041787   MAGAR J S, RUSTAGI P S, MALDE A D (Anesthesia Dep, Lokmanya Tilak Municipal Medical Coll, Mumbai - 400 022, Maharashtra, Email: drpreetirustagi@gmail.com) : Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using ‘WHO near miss approach’ and the applicability of maternal severity score as a predictor of maternal outcome. Indian J Anaesth 2020, 64(7), 585-93.

Risk stratification of severely morbid obstetric patients receiving anaesthesia services can be helpful in improving maternal outcomes. This study was undertaken to analyse these patients using the WHO near-miss (NM) approach and to assess the applicability of maternal severity score (MSS) to predict maternal mortality. This is a one-year retrospective cohort analysis at a tertiary care centre. Of all the obstetric patients receiving anaesthesia, those with ‘potentially life‑threatening conditions’ (PLTC) were identified. Amongst women with PLTC, those fulfilling the WHO NM criteria were grouped into either maternal near miss (MNM) or maternal death (MD) depending on final survival outcome. The MSS was assessed upon admission to post-anaesthesia ICU. The cases of “near miss” were compared to maternal death to determine the factors and WHO NM criteria significantly associated with mortality. Area under ROC curve (AUROC) was used to assess the accuracy of MSS to predict maternal mortality. Of the 4351 anaesthetised obstetric patients, 301 were PLTC, 59 MNM and 11 MD. Obstetric haemorrhage was the commonest PLTC with the highest risk for MNM and MD. Preoperative organ dysfunction, referral from other centres, intra-uterine fetal death (IUFD) and WHO cardiovascular and respiratory NM criteria were significantly associated with mortality. MSS had excellent accuracy for the prediction of mortality (AUROC was 0.986 and 95% CI 0.966–0.996). Haemorrhage is the leading cause of MNM and MD. MSS is reliable in stratifying the severity of maternal morbidity and in predicting maternal mortality. Thus it can be used as an effective prognostic tool.

2 illus, 4 tables, 30 ref

046691   REZA RAHMAN R, MARTIANA I K (Orthopaedics and Traumatology Dep, Airlangga Univ, Surabaya- 60285, Indonesia) : The stiffness comparison of four-screw versus six-screw short segment pedicle posterior stabilization instrumentation in cyclic axial compression. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194366.

Thoracolumbar burst fracture required to conduct short segment posterior stabilization as the operative therapy. The short segment fixation (above and under fracture level (four-screw pedicle)) encounters loss of correction and failure including progressive kyphosis, screw pedicles and rods that are bent or fractured. Rod around fracture site receives bigger loads than other parts due to its function as cantilever. To overcome this, it uses short-segment posterior stabilization instrumentation in which pedicle screw is installed above, under, and on fracture site level (six-screw pedicle) to increase stiffness. To analyze the comparison stiffness of four-screw versus six-crew short segment pedicle posterior stabilization instrumentation in cyclic axial compression. This study used in vitro mechanical test in simulation of vertebrae from UHMWPE (Ultra High Molecular Weight Polyethilene) that was fixated with four-screw and six-screw pedicle. Each construction is given cyclic axial compression. Afterwards, the stiffness of each construction was measured. Six-screw short segment pedicle posterior vertebrae stabilization instrumentation had higher stiffness of 43.38 % than four-screw short segment pedicle posterior vertebrae stabilization instrumentation in cyclic axial compression. There was a significant difference in both groups (p<0.05). Six-screw short segment pedicle posterior vertebrae stabilization instrumentation was better than four-screw short segment pedicle posterior vertebrae stabilization instrumentation in cyclic axial compression.

2 tables, 12 ref

045350   KHOSLA A, GUPTA S J, JAIN A, SHETTY D C, SHARMA N (I T S Dental Coll, Ghaziabad, Uttar Pradesh, Email: ak.anjalikhosla@ gmail.com) : Evaluation and comparison of the antimicrobial activity of royal jelly – A holistic healer against periodontopathic bacteria: An in vitro study. J Indian Soc Periodontol 2020, 24(3), 221-6.

RJ is a natural bee product and is known to have remarkable health benefits. The objective was to evaluate its antimicrobial potential against periodontopathic bacteria and compare the same with chlorhexidine. The aim was to evaluate and compare the antimicrobial activity of royal jelly (RJ) with chlorhexidine against the periodontopathic bacteria (aerobic and anaerobic) in subgingival plaque. Subgingival plaque samples of 15 chronic periodontitis patients were taken, and clinical parameters were evaluated. Inhibitory effect of RJ and chlorhexidine was investigated “in vitro” on the growth of aerobic and anaerobic bacteria by colony count, minimum inhibitory concentration, and minimum bactericidal concentration (MBC) by the method of serial broth dilution.  ANOVA statistical analysis was used in this study. Subgingival anaerobic bacteria predominate (colony‑forming unit). Chlorhexidine is more sensitive in inhibiting aerobic and anaerobic bacteria (at concentration 50 µg/100 µl). A higher concentration of RJ is required to have an inhibitory effect. MBC of chlorhexidine shows no growth on blood agar plates, whereas minimum bacterial growth is seen around the RJ. Chlorhexidine (gold standard) has a higher inhibitory effect in the case of chronic periodontitis; however, RJ can also be used as an alternative but at higher concentration and lesser dilution. Evaluation of the quality, quantity and the biological activity of RJ is a necessity and must be done before its “in vivo” application.

6 illus, 2 tables, 14 ref

045348   MAZREAH S, SHAHSAVARI M, KALATI P A, MAZREAH H (Pathology Dep, Zahedan Univ of Medical Sciences, Zahedan, Iran, Email: siavash199270@ gmail.com) : Immunohistochemical evaluation of CD117 in mast cell of aggressive periodontitis. J Indian Soc Periodontol 2020, 24(2), 216-20.

Aggressive periodontitis is a type of inflammatory response in periodontal tissues that is differentiated from chronic by its earlier onset, its high rate of progression, subgingival microbial composition, the difference in the host’s immune response, and family history of the disease. Mast cells live in tissues and contribute to the various allergic and inflammatory conditions, including periodontal diseases, through the release of cytokines, chemokines, and proteolytic enzymes. CD117, the receptor of the stem cell factor expressed by the mast cells, is the hallmark of mast cell development. This study aimed to determine the expression level of CD117 in the mast cells of aggressive periodontitis using immunohistochemistry. This study aimed to determine the expression level of CD117 in the mast cells of aggressive periodontitis using immunohistochemistry. Subjects and Methods: The study was conducted on tissue samples from 15 patients with aggressive periodontitis and 15 patients with healthy gingival tissue. Samples were stained for CD117 markers using immunohistochemistry. After the microscopic examination of samples, all data were entered into SPSS 20 and analyzed. Statistical data were analyzed using Kolmogorov–Smirnov test and independent t‑test. According to the results, the mean expression levels of CD117 in the aggressive periodontitis and normal gingival groups were 19.08 ± 6.9 and 18.2 ± 8.1, respectively, which were not statistically significant (P = 0.75). The Kolmogorov–Smirnov test verified the normality of distribution of CD117 expression level. Given the normal distribution of the scores, the independent t‑test was used to compare the CD117 expression level in the two study groups. There was no significant difference in the level of CD117 expression between the control and aggressive periodontitis groups.

3 illus, 3 tables, 23 ref

046690   TUNNY R, ADRIANI M, WIRJATMADI B (Airlangga Univ, Mulyorejo, Surabaya-Indonesia) : The influence of additional food hotong porridge with moringa leaves mixture on improvement nutritional status of children nutritional children. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194365.

Malnutrition is one of the main nutritional problems in Indonesia. Toddler is one of the age groups that are vulnerable to nutritional problems. One of the causes immediate nutritional problem is a lack of energy. This study aims to analyze the effect of supplementary feeding (PMT) hotong porridge mixed with moringa leaves and government biscuits on weight gain and underweight nutritional status in the working area of the Five Public Health Center. This study used Randomized Controlled Trial Design, with a quasi-experimental approach. The distribution of PMT hotong porridge with Moringa leaf mixture as a treatment group and the administration of PMT biscuits by the government program as a control group. The sample size was 32 toddlers. Data were analyzed using paired-sample T test. There was a significant effect on body weight and nutritional status after administration of PMT hotong porridge with moringa leaf mixture and PMT biscuits of government programs with p-value of 0.001 in the treatment group and the control group. Hotong slurry feeding and biscuit mix Moringa leaves government programs throughout a period of 30 days to take effect on the increase in body weight and nutritional status of children on the mark with most of the value of z-score infants already stood at -2SD s/d + 2SD, which means that most of the children under five are already in the nutritional status of the mall.

2 tables, 14 ref

041786   SRINIVASAN S, SUBRAMANIAM R, CHHABRA A, BAIDYA D K, ARORA M K, MAITRA S, BANSAL V K, BHATTACHARJEE H K (Anesthesiology Dep, All India Institute of Medical Sciences, New Delhi - 110 029, Email: drsrajeshwari@gmail.com) : Comparison of transversus abdominis plane block and intrathecal morphine for laparoscopic donor nephrectomy: Randomised controlled trial. Indian J Anaesth 2020, 64(6), 507-12.

Postoperative pain following laparoscopic donor nephrectomy (LDN) is significant and no suitable analgesic technique is described. Opioid analgesia in standard doses is often suboptimal and associated with numerous adverse effects. Transversus abdominis plane (TAP) block has been evaluated in various laparoscopic procedures. Intrathecal morphine (ITM) has been seen to provide long-lasting analgesia of superior quality in laparoscopic colorectal procedures. The present study was undertaken to evaluate the analgesic efficacy of single‑dose ITM 5 µg/kg for LDN. After ethics approval, 60 adult patients scheduled for LDN were randomised to receive intravenous fentanyl, ultrasound-guided TAP block or ITM for postoperative analgesia. Postoperative 24-h patient-controlled analgesia (PCA) fentanyl consumption, visual analogue scale (VAS) score and intraoperative fentanyl and muscle relaxant requirements were compared. Statistical analysis was performed using appropriate statistical tests by using Stata 11.1 software. Haemodynamic stability at pneumoperitoneum and in the post anaesthesia care unit was significantly better in patients receiving ITM. Intraoperative rescue fentanyl requirement (P = 0.01) and postoperative fentanyl requirement until 24 h (P = 0.000) were significantly lower in the morphine group. Postoperative VAS at rest and on movement was significantly lower in the morphine group at all points of assessment (P = 0.000). ITM 5 µg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.

