Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring

Background/Aims@#Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD). @*Methods@#Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies. @*Results@#One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; P=0.001) on multivariate analysis respectively. @*Conclusions@#Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.

Aspergillus spp., a versatile cell factory for enzymes and metabolites: Interventions through genome editing

Aspergillus sp. is widely distributed in nature and plays significant roles in the degradation of lignocellulose biomass and extensively used in bioprocess and fermentation technology and many species are also a generally regarded safe. Many of the Aspergillus species are established cell factories due to their inherent capacity in secreting large number of hydrolytic enzymes. With the advent of next generation genomic technologies and metabolic engineering technologies, the production potential of Aspergillus cell factory has improved over the years. Various genome editing tools has been developed for Aspergillus like engineered nucleases, zinc finger nucleases, TALEN and CRISPR-Cas9 system. Currently, the CRISPR/Cas9-based technique is extensively used to enhance the effectiveness of gene manipulation in model system Aspergillus nidulans and other strains like Aspergillus oryzae, Aspergillus niger and Aspergillus fumigatus. This review describes the recent developments of genome editing technologies in Aspergillus the synthesis of heterologous proteins and secondary metabolites in the Aspergillus species.

Use of thiopurines in inflammatory bowel disease: an update

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

Eclipta alba Derived Phytochemicals against Jaundice

Phytochemicals otherwise known assecondary metabolites means the small organic molecules that are not essential for growth, development and reproduction but can protect from various diseases. Infact these phytochemicals are the key source of medicine. Secondary metabolites from Eclipta alba plant extract are traditionally used to cure Jaundice which is caused by Leptospira interrogans. The curative property of Eclipta alba against Leptospira interrogans was proved by molecular docking method in “Biovia Discovery Studio”. “High positive values of -CDOCKER energy and -CDOCKER interaction energy” recommended that pentadecan, heptadecane, 6,10,14-trimethyl-2-petadecanone can successfully deactivate the thioredoxin-disulfide reductase enzyme thereby disrupting the cellular function as well as the lifecycle of causative organism

Eclipta alba L. Derived Phytochemicals against Campylobacter Causing Diarrhea

Phytochemicals from Eclipta albaL.plant extract are traditionally used to cure Diarrhea. It is caused by Campylobacter. Molecular docking method applied using “Biovia Discovery Studio”. “High positive values of -CDocker energy and -CDocker interaction energy” suggested that 6, 10, 14-trimethyl-2-pentadecanone can effectively deactivate the Argininedecarboxylase enzyme (protein database code 3N29) thereby interrupting the life cycle of the organism

Determining the Neurocognitive Status and the Functional Ability of Patients to Screen for HIV-Associated Neurocognitive Disorder (HAND)

BACKGROUND AND PURPOSE: To adequately evaluate the extent of neurocognitive impairment in patient living with human immunodeficiency virus (PLHIV), a battery of neuropsychological tests is typically administered which are neither cost effective nor time efficient in the outpatient clinical setting. The aim of the study was to assess neurocognitive status and functional ability of people living with HIV and find a brief screening tool to identify those who would benefit from a full diagnostic evaluation.METHODS: The study enrolled 160 PLHIV (80 pre-antiretroviral therapy [ART] and 80 on ART) fulfilling the inclusion and exclusion criteria. Neurocognitive assessment and an assessment of Functional ability was done by using the Montreal Cognitive Assessment (MoCA) and Lawton and Brody Instrumental Activities of Daily Living Scale scale, respectively.RESULTS: The study population consisted of 75.6% males and 24.4% females with mean age of 44±10 years. The overall prevalence of HIV associated neurocognitive disorder (HAND) in the study subjects was 52.5%. Of these, 47.5% had asymptomatic neurocognitive impairment and 5% had minor neurocognitive disorder. In MoCA, the most frequently affected domains were Language (97.6%), visuospatial ability (92.9%) and memory (71.4%).CONCLUSIONS: The prevalence of HAND in both groups were similar suggesting that neurocognitive impairment starts early in HIV infection. Memory and Visuospatial function impairment had the most predictive potential for detecting the presence of HAND. HAND screening is recommended in all PLHIV at enrolment into care. Simple tools like MoCA can be used in busy outpatient settings by healthcare workers to screen for HAND.

