bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Asphalt Performance and Its Long-Term Sustainability with Nano Calcium Carbonate and Nano Hydrated Lime
Authors: Albayati Amjad H. , Al-Ani Aliaa F. , Byzyka Juliana , Al-Kheetan Mazen , Rahman Mujib
Published: February 2024

Nanomaterials enhance the performance of both asphalt binders and asphalt mixtures. They also improve asphalt durability, which reduces resource consumption and environmental impact in the long term associated with the production and transportation of asphalt materials. Thus, this paper studies the effectiveness of Nano Calcium Carbonate (Nano CaCO3) and Nano Hydrated Lime (NHL) as modifiers and examines their impact on ranges from 0% to 10% through comprehensive laboratory tests. Softening point, penetration, storage stability, viscosity, and mass loss due to short-term aging using the Rolling Thin Film Oven Test (RTFO) were performed on asphalt binders. Results indicated a significant improvement in binder stiffness, particularly at 4% Nano CaCO3 and 6% NHL content by weight. Dynamic Shear Rheometer (DSR) tests further revealed substantial improvements in rutting resistance, with NHL exhibiting superior high-temperature stability and a notable increase in the rutting factor. Marshall stability tests on asphalt concrete (AC) mixtures showed a 22.3% increase in stability with 6% NHL by weight, surpassing the 20.2% improvement observed with Nano CaCO3 and indicating enhanced load-bearing capacity. The resilient modulus of the mixtures consistently increased with the addition of NHL, suggesting improved durability in rutting. Moisture susceptibility tests revealed that NHL significantly enhances moisture resistance, exceeding the 80% TSR benchmark at just 2% content by weight and reaching an impressive 94.6% at 10% content by weight. In contrast, Nano CaCO3 demonstrated a more gradual improvement, achieving an 88.2% TSR at 10% content. Furthermore, permanent deformation analysis indicated a 68.64% improvement in rutting resistance with 10% NHL content by weight, exceeding Nano CaCO3’s improvement rate. Optimal fatigue resistance was achieved at 4% for Nano CaCO3 and 6% for NHL by weight, with respective CT index improvements of 30% and 35.4%, showing NHL’s consistent benefits across various nanomaterial contents. Overall, the study suggests that both Nano CaCO3 and NHL positively impact asphalt performance, with NHL offering more pronounced benefits across a range of properties. These findings provide valuable insights for pavement engineers and underscore NHL’s potential as an effective additive in asphalt mixture design. Real-world applications and validations are essential for a comprehensive understanding of these nanomaterials in practical pavement engineering scenarios.
On the Entire Harmonic Index and Entire Harmonic Polynomial of Graphs
Authors: Saleh Anwar , Alsulami Samirah H.
Published: February 2024

A topological descriptor is a numerical parameter that describes a chemical structure using the related molecular graph. Topological descriptors have significance in mathematical chemistry, particularly for studying QSPR and QSAR. In addition, if a topological descriptor has a reciprocal link with a molecular attribute, it is referred to as a topological index. The use of topological indices can help to examine the physicochemical features of chemical compounds because they encode certain attributes of a molecule. The Randić index is a molecular structure descriptor that has several applications in chemistry and medicine. In this paper, we introduce a new version of the Randić index to the inclusion of the intermolecular forces between bonds with atoms, referred to as an entire Harmonic index (EHI), and we present the entire Harmonic polynomial (EHP) of a graph. Specific formulas have been obtained for certain graph classes, and graph operations have been obtained. Bounds and some important results have been found. Furthermore, we demonstrate that the correlation coefficients for the new index lie between 0.909 and 1. In the context of enthalpy of formation and π-electronic energy, the acquired values are significantly higher than those observed for the Harmonic index and the Randić index.
A Review of Biological Processes for Dairy Wastewater Treatment and the Effect of Physical Parameters Which Affect Their Efficiency
Authors: Ramsuroop Jyestha , Gutu Laurah , Ayinde Wasiu B. , Basitere Moses , Manono Malibongwe S.
Published: February 2024

The global dairy sector produces upwards of 900 million tonnes of milk each year, resulting in 2.25 billion tonnes of wastewater being generated. This is significant in the South African context as a large percentage of the population lives without reliable access to clean, reliable water. The treatment of dairy wastewater (DWW) in this context would help alleviate the unavailability for many people in this country. DWW has a high fat content along with a high chemical oxygen demand (COD), which makes it problematic to dispose of. Biological treatment processes have shown great success in the remediation of this water. However, these are not without their shortfalls. A variety of biological processes have been listed here as well as suggestions to improve their effectiveness. To improve the treatment efficiency, there are two main lines of thinking: First, to optimise the process through the manipulation of the physical parameters of the systems (e.g., temperature, pH, hydraulic retention time (HRT), agitation, etc.). Second, to add either pre-treatment or post-treatment processes to the main process to increase the effectiveness of the entire process overall. These different options have been discussed, with suggestions being made on the way forward.
A Unified Spatial-Pressure Sensitivity Partitioning and Leakage Detection Method within a Deep Learning Framework
Authors: Dong Bo , Shu Shihu , Li Dengxin
Published: February 2024

