046704   HAMD H T (Thi-Qar Univ, Thi-Qar, Iraq) : Simulation of poly (ADP-ribose) polymerase (PARP) enzyme with BAI compound in the for thyroid cells. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194380.

In this study, the simulation for the preparation of pharmacological compound anti-cancer Baicalein (6,7-dihydroxy-2-phenyl-4H-chromen-4-one). These compounds have an importance of the known biologic and its wide medical requests. Our theoretical results dedicated to simulating that acquired for researchers (SE EUN HAN et. al) Practically against cancerous cells in the thyroid gland and matching them through a program (MOE) theoretically. From the illustrious effects, the compound (BAI) is behaving as a good legend when it interacted with amino acid for the enzyme (PARP).

9 illus, 3 tables, 21 ref

041813   WILTON J, CHIU H, CODIANNE N, KNAPP H, ESCOLAR V R, BURNS S (Anaesthesia Dep, Dignity Health Mercy Medical Center Mt. Shasta, Mount Shasta, CA 96067, USA, Email: jon.wilton@dignityhealth.org) : Continuous quadratus lumborum block as post‑operative strategy for pain control in spinal fusion surgery. Indian J Anaesth 2020, 64(10), 869-73.

Lumbar spinal fusions have post-operative pain levels that can be difficult to treat. The objective of this study was to determine if using bilateral quadratus lumborum (QL) nerve block catheters for lumbar fusions changes the patient’s post-operative recovery experience by reducing opioid consumption, thereby limiting potential risks and side effects and reducing recovery time. There were a total of 52 surgical lumbar fusion patients in this single-center, retrospective cohort review. In control Group A, there were 26 patients who received opioid regimens. In control Group B, there were 26 patients who received bilateral QL block catheters with breakthrough opioid regimens. Forty-eight hour post-operative opioid use in oral morphine milligram equivalents (MME) and length of stay (LOS) from the post-anaesthesia care unit to hospital discharge were examined. Group A had a mean MME of 307.62 ± 305.37 mg. Group B had a statistically significant lower mean total MME of 133.78 ± 152.66 mg (P = 0.012, α = 0.05). On an average, Group A required 2.3 times the MMEs than Group B. Group A had a mean LOS of 2.34 ± 1.87 days, whereas Group B had a lower mean LOS of 1.98 ± 0.51 days. This difference of 0.36 days was not statistically significant (P = 0.522, α = 0.05). Surgical lumbar fusion patients who received the QL block catheter had a lower opioid requirement compared to standard opioid regimens. The study was underpowered to detect a difference in LOS.

4 illus, 1 table, 29 ref

041812   THOMAS D, CHACKO L, RAPHAEL P O (Anaesthesiology Dep, Amala Institute of Medical Sciences, Thrissur - 680 555, Kerala, Email: derlin.t@gmail.com) : Dexmedetomidine nebulisation attenuates post‑operative sore throat in patients undergoing thyroidectomy: A randomised, double‑blind, comparative study with nebulised ketamine. Indian J Anaesth 2020, 64(10), 855-62.

Endotracheal intubation is the predominant cause of airway mucosal injury, resulting in post-operative sore throat (POST), with an incidence of 20-74 %, which brings immense anguish to patients. This study was conducted to evaluate and compare the efficacy of nebulised dexmedetomidine and ketamine in decreasing POST in patients undergoing thyroidectomy. Patients were randomly allocated into two groups of 50 each; Group 1 received ketamine 50mg (1mL) with 4mL saline nebulisation, while Group 2 received dexmedetomidine 50µg (1mL) with 4mL saline nebulisation for 15 min. GA was administered 15 min after completing nebulisation. POST monitoring was done at 0,2,4,6,12 and 24h after extubation. POST was graded on a four-point scale (0-3). The statistical analysis were performed using Statistical Package for Social Sciences (SPSS) software version 17.0. Fisher Exact-t-test, Chi square test, Student t-test, Paired t test and repeated measure analysis of variance (ANOVA) were used for analysis. The overall incidence of POST in this study was 17 %: POST was experienced by seven patients (14.3 %) in ketamine and 10 patients (20.4 %) in dexmedetomidine group (P = 0.424). There was no statistically significant difference in the incidence of POST between the two groups at 0,2,4,6,12 and 24h post-operatively. Severity of sore throat was also significantly lower in both groups at all time points. A statistically significant increase in heart rate, systolic and diastolic blood pressure was noted in ketamine group, post nebulisation. Pre-operative dexmedetomidine nebulisation can be utilised as a safe and ideal alternative to ketamine nebulisation in attenuating POST, with less haemodynamic derangement.

1 illus, 4 tables, 27 ref

046703   SELMAN NIHAD A, RAHMA ABBAS M, ALI ATHEER Y (Babylon Univ, Babil, Iraq) : Thyroid dysfunction in Iraqi patients with Acromegaly. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194379.

This study designed to identify the prevalence of thyroid dysfunction in Iraqi patients with acromegaly ,to identify the factors responsible for thyroid dysfunction in patients with acromegaly.Is the treatment modalities for acromegaly has a role in thyroid dysfunction? A cross sectional case control study. seventy patients with acromegaly were enrolled from 2 different tertiary centers of endocrinology from Jan. -Dec. 2017 compared with 70 non acromeglic subjects. Their mean age 46 +/-11 years ;forty one (58.5 %) males and 29(41.5 %)females. Thyroid function test conducted to both patients and control groups including TSH, free T4 and total T3 in both centers. In addition to other variables.Out of 70 (100 %) patients with acromegaly; (51.5 %) were euthyroid, (20 %) had primary hypothyroidism, (15.7 %)had central hypothyroidism and (12.8 %) had hyperthyroidism that is significantly higher than normal population (p<0.001).Patient with acromegaly had significant systolic and diastolic hypertension vs. control (p=0.015 ,0.004 respectively). Age of the patients, diastolic blood pressure ,first GH and history of hypophysectomy were significant risk factors for thyroid dysfunction (p=0.02,0.008,0.008 and 0.02 respectively). Thyroid dysfunction is more prevalent in patient with acromegaly whether hypothyroidism (both primary and secondary) and hyperthyroidism. The Age and diastolic blood pressure are independent risk factors of thyroid dysfunction. There is significant role of hypophysectomy in thyroid dysfunction development while Sandostatin (Octreotide LAR) treatment had no role.

1 illus, 3 tables, 23 ref

041811   AYYANAGOUDA B, AJAY B C, JOSHI C, HULAKUND S Y, GANESHNAVAR A, ARCHANA E (Anaesthesiology Dep, S N Medical Coll and HSK Hospital, Bagalkot - 587 102, Karnataka, Email: drchhayajoshi1@gmail.com) : Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia‑induced hypotension for hernia and hydrocele surgeries—A prospective randomised controlled study. Indian J Anaesth 2020, 64(10), 849-54.

Hypotension is one of the most common side effects of spinal anaesthesia and preoperative volume status is one of the predictive variables for developing spinal-induced hypotension (SIH). Inferior venacaval ultrasound (IVCUS) is effective to assess fluid responsiveness in critical care patients. The aim of this study was to evaluate the IVCUS-guided volume optimisation prior to spinal anaesthesia to prevent SIH and requirement of vasopressors. Eighty patients undergoing inguinal hernia/hydrocele surgeries under spinal anaesthesia were randomised into group A consisting of an IVCUS-guided volume optimisation before spinal anaesthesia and group B with no IVCUS assessment. Unpaired t-test and Z test were used for statistical analysis. Pearson’s correlation coefficient was used to find correlation. The primary outcome was relative risk reduction in the incidence of SIH between the groups. Secondary outcomes were the need for vasopressor drugs, the total volume of fluids required throughout procedure, and correlation between IVC collapsibility index (IVCCI) versus prespinal fluids, IVCCI versus baseline mean arterial pressure (MAP). The relative risk reduction in the incidence of SIH was lower in group A compared to group B which was 40 % (P = 0.002 CI = 95 %). The SIH in group A was 20 % and group B was 50 %. There was decreased requirement of vasopressors in group A compared to group B. Total IV fluids given was more in group A. There was a positive correlation between IVCCI and pre-spinal fluids. IVCUS assessment reduces the SIH as well as requirement of vasopressor for hernia and hydrocele surgeries.

5 illus, 2 tables, 18 ref

041810   NETHRA S S, NAGARAJA S, SUDHEESH K, DUGGAPPA D R, SANKET B (Anaesthesia Dep, Bangalore Medical Coll and Research Institute, Bengaluru, Karnataka, Email: swathisaggi@gmail.com) : Comparison of effects of volume‑controlled and pressure‑controlled mode of ventilation on endotracheal cuff pressure and respiratory mechanics in laparoscopic cholecystectomies: A randomised controlled trial. Indian J Anaesth 2020, 64(10), 842-8.

One of the pathophysiological consequences of pneumoperitoneum is variations in endotracheal cuff pressure (ETTc). Volume-controlled mode and pressure-controlled mode of ventilation being two modes of ventilatory strategies; we intended to find out variations in ETTc governed by respiratory mechanics between these two modes during laparoscopic cholecystectomies. After obtaining ethics committee approval, this randomised (1:1), active-controlled, parallel-assigned study was done on 60 patients undergoing laparoscopic cholecystectomies. These patients were allocated into two groups by computer-generated randomisation: Volume-controlled mode (V) and pressure-controlled mode (P). We observed for variations in ETTc which was the primary aim and haemodynamic parameters; respiratory mechanics at baseline (T1), at pneumoperitoneum (T2), after 10 min (T3), 20 min (T4) of pneumoperitoneum and at desufflation (T5). Post‑operative laryngotracheal co‑morbidities were also observed. Analysis was done using Statistical Package for the Social Sciences version 16.0 (IBM SPSS Statistics, Somers NY, USA). No statistically significant difference was found in both groups either concerning ETTc, haemodynamic parameters or complications. In both groups, ETTc variation was statistically significant when compared from baseline to desufflation (T1 versus T5) and in group V additionally from baseline to time of pneumoperitoneum (T1 versus T2). Group P showed lower peak airway pressure at desufflation and higher mean airway pressure throughout at all the time intervals. There is no variation in ETTc between the two modes. Group P appears to be better in terms of lower Ppeak and better Pmean.