Utility of MELD Score as Prognostic Indicator in Patients of Liver Cirrhosis and its Correlation with Child-Pugh Score

Introduction: The model for end-stage liver disease (MELD)score is a useful tool to assess prognosis in critically illcirrhotic patients. Therefore present study’s aim is to evaluateprognostic value of MELD score in patients with cirrhosis andto find out the correlation of MELD score with Child-PughScore.Material and Methods: Present study was carried out ina large public hospital in Mumbai from October 2003 toNovember 2004 on liver cirrhosis patients. Seventy sixpatients of cirrhosis of liver who had attended gastroenterologyoutpatient department of the hospital were included in thestudy. Thirty age and sex matched healthy controls wereincluded in the study. MELD score was calculated at Mayoclinic calculator site.Results: Mean age of cases of cirrhosis was 46.97 + 12.96years with range of 15-74 years. There was no significantdifference in the age or sex distribution of cases in the survivalor expired category (p>0.05). Our study showed significantdifference in mortality between the three Child Pugh grades(p<0.05). Present study showed significant correlationbetween MELD score and Child-Pugh Score. Mean MELDscore was significantly more in expired cases (22.0+7.74)than in survived cases (14.87+6.42) during six monthlyfollow up period (p<0.05).Cases with MELD scores ≥30 hadsignificantly high mortality rate.Conclusion: Therefore MELD score can be used as significantshort term prognostic factor in patients with cirrhosis.

Comparison of the Effectiveness of Bone Marrow Aspiration, Imprint and Biopsy in Patients Suffering From Acute Leukaemia

Background: Examination of bone marrow has wideapplications in clinical medicine. Bone marrow can beevaluated by three ways – Bone marrow aspirate (BMA)smears, Imprints or touch preparations (BMI) of bone marrowcore biopsies, and histological sections of core biopsies(BMBx). Hence; we planned the present study to assess andcompare the effectiveness of bone marrow aspiration, imprintand biopsy in patients suffering from acute leukaemia.Materials & Methods: The present study includedcomparative evaluation of efficacy of bone marrow aspiration,imprint and biopsy in acute leukaemia cases. We carried outbone marrow examination on 10 cases presenting with acuteleukaemia’s. We included only those cases in which bonemarrow examination was done by using all the three methodsof BMA, BMI and BMBx will be included in the study. A Salah'sneedle was used to aspirate material from bone marrow.Biopsy was done using a Jamshidi/Janus trephine needle.After routine processing and paraffin embedding thin sectionswere cut and stained with Haematoxylin and Eosin stain. Weanalyzed all the results by SPSS software.Results: Out of 10 cases, findings of BMA, BMI and BMBxwere in concordance with each other in 70 percent of thecases. In two cases, dry tap was observed, which was furtherdiagnosed with BMI and BMBx. Diluted marrow was observedin one case which was further diagnosed with BMI and BMBx.Findings of BMI and BMBx were in concordance with eachother in 100 percent of the cases.Conclusion: All the three diagnostic techniques arecomplementary to each other.

Study on Economic Impact of Pulmonary Tuberculosis Treatment of Patient Under DOTS Programme or Private Practitioner in a Rural and Urban Population

Introduction: The Revised National TB Control Programme(RNTCP), a state-run tuberculosis (TB) control initiative of theGovernment of India, has been very successful inimplementing the DOTS strategy in India. It is based onsputum smear diagnosis and a reliable supply of good qualitydrugs, both provided at no cost to the patient.Methodology: In this cross-sectional study, the data wascollected from 150 eligible patients during the period January2018 to July 2019, from a peripheral DOTS TB centre and 5private medical practitioners representing both private andgovernment clinics. 75 patients enrolled from private medicalpractitioners were not enrolled under RNTCP programme.Result: 150 patients were enrolled in this study. 75 patientswere enrolled in DOTS Programme in a Rural Dots Centrewhile remaining 75 were investigated and treated by privatepractitioners. Both groups of patients were given standardisedCategory 1 regimen. None of the patient had received previousTB treatment.Conclusion: This study concludes that reducing out-of-pocketcosts to patients may increase the access to the poor peopleand thus promoting the universal access of TB care servicesas well.

