bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Groundwater Resources Vulnerability with the New DRASTIC-LP: A Case Study in Chiang Mai Province, Thailand
Authors: Imsamranrat Chaiyathat , Leelasantitham Adisorn
Published: February 2024

Groundwater vulnerability has gained widespread attention, particularly in Chiang Mai Province, one of Thailand’s fastest-growing cities, which is experiencing rapid development in both economic and social sectors. The expansion of urban communities and the industrial, tourism, and agriculture sectors has resulted in the overutilization of available resources, notably water resources. This overuse, coupled with the adoption of modern technology to boost productivity and meet market demands, has led to an increased reliance on groundwater to supplement surface water sources, providing benefits across all sectors. However, the economic and social growth plays a pivotal role in shaping the diversity of land use, encompassing residential, commercial, industrial, and agricultural activities. These activities, in turn, directly contribute to environmental pollution, particularly in terms of the risk of groundwater contamination in Chiang Mai Province. This study aims to predict the future vulnerabilities of groundwater resources under an ensemble of climate change scenarios and changes in land-use patterns. Chiang Mai Province in northern Thailand is one of the fastest-growing cities and therefore is experiencing rapid urbanization, as well as land-use pattern changes, which was important for the case study. The new DRASTIC model, namely the DRASTIC-LP model, combined with GIS-based techniques and overlay techniques, was used to generate the map of groundwater resource vulnerabilities. A point pollution source (P)-related land-use pattern (L) that represents contamination impacts was considered an additional new DRASTIC parameter. The study’s findings reveal the high reliability and maximum effectiveness of the new DRASTIC-LP model in assessing groundwater vulnerability and contamination-risk areas under a climate change scenario (by MIROC-ESM-CHEM model under RCP.8.5 scenario) and land-use pattern changes (by CA_Markov Chian Model) for both the current year (2020) and the next 50-year period (2021–2070). Furthermore, the new DRASTIC-LP model is employed to trace the movement of pollutants from high- to very high-risk areas based on the groundwater vulnerability and contamination-risk maps. The results highlight that waste disposal dumping sites pose a more critical distribution and movement of pollutants when compared to industrial sites. Additionally, unconsolidated aquifers and cracked consolidated rock aquifers show a potentially higher occurrence of pollutant distribution and movement when compared to consolidated aquifers. Consequently, the study’s outcomes are applied to formulate guidelines for the management and control of groundwater resource contamination. These guidelines serve as valuable tools for decision makers, aiding in pollution prevention and the effective management of contamination risks in groundwater resources.
The Influence of Regional Groundwater Flow and a Neighbouring River on the Behaviour of an Aquifer Thermal Energy Storage System
Authors: Al-Madhlom Qais H. M. , Jassim Sanaa A. , Muttaleb Riyadh H. M.
Published: February 2024

One promising solution for mitigating CO2 emissions in arid regions is to use Aquifer Thermal Energy Storage (ATES) systems in cooling and heating systems. However, ATES systems need to be subjected to geohydrological investigations before their installation to ensure high performance. Two geohydrological properties are considered: regional groundwater flow and the influence of neighbouring rivers. This study considers a hypothetical ATES system within the city of Hilla, Iraq. MODFLOW 6.1 software was used to simulate the influence of the two properties. The simulation tested two locations situated at 75 m and 300 m from the river. Each location was explored using three flow rates: 10 m3/d, 50 m3/d, and 100 m3/d. The results indicate that the temperature change in the warm and cold wells increases proportionally with time of operation and rate of flow. For example, the temperature of the middle layer (for 10 m3/d operation) changes from 29 °C (after one year) to 34 °C (after twenty years operation), while it changes from 34 °C (one year) to 35 °C (twenty years) under 100 m3/d operation. Another result is that the available regional groundwater flow has a negligible influence on the storage system, while the neighbouring river has a high influence on the stored energy when the distance between them is 75 m or less. The paper recommends the installation of ATES systems at least 300 m from the bank of a river.
Optimizing Electric Vehicle Battery Life: A Machine Learning Approach for Sustainable Transportation
Authors: Karthick K. , Ravivarman S. , Priyanka R.
Published: February 2024

