041207   CHOUDHARY M, VERMA M, GHOSH S, DHILLON J K (Oral Medicine and Radiology Dep, Maulana Azad Institute of Dental Sciences, New Delhi, Delhi - 110 002, Email: drchoudhary2000@yahoo.in) : Assessment of knowledge and awareness about biomedical waste management among health care personnel in a tertiary care dental facility in Delhi. Indian J Dent Res 2020, 31(1), 26-30.

The study was conducted to assess knowledge and awareness of biomedical waste management (BMWM) among undergraduate students, residents, and nursing staff in a tertiary care dental facility in Delhi. A questionnaire survey (using ten close ended questions) was conducted regarding various aspects of BMWM among undergraduate students, residents, and nursing staff in a tertiary care dental facility. In each group, scores were determined depending upon the correct responses, the participants marked. The data were compiled and subjected to statistical analysis. Only 33.3 % undergraduate students gave over 70 % correct answers as compared to nursing staff (100 %) and residents (62.2 %). Undergraduate students showed various lacunae in terms of knowledge regarding BMWM. The difference between the knowledge of the 3 groups i.e., nursing staff, residents, and undergraduate students was statistically significant (P = 0.001). Residents exhibited better awareness regarding BMWM as compared to undergraduate students (P = 0.003). The pertinence of the issue of BMWM and lack of adequate preparation of the trainee dentists at undergraduate level reflects the urgent need to fill the lacunae in the dental undergraduate curriculum.

7 tables, 13 ref

043045   YADAV S, MARATHA S (SGT Univ, Gurugram, Harayana) : Analgesis potential of novel prodrugs of naproxen. Int J Res Pharm Chem 2020, 10(2), 249-53.

Non-steroidal anti-inflammatory drugs are mostly prescribed drugs for patients with inflammatory conditions, but their efficacy is offset by a significant incidence of gastrointestinal (GI) side effects. A series of novel prodrugs of naproxen have been synthesized and evaluated for analgesic potential. The results indicate good analgesic activity.

1 table, 10 ref

043044   PATEL G K, PATEL P D (Pharmaceutics Dep, Ganpat Univ, Kherva - 384 012, Gujarat) : Formulation and evaluation of liquisolid compact of chlorthalidone. Int J Res Pharm Chem 2020, 10(2), 238-48.

Liquisolid compacts were used to formulate water insoluble drugs in non-volatile solvents and converting into acceptably flowing and compressible powders. The main objective of present investigation was to enhance the dissolution rate of poorly water soluble drug Chlorthalidone by using liquisolid technique. Several liquisolid tablets were prepared by using different carrier materials such as microcrystalline cellulose (Avicel pH-102) and coating material such as Aerosil respectively. Polyethylene glycol 400 was used as nonvolatile water miscible liquid vehicle. The liquid loading factors for such liquid vehicle was calculated to obtain the optimum amounts of carrier and coating materials necessary to produce acceptable flowing and compactable powder admixtures viable to produce compacts. Before compression, powdered mass were evaluated for various parameters like flow properties, content uniformity etc. All the prepared formulations were compressed using 13mm punch after addition of 5 % Sodium starch glycolate and crospovidone to each formulation. The formulated liquisolid tablets were evaluated for post compression parameters such as weight variation, hardness, drug content uniformity,percentage friability and disintegration time. The in-vitro release characteristics of the pure drug, drug from marketed tablets (as reference) and liquisolid technique (test sample), were studied. DSC study was performed to check drug excipients compatibility. The spectra revealed that there was no interaction between drug and excipients.The results showed that liquisolid formulations of Chlorthalidone exhibited higher percentage of drug release than marketed formulation.

5 illus, 8 tables, 18 ref

041205   RAJPUT S, PURANIK M P, SHANBHAG N, KUMAR A (Community Dentistry Dep, Goa Dental Coll and Hospital, Bambolim - 403 802, Goa, Email: sonirajput1190@gmail. com) : Factors affecting empathy among Indian dentists. Indian J Dent Res 2020, 31(1), 14-21.

Empathy is one of the major essential elements in patient and dentist relationship. Interpersonal Reactivity Index (IRI) has been used extensively to measure empathy among medical and other health professions. However, its validity in dental profession remains to be explored. To examine the psychometric properties of IRI and also to assess the factors influencing the dental students’ empathy. A cross‑sectional questionnaire study was carried out among 100 dental interns and postgraduates using IRI. Patients were selected randomly from six dental colleges in Bangalore. Internal consistency of items was evaluated by Cronbach’s alpha and construct validity was assessed by confirmatory factor analysis with an orthogonal varimax rotation of factors. The data were evaluated using SPSS 22. Descriptive and inferential statistics were performed with significance set at 5 %. Internal consistency of IRI (Cronbach’s alpha: perspective taking = 0.76, fantasy = 0.80, empathic concern = 0.72, and personal distress = 0.79) was good. A four‑factor solution emerged, accounting for 52 % of total variance. The mean age of the participants was 24.25 ± 1.95 years. The mean for empathic concern domain was highest (20.75 ± 1.64). Gender, career choice, academic performance, and work satisfaction were associated with increased empathy scores, whereas depression and stress were associated with decreased empathy scores (P < 0.05). This study confirms the construct validity and reliability of the IRI for assessing empathy in dental students. Empathy scores among students varied depending on professional/personal factors.

4 tables, 30 ref

043043   RAO L V, RAO K T, MOHAN KVV K (Chemistry Dep, GITAM (Deemed to be) Univ, Visakhapatnam - 530 045, Andhra Pradesh) : A validated rapid RP-UHPLC method for determination of assay and related substances in ttbb. Int J Res Pharm Chem 2020, 10(2), 224-37.

A simple eco-friendly linear gradient liquid chromatographic method (RP-UHPLC) is recommended for the simultaneous determination of assay and its related compounds in methyl 5-(4'-(bromomethyl)-[1,1'-biphenyl]-2-yl)-1-trityl-1H-tetrazole (TTBB) in commercial bulk samples. The chromatographic separation is achieved on Zorbax Eclipse Plus C18 RRLC column (100×4.6 mm; 3.5 µm) and eluent A used as 0.05 % v/v ortho phosphoric acid and eluent B used as acetonitrile using Agilent UHPLC system. The mobile phase flow rate was set at 1.0 mL/min and the eluted peaks were monitored at 220 nm for related substance and assay method. The adequate separation was achieved between TTBB and its related impurities and those were eluted within 16 min of the chromatographic run time. The enactment of the method is validated according to the present ICH guidelines for specificity, limit of detection, limit of quantification, linearity, accuracy, precision, and robustness. Repeatability, intra, and inter-day precision results were well within the tolerable limits. Limits of detection were found to be 0.084, 0.084 and 0.085 ppm and limits of quantitation as 0.251, 0.253 and 0.256 ppm for TTBB, TTMB and Dibromo TTBB respectively. The correlation coefficient of linearity for TTBB and its impurities were found to be ≥0.999. The related substances method recoveries were found between 80 and 120 % and also assay method recovery was found between 98.0 to 102.0 %. Peak homogeneity data for TTBB and its related compounds is indicates that specificity of method.

12 illus, 7 tables, 27 ref

041204   RAGHU K, SELVAKUMAR S R, MUTHUKUMAR R, THANGAVELU A, SATHYANARAYANAN R, MANI M, BALASUBRAMANIAM M (Indra Gandhi Institute of Dental Science, Puducherry - 607 402, Email: dr.raghuk@gmail.com) : Beak and bumper – physics forceps: Evaluation of new technique in extraction. Indian J Dent Res 2020, 31(1), 4-13.

The history of dentistry is not short; it started from ancient Egypt to ancient Romans and ancient Greeks. When it comes to extraction, all of them have made their own discoveries and progress. The progress they made also helped dentistry to move ahead in evolution of new extraction technique – the Physics Forceps. We have assessed the viability in using the Physics Forceps for routine dental extraction in our study for a period of 1 year. The study was conducted on 241 patients indicated for extraction based on our inclusion criteria using Physics Forceps after obtaining informed consent and University Ethics Committee approval. Tooth fracture, buccal alveolar bone fracture, and soft tissue injury around the tooth to be extracted were studied. In our present study of 241 patients, 57.67 % were females and 42.32 % were males, out of which 93.77 % had no tooth fracture, 3.32 % had crown fracture, 1.65 % had root fracture, and 1.24 % had apex fracture. Further, 85.47 % had no buccal alveolar bone fracture and 14.53 % had buccal alveolar bone fracture. Using proper technique, 96.26 % of patients had no soft tissue damage, and minimal damage was seen in 3.73 % of patients. Extraction by Physics Forceps is a very good technique of extraction. No or very minimal tooth fracture and soft tissue injury were noted. Though the forceps is costly, it represents a valuable addition to regular armamentarium for a general dentist for routine extraction. Physics Forceps is a dental extractor rather than a forceps.

4 illus, 4 tables, 13 ref

043042   KHAN A S, KHAN F, RAO N (Mumbai Univ, Maharashtra) : Quality risk management in pharmaceutical industries. Int J Res Pharm Chem 2020, 10(2), 215-23.

Current review explains the principles and examples of tools for Quality Risk Management (QRM) that can be applied to different aspects of pharmaceutical quality. Quality and attributes of pharmaceutical product is an important parameter throughout lifecycle owing to its importance as acceptance criteria at customer’s end. Drugs regulatory agencies have issued guidelines (ICH Guideline) for quality risk evaluation, mitigation and review management. The Quality risk management has become an important and integral part of quality management system at manufacturing plants. These are somerelatedmethods for change control, deviation control, investigations of market complaints and batch failures and are dealt with the principle of quality risk management at the manufacturing facility. These are afew of the parameters which consist of manufacturing, distribution, product development, inspection and submission of reviewprocesses during the lifecycle of drug substances, drug products and biological products.

