Comparison of Three Methods of Umbilical Cord Management in Late Preterm and Term Newborns on Hemoglobin and Ferritin Levels at Six Weeks of Age: A Randomized Controlled Trial.

BACKGROUND: Umbilical cord milking (UCM) and delayed cord clamping (DCC) are strategies that improve the hemodynamic condition of the newborn and also increase the storage of iron. This study aimed to compare the effects of DCC with or without milking in late preterm and term neonates at different time intervals after birth (60, 120, and 180 seconds) on hematological and hemodynamic parameters in neonates at six weeks of age. MATERIALS AND METHODS: In this double-arm, parallel-group, triple-blind, and active-controlled trial, all 150 eligible neonates were randomized with allocation concealment into three groups: Group A (DCC with UCM at 60 seconds), Group B (DCC with UCM at 120 seconds), and Group C (only DCC for 180 seconds). Hemodynamic parameters were recorded and compared during the first 48 hours, and hematological parameters were compared at six weeks of age. RESULTS: At six weeks, a significant difference in hemoglobin levels was noted between Groups A, B, and C (p<0.001). The difference in serum ferritin values at six weeks was also statistically significant in comparisons across all three groups (p=0.003). Regarding secondary outcomes examined, hemodynamic parameters and the incidence of neonatal hyperbilirubinemia were found to be comparable at 48 hours after birth. CONCLUSION: DCC followed by UCM at 120 seconds and DCC till 180 seconds proves superior to DCC with UCM at 60 seconds in preserving elevated hemoglobin levels and iron stores in neonates at six weeks of age. DCC for 180 seconds yielded comparable results, followed by UCM at 120 seconds. All three methods are considered safe and effective without compromising the neonate's hemodynamics.

Transdermal Drug Delivery Systems: A Focused Review of the Physical Methods of Permeation Enhancement.

The skin is the body's largest organ and serves as a site of administration for various medications. Transdermal drug delivery systems have several advantages over traditional delivery systems. It has both local and systemic therapeutic properties. Controlled plasma drug levels, reduced dosing frequency, and avoidance of hepatic first-pass metabolism are just a few of these systems' advantages. To achieve maximum efficacy, it is critical to understand the kinetics, physiochemical properties of the drug moiety, and drug transport route. This manuscript focused on the principles of various physical means to facilitate transdermal drug delivery. Some examples are iontophoresis, electrophoresis, photomechanical waves, ultrasound, needleless injections, and microneedles. Mechanical, chemical, magnetic, and electrical energy are all used in physical methods. A major advantage of physical methods is their capability to abbreviate pain, which can be used for effective disease management. Further investigation should be carried out at the clinical level to understand these methods for effective drug delivery.

Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial.

Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t -test was used for normal distribution data and Mann-Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.

Folic acid-chitosan functionalized polymeric nanocarriers to treat colon cancer.

In the present study, polymeric nanoparticles loaded with IRI and quercetin, a p-gp inhibitor, were developed to target folate receptors expressed by colon cancer cells for oral targeted delivery. This work reports the development of PNPs with an entrapment efficiency of 41.26 ± 0.56 % for IRI and 55.83 ± 4.51 for QT. PNPs were further surface modified using chitosan-folic acid conjugates for better targetability to obtain folic acid-chitosan coated nanoparticles. DLS and FeSEM revealed particles in the nanometric size range with spherical morphology, while FTIR and DSC provided details on their structure and encapsulation. In vitro drug release studies confirmed a sustained release pattern of IRI and QT, while cell line studies confirmed the superiority of C-FA-PNPs when tested on Caco2 cells. Pharmacodynamic studies in colon cancer induced rats showed similar efficacy for PNPs and C-FA-PNPs. Further examination from a bio-distribution study in healthy rats, revealed the failure of C-FA-PNPs to deliver the drugs to the colon adequately, while the PNPs improved the available concentration of IRI at the colon by almost 1.8 folds when compared to the available marketed product. Hence, the developed PNP formulation sticks out as a plausible substitute for the intravenous dosage forms of IRI which have been conventionally prevailing.

