The use of sitting position craniotomy in Neurosurgical procedures provides several advantages to Neurosurgeons. This patient position provides optimum access to midline lesions, improves cerebral venous decompression, decreases intracranial pressure (ICP), and promotes gravity drainage of blood and cerebrospinal fluid (CSF). These advantages provide an optimum visualization of structures to the neurosurgeon. However, it comes with unique challenges to Neuroanaesthesiologists. Complications related to the use of this position include hemodynamic instability, venous air embolism (VAE), with possibility of paradoxical air embolism, pneumocephalus, quadriplegia and compressive peripheral neuropathy. The gravity assisted drainage of blood into lower limbs increases the risk of hypotension during intraoperative period. The incidence of venous air embolism is high (40-70%) in this position due to valveless, noncollapsible venous structures which allow entrainment of air. Though the use of sitting position has decreased in the last three decades, mainly due to the fear of VAE, there is a rejuvenated interest in the use of sitting position in recent times owing to better understanding of the physiology and availability of sensitive monitors for the early detection of VAE.

Synucleinopathies such as Parkinson's disease (PD), dementia with Lewy bodies (DLB) are characterized by the deposition of misfolded protein aggregates consisted of alpha-synuclein in the central nervous system (CNS). Previous efforts have focused on the development of CNS-proximal clinical biomarkers, including cerebrospinal fluid measures of alpha-synuclein, and tau. However, these diagnostic techniques are often used in clinical studies on patients with advanced disease state, and are invasive. Therefore, there remains an urgent need for reliable, inexpensive and minimally invasive peripheral biomarkers. Recent studies have revealed widespread peripheral involvement of Lewy body-like pathology, often prior to clinical manifestations of the diseases. Indeed, alpha-synuclein deposits have been observed in peripheral tissues in PD and DLB. A formidable challenge is that the levels of the amyloidogenic protein aggregates in peripheral tissues are extremely low and thus only variably detectable using immunological methods. Therefore, highly sensitive analytical platforms are required as the new generation of biomarker assays specific for protein aggregates and amyloid fibrils. The real-time quaking induced conversion (RT-QuIC) has emerged as a robust, rapid and ultrasensitive technology for template-assisted amplification of misfolded protein aggregates in neurodegenerative diseases. Using the RT-QuIC technique, our recent studies have shown that disease-associated protein aggregates are readily detectable in peripheral tissues of patients affected by PD, and dementia with Lewy bodies. Validation of peripheral protein biomarkers will enable sensitive premortem diagnostic tests for PD, DLB, and other related disorders, and accelerate clinical trials for disease-modifying therapies.

The concept of Recovery has taken on new meanings in recent years. Traditional emphasis on diagnosis and repair, has been steadily replaced with the notion of developing and maintaining psychological wellness. This study examined Wellness Recovery Action Planning (WRAP), as a possible intervention in mental health management.  A between groups case cohort design was employed to examine the effects of WRAP with Mental Health and ABI populations, as well as their respective wait list control counterparts. Cohen’s d showed large effect sizes in the difference between treatment and respective control groups in the reduction of Anxiety and Depression, measured by the HADS, for both the ABI ( Cohen’s d for Anxiety  1.03; Cohen’s d for Depression  1.73 ) and Mental Health cohorts ( Cohen’s d for Anxiety 1.29; Cohen’s d  for Depression 1.13) . Results demonstrate the potential of WRAP in offering a fresh, twenty-first century perspective, in the functional management of mental health.  Prior to this study, there was no evidence of WRAP having been trialled within the context of ABI, and based on the results indicated, it may indeed be a worthy contender in the everyday management of mental health across populations.

Spatial aesthetics in health settings remain a challenge due to the difficulty in balancing disease prevention, such as the aseptic and ergometric protective needs of clinical hospital design, with health promotion through exposure to beauty. The objective of this work is to identify the importance of the aesthetics of the environment in the treatment of Mental Health, through bibliographic research of qualitative character using Pubmed and Scielo databases, between the years 1996 to 2018, with the key words: Design, Architecture, Art, Mental Health, Humanization, Psychiatry and Aesthetics. It is having as an indication that the aspects that make up the design were extremely important as attributes of humanization because they produce belongingness, respect and specially dignity in the patient. The main variables influencing the aesthetic environment highlighted in this article are: light, sound, color, aroma, texture and shape. The design belongs to the aesthetic-artistic perspective, reinforces the protagonism of the sick human being in detriment of the disease, reinforces the expansion of the concept of care and enhances the patient's response to treatment. The conclusion reiterates that the multiaxial aspects brought about by the design of environments within hospitals, is in line with the Holistic model of Health, producing Health promotion and positive responses to patients.

In the recent years Ultrasounography (USG) has emerged as a valuable tool in intensive care. It has moved successfully from radiological suite to operation theatre and intensive care unit. The main advantages of USG are as a point of care (bed-side) tool which provides vital information. It has many diagnostic and therapeutic applications in the Neurointensive care unit. The main applications of USG in Neurocritical care are as follows. In diagnosis of intracranial hypertension: Increased Optic nerve sheath diameter is a qualitative marker of raised intracranial pressure. A linear high frequency probe can be used for visualization of optic nerve. Trancranial Doppler: TCD has been used in recognition of cerebral autoregulation, diagnosis of cerebral vasospasm and as an ancillary tool in the diagnosis of brain death. USG have been found to be useful in dissolution of clot in cerebral vessels when used in conjunction with thrombolytic agents. Many patients with subarachnoid hemorrhage have cardiac dysfunction. Bed side echocardiography can be used to diagnose cardiac dysfunction. In sitting position craniotomy: Transesophageal echocardiography can be used for the detection of patent foramen ovale and monitoring of venous air embolism. Traumatic brain injury and other associated injuries: USG can be used for detection of pupillary reaction to light in patients with orbital edema. These patients can have associated injuries like pneumothorax, which can be detected by USG. Deep veinous thrombosis (DVT) monitoring: Critically ill neurological patients are at high risk of DVT. USG can be used for monitoring of DVT.

Debendra Kumar Tripathy has completed his under graduation from Sambalpur University and has completed his post-graduation in anaesthesiology from National Board of Examination, New Delhi. He is working as additional Professor at AIIMS Rishikesh a premier Medical Institute. He has published more than 18 papers in reputed journals and has been faculty in more than 60 conference and workshops. He has also served as vice president, secretary and treasurer of Indian Society of Anaesthesiology, Pondicherry State.