1 illus, 1 table, 17 ref

043041   KHAN F, KHAN A S, RAO N (Quality Assurance and Medicinal chemistry Dep, Oriental Coll of Pharmacy, Sanpada, Navi Mumbai, Maharashtra) : Cleaning validation in pharmaceutical industries. Int J Res Pharm Chem 2020, 10(2), 205-14.

In pharmaceutical industries, to ensure safety, efficacy and quality of subsequent batches of drug products,care must be taken to avoid cross-contamination, adulteration of drugs or drugs with other active ingredients, unintended compounds, contamination of microbiological origin or contamination by cleaning or sanitizing agents. Hence it becomes very necessary to validate cleaning procedures which strictly follow the guidelines and methods developed for the same. Cleaning is done to eliminate product and non-product contamination as ineffective cleaning can lead to adulterated and contaminated product. It includes different levels of cleaning, cleaning procedure, sampling procedure, cleaning agent selection etc to ensure the efficacy of cleaning procedures to ensure that the patients are not put at risk due to cross-contamination and ultimately result in better customer care and quality of product.

5 illus, 2 tables, 51 ref

043040   NAGARAJU P, CHANDRA S R, PAVITHRA B, AKHIL SK, ALTAF SK (Pharmaceutical Analysis Dep, Hindu Coll of Pharmacy, Guntur – 522 002, Andhra Pradesh) : Development and validation of RP-HPLC method for the simultaneous estimation of darunavir and cobicistat in combined tablet dosage forms. Int J Res Pharm Chem 2020, 10(2), 191-204.

The study describes method development and subsequent validation of RP-HPLC method for simultaneous estimation of darunavir and cobicistat in combined tablet dosage forms. Chromatographic separation was achieved Inertsil ODS C18 column (150 mm x 4.6 mm, 5 µm)using a mobile phase consisting of (30:70 v/v) 0.1% TEA: methanol at a flow rate of 1.2 mL/min. The detection wavelength is 242 nm. The retention times of darunavir and cobicistatwere found to be 3.237 min and 4.805 min respectively. The developed method was validated as per ICH guidelines. The developed and validated method was successfully used for the quantitative analysis of darunavir and cobicistat in tablet dosage forms.

26 illus, 5 tables, 7 ref

044973   AGGARWAL R, CALICUT S M, SHEIK R A, THEEGALA V S, MUKHOPADHYAY I (Radiology Dep, 7 Air Force Hospital, Kanpur- 208 004, Uttar Pradesh, Email: rohitaggy@gmail.com) : In vivo cross-sectional topographic anatomy at sternal angle on magnetic resonance imaging. J Anat Soc India 2020, 69(4), 243-8.

The manubriosternal angle, first described by Louis in 1825, is an important landmark in the anatomy of the thorax and has been conventionally described as corresponding to the T4–5 IV disc level based on cadaveric dissections. The objective of this study was to document the level of the angle of Louis and various anatomic structures that also correspond to the same level in living individuals based on multiplanar magnetic resonance (MR) images. We reviewed MR scans of the cervicodorsal spine of 262 individuals comprising 174 males and 88 females in the age range 14–76 years. For each individual, the vertebral level of the following structures was noted on T1‑weighted (T1W)/T2‑weighted (T2W) turbo spin echo (TSE) coronal and sagittal images, namely tracheal bifurcation (TB), aortic arch (AA), and sternal angle (SA).  The SA was most commonly seen corresponding to the T5 vertebral body level (45.20 %) and at T4–5 IV disc level in only 20.45 % of the individuals. The convexity of the arch of the aorta was seen in the majority of the individuals corresponding to the T3 vertebral body level (47.96 %). TB was seen at T4 level in 34.35 % and only in 22.69 % at the T4–5 IV disc level. The anatomical level of the SA, AA, and TB in living individuals as assessed on MR images is significantly different from the traditionally held belief based on cadaveric dissections.

6 illus, 4 tables, 16 ref

043039   RAI K, POTPHODE P, GUPTA C, RAO N (Mumbai Univ, Maharashtra) : Comparitive study between ich guideline and anvisa guideline. Int J Res Pharm Chem 2020, 10(2), 173-90.

In November 2016, The Brazilian National Agency for Health Surveillance (AgênciaNacional de VigilânciaSanitária - ANVISA) became a member of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). Brazil was the first country in Latin America to join the ICH as a member, and together with South Korea, were the first two countries to be accepted into ICH as regulatory members. Joining the ICH, the agency has to fulfil with some obligations such as implementation of guidelines. As a commitment, within five years, ANVISA should adopt a set of five ICH guidelines that mainly concerns the Quality, Pharmacovigilance, Clinical Research, implementation of the Common Technical Document (CTD) and Medical Dictionary for Regulatory Activities (MedDRA). In which we have focused on Quality. The paper provides a critical assessment to implement the ICH guidelines in Brazil, with focus on the ICH guidelines for stability studies, analytical validation and pharmaceutical development. Both guidelines have been selected due to major differences between the current Brazilian regulations and ICH guidelines, leading to a huge challenge for the Brazilian Health Authority and the locally established Pharmaceutical Companies to implement these guidelines. Although many differences still in existing and efforts will be needed to implement the ICH guidelines in Brazil, ANVISA is putting a lot of efforts to implement the guidelines within the next years, in an open communication with the Industries, in order to reduce as much as possible, the impact. The implementation of the ICH guidelines will bring many benefits for the Industry and Regulator. By implementing the ICH guidelines in Brazil, the country will contribute to the global regulatory harmonisation, which will bring a great benefit to the public health and important medicines will be faster available to the patients.

29 ref

044972   EZEMAGU U K, AKPUAKA F C, IYIDOBI E C, ANIBEZE C P (Anatomy Dep, Alex Ekwueme Federal Univ, P.M.B- 1010, Nigeria, Email: uchennaezemagu@ gmail.com) : Considering the surface area and sagittal angle in a pair of lumbosacral facets: Determining the structural relevance of asymmetric facets at the lumbosacral junction. J Anat Soc India 2020, 69(4), 237-42.

The mechanism of spine dysfunction that was linked to asymmetry in facet joint planes remains poorly understood. We determined the surface area and sagittal angle in a pair of L4, L5, and S1 vertebral facets. We aimed to explain the structural relevance of asymmetric facets at the lumbosacral junction. Vertebral columns of 45 adult male human cadavers were cut at the L3–L4 intervertebral disc. Each section was macerated and tied together in a sequence to obtain the value of sagittal angle of the superior facets of L4, L5, and S1 vertebrae and area of the inferior facets of L4 and L5 vertebrae, using a modified protractor and graph paper method, respectively. Asymmetry was determined using the formula propound by Plochocki (2002). The mean value of surface area of the left and right inferior facets of L4 and the left and right inferior facets of L5 was 161 ± 24 and 168 ± 23 mm2 and 200 ± 28 and 218 ± 33 mm2 , respectively. The mean value of sagittal angle of the left and right superior facets of L4, L5, and S1 was 37.71 ° ± 4.38 °, 36.18 ° ± 4.8 °, 46.96 ° ± 6.49 °, 48.51 ° ± 6.25 °, 52.49 ° ± 5.1 °, and 54.67 ° ± 5.25 °, respectively. The degree of asymmetry in the area of the inferior facets of L4 and L5 ranges from 0 % to 30 % and 0 %–32.26 %, respectively, and that for sagittal angle of the superior facets of L4, L5, and S1 was 0 %–37.93 %, 0 %–30.95 %, and 0 %–26.32 %, respectively. This study would suggest that despite the statistically significant mean differences in the paired variables, the vertebrae were free of any pathological change but with consequent adaptive features. However, the stress effects would suggest that the left lumbosacral facet joints are predisposed to dysfunction of mechanical origin.

2 illus, 3 tables, 28 ref

044971   LUCKRAJH J S, NAIDOO J, LAZARUS L (Clinical Anatomy Dep, KwaZulu-Natal Univ, Durban- 4000, South Africa, Email: ramsaroopl@ukzn.ac.za) : An anatomical description of the vermian fossa: The reappraisal of an overlooked entity. J Anat Soc India 2020, 69(4), 233-6.

The vermian fossa (VF) is a shallow depression at the inferior end of the internal occipital crest, which lodges the inferior part of the cerebellar vermis. Published literature describes the VF as having a highly variable incidence and morphology. The present study is aimed to investigate the incidence, morphology, and morphometry of the VF within a select South African population and to conduct a review of the literature regarding this structure. A total of 100 dry, adult skulls of South African origin were analyzed to determine the morphological and morphometric parameters of the VF. The VF was found to be present in 62 % of cases. The shape of the VF was classified as triangular (27 %), quadrangular (8 %), and atypical (27 %). The average length of the VF was 13.78 mm, and the average width was 11.62 mm. The morphometric findings of this study correlate with that of previous studies; however, the incidence of atypical shaped VF (27 %) is higher in comparison to previous studies (9.7 %). The detailed anatomical description of the VF may aid in the study of diseases which cause alterations in the size and morphology of the vermis of the cerebellum as well as in transvermian approaches to tumors within the fourth ventricle. Furthermore, due to the paucity of anatomical descriptions of the VF, a reappraisal of this structure is warranted as it is of prime importance to clinicians operating in or interpreting radiological images of the posterior cranial fossa.

1 illus, 2 tables, 16 ref

044971   SINGH B, BOSE P, SHAMAL S N, JOSHI D, SINGH R (Anatomy and Neurology Dep, Banaras Hindu Univ, Varanasi- 221 005, Uttar Pradesh, Email: royanasingh@bhu.ac.in) : Polymorphic study of ataxin 3 gene in Eastern Uttar Pradesh population. J Anat Soc India 2020, 69(4), 226-32.

