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.

OCCURRENCE OF PHYTOPLANKTON OF SOME ESTUARIES FROM RATNAGIRI DISTRICT DURING RAINY SEASON

Occurrence, diversity and density of phytoplankton were recorded in five estuaries from Ratnagiri district of Maharashtra during rainy season. A total of 104 phytoplankton species belonging four division, viz, Cyanophyceae (11), Chlorophyceae (7), Dinophyceae (3) and Bacillariophyceae (83) were reported in the present study. Species diversity and density was recorded highest at Ranpar estuary and from Bacillariophyceae it was greater than other divisions. Diversity index is very high due to number of contributing species. He result concluded that the selected estuaries are more fertile with rich phytoplankton productivity.

Challenges of Second-hand Smoke: Are We Asking the Right Questions?

Second-hand tobacco smoke as defined by WHO is the smoke emitted by a smoker or released from a burnt cigarette or any tobacco product. It is highly prevalent all over the globe but its serious health implications are often neglected by the public and the scientific community alike. Second-hand smoke has everlasting impact on all the body’s major organs, especially among the vulnerable population of children, pregnant ladies, people with chronic diseases and senior citizens. Although India started its war against this menace earlier than other counties, all its efforts remain bootless as its approach and implementation have a wide range of lacunae. This review aims to give a big picture of second-hand smoke, highlighting its pathophysiological changes in the body, socioeconomic impact, various strategies, and the gap that prevents these strategies from finding a favorable result in India. It becomes all the more important to reduce its impact owing to the increase in prevalence among youth reducing their vitality, derailing the society and the nation. It is recommended that the health authorities approach this health problem with utmost seriousness as a laid-back approach could welcome this silent killer’s known and unknown repercussions

Unraveling Prostaglandin and NLRP3 Inflammasomemediated Pathways of Primary Dysmenorrhea and the Role of Mefenamic Acid and Its Combinations

Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1?. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial

Background: There is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC). Objective: To compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC. Study design: Open-labelled randomized controlled trial Participants: Children aged 1-14 years with newly diagnosed active neurocysticercosis. Intervention: Albendazole (15 mg/kg/day) for either 14 days or 28 days. Outcome: The primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging. Results: 65 children with newly diagnosed NCC were randomized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51-16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59-5.99); P=0.39] were also comparable. There were no major side-effects noted during the study. Conclusion: 14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up

Perspectives of women on availing antenatal services in urban poor areas of Rishikesh, Uttarakhand

BACKGROUND Antenatal care (ANC) is the essential regular care of women that prevents potential health problems during pregnancy. In India, the proportion of women who received four or more antenatal visits was only 51% (National Family Health Survey, 2015–2016). An even worse situation prevails in urban areas where women from poor communities face greater health risks. We assessed various barriers women residing in these areas come across in availing ANC services. METHODS This study is a part of a mixed-methods, community-based study, and we report its qualitative component. We conducted the study at the residence of the study participants in September–October 2019. The study participants were women who had less than four antenatal visits throughout the pregnancy. Twelve in-depth interviews were conducted based on data saturation. Data were transcribed and themes were drawn concerning the gender analysis framework. RESULTS Through this study, we found how gender relations affect the utilization of antenatal services concerning access to resources, division of labour, social norms including the belief of husband and other family members towards pregnancy and decision-making power of women. CONCLUSION Our findings underline the importance of making the urban health system gender-sensitive and responsive to the needs of women during pregnancy. There is a need to educate men regarding maternal health so as to allay such social norms that label pregnancy as a woman’s responsibility and encouraging them to accompany their wives during pregnancy visits, thus making men a part of antenatal services.

Burden of COVID-19: DALY and Productivity Loss for Karnataka, India

Background: COVID?19 is a pandemic that is devastating the world right now quelling over 2.5 million people worldwide. Similarly, in India and its largest southern state Karnataka, the coronavirus is responsible for around 161,000 and 12,449 deaths, respectively. These numbers capture the havoc caused by this novel coronavirus, but fail to discern the complete picture. Objectives: Broadly, this study aimed to study the mortality, morbidity, and the economic issues inflicted by the COVID?19 in the state of Karnataka. Specifically, the study used publically available epidemiological data to study both mortality and morbidity by means of disability?adjusted life years(DALYs). Furthermore, the study aimed at estimating the permanent losses to the state gross domestic product (SGDP) due to the pandemic. Materials and Methods: Publicly available epidemiological data are used from selected sources and DALYs are computed. The permanent loss to the SGDP is estimated using the human capital approach. Results: The total DALYs for Karnataka are computed to be 22,506 of which 22,041 correspond to mortality and remaining correspond to morbidity. Financially, Karnataka lost around 208 years of productive years of lives costing around ?590 million rupees to the SGDP. Conclusions: It is found that major burden of COVID?19 during study period is due to mortality. Morbidity accounts for around 2% of the total DALYs. Males are the most affected by the mortality and also the morbidity. With respect to loss in productivity, the losses due to premature mortality of COVID-19 amounted to ?590 million.

