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.

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

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.

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 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

Socio economic differentials in utilization of maternal health care services: A study in urban slums of District Dehradun.

Background: Health inequity is becoming an emerging issue all over the world. Improving maternal health is one of the UN Millennium Development goals. Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facility. Objective: To study the socio economic profile of the mothers and to study the differentials in utilization of maternal health care by the beneficiaries. Study Design: Descriptive, observational cross-sectional field based study in two purposively selected urban slums of district Dehradun. Results: About 70.9% of mothers belonged to social class II and III and 66% of them belonged to nuclear families. Teenage pregnancy was seen in 8.5%. 93.8% of women received complete antenatal care, majority preferring government hospitals. 93.2% of the women received 100 IFA tablets or more but only 63.7% consumed them for 100 days. Majority of the deliveries were institutional and 79.9% were conducted by trained personnel. About 68.5 % received postnatal care. Conclusion: Although usage of ANC service was high, opportunity to deliver important health services was not fully utilized. Policy and programme to improve the quality and care of antenatal mothers, especially for the poor and under privileged are essential to improve maternal health care. Special interventions should be undertaken on priority basis so as to achieve millennium developmental goals in all population groups.

Socio-Demographic Characteristics of Substance Abusers Among Intercollege Students in a District of Uttarakhand.

Substance abuse by children and adolescents is a major health problem. The use of illicit substances frequently starts among school children during adolescence. Concern with the use of harmful habit forming substances in students appears to be a very natural reaction; as they constitute a vital part of the society. Their age and often sudden wide exposure to new environments may render them extremely vulnerable for substance abuse. To find out the association of socio-demographic factors with substance abuse among intercollege students, a Cross-sectional study was conducted among intercollege students of district Dehradun. Multistage random sampling was used for the selection of two intercolleges (one rural and one urban). Overall 1094 students from 9th to 12th classes were included in the study. Statistical analysis was done by entering the data in SPSS software. The prevalence of substance abuse was found to be maximum in the students belonging to the middle slab of income group (socio-economic classes II, III and IV). Nonvegetarian dietary habits, Hindu religion and fathers in professional jobs were also found to be major risk factors for substance abuse behaviour among students.

Morbidity Profile of Elderly Persons

This cross-sectional study was conducted to know about the morbidity status of the geriatric population reporting at RHTC. A total of 285 elderly persons (>=60 yrs.) had reported at RHTC during the study period. All the subjects underwent personal interview and clinical examination. Hypertension was the commonest morbidity (41.4%) followed by musculoskeletal problems (36.8%) and respiratory problems (36.1%). The prevalence of psychosocial problems among patients was found to be 28.8 % (males-16.9%, females-48.1%). With the changing pattern of family, migration and other socio-demographic factors; there is a continuous rise in the health problems of elderly in developing countries. It makes a greater demand on the health services of a community.

Tobacco Addiction Amongst Adolescents in Rural Areas of District Wardha

The present study was conducted in order to find out the use of tobacco amongst adolescents in a village of Wardha district. From the total 2200 population covered, 474 (21.54%) were adolescents {boys 216 (45.57%) and girls 258 (54.43%)}. Majority of the adolescent boys and girls were from unitary family. About 152 boys (70.37%) were using tobacco and remaining boys were non-user of tobacco. About 70 girls were using tobacco and 188 were non-users. Majority of the boys were engaged in tobacco chewing and smoking (69.74% & 17.1% respectively), whereas majority of the girls were found to be practicing other methods of tobacco use (Nas / Mishri, etc.). The exposure of the habit of tobacco use in adolescent was influenced by various factors like peer pressure, friends, elders, boys trying to follow hero images, feel great and powerful when smoking and for fun.