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Background: The defining characteristic of posterior reversible encephalopathy syndrome (PRES) is a reversible, predominantly vasogenic edema of the white matter, particularly affecting the parenchyma supplied by the posterior circulation. PRES is most commonly associated with hypertension. We present a case series of seven normotensive patients diagnosed with cancer who had posterior reversible encephalopathy syndrome., Materials and Methods: This series of retrospective cases includes seven patients hospitalized between August 2022 and October 2024, all with a primary oncological condition and diagnosed with PRES either at admission or during their hospital stay. PRES was established according to the diagnostic criteria outlined in the 2012 Berlin Study. Our study concentrated on clinical characteristics, including underlying disease, triggering clinical events, chemotherapy agents, and outcome measures such as reversibility, functional status, and mortality., Results: The median age of patients in this study was 48 years. No patient exhibited significantly elevated blood pressure during their inpatient stay. Altered consciousness with seizures was the primary initial manifestation in most patients, followed by headache. The predominant observation on the MRI was T2 flair hyperintensity in the posterior circulation. All subjects attained nearly full neurological recovery by 28 days, regardless of steroid therapy. The 90-day all-cause mortality rate was 14% (one out of seven patients). There were no fatalities attributable to PRES., Conclusion: Posterior reversible encephalopathy syndrome is a neurological emergency that may evade the discerning attention of the attending physician. Owing to the extensive range of clinical features and MRI findings, the list of differential diagnoses is substantial. The reversibility of symptoms, while not always applicable, is predominantly certain, as demonstrated in our case series. We must extend our focus beyond conventional risk variables such as hypertension to consider additional clinical insults. Delayed diagnosis may lead to worse neurological outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Vydehi Institutional Ethics Committee issued approval VIEC/2024/APP/83. This is to certify that the case series titled "A Pressing Emergency in Oncology: A Case Series of Patients With Posterior Reversible Encephalopathy Syndrome, "submitted by Dr. Vikram L., Assistant Professor, Department of Critical Care, Vydehi Institute of Medical Sciences and Research Centre, is approved by the Vydehi Institutional Ethics Committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Narasimhan et al.)

Background: Skin mottling as a clinical perfusion marker in septic shock is significantly associated with severity and outcome in white-skinned population and its validity as a clinical sign in dark-skinned population is not known. The objectives of this study were to evaluate mottling in septic shock in the Indian ethnic population who has different skin color as compared to the white-skinned population and to assess mottling as an outcome predictor with capillary refill time (CRT) and other biochemical parameters which are the established clinical markers of perfusion in septic shock., Materials and Methods: We conducted a prospective observational study of patients with skin color categories 21-34 on the von Luschan scale or Fitzprick type IV-VI who had septic shock needing a high dose of norepinephrine ≥0.2 μg/kg/min after fluid optimization. The study was conducted in a mixed medical-surgical ICU over 12 months. Two blinded experts (a Dermatologist and a plastic surgeon) independently classified the skin type, validated the occurrence of mottling, and scored mottling in our patients. We recorded the demographics, hemodynamic variables, and mottling score and observed the incidence of mottling and its correlation with predictors of the severity of septic shock. We also compared CRT, arterial lactate, central venous oxygen saturation, and venoarterial PCO 2 gap with occurrence of mottling in septic shock patients., Results: We included 108 patients with age 61 ± 16 years. Mean Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at enrolment were 10.3-21.9, respectively. Incidence of mottling was 20.3% (22/108). CRT >3 seconds was observed in 50.9% (55/108). Development of mottling was significantly associated with 90-day mortality; 20/22 (90.9%) patients died in the mottling group versus 58/86 (65.1%) in the non-mottling group ( p = 0.028). Capillary refill time >3 seconds did not corelate with mortality; 40/55 (72.7%) Patients with CRT >3 seconds died versus 32/53 (60.4%) patients died in CRT ≤3 seconds group. Occurrence of mottling could predict mortality; positive predictive value of 90.9% which was comparable to positive predictive value of lactate levels >4 mmol/L, i.e., 94.1%., Conclusion: The incidence of mottling in septic shock is much less in patients of Indian ethnicity with brown skin color than in white-skinned population. Occurrence of mottling and not delayed CRT, is a better predictor of outcome in this setting., How to Cite This Article: Jog SA, Narasimhan VL, Rajhans PA, Akole PV, Pawar B, Bhurke B, et al . Mottling in Septic Shock: Ethnicity and Skin Color Matter. Indian J Crit Care Med 2023;27(12):902-909., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2023; The Author(s).)

Objectives: To describe the demographics and evaluate the clinical outcomes of hypoxic coronavirus disease-2019 (COVID-19) patients treated with different immunomodulatory (IM) drugs in a resource-limited setting., Materials and Methods: We conducted a retrospective cohort study of these patients admitted to our hospital between March 22 and May 31, 2020. Data were abstracted from multiple electronic data sources or patient charts to provide information on patient characteristics, clinical, laboratory variables, and outcomes., Results: A total of 134 patients met the inclusion criteria and were followed up till June 7, 2020. The median age of the patients was 55.6 years (range 20-89 years) and 68% were men. At least one comorbidity was seen in 72% of the patients with diabetes (44%) and hypertension (46%) being the most common. At triage, fever (82%), shortness of breath (77%), and cough (61%) were the most common presenting symptoms. A PaO 2 /FiO 2 ratio less than 300 was seen in 60%, and 4.5% required invasive mechanical ventilation within 72 hours of hospital admission. Five immunomodulatory agents (hydroxychloroquine, methylprednisolone, colchicine, etoricoxib, and tocilizumab) were administered in different combinations. Overall, in-hospital mortality was 26.9%, and 32% required mechanical ventilation. Around 69% of patients were discharged home. Five variables (SpO 2 , PaO 2 /FiO 2 ratio, leucocytosis, lymphopenia, and creatinine) on admission were found to be significant in the patients who died., Conclusion: Our study provides the characteristics and outcomes of hypoxic COVID-19 patients treated with IM drugs in varied combination. Five independent variables were strong predictors of mortality., How to Cite This Article: Mahale N, Rajhans P, Godavarthy P, Narasimhan VL, Oak G, Marreddy S, et al. A Retrospective Observational Study of Hypoxic COVID-19 Patients Treated with Immunomodulatory Drugs in a Tertiary Care Hospital. Indian J Crit Care Med 2020;24(11):1020-1027., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.)

This paper reports studies undertaken on 3,7-dinitro-1,3,5,7-tetraazabicyclo[3,3,1]nonane (DPT). The synthesis of DPT was carried out by the nitration of hexamine based on the lines of reported method with minor modification. DPT was characterized by elemental analysis, scanning electron microscopy (SEM), Fourier transform infrared (FTIR) and (1)H nuclear magnetic resonance (NMR) techniques. Thermal stability of DPT was studied using thermogravimetry (TG) and differential scanning calorimetry (DSC). The thermal analysis studies revealed that DPT undergoes decomposition at 211 degrees C. Decomposition of DPT using TG-FTIR indicated the evolution of carbon dioxide, water and oxides of nitrogen as main gaseous products. The electrochemical behavior of DPT was studied using cyclic voltammetric (CV) studies. The experimentally determined sensitivity parameters indicated the insensitive nature of DPT towards external stimuli. The performance parameters of DPT, RDX and HMX have been computed using Linear Output Thermodynamic User Friendly Software for Energetic Systems (LOTUSES) code. The predicted properties of DPT are interesting and important from the point of process technology and/or safety. The work reported in this paper enriches the existing scanty research and development data on one of the key precursor used for synthesis of important high energy materials (HEMs).