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As the pandemic unfolded, the uncertainty about the continuity of learning became a source of stress for medical and dental undergraduates. Cognitive flexibility (CF) is one's capacity to adapt in response to environmental changes. CF correlated with intolerance of uncertainty (IU) which influences one's reaction to events. Previous literature has analyzed students' CF and IU. However, CF and IU during the COVID-19 pandemic needs to be explored especially for medical and dental students as these courses are practical skill based and when taught virtually can give rise to stress students and create self-doubt of their abilities. The Cognitive Flexibility Scale (CFS) and Intolerance of Uncertainty Scale (IUS) scales were administered to 74 medical and 89 dental students. An independent t-test revealed a significant difference in CF and IU between the medical and dental students. Dental students possessed lower CF and higher IU as opposed to medical students. A simple linear regression, IU was found to be inversely predicted by CF. The findings infer that medical students who have high CF are able to adjust to changes such as the sudden transformation to online learning settings during uncertain events like the COVID-19 pandemic as opposed to dental students. This study implies that the university needs to devise an intervention to assist dental students, particularly prepare them to face challenges and, to adapt to uncertainties in future. [ABSTRACT FROM AUTHOR]

Byline: H. Prashant, Sukhyanti. Kerai, Kirti. Saxena, Bharti. Wadhwa, Prachi. Gaba Background and Aims: Thermosoftening of endotracheal tube (ETT) is a simple method which reduces risk of epistaxis during nasotracheal [...]

Byline: Mousumi. Saha, Kirti. Saxena, Bharti. Wadhwa Background and Aims: Sevoflurane and desflurane have almost similar blood-gas solubility but recent studies suggest that desflurane compared to sevoflurane leads to faster [...]

Background and Aims: The passage of a Ryle's tube through the drain port on the laryngeal mask airway (LMA) ProtectorTM has been reported to be arduous despite the larger gastric channel. There are no studies on the evaluation of the guided insertion of LMA ProtectorTM to achieve adequate gastrointestinal drainage function. Methods: This randomised study included 132 patients who underwent surgery under general anaesthesia. The gum elastic bougie (GEB)-guided insertion of LMA ProtectorTM (group I) was compared with the conventional method (group II), and the alignment of the tip of the drain tube with the oesophagus was assessed. The insertion characteristics of the device, accuracy of LMA ProtectorTM placement, haemodynamic parameters, and post-operative airway morbidity following the insertion of the device were also compared between the two groups. Results: The first-attempt success rate for the placement of LMA ProtectorTM and the patency of oesophagus was higher in group I patients than in group II (100% vs 84.8%; P < 0.001). However, the time taken for device insertion and associated haemodynamic changes were significantly longer in group I. The patients in group I had better visualisation of laryngeal structures. The GEB-assisted insertion of LMA ProtectorTM resulted in less incidence of blood staining at the cuff of the device. Conclusion: GEB-guided insertion of LMA ProtectorTM achieved better oesophageal patency than the conventional insertion method. This method also had higher first-attempt success at the placement of the device and was observed to be less traumatic. [ABSTRACT FROM AUTHOR]

Background and Aims: Post the second wave of COVID-19 in India, our institute became a dedicated center for managing COVID-19-associated mucormycosis (CAM), but there was a paucity of data regarding perioperative considerations in these patients. The objectives of present study was to describe the preoperative clinical profile, the perioperative complications and outcome of CAM patients undergoing urgent surgical debridement. Material and Methods: This prospective observational study was conducted on CAM patients presenting for surgical debridement from July to September 2021. During preoperative visits, evaluation of extent of disease, any side effects of ongoing medical management and post-COVID-19 systemic sequalae were done. The details of anaesthetic management of these patients including airway management, intraoperative haemodynamic complications and need for perioperative blood transfusion were noted. Results: One hundred twenty patients underwent surgical debridement; functional endoscopic sinus surgery (FESS) was carried out in 63% of patients, FESS with orbital exenteration in 17.5%, and maxillectomy in 12.5%. Diabetes mellitus was found in 70.8% and post-COVID new onset hyperglycemia in 29.1% of patients. Moderate-to-severe decline in post-COVID functional status (PCFS) scale was observed in 73.2% of patients, but with optimization, only 5.8% required ICU management. The concern during airway management was primarily difficulty in mask ventilation (17.5%). Intraoperatively, hemodynamic adverse events responded to conventional treatment for hypotension, judicious use of fluids and blood transfusion. Perioperatively, 10.8% of patients required blood transfusion and 4.2% of patients did not survive. Non-surviving patients were older, with a more aggressive involvement of CAM, and had comorbidities and a greater decline in functional capacity. Conclusion: A majority of patients reported a moderate-to-severe decline in PCFS that required a preoperative multisystem optimization and a tailored anesthetic approach for a successful perioperative outcome. [ABSTRACT FROM AUTHOR]

Byline: Nitin. Choudhary, Kirti. Saxena, Bharti. Wadhwa, Rohan. Magoon Sir, The burden of cardiac disease in parturients continues to escalate owing to diagnostic proficiency and treatment advancements and contributes significantly [...]

