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.

Laboratory Diagnosis of COVID-19 Infection: Current Issues and Challenges: An Indian Perspective

COVID-19, a disease caused by SARS-CoV-2 has become a public health emergency affecting morethan 215 countries worldwide. It originated from Wuhan district of China and in a very short span of time, it has spread rapidlycausing millions of deaths worldwide. India reported its first case on 30thJanuary 2020 and since then the numbers have been increasing exponentially every day. As of 9thAugust 2020, India had recorded 21, 09,631 confirmed cases and 43,379 deaths. Because of the complex dynamics involved in its infection and immunity, proper diagnosis is imperative in order to unravel this ongoing mystery. It has clearly told us the importance of establishing and strengthening a strong network of molecular virology laboratories in the country enabling us to strengthen the diagnostic arm which is the first step in disease control. The addition of serological tests has helped in surveillance and also to estimate the overall burden of disease.