2 illus, 4 tables, 125 ref

041809   SENNIAPPAN K, JEYABALAN S, RANGAPPA P, KANCHI M (Anaesthesia and Intensive Care Dep, Narayana Institute of Cardiac Sciences, Bangalore, Karnataka - 560 099, Email: muralidhar.kanchi.dr@narayanahealth.org) : Hyperbaric oxygen therapy: Can it be a novel supportive therapy in COVID‑19?. Indian J Anaesth 2020, 64(10), 835-41.

The coronavirus disease 2019 (COVID-19) is a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Although 85 % of infected patients remain asymptomatic, 5 % show severe symptoms such as hypoxaemic respiratory failure and multiple end organ dysfunction (MODS) requiring intensive care unit (ICU) admission with a mortality rate of about 2.8 %. Since a definitive treatment is yet to be identified, preventive and supportive strategies remain the mainstay of management. Supportive measures such as oxygen therapy with nasal cannula, face mask, noninvasive ventilation, mechanical ventilation and even extreme measures such as extracorporeal membrane oxygenation (ECMO) fail to improve oxygenation in some patients. Hence, hyperbaric oxygen therapy (HBOT) has been proposed as a supportive strategy to improve oxygenation in COVID-19 patients. HBOT is known to increase tissue oxygenation by increasing the amount of dissolved oxygen in plasma. HBOT also mitigates tissue inflammation thus reducing the ill effects of cytokine storm in COVID-19 patients. Though there is limited literature available on HBOT in COVID-19 patients, considering the present need for additional supportive therapy to improve oxygenation, HBOT has been proposed as a novel supportive treatment in COVID-19 patients.

4 illus, 28 ref

046702   YASIR I O, SHOELEF S R (Alhusein Teaching Hospital, Thiqar, Iraq) : Characteristics of lower back pain in pregnant ladies in Thiqar-Iraq. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194378.

To evaluate the frequency of back pain among pregnant female in Thiqar province in Iraq and its demographic characteristics. This is a case series descriptive study of one hundred pregnant female in Thiqar province in Iraq complaining from lower back pain in different stages of their pregnancies. the patients were evaluated firstly by history taking through questioner specially prepared for this study ;as well as; clinical and radiological assessment. In our study seventy one patients experience back pain in different stages of pregnancy giving a (71 %) as frequency of back pain in the studded group. Most of the patients Seventy four patients (74 %) developed the pain during the first trimester of pregnancy and ( 22 %) experience the pain during the second trimester. Fifty eight (14) patients (11.96 %) gave history of previous back problems before pregnancy; of these; nine patients (7.69 %) diagnosed before pregnancy as herniated lumbar disc prolapse and kept on medical treatment and physiotherapy, 2 patients (1.7 %) with previous laminectomy surgeries for herniated lumbar disc prolapse, 3 patients (2.56) with diagnosis of degerative spine. One patient underwent cesarean section for sever back pain dueto lumbar disc prolapse at the end of the pregnancy period ( non-gynecological indication for cesarean section ).

7 ref

046701   SALEH A H, ABBOOD H A R (Medical Analysis Dep, Al-Qalam Coll, Kirkuk, Iraq) : The role of silver (Ag) nanoparticles synthesis by penicillium spp against the toxicity of Echinococcus granulosus in adult albino male rats. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194377.

The aim of the study was to synthesize Ag nanoparticles by using filamentous fungus Penicillium sp. The fungal culture was isolated from the soil samples collected from agriculture fields in Kirkuk city. The synthesis of silver nanoparticles was investigated by X-ray difraction peaks were measured at (101), (200) and (202) respectively, and scanning electron microscopy . The present study was designed to indicated the role of Ag nanoparticles synthesis by Penicillium spp against toxicity of Echinococcus granulosus. The present study used twenty adult albino male rats that distributed at random to following teams (each group consist five rats); management group received ad libidium, second group injected with 2,5 X 10³ of Echinococcus granulosus protoscolices third group injected with protoscolices and treatd with 50 mg/kg AgNanoPs, fourth group injected with protoscolices and treatd with 100 mg/kg AgNanoPs. The results show high important exaggerated (P < 0.05) in levels of MDA (malonedialdehyied) and important decrease (P < 0.05) in levels of glutathione (GSH) and catalasce compared with management group. While, after used AgNPs with Echinococcus granulosus, the results indicated non-significant changes (P < 0.05) in MDA, GSH and catalse also showed non-significant changes (P < 0.05) compared with control group. histological study show decrease in numbers of spermatogonia and spermatocytes with absent of spermatid. While, after using AgNPs the testis in third and fourth groups appear semi-normal. It had been ended that AgNanoPs has been potential role against tocxicity of Echinococcus granulosus in rats male.

4 illus, 1 table, 25 ref

041808   JOSEPH N, KUMAR L, SHYAMSUNDAR P, BALAKRISHNAN S, KESAVAN R, RAJAN S (Anaesthesiology Dep, Amrita Institute of Medical Sciences, Kochi, Kerala, Email: lakshmi.k.238@gmail.com) : Evaluation of segmental epidural blockade following standard test dose versus test dose with addition of saline in abdominal surgeries. Indian J Anaesth 2020, 64(9), 790-5.

Epidural analgesia is widely used for pain relief but confirmation of accurate epidural placement is poorly understood. We proposed that sensory blockade to cold sensation would predict the accurate placement of epidural. The primary outcome was the assessment of sensory blockade at 5 and 10 min with a standard epidural test dose versus test dose with additional saline. We looked at haemodynamic changes following administration as secondary outcomes. Following Ethics Committee approval, 161 patients presenting for elective abdominal surgery needing epidural analgesia with general anaesthesia were randomly allocated into Group 1 receiving standard test dose (3 ml of 2 % lignocaine with 1:2,00,000 adrenaline) or Group 2 (standard test dose with 6 ml of saline) epidurally. The blockade to cold sensation was assessed at 5 and 10 min. The heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP) were recorded at baseline, 1, 5, and 10 min following epidural dosing. Statistical analysis was performed with Chi‑square test for categorical and Student’s t-test for continuous variables. The sensory blockade at 5 min was 69.5 % versus 82.3 % (P = 0.059), and at 10 min 85.4 % versus 97.5 % (P = 0.01) in Groups 1 and 2, respectively. The MAP at 5 min (P = 0.032) and the HR and MAP at 10 min (P = 0.015, 0.04) were significantly lower in Group 2. An epidural test dose of 3 ml followed by additional 6 ml saline accurately predicted sensory blockade to cold at 10 min in comparison to the standard dose of 3 ml but was associated with a decrease in the HR and MAP.

2 illus, 4 tables, 21 ref

041807   BAKSHI S G, PAULIN S V, BHAWALKAR P (Anaesthesia Dep, Tata Memorial Hospital, Mumbai, Maharashtra, Email: sumitrabakshi@yahoo.in) : A randomised controlled trial to evaluate the peri‑operative role of intraoperative dexmedetomidine infusion in robotic‑assisted laparoscopic oncosurgeries. Indian J Anaesth 2020, 64(9), 784-9.

Robotic and minimal invasive surgeries pose challenges to the anaesthesiologists. Dexmedetomidine (dexmed), with distinct properties of sedation and analgesia has emerged as a promising drug. Our primary aim, in this double-blinded study, was to evaluate reduction in the intraoperative opioid requirement with the use of intravenous dexmed infusion. Secondary objectives included effect on intraoperative anaesthetic and postoperative analgesic requirement. After approval from Ethics board and registration of the trial, 46 eligible patients planned for robotic oncosurgeries (abdomen) were included. As per computer generated randomisation chart, patients were randomised into either dexmed or saline group. Five minutes after insufflation of the abdomen, the study drug bolus—saline or dexmed (1 µg/kg) was given over 10 min and was followed by maintenance infusion (0.2 μg/kg/h) until release of pneumoperitoneum. Study drug titration, fentanyl boluses, and changes in minimum alveolar concentration (MAC) of inhalational agent were protocolised. The mean intraoperative fentanyl requirement was significantly lower in the dexmed group 192.6 µg (±66.4) versus the saline group 260.7 µg (±88.6), P = 0.013. The MAC requirement of inhalational agent was significantly lower in the dexmed group. Intraoperative episodes of hypotension and bradycardia were similar in both groups. First analgesic request, 24 h postoperative pain scores and side effects profile were comparable in both groups. Intraoperative dexmed (bolus of 1 µg/kg followed by 0.2 µg/kg/h infusion) has an opioid and inhalational anaesthetic sparing role during robotic oncosurgeries. However, no benefit of the infusion is seen in the postoperative period.

4 illus, 2 tables, 21 ref

041806   JAIN A, SINGARIYA G, KAMAL M, KUMAR M, JAIN A, SOLANKI R K (Anaesthesiology and Critical Care Dep, Dr S N Medical Coll, Jodhpur - 342008, Rajasthan, Email: geetamanoj007@yahoo.co.in) : COVID‑19 pandemic: Psychological impact on anaesthesiologists. Indian J Anaesth 2020, 64(9), 774-83.

The anaesthesiologists are at the highest risk of contracting infection of coronavirus disease 2019 (COVID-19) in emergency room, operation theatres and intensive care units. This overwhelming situation can make them prone for psychological stress leading to anxiety and insomnia. We did an online self-administered questionnaire-based observational cross-sectional study amongst anaesthesiologists across India. The objectives were to find out the main causes for anxiety and insomnia in COVID‑19 pandemic. Generalised Anxiety Disorder-7 (GAD-7) scale and Insomnia Severity Index (ISI) were used for assessing anxiety and insomnia. Of 512 participants, 74.2 % suffered from anxiety and 60.5 % suffered from insomnia. The age <35 years, female sex, being married, resident doctors, fear of infection to self or family, fear of salary deductions, increase in working hours, loneliness due to isolation, food and accommodation issues and posting in COVID-19 duty were risk factors for anxiety. ISI scores ≥8 was observed in <35 years, unmarried, those with stress because of COVID-19, fear of loneliness, issues of food and accommodation, increased working hours and with GAD‑7 score ≥5. Adjusted odd’s ratio of insomnia in participants having GAD‑7 score ≥5 was 10.499 (95 % confidence interval 6.097–18.080; P < 0.001). The majority of anaesthesiologists on COVID-19 duty suffer from anxiety and insomnia. Addressing risk factors identified during this study with targeted interventions and psychosocial support will help them to cope better with the stress.