3 illus, 3 tables, 21 ref

045347   BRUM R S, DUARTE P M, CANTO G D L, FLORES MIR C, BENFATTI C A M, PORPORATTI A L, ZIMMERMANN G S (Dentistry Dep, Federal Univ of Santa Catarina, Santa Catarina- 88040-900, Brazil, Email: renatasbrum@live. com) : Biomarkers in biological fluids in adults with periodontitis and/or obesity: A meta‑analysis. J Indian Soc Periodontol 2020, 24(2), 191-215.

Obesity and periodontal diseases have been investigated to be interconnected, but the molecular mechanism underlying this association is still not clear. The aim of this systematic review is to assess the association of serum, salivary and gingival crevicular fluid (GCF) inflammatory markers (IMs), obesity, and periodontitis. Studies that evaluated IM of adults according to obesity status (O) and periodontitis status (P) (O+P+; O-P+; O+P-) were screened on several electronic databases and grey literature up until February 2019. Risk of bias assessment and level of evidence were evaluated through Fowkes and Fulton scale and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta‑analyses were grouped according to the biological matrix studied (serum/GCF) and groups (O+P+ vs. O−P+/O+P+ vs. O+P−). Out of the 832 studies screened, 21 were considered in qualitative synthesis and 15 in quantitative synthesis (meta‑analysis). Although included studies showed mostly “no” or “minor” problems during the quality assessment, GRADE assessment indicated very low to moderate level of evidence based on the question answered. O+P+ adults exhibited significantly higher serum levels of C‑reactive protein (CRP), interleukin 6 (IL‑6), leptin, and tumor necrosis factor‑α (TNF‑alpha) and higher resistin GCF levels than O−P+. O+P+ adults showed significantly higher serum levels of IL‑6 and leptin and lower adiponectin serum levels than O+P−. Only qualitative information could be obtained of the IM vaspin, omentin‑1, chemerin, IL‑10, progranulin, MCP‑4, IL‑1β, and interferon‑γ (IFN‑γ). Obesity and periodontitis, together or separately, are associated with altered serum and GCF levels of CRP, IL‑6, leptin, TNF‑alpha, adiponectin, and resistin. It was not possible to evaluate the association between obesity and periodontitis at salivary levels. The role of recently investigated biomarkers as vaspin, omentin‑1, chemerin, IL‑10, progranulin, MCP‑4, IL‑1β, and IFN‑γ, which can be key points underlying the association between obesity and periodontitis, remains to be further investigated.

12 illus, 7 tables, 73 ref

041785   DHANSURA T, GHURYE N, KHURANA A, KUDALKAR S, UPADHYAY Y (Anaesthesiology Dep, Grant Government Medical Coll and JJ Hospital, Mumbai - 400 051, Maharashtra, Email: nirbhaghurye@gmail.com) : The understanding and recall of school children in Mumbai in compression only life support cardiopulmonary resuscitation. Indian J Anaesth 2020, 64(6), 501-6.

Out of hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide. Increased bystander cardiopulmonary resuscitation (CPR) is observed in regions where school CPR training has been mandatory and led to reduced mortality by OHCA. We would like to explore the feasibility of teaching compression only life support (COLS) CPR to Indian school children through the following objectives determining their understanding of theoretical knowledge after a training session in the Indian Society of Anaesthesiologists’ (ISA) COLS protocol and reviewing the information recall three months later. The participants of this quasi-experimental study were 132 school children, aged 12 to 15. The children were all below the age of 18 and consent was obtained vicariously through the principals of the schools and assent from the students in the form of willingness to answer the multiple-choice questionnaires. The study sample comprised of participants who responded to both questionnaires, immediately post-training session and three months later. Their responses were compiled in Excel and analysed using the paired t-test and R programming language. None of the children had any previous knowledge on COLS. A one‑hour session in COLS proved sufficient to increase the baseline knowledge with a mean post-training score by 82%. On comparing the two scores obtained, a statistically significant attrition rate was observed (P < 0.001). The children exhibited good understanding of COLS after a single training session. This makes us believe that more periodic revision, probably by inclusion of COLS in school curricula could be a satisfactory solution towards lowering the attrition in knowledge recall.

2 tables, 17 ref

041784   MISHRA R K, PANDIA M P, KUMAR S, SINGH G P, KALAIVANI M (Neuroanaesthesia and Critical Care Dep, All India Institute of Medical Sciences, New Delhi - 110 029, Email: pandiamihir@gmail.com) : The effect of anaesthetic exposure in presurgical period on delayed cerebral ischaemia and neurological outcome in patients with aneurysmal subarachnoid haemorrhage undergoing clipping of aneurysm: A retrospective analysis. Indian J Anaesth 2020, 64(6), 495-500.

Delayed cerebral ischaemia is one of the major contributors to morbidity in aneurysmal subarachnoid haemorrhage (aSAH). General anaesthesia (GA) in the presurgical period may have a preconditioning effect. The primary aim was to assess the effect of preoperative exposure to GA during digital subtraction angiography (DSA) on neurological outcome in patients presenting with aSAH. After Ethical Committee approval, we conducted a retrospective analysis of the data of patients with aSAH treated surgically. Patients, admitted to neurosurgical ICU (June 2014 and December 2017) with a computed tomography (CT) diagnosis of aSAH and underwent DSA, were included. DSA, done with or without exposure to a general anaesthetic, was classified to GA group and LA group, respectively. Propensity score matching was done on the baseline variables. Appropriate statistical methods were applied. Of the 278 patients, 116 (41.7 %) patients had received GA during DSA. Propensity matching yielded 114 (57 in each group) matched patients. In a logistic regression model, the odds ratio (OR) for poor outcome at discharge in GA group as compared to LA group was 4.4 (CI: 2.7–7.4), P = 0.001, whereas, in the matched data, the OR for poor outcome at discharge in GA group as compared to LA group was 1.2 (CI: 0.6–2.6), P = 0.57. The presurgical exposure to GA did not offer any neuroprotection and the odds of poor outcome were higher compare to non-exposure to GA group.

1 illus, 3 tables, 20 ref

041783   JAIN D, JOAD A S K (Anaesthesia and Palliative Care Dep, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur - 302 015, Rajasthan, Email: anjumjoad@gmail.com) : Head and neck radiotherapy - A risk factor for anaesthesia?. Indian J Anaesth 2020, 64(6), 488-94.

The aim was to study perioperative management in head and neck cancer, the commonest cancer in Indian men, after radiation therapy. Radiotherapy (RT) targets the tumour and the neck including the thyroid gland. RT induced physical effects (on the airway) and physiological effects (on the thyroid) impact perioperative care. Patients with RT-induced subclinical and mild clinical hypothyroidism are often asymptomatic. Cancer surgery is time-sensitive. Given that parenteral levothyroxine is not available, is a TSH of 15 acceptable for cancer surgery? Aretrospective study was conducted in a tertiary cancer centre. The records of elective surgery (72 patients) were scrutinised. Data on thyroid profile, airway, treatment of clinical and subclinical hypothyroidism, airway access, recovery and perioperative haemodynamic parameters were retrieved. Correlation of age, sex, RT, chemotherapy with hypothyroidism was done by Chi-square test. The perioperative course was studied. Hypothyroidism (subclinical and clinical) was diagnosed in 39 % of patients. All were asymptomatic. There was a significant association between RT and hypothyroidism. In 50 % of patients, we encountered a difficult airway. In subclinical hypothyroidism (TSH less than 15), after levothyroxine initiation, the course of anaesthesia, extubation, recovery and postoperative stay was uneventful. Hypothyroidism and difficult airways are a common sequel of RT. Selected cancer patients with subclinical hypothyroidism had a smooth perioperative course.

2 illus, 2 tables, 31 ref

041782   JING Z, LING Y, YI F (Anaesthesiology Dep, Peking Univ People’s Hospital (Beijing Cancer Hospital), Beijing, China, Email: doctor_yifeng@sina.com) : Multipoint transcutaneous electrical stimulation reduces median effective plasma concentration of propofol: A randomised clinical trial. Indian J Anaesth 2020, 64(6), 483-7.

Previous work shows that transcutaneous electrical stimulation (TES) has analgesic and sedative effects. However, it is unclear whether TES can affect the sedative effect of propofol or not. This study was designed to assess the effect of TES on median effective plasma concentration (Cp50) of propofol and haemodynamic changes before and after tracheal intubation. 48 patients belonging to ASA I or II posted for thyroidectomy were randomly allocated into control and TES groups. Up-and-down method was used to determine Cp50 of propofol. The average concentration of propofol in each crossover was calculated and the average concentration of those six values was defined as Cp50 of propofol. Cp50 of propofol was 3.70 ± 0.28 µg/mL and 3.08 ± 0.31 µg/mL in control and TES groups, respectively (P < 0.05). There were no significant differences in MAP (90.3 ± 12.4 mmHg vs. 97.0 ± 10.8 mmHg, 94.2 ± 18.7 mmHg vs. 98.3 ± 16.6 mmHg and 84.9 ± 14.1 mmHg vs. 91.6 ± 16.2 mmHg) and HR (78.2 ± 11.3 b/min vs. 75.6 ± 9.5 b/min, 90.9 ± 15.4 b/min vs. 90.4 ± 14.9 b/min and 86.7 ± 13.7 b/min vs. 84.0 ± 15.9 b/min) at T0, T1 and T2 between two groups. In TES group, HR changes at T1 and T2 were significantly higher than those at T0. TES can make an assistant effect on sedation and decrease Cp50 of propofol. But the haemodynamic fluctuations in TES group, especially the HR changes, seem to be more obvious than those in control group.

1 illus, 2 tables, 28 ref

045346   GULATI N N, MASAMATTI S S, CHOPRA P (Periodontics Dep, SGT Univ, Gurugram, Haryana, Email: drpriyankachopra 79@gmail.com) : Association between obesity and its determinants with chronic periodontitis: A cross‑sectional study. J Indian Soc Periodontol 2020, 24(2), 167-72.

