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Background and Aims: Caudal block is among the most widely administered regional anesthesia in pediatric patients. The clinical signs and objective assessments are not fast and reliable enough to provide a good feedback. Perfusion index (PI) is considered as a sensitive marker to assess the efficacy of caudal block. We aim to assess PI as an indicator for success of caudal block in pediatric patients., Material and Methods: Sixty pediatric patients scheduled for elective surgery of lower abdomen and below were included. Patients were randomly allocated into two groups (n = 30): Group 1 received caudal block after general anesthesia and Group 2 only received general anesthesia. PI, heart rate, mean arterial pressure, and anal sphincter tone (AST) were recorded at 5, 10, 15, and 20 min following induction of anesthesia., Results: A persistent increase in the PI value was observed in Group 1 starting from 5 min till 20 min, as compared to Group 2, at all the time intervals. When mean PI was statistically compared between both the groups, it was found to be highly significant ( P = 0.001). Group 1 patients have progressive laxity of AST which was found to be significantly different from Group 2 ( P < 0.001)., Conclusion: We have found that both PI and AST are good indicators for assessing success of caudal block onset in pediatric patients but AST took slightly longer time (~20 mins). Therefore, we conclude that PI is simple, economical, and noninvasive monitor that predicts the caudal onset much earlier than AST., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Anaesthesiology Clinical Pharmacology.)

Background and Aim: Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq., Material and Methods: A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C 1; C 1 and C 2; C 2 and C 3; C 3 and C 4; and occiput and C 4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C 1 ., Results: Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C 2 -C 3 and C 0 -C 4 . Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant ( P < 0.05)., Conclusion: We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Anaesthesiology Clinical Pharmacology.)

Background-Respiratory symptoms are not uncommon in thyroid diseases and can be overlooked and misdiagnosed as acute exacerbation of asthma or COPD. Case report- A 58 years old female presented to emergency department with complaints of fever, shortness of breath from last 3-4 days for which she intubated in emergency department and shifted to ICU. Next day patient was absolutely fine and extubated and was planned to be shifted out surprisingly the same episode was repeated following which patient was intubated again and was found to be absolutely normal after 3-4 h and extubated again. The same episode was repeated next day as well. Eventually she was diagnosed to have cystic thyroid swelling. Immediate aspiration of the cyst done to relieve the symptoms and total thyroidectomy was done subsequently and patient was cured of the symptoms. Conclusion- Acute airway obstruction can occur in asymptomatic goitre patients. The anaesthetic management is crucial for airway till definitive surgery is done., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03179-x., Competing Interests: Competing InterestsNone., (© Association of Otolaryngologists of India 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction Spinal anaesthesia is frequently associated with adverse effects like maternal hypotension and bradycardia. This effect is due to a decrease in systemic vascular resistance, a decrease in central venous pressure or Bezold-Jarisch Reflex (mediated by 5-HT3 receptors). We aimed to measure the effect of three different doses of prophylactic intravenous ondansetron (5-HT3 antagonists) with a placebo on maternal haemodynamics. Methods A prospective randomised control study was done over 240 parturients, aged 19-35 years. They were randomly allocated into four groups (n=60) Group O4, Group O6, Group O8 and Group S to receive either intravenous ondansetron 4 mg, 6 mg, 8 mg or 0.9% normal saline respectively. Haemodynamic variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate [HR]) were recorded at 2-minute intervals for the first 20 minutes and at 5-minute intervals for further 30 minutes. Results A significant decrease in haemodynamic parameters was observed in group S when compared with ondansetron groups at various time intervals (p<0.05). The difference was most significant in groups O6 and O8. Development of nausea and vomiting was significantly higher in Group S compared to ondansetron groups (p< 0.005). The requirement for ephedrine was more in Group S in comparison to ondansetron groups (p<0.0001). Conclusion All three groups of ondansetron showed a decrease in the incidence of hypotension and use of vasopressor but Group O6 and O8 were more effective in attenuating spinal-induced hypotension in parturients undergoing caesarean section., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Vashishth et al.)