Spinocerebellar ataxia type 3 (SCA3), or Machado‑Joseph disease (MJD), is a prevalent autosomal dominant‑inherited disease that causes progressive problems with movement. Abnormal repetitive expansion of CAG trinucleotide in the ATXN3 gene results in SCA3. This study was done to review the corporation of CAG repeats and polymorphisms in definitive genes with the occurrence of SCA3 in the Indian community, especially in the eastern UP population. The 40 Ataxia’s patient and their parents were listed after obtaining written consent from the participant’s attendant/guardians. Out of these, we have identified polymorphism in three patients. In one patient, we have found a single base change, g.31483A>T in Exon 10, which changes the nucleotide from Adenine to Thymine (A31483T), while in the second patient, we have identified an intronic change at g.35690A>G in Exon 10, which changes the nucleotide from Adenine to Guanine (A35690G) and in the third patient DNA sequence analysis identified an intronic change at g.35587A>G Exon 10, which changes the nucleotide from Adenine to Guanine (A35587G). Although the partial loss of ATXN3 function may also contribute, the disease mechanism in MJD is believed to be a toxic gain‑of‑function. Several pathogenic cascades have been reported to be triggered by mutant ATXN3, but the critical molecular events driving MJD pathogenesis stay unresolved. While significant developments in studies have enhanced our knowledge of MJD, there is presently a lack of preventive treatment. Results presented here also expand our knowledge about MJD found in the eastern UP population.

5 illus, 2 tables, 13 ref

043039   KAUSHIK A, ARORA S (Rufaida Coll of Nursing, Delhi, Email: anjalikaushik@jamiahamdard.ac.in) : Respectful adolescent care: A right of every adolescent. Indian J Youth Adol Health 2020, 7(3), 16-9.

Adolescence is a crucial period in the life of every individual. The significance of adolescence and young adulthood is highlighted in relation to the crucial developmental process of preparing and transitioning to adulthood. During this period, the important developmental milestones are reached, and the young person develops a greater understanding about who they are and form their self-identity as per the Erikson. Adolescents become more independent and autonomous during this time. Adolescence is marked by changes that are not only physical but also psychological, social and emotional. Sometimes due to lack of proper knowledge and guidance, they end up having health related issues like teen pregnancy, STDs and other mental health issues like breakups etc. To tackle all these issues the health professionals should be sensitive and non-judgmental and should provide unbiased care. Adolescents have their own experiences and point of view that should be respected and taken into account. It is important to trust adolescents and their sense of responsibility. Adolescents are often reluctant to visit health facilities. It is therefore important to reach out to them by providing adolescent friendly services. It is their right also to have access to health care whenever they need it. It is essential to have trained and sensitive staff in these health centers so that young people access services in these centers in a confidential and non-judgmental manner.

11 ref

043038   NAZ F, ZUTSHI K, DHINGRA M, KUMAR M (Jamia Hamdard, New Delhi, Email: zutshi.kalpana@gmail.com) : Comparative effects of dynamic stretching and cryotherapy on the physical performance in recreational football players: A randomised crossover study. Indian J Youth Adol Health 2020, 7(3), 10-5.

It has been seen that the effects of dynamic stretching and cryotherapy has good effects in the performance of the football players. There are enough evidences and literature on both individually but the comparison between the two was not found. So, with the same concept comparison has been taken out with some interventions  in the recreational football players. The purpose of this study was to check the comparative effects of both the interventions upon different variables like vertical jump height, agility and 20 meter sprint.Methodology: 30 subjects were taken, who were divided into 2 groups. The first group received dynamic stretching first and then cryotherapy and the second group vice-versa. Further, after a period of 48 hours of flush out time the interventions were reversed to both the groups. Pre and post readings of variables were taken: vertical jump height, agility and 20 meter sprint. Vertical jump height test was significant for both the groups, after dynamic stretching. Vertical Jump height test had a significant p-value of 0.01 in group A and non-significant value for group B, after cryotherapy that is 0.531. T-test was significant for group A with a p value of 0.01 and non-significant for group B with a P value of 0.481. Significant for group B after cryotherapy with a p-value of 0.061. It can be inferred from the result of the study that each Variable: vertical jump height increased significantly in Group A and B after stretching but there was no significance in group B in the vertical jump height test in which cryotherapy was given first. Cryotherapy significantly increased the 20 meter sprint. Agility increased with dynamic stretching. On comparing the two groups-A and B, it was found that the sequence of altered interventions given (dynamic stretching/ cryotherapy) do not give any significant difference in the results as a whole.

5 tables, 21 ref

043037   BALI S, YADAV K, ALOK Y (Community and Family Medicine Dep, All India Institute of Medical Sciences, Bhopal, Email: surya.cfm@aiimsbhopal.edu.in) : A study of quality and proficiency of the service providers in delivering the adolescent and youth friendly services under the rashtriya kishor swasthya karyakram programme in Madhya Pradesh. Indian J Youth Adol Health 2020, 7(2), 1-9.

Despite existing frameworks for the improvement of adolescent reproductive health, there is a lack in provision of the Adolescent Friendly Health Services (AFHS). The primary objective of this study was to assess the quality and proficiency of service providers to deliver Adolescent Friendly Health Services (AFHS) in central India. Data was gathered by visiting 30 secondary and tertiary level health facilities to assess their infrastructure and preparedness for providing AFHS using a pre-designed questionnaire based on WHO guidelines for assessing quality. Descriptive analysis was done using SPSS v21 and Microsoft Excel. Quality of AFHS services was found to be poor in non- RKSK facilities. However the knowledge level, training status and counseling skills of the service provider was found to be highly substandard in both RKSK and Non-RKSK facilities. The RKSK program has not been properly implemented and has failed to make an impact where it was required. 

3 illus, 3 tables, 17 ref

043036   GEORGE L, SABITHA N, REHMAN R, LIBU GK (Nutrition and Dietetics Dep, ellalar Coll for Women, Erode-638012, Tamil Nadu, Email: publichealth10@gmail.com) : Review on public health services among school- going adolescents in Kerala. Indian J Youth Adol Health 2020, 7(2), 23-7.

Global  investment  in  adolescent  health  is  crucial.  Adolescents aged 10-19 years constitute around one sixth of the world’s population, account for 6 % of the global burden of disease and injury, and suffer over 1.2 million deaths each year. India is home to 253 million adolescents, accounting for 20.9 % of the country’s population. The study was cross sectional and implemented in government and government aided schools in central Kerala, Pathanamthitta district. Study assessed the public health services availed in the type of schools. Total 869 schools going adolescent selected from class 5th  to  12^th   standard and the age group between 10-18 years across the 20 schools among government and government aided school in rural, urban and semi-urban areas. Selected random sample of 50 respondents in each classes and self-administrated questionnaire were distributed. Public health services provided by schools to the adolescents were studied and it was revealed that 86.8 % of adolescents were provided with iron tablets, 91.7 % de-worming completed. School authorities were not engaging students in anaemia education and less than half 44.6 %. 27.9 % had their blood test done last five years. Two-third of the students 59.1 % said that there were timely health visits by the health professionals. On account of supplementary nutrition 48.2 % agreed on proper supply of cooked food within the school, Moreover 70 % girls said anthropometric measurements were taken during health visits. The  study  found  the  need  to  improve  adolescent  public  health services  periodic health check-up, strengthening the school monitoring system to ensure the health, nutrition and wellbeing in largely to the aided and governments schools. Priority has to be given for improving mental health, knowledge about contraception and school retention.

5 tables, 14 ref

043035   VIVEK K S, ZUTSHI K, WARDHAN D (Rehabilitation Sciences Dep, Jamia Hamdard, New Delhi, Email: zutshi.kalpana@gmail.com) : Is foot type an indicator of anterior cruciate ligament injury in football players?. Indian J Youth Adol Health 2020, 7(2), 16-22.

Prevention of sports injuries requires a comprehensive analysis of intrinsic and extrinsic factors of injuries in athletes. Pre-participation, evaluation, biomechanical assessment and new technology are helpful in providing useful information about the cause and mechanism of  sports injury and strategies for injury prevention. However, there have been only few previous investigations which can conclusively correlate certain foot types with specific knee injury. To determine any relationship between foot type and ACL injury. A case-control study design was adopted for this clinical study to investigate foot- type as a risk factor for ACL injury. 35 professional football players with a surgical history of ACL reconstruction and 35 professional football players without any history of ACL injury participated in our study. Foot types were determined by measuring their medial longitudinal arch angle and rearfoot-leg eversion angle. Questionnaire which included other variables of ACL injury were filled and analysed to eliminate their interference in this study. Odds ratio was used as reliable statistical tool to estimate the relative risk. There was a significant relationship between pronated foot type as a risk factor for ACL injury. This suggests that pronated foot is a risk factor for ACL injury in football players.

1 illus, 3 tables, 20 ref

043034   ROY S, TIWARI S, KANCHAN S, BAJPAI P (King George’s Medical Univ, Lucknow, Uttar Pradesh, Email: shubhajeet5944.19@kgmcindia.edu) : Impact of COVID-19 pandemic led lockdown on the lifestyle of adolescents and young adults. Indian J Youth Adol Health 2020, 7(2), 12-5.

The COVID-19 pandemic led lockdown-an unprecedented event wherein people globally have been hit hard. This lockdown has caused a deep impact on lifestyle-related parameters like sleep pattern, diet pattern, stress level, physical activity level and circadian rhythms. This study was designed to study effect of COVID-19 pandemic on lifestyle of young adults and adolescents. Online survey was conducted in 1065 respondents in the age group of 13 to 25 years. Questionnaire-based survey showed mean sleep duration changing from 6.85 hours to 8.17 hours, average screen time increased to 5.12 hours from 3.5 hours, 51.9 % subjects experienced higher stress levels, 76.4 % subjects experienced more food intake and 38.6 % subjects had decreased levels of physical activity as per self-monitoring. These changes might have long lasting effects on their physical, mental and social health and need counteractive measures to help young people lead a healthy lifestyle during the epidemic and beyond.

