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Background: There is paucity of Indian data on nebulizer usage, patients’ and caregivers’ attitudes towards nebulization in COPD. Objective: Survey aimed to evaluate Indian adult male and female patients’ and caregivers’ attitudes and perceptions towards nebulization for COPD management. Methods: Survey was conducted from July-August 2019 among 103 COPD patients [>40 years] receiving home nebulization (>3 weeks), and their caregivers, to assess usage, satisfaction, perceived benefits and concerns with nebulizers. Results: Overall, 54% patients were on nebulizer regimen for >8 weeks (occasionally/daily) and 27% patients used nebulizers daily for home maintenance. Key benefits of nebulizers perceived by patients were easier breathing (93%), ease of use (89%) and fewer doctor visits (86%) while caregivers cited reduced hospitalization (76%), easier breathing (75%) and better control on overall symptoms (73%). Patients perceived short-term duration of effect (61%), social embarrassment (54%) and device being bulky and noisy (50%) as major concerns for nebulizers; while caregivers cited multiple uses per day (45%) and social embarrassment (43%). Among patients prescribed inhaler therapy earlier, 72% felt nebulizers gave long-term relief compared to inhalers. 61% patients opined that benefits with nebulizers outweighed the inconvenience associated with its use. Overall 99% patients reported satisfaction with nebulizers. Conclusion: This first of its kind survey demonstrated that majority of COPD patients and their caregivers were satisfied with nebulizers, with reported benefits of reduced hospitalization, better symptom control and ease of use.

Aim: An alternative technique of C1-2-3 fixation is described that blocks the critical anteroposterior odontoid process movements and retains rotatory movement at the atlantoaxial joint. The technique involves sharp section of the muscles attached to the C2 spinous process and C2-3 transarticular interfacetal screw fixation. Materials and Methods: We successfully used this technique of fixation in 14 cases wherein in similar case situation; we earlier advocated inclusion of C1 in the fixation construct. Eleven patients had multisegmental spinal degeneration, 1 patient had Hirayama disease, and 2 patients had ossified posterior longitudinal ligament. Results and Technical Advantages: The procedure avoids manipulating C1 vertebra and excludes it from the fixation process, disables movement of C2 vertebra but retains rotation movements of the atlantoaxial joint that are executed by the muscles attached to the transverse process of atlas. The net effect is that the anteroposterior odontoid process movements that threaten the cervicomedullary neural structures are blocked and the critical rotatory atlantoaxial movements are retained. Conclusions: The discussed technique can be useful for cases undergoing multisegmental fixation that includes atlantoaxial joint.

Background We present 2 cases involving a previously unreported clinical situation in which basilar invagination, atlantoaxial instability, and C2-3 instability were associated with a bifid posterior arch of the axis bone. Case Descriptions Two young males presented with limb weakness, spasticity, and paresthesias. Both patients had altered voice quality, with reduced and thin volume, and difficulty sleeping supine. Radiologic imaging showed an absence of the posterior elements of the C2 vertebrae. The C3 spinous process mimicked the C2 spinous process in shape and size. C1-2 and C2-3 posterior fixations were performed. Conclusions C1-2 and C2-3 fixation resulted in firm fixation of the region and a remarkable clinical recovery. The most significant features were an immediate postoperative improvement in voice quality and the ability to sleep comfortably in the supine position.

Objective The authors analyze 124 cases with fracture of odontoid process. All patients were surgically treated by posterior atlantoaxial fixation. Methods There were 96 male and 28 female patients. The ages of the patients ranged from 12 to 80 years. Apart from Anderson and D'Alonzo type I (6 cases), type II (93 cases) and type III (25 cases), three sub-types of odontoid fractures were included in the classification. In type A (118 cases), there was vertical compression fracture that resulted in malalignment of the fractured odontoid process segments. Type B (49 cases) resulted when the fracture resulted in malalignment of the facets of atlas and axis. Type C (25 cases) included cases in which the fracture line involved the facet of axis. Fractures were divided into acute type when the injury was less than 3 months old (50 cases), delayed type when the injury was between 3 months to one year (34 cases) and chronic type when the injury was more than 1 year in duration (40 cases). All patients were treated with posterior atlantoaxial fixation with the techniques described in 1994 and 2004. Follow-up period ranged from 6 to 156 months (average 72 months). Results All patients improved in symptoms after surgery. There were no significant postoperative complications. Conclusions Posterior atlantoaxial stabilization forms a safe surgical strategy for all kinds of odontoid fractures. Additional characteristics of odontoid fractures further subclassified them and assisted in surgical decision-making and in formulating the surgical strategy.

