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.

A study of retinal changes in women with polycystic ovarian syndrome

Purpose: To compare the optical coherence tomography (OCT)?based retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness at the posterior pole, and total macular thickness of women with the polycystic ovarian syndrome (PCOS) versus healthy reproductive age group females. Methods: The study included 110 eyes of 55 diagnosed cases of PCOS (study group) and 110 eyes of 55 healthy reproductive age group (15–49 years) females (control group). All patients underwent a detailed ophthalmological evaluation followed by an OCT to measure their retinal thicknesses. The body mass index (BMI) of patients was noted and compared with the retinal thickness. Also, the lipid profile and serum testosterone levels of PCOS patients were recorded. Results: The retinal thicknesses in the two study were similar and there was no statistically significant difference. However, on stratification with BMI, it was seen that in patients with BMI>30 kg/m2, the superior Retinal Nerve Fibre Layer (RNFL) was significantly thicker in the PCOS group as compared with the control group (P = 0.0006). The mean serum testosterone level in patients with PCOS was 141.3 ± 23.2. Also, 65.45% of patients had a serum testosterone level of more than 70 ng/dL. The mean HDL cholesterol in patients with PCOS was 38.1 ± 15.6. The mean LDL cholesterol in PCOS patients was 98.4 ± 21.7, and the mean total cholesterol in PCOS patients was 153.6 ± 27.3. Conclusion: Androgens have a trophic action on nerves, which could explain the increased RNFL thickness in these patients.

Prospective study of clinical profile of acute ischemic stroke in a tertiary care hospital of North India

Background: Owing to the recent demographic shifts and negative lifestyle changes, stroke is one of the leading causes of mortality across every income group in most of the countries. It is of the utmost importance to devolve into the clinical profile, etiology and management of patients with acute ischaemic stroke.Methods: It is a prospective case control study. Data was collected using a pre-tested pro forma meeting the objectives of the study. Patients who consented were divided into two groups and complete examination and investigations were carried out.Results: There were 94 patients with AIS enrolled for the study. The mean age was 56.2 years, of which 68.08% were males and 31.92% were females. The mean time for these patients to reach the health facility was 12.6 hours and only 36.17% of patients reached in the window period of 4.5 hours and were eligible for thrombolysis. Hypertension, Diabetes and smoking were the most common risk factors in this order among others.Conclusions: There is poor awareness regarding identification of stroke related symptoms and warning signs as majority of patients were unable to reach the hospital in the window period making them ineligible for thrombolysis. The leading etiology runs in the direction of modifiable risk factors which can be corrected at a primary prevention level.

An Overview of Buckwheat Fagopyrum spp An Underutilized Crop in India-Nutritional Value and Health Benefits

Buckwheat is one of the pseudocereals grown annually in hilly regions of India. It belongs to the family Polygonaceae and genus (Fagopyrum spp.) Buckwheat is adaptable to extreme cold temperatures, stress conditions of water, less soil fertility and varying climatic conditions, making it a sustainable crop. A literature search on Buckwheat was done using PubMed and Google search engines and reviewed to prepare an overview of its cultivation, nutritional and health value. In India, twenty species of Buckwheat are cultivated across various hilly regions. Out of these only nine species have desirable nutritional value and two are commonly grown. They are Fagopyrum esculentum Moench (Common buckwheat) and Fagopyrum tataricum (Tartary buckwheat). However, the cultivation of Buckwheat has declined in the 20th century making it an underutilized crop. Buckwheat has good amount of nutrients and many health benefits. There is a need to research about this under-utilized crop and create awareness as this crop has many nutritional and health benefits.

Management and therapeutic implications of combined protein C and S deficiency in pregnancy: a case report

The pregnancy is an immunocompromised state. Thus, autoimmune diseases may affect pregnancy and get worsen during pregnancy. Here authors discuss a rare autoimmune thrombophilia disorder, protein C and S deficiency which may cause recurrent pregnancy losses by affecting haemostatic mechanisms in the body. This patient with recurrent pregnancy loss when evaluated extensively was found to have combined inherited protein C and S deficiency. It was successfully managed with thromboprophylaxis therapy, which resulted in the delivery of healthy baby. Long term anticoagulant prophylaxis should be considered weighing the risk of bleeding to thrombotic recurrence in such cases. In conclusion, combined protein C and S deficiency and that too presenting as recurrent pregnancy loss is very rare. Thrombophilia screening should be considered in cases of recurrent pregnancy losses. Adequate and appropriate thromboprophylaxis is an important part of the management of pregnant women with inherited thrombophilia.