2 illus, 4 tables, 32 ref

041805   GUPTA R, KAUR H, KAUR S, MAHAJAN L, KAUR T (Anaesthesia Dep, Sri Guru Ram Das Institute of Medical Science and Research Sri Amritsar, Punjab - 151 211, Email: honey290591@gmail.Com) : To compare the analgesic efficacy of two different doses of epidural ketamine in chronic low back‑pain patients: A randomised double‑blind study. Indian J Anaesth 2020, 64(9), 768-73.

Ketamine, an adjunct to epidural steroid injections (ESI) for chronic back-pain provides better quality and prolonged duration of analgesia. The present study aims to evaluate the analgesic efficacy in terms of pain scores, duration of pain‑free period, patient satisfaction score (PSS) and number of repeat injections with 25 mg versus 50 mg ketamine as adjuvants to ESI. In a prospective, randomised, double-blind trial at a tertiary care hospital, 60 patients of chronic low back-pain of either sex, aged 18–65 years, received preservative free 25 mg ketamine in Group Ι and 50 mg ketamine in Group ΙI as adjunct to 40 mg triamcinolone in total 6 ml volume given epidurally. Baseline data along with follow-ups at 2, 4, 8 and 12 weeks post-procedure included assessment of pain using Visual Analogue Scale (VAS), duration, number of repeat blocks using PSS, Quality of Life (QoL) and side-effects. Categorical data analysed using the Chi-Square test, and continuous data using paired t-test. Pain evaluation within the groups over time showed significant improvement from baseline (P = 0.000), and between the groups showed comparable VAS scores at 12 weeks (P = 0.392). The PSS, pain-free duration and number of repeat injections were also statistically comparable. However, the QoL improved more in Group II vs Group I (P = 0.024). The short-lasting side effects were more in Group II, but no features of neurotoxicity were observed in any patient. The analgesic efficacy of adjuvant therapy with 50 mg ketamine appeared comparable to 25 mg ketamine. Although, there was a better quality of life and longer pain-free interval with 50 mg ketamine, the side effects were more.

3 illus, 5 tables, 21 ref

041804   SINGH S, JHA R K, SHARMA M (Anaesthesia and Critical Care Dep, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, Email: deepakswat@yahoo.com) : The analgesic effect of bilateral ultrasound‑guided erector spinae plane block in paediatric lower abdominal surgeries: A randomised, prospective trial. Indian J Anaesth 2020, 64(9), 762-7.

This study aims to evaluate the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) in paediatric lower abdominal surgeries. Randomised, prospective trial. Forty patients, aged 2–10 years with the American Society of Anesthesiologists Score of I and II scheduled for elective lower abdominal surgery were included in the study. Patients were randomised into two groups as control group and ESPB group. Ultrasound-guided erector spinae plane block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25 % bupivacaine (max 20 ml) for the patients in ESPB group. Analgesic requirements and time to first analgesic requirement were recorded and Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 2, 3, 6, 12 and 24 h postoperatively. Forty patients were included in the final analyses. Significant difference was determined between the groups on post-operative morphine requirement and FLACC scores at 3 h and 6 h postoperatively (P < 0.05). Significant difference was also determined in time to first dose of rescue analgesia between the groups (P < 0.05). This study shows that the ESPB provides adequate post-operative analgesia in paediatric patients undergoing lower abdominal surgery.

2 illus, 3 tables, 27 ref

041803   SRIPRIYA R, RAVINDRAN C, MURUGESAN R (Anaesthesiology Dep, Mahatma Gandhi Medical Coll and Research Institute, Pondicherry - 607 402, Email: ravindrancharulatha@gmail.com) : Comparison of recovery characteristics with two different washout techniques of desflurane anaesthesia: A randomised controlled trial. Indian J Anaesth 2020, 64(9), 756-61.

Rapid emergence with low soluble inhalational agents (IA) is offset by a significant association with emergence agitation (EA). Research on the influence of elimination methods of IA on recovery characteristics is very few. We conducted this study to compare the recovery characteristics of slow elimination (SE) of desflurane with purging technique. Forty‑five participants, 18–60 years, undergoing elective laparoscopic surgeries were randomised either into Group-P (n = 23) or Group-SE (n = 22). A standardised induction-maintenance protocol including desflurane and fresh gas flow (FGF) of 0.8 l/min was followed. During recovery, the FGF was increased in Group-P to 10 L/min and in Group-SE it was continued at 0.8 L/min. The decrement in end‑tidal concentration of desflurane, time for emergence and extubation, EA and time for psychomotor recovery were noted. Time for emergence (Group-SE: 22.8 ± 9 vs. Group-P: 5.6 ± 1.5 min; P = 0.000) and emergence to extubation duration (Group-SE: 128 ± 36 s vs. Group-P: 11.5 ± 1.7 s; P = 0.000) were longer in the Group-SE than in Group-P. EA occurred in 22.7 % patients in Group-SE and in 4.3 % patients in Group-P (P = 0.07). Psychomotor recovery to baseline values was seen in more number of patients in Group-SE than Group-P at 30 min. There was no difference between the groups at 60 min post-extubation. Slow elimination using FGF of 0.8 L/min significantly prolongs emergence even with low soluble agent like desflurane. SE is not beneficial in decreasing the incidence of EA or hastening psychomotor recovery. Purging technique is, therefore, a better-suited technique with fewer complications for eliminating desflurane.

2 illus, 3 tables, 16 ref

045362   PRUDHVI K, MURTHY K R V (Periodontics Dep, GITAM Dental Coll and Hospital, Visakhapatnam, Andhra Pradesh, Email: koyyalamudiprudhvi @gmail.com) : A novel approach in the management of mandibular degree II furcation defects using bone grafts in conjunction with a biomimetic agent: A randomized controlled clinical trial. J Indian Soc Periodontol 2020, 24(4), 334-41.

Of the periodontal defects requiring regeneration, degree II furcation defects pose a substantial challenge to clinicians. This study was designed to evaluate the relative effectiveness of bone autograft (BA) and autologous platelet‑rich fibrin (PRF) as against decalcified freeze‑dried bone allograft (DFDBA) along with autologous PRF in the management of degree II mandibular furcation defects. Fourteen patients (11 men and 3 women; mean age: 42.36 years), with bilateral degree II buccal furcation defects in the mandibular molars, were enrolled in the study. In each patient, randomly selected sites were divided into control site (site A) which received BA with PRF membrane and test site (site B) received DFDBA + PRF mixed with graft and also as a membrane using split-mouth design. Clinical parameters including plaque index, gingival index, gingival marginal levels, probing depth, and clinical attachment level were recorded at baseline and at 3 and 6 months’ postsurgery. Horizontal and vertical furcation measurements were taken prior to the surgery through sounding and after degranulation. These measurements were repeated after 6 months. Results: The mean reduction in the horizontal defect depth was 1.86 ± 0.66 mm (70.75 %) in site A and 1.71 ± 0.73 mm (74.25 %) in site B. The mean improvement in the vertical defect fill was 1.64 ± 0.74 mm (55.8 %) in site A and 1.43 ± 1.34 mm (64.86 %) in site B was achieved. The use of combination therapy using either BA or DFDBA in conjunction with PRF appears to be effective in treating furcations.

2 illus, 4 tables, 20 ref

045361   RADAFSHAR G, KHAGHANI F, RAHIMPOOR S, SHAD A (Periodontology Dep, Guilan Univ of Medical Sciences, Raht- 41941-73774, Iran, Email: golishad@gmail. com) : Long‑term stability of retreated defective restorations in patients with vertical food impaction. J Indian Soc Periodontol 2020, 24(4), 329-33.

Vertical food impaction (VFI) is a common complaint among patients receiving interproximal restorations. However, there is a gap in the literature regarding outcomes of treating defective restorations with VFI. This study sought to determine 10-year stability of retreated defective restorations in patients diagnosed with VFI. A total of 150 teeth (75 pair), in 38 patients comprised our study population. All the participants had been diagnosed with VFI due to faulty restorations and treated by means of redoing the restoration to build a stable contact in at least one restored tooth. The criteria for building an optimum dental contact were defined. Demographic characteristics, date and frequency of redoing the restoration, type and material of restoration, number of restored surfaces, occlusal intercuspal relationship, missing adjacent and/or opposing teeth, cemento enamel junction to alveolar crest distance, recurrence of VFI symptoms, recurrent caries, and periapical pathology as well as periodontal variables were recorded. Kaplan–Meier estimator revealed that the mean ± standard deviation of 1, 3, 5, and 10-year stability of reconstructed contacts was 89/2 % ± 3/6 %, 79/2 % ± 5 %, 70/7 % ± 0/06 %, and 66/3 % ± 7/1 %, respectively. The overall cumulative stability rate was 74/4 %. Further analysis predicted that over a 12-year period, restored contacts were stable for 8.86 ± 0.6 years. Cox regression model indicated that having cusp to marginal ridge occlusal relationship (95 % confidence interval [CI] for hazard risk (HR) = 1/1–13/9, HR = 3/93), and being over 40 years of age (95 % CI for HR = 0/88–17/66, HR = 3/95) were major determinants of contact stability. Long-term stability of retreated and restructured tooth contacts with a history of VFI was 66 %–89 % in this specific sample.

2 illus, 4 tables, 20 ref

046699   ZAIDAN Z J, HUSSEIN A M, AHMED S M (Basrah Univ, Basrah, Iraq, Email: drzainabA2018@gmail.com) : Isolating some pathogenic bacteria from packed milk and detecting of formalin in its components. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194375.