This study introduces an innovative approach for leak detection in water distribution systems (WDSs), integrating three-order embedding, k-means clustering, and long short-term memory (LSTM) networks, with pressure-sensitive analysis techniques. This comprehensive methodology segments the network into distinct partitions, utilizes simulated leak events to train the deep learning networks, and establishes a sophisticated model for accurately identifying leak partitions. This approach generates a leak dataset by adjusting water demands, which could effectively pinpoint the leaks in a specific partition by leveraging both the pressure sensitivity and spatial coordinates of nodes, allowing for the elimination of the need for manual work and precise identification of leaks in targeted areas. Through the analysis of two case studies, the model demonstrates its ability to effectively pinpoint potential leak partitions, significantly enhancing operational efficiency and reliability in managing the complex problems of urban water resource management. This approach not only optimizes leak detection but also paves the way for advanced, data-driven strategies in WDSs, ensuring sustainable and secure water distribution in urban settings.
Spatial–Temporal Water Balance Evaluation in the Nile Valley Upstream of the New Assiut Barrage, Egypt, Using WetSpass-M
Authors: Li Zhanchao , Eladly Ahmed S. , Amen Ehab Mohammad , Salem Ali , Hassanien Mahmoud M. , Yahya Khailah Ebrahim , Liang Jiaming
Published: February 2024

The components of water balance (WBC) that involve precipitation, evapotranspiration, runoff, irrigation, and groundwater recharge are critical for understanding the hydrological cycle and water management of resources in semi-arid and arid areas. This paper assesses temporal and spatial distributions of surface runoff, actual evapotranspiration, and groundwater recharge upstream of the New Assiut Barrage (NAB) in the Nile Valley, Upper Egypt, using the WetSpass-M model for the period 2012–2020. Moreover, this study evaluates the effect of land cover/land use (LULC) alterations in the study period on the WBC of the NAB. The data provided as input for the WetSpass-M model in the structure of raster maps using the Arc-GIS tool. Monthly meteorological factors (e.g., temperature, rainfall, and wind speed), a digital elevation model (DEM), slope, land cover, irrigation cover, a soil map, and depth to groundwater are included. The long-term temporal and spatial mean monthly irrigation and precipitation (127 mm) is distributed as 49% (62 mm) actual evapotranspiration, 15% (19 mm) groundwater recharge, and 36% (46 mm) surface runoff. The replacement of cropland by built-up areas was recognized as the primary factor responsible for the major decrease in groundwater, an increase in evapotranspiration and an increase in surface runoff between LCLU in 2012 and 2020. The integration of the WetSpass model with GIS has shown its effectiveness as a powerful approach for assessing WBC. Results were more accurate and reliable when hydrological modeling and spatial analysis were combined. The results of this research can help make well-informed decisions about land use planning and sustainable management of water resources in the upstream area of the NAB.
Modelos cognitivos de emoções musicais: abordagens discreta e dimensional
Authors: Nunes-Silva Marília , Moreira Paulo Sergio da Conceição , Eyer Pollyanna
Published: February 2024

Emotions are biological, chemical, and neural reactions to stimuli, influenced by crucial brain mechanisms for human survival and well-being. Music is linked to the induction of emotions with neurobiological foundations associated with the activation of structures in the limbic and paralimbic systems. The induction of emotions is also related to specific features of mu-sical stimuli. This article aims to discuss the discrete and dimensional approaches to emotions and cognitive models of musical emotions through a literature review. The discrete approach argues that certain emotional categories are universal and innate, reflecting internally trig-gered states driven by genetically programmed bodily changes. The dimensional approach involves models that represent emotions in a few dimensions rather than specific emotional states. Both guide models of musical emotions and enable testing hypotheses and creating emotional assessment tools with music.
Prática musical livre, instrumental e vocal, em musicoterapia: musicalidades em ação com potência transformadora
Authors: Piazzetta Clara Márcia , da Rocha Khauê Augusto , Zimmer Luana , da Silva Yolanda Aline
Published: February 2024

In Music Therapy, Music is understood as an intentional human action in the happening of musicalities in action. This research sought to understand what improvised and spontaneous sounds reveal in practice. With a qualitative, exploratory methodology, it made use of video recordings and used music therapy analysis (MTA) and microanalysis as data collection tools through descriptive and reflective analysis of the musical event in improvised musical expe-riences. The triad of listening, reading and music therapy analysis is contemplated, and these constitute the specificities of action for the construction of the music therapy process (MTP). Fragments of moments, one at the beginning and the other at the end, reveal changes in mu-sicality in terms of the duration of musical interaction and the exchange of turns. Through AMT, these changes are understood as cognitive gains, neuronal plasticity and linguistic functions, loaded with traces. Meanings are attributed to these traces, in relation to clinical and life history, in order to better understand MTP.
Austrian toponymic policy in the late 18th to early 20th century cartography of Galicia and Bukovina
Authors: Włoskowicz Wojciech
Published: February 2024

