047679   RIMAWI M R, AL - HIARI Y M, AL - BAKRI A G, BARDAWEEL S K (Allied and Medical Sciences Dep, , Al - Balqa Applied Univ, Email: Zarqa - 313, Jordan) : Antibacterial and anticancer properties of new fluoroquinolones. Asian J. Chem 2020, 32 (2), 427 - 34.

Fluoroquinolones are clinically successful antibacterial agents. In this work a series of novel 7 - substituted anilino - 8 - nitrofluoroquinolone esters (3 - 9), acids (10 - 16) and 8 - amino reduced derivatives (17 - 23) of the later compounds were successfully prepared and characterized using spectroscopic techniques. All the compounds tested (10 - 23) showed good antibacterial activity against both Gram - positive and Gram - negative standard bacterial strains. Interestingly, 8 - amino reduced derivatives (17 - 22) were more active against both standard strains than their 8 - nitro acid analogues (10 - 15). Moreover, some targeted compounds have shown reasonable activity mainly against resistant gram positive bacteria. In particular compounds 10, 12 and 16 displayed a potent activity against methicillin resistant S. aureus (MRSA) with MIC values of 4.7, 2.3 and 1.2 ?g/mL, respectively. Lipophilicity could be a plausible explanation of such higher activity against the gram positive resistant strain (MRSA). Biological screening of cytotoxic activity against five cancer cell lines using an in vitro cell culture system was achieved for all tested compounds. These derivatives have shown weak activity for most of them. Interestingly, more lipophilic nitroacids (10 - 15) were more active than their analogous reduced acids (17 - 22).

2 tables, 29 ref

047517   MAURYA K K , TRIPATHI A D, KUMAR D, SRIVASTAVA S K (Dairy Science and Food Technology Dep, Banaras Hindu Univ, Varanasi - 221 005, Email: kamleshcfstbhu@gmail.com) : Production, purification and characterization of prodigiosin by Serratia nematodiphilia (NCIM 5606) using solid - state fermentation with various substrate. Ann. Phytomed 2020, 9 (2), 302 - 6.

Agroindustrial wastes such as wheat bran, rice bran, orange peel, sweet lemon peel and pigeon pea peel were examined in order to choose the substrate that support the maximum prodigiosin yield using Serratia nematodiphilia. The conversion of agrowaste to a valuable prodigiosin by fermentation process is done to minimize the production cost and environmental risks. Findings revealed that the maximum production yield (1.3075 mg/l) was observed in wheat bran. Sweet lemon and orange peel gave prodigiosin yield of 0.1693 and 0.1495 mg/l, respectively. Pigeon pea and rice bran media gave minimum prodigiosin yield of 0.0082 and 0.0667 mg/l, respectively. Extracted pigment purified by TLC gave Rf value of 0.85. Further, purified pigment was characterized as prodigiosin by absorption sepctra (?max=535 nm) and FTIR.

4 illus, 1 table, 23 ref

047516   BUNKAR D S, ANAND A, MEENA K K, GOYAL S K, PASWAN V K (Dairy and Food Microbiology Dep, CDFT, MPUAT, Udaipur - 313 001, Rajasthan, Email: kamleshrj14@gmail.com) : Development of production technology for preparation of beetroot powder using different drying methods. Ann. Phytomed 2020, 9 (2), 293 - 301.

In recent years, the root vegetable, Beta vulgaris L. has attracted significant attention as a healthpromoting functional food product because it is a rich source of betalains and has high antioxidant capacity. So, there is an increased interest in preserving its nutrients through drying. In this study, the fresh beetroots (Vulgaris) were cleaned, peeled, crushed, and sliced longitudinal in four parts. The sliced beetroot dried separately by sun drying (35 - 45?C), tray drying (at different temperature i.e., 40, 50 and 60?C) and lyophilizer drying ( - 40?C), followed by grinding to powder using mixer grinder and subsequently packed in LDPE bags separately and stored at room temperature (25 - 30?C) for shelf life studies. The beetroot powder quality was assessed by using proximate composition, physicochemical and sensory analysis. There was significant amount of variation in chemical composition and organoleptic quality of different beetroot powders but the powder prepared through lyophilizer had higher total phenolic content (0.58 mg gallic acid eq/g), betalain content (4.89 mg/g) and antioxidant activity (DPPH free radical scavenging activity) (95.31%), compared to all other drying methods used. The statistical analysis in response of sensory properties of taste panel revealed that the beetroot powder obtained by lyophilizer was most acceptable with respect to color retention, flavour, texture and overall quality of product than the other drying methods.

3 illus, 7 tables, 46 ref

047515   PATEL H B, PATEL U D, MODI C M, FEFAR D T, BHADANIYA A R (Veterinary Pharmacology and Toxicology Dep, Junagadh Agricultural Univ, Junagadh - 362 001, Email: harshadvet@gmail.com) : Effect of piperine and quercetin pretreatment on safety profile of marbofloxacin after repeated oral administration in broiler chickens. Ann. Phytomed 2020, 9 (2), 283 - 92.

The present study was carried out to investigate the effect of pretreatment of bioenhancers like piperine and quercetin on safety profile of marbofloxacin after repeated oral administration in broiler chickens. Hemato - biochemical and histopathological alterations after repeated dose oral administration of marbofloxacin (5 mg/kg, PO, 5 days) in normal, piperine, quercetin and both in combination (10 mg/kg, each, PO, for 3 days) pretreated broiler chickens were investigated. After repeated oral administration of marbofloxacin, mean hemoglobin, packed cell volume, total erythrocyte count and total leukocyte count in quercetin pretreated broiler chickens were 9.52 ? 0.33 g/dl, 28.33 ? 1.00 %, 2.12 ? 0.05 x 106/?l and 20.38 ? 0.29 x 103/?l, respectively which significantly ( p<0.05) lower as compared respective values of 12.48 ? 0.47 g/dl, 35.72 ? 1.39 %, 2.80 ? 0.13 x 106/?l and 22.81 ? 0.27 x 103/?l of control group. However, these alterations were in the normal clinical range of broiler chickens. The differential leukocyte count, mean corpuscular volume, mean corpuscular hemoglobin concentration and mean corpuscular hemoglobin were not significantly different as compared to control group. Biochemical parameters, viz., alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, total protein, creatinine, blood urea nitrogen and total bilirubin were also not significantly different from control group. No major histomorphological changes were observed in liver, intestine and kidney of broiler chickens. The present dosage regimen of piperine, quercetin and marbofloxacin was found to be safe and might be helpful to explore therapeutic efficacy of herbal drugs with antibiotics in broiler chickens.

5 illus, 3 tables, 49 ref

047502   SABER M S, FAHIM H I, AHMED O M, AHMED N A, ABDEL - GABBAR M (Biochemistry Dep, Beni - Suef Univ, Beni - Suef, Egypt, Email: hhmgabar@yahoo.com, hhmgabar@science.bsu.edu.eg) : Assessment of the preventive effects of Silybum marianum (L.) Gaertn. seeds hydroethanolic extract and silymarin on complete Freund's adjuvant - induced arthritis in wistar rats. Ann. Phytomed 2020, 9 (2), 172 - 82.

This study aims to evaluate the antiarthritic activity of milk thistle and silymarin in complete Freund?s adjuvant (CFA) - induced arthritis in male rats. Rheumatoid arthritis was induced by injection of 0.2 ml of CFA into the right hind leg at two consecutive days. These rats were treated with milk thistle seeds hydroethanolic extract (MTHE) (100 mg/kg b.wt/day) and silymarin (100 mg/kg b.wt/day) for 9 and 18 days. MTHE and silymarin ameliorated the CFA - induced increase in paw circumference, serum RF, TNF - ?, IL - 1?, IL - 17 and PGE2, and liver lipid peroxidation. They also corrected the CFA - induced decrease in serum IL - 4 level and antioxidant defense system. Moreover, both treatments reduced the synovial hyperplasia and inflammation in ankle joints as well as lymphoblastic necrosis and mitotic figures in spleen and thymus of arthritic rats. In conclusion, MTHE and silymarin have antiarthritic efficacies which may be mediated via their anti - inflammatory and antioxidant properties in CFA - induced arthritic rats.

6 illus, 4 tables, 52 ref

047501   UDDIN M I, SRIKAR P V R, KARUNYA Y P, CHAKRABORTY R, DEEPIKA R (Pharmacology Dep, Pulla Reddy Institute of Pharmacy, Hyderabad - 502 313, Telangana, Email: imadpharma111@gmail.com) : Synthesis and characterization of chitosan nanoparticles loaded with 6 - gingerol isolated from Zingiber officinale Rosc.. Ann. Phytomed 2020, 9 (2), 164 - 71.

6 - gingerol is known to possess various pharmacological activities such as anticancer, obesity, antiinflammatory, antioxidant, antibacterial, antiangiogenic as well as gastroprotective activities. Dried rhizomes (1000 gm) of Zingiber officinale Rosc. was subjected to soxhlet extraction to obtain 200 gm of thick paste. It is mixed with silica gel to make fine powder of 230 gm. This fine powder is subjected to column chromatography. All fractions of n - hexane and ethyl acetate in the ratio of 6:4 and 5:5 showed the same Rf value (0.93) on thin layer chromatography (TLC), so they are mixed and evaporated to collect 6 - gingerol. High performance liquid chromatography (HPLC) of 6 - gingerol showed a retention time of 9.339 min. Structure of 6 - gingerol (C17H26O4) was elucidated by proton nuclear magnetic resonance spectroscopy (1H NMR) and mass spectroscopy (MS). Plane chitosan nanoparticles (PCNPs) and 6 - gingerol loaded chitosan nanoparticles (6 - GCNPs) were prepared by using ion gelation method. Synthesized nanoparticles were characterized by fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), particle size analyzer, polydispersity index (PI), and zeta - potential (ZP). FTIR analysis showed the presence of various functional groups. The results of SEM and ZP analysis showed that 6 - GCNPs have nanoparticle size (196 nm) and stability (?14.1). Our study confirms the easy method for the preparation of 6 - gingerol loaded chitosan nanoparticles and put forth the way to evaluate their biological activities.

7 illus, 28 ref

047499   ANSARI A, NAIKODI M A R, VIQUAR U , SIDDIQUI J I, KAZMI M H (Pharmacology Dep, National Research Institute of Unani Medicine for Skin Disorders, Hyderabad - 500 038, Telangana, Email: viquar.uzma@gmail.com) : Development of standard operating procedures, phytochemical screening with HPTLC fingerprint of a polyherbal formulation. Ann. Phytomed 2020, 9 (2), 142 - 54.

