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Abstract Background Normal saline (NS) infusion in large volumes may result in hyperchloremic metabolic acidosis and renal compromise. Balanced crystalloid (BC) with physiochemical composition akin to that of plasma may avoid these problems associated with NS. The present study aimed to evaluate effects of NS versus BC on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries. Methods Fifty adult patients scheduled to undergo elective neurosurgery for intracranial tumor resection were randomized to receive either NS or BC as intraoperative or maintenance fluid. Metabolic and renal parameters were estimated prior to induction (baseline), at 1 h and 2 h after induction, at the end of surgery and 4 h after extubation. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured postoperatively. Brain relaxation score was assessed by the operating surgeon. Results Baseline values of variables were similar between the groups. At rest of the observed time-points, pH was significantly lower, while blood urea, serum creatinine, sodium, chloride, NGAL and plasma osmolality were significantly higher in the NS group as compared to the BC group. Brain relaxation score, serum bicarbonate and base excess were comparable between the two groups. Conclusion Use of balanced crystalloid (plasmalyte) resulted in better metabolic and renal profile as compared to normal saline in neurosurgical patients.

Introduction: Direct laryngoscopy followed by intubation induces a stress response leading to haemodynamic changes that are often transient, unpredictable, and variable. Both dexmedetomidine and lignocaine have been used in nebulised form successfully to blunt haemodynamic stress response, but they have never been compared previously. Aim: To compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation. Materials and Methods: This randomised, double-blinded study was conducted on 135 patients with American Society of Anesthesiologists (ASA) physical Status I and II, aged 18 to 60 years, planned for surgery under general anaesthesia with endotracheal intubation. Patients were divided into three groups of 45 each using a computer-generated random number table. Patients in group D were nebulised with dexmedetomidine 1 μg/kg, with lignocaine 1.5 mg/kg in group L, and with normal saline in group C. The primary objective was to compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation with respect to Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure, and Mean Arterial Pressure (MAP). The secondary objective was to study side-effects associated with the use of nebulised dexmedetomidine and lignocaine. Results: The demographic profile was found to be comparable in all three groups. The mean age was 40.44±11.77 years, 40.04±12.33 years, and 42.89±11.57 years in group D, group L, and group C, respectively, with a p-value of 0.4. The rise in HR during intubation and at all later time points was found to be less in group D and group L compared to group C. Additionally, the rise in HR was found to be higher in group L compared to group D. Similarly, the attenuation effect on SBP and Diastolic Blood Pressure (DBP) was greater in group D patients. Conclusion: Both nebulised dexmedetomidine and lignocaine were effective in attenuating the pressor response during laryngoscopy and intubation, with dexmedetomidine being more effective than lignocaine without any adverse haemodynamic effects.

Background: Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population. Methods: A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED. Results: The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56–65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia. Conclusion: Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.

The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical region of maxillary central and lateral incisors, and highlights the efficacy of natural platelet concentrate [platelet-rich fibrin (PRF)] along with Ostoden bone graft material used for postoperative healing. A 46-year-old male patient presented to the department with swelling in the palatal aspect of the maxillary anterior region. On radiographic examination, a radiolucent periapical lesion was evident in relation to the left maxillary central and lateral incisor. In the maxillary anterior region, root canal therapy was performed, followed by periapical surgery, and PRF with Ostoden bone graft was placed in the surgical site to initiate the healing at a faster rate. The patient was recalled at follow-ups after 7 days, 3, 6, and 9 months. No symptoms such as pain, inflammation, or discomfort were observed during the review period.

Elevational gradients impact organisms in diverse ways because of lower temperatures and oxygen levels at higher elevations. Birds adapt to these constraints through changes in body size, plumage, metabolism, and behaviors such as elevational migration. But whether species show variation across multiple axes of adaptations along a single elevational gradient is not well demonstrated in the literature. The broad elevational distribution of the House Sparrow Passer domesticus in the Himalayas provides a rare insight into whether morphological and plumage modifications can simultaneously arise within a species across its elevational distribution. Drawing insights from eco-physiological patterns, we hypothesized that sparrows at higher elevations would exhibit larger body sizes (Bergmann’s rule), shorter extremities (Allen’s rule), and a more insulative feather structure. We sampled sparrows at 13 sites (n = 169) from 300 m to 3500 m along an elevational gradient in the western Himalayas and found that sparrows at higher elevations were significantly larger following Bergmann’s rule, and had more downy dorsal feathers likely giving higher-elevation sparrows thermal advantages at low temperatures. We show that House Sparrows may show convergent modifications in response to temperature clines whether they are elevational or latitudinal.