Electric vehicles (EVs) are becoming increasingly popular, due to their beneficial environmental effects and low operating costs. However, one of the main challenges with EVs is their short battery life. This study presents a comprehensive approach for predicting the Remaining Useful Life (RUL) of Nickel Manganese Cobalt-Lithium Cobalt Oxide (NMC-LCO) batteries. This research utilizes a dataset derived from the Hawaii Natural Energy Institute, encompassing 14 individual batteries subjected to over 1000 cycles under controlled conditions. A multi-step methodology is adopted, starting with data collection and preprocessing, followed by feature selection and outlier elimination. Machine learning models, including XGBoost, BaggingRegressor, LightGBM, CatBoost, and ExtraTreesRegressor, are employed to develop the RUL prediction model. Feature importance analysis aids in identifying critical parameters influencing battery health and lifespan. Statistical evaluations reveal no missing or duplicate data, and outlier removal enhances model accuracy. Notably, XGBoost emerged as the most effective algorithm, providing near-perfect predictions. This research underscores the significance of RUL prediction for enhancing battery lifecycle management, particularly in applications like electric vehicles, ensuring optimal resource utilization, cost efficiency, and environmental sustainability.
Marcos estruturais como balizadores da prática pianística: um estudo com estudantes de graduação
Authors: dos Santos Junior Celso Luiz Barruffi , dos Santos Regina Antunes Teixeira
Published: February 2024

Research in musical practice points out that structural awareness of the piece to be learned is a strategic element for performance improvement. Nonetheless, the relationship between practice and musical structure in piano students’ learning has been little explored. The present article aimed to examine the segmentation of practice sessions of two undergraduate piano students in light of the musical structure of D. Scarlatti’s Sonata K. 271. In a longitudi-nal perspective, data from the first month of practice were mapped, described, and analyzed based on practice segmentation and content of semistructured interviews as well as markings on the score. Starts and stops of practice segments were interpreted considering musicologi-cal analytical principles. The results showed that the impact of the piece’s structure on prac-tice differed for each participant and that the acquisition of fluency seemed determinant for the higher incidence of stops on structural points.
ChatGPT and Assessment in Higher Education: A Magic Wand or a Disruptor?
Authors: Klyshbekova Maira , Abbott Pamela
Published: February 2024

There is a current debate about the extent to which ChatGPT, a natural language AI chatbot, can disrupt processes in higher education settings. The chatbot is capable of not only answering queries in a human-like way within seconds but can also provide long tracts of texts which can be in the form of essays, emails, and coding. In this study, in the context of higher education settings, by adopting an experimental design approach, we applied ChatGPT-3 to a traditional form of assessment to determine its capabilities and limitations. Specifically, we tested its ability to produce an essay on a topic of our choice, created a rubric, and assessed the produced work in accordance with the designed rubric. We then evaluated the chatbot’s work by assessing ChatGPT’s application of its rubric according to a modified version of Paul’s (2005) Intellectual Standards rubric. Using Christensen et al.’s (2015) framework on disruptive innovations, our study found that ChatGPT was capable of completing the set tasks competently, quickly, and easily, like a “magic wand”. However, our findings also challenge the extent to which all of the ChatGPT’s demonstrated capabilities can disrupt this traditional form of assessment, given that there are aspects of its construction and evaluation that the technology is not yet able to replicate as a human expert would. These limitations of the chatbot can provide us with an opportunity for addressing vulnerabilities in traditional forms of assessment in higher education that are subject to academic integrity issues posed by this form of AI. We conclude the article with implications for teachers and higher education institutions by urging them to reconsider and revisit their practices when it comes to assessment.
FACTORES DE RIESGO Y MEDIDAS PREVENTIVAS DEL CÁNCER DE MAMA EN PACIENTES MUJERES ATENDIDAS EN EL CENTRO DE SALUD SUBTANJALLA, ICA – 2019
Authors: Palma Rojas Joselyn Nataly , Pacheco Villa García Luisa Antonia
Published: February 2024

