bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance and Uncertainty of λ-Estimation for Box–Cox Transformations to Compute and Verify Reference Intervals in Laboratory Medicine
Authors: Klawonn Frank , Riekeberg Neele , Hoffmann Georg
Published: February 2024

Reference intervals play an important role in medicine, for instance, for the interpretation of blood test results. They are defined as the central 95% values of a healthy population and are often stratified by sex and age. In recent years, so-called indirect methods for the computation and validation of reference intervals have gained importance. Indirect methods use all values from a laboratory, including the pathological cases, and try to identify the healthy sub-population in the mixture of values. This is only possible under certain model assumptions, i.e., that the majority of the values represent non-pathological values and that the non-pathological values follow a normal distribution after a suitable transformation, commonly a Box–Cox transformation, rendering the parameter λ of the Box–Cox transformation as a nuisance parameter for the estimation of the reference interval. Although indirect methods put high effort on the estimation of λ, they come to very different estimates for λ, even though the estimated reference intervals are quite coherent. Our theoretical considerations and Monte-Carlo simulations show that overestimating λ can lead to intolerable deviations of the reference interval estimates, whereas λ=0 produces usually acceptable estimates. For λ close to 1, its estimate has limited influence on the estimate for the reference interval, and with reasonable sample sizes, the uncertainty for the λ-estimate remains quite high.
The Phenomenon of Lecturer Competences as a Prerequisite for the Advancement of Sustainable Development Ideas in the Context of Student-Centred Studies
Authors: Valantinaite Ilona , Navickiene Vida
Published: February 2024

Research and higher education regulations have been shaping attitudes not only towards the higher education lecturer as a professional in the field who is able to use educational tools but also towards the interfaces between lecturers and students. In this lecturer–student interaction, the students’ own perception of the qualities of the lecturer’s personality and/or possessed competences that are acceptable to them and that motivate them to participate in the learning process should be emphasised as an important aspect of success. Thus, the article raises the following problem questions: (1) What competences should a lecturer have from the students’ point of view to achieve student-centred studies? (2) What is the relationship between the competences of the lecturer and the implementation of sustainable development ideas in the organisation of student-centred studies? This article is based on a 2019 survey conducted among Lithuanian university and college students, employing a questionnaire survey with a survey instrument that included open-ended questions. The survey was conducted with a sample of 390 participants. In addressing the issue at hand, it becomes evident that, from the students’ perspective, the personality of the lecturer possesses a multidimensional character. They not only value the lecturer’s expertise in the subject matter taught (subject competence) but also place a stronger emphasis on two other aspects. First, they value the lecturer’s ability to motivate and engage students in the learning process (educational competence), which includes an essential component: communication competence. Second, the lecturer’s personality acquires meaning through fundamental human values.
Comparative Analysis of Electrokinetic Properties of Periodate- and TEMPO-Oxidized Regenerated Cellulose Fabric Functionalized with Chitosan
Authors: Kramar Ana , Korica Matea , Kostić Mirjana
Published: February 2024

The electrokinetic properties of materials give useful insight into the behavior of surfaces in contact with liquids and other compounds and their quantification is a powerful tool to predict their behavior during further processing and application, especially in textile materials. In this work, we perform a comparative analysis of influence of the two most common selective oxidative protocols for viscose (regenerated cellulose) fabrics on subsequent functionalization with chitosan, and cellulose fabrics’ electrokinetic properties, zeta potential in a pH range of approx. 3–10, and isoelectric point (IEP). For oxidation before deposition of chitosan, sodium periodate and 2,2,6,6-tetramethylpiperidine-1-oxy radical (TEMPO) were used. The content of functional groups in oxidized cellulose fabric (carboxyl and carbonyl groups) was determined by titration methods, while amino functional groups’ availability in samples with chitosan was determined using the CI acid orange 7 dye absorption method. This study reveals that the periodate oxidation (PO) of cellulose is more effective for binding chitosan onto material, which gave rise to higher availability of amino groups onto cellulose/chitosan material, which also influenced the shift in zeta potential curve towards positive values at a pH below 5. Analysis of a relationship between zeta potential increase at pH 4.4 and amino groups’ amount measured using absorption of CI acid orange 7 dye at pH 4.4 revealed dependency that can be fitted linearly or exponentially, with the latter providing the better fit (R2 = 0.75).
Migration of Melamine and Its Derivatives from Melamine/Bamboo/Wheat Straw-Made Tableware Purchased from Internet Markets or Retail Shops in China
Authors: Liu Shaojie , Wang Yifei , Liu Zhanren , Yang Zhiping , Chen Liang , Chen Bo
Published: February 2024

