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Dengue infection is endemic in more than 100 countries, mostly in the developing world. Recent observations indicate that the clinical profile of dengue is changing, and that neurological manifestations are being reported more frequently. The exact incidence of various neurological complications is uncertain. The pathogenesis of neurological manifestations is multiple and includes: neurotrophic effect of the dengue virus, related to the systemic effects of dengue infection, and immune mediated. In countries endemic to dengue, it will be prudent to investigate for dengue infection in patients with fever and acute neurological manifestations. There is need for understanding of the pathogenesis of various neurological manifestations.

A 31-year-old postpartum woman presented with a generalised tonic–clonic seizure on the seventh day of delivery. The antepartum period was uneventful, and there was no significant medical history. Examination showed elevated blood pressure (160/100) and a disoriented patient. MRI of the brain showed hyperintensities in bilateral parieto-occipital areas (figure 1A–E) suggestive of posterior reversible encephalopathy syndrome (PRES). Pulsed arterial spin labelling (ASL) showed hyperperfusion in corresponding areas (figure 1F,G). Electroencephalography showed delta range slowing in the left parieto-occipital leads. She was treated with intravenous magnesium sulfate, oral levetiracetam, lacosamide and nifedipine. She recovered in 2 days, and all drugs were withdrawn 6 weeks later.

In the present work, tribological mechanisms under different sliding wear parameters, viz. applied load, sliding speed, and sliding distance, have been investigated in an Fe-based amorphous/ nanocrystalline coating synthesized by atmospheric plasma spraying. To understand the role of different wear parameters, Taguchi method was employed to design the experiments, and the results were analyzed using analysis of variance. The results revealed that sliding speed is the most significant contributing factor for wear rate of Fe-based amorphous/ nanocrystalline coating deposited by atmospheric plasma spraying process. A comprehensive understanding of influence of the sliding parameters on the wear process was understood based on different wear mechanisms. It was found that low sliding speeds resulted in predominantly abrasive wear, while high sliding speed led to mainly fatigue wear with a minor amount of abrasive wear. Interestingly, alterations in applied load and sliding distance did not induce a transformation in the wear mechanism itself; rather, they manifested in variations in the severity or extent of the wear mechanism. Increase in sliding speed and applied load led to an increase in the extent of wear loss, which was correlated with flash temperature on the coating surface and kinetic energy of the countermaterial during the wear process. On the contrary, increase in sliding distance caused a decrease in wear rate of the coating.

[2] The role of cytokines especially tumor necrosis factor, vascular endothelial growth factor, and matrix metalloproteinases in the blood–brain barrier (BBB) damage, attracting leucocytes, and release of vasoactive autocoids have been suggested. The addition of aspirin to antituberculosis drug regimen did not significantly reduce mortality [Relative risk (RR) = 0.66 (0.42–1.02); low-quality evidence] but significantly reduced the risk of new infarcts [RR = 0.52 (0.29–0.92); moderate-quality evidence]. [...]there are no high-quality data for the beneficial effects of this combination as adjunctive therapy in TBM. [...]time, all the HIV-negative patients with TBM should receive the benefit of adjunctive corticosteroid therapy.

The present article discusses the solute transport process in steady laminar blood flow through a non-Darcy porous medium, as a model for drug movement in blood vessels containing deposits. The Darcy–Brinkman–Forchheimer drag force formulation is adopted to mimic a sparsely packed porous domain, and the vessel is approximated as an impermeable cylindrical conduit. The conservation equations are implemented in an axisymmetric system ( R ,  Z ) with suitable boundary conditions, assuming constant tortuosity and porosity of the medium. Newtonian flow is assumed, which is physically realistic for large vessels at high shear rates. The velocity field is expanded asymptotically, and the concentration field decomposed. Advection and dispersion coefficient expressions are rigorously derived. Extensive visualization of the influence of effective Péclet number, Forchheimer number, reaction parameter on velocity, asymptotic dispersion coefficient, mean concentration, and transverse concentration at different axial locations and times is provided. Increasing reaction parameter and Forchheimer number both decrease the dispersion coefficient, although the latter exhibits a linear decay. The maximum mean concentration is enhanced with greater Forchheimer numbers, although the centre of the solute cloud is displaced in the backward direction. Peak mean concentration is suppressed with the reaction parameter, although the centroid of the solute cloud remains unchanged. Peak mean concentration deteriorates over time since the dispersion process is largely controlled by diffusion at the large time, and therefore the breakthrough curve is more dispersed. A similar trend is computed with increasing Péclet number (large Péclet numbers imply diffusion-controlled transport). The computations provide some insight into a drug (pharmacological agents) reacting linearly with blood.

