046718   AL-DARAGHI W A H, AL-BADRWI M S A (Baghdad Univ, Baghdad, Iraq) : Molecular detection for nosocomial Pseudomonas aeruginosa and its relationship with multidrug resistance, isolated from hospitals environment. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194394.

Pseudomonas aeruginosa is an important pathogen in hospitalized patient’s causative to their morbidity and mortality due to its multiple resistance mechanisms. Therefore, as a therapeutic option becomes restricted, the search for a new agent is a priority. So Pseudomonas aeruginosa is an extremely versatile Gram-negative bacterium capable of thriving in a broad spectrum of environments, and this performs main problems to workers in the field of doctors and nurses. One hundred and fifty samples were collected from different sources from Al-Kut hospitals, divided into two main groups: clinical (80) samples and (70) samples as a Nosocomial, collected from October to the December of the year 2018. All of these samples were cultured by specific and differential media, Forty (40) isolates of P.aeruginosa bacteria were identified by using microscopic examination, biochemical tests. The identification of (40) isolates of P.aeruginosa confirmed VITEK-2 system. The antibiotic sensitivity test recognized for all bacterial isolates and the results showed high sensitivity to amikacin, gentamicin, ciprofloxacin and Chloramphenicol, and high resistant to oxacillin and Cefoxitin. A molecular diagnosis is recognized by conventional PCR technique to detect the specified gene amplification products of the blaOXA-1 gene for Pseudomonas aeruginosa.

1 illus, 5 tables, 22 ref

046717   ALLO R R, MAYOUF T T, AL-FATTAH M N (Mosul Univ, Mosul, Iraq) : Personal hygiene and safety among governmental hospitals nurses staff in Mosul City. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194393.

The present study aimed to knowing weak points which is lead to negligence it could be transmission of nosocomial infection. The sample of the study included 100 nurses were selected randomly from the pediatric, surgical, emergency, I.C.U and operation room departments in AL-Salam and AL-Jamhory Teaching Hospitals in the Mosul City during a period which extended from the 1/10/2018 to 20/1/2019, the data were collected through an observation of each subject of the sample during working with the patients and fulfill in the checklist sheet. The findings of this research revealed significant values between gender and personal hygiene practices to the advantage of female, also there is significant relationship between level of education and personal hygiene practices to the advantage of colligate nurses. The present study demonstrated that there was negligence in some personal hygiene practices among nurses such as (hand washing, use protective devices, use protective measures, and hepatitis B vaccination).

6 tables, 13 ref

046716   HASAN W A, AL-SAAD S F, ALJUMAILY H S (Babylon Univ, Babylon, Iraq) : The role of global longitudinal strain in early detection of doxorubicin induced cardiotoxicity in breast cancer patients. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194392.

Cardiotoxicity is a recognized side effect of many antineoplastic drugs, particularly anthracyclines which used for breast cancer treatment. The identification of patients at high risk for developing cardiotoxicity would be a good strategy to decrease mortality. the aims was to assess the incidence of chemotherapy induce cardiotoxicity and identifying the reduction in global longitudinal strain in various treatment cycles for the early detection of cardiotoxicity, prior to ejection fraction reduction. A prospective cohort study of confirmed and newly diagnosed breast cancer patients, who attend the Babylon oncology center in Marjan medical city between the fifth of January and the first of July of 2019. The mean patient’s age was 51.3(±10.5) years, There is no association difference in systolic function during the follow up period. The reduction in global longitudinal strain by 8 %-15 % from baseline was found in 8 patients, while reduction ≥15% from baseline was found in only 2 patients during the follow up period. Global longitudinal strain drop was observed three weeks after chemotherapy onward without significant reduction in ejection fraction.

2 illus, 3 tables, 25 ref

046715   NASER H Y, AL-NEAMI A Q, IBRAHIM Y (Biomedical Engineering Dep, Al Nahrin Univ, Baghdad, Iraq) : Study the effect of temperature variable on the patient with jaundice stay period inside the incubator. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194391.

This study is used for measuring the temperature of incubator during its used in the treatment of newborns who suffering from jaundice. The present system is characterized as low cost, easy to use and does not require a highly skilled operator, in which that used of DHT22 sensor based on the Arduino hardware platform. This system facilitates the continuous monitoring and the true knowledge of the temperature of the incubator for determination the period of stay of the child with jaundice in the hospital. In addition, the current system represents not only the possibility of knowing the temperature of the incubator but also a tool to assess the incubator’s performance, and find out the percentage of error in the temperature and the difference between the required temperature and the real temperature.

4 illus, 1 table, 8 ref

046714   AL-ARIDHI D T N, ALLEHIBI K I H, AL-SHARIFI Z A R, AL-QURAISHI M (Biomedical Engineering Dep, Al-Nahrain Univ, Baghdad, Iraq) : Serum levels of novel biochemical marker (irisin) in relation to the duration of type 2 diabetes & in cases of type 2 diabetes with coronary artery disease in Iraqi patients aged (40- 60 year). Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194390.

Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that affects a large proportion of the population, iIrisin is a peptide hormone, secreted mainly by the heart and skeletal muscle. It has a role in converting white adipose tissue to brown adipose tissue. It is one of the novel biochemical markers that link diabetes with CAD. not well controlled; this will lead to serious metabolic problems, including atherosclerosis, predominantly coronary artery disease (CAD). Irisin is a peptide hormone, secreted mainly by the heart and skeletal muscle. It has a role in converting white adipose tissue to brown adipose tissue. It is one of the novel biochemical markers that link diabetes with CAD. To explore the relationship between serum Irisin level and duration of diabetes, in cases of presence and absence of CAD, As well as the possibility of using it as a marker for the assessment of the severity of the disease. One hundred sixty-one volunteers aged [(40-60 year), body mass index (20- 25Kg/m²)], with normal blood pressure. They divided into six groups, that distributed as [(I_a = control (negative catheterization without DM), I_b = control (apparently healthy), II_a = DM (with negative catheterization) II_b = DM (diagnosed by history and clinical examination), III_a = CAD (without DM, positive catheterization), III_b = CAD + DM (positive catheterization)]. The diabetic groups with and without CAD had been divided depending on the duration of the diabetic onset into three periods ( 10 years). The parameters that measured were FPG, HbA1c and fasting serum (Irisin, lipid profile). The present findings showed the Means (± SD) value of Irisin levels was a significant decrease in (II_a, II_b, III_a, III_b ) groups as compared with control groups (I_a, I_b). In addition, there is an inverse relationship between serum Irisin and the duration of DM in the total DM groups (II_a +II_b) and the CAD + DM group (III_b). Moreover, higher statistical decrease in mean serum level of Irisin with duration of DM was found in CAD + DM group as compared with the total DM group. Also, there was a significant decrease in mean serum level of HDL-C for (II_a, II_b, III_a, III_b) groups than in (I_a, I_b) groups. Besides, there was a significant decrease in the mean of serum HDL level in CAD groups (III_a, III_b) than in DM groups (II_a, II_b). While the means of FPG level, HbA1c, serum cholesterol level, were significantly elevated in groups (II_a, II_b, III_b) as compared with (I_a, I_b) groups. Also, there was a significant increase in the mean serum levels of triglyceride, VLDL-C and LDL-C for (II_a, II_b, III_a, III_b ) groups than in the control groups. Irisin was lower among patients with long-standing diabetes (with or without CAD) as compared to those with short duration of T2DM that can be included as a marker for assessment the severity of diabetes and prediction of CAD. 

2 illus, 5 tables, 13 ref

046713   HINDY N A A (Dermatology and Venereology Dep, Al-Imam Al-Sadiq Teaching Hospital, Hilla, Iraq) : Evaluation of amateur and professional tattoo removal by the Q switched Nd : YAG laser. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194389.

A tattoo is visible and permanent pigmentation of the skin secondary to the deliberate or accidental deposition of exogenous pigment within the dermis. A variety of procedures have been used to remove tattoos, such as laser therapy, surgical excision, and dermabrasion. QS laser treatment can result in good cosmetic outcomes and complete or near-complete removal of many unwanted tattoos. to evaluate the QS Nd:YAG laser effects for amateur and professional tattoos removal. The study was done on 293 tattoo lesions from 176 patients (in both genders) , there were 239 amateur tattoos (136 patients) and 54 professional tattoos(40 patients). Tattoos on a wide range of body sites (limbs, feet, face, chest, shoulders and legs) were treated. Ages were between 17- 60 years. In this work, tattoos were divided to amateur and professional tattoos. A Q-switched Nd:YAG laser system was used throughout this study. All tattoos containing black and blue pigment were treated at 1064 nm. Tattoos containing red pigment were treated at 5 32 nm. Treatment was scheduled at 4-6 weeks intervals and continued until maximum clearance of the tattoo was achieved, and the number of sessions varies from one to five sessions. For assessment of degree of lightening the method proposed by Lanigan was used: grade 1, complete response (> 95 % lightening); grade 2, excellent response (76–95 % lightening); grade 3, good response (51–75 % lightening); grade 4, fair response (26–50 % lightening); grade 5, poor response (0–25 % lightening). Amateur tattoos were often more numerous than professional tattoos. Eighty per cent of tattoos (198 of 239) were clinically clear at the time of analysis, this included 70.7 % (169 of 239) which were ≥ 95 % clear. Overall 56.6 % of amateur tattoos were clinically clear after two treatments, and 82 % (110 of 134) were clinically clear after 2-3 treatments, while the clinical clearance rate was 40 % after six treatments for professional black tattoos. It is anticipated that response rates will increase when tattoos at an early stage of treatment receive further treatments,and P value was (0.004) which mean that there is significant difference between two groups. Amateur tattoos generally require fewer treatment sessions and the response is better than professional tattoos. 

2 illus, 4 tables, 22 ref

045380   AGUIAR SANTOS T, SCORZONI L, SANTOS A D C, JUNQUEIRA J C, ANBINDER A L (Bioscience and Oral Diagnosis Dep, Institute of Science and Technology, SP, Brazil, Email: ana.anbinder@ unesp.br) : Galleria mellonella as an experimental model for studying periodontopathogens. J Indian Soc Periodontol 2020, 24(6), 593-6.

In the present study, Galleria mellonella was evaluated as a potential infection model for periodontal bacteria, more specifically, Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans. All the bacteria evaluated were pathogenic to G. mellonella, causing their death in a concentration‑dependent manner, and a decrease in their hemocyte count. Moreover, it was possible to recover the bacteria from the larvae hemolymph and determine the colony‑forming units per larvae. G. mellonella is an effective model that may help to better understand the host‑microbe interactions in periodontics.

