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Background: Personal Protective Equipment (PPE) including gown, shoe cover, face mask, eye goggles, cap, face shield and gloves for health-care professional in operation theatre is a must in order to contain COVID-19 pandemic. It is imperative to mention that a surgical patient whether suspected or confirmed cases of COVID-19 must receive peri-operative care as it is the mainstay in care of surgical patient which cannot be denied to anyone. If we look at the incidences and the trend of spreading the COVID-19 infection, any breech in the personal and professional preventive steps to this infection in peri-operative care imposes greater risk to the public health as it affects the health care workers. Anesthetisologist and other staffs and health care workers (HCWs) in the operating room are in close proximity to patients. They are always in events of increased aerosol production from an infected patients, whether it is intubation, Bag and mask Ventilation or suctioning of the airway and life saving procedures.The major route of spread is contact transmission.Cross-infection is the major hindrance to seamless healthcare service to Covid-19 patients. Hand-washing is the universal viral transmission containment step. But it will not suffice to the preventive goal of these HCWs. Though operation rooms are maintained with negative pressure atmosphere which is ideal to minimize infection risk but this is the time to rehearse and practice other aspects too. Conclusion: The peri-operative care providers’ face several challenges in operation theatre and during per-operative care while treating suspected or confirmed cases of COVID-19 and thus pose a greater risk to the society. We tried to summarise these vital points and practices, dissemination of which is of utmost importance at this pandenmic scenario.

Abstract Background Gingival tissue enlargement is a common side effect of antiepileptic medications (e.g. phenytoin and sodium valproate), immunosuppressing drugs (e.g. cyclosporine) and calcium channel blockers (e.g. nifedipine, verapamil, amlodipine) (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). The clinical and histological appearances of lesions caused by these drugs are indistinguishable from one another (Murakami et al. 2018, Clin Periodontol 45:S17–S27, 2018). Drug-induced gingival enlargement is rarely seen in edentulous patients. Case presentation This case presents a 72-year-old female with a history of squamous cell carcinoma of the floor of the mouth treated with surgical excision and fibula-free flap reconstruction. Following the uncovering of osseointegrated implants placed in the fibular-free flap, the patient developed gingival enlargement of the floor of the mouth. Cessation of amlodipine and switching to an alternative medication lead to a resolution of the enlarged tissue. Conclusions This case illustrates that gingival enlargement can occur around dental implants, most notably in rehabilitation cases in patients who have had head and neck cancer. Clinicians should be aware of the risk of gingival enlargement in hypertensive patients taking calcium channel blockers prior to implant placement.

Introduction: Identifying the Paravertebral Space (PVS) by its anatomical landmarks is associated with high failure rates and complications. With the advent of Ultrasonography (USG), failure rate has decreased leading to an increased interest in performing USG-guided Thoracic Paravertebral Block (TPVB). Aim: To assess the efficacy and safety of ultrasound guided TPVB and its comparison with the landmark-based technique, in patients undergoing elective unilateral breast surgery. Materials and Methods: This cross-sectional study was carried out at Command Hospital, Pune from July 2014 to December 2015, on females between 18-70 years, accepted in American Society of Anaesthesiology (ASA) I-III for unilateral breast surgeries. Patients were divided into two groups with 40 subjects in each group. Group A subjects were treated with anatomical landmark technique and group B subjects with Ultrasound-guided (USG-guided) technique. The p-value 0.05 using Fisher’s-Exact test). Mean (SD) time taken for performing the block in group A was 371.10 (10.37) seconds while it was 613.73 (37.15) seconds in group B (p-value

Abstract Attention maps, a popular heatmap‐based explanation method for Visual Question Answering, are supposed to help users understand the model by highlighting portions of the image/question used by the model to infer answers. However, we see that users are often misled by current attention map visualizations that point to relevant regions despite the model producing an incorrect answer. Hence, we propose Error Maps that clarify the error by highlighting image regions where the model is prone to err. Error maps can indicate when a correctly attended region may be processed incorrectly leading to an incorrect answer, and hence, improve users' understanding of those cases. To evaluate our new explanations, we further introduce a metric that simulates users' interpretation of explanations to evaluate their potential helpfulness to understand model correctness. We finally conduct user studies to see that our new explanations help users understand model correctness better than baselines by an expected 30% and that our proxy helpfulness metrics correlate strongly (ρ>0.97) with how well users can predict model correctness.

Abstract In the domain of visual question answering (VQA), studies have shown improvement in users' mental model of the VQA system when they are exposed to examples of how these systems answer certain image‐question (IQ) pairs. In this work, we show that showing controlled counterfactual IQ examples are more effective at improving the mental model of users as compared to simply showing random examples. We compare a generative approach and a retrieval‐based approach to show counterfactual examples. We use recent advances in generative adversarial networks to generate counterfactual images by deleting and inpainting certain regions of interest in the image. We then expose users to changes in the VQA system's answer on those altered images. To select the region of interest for inpainting, we experiment with using both human‐annotated attention maps and a fully automatic method that uses the VQA system's attention values. Finally, we test the user's mental model by asking them to predict the model's performance on a test counterfactual image. We note an overall improvement in users' accuracy to predict answer change when shown counterfactual explanations. While realistic retrieved counterfactuals obviously are the most effective at improving the mental model, we show that a generative approach can also be equally effective.