Purpose: Phacoemulsification is the surgical procedure of choice for cataract, providing excellent visual and safety outcomes. Femtosecond laser-assisted cataract surgery (FLACS) is an addition to the surgical armamentarium. The study aims to compare the outcomes of FLACS using LenSx™ (Alcon Inc., USA) to standard 2.2 mm clear corneal phacoemulsification. Prospective case-control, comparative, interventional study was conducted in a tertiary care center. Methods: In each group, 55 eyes of 55 patients underwent cataract surgery using either FLACS or conventional phacoemulsification (control group). The primary outcome variables, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), specular microscopy, pachymetry, mean absolute error (MAE), and anterior chamber depth (ACD) were compared between two groups at 4 weeks postoperatively. Intraoperative effective phaco time (EPT), postoperative circularity of the rhexis, capsular overlap over the edge of the intraocular lens (IOL), and decentration of the IOL were the secondary variables which were compared. Results: No significant difference was found between the groups for UCVA, pachymetry, MAE, and ACD at 4 weeks postoperatively. The FLACS group had better BCVA (P = 0.0294). Circularity of capsulorrhexis (P = 0), circular overlap over the edge of IOL (P = 0), and centration of IOL (P = 0.002) at 4 weeks postoperatively were better in the FLACS group. EPT was lower in FLACS for similar grade of cataract (P = 0). Endothelial cell loss in FLACS group was 4.2% more (P = 0.032). Conclusions: FLACS is superior to conventional phaco in the circularity of rhexis, capsular overlap, and centration of the IOL and uses less EPT. However, conventional phacoemulsification is equivalent to FLACS in most other parameters.

Background: Cataract and corneal blindness continue to be leading causes of reversible blindness in India. These can co-exist in a multitude of pathologies such as trauma, healed keratitis (old herpetic scar), chronic degenerative changes such as labrador keratopathy, bullous keratopathy, corneal dystrophies etc. Phacoemulsification in such eyes is rewarding to the patient in terms of minimal intervention, less risk of complications owing to reduced open sky time (as in case of combined keratoplasty), and better predictable visual outcomes. Approach to such eyes with poor visualisation is highly challenging. Purpose: We illustrate a modified surgical technique of chandelier illumination through pars plana for cataract surgery in eyes with corneal opacity of varying grades. Synopsis: Five patients with dense cataract and small pupils, associated with corneal opacity (leucomatous and macular grade) are described. Closed chamber phacoemulsification with intraocular lens with or without pupil expanders was performed assisted by 23 or 25 gauge pars plana chandelier illumination introduced in the vitreous cavity through a sclerotomy wound made prior to phacoemulsification in the inferotemporal quadrant. Highlights: Chandelier illumination aids in reducing the light scatter that occurs due to corneal opacity. Ease of visualisation of lens structures and of performing cataract surgery was noticed. One case was combined with penetrating keratoplasty with reduced open sky time. This assisted technique has advantages such as enhancing visualisation intraoperatively and allowing working in closed chamber. Its self-retaining nature aids bimanual manipulation. No complications were encountered. The video highlights the utility, advantages and practicality of chandelier retroillumination in patients with corneal opacities of varying degree undergoing phacoemulsification. Video Link: https://youtu.be/I3z6QG-_wD8

Background and Objectives: Transient thyroid hormone alterations are common during critical illness and are termed non-thyroidal illness syndrome (NTIS). We studied the prevalence of NTIS in the ICU setting and its impact on predicting mortality and other outcomes and compared it to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Materials and Methods: The study included 119 consecutive patients admitted with a critical illness. APACHE II score was calculated. Total T3, total T4, TSH, free T3, and free T4 were measured at admission and after six weeks of discharge. NTIS and euthyroid groups were studied for ICU, hospital stays, mortality, readmission, and recovery. Predictors of mortality were compared between survivors and non-survivors. Results: The mean age was 60.15 ± 14.50 years with M:F = 84 (71%):35 (29%). NTIS was observed in 84 (71%), low T3 being the most common abnormality in 53 (63%). The occurrence of NTIS was significantly higher among non-survivors (28/30, 93%) versus survivors (56/89, 63%) (P = 0.002). Non-survivors showed significantly lower T3, TSH, and FT3/FT4 ratios and higher readmissions. NTIS group showed significantly greater ICU stay (P = 0.02) and had higher readmission rates (P = 0.032). Baseline T3 had the greatest power to predict mortality. APACHE II score also correlated significantly with mortality (19.60 ± 10.58 vs 11.99 ± 6.80, P < 0.001). The area under the curve (0.677) for the T3 level was lower than the APACHE II score (0.760). After six weeks, 61% had recovered from NTIS. Conclusions: NTIS was common amongst critically ill patients (71.5%), which reversed in 61% at six weeks. Low T3 was the most common abnormality and independently predicted mortality. Free T3/free T4 also significantly predicted mortality. The correlation between thyroid dysfunction and the severity of primary illness makes it an additional attractive low-cost marker of mortality.