Objectives: The ecofriendly and sustainable concept of bamboo- and wheat straw-made tableware has gained attention in recent years. However, it is necessary to note that these kinds of tableware are composed of melamine (MEL)–formaldehyde resin with the addition of bamboo fibers or wheat straw. This study aims to explore the potential migration of MEL and its derivatives from the tableware and conduct a risk assessment. Methods: The study involved 46 bowls or cups purchased from Internet markets or retail shops in China, whose raw materials included MEL, bamboo, and wheat straw. There were four pieces of glass- or ceramic-made tableware used as the control group. Migration testing was performed according to the test conditions selected from the European Union Reference Laboratory for Food Contact Materials. Considering the realistic worst-case scenario, we measured the concentrations of MEL and its derivatives in food simulants using ultra-performance liquid chromatography–tandem mass spectrometry and estimated the exposure risks for adults and 1-year-old infants. Results: MEL and its derivatives could migrate from MEL-, bamboo-, and wheat straw-made tableware with varying concentrations. The total migration was ranked as follows: bamboo-made tableware > MEL-made tableware > wheat straw-made tableware > glass- or ceramic-made tableware (p < 0.001). The primary contributor to the total concentration for MEL- and bamboo-made tableware was MEL, whereas cyanuric acid (CYA) was the main contributor for wheat straw-made tableware. Based on the total concentration of MEL and its derivatives and the strictest TDI value, the proportions of the calculated hazard quotient ≥1 for MEL-, bamboo-, and wheat straw-made tableware in adults were 53.50%, 92.30%, and 1.90%; and the proportions in 1-year-old infants increased to 86.00%, 100.00%, and 7.40%. Conclusion: The utilization of MEL-, bamboo-, and wheat straw-made tableware could be regarded as a significant source of human exposure to MEL and its derivatives. It is advisable for both adults and infants to refrain from using tableware manufactured with MEL and bamboo fiber, as it may increase the susceptibility to MEL-related diseases.
The Non-Thermal Radio Emissions of the Solar Transition Region and the Proposal of an Observational Regime
Authors: Tan Baolin , Huang Jing , Zhang Yin , Deng Yuanyong , Chen Linjie , Liu Fei , Fan Jin , Shi Jun
Published: February 2024

The transition region is a very thin but most peculiar layer in the solar atmosphere located between the solar chromosphere and the corona. It is a key region for understanding coronal heating, solar eruption triggers, and the origin of solar winds. Here, almost all physical parameters (density, temperature, and magnetic fields) have the maximum gradient. Therefore, this region should be highly dynamic, including fast energy releasing and transporting, plasma heating, and particle accelerating. The physical processes can be categorized into two classes: thermal and non-thermal processes. Thermal processes can be observed at ultraviolet (UV) and extreme ultraviolet (EUV) wavelengths via multi-wavelength images. Non-thermal processes accelerate non-thermal electrons and produce radio emissions via the gyrosynchrotron mechanism resulting from the interaction between the non-thermal electrons and magnetic fields. The frequency range spans from several GHz to beyond 100 GHz, in great number of bursts with narrowband, millisecond lifetime, rapid frequency drifting rates, and being referred to as transition region small-scale microwave bursts (TR-SMBs). This work proposes a new type of Solar Ultra-wide Broadband Millimeter-wave Spectrometer (SUBMS) that can be used to observe TR-SMBs. From SUBMS observations, we can derive rich dynamic information about the transition region, such as information about non-thermal energy release and propagation, the flows of plasma and energetic particles, the magnetic fields and their variations, the generation and transportation of various waves, and the formation and evolution of the source regions of solar eruptions. Such an instrument can actually detect the non-thermal signals in the transition region during no flare as well as the eruptive high-energy processes during solar flares.
Hemeroby Mapping of the Belém Landscape in Eastern Amazon and Impact Study of Urbanization on the Local Climate
Authors: Furtado Leonardo Seabra , Pereira Raimundo Vitor Santos , de Souza Everaldo Barreiros
Published: February 2024

This work contributes to the studies on landscape mapping induced by human pressure directly related to the urbanization process, whose approach is based on the concept of hemeroby adapted to the metropolitan area of Belém in the eastern Amazon. The mapping results using 1985 and 2021 Landsat satellite data indicated that the artificial coverage characterized as medium to the high urban system (polyhemerobic and metahemerobic degrees) has increased by almost 17% toward northern districts and Outeiro/Mosqueiro islands, while the natural vegetation cover suppression (ahemerobic degree) was around 11%. In addition, we investigated the impacts of urban expansion on seasonal (WET from January to April and DRY from July to November) surface air temperature (minimum TN and maximum TX) patterns. From statistical comparisons between 18-year samples (2004/2021 to 1985/2002), we find evidence of a current significantly warmer climate, with a notable indication of higher surface temperature over densely urbanized areas compared to lower values over natural areas. In the TX climatology, particularly for the DRY regime, we identified a pattern similar to the classic heat island model with concentric isotherms reaching a maximum center over the more urbanized continental region of Belém and a thermal decrease at the edges. Therefore, the findings of this work are convincing that Belém already faces the direct impacts of urbanization on the local climate, so it is crucial to develop government strategies aimed at taking action to mitigate socioenvironmental risks and threats to the well-being of urban populations.
Prevalence and Diversity of Haemotropic Mycoplasma Species in Cats and Their Ectoparasites (Fleas and Ticks)
Authors: Razgūnaitė Miglė , Lipatova Indrė , Paulauskas Algimantas , Snegiriovaitė Justina , Karvelienė Birutė , Zamokas Gintaras , Laukutė Monika , Radzijevskaja Jana
Published: February 2024