3 illus, 3 tables, 16 ref

043033   GAUTAM L, GUPTA A, KHADKA R, PANT G P (Public Health Dep, Tribhuvan Univ, Kathmandu, Nepal, Email: laxmi.dp26@gmail.com) : A study to assess contributing factors of teenage pregnancy in Sunsari district of Nepal. Indian J Youth Adol Health 2020, 7(2), 5-11.

Early  child  bearing  is  a  widely  observed  phenomenon  in  Nepal.  However,  little  information  is  available  in  regard  to  its  contributing factors. Teenage pregnancy is major contributing factor of maternal and child health and a challenging issue of public in developed and developing countries. This study explores the contributing factors of teenage pregnancy and knowledge about its consequences. A descriptive study was conducted to find out contributing factors of teenage pregnancy among 102 pregnant teenagers at selected health facilities of Sunsari district. Pregnant teenagers visiting health facilities for antenatal check-up during study period were interviewed using pre-designed questionnaire. Data was managed using SPSS software. Descriptive statistics and chi square test were used. The mean age of teenage pregnancy was 18±1.04 years and age at marriage 16.69±1.09 years. Majority were Muslim, 86.3 % were homemaker, 31.4 % had positive history of teenage pregnancy in family either-side, 38.2 % had married at an age of 17 years, 31.4 % were pregnant with their first child. Inadequate knowledge about teenage pregnancy, cultural acceptance, illiteracy, lack of knowledge on consequence of teenage pregnancy, difficulty to get information and access on family planning methods were major contributing factors and school dropout was reported as consequences of teenage pregnancy. Ethnicity, religion and education were associated with knowledge of teenage pregnancy. Knowledge about the risk and drawbacks of early marriage and early pregnancy should be increased not only among teenage girls but also to their parents and in-laws to change the attitude and practice of early marriage and teenage pregnancy.

6 tables, 12 ref

041199   SARKAR R, MAHESH E (Economics Dep, CHRIST (Deemed to be Univ), Bangalore, Karnataka – 560 029, Email: rupasneha72@gmail.com) : Should we judge PHCs by only IPHS guidelines or probe further?. Indian J Comm Health 2020, 32(2), 464-7.

Indian Public Health Standards (IPHS) evaluates supply side compliance of Primary Health Centers (PHCs). Patient Satisfaction (PS) on the other hand, assesses the demand side. Examining the supply side compliance and relating it to PS in the domain of Reproductive Health (RH). Using multistage stratified sampling, six rural and three urban PHCs in sub-districts, Ramanagara and Channapatna, in District Ramanagara, state of Karnataka, India, were chosen. Information collected using IPHS proforma for PHCs was compared with PS questionnaire (PSQ 18) data, collected from 398 patients visiting these facilities. Using descriptive and inferential analysis, sub-optimal compliance levels in ease of access, physical & human infrastructure, patient data and usage of untied funds was found. Existing behavioral compliance was found to be optimal. These findings were in alignment with PS findings. Results call for PHC capacity building, incentivization and a crucial need to look into PS side, before passing judgement about performance standard.

2 tables, 10 ref

041198   REHAN A, KISHORE S, SINGH M, BAHURUPI Y, AGGARWAL P, JAIN B (Community and Family Medicine Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: rehanabu975@gmail.com) : Undernutrition and associated common comorbidities among 6 -59 months old children. Indian J Comm Health 2020, 32(2), 461-3.

Undernutrition has long been a major public health concern in developing country like India as a leading cause of child morbidity and mortality. To assess undernutrition in under five children and various associated factors affecting it. A community based cross sectional study was conducted among 400 under five children in Rishikesh. The prevalence of underweight was 37.3 %, stunting was 43.3 % and wasting was 24.5 % respectively. Common morbidity emerged as significant predictors of under nutrition. The burden of common morbidities and prevalence of malnutrition among under-five children in this community is very high.

2 tables, 10 ref

041197   VAIDYA S, KUNDAPUR R, PRABHU S, HARSHITHA H N, RAI S V P, RASHMI A (Community Medicine Dep, Father Muller’s Medical Coll, Mangalore, Karnataka - 575 002, Email: sudhirhaladi@gmail.com) : An audit of loss of pregnancy as an answer to differentiated sex ratio. Indian J Comm Health 2020, 32(2), 458-60.

Abortion and unintended pregnancy in India is on the rise, and a large proportion of these unintended pregnancies end up in induced abortion. The soaring rate of abortion among Indian women can be influenced by a plethora of reasons. 1) To identify the rate of second trimester abortion 2) To determine the reasons behind second trimester abortions. An audit of all the abortions in a district of South India was conducted. The data was obtained from the records of abortion reported in the year 2018 from the District Health Office and analysed. Descriptive statistics Majority of the pregnant ladies with abortion (55.73 %) were aged between 21-30 years and abortions in second trimester were observed to be comparatively higher (50 %). Among the myriad of reasons found for second trimester abortions, spontaneous abortions contributed to around 30 % while 11.92 % had no cause mentioned. A high rate of second trimester abortion throws suspicion towards sex selective abortions.

2 tables, 7 ref

041196   GUPTA P, KAISTHA N, OMAR B (Microbiology Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: drpratima68@gmail.com) : HBV and HCV in health care workers and students of a newly established Tertiary care hospital at Rishikesh: Prevalence and immunity status. Indian J Comm Health 2020, 32(2), 454-7.

Hepatitis B and C cause serious infectious disease of the liver which affects millions of people worldwide. More than 2 billion people living today have been infected with Hepatitis B virus (HBV) at some time in their lives and about 350 million people are carriers of the virus. To detect HBV and HCV infection and assess HBV immunity status amongst healthcare workers, medical students and nursing students at AIIMS Rishikesh. 135 participants (Medical faculty, Nursing Faculty, Resident Doctors, laboratory technicians, laboratory attendants, medical and nursing students) were enrolled for the study. Serological tests HBsAg, anti-hepatitis C virus antibodies (anti-HCV), anti-HBs antibodies, were performed. None were positive for HBsAg 1.5 % were positive for Anti HCV antibodies and 61.75 % had protective levels of antiHBs. Conclusion: HBV vaccination and screening for HBV, HCV, and anti-HBs of all HCW and students at time of entry should be done. Yearly screening thereafter should be done to check as follow up. Regular training on HBV vaccination and safe practices should be emphasized at all levels of HCW.

2 tables, 14 ref

041195   SHARMA R, BAKSHI H, PATEL S, PANCHAL M, GAJJAR S (Community Medicine Dep, GMERS Medical Coll, Ahmedabad, Gujarat - 380 060, Email: drrashmi_psm@yahoo.com) : Investigation of community outbreak of enteric fever associated with drinking water in Borsad, Anand, Gujarat. Indian J Comm Health 2020, 32(2), 450-3.

Enteric fever is an endemic health problem and frequently associated with outbreaks. Investigate sudden surge in gastroenteritis cases to confirm the outbreak, describe it in terms of time place and person, identify source of infection, modes of transmission and suggest remedial measures. Field visit was undertaken by the rapid response team (RRT) at Borsad town of Anand district in Gujarat for investigating suspected typhoid outbreak. This involved gathering information from local authorities, hospital admissions and home visits; collection of blood samples and water samples. Of 30 suspected cases, 19 (63.3 %) tested Widal positive. Common presenting symptoms were fever, vomiting followed by diarrhea and abdominal pain. Chlorine levels at source and end users were inadequate. 5 leakage points in water supply were identified in areas around the clustered cases. Leakage in piped water supply coupled with inadequate chlorination lead to contaminated drinking water and subsequent Typhoid epidemic. Corrective steps in form of rapid surveys to identify cases, household chlorination and appropriate engineering measures were recommended and implemented.

2 illus, 2 tables, 15 ref

041194   USHA P, KISHORE S, SINGH M, AGGARWAL P, JAIN B, GAWANDE K (Community and Family Medicine Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: dr.preetiusha2012@gmail.com) : Assessment of activities of daily living (ADL) in elderly population. Indian J Comm Health 2020, 32(2), 447-9.

Most of the developing country facing growing number of elderly population because of decrease in fertility and increase in longevity. Elderly age (≥ 60 years) is a period in which people are prone to chronic diseases and their functional independency is probably restricted by physical and mental disabilities. To find out the prevalence of physical dependency among elderly in Uttarakhand, India. Activities of daily living (ADL) comprise the basic actions that involve caring for self and body, including personal care, eating and mobility. In the present study population of 400, 112 (28 %) study population were found to be physically dependent for their daily activities and out of them 63.39 % had moderate to severe dependency. High level of physical dependency in this study population need urgent attention towards good quality home care and geriatric health care services in India at primary, secondary and tertiary level.

2 tables, 11 ref

041192   MOLLAH A, SHRIVASTAVA P, DAS D K, RAY S (Community Medicine Dep, Burdwan Medical Coll and Hospital, Burdwan, West Bengal - 713 104, Email: drsoumalya@gmail.com) : Nutritional status of adult tuberculosis patients in Burdwan municipality area of West Bengal. Indian J Comm Health 2020, 32(2), 438-43.

Nutritional status of a Tuberculosis (TB) patient plays a role in disease manifestation. To assess the nutritional status of adult tuberculosis patients under intensive phase of treatment. Settings and Design: A descriptive study with cross-sectional design was conducted at Burdwan Municipality of West Bengal. In this study, TB patients aged 18 years and above receiving intensive phase of treatment, registered in the Tuberculosis units in the months of October-December, 2018 and residing in the municipality were approached. Nutritional status was evaluated through two approaches - dietary intake by twenty-four hours recall method and anthropometric status by measuring weight, height, BMI and MUAC. Data were analysed using SPSS v20. Out of 113 study subjects, under-nutrition was present in 61.9 % and inappropriate MUAC was observed in 68.1 %. Interestingly, intake of Cereals and Millets among food groups was found to be deficient. The adjusted odds ratio for having under-nutrition among new cases compared to previously treated was 0.16 (0.33-0.82). For combating protein energy malnutrition in TB patients, emphasis should be given on balanced diet intake.