The aim of the paper is to partially reconstruct and outline the Habsburg toponymic policy in the late 18th to early 20th century cartography of Galicia [Galicja, Galyčyna] and Bukovina [Bucovina, Bukovyna]. This is done by means of analysis of samples of toponyms extracted from the maps of (selected parts of) Galicia and Bukovina: the First and the Third Survey of Austria(-Hungary) as well as the Spezialkarte. Attention is paid mainly to the eastern part of Galicia and to Bukovina in order to highlight the cartographic relations between Ruthenian (Ukrainian) and Polish toponym forms. The discussion of the toponymic policy within the Third Survey is based on the analysis of survey manuals of 1875, 1887, and 1903. The empirical findings are preceded by a brief discussion of theoretical issues. An outline of the concepts of toponymic usus, norm/standard, and codification is made. The main elements of the theory of name and naming policy are presented.
When Harvati became Mycenae (1916). Toponyms and nation building in early-20th century Greece
Authors: Hionidis Pandeleimon
Published: February 2024

This article examines Greek perceptions and politics related to place names in the early 20th century. Although the tendency to rename places was already strong during the War of Independence in the 1820s, it finally became a systematic process in June 1909, when the “Toponyms of Greece Committee” was established and staffed by distinguished academics. The case of Harvati-Mycenae, though not unique in modern Greek history, presents an indicative example of the interaction between administrative expediency and national aspirations in the reshaping of the map of Greece. The history of this small village in Argolida [Argolída], which in 1916 was renamed from Harvati to Mycenae, is part of the long-lasting practice of changing names and adapting geography to the political and ideological necessities of the state. We argue that this process was an integral part of a ruling ideology that stressed continuity and kinship of the modern Greeks with an alleged glorious national past.
The earliest journal on toponymy and its spin-off effects on place-name research
Authors: Schochenmaier Eugen
Published: February 2024

Our study briefly outlines the history of the first toponomastic journal worldwide and the first journal devoted to Dutch toponymy, Nomina Geographica Neerlandica, which was launched in 1884. It presents the creation, objectives, editorial boards, evolutionary paths and inevitable end. The final part focuses on its decisive influence on the development of place-name research in the Netherlands and Belgium until 2011.
Wherein lies the heritage value of place names?
Authors: Mácha Přemysl
Published: February 2024

There is a growing academic consensus that place names represent a valuable form of intangible cultural heritage of humanity and therefore they deserve systematic recognition and protection. However, when we attempt to put this idea into practice, we run into many problems. First, we have to define the heritage value of place names and establish the object of protection efforts. Second, we have to weigh political, moral, and practical implications of specific choices, set protection priorities and select from alternative courses of action each of which has its advantages and disadvantages. Finally, we have to reflect self-critically on our protection efforts in order to honour the dynamic nature of toponymic systems and allow people to choose or coin place names for the places which are important to them. The paper discusses the most important dilemmas we face in place-name recognition and protection and suggests possible solutions to some of them.
Microtoponymy as a paradigm of cultural heritage – A case study of Catalan oronyms
Authors: Tort i Donada Joan
Published: February 2024

This article focuses on the heritage value of microtoponymy in the sense of toponyms for small geographical features or the system of place names at the municipal level in Catalonia [Catalunya/Cataluña] (Spain), a region in the western Mediterranean that has its regional, highly dynamic language (Catalan) and a toponymy studied since the beginning of the 20th century from a systematic perspective. This study departs from a set of toponyms referring to orography (oronyms) of the Baix Camp Comarca in the province of Tarragona. It comprises 1,776 oronyms spread over an area of 690 km² and 29 municipalities. The study considers to which extent the microtoponymy of Catalonia can be considered a paradigm of the heritage value of toponymy at the local scale, i.e., at the level closest to citizens, and to which extent this paradigm can be projected onto other toponymic systems.
“This is water’s world/And the works of men are vanishing”: Hydronymy & anonymity honour water in Alice Oswald’s Dart & Memorial
Authors: Rader Pamela J.
Published: February 2024

Alice Oswald’s full-length poems Dart (2002) and Memorial (2013) draw attention to the ecology of water in the 21st century by excavating stories and myths around place names, specifically waterways. Hydronyms for the River Dart and the potamoi and naiads of Greco-Roman mythology re-envision history through narrative and its relationship to sites or places. While Dart underscores the human lore around the river by the same name, Memorial rejects human desire for immortality and glory with the remembrance of the Iliad’s dead who return to earth and life cycles with the aid of water. Poetry that focuses on place and history of place names inspires curiosity to rebuild human and non-human relationships.
Heritagisation as decolonisation. Giving back to the inhabitants of Comelico valley their minority language toponyms
Authors: Ferrario Viviana , Cesco Frare Piergiorgio , Turato Andrea
Published: February 2024

This paper presents and discusses an empirical experience of cadastre-based Historical GIS applied to minority language place names in the Alpine valley of Comelico. The Comelico digital toponymy atlas (T-Atlas) is a tool to record and map local place names for scientific purposes; it promotes the linguistic minority as a resource for cultural tourism; it intends to revitalise the use of Ladin toponyms among local population and visitors; it aims to unravel the process of translation of local place names into dominant language in official cartography (namely in cadastral maps of 19th century), so strengthening the awareness about the value of minority language in the valley.
Rubiaceae Americanarum Magna Hama Pars LII. New Species and Taxonomic Notes for Notopleura (Palicoureeae) of South America
Authors: Taylor Charlotte M.
Published: February 2024

