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Provide a safety anesthesia to patient is only possible with the knowledge of material surrounding the operation room. Benzine is highly flammable substance and can produce several injures without the necessary care. This case describes a small fire caused by the presence of benzine in the surgical field concomitant with the use of electrocautery, which caused slight burns to the patient, but which could have been catastrophic, and proposes the use of protocols to prevent such accidents.

Aerobic capacity of young men (19 years - 24 years) is high, but can be influenced by many factors like physical activity, smoking, and air pollution with environmental PM 2.5. Objectives: (a) - to estimate the aerobic capacity in young men (smokers and non-smokers) living in areas with higher PM 2.5 using Queen’s College Step Test (QCT). (b) - to find whether aerobic capacity is associated with the International Physical Activity Questionnaire (IPAQ)’ three classes, for smokers and non-smokers. Methods: In a cross-sectional study using criteria-based sampling a total of N = 60 smokers & non-smokers were included from the Delhi NCR region. IPAQ, Peak Expiratory Flow Rate (PEFR), Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure, and PM 2.5 and PM 10 levels were recorded. A comparison of smokers and non-smokers was performed using z test. Smokers and non-smokers were divided into three classes using physical activity levels and compared for aerobic capacity. The correlation of aerobic capacity with variables was seen using Pearson’s correlation coefficient. Multiple R was checked to study the model of cause and effect for aerobic capacity. Results: Significant difference is seen between smokers and non-smokers in the aerobic capacity (Mean ± SD smokers - 65.22 ± 8.73 ml/kg/min; Mean ± SD non-smokers 60.04 ± 7.7 ml/kg/min p value = 0.00). For non-smokers, a low level of physical activity shows a strong correlation with aerobic capacity (r = 0.78; p = < 0.05). No correlation of aerobic capacity is seen with physical activity levels among smokers. Aerobic capacity shows a significant negative and moderate correlation with PM 2.5 (r = -3.1; p = 0.016). The multiple R coefficient value for the model of cause and effect is 6.99 with a p - value of 0.0449 for this. Conclusion: Smoking affects aerobic capacity significantly for young men. High and moderate levels of outdoor physical activity do not increase aerobic capacity in areas with high PM 2.5, whereas low levels show a positive correlation among non-smokers only. 

Atheroembolic disease (AED), or Cholesterol Crystals Embolism, is a systemic disease presented as a complication of severe atherosclerosis [1], where older age, male sex, diabetes hypercholesterolemia, smoking and hypertension [2], are the main risk factors for the development of Atherosclerosis, it is known that spontaneous atherosclerotic renal disease is rare in the absence of any vascular intervention [3], and in the absence of anticoagulant [4], or the absence of calcified aorta, with the most common presentation of the disease is subacute kidney injury progress into renal dysfunction occurs in like a staircase pattern and the renal dysfunction is usually observed several weeks after a possible intervention, caused by dislodging the micro cholesterol plaques from a major artery, and start showering multiple organs causing micro and macro embolic phenomena. In our case, we report acute kidney injury on a previously stable kidney disease in a female with diabetes mellitus type 2 presented with severe anemia, dyspnea, massive fluid overload with bilateral pleural effusion, patient had a history of multiple IV contrast exposures, with peripheral vascular occlusive disease (PVOD), required amputation of right below the knee amputation, presented during the COVID-19 pandemic, found with nephrotic syndrome, a kidney biopsy has shown cholesterol crystal embolization compatible with Athero-embolic Disease with severe Diabetic Nephropathy.

Objective: Cardiac implantable electronic device (CIED) infections now constitute ∼ 10% of all endocarditis cases. The incidence of CIED infection is usually < 2%. Our objective was to study pacemaker pocket infection rate and different risk factors in our institution. Methods: This observational study was conducted over a period of five years from January 2011 to December 2016 and it included 1096 patients. Common risk factors like patients with diabetes, repeat procedure, chronic renal failure, chronic obstructive airway disease, immunosuppressive agents were studied in our patients. Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%). Results: Our study consisted of 1096 patients. Pacemaker pocket infection occurred in sixteen patients (1.5%). Chronic renal failure patients were one hundred thirty in our study (11.86%). There were three hundred fifty six diabetic patients (32.48%). Repeat procedure was done in ninety five patients (8.6%) Eighty six patients were suffering from chronic obstructive airway (7.8%). Patients on immunosuppressive therapy were fourteen in our study (1.2%). Conclusion: Pacemaker pocket infections is a dreaded complication after pacemaker implantation. During implantation, there is a risk of device contamination with the patient’s own skin flora and it can be prevented by ideal surgical asepsis technique, pre and perioperative use of antibiotics.

Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L.Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.

Biventricular (BiV) pacing revolutionized the heart failure management in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Also, BiV pacing does not fully normalize ventricular activation and, therefore, the ventricular resynchronization is imperfect. On the other hand, right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing comes as an alternative to current approaches as it activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it has the potential to open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the history, clinical evidence, proposed mechanisms, procedural characteristics, and the role in current therapy of His bundle pacing in the prevention and treatment of heart failure.

Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.

Eucalyptus camaldulensis (Ec) is considered as a traditional medicinal plant with valuable therapeutic effects. Here we evaluated the antiviral activity of its ethanolic leave extract on different herpes viruses. Vero cells were infected with either of the tested viruses [herpes simplex virus -1 and 2 (HSV-1, HSV-2) and Varicella-Zoster Virus (VZV)] with or without treatment with Ec extract and viral infection development was evaluated by plaque assay. Our results showed significant antiviral activity of the examined extract against all tested viruses. The 80%-MeOH fraction of this extract offered the highest activity against these viruses with 50% inhibitory concentration (IC50) of 0.1±0.08, 0.3±0.02 and 1±0.03 μg/ml against HSV-1, HSV-2 and VZV respectively and 50% cytotoxicity (CC50) at 700 μg/ml. The highest antiviral effect of this fraction was obtained mainly when it was added during and post infection (p.i.) or when it was added only p.i. Also, this fraction significantly reduced the amount of infective endogenous viral particles in cells that were treated with the 80%-MeOH fraction only post viral entry into the host cells. A synergistic antiviral effect against all tested viruses was also observed when cells were treated with a combination of acyclovir (ACV) and 80%-MeOH fraction of Ec. Further study is required for the isolation and identification of the anti-virally active component/s of this fraction.

Background: Various surgical methods have been utilized in the management of complete atrioventricular septal defects (CAVSD). Early intervention and achievement of a competent left atrioventricular valve are the key factors for successful treatment. Methods: A total of 66 patients with complete atrioventricular septal defect have been operated in a tertiary care center. Patient group consisted of 28 males and 38 females with an average age of 6.2 ± 3.3 months. Ventricular and atrial defects were repaired generally with single-patch technique using autogenous pericardium. Results: Preoperative catheterization and angiography was performed in 41 patients. Single patch and modified single patch techniques were preferred in 57 and 9 patients respectively. The average duration for respiratory support, intensive care unit stay and discharge from hospital were 36 ± 49.3 hours, 4.1 ± 1.9 days, and 10.1 ± 3.3 days respectively. In the left atrioventricular valve mild, moderate and severe regurgitation were detected in 44 (66.6%), 17 (25.7%) and 2 (3%) patients postoperatively. No regurgitation was determined in 3 patients (4.5%). Two cases ended up with mortality (3%). Conclusion: Single patch repair technique can provide satisfactory surgical outcomes in patients with complete atrioventricular septal defect.

This opinion essay is about how singularities may exist in a different dimension than we are, and on black holes and their time correlations. It also briefly mentions another way the universe may have been created.