3 illus, 5 ref

045379   GAIDHANKAR S, SOWMYA N K, PREETI K B, MEHTA D S (Periodontology and Implantology Dep, Bapuji Dental Coll and Hospital, Davangere, Karnataka, Email: bhargavi.preeti@ gmail.com) : Knowledge, attitude, and implementation of nicotine replacement therapy by dental and medical interns in Davangere city: A cross‑sectional survey. J Indian Soc Periodontol 2020, 24(6), 567-71.

One of the prime causes of illness and premature death is smoking. Almost 50 % of smokers attempt to quit the habit; however, at most, 2 %–3 % achieve success. The rationale is that innumerable withdrawal attempts are unplanned, and the most effective cessation aids are unacquainted. Nicotine replacement therapy (NRT) is the most common cessation aid. Furthermore, motivation from dental and medical professionals can be effective for patients to quit smoking. The study aimed to assess the knowledge, attitude, and practice regarding the implementation of NRT among dental and medical interns in Davangere city. A questionnaire‑based survey was conducted, which included 442 dental and medical interns from two dental and two medical colleges in Davangere city, Karnataka. The questionnaire included multiple‑choice questions regarding knowledge, attitude, and implementation of NRT. The response rate of interns was 93.67 %. Among dental and medical interns, there was no statistically significant difference in knowledge about NRT with P = 0.976 (P > 0.05). However, a statistically significant difference existed regarding attitude and implementation in the interns about NRT among dental and medical interns with P = 0.001 (P < 0.05). Among dental and medical interns, dental interns had a positive attitude and implementation toward NRT than medical interns. The overview implicated that the dental interns had better vision than medical interns; however, both the groups’ comprehension concerning NRT is scanty and advocates education about the fundamentals of NRT either via workshop or by continuing dental education programs.

3 tables, 18 ref

046711   ALAMERI L M, MANSOUR T S, RASHID F F, BELAL S J (Baghdad Univ, Baghdad, Iraq) : Design in line LMA-10 photonic crystal fiber MZI for detection and investigation of Beta Thalassemia. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194387.

Consequent to the scarcity of removable rapid diagnostic examines for detecting the thalassemia, specially beta thalassemia trait or Cooly’s Anemia, present detection methods include the collection of the blood, which then required being more tests before reports can be made by the treating physicians.Traditional methods like hemoglobinopathy tests and blood picture are time expending, needing specialized technical personnel, extra huge and costly laboratory instrument. Here, we simulated and demonstrated micro- hole collapsing, type of Mazh-Zehnder interferometer (MZI) that formed using LMA-!0 fiber, with a laser beam for detection the most common type of anemia, beta thalassemia trait or Cooly’s Anemia. This interferometer made-up of two conventional optical fibers splicing to apart of photonic crystal fiber (PCF). This method makes a high sensitive regions for the optical characteristics in the blood sample. Biological changes in the blood sample consequent to the presence the beta thalassemia trait lead to changes optical characteristics (refractive index and absorption) of the blood sample the demonstrated laser biosensor has the ability for use as a removable, rapid diagnosis examines and the high sensitive which rises to 24.367 ABS/RIU.

5 illus, 1 table, 20 ref

045378   DIAS J J, PANWAR M, KOSALA M (Dental Surgery and Oral Health Sciences Dep, AFMC, Pune- 411 040, Maharashtra, Email: catchme.jacinta@ gmail.com) : Management of inadequate keratinized gingiva and millers class III or IV gingival recession using two‑stage free gingival graft procedure. J Indian Soc Periodontol 2020, 24(6), 554-9.

Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long‑term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique. Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline.  Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4 %. Two‑stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

17 illus, 1 table, 20 ref

045377   SHARMA P, VAISH S, SHARMA N, SEKHAR V, ACHOM M, KHAN F (Periodontology and Implantology Dep, I.T.S?CDSR, Ghaziabad, Uttar Pradesh, Email: drpreetimds@ gmail.com) : Comparative evaluation of efficacy of subepithelial connective tissue graft versus platelet‑rich fibrin membrane in surgical reconstruction of interdental papillae using Han and Takie technique: A randomized controlled clinical trial. J Indian Soc Periodontol 2020, 24(6), 547-53.

Platelet‑rich fibrin (PRF) has emerged as one of the promising regenerative materials in the field of periodontics. Hence, this study evaluated the efficacy of subepithelial connective tissue graft (SCTG) and PRF in surgical reconstruction of interdental papillae using Han and Takei technique. A total of 20 sites with Class I and Class II interdental papilla defects were assigned to two groups (Group 1 – Han and Takie technique + SCTG and Group 2 – Han and Takie technique + PRF). Parameters such as papillary height (PH), distance from the contact point to the tip of papillae (CPTP), papilla presence index (PPI), pocket probing depth (PPD), relative clinical attachment level (RCAL), plaque index (PI), gingival index (GI), and distance from contact point to alveolar crest (CP‑BC) were measured at baseline and after 3 months. The significance of difference within and between the groups was evaluated with paired and unpaired t‑tests. The mean PI, GI, PPD, RCAL, PPI, and CPTP distance decreased significantly, whereas the mean PH increased significantly in Group 1 as well as in Group 2. After 3 months, mean reduction in CPTP distance and mean gain in PH were statistically significant in Group 1 as compared to Group 2. However, there was no significant difference in mean CPBC distance between baseline and 3 months in Group 1 as well as in Group 2. Both the techniques were effective in the treatment of papillary recession defects; however, more significant clinical papillary enhancement was achieved after the surgical reconstruction with SCTG.

3 illus, 4 tables, 25 ref

045376   PATIL C L, POL D G, GAIKWAD R P (Periodontology Dep, Government Dental Coll, Mumbai- 400 076, Maharashtra, Email: drchitrat@gmail. com) : Comparative evaluation of use of a diode laser and electrode application with and without two dentinal tubule occluding agents in the management of dentinal hypersensitivity – A clinical study. J Indian Soc Periodontol 2020, 24(6), 535-40.

Dentinal hypersensitivity (DH) is common problem in dentistry. Traditional agents along with alternative therapies have been researched. To study the efficacy of a diode laser (DL) and electrode application with and without hydroxyapatite (HAP) and strontium chloride (SrCl2) powder. 60 Patients with mild cervical abrasion in at least two quadrant with two teeth per quadrant were selected and randomly divided into four groups: (i) Group 1– DL versus DL with HAP (ii) Group 2 – electrode application versus electrode application with HAP (iii) Group 3 - DL versus DL with SrCl2 (iv) Group 4 - electrode application versus electrode application with SrCl2 and were subjected to tactile stimulus and air blast test and scores were recorded on verbal rating scale (VRS) and visual analogues scale (VAS) at different time for 3 months. The data was statistically evaluated by one way ANOVA and paired t test. Results: In group 1 and 3, DL alone had a short term reduction of hypersensitivity (P = 0.001). Synergistic effect of DL and HAP (group 1) showed a prolonged reduction on both scales (P < 0.001) whereas the additive effect of SrCl2 with DL (group 3) showed statistically significant reduction on both scales at all time (p 0.05) however group 4 showed significant reduction only in VAS score (p>0.05). DL alone had a short lived effect however with adjunctive sustained results were obtained whereas electrode application was neither beneficial nor did cause any adverse effect.

3 illus, 4 tables, 17 ref

045375   PAUL R, SURESH S, SUDHAKAR U, JEAN C, FERNANDEZ K J (Periodontics Dep, Thai Moogambigai Dental Coll, Chennai, Tamil Nadu, Email: suresh_sno@ yahoo.com) : Evaluation of association between Porphyromonas gingivalis and visfatin levels in chronic periodontitis patients. J Indian Soc Periodontol 2020, 24(6), 530-4.

Periodontal disease is one of the most common prevailing diseases, where the destruction occurs due to the direct effect of microorganisms and indirectly by the stimulation of host cells. The diverse inflammatory action of visfatin made this adipokine a potential periodontal biomarker of choice along with the periopathogen Porphyromonas gingivalis. Our study was carried out to evaluate the visfatin levels in gingival crevicular fluid (GCF) and P. gingivalis levels in subgingival plaque in periodontal health and disease.  A total of 60 participants were divided into two groups of thirty participants each as Group I – patients who have healthy periodontium and Group II – patients with generalized chronic periodontitis. The clinical parameters assessed for the participants were plaque index, probing pocket depth, papillary bleeding index, and clinical attachment loss. The subgingival plaque samples were obtained to estimate P. gingivalis levels and GCF was collected to check visfatin levels. The clinical parameters, P. gingivalis, and GCF visfatin levels between the two groups showed a notable significant difference. A significant positive correlation was noted on the correlation of GCF visfatin levels with clinical parameters. Our study outcomes propose that P. gingivalis can be the bonafide periopathogen which modulate the visfatin levels in individuals with periodontal disease and GCF visfatin can also be evaluated as a biomarker in periodontal disease.

6 illus, 4 tables, 24 ref

045374   YADAV A R, DESHMUKH J, DEVARATHNAMMA M V, KARDAL A, BHAGCHANDANI M, SRIVASTAVA R (Periodontics Dep, Navodaya Dental Coll and Hospital, Raichur- 584 103, Karnataka, Email: yadavankita.40@ gmail.com) : An assessment of anti‑citrullinated protein antibody in systemically healthy individuals with or without chronic periodontitis: A case–control study. J Indian Soc Periodontol 2020, 24(6), 525-9.

Periodontitis has been implicated as a risk factor for rheumatoid arthritis (RA). This study aimed to assess the relationship between RA and chronic periodontitis (CP) by evaluating the serum levels of the anti citrullinated protein antibody (ACPA) which is a marker of RA in systemically healthy individuals with and without CP. This case–control study enrolled 40 systemically healthy individuals. Participants were divided into two groups, i.e., CP group Systemically healthy chronic periodontitis (CPSH) (n = 20) and control group Systemically healthy (SH) (n = 20), matched for age and gender. The CP patients were evaluated for periodontal parameters, namely probing pocket depth, clinical attachment loss, percentage of the site involved with attachment loss, and number of teeth present. A volume of 5 ml of venous blood was collected from both the groups and centrifuged; the separated serum was stored at − 70°C before being analyzed. Later, serum samples were tested for levels of ACPA in both the groups and compared. The mean serum ACPA levels were higher in CPSH patients compared to SH (131.38 RU/ml vs. 34.54 RU/ml, P = 0.001), which was statistically highly significant. In addition, we found a significant elevation of serum ACPA levels in severe generalized CP patients compared to moderate generalized CP patients (175.47 RU/ml vs. 95.31 RU/ml, P = 0.001), and the difference was statistically highly significant. The results of the study confirmed that CP can be a risk factor for RA. Moreover, the severity of periodontitis appeared to be related to elevated serum levels of ACPA.