Various systemic disorders such as cardiovascular, diabetes, and osteoporosis are linked to periodontitis. Obesity is one such epidemic, and although many studies have addressed its relationship with periodontitis, the mechanism still remains unclear.  This study aims to assess the association between obesity and its determinants with clinical periodontal parameters in adult patients visiting a dental college in Haryana. This cross‑sectional study was performed in 317 patients visiting a dental college in Gurugram. Obesity parameters such as body mass index (BMI), body fat percentage (BF %), waist circumference (WC), and waist–hip ratio (WHR) were assessed using body fat analyzer (Omron HBF 701). Depending on their BMI, individuals were stratified as overweight (OW), Class 1, Class 2, and Class 3 obese. Periodontal status was assessed by plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level. These periodontal parameters were correlated with BMI, BF %, WC, and WHR. Statistical analysis was done, and P ≤ 0.05 was considered as statistically significant. The prevalence of periodontitis in OW, Class 1, Class 2, and Class 3 obese was 16.4 %, 79.2 %, 2.8 %, and 1.6 %, respectively. PPD was significantly associated with obesity determinants, especially among Class 2 and Class 3 obese individuals. Similarly, BF % was associated with all the periodontal parameters. Within the restrictions of the study, it can be concluded that obesity and chronic periodontitis are interlinked.

1 illus, 4 tables, 40 ref

045346   GULATI N N, MASAMATTI S S, CHOPRA P (Periodontics Dep, SGT Univ, Gurugram, Haryana, Email: drpriyankachopra 79@gmail.com) : Association between obesity and its determinants with chronic periodontitis: A cross‑sectional study. J Indian Soc Periodontol 2020, 24(2), 167-72.

Various systemic disorders such as cardiovascular, diabetes, and osteoporosis are linked to periodontitis. Obesity is one such epidemic, and although many studies have addressed its relationship with periodontitis, the mechanism still remains unclear.  This study aims to assess the association between obesity and its determinants with clinical periodontal parameters in adult patients visiting a dental college in Haryana. This cross‑sectional study was performed in 317 patients visiting a dental college in Gurugram. Obesity parameters such as body mass index (BMI), body fat percentage (BF %), waist circumference (WC), and waist–hip ratio (WHR) were assessed using body fat analyzer (Omron HBF 701). Depending on their BMI, individuals were stratified as overweight (OW), Class 1, Class 2, and Class 3 obese. Periodontal status was assessed by plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level. These periodontal parameters were correlated with BMI, BF %, WC, and WHR. Statistical analysis was done, and P ≤ 0.05 was considered as statistically significant. The prevalence of periodontitis in OW, Class 1, Class 2, and Class 3 obese was 16.4 %, 79.2 %, 2.8 %, and 1.6 %, respectively. PPD was significantly associated with obesity determinants, especially among Class 2 and Class 3 obese individuals. Similarly, BF % was associated with all the periodontal parameters. Within the restrictions of the study, it can be concluded that obesity and chronic periodontitis are interlinked.

1 illus, 4 tables, 40 ref

046689   FAYYADH R A, ABADY N H (Fallujah Univ, Fallujah, Iraq, Email: dr.rafea_ophthalmologist@uofallujah.edu.iq) : Prevalence of uncorrected refractive errors among the internally displaced schoolchildren in Iraq. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194364.

The aim of this study was to estimate the prevalence of uncorrected refractive errors among the internally displaced schoolchildren in Iraq. A school-based cross-sectional study in the academic year of 2016-2017. Schoolchildren were selected from 8 primary schools for the internally displaced children in Kurdistan region, Iraq. All children underwent full ophthalmic examination, uncorrected visions were tested and cycloplegic refractions were done for children with visual impairment. Refractive errors in this study were determined by the results of the cycloplegic refraction. : From 592 selected children, 94.7 % had participated in our study, and 553 were eligible (age ranged from 6 to 12 years). The prevalence of refractive errors was 34.5 %; 32.2 % of them were uncorrected. The prevalence rates of myopia, hyperopia and astigmatism were 3.8 %, 13.9 % and 14.9 %, respectively. This study has found a high prevalence of uncorrected refractive errors among the internally displaced children in Iraq. This result represents an important health issue among those children, requiring major actions to tackle and resolve it.

6 tables, 20 ref

041781   KAUSHAL S, SINGH S, SHARMA A (Anaesthesiology Dep, Indira Gandhi Medical Coll, Shimla - 171 001, Himachal Pradesh, Email: sonalikaushal33@gmail.com) : A randomised study comparing the extent of block produced by spinal column height and body weight-based formulae for paediatric caudal analgesia. Indian J Anaesth 2020, 64(6), 477-82.

Height and weight-based formulae are used for calculation of dose of medications for caudal analgesia but these have not been compared. We compared spinal column height-based Spiegel and weight-based Takasaki and Armitage formulae for achieving maximum height of sensory neuraxial block after caudal epidural analgesia in paediatric patients. In this double-blind randomised study, children aged between 1 and 6 years and planned for infra-umbilical surgery were randomly allocated to receive caudal epidural block (targeting T10 level block) with 0.25 % bupivacaine, using a volume calculated by modified Spiegel formula (group I), Takasaki formula (group II), and Armitage formula (group III). The Institute ethics committee reviewed and approved the study protocol. The primary endpoint of the study was the difference in the number of spinal segments blocked as assessed by pinprick method. The secondary endpoint was the difference in volume of 0.25 % bupivacaine used among the groups. The groups were compared using one-way ANOVA. Seventy‑five patients (25 in each group) completed the study as per protocol. The mean number of spinal segments blocked was significantly different among groups (P < 0.001) with patients in group I (13.8 ± 0.83) showing significantly lower number of spinal segments blocked as compared to that in group II (15.8 ± 1.06; P < 0.001), and group III (16.8 ± 1.28; P < 0.001). The mean volume of 0.25 % bupivacaine used in group I was significantly lower (P < 0.001) than that in group II and group III. Dose calculation in caudal epidural analgesia as per spinal column height‑based modified Spiegel formula was more precise than bodyweight-based Takasaki and Armitage formulae.

1 illus, 3 tables, 25 ref

041780   BAKSHI S G, GAWRI A, PANIGRAHI A R (Anaesthesia Dep, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra, Email: sumitrabakshi@yahoo.in) : Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital. Indian J Anaesth 2020, 64(6), 470-6.

Emergency laparotomies present a challenge in pain management given sick patients, odd timings and poor outcomes. Current recommendations favour multimodal opioid-sparing analgesia following elective laparotomies. No recommendation exists for emergency surgeries. After approval and registration of the trial, adult patients posted for emergency laparotomy in the hospital (tertiary centre for cancer care) starting August 2015, for 6 months, were included in this prospective study. Patients’ details including indication for emergency surgery, preoperative haemodynamic parameters, baseline coagulation status were captured. Patients were followed for pain scores, satisfaction with pain management and outcome. The number of anaesthesiologists present and their experience concerning regional techniques were noted. Intestinal obstruction was the commonest cause of emergency laparotomy. Most patients belonged to the ASA IE/IIE class (91 %). Intraoperatively, opioids were the mainstay of pain management with an epidural catheter inserted in only 9 % of cases even though most cases were conducted by anaesthesiologists confident/expert in thoracic epidural insertion. There was no correlation of choice of pain management technique with the time of surgery (P = 0.22), ASA grading (P = 0.28), predicted mortality by p-Possum scores (P = 0.24). Pain at movement was moderate‑severe in more than 50 % of patients within the first 24 h. The regional group had better satisfaction when compared to opioid and non-opioid based management. (P < 0.001). Regional techniques for pain management in emergency laparotomies are less preferred, therefore, opioids are the mainstay. Lack of experience is essentially not the primary reason for regional techniques not gaining popularity. Pain management in this group needs a thorough re-evaluation.

4 illus, 2 tables, 23 ref

045345   SINGHAL R, JAIN A, RASTOGI P (Periodontology Dep, King George’s Medical Univ, Lucknow, Uttar Pradesh, Email: rameshwarisinghal@ kgmcindia.edu) : Prevalence of herpesviruses in periodontal disease of the North Indian population: A pilot study. J Indian Soc Periodontol 2020, 24(2), 163-6.

Periodontitis is a multifactorial disease of diverse microbiome, predominantly bacterial. Bacterial infection alone may not explain complete pathophysiology and clinical variations in disease pattern. Concept of herpesviruses playing a significant role in periodontal pathogenesis has been explored globally. Studies show varied results and difference may be accounted to variations existing in studied populations. The present study explored the prevalence of herpesviruses in periodontal disease of the North Indian population. In this case–control study, tissue samples were collected from the normal gingiva (control: n = 48) and deepest pocket (cases: n = 48) using a single curette stroke. Periodontal disease status was assessed through the gingival index, pocket depth, and clinical attachment level which were compared to viral marker positivity. Ninety samples from 48 healthy gingiva and 48 periodontitis patients were assessed between the age range of 17–60 years. The prevalence of cytomegalovirus was 2.083 % (cases) and 2.083 % (controls) and Epstein–Barr virus (EBV) was 18.75 % (cases) and 0 % (controls). Odd’s ratio for EBV in patients with periodontitis is calculated (Haldane–Anscombe correction) to be 21.82 %. Herpes simplex virus 1/2 and varicella‑zoster virus were absent in both groups. Within the limitation of this study, EBV was found in cases of periodontitis patients. Its role in disease initiation and progression is not clear. Further studies are required to ascertain EBV as risk factor in periodontal disease.

3 tables, 28 ref

041779   SHARMA I, RANA S, CHOUDHARY B, DHIMAN T, SHARMA S, KUMAR M (Anaesthesia Dep, Dr Rajendra Prasad Medical Coll, Kangra - 176 001, Himachal Pradesh, Email: shelkbj@yahoo.com) : Comparative analgesic efficacy of intravenous vs intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine in subarachnoid block for below knee orthopaedic surgery. Indian J Anaesth 2020, 64(6), 463-9.

