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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: 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]