also compared by pre and post-vertebroplasty lateral view skiagrams. Results A total of 24 patients were included in this study based on the inclusion and exclusion criteria. The demographic data were comparable. The RMDQ score showed a statistically significant difference in post-PVP at one week (p = 0.044), one month (p = 0.031), three months (p = 0.022), and six months (p = 0.018). There was a statistically significant difference in the NPRS at six months compared to the pre-PVP status, showing drastic pain relief in patients after PVP. The mean wedge angle (20.5 ± 2.07) measurement was reduced with a statistically significant increase in anterior body height restoration from pre-PVP to six months. There was no significant change in height at the middle and posterior columns compared to the pre-PVP height. Conclusions PVP is an effective, safe, minimally invasive pain and spine intervention for OVCFs with improved QOL and restoration of vertebral height.

Comparative evaluation of visual analogue scale and pupillary diameter for post-operative pain: An observational study.

Background and Aims: An objective understanding of pain guides the effectiveness of various postoperative pain management strategies. The measurement of pain by the visual analogue scale (VAS) is dependent on the individual's cognitive and emotional ability. Pupillary dilatation has been successfully used to measure pain in quantitative terms. The present study was conducted to study the correlation between VAS and pupillary diameter in the evaluation of postoperative pain. Methods: This observational study was carried out on 85 patients 18-65 years of age, scheduled for lower abdominal surgical procedures under general anaesthesia. Postoperative pain assessment was done using the VAS at 6 h, 12 h, 18 h and 24 h. In addition, the pupillary diameter of both eyes was measured simultaneously. Paired t-test and analysis of variance (ANOVA) were used to compare the data, and Pearson's correlation coefficient was calculated to assess the bivariate correlation between VAS score and pupillary diameter. Results: Mean ± standard deviation (SD) of VAS scores at baseline, 6 h, 12 h, 18 h and 24 h postoperatively were 0, 4.88 ± 0.88, 3.39 ± 0.86, 2.19 ± 0.66 and 1.40 ± 0.49, respectively. Mean change was significant at all time intervals (P < 0.001). The mean ± SD change in average pupillary diameter was 0.59 ± 0.64, 0.44 ± 0.54, 0.22 ± 0.34 and 0.07 ± 0.22 mm, respectively, showing a significant change from baseline (P < 0.05). On overall evaluation, mean pupillary diameter showed a significant incremental trend with an increasing VAS score (P < 0.001). Conclusion: Change in pupillary diameter correlated well with the pain scores (VAS) and thus pupillary diameter can be chosen as an objective measurement of postoperative pain severity.

Occupational exposure to respirable crystalline silica among US metal and nonmetal miners, 2000-2019.

BACKGROUND: In metal and nonmetal (M/NM) mines in the United States, respirable crystalline silica (RCS) exposures are a recognized health hazard and a leading indicator of respiratory disease. This study describes hazardous exposures that exceed occupational exposure limits and examines patterns of hazardous RCS exposure over time among M/NM miners to better inform the need for interventions. METHODS: Data for this study were obtained from the Mine Safety and Health Administration (MSHA) Open Government Initiative Portal for the years 2000-2019, examining respirable dust samples with MSHA-measured quartz concentration >1%. Descriptive statistics for RCS were analyzed for M/NM miners by year, mine type, sector, commodity, occupation, and location in a mine. RESULTS: This study found the overall geometric mean (GM) for personal exposures to RCS was 28.9 µg/m3 (geometric standard deviation: 2.5). Exposures varied significantly by year, mine type, sector, commodity, occupation, and location in a mine. Overall, the percentages of exposures above the MSHA permissible exposure limit (PEL for respirable dust with >1% quartz, approximately 100 µg/m3 RCS) and the National Institute for Occupational Safety and Health RCS recommended exposure limit (REL, 50 µg/m3 ) were 11.8% and 27.3%, respectively. GM exposures to RCS in 2018 (45.9 µg/m3 ) and 2019 (52.9 µg/m3 ) were significantly higher than the GM for all years prior. The overall 95th percentile of RCS exposures from 2000 to 2019 was 148.9 µg/m3 , suggesting a substantial risk of hazardous exposures above the PEL and REL during the entire period analyzed. CONCLUSIONS: The prevalence of high exposures to RCS among M/NM miners continues in the past 20 years and may be increasing in certain settings and occupations. Further research and intervention of the highest exposures are needed to minimize the risks of acquiring silica-induced respiratory diseases.