Intrathecal and intravenous dexmedetomidine has been used as adjuvant in subarachnoid block [SAB]. The aim of this study was to compare the analgesic efficacy of intravenous vs intrathecal dexmedetomidine as adjuvant to intrathecal bupivacaine. Ninety patients, aged 20–60 years belonging to American Society of Anaesthesiologists (ASA) physical status I and II, scheduled for below knee orthopaedic surgeries under SAB were enrolled. In group I (n = 45) patients received intravenous dexmedetomidine 0.5 µg/kg in 100 mL 0.9 % normal saline [NS] intravenous over a period of 15 minutes given 20 minutes before SAB. Subarachnoid block was given with intrathecal (IT) 0.5 % bupivacaine (H) 12.5 mg (2.5 mL) with 0.3 mL of NS. Patients in group II (n = 45) received 100 mL of 0.9 % NS over a period of 15 minutes given 20 minutes before subarachnoid block. SAB was given with intrathecal 0.5 % heavy bupivacaine 12.5 mg with 3 µg of dexmedetomidine (0.3 mL). The primary outcome was duration of analgesia and rescue analgesic requirement, whereas secondary outcome included pain scores. The duration of analgesia was prolonged in group II (median [IQR]: 5 (6–7.5) h than in group I (median[IQR]: 4[2–4.5] h, P = 0.000). Median dose of rescue analgesics over period of 24 hours was less in group II as compared to group I (median [IQR]:150 (75–150) mg vs 195 (150–225) mg, P = 0.000). VAS score was lower in group II till 12 h in the postoperative period (P = 0.00). Intrathecal dexmedetomidine is more efficacious as compared to intravenous dexmedetomidine, due to favourable outcomes in terms of increased duration of postoperative analgesia and reduced rescue analgesic requirement.

5 illus, 1 table, 19 ref

045344   GOYAL J, SACHDEVA S, SALARIA S K, VAKIL N, MITTAL A (Periodontology Dep, Luxmi Bai Institute of Dental Sciences and Hospital,, Patiala- 147 001, Punjab, Email: jyotp1431@gmail. com) : Comparative assessment of periodontal regeneration in periodontal intraosseous defects treated with PepGen P‑15 unaided or in blend with platelet‑rich fibrin: A clinical and high‑resolution computed tomography scan‑assisted volumetric analysis. J Indian Soc Periodontol 2020, 24(2), 156-62.

PepGen P‑15, a xenograft, has proven its periodontal regenerative potential. Platelet‑rich fibrin (PRF) is an autologous platelet concentrate which too contributes to periodontal redevelopment through the release of different polypeptide progression factors. The present study intended to evaluate the regenerative potential of PepGen P‑15 xenograft when used unaccompanied or in blend with PRF in periodontal intraosseous defects in humans through clinical and a novel computed tomography (CT) scan analysis technique. Twelve chronic periodontitis individuals with paired periodontal intraosseous defects were randomly treated either with PepGen P‑15 exclusively (Control/Group A) or in concoction with PRF (Test/Group B) utilizing split‑mouth study design. Pocket probing depth (PPD), relative attachment level (RAL), and relative position of gingival margin were assessed at 3‑ and 6‑month interval, whereas the linear and volumetric bone defect regeneration were assessed at 6 months postoperatively using CT scan. Both the groups validated statistically significant PPD reduction, RAL gain at 3 and 6 months, but on intergroup comparison, test group CT images revealed significantly greater linear bone gain and volumetric bone gain, with mean difference of 0.73 ± 0.28 (P = 0.018) and 2.70 ± 1.36 (P = 0.06) at 6 months in comparison to the baseline data. PepGen P‑15 and PRF blend had better regeneration potential for the management of intrabony defects. Further long‑term investigations on large sample size are recommended to authenticate the same.Luxmi Bai Institute of Dental Sciences and Hospital,

4 illus, 4 tables, 36 ref

041778   GHAI B, MALHOTRA N, BAJWA S S (Anaesthesia and Intensive Care Dep, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: ghaibabita1@gmail.com) : Telemedicine for chronic pain management during COVID-19 pandemic. Indian J Anaesth 2020, 64(6), 456-62.

Treatment of chronic pain is an essential service. Due to lockdown, travel restrictions, social and physical distancing requirements or fear that health care facilities may be infected; patients may avoid visiting health care facilities in person. It is also imperative to decrease the risk of exposure of the health care workers (HCWs) to severe acute respiratory syndrome corona virus 2 (SARS CoV2) and to ease the overtly burdened health care system. But any disruption in pain practice will have alarming consequences for individuals, society, and whole of health care system and providers. In the current scenario of COVID-19 pandemic, telemedicine is emerging as a key technology for efficient communication and sustainable solution to provide essential health care services and should be considered for chronic pain patients (CPPs). Recently, Board of Governors in supersession of Medical Council of India along with National Institution for Transforming India (NITI Aayog) released “Telemedicine Practice Guidelines” enabling registered medical practitioners to provide healthcare using telemedicine. This article describes the challenges in CPPs during COVID-19 pandemic and the use of telemedicine as the rescue management vehicle for CPPs in current scenario.

26 ref

046688   EMAM S A, KASEM E M, SEDHOM A E (Public Health Dep, Minia Univ, El-Minia- 1666, Egypt, Email: shimaa_anwer3@yahoo. com) : Characteristics of multidrug resistant tuberculosis in Minia, Egypt. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194656.

Tuberculosis (TB) is a disease of great antiquity and has almost certainly caused more suffering and death than any other infection. A total of 40 patients were registered with a diagnosis of MDR-TB during 2010– 2018 in Minia. The majority of patients were from rural areas (27; 67.5 %) and male (27; 67.5 %). Emergence of MDR-TB has the potential to be a serious public health problem in that necessitates strengthened TB control and improved continuous monitoring of therapy

3 illus, 2 tables, 22 ref

043564   MULTANI S , RATHORE A , KHEDULKAR A , BLESSON A S (Public Health Dentistry Dep, Chhattisgarh Dental College & Research Institute, Sundra, Rajnandgaon, Chhattisgarh) : Single use plastics: A miracle or curse. Int J Ecol Environ Sci 2020, 2(3), 320-5.

The production of plastic has outpaced that of almost every other material. While plastic has many valuable uses, we have become addicted to single-use or disposable plastic with severe environmental consequences. In total, half of all plastic produced is designed to be used only once- and then thrown away. Plastic pollution is the accumulation of plastic objects and particles in the earth’s environment that adversely effects wild life, wild life habitat. Our ocean and array of species that call it home are succumbing to the poison of plastic. Plastic pollution on land poses a threat to the plants and animals including humans based on the land. Plastic bags are popular with consumers and retailers as they are functional, light weight, strong, cheap and hygienic way to transport food and other products. Most of these go to landfill and garbage heaps after they are used, and some are recycled. The immortal waste (plastic waste) has to be treated to sustain a healthy life to the planet and its inhabitants. To do so we need to take into serious consideration on 4 R’s of waste management. Reduce, Reuse, and Recycle, Recovery. For a better future we need to create and work in the present.

27 ref

046687   GHANEM M E, ELEIWE S A (Anatomy, Histology & Embryology Dep, Baghdad Univ, Baghdad, Iraq) : Expression of e-NOS in human placentas of idiopathic intra uterine growth restriction at term. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194660.

Endothelial nitric oxide synthase (e-NOS) is a chemical agent that involves in placental angiogenesis. It is conveyed through embryogenesis. In the contemporary study, we intended to examine the character of placental angiogenesis in the progress of intrauterine growth restriction (IUGR) by means of matching the levels of expression of e-NOS in normal-term pregnancy and IUGR placentas. Angiogenesis is one dominant factor in normal embryogenesis and hence the wellbeing of the newborn. The expression of e-NOS was planned using the streptavidin-biotin-peroxidase technique in placental tissues identified as normal (n = 33) and IUGR (n = 33) cases from mothers looking apparently normal. All were chosen at term pregnancy and obtained between 2nd of February of 2018 and 31th of January 2019 at selected hospitals. Outcomes were appraised semi-quantitatively. The expression of e-NOS marker as an immunohistochemistry total score and staining percentage were significantly greater (p < 0.05) in epithelial surface, smooth muscle cells of fetal vessels and the connective tissue terminal villous core of the IUGR placentas when matched with placentas collected from normal pregnancies at term. Encountered placental histochemical changes regarding the expression of the e-NOS angiogenic factor for idiopathic IUGR newborns raised the suspicion of that, it was caused by pure placental factors and could represent further requirement for Nitric Oxide to dilate fetal vessels to optimize functional requirement during placental insufficiency. The noticed Increased expression of e-NOS may be the result of inadequate uteroplacental perfusion supporting the proposal that abnormal angiogenesis plays a role in the pathophysiology of IUGR.

3 illus, 1 table, 35 ref

045343   PATIL C L, GAIKWAD R P (Periodontology Dep, Government Dental Coll and Hospital, Mumbai- 400 001, Maharashtra, Email: drchitrat@gmail. com) : Comparative evaluation of use of diode laser and electrode with and without two dentinal tubule occluding agents in the management of dentinal hypersensitivity: An experimental in vitro study. J Indian Soc Periodontol 2020, 24(2), 150-5.

The present study aims to assess area of open dentinal tubules by use of diode laser and electrode alone and in combination with hydroxyapatite powder and strontium chloride powder by using the scanning electron microscope (SEM). A double‑blinded study was carried out with 30 extracted teeth with no carious lesion or restored teeth were selected and grouped randomly as Group A ‑ diode laser, Group B ‑ electrode application, Group C ‑ hydroxyapatite powder plus diode laser, Group D ‑ hydroxyapatite powder plus electrode application, Group E ‑ strontium chloride powder plus diode laser, and Group F ‑ strontium chloride powder plus electrode application. All the samples were made by preparing a notch of 2 mm measured with UNC‑15 probe at cementoenamel junction using a diamond cylindrical bur at high speed. The teeth were then washed with distilled water and stored in solution containing 2.5 % glutaraldehyde solution in 0.1 M sodium phosphate buffer for 24 h. The samples were treated as mentioned in above said groups and were viewed under SEM the degree of occlusion of the dentinal tubules were quantified using an image analyzer. Highest number of open dentinal tubules was found with Group B, that is, electrode application, whereas Group C, that is, hydroxyapatite powder plus diode laser showed highest occluded tubules. One‑way ANOVA showed statistically significant difference across all the groups (P = 0.000); further, intergroup comparison with Tukey’s test showed better tubular occlusion with Group C. The SEM results showed highest tubular occlusion with hydroxyapatite powder plus diode laser and least with electrode.

6 illus, 3 tables, 15 ref

045342   KAMBOJ S, SALARIA S K (Surendera Dental Coll and Research Institute, Sriganganagar, Rajasthan, Email: sanjeevmutti@ gmail.com) : Efficacy of liquid nitrogen and electrocautery assisted gingival depigmentation in term of patient’s perception, histological wound healing - A randomized triple blind clinical trial. J Indian Soc Periodontol 2020, 24(2), 135-44.

