Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

OBJECTIVE

To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.

METHODS

In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).

RESULTS

We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.

CONCLUSION

Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

Severe back labor pain masks a scald caused by shower hydrotherapy: a case report

Shower hydrotherapy is generally considered benign during labor. We report a case of extensive scalds in a primigravida who used shower hydrotherapy to treat severe back labor pain from fetal malposition. Interestingly, her back pain was so severe that she felt no pain as her scald developed, describing the hot water from the showerhead as the only measure which "soothed" her pain. Her scald was diagnosed presumptively during assessment for epidural analgesia. The nature of her back labor pain, associated with occiput posterior fetal head position and her management are described. Severe pain from persistent fetal malposition may alter somatic pain perception during labor, increasing burn risks during shower hydrotherapy. These women are also at increased risk of operative delivery and infection risks from inadvertent neuraxial blockade after burns. Improved prevention strategies and vigilance for scalds are warranted in women with severe back labor undergoing shower hydrotherapy, including by anesthesiologists assessing them for neuraxial blockade.

Transitional Pain Service: An Update

PURPOSE OF REVIEW

Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possible interventions to adress postoperative pain. Areas of future work in TPS-related research are discussed.

RECENT FINDINGS

Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. While some studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.

Supraglottic airway device versus tracheal tube for pediatric laparoscopic surgery-A systematic review and meta-analysis

BACKGROUND

Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain.

METHODS

A systematic review and meta-analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H2 O), end-tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model.

RESULTS

Eight trials (n = 591) were included in the final meta-analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: -0.65 to 1.8; p = .36) and end-tidal carbon dioxide (MD -0.60, 95% CI: -2.00 to 0.80; p = .40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69-6.45; p = .0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12-5.31; p < .0001), which were statistically significant. The certainty of evidence is graded low.

CONCLUSION

There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes.

Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting-A systematic review and meta-analysis

BACKGROUND

Postoperative nausea and/or vomiting is a relatively frequent occurrence after general anesthesia in pediatric patients. Supplemental perioperative crystalloid fluid administration has been shown to have a positive effect on the incidence of nausea and/or vomiting in adults undergoing surgery. The question arises whether supplemental intraoperative intravenous fluids in pediatric patients offers beneficial results with regards to pediatric postoperative nausea and/or vomiting.

METHODS

Pubmed, EMBASE, Google Scholar, and Web of Science were searched up to March 2022 to perform a systematic review with meta-analysis of randomized controlled trials involving patients ≤18 years undergoing elective surgery under general anesthesia, with one group receiving conventional intraoperative fluids therapy and the other group receiving supplemental intraoperative fluid therapy, with intravenous crystalloids. The outcomes included incidence of postoperative vomiting, postoperative nausea and vomiting, the need for rescue anti-emetics, postoperative thirst, and adverse events attributed to supplemental intravenous fluid therapy. Relative risk (RR) with 95% confidence intervals (CIs) were reported for the outcomes using a random or fixed effects model.

RESULTS

Seven randomized controlled trials (864 patients) were included in the final analysis. Supplemental intraoperative crystalloids reduce postoperative vomiting (RR 0.56, 95% CI 0.39-0.80; p = .001), postoperative nausea and vomiting (RR 0.52, 95% CI 0.37-0.74; p = .0003), postoperative thirst (RR 0.21, 95% CI 0.13,0.34; p < .01), and the need for rescue anti-emetics postoperatively (RR 0.60, 95% CI 0.49-0.74; p = .00001).

CONCLUSION

Supplemental intraoperative intravenous crystalloids significantly reduce several PONV outcomes in healthy children undergoing relatively simple and superficial surgeries under volatile agent-based general anesthesia.

Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment

How to cite this article: Bandyopadhyay A, Puri S, Ashok V. Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment. Indian J Crit Care Med 2023;27(1):78.