Unani Medicines have been in use from centuries, but have not been able to achieve its importance globally in spite of their efficacy. This is mainly due to the fact that there is a lack of standard operating procedures (SOPs) of the manufacturing steps and establishment of monographs of standardization parameters which create difficulties in establishing the quality of drug. The essential role for the development of SOPs and physiochemical standardization studies is to improve the quality of medicines. Likewise, there are a large number of drugs in the Unani System of Medicine which have proved to be much effective and safer than the Modern Medicine. The safety and efficacy of such drugs depend on the identity, purity and strength of the ingredient used in the formulation. Hence, SOPs becomes an essential part of preparation of formulation and motivated to study Itrifal Hakeem Ali (IHA) a Unani formulation for its standardization process and to develop SOPs. IHA, mentioned in the classical Unani Pharmacopoeias prepared in three batches, following the general method of preparation of Itrifal as described in Unani Pharmacopeia of India (UPI). IHA is quoted as quite effective in the classical Unani texts for skin depigmentation disorders, specifically for vitiligo, pityriasis and naevi. The standardization parameters as per UPI for organoleptic evaluation, physicochemical properties and safety studies, viz., microbial load, aflatoxin, heavy metal and pesticide residue contamination was studied. HPTLC fingerprint studies of IHA was developed and phytochemical screening carried out qualitative in alcohol, chloroform and aqueous extract of IHA to identify the nature of phytoconstituents present in the formulation.

15 illus, 12 tables, 33 ref

047498   KHARE C P, NAHARWAR A V (Society for New Age Herbals, New Delhi - 110 075, Email: khare.herbalsociety@gmail.com) : Ashwagandha (Withania somnifera (L.) Dunal): A scientific review with respect to Ayurvedic perspectives. Ann. Phytomed 2020, 9 (2), 134 - 41.

Ashwagandha (Withania somnifera (L.) Dunal, Fam. Solanaceae) is one of the most important herb of Ayurveda System of Medicine used for millennia as a therapeutic tonic (Rasayana) for its wide - ranging health benefits. Among the Ayurvedic Rasayana herbs, Ashwagandha holds the most prominent place. In present review, different aspects of Ashwagandha including botanical, phytochemical and pharmacological has been covered in light of ayurvedic references has been elaborated. It discusses different vernacular names, chemotypes and details of cultivated varieties available, in addition to morphological characters, quality gradings, DNA barcoding, chemical constituents of cultivated varieties and comparison of wild and cultivated varieties. It has also included pharmacological studies reported on Ashwagandha such as neurpprotective, immunomodulatory responses, antitumor, radiosensitizing effects, antistress, adaptogenic, anticancer and toxicological profiles relevant to AYUSH. Cultivated varieties also showed hope against Alzheimer?s disease. The major phytoconstituents have also been reported for their biological effects as reported. This review may be useful for academia and industry for identity confirmation and for referring other biological effects.

2 tables, 30 ref

047496   UDDIN M I, VEERESH B (Pharmacology Dep, Pulla Reddy Institute of Pharmacy, Hyderabad - 502 313, Telangana, Email: imadpharma111@gmail.com) : Systematic review on screening the role of chemosensitizer or synergistic drug and doxorubicin as dual drug loaded nanoparticle in overcoming multidrug resistant breast cancer. Ann. Phytomed 2020, 9 (2), 113 - 24.

Doxorubicin (DOX) is a widely used anticancer drug. Outspread and prolonged usage results in the development of multidrug resistance (MDR). Marry of a chemosensitizer/synergistic drug (CZ/SD) and DOX with a suitable drug delivery platform helped to overcome this problem. In this context, this study is framed to screen the role of chemosensitizer/synergistic drug and DOX as dual drug - loaded nanoparticles (NPs) in overcoming MDR breast cancer. To conduct a literature search authors used the following mesh terms: ?doxorubicin? and ?breast neoplasms? and ?nanoparticles? and ?drug resistance, multiple? and nonmesh terms such as ?dual drug? or ?codelivery? or ?coloaded? or ?coencapsulated? in different databases such as PubMed, google scholar, Science direct and Springer. These databases explored titles and abstracts of original research articles from inception to Jul 2020. This search identified a total of 44 papers. Three duplicate records are removed from these 44 papers. The remaining 41 records were screened by following their titles and abstracts. From 41 records, 14 removed as they were not fulfilling the eligibility criteria of the present study design. After removing sixteen articles (not satisfy inclusion criteria), finally eleven articles were included in this systematic review. This systematic review summarizes the enhanced chemotherapeutic effect of DOX in both in vitro and in vivo MDR cancer models. This improved efficacy of DOX was due to the simultaneous codelivery of DOX and CZ/SD by using a suitable drug delivery platform. In a word, this review emphasizes to move onward to conduct a meta - analysis of similar reported studies.

4 illus, 2 tables, 40 ref

047484   SREENIVASAGAN S, SUBRAMANIAN A K, RAJESHKUMAR S (Orthodontics Dep, Saveetha Dental Coll, Chennai - 600 077, T.N, Email: swapnasreenivasagan@gmail.com) : Assessment of antimicrobial activity and cytotoxic effect of green mediated silver nanoparticles and its coating onto mini - implants. Ann. Phytomed 2020, 9 (1), 207 - 12.

Mini - implants have become a major device in orthodontic treatment in this era, and practitioners intend to use for different clinical situations. Silver nanoparticle coating onto metal is known to reduce the colonization of bacteria, thus coating mini - implants will reduce the risk of peri - implantitis and implant failure. As there are new horizons being explored with nanotechnology, assessing its toxicity is very essential for its use in medicine. Chitosan based silver impregnated nanoparticles were synthesised using green tea extract and chitosan particles using thermal treatment. Formation of silver nanoparticles were assessed using double beam UV spectrophotometer. Mini - implants coated with silver nanoparticles were tested for antimicrobial property against Streptococcus mutans, Staphylococcus aureus, Lactobacillus and Candida albicans. Characterisation of the surface coating was done by using TEM. To assess the cytotoxic potential of silver nanoparticles, shrimp was cultured and were tested by adding various concentration of silver nanoparticle to it. UV - vis spectrophotometer was used to examine the formation of silver nanoparticles at 440 a.u peak. Transmission electron microscope (TEM) was used to characterize the nanoparticles that showed particles spherical in shape. A considerable zone of inhibition was also formed after 24 h of incubation for bacteria and 48 h of incubation of silver nanoparticles in Candida albicans. Cytotoxicity was assessed by testing on shrimp culture. Titanium mini - implants when coated with silver nanoparticles has excellent antimicrobial properties and, hence can be used a biomaterial in orthodontics but further tests are needed to evaluate the coating during and after placement.

8 illus, 3 tables, 26 ref

047479   SHASTRY R A, HABBU P V, SMITA D M, CHETAN S, KULKARNI V H (Pharmacognosy Dep, S. E. T's Coll of Pharmacy, Dharwad - 580 002, Karnataka, Email: rashastri123@gmail.com) : Isolation, characterization and evaluation of endophytic fractions of Centella asiatica (L.) Urb. (Leaves) for the management of Alzheimer's disease. Ann. Phytomed 2020, 9 (1), 171 - 80.

In the present investigation, we have carried out the isolation of fungal endophytes from Centella asiatica (L.) Urb. leaves followed by fermentation and extraction of fungal endophytes with non - polar solvents such as chloroform, ethyl acetate and n - butanol. Preliminary phytochemical investigation of endophytic crude fractions of plant was determined to detect the presence of primary/secondary metabolites. Based on the report of our earlier studies in in vitro antioxidant activity, endophytic crude fractions of plant ethyl acetate and n - butanol exhibited potential antioxidant activity. Therefore, potential endophytic fractions were further screened for nootropic activity, using various animal models such as Elevated plus maze, Morris water maze and Passive avoidance paradigm. To know the probable mode of action in these models, estimation of whole brain acetylcholinesterase and monoamines such as nor - adrenalin (NA), and dopamine (DA) was carried out. The pretreatment of ethylacetate fungal endophytic fractions (50 mg and 100 mg/kg, p.o) exhibited significant (p<0.01) improvement in learning and memory and also revealed significant ( p<0.01) decrease in whole brain Ache activity as compared to n - butanol fraction. Results were further supported by histopathological studies of young mice brain. Further, investigations are required to isolate and characterize the potential metabolites from endophytic fungal fractions of C. asiatica leaves responsible for the anti - Alzheimer?s activity.

6 illus, 4 tables, 43 ref

047478   DAS K , KHAN A A, GOWTHAMI V, SHARMA V, AHMED S Y (Pharmacognosy and Natural Product Chemistry Dep, Krupanidhi Coll of Pharmacy, Bangaluru - 500 035, Karnataka, Email: drkkdsd@gmail.com) : Mitigation of dermal auto immune disease through combined action of natural constituents: An advantageous over allopathic medicines. Ann. Phytomed 2020, 9 (1), 162 - 70.

The present study was aimed for the phytochemical screening of Phlebodium decumanum (Willd.) J. Sm. (PD) and Bauhinia variegata (L.) Benth. and their synergistic efficacy for the treatment of psoriasis. Herb extract ratio followed by Pharmacognostical screening for both the plants (PD and BV). Thereafter, TLC was performed to detect the constituents. Furthermore, two different dose levels (200 mg/kg b.w., and 400 mg/kg. b.w.) were used for both the methanol extracts (based on acute toxicity study) and the result was compared with standard Rentino A (0.05%). Psoriasis severity index (PSI) according to the phenotypic changes (redness, erythema, and scales) and histological features (epidermal thickness) were evaluated for 28 days. Finally, the correlation study was performed between the activity, yield of extract and constituent present. Series of chemical tests revealed the presence of alkaloids, flavonoids, steroids and polyphenols in both PD and BV plants and based on the chemical nature further Quercetin (flavonoid) was isolated from both the plants. Further, resulted progressive reduction (p<0.05) in the severity of psoriatic lesions (redness, erythema, and scales from histopathology study) from the 7th day to the 28th days and decreased epidermal thickness in animals treated with combined extracts at a dose of 400 mg/kg b.w. Finally, the result concluded that the isolated Quercetin showed significant antipsoriasis activity when compared with the combination of methanolic extract of both the studies plants by the mechanism of inhibition of the keratinocyte proliferation.

14 illus, 6 tables, 36 ref

047475   THAKUR S, KHAN A A, AZMI W (Biotechnology Dep, Himachal Pradesh Univ, Shimla - 171 005, Himachal Pradesh, Email: wamikazmi@rediffmail.com) : Potential of oligosaccharides from inulin in human nutrition and health. Ann. Phytomed 2020, 9 (1), 141 - 6.