Evaluation of the Role of Preoperative Oral Amisulpride as Part of a Multimodal Antiemetic Prophylaxis Regime on Postoperative Nausea and Vomiting in Patients Undergoing Craniotomy: A Prospective, Double-Blind, Randomized, Placebo-controlled Study.

BACKGROUND: Patients undergoing craniotomy are at high risk for postoperative nausea and vomiting (PONV) despite the use of prophylactic antiemetics. We hypothesized that a single preoperative oral dose of amisulpride as part of a multimodal antiemetic regimen would decrease the incidence of PONV in patients undergoing craniotomy for intracranial tumor surgery. METHODS: Adult patients scheduled for elective craniotomy requiring general anesthesia were enrolled and randomized to receive either oral amisulpride 25 mg or placebo 2 hours before surgery in addition to our institution's usual antiemetic regimen. The primary outcome of the study was the incidence of nausea and/or vomiting during the first 24 hours postoperatively. Secondary outcomes included severity of nausea, use of rescue antiemetic medications, and treatment-related adverse events. RESULTS: A total of 100 patients were included in the analysis. More patients in the amisulpride group had no episodes of nausea (90% vs. 40%; P<0.001) and no episodes of vomiting (94% vs. 46%; P<0.001) compared with the placebo group. The severity of nausea was lower in the amisulpride group than in the control group in the first 4 hours after surgery (P<0.05), and fewer patients receiving amisulpride required rescue antiemetics (P<0.001). The incidence of treatment-related adverse events was similar between groups. CONCLUSIONS: A single preoperative oral dose of amisulpride 25 mg as a component of a multimodal antiemetic regimen decreased the incidence and severity of PONV in patients undergoing craniotomy for intracranial tumor surgery, with no adverse effects.

Fullerenes for the treatment of cancer: an emerging tool.

Cancer is a most common cause of mortality globally. Available medicines possess severe side effects owing to their non-specific targeting. Hence, there is a need of an alternative in the healthcare system that should have high efficacy with the least side effects, also having the ability to achieve site-specific targeting and be reproducible. This is possible with the help of fullerenes. Fullerenes are having the unique physicochemical and photosensitizer properties. This article discusses the synthesis, functionalization, mechanism, various properties, and applications of C60 fullerenes in the treatment of cancer. The review article also addresses the various factors influencing the activity of fullerenes including the environmental conditions, toxicity profile, and future prospective.

Design and development of naringin-loaded proposomal gel for wound healing.

BACKGROUND: The injuries or wounds caused by various means will impact human lives severely. An increase in the demand for wounds or burns was observed. For better wound healing and to combat the free radical effect on the healing process, wounds must be treated with multifunctional or multipurpose dressing or gel or any other type of biomaterial. OBJECTIVES: The study aimed to develop, optimize, and evaluate the naringin-loaded proposomal gel (PPG) for quick wound healing. METHODS: The central composite design was employed for the optimization of proposomes. Naringin-loaded proposomes were evaluated for percentage entrapment efficiency (EE), the particle size of proposomes (PsP), and the zeta potential of proposomes (ZpP). The change in drug release profile was studied by dissolution. Furthermore, naringin and naringin-loaded proposomes, antioxidant activity was determined by 2,2-diphenyl-1-picrylhydrazyl hydrate (DPPH) reagent and ascorbic acid as a reference standard. Different gel bases were prepared, and based on various parameters, the G2 (0.6% Carbopol 974) gel base was selected for naringin proposomes loading. The naringin-loaded PPG was evaluated for various in vitro and in vivo wound-healing properties. RESULTS: The optimized naringin-loaded proposomes showed extended drug release (90.78 ± 2.19%) for 72 h. The naringin-loaded PPG improved the permeability of naringin, which showed 28.91 ± 2.81% of drug release after 96 h, and the drug solution showed 9.05 ± 0.92%. IC50 values of antioxidant activity of naringin and naringin proposomes were found to be 337.31 µg/ml and 201.86 µg/ml, respectively. The naringin-loaded PPG showed better wound closure on the 15th day (3.32%) compared with proposomal solution (4.75%) or naringin topical gel (4.2%). CONCLUSION: Based on the obtained results, we conclude naringin-loaded PPG can be an alternative strategic approach to deliver the naringin for quick wound healing.