2 illus, 3 tables, 31 ref

046709   FAHAD E H , HASHIM Z H, NEMA I S (Physiology Dep, Al-Nahrain Univ, Baghdad, Iraq) : Cervical spinal stenosis and risk of pulmonary dysfunction: case control study. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194385.

Cervical spinal stenosis is well-defined as debility in the volume of the spinal canal. Consequently, distracting in the descending neural pathways at any level in the cervical spine lead to impaired smooth and effective breathing under normal conditions. To assess the effect of cervical spinal stenosis (C5and above) on pulmonary function tests , to assess the sensitivity and specificity of pulmonary function tests in patient with cervical spinal stenosis (C5 and above). This is a case-control study which included 40 patients divided into two groups 30 females and 10 males patients with cervical spinal stenosis (C5 and above) and 60 healthy volunteers with body mass index ˂ 30 (Kg/m²). Pulmonary function tests has been done for all subjects. The results demonstrate the comparison between all patients and controls show that VC EX % ,FEV1 % ,FVC % ,PEF % ,MVV % , were significantly lower in patients in comparison to control groups as well as VC EX %, FEV1 %, FVC % were significantly lower in male patients in comparison to controls and in female patients as compared to female controls and MVV% were significantly lower in female patients in comparison to male patients ,while no significant difference has been identified between patients and controls regarding age ,weight , height , BMI,VC IN % and FEV1\FVC %. Sensitivity and specificity and cut off value for pulmonary function tests parameters show FEV1 % is the highest specificity and sensitivity. The respiratory dysfunction that is established in patients with cervical spinal stenosis usually subclinical not overt defect that compromised respiration ,this pulmonary dysfunction is a type of restrictive lung disease since phrenic nerve is affected. . FEVI % is most essential among other parameters of spirometry in patients with cervical spinal stenosis.

5 tables, 18 ref

045373   GARG Y, CHOWDHARY Z, GARG K, GUPTA A, KSHIRSAGAR M, REDDY J R (Public Health Dentistry Dep, Surendera Dental Coll, Sriganga Nagar, Rajasthan, Email: dr.zoya1988@ gmail.com) : Oral health status and treatment needs of substance abusers in Western Uttar Pradesh. J Indian Soc Periodontol 2020, 24(5), 467-72.

Substance abuse has often associated with high caries, poor periodontal health, and altered functioning of the individual. The substance abuse may be natural or synthetic in origin, both causing deleterious effect on the oral and overall health of the individual.  To assess the oral health status and treatment needs of substance abusers attending deaddiction centers in Western Uttar Pradesh.  A cross‑sectional study was conducted among 220 substance abusers from 6 randomly selected deaddiction centers. The subjects were divided into four groups: Group 1, alcohol (A); Group 2, nicotine (N); Group 3, alcohol + nicotine (AN); and Group 4, other drugs (O). A demographic record along with full‑mouth examination was recorded based on the World Health Organization pro forma.  The overall results showed that out of the total participants, 144 had oral mucosal lesions. Alcohol group had significantly higher mean community periodontal index code 3 (pockets 4–5 mm) than the other groups (P < 0.05). The prevalence of decayed, missing, filled teeth (DMFT) was 83.33 %, and the mean DMFT of the alcohol group was significantly higher than the other combinations group (P < 0.01). The oral health status of substance abusers was poor, with a large number of oral mucosal lesions. The dental caries status and periodontal status were the worst among the alcohol group.

6 tables, 25 ref

045372   CHAKRAVARTHY Y, CHANDRA R V, REDDY A A, REDDY G P (Periodontics Dep, SVS Institute of Dental Sciences, Mahbubnagar- 509 002, Telangana, Email: yshschakri@gmail. com) : Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single‑center, open‑label trial. J Indian Soc Periodontol 2020, 24(5), 454-60.

The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller’s Class III gingival recession. Twenty‑two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller’s Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery. OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF‑treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW. Data from this 6‑month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller’s class III recessions with adjacent edentulous sites or wide interproximal spaces. Long‑term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.

13 illus, 2 tables, 28 ref

045371   AMEYAROY D K, RAMABHADRAN B K, EMMATTY R, PAUL T P T, JOSE P (Clinical Periodontology and Oral Implantology Dep, Royal Dental Coll, Palakkad, Kerala, Email: diya.adayeen@ gmail.com) : Comparative evaluation of the effect of Ozone therapy and Photodynamic therapy in non-surgical management of Chronic periodontitis: A split mouth longitudinal study. J Indian Soc Periodontol 2020, 24(5), 447-53.

A split‑mouth longitudinal study was conducted to compare and evaluate the effect of ozonated water and photodynamic therapy (PDT) in nonsurgical management of chronic periodontitis, along with mechanical debridement procedure.  Twenty‑two patients diagnosed with chronic generalized periodontitis were subjected to the study. Following the assessment of gingival index, periodontal pocket depth, and clinical attachment loss, all patients underwent full‑mouth scaling and root planing. Upper right and left quadrants of each patient were considered as sample sites in the study. Among these split‑mouth sites, upper right quadrant of each patient was subjected to ozonated water irrigation with a 22‑gauge needle and left upper quadrant was treated with PDT, which involved sulcus irrigation with indocyanine green dye (0.05 mg/ml) followed by low‑level diode laser light application at 0.5 W and 810 nm (AMD Picasso) through a fiber‑optic tip of 10 mm length, default angle of 60 °, and fiber core diameter of 400 µm in noncontact continuous wave mode. Patients were recalled at the 2nd and 4th months regularly, and the therapy was repeated at the same sites in the same manner. Clinical parameters recorded before the study were assessed again at the end of the 2nd‑ and 6th‑month period. A statistically significant reduction (P < 0.05) was observed in gingival index scores within both the study groups at all intervals of the study. In Ozone therapy (OT) group, a statistically significant difference was noted for total periodontal pocket depth values between baseline and 2nd month (P = 0.000), baseline and 6th month (P = 0.000), and between 2nd month and 6th month (P = 0.029). In the PDT group, on contrary, a statistically significant difference was noticed in total periodontal pocket probing depth values between baseline and 2nd month (P = 0.000) and baseline to 6th month (P = 0.000), but a similar significant difference was not noticed between 2nd‑month and 6th‑month periods (P = 0.269). In group OT, a statistically significant difference was noted for total clinical attachment loss between baseline and 2nd month (P = 0.000), baseline and 6 months (P = 0.000), and 2nd month and 6th month (P = 0.019). In group PDT, a statistically significant difference in terms of its improvement was noted at intervals between baseline and 2 months (P = 0.000) and from baseline to 6 months (P = 0.000) but not between 2nd month and 6th month (P = 0.129). Results of the study showed that sub-gingival OT and PDT equally improved the clinical outcomes of treatment drastically following mechanical debridement at the end of first 2 months. Thereafter, it was shown to improve steadily throughout the study period, with slightly better results with OT compared with PDT.

7 illus, 25 ref

045370   MAITY S, PRIYADHARSHINI V, BASAVARAJU S (Periodontology Dep, JSS Dental Coll and Hospital, Mysuru- 570 015, Karnataka, Email: snigdha.ria@gmail. com) : A comparative evaluation of propolis and light‑cured ormocer‑based desensitizer in reducing dentin hypersensitivity. J Indian Soc Periodontol 2020, 24(5), 441-6.

The purpose of the study was to evaluate and compare the clinical efficacy and the durability of propolis and Light‑cured ormocer‑based desensitizer (Admira Protect, Voco: Cuxhaven Germany) in the treatment of dentin hypersensitivity (DH). The study was conducted over a period of 2 months on 13 patients with 72 hypersensitive teeth, randomly allocated into three treatment groups: Group A: Treated with Propolis, Group B: Admira protect (Voco: Cuxhaven Germany), and Group C: Sterile water (Placebo control). Baseline sensitivity was recorded by the operator using tactile and evaporative stimuli. Visual analog scale (VAS) was used to record the degree of sensitivity perceived by the patients. All the groups received applications of allotted materials on day 1, 7, 14, and 21. After each applications VAS scoring was recorded. On day 30 and 60, only pain evaluation was done to determine the durability of each test materials. One‑way ANOVA, repeated measure ANOVA and post hoc test was done for multiple comparison. All the groups showed significant results in reducing DH. Among Groups A and B, Group B showed immediate postoperative result at the end of the 1st week. Both the test materials were effective in reducing DH but Admira protect was found to be more efficient in reducing pain with longer duration of action (CTRI regd no: CTRI/2017/12/010755).

2 illus, 4 tables, 28 ref

045369   MITHRADAS N, SUDHAKAR U, ARUNACHALAM L T, SURESH S, RAJA M (Periodontics Dep, Thai Moogambigai Dental Coll and Hospital, Chennai- 600 102, Tamil Nadu, Email: drnimishamithradas 1983@gmail.com) : A novel soft tissue cone‑beam computed tomography study in the evaluation of gingival thickness associated with subepithelial connective tissue graft versus acellular dermal matrix in the management of gingival recession: A clinical study. J Indian Soc Periodontol 2020, 24(5), 421-7.