Various azo compounds (Modified dyes) have been synthesised by chemical modification of areca nut extract (epicatechin), a plant-based Polyphenolic compound to get semi-synthetic dyes. Three different primary amines namely p- nitro aniline, p-anisidine and aniline, were diazotized to form their corresponding diazonium salts which were further coupled with an areca nut extract. Preliminary characterization of the areca nut extract and the resultant azo compounds (Modified dyes) was carried out in terms of melting point, solubility tests, thin layer chromatography, UV–Visible and FTIR spectroscopy. These modified dyes were further applied on polyester and nylon fabrics and % dye exhaustion was evaluated. Dyed fabrics were further tested for their fastness properties such as wash fastness, rubbing fastness, light fastness and sublimation fastness. The results of the fastness tests indicate that, all the three modified dyes have good dyeability for polyester and nylon fabrics. The dyed fabrics were also tested for ultraviolet protection factor which showed very good ultraviolet protection.

Disperse dyes contain around 30–60% of dispersing agents as well as dyeing with disperse dyes requires around 2–5 g/L of dispersing agent for faultless dyeing of polyester and other hydrophobic fibres. Dispersing agents are not absorbed by the fibres and a large quantity of dispersing agent creates unavoidable load on the effluent treatment. Dispersant-free disperse dyes seem to have an acceptable solution to this existing problem. These dyes can work in absence of dispersing agents and thus are called as dispersant free disperse dyes. In this work, dispersant-free disperse dyes were synthesised by coupling diazotised p-nitroaniline with the different components like sulfomethylated aniline and m-toluidine. These synthesised dyes were applied successfully on polyester which resulted into uniform dyeing, good build-up and desired colour yield. The dyeing was dependent on the pH and the optimum pH was 5 similar to that employed in conventional polyester dyeing. The fastness properties obtained were ...

Aim: An alternative form of surgical treatment of prolapsed cervical intervertebral disc in patients presenting with symptoms related to myelopathy is discussed. The treatment involved fixation of the affected spinal segments and aimed at arthrodesis. No direct manipulation or handling of the disc was done. Materials and Methods: During the period August 2010 to June 2017, 16 patients presenting with symptoms attributed to myelopathy and diagnosed to have prolapsed cervical intervertebral disc were surgically treated by spinal stabilization. There were 11 males and 5 females and their ages ranged from 20 to 66 years (average: 40.6 years). Apart from clinical and radiological indicators, the number of spinal segments that were stabilized depended on direct observation of facetal morphology, alignment, and stability. Surgery involved distraction-fixation of facets using Goel facet spacer (8 patients), transarticular facetal fixation (5 patients) using screws or a combination of both facetal spacer, and transarticular screws (3 patients). Results: All patients had “remarkable” clinical improvement in the immediate postoperative period as assessed by visual analog scale, Goel's clinical grading, and Japanese Orthopedic Association scores. Follow-up ranged from 3 to 84 months (average: 50 months). The herniated disc regressed or disappeared at follow-up radiological assessment that ranged from 24 h to 3 months after surgery. Conclusions: Spinal segmental fixation aiming at arthrodesis with or without distraction of facets and without any direct surgical manipulation in the disc space or removal of the prolapsed portion of the disc can be considered in the armamentarium of the surgeon.

We investigated the synthesis of one-dimensional nanostructures via Schiff base (imine) formation on three close-packed coinage metal (Au, Ag, and Cu) surfaces under ultrahigh vacuum conditions. We demonstrate the feasibility of forming pyrene-fused pyrazaacene-based oligomers on the Ag(111) surface by thermal annealing of tetraketone and tetraamine molecules, which were designed to afford cyclocondensation products. Direct visualization by scanning tunneling microscopy of reactants, intermediates, and products with submolecular resolution and the analysis of their statistical distribution in dependence of stoichiometry and annealing temperature together with the inspection of complementary X-ray photoelectron spectroscopy signatures provide unique insight in the reaction mechanism, its limitations, and the role of the supporting substrate. In contrast to the reaction on Ag(111), the reactants desorb from the Au(111) surface before reacting, whereas they decompose on the Cu(111) surface during the relevant thermal treatment.

Ropinirole, an antiparkinsoism dopamine agonist, is used to treat Restless Legs Syndrome. However, orally it undergoes degradation in gastrointestinal tract and extensive first pass metabolism, resulting in its poor and variable bioavailability of the commercially available oral tablets. In the present investigation, soft nanocarriers, viz., microemulsion of ropinirole with the globule size of 160.2 ± 3.87 nm and zeta potential of -4.24 mV was explored for transdermal application. Transdermal drug delivery offers benefits such as sustained therapeutic plasma levels of drugs, avoidance of first pass effect, and improved patient compliance. In comparison to the hydrogel, the developed microemulsion enhanced the drug permeation across the rat skin and porcine ear skin by 3.5 and 2 folds, respectively. Further, the developed microemulsion antagonized the catalepsy in the haloperidol-induced catalepsy rat model by 10 folds as compared to the marketed tablets. Additionally, in rotenone induced Parkinsonism rat model, the microemulsion showed improvement in the motor function by 76% whereas the oral tablet showed only 5% restoration of the normal function. Besides this, the developed formulation successfully restored the catalase and superoxide dismutase levels which were significantly reduced by rotenone administration. Overall, the in vivo studies suggested the potential of the developed transdermal microemulsion of Ropinirole as a viable alternative to marketed formulations.