The main aims of thisstudyis to isolate pathogenic bacteria from packed milk in Basrah city, and to detect the presence of formalin in milk samples. :A total of 9types of packed milk were collected from the market in different period. The samples were transported to the laboratory in cooling conditions. They were stored in a refrigerator and analyzed within 24 hours. One ml from each sample was diluted in 9 ml sterile distilled water, the diluted sample was a streak inoculated on chromogenic media. Three ml of milk sample was taken in a test tube and diluted with equal size of water. 5ml of sulfuric acid (90 %) were added to the diluted milk slowly to the side of test tube which must handle with slant position in order to form separation layer. In case of formaldehyde presence a violet layer will form. This method detect of 1 part of formaldehyde in 200000 parts of milk. The result showed only Staphylococcus saprophyticus and Staphylococcus aureus have been isolated from milk samples (23.4 %) and (10.6 %) respectively. The result showed that high temperature not very effective since two pathogenic bacterial species have been isolated and formalin have been detected in milk samples. The result showed no effect of addition of formalin in some sample and did not inhibit the growth of bacteria. This study concludes that most of the packed milk under study contaminated with some pathogenic bacterial species, most of milk samples contained formalin.

2 tables, 14 ref

041802   GUPTA N, KUMAR A, HARISH R K, JAIN D, SWAMI A C (Anaesthesia Dep, Fortis Hospital, Ludhiana - 141 003, Punjab, Email: drnanditagupta4@gmail.com) : Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia – A prospective randomised controlled study. Indian J Anaesth 2020, 64(9), 750-5.

To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies. A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2 % Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann–Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0). Opioid consumption in both groups was comparable, for the first two post‑operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group. As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA.

5 illus, 1 table, 12 ref

041801   GOPAN G, KUMAR L, BABU A R, SUDHAKAR A, GEORGE R, MENON V P (Anesthesiology Dep, Amrita Institute of Medical Sciences, Kochi, Kerala, Email: lakshmi.k. 238@gmail.com) : Intraoperative factors contributory to myocardial injury in high‑risk patients undergoing abdominal surgery in a South Indian population. Indian J Anaesth 2020, 64(9), 743-9.

Myocardial injury after non-cardiac surgery (MINS) is associated with high postoperative mortality. We sought to examine the intraoperative variables associated with MINS among high-risk patients undergoing abdominal surgery at a South Indian Centre. A retrospective analysis of patients who underwent abdominal surgery, aged >45 years with one of five factors: hypertension, diabetes mellitus, previous coronary artery disease (CAD), stroke, or peripheral vascular disease or all patients >65 years of age was undertaken. Forty-six patients with raised troponin Group P (Trop I > 0.03 ng/d) were compared with 125 troponin-negative patients Group N (Trop I < 0.012 ng/dL) as well as 51 with intermediate levels Group I (Trop I > 0.012 and < 0.03 ng/dL). We evaluated the association of pre and intraoperative factors on MINS using logistic regression to identify the explanatory variables. Demographics were similar among the three groups. In‑hospital mortality was significantly higher in group P (P = 0.005). The use of vasopressors (OR 2.6; 95 % CI 1.2–5.5), female gender, (OR 2.3; 95 %CI 1.1–4.7), associated CAD (OR 2.8;95 % CI 1.1–7.4), and fresh frozen plasma (FFP) transfusion (OR 12.1;95 % CI 1.3–11.7) were associated with MINS in regression analysis between group P versus group N. Female gender (OR2.3; 95 % CI 1.2–4.5), postoperative mechanical ventilation (OR 3.5; 95 % CI 1.2–10.4), and perioperative hypothermia (OR 4.5; 95 % CI 1.3–14.9) were significant between Group P and Group I with Group N. Female patients with CAD undergoing abdominal surgery, needing vasopressors and transfusion of plasma are at high risk for MINS with higher hospital mortality and merit vigilant monitoring postoperatively.

2 illus, 4 tables, 24 ref

045360   SYED S, KANKARA V R, PATHAKOTA K R, KRISHNAN P, MISHRA A (Periodontics Dep, Sri Sai Coll of Dental Surgery, Vikarabad, Telangana, Email: vinathimallapu@ gmail.com) : Evaluation of deoxypyridinoline levels in gingival crevicular fluid and serum as alveolar bone loss biomarker in patients with periodontitis. J Indian Soc Periodontol 2020, 24(4), 322-8.

Several components of gingival crevicular fluid (GCF) reflect the course and predictability of periodontal disease and provide a pointer toward disease status. Potential biomarkers deoxypyridinoline (DPD), a metallophosphoesterase would correctly determine the presence of osteoclast-mediated bone turnover activity and seems to hold great promise as a predictive marker to determine bone destruction and active phases in the disease progression. The aim of the current study is proposed to investigate the biologic plausibility for the levels of DPD as biomarker in chronic periodontitis patients. The present cross-sectional study comprised 15 periodontally healthy and 15 chronic periodontitis patients who were age and genders matched, recruited from the outpatient department of Periodontics. GCF and blood samples for DPD estimation were collected from all the patients and analyzed using enzyme-linked immunosorbent assay kit. The clinical parameters such as clinical attachment loss (CAL), probing pocket depth (PPD), modified gingival index, bleeding index , and plaque index were recorded. GCF DPD levels were significantly higher in chronic periodontitis patients when compared to periodontally healthy group. There were no significant correlations found among GCF and serum DPD levels with increasing age, gender, disease severity, and increase in PPD and CAL in both the groups. Within the limitations of this study, increased GCF DPD levels in chronic periodontitis can gauge ongoing periodontal destruction.

9 illus, 4 tables, 24 ref

045359   RESENDE M, MARTINEZ E F ( Periodontology Div, São Leopoldo Mandic Research Institute, São Paulo- 13045-755, Brazil., Email: ceicasaudemr@ gmail.com) : Topographic characterization and in vitro biofilm adhesion to titanium and polypropylene membranes used for alveolar preservation. J Indian Soc Periodontol 2020, 24(4), 316-21.

Nonresorbable membranes have been widely used in guided bone regeneration (GBR) procedures in posttooth extraction alveoli. In this context, one of the properties suggested by the GBR technique is that these barriers, when exposed to the oral environment, control or prevent the infiltration of connective and epithelial tissue cells, favoring the proliferation of bone cells inside the alveolus, without the growth of biofilm. This in vitro study evaluated the topographic characteristics and in vitro biofilm adhesion on membranes used for alveolar preservation, bone Heal™ and Titanium Seal™. Fragments of these membranes (5 mm × 5 mm) were used for all experiments. The topographical morphology and chemical characterization of the membranes were analyzed by scanning electron microscope and dispersive energy X-ray spectroscopy, respectively. For the in vitro biofilm adhesion assay, samples were immersed in Candida albicans (American Type Culture Collection [ATCC] 10231) and Staphylococcus aureus (ATCC 25923) mixed biofilm for 7 and 14 days. Biofilm formation was measured by quantitative analysis with crystal violet aqueous solution, in a spectrophotometer, with a wavelength of 590 nm. The ultrastructural images showed a rough surface for the titanium membrane, without homogeneity in the surface structure, while the polypropylene membrane presented a smoother surface without depressions. The chemical composition of the membranes by Ehlers–Danlos syndrome has identified the presence of copolymer and traces of zinc for the polypropylene membrane; in contrast, the titanium membrane revealed the unique presence of titanium. In addition, there was a decrease in biofilm formation on the surface of the titanium membrane compared to polypropylene (P < 0.05), at both evaluated times. It can be concluded that despite the greater heterogeneity of the titanium membrane surface, the results showed less biofilm formation on this membrane (P < 0.05), which may be indicated in cases of oral cavity exposure.

2 illus, 2 tables, 35 ref

041800   CHILKOTI G T, AGARWAL M, MOHTA M, SAXENA A K, SHARMA C S, AHMED Z (Anesthesiology and Critical Care Dep, Medical Sciences and Guru Teg Bahadur Hospital Univ Coll, Shahdara, Delhi, Email: geetanjalidr@yahoo.co.in) : A randomised preliminary study to compare the performance of fibreoptic bronchoscope and laryngeal mask airway CTrach (LMA CTrach) for visualisation of laryngeal structures at the end of thyroidectomy. Indian J Anaesth 2020, 64(8), 704-9.

Various methods have been used to check vocal cord movements as a routine before awakening the patient at the end of thyroidectomy to rule out recurrent laryngeal nerve (RLN) palsy; out of which, fibreoptic‑assisted visualisation via laryngeal mask airway (LMA) being the most desirable. Thirty patients of either sex, aged 18-65 years, American Society of Anaesthesiologists (ASA) grade I/II, scheduled for thyroidectomy under general anaesthesia (GA) were included and were randomised to receive either fibreoptic assisted (FB) or LMA CTrach‑assisted (CT) visualisation of laryngeal structures at the end of thyroidectomy. The primary outcome was grade of view of laryngeal structures and secondary outcomes were time taken to achieve optimal view of laryngeal structures, ease of visualisation, hemodynamic parameters, and complications. In the fibreoptic group, we obtained comparable optimal laryngeal view i.e., grade 1 and 2 in all (100 %) patients in comparison to 14 (93.33 %) in LMA CTrach group. The “time taken to achieve the optimal view” was significantly lower in the CTrach group when compared to Fibreoptic group (220.67 ± 95.98 vis-a-vis 136.67 ± 68.98). The ease of visualisation of laryngeal structures was comparable (P= 0.713) and the baseline haemodynamic parameters were comparable between the 2 groups and at various designated intervals. In total, 6.66 % and 26.66 % patients in group FB and CT group, respectively, required manoeuvres. However, difference was statistically significant (P < 0.05). Both Fibreoptic-assisted and LMA CTrach-assisted visualization of laryngeal structures in thyroidectomy are equally efficacious in terms of the optimal laryngeal view obtained and ease of visualisation. However, the time taken to achieve optimal laryngeal view was lesser with LMA CTrach.