PHYSICAL AND FINANCIAL PERFORMANCE OF PUBLIC, PRIVATE AND FOREIGN BANKS IN INDIA

Banks are the fundamental components of the financial system and are also active players in the financial markets. Therefore an efficient banking system is needed in mobilizing the savings and channeling them to productive purposes for the development of any economy. This paper attempts to analyze and compare the physical and financial performance of three banking sectors: Public, Private and Foreign banks using physical and financial quantities of inputs and comparing the revenue maximization of banks during 2009-10 to 2018-19

Factors contributing to falls and the effect of a multipronged approach on the incidence of falls in the older person in an outpatient setting in South India

Background: A fall is an important predictor of morbidity and mortality in an older adult. Objectives: The aim of this study was to enumerate the various factors contributing to falls and assess the effect of a multipronged approach on the incidence of falls in older individuals who are at a risk of falls. Methodology: In this prospective interventional trial, we recruited sixty subjects, who presented to the Geriatrics Outpatient department of a tertiary care hospital in South India. Using the Stop elderly accidents, deaths, and injuries protocol, we included subjects who presented with a history of fall in the year preceding the study, those with fear of fall and those who felt unsteady while standing or walking. These subjects were subjected to a detailed assessment and an individualized multipronged interventional program was initiated. The subjects were followed up telephonically after 1 and 3 months to assess compliance and the details of incident fall (if any). Results: At baseline, 48.3% had fallen in the year prior to enrolment, of whom 16.7% were recurrent fallers. Various contributory factors for falls were identified ? including older age, polypharmacy, sedatives, and anticholinergic drugs. Following a multipronged intervention, 3.6% and 5.3% of the subjects reported falls after 1 and 3 months, respectively. Subjective improvement was reported by 80% and 78.2% of the subjects at 1 and 3 months’ follow-up and the compliance with exercises during the follow-up period was good (73%). Conclusion: Identifying the subjects at risk for falls and implementing a tailored approach contributed to a reduction in the incidence of falls

Review on Vaidyaka Paribhasha Pradipa- A Comprehensive Treatise of Indian Pharmaceuticals by Govind Sen

Vaidyaka Paribhasha Pradipa was written by Govind Sen, son of Krishna Vallabh Sen. Vidyotini Hindi Tika was written by Indradev Tripathi. The book Vaidyaka Paribhasha Pradipa consists of almost all references collected from various Samhitas regarding the fundamental principles and different Ayurvedic herbal pharmaceutical preparations and descriptions on Panchakarma. The whole content of the book is divided into 4 Khandas. Prathama khanda deals with Mana paribhasha, Dravya samgrahana vidhi, and shelf life of different Kalpana etc. Dwitiya khanda deals with Panchavidha kashaya kalpana and its Upakalpana and dose. Tritiya khanda deals with Sneha kalpana, Sandhana kalpana and Paribhasha of different Gana. Chaturtha khanda deals with Panchakarma procedures and Sneha murchana. The present book review mainly focuses to highlight the framework of Vaidyaka Paribhasha Pradipa, provides information about the author, details of 4 Khandas, a special contribution to the field of pharmaceutical science by the author. Thus, Vaidyaka Paribhasha Pradipa, the compilation book on Bhaishajya Kalpana is a very essential and mandatory book for those who aspire to gain basic, clear, and thorough knowledge in Ayurvedic pharmaceuticals. It is one of the indispensable reference books. The present book is designed to help the young practitioners who prepare medicines and graduates and post-graduate scholars get a clear idea of medicine preparation.