Dental esthetic awareness among patients led the clinicians to introduce newer materials and predictable techniques that satisfy the patients’ esthetic demands. Aim: To evaluate and compare the efficacy of subepithelial connective tissue graft (SECTG) and acellular dermal matrix (ACDM) allograft in the treatment of Millers Class I or Class II recession with the determination of gingival thickness using an impertinent method, soft tissue cone‑beam computed tomography (ST‑CBCT).  A split‑mouth study with a total of ten patients with bilateral Millers class I or class II recession is randomly assigned by a coin toss method as Group I (SECTG) and Group II (ACDM) along with coronally advanced flap. Clinical parameters including recession height (RH), recession width (RW), probing depth, clinical attachment level (CAL), and height of keratinized tissue (HKT) were evaluated at baseline, 90th day, and 180th day for both groups. The thickness of keratinized tissue (TKT) was determined by most reliable, predictable and noninvasive method called ST‑CBCT. Statistically significant reduction in RH and RW, gain in CAL, and increase in HKT and TKT in both Group I and Group II were seen in 90th day and 180th day. However, when both Group I and Group II were compared between 0 and 180th day, the change in RH and RW, gain in CAL, and increase in HKT and TKT did not show any statistically significant change. The present study suggested that root coverage with both SECTG and ACDM is very predictable procedure and it is stable for 6 months. ST‑CBCT is a newer dimension in periodontal imaging and will certainly aid clinicians in the execution of various treatment modalities with increased predictability.

8 illus, 7 tables, 33 ref

046708   AL-NAFFAKH A S F, RISAN F A (Middle Technical Univ, Baghdad, Iraq) : Assessment of anti-mullerian hormone and anti ovarian antibody in the sera of patients with polycystic ovarian syndrome in Al-Najaf Al-Ashraf Province. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194384.

Polycystic ovarian syndrome(PCOS)is the most common endocrinopathy,that affects 5 to 20 % of women in age of (12-45 year)and cause a widespread of reproductive disorder in women and it is a major cause of hirsutism,acne, hormonal disturbance and infertility. Women with PCOS may associated with health conditions obesity,amenorrhea, oligomenorrhea,hyperandrogenemia and insulin resistance.The PCOS patients are with increased risk for type 2 diabetes mellitus, diabetic complications, dyslipidemia and cardiovascular disease. Aim of the study to investigate the pathogenicity,disease severity and early diagnosis roles antiMullerian hormone and anti-ovarian antibody in ladies with PCOS. Polycystic ovarian syndrome was related to the increase level of AMH in different age of PCOS patients,which comprised 55.0 % in PCOS patients that cause defect in ovulation and resulting fertility problem,while no relationship between anti-ovarian antibody and patients with PCOS.

5 illus, 2 tables, 27 ref

045368   RATHOD S R, GONDE N P, KOLTE A P, BAWANKAR P V (Periodontics and Implantology Dep, VSPM Dental Coll and Research Centre, Nagpur, Maharashtra, Email: drsurekhar@gmail. com) : Quantitative analysis of gingival phenotype in different types of malocclusion in the anterior esthetic zone. J Indian Soc Periodontol 2020, 24(5), 414-20.

For any esthetic treatment planning, the shape and form of gingiva should be a prime factor of concern. The correct identification of gingival phenotype (GP) ensures a firm foundation for future health and prognosis of the treatment indicated. Hence, the aim of the present study was to evaluate the correlation between the GP in the anterior esthetic zone with different types of maloclussion and severity of crowding.  A total of 110 periodontally healthy controls were equally divided into two groups depending on the type of malocclusion. They were further divided according to the levels of dental crowding as mild, moderate, and severe. GP was measured on the anterior esthetic teeth using transgingival probing, and width of the attached gingiva (WAG) was measured using histochemical staining method. In severe crowding group, the GP in 12 and 22 region was found to be thick (P = 0.035) while, in 32 and 42 region was thin (P = 0.042). The WAG shows a significant difference between WAG with 23 in severe crowding group with P = 0.042, whereas there was no significant relationship found between the GP with Angle’s classification. Within the limitations of the study, it can be concluded that the teeth in the maxillary and mandibular anterior esthetic region showed the thin phenotype. When the severity of crowding increases, the GP and WAG vary depending on the position of the tooth. There is no association between the Angle’s classification and the mean GP of the maxillary and mandibular anterior region teeth.

1 illus, 5 tables, 23 ref

045367   SAI K S S, SHIVA MANJUNATH R G, KUMAR G, CHAUDHARY B (Periodontics Dep, Bareilly International Univ, Bareilly, Uttar Pradesh, Email: drmanjuperio@ gmail.com) : Soluble CD163 as a biomarker of periodontal disease – A biochemical study using enzyme‑linked immunosorbent assay. J Indian Soc Periodontol 2020, 24(5), 409-13.

The aim of the study was to evaluate the levels of soluble CD163 (sCD163) in gingival crevicular fluid (GCF) and blood serum of individuals having periodontitis, gingivitis, and healthy periodontium. Further, the role of sCD163 as a biomarker of periodontal disease was also assessed. A minimum of 5‑µl GCF and 10 ml of venous blood was collected using a micropipette and 10‑ml syringe, respectively, from the study population which was divided into three groups as healthy (Group I, n = 10), gingivitis (Group II, n = 10), and periodontitis (Group III, n = 10). sCD163 samples were assessed using a commercially available sCD163 enzyme‑linked immunosorbent assay kit. Clinical parameters such as oral hygiene index simplified, gingival index (GI), percentage of sites with bleeding on probing, probing depth, and clinical attachment loss were recorded. The mean serum sCD13 levels were 743.45 ± 51.17 ng/ml, 563.25 ± 103.74 ng/ml, and 431.0 ± 31.08 ng/ml when compared to the mean GCF sCD163 levels which were 59.81 ± 7.61 ng/ml, 38.93 ± 12.42 ng/ml, and 30.49 ± 12.60 ng/ml for periodontitis, gingivitis, and healthy individuals, respectively. The sCD163 levels were higher in patients with periodontitis when compared to the periodontally healthy individuals. Within the limitations of the present study, it can be concluded that sCD163 levels can be used as a diagnostic marker of disease as its levels are remarkably increased in GCFs of patients having periodontitis.

3 tables, 39 ref

045366   VANDANA K L, TATUSKAR P V, VALAVALKAR N N (Periodontics Dep, Dental Sciences Coll, Davangere - 577 004, Karnataka, Email: vanrajs@gmail.com) : A comparative evaluation of manual and powered brushing on oral health and microbial status of mentally challenged individuals. J Indian Soc Periodontol 2020, 24(4), 362-8.

Tooth brushing is a very simple and effective method for removing daily dental deposits and for preventing dental and periodontal diseases. In physically or mentally challenged person, there arises difficulty in oral hygiene maintenance so that oral hygiene methods may need to be simplified or modified to suit the individual situation. Thirty individuals of age group 15–30 years with mild to moderate degree of mental retardation were selected. A randomized double-blind split-mouth design with Clinical Phase-i (aided brushing) and Clinical Phase-ii (unaided brushing) with a washout period of 3 days was conducted. The study duration was for 0–45 days. Two types of brushing that is manual and powered brushing were done. The recording of all clinical and microbial parameters were done on 0th day and 21st day while the clinical parameters were recorded up to 45th day. On intragroup comparison, throughout the study phases, both manual and powered brushing significantly reduced the Quigley–Hein plaque index (48 %), gingival bleeding index (GBI) (44 %), and modified gingival index (52 %). The Pearson correlation between GBI and periodontal pathogens like Prevotella internedia, Porphyromonas gingivalis, and Fusobacterium nucleatum showed statistically significant relation (P < 0.05) in powered brushing group. Powered toothbrush was more effective than manual toothbrush in reducing plaque levels and microbial count in the mentally challenged individuals. The Colgate 360 tooth brush is advisable to mentally challenged individuals.

4 illus, 5 tables, 11 ref

045365   AGARWAL A, CHAUDHARY B (Periodontics Dep, Institute of Dental Sciences, Bareilly, Uttar Pradesh, Email: drashish.aag@ gmail.com) : Clinical and microbiological effects of 1% Matricaria chamomilla mouth rinse on chronic periodontitis: A double‑blind randomized placebo controlled trial. J Indian Soc Periodontol 2020, 24(4), 354-61.

Several herbal mouth rinses are assessed in the literature as an adjunct to scaling and root planning (SRP) for the treatment of periodontal diseases. The objective of this study was to evaluate and compare the clinical and microbiological effects of Matricaria chamomilla (MTC) mouth rinse with chlorhexidine (CHX) and placebo mouth rinse for the management of chronic periodontitis. This double‑blind, randomized, placebo controlled, clinical trial involved seventy five patients, suffering from chronic periodontitis, which were randomly divided into three groups: negative control (SRP + placebo), positive control (SRP + 0.12 % CHX), and test group (SRP + 1 % MTC mouth rinse). Mouth rinsing (adjunctive therapy) was continued for 1 month while clinical parameters (plaque index, gingival index, sulcus bleeding index, probing pocket depth [PPD], clinical attachment level, gingival recession [GR], stain index) and microbial colony forming units were evaluated at base line, 6 weeks, and 3 months. All groups showed a significant change in parameters (except GR for placebo group) between base line and 3 months. MTC mouth rinse suggested added significant benefits over placebo group over the study period. However, it determined more but nonsignificant improvement in PPD (3.68 mm vs. 3.36 mm) and CAL (3.00 mm vs. 2.72 mm) as compared to CHX rinse at 3 months’ period as compared to baseline.  Advantages of using test group were comparable to CHX associated group; therefore, MTC mouth rinse can be used as an effective adjunct during nonsurgical periodontal therapy for chronic periodontitis.

5 illus, 8 tables, 41 ref

045364   JAIN R, CHATURVEDI R, PANDIT N, GROVER V, LYLE D M, JAIN A (Periodontology Dep, Punjab Univ, Chandigarh, Email: ashish@justice.com) : Evaluation of the efficacy of subgingival irrigation in patients with moderate‑to‑severe chronic periodontitis otherwise indicated for periodontal flap surgeries. J Indian Soc Periodonto 2020, 24(4), 348-53.

In certain medically and physically compromised; and terminally ill patients, periodontal surgery may not be feasible. They need special attention and assistance for their daily plaque control regimens for the management and maintenance of periodontal conditions. Subgingival irrigation home care devices with antiplaque agents may serve as useful tools in such specific patient populations. The aim of this study was to evaluate of the efficacy of sub‑gingival irrigation in patients with moderate‑to‑severe chronic periodontitis otherwise indicated for periodontal flap surgeries. Randomized comparative parallel group interventional clinical trial. Materials and Methods: Forty adults with moderate-to-severe periodontitis, divided inot Group A and B, were subjected to the use of subgingival home irrigations using 0.06 % chlorhexidine (CHX) and mouth-rinsing with 15 ml of 0.12 % CHX twice daily, respectively after Phase I therapy. Clinical parameters, i.e., gingival index, oral hygiene index simplified, and bleeding on probing scores were assessed at baseline, 2 weeks, 4 weeks, and 12 weeks’ postphase I therapy, whereas clinical attachment level (CAL), probing depth (PD), and stain assessment at baseline and 12 weeks following Phase I therapy. Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA version 15.0 for Windows). A statistically significant difference was seen with the use of 0.06 % CHX irrigations in PD (P = 0.004) and CAL (P = 0.002) as compared to the use of mouth rinsing with 0.12 % CHX. Similar differences were observed in both intensity (P = 0.014) and area (P = 0.034) of lingual surface staining with greater staining with CHX mouth rinsing. The adjunctive use of subgingival home irrigations using 0.06 % CHX has a promising potential to maintain the oral health and results in lesser staining compared to CHX mouth rinsing. The regimen may further obviate the need of periodontal surgery in medically compromised subjects.