Background: Radial arterial cannulation is a commonly done procedure in ICU. Multiple cannulation attempts can lead to radial artery spasm resulting in low pulse volume, decreased pulse palpability and cannulation failure. This study evaluates the effects of periarterial nitroglycerine infiltration with lignocaine vs lignocaine alone in USG guided radial artery cannulation in ICU patients. Methods: A total of 60 ICU patients in age group 18-65 years who required radial artery cannulation for ABG analysis and invasive blood pressure monitoring were enrolled. They were randomly allocated to Group LN (periarterial infiltration with 0.2ml nitroglycerine+0.8 ml lignocaine 2%) and Group L (periarterial infiltration with 1ml of lignocaine 2%) of 30 patient each. Both groups were compared with respect to radial artery dimensions before and after infiltration of drug, pulse palpability score, no of attempts, time of cannulation and failure rates. Results: There was significantly greater increase in radial artery dimensions in group LN as compared to group L after intervention. Pulse palpability score was also better in group LN. Mean time required for cannulation, number of attempts and insertion failure were significantly lesser in group LN as compared to another group. No hemodynamic adverse effect was reported in either group. Conclusion: Periarterial infiltration with lignocaine and nitroglycerine combination increase radial artery dimension with improved cannulation success rate.

Most drug structures lack appropriate chromophores that can be examined at wavelengths other than the generic UV part of the electromagnetic spectrum. Indirect spectrophotometric/spectrofluorimetric analysis involving chemical derivatization in which molecules lacking UV-Vis absorbing moieties are transformed into derivatives with good chromophores. The article highlights the discussion of significant derivatizing agents for the derivatization of drug molecules that lack the chromophoric moiety required for spectrometric analysis. In addition, the probable reaction for colour generation is also discussed. The current developments of derivatizing agents for the spectrophotometric determination of pharmaceuticals are considered.

Background: Studies have shown homoeopathy to effectively control blood sugar levels and improve quality of life (QOL), though a standard treatment protocol is required. Objective: This study intended to assess the homoeopathic practice, prescription habits, experience, and perception of Indian Homeopathic Practitioners (HPs) in treating DM. Methodology: A web-based cross-sectional with a snowball sampling method was conducted between 30th July 2021 and 18th August 2021. A questionnaire to record clinical attributes of Indian HPs in the management of DM was formed after the consensus of the subject experts and pilot testing for feasibility. Results: Participants were 513 HPs with mean age [Standard Deviation (SD)] of 40.44 years (11.16) and a mean duration of the homoeopathic medical practice of 14.67 years [95% Confidence Interval (CI) = 13.71–15.63]. The majority of HPs made classical homoeopathic prescription (201, 39.2%) though the success in the management of DM was better among HPs who prescribed more than one potentized medicine [vs classical prescription, Odds Ratio (OR) = 2.34, p = 0.032]. As perceived by the HPs, homoeopathic treatment resulted in a major improvement in QOL of the diabetic patients (418, 81.5%) with very few adverse effect (100, 19.5%). The blood sugar level was controlled better when homoeopathy was given alongside conventional medicine (348, 67.8%). Conclusion: The clinical experience of HPs in this study has shown that homoeopathic treatment can benefit DM patients in preventing complications and improving QOL. It further reported that homoeopathy can be an important adjuvant to conventional treatment in managing DM.

Background: The 11th revision of the International Classification of Diseases (ICD-11) aims to provide a new definition of adjustment disorder (AjD), which is one of the most frequently diagnosed disorders. Coronavirus disease (COVID-19) pandemic has affected the mental health of people and the associated stressors could lead to AjD. The study aimed to investigate the AjD symptoms during COVID-19 pandemic based on the ICD-11 concept on a clinical sample. Methodology: A cross-sectional observational study was conducted between June 10, 2020, and August 9, 2020, among patients visiting the outpatient department of the authors' institute. Prevalence rates of stressors due to COVID-19 and AjD were estimated using scale of the International AjD Questionnaire (IADQ). Results: The study enrolled 723 subjects and 638 subjects endorsed at least one psychological stressor. The IADQ algorithm showed that 25.24% (161) of subjects were suffering from AjD due to the COVID-19 pandemic with a mean score of 20.29 (standard deviation = 4.26) among them. The most common stressors were related to financial problems (81.03%), work problem (63.17%), and personal health problems (27.43%). Conclusion: The high proportion of AjD during COVID-19 in this study may reflect a need for specific interventions. Provision for health-care services for such individuals is essential to avoid other mental disorders in the future.