Mycoplasma spp. pathogens frequently cause chronic and acute diseases in cats. The aim of the present study was to investigate the presence and genetic diversity of Mycoplasma spp. in cats and their ectoparasites using PCR and sequence analysis of the 16S rRNA gene. Blood samples were collected from 541 domestic and stray cats in Lithuania. Ectoparasites (153 fleas and 321 ticks) were collected from owned domestic cats that live both outdoors and indoors. Mycoplasma spp. were detected in 7.2% of cat blood samples and 4.4% of Ctenocephalides felis fleas. The sequence analysis revealed the presence of Mycoplasma haemofelis in 1.1% of cats and ‘Candidatus Mycoplasma haematominutum’ in 4.8% of cats. Ct. felis fleas harboured M. haemofelis. To the best of the authors’ knowledge, this is the first report on the prevalence and molecular characterisation of Mycoplasma bacteria in cats in Lithuania and cat fleas in the Baltic States.
The Mediating Effect of Loneliness on the Relationship between Bullying Victimization and Suicidal Behavior among Adolescents in Ghana
Authors: Duah Ebenezer
Published: February 2024

Research from Western countries, Asia, and some parts of Africa has documented that bullying victimization has ramifications for adolescents, including suicidal tendencies. Some studies have also reported that loneliness among teenagers is strongly linked to suicidal behavior. However, little is known about whether loneliness mediates bullying victimization and suicidal behavior. The present study aims to apply the general strain theory to explore the relationship between being bullied and suicidal behavior among juveniles in Ghana. The study also examines the effect of bullying victimization on loneliness. Additionally, the research evaluates the impact of loneliness on suicidal behavior. Lastly, the study explores the mediation role of loneliness on the association between peer victimization and suicidal behavior among juveniles in Ghana. Data from the 2012 Global School-based Student Health Survey (GSHS) and a sample size of 2626 were used in this research. The results revealed that bullying victimization positively predicted loneliness, and bullying victimization and loneliness significantly predicted suicidal behavior. Finally, loneliness partially mediated the association between bullying experience and suicidal behavior. This study not only provides new evidence to support the general strain theory (GST) but also discusses the theoretical and political implications of the findings.
Música e psicanálise: uma abordagem para os processos criativos e suas dimensões inconscientes
Authors: de Araújo Andressa Raiana Nunes , Bertissolo Guilherme
Published: February 2024

This paper presents an approach for songwriting from a Lacanian psychoanalysis’ perspec-tive based on an ongoing master's degree research. The departure point is related the rele-vance of the unconscious processes already highlighted in musical cognition research. The research establishes a conversation between these two fields – psychoanalysis and cognition – to, subsequently, address methods and theories that enable a deeper understanding of the different relevant issues on creative process in songwriting. Introducing a brief literature re-view and proposing the use of methods such as memorial and genetic criticism. Finally, we present the initial steps towards a methodology for approaching the creative process in music with psychoanalytic orientation, based on the analysis of drafts and personal reports in free association.
Morphological, cytotoxic and apoptotic effects of different concentrations of nisin ZP on MG63 cells in a 3-dimensional culture system
Authors: Alkhateeb Alyaa R. , Ab-Rahim Sharaniza , Azmi Muhammad F. , Din Aisha M. , Omar Effat , Frömming Gabriele Ruth Anisah
Published: February 2024

Osteosarcoma (OS) is a primary bone cancer that commonly affects young individuals. Despite treatment, it is known to be highly resistant to therapy. Nisin, a bacteriocin released by Lactococcus lactis has been shown to exhibit an apoptotic effect on cancer cells. To better represent in vivo cancer cell constructs, 3-dimensional (3D) culture systems have been used in vitro. This study aims to compare the effects of nisin on OS cell culture in both monolayered and 3D gas-permeable VECELL® G-Plate. Osteosarcoma cells (MG63) were cultured on 3D culture (G-Plate) and normal culture plates. Morphological assessments were carried out through light and scanning electron microscopic examinations. The results showed that the use of a 3D system is more reliable in the development of 3D osteosarcoma models compared to the 2-dimensional (2D) culture system. Specifically, the 3D culture demonstrated the formation of MG63 spheroids, indicating the reliability of the hanging drop methods to produce spheroidal cell morphology. Additionally, the cell viability assay showed a higher IC50 value for 2D groups compared to the 3D groups, with values of 102.56 µg/mL and 33.96 µg/mL, respectively. Finally, a dose-dependent apoptosis was noticed for the apoptotic assay, further demonstrating the effectiveness of the 3D culture system. The effectiveness of nisin ZP as an anticancer agent was observed in both 2D and 3D culture systems. However, the 3D culture system required a higher dose of nisin ZP to demonstrate its potential, indicating that this system could be a promising approach in OS intervention studies.
The miR-221/222 regulates the ID1 gene expression through PTEN, c-JUN and ARF4 mediators to control cell proliferation
Authors: Yingjamsiri Panus , Paca-uccaralertkun Saowakon
Published: February 2024