Correlation of central venous-to-arterial carbon dioxide difference to arterial-central venous oxygen difference ratio to lactate clearance and prognosis in patients with septic shock: A prospective observational cohort study.

Background: To assess the relationship between the ratio of difference of venoarterial CO2 tension (P (v-a) CO2) and difference of arterio-venous oxygen content (C (a-cv) O2), i.e., ΔPCO2/ΔCaO2 with lactate clearance (LC) at 8 and 24 h, to define a cutoff for the ratio to identify LC >10% and >20% at 8 and 24 h, respectively, and its association with prognosis in septic shock. Methods: Adult patients with septic shock were included in this prospective, observational cohort study. Blood samples for arterial lactate, arterial, and central venous oxygen and carbon dioxide were drawn simultaneously at time zero (T0), 8 h (T8), and 24 h (T24). At T8, patients were divided into Group 8A (LC ≥10%) and Group 8B (LC <10%). At T24, patients were divided into Group 24A (LC ≥20%) and Group 24B (LC <20%). Results: Ninty-eight patients were included. The area under the curve of ΔPCO2/ΔCaO2 at T8 (0.596) and T24 (0.823) was the highest when compared to P(v-a) CO2 and C(a-v) O2. The best cutoff of P(v-a) CO2/C (a-v) O2 as predictor of LC >10% was 1.31 (sensitivity 70.6% and specificity 53.3%) and for LC >20% was 1.37 (sensitivity 100% and specificity 50%). At both T8 and T24, P(v-a) CO2/C (a-v) O2 showed a significant negative correlation with LC. Groups 8A and 24A showed lower intensive care unit mortality than 8B and 24B, respectively. Values of P(v-a) CO2/C (a-v) O2 at T8 were comparable, but at T24, there was a significant difference between the survivors and nonsurvivors (P < 0.001). Conclusion: ΔPCO2/ΔCaO2 predicts lactate clearance, and its 24 h value appears superior to the 8-h value in predicting LC and mortality in septic shock patients.

Clinical Relevance of Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter (ONSD) for Estimation of Intracranial Pressure Following Cerebrospinal Fluid Diversion Surgery.

Background and aim Raised intracranial pressure (ICP) can be estimated by various invasive as well as non-invasive techniques. Optic nerve sheath diameter (ONSD ) is a bedside non-invasive technique for assessment of ICP as a regular follow-up tool and has added advantage over CT scan/MRI, which require patient transfer to the suite. Cerebrospinal fluid (CSF) diversion procedures such as a ventriculoperitoneal shunt or external ventricular drainage are commonly done to relieve symptoms of patients with raised ICP. Change in ICP measured through ONSD after CSF diversion procedures may guide the proper functioning of the shunt and immediate post-operative management. The present study was conducted to compare ONSD before and after CSF diversion procedures and correlate the ONSD with ICP. Our secondary objective was to determine the ONSD cutoff for the prediction of ICP >20mm Hg. Setting, design, and methods This prospective, comparative, and observational study was carried out at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. The present study was conducted on 40 adult patients undergoing CSF diversion surgery under general anaesthesia. Ultrasonographic measurement of the ONSD was performed before induction, after induction, after endotracheal intubation, after completion of shunt surgery, and then every two hours for 12 hours. The direct ICP was measured by the neurosurgeon at the time of the initial ventricular puncture. Statistical analysis The Wilcoxon signed-rank test was used to compare pre and post variables. Qualitative variables were compared using the Chi-Square test/Fisher's exact test as appropriate. Spearman's rho statistical measure of linear association was applied to measure the strength of linear association between parameters to show how close the points lie to a straight line. A p-value of <0.05 was considered statistically significant. Results The mean value of ONSD before induction and after induction was 6.36 ± 0.61 mm and 6.29 ±0.64 mm, respectively. After endotracheal intubation, ONSD slightly increased to 6.34 ±0.62mm, followed by a consistent decrease in ONSD values. The mean direct ICP recorded was 30.93±6.22 mmHg. Comparison of mean ONSD before induction, after induction, and after intubation with ONSD after surgery was statistically significant (p <0.001). We found a strong positive correlation between direct ICP and ONSD after intubation with a correlation coefficient of 0.969 (P <0.001). Receiver operating characteristic (ROC) curve analysis showed an ONSD cutoff of >5.85, predicted ICP>20 mmHg with a sensitivity of 92.3%, and specificity of 85.7%. Conclusion Measurement of ONSD by ultrasonography is an important and reliable tool in the assessment of normalization of ICP post CSF diversion procedure.

Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study.