Inulins are linear fructan polymers which contain fructose units joined by ? - 2,1 glycosidic bonds, typically terminating in a glucose residue linked by an ? - 1,2 bond as in sucrose. The major source of inulin is plants like Jerusalem artichoke and chicory root. Fructo - oligosaccharides consist of a fructose units polymerized to different extent and can be formed in vitro from substrate such as inulin. These oligosaccharides can be produced from the enzymatic hydrolysis of inulin by inulinase under controlled reaction conditions. In recent years, the oligosaccharides production has revolve around it?s cost effective production from inexpensive and abundantly available raw materials. Inulin is a very promising source for oligosaccharide production. An exoinulinase and invertase activities free endoinulinase is required to acts on inulin because these two enzymes contaminate the final products with release of free sugars, which subsequently require more stringent purification protocols. Oligosaccharides obtained from inulin have similar chemical structures to fructo - oligosaccharides which were obtained by reaction of fructosyltransferase on sucrose. These oligosaccharides are regarded as a soluble dietary fiber, non - cariogenic, of low caloric value and showed strong bifidus - factors. They have proven health benefits which include role in absorption of calcium and minerals, replacement of sugar and fat in food products, reduction in cholesterol and ability to control cancer.

2 illus, 1 table, 49 ref

047474   SHWETHA R, ROOPASHREE T S, DAS K, PRASHANTH N, KUMAR R (Pharmacognosy Dep, Government Coll of Pharmacy, Bengaluru - 560 027, Karnataka, Email: shwetharamesh641@gmail.com) : HPTLC fingerprinting of various extracts of Couroupita guianensis flowers for establishment of in vitro antimalarial activity through isolated compound. Ann. Phytomed 2020, 9 (1), 133 - 40.

Malaria is the most common infectious disease, due to multi drug resistance parasites and the limited number of effective drugs available in this situation is complicated, it is necessary to discover new antimalarial drugs. HPTLC fingerprint analysis is the most potent tool for quality control and standardization of herbal drugs. In the present study, five different extracts of Couroupita guianensis Aubl. flowers were screened for their anti - malarial activity by in vitro inhibition of ? hematin formation assay and their HPTLC fingerprinting was carried out. The most potent antimalarial activity was shown by ethyl acetate extract of flowers then isolation of compound responsible for activity was carried out and characterized by UV, FTIR, H - NMR, Mass Spectroscopy, the structure was found to be Stigmasterol.

10 illus, 4 tables, 36 ref

047469   VARGHESE L N, MEHROTRA N (Biochemistry Dep, SVKM's Mithibai College of Arts, Mumbai - 400 056, Maharashtra, Email: nupur.mehrotra@mithibhai.ac.in) : ? - Amylase inhibitory activity of microencapsulated Nigella sativa L. and herbdrug interaction: An in vitro analysis. Ann. Phytomed 2020, 9 (1), 107 - 12.

Diabetes mellitus poses a threat to the developed and developing countries, especially India. The availability of drugs for diabetes mellitus remains largely inadequate, especially in the rural areas of India. Various antidiabetic medications available in the market result in undue side effects. Spices and herbs have long been used as a traditional medicine for diabetes as they possess several antidiabetic properties. In the present study, microencapsulated Hydroacetone extract of Nigella sativa L. seeds was analyzed for its ? - amylase inhibitory activity and its herb - drug interaction with antidiabetic drug, Acarbose. The IC50 value of N. sativa extract was found to be 314.4 ?g/ml while that of the microencapsulated extract was 224.1 ?g/ml indicating that microencapsulation enriches the ? - amylase inhibitory activity. The extract released from microcapsules, led to higher ? - amylase inhibitory activity in comparison to that in presence of the drug Acarbose, over 360 min. This elucidates that microencapsulated N. sativa is less likely to cause serious hypoglycemia or diabetic coma, since for its antidiabetic properties, the spice is consumed along with the regular therapeutic drugs. Further, microencapsulated N. sativa extract shows promising potential as an antidiabetic that can be incorporated as a nutraceutical.

4 illus, 6 tables, 28 ref

047467   DAS K , ABDOOLAH T A, SOUNDER J (Krupanidhi Coll of Pharmacy, Bangalore - 560 035, Email: drkkdsd@gmail.com) : Formulation and evaluation of Stevia oral hygiene preparation: A noble herbal toothpaste. Ann. Phytomed 2020, 9 (1), 91 - 7.

Polyherbal toothpastes are gaining importance due to less side effects and maintain the healthy teeth than non herbal toothpastes but use of sole herbal in toothpaste formulation with multiple action is rare. The aim of the present research was to formulate and evaluate herbal toothpaste, prepared with Stevia extract. Four different formulations were prepared: 0.5%, 1.0%, 2 % and 3%. All the formulated toothpaste was satisfied with all the required conditions for avoiding halitosis, prevent dental caries and periodontal diseases. The formulated herbal toothpaste compared with marketed preparation. Various physical parameters were evaluated as per Bureau of Indian Standards (BIS), and International Conference on Harmonisation (ICH) guidelines and revealed F3 (2 % Stevia extract) was the better formulation with respect to various compiled results. The colour of F3 formulation was moss green, smooth in nature, relative density 11.098, pH - 7.12, extrudability - 96.2%, good spreadability (5.4 cm/sec), viscosity (78302 cP) and quite stable for 6 months. The antimicrobial activity is evaluated against both the Grampositive and Gram - negative bacteria and revealed formulated herbal toothpaste with 2.0 % Stevia extract exhibited significant activity with the zone of inhibition against Gram - positive and Gramnegative bacteria at MIC of 20 ?g/ml. The result of this investigation showed better patronizing and engrossing passion over commercial preparation (non - herbal and herbal) with formulated natural Stevia toothpaste. The research was challenging and showed good scope in future dental research as well as economic to the World market for human use.

3 illus, 4 tables, 38 ref

047466   THAKUR K, MOL P M, GAWHANKAR M, GUPTA H, PATIL P, SALMANI S, THAKUR M (Shree Dhootapapeshwar Limited, Panvel - 410 206, Navi Mumbai, Email: ksthakur123@gmail.com, kst@sdlindia.com) : Physicochemical characterization and antimicrobial properties of Mahamanjishthadi kadha: An Ayurvedic formulation. Ann. Phytomed 2020, 9 (1), 78 - 90.

Skin infections are common throughout the world. With high infectivity amongst skin pathogens, approximately 300 million people are affected worldwide. The increasing rate of failure of chemotherapeutics and antibiotic resistance exhibited by pathogenic microbial infectious agents, has increased the use of Ayurvedic medicines. This study aims to standardize an Ayurvedic formulation, Mahamanjisthadi kadha and to evaluate its antimicrobial properties against skin infection, causing pathogens. Physicochemical analysis such as organoleptic tests, pH, alcohol content, Brix and Specific gravity was done. Phytochemical screening was performed for various bioactive compounds. Heavy metals, aflatoxins and microbial load were checked for contaminants. Chromatographic analysis was performed to estimate lupeol, ellagic acid and gallic acid, using high performance thin layer chromatography (HPTLC). Antimicrobial activity was determined against five common pathogens causing skin infections, using well - diffusion method. Organoleptic tests confirmed brown color and characteristic odor of self generated alcohol with bitter and astringent taste. Phytochemical screening showed the presence of alkaloids, steroids, triterpenoids, tannins, phenolic compounds, saponins and flavonoids. HPTLC analysis confirmed the presence of lupeol, ellagic acid and gallic acid. Heavy metals, aflatoxins and microbial load were found within the permissible limit. Antimicrobial study showed the formulation could inhibit growth of Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Staphylococcus epidermidis and Escherichia coli. The study presented has completely characterized the formulation will serve as reference to develop quality control profile of Mahamnjishtadi kadha and help in validating therapeutic efficacy of this formulation.

6 illus, 12 tables, 65 ref

047465   ZAFAR M, NAIKODI M A R, NAGAIAH K, RAJU P V S (CSIR - Indian Institute of Chemical Technology, Tarnaka, Hyderabad - 500 007, Telangana, Email: nagaiah@iict.res.in) : Development of standard operating procedures and quality standard of Kushta Gaodanti with HPTLC fingerprinting and hyphenated techniques. Ann. Phytomed 2020, 9 (1), 66 - 77.

Kushta Goadanti is a compound Unani formulation, prescribed in Unani System of Medicine for therapeutic actions, such as Daf - e - Tap (Antipyretic), Mohallil - e - Waram (Anti - inflammatory) and therapeutic used such as In Waja - ul - Mafasil (Arthralgia), Niqras (Gout) and Irq - un - Nisa (Sciatica) has been taken up for standardization by modern hyphenated techniques, so as to ascertain its quality standards. In the present study, Kushta Gaodanti was prepared by classical methods and standardization, was carried out in the premises of Department of Ilmul Advia and approved by the Institutional Ethical Committee (NTC/A/16/101), Government Nizamia Tibbi College, Hyderabad and the modern hyphenated techniques were studied in the laboratory of CSIR - IICT (DW 0560), Tarnaka. In this study, Kushtae Gaodanti was prepared by three methods. The Kushta Gaodanti prepared was analyzed through organoleptic properties, preliminary tests and physicochemical parameters, HPTLC fingerprint study along with hyphenated techniques such as XRD studies for the metal analysis in the samples. Moreover, elements and heavy metals were also estimated in all the three samples of Kushta Gaodanti. The data and results obtained in the study are thoroughly described in the paper. The parameters such as physicochemical parameters, high performance thin layer chromatography (HPTLC) and XRD studies which are carried out, revealed as the specific identity for the drug under study and to establish as a pharmacopoeial standards. Results suggested that the drug is safe for therapeutic use and its batch - to - batch identification and determination of quality can be checked using the present study as reference standard in future.

7 illus, 3 tables, 32 ref

047464   UDDIN M I, VANDANA A, KAVYA G, SYED Y H (Pharmacology Dep, Pulla Reddy Institute of Pharmacy, Hyderabad - 502 313, Telangana, Email: imadpharma111@gmail.com) : Systematic study on protective role of date palm (Phoenix dactylifera L.) on central nervous system disorders. Ann. Phytomed 2020, 9 (1), 58 - 65.