Objective: To explore the effect of miR-221/222 on cell proliferation and regulation of inhibitor of differentiation1 (ID1) expression concerning the value of miR-221/22 in cancer diagnosis, prognosis, or therapeutic use. Methods: Embryonic cell line (HEK293), breast cancer cell line (MCF7), and lymphoblast cell line (U937) were employed to investigate cell proliferation in the presence or absence of miR-221/222 using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction assay. The relation of miR-221/222 and expression of the ID1 gene was monitored via luciferase activity and real-time PCR. Quantitative PCR was used to detect the effect of miR-221/222 on the expression of cellular proteins, c-JUN, ARF4, and PTEN. Results: The miR-221/222 significantly increased the expression level of the ID1 gene in MCF7 and U937 cell lines but downregulation of the ID1 gene was revealed for transfected HEK293 cells. Level of the ID1 mRNA showed that miR-221/222 regulated the ID1 gene expression at the transcriptional level. Moreover, miR-221/222 enhanced the cellular proteins, ARF4 and c-JUN, and expression in MCF7 and U937, while inhibiting them in HEK293. These findings indicated that the effect of miR-221/222 on ARF4 and c-JUN expression in HEK293 may be mediated by different pathways from MCF7 and U937. Conclusions: Increasing levels of miR-221/222 expression are correlated with cell proliferation and the regulation of ID1 expression. ID1 regulation is a complex process and miR-221/222 may regulate its expression via c-JUN and ARF4. The value of miR-221/22 in cancer diagnosis, prognosis, or therapeutic use may be cancer type dependent.
NEPOTİZM İLE İŞE YABANCILAŞMA ARASINDAKİ İLİŞKİNİN İNCELENMESİNE YÖNELİK BİR ARAŞTIRMA: DEVLET SU İŞLERİ ÖRNEĞİ
Authors: Alhas Fidan
Published: February 2024

Bu çalışmada nepotizm ile işe yabancılaşma arasında ilişki olup olmadığı incelenmiştir. Çalışanların kurumda nepotizm ile karşılaşmalarının kurumdaki işlerine yabancılaşmalarına neden olabileceği düşüncesinden hareketle bu konu araştırılmıştır. Çalışma Kars İlinde bulunan 24. Bölge Müdürlüğü Devlet Su İşleri’nde çalışan 415 personel ile gerçekleştirilmiştir. Çalışmaya ait verileri hızlı ve kolay toplayabilmek amacıyla kolayda örnekleme yönteminden faydalanılmıştır. Çalışmada “İşe Yabancılaşma Ölçeği” ve “Nepotizm Ölçeği” kullanılmıştır. Değerlendirmeleri gerçekleştirebilmek amacıyla frekans dağılımları, çarpıklık, ortalama, basıklık, normal dağılım, standart sapma, doğrulayıcı faktör analizi ve çoklu regresyon analizi yapılmıştır. Çalışmada genel nepotizm ile genel işe yabancılaşma arasında pozitif bir ilişki olduğu belirlenmiştir. Ayrıca terfide kayırmacılık ile işe yabancılaşma arasında pozitif ve işe alma sürecinde kayırmacılık ile işe yabancılaşma arasında pozitif bir ilişki olduğu tespit edilmiştir. Fakat işlem kayırmacılığı ile işe yabancılaşma arasında herhangi bir ilişki bulunamamıştır. Çalışanların kurumda nepotizm ile karşılaşmaları diğer çalışanlarda işe yabancılaşmaya neden olacağı için iş yerinde yapılan kayırmacılık davranışlarına olumlu bakılmamaktadır. Bu nedenle kurumda hem nepotizm hem de işe yabancılaşmayı azaltabilecek önerilerde bulunulmuştur.
ADHERENCIA AL TRATAMIENTO RELACIONADA A LA SALUD FÍSICA EN PACIENTES DIABÉTICOS DEL PROGRAMA DE DIABETES DE UN HOSPITAL PÚBLICO DEL PERÚ
Authors: Soto Hernández Francis Oliver , Urure Velazco Isabel Natividad
Published: February 2024

La investigación tuvo por Objetivo: Determinar la relación entre la adherencia al tratamiento y la salud física en los pacientes diabéticos del programa de diabetes de un público del Perú. Material y Métodos: Se utilizó la metodología descriptiva, transversal y de enfoque cuantitativo, de diseño no experimental-correlacional. La muestra fue de 50 pacientes, empleándose la técnica de la encuesta y como instrumento un cuestionario estructurado validado y confiabilidad Alfa de Cronbach de 0.79. Resultados: La adherencia al tratamiento fue regular 86% y bueno 14% y por otro lado, la salud física estuvo medianamente afectada 54%, y nada afectada en el 46%. Conclusiones: Existe relación entre la adherencia al tratamiento y la salud física en los pacientes diabéticos del programa de diabetes (r = 0.322, p = 0.004).
Pendapatan Usahatani Kelapa Di Desa Tumani Kecamatan Maesaan Kabupaten Minahasa Selatan
Authors: Tania Nefaria Trifena , Lolowang Tommy Fredy , Tangkere Ellen Grace
Published: February 2024

The purpose of this study was to determine the amount of coconut farming income in Tumani Village, Maesaan District, South Minahasa Regency. The research was conducted for 2 months from June to July 2023 in Tumani Village, Maesaan Subdistrict, South Minahasa Regency. The data concluded included primary data and secondary data. Farmer data collection was carried out using the simple random sampling method with the analysis method using income analysis. Coconut farming income in Tumani Village, Maesaan District, South Minahasa Regency with the sales method by selling copra gets a result of Rp6,760,918 per harvest which is obtained from total revenue of Rp9,279,700 per harvest minus the total cost of Rp2,518,782 per harvest and sales by selling coconut grains get a result of Rp2,557,546 per harvest which is obtained from total revenue of Rp3,876,600 per harvest minus the total cost of Rp1,322,176 per harvest.
Analisis Keuntungan Usaha Gula Aren Di Desa Ranoiapo Kecamatan Ranoyapo
Authors: Tilaar Prichilia Theresa , Mandei Juliana Ruth , Laoh Esry Olly Harryani
Published: February 2024