2 illus, 4 tables, 16 ref

045358   BOYAPATI R, VUDATHANENI V, NADELLA S B, RAMACHANDRAN R, DHULIPALLA R, ADURTY C (Periodontics Dep, Sibar Institute of Dental Sciences, Guntur- 522 509, Andhra Pradesh, Email: dr.ramanarayana@ gmail.com) : Mapping the link between cardiac biomarkers and chronic periodontitis: A clinico-biochemical study. J Indian Soc Periodontol 2020, 24(4), 309-15.

Various risk factors are coupled with atherosclerotic complications, such as myocardial infarction and stroke. Periodontitis is considered one of them. The objective of the study is to compare and correlate the occurrences of periodontitis with serum levels of cardiac-biomarkers in patients with coronary heart-disorders. Of 70 individuals diagnosed with coronary artery diseases, 32 patients with chronic periodontitis constituted the test group, 31 without chronic periodontitis constituted the control group. Cardiac-biomarkers analyzed were Troponin T, Troponin I, Myoglobin; low density lipoprotein (LDL), high-density lipoprotein, very LDL (VLDL), total cholesterol (TC), and highly sensitive C-reactive protein (Hs-CRP). Periodontal characteristics were drawn from the plaque index (PI) and gingival index, probing depth (PD), clinical attachment loss, and periodontal inflammatory surface area (PISA). Statistical Analysis: In order to separate any association between cardiac biomarkers and clinical parameters of periodontitis, detailed statistical analysis through independent t-test and Pearson test of correlation was done. Statistically significant differences were seen not only in PI, PD, and PISA between both the groups (P < 0.05), but also between various cardiac parameters of test and control groups (P < 0.001). Positive relations were seen in the test group, between cardiac biomarkers such as TC, VLDL, Hs-CRP, and Troponin T with periodontal parameters such as PD and PISA. The study reveals, a strong association between periodontitis and diseases of cardiovascular nature, highlighting the need for awareness and timely medical interventions to prevent periodontitis from scaling up and interfering with the risk of cardiovascular problems.

1 illus, 4 tables, 26 ref

041799   CHOUDHARY S, SHARMA S, KUMARI I, KALLURAYA S, MEENA K, DAVE T (Anaesthesiology Dep, RNT Medical Coll, Udaipur - 313 001, Rajasthan, Email: sharma0979@yahoo.co.in) : Comparative evaluation of oral melatonin and oral clonidine for the attenuation of haemodynamic response to laryngoscopy and tracheal intubation—A prospective randomised double blind study. Indian J Anaesth 2020, 64(8), 696-703.

Laryngoscopy and endotracheal intubation cause significant derangement of the haemodynamic parameters proving detrimental for some patients. Clonidine, an α-2 adrenoreceptor agonist, and melatonin, the pineal hormone, have been used for the attenuation of these haemodynamic responses. This study was designed to evaluate the effect of oral melatonin and clonidine in attenuating the haemodynamic responses to laryngoscopy and intubation. In this prospective randomised double-blind study, 60 American Society of Anaesthesiologists (ASA) grade I and II patients aged 20–60 years of either gender scheduled to undergo elective surgery under general anaesthesia were randomly divided into Group M and Group C and orally received 6 mg of melatonin and 0.2 mg of clonidine, respectively, 120 min before the induction of anaesthesia. The haemodynamic parameters-heart rate (HR), systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate -pressure product(RPP) were recorded before and 120 min after the administration of the study drug, before induction, immediately after intubation and at 1, 3, 5 and 10 min following intubation. Sedation was assessed using the Ramsay Sedation Scale. The qualitative and quantitative variables were analysed using Chi square test and unpaired student t test, respectively. For intragroup comparison of quantitative data, paired t test was applied. A P value <0.05 was considered as statistically significant. A significant difference was noted between the groups regarding HR and RPP 0, 1, 3 and 5 min after intubation. The Ramsay sedation score ranged between 2 and 3 at all time intervals. Although both the drugs are effective, oral melatonin proved superior to oral clonidine in attenuating the haemodynamic response to laryngoscopy and tracheal intubation without any side effects.

1 illus, 4 tables, 25 ref

046698   ABDULLAH W H, NAJIB B M (Midwifery Dep, Hawler Medical Univ, Kurdistan Region, Iraq, Email: warda.abdullah@hmu.edu.krd) : Effect of antenatal exercise teaching program on neonatal outcomes during delivery in Erbil, Iraq. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194373.

Antenatal exercises are safe and beneficial for the fetus, and neonatal health, wellbeing, were positive effect on neonatal outcomes during delivery, such as prevent fetal distress, remained the Apgar score and birth weight in normal range level. The aim of this study was to determine the effect of antenatal exercise classes on the neonatal outcomes during delivery. Methods: prospective -Interventional study was conducted in Maternal – Child Health Department in Najdi Heydari Health Care Center, Maternity and Razgary Teaching Hospitals / Erbil City / Kurdistan region / Iraq. One hundred and twelve healthy pregnant women. One half of the pregnant women were included in the intervention group (n = 56) and the other half in the control group (n= 56). The intervention group was educated about antenatal exercises. While the control group remained on standard maternal health care program (without exercise classes). Neonatal outcomes evaluated from documents of birth registry and mothers interview in the postpartum ward using a special check list prepared for that purposed. : In the original data, there was a statistically significant difference between both groups. Regarding the fetal heart rate (P<0.01), Apgar score (P<0.004), neonatal complications (P<0.039), admission neonatal intensive care unit (P<0.003) through the progress of delivery. in other hand, not a statistically significant difference between intervention and control groups concerning neonatal weight. Conclusion: Antenatal exercise is recommended for healthy pregnant women as a safe and effective strategy, enhance the neonatal outcomes during the delivery process.

1 illus, 4 tables, 23 ref

041798   PANDIT A, SINGH V, BHARATI S J, MISHRA S, DEO S V S, BHATNAGAR S (Onco-Anaesthesia and Palliative Medicine Dep, All India Institute of Medical Sciences, New Delhi - 110 029, Email: sushmabhatnagar1@gmail.com) : A pilot randomised clinical trial comparing desflurane anaesthesia vs total intravenous anaesthesia, for changes in haemodynamic, inflammatory and coagulation parameters in patients undergoing hyperthermic intraperitoneal chemotherapy. Indian J Anaesth 2020, 64(8), 688-95.

Cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) cause numerous pathophysiological changes. The objective of this study was to compare the effect of two anaesthetic techniques on haemodynamic changes, inflammatory and coagulation parameters during this procedure. Twenty-one consenting adults undergoing CRS+HIPEC procedure, were block randomised to receive desflurane (V, n = 9) or TIVA (T, n = 12). After epidural catheter placement and intravenous induction of anaesthesia in both groups with fentanyl, propofol and rocuronium, anaesthesia was maintained with propofol or with desflurane, based on group allocation. Haemodynamic and temperature changes were assessed intra‑operatively and variance was analysed. Inflammatory and coagulation markers were measured and compared at five time‑points in the peri‑operative period. Categorical variables were analysed using Chi square or Fisher exact test. Continuous variables were compared using t-test or Wilcoxon rank sum test. Changes in core body temperature and haemodynamic variables during the hyperthermic intraperitoneal chemotherapy (HIPEC) phase were comparable between the two groups; except mean variance of mean arterial pressure, which was significantly higher (P = 0.0056) in group V (receiving desflurane) (58.98 ± 36.74) than TIVA group (27.51 ± 14.22). Inflammatory markers in both groups were comparable at five defined time points in the peri‑operative period. On post‑hoc analysis, pairwise comparisons with baseline, between levels of inflammatory markers within each group showed increased post‑operative inflammation in group V. Mean prothrombin time was comparable. Desflurane group suffered greater mean arterial pressure (MAP) instability during the HIPEC phase. Inflammation in both groups was highest during the first 24 h after surgery. Prolonged inflammation was noted in patients receiving desflurane.

3 illus, 3 tables, 26 ref

045357   HEMALATHA D M, MELATH A, FEROZ M, SUBAIR K, MOHANDAS A, CHANDRAN N (Periodontology Dep, Mahe Institute of Dental Sciences and Hospital, Mahe- 653 310, Puducherry, Email: ashitham@gmail. com) : A survey on the awareness of interrelationship of periodontal disease and systemic health among Mahe population. J Indian Soc Periodontol 2020, 24(3), 271-5.

Systemic health is the fundamental right of any individual, and it cannot be attained or maintained without oral health. Oral cavity is the gateway and the mirror of health. This link is often ignored. This lack of understanding of the correlation between oral and systemic health often leads to the poor systemic health because of the poor oral status. The aim of the study was to assess the awareness among the general public about periodontal diseases and its impact on systemic health. A questionnaire with 15 questions including general awareness about periodontitis and its impact on systemic health were given to patients and were asked to select their preferred option of yes, no, and don’t know. The awareness of the individuals was categorized based on their educational qualification, age, and gender as well. Results: The results obtained showed increased awareness among females, postgraduates, and 35–50 years group of individuals according to their category of gender, education, and age group, respectively. There is always a strong influence of oral health on systemic well‑being. This link among the two is often ignored and overlooked. Oral health upholds the overall well‑being of the patient. Further studies need to be conducted on large scale population and camps need to be conducted to increase the awareness among the general public of periodontal diseases and their systemic impact.

6 illus, 20 ref

046697   THOMAS T E, MAGENDRAN J (Forensic Medicine Dep, Saveetha Medical Coll, Thandalam, Chennai, Email: tabithathomas2000@gmail.com) : Awareness of medico-legal issues among medical college health professionals. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194372.

Medicine, a noble profession, aims at providing healthcare service to the people. But today medical practice is much beyond the concept of service. It deals with legal issues and it is necessary for doctors to know about the various medico-legal aspects of their practice. A doctor is solely responsible for the patient who comes to him for treatment. A patient has all rights to sue the doctor if the treatment and care provided is not satisfactory. Assessment of awareness about medico-legal issues and related aspects among the health professional population thus becomes necessary. A cross sectional study was conducted using a self administered questionnaire with clinical scenario based questions. Responses were tabulated and analyzed. Most of the doctors are aware about various medico-legal issues and precautions to be followed to prevent getting involved in such situations. Doctors have knowledge about informed consent, record keeping, confidentiality etc. Medical practitioners are well aware about the consequences they will have to face if treatment and care provision becomes faulty. They also have knowledge about the steps to be followed in order to protect themselves from getting involved in such situations. There is a need to spread awareness about medico-legal issues to further raise the quality of the service they provide. 