Expert survey on management of prostate cancer in India: Real?world insights into practice patterns

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State

Purpose: To estimate prevalence of common ocular morbidities including color blindness among school?attending children of an urban foothill town of Uttarakhand State in Northern India. Methods: A cross?sectional study was conducted among school?going children of age group 6–16 years of standard I– XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05. Results: In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7–2.9) (P < 0.001). Conclusion: Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect

Acute motor axonal neuropathy following anti-rabies human diploid cell vaccine: A rare case and review

Rationale: Guillain Barre syndrome (GBS) is an acute neurological illness leading to quadriparesis with respiratory involvement. It can be triggered by infections, vaccinations, surgery, trauma, transplantation and drugs. Anti-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine, can be very rarely associated with GBS. Patient concerns: A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for rabies. Diagnosis: Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell vaccine. Interventions: Intravenous high dose steroids. Outcomes: Patient recovered completely within 1 month. Lessons: Although anti-rabies cell culture vaccines are highly immunogenic and safe, they are rarely associated with GBS. Clinicians should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.

Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth

Background: Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. Aim: The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. Settings and Design: This was an in vitro study. Materials and Methods: Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. Statistical Analysis: Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. Results: A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). Conclusion: Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.

Clinical Study of Risk Factors for Diabetic Maculopathy

Aim:To determine the association between various systemic risk factors with diabetic maculopathy. Methodology:A prospective observational study was conducted on 50 patients having diabetic maculopathy. Patients with maculopathies secondary to Vitreous Haemorrhage, Ocular disorders like Glaucoma, Uveitis, Advanced Diabetic Eye Disease, Vitreo-macular traction, maculopathy along with proliferative diabetic retinopathy, ischemic maculopathy, and history of laser treatment in last six months were excluded from the study. Data was collected using a structured proforma that included name, age, sex, occupation, height, weight, history of other systemic diseases like hypertension, investigations and treatment taken in past, family history, duration of DM, smoking, hyperlipidemia, hyperglycemia and nephropathy. Results:Out of 50 patients, 38 (76%) were males and 12 (24%) were females suggestive of male predominance. Mean age of the patient was 57.36±11.65 years in males and 56.67±10.17 years in females. Among 50 patients, 19 patients had diabetes mellitus for 6-10 years duration, 14 patients had diabetes mellitus for 1-5 years, in 12 patients for 11-15 years, in 2 patients for 16-20 years, in 2 patients for 21-25 years and only 1 patient more than 25 years. Mean duration of DM was 12.2±6.1 years. Majority of patients having maculopathy had duration of DM up to 20 years. Among 50 patients, 27 patients (54%) had systemic hypertension, 37 patients (74%) had uncontrolled blood sugar level, 29 patients (58%) were found to have hyperlipidemia and 20 patients (40%) had nephropathy. Among 50 patients, pseudophakia was noted in 7 patients (14%), obesity was noted in 21patients (42%). Eleven patients (22%) were found to have anemia, 6 patients (12%) had family history of DM and 13 patients (26%) had history of smoking. Conclusion: Hyperglycemia, hypertension, duration of DM, hyperlipidemia are the major risk factors for the development and progression of diabetic maculopathy. While anemia, smoking, obesity and family history of DM is the less signi?cant risk factors

Intervention on depression and insomnia symptoms during the COVID-19 pandemic

Objectives: The COVID-19 pandemic has created significant psychological challenges globally. Evidence has been mounting of greater emotional distress and possible worsening of underlying psychiatric disorders, due to repercussions of COVID-19. In addition, the pandemic has created barriers to access for help, due to social distancing and travel restrictions. Thus, creating a major need for effective interventions that can be accessed safely from home and provide coping tools which can be learned and practiced while in isolation. An App based Yoga of Immortals (YOI) program is one such strategy to help cope with stressful situations. The objective of this study was to investigate if the YOI program can provide significant benefit for depressive and insomnia symptoms. Material and Methods: Participants in this study were asked to complete two brief online but well validated mental health screening tools before intervention. This was followed by a 7-week long YOI intervention. Following the intervention, participants were once again asked to complete the online validated questionnaires. The survey questionnaires included baseline demographic data and validated scales for measuring insomnia severity Insomnia severity Index (ISI) and levels of depression symptoms patient health questionnaire-8, (PHQ-8). All statistical analysis was performed using the Statistical Package for the Social Science. Results: SY YOI intervention of 7 weeks significantly improved the ISI scores as well as PHQ-8 scores in the study population (P < 0.0001 in all comparisons). Conclusion: YOI intervention is an effective intervention strategy for decreasing insomnia and depression symptoms, even during the pandemic