3 tables, 12 ref

044970   SINGH A, GUPTA R, SINGH A (Anatomy and Community Medicine Dep, Rohilkhand Medical Coll and Hospital, Uttar Pradesh, Email: drarchana279@gmail. com) : Morphological and morphometric study of the acetabulum of dry human hip bone and its clinical implication in hip arthroplasty. J Anat Soc India 2020, 69(4), 220-5.

The objective was to study the morphology of the acetabular margin and articular surface and to measure the various dimensions of the acetabulum in dry human hip bones. A cross‑sectional morphological and morphometric study was performed on 92 undamaged acetabulum of adult dry human hip bone of unknown age and gender. The shape of anterior margin of the acetabulum and shape of the anterior and posterior ends of the articular surface of the acetabulum were observed. Morphometry was done using a Vernier caliper of accuracy of 0.01 mm. Vertical diameter (VD), transverse diameter (TD), anteroposterior diameter (APD), internotch distance (ND), and depth of the acetabulum were measured. Surface area (SA) and volume (V) of the acetabulum were calculated by mathematical calculation of dome. Statistical analysis was done using SPSS software version 22.0 (IBM, SPSS statistics, UNICOM GLOBAL, California, United States). The Pearson’s correlation test was used.  In the present study, the anterior acetabular ridge was curved in 45.7 % (42), angulated in 26.17 % (24), straight in 13 % (12), and irregular in 13 % (12) bones. The anterior end of the lunate articular surface was angulated, and the posterior end was lunate in shape in 45.7 % (42), whereas in 54.3 % (50), bone both the ends were lunate in shape. Morphometric values and mean ± standard deviation were as follows: 48.21 mm ± 3.31 mm (VD), 47.81 mm ± 3.37 mm (TD), 48.79 mm ± 4.08 mm (APD), 23.58 mm ± 2.77 mm (ND), 27.45 mm ± 3.02 mm (D), 4162.56 mm2 ± 755.58 (SA), and 36,563.65 mm3 ± 9408.67 (V). The knowledge of these acetabular parameters is necessary for the creation of acetabular prosthesis and surgical procedures such as acetabular reconstruction in hip joint surgeries.

4 illus, 10 tables, 22 ref

044969   KABAKCI A D A, SAYGIN D A, ALPA S, BUYUKMUMCU M, YILMAZ M T (Anatomy Dep, Necmettin Erbakan Univ, Konya, Turkey, Email: anil_didem_aydin@ hotmail.com) : An evaluation on the morphology of the nasal bone, piriform aperture, and choana on dry skulls. J Anat Soc India 2020, 69(4), 213-9.

Piriform aperture (PA) and nasal bone (NBs) are important structures that contribute to the formation of the nose. Both anatomic structures show differences based on ethnicity, gender, and age. Hence, it is widely used to determine sex in science branches such as anthropology and forensic medicine. Furthermore, morphometry of the PA and choana is an important criterion for physiological nasal respiration of individuals. Recognition of structural differences of PA, NB, and choana along with all this information becomes important during maxillofacial procedures to be performed especially in plastic and reconstructive surgery. The aim of the present study is to determine the individual differences in NBs, PA, and choana. This study was conducted on 83 Turkish dried skulls and PA, NBs, and choana was examined as morphometrically. PA was classified into seven types and NB was classified into eight subtypes. The most common type of PA was found type 5 (20 %–24.1 %) and the least most common type of PA was type 7 (4 %–4.8 %). Type 1 was determined as the most common observed shape of the NB. The mean width of the choana on the right and left sides was found 13.21 ± 1.4 and 13.98 ± 1.81 mm, respectively. Moreover, the mean height of the choana on the right and left sides was found 25.56 ± 3.06 and 26.1 ± 2.5 mm, respectively. We believe that obtained data from our study will constitute a morphometric data set and will be useful in a wide range of fields from forensic science to reconstructive surgery.

7 illus, 5 tables, 30 ref

044968   ÖZKAÇMAZ S, DADALI Y, ALPASLAN M, UÇAR I (Radiology Dep, Yuzuncu Yil Univ, Van- 65100, Turkey, Email: sercanozkacmaz@ hotmail.com) : The morphological variants of dural venous sinuses. J Anat Soc India 2020, 69(4), 207-12.

In this study, we aimed to analyze the dural venous system variations in Turkey by magnetic resonance imaging examinations. Images of a total of 200 patients (65 males, 135 females M/F: 0.48) who underwent a magnetic resonance venography examination were retrospectively screened.  Variation was detected in 101 patients (53.85 % of males [35/65] and 48.89 % of females [66/135]). In 16.5 % of the patients, only one variation of dural venous system was detected, while the most common variation was left transverse hypoplasia in this group. Twenty‑six percent of the patients had two variations of the dural venous system since the most common dual variations were left transverse hypoplasia + left sigmoid hypoplasia in this group. In 8 % of the patients, three or more variations of the dural venous system were observed as the most common variations were right transverse hypoplasia + right sigmoid hypoplasia + presence of occipital sinus in this group. It is essential to know the anatomical variations of the dural venous system for the discrimination between pathological processes such as thrombosis and physiologic conditions. Furthermore, the association of these variations with each other must be kept in mind for the explanation of the presence of multiple variations in the same individuals.

4 illus, 5 tables, 13 ref

044967   ÖZKAÇMAZ S, DADALI Y, ALPASLAN M, UÇAR I (Radiology Dep, Yuzuncu Yil Univ, Van- 65100, Turkey, Email: sercanozkacmaz@ hotmail.com) : The morphological variants of dural venous sinuses. J Anat Soc India 2020, 69(4), 207-12.

In this study, we aimed to analyze the dural venous system variations in Turkey by magnetic resonance imaging examinations. Images of a total of 200 patients (65 males, 135 females M/F: 0.48) who underwent a magnetic resonance venography examination were retrospectively screened.  Variation was detected in 101 patients (53.85 % of males [35/65] and 48.89 % of females [66/135]). In 16.5 % of the patients, only one variation of dural venous system was detected, while the most common variation was left transverse hypoplasia in this group. Twenty‑six percent of the patients had two variations of the dural venous system since the most common dual variations were left transverse hypoplasia + left sigmoid hypoplasia in this group. In 8 % of the patients, three or more variations of the dural venous system were observed as the most common variations were right transverse hypoplasia + right sigmoid hypoplasia + presence of occipital sinus in this group. It is essential to know the anatomical variations of the dural venous system for the discrimination between pathological processes such as thrombosis and physiologic conditions. Furthermore, the association of these variations with each other must be kept in mind for the explanation of the presence of multiple variations in the same individuals.

4 illus, 5 tables, 13 ref

044966   HOHENBERGER G M, SCHWARZ A M , WEIGLEIN A H, KUCHLING S, HAUER G, BERZINS U, HOLTER M, GRECHENIG C, KRASSNIG R, GÄNSSLEN A (Orthopaedics and Trauma Dep, Medical Univ of Graz, Graz- 8036, Austria, Email: hohenberger.gloria@ gmail.com) : Morphological side differences of the hemipelvis. J Anat Soc India 2020, 69(4), 201-6.

Differences of anatomical characteristics regarding side and gender have been the topic of interest in various recent studies. Studies have reported either significant or insignificant differences of the bony pelvis. The aim of this study was to evaluate possible gender and side differences of the pelvis in a cadaveric model. Fifty human cadaver pelves, preserved by the use of Thiel’s method, underwent measurement during this study. Diverse parameters were measured on both hemipelves by three surgeons. Analysis of the morphology of the acetabular cavity was performed by measuring its longitudinal, horizontal, and maximal diameters. The distance between the anterior superior iliac spine and the posterior superior iliac spine (females: mean of 15.9 cm; males: mean of 16.9 cm) and the horizontal diameter of the acetabular cavity (females: mean of 4.5 cm; males: mean of 4.9 cm) were statistically significantly shorter in females than in males. The subpubic angle was significantly (P < 0.001) larger in females (mean 61.4 °; standard deviation [SD] 11.02 °; range 37 °–82 °) when compared to males (mean 45.5 °; SD 7.48 °; range 35 °–60 °). The vertical diameter of the obturator foramen was significantly (P = 0.002) smaller for the right (mean 3.1; SD 0.56; range 1.9–4.6) in comparison to the left side (mean 3.4; SD 0.57; range 2.5–5.2). Overall, a clear gender difference was observed for typical gender‑specific parameters, whereas the anatomy of the hemipelves showed no relevant side differences.

4 illus, 2 tables, 18 ref

044964   GOEL N, CHOWDHURY I, DUBEY J, MITTAL A, PATHAK S (Anaesthesia Dep, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, Email: drniteshgoel@gmail.com) : Quantitative rise in intraocular pressure in patients undergoing robotic surgery in steep Trendelenburg position: A prospective observational study. J Anaesthesiol Clin Pharmacol 2020, 36(4), 546-51.

Raised intraocular pressure (IOP) is one of the known causes of anterior ischemic optic neuropathy. In the case of robotic urological‑gynecological surgeries, patient is kept in steep Trendelenburg supine‑lithotomy position. Aim of this study was to observe the quantitative rise in IOP in steep Trendelenburg position (>45 °) in robotic‑assisted prostatectomy and hysterectomy. After institutional ethical clearance and written informed consent, 100 patients undergoing robotic surgeries in steep Trendelenburg position were recruited for the study. IOP was measured at different time intervals in steep Trendelenburg position using Schiotz tonometer: Post intubation (T1), post pneumoperitoneum (T2), post steep Trendelenburg (T3), and rest readings were taken 30 min apart. T9 was taken 10 min after patient is made supine and parallel to the ground. Mean arterial pressure (MAP), positive inspiratory pressure (PIP), and end‑tidal carbon dioxide (EtCO2) values were recorded at different time points. Descriptive analysis, linear regression analysis, and Freidman’s nonparametric tests were used to analyze the results. Ninety‑five patients were included for statistical analysis as five patients were excluded due to intraoperative interventions leading to alteration of results. Mean IOP at T1 was 19.181/18.462 mmHg in L/R eye. A gradual rise in IOP was observed with every time point while patient was in steep Trendelenburg position which reverts back to near normal values once the patient is changed to normal position 21.419/20.671: Left/right eye in mm of Hg. Uni and multiple regression analysis showed insignificant P value, thus no correlation between MAP, PIP, and EtCO2 with IOP. Steep Trendelenburg position for prolong duration leads to significant rise in intraocular pressure.