Dentists' Preference toward Fixed Versus Removable Implant Prosthesis on Edentulous Jaws to Improve Quality of Life

Implants that can be used in the prosthetic rehabilitation of full and partial edentulous patients are now frequently used due to advances in dentistry. The aim of the study is to find the prevalence of implant supported fixed vs. removable prosthesis and associated quality of life evaluation. A cross-sectional, descriptive study was conducted in an institution, on randomly selected individuals. The study group consisted of adult patients who attended the outpatient Department of Prosthodontics from June 2019-March 2020. Eighty-six thousand (86,000) case sheets were evaluated and Chi-square test, independent t-test and frequency analysis were used to explore the relationship between two variables. Out of the patients, 76.5% preferred fixed prosthesis while 23.5% chose removable prosthesis. Females preferred fixed prosthesis over removable. The young-old age group had more removable prosthesis compared to the middle- and elderly age group. Patients with implant supported fixed dental prosthesis had a better quality of life compared with patients with implant supported overdentures. Esthetic and functional rehabilitation is a preferred option females generally care more about their teeth and looks so wanted more fixed options. The young-old age group preferred removable prosthesis over fixed prosthesis. Patients with implant supported fixed dental prosthesis have a better quality of life compared with patients with implant supported overdentures.

Atomised intranasal dexmedetomidine versus oral melatonin in prevention of emergence delirium in children undergoing ophthalmic surgery with sevoflurane: A randomised double-blind study

BACKGROUND

Melatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied.

OBJECTIVE

To study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.

DESIGN

A prospective, randomised, double-blind trial.

SETTING

Ophthalmic surgery in a university teaching hospital, April 2021 to October 2021.

PATIENTS

A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia.

INTERVENTION

Children were randomised to receive pre-operative intranasal dexmedetomidine 2 μg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg -1 (melatonin group), 45 min before surgery.

OUTCOMES MEASURED

The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain.

RESULTS

The incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P  = 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit ( P  < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0-4], ( P  = 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.

CONCLUSION

Atomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin.

TRIAL REGISTRATION

Clinical Trials Registry of India CTRI/2021/03/032388 ( www.ctri.nic.in ).

Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study

Background

Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients.

Materials and Methods

Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021.

Results

In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS).

Conclusions

The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.

Comparative analysis of different impression techniques in relation to single tooth impression

It is of interest to compare the accuracy of three different impression techniques for a single tooth impression. We used 3 groups with 15 samples each in this study. Group 1: Putty and light body in a sectional stock tray; Group 2: Monophase and extra light body in a sectional stock tray; Group 3: Matrix impression technique. 15 impressions were taken of a prepared tooth on a typodont with each technique. The dimensions of the casts poured from these impression techniques were compared with the control typodont tooth. Data analysis shows that the matrix impression technique gave the best results in terms of dimensional study followed by monophase and extra light body impression technique and putty and light body impression technique gave the least accurate results. The results show that there is a statistically significant difference between the three impression techniques in terms of dimensional stability. Data analysis shows that the matrix impression technique gave the best results in terms of dimensional study followed by monophase and extra light body impression technique and putty and light body impression technique gave the least accurate results. The variations between the groups are within acceptable limits. Hence, it can be concluded that all the impression techniques will result in adequate dimensional stability and can be used in clinical scenarios.

Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study

BACKGROUND

The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11.

METHODS

In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility.

RESULTS

The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min).

CONCLUSION

The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.

Role of solution reconstruction in hypersonic viscous computations using a sharp interface immersed boundary method

This work discusses the development of a sharp interface immersed boundary (IB) method for viscous compressible flows and its assessment for accurate computations of wall shear and heat fluxes in hypersonic flows. The IB method is implemented in an unstructured Cartesian finite-volume (FV) framework and resolves the geometric interface sharply on the nonconformal mesh through direct imposition of boundary conditions employing a local reconstruction approach. The efficacy of the IB-FV solver is investigated for canonical high-speed viscous flows over a range of Mach numbers. The numerical results indicate that the surface pressure and shear stress distributions are computed with reasonable accuracy, whereas surface heat fluxes for aerodynamically blunt configurations are underpredicted. Employing a set of carefully designed experiments and simple diagnostic tools, we probe the possible causes for the underprediction in heat flux. We show that there exist two sources of error-one due to grid resolution and the other due to solution reconstruction, with the latter being more prominent and responsible for the observed underprediction in heat fluxes. Studies reveal that the heat flux estimates are sensitive to the choice of temperature reconstruction and linear interpolations could lead to poor estimates of heat flux. Our investigations conclusively point out the fact that existing polynomial-based reconstruction approaches for sharp interface IB techniques are not necessarily adequate for heat transfer predictions in high Reynolds number hypersonic flows.