Eight species of Notopleura (Benth.) Bremek. are newly described here, all but one in Notopleura subg. Notopleura. Notopleura aurantiaca C. M. Taylor is found from Ecuador to Peru and western Brazil; N. bracteata C. M. Taylor in central Peru; N. cajamarcana C. M. Taylor in northern Peru; N. divaricata C. M. Taylor in western Colombia; N. harlingii C. M. Taylor in central Ecuador; N. kosnipatana C. M. Taylor in southern Peru; N. valenzuelae C. M. Taylor in central Peru; and N. stevensonii C. M. Taylor, which belongs to Notopleura subg. Viscagoga (Baill.) C. M. Taylor, in central Colombia. The identities of several published names that apply to species of Notopleura are clarified, new combinations are made for three older names that apply to previously described species, and several other names are newly synonymized here. Notopleura chasaliodes (Kunth) C. M. Taylor is based on Uragoga chasaliodes Kunth and is an older name for N. plagiantha (Standl.) C. M. Taylor; N. paramorum (Standl.) C. M. Taylor is based on Psychotria paramorum Standl. and is an older name for N. pithecobia (Standl.) C. M. Taylor; and N. semimetralis (K. Krause) C. M. Taylor is based on P. semimetralis K. Krause and is an older name for N. vargasiana C. M. Taylor. The identities of several other names are also newly clarified: P. albacostata Rusby is a distinct species, treated here as the new combination N. albacostata (Rusby) C. M. Taylor; Hoffmannia striata Rusby is a synonym of N. tolimensis (Wernham) C. M. Taylor; and P. dudleyi Steyerm. is a synonym of N. paramorum. Additionally, eight names are lectotypified and the nomenclatural status of Uragoga Baill. is discussed.
Analisis Struktur Biaya Usahatani Cengkeh Di Desa Raanan Baru Dua Kecamatan Motoling Barat Kabupaten Minahasa Selatan
Authors: Mamero Putri , Laoh Olly Esry Harryani , Montolalu Maya Hendrietta
Published: February 2024

This study aims to analyze the cost of cloves in Raanan Baru 2 Village, West Motoling District. Sampling in this study used the method (Purposive Sampling) or deliberately from clove farmers in Raanan Baru Dua Village, West Motoling District. The number of respondents was 10 people as respondents. The data used in this study are primary data and secondary data. Primary data was obtained by using direct interview techniques with clove farmers as respondents, by using a questionnaire (questionnaire) as an aid in data collection. While secondary data were obtained from the agencies involved in this study. The analytical method used in this research is cost analysis, analysis of total revenue and total income and the cost structure of farming. the results of research conducted on clove farming in Raanan Baru Dua Village, West Motoling District, obtained an income of Rp.93,906,348.- per harvest with a total income of IDR 196,790,000.- per harvest and a total cost of IDR 102,883,652.- per harvest of the total costs incurred fixed costs (Fix Cost) contributed to the total cost of 0.03 percent and variable costs (Variable Cost) contributed to the total cost of 99.96 percent and for the contribution of costs based on harvest preparation activities contributed to the total cost of 0.59 percent and for cost contributions based on harvest activities contributing to costs of 97.84 percent and for cost contributions based on post-harvest activities contributing to total costs of 1.16 percent.
Pendapatan Usahatani Jagung Di Desa Tumani Selatan Kecamatan Maesaan Kabupaten Minahasa Selatan
Authors: Panelewen Elisa , Laoh Olly Esry Harryani , Sondakh Mex Frans Lodwyk
Published: February 2024

This study aims to calculate corn farming income in Tumani Selatan Village, Maesaan Sub-district, South Minahasa Regency. The research was conducted from June to July 2023. Sampling using sample survey method with 16 farmers as respondents. The data used in this study are primary data and secondary data and use income analysis calculations. Data analysis used in this research is quantitative descriptive analysis in determining production, revenue and income. The results showed that the average revenue of corn farmers per hectare in South Tumani Village, Maesaan Subdistrict, South Minahasa Regency in one harvest was IDR16.588.090. The average income of corn farmers per hectare amounted to IDR8.537.786.
Development and implementation of new clinical research program in a rural hospital for children undergoing myringotomies or tonsillectomies and adenoidectomies
Authors: Bryan Yvon F. , Wong Kristal , Johnson Kathleen N. , Choi Jungbin A. , Harris Hannah , Galla Jodi , Chapman Brandon
Published: February 2024