Impact of Severity of Maternal COVID-19 Infection on Perinatal Outcome and Vertical Transmission Risk: An Ambispective Study From North India.

Background In contrast to the first wave, the second COVID-19 wave has taken a huge toll affecting maternal outcomes adversely. The aim of this study was to investigate the consequences of the severity of maternal disease on perinatal outcomes and the risk of vertical transmission and to find out the factors associated with adverse fetomaternal outcomes. Materials and methods This was an ambispective observational study including COVID-19 infected pregnant patients; 20-40 years of age irrespective of gestational age admitted at Government Institute of Medical Sciences, UP, India. The patients were divided into two groups: CW 1 (COVID-19 Wave 1): Patients admitted between April 1, 2020 and December 31, 2020 and CW 2 (COVID-19 Wave 2): Patients admitted between April 1, 2021 to May 31, 2021. Data in two groups were compared and analyzed with respect to the clinical profile, laboratory parameters, fetomaternal outcome and the risk of vertical transmission of COVID-19 infection. Results We included 134 eligible patients in the CW1 group and 58 in the CW2 group. Significantly more patients were symptomatic in CW2 (23.1% versus 60.3%, p= <0.001). In CW2, maternal neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) and D-Dimer were significantly raised along with abnormal chest x-rays. There was a significant increase in maternal mortality in CW2 (1.5% vs 13.7%; p≤0.001). A total of 76 patients delivered in CW1 and 26 in CW2 with increased incidence of cesarean section (43.4%; 42.3%), preterm deliveries (28.2%; 37%) and low birth weight (34.6%; 25.9%) in both waves, the difference among two groups being statistically insignificant. Compared to CW1, perinatal mortality was significantly increased in CW2 (2.2% vs 15.5%; p<0.001). Though nasopharyngeal swab tested positive in four neonates in CW1 and two neonates in CW2, no evidence of vertical transmission was observed even with increased severity of maternal illness. On regression analysis, D-Dimer and CRP were found to have a positive association with maternal and perinatal mortality.  Conclusion The severity of maternal illness proportionately affects the neonatal outcome with no impact on the risk of vertical transmission of infection. D-Dimer and CRP have emerged as independent predictors for maternal and perinatal mortality and hence can be utilized in obstetrics decision-making.

Study on the Effect of Berberine, Myoinositol, and Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomised Study.

OBJECTIVE: This study was conducted to see the effects of berberine, metformin, and myoinositol in women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Subjects were randomly assigned via computer-generated randomization to one of the three treatment groups. Group 1 received berberine hydrochloride 500 mg twice daily, group 2 received metformin hydrochloride 500 mg twice daily, and group 3 received myoinositol 1000 mg twice daily to compare clinically (mean weight, waist circumference, waist-to-hip ratio, and body mass index), metabolic (fasting blood sugar, serum fasting insulin, fasting blood sugar/serum fasting insulin [FBS/FI]), hormonal effects (serum total testosterone [TT], serum sex hormone-binding globulin [SHBG] and free androgen index) together with the lipid profile (total cholesterol, serum triglyceride, serum low-density lipoprotein [LDL], very-low-density lipoprotein [VLDL], serum high-density lipoprotein [HDL]) in patients receiving metformin, berberine, and myoinositol before and after three months of treatment. RESULTS: Weight, BMI, waist circumference, waist-hip ratio, FBS, FI and fasting glucose/insulin ratio, total testosterone, free androgen index (FAI), SHBG, total cholesterol, triglycerides, LDL, VLDL, and HDL showed significant differences in three groups after three months of treatment (p<0.0001). Between the three groups, berberine showed greater differences in clinical, hormonal, and lipid parameters compared to metformin and myoinositol, while myoinositol showed greater improvement in carbohydrate metabolic parameters. CONCLUSIONS: Metformin, the classical drug used in PCOS, improves all the parameters in polycystic ovary syndrome women. Berberine may have greater potential to reduce the risk of cardiovascular disease than metformin in PCOS patients due to its effect on body composition, lipid profile, and improvement in hormone status. Myoinositol administration improves endocrine parameters and insulin sensitivity. It may be considered as a first-line option in PCOS patients with insulin resistance without prediabetes or diabetes.