Visual evoked potentials’ responses in hypothyroidism and hyperthyroidism

Background: Visual Evoked Potentials (VEP) provides important diagnostic and prognostic information regarding the functional integrity of the visual system. This study, describes the effects of less or excess thyroid hormones of adults in visual conduction that helps to know the progression to neurological functional defects.Methods: The study was done in 75 consenting subjects (hypothyroid = 24, hyperthyroid = 25, euthyroid = 26). The VEP parameters N75, P100, N145 latencies and its amplitudes within different thyroid status (hypothyroidism, hyperthyroidism and euthyroidism) were compared. One way ANOVA was used to compare VEP parameters among three groups and Pearson’s correlation to find relation between thyroid hormones and VEP parameters.Results: There was positive correlation of 0.335, 0.338 and 0.301 between amplitudes of N75, P100 and N145 waves and fT3 hormone respectively. Furthermore, fT4 showed a positive correlation of 0.186 and 0.185 with the wave amplitudes of N75 and N145 waves respectively and negative correlation of TSH levels of -0.492, -0.280, -0.397 with amplitudes of N75, P100, N145 waves respectively. Hyperthyroid group had higher in VEP latency than euthyroid group in N75 (73±5.77 vs. 68.54±4.32), P100 (106.42±9.74 vs. 100.94±8.17) and N145 (153.03±16.39 vs. 144.37±7.02) waves. Similarly, hypothyroid group had higher in VEP latency than euthyroid group in N75 (72.12±6.34 vs. 68.54±4.32) wave.Conclusions: Both hypothyroidism and hyperthyroidism led to conduction delay in adults, possibly adversely affecting function of myelin. The prominent visual evoked potential abnormalities in hyperthyroidism and less change in hypothyroidism show that the visual neuropathy is more common in hyperthyroidism.

An Analytical Study on Visual Handicap in Patients Attending Ophthalmology OPD: A Hospital Based Study in Mathura

Background: India requires 40,000 optometrists, it has only 8,000. Besides this, we needs 2.5 lakh donated eyes every year, the country’s 109 eye banks manage to collect a maximum of just 25,000 eyes, out of which 30% can’t be used. It is reported that India has 12,000 ophthalmologists who have no time to conduct blindness-preventing surgeries as they are flooded with general eye check-up of patients. Methods: This study conducted in the Department of Ophthalmology in the K M Medical College & Hospital, Mathura. The duration of study was over a period of one year Result: In this study we revealed that the visually disabled retinitis pigmentosa accounted for (16%), congenital anomalies which included microcornea, microphthalmos, anophthalmos, and coloboma of eye (15.3%), refractive errors (11.6%),age related macular degeneration(10%), corneal opacity(9.6%), uveitis(8.6%), glaucoma(6.6%), optic atrophy(6%), lens(congenital cataract and complicated cataract) (5.3%), diabetic retinopathy(5%). Conclusion: This study was revealed that there is no proper treatment available for the most common causes of blindness, only preventive measures can be undertaken.

In vitro evaluation of antimicrobial activities and antibiotic susceptibility profiling of culturable actinobacteria from fresh water streams

Actinobacteria are major producers of antibiotics, industrially significant enzymes and many pharmaceutically important biologically active compounds. Twenty two actinobacterial strains were isolated from fresh water stream sediment samples of Murlen National Park, Mizoram, India. The actinobacterial strains were screened against antifungal pathogens (Fusarium oxysporum, Fusarium udum, Fusarium proliferatum, Fusarium oxysporum ciceri and Fusarium graminearum), and antibacterial activities against five bacterial pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Micrococcus luteus, Bacillus subtilis and Escherichia coli) and a yeast pathogen Candida albicans. All strains showed antibacterial activity against E. coli and F. proliferatum. Based on the results of antagonistic, antibacterial and anti-yeast, two most potent strains Kocuria sp. and Streptomyces intermidus were further evaluated for their antibiotics susceptibility activity against 21 different antibiotics. Kocuria sp. showed resistance to 10 antibiotics whereas Streptomyces intermidus was resistance to 15 antibiotics. Modular genes Polyketide Synthase (PKS II) and Nonribosomal Peptide Synthetase (NRPS) were also detected in these two strains, which might be responsible for the production of secondary metabolites. Two volatile compounds, Di-N-octyl phthalate and 1-Bromo-3, 7-Dimethyloctane were identified from the extract of Streptomyces intermidus BPSWAC29 strain using Gas chromatography Mass spectrometry (GC-MS). This study highlights the promise of discovering novel actinobacteria with antimicrobial activity from underexplored niche biotopes such as fresh water stream sediments.

Moderate intensity exercise improves heart rate variability in obese adults with type 2 diabetes

Aim The aim of this study was to determine the effect of moderate aerobic exercise on heart rate variability (HRV) in obese adults with type 2 diabetes. Methods Forty-one obese adults with type 2 diabetes participated in this study. Anthropometric and metabolic parameters were measured, and resting electrocardiogram (ECG) for the HRV analysis at spontaneous respiration was recorded for 5 min in supine position before and after six months of supervised aerobic training given thrice-a-week. Results The mean age, body mass index (BMI), and duration of diabetes of the study population were 44.1 ± 4.5 years, 30.94 ± 1.36 kg/m2, and 16.3 ± 2.7 years, respectively. In time domain variables, standard deviation of all RR intervals (SDNN), the square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD) and percentage of consecutive RR intervals that differ by more than 50 ms (pNN50) were significantly increased after exercise. In frequency domain variables, high frequency (HF) (ms2) and HF (nu) were significantly increased while low frequency (LF) (ms2) and LF/HF ratio were significantly decreased after exercise. But LF (nu) was unaffected after exercise. Conclusion This study suggests that thrice-a-week moderate intensity aerobic exercise for six months improves cardiac rhythm regulation as measured by HRV in obese adults with type 2 diabetes