The purpose of this research is to analyze the profit of palm sugar business in Ranoiapo Village, Ranoyapo Subdistrict. The research was conducted for 2 months from June to July 2023 from the preparation to the preparation of the research report located in Ranoiapo Village, Ranoyapo Subdistrict. The research data sources are primary data and secondary data where primary data obtained from direct interviews with palm sugar entrepreneurs in Ranoiapo Village, Ranoyapo Subdistrict and secondary data from relevant agencies, books, journals, scientific papers and google scholar. The population in this study are residents who do palm sugar business in Ranoiapo Village, Ranoyapo Subdistrict with a total of 18 entrepreneurs. As for the sample in this study as much as 35 percent of the total population of palm sugar entrepreneurs then obtained as many as 6 entrepreneurs who were used as respondents sampling was taken by simple random sampling or simple random. The research data were analyzed using profit analysis. The results showed that the profit of palm sugar business in Ranoiapo Village, Ranoyapo Subdistrict, obtained a result of Rp568,470 per week with a total cost of IDR208.655 per week and a total revenue of IDR777.125 per week, from the results of this profit if calculated per month then get a total profit of IDR2.253.880 from this total palm sugar business is profitable but still below the provincial minimum wage (UMP) of North Sulawesi Province which amounted to IDR3.485.000 in 2023.
PENERAPAN E-GOVERNMENT SISTEM INFORMASI PELAYANAN PERLINDUNGAN PEREMPUAN DAN ANAK DI KELURAHAN PUTAT JAYA
Authors: Mohamad Geoveza Putra Syahtoni  , Oktarizka Reviandani
Published: February 2024

The aim of this research is to determine the implementation of the Women and Child Protection Services Information System (SIAP-PPAK) in Putat Jaya Village. Women and Child Protection Services Information System is a website-based application designed as a one click for all solution to integrated women's, children's and family problems. The idea for this e-Government innovation came from the Department of Women's Empowerment and Child Protection and Population Control and Family Planning (DP3APPKB) of Surabaya City. This study used descriptive qualitative method. The data collection technique is carried out through data triangulation which combines interviews, observation, literature study and documentation. The research results show that the implementation of SIAP-PPAK in Putat Jaya Subdistrict has been carried out well by fulfilling the six (6) indicators of the Van Meter and Van Horn theoretical models. Although, there are still several obstacles, these can be overcome so that women and child protection services using SIAP-PPAK can be provided with quality.
Effectiveness of ultrasound-guided stellate ganglion block in a patient with Dejerine-Roussy syndrome
Authors: Novy Theresia Chandra Tania
Published: February 2024

Dejerine-Roussy syndrome or Central Post-Stroke Pain (CPSP) is one of the most debilitating complications of cerebrovascular accidents. Sympathetic block such as stellate ganglion block (SGB) is one of the modalities used for this condition. Ultrasound guidance provides advantages for these procedures by increasing accuracy and practicality with lower exposure to radiation. A 43-year-old man came to our clinic with chronic pain which started nine years earlier after an episode of hemorrhagic stroke. The pain was refractory to analgesics, which were prescribed by healthcare facilities he visited. Further examination revealed a burning sensation and allodynia on the left side of his body. We then proceeded to perform ultrasound-guided SGB using 8 ml of 1% lidocaine along with dexamethasone 5 mg as an adjuvant agent. After two procedures within two months, SGB decreased the patient’s pain by 50−85%. Ultrasound-guided stellate ganglion appears to be safe and effective as a treatment for Dejerine-Roussy syndrome.

Abbreviations: CPSP: Central Post-Stroke Pain; IPM: Interventional Pain Management; NRS: Numeric Rating Scale; SGP: Stellate Ganglion Block

Key words: Case report, Dejerine-Roussy syndrome, Pain, Stellate ganglion block, Ultrasound

Citation: Novy TCT. Effectiveness of ultrasound-guided stellate ganglion block in a patient with Dejerine-Roussy syndrome. Anaesth. pain intensive care 2023;27(3):441−343; DOI: 10.35975/apic.v27i3.2165

Received: March 08, 2023; Reviewed: April 15, 2023; Accepted: April 20, 2023
Self-medication in general ailments and its potential risks
Authors: Waqar Muhammad Ahsan , Riaz Tehseen , Munir Minahal , Abid Syed Zeeshan , Tayyab Saqiba , Razaq Ansa , Iqbal Sehrish , Yousaf Arooj
Published: February 2024

Self-medication is thought to be very widespread, especially among adults and teenagers. It is the practice of using medications to treat conditions or symptoms that one has recognized or diagnosed oneself. The area of healthcare involving self-medication is becoming more and more significant. Self-medication is widely used for many common illnesses, including headaches, common cold, flu and diarrhea. During the COVID-19 pandemic, self-medication was also discovered to be very prevalent. However, self-medication with antibiotics is not considered as safe. People may self-medicate due to socioeconomic factors like lifestyle, drug availability, or financial hardship. Individuals who cannot afford the cost of a doctor's visit or clinical services can self-medicate because it is a less expensive option. Self-medication does, however, come with risks, such as the potential for prolonged use, misdiagnosis, overdosing, polypharmacy and drug interactions. This review describes the use of various drugs as self-medications in general ailments, in COVID-19 as well as use of antibiotics as self-medication and various risks associated with the self-medication.