Relation between Bone Density and Primary Stability in the Posterior Mandibular Region in Patients Undergoing Dental Implant Treatment: A Retrospective Study

Tooth loss has become one of the most raising issues to be brought up in dentistry, by both patients and dentists. Teeth are considered to be important in case of function and esthetics. Compromise to the dentition would raise social disturbances for the individual. Dental implants are surgical fixtures or artificial tooth roots that are placed into the jawbone. It is one of the best methods of tooth replacement. When considering implants, the dentist must approach it with a multidisciplinary treatment plan. They should consider factors such as age, gender, habit, systemic diseases, oral hygiene, placement site and technique, bone width and bone height, bone density, etc. complications for implant surgery would include bleeding, infections, pain, breakage, etc. A single center retrospective study was done in an institutional setting. The data for the study was retrieved from the college's patient records management software. All patients undergoing implant surgery in the posterior mandibular region were considered. The patients age, gender, implant site, bone width, and bone height were taken into account as variables. The data received was analyzed using SPSS. A total of 737 patients were considered in the study, 383 being male patients and remaining 354 being female patients. the right and left molar teeth were more commonly replaced in comparison to premolars. The association between the primary stability and bone density was statistically significant (p < 0.05). Within the limitations of the study, males had better bone density than females and D2 bone density was predominantly seen in both males and females and between the age group between 26 to 40 years. D2 bone density is seen in both left and right molar regions. Primary stability was associated with the implant length, width and bone density.

Retrospective Analysis of the Bone Density in the Maxillary Anterior Region among Patients with Dental Implants

Implant systems today have come a long way to provide comfort and long-term success rate in patients requiring implant supported prosthesis as part of their oral rehabilitation. It is currently overtaking the other prosthetic treatment especially in the case of replacing anterior teeth. The aim of this study was to evaluate the association of age, gender, bone density and implant brands with respect to implants placed in the maxillary anterior region in a private hospital setup. It is a retrospective university setting study performed by evaluating the case histories of patients placed with implants in the anterior region. The data was extracted and subjected to statistical analyses using SPSS software. In this study, D2 bone was most commonly seen in the anterior region followed by D3 and D1. D1 and D3 bone were prevalent in patients in the age group of 41 to 60 years and D2 bone was prevalent in the group of 26-40 years. Males showed greater bone density than females. Implant brand Straumann Roxolid SLActive was mostly used in the anterior region and most of the implants are placed equicrestal in position. As a practitioner, one should have clear knowledge on implant brand, bone densities, crestal relation and age association in order to exert a successful treatment response in the future.

Correlation of soft tissue biotype with pink aesthetic score in single full veneer crown

It is of interest to document the correlation of soft tissue biotype with pink esthetic score in single full veneer crown in Indian population. Hence, a Cross-sectional, descriptive study was conducted in an institution, on randomly selected individuals from a data collection of 86000 patient data. Scalloped and thin gingival biotype was present in 62.1 % patients and flat and thick was present in 37.9% individuals according to Anon and Ross Classification. Pink esthetic score didn't give any significant value in single crown cases where 85% cases had a good pink aesthetic score. Thus, the rightness of the PES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth crown was confirmed. However, many randomized clinical trials are needed to further validate and refine this index for its clinical use in prosthetic rehabilitation.

