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Background and Aims: Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in preventing PONV in patients undergoing non-laparoscopic surgeries. Methods: A PRISMA-guided systematic review and meta-analysis was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at postoperative time points, namely T1 (0-2 hours), T2 (0-6 hours), T3 (12-24 hours), T4 (24-48 hours), and T5 (24-72 hours), as well as safety (number of incidence of adverse effects). A meta-analysis of the efficacy and safety groups was performed using a random-effects model. Results: Nineteen randomised controlled trials were included. Pooled risk ratio (RR) revealed that patients receiving palonosetron were significantly less likely to develop nausea [0-2 h, RR = 0.82 (95% confidence interval (CI): 0.50, 1.34), P = 0.317, I[sup.2] = 15.3%], [0-6 h, RR = 0.76 (95% CI: 0.44, 1.29), P = 0.137, I[sup.2] = 45.7%], [12-24 h, RR = 0.39 (95%CI: 0.16, 0.96), P = 0.088, I[sup.2] = 54.2%], [24-48 h, RR = 0.44 (95% CI: 0.20, 0.96), P = 0.598, I[sup.2] = 0%], [24-72 h, RR 0.22 (95% CI: 0.08, 0.57), P = 0.119, I[sup.2] = 53.0%] and vomiting [0-2 h, RR = 0.59 (95% CI: 0.29, 1.23), P = 0.868, I[sup.2] = 0%], [0-6 h, RR = 1.42 (95% CI: 0.74, 2.72), P = 0.790, I[sup.2] = 0%], [12-24 h, RR = 0.14 (95% CI: 0.04, 0.51), P = 0.749, I[sup.2] = 0.0%], [24-48 h, RR = 0.24 (95%CI: 0.09, 0.62), P = 0.561, I[sup.2] = 0%], [24-72 h, RR = 0.11 (95% CI: 0.02, 0.58), P = 0.859, I[sup.2] = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), P = 0.940, I[sup.2] = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), P = 0.870, I[sup.2] = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), P = 0.650, I[sup.2] = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), P = 0.644, I[sup.2] = 0%]. Conclusion: Palonosetron and ondansetron exhibited comparable efficacy in the early hours (0-6 h). Palonosetron showed superior efficacy beyond 6 hours, providing sustained PONV prophylaxis in patients undergoing various surgeries, excluding laparoscopic procedures. Keywords: Antiemetic drugs, meta-analysis, nausea, ondansetron, palonosetron, postoperative nausea and vomiting, systematic review, vomiting, Author(s): Babu Lal [1]; Ragavi Alagarsamy [2]; Jitendra Kumar (corresponding author) [3]; Anshul J. Rai [3]; Vineeta Yadav [4]; Rajnish Joshi [5]; Md. Yunus [1] INTRODUCTION Postoperative nausea and vomiting [...]

Brain arteriovenous malformations (AVM) present complex treatment decisions, particularly for low-grade AVM where surgical resection is often considered the standard. This case report emphasizes the importance of patient preferences and cultural considerations in selecting endovascular embolization over traditional surgical approaches for Spetzler-Martin Grade I AVM management, highlighting the evolving practice of patient-centered care in neurointervention. A 30-year-old male presented with recurrent seizures, characterized by a sudden onset of headache followed by speech arrest, without any preceding medical history of neurological deficits. Initial physical examination revealed no focal neurological deficits. Non-contrast computed tomography, magnetic resonance imaging, and magnetic resonance angiography suggested an AVM involving the cortical-subcortical regions of the left frontal lobe, measuring approximately 1.7 × 2.6 × 1.5 cm, fed by the left middle cerebral artery M3 segment, and draining into the superior sagittal sinus. Spetzler-Martin Grade I classification was confirmed via digital subtraction angiography. Given the patient's strong preference against invasive procedures, driven by personal and cultural beliefs, endovascular embolization was selected as the treatment strategy. Post-embolization, the patient showed marked symptomatic improvement with no evidence of residual AVM on follow-up imaging, and no postprocedure complications were reported. This case highlights the importance of considering patient preferences in AVM treatment planning, illustrating that endovascular embolization can be an effective and less invasive alternative to surgery in selected patients, reinforcing the need for personalized, patient-centered approaches in neurointerventional care.

Distinguishing Libman-Sacks endocarditis from other valvular heart disease etiologies has important implications for management. We present a case of a 23-year-old man who presented in extremis with fever and cardiogenic shock caused by Libman-Sacks endocarditis with associated mitral valve chord rupture. (Level of Difficulty: Beginner.)