Abstract Introduction Coronavirus disease 2019 (COVID-19) is adversely affecting the mental health of patients infected with the virus and the psychological impact on recovered COVID-19 patients is unclear. Objectives The study aimed to assess posttraumatic stress disorder (PTSD) and depression among COVID-19 patients after recovery from the disease. Methods This cross-sectional study was conducted from November 9, 2020, to December 23, 2020. The study used a telemedicine model to enroll recovered COVID-19 patients from a database of patients provided by the health authorities. The National Stressful Events Survey PTSD Short Scale (NSESSS) for adults was used to assess PTSD symptoms and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Results The study enrolled 503 recovered COVID-19 patients with a mean age of 41.90 years. The majority were asymptomatic (64.6%), while 21.5% had had moderate to severe forms of the disease. Prevalence rates of PTSD symptoms and depression were 56.9 and 29% respectively. COVID-19 patients with severe forms of the disease were significantly more affected by PTSD symptoms (vs. mild, odds ratio [OR] = 18.7, 95%confidence interval [CI] 9.9-35.5) and depression (vs. mild, OR = 19.8, 95% CI 9.9-39.5). Similarly, patients who required oxygen or ventilator support reported significantly higher rates of PTSD symptoms (vs. managed at home, OR = 17.4, 95% CI 8.3-36.4) and depression (vs. managed at home, OR = 22.0, 95% CI 10.1-47.7). Conclusion This study reports that recovered COVID-19 patients suffered from a significant amount of depression and experienced significant PTSD symptoms. It will help with addressing a major psychological concern among the recovered subjects.

BACKGROUND AND AIMS: Fluid therapy is one of the most important components of the management of patients with traumatic brain injury (TBI). The present study was planned to compare plasmalyte and normal saline (NS) in patients who underwent craniotomies for TBI in terms of their effects on acid–base equilibrium, renal functions, and coagulation profile. METHODS: Fifty patients of age 18–45 years of either sex, who underwent emergency craniotomy for TBI, were included in the study. The patients were randomized into two groups. Group P (n = 25) received isotonic balanced crystalloid (plasmalyte) and Group N (n = 25) received NS intraoperatively and postoperatively till 24 h after surgery. RESULTS: The pH was lower in Group N (P < 0.05) at different time points after surgery. Similarly, more patients in Group N had pH

Background: In December 2019, severe acute respiratory syndrome coronavirus 2, was identified as the causative agent of coronavirus disease 2019 (COVID-19). As a part of control measures against COVID-19, vaccination started in India from January 16, 2021. People's hesitancy may become an important challenge in the immunization campaign against COVID-19. This study aimed to assess the confidence of the general public and acceptance of the vaccines in India. Materials and Methods: A web-based cross-sectional survey was conducted between February 21, 2021, and March 10, 2021, by Google Forms utilizing a snowball sampling method. The psychological antecedents of vaccination for COVID-19 in India were assessed using a 15-item (3 items per antecedent) 5C scale. Results: The study received 720 responses, out of which 466 (64.72%) participants were willing to accept the CoV vaccines. Data were analyzed using STATCRAFT online statistical software version 2.0 (Bangalore, Karnataka, India). The participants who expressed more confidence in vaccines (odds ratio [OR] =1.818, P < 0.001) and who took a calculated decision (OR = 1.183, P = 0.001) were more likely to accept CoV vaccines while the participants who were complacent (OR = 0.852, P < 0.001) and who took collective responsibility (OR = 0.891, P = 0.033) were less likely to accept CoV vaccines. Conclusion: The findings of this study point to the importance of confidence, constraints, and calculation for vaccines among the Indian population, so that policymakers can monitor the acceptance for the vaccines and can plan future strategies to address hesitancy issues more effectively.

Background: Hydroxyethyl starch solutions which have been introduced some three decades ago, have been extensively used for treatment of intraoperative hypovolaemia. Aims and Objectives: The present prospective study was conducted to study changes in post-operative renal function and coagulation profile in patients undergoing orthopedic hip surgery under spinal anesthesia after coloading with 6% HES 130/0.4. Materials and Methods: Seventy patients, aged between 50 and 80 years, of either sex, belonging to ASA physical Status I and II, scheduled for orthopedic hip surgery under spinal anesthesia were included in the study. As per the group allocation, coloading was done with 7.5 mlkg-1 of either Group RL or 6% 130/0.4 Group HES during the 1st h of surgery. Venous samples were withdrawn before the day of surgery, on the day of surgery, and on the 3rd day of surgery. Results: No statistically significant difference between renal and coagulation profile was found among groups. Conclusion: Thus, we recommend using tetrastarch (6% HES 130/0.4) for intraoperative hypovolemia in elderly patients with normal renal function and coagulation profile undergoing orthopedic hip surgery.