Sustenance of Himalayan springs in an emerging water crisis.

Springs are a significant source of high quality and perennial freshwater supply for remote communities and sustain rich biodiversity and ecosystems in the Himalayas. About 60-70% of the Himalayan population directly depends on springs to meet their domestic and livelihood needs. Despite that, decline in approximately 60% of low discharge springs have been reported in the last couple of decades. In addition, nitrates and faecal coliform contamination linked to septic tanks, open defecation, and fertiliser application have been reported. A high degree of urbanization with 500 growing townships and 8-10 large cities has further threatened the sustenance of these vital resources, causing a severe water crisis in the Himalayas. Spring rejuvenation can enhance water access and livelihoods and help achieve several sustainable development goals (SDGs). However, multiple challenges hinder the success of such initiatives. A fundamental limitation is the poor understanding of complex groundwater (spring) systems and their interactions with human societies. This review identified crucial knowledge gaps by synthesizing available knowledge on springs and revival efforts from peer-reviewed journals and reports by practitioners and governing bodies. The review also highlights the limitations of spring revival approaches and recommends future management options. There is a critical lack of comprehensive data as a large research on the Himalayan spring systems results from small-scale spring centric studies focussing primarily on hydrology. In contrast, the impacts of hydrogeology, ecology, socio-economics and developmental activities on springs are less explored. Lack of scientific inputs on the hydrogeological regime and limited support by the state is a barrier to scaling spring rejuvenation programs. Long term monitoring, location-specific mapping of local hydrogeological and socio-economic settings at aquifer scale and collaborations among different stakeholders are essential to facilitate holistic knowledge development on spring systems and successful spring revival. The authors recommend ensuring sustenance by recognizing the value of springs in the mainstream programs and policies and develop appropriate management framework for the management of spring systems.

Lamotrigine-A Review of Analytical Methods Developed for Pharmaceutical Formulations and Biological Matrices.

Lamotrigine owing to its excellent inhibitory property of neurotransmitter release especially glutamate is used in the treatment of epilepsy as a second-line antiepileptic drug. It differs from other antiepileptic drugs chemically and pharmacologically and is used as both monotherapy and adjunct therapy in the treatment of epilepsy. The present review focuses on two aspects (a) various analytical methods used in quantification of Lamotrigine in pharmaceutical formulations and (b) various analytical methods used to determine Lamotrigine in biological matrices. Here the various analytical methods are developed using different parameters and validation of employed methods is discussed. Estimated parameters like the linearity, LOD (Limit of detection) and LOQ (Limit of quantification) of validation are discussed for the individual method. The critical quality attributes like the wavelength of detection, mobile phase, columns, flow rate, retention time, and the sample preparation methods for the estimation of Lamotrigine by bioanalytical methods are also discussed.

An Overview of Analytical Methods for the Estimation of Propofol in Pharmaceutical Formulations, Biological Matrices, and Hair Marker.

Propofol (PFL) owing to its excellent inhibitory property of neurotransmitters in CNS by positive modulation of ligand gated ion channels to an integrated chloride channeled GABAA thereby acts as a general anesthetic. It differs from other general anesthetics chemically and pharmacologically as it has lesser side effects compared to other general anesthetics and is most commonly used. The present review focuses on two aspects (a) various analytical methods used in quantification of Propofol in pharmaceutical formulations and (b) various analytical methods used to determine Propofol in biological matrices and some biological markers like hair and end tidal nasal air for forensic purpose to estimate drug concentration in suspected cases. Here the various analytical methods are developed using different parameters and validation of employed methods are discussed. Estimated parameters like the linearity, LOQ (Limit of quantification), % recovery, slope, intercept, validation are discussed for the individual method. The critical quality attributes like the wavelength of detection, columns, flow rate, gas flow, and the sample preparation methods for the determination of PFL by bioanalytical methods are also discussed. Type of electrode, mechanism involved and the potential voltage applied for a particular electrochemical method are also discussed.