Hyper-melanin pigmentation of the gingiva (GMP) is one of the imperative contributory factors for smile‑sensitive individuals. Numerous gingival depigmentation (GD) procedures have been attempted in the literature to evaluate the clinical outcome mostly. Hence, a randomized clinical‑histopathological triple‑blinded trial was planned to evaluate the pain experienced by the patient, gingival wound healing, and density of melanocytes following liquid nitrogen‑assisted GD (LNAGD) and electrocautery‑assisted GD (ECAGD) procedures. Thirty‑two arches with bilateral physiologic labial/buccal GMP extending from distal aspect tooth #14–24 and #34–44 in 16 healthy individuals were selected and were equally treated with LNAGD and ECAGD techniques. Dummett oral pigmentation index and Hedin melanin index were evaluated at baseline and 3 months’ postoperatively (PO). The visual analog scale was utilized for the intensity of pain assessment at baseline (immediately after treatment) and 1st day and 7th day PO. Histological wound healing and density of melanocytes were evaluated using Gal et al.’s wound‑healing assessment index and Patsakas et al.’s criterion, at baseline (0), 8, 24, 72, and 96 h; 1st, 2nd, 3rd, and 4th week; and 3 months and at 0 and 3 months’ PO, respectively. Statistical analysis was done using one‑way ANOVA, post hoc Tukey, unpaired, and paired “t” test.  Both groups showed a statistically significant influence on the parameters evaluated. The LNAGD had a substantial superior result in terms of early wound healing, reduction in density of melanocytes, reduction in pain experienced by the patient, with reduction and delay in the recurrence of GMP.

4 illus, 4 tables, 43 ref

041777   SIVASHANMUGAM T, SRIPRIYA R, JAYARAMAN G, RAVINDRAN C, RAVISHANKAR M (Anaesthesiology Dep, SBV Univ, Pondicherry – 607 402, Email: docsripriya@gmail.com) : Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study. Indian J Anaesth 2020, 64(5), 415-21.

Brachial plexus (BP) blocks continue to be described with reference to anatomical landmarks (Interscalene and Supraclavicular), even after the introduction of ultrasound which enables us to directly identify the roots, trunks and divisions of the BP. The aim of this study was to describe a novel injection technique targeting trunks of BP and to determine the minimum effective local anaesthetic volume (MELAV) required to produce BP block with this approach. Twenty‑one male patients in the age group 20–40 years, undergoing elective forearm bony procedures received an ultrasound‑guided truncal injection BP block. MELAV₅₀ was determined using the Dixon and Mood up‑and‑down method. Initial volume of local anaesthetic (LA; 50:50 mixture of bupivacaine 0.5 % and lignocaine 2 % with 5 µg/ml epinephrine) injected was 6 ml in each trunk, which was varied by 1 ml/trunk for each consecutive patient according to the response of the previous patient. The MELAV₅₀, MELAV₉₅ and MELAV₉₉ were calculated using Probit transformation and logistic regression. Out of the 21 patients, 13 patients had a successful block. The MELAV₅₀, MELAV₉₅ and MELAV₉₉ were 7.41, 10.47 and 12 ml, respectively. Eight patients in whom block failed had sparing in the ulnar and median nerve territories. Trunks of the brachial plexus can be identified and targeted for the injection of local anaesthetics. The MELAV₅₀ and MELAV₉₅ required for ultrasound‑guided truncal injection brachial plexus block were 7.4 and 10.4 ml, respectively

4 illus, 2 tables, 26 ref

041776   SARKAR T, MANDAL T (Anaesthesiology Dep, North Bengal Medical Coll, Darjeeling - 734 012, West Bengal, Email: tanuka4@gmail.com) : Preoperative oral zinc tablet decreases incidence of postoperative sore throat. Indian J Anaesth 2020, 64(5), 409-14.

Postoperative sore throat (POST) is very frequently reported after endotracheal intubation. Zinc lozenge has been shown to reduce POST. The aim of this study was to evaluate the effect of dispersible zinc tablet on POST. Eighty‑eight patients undergoing surgery with endotracheal intubation were randomly allocated into two groups, to either receive dispersible zinc tablet 40 mg (zinc group) or placebo tablet (control group), 30 min preoperatively. Assessment for incidence and severity was performed for POST, on a 4‑point scale (0–3) at 0, 30 min, 2, 4, and 24 h postoperatively. The primary outcome was incidence of POST at 4 h postoperatively. Secondary outcome was severity of POST at the 5 evaluation time points postoperatively. Mann–Whitney U test, Fisher’s exact, and Chi‑square test were used as applicable. At 4 h, there was a significantly lower incidence of POST in zinc group (6.8 %) than the control group (31.8 %) with a P value of 0.003. Three patients in placebo group complained of severe POST compared to none in the zinc group. The severity of POST was significantly lower in Zinc group than Placebo group at 0 min (P = 0.003), 30 min (P = 0.002), 2 h (P < 0.001), and 4 h (P = 0.001). Preoperative administration of 40 mg dispersible zinc tablet effectively reduces the incidence and severity of POST in the immediate postoperative period.

1 illus, 5 tables, 19 ref

045341   PITALE U, MANKAD H, PANDEY R, PAL P C, DHAKAD S, MITTAL A (Periodontics Dep, Modern Dental Coll and Research Centre, Indore- 453 112, Madhya Pradesh,, Email: dr.unnati10@gmail. com) : Comparative evaluation of the precision of cone‑beam computed tomography and surgical intervention in the determination of periodontal bone defects: A clinicoradiographic study. J Indian Soc Periodontol 2020, 24(2), 127-34.

Major limitations of conventional radiography are overlapping and lack of 3D information. Surgical exposure, though being able to provide accurate information, provides very little time to plan-out the type of periodontal regeneration required during surgery. Cone Beam Computed Tomography (CBCT) has emerged as a feasible tool and found to be accurate. Unfortunately, in-vivo studies are still scarce. Aim of the present study was to assess the efficacy of CBCT in the detection of periodontal bony defects while determining its quantitative precision in the measurement of alveolar bone height as against the open flap debridement (OFD) procedure which is set as the gold standard. Setting and Design: Present study is a cross-sectional study. The present study includes patients with Chronic Periodontitis indicated for periodontal surgeries. Bone defects were measured with the help of CBCT and with William’s periodontal probe during surgical intervention and compared. Measurements were compared with Student’s t-test; unpaired t-test & correlation were tested with Pearson’s correlation coefficient test. P < 0.05 was considered statistically significant. The mean CBCT & surgical value of palatal/lingual & distal sites of anterior teeth showed statistically significant difference (P = 0.001). All the values for posterior teeth were statistically non-significant. Statistically CBCT & clinical measurement with OFD have similar potential of accuracy to access the bony topography but CBCT provides good accessibility to visualize the sites which are difficult to access during surgical interventions like palatal sites & the distal sites of the posterior teeth.

4 illus, 9 tables, 42 ref

046686   ALMOSAWI H S, ISSA S S, AKBER M A (Radiology Dep, Airlangga Univ, Surabaya, Indonesia- 60131, Email: prijambodoradiologyunair@gmail.com) : Prevalence of childhood disability in Basrah city using the ten questions too. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194661.

The neglect of disabled children in the developing countries and less information about its types and prevalence in addition to the low level of health services they had. To identify the prevalence of handicapping disabilities among children up to 9 years of age and their epidemiological pattern in the Basrah city center. In a population-base, cross-sectional household survey was carried out in Basrah city.  A total sample (1734) children, males were 56 % and females were 44 % of the sample using the ten questions survey tool. The survey team detected 73 disability cases 48 were males and 25 were females. The detected prevalence of disability in our sample was 37.7 %.Disabled children, on average, were in the fourth or fifth birth order among their brothers and sisters and 47 % of them were counted as the second or third disability inthe same family. The number of disabling conditions in the same child varied widely: 31.5 % of cases had a single disability, 24.6 % had two conditions and 43.8 % had three or more conditions. The questionnaire children up to 9 years of age in thesefamilies formed 56.2 % of the population. The survey managed successfully to document a comparable estimate of the prevalence rate for childhood disabilities in the community and provided a general picture of their types and suspected causes. It also reported a low service delivery for these disabilities and identified some risk factors related to their occurrence.To apply this survey method in center Basra city is justified in an extended field study with certain modifications to suit the local culture. This study also should be complemented with a second stage referral for follow up examination of detected cases of and evaluation of the disability and its required services.

5 tables, 19 ref

041775   SHARMA S K, THAKUR K, MUDGAL S K, PAYAL Y S (AIIMS, Rishikesh - 249 203, Uttarakhand, Email: sk.aiims17@gmail.com) : Acute postoperative pain experiences and satisfaction with its management among patients with elective surgery: An observational study. Indian J Anaesth 2020, 64(5), 403-8.

There is a paucity of regional data on acute postoperative pain. The present study was conducted with an aim to assess the acute postoperative pain experiences, its interference with ADLs, emotions, sleep, IPR and satisfaction with pain management among patients who had undergone elective surgeries. In this observational study, 200 postoperative adult patients; who had undergone elective surgery were interviewed using American Pain Society’s Patient Outcome and Satisfaction Survey Questionnaire. Pain perception and interference of pain with ADLs, emotions, sleep, and IPR was measured on 0–10 numerical scale and satisfaction on 6 point Likert scale, i.e., very satisfied to very dissatisfied. There was high incidence (82.5 %) of acute postoperative pain experience and mean score for worst episodes of pain was significantly high, i.e., 7.6 ± 1.5, which had significant interference with ADLs (5.6 ± 2.1), sleep (3.6 ± 1.7), and emotions (3.6 ± 1.6). Majority of patients reported that pain was assessed only once (17 %) or twice (48.5 %) in each shift. Despite of poor pain control, a large number of patients were satisfied with overall pain treatment (69 %), and response of physicians (81 %) and nurses (62 %) for their pain complaints. Acute pain score was directly associated with the duration of postoperative hospital stay (P = 0.001). Acute postoperative pain was inadequately assessed and undertreated but still a large number of participants were satisfied with acute postoperative pain management probably because patients expects that pain is inevitable after surgery. Postoperative pain had significant interference with ADLs, emotions and sleep of patients, which may affect postoperative comfort and recovery.

1 illus, 3 tables, 25 ref

041774   BARIK A K, KUMAR A, DHAR M, RANJAN P (Anaesthesiology Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: ajitdr.ajit@gmail.com) : A prospective comparative study of arterial blood gas parameters in smoker versus non‑smoker patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 2020, 64(5), 397-402.