Abstract Background Ventriculoperitoneal (VP) shunts are commonly performed procedures for a variety of disorders and are mostly long standing. These patients when present for non-neurological surgeries like gastrointestinal, urology, or caesarean section, there are several concerns like difficult abdominal surgery due to peritoneal adhesions, chances of shunt infection with potential retrograde infective meningoencephalitis, and ventriculitis or shunt failure with recurrent hydrocephalus. Case presentation A 35-year-old male, known case of third ventricular tumour with functional left-sided ventricular peritoneal shunt was scheduled to undergo cholecystectomy for gall bladder stone. Intraoperatively optic nerve sheath diameter was measured as an indicator of raised intracranial pressure. Intraoperative was uneventful. Efforts were taken to prevent rise in intracranial pressure perioperatively. Patient was discharged on third postoperative day. Conclusion A vigilant perioperative care along with adequate team work go a long way in achieving success in patients of ventriculoperitoneal shunts presenting for non-neurological surgeries.

Objectives The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency posing unprecedented challenges for health authorities. Social media may serve as an effective platform to disseminate health-related information. This study aimed to assess the extent of social media use, its impact on preventive behavior, and negative health effects such as cyberchondria and information overload. Methods A cross-sectional observational study was conducted between June 10, 2020 and August 9, 2020 among people visiting the outpatient department of the authors’ institution, and participants were also recruited during field visits for an awareness drive. Questions were developed on preventive behavior, and the Short Cyberchondria Scale and instruments dealing with information overload and perceived vulnerability were used. Results The study recruited 767 participants with a mean age of about 45 years. Most of the participants (>90%) engaged in preventive behaviors, which were influenced by the extent of information received through social media platforms (β=3.297; p

Background: Early pregnancy losses can be a distressing experience both for the parents and the treating clinician. We aim to explore the role of chemokine receptor 4 (CXCR4) in early pregnancy losses by comparing its expression among patients with spontaneous miscarriages and patients undergoing termination of viable pregnancies for unwanted pregnancies. Aim: The aim of the study was to investigate the expression of CXCR4 in early pregnancy losses and correlate the various clinical parameters with differential expression of the above receptor in the chorionic villi and maternal decidua. Study and Setting: The present study is a case-“control study done in a tertiary care center. Methodology: Fifty patients attending outdoor and antenatal clinic of the hospital aged 18-“40 years with spontaneous miscarriage under 20 weeks of gestational age were included as cases and compared with fifty females of comparable age group (18-“40 years) seeking medical termination of pregnancy as controls. Chorionic villi and decidua obtained from the cases and controls were analyzed for CXCR4 expression. Statistical Analysis: The results were analyzed using mean ± standard deviation, percentiles values, Chi-square test, and P value to determine the association of CXCR4 expression in decidua and chorionic villi of cases versus controls. Results: CXCR4 expression was significantly downregulated in cases as compared to the controls with P < 0.001. The mean normalized ratio of CXCR4 expression to housekeeping gene (β Actin) expression in the case group was 1.607 ± 1.108 and in the control group, it was 2.506 ± 1.457. There was a strong correlation between the expression of CXCR4 and maternal age. With increasing age, the expression of CXCR4 was more downregulated in both the cases and control groups (P < 0.001). The expression of CXCR4 was elevated in controls as compared to cases in

CONTEXT: Coronavirus disease (COVID-19) poses an unprecedented challenge and adversely affects the lifestyle of people with noncommunicable diseases (NCDs) due to enforced restrictions by the governments. AIMS: The study aimed to assess the physical activity and prophylactic behavior, along with change in sleep, alcohol intake, and tobacco consumption during the enforced lockdown. MATERIALS AND METHODS: The study was conducted in August 2020 and recruited NCD patients visiting the institute's outpatient department. Questions were formed on prophylactic behavior, changes in sleep, and alcohol and tobacco consumption along with a validated scale of International Physical Activity Questionnaire (IPAQ) Short Form. RESULTS: The study recruited 413 patients with a mean age of 54.34 years. The median IPAQ score was 536 metabolic equivalent task-minutes/week, with 41.96% of the patients demonstrating low physical activity. A statistically significant difference between the IPAQ scores was found among different NCD groups (P = 0.009). There was a statistically significant decrease in number of hours of sleep during the pandemic as compared to before the pandemic (P = 0.000). Furthermore, there was a significant change in tobacco consumption (P = 0.000) and alcohol consumption (P = 0.000) during the pandemic. The patients followed preventive practices to a larger extent. CONCLUSION: The study highlighted that the NCD patients should follow an optimal physical activity schedule, take proper sleep, and continue following prophylactic behavior.