4 illus, 18 ref

041797   LIM W Y, FOOK CHONG S, WONG P (Anaesthesiology Dep, Singapore General Hospital, Singapore - 169608, Singapore, Email: lim.wan.yen@ singhealth.com.sg) : Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine ‘sniffing air’ position: A pilot feasibility study. Indian J Anaesth 2020, 64(8), 681-7.

Airway management in obese patients is associated with increased risk of difficult airway and intubation. After failed intubation, supraglottic airway‑guided flexible bronchoscopic intubation (SAGFBI) may be required. It is uncertain whether SAGFBI is best performed in the ramped versus conventional supine “sniffing air” position. We conducted a feasibility study to evaluate the logistics of positioning, compared glottic views, and evaluated SAGFBI success rates. We conducted a prospective, pilot study in patients with a body mass index (BMI) 30–40 kg/m² undergoing elective operations requiring tracheal intubation. All patients were placed in a ramped position. After induction, a supraglottic airway device (SAD) was inserted. A flexible bronchoscope was inserted into the SAD and a photograph of the glottic view taken. The patient was repositioned to the supine position. A second photograph was taken. SAGFBI was performed. Images were randomised and assessed by two independent anesthetists. Of 17 patients recruited, 15 patients were repositioned successfully. There were no differences in glottic views observed in the two positions. SAGFBI was successful in 92.9 % of patients (median time 91.5 s). Haemodynamic changes were noted in 42.7 % of patients which resolved spontaneously. Our pilot study was completed within 5 months, achieved low dropout rate and protocol feasibility was established. SAGFBI was successfully and safely performed in obese patients, with a median time of 91.5 s. The time taken for SAGFBI was similar to awake intubation using FBI and videolaryngoscopy. Our study provided preliminary data supporting future, larger-scale studies to evaluate glottic views in the ramped versus supine positions.

5 tables, 21 ref

045356   GOPALANKUTTY N, VADAKKEKUTTICAL R J, REMADEVI S, PILLAI A S (Periodontics Dep, Government Dental Coll, Kozhikode, Kerala, Email: drrosammajoseph@ gmail.com) : Prevalence of periodontitis and its correlates among tribal population of Attapady block, Palakkad District, Kerala. J Indian Soc Periodontol 2020, 24(3), 264-70.

Periodontal disease is an immunoinflammatory disease characterized by loss of clinical attachment with subsequent tooth loss. It includes periodontitis and gingivitis. The studies regarding the prevalence of periodontitis among the tribal populations are scarce. The periodontal health status of the tribal population of Attapady has not been reported so far. Objective: The present study was conducted to assess the prevalence of periodontitis and its association with oral hygiene habits, tobacco usage, and oral health beliefs among tribal population of Attapady. This population‑based cross‑sectional survey of periodontal disease consisting of 360 individuals was conducted among the tribal population of three different panchayats of Attapady. A multistage stratified random sampling was used in the selection of hamlets and cluster sampling for selection of study participants. The sociodemographic characteristics, oral hygiene habits, tobacco usage, and oral health beliefs were assessed using a questionnaire, and clinical examination was based on WHO oral health assessment form 2013. The prevalence of periodontal disease among tribal population of Attapady was 87.5 % (95 % Confidence interval [CI] 78.48, 96.51).73.3 % had gingival bleeding and 13.3 % had no/mild periodontitis, The proportion of periodontitis was 84.2 % (95 % CI 75.5, 92.8). Among chronic perioodntitis subjects 22.8 % had moderate periodontitis and 61.4 % had severe periodontitis. Asignificant association was observed between tobacco use (Odds ratio [OR] 5.6, CI 2.99, 10.74), bad oral hygiene habits (OR 4.9, CI 2.64, 9.43), unfavorable oral health beliefs (OR 3.21, CI 1.63, 6.32), and periodontitis. The prevalence of periodontal disease and periodontitis are high among tribal population of Attapady. Unfavorable oral health belief, bad oral hygiene habits, and detrimental habits like tobacco use were the modifiable risk factors identified in this group.

5 illus, 8 tables, 26 ref

041796   SIDHU G K, JINDAL S, MAHAJAN R, BHAGAT S (Anaesthesia and Intensive Care Dep, Guru Gobind Singh Medical Coll and Hospital, Faridkot - 151 203, Punjab, Email: jindalseema77@gmail.com) : Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I‑gel^TM; a randomised clinical study. Indian J Anaesth 2020, 64(8), 675-80.

Oropharyngeal seal pressure (OSP) achieved by a supraglottic airway device holds due importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra-cuff soiling and also relates to postoperative morbidity. The primary outcome measure was to assess and compare OSP in different head and neck positions with Baska mask_® and I-gel^TM. Secondary outcome measures were to compare peak inspiratory pressure (PIP), exhaled tidal volume (ETV), ease of insertion, time taken for insertion, number of attempts, intraoperative manipulations, and postoperative airway morbidity with both the devices. Seventy consenting adults scheduled for a variety of surgical procedures under general anesthesia were allocated to Group B and Group G using Baska mask_® and I-gel^TM respectively. All statistical calculations were done using SPSS (Statistical Package for the Social Science). The comparison of quantitative variables between the study groups was done using Student t-test and within the variables was done by paired t-test. For comparing categorical data, Chi-square (χ²) test was performed. OSP was significantly higher in group B than in group G in all head and neck positions (neutral 33 ± 2.8 vs. 23.2 ± 1.8, flexion 35.5 ± 2.5 vs. 25.2 ± 1.6, extension 30.6 ± 2.7 vs. 21.4 ± 1.7, right lateral 32.6 ± 2.8 vs. 23.0 ± 1.5. left lateral 32.6 ± 2.7 vs. 23.1 ± 1.7 cm H₂O, respectively) (P = 0.000). PIP increased significantly in group G as compared to group B in flexion. (P = 0.009). Baska mask_® had significantly higher ETV in flexion compared to I-gel^TM. (P = 0.009). Baska mask_® may provide a useful alternative to I-gel^TM where the glottic seal has precedence over ease of insertion.

3 illus, 3 tables, 23 ref

046696   AL-NAJJAR S G (Thi-Qar Univ, Thi-Qar, Iraq, Email: dr.basim_moter@yahoo.com) : The prevalence of sperm parameters for infertile males in Thi-Qar City. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194371.

Objective Male infertility is a term in which the male is not capable to attain pregnancy in a female. It occurs due to a lack of semen and low-quality semen. Semen Quality is referred to as a surrogate measure of male fecundity. This study aims to assess the frequency of sperm factors in infertile men in Thi-Qar City. Materials and Methods: This study involved an infertile couple, seminal fluid analysis (SFA) was done to evaluate male factors. Males with normal seminal fluid parameters were excluded. Regarding male, SFA was examined according to WHO 2010. Information such as age, duration of infertility and type of infertility were taken Results Among the percentage of abnormal sperm parameters for infertile couples in which the largest percentage was for asthenozoospermia that represent 66.70 % of all infertile males. The second sperm abnormality is 12.13 % for oligoasthenozoospermia. Asthenoteratozoospermia and oligoasthenoteratozoospermia have the same percentage (4.4). Azoospermia represents 6.7 % while the lower percentage for teratozoospermia. Conclusions largest percentage was for asthenozoospermia that represents 66.70 % of all infertile males .

4 illus, 14 ref

045355   PANTUZZO E S, CUNHA F A, ABREU L G, LIMA R P E (Clinical, Pathology and Dental Surgery Dep, Federal Univ of Minas Gerais, Brazil, Email: rafaelpaschoa lesteves @yahoo.com.br) : Effectiveness of diode laser and fluoride on dentin hypersensitivity treatment: A randomized single‑blinded clinical trial. J Indian Soc Periodontol 2020, 24(3), 259-63.

This randomized single‑blinded clinical trial aimed to evaluate the effectiveness of diode laser and fluoride in the treatment of dentin hypersensitivity (DH) due to gingival recession. Twenty‑eight individuals randomly distributed across three groups participated: 10 individuals who were treated with diode laser, nine who were treated with fluoride, and nine who received placebo. Pain was assessed with the Visual analog scale (VAS). Evaporative stimulus and tactile stimulus were evaluated with the verbal rating scale (VRS). VAS was applied shortly after, 6 h after, 12 h after, and 24 h after the single‑session treatment for DH, whereas VRS was applied shortly after, 15 min and 7 days after the treatment. Participants’ quality of life was assessed with the validated Brazilian version of the Dentine Hypersensitivity Experience Questionnaire assessing functional limitations, coping behaviors, emotional, and social impacts caused by DH. Descriptive statistics and the ANOVA test were used. Values of P < 0.05 were statistically significant. Diode laser significantly reduced the DH to the evaporative stimulus (P = 0.002). The application of fluoride did not change the degree of DH to evaporative and tactile stimuli (P > 0.05). The group of individuals who were treated with diode laser presented a higher reduction in DH (25.4 %) when compared to the group of individuals treated with fluoride (17.1 %), and the group of individuals among whom placebo had been used (2.9 %). Descriptive analysis indicated that the items measuring the emotional and social impacts of DH were those with a more negative impact on the individuals. Therapy with diode laser was more effective in reducing DH than therapy with fluoride.

2 illus, 4 tables, 27 ref

046695   FAJRIAH S N, PUTRA S T, PROBOWATI Y, RIKA SUBARNIATI T (Physiotherapy Dep, Airlangga Univ, Jawa Timur- 60115, Indonesia) : Stress perception and stress response against Internet Psychological Addiction (IPA) on adolescents (Psychoneuroimmunology approach). Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194370.

