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Background and Aims: Sepsis-induced immunosuppression appears to be reversible with immunomodulatory drugs. Mycobacterium indicus pranii (MIP) stimulates the Th1 type of immune response. This systematic review and meta-analysis of randomised controlled trials (RCTs) was aimed to find out if MIP is effective at improving clinical outcomes in sepsis patients. Methods: The databases (PubMed, Google Scholar, Web of Science, and Cochrane Library), along with preprint servers until June 2023, were searched. The methodology was evaluated using the 'Cochrane Collaboration risk of bias-2 tool' for RCT. The study included patients more than 18 years of age with sepsis within 48 h of first organ dysfunction. The primary outcome was 28-day mortality, and secondary outcomes were the length of stay in the intensive care unit (ICU), days on vasopressor support, ventilator-associated pneumonia (VAP), secondary infections, catheter-related bloodstream infections (CRBSI), and the delta sequential organ failure assessment (SOFA) score. Results: The meta-analysis included two studies with 252 participants. In a pooled analysis, mortality in the MIP group was 43% lower than in the control (RR: 0.57, 95%CI: 0.33–1); however, this difference was statistically not significant. We observed the days on a vasopressor day (standardised mean difference [SMD]: 0.38; 95%CI: −1.20 to 0.44), length of ICU stay (SMD: 0.46; 95%CI: −1.44 to 0.51), secondary infection (RR: 0.75; 95%CI: 0.19–3.01), VAP (RR: 0.6; 95%CI: 0.28–1.56), CRBSI (RR: 0.97, 95%CI: 0.14–6.98), delta SOFA score (SMD: 0.88, 95%CI: −1.66 to − 0.10) between the two groups. Conclusions: Our findings observed preliminary evidence in the trends for a positive association of MIP with better outcomes in sepsis patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative pain for patients having hip arthroplasty ranges from moderate to severe. Many regional anaesthesia procedures treat postoperative pain to improve functional ability and quality of life. Evidence comparing the analgesic effects of the pericapsular nerve group (PENG) block and fascia iliaca compartment block (FICB) remains unclear. The analgesic efficacies of PENG and FICB in hip arthroplasty were compared to determine which technique is associated with superior analgesia. Methods: The electronic databases (PubMed, Cochrane Library, Google Scholar and Web of Sciences) were searched for published randomised controlled trials (RCTs) till 5 April 2023 comparing PENG block vs. FICB following hip arthroplasty. The primary outcome was pain scores [numerical rating scale (NRS) or visual analogue scale (VAS)] between 0 and 10 at rest and during movement at 24 h. Secondary outcomes included pain scores at rest and during movement within 30 min, at 6 h and 12 h, time to first rescue analgesia and cumulative postoperative opioid use in 24 h. We assessed the risk of bias using the Cochrane Collaboration Risk-of-Bias 2 tool. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the certainty of the evidence was assessed. Subgroup analysis was performed to explore the source of heterogeneity. Results: We included 12 RCTs examining 644 patients. Pain scores at rest at 24 h (standardised mean differences (SMDs): 0.17; 95% confidence interval (CI): -0.90 to 1.23; P = 0.76, moderate certainty) and during movement at 24 h (SMD: -0.58, 95% CI: -1.53 to 0.38, P = 0.24, moderate certainty) were not different in both PENG block and FICB. Pain scores at rest and during movement within 30 min may be lower with PENG block than FICB. However, the pain score at rest and during movement at 6 h and the time to first rescue analgesia were not different between the two treatment arms. The mean opioid consumption in oral morphine equivalents (mg) in 24 h may be lower with PENG than FICB. Conclusion: We observed no difference between the PENG block and the FICB at 24 h for pain at rest and movement with a moderate degree of certainty. However, PENG block showed improved analgesia within 30 min at rest and during movement, and reduce postoperative opioid consumption in 24 h with moderate certainty of evidence. Further large-scale and high-quality RCTs are required to supplement the present findings. [ABSTRACT FROM AUTHOR]