Data on dental bite materials with stability and displacement under load

It is of interest to document the accuracy, time dependent dimensional stability and displacement to load for 5 types of inter-occlusal recording materials. We used cad bite paste, putty, lab putty, pattern resin and poly tray acrylic material in this study. A total of 25 samples were fabricated to evaluate the accuracy and dimensional stability. The amount of displacement was calculated by applying displacing force on the bite registration materials till they fractured using Instron 3000 UTS machine. Statistical analysis of the data shows that CAD bite paste has the maximum amount of accuracy and dimensional stability whereas pattern resin showed the least amount of displacement to applied force. Thus, we report that CAD bite registration material displayed best results in terms of accuracy and dimensional stability and moderate results in terms of displacement to force.

An Innovative Meta-Systematic Review into the Landscape of Literature and the Concluding Evidence on the Quality of Life of Patients Using Two Implant Supported Mandibular Complete Denture Prosthesis

Aim:

The aim of this systematic review is to analyze the existing evidence on the quality of life of patients completely edentulous in the mandible.

Materials and Methods:

A search questionnaire was formulated using population intervention comparison outcome (PICO) analysis, and a comprehensive search was initiated in PubMed Central, Medline, Cochrane, and Google Scholar databases for the related topics. Manuscripts published till December 2019 were included in this review. Out of the 63 articles obtained from searching all databases, 27 studies were excluded based on the title and abstract. Out of the remaining 36 studies, 12 were excluded based on the inclusion and exclusion criteria of our interest and 24 were included on the basis of core data.

Results:

One review author identified randomized trials meeting inclusion criteria for this review. Two review authors extracted data and assessed study quality. The oral health-related quality of life in completely edentulous mandibular patients wearing implant-supported overdentures was better when compared to conventional tissue-supported complete denture, and a minimum two implant-supported mandibular complete denture has sufficient improvement in oral health-related quality of life.

Conclusion:

There are about more than 170 reviews and clinical trials that have been published in support of the same for the past two decades. Thus, the clinicians may not be tempted in placing additional implants in well-formed mandibular edentulous ridges. To enhance the understanding of mandibular implant overdenture treatment, clinicians must scrutinize the existing evidence and formulate a protocol by striking a balance between efficient and evidence based treatment.

Ventilation Failure due to Endotracheal Tube Migration Into a Tracheal Pouch in a Toddler With a Repaired Tracheoesophageal Fistula: A Case Report

A tracheal pouch is a rare complication of successful repair of a congenital tracheoesophageal fistula (TEF). An 18-month-old child with a repaired congenital TEF was scheduled for esophageal dilation to treat his esophageal stricture. Migration of the distal end of the endotracheal tube into a previously undetected tracheal pouch caused an abrupt failure to ventilate at the end of surgery. Given our experience, we recommend to screen the trachea of every patient with corrected TEF for a tracheal pouch when they are scheduled for another procedure requiring general anesthesia.

A geometrical method to classify face forms

INTRODUCTION

Face form is a useful reference in numerous clinical prosthodontic procedures for nearly ten decades since the postulation of Leon Williams typal form theory. Hitherto, face forms has been studied by clinical and photographic assessment methods and classified it as square, tapering, square tapering and ovoid forms. The existing method of classifying face form is subjective as it is derived on visual perception and hence alternative methods have to be studied further.

AIM

The aim of the study was to analyze the existing classification of face form and to classify face forms based on geometrical method to eliminate the errors in classifying the face form by visual judgment.

METHODS

200 subjects of age group 18 to 25 were investigated with the clinical method using face form indicator and photographic method. Reference points were marked on the face form indicator and the photographs to classify face form. A geometrical method was used to classify face form based on the angle of convergence in the photograph. Based on the angle of convergence between the widest part of the face to the lower, middle and the upper third of the face, face form was classified. This method of classification widens the existing classification of face form with three additional types of face forms.

RESULTS

A Comparison was done between the face forms obtained by clinical and photographic methods. Face forms obtained by clinical and photographic method showed no significant differences (p > .05) between them.

CONCLUSION

A geometrical method on photograph can be an effective method to analyze the various face forms to overcome the errors in visual judgment in the commonly used clinical method with face form indicator.

