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PurposeThis study aims to analyse the factors that caused Indian tourists to avoid travelling abroad because of the recent outbreak of COVID-19 in 2020. It will also identify the relationship between the perceived risk of travelling and the probability of travel evading in India owing to COVID-19.Design/methodology/approachThis study used an online structured questionnaire to collect data from Indian tourists to study six independent variables linked with their behavioural intentions (travel evading). The health belief model was used to examine tourist behaviour.FindingsThe results revealed a positive correlation between the perceived risk associated with COVID-19 and travel avoidance. Familiarity with COVID-19 was positively correlated with travel evading behaviours.Practical implicationsThis study will assist stakeholders from around the world to adequately identify and thoroughly plan for logistical problems associated with travel such as travel insurance and pre-travel booking expenses to reduce travel evading behaviour and promote travel.Originality/valueWhile a few studies have been conducted related to pandemics (Ebola, MERS-CoV, SARS), there is a paucity of literature that examines the factors which influence tourists’ travel evading behaviour owing to COVID-19. Moreover, most of the previous literature on pandemics is concentrated on American and European countries, whereas studies on the Indian sub-continent are very scarce. This study will fill this gap and will identify the factors which influence tourists in India to evade travel in response to COVID-19.

Background Clear evidence of overprescribing of psychotropic medicines to manage behaviours that challenges in people with intellectual disabilities has led to national programmes within the U.K. such as NHS England’s STOMP to address this. The focus of the intervention in our review was deprescribing of psychotropic medicines in children and adults with intellectual disabilities. Mental health symptomatology and quality of life were main outcomes. Methods We reviewed the evidence using databases Medline, Embase, PsycINFO, Web of Science, CINAHL and Open Grey with an initial cut-off date of 22nd August 2020 and an update on 14th March 2022. The first reviewer (DA) extracted data using a bespoke form and appraised study quality using CASP and Murad tools. The second reviewer (CS) independently assessed a random 20% of papers. Results Database searching identified 8675 records with 54 studies included in the final analysis. The narrative synthesis suggests that psychotropic medicines can sometimes be deprescribed. Positive and negative consequences were reported. Positive effects on behaviour, mental and physical health were associated with an interdisciplinary model. Conclusions This is the first systematic review of the effects of deprescribing psychotropic medicines in people with intellectual disabilities which is not limited to antipsychotics. Main risks of bias were underpowered studies, poor recruitment processes, not accounting for other concurrent interventions and short follow up periods. Further research is needed to understand how to address the negative effects of deprescribing interventions. Trial registration The protocol was registered with PROSPERO (registration number CRD42019158079)

This case series explores the various manifestations of central nervous system (CNS) involvement in neonatal herpes simplex virus (HSV) infection and highlights the challenges involved in their diagnosis and treatment. Neonatal HSV infection is a rare but serious condition that can have significant neurological consequences. The article presents three cases of neonatal HSV infection, all involving the CNS, each characterized by distinct clinical features and outcomes. Case 1 describes a three-week-old male with severe HSV meningoencephalitis resulting in poor response to treatment and death. Cases 2 and 3 describe younger neonates who presented early in the disease course with disseminated infection and skin, eye, and mouth (SEM) lesions. Although both patients had CNS involvement, their outcomes were remarkably favorable. The wide range of clinical presentations of CNS manifestations in neonatal HSV infection, ranging from nonspecific to evident neurological symptoms, underscores the need for a high index of suspicion and comprehensive evaluation to ensure early diagnosis and appropriate treatment. However, it also notes that even with timely treatment, some cases may still have a poor prognosis.

Landslide catastrophe happen on 30 July 2014 has buried almost 140 peoples under a loose soil mass in Malingaon village of Pune district, Maharashtra, India. Soil samples from a hill slope sections were collected (viz. bottom, middle, and top) for determination of the soil properties and slope stability. Mainly excess rainfall triggered the land slide, which directly affected on geotechnical properties of soil. The results showed that the hill slope was unstable with factor of safety less than one and which is prone to failure. The land use and land cover map (viz. before and after of land slide) analysis have inferred that the hill slope was unstable. The unscientific way of agriculture practices method and conversion of nonagricultural land into agricultural usage was the major cause for land slide in the study area. This study provides a technically viable solution method to avoid such disaster in same topographical features.

Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serious concern for anesthesiologists, making this routine procedure a high-risk one. The utmost vigilance of the anesthesiologist is demanded by the surgery to prevent morbidities such as hemiplegia, hemiparesis, or speech abnormalities that may occur due to perfusion insufficiency secondary to the mechanical blockage of the carotid arteries. Hence, an undiagnosed case of carotid artery block may result in disastrous consequences for the patient, surgeon, and anesthesiologist. Hence, it is imperative to perform all the pre-operative investigations with due diligence. We present the case of a 74-year-old male who was admitted to our set-up for laryngeal carcinoma surgery. The patient had received chemoradiotherapy (CRT) six months earlier. He complained of hoarseness in his voice and a painless neck mass. He was a known case of hypertension for 14 years, controlled by oral medication, and had a history of stroke five years ago, when he was also diagnosed with a completely blocked right common carotid artery (CCA) and a partially blocked left common carotid artery.