Background: COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and virulent. Sudden surge in cases of mucormycosis after recovery of COVID surprised many clinician. Mucormycosis being a rapidly progressive and fulminant fungal infection required surgical debridement of necrotic tissue on emergency basis. The fatal combination of immunocompromised status, multisystemic involvement, and difficult airway in these patients pose numerous new challenges regarding anesthetic management. The present study was conducted to outline major concerns and the anesthetic management of patients undergoing surgical resection for rhinoorbital mucormycosis (ROM). Materials and Methods: A retrospective observational study was conducted in our institute for a duration of 2 months (June and July 2021). The data of all the cases posted for ROM was collected from the ENT and Anesthesia record register. Total 70 patients presented with mucormycosis, for surgical debridement out of which 25 patients were posted for surgery under general anesthesia or monitored anesthesia care (MAC). Demographic characteristics, comorbidities, duration of COVID illness, treatment taken during COVID (oxygen therapy/steroid intake), hemodynamic parameters, monitoring methods, and surgical procedures were recorded for each patient. Statistical Evaluation: SPSS version 21.0 was used for data analysis. Mean and SD were used to analyze the difference in mean values, and independent Student's t-test were utilized to compare the quantitative variables. Frequency distribution and percentage were used for qualitative parameters. Significant difference was accepted at P ≤ 0.05 with 95% CI (confidence interval) in the study. Results: Demographic data were comparable with respect to age, gender distribution, and ASA status. Mean duration of Covid illness was (12.18 ± 3.68) days. The mean HbA1C measured was (10.8 ± 1.42). Strong correlation was found between steroid intake and raised HbA1c in all patients (r = 0.77). Regarding the comorbidities, 24 (96%) patients had associated type 2 diabetes mellitus, 16 patients (64%) had pneumonitis, and 1 patient had pulmonary TB and hepatitis. Conclusion: Considering the perioperative risk associated with high HbA1C and pneumonitis, MAC was preferred in majority of cases. Strict hemodynamic monitoring, perioperative glucose control, difficult airway cart, metabolic and electrolyte balance and vigilant peri-operative monitoring are cornerstone for better outcome and short length of hospital stay.

Effect of environmental enrichment and group size on the water use and waste in grower-finisher pigs.

The grower-finisher stage accounts for 64% of the total on-farm herd water use. Part of this is consumed by the pigs, but a part is also wasted. Drinking water usage and wastage is affected by different factors. We investigated how different group sizes and different levels of enrichment affect water usage (ingested plus wasted), water wastage, behavior and performance in grower-finisher pigs. Pigs (n = 672), 11 weeks of age (77 ± 2 days) were used for the experiment. The effect of group size: SMALL (12 pigs), MEDIUM (24 pigs), and LARGE (48 pigs) was assessed across two levels of enrichment (LOW-wooden post, hanging rubber toy, HIGH-Same as LOW + fresh grass). There was no effect of group size on water use or wastage. Pigs with HIGH enrichment (10.4 ± 0.4 L/pig/day) used less water than LOW enrichment (11.0 ± 0.4 L/pig/day; p < 0.001). The water wastage/drinker/hour was lower in pens with HIGH enrichment than LOW (p = 0.003). The drinking bout number (p = 0.037) and total occupancy/hour (p = 0.048) was also higher for pens with LOW than HIGH enrichment. Aggressive and harmful behaviour were performed less in LARGE groups and pens with HIGH enrichment. Thus, HIGH enrichment allowance reduced water usage and wastage so may have benefits for the environment, as well as animal welfare.

Effect of different cleaning procedures on water use and bacterial levels in weaner pig pens.

Pork is one of the most globally eaten meats and the pig production chain contributes significantly to the water footprint of livestock production. However, very little knowledge is available about the on-farm factors that influence freshwater use in the pig production chain. An experiment was conducted to quantify the effect of three different washing treatments on freshwater use, bacterial levels [(total bacterial counts; TBC), Enterobacteriaceae and Staphylococcus] and cleaning time in washing of pens for weaning pigs. Three weaner rooms were selected with each room having 10 pens and a capacity to hold up to 14 pigs each. Pigs were weaned and kept in the pens for 7 weeks. Finally, the pens were cleaned before the next batch of pigs moved in. The washing treatments used were power washing and disinfection (WASH); presoaking followed by power washing and disinfection (SOAK), and presoaking followed by detergent, power washing and disinfection (SOAK + DETER). A water meter was used to collect water use data and swab samples were taken to determine the bacterial levels. The results showed that there was no overall effect of washing treatments on water use. However, there was an effect of treatment on the washing time (p<0.01) with SOAK and SOAK+DETER reducing the washing time per pen by 2.3 minutes (14%) and 4.2 minutes (27%) compared to WASH. Nonetheless, there was an effect of sampling time (before or after washing) (p<0.001) on the levels of TBC and Staphylococcus, but no effect was seen on Enterobacteriaceae levels. Thus, the washing treatments used in this study had no effect on the water use of the pork production chain. Although there was no difference in both water use and bacterial load, from a producer perspective, presoaking and detergent use can save time and labour costs, so this would be the preferred option.