El estudio tuvo como Objetivo: Identificar los factores de riesgo y medidas preventivas del cáncer de mama en pacientes mujeres atendidas en el centro de salud Subtanjalla de Ica - 2019. Material y métodos: De tipo no experimental, descriptivo, transversal, con muestra de 108 mujeres, aplicándose un cuestionario estructurado de 15 preguntas, validado por expertos, y con Alfa de Cronbach de 0.77. Resultados: Los factores más relevantes menarquia precoz, que fue a los 12 años en el 35%, los antecedentes familiares con cáncer con un 51%, el 44% utiliza el inyectable como método anticonceptivo, el 65% a veces consume bebidas alcohólicas; en las medidas preventivas el 75% no realiza actividad física, el 49% no consume frutas y verduras frecuentemente, el 44% no se realiza el autoexamen de mama; según los factores de riesgo; el 44% de mujeres tienen entre 21 a 30 años; el 35% de mujeres tuvo su primera menstruación a los 12 años; el 32% de mujeres no utiliza ningún método anticonceptivo;, el 51% de mujeres tienen antecedentes de cáncer; el 81% de mujeres no consume cigarrillos, el 69% de mujeres consume bebidas alcohólicas a veces. El 75% de mujeres no realiza actividad preventiva, el 49% de mujeres tienen dieta saludable; el 44% de mujeres refiere realizar cada mes el autoexamen de mama. Conclusiones: Los datos estadísticos demuestran que existen factores de riesgo y medidas preventivas del cáncer de mama.
Persepsi Generasi Milenial Terhadap Pekerjaan Pada Sektor Pertanian Di Kecamatan Likupang Selatan Kabupaten Minahasa Utara
Authors: Mundung Dewi Chinta Claudia , Waney Nordy F.L. , Lumingkewas Jelly R.D.
Published: February 2024

The purpose of the study was to determine the millennial generation's perception of work in the agricultural sector in South Likupang District, North Minahasa Regency. The research was conducted for three months from May to July 2023, located in South Likupang District, North Minahasa Regency. The type of data used in the research is primary data obtained directly through interviews and filling out questionnaires from millennial generation groups. Secondary data were obtained from relevant agencies, namely the South Likupang District Office, the North Minahasa Regency Statistics Agency, research results and literature related to the research conducted. The research population was the millennial generation from farming families in South Likupang District, North Minahasa Regency. Sampling was carried out by proportional sampling, namely sampling that takes into account the elements or categories in the research population. The research population is all children with heads of families with agricultural livelihoods, namely a total of 53 families out of 278 families with heads of families who make a living from the agricultural sector. Data analysis used to see the influence variable used Likert scale. The results showed that the millennial generation's perception of work in the agricultural sector in South Likupang District, North Minahasa Regency on internal factors from the education level indicator was on doubtful criteria, parental support was on very agreeing criteria and peer influence was on very agreeing criteria. External factors in the income indicator are in the criteria strongly agree, the agricultural socialization indicator is in the doubtful criteria and the agricultural innovation indicator is in the criteria strongly agree. Millennial perceptions of employment in the agricultural sector agree that work in the agricultural sector is profitable with a percentage of 73.33 percent.
Faktor Faktor Yang Mempengaruhi Produksi Jagung Di Desa Raraatean Kecamatan Tompaso Baru Kebupaten Minahasa Selatan
Authors: Rampengan Gratcia , Mandei Juliana Ruth , Tangkere Ellen Grace
Published: February 2024

This research aims to analyze the influence of independent variables, namely land area, capital, seeds, fertilizer and number of workers on the dependent variable on corn production results in Raraatean Village, Tompaso Baru District. This research lasted for 2 months, starting from February to March 2023. The data used was primary data obtained through direct interviews with corn farmers based on a list of questions, and secondary data obtained from related agencies such as village offices, scientific papers, journals, or theses. The results of this research are the influence of the independent variables on the dependent variable on production results based on the land area t test showing that there is an influence between land area and production, for seeds it shows that there is a positive and significant influence between seeds and production, for fertilizer it shows that there is no positive influence and significant between fertilizer and production and labor shows that there is a positive and significant influence between labor and production, while the simultaneous influence for the variables of land area, seeds, fertilizer and labor shows that there is a joint positive and significant influence between farming production with land area, seeds, fertilizer and labor and for business scale, it shows that the scale of corn farming reaches the Increasing Return To Scale (IRS) criteria.
PELAKSANAAN KELAS PARENTING BALAI RW OLEH MAHASISWA MSIB FASILITATOR PUSPAGA KELURAHAN PERAK BARAT
Authors: Rahmaida Riska Ayu , Wahyudi Kalvin Edo
Published: February 2024