Development and Validation of High-Performance Liquid Chromatography Method for the Quantification of Remdesivir in Intravenous Dosage Form.

Corona virus disease 2019 (COVID-19) has posed a mounting threat to public health with worldwide outbreak caused by a novel virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recently, remdesivir (RDV) has been approved by Food and Drug Administration (FDA) for treating COVID-19 patients ≥12 years old requiring hospitalization. To the best of our knowledge, a simple method to estimate RDV in the pharmaceutical formulations using high-performance liquid chromatography (HPLC) is still unexplored, highlighting the need for a precise analytical method for its quantification. The prime purpose of the current investigation was to develop and validate a well-grounded HPLC method for quantification of RDV in pharmaceutical formulations. The best chromatogram was obtained by means of an Inertsil ODS-3V column using a mobile phase of milli-Q water modified to pH 3.0 with o-phosphoric acid and acetonitrile (50:50, % v/v) at a flow rate of 1.2 mL/min and wavelength of detector set at 246 nm with retention time being achieved at 6.0 min. The method was validated following International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q2 (R1) guidelines for various parameters such as specificity and selectivity, system suitability, linearity, precision, accuracy, limits of detection and quantification, and robustness. The method developed for the quantification of RDV was found to be linear in the concentration range of 25-2,500 ng/mL with limit of detection and limit of quantification of 1.95 and 6.49 ng/mL, respectively. Assay value of 102% ± 1% was achieved for marketed injectable dosage form when estimated by the validated method. Therefore, in this study a simple, rapid, sensitive, selective, accurate, precise, and robust analytical method was developed and validated for the quantification of RDV using HPLC. The established method was successfully employed for quantification of RDV in marketed pharmaceutical formulation.

Lacidipine: review of analytical methods developed for pharmaceutical dosage forms and biological fluids.

Lacidipine (LAC) is a calcium antagonist used in the treatment of hypertension. It is a lipophilic drug containing dihydropyridine ring that is responsible for the activity. This review article gives an overview of various analytical techniques proposed for the determination of LAC in pharmaceutical dosage forms, in pure form, in biological fluids and to determine characteristics of LAC in modified release dosage forms. Ultra violet/visible spectrophotometric, spectroflourimetric, high performance liquid chromatography, high performance thin layer chromatography, electro-analytical, bioanalytical and miscellaneous methods such as microbiological assay, X-ray diffraction, differential scanning calorimetry, were discussed. Various parameters such as system suitability, selectivity, linearity, precision, accuracy, limit of detection, limit of quantification and robustness have been discussed for the employed methods.

Lay abstract Lacidipine (LAC) is a calcium channel blocker used to reduce blood pressure in hypertension. It has good hydrophobic interactions that gives high distribution of drug in the lipophilic membrane. Chemically, it is (E)-4-[2-[3-(1, 1-dimethylethoxy)-3-oxo-1-propenyl] phenyl]-1, 4-dihydro-2, 6-dimethyl-3,5 pyridine di-carboxylic acid diethyl ester that contains dihydropyridine ring responsible for antihypertensive activity. It is the most commonly used antihypertensive drug as it has high vascular selectivity, tolerability and large dose acceptability with negative ionotropic effects. In spite of anti-hypertensive activity, it shows anti-atherosclerotic, antibacterial and antioxidant effects such as Vitamin E. It has such an important role in treating the life-threatening cardiovascular disorders. The various formulations are available in the market pertaining to this drug. In order to assess the pharmacokinetic parameters, toxicological properties and to estimate the exact concentration of LAC, various analytical techniques are employed for the estimation of LAC in pharmaceutical dosage forms, biological matrices and for the physical characterization of LAC. Here these methods are described to give a clear glance for the future scientists to develop few more easily adoptable methods.