Phenomenon of IPA in long-term effect is dominated by negative effect that has risk in undergoing stress. Stress perception will activate the change of physiology system in the body in form of stress response through activating Hypothalamic-Pituitary Adrenocortical (HPA) that will increase cortisol production. Investigate how the correlation between stress perception and stress response against IPA for adolescents based on psychoneuroimmunology (PNI) concept. This research used crosssectional design. There were 39 Senior High School students, who were indicated to undergo internet psychological addiction and they were as the sample of this research. There were 39 students in six Senior High Schools in Makassar, Indonesia, who were identified to undergo IPA. Stress perception in most of adolescents who underwent IPA was high (61.5 %), particularly for adolescent who underwent high internet addiction, and so as the stress response on IPA, which was also high (53.8 %), which described health quality for IPA. There was a significant correlation between stress perception and stress response on adolescent who underwent IPA based on psychoneuroimmunology approach.

2 illus, 2 tables, 35 ref

041795   SINGARIYA G, CHOUDHARY S, KAMAL M, SEERVI S N, BIHANI P, KUMAR M (Anaesthesiology and Critical Care Dep, Dr S N Medical Coll, Jodhpur - 342 008, Rajasthan, Email: geetamanojkamal@gmail.com) : Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial. Indian J Anaesth 2020, 64(8), 668-74.

Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery. A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h. The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; P < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; P < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L. The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.

4 illus, 2 tables, 24 ref

045354   GURU S R, ADITHYA REDDY K, RAO R J, PADMANABHAN S, GURU R, SRINIVASA T S (Periodontology Dep, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru- 560 066, Karnataka, Email: sanjeelaguru@ yahoo.co.in) : Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial. J Indian Soc Periodontol 2020, 24(3), 244-52.

Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2 % curcumin with nanocarrier and 1 % chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets. Forty‑five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full‑mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2 % curcumin with nanogel (Group 2), and 1 % chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day. The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2 % turmeric extract with a nanocarrier system with 1 % chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria. The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2 % curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

2 illus, 6 tables, 35 ref

045353   ASWIN P S, VANDANA K L (Periodontics Dep, Dental Sciences Coll, Davangere- 577 004, Karnataka, Email: vanrajs@gmail.com) : A comparative assessment of clinical parameters, sialic acid, and glycosaminoglycans levels in periodontitis patients with and without dental fluorosis: A clinical and biochemical study. J Indian Soc Periodontol 2020, 24(3), 237-43.

This study was aimed to evaluate and compare the clinical parameters and the gingival crevicular fluid (GCF) levels of sialic acid (SA) and chondroitin sulfate (CS) in dental fluorosed and nonfluorosed (NF) gingivitis and periodontitis patients. A total of 100 patients were divided into two control (healthy) and four test (diseased) groups of gingivitis and periodontitis patients with and without dental fluorosis. The GCF‑SA and chondrotin sulphate levels were measured using the conventional method and enzyme‑linked immuno sorbent assay, respectively. The plaque levels (2.9 ± 0.44), gingival bleeding levels (2.75 ± 0.55), and clinical attachment loss (0.44 ± 0.45) between dental fluorosed participants with chronic periodontitis (fluorosed periodontitis [FP]) and NF participants with chronic periodontitis (nonfluorosed periodontitis [NFP]) groups showed no statistically significant difference. Higher probing pocket depth by community periodontal index (CPI) scores of 4 and clinical attachment level CPI score of 1 (75 %) was found in FP group when compared to a score of 3 (FP: 24.5 % and NFP: 73.5 %) of the NFP group. The GCF SA levels (679.05 ± 101.06) were significantly higher in FP group than NFP group (553.80 ± 49.40) (P = 0.048). Similarly, the GCF CS showed highly significant levels in fluorosis periodontitis (48.08 ± 18.13) group than the NFP group (26.95 ± 8.69). Increased pocket depth score, GCF–SA, and CS levels in the dental fluorosed group were observed when compared with NF group. The diagnostic ability of clinical examination is most often supported by the relevant biochemical parameters that are applicable in this study. The newer diagnostic ability of SA is found to be contributory in this study. The diagnostic ability of CS representing tissue destruction served as an important GCF marker along with SA. Clinical Relevance: In dental fluorosis, estimation of SA and CS is recommended in periodontitis patients.

4 tables, 21 ref

046694   JAAFAR S O, ALSAKKAL G S, AL-TAWIL N G (Obstetrics and Gynecology Dep, Hawler Medical Univ, Erbil, Iraq) : Demographic, clinical and hormonal characteristics as predicting factors affecting the outcome of laparoscopic ovarian drilling in women with poly cystic ovary syndrome. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194659.

Laparoscopic ovarian drilling as a second line of treatment modality for those PCOS patients failed to respond to clomophine citrate they may have the benefit of avoiding the side effects of long term drug therapy, lower costs and less time for successful ovulation and conceprtion compared to medical treatment. Before doing LOD recognize factors that affect the outcome of the procedure for selecting patients to avoid unnecessary or unbeneficial intervention. 143 anovulatory infertile PCOS patients followed up for 6 months after LOD for ovulation with pre-operative assessment for demographic characters and serum hormone levels (LH, FSH, free testosterone, AMH and prolactin). Ovulation was demonstrated in 59.4 %. Regression analysis showed significantly higher rates of ovulation among women < 5 years duration of infertility (OR = 3.35, 95 % CI = 1.47-7.65), LH > 12 mIU/ml (OR = 4.18, 95 % CI = 1.28-13.63) and free testosterone <4.5 ng/ml (OR = 3.22, 95 % CI = 1.08-9.59). No significant (p = 0.078) association was detected between the ovulation rate and the AMH level, but it is evident that the OR was around 2 among women with AMH level of less than 7.7 ng/ml. Preoperative LH, free testosterone and duration of infertility regarded as 3 important predicting factor for success of LOD.

5 tables, 17 ref

041794   THOMAS A S, MOORTHY R K, RAJU K, LAKSHMANAN J, JOY M, MARIAPPAN R (Anaesthesia Dep, Christian Medical Coll, Vellore, Tamil Nadu, Email: ramamani@cmcvellore.ac.in) : Measurement of non‑invasive blood pressure in lateral decubitus position under general anaesthesia — Which arm gives more accurate BP in relation to invasive BP ‑ dependent or non‑dependent arm?. Indian J Anaesth 2020, 64(7), 631-6.

Non-invasive blood pressure (NiBP) varies with the arm and body position. In the lateral decubitus position (LDP), the non-dependent arm reads lower, and the dependent arm reads higher pressure. We aimed to study the correlation between the NiBP and invasive arterial blood pressure (ABP) as anaesthesia progressed and its correlation in different BP ranges. American Society of Anesthesiologists (ASA I–III) patients, between 18–70 years undergoing neurosurgical procedures in the LDP were studied. All were anaesthetised using a standard protocol, positioned in the LDP. NiBP was measured every 15 min in both dependent and non-dependent arms and correlated with the ABP. Intra-class correlation (ICC) done between the dependent arm NiBP and ABP showed good correlation for mean and systolic BP and moderate correlation for diastolic BP. ICC was 0.800, 0.846 and 0.818 for mean and 0.771, 0.782, 0.792 for systolic BP at 15 min, 1 h, and 2 h, respectively. The ICC between the non-dependent arm NiBP and the invasive ABP showed poor correlation for all BP (systolic, diastolic and mean). As anaesthesia progressed, the mean difference between the NiBP and the ABP decreased in the dependent arm and increased in the non-dependent arm. The strength of agreement between the NiBP and the ABP in various BP ranges showed moderate correlation for the dependent arm NiBP (0.45–0.54) and poor correlation (0.21–0.38) for the non-dependent arm. The NiBP of the dependent arm correlated well with ABP in LDP under general anaesthesia (GA). It is better to defer measuring NiBP in the non-dependent arm as the correlation with ABP is poor.

3 illus, 3 tables, 12 ref

041793   SIVAPURAPU V, BHAT R R, VANI N I, RAAJESH J I, ARUNA S, PAULOSE D T (Anaesthesiology Dep, Indira Gandhi Medical Coll and Research Institute, Puducherry - 605 009, Email: prerana10@yahoo.com) : A cadaver study of four approaches of ultrasound‑guided infraclavicular brachial plexus block. Indian J Anaesth 2020, 64(7), 624-30.

The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area – lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection. USG ICBPB was performed in 10 cadavers—5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ, and US characteristics were noted. Anatomical dissection was done and important structures were described in detail. Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the ‘blind spot’ behind the clavicle is an area where neurovascular structures were present. The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a ‘blind-spot’ for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.

1 illus, 3 tables, 19 ref

046693   SARANBHARATI B, RAMYA V, RAJALAKSHMI, DEVAKI K (Chettinad Academy of Research and Education, Tamil Nadu) : A descriptive study to assess the problem faced by the adolecents of alcoholic parent. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194369.

A descriptive study to assess problems faced by the adolescents of alcoholic parent in selected community area, Kancheepuram district, Tamil Nadu. Objectives of the study to assess the problems faced by the adolescents of alcoholic parents and to find out association between the problems faced by the adolescents of alcoholic parent with their selected demographic variables. Non experimental approach and descriptive design used for this study. Samples were selected by using purposive sampling technique. The sample consisted of 50 adolescents. Self-structured questionnaires for assessment of demographic variables and used to assess the problem faced by adolescents of alcoholic parents. The data collected from 50 adolescents (Grils and boys) in the age group between15 to 18 years. Study show that 9(18 %) severe problems, 31(62 %) moderate problems and 10(20 %) mild problems. Study shows that there was significant association between the levels of problem faced by the adolescents of alcoholic parent with age and occupation of alcoholic parent (p value =< 0.05).

1 table, 5 ref

041792   BHARDWAJ M, SINGHAL S K, RASHMI, DAHIYA A (Anaesthesiology and Critical Care Dep, Pt. BD Sharma Univ of Health Sciences, Rohtak, Haryana - 124 001, Email: ssinghal12@gmail.com) : A prospective randomised trial to compare three insertion techniques for i‑gel^TM placement: Standard, reverse, and rotation. Indian J Anaesth 2020, 64(7), 618-23.