Present study was designed to screen the role of Phoenix dactylifera L. (P. dactylifera) in CNS disorders. All the records were summarized according to PRISMA statement of systematic reviews. By applying identification, exclusion, eligibility and inclusion criterias, 17 original research articles were selected. In these studies, P. dactylifera was used as either long term dietary supplementation or aqueous or ethanolic or methanolic extracts. These studies reported different activities such as anti - Alzheimer?s, anticonvulsant, cerebral antiischemic, neuroprotective, anxiolytic, nootropic and antipsychotic. Mechanisms underlying anti - Alzheimer?s activity of P. dactylifera were antioxidant, anxiolytic, cholinomimetic and anti - inflammatory actions. Anticonvulsant activity was due to GABA facilitatory action and blocking of NMDA action. Antioxidant nature of flavonoids, tannins and phenols of P. dactylifera showed neuroprotective and cerebral anti - ischemic actions. whereas antipsychotic actions were due to decreased serotonergic and dopaminergic transmissions and increased cholinergic transmission. This systematic study successfully establishes and supports protective role of P. dactylifera in treatment of CNS related disorders and put forth the path to carry out the meta - analyses for increasing the use of safer plant based remedies.

2 illus, 1 tables, 62 ref

047463   MAMARASULOV B, DAVRANOV K, JABBOROVA D (Institute of Microbiology of the Academy of Sciences of Uzbekistan, Tashkent, Uzbekistan, Email: k.davranov@mail.ru, bakhodir85@mail.ru) : Phytochemical, pharmacological and biological properties of Ajuga turkestanica (Rgl.) Brig (Lamiaceae). Ann. Phytomed 2020, 9 (1), 44 - 57.

Ajuga turkestanica (Rgl.) Brig (Lamiaceae) is a medicinal, herbaceous flowering species which has been traditionally used in Uzbekistan for cure of various human diseases like, heart disease, muscle aches and stomach problems. This plant possesses diverse pharmacological activities, antibacterial activity, hypoglycemic activity, hypolipidemic action, anabolic activity: growth promotion, increase in protein synthesis in skeletal muscle cells, hepatoprotection activities. Several compounds have been isolated from A. turkestanica, which display a wide spectrum of biological and pharmacological activities. This review provides scientific information on the biologically active substances of the medicinal plant A. turkestanica, their structure, pharmacology, and applications in pharmaceuticals and medicine.

5 illus, 5 tables, 133 ref

047460   KHAN A A, KHAN S, KHAN U, DAS K (Medicine Dep, California Univ, San Diego - 92121, USA , Email: khan.dr.adnan@gmail.com) : The COVID - 19 pandemic: A scoping review. Ann. Phytomed 2020, 9 (1), 18 - 26.

The entire world is currently under the grip of a pandemic of COVID - 19, caused by the novel coronavirus, also known as SARS - CoV2. The virus caused an initial outbreak in Wuhan, China with affected individuals presenting with viral pneumonia. Early on, in the outbreak, metagenomic RNA sequencing shed light on this novel coronavirus which is an enveloped virus, containing a single stranded RNA and gets it name from the crown like spikes on their surface. With limited availability of antivirals at the beginning of the pandemic and no vaccine; a lot of medications were initially re - purposed to treat COVID - 19. As more clinical studies continue to be done, and the availability of antivirals increase, there is a huge need to consider alternative ways and means to boost one?s immune system along with preventive measures of social distancing, masking and isolation of infected individuals. Natural plant - based products with medicinal properties along with increased exercise and meditation to relax and de - stress, are vital resources that should be overlooked.

2 tables, 36 ref

047431   RALHAN S, ARYA R C, GUPTA R, WANDER G S, GUPTA R K, GUPTA V K, BAGGA S, MOHAN B (Cardiology Dep, Unit Dayanand Medical Coll and Hospital, Ludhiana, Punjab - 141 001, Email: drrajesharya@yahoo. Com) : Cardiothoracic surgery during COVID - 19: Our experience with different strategies . Ann. Card. Anaesth 2020, 23 (4), 485 - 92.

An acute respiratory disease (COVID - 19), caused by a novel coronavirus (SARS?CoV?2,), has been declared a pandemic by WHO. A surgery on COVID?19 patients not only involves a risk of spread of the disease but also there is a serious concern for the patient?s surgical outcomes and resources requirement. The retrospective study is aimed to provide a protocol for pre?operative testing of SARS CoV?2 using RT?PCR in the patient undergoing cardio?thoracic surgeries. To analyze the impact of pre?operative testing of SARS? CoV?2 using RT?PCR in the patient undergoing elective cardio?thoracic surgeries. The patient who underwent surgical interventions during the COVID?19 lockdown period was divided into two phases. Phase I (without COVID?19 RT?PCR testing) and Phase II (with pre?operative COVID?19 RT?PCR testing). The retrospective comparison between the two study groups was done using Student t?test, Mann?Whitney U, and Chi square (?2) test depending upon the clinical variable to be analyzed. During the early phase (phase I), 26 patients underwent cardio?thoracic surgery without COVID?19 RT?PCR test. Whereas, during phase II, all patients were tested for COVID?19 using RT?PCR, preoperatively and a total of 64 surgeries were performed during this phase. One patient planned for CABG was positive on RT?PCR for COVID?19 and was sent to the quarantine ward. The difference in the pre?operative hospital stay between two groups was found to be statistically significant and a significant decrease in the number of PPE kits used, during the phase I. All asymptomatic patients should be tested for COVID?19 using RT?PCR prior to cardio?thoracic surgeries not only to contain the disease but to avoid potential implications of COVID?19 on the perioperative course, without added financial implications.

2 tables, 23 ref

047430   GEORGE G, AV V, PHILIP M A, VITHAYATHIL R, SRINIVASAN D, FX S P, SAHAJANANDAN R (Cardiothoracic Surgery Dep, Christian Medical Coll and Hospital, Vellore, Tamil Nadu, Email: drvarshaav@gmail.com) : Myocardial protection in cardiac surgery: del nido versus blood cardioplegia . Ann. Card. Anaesth 2020, 23 (4), 477 - 84.

del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase?MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30?day mortality or postoperative myocardial infarction in both the groups. DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.

5 tables, 28 ref

047429   BISOYI S, JAGANNATHAN U, DASH A K, MOHAPATRA R, NAYAK D, SAHU S, SATYANARAYAN P (Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar - 751 005, Odisha, Email: dr_sbisoyi@rediffmail. Com) : Decision making, management, and midterm outcomes of postinfarction ventricular septal rupture: Our experience with 21 patients . Ann. Card. Anaesth 2020, 23 (4), 471 - 6.

Ventricular septal rupture (VSR) is a dreaded complication following myocardial infarction. Surgical repair of VSR is associated with significant early mortality. Variable outcomes in terms of early mortality and midterm functional status have been reported from different centers. In our study, we attempt to review the experience of decision making and surgical repair of postinfarction VSR, and to analyze the factors contributing to the early mortality and midterm outcome after repair. It is a retrospective study. Data were summarized retrospectively by frequencies and percentages for categorical factors, and means and standard deviations for continuous factors. Multivariate logistic regression, odds ratios, 95 % confidence intervals, and P value were calculated for different variables to determine their independent effect on operative mortality. All surviving patients answered the EQ?5D Health Questionnaire. Preoperative renal failure, left ventricular dysfunction (moderate and severe), and Killip class (III and IV) were significantly associated with early mortality after surgery. Small residual ventricular septal defect (VSD) was not found to affect the midterm quality of life. Early surgical repair benefits the patient by preventing early end?organ damage. The renal failure left ventricular dysfunction (moderate and severe) and Killip class (III and IV) adversely affect early outcomes after surgery. Small residual ventricular septal defect (VSD) does not affect the midterm quality of life.

1 illus, 5 tables, 33 ref

047428   KANCHI M, INDERBITZIN D T, RAMESH K N, SURESH P V, MAYYA S S, SIVANANDAM S, BELANI K (Anaesthesiology and Critical Care Medicine Dep, Narayana Hrudayalaya Hospitals, engaluru - 560 099, Karnataka, Email: muralidhar.kanchi.dr@ narayanahealth.org) : Effect of dexmedetomidine on pulmonary artery pressure in children with congenital heart disease and pulmonary hypertension . Ann. Card. Anaesth 2020, 23 (4), 465 - 70.

This study was undertaken to determine the effects of dexmedetomidine on pulmonary artery pressure (PAP) in children with congenital heart disease (CHD) and pulmonary hypertension (PH) undergoing cardiac catheterization with and without a planned intervention during monitored anesthetic care using midazolam and ketamine. Materials and Methods: Children (<18 years) with known CHD and PH who were scheduled for cardiac catheterization and interventional procedures were included in the study. The procedures were performed under monitored anesthesia. After obtaining baseline PAPs, an intravenous (IV) infusion of dexmedetomidine (1 ?g/kg) was given for over 10 min. During infusion, heart rate (HR), blood pressure (BP), respiratory rate (RR), and peripheral arterial oxygen saturation (SPO2) were recorded every 2 min until completion of dexmedetomidine infusion, 15 min later, and when the procedure was completed. In addition, pulmonary artery systolic and diastolic pressures, and mean pulmonary artery pressure (MPAP) were recorded and the pulmonary artery systolic pressure (PASP)/systolic blood pressure (BP) ratio was calculated. Results: All children tolerated the procedure without adverse events. The HR decreased significantly over time during dexmedetomidine infusion. The changes in systemic systolic BP and PAPs were not significantly different from the baseline value at all points of measurement as was the ratio between the systolic pulmonary artery and systolic systemic BPs. Conclusions: Administration of dexmedetomidine in a dose of 1 ?g/kg over 10 min did not significantly alter the PAP in children with CHD and PH. There was a decrease in the HR that was not clinically significant. The children tolerated dexmedetomidine without adverse events.

4 illus, 1 table, 23 ref

047427   BORDE D P, PANDE S, ASEGAONKAR B, KHADE S, GEORGE A, JOSHI S (Cardiac Anesthesia Dep, United CIIGMA Hospital, Aurangabad, Maharashtra - 431 005, Email: deepakborde2482@ gmail.com) : Does the endotracheal tube cuff pressure increases with transesophageal probe insertion? . Ann. Card. Anaesth 2020, 23 (4), 460 - 4.