2 illus, 6 tables, 17 ref

044963   BANSAL T, GARG K, KATYAL S, SOOD D, GREWAL A, KUMAR A (Anaesthesiology and Medicine Dep, Dayanand Medical Coll and Hospital, Ludhiana, Punjab, Email: drkamakshigarg@gmail.com) : A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile. J Anaesthesiol Clin Pharmacol 2020, 36(4), 541-5.

Anesthesia in obese patients is difficult due to associated comorbidities and altered physiology. Desflurane and sevoflurane have a low fat‑blood solubility coefficient and are better suited in these patients to achieve a rapid emergence. We studied BIS guided drug titration to compare the postoperative recovery characteristics and cognitive function of desflurane versus sevoflurane in obese patients undergoing laparoscopic abdominal surgeries. After institutional ethics committee approval and written informed consent, sixty obese patients (BMI ≥30 kg/m2 ) were randomized to receive either BIS guided desflurane or sevoflurane. Recovery was assessed by time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person after discontinuation of volatile anesthetic agent. For cognitive function, time taken to complete Mini mental state examination (MMSE) score to baseline was compared in both study groups. Difference of time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person was not significant between both anesthetic groups. Patients in sevoflurane group took significantly (P‑value = 0.001) less time (40.07 ± 13 min) to achieve preoperative MMSE score than desflurane group (51.2 ± 11.7 min). Both desflurane and sevoflurane have similar recovery profile in obese patients when anesthetic concentration is carefully titrated. Reversal of cognitive function is significantly earlier in obese patients anesthetized with sevoflurane.

1 illus, 3 tables, 16 ref

044962   PRASAD T K, GNANASEKAR N, PRIYADHARSINI K S, CHACKO R S (Anesthesiology and Pharmacology Dep, Sathya Sai Medical Coll and Research Institute, Kancheepuram? 603 108, Tamil Nadu, Email: matmon_3641@hotmail.com) : Randomized double‑blind trial comparing effects of low‑flow vs high‑flow anesthesia on postoperative lung functions using respirometer. J Anaesthesiol Clin Pharmacol 2020, 36(4), 535-40.

Modern anesthetic practice utilizes low‑flow anesthesia with evolving evidence on its pulmonary effects. Studies comparing measurement of vital capacity and inspiratory reserve volume using respirometer in both low‑flow and high‑flow anesthesia are sparse. We evaluated the effects of low‑flow and high‑flow anesthesia on postoperative pulmonary functions using respirometer. This was a prospective randomized double blind study wherein One hundred and ten patients undergoing peripheral surgeries under general anesthesia were allocated into two groups Group I‑ Low‑flow anesthesia with O2 + N2O + Sevoflurane (0.5L + 0.5L + 3.5 %) and Group II‑ High‑flow anesthesia with O2 + N2O + Sevoflurane (2L + 2L + 2%). The difference in vital capacity (VC), inspiratory reserve volume (IRV), and peak expiratory flow rates (PEFR) from the preoperative period were compared in both the groups postoperatively. The difference in VC, IRV, and PEFR measured in both the groups between the preoperative and postoperative period were found to be similar and statistically insignificant (P ‑ 0.173, 1.00 and 0.213 respectively). The difference in single breath count (SBC), breath holding time (BHT), and respiratory rates (RR) were also similar in both the groups (P – 0.101, 0.698, and 0.467) respectively. The pulmonary effects of low‑flow anesthesia are comparable with the high‑flow ones in patients undergoing elective surgeries under general anesthesia.

6 illus, 4 tables, 10 ref

044961   GUPTA M K, YADAV G, SINGH Y, BHALEKAR A (Anaesthesiology Dep, IMS, Varanasi? 221005, Uttar Pradesh, Email: dryashacin1999@rediffmail.com) : Correlation of the changing trends of red cell distribution width and serum lactate as a prognostic factor in sepsis and septic shock. J Anaesthesiol Clin Pharmacol 2020, 36(4), 531-4.

Various biomarkers are used for predicting outcome from sepsis and septic shock but single value doesn’t give clear‑cut picture. Changing trends of serum lactate and red cell distribution width (RDW) gives more accurate information of patient outcome. So, aim of this prospective observational study was to identify the correlation, for initial and changing trend of blood lactate level and RDW, with 28‑day mortality in sepsis and septic shock. Patient who fulfills the criteria of sepsis and septic shock, according to the consensus conference published in 2016, were included in this study. All patients were resuscitated and managed according to institutional protocol for sepsis and septic shock. Serum lactate and RDW was obtained from arterial blood gas and complete blood count, respectively. Serum lactate and RDW were recorded at 0 h, 6 h, 24 h, day 2, day 3, day 7, week 2, and week 3. Mean between two groups were compared with student t‑test. Pearson and Spearman correlation coefficient was used for establishing correlation between two continuous data. P value < 0.05 indicates significant difference between two groups. There is positive correlation between serum lactate and RDW at all‑time point in non‑survival group while negative correlation was found in survival group except on day1 and 2. Changing trends of serum lactate and RDW can be used as a prognostic marker in patient of sepsis and septic shock.

2 illus, 5 tables, 24 ref

044960   PRAJAPATI D J, PATEL M, PATEL P, VIJAYAKUMAR M, GANPULE A, MISTRY D (Anaesthesiology Dep, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, Email: dr_djp2011@hotmail.com) : Effect of caudal bupivacaine alone and with adjuvant fentanyl and nalbuphine to minimize the catheter‑related bladder discomfort after tubeless percutaneous nephrolithotomy: A prospective randomized study. J Anaesthesiol Clin Pharmacol 2020, 36(4), 524-30.

Catheter‑related bladder discomfort (CRBD) is a major cause of postoperative morbidity following urological procedures. The aim of this study was to compare the effect of caudal bupivacaine alone and with adjuvant fentanyl and nalbuphine to minimize the severity of CRBD after tubeless percutaneous nephrolithotomy (PCNL). A randomized prospective study was conducted on one hundred thirty‑two (American society of Anaesthesiologist physical status I to II) patients who presented for tubeless PCNL under general anesthesia. Patients were randomly divided into four groups control (C), bupivacaine (B), bupivacaine‑fentanyl (BF), and bupivacaine‑nalbuphine (BN) by using computer‑generated codes. All patients received local infiltration at the procedure site while Groups B, BF, and BN received caudal epidural block (CEB) under ultrasound guidance after conclusion of the procedure. Groups B, BF, and BN received bupivacaine alone, bupivacaine‑fentanyl, and bupivacaine‑nalbuphine, respectively, for CEB. Patients were monitored 24 h for CRBD scale, visual analogue score (VAS), and duration of analgesia at 30 min, 1, 2, 4, 6, 12, 18, and 24 h intervals. The analgesics were supplemented if the CRBD score was >2 and VAS was ≥4. Student t‑test, analysis of variance, and Chi‑square test were applied for quantitative, within group occurrence, and qualitative analysis respectively. The CRBD scores were considerably lower in the Groups BF and BN as compared to Groups C and B during the first four hours. The duration of analgesia was significantly prolonged in Group BN (475 ± 47 min) versus BF (320 ± 68 min) versus B (104 ± 40 min) versus C (26 ± 14 min). The severity of CRBD can be reduced with CEB. The effect of CEB can be prolonged with the addition of opioid.

4 illus, 2 tables, 30 ref

044959   SINGH T, KATHURIA S, JAIN R, SOOD D, GUPTA S (Anaesthesia Dep, Dayanand Medical Coll and Hospital, Ludhiana, Punjab, Email: richajain2105@gmail.com) : Premedication with pregabalin 150mg versus 300mg for postoperative pain relief after laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2020, 36(4), 518-23.

Pregabalin has been used in various studies for postoperative pain relief in varying doses. However, there is no conclusive evidence to support a safe and effective dose of pregabalin. The present study was designed to compare the efficacy of two different preoperative doses of pregabalin (150 mg and 300mg) in patients undergoing laparoscopic cholecystectomy for postoperative pain relief. Ninety adult patients of either sex with American Society of Anesthesiologist physical status I and II scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomized to receive pregabalin 150mg (group A), pregabalin 300mg (group B), or placebo (group C) orally 1 h before surgery. The pain was assessed using a visual analog scale (VAS) and a verbal rating scale (VRS) for the initial 24 h postoperatively. The primary outcome of our study was the comparative assessment of the severity of pain in the postoperative period in three groups. Postoperative analgesic consumption and incidence of side effects were assessed as secondary outcome measures. VAS score was significantly more in group C than group A and B (P‑value <0.05). The total amount of fentanyl required in 24 h was least in group B (228.33 ± 42.41µg) followed by group A(292.50 ± 46.49µg) and group C(322.50 ± 39.58µg) (P‑value 0.0001). The incidence of sedation, dizziness, and visual disturbances was more in group B as compared to group A and was least in group C. Pregabalin 150 mg is effective in decreasing postoperative pain after laparoscopic cholecystectomy with fewer incidences of adverse effects such as sedation and visual disturbances as compared to pregabalin 300 mg.