Background & Objective: Pediatric sub-specialty procedures are usually performed in large hospitals by specialists. We aimed to develop a protocol in pediatric patients undergoing bilateral myringotomies (BMT) or tonsillectomies and/or adenoidectomies (T&A) in a rural community hospital. Methodology: An IRB-approved, prospective study was performed at Lexington Medical Center to examine the safety (S), emergence (E), and efficacy (E) (SEE) of an anesthetic protocol in patients under 7 y of age undergoing BMT or T&A. A non-specialist anesthesiology-based team performed the protocol related to SEE. Results: Out of 60 patients enrolled in the study, 4 (6.6%) desaturated (lowest SpO2 87%), and 6 (10%) had poor quality of emergence from anesthesia. The mean times for induction, emergence, and surgery for BMT were 4.8 ± 1.3, 4.2 ± 2.2, and 3.9 ± 1.0 min respectively. The mean times for induction-intubation, emergence-extubation, and surgery for T&A were 9.0 ± 2.9, 12.1 ± 6.8, and 14.6 ± 5.8 min respectively. Conclusion: The development of a clinical research program and study protocol was achieved for pediatric ENT procedures at a rural hospital. We found that Lexington Medical Center had a low incidence of desaturation, good quality of emergence from anesthesia, and efficacy. Key words: BMT: bilateral myringotomies; Desaturation; Emergence; Protocol; Pediatric; Citation: Bryan YF, Wong K, Johnson KN, Choi JA, Harris H, Galla J, Chapman B. Development and implementation of the new clinical research program in a rural hospital for children undergoing myringotomies or tonsillectomies and adenoidectomies. Anaesth. pain intensive care 2023;27(3):315−324. DOI: 10.35975/apic.v27i3.1501 Received: May 17, 2021; Reviewed: August 30, 2021; Accepted: May 10, 2023
Changes in Bispectral Index with different positions during general anaesthesia.
Authors: Kamaruzaman Khairunnadiah , Izaham Azarinah , Rahman Raha Abdul , Mokhtar Mohammad Nizam
Published: February 2024

Background & Objective: Bispectral index (BIS) is used for intraoperative anesthesia depth assessment during general anesthesia (GA). This monitoring modality has been used routinely at many centers during GA, but especially during susceptible patients, in which precise depth of anesthesia is required. We aimed to compare changes of BIS in different head positions under GA, but without surgical stimulation. Methodology: Thirty ASA physical status I patients aged 18−60 y were recruited for this prospective, observational study after ethical approval by the institutional ethical review committee. After administration of GA, patients were kept in supine position for 15 min and the BIS, signal quality index (SQI), electromyography (EMG), mean arterial pressure (MAP) and heart rate (HR) were recorded. Patients were then sequentially placed in: reverse Trendelenburg (45°), supine, Trendelenburg (45°) positions, each for 15-min duration and 3 readings were taken in each position at 5 min interval. Lastly patient was positioned back to supine position for the surgery to begin. Results: There was a statistically significant decrease of BIS value with a change from supine position to reverse Trendelenburg position (P = 0.02) and increase in BIS value from supine to Trendelenburg position (P = 0.01). Changing of position from supine to reverse Trendelenburg was found to have a statistically significant decrease in MAP (P = 0.005), whereas changing to Trendelenburg position significantly increased MAP compared to supine position (P < 0.001). There was a positive moderate linear correlation between BIS and MAP (r = 0.513, P = 0.004). Conclusion: A change of position from supine to reverse Trendelenburg decreases and from supine to Trendelenburg position transiently increases the BIS values. Abbreviations: BIS - Bispectral Index; SQI - Signal Quality Index; EMG – Electromyography; MAP - Mean Arterial Pressure Key words: Anesthesia; Anesthesia, General; Bispectral Index; Electroencephalography; Electromyography; Monitoring; Positioning Citation: Kamaruzaman K, Izaham A, Rahman RA, Mokhtar MN. Changes in bispectral index (BIS) with different positions during general anesthesia. Anaesth. pain intensive care 2023;27(3):325−331. DOI: 10.35975/apic.v27i3.1922 Received: June 24, 2022; Reviewed: April 10, 2023; Accepted: April 10, 2023
Anesthetic management of adult patients with tetralogy of Fallot: a case series
Authors: Sengottian Mano Praveen , Ajanth S. , Baliarsing Lipika A. , Deshpande Charulata
Published: February 2024

Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease, occurring predominantly in the childhood with a rare late presentation in the adults. the prognosis OF ToF remains poor, especially in those who do not undergo surgical correction. However, in the recent times, there is a significant improvement in the prognosis of congenital heart diseases and almost 85% patients are expected to survive till adulthood due to early diagnosis and appropriate medical and surgical management. These adult patients with congenital heart disease exhibit specific and complex anatomic and physiological changes, which can affect the perioperative morbidity and mortality to a great extent. We present this case series to discuss the relevant clinical and successful anaesthetic conduct of adult patients with ToF. before and after surgical repair, with good perioperative outcome.

Key words: Tetralogy of Fallot; Congenital heart disease; Anesthesia; Cyanosis; Pulmonary stenosis; Pulmonary atresia.

Citation: Sengottian MP, Ajanth S, Baliarsing LA, Deshpande C. Anesthetic management of adult patients with tetralogy of Fallot: a case series. Anaesth. pain intensive care 2023;27(3):429−433; DOI: 10.35975/apic.v27i3.2229

Received: November 27, 2022; Reviewed: March 16, 2023; Accepted: April 05, 2023
A retrospective analysis of the incidence and determinants of self-extubation in a tertiary care surgical intensive care unit
Authors: Ali Muhammad Asghar , Rashid Saima , Siddiqui Khalid Maudood , Yousuf Muhammad Saad
Published: February 2024