46XX pure gonadal dysgenesis with dysgerminoma along with leydig cells: a unique presentation

Authors report a unique case of 46XX gonadal dysgenesis, with dysgerminoma in one ovary and other streak ovary with hilar nests of leydig cells. It is exceptionally rare to find dysgerminoma in a dysgenetic gonad with no Y chromosome and so is the presence of leydig cells in the contralateral streak ovary in a patient with 46XX pure gonadal dysgenesis.

A prospective study of cervical lesions diagnosed by liquid based cytology in Western Rajasthan, India population

Background: Carcinoma cervix is the second most common malignancy of women in India after breast cancer. The present study was conducted to determine the spectrum of cervical lesions by liquid-based cytology in Western Rajasthan population.Methods: It is a Prospective study on 1087 cervical samples carried over a period of 1 year. Cervical samples were taken and processed by SurePath™ LBC.Results: Of total 1087 cases 959 were negative for intraepithelial lesion or malignancy (88.22%). 88 cases (8.09%) were reported as unsatisfactory. Among the non- neoplastic cases- bacterial vaginosis was reported in 209 cases (21.8%), Candida in 77 cases (8.02%), both Candida and bacterial vaginosis in 12 cases (1.25%), reactive cellular changes in 193 cases (20.12%), and Trichomonas vaginalis in 01 case. Among pre-malignant and malignant lesions, 40 cases (4.17%) the distribution was as follows-atypical squamous cells of undetermined significance 16(1.67%), atypical squamous cell-cannot rule out high grade 08 cases (0.83%), Low grade squamous intraepithelial lesion 04 cases (0.42%), high grade squamous intraepithelial lesion 07 cases (0.73%), Atypical glandular cell favoring neoplastic 01 case (0.15%), and squamous cell carcinoma 04 cases (0.42%). Histopathological co-relation of premalignant and malignant lesions was further studied.Conclusions: Liquid based cytology is an effective screening and diagnostic procedure for cervical abnormalities. Among pre-malignant and malignant lesions, histo-pathological correlation increased with increased grade of severity of lesions. To the best of knowledge, this is the largest study of liquid based cytology in the Western Rajasthan.

The perplexity of malignant ovarian mass in cystadenofibroma: a lesson learnt

The aim of this study is to report a rare case of ovarian cystadenofibroma with even scarcely observed mucinous type histopathological variant and to discuss the modalities which can contribute to prevent misdiagnosing it as a malignant tumor that may inappropriately lead to aggressive surgical interventions. A 40-year-old female presented with pain in lower abdomen and dysmenorrhea of 3 months duration and a large right adnexal mass which had all the features suggestive of malignancy in pre-operative investigations and even on gross overview and cut section. On the contrary histopathology reports confirmed its benign nature and reported it as mucinous cystadenofibroma. Role of Preoperative MRI and intraoperative frozen section cannot be overemphasized in distinguishing ovarian cystadenofibroma from malignant tumors, which can avoid an unnecessary extensive surgery.

Morpheaform Basal Cell Carcinoma: A Case Report with Review of Literature

Basal cell carcinoma (BCC) is the most frequently occurring skin cancer. Most cases are not life threatening, as very small proportions of BCCs metastasise. However, a high tendency to recurrence makes characterising BCCs and tumour margin areas obligatory. It will assist in better understanding their pathogenesis and in more effective treatment through prevention of recurrence and second primary disease. Various morphological subtypes have been described, nodular BCC being the most common type. Morpheaform or sclerosing BCC is a rare but high risk variant of BCC. One such case of Morpheaform, BCC in a 30-year old female patient is reported here to emphasise the nature and early diagnosis of this malignancy.

Analysis of expression profile of mce operon genes (mce1, mce2, mce3 operon) in different Mycobacterium tuberculosis isolates at different growth phases.

Background & objectives: Mycobacterium tuberculosis (M. tuberculosis) has four homologous mammalian cell entry (mce) operons (mce1-4) that encode exported proteins and have a possible role in the virulence mechanism of this pathogen. The expression of mce operon is considered to be complex and not completely understood. Although expression of mce operon at different in vitro growth phases has been studied earlier, its expression in different M. tuberculosis isolates under different growth phases is not yet studied. The present preliminary study was conducted on a limited number of isolates to know the trend of expression pattern of mce operon genes in different M. tuberculosis isolates under different growth stages. Methods: In this study, we monitored the transcriptional profile of selected mce operon genes (mce1A, mce1D, mce2A, mce2D, mce3A, mce3C) in different M.tuberculosis isolates (MDR1, MDR2, and sensitive isolate) at early exponential and stationary phases using real-time quantitative PCR. Results: The expression ratio of all selected mce operon genes in all M. tuberculosis isolates was reduced at the initial phase and increased substantially at a later phase of growth. Higher expression of mce1 operon genes was found in all M. tuberculosis isolates as compared to other mce operon genes (mce2 and mce3 operons) at stationary growth phase. Interpretation & conclusions: The higher expression of mce operon genes at stationary phase (as compared to early exponential phase) suggested growth phase dependent expression of mce operon genes. This indicated that the mce operon genes might have a role in M. tuberculosis survival and adaptation on the onset of adverse condition like stationary phase. Identification of differentially expressed genes will add to our understanding of the bacilli involved in adaptation to different growth conditions.