2 illus, 5 tables, 25 ref

044958   GUPTA R, ARORA D, KAUR S, KAUR B, KAUR S (Anaesthesia Dep, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar- 143 001, Punjab, Email: shubhdeep999@yahoo.co.in) : Comparative study of hemodynamic effects of intrathecal bupivacaine with butorphanol in cardiac and non‑cardiac patients. J Anaesthesiol Clin Pharmacol 2020, 36(4), 511-7.

The synergism between intrathecal opioids and low dose local anesthetics makes it possible to achieve reliable spinal anesthesia (SA) with minimal hypotension. The study objective was to compare the hemodynamic effects of reduced dose of 0.5 % intrathecal bupivacaine (2mL) with 25 µg butorphanol in cardiac vs non‑cardiac patients.  We included sixty patients aged 30‑80 years, undergoing infraumbilical surgeries in the study and compared thirty cardiac patients with mild to moderate reduction in left ventricular ejection fraction (LVEF) on 2D echocardiography (Group C) with 30 non‑cardiac patients (Group NC) for similar types of surgery. Both the groups received 0.5 % bupivacaine 2.0 ml with 25 µg butorphanol. The spinal block characteristics were similar in both groups (P > 0.05). The blood pressure of the patients in the two groups was comparable till 80 min P > 0.05 after which Group NC had significant increase in blood pressure compared to Group C upto 95 min (P < 0.05). Similarly, heart rate was comparable until 90 min (P > 0.05) after which Group NC had significant increase in heart rate versus Group C upto 100 min (P < 0.05). Eight patients in group C and five patients in group NC showed hypotension. Bradycardia was seen in 4 patients in group C in comparison to only one patient in group NC. We can safely consider spinal anesthesia with 10 mg bupivacaine and 25µg butorphanol in cardiac patients with mild to moderately reduced ejection fraction presenting for infraumbilical non‑cardiac surgeries with the advantage of intraoperative hemodynamic stability and adequate postoperative analgesia.

2 illus, 5 tables, 24 ref

044957   THANGAVELU R, GEORGE S K, KANDASAMY R (Anaesthesiology Dep, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, Email: ramyavel1988@gmail.com) : Prophylactic low dose ketamine infusion for prevention of shivering during spinal anesthesia: A randomized double blind clinical trial. J Anaesthesiol Clin Pharmacol 2020, 36(4), 506-10.

Regional anesthesia is known to produce perioperative hypothermia and shivering. We aimed to evaluate if prophylactic low dose ketamine bolus followed by infusion would prevent intraoperative and postoperative shivering under spinal anesthesia. Sixty patients belonging to American Society of Anaesthesiologists (ASA) 1 and 2 undergoing abdominal and lower limb surgery were randomized to receive either 0.2 mg/kg iv of ketamine bolus followed by infusion 0.1 mg/kg/hr (Group K) or5 ml of saline followed by 0.1 ml/kg/hr solution (Group S) as an infusion throughout the period of surgery. The incidence of shivering was the primary outcome of the study with degree of sedation and the hemodynamic profile between the two groups being the secondary outcomes. Hemodynamics (Heart rate, Mean Blood Pressure and temperature), Grade of shivering and grade of sedation were assessed intraoperatively and for grade of shivering and sedation two hours postoperatively. Repeated measures Analysis of Variance (ANOVA) was used to compare the hemodynamic variables and Chisquare test/Fisher’s exact test to compare the grades of shivering and sedation between the two groups. Intraoperative shivering was seen in eighteen patients in saline group (58.06 %) and only with four patients (13.79 %) with ketamine group (P < 0.001). Post operative shivering was also significantly less in ketamine group compared to saline (P = 0.01). Also, patients who received ketamine had significant sedation in the intraoperative period (P < 0.001). Prophylactic low dose ketamine administered as a small bolus followed by an infusion was effective in preventing both intraoperative and postoperative shivering.

1 illus, 2 tables, 26 ref

044956   GUPTA R, KAUR G, KAUR J, CHAWLA S, KAUR S, KULLAR K K, AUJLA S (Anaesthesia Dep, SGRD Institute of Medical Sciences and Research, Amritsar- 143 001, Punjab, Email: drgaganjot@yahoo.com) : Evaluating the effectiveness of TENS for maternal satisfaction in laboring parturients – Comparison with epidural analgesia. J Anaesthesiol Clin Pharmacol 2020, 36(4), 500-5.

Labor pain is one of the most severe pain that a woman experiences in her lifetime. Various methods are being used to relieve this pain and to achieve higher maternal satisfaction. One such technique is transcutaneous electrical nerve stimulation (TENS) that uses low-frequency electrotherapy. The aim of our study was to evaluate TENS by comparing it to an established labor analgesia technique, i.e., epidural analgesia in terms of maternal satisfaction. This prospective study was conducted on 60 parturients in active stage of labor. The choice of analgesia was made by the parturient after informed consent. In group A (n = 30) TENS was used, while in group B (n = 30) epidural ropivacaine 0.125 % + 2 µg/ml fentanyl was given. Continuous monitoring of maternal vitals, visual analogue score, and fetal heart rate (FHR) was done. Maternal satisfaction was scored considering pain relief, ability to move and experience of labor at the end of delivery and outcome was labeled as favorable and unfavorable. TENS was found to be favorable in 90 % of parturients as compared to 96.6 % in epidural (P 0.301). The number of highly satisfied parturients was 4 (13.3 %) in TENS group and 17 (56.6 %) in the epidural group (P= 0.000). Three patients in the epidural group had assisted delivery and two had cesarean section whereas all patients in TENS group delivered normally (P= 0.065). No significant difference was found in the fetal outcome. TENS is a good alternate choice for providing labor analgesia and may have a major role in future.

6 illus, 4 tables, 18 ref

044955   SOOD S, CHAHAR S, THAKUR A, GUPTA M, SAXENA A, SUBRAMANIAN S (Anesthesiology Dep, ESI-PGIMSR, New Delhi- 110 015, Email: shikhachahar123@gmail.com) : Comparison and evaluation of single‑use LMA supreme versus the reusable proseal LMA in paralyzed patients undergoing surgery with controlled ventilation. J Anaesthesiol Clin Pharmacol 2020, 36(4), 494-9.

The objective of this prospective randomized blinded study was to assess the safety and efficacy of the laryngeal mask airway (LMA) Supreme as compared with the LMA Proseal. A total of 60 patients were randomised into two groups to either receive a Proseal LMA (PLMA) or Supreme LMA (SLMA) for airway management. The primary outcome was to measure oropharyngeal leak pressure (OLP) in both groups. The secondary outcomes were the measurement of insertion time, insertion success rate, fibreoptic grading, intracuff pressure, ease of ventilation, and airway pressure on standard ventilatory settings and postoperative complications. Intracuff pressure increase after 60 minutes of induction was significantly higher in the PLMA group (PLMA 97.43 ± 11.03 cm of H2 O and SLMA 75.17 ± 8.95 cm of H2 O). OLP was recorded after device insertion, after 30 min and after 60 min in each group and was found to be 28.71 ± 2.97, 30.93 ± 2.87, and 31.93 ± 2.72 cm of H2 O in PLMA and 24.84 ± 2.08, 26.73 ± 2.26, and 27.95 ± 2.55 cm of H2 O in SLMA group, respectively. The mean OLP with the SLMA was significantly (p=<.001) lower than PLMA. All the other parameters were comparable in both groups.  PLMA is better than SLMA as airway device to ventilate at higher airway pressure in paralyzed adult patients. On the basis of our study, we recommend Proseal over Supreme LMA.

4 tables, 15 ref

044954   SETHI S, GOEL N, GHAI B, SHARMA M N, JAGAT RAM (Anaesthesia and Ophthalmology Dep, PGIMER, Chandigarh, Email: nitikagoel7@gmail.com) : EC50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial. J Anaesthesiol Clin Pharmacol 2020, 36(4), 489-93.

Literature documents EC50(End‑tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2 % and most of these studies suggest maintaining the required end‑tidal sevoflurane concentration for 10‑25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min. In this randomized trial, children aged 2_ 8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8 % sevoflurane and 100 % oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end‑tidal sevoflurane concentration at 2 % for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was “movement” and successful if “no movement” occurred. End‑tidal concentration was increased/decreased (step‑size 0.2 %) using Dixon and Massey up and down method in the next patient depending upon the previous patient’s response. EC50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100 % oxygen was 1.1 % (0.9-1.2) at 2.5 min and 1.6 % (1.5-1.7) at 5.0 min. Derived EC95 (95 % CI) at 2.5 min was 1.8 % (1.5-9.2) and at 5.0 min was 1.8 % (1.4-8.8) respectively. We suggest maintaining end‑tidal sevoflurane of 1.6 % for 2.5 min and 1.8 % for 5 min for successful CLMA insertion.

5 illus, 2 tbales, 24 ref

043031   ANGAYARKANNI A, ARIVARASAN BARATHI A, RAMESH RS, LAKSHMINARAYANAN S (Preventive and Social Medicine Dep, JIPMER, Gorimedu, Puducherry, Email: ari_raj84@yahoo.com) : Stages of behaviour change related to physical activity and the associated barriers among college-going adolescents in puducherry- cross sectional study. Indian J Youth Adol Health 2020, 7(1), 15-22.

One in every ten deaths globally is reported by physical inactivity related risks. Adolescents constitute 18% of the total population, due to physical inactivity they are more at risk of non-communicable diseases. This study aims to find the level, stages of behaviour changes, associated barriers related to physical activity among adolescents. Quantitative, cross-sectional study was done at Tagore College based on Multi-stage cluster sampling. 920 adolescents in the age group of 18-19 years were included in the study. Global Physical Activity Questionnaire (GPAQ) and Trans theoretic models were used to assess the level of physical activity and stages of behaviour change related to physical activity. In addition, barriers to participating in physical activity were also elicited.  About one-fifth of the subjects (20.4 %) were physically inactive. It was found that they are in pre-contemplation and contemplation stages (14.7 %) of behaviour change related to physical activity. Compared to females, males have a higher chance to do physical activity and was statistically significant (p<0.001). The major barriers to physical activity were personal barriers like lack of time and having multiple tasks. Healthy practices in a family also found to have a significant association with increased physical activity. (p<0.001). Many barriers were reported that prevent adolescents from taking up sufficient physical activity. Therefore, attempt should be taken to emphasize the importance of physical activity among family members, individuals, and the peer friends at the community level. Primordial prevention in the vital emergence of risk factors for NCDs like sufficient physical activity is vital for reducing burden of chronic diseases in our country.