A cast partial obturator with hollow occlusal shim and semi-precision attachment

A maxillofacial patient's quality of life is distorted and social integration becomes difficult. An obturator is a maxillofacial prosthesis used to close a congenital or acquired tissue defect, primarily of the hard palate and/or contiguous alveolar/soft-tissue structures. Subsequently, it restores the esthetics, speech, and function. The present clinical report aimed for the prosthetic rehabilitation of a maxillectomy defect by the incorporation of a semi-precision attachment as PRECI-SAGIX – male part of 2.2 mm on fixed partial denture (#22 and #23 teeth) and matrix – plastic female part of size 2.2 mm and height 4.2 mm of yellow on cast partial in polymer base. It aids in the retention of a hollow lightweight obturator. The technique also described the method to make a bulbless obturator with a hollow self-cured acrylic resin occlusal shim. A patient is quite satisfied with bulb less, lightweight cast partial and hollow shim palatal obturator.

A Prospective Obsevational Study For Use Of Intranasal Dexmedetomidine In Paediatric Sedation For Diagnostic Magnetic Resonance Imaging Studies.

Context: Children undergoing MRI often require sedation to avoid motion artifacts and anxiety attacks. Dexmedetomidine is a highly selective α2 adrenoceptor agonist that has sedative and analgesic effects. Aim: This study was conducted to determine whether intranasal Dexmedetomidine 2 µg/kg offered effective sedation in children posted for diagnostic MRI studies. Methods: This prospective pilot study was conducted on 30 ASAI/II patients aged upto 12 years posted for Magnetic Resonance Imaging Studies. In this study all patients were administered with intranasal dexmedetomidine 2 µg/kg in the presence of parents, 30 minutes before scheduled MRI scan. The time of administration and reaction of children were noted. Children were observed in holding area with standard monitors applied. The degree of sedation was assessed at 15 and 30 minutes by using University of Michigan Sedation Scale (UMSS). Recovery time and recovery score were noted according to Modified Aldrete recovery score and quality of MRI is also observed. Statistical analysis:The data was entered in MS EXCELspreadsheet and analysis was represented as mean plus standard deviation. Results: Mean sedation scores after 15 minutes and after 30 minutes were 1.20±1.8 and 2.80±0.7 respectively. Mean discharge time according to modified Aldrete score was 82.42±32.68 minutes. There were no adverse events. No sneezing or coughing episodes were observed during drug administration. Conclusion: Dexmedetomidine is a useful agent for sedation of children undergoing MRI studies.

Correlated Study of Dengue Serological markers and Platelet count

Background: Dengue being the most prevalent mosquito borne arboviral infection in India, has become endemic in India with every year outbreaks. Despite substantial efforts to control the mosquito populations, dengue fever has spread, emerged and established itself rapidly.  Objectives: This study is to correlate the platelet count and IgM /IgG and NS1 in the acute stage of dengue infection Materials & Methods: The present study was conducted for a period of 22 months in Heritage Institute of Medical Sciences from January 2016 to November 2017. Blood samples were collected from 1347 suspected Dengue patients. In all the serologically positive cases, serological confirmation and evaluation of platelet counts of dengue infection was done. Results: A total of 1347 suspected cases were admitted during the study period and among them, 155 (11.51%) were found to be seropositive for dengue. Among the dengue cases, Males (61.05%) were affected more than females (38.7%). Out of 155 positive cases, 108 [69.7%] cases were positive for NS1antigen either alone or in combination with antibodies.77 [49.7%] cases were exclusively positive for NS1 antigen only. Out of 108 cases that were positive for NS1, thrombocytopenia was observed in 70 cases (64.8%) whereas when the antibodies alone were considered, thrombocytopenia was observed in 18 out of 47 cases (38.3%. In a total of 155 cases, thrombocytopenia was seen in 88 cases (56.8%). Conclusion: The study draws attention toward diagnosis of dengue serologically by testing NS1 antigen and IgM / IgG antibodies. NS1inclusion in the diagnosis of dengue increases the chance of early diagnosis in order to avoid complications significantly