The cuff pressure (CP) of the endotracheal tube (ETT) exceeding 30 cm of H2O results in reduced perfusion of lateral mucosa of trachea leading to complications. As the posterior tracheal wall is in contact with the esophagus, there is a possibility that the insertion of transesophageal echo (TEE) probe may compress the tracheal wall and increase CP. This study was aimed to assess the impact of TEE probe insertion on CP in adults undergoing cardiac surgery. Prospective observational study of 65 patients at tertiary care level hospital. After balanced general anesthesia, patients were intubated with high volume low?pressure ET.TEE probe was then inserted with gentle jaw thrust. CP was measured by standard invasive pressure monitoring device at four points: T1 at baseline before TEE probe insertion; T2 maximum CP noted at TEE probe insertion; T3 at 5 min post TEE probe insertion; and T4 at post?TEE exam. CP was compared between pairs of time points (T1 vs. T2; T1 vs. T3; and T1 vs. T4) using Mann?Whitney U test. Factors predicting CP >30 cm of H2O at T4 were assessed by backward stepwise regression. CP (mean ? S.D.) at T1, T2, T3, and T4 was 22 ? 3, 38 ? 10, 30 ? 6, and 30 ? 7, respectively. CP increased significantly from T1 to T2 (P < 0.001), T1 to T3 (P < 0.001), and T1 to T4 (P < 0.001). There were 26 patients (40 %) with CP >30 cm of H2O at end of TEE exam (T4). On multivariate analysis baseline, CP (T1) >20 cm of H2O was significantly associated with CP >30 cm of H2O at end of TEE exam with Odd?s Ratio (OR) of 8.5 (1.76?41.06, P = 0.008). To conclude, the CP increases significantly with TEE probe insertion in 40 % of patients exceeding a safe limit of 30 cm of H2O. The monitoring and optimization of CP is advisable.

2 illus, 1 table, 22 ref

047426   SUBRAMANIAN H, PARIDA S, THANGASWAMY C R, BADHE A S, BV S C, MISHRA S K (Anesthesiology and Critical Care and Cardiothoracic and Vascular Surge, JIPMER, Puducherry - 605 006, Email: jipmersatyen@gmail. Com) : Relationship between transesophageal echocardiography?derived pulmonary artery systolic pressure measurements and early morbidity in patients undergoing coronary artery bypass grafting . Ann. Card. Anaesth 2020, 23 (4), 453 - 9.

We studied the relationship between intraoperative transesophageal echocardiography?derived (TEE?derived) pulmonary artery systolic pressure (PASP) measurements with early morbidity in on?pump coronary artery bypass grafting (CABG) surgery. The objective of the study was to assess whether TEE?derived elevated PASP is independently predictive of significant morbidity. Prospective observational study in a university hospital. Around 54 patients who underwent CABG under cardiopulmonary bypass (CPB) were divided into two groups; with PASP ?35 mmHg and PASP <35 mmHg, assessed by intraoperative TEE. Outcomes studied were poor coronary revascularization, postoperative arrhythmias, myocardial infarction, respiratory failure, intra?aortic balloon pump use, pacemaker dependence, significant inotrope use, prolonged intensive care unit stay, and the total length of stay in the hospital. Mortality analysis was not a part of this study since expected sample sizes were low. Patients with PASP ?35 mmHg had a higher risk of respiratory failure, increased inotrope use and prolonged hospital stay, although multivariate analysis failed to demonstrate an independent association of PASP with these outcomes. Diabetes mellitus (DM), peripheral vascular disease, low cardiac output and elevated mitral annular E/e? ratio were significantly associated with higher pulmonary arterial pressures. Multivariate analysis showed that PASP was independently associated with higher mitral annular E/e? ratio. Our study, therefore, suggests that higher PASP may predict higher left ventricular filling pressures, and although elevated PASP ?35 mmHg may be associated with DM; peripheral vascular disease, lower intraoperative cardiac output, postoperative respiratory failure, higher inotrope use, and delayed hospital discharge, it is not an independent predictor of any of these variables.

1 illus, 4 tables, 22 ref

047425   PAN S J, FRABITORE S Z, INGRAM A R, NGUYEN K N, ADAMS P S (Anaesthesiology and Perioperative Medicine Dep, , PA, USA, Email: adamsp@upmc.edu) : Transesophageal probe placement increases endotracheal tube cuff pressure but is not associated with postoperative extubation failure after congenital cardiac surgery . Ann. Card. Anaesth 2020, 23 (4), 447 - 53.

The concomitant use of cuffed endotracheal tubes (ETT) and transesophageal echocardiography (TEE) probes increases ETT cuff pressures (CP), which may contribute to mucosal ischemia and perioperative complications such as failed extubation. To assess changes in ETT CP after TEE insertion in patients of different age groups undergoing congenital heart surgery and examine the relationship between ETT CP and postoperative extubation failure. Single?center quality improvement project. ETT CP was measured with a manometer following intubation and again after TEE insertion. Tracheal perfusion pressure was then calculated and postoperative extubation failures were recorded. Chi?square testing, Fisher?s?exact testing, one?way analysis of variance testing or Kruskal?Wallis testing with Dunn?s pairwise, and student?s t?test or Wilcoxon rank?sum testing were used to analyze the data. Median ETT CP increased significantly after TEE insertion in each age group, with infants showing a smaller magnitude of increase (+2 [1?6] cm H2O, P < 0.001) than adults (+12 [8?14] cm H2O, P = 0.008) (intergroup comparison P = 0.002). Five patients (9 %) failed extubation, all of which were infants. Within the infant subgroup, no significant difference existed between failed vs successful extubation regarding ETT CP during bypass (15 ? 1 vs 16 ? 2 mmHg, P = 0.206) or tracheal perfusion pressure pre?bypass (34 ? 9 vs 38 ? 11 mmHg, P = 0.518), during bypass (20 ? 9 vs 22 ? 6 mmHg, P = 0.697), or post?bypass (42 ? 9 vs 41 ? 9 mmHg, P = 0.923). There was a significant difference in cardiopulmonary bypass duration (151 ? 29 vs 85 ? 32 min, P < 0.001). Factors beyond intraoperative ETT CP likely play a larger role in postoperative extubation failure.

1 illus, 4 tables, 19 ref

047424   SURESH V, SETHURAMAN M, KARUNAKARAN J, KOSHY T (Anaesthesiology Dep, Sree Chitra Tirunal Institiute for Medical Sciences and Technology, Thiruvananthapuram - 695 011, Kerala, Email: koshy@sctimst.ac.in) : Fluid responsiveness to passive leg raising in patients with and without coronary artery disease: a prospective observational St . Ann. Card. Anaesth 2020, 23 (4), 439 - 46.

Hemodynamic stability and fluid responsiveness (FR) assume importance in perioperative management of patients undergoing major surgery. Passive leg raising (PLR) is validated in assessing FR in intensive care unit patients. Very few studies have examined FR to PLR in intraoperative scenario. We prospectively studied FR to PLR using transesophageal echocardiography (TEE), in patients with no coronary artery disease (CAD) undergoing major neurosurgery and those with CAD undergoing coronary artery bypass grafting (CABG). We enrolled 29 adult consenting patients undergoing major neurosurgery with TEE monitoring and 25 patients undergoing CABG. After induction of anesthesia, baseline hemodynamic parameters were obtained which was followed by PLR using automated adjustment of the operating table. Clinical and TEE?derived hemodynamic parameters were recorded at 1 and 10 min after PLR following which patients were returned to supine position. A total of 162 TEE and clinical examinations were done across baseline, 1 and 10 min after PLR; and paired comparison was done at data intervals of baseline versus 1 min PLR, baseline versus 10 min PLR, and 1 min versus 10 min PLR. There was no significant change in hemodynamic variables at any of the paired comparison intervals in patients undergoing neurosurgery. CABG cases had significant hemodynamic improvement 1 min after PLR, partially sustained at 10 min. Patients undergoing CABG had significant hemodynamic response to PLR, whereas non?CAD patients undergoing neurosurgery did not. A blood pressure? left ventricular end?diastolic volume combination represented strong correlation in response prediction (Pearson?s coefficient 0.641; P < 0.01).

1 illus, 4 tables, 30 ref

047423   KUNIGO T, NAWA Y, YOSHIKAWA Y, YAMAKAGE M (Anesthesiology Dep, Hokkaido P.W.F.A.C. Obihiro Kosei General Hospital, Hokkaido 080 - 0024, Japan, Email: tatsuya_9250@yahoo. co.jp) : Tracheal extubation of anesthetized pediatric patients with heart disease decreases the incidence of emergence agitation: A retrospective study . Ann. Card. Anaesth 2020, 23 (4), 433 - 8.

Emergence agitation for pediatric patients after general anesthesia is one of the postoperative complications. The relationship between consciousness at tracheal extubation and emergence agitation is not clear. The aim of the present study was to determine whether tracheal extubation of anesthetized pediatric patients with heart disease by propofol decreases the incidence of emergence agitation. This was a retrospective case - control study conducted at a children?s hospital. Pediatric patients with heart disease aged 0 - 14 years who underwent cardiac catheterization under general anesthesia by propofol between October 2014 and September 2018 were enrolled. The incidence of emergence agitation by anesthetized extubation was compared with that by awake extubation. Logistic regression analysis was performed. Anesthetized extubation was performed in 202 patients and awake extubation was performed in 56 patients. The incidence of emergence agitation was significantly lower in patients who underwent anesthetized extubation than in patients who underwent awake extubation (25.2 % vs. 69.6 %, P = 0.000). In logistic regression analysis, anesthetized extubation [odds ratio (OR): 0.075, 95 % confidence interval (CI): 0.034 - 0.165, P = 0.000] and older age (OR: 0.808, 95 % CI: 0.728 - 0.897, P = 0.000) were associated with a decreased incidence of emergence agitation, and preoperative anxiety (OR: 2.220, 95 % CI: 1.060 - 4.660, P = 0.03) was associated with an increased incidence of emergence agitation. Tracheal extubation under anesthesia by propofol decreases the incidence of emergence agitation in pediatric patients with heart disease.

2 illus, 3 tables, 25 ref

047422   KUNDRA T S, THIMMARAYAPPA A, SUBASH S S, KAUR P (Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, Email: tanveerashwini@yahoo. Com) : Monitoring of limb perfusion after vascular surgery in critical limb ischemia using near - infrared spectroscopy: A prospective observational study . Ann. Card. Anaesth 2020, 23 (4), 429 - 32.

Intra and postoperative perfusion monitoring should be used in critical limb ischemia patients undergoing vascular surgery to improve outcomes and reduce costs. While a pulse oximeter can be applied on the affected limb to monitor the arterial saturation of the limb, thus reflecting flow in that limb, we need to focus on other important parameters like muscle oxygen consumption and regional blood flow for a good outcome. Near - infrared spectroscopy (NIRS) can be used in such patients to monitor regional and tissue oxygenation. In this prospective observational study, 30 adult patients undergoing infra - inguinal bypass were recruited. All these patients were given combined spinal - epidural anesthesia. In addition to routine monitoring, a pulse oximeter and NIRS electrodes were applied on the affected limb. rsO2, limb spO2, and Doppler signals were noted before the induction of anesthesia (baseline) and postoperatively at 0, 6, and 12 h. Improvement in rsO2 and limb spO2 values after surgery was noted and fall in these values was evaluated. Pearson correlation between rsO2 and limb spO2 was assessed. The data was analyzed using repeated - measures ANOVA. Pearson correlation between rsO2 and limb spO2 was r > 0.8. Two patients had a fall in rsO2 in postoperative period, which co - related with a fall in limb spO2 and decreased/absent Doppler signals. NIRS represents a noninvasive and reliable means to monitor limb perfusion in patients undergoing vascular surgery for rest pain.