Background: The duration of analgesia in the brachial plexus block (BPB) with local anesthetics (LAs) only is not sufficient to avoid the requirement of analgesia for breakthrough pain. Dexmedetomidine (DEX) is an upcoming adjuvant with long-acting LA to reduce the requirement of analgesics in the postoperative period. However, there is no documented consensus about the dose of DEX in this regard. Aim: We compared two doses of DEX with LA in the BPB to find out the effectiveness of analgesia and other effects. Materials and Methods: All patients were separated into two groups, namely Group A (0.5 μg/kg DEX added to 20 mL of 0.25% bupivacaine) and Group B (1.0 μg/kg DEX added to 20 mL of 0.25% bupivacaine). Thirty patients in each group were analyzed. The sample size was estimated with a type I error of 0.05 and a power of the study as 80%. Statistical analysis was performed using SPSS (version 13.0) software. Rescue analgesia was decided as injection morphine (0.05–0.15 mg/kg) intramuscularly as indicated. Results: The mean time of onset of sensory analgesia (18.04 ± 3.195 vs. 12.20 ± 1.848 min) and motor blockade (23.7 ± 2.8 vs. 17.3 ± 1.7 min) were comparable (P < 0.05); however, the duration for the motor (668.0 ± 22.7 vs. 702.0 ± 111.6 min) and sensory blockade (734.8 ± 47.9 vs. 755.6 ± 126.8 min) and time to first demand of analgesics were insignificant. Conclusion: A dose of 1.0 μg/kg DEX has no added benefit when compared with a lower dose of 0.5 μg/kg DEX as an adjuvant to LA.

Introduction: Magnetic Resonance Imaging (MRI) is not painful, but frightening especially in children leading to movement and artefacts causing prolongation of the procedure. Though analgesia is not required, but being a noisy suite, deep sedation is a prerequisite for it. Dexmedetomidine (DEX) and Ketamine both anaesthetic drugs can achieve the sedation in the children but never had been compared. Aim: To compare the effect of DEX and Ketamine in paediatric patients undergoing MRI under sedation. Materials and Methods: This was a cross-sectional study carried out from August 2017 to July 2018 included 74 patients. All patients were separated into Group K for Ketamine (loading dose of 1 mg/kg, intravenous over 10 min followed by infusion of 10-15 mcg/kg/min) and Group D for DEX (loading dose of 1 mcg/kg over 10 min followed by infusion of DEX at 0.2-0.7 mcg/kg/h). Ramsay sedation score of five was considered as onset of sedation. Midazolam 0.1 mg/kg IV was decided as rescue sedation. Unpaired t-test was applied for the continuous variables. Results: Sixty-one patients were analysed, 31 in Group K, and 30 in Group D. The onset time for sedation in Group K was 6.30±1.32 minutes and 12.20±SD=2.01 minutes in Group D which was significantly shorter in Group K (p=0.001). However, the time to Modified Aldrete Score of 10/10 was higher in Group K (21.10±1.84 minutes) vs (13.73±1.89 minutes) in Group D which is statistically significant. (Mean±SD; p=0.001). No adverse events were reported in both the groups. Conclusion: Ketamine and DEX can both be used for MRI sedation in children successfully without any adverse effects. The onset of sedation is faster in Ketamine, but discharge and recovery are significantly delayed with Ketamine as compared

Introduction: Ringer’s Lactate (RL), a crystalloid is the most common co-loading fluid used to limit haemodynamic complications following the Subarachnoid Block (SAB). Colloids like Hydroxyethyl Starches (HES) are occasionally used as the co-loading fluid despite controversies due to its better haemodynamic effect and are not written-off to date. So knowledge of the effect of co-loading fluid is of paramount importance if it contributes to hyperglycaemia, a detrimental factor for the outcome. Aim: To compare the Blood Sugar Levels (BSL) in different preparations of HES and to that of RL when administered as co-loading fluid following SAB. Materials and Methods: Eighty-nine patients were randomly allocated into three groups, namely HES 200, HES 130, and RL, and were co-loaded with either 20 mL/kg body weight of HES 200/0.5, 20 mL/kg body weight of HES 130/0.4 or 20 mL/kg body weight of RL respectively. BSL for each subject was recorded at 0, 15, 30, 45, 60, 120, 180, 240 min (post-hoc analysis was done with Tukey’s test). Results: In all the three groups, there was a statistically significant rise in BSL from baseline. The BSL in the RL group reached its peak at 45 minutes and gradually dropped down to baseline. BSL increased more gradually with HES 130/0.4 reaching a peak value at 60 minutes, and at around 240 minutes for HES 200/0.5. Conclusion: HES causes an increase in BSL, though within physiological limits.