Background: The incidence of postoperative nausea and vomiting (PONV) is quite high after laparoscopic surgeries. This study endeavors to compare the efficacy of the combination of palonosetron and dexamethasone with that of either drug alone in the prevention of PONV in patients undergoing laparoscopic surgeries. Methods: This randomized, parallel-group trial was done on ninety adults of American Society of Anesthesiologists Grade I and II patients aged 18–60 years undergoing laparoscopic surgeries under general anesthesia. The patients were randomly divided into three groups of thirty patients each. Group P (n = 30) received palonosetron 0.075 mg intravenously (iv), Group D (n = 30) received dexamethasone 8 mg iv and Group P + D (n = 30) received palonosetron 0.075 mg and dexamethasone 8 mg iv. The primary outcome was incidence of PONV in 24 h, and the secondary outcome was a number of rescue antiemetics required. To compare the proportions in the groups, unpaired t-test, Mann–Whitney U-test, Chi-square test, or Fisher's exact test was applied. Results: We found that the overall incidence of PONV was 46.7% in Group P, 50% in Group D, and 43.3% in Group P + D during the first 24 h. Rescue antiemetic was required in 27% of the patients in Group P and Group D compared to 23% of the patients in Group P + D and twice in 3% of the patients in Group P, 7% of the patients in Group D, and none in Group P + D which were not significant. Conclusions: The combination therapy of palonosetron plus dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone. [ABSTRACT FROM AUTHOR]

Background: Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration. The gold standard method for discriminating the causes of thrombocytopenia is bone marrow examination, but it is invasive and expensive. Therefore, an alternative method should be introduced as a first-line diagnostic procedure. Of late, the automated blood cell analyzer has made it possible to assess the cause of thrombocytopenia through various machine-derived parameters, known as platelet indices, which include the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are provided as a part of routine complete blood count. Objectives: The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia. Method: An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. The study group was classified into two groups: hypo-productive and hyper-destructive. Platelet indices were recorded and compared in the two groups along with the normal group. Results: The mean platelet count (10^3 µL) in the normal, hypo-productive, and hyper-destructive groups was 232.03 ± 74.84, 73.00 ± 36.52, and 68.28 ± 38.24, respectively. The MPV and mean PCT in the normal, hypo-productive, and hyper-destructive groups were 9.46 ± 1.68fL, 8.99 ± 1.49fL, and 11.35 ± 1.35fL and 0.22 ± 0.06%, 0.07 ± 0.04%, and 0.08 ± 0.05%, respectively. The mean PDW in the normal, hypo-productive, and hyper-destructive groups was 15.66 ± 1.76fL, 17.63 ± 1.01fL, and 18.32 ± 1.10fL, respectively. Conclusion: In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia. [ABSTRACT FROM AUTHOR]

Objective: Due to the lack of resources for culture and antibiotic susceptibility testing in most underdeveloped countries, puerperal sepsis is treated empirically with a wide range of antibiotics. Empirical treatment, on the other hand, does not ensure treatment effectiveness and may even contribute to antibiotic resistance. So, we studied cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity in a tertiary health center. Material and Methods: This was a cross-sectional study conducted at the obstetrics and gynecology department of a tertiary health center in India from April 2019 to September 2020. During this time, all patients with sepsis who met the criteria for inclusion were included. After granting an informed written consent, the subjects were registered on a pre-designed proforma. Results: There were 2,049 obstetrical admissions throughout this period, with 106 (5.1%) of these having puerperal sepsis. The majority of these women (58.7%) were between the ages of 21 and 30, were multiparous (96.5%), and unbooked. Fever 104 (98.1%) was the most prevalent clinical characteristic, whereas wound gape was the most common consequence (47.1%). Klebsiella aerogens was the most common organism found in various cultures. Many organisms were shown to be multidrug-resistant and sensitive to gentamycin and amikacin. Conclusion: Klebsiella aerogens wasthe most common cause of puerperal sepsis in this investigation. Because the causal agents of puerperal sepsis and their antibiotic sensitivity patterns change over time, positive blood culture and antibiotic susceptibility of the isolates are the best guides for selecting the optimum antimicrobial therapy for treating sepsis. [ABSTRACT FROM AUTHOR]