3 tables, 26 ref

041833   HASHIMOTO W, TAKENAKA I, YASUNAMI K, MINAMI T, SANO H (Anaesthesia Dep, Kyushu Rosai Hospital, Kitakyushu - 800?0296, Japan, Email: dd6xj6rx7@yahoo.co.jp) : Comparison of effectiveness of the piston‑pump method versus the pressure‑infusor method for rapid infusion of crystalloids: A bench study. Indian J Anaesth 2020, 64(12), 1059-63.

The piston-pump method is a simple method for rapid administration of fluids but some problems are unsolved. We compared the effectiveness of using the piston-pump method with that of the pressure-infusor method. Twelve anaesthetists were classified randomly into the piston‑pump and pressure‑infusor groups. They were asked to infuse 500 ml of saline three times successively through a 16-G intravenous cannula as rapidly as possible using a pump with a 50-ml syringe or a pressure-infusor at 300 mmHg. The time taken for infusion and the maximum or minimum pressure in the infusion circuit and substitute vessel were measured. Bacterial culture of the saline infused sterilely was performed to estimate bacterial contamination. The pressure-infusor group led to faster infusion of 500 ml of saline (233 ± 19 s) than the piston‑pump group (301 ± 48 s) (P < 0.01). The infusion time at the third attempt (316 ± 43 s) was significantly longer than that at the first attempt (285 ± 53 s) only in the piston-pump group (P < 0.05). The maximum pressure (mmHg) in the circuit was 131 ± 9 and > 200 (P < 0.01) and in the substitute vessel was 5 ± 1 and 17 ± 7 (P < 0.01) in the pressure-infusor and piston-pump groups, respectively. A pressure of <-200 mmHg occurred at all infusion attempts in the piston-pump group. Bacterial contamination was not observed in either group. If fluids must be administered rapidly, the pressure‑infusor method is more efficient than the piston‑pump method because the latter is less effective in infusing fluids rapidly and associated with excessive positive and negative pressure in the infusion circuit.

1 illus, 1 table, 18 ref

045363   MUTHURAJ T S, BAGCHI S, BANDYOPADHYAY P, MALLICK S, GHOSH P, RENGANATH M J (Periodontics Dep, CSI Coll of Dental Sciences and Research, Viruthunager, Tamil Nadu, Email: thamil3011@gmail. com) : A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller’s Class I recession coverage therapy. J Indian Soc Periodontol 2020, 24(4), 342-7.

According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller’s Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller’s Class I GR.  All the 15 patients participated in the study who had totally 30 bilateral Miller’s Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller’s Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.

3 illus, 4 tables, 29 ref

041832   DHAWAN S, GURI M, BHATI K, AERON N (Anaesthesia Dep, S.P. Medical Coll and A.G. Hospitals, Bikaner - 334 001, Rajasthan, Email: gurimaniram@gmail.com) : Comparison of airway blocks versus general anaesthesia for diagnostic direct laryngoscopy: A randomised comparative trial. Indian J Anaesth 2020, 64(12), 1054-8.

Direct rigid laryngoscopy and general anaesthesia(GA) are associated with many problems. Regional anaesthesia/airway blocks can be considered as safer and easier alternative techniques especially among old and comorbid patients and conditions with difficult airways as well. The present study was conducted to compare efficacy of regional anaesthesia/airway blocks versus general anaesthesia for diagnostic direct (rigid) laryngoscopy. A randomised comparative trial was conducted among patients undergoing diagnostic direct laryngoscopy (DLS) for perilaryngeal lesions. Eighty patients of either sex aged between 20and 80 years and categorised as American Society of Anesthesiologists(ASA) grade I, II, III or IV were divided under two groups of 40 patients each. Group-A underwent DLS with airway blocks and group-B underwent DLS under GA. Haemodynamic parameters and analgesia were interpreted statistically. Difference in haemodynamic stability and quality of post- operative analgesia were primary outcomes. Patients in group-A were observed to be haemodynamically more stable as compared to group‑B patients with statistically significant Pvalue(0.003 and 0.016 for pulse rate at 6 min and mean arterial pressure at 4 min, respectively). In postoperative period, group-A patients were found to be more comfortable (lower VAS scores) than group-B patients with P value (0.040, 0.043, 0.044 at 0, 5, 15 min, respectively). Regional airway blocks provide better haemodynamic stability and postoperative analgesia than general anaesthesia.

1 illus, 4 tables, 10 ref

041831   GHOSH D, JAIN G, AGARWAL A, GOVIL N (Anaesthesiology and Critical Care Dep, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand, Email: gauravhld@gmail.com) : Effect of ultrasound‑guided–pressure‑controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery. Indian J Anaesth 2020, 64(12), 1047-53.

Identifying an ideal intraoperative ventilation strategy remains an area of research. We evaluated the effect of ultrasound-guided–pressure-controlled ventilation (UG-PCV) on the blood-gas and ventilatory parameters, during both two-lung ventilation (TLV) and one-lung ventilation (OLV) for thoracic surgery of unilateral pulmonary disease, compared with volume-targeted PCV (VT-PCV). In a prospective, parallel-group and double-blinded design, 40 consecutive patients were randomised into two groups. Group A: Received VT-PCV at a tidal volume (TV) of 9 mL/kg for TLV and 5 mL/kg for OLV; group B: Received UG‑PCV at an inspiratory pressure (2 cmH₂O increments every 15 s) targeted to achieve the alveolar aeration at the base of the dependent lung (ultrasound-guided), for both TLV/OLV, respectively. Primary outcome included arterial oxygen partial pressure (PaO₂) measured at baseline before anaesthesia induction (T1), at 30 min immediately before conversion from TLV to OLV (T2), at 30 min on OLV (T3) and before terminating OLV at the end of surgery (T4). Statistical tool included Mann-Whitney test. The PaO₂ (mmHg) was significantly higher in group B (374.5 ± 25.9, 321.7 ± 35.2 and 357.0 ± 24.7) as compared to group A (353.3 ± 38.1, 272.6 ± 37.9 and 295.3 ± 40.1), at T2, T3 and T4, respectively. The acid‑base status remained preserved in group B, while gradual respiratory acidosis was observed in group A. The bicarbonate levels remained uniform in all patients. The TV and airway pressures were marginally higher in group B, with no intraoperative complications. The UG-PCV mode offered better oxygenation, homogenous acid-base balance and individualised alveolar ventilation for thoracic surgery.

1 illus, 3 tables, 15 ref

041830   SHAH S B, CHAWLA R, PAHADE A, MITTAL A, BHARGAVA A K, KUMAR R (Anaesthesiology Dep, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi ? 110 085, Email: drshagun_2010@rediffmail.com) : Comparison of pectoralis plane blocks with ketamine‑dexmedetomidine adjuncts and opioid‑based general anaesthesia in patients undergoing modified radical mastectomy. Indian J Anaesth 2020, 64(12), 1038-46.

Regional anaesthesia attenuates surgical stress-response, provides superior analgesia, reduces recovery time with early mobilisation and is opioid-sparing [addresses post-operative nausea vomiting (PONV), constipation, immunosuppression and cancer-progression concerns with opioids]. Hence, we studied pectoralis (PECS) blocks for modified radical mastectomy (MRM). A prospective, interventional, double-blind, randomised, parallel-arm, active-controlled study comparing two anaesthetic techniques for post-operative pain relief in70 adult American Society of Anesthesiologists grade I/II carcinoma breast patients undergoing MRM was conducted. Patients were randomised to Group‑O (opioids, sevoflurane) and Group-P (PECS-block, pre-incisional intravenous (IV) ketamine (0.5 mg/kg), pre-incisional IVdexmedetomidine (1 µg/kg over 10 min, then 0.6 µg/kg/h). Data were subjected to statistical analysis using the Statistical Package for Social Sciences, version-23 and independent sample t-test/Welch test for equality of means and expressed as dotted box-whisker plots. Nominal categorical intergroup data was compared using Chi-squared test/Fisher’s exact test. P<0.05 was considered statistically significant. Clinical significance was calculated. Higher Visual Analogue Scale (VAS)-scores were recorded in Group-O versus Group-P, immediately post‑extubation [mean (SD) 3.6 ± 1.5 and 0.76 ± 0.6] and at 1h (3.1 ± 1.2 and1.4 ± 0.5), 2h (2.5 ± 0.9 and 1.2 ± 0.6) and 4h (2.2 ± 0.5 and 1.7 ± 0.9) respectively. At 8h and 24h post‑surgery VAS was comparable. Cumulative-VAS was lower in Group-P. Intraoperative haemodynamics were comparable. Incidence of PONV and constipation was higher in Group-O where each patient received average 27.46 mg morphine-equivalents of opioids. Time to discharge from surgical intensive care unit was 2h shorter in Group-P. Pre-emptive PECS-blocks supplemented with low-dose ketamine and dexmedetomidine comprise a practical and useful alternative technique to the standard opioid-based general anaesthetic technique for MRM.

5 illus, 1 table, 29 ref

041829   KUMAR V, SIROHIYA P, GUPTA N, BHARATI S J, GARG R, MISHRA S (Onco-Anaesthesia and Palliative Medicine Dep, AIIMS, New Delhi, Delhi - 110 029, Email: sirohiyaprashant@gmail.com) : Effect of adding dexamethasone to ropivacaine for ultrasound‑guided serratus anterior plane block in patients undergoing modified radical mastectomy: A preliminary trial. Indian J Anaesth 2020, 64(12), 1032-7.