Spinal anesthesia (SA) is utilized as an effective means of anesthesia and has an impressive safety record but it is not devoid of complications, and sometimes, the complications are as fatal as cardiac arrest. Although many factors are involved in etiology of cardiac arrest under SA, the vagal responses to the decreased preload are the most common culprits. We report two cases of cardiac arrest under SA; which happened despite our patient being adequately preloaded utilizing the ultrasonography-guided targeted volume therapy. The patients were successfully resuscitated with no neurological deficit.

Context: A retrospective observational study conducted to assess transversus abdominis plane (TAP) block as a tool for providing multimodal analgesia postoperatively for abdominal surgeries. Aims: The aim is to compare the visual analog scale (VAS) of pain and the requirement of rescue analgesia postoperatively in patients undergoing various abdominal surgeries (open and laparoscopic) where TAP block was given for postoperative analgesia and was compared with patients who received pain relief according to the institutional protocol. Settings and Design: Retrospective observational study conducted in a tertiary care hospital. Subjects and Methods: Retrospective data from anesthesia records of patients, who underwent abdominal surgeries from January 2016 to December 2016, were analyzed and were divided into two groups. Group A (n = 250) consisted of patients who received the conventional standard postoperative analgesia protocol of the department of anesthesia. Group B (n = 136) consisted of patients who were administered TAP block postsurgery for the postoperative analgesia by the trained anesthesiologist. Primary outcome considered was (i) average VAS at 02, 06, 12, and 24 h and (ii) average opioid/nonsteroidal anti-inflammatory drug consumption at 24 h postoperatively. Secondary outcome considered was time to first rescue analgesia. Statistical Analysis: All parametric data were analyzed using unpaired t-test. Data are expressed as the mean ± standard deviation. A SPSS version 17 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: Average pain scores (VAS) were lower in Group B as compared to Group A in all subcategories of surgery postoperatively. Patients given TAP block (Group B) required less rescue analgesia in the postoperative period with time to first rescue analgesia being prolonged. Conclusions: On the basis of our retrospective study, we suggest that TAP block can be utilized as a part of multimodal analgesia regimen for abdominal surgeries, laparoscopic as well as open. Tap block has demonstrated a good safety profile in experienced hands; it is easy to perform and has displayed consistent analgesia over a prolonged period. It reduces postoperative morbidity and supports early ambulation.

Tumors from remnants of the embryonic notochord are called as Chordomas. These are slow growing, yet aggressive tumors. Despite treatment, these, low grade, malignant tumors are very prone to recurrence and 6 years is approximately the median survival time. Though commonly located in the sacrococcygeal or sphenooccipital regions, their incidence in the cervical spine is around 7.5%. Treatment approaches vary from surgical excision to radiotherapy and chemotherapy. Outcome of these tumors depends on the size and location of tumour and the course of treatment delivered. Surgery is the treatment of choice with the goal to remove maximum tumor as possible and thereafter, patients are offered radiotherapy or chemotherapy. Due to the proximity of these tumors to various vital structures such as brain and spinal cord, the management requires the involvement of various subspecialties working in cohesion. We present the anesthetic management of a 32-year-old male patient who presented with recurrence of C2 chordoma postradiotherapy and was a challenge for airway management.

Takayasu arteritis is an entity resulting in pan-endarteritis. It involves the principal arteries resulting in ischaemia and persistent hypertension. Hypertension affects the anaesthetic management where the principal goal is to control the haemodynamic stability during the induction and for the entire course of anaesthesia preventing damage to the end organs. We present two cases, one paediatric with hypertension refractory to medical management posted for nephrectomy and one adult patient posted for diagnostic hysterolaparoscopy. Both the cases were administered dexmedetomidine, an alpha 2 agonist during the pre-induction period. Sympatholysis caused by infusion dexmedetomidine was effectively utilized in both the cases hence, pre-induction infusion of dexmedetomidine can be utilized to obtund the haemodynamic response to intubation.

On-device intelligence and AI-powered edge devices require compressed deep learning algorithm and energy efficient hardware. Compute-in-memory (CIM) architecture is a more suitable candidate than traditional Complementary Metal-Oxide-Semiconductor (CMOS) technology for deep learning applications since computations are performed directly within the memory itself, reducing the need for data movement between memory and processing units. However, the current deep learning compression techniques are not designed to take advantage of CIM architecture. In this work, we proposed Twofold Sparsity, a joint bit- and network-level sparsity method to highly sparsify the deep leaning models by taking advantage of CIM architecture for energy-efficient computations. Twofold Sparsity method sparsify the network during training by adding two regularizations, one to sparsify the weights using Linear Feedback Shift Register (LFSR) mask, and the other one to sparsify the values in the bit-level by making bits zero. During inference, the same LFSRs is used to choose the correct sparsed weights for multiplication between input and weights and 2bit/cell RRAM based CIM is responsible to do the computation. Twofold Sparsity method achieved 1.3x to 4.35x energy efficiency in different sparsity rates compared to baselines and eventually enabling powerful deep learning models to be run on power constrained edge devices.