Background Nasogastric tube insertion is a routinely performed technique in anesthetized and intubated patients. However, failure leads to repeated insertion attempts causing injury, which makes the situation cumbersome. Therefore, we introduce a simple technique of deflating endotracheal tube cuff for nasogastric tube insertion in such patients. Methods Eighty adult patients scheduled for elective abdominal surgeries were randomly allocated into two groups, Group A (nasogastric tube insertion without endotracheal cuff deflation) and Group B (nasogastric tube insertion with endotracheal tube cuff deflation) along with lateral pressure application at cricoid in both groups. The number of attempts required, overall success rate, the time taken, rescue maneuvers, and incidence of complications were compared between the groups. Results In Group B, the total success rate for nasogastric tube placement was significantly higher than in Group A (80% vs 55%, p=0.016). Group B had a 55% first attempt success rate, but only 25% of patients in Group A had a first attempt success rate (p=0.014). The overall time for successful nasogastric tube placement was longer in Group A than in Group B (65.4 ± 28.72 seconds vs 43.5 ± 25.37 seconds, p=0.0005). The differences in nasogastric tube kinking and coiling between Group B and Group A were not statistically significant (20% vs 22.5%, 10% vs 27.5%, p = 0.78 and 0.08, respectively). Mucosal bleeding was substantially higher in Group A than in Group B (30% vs 10%, p=0.025, respectively). Conclusions This study showed that endotracheal tube deflation significantly increased the first-attempt success rate, overall successful placement of the nasogastric tube in intubated patients, and incidence of complications like mucosal bleeding decreased., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bangarwa et al.)

Objectives: Biomedical natural language processing tools are increasingly being applied for broad-coverage information extraction-extracting medical information of all types in a scientific document or a clinical note. In such broad-coverage settings, linking mentions of medical concepts to standardized vocabularies requires choosing the best candidate concepts from large inventories covering dozens of types. This study presents a novel semantic type prediction module for biomedical NLP pipelines and two automatically-constructed, large-scale datasets with broad coverage of semantic types., Methods: We experiment with five off-the-shelf biomedical NLP toolkits on four benchmark datasets for medical information extraction from scientific literature and clinical notes. All toolkits adopt a staged approach of mention detection followed by two stages of medical entity linking: (1) generating a list of candidate concepts, and (2) picking the best concept among them. We introduce a semantic type prediction module to alleviate the problem of overgeneration of candidate concepts by filtering out irrelevant candidate concepts based on the predicted semantic type of a mention. We present MedType, a fully modular semantic type prediction model which we integrate into the existing NLP toolkits. To address the dearth of broad-coverage training data for medical information extraction, we further present WikiMed and PubMedDS, two large-scale datasets for medical entity linking., Results: Semantic type filtering improves medical entity linking performance across all toolkits and datasets, often by several percentage points of F-1. Further, pretraining MedType on our novel datasets achieves state-of-the-art performance for semantic type prediction in biomedical text., Conclusions: Semantic type prediction is a key part of building accurate NLP pipelines for broad-coverage information extraction from biomedical text. We make our source code and novel datasets publicly available to foster reproducible research., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Knowledge Graph (KG) completion research usually focuses on densely connected benchmark datasets that are not representative of real KGs. We curate two KG datasets that include biomedical and encyclopedic knowledge and use an existing commonsense KG dataset to explore KG completion in the more realistic setting where dense connectivity is not guaranteed. We develop a deep convolutional network that utilizes textual entity representations and demonstrate that our model outperforms recent KG completion methods in this challenging setting. We find that our model's performance improvements stem primarily from its robustness to sparsity. We then distill the knowledge from the convolutional network into a student network that re-ranks promising candidate entities. This re-ranking stage leads to further improvements in performance and demonstrates the effectiveness of entity re-ranking for KG completion.

Quadriceps tendon is one of the important segment of knee extensor mechanism. Acute ruptures are more common than chronic ruptures and have better outcomes. Chronic ruptures are rare with lot of surgical challenges including tendon retraction, fibrosis, degenerative calcification. We present a rare case of a 48 year old male diabetic patient with history of fall eight months ago and chief complaint of inability to actively extend his left knee. Diagnosis was made clinically and was confirmed radiologically with MRI. Surgical management was done with the use of novel " Chariot Suture Technique ". It involves use of three Krakow whipstitches with Ethibond No. 5 suture across the distal ruptured end of quadriceps tendon and their intraosseous passage through patella in longitudinal fashion followed by tying knot at the distal pole of patella. The formation of Chariot makes the construct stable. At one year follow up patient was actively able to extend the knee with good range of motion. The technique is relatively cost effective, has no donor site morbidity, easy to learn and practice., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Introduction: Monolateral rail fixators are more comfortable to the patients and have a lesser learning curve compared to ring fixators. Guidelines are still lacking for rational use of monolateral fixator for bone transport. This retrospective study aimed to analyze and compare the clinico-radiological outcomes of monolateral fixator in infected non union of tibia based on bone gap quantification., Materials and Methods: This retrospective study included 35 patients of post traumatic infected osteocutaneous defects of tibia operated from May 2013 to May 2016. Group I having bone gap of 6 cm or less ( n  = 20) and group II with > 6 cm bone gap ( n  = 15). The mean age was 29.56 (range 18-62) years in group I and 29.67 (range 20-65) years in group II. The mean bone gap was 4.62 (2-6 cm) in group I and 7.6 cm (6.5-10 cm) in group II ( P  < 0.00001, Mann-Whitney test). The results were assessed by Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria., Results: Union was achieved primarily in 90% ( n  = 18) cases in group I and 73.34% ( n  = 11) cases in group II. The bone result was excellent, good, fair/poor in 14, 5, 1 in group I; and in 4, 6, 5 in group II, respectively ( P  = 0.020, Chi-square test). The functional results were excellent, good, fair/poor in 15, 4, 1 in group I; and 5, 8, 2 in group II, respectively ( P  = 0.0479, Chi-square test)., Conclusion: We recommend use of monolateral fixator in patients with infected diaphyseal non union of tibia with bone gap ≤ 6 cm. Use of monolateral fixator in patients with bone gap > 6 cm is associated with higher incidence of residual problems and complications., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interests regarding the publication of this paper., (© Indian Orthopaedics Association 2020.)