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences.

Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Influence of APOA5 (rs662799 and rs3135506) gene polymorphism in acute myocardial infarction patients and its association with basic coronary artery disease risk factors.

The aim of this study was to examine the allele and genotype of APOA5 -1131T/C (rs662799) and APOA5-56C/G (rs3135506) gene in acute myocardial (AMI) case and control subjects. 304 case and 304 controls were enrolled in this study. DNA was extracted using salting out method followed by polymerase chain reaction amplification and restriction endonuclease digestion (using MseI for -1131T/C and Taq1 for -56C/G). Digested PCR products were identified using agarose gel electrophoresis and stained with ethidium bromide. There was a strong association between APOA5 -1131T/C (TC vs. TT, OR= 1.58 and CC vs. TT OR= 2.43) and APOA5 -56C/G (CG vs. CC, OR= 1.64 and GG vs. CC, OR= 2.44) polymorphisms with AMI. Out of the six potential risk factors for coronary artery disease, only smoking, diabetes and hypertension were found to be associated with APOA5 gene and increased the risk of AMI. Smoking was the most prominent risk factor for both the genes. Other risk factors like history of dyslipidemia, obesity and family history of coronary artery disease did not reveal any potential association with the candidate gene. Our data demonstrate that both the SNPs in the APOA5 gene (-1131T/C, and -56C/G) were strongly associated with AMI in north Indian population.

Hantavirus Pulmonary Syndrome (HPS): A Concise Review based on Current Knowledge and Emerging Concept.

Hantaviruses are rodent-borne bunyaviruses transmitted from the rodents. Today numerous rodent species are carrying hantaviruses throughout the world. These group of viruses can cause one of two types of viral hemorrhagic fever (VHF) in human beings namely hemorrhagic fever with renal syndrome (HFRS), and hantavirus pulmonary syndrome (HPS). In the spring of 1993, an unknown group of hantaviruses emerged in the United States as the cause of an acute respiratory disease currently termed as Hantavirus pulmonary symdrome (HPS), also referred to as hantavirus cardiopulmonary syndrome (HCPS). HPS is characterized by an acute onset of headache, fever, hypovolemic hypotension, myalgia and respiratory failure. This review covers the distribution, virology, epidemiology, pathophysiology, symptoms, treatment and prevention of hantavirus causing HPS/HCPS.

Ameliorative effects of Panax quinquefolium on experimentally induced reflux oesophagitis in rats.

Background & objectives: Reflux oesophagitis (RE), is one of the most prevalent chronic gastrointestinal disorders commonly referred to as gastroesophageal reflux disease (GERD) and requires long term therapy. The present study was designed to investigate the protective effects of Panax quinquefolium (PQ), administered with variable doses, on experimentally induced reflux oesophagitis (RE) in rats. Methods: Forty two female Sprague-Dawley (180-220 g) rats were randomly divided to receive standardized root powder of PQ (50-200mg/kg, po), standard anti-reflux (omeprazole, 5 mg/kg, ip) and anti-oxidant (α-tocopherol, 16 mg/kg, po). After 45 min drug pretreatment, RE was produced in rats by simultaneous ligation of the pyloric end and forestomach. Several parameters, including macroscopic lesion index, glutathione system, lipid peroxidation (LPO) and tissue myeloperoxidase (MPO) activity were measured. Alterations in ICAM-1, CINC-2 and MCP-1 gene expression were examined through reverse transcriptase polymerase chain reaction (RT-PCR). Results: PQ significantly attenuated the severity of the macroscopic signs of RE-induced tissue damage, replenished the depleted GSH level and reduced the RE-associated LPO levels dose dependently. In contrast, omeprazole though effectively improved the mucosal damage, it failed to bring significant attenuation of RE-associated changes in LPO, GSH level and MPO activity. α-Tocopherol significantly ameliorated RE-induced tissue injury and improved LPO level and GSH/GSSG ratio but failed to counteract RE-induced MPO activity. PQ at dose of 100 mg/kg significantly downregulated ICAM-1 and CINC-2 expression whereas it showed no effect over MCP-1 expression. Interpretation & conclusions: The present data indicate that PQ protects against RE-induced oesophageal damage via a mechanism that inhibits the influx of inflammatory cell to oesophagus and a consequence excessive oxidative load, opening the avenue to its promising protective role in patients with gastroesophageal reflux disease (GERD).