Ultrasound‑guided serratus anterior plane (SAP) block is a field block with high efficacy. We studied the analgesic effect of the addition of dexamethasone to ropivacaine in SAP block for modified radical mastectomy (MRM). Sixty patients undergoing MRM were randomised into two groups. Patients in Group P (n = 30) received 0.375 % ropivacaine (0.4 ml/kg) with normal saline (2 ml) and those in group D (n = 30) received 0.375 % ropivacaine (0.4 ml/kg) with 8 mg of dexamethasone (2 ml) in ultrasound‑guided SAP block.The primary objective was to compare the time to first rescue analgesia and the secondary objectives were to compare the intraoperative fentanyl requirement, total diclofenac and tramadol requirements, and occurrence of nausea and vomiting in 24 hours, postoperatively. The statistical analysis was done using Mann–Whitney U-test, Chi-square test, Fisher’s exact test, and Kaplan Meier survival estimates. More patients required rescue analgesia in 24 hours in group P (33 %) than group D (10 %, P = 0.04). The probability of a pain free‑period was significantly higher in group D than group P (P = 0.03, log-rank test).Intra-operative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable in both the groups. The incidence of postoperative nausea and vomiting was significantly more in Group P than Group D. Addition of dexamethasone to ropivacaine for SAP block increases the time to first rescue analgesic in the postoperative period.

2 illus, 3 tables, 19 ref

041828   BALAKRISHNAN K, SRINIVASARAGHAVAN N, VENKETESWARAN M V, RAMASAMY T, SESHADRI R A, RAJ E H (Anaesthesiology Dep, Cancer Institute (WIA), Chennai - 600 041, Tamil Nadu, Email: nivedhyaa@gmail.com) : Perioperative factors predicting delayed enteral resumption and hospital length of stay in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Retrospective cohort analysis from a single centre in India. Indian J Anaesth 2020, 64(12), 1025-31.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS‑HIPEC) is an extensive procedure associated with significant morbidity, delay in return of gastrointestinal function and discharge from hospital. Our aim was to assess perioperative factors influencing enteral resumption (ER) and length of stay in the hospital (LOS) in CRS‑HIPEC. A retrospective analysis was conducted in a major tertiary cancer centre. Sixty‑five patients who underwent CRS‑HIPEC between July 2014 and March 2019 were included in the study. The perioperative data were collected from patient records. The primary outcome measure was day of oral resumption of 500 ml of clear fluids and secondary outcome was the LOS. Univariate and multivariate logistic regression analysis was done for the various continuous and categorical perioperative variables for both ER and LOS to elicit the magnitude of risk for both outcomes. Univariate logistic regression revealed that peritoneal carcinomatosis index score (PCI), duration of surgery, blood loss and postoperative ventilation influenced both ER and LOS. Serum albumin, plasma usage and total peritonectomy affected only the LOS but not ER. Multivariate analysis showed that duration of surgery (P = 0.006) and quantum of intravenous fluid infused (P = 0.043) were statistically associated with ER, while serum albumin level (P = 0.025) and postoperative ventilation (P = 0.045) were independently predictive of LOS. CRS-HIPEC is an extensive surgery and multiple factors are associated with ER; of these, duration of surgery and intraoperative fluid therapy are significant factors. Low serum albumin and prolonged postoperative ventilation are associated with increased LOS.

6 tables, 29 ref

041827   MAGOON R, KAUSHAL B, CHAUHAN S, BHOI D, BISOI A K, KHAN M A (Anaesthesia Dep, Gandhi Medical Coll and Hamidia Hospital, Bhopal - 462 001, Madhya Pradesh, Email: brajeshkaushal3@gmail.com) : A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post‑thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth 2020, 64(12), 1018-24.

Enhanced recovery after cardiac surgery is centred around multimodal analgesia which is becoming increasingly feasible with the advent of safer regional analgesic techniques such as fascial plane blocks. We designed this prospective, single-blind, randomised controlled study to compare the efficacy of serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for post-thoracotomy analgesia in cardiac surgery. 100 adults posted for cardiac surgery through a thoracotomy were randomly allocated to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after completion of surgery. Postoperatively, intravenous (IV) paracetamol was used for multimodal and fentanyl was employed as rescue analgesia. Visual analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours post-extubation. The early mean VAS scores at 2, 4 and 6 hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12 hours) was significantly lower in the SAPB and Pecs II group compared with that of the ICNB group (P value <0.05). The cumulative rescue fentanyl dose was significantly higher in ICNB group compared to SAPB and Pecs II group (P value <0.001). The SAPB group had the highest time to 1^st rescue analgesic requirement in contrast to the other groups. SAPB and Pecs II blocks are simple single-shot effective alternatives to ICNB with a prolonged analgesic duration following thoracotomy and can potentially enhance pain-free recovery after cardiac surgery.

3 illus, 3 tables, 26 ref

041826   VENKATRAMAN R, SARAVANAN R, DHAS M, PUSHPARANI A (Anaesthesiology Dep, SRM Medical Coll Hospital and Research Institute, Chengalpattu - 603 211, Tamil Nadu, Email: drcrsaravanan@gmail.com) : Comparison of laparoscopy‑guided with ultrasound‑guided subcostal transversus abdominis plane block in laparoscopic cholecystectomy – A prospective, randomised study. Indian J Anaesth 2020, 64(12), 1012-7.

Subcostal transversus abdominis plane (TAP) block is usually done under ultrasound guidance in laparoscopic cholecystectomy. Laparoscopic-guided subcostal TAP block is an alternate technique where ultrasound is not available. Our primary objective was to compare the success rate of ultrasound and laparoscopic approaches to the subcostal TAP block. The secondary objectives were to assess the duration of postoperative analgesia and morphine consumption postoperatively for 24 h. Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into two groups with patients receiving ultrasound-guided (group U) or laparoscopy-guided (group L) subcostal TAP block at the end of surgery. The success rate was assessed by a sensory blockade of T7 and T8 dermatomes 30 min after extubation. The duration of analgesia was taken as time from block administration to the visual analogue scale of ≥3. Morphine was administered in patient-controlled analgesia (PCA) pump with a bolus of 1 mg and a lock-out interval of 10 min. The total morphine consumption was recorded. The statistical analysis was performed with student t-test and Chi-square test. The success rate of group U (100%) was higher than group L (88%) but it was not statistically significant (P = 0.054). The duration of postoperative analgesia was significantly prolonged in group U (867.24 ± 135.83 min) than group L (751.31 ± 311.22 min) (P = 0.033). Morphine consumption was also less in group U (4.72 ± 0.94 mg) than group L (5.57 ± 2.53 mg) (P = 0.049). There was no significant difference in the VAS scores after 4 h postoperatively. Laparoscopy-guided subcostal TAP block is a suitable alternative to ultrasound-guided block and can be utilised in places where an ultrasound machine is not available.

3 illus, 2 tables, 17 ref

041825   VENKATRAMAN R, SARAVANAN R, MOHANA K V, PUSHPARANI A (Anaesthesiology Dep, SRM Medical Coll Hospital and Research Institute, Chennai, Tami Nadu, Email: drcrsaravanan@gmail.com) : Evaluation of ultrasound‑guided quadratus lumborum block for post‑operative analgesia in unilateral laparoscopic renal surgeries – A randomised controlled trial. Indian J Anaesth 2020, 64(12), 1007-11.

Quadratus lumborum block (QLB) is a novel anaesthetic technique for abdominal wall block providing excellent post-operative analgesia. The primary objective of this study was to evaluate the duration of post-operative analgesia with QLB in unilateral laparoscopic renal surgeries. The secondary objectives were to assess total morphine consumption during the first 24 h postoperatively and observe for complications. Sixty patients undergoing unilateral laparoscopic renal surgeries were randomly divided into two groups, with patients receiving QLB (Group A) or no block (Group B) at the end of surgery. General anaesthesia was standardised in both the groups. The pain was assessed by a Visual Analogue Scale (VAS) of 1–10. The duration of analgesia was taken as time from extubation to VAS of ≥3. Morphine was administered in patient-controlled analgesia pump with a bolus of 1 mg and a lockout interval of 10 min (min). The total morphine consumption was recorded. The statistical analysis was performed with the Student’s t-test and Chi-square test. The duration of post-operative analgesia was significantly prolonged in Group A (1288 ± 288.92 min) than Group B (138 ± 54.92 min). Morphine consumption was also less in Group A (3.1 ± 0.87 mg) than Group B (10.46 ± 1.8 mg). There was a significant difference in the VAS score from 16 to 20 h. No complications were recorded. Ultrasound-guided QLB after laparoscopic renal surgery is safer to perform, effective with an increased post-operative duration of analgesia, reduces the consumption of opioids and is associated with fewer side effects.

3 illus, 3 tables, 21 ref

041824   SHIVANAND M, SMITA P, PARUL M, KESHABANAND M (Anaesthesia and Intensive Care Dep, Vardhman Mahavir Medical Coll and Safdarjung Hospital, New Delhi - 110 049, Email: drsunilprakash@gmail.com) : Effect of reinsertion of the spinal needle stylet after spinal anaesthesia procedure on post dural puncture headache in women undergoing caesarean delivery. Indian J Anaesth 2020, 64(11), 971-8.

Post dural puncture headache (PDPH) following caesarean delivery (CD) is a cause for concern for anaesthesiologists. We aimed to study the effect of reinsertion of the stylet after spinal anaesthesia procedure, prior to spinal needle removal, on the incidence of PDPH in women undergoing CD. We also evaluated the risk factors associated with PDPH. In this randomised, double-blind study in a tertiary care hospital, 870 American Society of Anesthesiologists (ASA) II/III women undergoing CD under spinal anaesthesia were randomly divided into-GroupA (n = 435): stylet reinsertion before spinal needle removal and Group B (n = 435): spinal needle removal without stylet reinsertion. All patients were questioned for occurrence of PDPH at various time-points. Statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 17 version program for Windows. Sixty-two (7.1 %) patients developed PDPH; 27 (6.2 %) patients with stylet reinsertion and 35 (8.0 %) patients in those with no stylet reinsertion; P = 0.389. The onset of headache was significantly delayed in patients with stylet reinsertion (16.2 ± 6.7 and 13.2 ± 4.3 h, respectively); P = 0.041 and they had greater severity of PDPH compared with those with no stylet reinsertion; P = 0.002. Factors significantly associated with PDPH were hypothyroidism, tea habituation, number of skin punctures and needle redirections, first pass success rate, occurrence of paraesthesia and contact with bone, intraoperative hypotension and time to ambulation. Reinsertion of the stylet before spinal needle removal did not influence the incidence of PDPH. The onset of PDPH was delayed and the severity of headache was greater in women in whom reinsertion of the stylet was done.