Study Design Prospective, randomized, double blind, placebo-controlled study. Purpose To compare clonidine and pregabalin with placebo for the attenuation of postoperative pain after thoracolumbar spinal surgery and instrumentation Overview of Literature Spine surgery is associated with moderate to severe postoperative pain that needs to be controlled to improve patient’s outcome. Alpha 2 agonists (e.g., clonidine) and gabapentenoids (e.g., pregabalin) are successfully used as part of a multimodal analgesic regimen. Methods Total 75 patients were enrolled and randomly allocated into three groups. Group P received pregabalin (150 mg), group C received clonidine (150 mcg), and group N received placebo 90 minutes preoperatively. A standard anesthesia protocol comprising fentanyl, thiopentone, vecuronium, nitrous oxide, and oxygen in isoflurane was used for all patients. Postoperative recovery profile, pain, time for first analgesic, 24-hour analgesic requirement, sedation, and hemodynamic parameters were noted. Results Recovery profile was similar in all three groups; however, the patients in group P and C were more sedated (p

Introduction: Eclampsia is one of the leading causes of maternal morbidity. Neurological sequelae are quite common and contribute to poor prognosis in these patients. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) as noninvasive monitor of raised intracranial pressure (ICP) might aid in management of these patients. Based on these facts, this study intended to study the difference between ONSD in eclampsia versus noneclamptic parturients admitted to intensive care unit (ICU). The trends in ONSD were followed in patients with eclampsia to assess the association between ONSD and resolution of neurological symptoms. Materials and Methods: The present observational study comprised 46 patients and was conducted in our ICU from January 2015 to June 2015. Postpartum eclamptic patients requiring ventilatory support in the ICU were enrolled in group E (n = 24), while postpartum patients admitted for some other causes but requiring ventilatory support were enrolled in group C (n = 22). Transorbital ultrasound was done to measure ONSD using SonoSite M-Turbo machine. It was repeated daily in both the groups till patients were extubated or expired. The vital parameters, treatment, and investigations were also noted. Results: The ONSD in group E was 0.64 ± 0.02 cm, while in group C it was 0.45 ± 0.03 cm (P < 0.0001). Blood pressure was much higher in group E (P < 0.001). ONSD had positive correlation with systolic blood pressure than diastolic blood pressure. In group E, 22 patients were extubated, and following extubation ONSD decreased to normal value in 16 patients while in 6 patients it was still raised. Overall mortality was 6 (13%); 2 (8.3%) in group E and 4 (18.2%) in group C. Conclusion: ONSD was higher in patients with eclampsia suggesting raised ICP, and with subsidence of disease process it decreased. Thus, it may be adopted as a routine monitoring in these patients to guide management and predict prognosis, although further studies are required to support our findings.

Background and Aims: PEEP is commonly used to improve postoperative respiratory outcomes in surgical and ICU patients. It is thought to increase ICP by impending CSF outflow and cerebral venous drainage. Hyperventilation is used to decrease ICP in patients having intracranial hypertension. We investigated the effect of various levels of PEEP and EtCO2 on ONSD as an indirect predictor of ICP in patients undergoing surgery under GA. Methods: After induction, different levels of PEEP and EtCO2 were applied to 50 patients. Sonographic ONSD was measured 5 minutes after stabilization of each new setting. Haemodynamic parameters like pulse, SpO2, BP were also recorded. Quantitative variables were expressed as Mean ± SD and compared across between follow-ups using paired t-test. Qualitative variables were expressed in number and percentage. Results: Baseline ONSD was 0.44 ± 0.06 cm. It increased significantly to 0.45 ± 0.07 cm, 0.47 ± 0.07 cm and 0.49 ± 0.07 cm after applying PEEP of 8, 12 and 15 cm H2O PEEP, respectively. It significantly decreased to 0.42 ± 0.06 cm, 0.41 ± 0.06 cm and 0.40 ± 0.06 cm after hyperventilation, EtCO2 range 35–37, 32–34 and 29–31 mm Hg. Results were statistically significant but clinically not significant. Conclusion: We conclude that there are acute and dynamic alterations in ONSD in response to hyperventilation and presence of PEEP in anaesthetised patients. Ocular sonography may be used as a reliable indicator of acute variations in ICP.