To Compare the Changes in Hemodynamic Parameters and Blood Loss during Percutaneous Nephrolithotomy - General Anesthesia versus Subarachnoid Block.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is done under general anesthesia (GA) in most of the centers. However, associated complications and cost are higher for GA than for regional anesthesia. AIM: The aim of the study was to compare the efficacy of GA versus subarachnoid block (SAB) with regard to intraoperative blood loss and postoperative drop in hemoglobin (Hb) in patients undergoing PCNL. SETTING AND DESIGN: This prospective, randomized, comparative clinical trial was carried out at a tertiary care hospital. After obtaining the institute ethical committee clearance (vide no 57/15), patients were randomly allocated into two groups using table of randomization (n = 30 each), Group A - GA, Group B - SAB. MATERIALS AND METHODS: Intraoperative blood loss was assessed by measuring the Hb of irrigated fluid and postoperative drop in Hb concentration. Other parameters such as intraoperative mean arterial pressure and heart rate were also compared in these groups. STATISTICAL ANALYSIS: The results are presented in frequencies, percentages, and mean ± standard deviation. The Chi-square test was used to compare the categorical variables between the groups. Unpaired t-test was used to compare the continuous variables between the groups. RESULTS: Hemodynamic parameters were similar in both the groups preoperatively. The Hb drop was significant in Group A (1.28 ± 0.35 g.dl-1) as compared to Group B (1.10 ± 0.67 g.dl-1). On calculating Hb in irrigated fluid-blood mixture, it was found to be significantly higher in Group A (1.87 ± 0.44 g.L-1) as compared to Group B (1.25 ± 0.25 g.L-1). CONCLUSIONS: Both GA and SAB are effective and safe in PCNL. However, SAB is associated with less blood loss as estimated by intraoperative blood loss and Hb drop.

Bed Tracking Systems: Do They Help Address Challenges in Finding Available Inpatient Beds?

OBJECTIVE: Locating open beds in hospital and residential mental health and substance use disorder treatment settings has been an ongoing challenge in the United States. The inability to find open beds has contributed to long emergency department wait times and missed opportunities to engage patients in treatment. Increasingly, states are creating online bed tracking systems to improve access to timely information about bed availability. This study aimed to document how states are implementing bed tracking systems, their successes and challenges, and lessons learned. METHODS: A review was conducted of the published and gray literature available between 2008 and 2018, and 13 interviews were conducted with 18 stakeholders in five states (Connecticut, Iowa, Kansas, Massachusetts, and Virginia). RESULTS: The authors identified 17 states with bed tracking systems, of which five make information available to consumers. Most interviewees reported that the bed tracking systems were improving the ability of providers and consumers to more readily locate openings. Challenges identified included that some hospitals will not participate in bed registries, data on bed availability is sometimes not timely enough, bed registries do not provide enough detail on whether the facility is capable of meeting a particular patient's needs, providers have not been coached to use the bed registry system and continue existing practices, and states that provide information to the public have not publicized the registry's existence. CONCLUSIONS: Bed tracking systems offer promise, but more needs to be done to understand how to realize their potential and to more widely implement lessons learned.

Towards the development of a biobased economy in Europe and India.

India has emerged as a key player with a high potential to develop a biomass and biobased economy due to its large geographic size and the massive amounts of agricultural and non agricultural biomass produced. India has joined hands with Europe to synchronize its efforts to create and facilitate the development of a biobased economy in this country. This paper aims to examine common research and development actions between the European Union (EU) and India to facilitate the development of these biobased economies. As a base, a thorough study has been performed considering the biomass potential and current status of the bioeconomy in both the EU and India based on the distillation of a series of 80 potential recommendations. The recommendations were grouped into four major categories: (1) biomass production, (2) by-products/waste, (3) biorefineries and (4) policy, market, and value-added products. A questionnaire was designed and distributed to key stakeholders belonging to: academia, industry, and policymakers in both India and the EU. A total of 231 responses were received and analyzed, based on the key recommendations made for the essential research and development topics that are of prime importance to develop biobased economies in both the EU and India. The findings of this study suggest recognizing the value-added contributions made by biobased products such as: food, feed, valuable materials and chemicals in both regions. It is important to reduce the overall process costs and minimize the environmental impacts of such a biobased economy.