This prospective randomised study was done to compare standard, reverse, and rotation techniques of i-gel^TM placement in terms of insertion characteristics and success rate. After institutional ethics committee approval, 135 patients aged 18-50 years, ASA I and II undergoing elective surgery under general anesthesia were included. After induction of anesthesia, i-gel^TM was inserted by standard, reverse, and rotation technique in Groups I, II, and III, respectively. The primary objective was mean time of insertion. Secondary variables included ease of insertion, first attempt success rate, manoeuvres required, fiberoptic view of placement, oropharyngeal leak pressure, ease of placement of nasogastric tube, and complications if any. Mean time of insertion was 18.04 ± 5.65 s, 15.00 ± 5.72 s and 16.12 ± 5.84 s for groups I, II, and III, respectively. Time taken for insertion was shortest and significantly lower (P = 0.048) for group II compared to group I. Insertion time was comparable between rest of groups. The overall success rate in groups I, II, and III were 91.1 %, 95.6 %, and 93.3 % respectively (P = 0.7). The first attempt success rate was 82.2 %, 89 %, and 84.4 % in groups I, II and III, respectively (P = 0.07). Manoeuvres were required in five (12.19 %) patients in group I, four (9.30 %) patients in group II, and three (7.14 %) patients in group III (P = 0.602). Complications occurred in eight, three, and three patients in groups I, II, and III, respectively. All techniques of i-gel insertion are equally good and choice of technique depends upon the experience and comfort of the investigator with the particular technique.

1 illus, 4 tables, 15 ref

041791   SALGAONKAR S V, JAIN N M, PAWAR S P (Anaesthesiology Dep, Seth G.S Medical Coll and K.E.M. Hospital, Mumbai, Maharashtra, Email: nishajain.2211@gmail.com) : Total intravenous anaesthesia with tumescent infiltration anaesthesia without definitive airway for early excision and skin grafting in a major burn ‑ A prospective observational study. Indian J Anaesth 2020, 64(7), 611-7.

Patients with major burns posted for early tangential excision and skin grafting pose peculiar challenges for anaesthesiologists. The purpose of the study was to assess safety and efficacy of total intravenous anaesthesia (TIVA) with tumescent infiltration anaesthesia (TIA) for these burn procedures. This observational single-arm study was conducted on 48 cases of a tertiary centre burn unit, requiring early tangential excision and skin grafting between third and fifth days of burn injury. TIVA was administered using a combination of intravenous (iv) infusion of injection dexmedetomidine and iv boluses of fentanyl, ketamine, propofol, midazolam and paracetamol. TIA was administered in burn wounds after aseptic preparation. Spontaneous breathing was maintained with oxygen supplementation. Haemodynamic and respiratory monitoring was done intraoperatively every 15 minutes and for 6 hours postoperatively. Modified Aldrete’s score was calculated at 10 minutes after completion of surgery. Statistical analysis was done using statistical package for the social science software (version 16). Descriptive statistics were used for quantitative variables. Baseline mean HR was 106.95 ± 11.17 bpm (beats per minute). HR settled at 73.17 ± 6.97 bpm during the intraoperative period. The baseline mean arterial pressure (MAP) of 82.42 ± 10.04 mmHg was maintained at 81 ± 7.32 mmHg during the intraoperative period. In all, 95.8% achieved early recovery with mean modified Aldrete’s score of ≥9 at 10 minutes post‑surgery. There was no episode of apnoea or desaturation. TIVA in combination with TIA minimally interferes with homeostasis and promotes early recovery in patients undergoing early excision and grafting in major burns.

3 illus, 3 tables, 27 ref

046692   PERDANA R F, HERAWATI S, SURARSO B, AKSONO H E B (Otorhinolaryngology Dep, Airlangga Univ, Surabaya- 60285, Indonesia) : Correlation of aggressivity papilloma recurrent respiratory tract with human papillomavirus types 6 and 11. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194367.

Recurrent respiratory tract papilloma (PSPB) is a viral disease that correlated with an airway exophthalmia lesion. Papilloma is primarily caused by human papillomavirus (HPV) types 6 and 11 which are classified as low-risk HPV. Reports indicate that patients with the HPV-11 experience more aggressive course of the disease than HPV-6. Patients are often diagnosed at a younger age, the longer duration, require more frequent surgery and rare diseases of the disease when compared with those caused by HPV-6. To investigate the correlation of aggressiveness of PSPB with HPV-6 and 11. Fifteen samples were conducted in the Outpatient Unit of Otorhinolaryngology and the Lotus Inpatient Installation of Dr. Soetomo General Hospital from December 2012 to March 2013 then determine the disease aggressiveness. PCR examination was done at the Tropical Disease Institute of Universitas Airlangga. Aggressive correlation of disease with HPV type was tested using Chi-Square. Fifteen patients were enrolled that divided; the male was 10 and female was 5. The mean annual number of operations was 2.8 ± 1.27 and 9 patients reported more than 3 surgeries each year. 10 patients had distal papilloma and 11 patients had a history of tracheostomy. PSPB was found in 12 patients, HPV-11 was 9 patients and HPV-6 was 6 patients. Chi-square test results showed no significant results with p = 0.525. There was no correlation between PSPB aggression with HPV-6 and 11.

5 tables, 19 ref

045352   AL NOAMAN A S (Oral Surgery Dep, Babylon Univ, Babylon, Iraq, Email: aalnoaman7@ gmail.com) : Pyogenic granuloma: Clinicopathological and treatment scenario. J Indian Soc Periodontol 2020, 24(3), 233-6.

Oral pyogenic granuloma is a soft‑tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision. A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage. Females (54 %) were slightly more predominant than males (46 %). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow‑growing rate. Rural residents were more affected (57 %) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8 % and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion. Modified excision with deep curettage prevents the recurrence of the lesion after 1‑year follow‑up.

3 illus, 2 tables, 30 ref

045351   MUTHURAJ T, RAJA J, JAMES J R, RAJ J P M, SUBRAMNIAN D, VARATHARAJAN A (Periodontics Dep, CSI Coll of Dental Sciences and Research, Viruthunager- 626 203, Tamil Nadu, Email: thamil3011@gmail. com) : Standardized photometric assessment method: A novel approach for the analysis of dental ergonomic posture. J Indian Soc Periodontol 2020, 24(3), 227-32.

Identification and documentation of the proper and improper dental ergonomic postures have gained its importance in the recent years due to the increased prevalence of work‑related musculoskeletal disorders (WMSDs) among dentists and dental students who do not practice proper ergonomic procedure. The aim of the present study is to analysis ergonomic posture among dental students while performing supragingival scaling (SGS) procedure, using the standardized photometric assessment method (SPAM). A total number of 90 students from the third year (III year) to final year (IV year) and internship (Intern) (30 each) were included in the study. All the 90 students were asked to perform SGS procedure and were photographed and analyzed using the current technique. Eight dental ergonomic postures were analyzed in this study and grouped according to the classification system developed for scoring dental ergonomic postures by Garbin et al., in 2011. Analysis of variance test with Bonferroni correction was used to statistically analyze the collected data. The mean index value for III year, IV year and Intern were 2.00, 2.03, and 2.13, respectively, which was not statistically significant (P = 0.709). Analysis of the dental students using the current method showed that most of them come under inadequate and regular category which puts them in a high risk for developing WMSDs. The SPAM to analyze the dental ergonomic posture was simple and effective and should be further explored in the future studies for its pros and cons.

4 illus, 5 tables, 27 ref

041790   SINDWANI G, SAHU S, SURI A, SUREKA S, THOMAS M (Anaesthesiology Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, Email: drsandeepsahu@yahoo.co.in) : Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study. Indian J Anaesth 2020, 64(7), 605-10.

Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann–Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h (P < 0.001). Type‑1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.

2 illus, 4 tables, 18 ref

041789   KUMAR L, KUMAR K, SANDHYA S, KOSHY D M, RAMAMURTHI K P, RAJAN S (Anaesthesiology Dep, Amrita Institute of Medical Sciences, Kochi - 682 041, Kerala, Email: lakshmi.k. 238@gmail.com) : Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot‑ assisted colorectal surgery. Indian J Anaesth 2020, 64(7), 599-604.

Minimally invasive and robotic surgeries need lesser fluid replacement but the role of restricted fluids in robotic surgeries other than prostatic surgeries has not been clearly defined. Our primary aim was to evaluate the effects of a restrictive fluid regimen versus a liberal policy on intra-operative lactate in robotic colorectal surgery. Secondary outcomes were need for vasopressors, extubation on table, post-operative renal functions and length of ICU (LOICU) stay. American society of anaesthesiologists (ASA) physical status I–II patients scheduled for robot-assisted colorectal surgery were randomised into one of two groups, receiving either 2 mL/kg/h (Group R) or 4mL/kg/h, (group L). Fluid boluses of 250 ml were administered if mean arterial pressure (MAP) <65 mmHg or urine output <0.5 ml/kg/h. Norepinephrine was added for the blood pressure after 2 fluid boluses. Surgical field was assessed by modified Boezaart’s scale and surgeon satisfaction by Likert scale. Demographics and baseline renal functions were comparable. Adjusted intra-operative lactate at 2 h, 4 h, and 6 h and need for noradrenaline and post-operative creatinine were similar. One patient in the group L was ventilated due to hypothermia. The field was better at the 4 h in group R and comparable at other time points. The LOICU stay was longer in Group L. The use of restrictive fluid strategy of 2 mL/kg/h (group R) does not increase lactate levels or creatinine, improves surgical field at 4 h and shortens ICU stay in comparison to a liberal 4 mL/kg/h (group L) in robotic colorectal surgery.

1 illus, 4 tables, 19 ref

041788   BALLARAPU G K, NALLAM S R, SAMANTARAY A, KUMAR V A K, REDDY A P (Anaesthesia and Critical Care Dep, Government Medical Coll, Kadapa - 516 002, Andhra Pradesh, Email: drvaasu@gmail.com) : Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study. Indian J Anaesth 2020, 64(7), 594-8.

Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture. All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle 50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test. Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B (P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45). The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia.

4 tables, 19 ref