Validation of age and height based formulae to predict paediatric airway distances - a prospective observational study

Background:

Preoperative airway evaluation in children is an important part of routine preanesthetic evaluation before surgery. External airway measurements, viz., thyromental, mentohyoid, and sternomental distances, while being growth dependent, could identify pediatric patients with potentially difficult airways.

Objectives:

This study was conducted to validate the age- and height-based formulae, derived from a previous study conducted in our institute, to predict thyromental distance, sternomental distance, and mentohyoid distance in relation with the height and age of pediatric patients.

Design:

Prospective cross-sectional single arm observational study.

Setting:

Tertiary level university teaching hospital from July 2015 to December 2016.

Patients:

Children (202) in the age group of 3-15 years with no obvious external airway anomaly scheduled for elective surgery under general anesthesia.

Outcomes Measured:

The thyromental, mentohyoid, and sternomental distances were measured preoperatively. The same parameters were then calculated based on age- and height-related formulae derived in the earlier study.

Results:

Bland-Altman analysis of the sample patients showed a mean difference (bias) between measured and calculated values ranging from 0.14 to –0.60 (3 - 13%). Overall agreement in terms of bias were found to be more with height-based equation for mentohyoid distance and thyromental distance and age-based equation for sternomental distance.

Conclusion:

Our study validates the formulae derived in the earlier study to predict thyromental, mentohyoid, and sternomental distances in children with no obvious external airway anomalies. Further studies are needed to extend the applicability of these formulae in obese children and those with craniofacial anomalies coming for general anesthesia and surgery.

An innovative technique for palatal reservoir construction in complete dentures: A case report

The retention and comfort of wearing prosthesis mainly depends on saliva. In reduced saliva conditions, such as xerostomia or radiation therapy, the oral mucosa tends to become dry and ulcerated, leading to the patient's inability to retain the prosthesis. Various techniques have been reported in the literature regarding the use of a reservoir with holes in dentures. The results have not been satisfactory because the flow of the salivary substitute could not be controlled and with frequent cleaning of the denture being necassary to maintain the patency of the reservoir holes. A newer technique for incorporation of a palatal reservoir with controlled artificial salivary flow in complete denture is being explained in this article, which improved the denture retention, comfort, mastication and speech of the patient.

Effects of intraoperative liberal fluid therapy on postoperative nausea and vomiting in children-A randomized controlled trial

BACKGROUND

Postoperative nausea and vomiting (PONV) is one of the most distressing complications following surgery. Supplemental perioperative fluid therapy might be an effective strategy to reduce PONV in children.

OBJECTIVES

The study was conducted to evaluate the effects of intraoperative liberal fluid therapy with crystalloids on PONV in children.

METHODS

In this randomized trial, a total of 150 children of 3-7 years undergoing lower abdominal and penile surgery under general anesthesia were randomly assigned into two groups. "Restricted group" received 10 mL kg^-1 h^-1 and "Liberal group" received 30 mL kg^-1 h^-1 infusion of Ringer's lactate solution intraoperatively. All patients received a caudal block and intravenous paracetamol for analgesia. No opioids and muscle relaxants were used. All episodes of nausea-vomiting and the requirement of rescue antiemetic were assessed during 24 hours postoperatively.

RESULTS

The incidence of PONV was significantly less in the liberal group patients as compared to the restricted group; 33 (45.8%) patients in the restricted group had vomiting as compared to 20 (27.4%) patients in the liberal group (RR 0.59, 95% CI: 0.38-0.93, P=.021). The adjusted odds ratio of PONV for the liberal group vs restricted group was 2.24 (95% CI: 1.12-4.48, P=.022). The incidence of fluid intake during the first 6 postoperative hours was significantly higher in the restricted group patients; 60 (83%) children in the restricted group complained of thirst as compared to 12 (17%) children in the liberal group (RR 0.19, 95% CI: 0.18-0.33, P=.0001). The parents of the liberal group were more satisfied as compared to the restricted group (mean difference -0.9, 95% CI: -1.8, -0.1, P=.04). None of the children had any complication attributed to the liberal fluid therapy.

CONCLUSION

Liberal intraoperative fluid therapy was found to be effective in reducing PONV in children undergoing lower abdominal surgery.