Smoking is a risk factor for postoperative pulmonary complications in patients undergoing general anaesthesia. These may get amplified with effects of pneumo‑peritoneum and carbon dioxide (CO₂) insufflation during laparoscopic surgeries. Our aim was to compare metabolic and blood gas analysis of smokers versus non‑smoker patients during laparoscopic surgeries under general anaesthesia. After permission from institutional review board, 60 patients undergoing laparoscopic cholecystectomy were divided into two groups, smokers and non‑smokers (30 each). Along with baseline haemo‑dynamic parameters, arterial blood gas sampling was done to assess and compare PCO₂, pH and bicarbonate (HCO₃) values at various time intervals with respect to pneumo‑peritoneum creation, between smokers and non smokers. Baseline systolic blood pressure was higher and oxygen saturation was significantly lower in smoker group. PCO₂ and end‑tidal CO₂ were significantly higher in smokers at all intervals (P < 0.001). pH was significantly lower and HCO₃ higher, in smokers after creation of pneumo‑peritoneum. Increase in PCO₂ due to pneumo‑peritoneum was higher in the smoker group (3.49 ± 8.5) mmHg versus non smoker (0.56 ± 4.86) mmHg, although statistically not significant. Change in pH and HCO₃ was similar between smokers and non‑smokers. There is a significant difference in baseline arterial blood gas characteristics between smokers and non‑smokers. Metabolic effects of CO₂ insufflation and increased intraabdominal pressure appears to be more enhanced in smokers.

1 illus, 3 tables, 19 ref

045340   BEY A, AHMAD S S, AZMI S A, AHMED S (Periodontics Dep, Aligarh Muslim Univ, Aligarh, Uttar Pradesh, Email: afshanbey@gmail. com) : Effect of antidepressants on various periodontal parameters: A case– control study. J Indian Soc Periodontol 2020, 24(2), 122-6.

Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case–control study was conducted to know the effect of two commonly prescribed antidepressants – venlafaxine (serotonin–norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti‑inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. Materials and Methods: The study sample consisted of 182 depressed patients divided into three study groups: Group I – the control group diagnosed as depressed on the first visit, Group II – depressed patients taking fluoxetine 20 mg/day, and Group III – patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire‑based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti‑inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants‑SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti‑inflammatory properties.

1 illus, 3 tables, 21 ref

041773   GARG H, PODDER S, BALA I, GULATI A (Anaesthesia and Intensive Care Dep, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: podder_s@yahoo.co.in) : omparison of fasting gastric volume using ultrasound in diabetic and non‑diabetic patients in elective surgery: An observational study. Indian J Anaesth 2020, 64(5), 391-6.

Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non‑diabetic patients scheduled for elective surgery using USG. This prospective observational study included 53 diabetic and 50 non‑diabetic patients aged >18 years, American Society of Anesthesiologists’ physical status I‑III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross‑sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm² and 3.73 ± 1.61 cm² in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm² and 2.30 ± 1.18 cm² of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group. Diabetic patients have higher gastric antral cross‑sectional area and gastric volumes as observed by gastric ultrasound than the non‑diabetic patients.

2 illus, 2 tables, 20 ref

041772   SOLIMAN R, YACOUB A, ABDELLATIF M (Anesthesia Dep, Cairo Univ, Cairo, Egypt, Email: rabiesoliman@hotmail.com) : Comparative effect of desflurane and sevoflurane on liver function tests of patients with impaired hepatic function undergoing cholecystectomy: A randomized clinical study. Indian J Anaesth 2020, 64(5), 383-90.

Desflurane and sevoflurane are the most common volatile anesthetics used during laparoscopic and hepatic surgery. The objective of the study was to evaluate the effect of desflurane and sevoflurane in patients with elevated preoperative liver functions undergoing laparoscopic cholecystectomy. The study was a randomized study and included 162 patients classified randomly into two groups: Desflurane group: The patients received desflurane (end‑tidal concentration 4 %–6 %) as an inhalational agent during the whole procedure. Sevoflurane group: The patients received sevoflurane (end‑tidal concentration 2 %–4 %) as an inhalational agent during the whole procedure. The investigations included serum level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma‑glutamyltransferase (GGT), and total bilirubin. The values were serially collected at the following timepoints; T0:at the preoperative period, T1:directly after surgery, T2:1^st postoperative day, T3:2^nd postoperative day, T4:3^rd postoperative day, T5:5^th postoperative day, T6:7^th postoperative day, and T7:10^th postoperative day. The statistics were described in terms of mean ± standard deviation, frequencies, and percentages. The preoperative liver enzymes and total bilirubin were higher than the normal range in patients of the two groups. Postoperatively, there was a decrease in the AST and ALT with desflurane more than sevoflurane from T1 to T6(P < 0.05). The ALP, GGT, and bilirubin decreased in patients of the two groups, but the comparison was insignificant (P > 0.05). The desflurane is a safe inhalational volatile for maintenance of anesthesia in patients with impaired liver function undergoing laparoscopic cholecystectomy. It was associated with a decrease in the liver enzymes more than the sevoflurane.

1 illus, 4 tables, 32 ref

045339   BEVINAGIDAD S, SETTY S, PATIL A, THAKUR S (Periodontics Dep, SDM Coll of Dental Sciences and Hospital, Dharwad- 580 009, Karnataka, Email: sangamesh346@ gmail.com) : Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients. J Indian Soc Periodontol 2020, 24(2), 117-21.

The initial carious lesions are the so‑called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re‑mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy. All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk’s test and Wilcoxon test were applied to the data collected for statistical analysis. There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH. Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84 %). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.

2 tables, 41 ref

041771   LI J, YE H, SHEN W, CHEN Q, LIN Y, GAN X (Anesthesiology Dep, Sun Yat-sen Univ, Guangdong Province, China, Email: ganxl@mail.sysu.edu. cn) : Retrospective analysis of risk factors of postoperative nausea and vomiting in patients undergoing ambulatory strabismus surgery via general anaesthesia. Indian J Anaesth 2020, 64(5), 375-82.

Postoperative nausea and vomiting (PONV), one of the common complications following strabismus surgery, would delay the ambulatory discharge time. The aim of this retrospective study was to determine the risk factors of PONV in patients undergoing ambulatory strabismus surgery under general anaesthesia, with the treatments of dexamethasone and 5‑HT₃ antagonist combination. We reviewed 721 consecutive patients (12–60 years old) undergoing ambulatory strabismus surgery under general anaesthesia at an academic eye centre between December 2016 and January 2019. Patients received prophylactic treatment of dexamethasone and 5‑HT₃ antagonist combination during anaesthesia induction, and PONV was evaluated during the early recovery period before discharge. The dexamethasone and 5‑HT₃ antagonist combination effectively reduced the incidence of PONV (3.05 %, 22/721), and the patients who experienced PONV had statistically prolonged phase II recovery time as compared those who did not (P = 0.006). The sum of the extraocular muscles manipulated and the use of nalbuphine (vs flurbiprofen axetil) were the independent risk factors for PONV (P < 0.05). The sum of the extraocular muscles manipulated and the use of nalbuphine are potentially modifiable risk factors for PONV after strabismus surgery with the treatments of dexamethasone and 5‑HT₃ antagonist combination.

1 illus, 4 tables, 27 ref

045338   SUKUMARAN S K, VADAKKEKUTTICAL R J, KANAKATH H (Periodontics Dep, Calicut Medical Coll, Calicut, Kerala, Email: drrosammajoseph@ gmail.com) : Comparative evaluation of the effect of curcumin and chlorhexidine on human fibroblast viability and migration: An in vitro study. J Indian Soc Periodontol 2020, 24(2), 109-16.

Chemical plaque control acts as an adjunct to mechanical periodontal therapy. Chlorhexidine (CHX) is considered as the gold standard in chemical plaque control, but the main concern is about its fibroblast cytotoxicity. Curcumin, a lipophilic polyphenol, may offer as a promising antiplaque agent. This study was conducted to compare the effect of curcumin (0.003 %, 0.03 %, 0.06 %, 0.1 %, and 0.12 %) and CHX (0.03 %, 0.06 %, 0.1 %, 0.12 %, and 0.2 %) on gingival fibroblast cell viability and wound healing at different time periods (1, 2, 4, 6, 8, and 10 min). The minimum inhibitory concentration (MIC₅₀) was determined before the evaluation of cytotoxicity and wound healing property. 3‑(4,5‑Dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazolium bromide assay and morphological examination by direct invert microscopy were carried out to determine cytotoxicity. Wound healing was evaluated by scratch wound assay. Results and Discussion: The MIC50 of CHX and curcumin was at 0.1 % and 0.003 %, respectively. The mean percentage of fibroblast viability at different concentrations of CHX and curcumin at each time period showed a significant difference. Curcumin exhibited less cytotoxicity as compared to CHX at all concentrations and at varying time periods. There was a significant difference between mean percentage of fibroblast viability at MIC₅₀ of CHX (0.1 %) and curcumin (0.003 %) at different time periods. The difference between percentage wound healing at antibacterial concentrations of CHX and curcumin at varying time periods was significant. The antibacterial concentration of curcumin (0.003%) exhibits less fibroblast cytotoxicity and excellent wound healing property as compared to CHX. Curcumin may offer as a promising chemical plaque control agent which is less cytotoxic, cost‑effective, safe, easily available, and with a possibly beneficial effect on wound healing.

4 illus, 3 tables, 34 ref

046684   ZAINEL M A M, SUHELMAWLOODALNAJJAR (Anatomy Dep, Hawler Medical Univ, Iraq, Irbil) : Incidence and variations of aberrant renal arteries in kidney donors cases. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194361.

The origin of renal arteries, vessel diameter, and point of entry to the kidney has all been analyzed as potential parameters which are a clinically relevant issue. This anatomical feature may be essential for fully understanding the process of renal perfusion, as it is not only the number of renal arteries that influences the extent of renal blood supply, also their diameter. The aberrant renal arteries that supply the inferior pole are more important because it provides arterial supply to the proximal part of the ureter. The objective of this study is to identify influences and prevalence of aberrant renal arteries of the kidney donors’ cases to perform role of the aberrant renal artery. Prevalence of aberrant renal artery was identified in 26.3 % of the cases, incidence was more frequent in left than right side; about 78.7 % of cases presented unilaterally. The remaining cases 21.2 % were RAs presented bilaterally. Diameter of main RA in kidney presenting the RA was 5.73 mm and that of kidney with only single renal artery was 6.19 mm.