Understanding (and Acting On) 20 Years of Research on Violence and LGBTQ + Communities.

Questions related to violence, vulnerability, and sexual and gender minorities continuing to occupy a focal place in U.S. public discourse. We reviewed findings from 20 years of research on that topic to make recommendations for policy, practice, and future research. This article synthesizes findings from 102 peer-reviewed articles as well as a small number of unpublished studies and grey literature. We found no data to support the idea (widespread in popular discourse) that those in the sexual or gender majority require protection from sexual or gender minority individuals. Instead, this wide body of research indicates that sexual and gender minorities are themselves at elevated risk for physical and sexual assault, harassment, bullying, and hate crime victimization throughout childhood, adolescence, and adulthood. Contradicting the image of hate crimes as perpetrated by strangers or acquaintances, we find that bias-related verbal abuse, physical, and sexual assault by close family members contribute heavily to observed victimization rates. Further, despite the perception that society is becoming more welcoming, victimization disparities appear to be stable or widening since the 1990s. More studies with probabilistic sampling approaches, standardized measures, and larger samples of gender minorities are needed. However, widespread victimization of sexual and gender minorities is clearly an urgent issue, demanding attention from clinicians, program developers, and policy makers.

Comparison between Epidural Ropivacaine versus Ropivacaine with Clonidine in Patients Undergoing Abdominal Hysterectomy: A Randomized Study.

CONTEXT: Regional anesthesia has emerged as one of the preferred and convenient modes for intra- and post-operative management owing to its advantage of not interfering with the metabolic functions, better tolerability, and decrease in reflex activity. In recent years, ropivacaine has increasingly replaced bupivacaine as a preferred local anesthetic because of its similar analgesic properties, lesser motor blockade, and decreased propensity of cardiotoxicity. Neuraxial adjuvant such as clonidine used in epidural anesthesia offers advantage by augmenting the local anesthetic effect and reducing the anesthetic and analgesic requirement. AIMS AND OBJECTIVES: Comparison of onset, duration of sensory and motor block, and any adverse effects between 0.5% ropivacaine with normal saline versus 0.5% ropivacaine with clonidine (75 µg/kg). MATERIALS AND METHODS: This prospective randomized study was carried out in 50 patients (25 in each group) of American Society of Anesthesiologist Grade 1 and 2 scheduled for abdominal hysterectomy under epidural block. Group-1 (ropivacaine-clonidine [RC]): Epidural ropivacaine 20 ml (0.5%) with 0.75 µg/kg clonidine. Group-2 (ropivacaine [R]): Epidural ropivacaine 20 ml (0.5%) with normal saline. Onset, duration of sensory-motor block, heart rate, blood pressure, oxygen saturation, and respiratory rate were recorded. STATISTICAL ANALYSIS: The statistical analysis was done using Statistical Package for Social Sciences version 15.0. Chi-square test, ANOVA, Student's t-test, and paired t-test were used. RESULTS: Groups were comparable with regard to demographic data and hemodynamic stability. Onset of sensory and motor blockade was faster in RC group as compared to R group. Duration of postoperative analgesia was significantly prolonged in RC group. No potential side effect was seen in either group. CONCLUSION: On account of faster onset, hemodynamic stability, and prolonged postoperative analgesia, ropivacaine with clonidine is a better option than ropivacaine alone.

Postoperative Analgesia After Panhysterectomy, Addition of Clonidine to Bupivacaine: Boon for the Patients.

