Context:Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia.Aim:We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries.Settings and Design:Double-blinded randomized controlled trial.Materials and Methods:Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 μg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h.Results:The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects.Conclusion:Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects.

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A 61-year-old obese man presented with 8-week history of nausea and occasional vomiting. He reported poor appetite and unintentional weight loss of more than 20 kg of his body mass. A week after admission, he developed double vision and unsteady gait. Neurological examination revealed isolated sixth cranial nerve palsy on the left side with horizontal nystagmus that progressed to bilateral lateral gaze palsy with normal vertical gaze. Brain MR revealed T2/fluid attenuation inversion recovery (FLAIR) high signal in mammillary bodies, tectum of the midbrain and the periaqueductal grey matter. He was diagnosed with Wernicke’s encephalopathy (WE). WE is a medical emergency that carries high mortality yet can be often under-diagnosed in the non-alcoholic patient. Varied presentation and absence of alcohol dependence lowers the degree of suspicion and this was true in this case. The patient was given intravenous thiamine and made a rapid and dramatic recovery.

Aeromanas salmonicida from human blood (Tewari et al., 2014). Case ReportA 12-year-old Muslim female child, visited medicine Out Patient Department (OPD), at AIIMS, Jodhpur in December 2015 with complaints of off and on low grade fever, pain abdomen associated with weakness and malaise for last 20 days. There was no history of chills and rigor, sore throat, diarrhea, urinary discomfort, any other

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