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Thoracic epidural placement is considered the gold standard for pain management for abdominal or thoracic surgery. It provides analgesia superior to that provided by opioids with a decreased risk of pulmonary complications. Insertion of a thoracic epidural catheter requires the knowledge and expertise of an anesthetist; epidural catheter insertion may be challenging especially when sited in the higher thoracic region, in patients with unusual neuraxial anatomy, patients unable to position adequately for insertion or morbidly obese patients. Postoperatively the anesthetic team is required to look after the patient and assess for any complications such as hypotension. Even though the incidence of complications may be low; however, some of these could have detrimental consequences for the patients such as epidural abscess, hematoma formation, and temporary or permanent neurological damage. In this case report, we will discuss a patient who underwent a three-stage esophagectomy for esophageal squamous cell carcinoma under general anesthesia with epidural analgesia. The epidural catheter (Portex® Epidural Minipack System with NRFit® connector, ICUmedical, USA) was found in the intrapleural space during video-assisted thoracoscopy for the thoracic part of esophagectomy. To facilitate surgical access, the catheter was removed immediately, and the patient was given patient-controlled analgesia with morphine for postoperative pain control.

Background: Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by deficits in reciprocal social interaction as well as communication and a restrictive repertoire of activities. Indian studies on this subject have been few. Objectives: The aim of this study was to assess clinical characteristics of children with ASD in Indian scenario. Methods: We conducted a cross-sectional observational survey in special schools involving diagnosed autistic children, and their parents using a pretested standardized questionnaire based on diagnostic and statistical manual IV criteria. Results: Males (n=25) outnumbered the females (n=11). Only 6 cases (16.7%) were diagnosed as autistic before 3 years of age. 39% cases were detected between ages of 3 and 4.11 years. 22% cases were diagnosed in each of 5-6.11 years and 7 years and above category. The must watch behavior characteristics that our study found were impaired eye to eye gaze, impaired peer relationships, poor facial expressions, language delay, lack of pretend play, and inflexible adherence to rituals. Conclusion: Clinicians should be educated and encouraged to make timely diagnosis of ASD so as to initiate earlyinterventions for these children.

Drug-induced liver injury (DILI) is a leading cause of candidate attrition during drug development in the pharmaceutical industry. This study evaluated liver toxicity signals for 249 approved drugs (114 of “most-DILI concern” and 135 of “no-DILI concern”) using PharmaPendium and assessed the association between nonclinical and clinical injuries using contingency table analysis. All animal liver findings were combined into eight toxicity categories based on nature and severity. Together, these analyses revealed that cholestasis [odds ratio (OR): 5.02; 95% confidence interval (CI) 1.04–24.03] or liver aminotransferase increases (OR: 1.86; 95% CI 1.09–3.09) in rats and steatosis (OR-1.9; 95% CI 1.03–3.49) or liver aminotransferase increases (OR-2.57; 95% CI 1.4–4.7) in dogs were significant predictors of human liver injury. The predictive value further improved when the liver injury categories were combined into less severe (steatosis, cholestasis, liver aminotransferase increase, hyperbilirubinemia, or jaundice) and more-severe (liver necrosis, acute liver failure, or hepatotoxicity) injuries. In particular, less-severe liver injuries in the following pairs of species predicted human hepatotoxicity {[dog and mouse] (OR: 2.70; 95% CI 1.25–5.84), [dog and rat] (OR-2.61; 95% CI 1.48–4.59), [monkey and mouse] (OR-4.22; 95% CI 1.33–13.32), and [monkey and rat] (OR-2.45; 95% CI 1.15–5.21)} were predictive of human hepatotoxicity. Meanwhile, severe liver injuries in both [dog and rat] (OR-1.9; 95% CI 1.04–3.49) were significant predictors of human liver toxicity. Therefore, we concluded that the occurrence of DILI in humans is highly likely if liver injuries are observed in one rodent and one nonrodent species and that liver aminotransferase increases in dogs and rats can predict DILI in humans. Together, these findings indicate that the liver safety signals observed in animal toxicity studies indicate potential DILI risk in humans and could therefore be used to prioritize small molecules with less potential to cause DILI in humans.