Lip Bumper Prosthesis for an Acromegaly Patient: A Clinical Report

Prosthetic rehabilitation is done to regain function, speech and esthetics. This article describes the treatment for an acromegaly patient with bony defect. Two piece magnet retained hollow lip bumper prosthesis was fabricated to reduce the weight of the denture and to attain esthetics.

Anti-Oxidative Effect of Cassia auriculata on Streptozotocin Induced Diabetic Rats

The anti oxidative effect of administration of 100 mg/kg bw and 200 mg/kg bw of the flower powder of Cassia auriculata (CFP) for 45 days to normoglycemic and diabetic rats (streptozotocin induced) was studied. Anti oxidative effect was not observed in normoglycemic rats in the experiment. There was significant (P > 0.05) increase in the level of Thio Barbituric Acid Reactive Substances (TBARS), hydroperoxide and conjugated dienes and significant (P > 0.05) decrease in the catalase, superoxide dismutase and glutathione peroxidase activities and in the level of ascorbic acid, vitamin E and reduced glutathione in diabetic rats. The flower powder of Cassia auriculata significantly (P > 0.05) decreased the TBARS, hydroperoxide and conjugated dienes and increased the antioxidant enzymes (catalase, superoxide dismutase and glutathione peroxidase) and non enzymic anti oxidants (ascorbic acid, vitamin E and reduced glutathione). The antioxidatve effect of 200 mg/kg bw CFP was significantly (P > 0.05) better than 100 mg/kg bw CFP and the reference drugs (tolbutamide and metformin). The mode of action of CFP remains to be elicited.

Uncorrected refractive error in Singapore teenagers

AIM

To study the prevalence rate of uncorrected refractive error and associated risk factors among Singapore schoolchildren aged 12-16 years (grade 7).

METHODS

A cross sectional study of 628 participants (participation rate 99.8%) was conducted in two schools. An interviewer led questionnaire asking about sociodemographic variables and risk factors was administered. Refractive errors were measured using a table mounted autorefractor. Participants with habitual visual acuity (VA) of 0.2 logMAR or worse underwent subjective refraction. Uncorrected refractive error was defined as improvement of at least 0.2 logMAR in best corrected visual acuity after subjective refraction.

RESULTS

The prevalence rate of uncorrected refractive error was 22.3% (95% confidence interval (CI) 19.0% to 25.5%). The multivariate adjusted odds ratio of uncorrected refractive error in students with the lowest academic ability was 2.24 (95% CI 1.34 to 3.73). Increasing time interval since the last visit to an eye care provider increased the risk of uncorrected refractive error (trend p = 0.001).

CONCLUSION

Uncorrected refractive error was a significant problem among Singapore students aged 12-16 years (grade 7). Uncorrected refractive error was more common among students with low academic ability or those who had not visited an eye care provider for a long time.

Off-pump coronary artery bypass grafting is a safe and effective treatment modality for Asian patients requiring coronary revascularisation

INTRODUCTION

Off-pump coronary artery bypass grafting (OPCABG) is gaining widespread acceptance as the preferred choice for myocardial revascularisation. However, no definite data exist as to whether it is better than conventional CABG. We aimed to study the efficacy of the procedure in our patients, which constituted of a predominantly Asian population.

METHODS

Between January 2000 and December 2002, 1062 patients underwent isolated coronary artery bypass in our institution. 184 patients (17.3 percent) underwent OPCABG. Patients were preoperatively prospectively risk stratified under the EuroSCORE risk assessment model under high, medium and low risk classes thereby making them comparable. Post-operative complications, intensive care unit stay, hospital stay, types of grafts done were then analysed in these different risk classes.

RESULTS

The incidence of off-pump procedures showed a gradual increase over the last three years in this institution. A reduction in the number of post-operative complications, hospital stay, intensive care unit stay and mortality in the off-pump group was observed. Certain differences were found to be statistically significant.

CONCLUSION

Off-pump CABG is a safe and viable alternative to conventional CABG as a treatment modality for surgical coronary revascularisation.