Low-frequency rTMS over pre-SMA may not be effective as an augmenting agent in partial/poor responders to SRIs. This study underlines the need to explore alternate rTMS protocols in OCD.
Reversible AKI without need for RRT occurred in nearly 12% of patients with severe TBI requiring surgical intervention. Aminoglycoside therapy was the only predictive factor for the occurrence of AKI. Patients with AKI have a longer period of mechanical ventilation, longer ICU and hospital stay, and poorer GCS at discharge.
Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.
Venous air embolism (VAE) is a well recognized complication during neurosurgery. Pre-cordial doppler and trans-esophageal echocardiography are sensitive monitors for the detection of VAE. A sudden, abrupt reduction in the end-tidal carbondioxide (ETCO2) pressure with associated hypotension during neurosurgery might suggest VAE, when more sensitive monitors are not available. We describe an unusual cause for sudden reduction in ETCO2 during neurosurgery and discuss the mechanism for such presentation.
Indocyanine green (ICG) video-angiography is used intraoperatively to visualize the vascular integrity during neurovascular surgical procedures [1]. Oxygen desaturation following ICG injection has not been described previously nor is it mentioned in the list of adverse effects of the dye by the manufacturer.We report here a 42-year-old female who underwent clipping of the basilar artery aneurysm. The ICG dye (Aurogreen TM , Aurolab, Madurai, India) was injected at the recommended dose of 0.25 mg/kg before clip application to visualize the vessels and their branches. After clipping, ICG was repeated to confirm correct clip placement and patency of parent and perforator vessels. On both occasions, there was reduction in the pulse-oximeter saturation reading (99-96 %), the decrease more after the second dose (94 %). We had a monitor (Radical-7 Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) where we observed that the methemoglobin level too increased during desaturation from 0.2 to 0.9 % and gradually returned to previous value in 8 min along with return of saturation to 99 %. The patient did not have any complications associated with these changes. This finding was reproducible and consistent in other patients as well. Decreased pulse-oximeter reading has been observed in dogs following ICG administration [2]. Therefore, though the change is insignificant and transient, it is desirable that this effect be listed by the manufacturer in the list of side effects. Caution should be exercised when repeat doses of ICG are administered especially within short periods of time.
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