A rapid method for solubilization of chimeric human interferon regulatory factor-1 (IRF-1) protein in Escherichia coli.

Interferon regulatory factor-1 (IRF-1) is a vertebrate transcription factor that plays significant roles in cell cycle regulation, anti-viral response, tumor suppression and immune response. High-level expression of recombinant IRF-1 at 37 °C leads to the formation of insoluble aggregates (insoluble fraction) in Escherichia coli (E. coli), which usually devoid of biological activity. In this study, we use chemical additives such as mannitol, proline, L-arginine and CTAB (cetyl trimethly ammonium bromide) at the recommended concentration during cell lysis to aid in solubility at 37 °C. The use of additives resulted in the increased solubility of the recombinant glutathione S-transferase-linked human IRF-1, with L-arginine being most effective. Here, we developed an efficient process for the manufacturing of soluble IRF-1 with the aid of minimizing the formation of degradation products and optimizing protein purification conditions. This result was further confirmed by western blot with anti-GST and anti-IRF-1 polyclonal antibodies. The functionality of GST-huIRF-1 was attained by elerophoretic mobility shift assay study as a clear band shifting showed with virus response element-Interferon beta (VRE-IFNß) promoter region. Taken together, the biological activity of purified GST-huIRF-1 was also optimized and confirmed by supershift assay concluded that GST-huIRF-1 interacts with the VRE motif of IFNß promoter that reflected to require for IFNß gene regulation. We describe a straightforward approach for the production of absolutely soluble and biologically active IRF-1 in E. coli. This method can be further used for the study of other recombinant proteins and this study will pave way for the analysis of IRF-1 function in vitro.

Level of anxiety and depression among health-care professionals amidst of coronavirus disease: A web-based survey from India.

BACKGROUND: The spread of novel coronavirus diseases-2019 (COVID-19) across the world and its associated morbidity and mortality confronted the nations by various means. COVID19 pandemic had significant psychological effects not only on the general population but also on health-care workers (HCWs). Hence, we aimed to found the level of anxiety and depression among health-care professionals amidst coronavirus. MATERIALS AND METHODS: This is a cross-sectional study conducted on 829 participants including doctors and nurses and other medical staff who were posted in the COVID ward and COVID intensive care unit using a well-structured questionnaire through the Google Forms. The two scales used to measure anxiety and depression among the HCWs were the Hamilton anxiety scale (HAM-A) and the Patient Health Questionnaire (PHQ-9), Cronbach's alpha of HAM A is 0.921 and Cronbach's alpha of PHQ 9 is 0.851. Data analysis was done using SPSS 26, Chi-square test and Fisher's exact test were used to establish the association between categorical independent and dependent variables. RESULTS: The results of this study demonstrate that anxiety and depression were significantly higher in doctors and staff nurses as compared to other medical staff. According to HAM-A, 65.1% of respondents were in the mild category, 22.0% mild to moderate, and 12.9% moderate to severe. The HAM-A (P = 0.022) and PHQ-9 (P = 0.001) for anxiety and depression respectively were significantly higher in females. The means of the scales got increased after postings in the corona wards. CONCLUSION: Concerning the high occurrence of anxiety and fear among health-care professionals, appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implement urgent measures to prevent further progress to severe mental health disorder.

Randomized Trial to Compare Plasma Glucose Trends in Patients Undergoing Surgery for Supratentorial Gliomas under Maintenance of Sevoflurane, Desflurane, and Propofol.

