BACKGROUND Spinal anaesthesia is the technique of choice for caesarean section as it is devoid of many potential problems associated with general anaesthesia. The usual dose required for reaching the desired block height for hyperbaric bupivacaine is 10-12 mg. A lower dose of bupivacaine with an adjuvant is used as a reliable combination which produces synergistic effect, prolonging the duration of sensory block without increasing sympathetic block or delaying recovery. METHODS A total of 110 patients undergoing elective or emergency Caesarean section under spinal anaesthesia, were screened for eligibility and 105 were randomised in the trial, allocated to 3 groups to receive injection bupivacaine 7.5 mg along with fentanyl 15 mcg (Group BF1, n=35), fentanyl 20 mcg (Group BF2, n=35), fentanyl 25 mcg (Group BF3, n=35). RESULTS The average time required to reach the block height of T4-T6 was around 3.26 min in BF1, 3.97 min in BF2, 4.63 min in BF3. The two-segment regression time of BF1 was 68.06 min; BF2 72.17 min and BF3 80.06 min. The recovery time of sensory block for BF1 is around 129.71 min, for BF2, 193.43 min and for BF3 200.86 min. The time for onset of motor block was BF1 1.49 min, BF2 1.51 min and BF3 2.34 min. The time to maximum of motor block was 2.8 min for BF1, 3.69 min for BF2, 7.8 min for BF3. The recovery time of motor block for BF1, was 107.14 min; BF2, 91.57 min and BF3, 65.66 min. CONCLUSIONS All the three doses of fentanyl-15mcg, 20mcg, 25mcg can be used as an adjuvant to 7.5 mg of 0.5% heavy bupivacaine for caesarean section to provide good quality surgical anaesthesia. Larger fentanyl dose group (25mcg) scores over small dose group in terms of sensory block with prolonged post-operative analgesia, early motor recovery and lesser incidence of hypotension.

Introduction: WHO defines anaemia in pregnancy as haemoglobin <11gm/dl and severe anaemia as haemoglobin < 7gm/dl.Anaemia is a major health concern during pregnancy particularly for the developing countries like India. Not many studies have been done so far regarding this health issue in this part of the country.Hence,this study was done to estimate the magnitude of the problem with focus on severe anemia. Objectives: To determine the prevalence of anaemia among pregnant women attending JNIMS Hospital, Manipur and classify the grades of anaemia and determine the factors leading to anaemia and study the outcomes of severely anaemic patients. Materials and methods: A prospective, hospital-based study was conducted in the Department of Obstetrics and Gynaecology,Jawaharlal Nehru Institute of Medical Sciences (JNIMS),Porompat,from August 2017 to April 2019 among pregnant women in second and third trimesters in a 20 months' duration,in a twice weekly survey,recruitment was done on all eligible women attending Obstetrics and Gynecology OPD, JNIMS using a pre-tested semi-structured questionnaire. Haemoglobin was measured using colorimetry method. All the very severely anaemic study-subjects were followed up for any interventions given and the pregnancy outcome until discharged alive or death. Data was analysed by SPSS version 20. Mean, standard deviation, Chi square test etc. were used for analysis. The study was approved by the Institutional ethics committee. Results: The prevalence of anaemia was found to be 30.8%; mild anaemia was found in 288(17.9%), moderate in 124 (7.8%) and severe anaemia was 82 (5.1%). Severe anaemia was found to be significantly associated with age group 34 years and above, Muslim community, rural residence, being illiterate, ANC less than three times, never taken supplemental iron,with increasing gravida and booking ANC visit after 12 weeks.Blood transfusion was given to 62 out of 82 (75.6%) patients and 20 patients (24.3%) received parenteral iron. Six patients (7.3%) had associated preeclampsia, 3 (3.6%) had ante-partum haemorrhage, and 4 (4.8%) had associated post-partum haemorrhage. There were 6 (7.3%) intrauterine deaths,10 preterm deliveries (12.1%),and 7 low birth weight babies (8.5%). There was one maternal mortality with the baby in utero. Conclusion: Almost around a third of the pregnant women suffered from anaemia with a sixth of them having severe anaemia.Three fourths of the pregnant women having severe anaemia received blood transfusion. Severe anemia was associated with pre-eclampsia, ante-partum haemorrhage and post-partum haemorrhage, intra-uterine deaths, preterm deliveries, low birth weight and maternal mortality. Regular antenatal checkups, adequate intake of iron and folic acid tablets and proper age at the time of pregnancy should be encouraged.

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

Background: Elderly in India suffers from both communicable and non-communicable diseases, also functional independence reduces due to physiological changes. This study aims to determine the pattern of morbidity, functional ability in activities of daily living (ADL), instrumental activities of daily living (IADL) and to assess any factors associated with ADL.Methods: A cross-sectional study was conducted from May 2017 to April 2019 among 420 elderly aged 60 years and above residing in rural areas of Wangoi in Manipur. Probability proportional to size (PPS) sampling method was used to select 6 villages out of 28 villages. A pre-tested interview schedule was used as study tool. Data were analysed using SPSS IBM statistics version 21 using mean, SD, proportion, chi-squared (χ²) test, univariate and multivariate logistic regression analysis were performed taking p-value<0.05 as statistically significant.Results: Some form of morbidity was reported by 49.1% of the respondents. The prevalence of dependent according to ADL was 8.1%. According to IADL score, 97.6% female and 46% male have limitation. Elder age group, female gender, living without spouse, illiterate were significantly associated with dependency according to ADL. In adjusted analysis, every unit increased in age, risk of being dependent increases significantly by 10% [AOR=1.10 (1.04-1.16)].Conclusions: Almost half of respondents had some form of morbidity. Only a few (4.5%) were dependent according to ADL. A more comprehensive study covering different communities using various laboratory investigations can be conducted in Manipur.

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.