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The Buchwald–Hartwig cross‐coupling reaction of 3‐bromo‐4‐indolylmaleimide with various anilines, aminopyridines and amides is described. A wide variety of 3‐amino‐4‐indolylmaleimides and 3‐amido‐4‐indolylmaleimides was prepared in good to excellent yields. We envisage that our protocol to access 3‐(amino/amido)‐4‐indolylmaleimides will find use towards constituting new potentially biologically active compounds. [ABSTRACT FROM AUTHOR]

Context: An objective conformal radiotherapy treatment planning criteria that can predict severity of early effects of radiotherapy would be quite useful in reducing the side effects of radiotherapy thereby improving quality of life for head and neck cancer patients.Aim Of Study: Retrospective study aimed at correlating the maximum dose in planning target volume (PTV) with early effects of radiation.Materials and Methods: Patients with squamous cell carcinoma of H and N region who received radical radiotherapy and concomitant chemotherapy were retrospectively analyzed for maximum dose in PTV and the requirement of gap during radiotherapy or else hospitalization for supportive care during or up to 1 month after completion of radical radiotherapy.Results: Of a total of 23 patients, 8 patients (34.7%) required a gap of 2-14 days during their treatment. Twelve patients (52.1%) required hospitalization for 1-4 days and 4 patients (17.3%) required hospitalization for supportive care after completion of radiotherapy. The maximum dose in PTV ranged from 105.1% to 132.8% with an average of 112.68%. Subgroup analysis revealed a nonsignificant highest maximum dose of 114.72% in subset of patients requiring gap during radiotherapy (n= 8).Conclusion: It was concluded that maximum dose in PTV is a useful predictor of need for inhospital supportive care. [ABSTRACT FROM AUTHOR]

Abstract: An unexpected MgI2‐promoted [2+4] cycloaddition reaction of in‐situ generated 2‐styrylmalonate from donor‐acceptor cyclopropanes with chalconimines to synthesize highly substituted indenopyridine derivatives under the mild reaction conditions have been developed. Additionally, these derivatives were utilized for the synthesis of highly substituted 9‐membered lactam by oxidative C=C bond cleavage and spiro[oxoindane‐pyrrolidine] derivative via Meinwald type rearrangement. [ABSTRACT FROM AUTHOR]

Lewis acid catalyzed formal [3+2] cycloadditions of 1-azadienes with donor acceptor cyclopropanes to synthesize varieties of imine functionalized cyclopentanes and pyrrolidine derivatives in moderate to high yield have been developed. Moreover, pharmaceutically relevant azabicyclo[3.2.1]octane, bearing two all-carbon quaternary stereogenic centers at the bridgehead positions, has been synthesized by nosyl group deprotection and intramolecular amidation of imine functionalized cyclopentane derivative. [ABSTRACT FROM AUTHOR]

A straightforward and efficient method for the synthesis of nitrogen-functionalized cyclopentane derivatives via [3+2] cycloaddition of enamines with donor-acceptor cyclopropanes in the presence of catalytic amounts of various Lewis acids at room temperature has been developed; furthermore, the corresponding β-amino acid was synthesized by monodecarboxylation and hydrogenolysis. An enantioenriched synthesis of nitrogen-functionalized cyclopentane derivatives through dynamic kinetic asymmetric transformation of racemic donor-acceptor cyclopropanes has also been achieved employing a copper complex [Cu(OTf)2- L1] as the catalyst affording an enantiomeric ratio up to 8:1. [ABSTRACT FROM AUTHOR]

Substance abuse is an important health problem throughout the world including India, but prevalence and pattern of abuse varies from country to country and in different types of population. Slums have their own social and economic problems so that substance abuse may be different in this population and might be related with these problems. The aim of the present study was to study the prevalence and pattern substances in slum population. Prakash Chandra Sethi Nagar slum area of Indore district was selected for the purpose of this study. In first phase of the study, first a camp was organized to sensitize local leaders, key persons, and local inhabitants about drug abuse at Chandra Prakash Sethi Nagar. After that basic information was gathered with the key persons in Chandra Prakash Sethi Nagar. In second phase by house‑to‑house survey, all members of the family were interviewed in detail and information was recorded on semi‑structured proforma. We observed prevalence rate of 560/1000 populations, 78.2% were males, 28.2% were females, and two‑third abusers were laborers (72%). In order of frequency, tobacco was the most common substance abused in 53.9% population followed by gutka (nontobacco pan masala). Other drugs in order of frequency were alcohol 46.5%, cannabis 8.9%, opiates 4.9%, sedative and hypnotic 2.0%, solvents 1.0%, and cocaine in 0.1%. Slum population has higher prevalence rates than general population. [ABSTRACT FROM AUTHOR]