Background: “Oblique subcostal” transversus abdominis plane (TAP) block is a combination of rectus abdominis and TAP block which is currently used in a wide variety of abdominal procedures. Dexamethasone and tramadol are both used as adjuvants in several blocks for improving efficacy and prolonging analgesia. The present study was intended to compare both these drugs along with ropivacaine in ultrasound-guided subcostal TAP block following open cholecystectomy. Materials and Methods: The present prospective, randomized, and double-blind study was conducted in 60 adult patients of either sex undergoing open cholecystectomy. The patients were randomized into two groups; Group D (n = 30) and Group T (n = 30). Former received 18 ml of 0.75% ropivacaine with 2 ml (8 mg) of dexamethasone whereas latter received 18 ml of 0.75% ropivacaine with 2 ml (25 mg/ml) of tramadol through right-sided ultrasound-guided oblique subcostal TAP block after the induction of general anesthesia following standard protocol. Postoperative pain at rest and knee flexion as per visual analog scale (VAS) score, time for first and second rescue analgesia, total tramadol consumption in 24 h, sedation and nausea score, and quality of healing at discharge were noted. Results: Requirement for first and second rescue analgesia was similar in two groups but overall 24 h tramadol consumption was less in Group D. VAS score was similar in two groups except at 4 and 24 h. None of the patients were sedated, but nausea score was less in Group D. The quality of wound healing was good in both groups. Conclusion: The addition of 8 mg dexamethasone or 50 mg tramadol as adjuvants to ropivacaine is effective and safe drugs to administer in TAP block for postoperative analgesia following open cholecystectomy.

Background: Longitudinal strain analysis has been shown to be useful in patients with acute coronary syndromes and in stress echocardiography. The objective of this study is to identify the incremental diagnostic value of longitudinal strain analysis at rest, when added to routine treadmill testing (TMT), in identifying the presence of coronary artery disease in patients presenting with chronic stable angina (CSA). Methodology: We conducted a prospective study in which adult patients presenting with CSA and normal systolic function were enrolled. All patients were examined by 2-D echocardiography, longitudinal strain analysis, TMT, and either conventional coronary angiography and/ or coronary computed tomography angiography. Results: We enrolled a total of 150 subjects (54±7.8 years, 63% male). The sensitivity and specificity of TMT was 60.2% and 65.5% respectively. In comparison, global longitudinal strain (GLS) alone had better sensitivity (72.7%) and specificity (74.2%). Post-systolic shortening (PSS) had similar sensitivity for early detection of significant CAD. The combination of TMT and GLS provided the best overall diagnostic accuracy with a sensitivity of 85.4% and specificity of 87.5%, respectively. The optimal cut off for GLS for identification of coronary artery disease was −17.75%. Conclusions: In patients presenting with chronic stable angina and normal systolic function, global longitudinal strain and post systolic shortening assessed at rest have excellent diagnostic accuracy for coronary artery disease. Longitudinal strain analysis is superior to conventional TMT and adds to its diagnostic performance.

Poly lactic acid is a biodegradable, biocompatible, and non-toxic polymer, widely used in many pharmaceutical preparations such as controlled release formulations, parenteral preparations, surgical treatment applications, and tissue engineering. In this study, we prepared lipid-polymer hybrid nanoparticles for topical and site targeting delivery of Norfloxacin by emulsification solvent evaporation method (ESE). The design of experiment (DOE) was done by using software to optimize the result, and then a surface plot was generated to compare with the practical results. The surface morphology, particle size, zeta potential and composition of the lipid-polymer hybrid nanoparticles were characterized by SEM, TEM, AFM, and FTIR. The thermal behavior of the lipid-polymer hybrid nanoparticles was characterized by DSC and TGA. The prepared lipid-polymer hybrid nanoparticles of Norfloxacin exhibited an average particle size from 178.6 ± 3.7 nm to 220.8 ± 2.3 nm, and showed very narrow distribution with polydispersity index ranging from 0.206 ± 0.36 to 0.383 ± 0.66. The surface charge on the lipid-polymer hybrid nanoparticles were confirmed by zeta potential, showed the value from +23.4 ± 1.5 mV to +41.5 ± 3.4 mV. An Antimicrobial study was done against Staphylococcus aureus and Pseudomonas aeruginosa, and the lipid-polymer hybrid nanoparticles showed potential activity against these two. Lipid-polymer hybrid nanoparticles of Norfloxacin showed the %cumulative drug release of 89.72% in 24 h. A stability study of the optimized formulation showed the suitable condition for the storage of lipid-polymer hybrid nanoparticles was at 4 ± 2 °C/60 ± 5% RH. These results illustrated high potential of lipid-polymer hybrid nanoparticles Norfloxacin for usage as a topical antibiotic drug carriers.