Abstract Background In order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health. Case presentation A self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector. Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few. Discussion and conclusions The strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements.

We assessed whether personal exposure to household air pollution [PM2.5 and black carbon (BC)] is associated with lung functions (FEV1, FVC, and their ratio) in non-smoking adults in rural Bangladesh. We measured personal exposure to PM2.5 using gravimetric analysis of PM2.5 mass and BC by reflectance measurement between April 2016 and June 2019. The average 24-hour PM2.5 and BC concentration was 141.0μgm−3 and 13.8μgm−3 for females, and 91.7 μgm−3 and 10.1 μgm−3 for males, respectively. A 1 μgm−3 increase in PM2.5 resulted in a 0.02 ml reduction in FEV1, 0.43 ml reduction in FVC, and 0.004% reduction in FEV1/FVC. We also found a similar inverse relationship between BC and lung functions (9.6 ml decrease in FEV1 and 18.5 ml decrease in FVC per 1μgm−3 increase in BC). A higher proportion of non-smoking biomass fuel users (50.1% of the females and 46.7% of the males) had restrictive patterns of lung function abnormalities, which need further exploration. [ABSTRACT FROM AUTHOR]

Objective: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. Methods: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. Results: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6-12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. Conclusions: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.

Endotracheal intubation using flexometallic tubes are often required in anaesthesia practice for a variety of reasons. It is preferred in the head and neck region surgeries due to its relative resistance to kinking forces. At times, these patients postoperatively may need to be shifted to ICU or HDU without extubation for further stabilization/management and extubation after adequate recovery. We present an unusual accident where a new flexometallic endotracheal tube was permanently tapered, transected and migrated proximally due to patient’s bite on tube leading to airway emergency in post-operative recovery period.

Vaccine uptake and coverage in susceptible populations are needed through effective vaccination campaigns to address the COVID-19 pandemic in South Asian countries. We aimed to measure the pooled proportion of COVID-19 vaccine hesitancy in this regard. Research articles published between January 1, 2020, to December 31, 2021, were searched through Medline, PubMed, Cochrane, Google Scholar, and the WHO COVID-19 database. The Joanna Briggs Institute (2014) tool for prevalence studies was used to assess data quality. We performed a meta-regression test and a sensitive analysis among the studies and used the DerSimonian and Laird random-effects model to measure the pooled effect estimates. Subgroup analyses were performed concerning vaccine hesitancy, countries, study population, study level, and the time since the first outbreak of the pandemic. A total of 43 studies out of 598 published articles across the eight countries in South Asia were included. The pooled proportion of COVID-19 vaccine hesitancy was 26.5% (95% CI [22, 31], I2 = 99.59%). Vaccine hesitancy was higher in Afghanistan (37%), Pakistan (33%), and Bangladesh (28.9%); among the general population (29%); at community levels (27.9%); and the duration of time of 1-12 months since the first outbreak in each country (27.5%). Vaccine hesitancy exists in South Asia with different rates among countries, population sub-groups, communities, studylevels, duration of time since the first outbreak, and study population. Therefore, enhancing public awareness of vaccination and vaccine hesitancy is required to prevent future pandemics. [ABSTRACT FROM AUTHOR]

Objectives: The neutrophil-to-lymphocyte ratio (NLR) is a simple and routinely performed hematological parameter; however, studies on NLR as a prognostic tool in traumatic brain injury (TBI) have yielded contradictory results. Materials and Methods: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-Analysis guidelines 2020. Electronic databases of PubMed, Cochrane Library, Web of Science, and Scopus were searched. The population consisted of TBI patients in the absence of moderate and severe extracranial injury. Day 1 NLR was taken for the analysis. The outcomes evaluated were mortality and the Glasgow Outcome Scale (GOS). No restrictions were placed on the language, year and country of publication, and duration of follow-up. Animal studies were excluded from the study. Studies, where inadequate data were reported for the outcomes, were included in the qualitative synthesis but excluded from the quantitative synthesis. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). The risk of bias was estimated using the Cochrane RoBANS risk of bias tool. Results: We retrieved 7213 citations using the search strategy and 2097 citations were excluded based on the screening of the title and abstract. Full text was retrieved for 40 articles and subjected to the eligibility criteria, of which 28 were excluded from the study. Twelve studies were eligible for the synthesis of the systematic review while seven studies qualified for the meta-analysis. The median score of the articles was 8/9 as per NOS. The risk of selection bias was low in all the studies while the risk of detection bias was high in all except one study. Ten studies were conducted on adult patients, while two studies reported pediatric TBI. A meta-analysis for GOS showed that high NLR predicted unfavorable outcomes at ≥6 months with a mean difference of -5.18 (95% confidence interval: -10.04, -0.32); P = 0.04; heterogeneity (I²), being 98%. The effect estimates for NLR and mortality were a mean difference of -3.22 (95% confidence interval: -7.12, 0.68), P = 0.11, and an I2 of 85%. Meta-analysis for Area under the curve (AUC) receiver operating characteristic of the included studies showed good predictive power of NLR in predicting outcomes following TBI with AUC 0.706 (95% CI: 0.582-0.829). Conclusion: A higher admission NLR predicts an increased mortality risk and unfavorable outcomes following TBI. However, future research will likely address the existing gaps. [ABSTRACT FROM AUTHOR]