Key words: Self-medication; Illness; COVID-19; Antibiotics; Headache

Citation: Waqar MA, Riaz T, Munir M, Abid SZ, Tayyab S, Razaq A, Iqbal S, Yousaf A. Self-medication in general ailments and its potential risks. Anaesth. pain intensive care 2023;27(4):579−584.

DOI: 10.35975/apic.v27i4.2089

Received: December 13, 2023; Reviewed: May 18, 2023; Accepted: June 21, 2023
Prone vs supine position in intubated COVID-19 patients with ARDS: a systematic review and meta-analysis
Authors: Aditianingsih Dita , Sugiarto Adhrie , Manggala Sidharta Kusuma , Angkasa Hansen , Natanegara Ahmad Pasha
Published: February 2024

Background & Objective: The recent COVID-19 pandemic has tested the healthcare sector to the maximum, but it also has taught us some valuable lessons, especially in the context of intensive care, and particularly in the respiratory support. This review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with ARDS.

Methodology: A computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adult (≥ 18 y old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position groups. Secondary outcomes were comparisons of PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.

Results: A total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to the supine position (MD 60.17, 95% CI 46.86−73.47; P < 0.00001). Four studies reported the PaCO2 measurements and showed no significant difference between prone and supine positions (MD 2.07, 95% CI -2.79−6.92; P < 0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and the other study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.

Conclusion: This meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS. It also prolonged ICU stay and mechanical ventilation duration, but had no effect on mortality rate.

Abbreviations: APACHE-II- Acute Physiology and Chronic Health Evaluation-II; ARDS - acute respiratory distress syndrome; ICU – Intensive Care Unit; MD – Mean Difference; NOS - Newcastle-Ottawa scale; SOFA - Sequential Organ Failure Assessment

Key words: Prone Position; Supine Position; COVID-19; ARDS, Intubation; Meta-Analysis

Citation: Aditianingsih D, Sugiarto A, Manggala SK, Angkasa H, Natanegara AP. Prone versus supine position in intubated COVID-19 patients with ARDS: a systematic review and meta-analysis. Anaesth. pain intensive care 2023;27(4):535−544; DOI: 10.35975/apic.v27i4.2136

Received: January 20, 2023; Reviewed: May 04, 2023; Accepted: June 23, 2023
Pre-emptive use of prolonged release oxycodone/naloxone combo significantly reduces postoperative pain after total hip arthroplasty
Authors: Jocović Jovan , Jocović Milena , Thieme Matthias , Eberle Thomas , Reppmann Jacqueline
Published: February 2024

Background & Objective: The role of pre-emptive analgesia remains controversial. Targeting the end of the surgery, the needed serum levels of analgesic can be achieved using prolonged release preparations, reducing acute postoperative pain and related complications. We assessed the efficacy of pre-emptive intake of prolonged release oxycodone/naloxone combination tablets on postoperative pain.

Methodology: We enrolled 152 patients who underwent an elective total hip arthroplasty under general anesthesia in the current study. The patients who prospectively received a tablet of prolonged release oxycodone 10 mg + naloxone 5 mg just before induction of general anesthesia, were categorized in the pre-emptive group (n = 76). The hospital records of 76 patients, already operated, and who did not receive any pre-emptive opioids before induction were included in the control group. Patients’ postoperative pain was measured on the Numerical Rating Scale (NRS). Piritramide is routinely used in our hospital for postoperative pain titrated until NRS level of 3 or less is achieved. Study outcomes were; the dose of piritramide used, and the time spent in post anesthesia care unit (PACU).

Results: Preoperative use of oxycodone/naloxone combination reduces the frequency of postoperative opioid use (25% vs. 7.8%; P = 0.007) and the piritramide usage (12 mg vs. 15 mg; P = 0.001) in the pre-emptive group compared to the control group. The number of patients who needed relatively small doses of piritramide (≤ 9 mg piritramide) was more in the pre-emptive group compared to the control group (44.7% vs 25%; P = 0.017).

Conclusion: The pre-emptive use of oxycodone/naloxone combination is a safe and effective way to reduce postoperative pain after total hip arthroplasty.

Abbreviations: NRS - Numerical Rating Scale; PACU - Post Anesthesia Care Unit; BMI - Body Mass Index; NSAIDs - Non-Steroidal Anti-inflammatory Drugs

Key words: Analgesia, Pre-emptive; Oxycodone; Pain, Postoperative; Total Hip Arthroplasty

Citation: Jocović J, Jocović M, Thieme M, Eberle T, Reppmann J. Pre-emptive use of prolonged release oxycodone/naloxone combination significantly reduces postoperative pain after total hip arthroplasty. Anaesth. pain intensive care 2023;27(4):464−469; DOI: 10.35975/apic.v27i4.2150

Received: February 06, 2023; Reviewed: March o3, 2023; Accepted: June 06, 2023
The anesthesiologist, stress, burn-out and the coping strategies
Authors: Zahid Muhammad Arslan , Nasir Huma , Zahid Zahra
Published: February 2024