Material in Maxillofacial Prosthodontics - A Review

As there is an increase in the rate of oral cancer, the surge for the various maxillofacial materials is increasing as well. Materials used for rehabilitation of congenital or acquired defects of patients should fulfil the requirements such as function, longevity, and aesthetics. Defects of face which may be congenital or acquired makes the condition of the affected person very disastrous mentally, physically as well as emotionally. Patient wants facial rehabilitation for a healthy happy life. To provide rehabilitation of these patients, re-evaluation of materials used in the field of maxillofacial prosthesis seems essential. Maxillofacial material should best suit the ideal selection criteria to satisfy the functionality, biocompatibility, aesthetics as well as durability. While the new materials have exhibited many desirable properties, there are also many insufficiencies involved in it. This article presents a systemic review of the evolution, current trends, and future requirements in maxillofacial materials for ensuring psychological well-being.In the recent years, a dramatic increase in the demand for prosthetic rehabilitation of patients with facial defects is seen. Increasing awareness of cancer is resulting in earlier diagnosis and treatment. Unfortunately, many of the surgical techniques are extensive and thus leave large defects that compromise not only function and aesthetics, but also psychosocial status of the patient. These problems require prompt rehabilitation with surgery or prosthetics.1 However, surgical reconstruction is often contraindicated in the presence of large defects or in high-risk patients. Prosthesis offers the advantage of quick, reversible and medically uncomplicated rehabilitation. In addition, the restoration may be readily removed to allow evaluation of the health of the underlying tissues. Historically, many types of materials have been used. Wood, wax metals, vulcanite and many types of plastics have been used as rigid materials while flexible ones like gelatin glycerine mixtures, latex and elastic plastics have also found some usefulness.2Presently, materials used for the maxillofacial prosthesis are vinyl plastics, polyurethane, silicone rubber and acrylic types.

Comparison of analgesic efficacy of intramuscular tramadol and pethidine in labour

Background: Labour pain is among the most severe pain experienced by women. It is unpleasant and distressing to the parturient. The objective of the study was to evaluate and compare the analgesic efficacy and adverse effects of intramuscular tramadol and pethidine in labour. Methods: The prospective study conducted in SDM College of Medical Sciences and Hospital, Department of OBG, from December 2013 to November 2014. The study was a study of the parturients admitted in the labour theatre. Written and informed consent was taken from all the patients enrolled in the study. One hundred parturient at term in active labour were randomly assigned to one of the two groups to receive intramuscularly either tramadol 100 mg or pethidine 75 mg. Results: Results were comparable in terms of maternal age, maternal weight and neonatal weight. Proportion of cases with satisfactory to good pain relief was 74% in the tramadol group and 78% in the pethidine group. Nausea and/or vomiting (12% versus 8%), fatigue (6% versus 4%) and drowsiness (8% versus 4%) were significantly high in the pethidine group than the tramadol group(p<0.05). The drugs used did not appear to influence the mode of delivery. Proportion of cases with non-reassuring foetal heart rate was high in the pethidine group. Meconium stained liquor was equally seen in both the groups and there were no incidence of neonatal respiratory depression in any of the groups.Conclusion: Tramadol is an equally effective labour analgesic as pethidine with less maternal and perinatal side effects.

Poly Ether Ether Ketone (PEEK) Applications in Prosthodontics - A Review Peek into PEEK at Peak

Life is becoming more convenient as advancement in materials has been taking place since the beginning of human history. The increased demand of aesthetics in day to day life and on the other hand disadvantages of the existing materials, clinicians are shifting their paradigms towards metal free restorations. Various researches are going on to identify the ideal restorative material with all the improved mechanical and physical qualities. Advances in the field of dental materials are providing promising results but each material is falling short of being an ideal one. One such material is biomaterials. Biomaterials are mainly used in medical sciences to replace or augment a natural function. Biomaterials are widely used in dentistry, they are divided into four categories metal, composites, polymer and resins. Biomaterials are considered as materials which replace the defects by either replacements or repair. Presently Poly-Ether Ether Ketone (PEEK) is a semi crystalline, synthetic, aromatic, thermoplastic material. Previously, it was used for industrial purposes but due to its excellent properties and biocompatibility, it has been used in medicine and dentistry. There are various applications of PEEK in dentistry such as orthodontic wires and brackets which are made from it to achieve aesthetics and strength. In endodontics PEEK posts and PEEK endocrowns are used when extensive tooth structure loss occurs, even due to its aesthetic property, it is used for anterior restorations. PEEK is a synthetic polymer and is greyish in colour which has a monomer unit of ether ether ketone. In prosthodontics, aesthetics plays an important role. Therefore, PEEK is considered as an alternative option to conventional dental materials because of its aesthetics and it being a scientifically approved material. In prosthodontics, it can be used in removable partial dentures, fixed partial dentures, dental implants and abutments, implant crowns as well as for restoring the maxillofacial defects. This review article describes the various applications of PEEK in prosthodontics in detail.