1 illus, 4 tables, 28 ref

041823   ALI W A, MOHAMMED M, ABDELRAHEIM A R (Anaesthesia and Intensive Care Dep, Minia Univ, Minia 61111, Egypt, Email: wegdan21122000@yahoo.com) : Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial. Indian J Anaesth 2020, 64(11), 965-70.

Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7 % and 79.3 % of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non‑significant manner, whereas its severity and duration increased significantly in the B0 group. Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

3 illus, 3 tables, 30 ref

041822   JOSEPH J, GEORGE S K, DANIEL M, RANJAN R V (Anaesthesiology Dep, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla - 689 101, Kerala, Email: drjoejoseph@gmail.com) : A randomised double‑blind trial of minimal bolus doses of oxytocin for elective caesarean section under spinal anaesthesia: Optimal or not?. Indian J Anaesth 2020, 64(11), 960-4.

Oxytocin administration regimens are arbitrary and highly subjective. Hence, it is essential to reinvestigate the appropriate dose for effective uterine contraction with minimal bleeding and adverse effects. To determine the optimal dose of bolus oxytocin for uterine contractions for elective caesarean section under spinal anaesthesia. Ninety term mothers (37 to 41 weeks) undergoing caesarean section electively under spinal anaesthesia were considered for the trial and divided into three groups to receive oxytocin bolus of one, two or three units. The uterine tone was assessed at 2 min after oxytocin administration. Intraoperative blood loss, mean arterial pressure, heart rate and possible side effects were also compared. Paired t-test, Kruskal-Wallis test, Chi-square test and analysis of variance (ANOVA) test with Scheffe multiple comparisons were used as inferential statistics. Adequate uterine contraction was seen in 66 % of participants who received one unit of oxytocin, and in 83.3 % of participants who received two units of oxytocin. All those who received three units of oxytocin had an adequate uterine contraction. Blood loss was inversely related to the bolus dose of oxytocin. Lower bolus oxytocin doses of one and two units were inadequate for uterine contraction at elective caeserean section, while three units appeared to be effective in terms of adequate uterine contraction, reduced blood loss and stable haemodynamic system and absent side effects.

3 illus, 3 tables, 17 ref

041821   SAMARAH W K, ALGHANEM S M, BSISU I K, RAHMAN Z A, GUZU H A, ABUFARES B N (Anesthesia Dep, Jordan Univ, Amman - 11942, Jordan, Email: alghanem@ju.edu.jo) : The effect of ondansetron administration 20 minutes prior to spinal anaesthesia on haemodynamic status in patients undergoing elective caesarean section: A comparison between two different doses. Indian J Anaesth 2020, 64(11), 954-9.

Spinal anaesthesia is currently the most common method used for managing patients undergoing elective caesarean sections. Recent meta-analyses have been supporting the use of 5-HT3 antagonists, like ondansetron, to attenuate hypotension induced by spinal block. Various doses of ondansetron were given intravenously five minutes before spinal block. However, a consensus on definitive dose and timing for maximal benefit is yet to be agreed upon. Our prospective randomised clinical trial investigated a new approach by administrating intravenous ondansetron 20 minutes before spinal anaesthesia. This work investigated ondansetron effect on both haemodynamic changes and vasopressors use by dividing patients into three groups. The first group O4 (n = 51) received 4 mg ondansetron, the second group O6 (n = 51) received 6 mg ondansetron, and the control group C (n = 50) received normal saline. We recorded systolic blood pressure (SBP), diastolic blood pressure (DBP) and the mean blood pressure (MBP) at different time intervals. There was no significant difference in blood pressure measurements among the study groups (P > 0.05). The consumption of ephedrine in the control group is higher than both of the ondansetron groups (P > 0.001), with a mean dose of 27.2 ± 20.5 mg of ephedrine for group C, compared to 17.8 ± 14.9 and 14.7 ± 11.3 in O4 and O6 groups, respectively. Episodes of hypotension and number of patients with hypotension were not significantly different among the studied groups (P = 0.07; P = 0.96, respectively). Prophylactic 4 and 6 mg ondansetron given 20 minutes before spinal anaesthesia in caesarean section does not reduce the incidence of hypotension.

5 tables, 21 ref

046705   AL-BAIDHANI A K S, ABDULAMEER M S (Al-Sadiq Teaching General Hospital, Iraq) : Advantage of application of topical hyaluronic acid in reducing post tonsillectomy pain; cross sectional comparative study. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194381.

Tonsillectomy is common surgical operation performed in otolaryngology department. Various techniques could be used that include traditional cold dissection, powered instrumentation like electro cautery, harmonic scalpel, laser, and radiofrequency technique. As with any surgery, there are some risks can occur with tonsillectomy, these includes bleeding, pain at the site of surgery and/or referred otalgia, and infection. The aim of our study was to assess the postoperative use of topical hyaluronic acid with regards to safety, pain relief. The research was considered a cross-sectional research made on 60 patients needing tonsillectomy from a period began from January to September 2018. The patients had been separated into two groups both from 30 patients, one group (group A) treated by using high molecular weight(HMW) Hyaluronic acid spray on tonsillar beds after operations , and the second group(group B) dealt as control. Early complications were registered in questionnaires and then the data were evaluated for each group. The use of high molecular weight (HMW) Hyaluronic acid spray on tonsillar beds after surgery has reduces the pain significantly after 3 – 7 days (p-value = 0.0001) while has no implication on pain reduction within12 - 24 hours p-value (0.17 and 0.3) respectively . Conclusion: The use of (HMW) hyaluronic acid spray can be used safely in post tonsillectomy patients. Hyaluronic acid spray can minimize post tonsillectomy pain.

1 illus, 2 tables, 33 ref

041820   KUMAR A, SINHA C, KUMARI P, KUMAR A, SINHA A K, KUMAR B (Anaesthesia Dep, AIIMS, Patna, Bihar, Email: chandni.doc@gmail.com) : Ultrasound guided rhomboid intercostal block: A pilot study to assess its analgesic efficacy in paediatric patients undergoing video‑assisted thoracoscopy surgery. Indian J Anaesth 2020, 64(11), 949-53.

Ultrasound guided rhomboid intercostal plane block (RIB) is a relatively new regional anaesthesia technique that has shown to provide dermatomal coverage from T2-9 on the whole anterior and posterior hemithorax. It has proved effective in providing preemptive analgesia in various surgeries like mastectomy and thoracotomy. The aim of the study was to study the efficacy of RIB in paediatric patients: 7 to 12 years undergoing thoracoscopic surgeries in terms of analgesic requirement, pain scores and adverse effects. In this randomised, prospective double-blind study, 40 American Society of Anesthesiologists I/II patients, of the age group 7-12 years scheduled for Video-assisted thoracoscopy (VATS) surgery were recruited. The patients were allocated to one of the two groups: group R: general anaesthesia + RIB (RIB group) and group F: general anaesthesia (FENT group). Perioperative opioid consumption and postoperative pain scores were recorded. Adverse effects like respiratory depression and nausea were also noted. Patients in group R required less intraoperative fentanyl dose (1.45 ± 0.65 vs 2.90 ± 0.45) (P < 0.05). Postoperative opioid consumption was also less in this group R (2.90 ± 0.91 vs 5.56 ± 1.08) (P < 0.05). Less number of patients experienced nausea (2 vs 6) and respiratory depression (2 vs 7) in group R. Ultrasound guided RIB reduces perioperative opioid consumption in patients undergoing VATS surgery with lesser postoperative pain scores.

2 illus, 4 tables, 13 ref

041819   MANIRAJAN M, BIDKAR P U, SIVAKUMAR R K, LATA S, SRINIVASAN G, JHA A K (Anaesthesia and Critical Care Dep, Jawaharlal Institute of Postgraduate Medical Research and Education, Puducherry - 605 006, Email: drprasannabidkar@gmail.com) : Comparison of paediatric King Vision™ videolaryngoscope and Macintosh laryngoscope for elective tracheal intubation in children of age less than 1 year: A randomised clinical trial. Indian J Anaesth 2020, 64(11), 943-8.

Paediatric airway, because of its consistent anatomical differences from that of an adult, often encounters difficulty in aligning the line of sight with the laryngeal inlet during intubation. Paediatric videolaryngoscopes (VLs), by obviating the need for aligning the line of sight with the glottis, offer several advantages over direct laryngoscopy. Therefore, this study aimed to compare the recently introduced paediatric King Vision™ VL (KVL) and the direct laryngoscope with Macintosh blade for elective tracheal intubation in infants of age <1 year. Seventy-eight infants of American Society of Anesthesiologists physical status 1 and 2, scheduled for elective surgery, were enrolled for this prospective randomised clinical trial and randomised into either of the two groups – Group K and Group C, where the infants were intubated using size 1 King Vision or direct laryngoscope with Macintosh blade. The primary objective of this study was the time taken for intubation and the first‑attempt intubation success rate. Time to intubate (25.90 ± 2.34 s vs. 25.03 ± 1.42 s, P = 0.05) and first‑attempt intubation success rate (100 % vs. 100 %, P = 1) were similar between the groups, whereas glottic visualisation (P = 0.01), alternate techniques used to assist intubation (P < 0.001), the ease of intubation (P = 0.02) and intubation difficulty score (P = 0.01) were better in Group K than that in Group C. The outcome of KVL and Macintosh laryngoscope was similar in terms of time taken for intubation and first‑attempt intubation success rate with KVL having superior glottic visualisation, better ease of intubation and lower intubation difficulty score for elective intubations in children of age <1 year.

1 illus, 3 tables, 21 ref

045363   MUTHURAJ T, BAGCHI S, BANDYOPADHYAY P, MALLICK S, GHOSH P, RENGANATH M J (Periodontics Dep, CSI Coll of Dental Sciences and Research, Viruthunager, Tamil Nadu, Email: thamil3011@gmail. com) : A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller’s Class I recession coverage therapy. J Indian Soc Periodontol 2020, 24(4), 342-7.

According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller’s Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller’s Class I GR. All the 15 patients participated in the study who had totally 30 bilateral Miller’s Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller’s Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.