Tuberculosis is a common infectious cause of splenic enlargement in developing countries, but tubercular splenic abscesses are a rare presentation, found predominantly in immunocompromised populations. We report a case of tubercular splenic abscesses with isolated splenic vein thrombosis in an immunocompetent person. [ABSTRACT FROM AUTHOR]

Reaction of the title substrates in the presence of MgI2 or Cu(O-Tf)2 leads to an efficient preparation of various highly functionalized cyclopentanes, generally with good to excellent diastereoselectivity. [ABSTRACT FROM AUTHOR]

Objective The “sural-sparing pattern” of Guillain–Barré syndrome (GBS) is believed to reflect demyelinating pathology. We asked if it is present in non-demyelinating GBS-subtypes, namely acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Miller Fisher syndrome (MFS), in addition to acute inflammatory demyelinating polyneuropathy (AIDP). Methods We studied the occurrence of sural-sparing pattern in clinically defined GBS and MFS patients. Using serial electrodiagnostic studies, GBS patients were divided into AIDP, according to appearance of demyelination–remyelination and AMAN/AMSAN, if there were signs of reversible conduction failure or Wallerian-like degeneration. Equivocal cases were left unclassified. We defined sural-sparing as a greater decrease in median and or ulnar sensory nerve action potential than that of the sural, compared to age and height-matched normal controls. Results Twelve of 30 GBS and 7 of 20 MFS patients had sural-sparing. This pattern was seen in 4 of 8 AIDP, 5 of 13 AMAN/AMSAN and 3 of 9 unclassified cases. Sequential studies uncovered sural-sparing, initially covert, in additional 1 MFS, 1 unclassified, 1 AIDP and 1 AMAN/AMSAN patient. Conclusions Sural-sparing occurs in axonal and demyelinating GBS subtypes. Significance The sural-sparing pattern reflects a pathological process common to axonal and demyelinating GBS-subtypes alike. [ABSTRACT FROM AUTHOR]

Sebaceous gland carcinoma commonly arises in the periocular area and is an uncommon condition. Its orbital origin is even rare with isolated reports in literature search. Its early diagnosis is frequently missed owing to the subtle presentation that mimics various benign conditions. Surgery with wide resection margin is considered the standard of care. Irradiation is frequently indicated and administered as an adjuvant regimen following surgical resection. The role of chemotherapy in this disease remains investigational and is usually employed in recurrent settings. [ABSTRACT FROM AUTHOR]

A 49-year-old woman presented with progressive dementia. Diffusion-weighted MR images showed abnormalities in the cerebral cortex as well as the putamen and caudate head bilaterally. MR spectroscopic imaging revealed marked asymmetric decrease of normal metabolites in the right basal ganglia, with concordant hypoperfusion on single photon emission computed tomography. Diffusion-weighted MR imaging is more sensitive to cortical involvement in sporadic Creutzfeldt-Jakob Disease, and MR spectroscopy may yield evidence of asymmetric involvement. Combined functional and metabolic MR imaging may be useful in studying CJD. [Copyright &y& Elsevier]

Objectives: Endoxifen is a protein kinase C inhibitor. The objective of the present phase III study was to demonstrate the safety and efficacy of endoxifen in treating bipolar I disorder (BPD I) patients. Methods: A multicenter, double‐blind, active‐controlled study was conducted using a daily dose of 8 mg endoxifen compared to 1000 mg divalproex, the current standard treatment, in patients with BPD I acute manic episodes with/without mixed features. The primary endpoint of our study was the mean change in total Young Mania Rating Scale (YMRS) score at day 21. Results: Endoxifen (n = 116) significantly (p < 0.0001) reduced total YMRS score (from 33.1 to 17.8. A significant (p < 0.001) improvement in Montgomery–Åsberg Depression Rating Scale (MADRS) score was observed for endoxifen (4.8 to 2.5). Early time to remission of the disease was observed with endoxifen compared to divalproex. None of the patients required rescue medication and there was no drug‐associated withdrawals. Changes in Clinical Global Impressions‐Bipolar Disorder and Clinical Global Impression‐Severity of Illness scores showed that treatment with endoxifen was well‐tolerated. Conclusions: Endoxifen at a low daily dose of 8 mg was as efficacious and safe in patients with BPD I acute manic episodes with/without mixed features. [ABSTRACT FROM AUTHOR]