Background & Objective: Self-extubation is reported as one of the most common adverse events in the adult intensive care units worldwide. We aimed to find out the incidence and determinants of self-extubation in surgical intensive care unit of our tertiary care hospital. Methodology: It was retrospective analysis of the data acquired from the hospital databases, about the patients who self-extubated during admission to surgical intensive care unit (SICU) of Aga Khan University Hospital, Karachi, Pakistan, during six calendar years, from January 01, 2010, through December 31, 2016. Data collection form was used to collect personal details, drugs used for sedation, sedation agitation score, pain score, nurse-patient ratio and the use of any restraint at the time of extubation. SPSS was used to analyze data applying the central limit theorem to calculate the mean and standard deviation for quantitative variables and the Chi-square test was conducted using a P < 0.05 for qualitative variables. Multivariate logistic regression analysis was performed to identify the independent risk factors for self-extubation Results: A total of 618 patients were admitted to the SICU who required mechanical ventilation during the study period. An overall 2.1% incidence of self-extubation was calculated with a documented thirteen self-extubation episodes. The mean age of patients was 38.46 ± 16.97 y with majority of them being males. Most, 9 (69.2%), of the patients were not restrained at the time of self-extubation. Nurse to patient ratio was 1:1. Majority of patients 7 (53.8%) were not on any sedative drug infusion and the mean sedation agitation score at that time was 4.46 ± 2.02 while mean pain score was 5.31 ± 2.72. Reintubation was performed in 10 (76.9%) of the patients, who had self-extubated. Conclusion: This study revealed that the incidence of self-extubation was 2.1% in SICU and there was strong correlation between absent physical restraint and self-extubation incidence during the weaning period. Key words: Mechanical ventilation; Reintubation; Self-extubation; Sedation; Surgical Intensive Care Unit; Tertiary Care Hospital Ali MA, Rashid S, Siddiqui KM, Yousuf MS. A retrospective analysis of the incidence and determinants of self-extubation in a tertiary care surgical intensive care unit. Anaesth. pain intensive care 2023;27(3):260−263; DOI: 10.35975/apic.v27i3.2231 Received: October 03, 2022; Reviewed: April 04, 2023; Accepted: April 19, 2023
Effectiveness of goal-directed fluid therapy guided by estimated continuous cardiac output (esCCO) in major gastrointestinal surgeries: a randomized controlled trial
Authors: Vu Phương Hoang , Duong Nu Diep Anh , Tran Viet Duc , Tran Thu Ha , Luu Xuan Vo , Truong Quang Trung , Nguyen Huu Tu , Ochiai Roy
Published: February 2024

Background & Objective: This study was conducted to compare the effectiveness between goal-directed fluid therapy guided by Estimated Continuous Cardiac Output (esCCO) monitoring and liberal infusion therapy on the early perioperative and postoperative complications, as well as long-term complications in major gastrointestinal surgeries.

Methodology: A randomized controlled trial was conducted at Hanoi Medical University Hospital, Hanoi, Vietnam from October 2020 to October 2021. There were 138 patients enrolled in the study and divided randomly into two groups: Group LIF (liberal infusion therapy) and Group GD (goal-directed fluid therapy using esCCO monitors). The logistic regression (univariate and multivariate) analysis models were performed to evaluate the relationship between the complication (yes or no) and potential predictors.

Results: Mortality and length of hospital stay in the esCCO group were not different from those in the liberal infusion therapy group (P > 0.05). Postoperative respiratory complications such as pneumonia and pulmonary edema were lower in the Group GD but not statistically significant compared with the Group LIF (5.7% vs 7.4% with P > 0.05). There was a higher rate of acute kidney injury in the Group GD than in the Group LIF, but the difference was not statistically significant (5.7% vs 1.5% with P > 0.05). Other complications such as bleeding, wound infection, and tissue edema in the Group GD was almost equivalent to those in the Group LIF and the difference was not statistically significant.

Conclusion: Goal-directed fluid therapy according to esCCO guidelines reduced the amount of intraoperative fluids while maintaining hemodynamic stability during surgery, but has not shown a real effect in reducing postoperative complications. Further studies with a larger number of patients are needed, in high-risk groups of patients requiring intravenous fluids according to esCCO guidelines to better evaluate the effectiveness of reducing postoperative complications.

Abbreviations: esCCO - Estimated Continuous Cardiac Output; esSVI - Estimated Stroke Volume Index; PEEP -Positive End-Expiratory Pressure; MAC - Minimum Alveolar Concentration

Key words: esCCO; Gastrointestinal Surgeries; Goal-directed Fluid Therapy; Infusion Therapy; Randomized Controlled Trial

Citation: Hoang Vu P, Anh Duong ND, Viet Duc Tran VD, Tran TH, Luu VX, Truong QT, Nguyen HT, Ochiai R. Effectiveness of goal-directed fluid therapy guided by estimated continuous cardiac output (esCCO) in major gastrointestinal surgeries: a randomized controlled trial. Anaesth. pain intensive care 2023;27(3):371−378; DOI: 10.35975/apic.v27i3.2242

Received: November 15, 2022; Reviewed: April 29, 2023; Accepted: April 29, 2023
Sub-hypnotic dose of midazolam is effective in reducing intraoperative nausea and vomiting during cesarean sections under spinal anesthesia
Authors: Ibrahem Ibrahem Ghaleb
Published: February 2024

Background & Objectives: Intra and postoperative nausea and vomiting under regional anesthesia is a common problem in cesarean sections. Globally, the incidence has been documented to be from 40−80%, and various drugs have been used to control it. We aimed to determine if a subhypnotic dose of midazolam will be effective to reduce intraoperative nausea and vomiting during an elective cesarean section under spinal anesthesia.