Osteochondroma is the most common benign tumour of bone seen in 3% of the general population. Complications such as neurological compromise, skeletal defects, vascular lesions, and compartment syndrome occur in about 4% of osteochondromas. We bring forth the case of a 16-year male who presented with the complaints of swelling in calf region associated with symptoms of claudication and paraesthesias in leg after exertion and absence of any such complaints at rest. Radiographs revealed a bony pedunculated mass originating from the posterior tibial metaphyseal region causing compression of posterior soft tissue structures. Excision biopsy of the mass was done by posterior approach with an L-shaped incision. The aim of this case report was to draw attention to the early signs of vascular compromise by osteochondroma in this region in order to prevent serious complications in future by early decompression.

Osteoma is a dense bony proliferation of otherwise normal membranous bone. This tumor is essentially restricted to the craniofacial skeleton and is rarely diagnosed in other bones. The mandible and the paranasal sinuses are the most common sites, while the involvement of the coronoid process has been reported in only 6 cases so far. This report demonstrated a case of osteoma occurring at the mandibular coronoid process in a 26-year-old female patient. The patient was managed with surgical resection of the osteoma followed by physiotherapy.

Cowden syndrome (CS) or multiple hamartoma syndrome is an infrequent genodermatoses, which is inherited as an autosomal dominant trait resulting from the mutation in the Phosphatase and Tensin homolog gene on the arm 10q and is principally characterized by multiple hamartomas with an increased risk of development of malignancies. Facial and oral signs are remarkable in the form of multiple papules and trichilemmomas on the face. We report one such rare case of CS in a 19-year-old patient who was diagnosed on the basis of her oral mucosal lesions and was further investigated and diagnosed with other hamartomas. The present case report signifies the responsibility of the oral physician in the early diagnosis of this progressive pathological syndrome as it leaves its footmark in the oral cavity in the form of oral mucosal lesions.

Objectives: The purpose of this study was to investigate the efficacy and safety of 0.1% tacrolimus powder in Oraguard-B for the treatment of patients with symptomatic oral lichen planus (OLP)., Methods: This was a nonrandomized, nonblinded study conducted in the outpatient department. The 20 patients with symptomatic OLP oral lichen planus who were asked to participate in the study were provided with 20-g containers of the study medication. Patients were asked to use the medication over the symptomatic areas three times a day until resolution of the lesion. Patients were recalled to assess the drug response every 15 days., Results: The duration of treatment ranged from 30 to 183 days, with a mean of 81.8 ± 44.4 days; all 20 patients reported a favourable response to the topical tacrolimus therapy. Eleven patients had complete resolution of their lesions. In 16 of 20 patients, there was marked resolution in symptoms as recorded by visual analogue scale. Out of 10 patients followed up for a period of 3 months, 5 had recurrence of their lesions but with less intensity, and the patients were symptomless. No serious side effects were associated with the study medication., Conclusion: Topical tacrolimus 0.1% in Oraguard-B was effective and safe in treating patients with OLP. However, there is still a need to undertake more detailed and objective clinical studies to determine the exact benefit of tacrolimus compared with conventional therapies and examine the influence of different dose regimes and formulations and assess the incidence of recurrence.

Cleidocranial dysplasia is an autosomal dominant condition caused by mutation of RUNX2, characterized by generalized dysplasia of the bones and teeth. Affected individuals have short stature, atypical facial features, and skeletal anomalies affecting mainly the skull and clavicle. The dental manifestations are mainly delayed exfoliation of the primary teeth and delayed eruption of the permanent teeth, with multiple impacted supernumeraries, and absence of cellular cementum. The frequency of this disorder is 1 per million individuals. Here we report a rare case of CCD in a 9-year-old male patient having most of the characteristic features of this syndrome. Interestingly, disorganized dentinal tubules were found in the roots of an extracted deciduous first molar, which seems to be a unique feature not reported previously.