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Introduction: Pregabalin (PGN) is an anxiolytic, analgesic, antiepileptic, and hypnotic medication.There are concerns about its abuse in the community for managing chronic insomnia and other risks when assumed in overdose or combination with other abuse substances. PGN is classified as a controlled medication. While its discontinuation is accompanied by rebound insomnia and other neurological symptoms, cross-tapering PGN with short-term diazepam (DZ) during inpatient admissions has shown promising results in dealing with PGN withdrawal symptoms accompanied by rebound insomnia. Material and Methods: We report three cases that began abusing their prescribed PGN. During hospital admission, our teams used a protocol for cross-tapering PGN with DZ to reduce withdrawal symptoms. Other sedative medications are suspended while alcohol is not allowed if patients are on leave from the hospital. Standardized scales for assessment were clinical global impression scale-severity (CGI-S), generalized anxiety disorder scale (GAD-7), and insomnia severity index (ISI). Results: The cross-tapering PGN with DZ showed similar clinical outcomes with reduced withdrawal symptoms and rebound insomnia during two weeks of cross-tapering. Eventually, DZ, too, is stopped in the hospital to avoid another dependence syndrome. Conclusion: As emerging in the current study, PGN has strong addictive effects in people who have insomnia and is mostly abused for its hypnotic or sleep-inducing properties when other medications have failed. As applied in the current study, DZ can manage PGN withdrawal symptoms with rebound insomnia while cross-tapering. DZ is then discontinued.

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Performance of electrochemical capacitors is largely determined by the properties of the electrodes and the electrolytes employed. In this work, we utilized carbon nanotubes to develop a range of nanostructured carbon electrodes and combined them with ionic liquid electrolytes to fabricate new electrochemical capacitors. Difference in the cost, preparation, and performance of these electrode materials allows us to achieve the optimal performance / cost value for the capacitors and to select a specific type of nanoelectrodes to fabricate capacitors for a particular application. Combing the highly conductive and electrolyte-accessible structures of these nanoelectrodes with the large electrochemical window of the ionic liquid electrolytes, the resultant capacitors have achieved superior performances over the current state-of-the-art electrochemical capacitor technology. Excellent safety-related properties of the ionic liquid electrolytes ensure superior safety and lifetimes for these new capacitors.

Marchiafava Bignami disease is a rare toxic disease seen mostly in chronic alcoholics, resulting in progressive demyelination and necrosis of the corpus callosum. Initially it was thought to be specific to individuals in central Italy, consuming large amounts of Chianti red wine; however, alcoholic beverages worldwide are presently implicated. In our case series of two cases, locally made “illicit” liquor (Mahuwa Alcohol) could be the causative factor. In radiological point of view typically the corpus callosum is affected, with involvement of the body, genu, and splenium in order of occurrence. Occasionally the entire callosum may be also involved. Clinical presentation varies from case to case.

Purpose: To determine the safety and efficacy of ultrasound (US)guided direct puncture for ethylene vinyl alcohol copolymer (EVOH) embolization in the treatment of uterine arteriovenous fistulas (UAVFs). Materials: A retrospective review of consecutive female patients treated for UAVFs from July 2015 to August 2018 was performed. Patient histories, laboratory values, imaging studies, and follow up clinic notes were reviewed. A total of 4 patients were included; median age was 28 years (range: 24-33). All patients had history of uterine instrumentation and presented with life-threatening vaginal bleeding with an UAVF visible on US or MRI. Two (50%) had previously undergone proximal uterine artery embolization (UAE) but had recurrent bleeding. US-guided direct UAVF puncture was performed by transabdominal (n¼2) or transvaginal (n¼2) approach with injection of EVOH in all patients (a detachable coil scaffold was deployed in the first case but was not necessary in subsequent cases). After the fistulous connection had been successfully closed, Gelfoam UAE was performed to stasis. Technical success was defined by resolution of UAVF on intraprocedural angiography/US and follow up MRI. Clinical success was defined as resolution of the bleeding without recurrence or need for other therapies. Results: Technical success was 100%. Angiography after obliteration of the fistulous connection with EVOH showed elimination of rapid filling of outflow veins in all cases and allowed for safe Gelfoam UAE. Follow up MRI showed EVOH filling the previously seen dilated vascular channels in all cases. Clinical success was 100% with resolution of bleeding in all patients; average follow up duration 395 days (range: 32 -1,123 days). All patients tolerated the procedure well without immediate or delayed complication at 1 year. A 24-year old patient was 19 weeks pregnant at the time of data collection. Conclusions: US-guided direct puncture for EVOH delivery prior to Gelfoam UAE is a safe and effective option for management of UAVFs, avoiding hysterectomy and preserving the option of fertility in young women.

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