BackgroundNeonates and young children require efficacious magnetic resonance imaging (MRI) examinations but are potentially more susceptible to the short- and long-term adverse effects of gadolinium-based contrast agents due to the immaturity of their body functions.ObjectiveTo evaluate the acute safety and diagnostic efficacy of gadoteridol (ProHance) for contrast-enhanced MRI of the central nervous system (CNS) in children ≤2 years of age.Materials and methodsOne hundred twenty-five children ≤2 years old (including 57 children <6 months old) who underwent contrast-enhanced MRI of the CNS with gadoteridol at 0.1 mmol/kg body weight were retrospectively enrolled at five imaging centers. Safety data were assessed for acute/subacute adverse events in the 48 h following gadoteridol administration and, when available, vital signs, electrocardiogram (ECG) and clinical laboratory values obtained from blood samples taken from 48 h before until 48 h following the MRI exam. The efficacy of gadoteridol-enhanced MRI compared to unenhanced MRI for disease diagnosis was evaluated prospectively by three blinded, unaffiliated readers.ResultsThirteen changes of laboratory values (11 mild, 1 moderate, 1 unspecified) were reported as adverse events in 7 (5.6%) patients. A relationship to gadoteridol was deemed possible though doubtful for two of these adverse events in two patients (1.6%). There were no clinical adverse events, no serious adverse events and no clinically meaningful changes in vital signs or ECG recordings. Accurate differentiation of tumor from non-neoplastic disease, and exact matching of specific MRI-determined diagnoses with on-site final diagnoses, was achieved in significantly more patients by each reader following the evaluation of combined pre- and post-contrast images compared to pre-contrast images alone (84.6–88.0% vs. 70.9–76.9%; P≤0.006 and 67.5–79.5% vs. 47.0–66.7%; P≤0.011, respectively).ConclusionGadoteridol at 0.1 mmol/kg body weight is safe, well tolerated and effective for contrast-enhanced MRI of the CNS in children ≤2 years of age.

Tick paralysis is a rare but potentially deadly form of muscle paralysis caused by a neurotoxin transmitted through the saliva of gravid, engorged female ticks of various species. Often, there is an initial misdiagnosis or delay in diagnosis due to the rarity of the diagnosis, the obscure location of the tick, and the disease’s clinical similarity to Guillain–Barre syndrome. We report the case of a 4-year-old girl with tick paralysis in whom the tick was not found until 2 days after hospital admission. Upon the review of the imaging, it was discovered that the tick was visible on the MRI of the brain that had been reported as normal.

Background/Objectives: Antipsychotic treatment response varies considerably between individuals, with one potential reason being genetic variation affecting the cytochrome P450 enzymes that metabolise them. Methods: With a diverse sample of 453 participants, we studied the influence of CYP1A2, CYP2D6, and CYP3A4 variation on three antipsychotic treatment outcomes: participant-reported adverse antipsychotic drug reactions, health-related quality of life, and the dose of antipsychotic medication prescribed. These measures were taken from the baseline assessment, before a pharmacogenetic intervention was delivered. Results: Over half of our sample (62.9%) were carriers of an allele associated with altered metabolism of antipsychotic medications on CYP2D6 or CYP3A4, the two genes with pharmacogenetic guidelines for antipsychotic medications. Ultrarapid CYP2D6 metabolisers reported significantly lower levels of adverse antipsychotic drug reactions than normal CYP2D6 metabolisers (mean difference: −11.1; 95% confidence interval [CI]: −18.9, −3.3; p = 0.00575). There was also suggestive evidence of lower quality of life scores in those carrying one (mean difference: −0.0863; 95% CI: −0.1806, 0.0081; p = 0.0731) or two copies (mean difference: −0.0803; 95% CI: −0.1734, 0.0129; p = 0.0914) of the CYP1A2*30-inducible allele. Conclusions: Our findings suggest that even when looking at a small number of cytochrome P450 genes, carrying an allele associated with altered antipsychotic medication metabolism is relatively common. We also found evidence that the CYP genotype can influence antipsychotic treatment outcomes, specifically adverse drug reactions and quality of life scores.

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.

Purpose of Review The purpose of this review is to introduce the non-pediatric radiologist to the many common conditions that can be diagnosed via pediatric magnetic resonance imaging (MRI), particularly in the emergency setting. Recent Findings The vast majority of radiologic examinations in children occurs in non-pediatric facilities, and is interpreted by non-pediatric radiologists. Therefore, it is essential that the non-pediatric radiologist is aware of the current and potential imaging trends occurring in the pediatric setting, largely focused on increased MRI utilization. With advances in MR technology, many MRIs can be performed relatively quickly, eliminating the need for sedation. Because of this, and its lack of ionizing radiation, pediatric MRI has been increasingly relied upon in the emergency setting over the past decade. It is ever more prudent that every radiologist familiarize him or herself with the varying MR studies that can be performed after hours, and the MR appearance of common diagnoses. Our review focuses on the more common conditions diagnosed via MR imaging including appendicitis, other causes of right lower quadrant pain, shunted hydrocephalus, limited sequence brain MR in the acute setting, musculoskeletal infections and spine emergencies. Summary With the continued advent of faster MRI scanners and avoidance of ionizing radiation, the usage of MRI in the pediatric setting will only increase in the future. We believe that it is important that every radiologist become familiar and comfortable in interpreting the common conditions that can be diagnosed via MRI.