Google Search Trends Predicting Disease Outbreaks: An Analysis from India / 대한의료정보학회지

OBJECTIVES: Prompt detection is a cornerstone in the control and prevention of infectious diseases. The Integrated Disease Surveillance Project of India identifies outbreaks, but it does not exactly predict outbreaks. This study was conducted to assess temporal correlation between Google Trends and Integrated Disease Surveillance Programme (IDSP) data and to determine the feasibility of using Google Trends for the prediction of outbreaks or epidemics. METHODS: The Google search queries related to malaria, dengue fever, chikungunya, and enteric fever for Chandigarh union territory and Haryana state of India in 2016 were extracted and compared with presumptive form data of the IDSP. Spearman correlation and scatter plots were used to depict the statistical relationship between the two datasets. Time trend plots were constructed to assess the correlation between Google search trends and disease notification under the IDSP RESULTS: Temporal correlation was observed between the IDSP reporting and Google search trends. Time series analysis of the Google Trends showed strong correlation with the IDSP data with a lag of −2 to −3 weeks for chikungunya and dengue fever in Chandigarh (r > 0.80) and Haryana (r > 0.70). Malaria and enteric fever showed a lag period of −2 to −3 weeks with moderate correlation. CONCLUSIONS: Similar results were obtained when applying the results of previous studies to specific diseases, and it is considered that many other diseases should be studied at the national and sub-national levels.

Understanding the Pathogenesis of Zika Virus Infection Using Animal Models

Zika virus (ZIKV) is a member of Flaviviridae family that has emerged as a pathogen of significant public health importance. The rapid expansion of ZIKV in the South and Central America has recently gained medical attention emphasizing the capacity of ZIKV to spread to non-endemic regions. ZIKV infection during pregnancy has been demonstrated to cause microcephaly and other fetal developmental abnormalities. An increased incidence of Guillain-Barre syndrome, an immune mediated neuropathy of the peripheral nervous system, has also been reported in ZIKV-infected patients in French Polynesia and Brazil. No effective therapies currently exist for treating patients infected with ZIKV. Despite the relatively short time interval, an intensive effort by the global scientific community has resulted in development of animal models to study multiple aspects of ZIKV biology. Several animal models have been established to investigate pathogenesis of ZIKV in adults, pregnant mothers, and developing fetuses. Here we review the remarkable progress of newly developed small and large animal models for understanding ZIKV pathogenesis.

Study of dexmedetomidine as an intrathecal adjuvant to ropivacaine for hemodynamic stability and for postoperative analgesia

Background: Various adjuvants that can be added to local anesthetics and administered in central neuraxial blockade are Opioids, α2 agonists, benzodiazepines. Knowledge and use of adjuvant drug therapy has rendered neuraxial analgesia more effective in the management of both acute and chronic pain conditions. α-2 adrenergic agonists have both analgesic and sedative properties when used as adjuvant in regional anaesthesia. Aim: To study the effects of intrathecal dexmedetomidine added to ropivacaine for surgeries under spinal anesthesia. Materials and methods: Clinical study conducted on 50 patients of ASA PS 1 and 2 in the age group of 18-50 years of either sex posted for elective lower limb orthopaedic and lower abdominal surgeries under spinal anaesthesia. Results: Subjects among the age groups and the mean age of study population was 40 years (SD: ±11.5). 66% (n=33) of study population were male and 34% (n=17) were female. Most of the study population had healthy BMI. 76% (n= 38) of subjects belonged to ASA grade 1 and 34% (n=12) subjects belonged to ASA grade 2. The average duration of surgery was 94.4 min ± 34.4 min. Level of sensory block was T6 in 24 (48%) of subjects, T4 in 17 (34%) of subjects, T8 in 6 (12%) and T2 in 3 (6%) of subjects. The mean duration for onset of Sensory block was 4.12 minutes (SD: ± 1.69) and the mean duration for onset of motor block was 10.12 minutes (SD: ± 2.89). Hypotension was Swetha Ambati, Mukesh Kumar B. Study of dexmedetomidine as an intrathecal adjuvant to ropivacaine for hemodynamic stability and for postoperative analgesia. IAIM, 2017; 4(11): 27-36. Page 28 observed in 3 patients after SAB (Fall in SBP > 20%) after 4 to 6 min. The mean RSS was 2.08 with SD 0.27. Side effects observed were mainly hypotension, nausea and shivering. Conclusions: 5 microgram dexmedetomidine is alternative as an adjuvant to spinal ropivacaine in surgical procedures. It has excellent quality of postoperative analgesia with minimal side effects.