3 tables, 10 ref

047421   NANDITHA S, MALIK V (Cardiac Anesthesia Dep, AIIMS, Ansari Nagar, New Delhi, Email: dr.vishwasmalik@gmail. Com) : Comparison of flow - independent parameters for grading severity of aortic stenosis using intraoperative transesophageal echocardiography - a prospective observational study . Ann. Card. Anaesth 2020, 23 (4), 425 - 8.

Discrepancies have been reported in grading of severity of aortic stenosis. We propose to compare Aortic valve area by continuity equation, Dimensionless Index and Acceleration time/ Ejection time in patients with documented severe aortic stenosis with normal left ventricular function by TEE after induction of anesthesia. This might give use insight about the best parameter we can rely on intra - operatively for decision making. 60 patients with severe AS undergoing elective cardiac surgery were enrolled in our study. Post intubation trans - thoracic echocardiography (TEE) was performed and above mentioned parameters was noted. 96.7 % of patients continued in severe AS category when AS was measured using AVA as echo parameter. So there is 3.3 % disparity. There was disparity in 13.3 % of cases when DI was considered. And there was 43.3 % disparity when AT/ET was considered. Perioperative grading of aortic stenosis continues to be a challenge for cardiac anesthesiologists. Multiple echocardiographic parameters have to be considered. We have found AVA and DI to have less disparity compared to AT/ET.

1 illus, 3 tables, 18 ref

047420   SABZI F, ASADMOBINI A (Cardiovascular Research Centre, Kermanshah - 6715847145, Iran, Email: a.asadmobini@gmail. Com) : Gender difference in long - .and short - term outcomes of off - pump coronary endarterectomy . Ann. Card. Anaesth 2020, 23 (4), 419 - 24.

The role of gender in the selection of the most effective method for treatment of patients with diffused coronary artery diseases remains a matter of debate. This study thus evaluated the effect of gender on long - and short - term outcomes of off - pump coronary endarterectomy (CE). This was a single - center retrospective study of patients who had undergone coronary artery bypass graft (CABG). The patients were divided into two groups, the CABG and the CABG + CE group, and further stratified into male and female. Long - term survival for each group was estimated by Kaplan?Meier analysis with log - rank testing. In addition, Cox regression analyses of each gender were also carried out to identify the predictors of the primary and secondary endpoints. Overall, 25.8 % of the patients were female. Diseased vessels were not statistically different in the two groups - men and women. There was no significant difference in postoperative outcomes between males and females in the CABG and CABG + CE groups. There was no significant difference in hospital mortality in the two groups between males and females. Kaplan?Meier curves show that there was no significant difference in the 5 - year cardiac mortality between males and females belonging to the CABG and CABG + CE groups. The results of this study show that there was no significant difference in the short - and long - term outcomes of off - pump CABG and CE in both genders although women tend to carry a greater risk.

2 illus, 4 tables, 30 ref

047419   PILLAI V V, SREEKANTHAN R, KARUNAKARAN J (Cardiothoracic Surgery Dep, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala, Email: drvivekpillai@ yahoo.co.in) : Quantitative estimation of LIMA blood flow between extraluminal papavarine vs extraluminal papavarine plus intraluminal vasodilator cocktail in CABG patients . Ann. Card. Anaesth 2020, 23 (4), 414 - 8.

In this study, we aimed at a comparative quantitative estimation of the difference in LIMA blood flow between LIMAs treated with topical papaverine alone and LIMAs treated with a combination of topical papaverine plus an intraluminal cocktail of papaverine, nitroglycerine, and milrinone. Nearly 50 consecutive patients with similar demographics undergoing elective on - pump CABG were recruited for the study. After pedicled LIMA harvest, topical papaverine was sprayed on the pedicle and kept enveloped in papaverine soaked gauze. LIMA flow was then estimated. Later, intraluminal vasodilator solution of papaverine, NTG, milrinone, and heparinized blood were instilled in LIMA, and LIMA flows were estimated. The mean LIMA flows with topical papaverine alone was 47.19 mL/min whereas the mean LIMA flows with topical papaverine plus intraluminal cocktail was 104 mL/min. There was a significant difference between the two flows as their mean was 56.815 mL/min and the paired t - test for significance had a P value of 0.0001. There was a significant difference in the LIMA flow when the LIMA had been treated with the intraluminal instillation of the vasodilator cocktail in addition to the topical application of papaverine solution. Therefore, intraluminal vasodilator cocktail of milrinone, NTG, and papaverine mixed with heparinized blood in addition to topical papaverine is a simple and effective method for LIMA preparation in CABG.

1 illus, 3 tables, 25 ref

047418   MAISAT W, SAWASDIWIPACHAI P, AROONRAT W, LAPMAHAPAISAN S (Anesthesiology Dep, Faculty of Medicine Siriraj Hospital, Bangkok - 10700, Thailand, Email: saowaphak.lap@gmail. Com) : Measurement of aortic root dimensions by transesophageal echocardiography in adult patients undergoing cardiac surgery . Ann. Card. Anaesth 2020, 23 (4), 409 - 13.

Normal aortic root dimensions were established from studies from Western countries. As the body size is significantly associated with the aortic root dimensions, Thai populations may have smaller aortic root diameters. To elucidate the aortic root dimensions using transesophageal echocardiography (TEE) in adult patients undergoing cardiac surgery. A retrospective cohort study including 150 patients aged >18 years undergoing cardiac surgery. Aortic root dimensions (annulus, sinus of Valsalva, sinotubular junction (STJ), and proximal ascending aorta) were measured using two - dimensional TEE. Patients with aortic - root related pathology were excluded. Men constituted 60% of the study population; the mean age was 61.9 ? 12.6 years, and mean body surface area (BSA) was 1.7 ? 0.2 m2. The absolute dimensions for the annulus, sinus of Valsalva, STJ, and proximal ascending aorta were 22.3 ? 3.4, 32.6 ? 3.9, 26.4 ? 3.3, and 29.3 ? 3.1 mm, respectively, in men (12.9 ? 1.6, 18.8 ? 2.6, 15.2 ? 2.1, and 17.9 ? 2.7 mm, respectively, after adjusting for BSA) and 20.3 ? 2.2, 29.8 ? 3.6, 23.8 ? 2.6, and 27.1 ? 3.1 mm, respectively, in women (13.5 ? 2.0, 19.8 ? 2.3, 15.8 ? 2.5, and 17.0 ? 2.1 mm, respectively, after adjusting for BSA). The absolute aortic root diameters were significantly greater in men at all levels (P < 0.001). The BSA - adjusted diameters were similar for both sexes at the annulus (P = 0.076) and STJ (P = 0.076), except for the sinus of Valsalva (P = 0.010) and proximal ascending aorta (P = 0.006). This study reports reference values of aortic root dimensions by TEE. The body size should be considered when comparing the aortic root dimensions of Thai populations with the standard normal values.

1 illus, 2 tables, 13 ref

047417   KAPOOR M C (Anaesthesia, Max Smart Super Specialty Hospital, Delhi - 110 092, Email: mukulanjali@gmail.com) : Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 2: Cognitive dysfunction after critical Illness; Potential contributors in surgery and intensive care; pathogenesis; and therapies to prevent/treat perioperative neurological dysfunction . Ann. Card. Anaesth 2020, 23 (4), 391 - 400.

Severe cognitive decline and cognitive dysfunction has been attributed to patient?s stay in the cardiovascular intensive care unit. Prolonged mechanical ventilation, long duration of stay, sedation protocols, and sleep deprivation contribute to patients developing neurocognitive disorder after intensive care admission and it is associated with poor clinical outcomes. Trauma of surgery, stress of critical care, and administration of anaesthesia evoke a systemic inflammatory response and trigger neuroinflammation and oxidative stress. Anaesthetic agents modulate the function of the GABA receptors. The persistence of these effects in the postoperative period promotes development of cognitive dysfunction. A number of drugs are under investigation to restrict or prevent this cognitive decline.

3 illus, 3 tables, 115 ref

047416   RASTOGI A, TEWARI P (Anaesthesiology Dep, SGPGI, Lucknow, Uttar Pradesh, Email: amit.rastogi.sgpgi@ gmail.com) : Covid 19 and its cardiovascular effects. Ann. Card. Anaesth 2020, 23 (4), 401 - 8.

COVID - 19 pandemic is mainly related with the pulmonary problems initially but now as the pandemic is growing it is observed that almost all organ systems of the body are affected. Up to 20 - 30 % patients who are admitted in Covid hospitals are showing cardiovascular involvement. Severity of cardiovascular disease in a COVID - 19 patient depends whether a patient is having pre - existing cardiac disease or not. Patients with pre - existing cardiac disease have more severe infection and associated mortality. Severe COVID - 19 infection shows close association with myocardial damage and various arrythmias. The cardiovascular involvement occurs by either engagement directly with the angiotensin converting enzyme 2 or indirectly by the effect of inflammatory mediators which are generated as a result of viral - host response to infection. The COVID - 19 disease is said to produce a wide spectrum of affliction ranging between even asymptomatic patient to Cardiovascular syndrome. Even after recovering from COVID - 19 patients can reappear in the hospital with cardiomyopathies and arrythmias.

7 illus, 1 table, 66 ref

047415   KAPOOR M C (Anaesthesia Dep, Max Smart Super Specialty Hospital, Delhi - 110 092, Email: mukulanjali@gmail.com) : Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia . Ann. Card. Anaesth 2020, 23 (4), 383 - 90.

The association with cardiac surgery with cognitive decline was first reported in the 1960s after the introduction of coronary artery surgery. The incidence in cognitive decline was thought to be more after cardiac surgery, especially with the use of the cardiopulmonary bypass. Anesthesia and surgery are both associated with cognitive decline but many other factors appear to contribute its genesis. On - pump surgery, microembolization during manipulation of the heart and great vessels, temperature changes, pH changes, and altered cerebral perfusion, during cardiac surgery, have all been blamed for this. Postoperative cognitive decline is associated with poor clinical outcomes and higher mortality. Several studies have been conducted in the last decade to determine the genesis of this malady. Current evidence is absolving cardiac surgery and anesthesia to be the primary causes per se of cognitive dysfunction.

