Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Study of Serum Selenium Levels in Schizophrenic Patients.

Deficiency and excess amount of trace elements play an important role in several well recognized diseases, studies are going on to establish their role in schizophrenia. Selenium and other trace elements are indispensable components for certain enzymes responsible for various metabolic processes in different tissues including the brain as they play important functional roles in peripheral and central nervous systems. Objectives: In this study, we examined the levels of selenium in serum of patients of schizophrenia and compare them with normal healthy controls. Selenium was also measured in acute and chronic stage of schizophrenia categorized on the basis of PANSS score and correlated by Spearman’s Correlation Coefficient (ρ) in total cases, acute cases and chronic cases. Method: The study population comprised 150 patients and 150 age matched controls. We measured levels of Selenium by AAS (Atomic Absorption Spectrophotometer). Results: We found that selenium levels were significantly lower in patients with schizophrenia than in the control group. The levels of micronutrients studied were also correlated with disease severity and duration but found non-significant relation. Conclusion: Evaluation of selenium levels in patients with schizophrenia could prove useful. There may be role of Selenium in the pathogenesis and course of Schizophrenia and new therapeutic approaches warrants further study.

In-vitro antidermatophytic activity of essential oil of Psidium guajava (Linn.).

Dermatophyte with the ability to digest keratine invade and therve on keratinized of human and animals. In the present study, the activity of essential oil of Psidium guajava (Linn.) was evaluated against four selected dermatophytes, namely Microsporiumcanis, Trichophytomruburum, T. verrucossum, T. tonsurans. Dermatophyteswere isolated with the infected skin, scalp, nail and genital organs of patients from districts hospital, Bareilly. Griseofulvin was used as a standard antifungal drug against the test dermatophytes. Oil was extracted through clevenger’s apparatus. Maximum inhibition zone was reported 69 mm against T. verrucossum followed by 60 mm Trichophytomruburum, 48 mm Trichophytomruburum and 45mm Microsporiumcanis. All five concentrations of oil showed excellent inhibitory effect against all test dermatophytes as compared to standard antifungal used.

Role of arbuscular mycorrhiza fungi on tolerance to salinity of the tree legume Albizia lebbeck (L.) inoculated by Rhizobium.

Myrica esculenta (Myricaceae) and Syzygium cumini(Myrtaceae), the Indian traditional fruits The effect of different level of salinity on growth, nodulation and Nitrogen fixation of single and dual inoculated tree legumes which help arbascular mycorrhizal fungi (AMF) Acaulospora laevis Gerd. and Trappe with Rhizobium bacteria in the presence of different levels of salinity (concentration of NaCl) conducted in earthen pots in a completely randomized block design with three replications resulted in effective plant growth, shoot and root biomasses, nodulation and N2 fixation. The effect of different levels of salinity (concentration of NaCl) on growth, nodulation and N2 fixation of single (Rhizobium or AMF alone) and dual inoculated (Rhizobium + AMF ) tree legume has a pot culture experiment using The parameter growth , nodulation, nitrogen fixation and % AMF colonization of roots were considerable influenced with the increase in salt concentration from 0.5 % to 4.0 % NaCl. It was observed that the mycorrhizal tree legume (inoculated with the most preferred AMF Acaulospora laevis) performed better in the increasing levels of salinity in comparison to non-mycorrhozal ones. These investigations suggested a protective role play by AMF in providing resistance to the tree legume against injurious effects of salinity. Inoculation of efficient strain of AMF (Acaulospora laevis) during the course of study, prevented the injurious effects of salinity in the test plants due to enhanced water and sustainable nutrient uptake thereby promoting growth, nodulation and biogeochemical N2 cycle (fixation of nitrogen) of the tree legume under investigation.

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.