Objectives: Conflicting studies have resulted in several systematic reviews and meta-analyses on the relationship between COVID-19 and body mass index (BMI). Methods: This systematic review of systematic reviews followed an umbrella review design, and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines; Medical literature analysis and retrieval system online (MEDLINE) and SCOPUS databases were searched for systematic reviews on the topic. A predefined screening and selection procedure was done for the retrieved results based on the population, intervention/interest, comparator, outcome, study (PICOS) framework. Results: The search strategy yielded 6334 citations. With the predefined selection and screening process, 23 systematic reviews were retrieved for inclusion in the present study. Twenty-three (n = 23) systematic reviews met the inclusion criteria. As expected, there was overlap across the reviews in the included primary studies. Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. It is difficult to draw a firm conclusion about Class I and Class II obesity due to conflicting outcomes of metanalyses. Increased obesity was consistently associated with increased risk of invasive mechanical ventilation (IMV) in all the reviews with low to moderate heterogeneity. Conclusions: Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. Increased BMI is positively associated with the risk of IMV and the severity of COVID- care. [ABSTRACT FROM AUTHOR]

Byline: Habib. Karim, Anilkumar. Narayan, Md. Yunus, Sanjay. Kumar, Avinash. Prakash, Sarasa. Sahoo Background and Aims: Minimum alveolar concentration (MAC) monitoring is an integral part of modern-day anaesthesia. Both MAC [...]

Author(s): Katia Koelle [1, 4]; Xavier Rodó [2, 4]; Mercedes Pascual (corresponding author) [1]; Md. Yunus [3]; Golam Mostafa [3] Outbreaks of many infectious diseases, including cholera, malaria and dengue, [...]

Byline: Habib. Karim, Md. Yunus, Prithwis. Bhattacharyya Background and Aims: Pre-operative investigations are often required to supplement information for risk stratification and assessing reserve for undergoing surgery. Although there are [...]

The practice of emergency medicine has reached its cross roads. Emergency physicians (EPs) are managing many more time-dependent conditions, initiating complex treatments in the emergency department (ED), handling ethical and end of life care discussions upfront, and even performing procedures which used to be done only in critical care settings, in the resuscitation room. EPs manage a wide spectrum of patients, 24 h a day, which reflects the community and society they practice in. Besides the medical and "technical" issues to handle, they have to learn how to resolve confounding elements which their patients can present with. These may include social, financial, cultural, ethical, relationship, and even employment matters. EPs cannot overlook these, in order to provide holistic care. More and more emphasis is also now given to the social determinants of health. We, from the emergency medicine fraternity, are proposing a unique "BRAVE model," as a mnemonic to assist in the provision of point of care, adaptive leadership at the bedside in the ED. This represents another useful tool for use in the current climate of the ED, where patients have higher expectations, need more patient-centric resolution and handling of their issues, looming against the background of a more complex society and world. [ABSTRACT FROM AUTHOR]

Safe and effective rotavirus vaccines (RVs) are needed to reduce the enormous public health burden of rotavirus illness in developing countries. Vaccination is critical for effective control of rotavirus infection since it cannot be prevented with improvements in water and sanitation. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has completed several groundbreaking RV trials (Phase I-Phase IV). The safety, immunogenicity, efficacy, and effectiveness of different RVs were evaluated among both urban and rural populations. In this study, we present the results, policy implications, and lessons learned for successful implementation of these trials as well as future directions for rotavirus vaccination in Bangladesh. [ABSTRACT FROM AUTHOR]

Abstract Background There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes. Methods In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months. Results There were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome. Conclusions Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life. Trial registration number ISRCTN: ISRCTN16581394