3 tables, 74 ref

047414   SURACI N, PRESTI S L, CONCEPCION G G, SANTANA O (Anesthesiology Dep, , Florida 33140, United States, Email: nicholas.suraci@gmail. Com) : Left ventricular pacemaker wire through patent foramen ovale. Ann. Card. Anaesth 2020, 23 (4), 528 - 9.

A 53 - year - old male status post pacemaker placement three months prior for sinus bradycardia presented with worsening dyspnea, holosystolic murmur, and a ventricular - paced right bundle branch block on electrocardiogram. Transesophageal echocardiography demonstrated a pacer wire in the right atrium coursing into the left atrium and ventricle through an undiagnosed patent foramen ovale. The patient underwent surgical repair and repositioning of the pacemaker lead without complication. Although rare, it should be suspected after recent lead placement.

3 illus, 3 ref

047413   PRUTHI G, SINGH N G, NAGARAJA P S, BALAJI R M, THA N M, CHOUDHARY P K, KURINCHI R M (Cardiac Anaesthesia Dep, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru - 560 069, Karnataka, Email: docnag10@gmail.com) : Pharmacological preconditioning with intralipid in patients undergoing off - pump coronary artery bypass surgery . Ann. Card. Anaesth 2020, 23 (3), 327 - 31.

The objective of the study was to determine the preconditioning myocardial protective effects of intralipid (IL) in off - pump coronary artery bypass (OPCAB) surgery by measuring highly sensitive troponin T (hsTnT) and cardiac - specific creatine kinase (CK - MB) as markers of myocardial injury. Thirty patients, scheduled to undergo elective OPCAB surgery, were randomly assigned to the IL group (n = 15) or control (C) group (n = 15); the IL group received an infusion of 20 % IL 2 ml/kg, 30 min prior to revascularization and the control group received an equivalent volume of normal saline. Serum levels of hsTnT and CK - MB were measured before surgery and at 6 h, 24 h, 48 h, and 72 h postoperatively. Also, intraoperative hemodynamic parameters, inotrope use, ventilatory hours, ICU stay, postoperative left ventricular ejection fraction, postoperative lipid profile, renal and hepatic function tests were measured. The hsTnT values at the 24 h, 48 h, and 72 h in IL group were significantly lower as compared with the control group. The decline in plasma levels of CK - MB mirrored the hsTnT levels post revascularization at 24 h and 48 h in the IL group compared with the control group; however, at 72 h, level was comparable in both the groups. None of the treated patients had abnormal lipid metabolism, deranged renal, and hepatic function. The study revealed Intralipid as a safe pharmacological preconditioning agent for OPCAB surgeries which can reduce the postischemic myocardial injury indicated by the reduction in postischemic cardiac enzymes hsTnT and CK - MB.

1 illus, 3 tables, 17 ref

047412   DIPROSE P, FOGG K J, PITTARELLO D, GAMMIE J S, D?AMBRA M N (Univ Hospital Southampton NHS Trust, Southampton, UK, Email: drpdiprose@gmail.com) : Intensive care and anesthesia management for harpoon beating heart mitral valve repair . Ann. Card. Anaesth 2020, 23 (3), 321 - 6.

Patients with severe mitral valve regurgitation secondary to degenerative disease are known to benefit from mitral valve repair surgery. Novel techniques for achieving mitral valve repair on the beating heart have been developed and are being introduced into clinical practice. The HARPOON Beating Heart Mitral Valve Repair System (MVRS) in recent studies has demonstrated efficacy and safety for the repair of degenerative mitral valve disease on the beating heart. The device uses transoesophageal echocardiographic guidance to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on prolapsed mitral valve leaflets in the beating heart. It requires general anaesthesia and there are specific intensive care and anaesthesia considerations for the safe management of these cases. This article describes the general principles of intensive care and anaesthesia management employed for the initial patients treated with the HARPOON Beating Heart MVRS, the outcomes for these patients, and the potential challenges for the future management of these cases.

3 illus, 2 tables, 11 ref

047411   GOVIL N, PARAG K, KUMAR B, KHANDELWAL H, DUA R, SIVAJI P (Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun - 248 001, Uttarakhand, Email: dr_parag1@yahoo.com) : Translation, cultural adaptation, and validation of the duke activity status index in the hindi language . Ann. Card. Anaesth 2020, 23 (3), 315 - 20.

The Duke Activity Status Index (DASI) is a validated questionnaire in English to assess the functional capacity (FC) of patients with cardiovascular disease (CVD). The aim of the study is to translate, cross - culturally adapt, and validate the DASI in Hindi. Observational validation study. Different translators translated the DASI into Hindi and then back - translated it into English. Validation for feasibility and psychometric properties of translated questionnaire was done on 200 adults, Hindi - speaking patients with CVD, who were advised exercise testing by a cardiologist. Internal consistency (Cronbach?s ?) and test?retest reliability (Pearson?s correlation coefficient) were calculated. Construct (correlation with the Canadian Cardiovascular Society Classification [CCSC] for angina and exercise capacity with treadmill testing [TMT]) and content validity (time taken to fill the questionnaire, ease of understanding the questionnaire items, and comprehensibility) were calculated. P < 0.05 was considered significant. The Cronbach?s ? for internal consistency was 0.78, which indicates adequate relatedness among the items of questionnaire, and the test?retest reliability was 0.65 (P < 0.05). A significant correlation between CCSC (r = ?0.60) and TMT (r = 0.56) was found. The median time taken by the respondents to fill the questionnaire was 4 min. Of all the respondents, 95.74 % of the respondents agreed that the Hindi questionnaire was easy to comprehend and 97.87 % patients correlated the translated items to their daily physical activity. The Hindi translated and culturally adapted version of the DASI is reliable, valid, and feasible to assess the FC in the Hindi - speaking CVD patients.

1 illus, 1 table, 24 ref

047410   YUHE K, CHEW S T H, ANG A S, NG R R G, BOONKIANGWONG N, LIU W, TOH A H H, CALEB M G, HO R C M, TI L K (Anesthesia Dep, National Univ Health System, Singapore, Email: lian_kah_ti@nuhs.edu.sg) : Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial . Ann. Card. Anaesth 2020, 23 (3), 309 - 14.

Neurocognitive dysfunction is a common complication of coronary artery bypass grafting (CABG) with incidence of 19?38 %. The miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce hemodilution and inflammation and provides better cerebral protection than conventional cardiopulmonary bypass (CCPB). In a meta - analysis, MCPB was associated with a 10 - fold reduction in the incidence of strokes. However, its effect on postoperative cognitive decline (POCD) is unknown. We assessed if MCPB decreases POCD after CABG and compared the risk factors. A total of 71 Asian patients presenting for elective CABG at a tertiary center were enrolled. They were randomly assigned to MCPB (n = 36) or CCPB group (n = 35) and followed up in a single - blinded, prospective, randomized controlled trial. The primary outcome was POCD as measured by the repeatable battery of neuropsychological status (RBANS). Inflammatory markers (tumor necrosis factor - alpha and interleukin - 6), hematocrit levels, and neutron - specific enolase (NSE) levels were studied. Overall, the incidence of POCD at 3 months was 50 %, and this was not significantly different between both groups (51.4 vs 50.0 %, P = 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95 % confidence interval (CI) = 1.054?8.618, P = 0.040] was significantly associated with POCD in the CCPB group, while the lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR = 0.931, 95 % CI = 0.868?0.998, P = 0.044). The postoperative inflammatory markers and NSE levels were similar between the two groups. This study shows that the MCPB was not superior to CCPB with cell salvage and biocompatible tubing with regard to the neurocognitive outcomes measured by the RBANS.

1 illus, 3 tables, 27 ref

047409   FRANCHI F, BALDINI G, MAUTONE M, TACCONE F S, SANTIS P D, ROCCO A S, MARCHETTI L, SCOLLETTA S (Medicine Dep, Univ of Siena, Siena , Italy, Email: sabino.scolletta@ dbm.unisi.it) : Evaluation of arterial stiffness in cardiac surgical patients using applanation tonometry . Ann. Card. Anaesth 2020, 23 (3), 302 - 8.

Applanation tonometry enables the noninvasive analysis of arterial pressure wave morphology. Applanation tonometry provides the augmentation index (AIx, %), an index of arterial stiffness that partially reflects arterial - ventricular (A - V) coupling. In addition, applanation tonometry provides the dP/dt (rate of intraventricular pressure variation over time), which reflects myocardial contractility, and the sub - endocardial viability ratio (SEVR, %), which is an indicator of myocardial oxygen supply and demand. There are no data on how cardiac surgery can modify these tonometry - derived indexes. The aim was to assess changes in AIx, dP/dt, and SEVR in patients undergoing cardiac surgery. This observational study was conducted at the University Hospital of Siena. We studied 32 patients before cardiac surgery in intensive care unit (ICU) on admission and at ICU discharge. We measured AIx, dP/dt, and SEVR using applanation tonometry (SphygmoCor). Changes in variables over time were evaluated by analysis of variance for repeated measurements. AIx decreased significantly from T1 [28.8 %, interquartile range (IQR) 21.6?36.6 %] to T2 (16.2 % IQR 8.1?22.4 %) and T3 (14.5 % IQR 7.9?23.6 %) (P = 0.01). dP/dt increased significantly from T1 (635 mmHg/ms, IQR 534?756 mmHg/ms) to T3 (751 mmHg/ms, IQR 651?1013 mmHg/ms; P = 0.03). The SEVR was lower at T2 than at T1, but returned toward T1 values by T3. Cardiac surgery was associated with an improvement in arterial stiffness, A - V coupling, and myocardial contractility as assessed using applanation tonometry. The results suggest, however, a transient imbalance between myocardial oxygen supply and demand in the immediate postoperative period.

4 illus, 2 tables, 23 ref

047408   CHAKRAVARTHY M, PRABHAKUMAR D T, SHIVALINGAPPA B, RAO S, PADGAONKAR S, HOSUR R, HARIVELAM C, JAWALI V (Anesthesia Dep, Fortis Hospitals, Bengaluru - ?560 076, Email: mailchakravarthy@ gmail.com) : Routine preoperative doppler ultrasound examination of arterial system in patients undergoing cardiac surgery is beneficial: A retrospective study . Ann. Card. Anaesth 2020, 23 (3), 298 - 301.