3 illus, 4 tables, 29 ref

045363   MUTHURAJ T, BAGCHI S, BANDYOPADHYAY P, MALLICK S, GHOSH P, RENGANATH M J (Periodontics Dep, CSI Coll of Dental Sciences and Research, Viruthunager, Tamil Nadu, Email: thamil3011@gmail. com) : A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller’s Class I recession coverage therapy. J Indian Soc Periodontol 2020, 24(4), 342-7.

According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller’s Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller’s Class I GR. All the 15 patients participated in the study who had totally 30 bilateral Miller’s Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller’s Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.

3 illus, 4 tables, 29 ref

041818   BEHERA B K, MISRA S, BELLAPUKONDA S, SAHOO A K (Anesthesiology and Critical Care Dep, AIIMS, Patrapada - 751 019, Odisha, Email: bikrambehera007@gmail.com) : Impact of visually guided versus blind techniques of insertion on the incidence of malposition of Ambu® AuraGain^TM in paediatric patients undergoing day care surgeries: A prospective, randomised trial. Indian J Anaesth 2020, 64(11), 937-42.

In adults, video laryngoscopy is recommended for supraglottic airway device (SGAD) placement as it results in better device position and higher oropharyngeal leak pressures. In children, there is a paucity of studies evaluating the impact of visually guided techniques on SGAD placement. Aim of the study was to evaluate the usefulness of visual-guided techniques of SGAD placement in children. Totally, 75 children, scheduled for elective surgery, were randomly allocated into three groups, that is, standard (S), direct laryngoscopy (DL), and video laryngoscopy (VL). Ambu AuraGain was placed blindly in group S, and under visual guidance with video laryngoscopy and direct laryngoscopy in groups VL and DL, respectively. Ambu AuraGain position was determined by flexible videoendoscope. First attempt success rate, time for successful insertion, oropharyngeal leak and any complications were studied. Incidence of malposition was not significantly different in group S (44 %), DL (48 %), and VL (64 %); P = 0.32. The first attempt success rate was 100 % in DL and 92 % each in S and VL. Time to insert (seconds) was significantly higher in VL (37.9 ± 21.6), compared to S (18.4 ± 7.9) and DL (27.4 ± 14.5); P < 0.001. Incidence of oropharyngeal leak, impact on ventilation, and complications were similar in all three groups. In this study, there was no advantage of visually guided techniques for Ambu AuraGain placement in children.

1 illus, 2 tables, 19 ref

041817   HALANSKI M A, STEINFELDT A, HANNA R, HETZEL S, SCHROTH M, MULDOWNEY B (Wisconsin School of Medicine and Public Health Univ, Wisconsin 53705, United States of America, Email: rbhanna@wisc.edu) : Peri‑operative management of children with spinal muscular atrophy. Indian J Anaesth 2020, 64(11), 931-6.

Current multi-disciplinary management of children with spinal muscular atrophy (SMA) often requires the surgical management of spinal deformities. We present the outcomes of our peri-operative experience around the time of their spinal surgery and share our neuromuscular perioperative protocol. Asingle-centre retrospective chart review was performed to evaluate all children with SMA types I and II that underwent thoracolumbar spinal deformity correction (posterior spinal fusion or growing rod insertion) from 1990 to 2015. Electronic medical records were reviewed to assess pre-operative, intraoperative, and postoperative variables. T-tests, Wilcoxon Rank Sum, Fisher’s Exact tests were performed as appropriate. Twelve SMA I and twenty-two SMA II patients were included. Type I patients tended to be smaller and had a higher percentage (36.4 % vs 4.5 %) of American Society of Anesthesiologists (ASA) class 4 patients. Preoperative total parenteral nutrition (TPN) was utilised in 75.0 % of type I and 18.2 % type II patients. A difficult intubation was experienced in around 25 % of the patients (20.0 % SMA I, 27.3 % SMA II). Approximately two hours of anaesthetic time was required in addition to the actual surgical time in both types. The intensive care unit (ICU) length of stay averaged 6 (4.0-7.5) days for type I and 3 (3-5) days for type II (p = 0.144). Average post-operative length of stay was (8 (7-9) vs. 7 (6-8)) P = 1.0. Children with type I and II SMA have similar hospital courses. The surgical and anaesthesia team should consider perioperative TPN and NIPPV(non‑invasive positive‑pressure ventilation), anticipate difficult intubations, longer than usual anaesthetic times, and potentially longer ICU stays in both SMA type I and II.

2 tables, 28 ref

041816   ABDUALLAH M A, AHMED S A, ABDELGHANY M S (Anaesthesia and Surgical Intensive Care Dep, Tanta Univ, Tanta, Al Gharbia Governate, Egypt, Email: samehabdelkhalik1982@gmail.com) : The effect of post‑operative ultrasound‑guided transmuscular quadratus lumborum block on post‑operative analgesia after hip arthroplasty in elderly patients: A randomised controlled double‑blind study. Indian J Anaesth 2020, 64(10), 887-93.

The best analgesic technique after hip surgeries is a matter of debate. This clinical trial aimed to assess the effect of transmuscular ultrasound-guided quadratus lumborum (QL) block on post-operative analgesic consumption after hip arthroplasty in elderly patients. This prospective randomised double-blind study was carried out on 60 patients aged 60–80 years presented for total hip replacement under unilateral spinal anaesthesia. Patients were randomly allocated to one of two groups: A control group, receiving sham transmuscular QL block (QLB) (1 ml of normal saline), and a QL group, receiving real transmuscular QLB (30 ml of plain bupivacaine 0.25%). Post-operative morphine consumption (primary outcome), post-operative pain score (secondary outcome), time to the first request of rescue analgesia, patient’s satisfaction and the occurrence of post-operative complications were measured. Compared to the control group, the use of QLB in the second group significantly decreased intravenous morphine consumption postoperatively from 8.50 ± 3.06 mg to 5.60 ± 3.22 mg (P = 0.0007) with a significant prolongation of the time to the first call for analgesia (P < 0.0001). It also decreased the post-operative visual analogue score 4 h, 6 h and 8 h postoperatively (P ˂ 0.05). However, there was no difference between both the groups regarding patient’s satisfaction and the occurrence of complications (P > 0.05). The use of transmuscular QLB in patients undergoing total hip replacement decreased post-operative analgesic consumption and post-operative pain score and prolonged post-operative analgesia. It did not affect patients’ satisfaction and occurrence of post-operative complications.

3 illus, 2 tables, 30 ref

041815   CHAWDHARY A A, KULKARNI A, NOZARI A (Anaesthesiology and Critical Care Dep, Dr. Baba Saheb Ambedkar Hospital and Medical Coll, New Delhi, Delhi - 110 085, Email: drabrar07@gmail.com) : Substitution of propofol for dexmedetomidine in the anaesthetic regimen does not ameliorate the post‑operative cognitive decline in elderly patients. Indian J Anaesth 2020, 64(10), 880-6.

Post-operative cognitive dysfunction (POCD) is a poorly understood complication particularly observed in elderly patients, with long-term poor outcome. The randomised study was to compare the incidence of POCD in elderly with bispectral index (BIS)-guided intra‑operative use of either dexmedetomidine or propofol with sevoflurane. Eighty-seven patients, planned for non-cardiac surgery under general anaesthesia, were included between June 2017 and March 2018. After exclusion of 7 patients, remaining 80 patients were randomised into dexmedetomidine group and propofol group with 40 patients each. In both the groups, BIS-guided anaesthesia was provided. Cognitive function was assessed by an anaesthesiologist using a battery of neuropsychological tests at baseline pre-operatively, third and seventh day after surgery. The data were entered into a Microsoft Excel spreadsheet and analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Propofol group had a non‑significant lower incidence of POCD on third day and dexmedetomidine group showed decreased incidence of POCD on seventh day, accompanied by lower anaesthetic requirement (inhalational as well as intravenous) concomitant with delayed emergence with an acceptable BIS value. Dexmedetomidine appeared to be anaesthetic sparing as compared to propofol. BIS monitoring for titrating depth of anaesthesia and hence the anaesthetic exposure is an invaluable tool as compared to routine care anaesthesia for reducing POCD. The patients in both groups did not develop significant POCD until the seventh post‑operative day.

4 illus, 3 tables, 20 ref

041814   KUMAR N R R, JONNAVITHULA N, PADHY S, SANAPALA V, NAIK V V (Anaesthesiology and Intensive Care Dep, Nizam’s Institute of Medical Sciences, Hyderabad - 500 027, Telangana, Email: ms.rajavicky@gmail.com) : Evaluation of nebulised dexmedetomidine in blunting haemodynamic response to intubation: A prospective randomised study. Indian J Anaesth 2020, 64(10), 874-9.

The process of laryngoscopy and endotracheal intubation is associated with intense sympathetic activity, which may precipitate intra-operative complications. Taking the advantage of dexmedetomidine’s good bioavailability and rapid absorption through nasal mucosa; we contemplated this study to evaluate the effects of nebulised dexmedetomidine as a premedication in blunting the haemodynamic response to laryngoscopy and tracheal intubation. This prospective, randomised, comparative study was conducted in 100 American Society of Anesthesiologists (ASA) I, II patients. The primary outcome was to evaluate the effects of dexmedetomidine nebulisation in blunting the stress response to laryngoscopy and intubation. The secondary outcome was to study its adverse effects. The study population was divided randomly into two groups. Control group C (n = 50) received nebulisation with 5 ml of normal saline and group D (n = 50) received 1 µg/kg dexmedetomidine 5 ml 10 min before induction in sitting position. Demographics were comparable. Following laryngoscopy and intubation, systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP), response entropy (RE) and state entropy (SE) were markedly increased in the control group whereas in group D there was a fall in SBP (at 1 min-126.64 ± 26.37; P 0.01, 5 min-109.50 ± 16.83; P 0.02, 10 min-106.94 ± 17.01; P 0.03), DBP (at 1 min-83.18 ± 17.89; P 0.001, 5 min-66.40 ± 13.88; P 0.001, 10 min- 62.56 ± 14.91; P 0.01) and MAP (at 1 min-99.68 ± 19.22; P 0.001, 5 min- 84.08 ± 13.66; P 0.003, 10 min- 81.74 ± 14.79; P 0.008), RE and SE which was statistically significant (P 0.002). There was a dose sparing effect of propofol in group D; sedation score was comparable. Nebulised dexmedetomidine effectively blunts the stress response to laryngoscopy and intubation with no adverse effects.

4 illus, 2 tables, 25 ref