BACKGROUND: Anesthetic agents influence the glycemic response by affecting the neuroendocrine surgical response or directly modifying pancreatic insulin release. Due to chances of neuronal damage, intraoperative hyperglycemia and hypoglycemia both are detrimental for patients undergoing neurosurgeries. Inhalational (sevoflurane and desflurane) and intravenous (propofol) agents have been found to raise intraoperative glucose levels in nonneurological surgeries. AIM: We aimed to compare the intraoperative glucose levels in supratentorial glioma surgeries under the maintenance of three anesthetic agents such as sevoflurane, desflurane, and propofol. MATERIALS AND METHODS: This randomized trial was conducted with 90 nondiabetic adults with supratentorial glioma. Thirty patients were allocated randomly to the three groups receiving sevoflurane, desflurane, and propofol. Baseline and hourly plasma glucose levels were recorded. Postoperatively, the time required to achieve an Aldrete score of 9 and complications were assessed. RESULTS: Baseline plasma glucose levels were 111.23 ± 11.67, 109.47 ± 19.75, and 111.7 ± 13.88 mg/dL (P = 0.84) in sevoflurance, desflurane, and propofol group, respectively. All of them showed an elevation of plasma glucose in relation to the time of surgery with variable trends. In the 4th and 5th h, the elevations in the inhalational groups (sevoflurane and desflurane) were significantly higher than the propofol group (P = 0.003 and 0.002, respectively). The time for achieving Aldrete's score of 9 was higher in the propofol group (P < 0.0001). No differences were observed in the duration of hospital stay or complications. CONCLUSIONS: Maintenance of anesthesia in nondiabetic patients showed clinically modest rise of plasma glucose which is higher in patients under sevoflurane and desflurane than under propofol. However, the immediate recovery was faster with inhalational agents compared to propofol-based anesthesia.

Ultrasound-guided Anterior Quadratus Lumborum Block for Postoperative Pain after Laparoscopic Pyeloplasty: A Randomized Controlled Trial.

BACKGROUND: Quadratus lumborum block (QLB) has provided adequate analgesia and lowered postoperative opioid requirement in comparison to controls for some urological surgeries. AIMS: The aim of this study was to assess the efficacy of postprocedure ultrasound-guided QLB in comparison to port-site infiltrations with local anesthetics (as control) in lowering postoperative pain after laparoscopic pyeloplasty. SETTINGS AND DESIGN: This was a prospective, single-blinded, randomized controlled trial. MATERIALS AND METHODS: Fifty-three adults undergoing laparoscopic pyeloplasty were randomly allocated to either anterior QLB group (n = 27) or port-site infiltration Group P (n = 26) with 20 mL of 0.5% ropivacaine. The primary outcomes were static and dynamic pain on the Visual Analog Scale (VAS) of 0-100 at the 30th min, 2nd, 6th, 12th, and 24th hour after surgery. The secondary outcomes were number of patients requiring rescue analgesics and having postoperative nausea or vomiting (PONV) in 24 hours after surgery. STATISTICAL ANALYSIS: Intergroup comparison of VAS was done with Student's t-test. Categorical data were analyzed using the Chi-square test. RESULTS: The static VAS scores were found to be significantly lower in QLB group at the 2nd, 6th, and 12th hour, and the dynamic VAS was lower at all time points after the 30th min in the QLB group. The number of patients requiring rescue analgesics were significantly lower in the QLB group (13 as compared to 21 in Group P; P = 0.015). The incidence of PONV was comparable. No other side effects were seen. CONCLUSION: Ultrasound-guided anterior QLB is more effective in comparison to traditional technique of port-site local anesthetic infiltration for providing analgesia after laparoscopic pyeloplasty.

Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

BACKGROUND: Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery. AIMS: The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later. SETTINGS AND DESIGN: This was a double-blinded prospective randomized controlled trial. MATERIALS AND METHODS: Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. STATISTICAL ANALYSIS: Independent t-test and Mann-Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data. RESULTS: Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 - ESPB, 180.95 ± 29.12 - controls, P = 0.020) and number of patients requiring diclofenac (28/42 - ESPB, 37/42 - controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 - ESPB, 9/42 - control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 - ESPB and 34/42 - control, P = 0.005) and 1 month (9/42 - ESPB and 13/42 - control, P = 0.207) were lower in ESPB group. CONCLUSION: ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.