Verbal Learning & Memory Function among Children with ADHD and Emotional Disorders.

Memory function and learning process are commonly observed impaired among children with Attention Deficit Hyperactive Disorder (ADHD). However, children with Emotional Disorders (ED) too report inability to attend, register and recall the stimuli that eventually result in poor academic performance. The present study aimed to study the nature of impairment in verbal learning and memory function among children with ADHD and ED. The study further aimed to explore the effect of severity of illnesses over the degree of impairment in verbal learning and memory function in both the groups. Twenty children meeting the ICD-10 criteria for ADHD and twenty children meeting the ICD-10 criteria under F-93 for Emotional Disorders (ED) were assessed on the measure of verbal learning & memory and compared with twenty age and education matched normal control group. Children with ADHD and ED performed poorly on the measure of verbal learning and memory in comparison of normal control, but the degree of impairment was observed relatively higher among ADHD children than children with ED. However, severity of illness was not observed a contributory factor for the impairment in verbal learning and memory function in both the groups. Impairment in verbal learning and memory function is not confined only to the children with ADHD but these are now recognizable among children with Emotional Disorders too. Both the groups (Children with ADHD and ED) reflected impaired memory and learning function but in terms of degree of impairment the children with ADHD were always found standing towards higher side than children with emotional disorder.

Perceived Self Efficacy and Mental Health among Elderly.

Objectives: Perceived self-efficacy is a belief centers on appraisal vs. misappraisal of capabilities within the individual to produce designated level of performance. It mediates the relationship between functional decline, health condition and the need for formal care services. The present stduy aimed to study the impact of perceived self efficacy on mental health and to explore the predictor of mental health among elderly population. Method: The study consisted of 160 elderly respondents. Half of these were males and the other half females. They were further sub-divided into eight groups on the basis of their gender and age. Each of eight subgroups consisted of 20 respondents and assessed on the measures of Perceived Self Efficacy (PSE) and Mental Health i.e. General Health Questionnaire (GHQ). Results: The mean differences showed that the elderly males scored higher on the measure of PSE and GHQ and showed better meatal health than elderly females. Again the younger elderly groups scored higher on the measures of PSE and GHQ and reported better mental health than the elderly of advanced age groups. Conclusion: The present study revealed that the problem of elderly is emerging not only due to their increasing proportion of age but also due to their own faulty cognitions and perceptionof aging. Perceived self efficacy emerged as an imjportant predictor of mental health among elderly males and females i.e. elderly who perceive themselves self efficacious to have control over their environment reported better mental health and vice versa.

Removal of melanoidin present in distillery effluent as a major colorant: A Review.

Effluent originating from distilleries contain large amount of dark brown coloured wastewater called molasses spent wash (MSW). This MSW is the unwanted residual liquid waste to dispose because of low pH, high temperature, dark brown colour, high ash content, unpleasant odour and high percentage of organic and inorganic matter. Dark brown colour of MSW is due to the presence of melanoidin pigment. It reduces sunlight penetration in rivers and lakes which in turn decrease both photosynthetic activity and dissolved oxygen concentration affecting aquatic life. So the disposal of this effluent is one of the critical environmental issues. A number of treatment processes have been employed for the distillery waste management. This review paper present an overview of the pollution problems caused by melanoidin and the technologies employed globally for its removal.

Sequential anaerobic and aerobic treatment of pulp and paper mill effluent in pilot scale bioreactor.

In the present study sequential anaerobic and aerobic treatment in two step bioreactor was performed for removal of colour in the pulp and paper mill effluent. In anaerobic treatment, colour 50%, lignin 62%, COD 29%, absordable organic halides (AOX) 25% and phenol 29% were reduced in eight days. The anaerobically treated effluent was separately applied in bioreactor in presence of fungal strain, Paecilomyces sp., and bacterial strain, Microbrevis luteum. Data of study indicated reduction in colour 80%, AOX 74%, lignin 81%, COD 93% and phenol 76 per cent by Paecilomyces sp. where as Microbrevis luteum showed removal in colour 59%, lignin 71%, COD 86%, AOX 84% and phenol 88% by day third when 7 days anaerobically treated effluent was further treated by aerobic microorganisms. Change in pH of the effluent and increase in biomass of microorganism's substantiated results of the study, which was concomitant to the treatment method.