Data from clinical trials indicate that augmentation facilitates seizure induction when maximal electrical stimuli fail. Anesthetic modifications, including hyperventilation and substitution with etomidate, ketamine, or other agents, often are successful in overcoming seizure resistance and compare favorably with the use of caffeine. In a few studies, augmentation enabled the use of lower stimulus intensities and fewer treatments without loss of efficacy, even in patients not resistant to seizure induction. However, effects of proconvulsants must be reconciled with increasing evidence of the importance of stimulus dosing relative to seizure threshold and other parameters, now considered key to the efficacy of ECT. Further investigations of pharmacologic augmentation could facilitate the administration of ECT and could provide further insights concerning parameters of seizure efficacy and the mechanism of action underlying convulsive therapies.

BACKGROUND The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications. AIM To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications. METHODS This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose). RESULTS The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients ( r = 0.393, P < 0.001). The dose–response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm 2 was associated with a 1.0% increase of HbA1c. CONCLUSION High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.

Snake bite continues to be a significant cause of Acute kidney injury (AKI) and subsequent Chronic Kidney Disease (CKD) in Asia.Methods: A retrospective observational study. Data of all snake bite induced AKI admissions collected from 2014 to 2018. Data related to clinical profile, AKI severity, renal and patient outcomes and kidney biopsy findings were analyzed by descriptive statistics. Results: There were 3105 patients with AKI in the study period. Of them, 208 patients had AKI due to snake bite. There were 128 (61.5%) males. The mean age was 44.7 +/-0.94 years. Mean bite to anti venom interval was 7.59 +/-1.55 hours (0.5 -96 hours). Toxicity profile included limb cellulitis in 86(40.4%) patients, hemotoxicity in 60(28.1%), neurotoxicity in 33(15.5%) and rhabdomyolysis in 34(15.5%). At presentation, 128 patients (81%) were in AKIN stage 3, 33(17.4%) were in stage 2 and 3(1.57%) were in stage 1. Dialysis was required in 142 patients (69.2%): hemodialysis in 138(67.3%) and peritoneal dialysis in 4(1.9%).Complete renal recovery (discharge creatinine <1.5 mg/dl) was seen in 128 patients (66.3%), partial renal recovery in 33(17%) and end stage renal disease in 19(9.8%). Mortality was 6.7%. Renal biopsy was done in 50 patients which revealed Acute tubular injury (ATI) in 18 (36%), Acute interstitial nephritis (AIN) in 12(24%), thrombotic microangiopathy (TMA) in 4(8%), Cortical necrosis in 8 (16%), ATI with pigment cast in 5(10%), ATI with AIN in 3 (6%). Conclusions: Snake bite accounted for 6.7% of all AKI in our center. Eighty one percent patients presented in AKIN stage 3, probably due to referral bias. Renal replacement therapy was required in 69.2% patients. ESRD was the outcome in 9.8% patients and 17% had partial renal recovery, who are at risk of developing CKD. Most common pathology in biopsy was acute tubular injury followed by acute interstitial nephritis. All patients with TMA and cortical necrosis progressed to CKD.

The bidirectional relationship between periodontitis and diabetes mellitus has been well documented. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently used tools such as Clinical Attachment Loss (CAL) and Probing Pocket Depth (PPD) to assess periodontitis are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal Inflamed Surface Area (PISA) reflects the surface area of bleeding pocket epithelium and estimate the inflammatory burden. This study was undertaken to assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 diabetes mellitus (T2D) with and without micro-vascular complications. The study comprised of 180 T2D patients who were divided into three groups based on their Glycosylated Hb levels (HbA1c) (i) well controlled T2D group: (HbA1c ≤ 7%) (ii) Uncontrolled T2D group: (HbA1c &gt; 7%) without complications, and (iii) Uncontrolled T2D group: (HbA1c &gt;7%) with microvascular complications. All subjects were assessed for the periodontal parameters (Bleeding on Probing (BOP), PPD, CAL and PISA) and systemic parameters (HbA1c, FPG, and PPPG). The proportion of periodontitis among Uncontrolled T2D group without complication and Uncontrolled T2D group with micro-vascular complications was (93.4% and 96.6%) very high as compared to Well controlled T2D group (75%) (p &lt;0.001). Extent and severity of periodontitis were high in uncontrolled T2D group. Uncontrolled T2D with micro-vascular complications group attained the highest mean score for PPD, CAL, BOP and PISA. Positive correlation was found between PISA and HbA1c among the groups (r = 0.079, 0.109, 0.248 respectively). A statistically significant positive correlation has been found between PISA and HbA1c among all study subjects (r= 0.393, p &lt; 0.001). Disclosure C. Radhakrishnan: None. R.J. Vadakkekuttical: None. K. Anil: None. F.C. Parambath: None.

BACKGROUND This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam and fentanyl as an additive agent to bupivacaine for lower abdominal elective surgeries. METHODS Sixty patients classified in American Society of Anesthesiologists (ASA) classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly divided to receive either 12.5 mg hyperbaric bupivacaine plus 1mg midazolam (group BM, n=30) or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group BF, n=30) intrathecal. RESULTS The time of onset and the duration of motor blockade were comparable among the groups while the time to sensory block regression was same in group BM and group BF. The duration of postoperative analgesia was similar in group BM and group BF. While it was same for group BM and BF. Symptoms of pruritus and vomiting was more in group BF. CONCLUSION We conclude that midazolam is as effective as fentanyl in prolonging the durations of both sensory block and analgesia with less side effects.