Fast dissolving tablets (FDTs) have received more interest in the pharmaceutical industry for those categories of drug which show slow dissolution and less oral bioavailability. Nowadays various technologies have been developed for FDTs with improved patient compliance and convenience. FDTs tablets provide an advantage particularly for the pediatric and geriatric patients who have difficulty in swallowing and also for that who are travelling for a long and suffers from lack of water availability. Lyophilization (freeze-drying) is a process in which water is sublimated from the product after freezing at a specific temperature and pressure. Lyophilization technique is used in order to improve the dissolution of the given substance and improve the oral bioavailability of the drugs with poor solubility and high permeability. In this work, chlorpheniramine maleate FDTs was formulated by lyophilization method. The prepared tablets were subjected to various evaluation such as hardness (2.4–2.9 kg/cm2), friability (0.68–0.79%), disintegration time (10–19 s), drug content (95.32–99.09%), water absorption ratio (31–53%), wetting time (64–106 s) and in-vitro drug release shown in 5 min (96.04–99.92%). FTIR studies showed that there is no interaction between drug and polymer. Stability studies showed that there is no change in drug content within three and six months. Results revealed that fast dissolving tablets of chlorpheniramine maleate prepared by lyophilization method result in rapid dissolution.

Background: Guggul, the gum resin obtained from Commiphora mukul, is one of the components of various formulations of traditional Ayurvedic medicine to treat inflammation, atherosclerosis, and weight loss. This research work describes Guggul lipid as a carrier and synergistic effect for anti-inflammatory drugs. Method: Guggulosomes prepared by trituration method was further incorporated into carbopol gel, developed for the enhanced topical drug delivery system for the phenylbutazone. This preparation was characterized by using Attenuated total reflection- Fourier transform infrared spectroscopy (ATR-FTIR), Scanning electron microscopy (SEM), Atomic force microscopy (AFM), Differential scanning calorimeter (DSC), Thermogravimetric analysis (TGA), Particle size & Zeta potential and further guggulosomes was tested for Anti-inflammatory activity and % cumulative drug release. All these study was carried out by using standard protocol. Results: The guggulosomes shows all the characteristic peaks in ATR-FTIR. The optimized formulation was spherical in shape having diameter >200 nm. The % entrapment efficiency was 77.2 ± 0.212 with good % Cumulative drug release 60.80 ± 0.707%. The anti-inflammatory activity of the optimized formulation was found satisfactory (89%). Conclusion: The guggulosomes prepared by trituration method was found to give a synergistic effect along with the phenylbutazone when incorporated into the carbopol gel. Thus, this present research shows that it can be good perspective for enhanced topical drug delivery system.

Early identification of elevated intracranial pressure (ICP) is critical to ensuring timely and appropriate management to improve patient outcome. Measurement of the optic nerve sheath diameter by ultrasound is a well studied modality for noninvasive assessment of ICP. Recent studies have shown it to correlate with invasively measured ICP. We utilized this technique in our ICU and found it to be of great help in guiding patient management and predicting the prognosis. A case series of four patients is reported illustrating its utility in ICU patients.

Background: Oxytocin, a commonly used drug to prevent uterine atony after caesarean section, should be administered as dilute rapid infusion rather than as a bolus. This study was conducted to calculate ED90 of oxytocin infusion during caesarean delivery in parturients at high risk of postpartum haemorrhage (PPH). Materials and Methods: One hundred and twenty parturients having one or more risk factors for PPH received a blinded infusion of oxytocin following emergency caesarean delivery. The initial dose of oxytocin infusion was started as 0.4 IU min−1. The dose of oxytocin infusion for the next parturient was based on the response of preceding patient in increments or decrements of 0.1 IU min−1 as per a biased-coin design up-down sequential method (UDM). Measurements of non-invasive blood pressure and heart rate were taken at 2 min intervals from the time of oxytocin infusion. Intraoperative blood loss was noted. Side effects such as tachycardia, hypotension, nausea, vomiting, chest pain, headache and flushing were also recorded. Results: The ED90 of oxytocin infusion was found to be 0.405 IU min−1 (95% confidence interval 0.3864–0.4125) as calculated by Firth's penalised likelihood estimation using a biased-coin design UDM. Hypotension was observed for brief period of time in 25.6% of parturients and brief period of tachycardia was observed in 9.4% of parturients. No headache, flushing, chest pain and vomiting were observed in any parturients in our study. The estimated blood loss was within the normal limits. Conclusion: Our study showed that ED90 of oxytocin infusion required to achieve adequate uterine tone (UT) after an emergency caesarean delivery in parturients at high risk of uterine atony was 0.405 IU min−1. The higher doses of oxytocin did not result in further improvement of UT. Therefore, early use of alternative uterotonic therapy is preferable to achieve adequate UT.

