More secure substances using less creatures: kick-off with the Eu ONTOX task.

Results Difficult intubation was observed in 62/310 patients (20%). learn more The AUC for USED-MSH score was greater than the MSH score (0.93, 95% CI [0.89-0.97] vs 0.76, 95% CI [0.69-0.84], P value less then 0.001). USED-MSH score had higher sensitivity (93.6% vs 59.7%) and lower specificity (85.9% vs 91.1%) with similar positive predictive value (62.7% vs 62.4%) in comparison with MSH score. Conclusion An airway scoring system using the ultrasound measurements of skin-to-epiglottis distance along with the clinical predictors would be helpful in the prediction of difficult intubation. Copyright © 2020 Indian Journal of Anaesthesia.Background and Aims The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection. Methods Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76%) cases were serologically proven as dengue fever. Results Median age (IQR) of study population was 36.0 (26.0-52.0) years. Liver (65.7%) was the main organ involved followed by acute kidney Injury (AKI) (18.6%). Dengue Shock Syndrome (DSS) was found in 18.6% of cases. Fifty-two patients died and the crude mortality was 38.0%. On multivariate analysis APACHE Score less then 10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality. Conclusion This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted. Copyright © 2020 Indian Journal of Anaesthesia.The output of inhalational agents from modern vaporisers are both electronically and pneumatically controlled. They are designed to deliver set agent concentrations accurately with low fresh gas flows and possess enhanced safety features. The purpose of this review article is to give an overview of three modern vaporisers, namely, the Aladin cassette vaporiser, injection vaporisers and AnaConDa™. The Aladin cassette is integrated with Datex Ohmeda S/5 ADU and GE Aisys anaesthesia machines. The electronic vapour control unit is incorporated within the anaesthesia machine. The agent specific cassettes act as a detachable vaporising chamber. The system can work as a variable bypass and measured flow vaporiser but requires a power supply to function. Injection vaporisers can achieve the set end-tidal agent concentration very rapidly with even metabolic flow rates. Hence, anaesthetic depth can be rapidly altered with minimal wastage and theatre pollution. The two types of injection vaporisers, namely, Maquet and DIVA™ are customised to function with Maquet FLOW-i and the Drager Zeus anaesthesia machine, respectively. AnaConDa™ is a combination of vaporiser and humidity and moisture exchange filter which can be fitted in the ventilatory circuit. It is primarily designed for use in intensive care for sedation and out of operating room use. Copyright © 2020 Indian Journal of Anaesthesia.This case note on the CJEU's decision in Fack Ju Göhte focuses on morality bars and freedom of expression in EU trade mark law. Based on the presumption that a refusal to register a trade mark for being contrary to accepted principles of morality interferes with freedom of expression, an empirical concept of morality appears incompatible with freedom of expression. However, the test for morality developed by the CJEU seems to employ such an empirical concept at least partially. In addition, the test seems to lack legal certainty. In light of freedom of expression, both represent a potential shortcoming of the decision. © The Author(s) 2020.Defects in histone methyltransferases (HMTs) are major contributing factors in neurodevelopmental disorders (NDDs). Heterozygous variants of SETD1A involved in histone H3 lysine 4 (H3K4) methylation were previously identified in individuals with schizophrenia. Here, we define the clinical features of the Mendelian syndrome associated with haploinsufficiency of SETD1A by investigating 15 predominantly pediatric individuals who all have de novo SETD1A variants. These individuals present with a core set of symptoms comprising global developmental delay and/or intellectual disability, subtle facial dysmorphisms, behavioral and psychiatric problems. We examined cellular phenotypes in three patient-derived lymphoblastoid cell lines with three variants p.Gly535Alafs*12, c.4582-2_4582delAG, and p.Tyr1499Asp. These patient cell lines displayed DNA damage repair defects that were comparable to previously observed RNAi-mediated depletion of SETD1A. This suggested that these variants, including the p.Tyr1499Asp in the catalytic SET domain, behave as loss-of-function (LoF) alleles. Previous studies demonstrated a role for SETD1A in cell cycle control and differentiation. However, individuals with SETD1A variants do not show major structural brain defects or severe microcephaly, suggesting that defective proliferation and differentiation of neural progenitors is unlikely the single underlying cause of the disorder. We show here that the Drosophila melanogaster SETD1A orthologue is required in postmitotic neurons of the fly brain for normal memory, suggesting a role in post development neuronal function. Together, this study defines a neurodevelopmental disorder caused by dominant de novo LoF variants in SETD1A and further supports a role for H3K4 methyltransferases in the regulation of neuronal processes underlying normal cognitive functioning.Cognitive dysfunctions, including impaired attention, learning, memory, planning and problem solving, occur in depressive episodes, often persist during remission, predict relapse, worsen with recurrent episodes, and are not treated by current antidepressants or other medications. Cognitive symptoms are also present in other psychiatric disorders, are a hallmark of aging, and define several late-life disorders, including Alzheimer's disease. This pervasive occurrence suggests either a non-specific outcome of a diseased brain, or a shared underlying pathology contributing to this symptom dimension. Recent findings suggest a role for altered GABAergic inhibition in cognitive symptoms. Cellular, molecular and biochemical studies in human subjects report changes affecting the gamma-amino butyric acid (GABA) system, specifically somatostatin-expressing (SST+) GABAergic interneurons, across brain disorders and during aging. SST+ neurons gate excitatory input onto pyramidal neurons within cortical microcircuits. Experimentally reducing the function of these neurons affects excitatory signal-to-noise ratio, reduces synchronized cellular and neural activity, and leads to cognitive dysfunctions.learn more