Anemia is the most common haematological disorder in pregnancy. Anemia increases maternal morbidity and mortality. It is a condition that can be diagnosed and treated during antenatal period, preventing the serious complications of anemia during pregnancy and labour. Aims: This study investigated the prevalence of types of anemia during pregnancy and fetomaternal outcomes among pregnant women. Study Design: This was a cross-sectional study that enrolled 1100 pregnant women who were in the third trimester of pregnancy with haemoglobin level <11.0 gm/dl between March 2019 and August 2020. Methods and Material: Participants were selected by consecutive sampling and baseline data were collected by using a predesigned and pretested structured questionnaire. Data Analysis: Data were entered and analysed by using SPSS version 20. Results: The prevalence of anemia in third-trimester pregnancy in this study was 91.05%. Iron deficiency anemia was most common (69.18%) among pregnant women followed by megaloblastic anemia (2.5%). Most of pregnant women (45.90%) were mildly anemic. Mean ± SD of haematological parameters among the anemic pregnant women during third trimester of pregnancy were haemoglobin (8.08±2.24 gm/dl), haematocrit (28.92±7.78%), mean corpuscular volume (MCV) (93.02±11.32fl), mean corpuscular haemoglobin (MCH) (26.03±2.90 pg), mean corpuscular haemoglobin concentration(MCHC) (27.99 ± 2.01 gm/dl), RBC count (3.05 ± 0.67million/mm3). Most common maternal complications due to anemia in pregnancy was preterm labour (30%). Fetal outcome in the form of an alive term, most commonly seen in mild anemia (34.7%), fetal complications like Preterm alive (11.3%), preterm intrauterine fetal death (IUFD) (2.7%) most commonly associated with severe anemia. Conclusion: The present study concludes that the prevalence of anemia among pregnant women in third trimester of pregnancy was 91.05% which is a serious public health problem. Proper counselling to the patients and their family members regarding cause of anemia, effect of anemia and complications of anemia. So, that such preventable condition can be prevented. [ABSTRACT FROM AUTHOR]

Background: Combined spinal and epidural anesthesia (CSEA) is commonly performed by double space technique (DST) and single space segment technique (SST) or needle-through-needle technique (NNT). Aims and Objectives: We designed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on time required by the procedure, the number of attempts, and a level of sensory, side effects and cost-effectiveness. Materials and Methods: Patients undergoing elective lower abdominal and lower limb surgeries under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 30) or the single-space technique (single group, n = 30). In the single group, the procedure was performed at the L3-4 interspace using the needle-through-needle technique. In the double group, an epidural catheter was inserted at the L1–2 interspace, and dural puncture was performed at the L3–4 interspace. Results: The single space (needle-through-needle) technique for CSE takes less time, less number of spinal punctures. There was no difference between the two groups in terms of side effects. Sensory level at T10 on 5 min in group I was 90% and group II was 100% whereas at T8 it was 10% in group I; sensory level at T10, T8 and T6 on 10 min. in group I were 53.3%, 43.3% and 3.3% respectively whereas in group II were 80%, 16.7% and 3.3% respectively; sensory level at T10, T8, T6 and T4 on 15 min. in group I were 6.7%, 43.3%, 50% and 0% respectively whereas in group II were 23.3%, 50%, 23.3% and 3.3% respectively; and sensory level at T4, T6 and T8 on 20 min. in group I were 0%, 73.3% and 26.7% respectively whereas in group II were 16.7%, 33.3% and 50% respectively. Conclusions: Single-space (needle-through-needle) CSEA takes less time, less number of spinal punctures and results in improved patient satisfaction. There were no differences in intraoperative variables between the DST and SST for CSEA. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 13-year-old male child with post-traumatic cervical epidural haematoma. The child presented with neck pain, weakness, and numbness in both upper limbs following a fall while playing. The patient underwent decompressive laminectomy and evacuation of the epidural haematoma under general anesthesia. The article highlights the concerns regarding positioning, airway management, pain management, and maintaining spinal perfusion pressure. The perioperative period was uneventful, and the patient was discharged with improved upper limb power. [Extracted from the article]