Background: Deep brain stimulation (DBS) surgery is an established therapeutic option for alleviating movement disorders. It represents unique challenges for anaesthesiologists. We retrospectively reviewed the patients, who underwent this surgery at our institution, to study anaesthetic management and perioperative complications. Materials and Methods: After taking approval from the Institutional Ethics Committee, medical, surgical and anaesthesia records of 67 patients who were admitted to undergo DBS surgery during 11 years period (January 2001 to December 2011) were retrieved and reviewed. Sixty-five patients underwent the procedure. Various anaesthetic events and perioperative complications were noted and appropriate statistical analysis was carried out to analyse the data. Results: Electrode placement under monitored anaesthesia care (MAC) was the most commonly used technique (86% of patients). Intra-operative complications occurred in 16 patients (24%) whereas post-operative complication occurred in 10 patients (15.4%). There was one mortality. Though age >60 years and American Society of Anesthesiologists status >II were found to be the risk factors for post-operative complications in the bivariate analysis; they were not significant in multivariate analysis. Conclusions: We report our experience of DBS surgery, which was performed using MAC in majority of patients, though general anaesthesia is also feasible. Further prospective randomised studies comprising large number of patients are warranted to corroborate our finding and to find out the most suitable sedative agent.

Spinal anesthesia is the preferred technique of administering anesthesia for elective cesarean section (CS). Hypotension, failed spinal anesthesia, postdural-puncture headache, cauda equina syndrome are a few complications that may occur but neurological complications particularly aphonia are quite rare. The use of lipophilic opioids as adjuvants with local anesthetics are considered as culprit but the exact mechanism remains unidentified. We report such presentation in our patient and discuss the likely cause.

Purpose: This paper seeks to further the understanding of the domain of the customer equity construct, in developing country context. Building on their framework, a modified and extended construct (CUSTEQUITY), using systematic scale development procedure, is established with nomological evidence of its impact in Indian banking industry. Design/methodology/approach: The data are collected from 550 accountholders of five major national Indian banks–State Bank of India (SBI), Punjab National Bank (PNB), Housing Development Finance Corporation (HDFC), Industrial Credit and Industrial Corporation (ICICI), and Jammu and Kashmir Bank (JKB). The respondents are contacted using purposive sampling from Jammu city of North India. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation model (SEM) are used to analyze the data. Findings: The study findings validate the extended customer equity scale comprising two additional dimensions namely relational equity and social equity, along with three established dimensions-brand equity, value equity and retention equity. Further, the nomological validity of the CUSTEQUITY scale is also established. The moderating role of age and gender in customer equity and customer loyalty relationship is also supported. Also, the role of relationship length as a nomological moderator is established. Research limitations/implications: The study focuses on scale development on customer equity in Indian banking sector. The scale validity and reliability across the globe need to be established to underpin customer equity framework.

Neurofibromatosis is a multisystem genetic disorder that is associated with cutaneous, neurologic and orthopedic manifestations. Type 1 neurofibromatosis is characterized by dermatological lesions, such as benign neurofibromas of the skin and cafι-au-lait spot, and is more common than type 2 neurofibromatosis. Anesthesiologists must be aware of and consider each of the multisystemic complications of the disorder when evaluating and managing patients for surgical procedures. Anesthesia for the pregnant patient with neurofibromatosis is not well documented. We report a successful case of spinal anesthesia for cesarean section in a parturient with type 1 neurofibromatosis.

Blockade of the trigeminal nerve and its branches at various locations is a well-established procedure to treat intractable pain syndromes in the distribution of the nerve. Mandibular nerve block is a commonly performed procedure by anesthesiologists, pain physicians, as well as dental practitioners. As it is considered to be a safe procedure, it is usually performed in an outpatient setting with or without monitoring. The complications associated with mandibular nerve block include intravascular injection, hypoesthesia, dysesthesia, sensory loss in mandibular nerve distribution, facial swelling, weakness of the masseter muscle, and injury to the auditory tube leading to severe vertigo. Here, we present an uncommon complication during mandibular nerve block with lignocaine in a patient of trigeminal neuralgia who suffered transient asystole during the procedure. The case highlights the importance of monitoring and emphasizes the need for additional precautions to be taken during pain procedures particularly in high-risk populations such as geriatric patients.

Mucopolysaccharidoses (MPSs) are a group of lysosomal storage disorder characterized by progressive multiorgan accumulation of glycosaminoglycans. Patients with MPS I (Hurler′s syndrome) present as one of the most difficult airway problems to be managed by anesthesiologists. Hydrocephalus with increased intracranial pressure is a frequent complication seen in these patients. The rarity of the syndrome accounts for the small number of case reports and anecdotal information on the intracranial manifestations of this syndrome. We describe the successful anesthetic management of 2 children with Hurler′s syndrome who underwent ventriculoperitoneal shunt surgery for acute hydrocephalus.

Hydatid disease is quite common in temperate climate like in India. The most common organs involved are liver and lung. We report a child in whom three major organs lungs (both), liver and spleen were involved which is quite a rare occurrence. He underwent cyst excision through simultaneous sternotomy and laparotomy.