To investigate response to Divalproex sodium (DVPX) with respect to Reactive/Affective/Defensive/Impulsive (RADI) and Proactive/Instrumental/Premeditated (PIP) aggression among adolescent males with conduct disorder (CD), using results from a randomized, double-blind, placebo-controlled trial. It was hypothesized that DVPX response among participants with RADI aggression would be greater than among those with PIP aggression. Fifty-eight ethnically diverse males with severe CD were assigned to High Distress (HDCD) or Low Distress (LDCD) Conduct Disorder, corresponding with RADI and PIP aggression, respectively. Following a 1-week washout, all subjects were randomized to a high dose (up to 1,500 mg/day) or low dose (up to 250 mg/day) of DVPX. Baseline and endpoint assessments included Clinical Global Impression (CGI), Achenbach Self Report (YSR), and Weinberger Adjustment Inventory (WAI-62). Response to DVPX was significantly higher in the HDCD group (64%) than in the LDCD group (22%) in the high-dose treatment group (p = 0.03). Mean weekly WAI-62 distress scores declined significantly among the HDCD subjects than among LDCD subjects in the high-dose group. These results support the utility of mood stabilizing agents such as DVPX in treating patients with disorders characterized by the RADI pattern of aggression, including those with severe CD.

This aim of this clinical trial was to study the effects of divalproex sodium (DVPX) in reducing Reactive/Affective/ Defensive/ Impulsive Aggression (RADI) in youth with Disruptive Behavior Disorders (DBD) in an outpatient clinic over a period of 3 months. We recruited forty participants with Oppositional Defiant Disorder or Conduct Disorder. Twenty participants received 12 weeks of openly titrated DVPX, whereas twenty participants served as a comparison control group. Primary efficacy measures were the Clinical Global Improvement-Severity (CGI-S) and CGI-C (Change) scales; secondary efficacy measures included standardized measures of aggression. Based on the CGI-S and CGI-C ratings, the DVPX group showed significant improvement by the last observation. Attrition rates were notably high, which is not surprising given the clinical population studied. This study provides further support for the efficacy of DVPX in decreasing RADI aggression in the context of DBD. These results are particularly noteworthy because the sociotherapeutic structures supporting patients in previous trials were not present.

We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16, SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI's. Parallel analyses comparing outcome by drug level achieved strengthened the results.

Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of psychopathology, utilizing a previous study in which 71 youth with conduct disorder were enrolled in a randomized controlled 7-week clinical trial. We examined weekly slopes of "emotional cognitions" of varying degrees of complexity obtained by Weinberger Adjustment Inventory (WAI), measuring more basic states, such as anger, depression, happiness and anxiety, and complex states, such as impulse control, consideration of others, responsibility and self-esteem. Intent-to-treat analyses showed significant associations between assignment to the active treatment and improvement in depression and impulse control. This is a rare clinical trial, which provides preliminary evidence for the different profiles of efficacy of medication treatment.

Objective: The treatment of pediatric bipolar depression has not been well studied. The authors wished to prospectively study the efficacy of lamotrigine as adjunctive or monotherapy in adolescents with bipolar disorder who were experiencing a depressive episode. Method: This was an 8-week open-label trial of lamotrigine with 20 adolescents ages 12-17 years (mean age 15.8; 7 boys, 13 girls) with diagnoses of bipolar disorder I, II, or not otherwise specified, who were experiencing a depressive episode. Lamotrigine was begun at 12.5 to 25 mg/day. Primary response criteria was a 1 or a 2 on the Clinical Global Impression-Improvement at week 8. A secondary criterion was at least a 50% decrease in Children's Depression Rating Scale-Revised scores. Results: Nineteen subjects completed the trial. The mean final dose was 131.6 mg/day. Seven subjects were taking other psychotropic medications. Sixteen subjects (84%) responded by primary criteria, and 12 (63%) responded to our secondary criteria. Eleven subjects (58%) were considered in remission at week 8. Young Mania Rating Scale and Overt Aggression Scale-Modified scores also decreased significantly during the trial. There was no significant weight change, rash, or other adverse effects during the trial. Conclusions: Adolescents with bipolar depression appeared to respond to lamotrigine treatment, whether as adjunctive therapy or monotherapy, with decreases in depression, mania, and aggression. Larger, placebo-controlled studies of lamotrigine are needed in this population. (Contains 2 figures and 2 tables.)

Byline: Sukhyanti. Kerai, Kirti. Saxena, Bharti. Wadhwa Surgery in a patient with unrecognised pregnancy has serious ethical and medicolegal implications. There are no guidelines in India for preoperative pregnancy testing [...]

Patients with spinal cord injury 4-8 weeks back presenting for non-spinal elective surgery, present a unique challenge to the anesthesiologist. The perioperative concerns include potential for perioperative autonomic hypereflexia, muscle spasms, respiratory inadequacy, controversies regarding the use of muscle relaxants and opioids as well as medico-legal and technical issues associated with administration of regional anesthesia. Both general as well as regional anesthesia has been used for surgery on the insensate part below the level of injury with variable success but no standard definitive anesthetic management is recommended. We present our case series of monitored anesthesia care administration in paraplegic patients who presented for lower limb surgeries. [ABSTRACT FROM AUTHOR]