Subacute combined degeneration of the spinal cord (SCD) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency.1 In the diagnosis of vitamin B12 deficiency, measurement of urine methylmalonic acid (MMA) and serum homocysteine levels has been reported as more useful than measurement of total vitamin B12 level.2 We report a rare case of SCD that we diagnosed by determining urine MMA, serum homocysteine levels with significant neurologic symptoms and characteristic magnetic resonance imaging (MRI) findings of the spinal cord, in the absence of characteristic findings of vitamin B12 deficiency and anaemia. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to the use of multiparity and lactation as a protective mechanism in females with breast cancer in Iraq, published in a previous issue of the periodical.

Background: There are widespread perceptions that excessive and unnecessary investigations are done in many patients with mental illnesses. There are no studies from India looking into this issue. Aims: (i) To study the frequency and pattern of various investigations such as electroencephalography (EEG), computerized tomography (CT) scan of head, magnetic resolution imaging (MRI) scan of brain, and blood investigations carried out by the previous doctors on patients seeking treatment in three different settings. (ii) To study the socio-demographic and clinical correlates of investigations carried out on these patients. Study Design and Settings: A cross-sectional study in a community outreach clinic, a district level psychiatric hospital, and psychiatry outpatient clinic of a medical college. Materials and Methods: 160 newly registered patients seeking treatment at these settings were assessed using a semi-structured pro forma regarding various investigations that they had undergone before seeking the current consultation. Frequency of investigations was analyzed. Results: About 47.5% of patients had at least one of the three brain investigations done. EEG, CT head, and MRI brain had been done in 37.5%, 20.0%, and 8.8% of the patients, respectively. Only 1.8% of the patients had blood tests done before current consultation. Conclusion: This study results raise question whether certain investigations such as EEG and CT head were carried out excessively and blood investigations were done infrequently. Further studies on larger samples with prospective study design to evaluate the appropriateness of current practices of carrying out investigations in patients presenting with psychiatric symptoms are required. [ABSTRACT FROM AUTHOR]

The primary endpoint was evaluated pooling patient data across all sites, and no effect of skewed recruitment of patients occurred in overall study assessments. Comments on Endoxifen: A new, protein kinase C inhibitor to treat acute and mixed mania associated with bipolar I disorder Study outcome remains unchanged between mITT & PP population confirmed that there was no impact of missing data or method of missing data imputation carried out in the trial. [Extracted from the article]

A letter to the editor is presented which discusses the application of positron emission tomography-magnetic resonance imaging (PET-MRI) in the diagnosis of an active disease in the pseudo progression (PP's) background.

BackgroundIgG anti-GQ1b antibodies are associated with Fisher syndrome (FS), Bickerstaff brainstem encephalitis (BBE), acute ophthalmoparesis and overlap of FS or BBE with Guillain–Barré syndrome (GBS) (FS/GBS or BBE/GBS). It has not been clearly established if the primary pathology of these disorders is demyelinating or axonal in nature. Rapid resolution of conduction slowing or block without signs of demyelination–remyelination has been reported in axonal subtypes of GBS that are associated with IgG anti-GM1 or -GD1a antibodies. We hypothesised that such reversible conduction failure would be also observed in FS and related disorders.MethodsSerial nerve conduction studies were prospectively performed in 15 patients with FS and related conditions.ResultsNeither conduction block nor abnormal temporal dispersion was observed in any of the nerves at any point in all the patients. Conduction velocities for none of the nerves were in the demyelinating range. The amplitude of sensory nerve action potential was decreased in three FS, one FS/GBS and two BBE/GBS patients. Compound muscle action potential amplitudes were decreased in the two BBE/GBS patients. These decreases in amplitudes of sensory nerve action potential and compound muscle action potential promptly resolved without significant change in duration on serial studies.ConclusionsReversible conduction failure was seen in six of the 15 patients with FS and related disorders on serial nerve conduction studies. There were no signs of demyelination or remyelination in the 15 patients. The pathology appears to be primarily non-demyelinating. We believe these conditions form a continuous spectrum with axonal GBS. [ABSTRACT FROM AUTHOR]