Burnout among anesthesiologists is a significant concern, and is thought to be due to the highly demanding and stressful nature of their work. Anesthesiologists face unique stressors, including long working hours, on-call duties, emotionally challenging situations, and limited control over surgical procedures. Factors such as inadequate institutional support, lack of adequate resources, and insufficient job recognition, contribute to the risk of burnout. We highlight the negative impact of burnout on anesthesiologists' physical and mental health, including increased risks of cardiovascular problems, a weakened immune system, and emotional exhaustion. Also are discussed coping mechanisms, such as seeking emotional support, practicing mindfulness and relaxation techniques, prioritizing self-care, and engaging in physical exercise. The role of organizational culture and support in addressing stress among anesthesiologists by policies promoting work-life balance and providing access to support programs is emphasized. It also explores emerging trends and advancements in stress management techniques tailored specifically for anesthesiologists, including mind-based therapies, resilience training, and technology-enabled stress management tools. Understanding and effectively managing stress is crucial for anesthesiologists to maintain their well-being, enhance job satisfaction, and ensure quality patient care.

Key words: Burnout Syndrome; Anesthesiologist; Stress Management; Job satisfaction; Professional development; Counselling

Citation: Zahid MA, Huma Nasir H, Zahra Zahid Z. The anesthesiologist, stress, burn-out and the coping strategies. Anaesth. pain intensive care 2023;27(4):444−448; DOI: 10.35975/apic.v27i4.2254

Received: June 10, 2023; Accepted: June 14, 2923
The Cappuccini Test: an audit of anesthesia supervision
Authors: Saleem Huma , Iqbal Almas , Bukhari Sadaf , Durrani Romana Shaida
Published: February 2024

Background & Objective: Cappuccini test was launched on 22th May 2019, at Royal College of Anesthetists 2019 conference. This is an audit tool to improve the patient safety in anesthesia, based on lessons learned from Frankie Cappuccini’s death. It has been incorporated into standards set by Royal College of Anesthetists and into their hospital accreditation process as a quality improvement tool. We conducted this audit to explore the current status of supervision of trainees in anesthesia in our hospital and to suggest potential improvement of training standards.

Methodology: This prospective audit was conducted in Shaukat Khanum Memorial Cancer Hospital & research Centre, Lahore, Pakistan. It was conducted for 6 weeks from June 20, 2021 to July 31, 2021. We used the tool kit provided by Royal College of Anesthetists and compared our practicing standards against Royal College of Anesthetists' newly set standard for safety of patients and healthcare staff.

Results: We collected twenty-one operation lists during the audit time period. All these lists had trainees under supervision by a consultant grade anesthetist (100%).  In response to questions (1−3 and 6) related to trainees’ knowledge about who was the supervising consultant, how she/he could be contacted if needed, being able to contact and supervisor able to attend if required, were all 100%.

The two questions (4 and 5) were related to supervising consultants, about their awareness of the operating list being supervised by them (90.5%) and accurate description of the nature of the work being supervised by them (81%).

Conclusion: The Cappuccini test is a simple safety and quality improvement tool. It provides assurance that the trainee is working in a safe environment and has full access to contact the supervising consultant. It is a useful indicator of supervision and potential improvement of training standards.

Abbreviations: AAGBI- Association of Anesthetists in Great Britain and Ireland RcoA-Royal College of Anesthetists UK; NCEPOD-National Confidential Enquiry into Patient Outcome and Death

Key words: Cappuccini test; Patient safety; Safer surgery; Supervision

Citation: Saleem H, Iqbal A, Bukhari S, Durrani RS. The Cappuccini Test: an audit of anesthesia supervision. Anaesth. pain intensive care 2023;27(4):490−495; DOI: 10.35975/apic.v27i4.2257

Received: November 27, 2022; Reviewed: June 04, 2023; Accepted: June 07, 2023
The effect of vitamin D supplementation on pain due to periodontitis in Wistar rats with hypovitaminosis
Authors: Budisulistyo Trianggoro , Yuwono Eko , Muhartomo Hexanto , Pramukarso Dodik Tugasworo
Published: February 2024

Background & Objective: Vitamin D (vit D) plays an important role in inflammation and pain as a result of inflammatory processes, probably through its neuroprotective function. But the association of dietary supplementation and pain improvement remains unclear. We conducted this experimental study on to evaluate the effect of vit D supplementation in Wistar rats with hypovitaminosis D due to periodontitis.

Methodology: We used 20 samples of Wistar rats with induced hypovitaminosis D due to periodontitis during 7 weeks; the first week allocated for cage adaptation, in next 2 weeks, frontal teeth ligation done aimed for vit D deficiency, and during next 4 weeks vit D supplementation was done. The rats were divided into four groups; P1 (controls without ligation), P2 (ligated without vit D supplementation), P3 (vit D 4000 IU/kg supplementation), and P4 (vit D 2000 IU/kg supplementation). Pain intensity was observed by rat grimace score (RGS) at one week of cage adaptation and at four weeks after periodontitis, as well as vit D levels. 

Results: Vit D deficiency was observed at 6 weeks, either the RGS worsened. The improvement noticed in P2 (49.95%), P3 (34.30%), and P4 (59.23%) supplemented groups without statistically significant differences (P = 0.236; P = 0.280). The RGS showed decrease on P1 (P = 0.009), P2 (P = 0.011), and P4 (P = 0.049), but without significance in accordance to vit D improvement (P = 0.528). 