Methodology: A randomized interventional study was done through a period of 6 months from March 11, 2019 to September 11, 2019 and included 100 full term pregnant women undergoing elective cesarean sections (CS) under spinal anesthesia. The participants were allocated to one of two groups: Midazolam group (received midazolam 1 mg bolus then 1.0 mg/h infusion after umbilical cord clamping), and placebo group (received normal saline). Bellville score was used to evaluate nausea and vomiting (N/V). The hemodynamic parameters were monitored at three-minute intervals.

Results: No statistically significant differences were noted between study groups regarding mean arterial pressure, heart rate and total ephedrine used in the two groups. Intraoperative nausea and vomiting were recorded midazolam (81.6%) with a significant association between prevention of intraoperative N/V and receiving midazolam. Insignificant association was noticed between the level of sedation and receiving midazolam.

Conclusion: Administration of low dose of midazolam during cesarean sections under spinal anesthesia can lessen intraoperative nausea/vomiting without significantly effect on blood pressure or heart rate and without any negative side effects.

Abbreviations: BMI – Body Mass Index; CS - Cesarean Section; LA – Local Anesthesia; N/V - Nausea/Vomiting; RASS - Richmond Agitation Sedation Score SA - Spinal Anesthesia

Key words: Nausea; Vomiting; Anesthesia, Spinal; Midazolam; Cesarean Section

Citation: Ibrahem IG. Sub-hypnotic dose of midazolam is effective in reducing intraoperative nausea and vomiting during cesarean sections under spinal anesthesia. Anaesth. pain intensive care 2023;27(4):485−489; DOI: 10.35975/apic.v27i4.2087

Received: October 12, 2022; Reviewed: May 16, 2023; Accepted: June 23. 2023
Accuracy of preoperative evaluation of inferior vena cava collapsibility index and caval aorta index for prediction of hypotension after induction of general anesthesia: a prospective observational study
Authors: Omar Heba , Moamen Ahmed , Abdelhamid Bassant Mohamed , Rady Ashraf , Farouk Inas
Published: February 2024

Background & Objective: Post general anesthesia induction hypotension (PGAH) is not a rare event. Almost every induction agent has been incriminated to a variable extent. Preoperative ultrasound assessment of Inferior Vena Cava Collapsibility Index (IVCCI) has been investigated for predicting hypotension with mixed results. Inferior vena cava to aorta diameter index (IVC/Ao) hasn’t been studied before as a predictor for PGAH. We studied the comparative accuracy of preoperative IVCC and IVC/Ao index for PGAH prediction.

Methodology: This observational prospective blinded study involved 102 participants undergoing different surgeries under general anesthesia. Preoperative ultrasound assessment of IVCCI and IVC/Ao index was done. Mean arterial pressure (MAP) was assessed 6 times; before induction, 1 min and 3 min after induction and 1, 5 and 10 min after endotracheal intubation. The area under the receiver operating characteristic curve (AUROC) was calculated for the ability of IVCC and IVC/Ao index to predict PGAH. Stepwise, backward logistic regression model was constructed to detect and quantify the predictive factors of PGAH.

Results: A total of 80 (78.43%) patients developed PGAH. ROC curve analysis for PGAH prediction demonstrated better diagnostic accuracy for IVC/Ao index than IVCCI, as the AUC of both were 0.666 (P < 0.017) and 0.487 (P = 0.852) respectively. IVC/Ao index cutoff value was 0.852

Conclusions: Inferior vena cava collapsibility index and inferior vena cava to aorta diameter ratio (IVC/Ao) index are both reliable indicators of post general anesthesia induction hypotension. IVC/Ao index is a more accurate and reliable indicator than inferior vena cava collapsibility index.

Abbreviations: CVP: Central Venous Pressure; IVCCI: Inferior Vena Cava Collapsibility Index; IVC/Ao: Inferior Vena Cava to Aorta Diameter Index; IVCD: Inferior Vena Cava Diameter; PAOP: Pulmonary Artery Occlusion Pressure; PGAH: Post General Anesthesia Induction Hypotension

Key words: Hypotension; General Anesthesia; Ultrasound; IVCCI; Aorta

Citation: Omar H, Moamen A, Abdelhamid BM, Rady A, Farouk I. Accuracy of preoperative evaluation of inferior vena cava collapsibility index and caval aorta index for prediction of hypotension after induction of general anesthesia: a prospective observational study. Anaesth. pain intensive care 2023;27(4):449−455; DOI: 10.35975/apic.v27i4.2255

Received: October 12, 2022; Reviewed: March 03, 2023; Accepted: May 20, 2023
Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial
Authors: Ali Wesam Nashat , Youssef Hamdy Abbas , Abbas Ahmed Mohammed , Roshdy Peter Eleshaa , Imbaby Ahmed Said Saad , Abdelrady Marwa Mahmoud
Published: February 2024

Background & Objective: Labor pain relief has been a challenge for the clinicians for centuries.  A lot many regimes and therapeutic interventions, including spinal and epidural injections, have been tried with variable effect. We aimed to compare the duration of analgesia and potency of bupivacaine plus fentanyl vs. levobupivacaine plus fentanyl for painless labor.