7 tables, 18 ref

044953   ARASU M, RUDINGWA P, SATYAPRAKASH M V S, PANNEERSELVAM S, KUBERAN A (Anesthesia and Critical Care Dep, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry- 605 006, Email: priyaab8@gmail.com) : Comparison of conventional C-MAC video laryngoscope guided intubation by anesthesia trainees with and without Frova endotracheal introducer: A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2020, 36(4), 483-8.

Successful intubation with video laryngoscopes necessitates good hand-eye coordination and the use of intubation adjuncts like bougie and stylet. We proposed this study to find whether using Frova introducer with C-MAC video laryngoscope will reduce the intubation time in trainee anesthesiologists. We enrolled 140 adults without any difficult airway predictors. They were randomly assigned to undergo C-MAC video laryngoscope guided intubation by anesthesia residents using tracheal tube preloaded over Frova introducer (n = 70) or without Frova introducer (n = 70). Primary outcome was the intubation time. Secondary outcomes were the number of redirections of tracheal tube or Frova introducer toward glottis, need for external laryngeal maneuvers (ELMs), first attempt intubation success rate, and ease of intubation.  The median actual intubation time (IQR) in Frova and non-Frova group, respectively, were 25.46 (28.11–19.80) and 19.96 (26.59–15.52) s (P = 0.001). The number of redirections of TT or Frova introducer toward glottis, first attempt success rate, and ease of intubation were comparable. The need for ELMs [n (%)] was 15 (21.4) and 26 (37.1) in Frova and non-Frova group, respectively (P = 0.04). Frova introducer guided endotracheal intubation with C-MAC videolaryngoscope in patients with normal airways had a marginally prolonged intubation time with a significant reduction in the need of external laryngeal manoeuvres but with a comparable number of redirections and attempts. Further research is needed to generalize these findings to patients with difficult airways.

1 illus, 4 tables, 24 ref

044952   AMBULKAR R, RANGANATHAN P, SAVARKAR S, DIVATIA J V (Anaesthesia Critical Care and Pain Dep, Tata Memorial Centre, Mumbai- 400 012, Maharashtra, Email: rambulkar@hotmail.com) : A randomized controlled trial comparing McGRATH series 5 videolaryngoscope with the Macintosh laryngoscope for nasotracheal intubation. J Anaesthesiol Clin Pharmacol 2020, 36(4), 477-82.

The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries. We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). The secondary objectives included success rates, number of attempts, need for optimization maneuvers, Cormack and Lehane (CL) grade, and percentage of difficult intubations. The mean TTI in the VL group was 43 (±10.6) versus 75 (±38.0) s in the Macintosh group (99 % CI: 12.5; –51.6 s; P < 0.001). The overall intubation success rate was 100 % in both groups. All 29 (100 %) patients in the VL group were intubated in the first attempt versus 26 (86 %) patients in the Macintosh group (99 % CI –5; 33%; P = 0.11). In the Macintosh group, 20 (66 %) patients needed optimization maneuver versus none in the VL group (99 % CI 40; 91 %; P < 0.001). In the VL group, 28 (96 %) patients had a CL grade 1 view versus 9 (31 %) in Macintosh group (99 % CI 38; 92 %; P < 0.001). There were no difficult intubations in the VL group versus 3 (10 %) in the Macintosh group (99 % CI: 7; 28 %; P = 0.237). There was no trauma to oropharyngeal structures in either group. The McGRATH series 5 VL has faster TTI, better glottic visualization, and less need for optimization maneuvers than the Macintosh laryngoscope for NTI in patients with unanticipated difficult airways, when performed by experienced anesthetists.

1 illus, 3 tables, 26 ref

044951   SHAH S B, PAHADE A, CHAWLA R (Anaesthesiology Dep, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, Email: drrajivchawla@gmail.com) : The COVID‑19 hydroxychloroquine prophylaxis perception of Indian anesthesiologists: A survey‑based original article. J Anaesthesiol Clin Pharmacol 2020, 36(4), 471-6.

HCQ gained importance following the National Task Force advisory as an anti‑SARS‑Cov‑2 (coronavirus disease‑2019 [COVID‑19]) drug for frontline healthcare workers (including anesthesiologists). Report of a young anesthesiologist in Assam developing cardiac arrest following HCQ intake for COVID‑19 prophylaxis made us even more concerned. A conscious decision has been made by a large majority among us––to have or not to have HCQ. However, less severe complications such as gastrointestinal upset, skin‑rash, visual‑disturbance, headache, and dizziness even if experienced by HCQ users were likely to go unreported unless shared. The present survey was conducted to assess the prevailing perception among Indian anesthesiologists about HCQ’s preventive effect against COVID‑19. The information has been pooled together and discussed in this study. A total of 247 respondents participated in this pan‑India survey. The survey questionnaire was prepared using “Google Forms” and conducted via links delivered through WhatsApp and electronic‑mail.  55.9 % (138/247) of the respondents had consumed HCQ, 38 % (94/247) did not, and 6.1 % (15/247) were undecided at the time of responding to the survey. In total, 47 respondents who ingested HCQ reported a side‑effect, gastritis being the commonest (31). The evidence for the effectiveness of HCQ against COVID‑19 in India is reportedly as strong and weak as other drugs that have been promoted. The survey highlights the reasons consumption of HCQ and represents the opinion of 247 practicing Indian anesthesiologists. It informs the benefits and side effects of HCQ, which can help others in reaching a balanced decision.

3 illus, 3 tables, 21 ref

044950   SIMS T, PETERSON J, HAKIM M, ROTH C, TUMIN D, TOBIAS J D, HANSEN J K (Anesthesiology Dep, Kansas Univ, Kansas, USA, Email: tsims4@kumc.edu) : Decrease in heart rate following the administration of sugammadex in adults. J Anaesthesiol Clin Pharmacol 2020, 36(4), 465-9.

Sugammadex is a novel agent for reversal of steroidal neuromuscular blocking agents (NMBAs) with potential advantages over acetylcholinesterase inhibitors. In preclinical trials, there have been rare instances of bradycardia with progression to cardiac arrest. To better define this issue, its incidence and mitigating factors, we prospectively evaluated the incidence of bradycardia after sugammadex administration in adults. Patients ≥ 18 years of age who received sugammadex were included in this prospective, open label trial. After administration, heart rate (HR) was continuously monitored. HR was recorded every minute for 15 minutes and then every five minutes for the next 15 minutes or until patient was transferred out of the operating room. Bradycardia was defined as HR less than 60 beats/minute (bpm) or decrease in HR by ≥ 10 beats per minute (bpm) if the baseline HR was <70 bpm. The study cohort included 200 patients. Bradycardia was observed in 13 cases (7 %; 95 % confidence interval: 4, 11), occurring a median of 4 minutes after sugammadex administration (IQR: 4, 9, range: 2-25). Among patients developing bradycardia, two (15 %) had cardiac comorbid conditions. One patient received treatment for bradycardia with ephedrine. No clinically significant blood pressure changes were noted. On bivariate analysis, patients receiving a higher initial sugammadex dose were more likely to develop bradycardia. On multivariable logistic regression, initial sugammadex dose was not associated with the risk of bradycardia. The incidence of bradycardia after administration of sugammadex in our study was low and not associated with significant hemodynamic changes.

1 illus, 4 tables, 23 ref

044949   PATNAIK R, AZIM A, MISHRA P (Critical Care Medicine and Biostatistics Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, Email: draazim2002@gmail.com) : Should serial monitoring of procalcitonin be done routinely in critically ill patients of ICU: A systematic review and meta‑analysis. J Anaesthesiol Clin Pharmacol 2020, 36(4), 458-64.

Sepsis is a life‑threatening condition with dysregulated host response to infection. It is a major determinant of mortality in the intensive care unit (ICU). Procalcitonin (PCT) is widely investigated for prognosis in patients with sepsis. Most of the studies have cited that elevated PCT concentrations and PCT non‑clearance are associated with poor outcomes in patients with sepsis and some studies have cited as having no additional benefit. Most of the studies have evaluated single PCT measurement and correlated with prognosis and outcome in septic patients. Limited literature is there about serial PCT levels and its impact on the outcome of patients with sepsis. We searched literature through PubMed, Embase, Web of Knowledge, and the Cochrane Library from 2007 to 2017 and present a systematic review and meta‑analysis of studies evaluating the utility of serial measurement of PCT for prognosis in critically ill patients. Articles that assessed PCT non‑clearance as a marker of mortality data were included. The primary objective of this meta‑analysis was to pool the results of all the available studies on serial PCT non‑clearance as a mortality predictor and formulate overall area under receiver operating curve (AUROC). To find out the overall proportion of mortality in PCT non‑clearance was our secondary objective. To detect the mortality using PCT non‑clearance, ROC curve analysis was done. Area under curve (AUC) of the studies was varying between 0.52 and 0.86. Overall AUC was observed 0.711 (95 % confidence interval (CI): 0.662–0.760) under fixed effect model and 0.708 (95 % CI: 0.648–0.769) under random effect model. There was moderate variation among the studies, i.e., I 2 50.80 % (95 % CI: 0.00–80.42 %). The overall proportion of mortality was 37.54 % with much heterogeneity (I2 88.24 %) among the studies. PCT non‑clearance is a fair predictor of mortality. Further studies are needed to define optimal cut off point for PCT non‑clearance in ICU patients with sepsis.

4 illus, 1 table, 38 ref