Violence cases in Surabaya City in 2022 experienced an increase in the number of cases compared to the previous year. The importance of parenting patterns in the family, efforts to fulfill children's rights, and the fact that some families are not harmonious trigger child abuse. This research aims to find out and describe the implementation of the parenting class program at the puspaga Balai RW Kelurahan Perak Barat Surabaya and the role of MSIB students as puspaga facilitators in the implementation of the parenting class program. This research uses qualitative research methods with descriptive research types. The research was analyzed using the theory of parenting program implementation by Asolihin (2013). The results showed that the implementation of the parenting class program at the puspaga RW hall in Perak Barat Surabaya has been running through 3 stages, that is the preparation/planning stage, the implementation stage, and the evaluation and monitoring stage. The role of the puspaga facilitator includes the role of promoter, communicator and companion in the implementation of parenting classes.
Renal perfusion pressure and capillary leaks index as risk factors for acute kidney injury after major abdominal surgery
Authors: Suria Mariati Ni Made Ayu , Aditianingsih Dita , Marsaban Arif Hari Martono
Published: February 2024

Background & Objective: Many factors can contribute to the development of acute kidney injury (AKI) following major abdominal surgery, including the effect of fluid extravasation into interstitial space due to capillary leakage. Microalbuminuria is also brought on by capillary leakage. Increased central venous pressure (CVP) or intra-abdominal pressure (IAP) will decrease renal filtration according to the degree of pressure transmission to the glomeruli. The objective of this study was to know the correlation of capillary leakage index (CLI), microalbuminuria [urine albumin to creatinine ratio (ACR)] and renal perfusion pressure (RPP) with the incidence of AKI. Methodology: A prospective longitudinal cohort design with consecutive sampling was used in this study. The parameters capillary leakage index (CLI), microalbuminuria (ACR) and renal perfusion pressure (RPP) were examined preoperatively, and at 12 h and 36 h postoperatively, and the incidence of AKI was observed till the fourth postoperative day. CLI was defined as C-reactive protein (CRP mg/dL) over albumin (g/L) multiplied by 100. RPP as glomerular pressure was obtained from mean arterial pressure (MAP), IAP, and renal venous pressure estimated by CVP, by the formula RPP = MAP-(IAP+CVP). Results: Following major abdominal surgery, 19 (25.68%) of the 74 subjects developed AKI. There was no significant difference in CLI and ACR between patients with and without AKI. Renal perfusion measurements examined at 0, 12, and 36 h showed significantly lower values in AKI patients. The relative risk (RR) of RPP was 9.125 with a 95 % CI of 1.141293−72.95725 (P = 0.037) after data analysis with Cox Regression to establish the correlation between CLI, ACR, and RPP, as well as covariate variables on the occurrence of AKI at 0 h. Compared to participants without AKI, those with AKI had a mortality risk of 2.384 times higher (P = 0.0351, 95 % CI = 1.133−5.018). Conclusion: Renal perfusion pressure showed a significant correlation with acute kidney injury. Additionally, there is a strong connection between acute kidney injury and mortality. Abbreviations: ACR- albumin to creatinine ratio; AKI- acute kidney injury; CLI- capillary leakage index; CVP- central venous pressure; IAP- intra-abdominal pressure; MAP- mean arterial pressure; RPP- renal perfusion pressure Key word: AKI; Capillary Leaks Index; Microalbuminuria; Renal perfusion pressure; Major abdominal surgery; Systemic capillary leak syndrome Citation: Suria Mariati NMA, Aditianingsih D, Marsaban AHM. Renal perfusion pressure and capillary leaks index as risk factors for acute kidney injury after major abdominal surgery. Anaesth. pain intensive care 2023;27(3):294−300. DOI: 10.35975/apic.v27i3.1925 Received: July 03, 2022; Reviewed: July 17, 2023; Accepted: April 22, 2023
Factors associated with parental self-medication for common childhood illnesses during the COVID-19 pandemic: a single centre study
Authors: FCPS Farhan Saeed DCH , FCPS, CHPE Shireen Qassim Bham, DCH, , MRCPCH Mohammed Iqbal MBBS, , Sharif Umer Hayat Ahmed
Published: February 2024

Background & Objective: People's interest regarding self-medication increased during the first half of 2020, when the COVID-19 was proclaimed a pandemic, although it has always persisted due to multiple factors. We aimed to identify the factors associated with the use of parental self-medication for their child’s illness during the COVID-19 pandemic.