3 illus, 3 tables, 18 ref

041770   KHEZRI M B, RAJABI M, YAGHOOBI S, BARIKANI A (Anesthesiology Dep, Qazvin Univ of Medical Sciences, Qazvin, Iran, Email: dr.108162@gmail.com) : Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double‑blind study. Indian J Anaesth 2020, 64(5), 369-74.

Systemic lignocaine has been shown to have sedative effects. We designed this randomised‑double‑blind, placebo‑controlled study to evaluate the effect of intravenous lignocaine on the bispectral index (BIS) during caesarean section under spinal anaesthesia. 80 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated to 2 study groups. Group L received intravenous 1.5 mg/kg of lignocaine bolus, 15 minutes before spinal anaesthesia followed by an intravenous infusion 1.5 mg/kg/h for 60 minutes intravenously. The patients in the control group (C group) were given 0.9 % sodium chloride in a double‑blind fashion. Spinal anaesthesia was performed with 10 mg of 0.5 % bupivacaine. The changes of Sao2, BIS and hemodynamic variables during caesarean section, Apgar score of neonate and the incidence of adverse effects were recorded. BIS values were lower in the L group compared to C group (P ≤ 0.001). Comparison of mean arterial pressure (MAP) changes during spinal anaesthesia and surgery reveal statistically significant difference between two groups through repeated measure analysis (P ≤ 0.001), but comparision of heart rate (HR) changes during spinal anaesthesia and surgery failed to reveal any statistically significant difference between two groups. (P = 0.261). The Apgar scores did not reveal a significant difference between the two groups at first and five minutes after delivery (P = 0.99). Intravenous lignocaine infusion given with spinal anaesthesia in women undergoing elective caesarean delivery providing lower BIS values without respiratory depression, in the absence of foetal compromise.

3 illus, 2 tables, 21 ref

045337   SRIVASTAVA A, SAHA S, SAHU C (Periodontology and Implantology Dep, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow- 226 025, Uttar Pradesh, Email: sonali10.sahu@ gmail.com) : Early and accurate detection of bacterial isolates from dental plaque in subjects with primary, mixed, and permanent dentition by matrix‑assisted laser desorption/ ionization time‑of‑flight mass spectrometry technique. J Indian Soc Periodontol 2020, 24(2), 104-8.

Bacterial colonization of dentition in different age groups can impact prognosis in different dental diseases. Latest diagnostic technique such as matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF) is increasingly being used for accurate identification of bacteria. This study was undertaken to evaluate the MALDI‑TOF MS technique to identify bacterial pathogens from dental plaques in subjects with primary, mixed, and permanent dentition. The study included 150 subjects of different age groups and were divided into three groups ‑ Group A: Subjects with primary dentition (n = 50), Group B: Subjects with mixed dentition (n = 50), and Group C: Subjects with permanent dentition (n = 50). Subgingival dental plaque samples were collected from buccal and lingual surfaces of premolar and molar teeth. Clinical parameters such as gingival index were recorded. Samples were cultured in routine aerobic and anaerobic medium. Bacterial growths were assessed by semiquantitative methods. Bacterial isolates were confirmed by MALDI‑TOF MS technique. MALDI‑TOF MS detected all the culture‑grown bacteria. In primary dentition group, purple and yellow complex bacteria predominated. Streptococcus spp. was the predominant bacteria (51 %) followed by Escherichia coli (19 %) and Veillonella spp. (19 %). In mixed dentition and permanent group also, Streptococcus spp. was predominant (46 %) followed by Veillonella spp. (24 %) and E. coli (19 %). However, in both groups, orange complex bacteria (bridge complex) such as Prevotella nigrescens and red complex bacteria (Porphyromonas gingivalis, 3 %) were seen. For majority of bacteria, the load increased with age. The bacterial isolates showed a distinct age‑specific colonization. The use of advanced technique such as MALDI‑TOF MS is helpful in the detection of periodontal pathogens, and the effective oral health programs can be implemented to minimize the risk of periodontal diseases.

1 illus, 3 tables, 20 ref

045336   BILLA A L, AVULA H, CHAKRAVARTHY Y (Periodontics Dep, Sri Balaji Dental Coll, Hyderabad, Telangana, Email: harithaavula@ gmail.com) : Career opportunities in periodontics: A road map to the future. J Indian Soc Periodontol 2020, 24(2), 3-12.

A solid career plan is crucial as it can provide a roadmap to the future. The motivating factors for selecting any career are complex, and periodontics is no exception. Periodontics is a dynamic profession that includes sophisticated treatment planning and a wide variety of treatment modalities ranging from conventional to advanced therapies. It is a unique branch of dentistry that enables both saving teeth and also replacing them in an effective way with implants. The purpose of this article is to provide an overview of various career opportunities for a periodontist. Career options in periodontics are manifold and diverse, enabling a periodontist a professionally gratifying and secure lifestyle. Future of the profession of periodontics appears exciting and rewarding but is not likely to happen without great effort and challenges. However, periodontics is not a static field and continues to evolve leaving a periodontist with no dearth in career opportunities.

7 illus, 12 ref

046683   ALKUMAIT M H M S, ABDUL-AZIZ M M , NIMA M H (Urology Dep, Tikrit Univ, Salahdine, Iraq, Email: malkumait@yahoo.com) : The effect of glutathione versus co-enzyme Q10 on male infertility original study. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194360.

Worldwide, numerous people are affected with the infertility problem. Especially married people find it the most stressful problem that can also cause psychological issues. Glutathione is a naturally produced oxidant that is quite useful to preserve other antioxidants. The level of glutathione varies from person to person. It plays a significant role to enhance the sperm motility pattern. Some men who are suffering from infertility problem because of andrological pathologies, the glutathione can eliminate such issues because of therapeutic effect. Men, who have a lower amount of Q 10 in the seminal fluid, experience the slow motion of the sperms. According to various studies, the increase in the quantity of Q 10 automatically enhances the motility of the sperm. : The presented prospective randomized placebo-controlled study was conducted in Saladin province of Samarra city (Iraq) between Jan 2016 to Dec 2018. The study deployed 51 infertile male subjects for the administration of oral glutathione (250 mg sachets) for tenure of 6-months. Another group of patients 50 received oral Co-enzyme q 10 (200 mg sachets) for 6 months, a third group received a placebo (sugar sachets) for another 6 months. The results revealed oral glutathione and co-enzyme q 10 as an effective treatment for improving the sperm parameters (motility, morphology, sperm concentration) which were statistically significant except for semen volume where P value was > 0.05. Also, this study showed no statistical significance between the use of glutathione and co-enzyme q 10 as a single agent therapy ( P>0.05 ). From this study, we can conclude that both glutathione and co-enzyme q 10 are effective treatment options for improving sperm motility, morphology and concentration. 

2 tables, 19 ref

041769   UDAYASANKAR M, UDUPI S, SHENOY A (Anaesthesiology Dep, Kasturba Medical Coll and Hospital, Manipal - 576 104, Karnataka, Email: doctor.sandesh@gmail.com) : Comparison of perioperative patient comfort with ‘enhanced recovery after surgery (ERAS) approach’ versus ‘traditional approach’ for elective laparoscopic cholecystectomy. Indian J Anaesth 2020, 64(4), 316-21.

Perioperative anxiety, hunger, thirst, fatigue, pain along with nausea and vomiting can influence a patient’s recovery after surgery. We aimed to compare ‘enhanced recovery after surgery’ (ERAS) protocol with a traditional perioperative approach to evaluate a patient’s recovery after elective laparoscopic cholecystectomy. A prospective randomised controlled study was conducted after institutional ethical clearance on 50 patients undergoing elective laparoscopic cholecystectomy, and divided equally into two groups. In group 1 (traditional); standard fasting guidelines and routine perioperative management was implemented. In group 2 (ERAS); patients received appropriate multimedia information about surgery and anaesthesia besidecarbohydrate loading with tender coconut water on the previous night and on the morning of surgery. Standard guidelines of fasting for solids were followed. Intraoperatively, goal‑directed fluid therapy and an inspired oxygen concentration of 60% were administered. Postoperatively, early diet and mobilisation were initiated. The primary outcome was the assessment of perioperative anxiety. Hunger, thirst, fatigue, pain, nausea, vomiting and overall perioperative experience were also evaluated. ERAS group had reduced anxiety prior to surgery: median (interquartile range) 3 (3–4) vs 2 (2–3) (P = 0.003), and at 6 h postoperatively: 4 (3–6) vs 3 (1–4) (P = 0.001). Hunger, thirst and fatigue (P < 0.01) were also decreased with better overall perioperative experience (5 [4–5] vs 6 [5–7], P = 0.004). Pain, nausea, vomiting and blood glucose were similar between the groups. ‘ERAS approach reduces anxiety in addition to hunger, thirst and fatigue with enhanced overall perioperative comfort in patients undergoing laparoscopic cholecystectomy.

3 tables, 22 ref

041768   DESHPANDE J P, PATIL K N (Anaesthesiology and Critical Care Dep, Shrimati Kashibai Navale Medical Coll and General Hospital, Pune, Maharashtra, Email: kalyanish19@gmail.com) : Evaluation of magnesium as an adjuvant to ropivacaine-induced axillary brachial plexus block: A prospective, randomised, double-blind study. Indian J Anaesth 2020, 64(4), 310-5.

Axillary brachial plexus block is commonly performed for surgeries on the hand and forearm. However, there are very few studies on the use of magnesium sulphate in axillary brachial plexus block and, hence, the study was designed to evaluate magnesium as an adjuvant to ropivacaine-induced axillary block with respect to onset and duration of sensorimotor block and postoperative analgesia. Sixty patients of the American Society of Anesthesiologists (ASA) physical status I and II, undergoing surgeries on the hand and forearm were randomly recruited to receive ultrasound-guided axillary block with either 150 mg magnesium sulphate or 1 mL normal saline added to 0.5 % ropivacaine. The primary outcome measure was to compare block characteristics including postoperative analgesia and the secondary outcome was to compare the use of rescue analgesia and the side‑effect profile. Data were statistically analysed using Statistical Package for Social Sciences (SPSS version 21.0). Categorical variables were compared using the Chi-square test or Fisher’s exact probability test; continuous variables compared using unpaired t-test or Mann-Whitney U test. Onset of sensory (9.93 ± 1.31 vs 8.83 ± 1.12 min) as well as motor block (13.37 ± 1.63 vs 11.57 ± 1.30 min) was significantly hastened with addition of magnesium to ropivacaine (p < 0.001) and so was the duration (sensory 386.60 ± 18.26 vs 526.37 ± 27.43, motor 323.73 ± 15.17 vs 436.97 ± 18.99 min) (p < 0.001) and postoperative analgesia (425 ± 21.39 vs 572.83 ± 32.04 min) (p < 0.001) which reflected in decreased requirement of rescue analgesic and total postoperative analgesic dosage. Magnesium is an effective and safe adjuvant to local anaesthetics and improves all characteristics of axillary brachial plexus block along with postoperative analgesia.