Presence of peripheral vascular disease enhances surgical risk in cardiac surgical patients. Prior knowledge of peripheral arterial disease may help the physician make changes in the monitoring and cardiopulmonary bypass cannulation plans. It is claimed that the incidence of peripheral vascular disease in cardiac surgical patients ranges from 11 to 30 %. This study was conducted to understand the characteristics of peripheral vascular disease and their implication on cardiac surgery. This was a prospective study undertaken in a tertiary referral hospital. All adult patients who underwent cardiac surgery during the period of six months were included. A Doppler examination of the neck, upper limb, abdomen and lower limb was carried out by our inhouse radiologist. The incidence of peripheral vascular disease, the implication on invasive pressure monitoring site and cannulation for cardiopulmonary bypass or intraaortic balloon pump or extracorporeal membrane oxygenation were made note of. During the said period, six hundred twenty eight patients underwent cardiac surgery, of whom five hundred and sixty - one patients who underwent CABG surgery. All these were subjected to Doppler examination. We observed peripheral arterial disease in 105 patients (20 %). In general men suffered from PAD more often than women. Monitoring site of invasive arterial pressure, the choice of beating heart surgery, insertion of intraaortic balloon pump, femoral arterial route for cardiopulmonary bypass were some of the decision that were altered. Performing Doppler examination in cardiac surgical patients may yield important data that might prevent complications and support patient safety.

5 illus, 3 tables, 12 ref

047407   HEMPEL C, TURTON E, HASHEMINEJAD E, BEVILACQUA C, HEMPEL G, ENDER J, ROTZOLL D (Anaesthesiology and Intensive Care Medicine Dep, Heart Center Leipzig, Leipzig, Germany, Email: J?rg.ender@medizin. uni - leipzig.de) : Impact of simulator - based training on acquisition of transthoracic echocardiography skills in medical students . Ann. Card. Anaesth 2020, 23 (3), 293 - 7.

Due to the expanding role of ultrasound as a diagnostic tool in modern medicine, medical schools rapidly include ultrasound training in their curriculum. The objective of this study was to compare simulator - based training along with classical teaching, using human models, to impart focused transthoracic echocardiography examination. A total of 22 medical students, with no former transthoracic echocardiography training, undertook a 90 - min e - learning module, dealing with focused echocardiography and important echocardiographic pathologies. Subsequently, they had to complete a multiple - choice - questioner, followed by a 120 - min practical training session either on the HeartworksTM, (Cardiff, UK) and the CAE Vimedix?, (Qu?bec, Canada) simulator (n = 10) or on a live human model (n = 12). Finally, both groups had to complete a post - test consisting of ten video - based multiple - choice - questions and a time - based, focused echocardiography examination on another human model. Two blinded expert observers scored each acquired loop which recorded 2 s of each standard view. Statistical analysis was performed with SPPS 24 (SPSSTM 24, IBM, USA) using the Mann - Whitney - Test to compare both groups. Analysis of measurable outcome skills showed no significant difference between transthoracic echocardiography training on human models and high - fidelity simulators for undergraduate medical students. Both teaching methods are effective and lead to the intended level of knowledge and skills.

1 illus, 1 table, 22 ref

047406   ELGEBALY A S, ANWAR A G, FATHY S M, SALLAM A, ELBARBARY Y (Anesthesiology Dep, Surgical Intensive Care and Pain Medicine, Elgharbia, Egypt, Email: elgebaly_13@hotmail. Com) : The accuracy of electrical cardiometry for the noninvasive determination of cardiac output before and after lung surgeries compared to transthoracic echocardiography . Ann. Card. Anaesth 2020, 23 (3), 288 - 92.

The anatomical changes associated with lung surgeries may decrease cardiac output and heart function. Therefore, monitoring of cardiac output (CO) is of significant value in these patients for clinical decision - making. This study is to evaluate the reliability of electrical cardiometry (EC) for the noninvasive continuous determination of CO after lobectomy or pneumonectomy compared to transthoracic echocardiography (TTE). This study was carried out on 60 patients, age ?18 years scheduled for elective lung surgery (lobectomy or pneumonectomy). All patients underwent simultaneous measurement by EC using the ICON_ device and by TTE by measuring left ventricle outflow tract diameter (LVOT) and velocity time integral (VTI). Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), stroke volume index (SVI), CO, and cardiac index (CI) were measured 1 day before the surgery and 7 days after the surgery. There was no significant difference between TTE and EC regarding preoperative and postoperative HR, SV, SVI, CO, and CI. There was a strong positive correlation between TTE and EC as regard preoperative and postoperative HR, SV, SVI, CO, and CI. Bland and Altman analysis showed low bias with accepted limits of agreement of HR, SV, SVI, CO, and CI. Postoperative readings showed a significant increase in HR and a significant decrease in SV and CO (either by TTE or EC), SBP, and DBP as compared to preoperative reading. Compared to the TTE, EC provides accurate and reliable CO, SV, and HR measurements before and even after lung surgeries.

2 illus, 6 tables, 15 ref

047405   HEMAMALINI P, DUTTA P T, ATTAWAR S (Cardiac Anesthesia Dep, Institute of Heart and Lung Transplantation, Chennai, Tamil Nadu, Email: drhema07@yahoo.com) : Transesophageal echocardiography compared to fluoroscopy for avalon bicaval dual - lumen cannula positioning for venovenous ECMO . Ann. Card. Anaesth 2020, 23 (3), 283 - 7.

The Avalon elite bicaval dual - lumen cannula for single site VenoVenous Extracorporeal Membrane Oxygenation (VV ECMO) offers several advantages. Correct placement of the Avalon cannula is safe using image guidance and needs either fluoroscopy or Transesophageal echocardiography (TEE). We assessed our institutional ECMO performance, cannulation related complications, instances of cannula malposition among patients cannulated using the two imaging modalities. We reviewed all patients who had Avalon cannula placement for VV ECMO at our institute. Ten patients were included in the study. Patients were cannulated using either fluoroscopy (Group A, n = 5) or TEE (Group B, n = 5). Data included patient demographics, diagnosis, evidence of cannula malposition, ECMO performance, cannulation related complications. The primary outcomes ease of cannulation; cannula malposition and the need for repositioning were compared between the two groups. Visualisation of guidewire, Avalon cannula and the average number of attempts to cannulate were similar (P > 0.05) between the two groups. Four patients cannulated using fluoroscopy had low flows whereas none of the patients cannulated using TEE had flow problems which was statistically significant (P = 0.024). Four cannulas (80 %) placed under fluoroscopy required repositioning whereas one cannula (20 %) placed under TEE needed repositioning. This difference was not statistically significant though (P = 0.099). TEE is the ideal imaging modality to guide Avalon elite cannula placement for VV ECMO.

3 illus, 2 tables, 25 ref

047404   GUILLET L, MOURY P H, BEDAGUE D, DURAND M, MARTIN C, PAYEN J F, CHAVANON O, ALBALADEJO P (Hopital Michallon, Grenoble, France, Email: MDurand@ chu - grenoble.fr) : Comparison of the additive, logistic european system for cardiac operative risk (EuroSCORE) with the EuroSCORE 2 to predict mortality in high - risk cardiac surgery . Ann. Card. Anaesth 2020, 23 (3), 277 - 82.

The aim of this study was to compare the new EuroSCORE (ES) 2 prediction model in high - risk patients with the 2 other oldest additive ES (aES) and logistic ES (lES). Consecutive adult patients undergoing all cardiac surgery except heart transplantation and left ventricular assist device were included. The 3 risk scores were collected before surgery. We defined 4 high - risk groups of patients, patients ?80 years, combined cardiac surgery, surgery of the thoracic aorta, and emergency cardiac surgery, and 2 low - risk groups, valve surgery and coronary artery bypass surgery. The predicted value of each score has been assessed by the area under the receiver operating characteristics curve (AUC). The study had included 3301 patients. Thirty - day mortality was 3.9 % (95 % confidence interval (CI), 3.3 ? 4.6 %). The AUC of ES2 was 0.81 (0.77 ? 0.84), 0.82 (0.78 ? 0.85), 0.70 (0.64 ? 0.76), 0.79 (0.74 ? 0.83), 0.85 (0.83 ? 0.87), and 0.88 (0.86 ? 0.90) for octogenarians, thoracic aortic surgery, combined surgery, emergency surgery, coronary surgery, and valve surgery, respectively. These ES2 AUC values were higher than those obtained with the aES for octogenarians, and with the lES for octogenarians and valve surgery. The ES2 calibration was better than the aES and lES calibration for the whole population, and low - risk groups. The ES2 calibration was superior to aES and lES in high - risk groups, except for octogenarians and thoracic aortic surgery compared to lES. In high - risk cardiac surgery patients, ES2 only marginally improve the predicted 30 - day mortality in comparison to other ES.

1 illus, 4 tables, 29 ref

047403   ELGEBALY A S, MOURAD M B E, FATHY S M (naesthesia and SICUD Dep, , Tanta, Egypt, Email: elgebaly_13@hotmail. Com) : The role of entropy monitoring in reducing propofol requirements during open heart surgeries. a prospective randomized study . Ann. Card. Anaesth 2020, 23 (3), 272 - 6.

Hypotension, which is commonly associated with propofol induction of general anesthesia in coronary artery bypass grafting (CABG) surgery, may cause adverse consequences in patients with coronary artery diseases undergoing this type of surgeries. The clinical absence of verbal response and eyelash reflex was used as an endpoint for hypnosis. Spectral entropy, as a novel monitoring method for the endpoint of hypnosis, affect the dose of required anesthetic agents for induction as well as the hemodynamic profile during general anesthesia in CABG surgery. We hypothesized that entropy monitoring might reduce the dose of propofol required for induction of anesthesia during CABG surgery and could maintain hemodynamic stability when compared with the conventional clinical monitoring. Sixty adult patients of both sexes, aged 30?60 years, ASA II and III, and scheduled for CABG surgery were enrolled in this prospective, controlled, randomized, double - blind study. These patients were randomly divided into two equal groups to receive intravenous propofol for induction of anesthesia guided by either the patients? clinical response (Group I) or by entropy monitoring (Group II). The total dose of propofol used for induction of anesthesia was recorded. Hemodynamic parameters and entropy values were also recorded. Propofol consumption was significantly reduced in Group II than Group I (P = 0.000*). Heart rate showed no statistical significance between the two groups, whereas the mean arterial pressure significantly decreased at induction in group I compared to Group II (P = 0.000*). The entropy values were significantly lower in Group I than Group II at induction (P = 0.036* for state entropy; 0.002* for response entropy). However, during intubation, and after 1 and 5 min, entropy indices displayed a significant increase in Group I than Group II. Entropy monitoring significantly reduced the dose of propofol required for induction of anesthesia and maintained hemodynamic stability compared to the conventional clinical monitoring during CABG surgeries.

3 illus, 2 tables, 21 ref