Conclusion: Vit D supplementation is beneficial for chronic pain when its level in the serum is low, but the effect is not statistically significant.

Abbreviations: MSK: Musculoskeletal; RGS: Rat Grimace Score; CWP: Chronic Widespread Pain

Keywords: Vitamin D; Supplementation; Wistar rat, Periodontitis; Chronic pain; Perception

Citation: Budisulistyo T, Yuwono E, Muhartomo H, Pramukarso DT. The effect of vitamin D supplementation on pain due to periodontitis in Wistar rats with hypovitaminosis. Anaesth. pain intensive care 2023;27(4):502−507; DOI: 10.35975/apic.v27i4.2259

Received: December 18, 2021; Reviewed: March 28, 2023; Accepted: April 04, 2023
Preventive efficacy of ibuprofen and dexamethasone combination for postoperative pain in posterior vertebral stabilization: a randomized controlled study
Authors: Gaus Syafruddin , Darise Sukriyah A. , Ala Alamsyah A. , Ahmad M. Ramli , Musba A. Takdir , Tan Charles W.
Published: February 2024

Background: Posterior vertebral stabilization procedures often cause acute postoperative pain that can turn into chronic pain if not managed adequately. We compared the interleukin 6 (IL-6) level and pain intensity with preventive use of multimodal analgesia with different combinations of intravenous ibuprofen and dexamethasone in these patients.

Methodology: Thirty-nine eligible patients were randomized to receive intravenous ibuprofen 400 mg and dexamethasone 10 mg (Group A), ibuprofen 800 mg and dexamethasone 10 mg (Group B), and ibuprofen 800 mg alone (Group C). The study drugs were injected 30 min before surgical procedure followed by fentanyl 24 h postop in a single‑blinded fashion. Serum levels of IL-6 were measured with ELISA. and pain intensity was measured using numeric rating scale (NRS) at preop, then at 2 h and 24 h postoperatively.

Results: There was a significant difference in the NRS scores between all treatment groups (P < 0.005) at all measurement times, where Group B had the lowest value. There was a significant difference between IL-6 levels between all treatment groups (P < 0.005) at all measurement times, where Group B had the lowest value at all measurement times. No side effects were observed in all treatment groups.

Conclusion: Preventive combination of ibuprofen and dexamethasone has efficacy and safety in managing acute postoperative pain in posterior vertebral stabilization procedures.

Abbreviations: COX – Cyclooxygenase; IL-6 - Interleukin 6; MAC - Minimum Alveolar Concentration; NRS - Numeric Rating Scale; NSAIDs - Non-Steroidal Anti-Inflammatory Drugs; PSA - Patient-Controlled Analgesia

Key words: Analgesia; Dexamethasone; Ibuprofen; Interleukin-6; Preventive Medicines; Spinal Surgery

Citation: Gaus S, Darise SA, Ala AA, Ahmad MR, Musba AT, Tan CW. Preventive efficacy of ibuprofen and dexamethasone combination for postoperative pain in posterior vertebral stabilization: a randomized controlled study. Anaesth. pain intensive care 2023;27(5):548−554; DOI: 10.35975/apic.v27i5.1851

Received: March 22, 2023; Reviewed: August 26, 2023; Accepted: September 04, 2023
The knowledge and attitudes of healthcare professionals of an orthopedic ward regarding opioid administration: a Caribbean perspective
Authors: Ventour Dale , Ragoonath Michele
Published: February 2024

Background & Objective: Opioids remain the mainstay of management of postoperative pain, despite a number of associated side effects and a chance of habituation or even addiction. This study aimed to look at the knowledge and attitudes of Health Care Professionals (HCPs) towards opioid use as the both of these directly impact management of post-operative pain in surgical patients.

Methodology: A questionnaire like the one used in a Taiwan study by Luo Ping Ger et al. was administered. A total of seventeen questions were used to evaluate knowledge and attitudes towards opioid use using a 5-point Likert scale ranging from Strongly agree to strongly disagree. The questionnaire was administered to HCPs at various levels who were involved in the treatment of the orthopedic patients.

Results: The paucity of knowledge about opioids and the methods of administration leads to poor attitudes regarding opioid prescribing, administration, and side effect profile. This would, in turn, lead to general noncompliance by nursing staff regarding administration of the drug. Also, it was determined in the survey that a notable percentage of HCPs may not know what to do if there was a side effect related to opioid administration, as there was a general lack of knowledge about how to recognize and precautionary measures to be instituted.

Conclusion: Most health care professionals had a positive attitude regarding respiratory depression and opioids; however, this was not seen with the other side effects such as abdominal distension, nausea and vomiting, and constipation where negative attitudes were expressed by the senior nursing staff. This may be attributed to lack of continuous medical training regarding pain management on the ward.

Key words: Health Care Worker; Opioids; Orthopedics; Pain, Acute; Pain, Perception; Pain, Relief; Pain, Attitude

Citation: Ventour D, Ragoonath M. The knowledge and attitudes of healthcare professionals of an orthopedic ward regarding opioid administration: a Caribbean perspective. Anaesth. pain intensive care 2023;27(5):539−547; DOI: 10.35975/apic.v27i5.2310

Received: February 16, 2023; Reviewed: July 27, 2023; Accepted: September 01, 2023