2 illus, 2 tables, 22 ref

041767   YADAV S, VYAS V, HAZARI S, GEHDOO R P, PATIL S (Dr. D. Y. Patil Medical Coll and Hospital, Navi Mumbai - 400 706, Maharashtra, Email: Varsha.vyas011@gmail.com) : Awareness of safety protocols for prevention of needle stick injuries in anaesthesiologists from Maharashtra: A survey study. Indian J Anaesth 2020, 64(4), 306-9.

Needle stick injury (NSI) has a serious risk of transmission of various blood borne pathogens amongst healthcare personnel and more so in anaesthesiologists. This survey assessed the prevalence of NSI and awareness of safety protocols for its prevention amongst the anaesthesiologists from Maharashtra, India. This self-administered survey was completed by 403 anaesthesiologists across Maharashtra from August 2019 to October 2019. The pre-validated and pretested 18-item questionnaire was administered using Google forms and the link was circulated amongst anaesthesiologists electronically. The questionnaire items included information on the awareness of safety protocols and immediate measure after NSI, knowledge of immunisation and safety practices followed in routine practice. Data were collected, tabulated and coded in Microsoft Excel. Descriptives are presented for the different items and prevalence of NSI. Comparison of prevalence of NSI in subgroups based on gender, period of experience and type of practice were analysed using Chi-square test. The prevalence of NSI was 73.7 % (n = 403) in anaesthesiologists with 71.1 % (n = 235) in males and 77.4 % (n = 168) in females. The anaesthesiologists from the medical schools had a prevalence of 75.0% (n = 148), those in private practice had a prevalence of 72.7 % (n = 216), whereas those working in both medical school and private practice had a prevalence of 74.4 % (n = 39). A greater prevalence was observed in those working for longer periods. The prevalence of NSI’s is alarmingly high amongst anaesthesiologists and there is an immediate need of creating awareness and practice safety protocols in routine practice. Training and education are required in the formative years of healthcare curriculum.

2 tables, 18 ref

041766   GHAI B, GUDALA K, ASRAR M M, CHANANA N, KANUKULA R, BANSAL D (Pharmacy Practice Dep, National Institute of Pharmaceutical Education and Research, Mohali - 160 062, Punjab, Email: dipikabansal079@gmail.com) : Development, validation and evaluation of a novel self-instructional module in patients with chronic non‑specific low back pain. Indian J Anaesth 2020, 64(4), 299-305.

Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the same with respect to Indian context is still lacking. The study was aimed to develop, validate and assess the acceptability and effectiveness of self-instructional educational module among Indian chronic LBP (CLBP) patients. A prospective single-arm open-label study was conducted in a pain clinic of a tertiary care public hospital in North India with ‘Backcare booklet-self-instructional module (SIM)’ as an intervention in patients with CLBP. SIM was developed with the intent to provide up-to-date evidence-based information in an easy understanding way to patients with CLBP. 132 patients were administered SIM with a single session of verbal explanation. Pain intensity (numeric rating scale [NRS]), disability, fear-avoidance belief Questionnaire (FABQ), quality of life (EQ5D) and knowledge level were assessed at baseline and after 3 months of intervention. Student’s paired t-test and Chi-square test were used. Data were analysed using SPSS version 15.0. 120 patients successfully completed the 3 months’ follow‑up. Significant reductions were observed in pain intensity (76[12] vs 55 [15, P < 0.01); disability (51[14] vs 43 [10], P < 0.01); FABQ (46[12] vs 41 [10], P < 0.01); EQ5D (0.35 [0.27] vs 0.18 [0.26], P < 0.01). Backcare booklet as an intervention, along with usual pharmacological care is a cost-effective educational medium to promote self-management of CLBP in the clinical outpatient settings.

1 illus, 2 tables, 31 ref

041765   PRASAD R, SONI S, JANWEJA S, RAJPUROHIT J S, NIVAS R, KUMAR J (Anaesthesiolgy and Critical Care Dep, Dr S.N. Medical Coll, Jodhpur, Rajasthan, Email: shikhasoni.19@gmail.com) : Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance. Indian J Anaesth 2020, 64(4), 292-8.

Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications. In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator. Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups. Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ² test, the Mann–Whitney U-test, Fisher’s exact test and Student’s t-test as appropriate. Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100 % in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups. Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.

4 illus, 2 tables, 19 ref

041764   SINGH S A, KRISHNAN G, ASHRAF H, SUBRAMANIAN R, PANDEY V, NASA V K, GOYAL S, GUPTA S (Max Super Speciality Hospital, New Delhi - 110 017, Email: drshwetasingh29@gmail.com) : Correlation between thromboelastography and rotational thromboelastometry values in adult liver transplant recipients. Indian J Anaesth 2020, 64(4), 286-91.

Viscoelastic haemostatic assays (VHA) namely Thromboelastogram (TEG) and Rotational thromboelastometry (ROTEM) are used for global assessment of coagulopathy and guiding transfusion during living donor liver transplant (LDLT).We conducted a study to compare the interchangeability of the values obtained from these devices in patients with End stage liver disease (ESLD) undergoing LDLT. In 76 patients undergoing LDLT, ROTEM and TEG were performed and assessed for interchangeability using Spearman Correlation. The direction and strength of correlation between equivalent parameters was calculated using Inter Class Correlation (ICC) and Bland Altman analysis. The correlation ρ between CT (clotting time) of ROTEM and R of TEG was 0.16 (P = 0.19).The ICC was 0.15, with 95 % confidence interval (CI) of -0.38-0.48 (P = 0.25).The ρ of CFT (ROTEM) with K (TEG) was 0.425 (P=<0.001). The ICC was0.49 with 95 % CI of 0.17-0.69, P = 0.003.Alpha of ROTEM correlated with Angle of TEG with ρ of 0.475 (P=<0.001). The ICC was 0.61, with 95 % CI of 0.36-0.76, P=<0.001.Maximum Clot firmness (MCF) correlated with maximum amplitude (MA) with ρ=0.76 (P=<0.001).The ICC was 0.86, with 95 % CI of 0.77-0.92, P=<0.001. Lysis index (L30) of ROTEM correlated clot lysis (CL30) of TEG with ρ of 0.16 (P = 0.18).However, the ICC was 0.45, with 95 % CI of 0.11-0.66, P = 0.08. The correlation between CT of ROTEM and R of TEG as well as L30 of ROTEM and CL30 of TEG was not significant.The strongest correlation was found between MCF and MA (P < 0.001). However the MCF/MA showed an agreement of only 86 % (ICC = 0.86). Values from ROTEM and TEG were not found to be interchangeable.

2 illus, 3 tables, 20 ref

041763   RANGANATHAN P, TADVI A, JIWNANI S, KARIMUNDACKAL G, PRAMESH C S (Anaesthesiology Dep, Homi Bhabha National Institute, Mumbai - 400 012, Maharashtra, Email: drpriyaranganathan@gmail.com) : A randomised evaluation of intercostal block as an adjunct to epidural analgesia for post-thoracotomy pain. Indian J Anaesth 2020, 64(4), 280-5.

Post-thoracotomy pain can be severe and disabling. The aim of this study was to examine the efficacy of intercostal nerve block when used as adjunct to thoracic epidural analgesia in patients undergoing posterolateral thoracotomy. This was a parallel-group randomised patient and assessor-blinded study carried out at a tertiary-referral cancer center. We included 60 adult patients undergoing elective lung resection under general anaesthesia with thoracic epidural analgesia. In addition, the intervention arm received single-shot intercostal blocks with 10 ml of 0.25 % bupivacaine at the level of and two levels above and below the thoracotomy. We assessed post-operative pain scores at 2 to 4 hours and 18 to 24 hours after surgery, peri-operative fentanyl requirement, percentage of patients who needed fentanyl PCA and maximum volume achieved on bedside spirometry 18 to 24 hours after surgery. Groups were compared using the unpaired t‑test for continuous data and the chi square test for categorical data at a 5 % level of significance. 2 to 4 hours post-operatively, mean pain scores at rest were 3.0 in both groups (difference 0.04, 95 % CI -1.1 to + 1.1) and on coughing were 4.6 (ICB group) and 4.9 (C group) (difference 0.32, 95 % CI -1.0 to + 1.6). There were no differences between the groups for any of the other outcomes. Addition of intercostal block to epidural analgesia does not confer any benefit in terms of post‑operative pain, fentanyl requirements or volume achieved on spirometry.

1 illus, 3 tables, 19 ref

041762   MYATRA S N, PATWA A, DIVATIA J V (Anaesthesiology Dep, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, Email: sheila150@hotmail.com) : Critical language during an airway emergency: Time to rethink terminology?. Indian J Anaesth 2020, 64(4), 275-9.

Clear language should be used during emergency airway management to aid communication and understand the nature of the emergency. Unfortunately, during emergency airway management, there is no uniform language used for communication. Various difficult airway guidelines use different terminologies. Terminologies like “can't intubate, can't oxygenate” (CICO) and “can't intubate, can't ventilate” (CICV) have certain limitations. Though terminology like “Front of Neck Access” (FONA) is dominant in the literature,“emergency cricothyroidotomy” is used more often in clinical practice, suggesting a disconnect between the dominant terminology in the literature and in clinical practice. Terminology should not be used merely because it is catchy, simple and advocated by a few. It must accurately reflect the nature of the situation, convey a sense of urgency, and suggest an action sequence. An initiative to achieve consensus among existing terminologies is much needed. Leaders in the field should work towards refining airway terminology and replace poor phrases with ones that are more concise, precise and can be used universally in an airway emergency.

1 illus, 25 ref