Methodology: We enrolled 70 parturients who requested spinal analgesia in active labor, and randomly divided them into two groups; Group B (35 women) received 2.5 ml of bupivacaine 0.5% plus fentanyl 25 µg, and Group L (35 women) received 2.5 ml of levobupivacaine 0.5% plus fentanyl 25 µg. We assessed motor and sensory block, the efficacy of analgesia, pain scores, adverse effects, and obstetric and neonatal outcomes of both groups.

Results: Time to reach maximum sensory block was significantly longer in Group L than in Group B (P = 0.002*). There was a statistically significant increase in the duration of motor blocks in Group B than in Group L (P < 0.05). The median VAS scores were significantly lower in Group L than in Group B after 2 and 3 h after injection. The duration of analgesia was significantly longer in Group L than in Group B (P < 0.05). The two study groups had no differences in the measured obstetric and neonatal outcomes.

Conclusion: Levobupivacaine with fentanyl was superior to bupivacaine with fentanyl regarding the duration and potency of analgesia with lower pain scores, high maternal satisfaction, and no adverse obstetric or neonatal outcomes. Therefore, spinal levobupivacaine plus fentanyl was a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.

Key words: Bupivacaine; Fentanyl; Levobupivacaine; Labor pain; Spinal Analgesia

Citation: Ali WN, Youssef HA, Abbas AM, Roshdy PE, ImbabyASS. Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2023;27(4):478−484; DOI: 10.35975/apic.v27i4.2256

Received: July 29, 2022; Reviewed: April 19, 2023; Accepted: April 21, 2023
The perception of obstetric healthcare workers to the partners’ presence in the operating room-a phenomenological study
Authors: Ventour Dale , Gardiner Kadija
Published: February 2024

Objective: It is current practice in our setting to not admit a partner in theatre during cesarean section (CS) even though this is becoming commonplace in various countries. This study is designed to determine the views of healthcare workers, postpartum mothers and their accompanying partners on having a partner present in the operating roon (OR) during an elective CS at Port of Spain General Hospital, Trinidad, West Indies.

Materials and Methods: The study’s theoretical model was based on a constructionist, interpretivist framework as well as phenomenological research. A semi-structured interview was conducted and a thematic approach was used to develop codes. This was analyzed by Qualitative Data Analysis (QDA miner) software and the following themes emerged: ‘Maternal support’; ‘Fathers’ marginalization’; ‘Nurses’ perception of fathers’ role’; ‘Healthcare workers’ perception of litigation and ‘Limiting factors’.

Results: 70% of respondents were in favor of a partner being present in the operating room for an elective CS and thought it would help to keep the mother at ease by allowing her to hold hands with the partner, talk to them and be accompanied by them to the recovery room. Healthcare workers did think that male partners might not have much of an impact in the operating room as they would not know what to do and may actually pose a security threat if things did not go exactly as planned.

Conclusions: Healthcare professionals were neutral about partners being present in the operating room but had concerns regarding partner’s presence in the operating room. 

Key words: Anesthesia; Cesarean section; Health personnel; Parturients; Obstetric; Perception

Citation: Ventour D, Gardiner K. The perception of obstetric healthcare workers to the partners’ presence in the operating room-a phenomenological study. Anaesth. pain intensive care 2023;27(4):528−534; DOI: 10.35975/apic.v27i4.2276

Received: May 08, 2023; Reviewed: June 22, 2023; Accepted: June 28, 2023
Non-inferiority trial of Channa striata extract on endothelial glycocalyx layer protection in septic patients
Authors: Permana Septian Adi , Hartono Hartono , Purwanto Bambang , Indarto Dono
Published: February 2024

Background: Sepsis causes significant damage to the endothelial glycocalyx layer, which albumin can protect against. Unfortunately, human albumin is quite expensive, so cheaper substitutes must be found without sacrificing effectiveness. Albumin extract called snakehead fish extract (SHFE) is one that is commonly used in Indonesia It is also called Channa striata extract. We conducted a non-inferiority study between human albumin and SHFE in protecting the glycocalyx layer through syndecan-1 levels.

Methodology: It was a prospective cohort study of adult patients with early sepsis, treated at ICU of Dr Moewardi Hospital, between May and October 2021. The study group was divided by giving Channa striata extract 15 mg/day for two days and the control group was given 20 grams of human albumin on the other day, and then syndecan-1 levels were compared before treatment and on the third day of the study.

Results: We discovered a statistically significant decrease in syndecan-1 levels in both the study (P = 0.013) and control groups (P = 0.027) from the 44 samples we obtained.

Conclusion: In both groups, there was a significant decrease in syndecan-1 levels, proving that Channa striata extract is not inferior to human albumin in terms of glycocalyx layer protection. And it has a higher economic value because the price is lower.

Key words: Sepsis; Channa striata; Albumin; Syndecan-1; Glycocalyx

Citation: Permana SA, Hartono H, Purwanto B, Indarto D. Non-inferiority trial of channa striata extract on endothelial glycocalyx layer protection in septic patients. Anaesth. pain intensive care 2023;27(4):523−527; DOI: 10.35975/apic.v27i4.2278

Received: May 15, 2023; Reviewed: June 22, 2023; Accepted: June 22, 2023