Background: The effect of perineural versus intravenous (i.v.) dexamethasone (4 mg) when added to levobupivacaine as an adjuvant has not been well studied. Aims: This study was conducted to compare the analgesic efficacy of perineural and i.v. dexamethasone as an adjuvant to levobupivacaine in infraclavicular brachial plexus (ICBP) block. Settings and Design: This was a prospective, randomized, double-blind study. Materials and Methods: This study was conducted on 68 patients with the ultrasound-guided ICBP block, randomly allocated into two groups (34 each). Four patients had failed block (2 in each group) that was excluded from the study. Group A received 25 mL of levobupivacaine 0.5% and 1 mL of normal saline for the block and i.v. dexamethasone 4 mg. Group B received 25 mL of levobupivacaine 0.5% with 4 mg of perineural dexamethasone for the block. Postoperative vitals and different block characteristics were assessed. Statistical Analysis Used: Student's independent sample t-test and Chi-square test were used for statistical analysis. Results: The duration of motor block and analgesia in Group A was 1245.94 ± 153.22 min and 1310.16 ± 151.68 min, respectively. However, in Group B, the duration of motor block and analgesia was 1768.13 ± 309.86 min and 1743.59 ± 231.39 min, respectively, which was more when compared to Group A (P < 0.001). The Visual Analog Scale score of ≥3 in Group A was 37% and in Group B was 9% (P = 0.008). Four cases had delayed regression of motor block in the perineural group. Conclusions: Perineural dexamethasone significantly prolonged the duration of motor block promoted by levobupivacaine in infraclavicular brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period when compared with the intravenous dexamethasone. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to compare the analgesic efficacy of intrathecal fentanyl with ultrasound-guided transversus abdominis plane (TAP) block after lower segment cesarean section. The objectives of the study were to compare the effects of subarachnoid fentanyl versus TAP block with respect to duration of postoperative analgesia, time for first analgesic request, total analgesic consumption in 24 h, time to first breastfeed and Apgar score at 1 and 5 min. Materials and Methods: Sixty-two patients undergoing elective or emergency cesarean delivery were recruited for the study in a prospective, randomized, single-blind manner. The patients were randomly allocated to either intrathecal fentanyl group (Group F) or TAP block group (Group T) after determining the eligibility criteria. Group F patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy with 25 mcg of fentanyl. Group T patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy prior to surgery and at the end of surgery, they received TAP block with 0.25% bupivacaine 20 mL on each side. Results: Group T had significantly longer time for the first analgesic request (7.65 ± 1.23 h) than group F (4.10 ± 0.32 h). The total analgesic consumption in 24 h was significantly less in Group T (1.0 ± 0) than Group F (2.13 ± 0.34). The Visual Analogue Scale scores at rest and on movement were significantly less in Group T than Group F at all-time points. The Apgar score at 1 and 5 min and time to first breast feed were comparable between the two groups. The incidence of side effects was less in Group T. Conclusion: This study indicated that ultrasound-guided TAP block has a better analgesic as well as safety profile compared to intrathecal fentanyl for cesarean delivery. [ABSTRACT FROM AUTHOR]

Context: Shivering is one of the most commonly recognized complications of the central neuraxial blockade. For optimal perioperative care, control of postspinal anesthesia shivering is essential. Aims: The present study designed to compare the clinical efficacy, hemodynamic parameters, and side effects of nalbuphine and tramadol for control of postspinal anesthesia shivering. Settings and Design: This was a prospective, randomized, double-blind study. Materials and Methods: This study was conducted on 90 American Society of Anesthesiologists Physical Status I and II patients of either gender, aged between 18 and 60 years, who subsequently developed shivering grade 3 or 4, scheduled for different surgical procedures under spinal anesthesia. The patients were randomized into two groups of 45 patients each to receive either nalbuphine 0.06 mg.kg−1 (Group N) or tramadol 1 mg.kg−1 (Group T). Grade of shivering, onset of shivering, time interval for cessation of shivering, response rate at 5 and 30 min, rescue dose, hemodynamic parameters, and side effects were observed at scheduled intervals. Statistical Analysis Used: Independent t-test and Chi-square/Fisher's exact test were used to analyze the data. Results: The time taken for cessation of shivering was significantly less with nalbuphine in comparison with tramadol (P < 0.05). It was observed that the response time at 5 and 30 min and rescue dose requirement for control of shivering were not much difference (P > 0.05). Conclusions: Both nalbuphine and tramadol are effective; however, the time taken for cessation of shivering is significantly less with nalbuphine when compared to tramadol. Furthermore, tramadol causes significantly more nausea and vomiting; however, nalbuphine causes significantly more sedation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-year-old female with Ebstein's anomaly and bleeding vagina after amenorrhea. It discusses the physiological effects of her condition, treatment using hysterotomy, and pathophysiological aspects of the patient. Particular focus is given to the issues faced by pregnant women with hypothyroidism when given anaesthesia.

Grisel's syndrome is a nontraumatic subluxation of atlanto-axial joint which is associated with inflammatory conditions of head and neck and occurs primarily in children. Anesthetic management is such cases constitute a multitude of challenges, especially related to the airway management. We presented here a case of 16-year-old male child weighing 23 kg, came to our hospital for the treatment of torticollis who was previously treated with intravenous antibiotics for rhinopharyngitis and diagnosed as a case of Grisel's syndrome. The child was operated on for unilateral resection of sternocleidomastoid muscle under general anesthesia. This case report pertains to the successful airway and anesthetic management in the background of difficult airway. [ABSTRACT FROM AUTHOR]

Dear Editor, The original research entitled, "Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals - A multicentric study in India"[[1]] is a great piece of academic research which creates an elite snapshot of current trauma set up in the country and enumerates various epidemiological factors associated with negative outcome in such population of patients. Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals - A multicentric study in India: A comment Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals-A multicentric study in India. [Extracted from the article]