INTRODUCTION: Postoperative period after panhysterectomy is very painful as there is too much tissue handling. In the practice of regional anesthesia neuraxial, opioids have been used extensively as an adjuvant to bupivacaine to enhance the potency and duration of sensory and motor block produced by bupivacaine with satisfactory results. However, delayed respiratory depression by opioids has prompted further research to develop nonopioid analgesics. This study was undertaken to assess the degree of sensory and motor block and postoperative analgesia provided by low dose 50 µg intrathecal clonidine admixed with 0.5% hyperbaric bupivacaine as compared to bupivacaine alone in patients undergoing a total abdominal hysterectomy. MATERIALS AND METHODS: Hundred adult patients of American Society of Anesthesiologist Class 1 and 2 were randomly allocated to Group A and Group B. Group A patients received 15 mg 0.5% hyperbaric bupivacaine with 50 µg clonidine intrathecally. Group B patients received 15 mg 0.5% hyperbaric bupivacaine with normal saline. OBSERVATION AND RESULTS: The mean duration of motor block was significantly higher in Group A (270.80± 66.0 min) as compared to Group B (184.60 ± 72.03 min), with statistically significant difference. There was also statistically significant difference in the duration of sensory block between Group A (290.20 ± 80.27 min) and Group B (190.83 ± 86.90 min). The duration of postoperative analgesia was significantly higher in Group A as compared to Group B (541.06 ± 130.64 min and 252.80 ± 84.10 min respectively). CONCLUSION: Addition of intrathecal clonidine 50 µg to bupivacaine (15 mg, 0.5%) prolongs the duration of sensory and motor block and duration of analgesia, thus produces an effective spinal anesthesia and good postoperative analgesia for longer duration and reduced postoperative analgesic requirement.

Ease of intubation: A randomized, double-blind study to compare two doses of rocuronium bromide for endotracheal intubation.

CONTEXT: Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. AIMS: The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. SETTINGS AND DESIGN: A prospective, randomized, double-blind study. MATERIALS AND METHODS: All the patients were divided in a randomized, double-blind fashion into two groups of twenty patients each. Group I patients received rocuronium bromide 0.6 mg/kg intravenously and intubated at 60 s, Group II patients received rocuronium bromide 0.9 mg/kg and intubated at 60 s. The neuromuscular block was assessed using single twitch stimulation of 0.1 Hz at adductor pollicis muscle of hand at every 10 s. STATISTICAL ANALYSIS USED: The results were compiled and analyzed statistically using Chi-square test for qualitative data and Student's t-test for quantitative data. RESULTS: Time of onset was significantly shorter (P < 0.01) and duration of action was prolonged (P < 0.001) for Group II as compared to Group I. The intubating conditions were (excellent + good) in 100% patients of Group II and (excellent + good) in 80% of Group I. There was no significant change in pulse rate and mean arterial pressure from the baseline value after the administration of muscle relaxants in either of the two groups. CONCLUSIONS: Rocuronium bromide 0.9 mg/kg is a safer alternative to rocuronium bromide 0.6 mg/kg for endotracheal intubation with shorter time of onset and better intubating conditions.

Postoperative pulmonary complication after neurosurgery: A case of unilateral lung collapse.

Pulmonary complications, especially postoperative pulmonary complications, are an important cause of morbidity and mortality in neurosurgical patients. Hypoxemia due to mucus plug causing lung collapse is a rare event. We report a case of a 40-year-old female with right cerebellopontine angle space occupying lesion, scheduled for elective craniotomy and tumor excision. The patient underwent surgery uneventfully and was shifted to Intensive Care Unit (ICU) for monitoring. Eight hours after extubation, she developed hypoxemia due to mucus plug resulting in left lung collapse. She was intubated, and mucus plug was aspirated through sterile endobronchial tube suction which resulted in reexpansion of the collapsed lung. The patient was managed with postural drainage, chest physiotherapy, and antibiotics and extubated after 24 h. This type of pulmonary complication may have a catastrophic course, especially in neurosurgical patients, if not diagnosed and managed in time.

Formal Total Synthesis of Echinopines A and B via Cr(0)-Promoted [6π + 2π] Cycloaddition.

A concise formal synthesis of echinopines A and B is reported. The key [5.5.7] tricyclic intermediate, which has been previously used for the synthesis of echinopine A and B, was assembled using Cr(0)-promoted photochemical [6π + 2π] cycloaddition followed by a radical cyclization step.

A synergistic approach to polycyclics via a strategic utilization of Claisen rearrangement and olefin metathesis.

Olefin metathesis promoted by a well-defined metal carbene complex has evolved into an efficient method for the construction of a broad range of carbocyclic and heterocyclic rings of varying size. The synthetic potential of the olefin metathesis has been further increased by combining various other C-C bond forming processes either in tandem or in sequence. Herein, application of Claisen rearrangement and olefin metathesis to prepare various intricate and/or biologically important targets has been described.

A new approach to 3-substituted tetrahydro-ß-carboline derivative via diethyl acetamidomalonate.

Strategically a new approach for the synthesis tetrahydro-ß-carboline unit with the aid of diethyl acetamidomalonate as a glycine equivalent has been described.