Methodology: A cross-sectional descriptive study was conducted at the pediatrics department at Darul Sehat Hospital, Karachi. An interviewer-administered questionnaire was used. We included 275 parents visiting the outpatient clinics with their children of ages 1 to 12 y. Chi-square test of independence was used to check the association of self-medication with studied factors. P-values less than 0.05 were considered significant.

Results: Out of 275 parents, 85% were practicing self-medication. 60.3% children suffered from some illness. Parents sought medical advice from pharmacists in 65% of cases, and allopathic drugs were preferred in 64% of cases. 70% of the patients used medicine until recovered, while 41.9% had to seek medical advice. Frequent symptoms obsereved and treated with self-medication were headaches 19.2% and fever 18.8%.

Conclusion: Parental self-medication for common childhood illnesses was substantially more prevalent during the COVID-19 pandemic. Allopathic medicines were preferred choice of parents while pharmacists were commonly consulted for information regarding drugs.

Abbreviations: OTC: Over-the-counter;

Key words: Self-medication; Side effects; Pharmacists: Medications; Antipyretics

Citation: Saeed F, Bham SQ, Mohammed Iqbal M, Sharif UHA. Factors associated with parental self-medication for common childhood illnesses during the COVID-19 pandemic: a single centre study. Anaesth. pain intensive care 2023;27(3):405−412.

DOI: 10.35975/apic.v27i3.2097

Received: December 26, 2022; Reviewed: January 15, 2023; Accepted: April 13, 2023
Early postoperative recovery quality assessment tools for day surgery patients
Authors: Nibaruta Janvier , Xingjiao Lv , Xiaoxia Han , Xiaoyu Hou , Xuefen Cao , Yufang Leng
Published: February 2024

From the patient's perspective, medical personnel must assess the patients’ recovery reliability in case of day surgery patients. Rather than focusing solely on clinical recovery indicators, it should consider the patient's pain, physiological, psychological, and social function, and quality of life, etc. Due to the return of day surgery patients to their homes following surgery, the doctors and the nurses require discrete observation and guidance. As a result, paying attention to the quality of recuperation following surgery of patients has critical clinical guiding significance. This guidance effectively pays attention to patient recovery, assists medical staff in taking some effective interventions for the quality of postoperative recovery of patients, and promotes high-quality nursing development. This review discusses the commonly used tools for postoperative evaluation in day surgery patients regarding pain assessment, quality of early postoperative recovery, and the quality of life. It examines some evaluation tools for their validity and application status in China and elsewhere. The clinical practice affects direct clinical personnel in evaluating the post-surgery quality of people undergoing daycare procedures.

Keywords: Day surgery; Assessment tools; Pain; Postoperative recovery; Quality of life

Citation: Nibaruta J, Xingjiao L, Xiaoxia H, Xiaoyu H, Xuefen C, Yufang L. Quality assessment tools for early postoperative recovery in day surgery patients. Anaesth. pain intensive care 2023;27(3):417−425; DOI: 10.35975/apic.v27i3.2201

Received: April 11, 2023; Reviewed: April 17, 2023; Accepted: May 12, 2023
Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19
Authors: Refaat Sameh A , Elshaer Ahmed N , Hamza Amr H , Abdou Amr M H , Sakr Heba A M
Published: February 2024

Background: COVID-19 has emerged as a rapidly spreading pandemic with millions of deaths. We aimed to investigate whether metabolic syndrome can be used as a prognostic factor for the outcome of patients infected with this viral disease, regarding the ICU stay, the requirement of mechanical ventilation (MV) and mortality. Methodology: This retrospective study included 90 patients admitted to intensive care unit (ICU) of Ain Shams University for pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and positive changes on chest computed tomography, over a period of 10 months from July 2021 to April 2022. They were divided into two groups according to the presence or absence of metabolic syndrome. The primary outcome measured was the length of ICU stay. Secondary outcome was the percentage of patients requiring mechanical ventilation (MV) and the mortality rate in the two groups. Results: Patients with metabolic syndrome had higher liver transaminases, random blood glucose, triglycerides, ferritin, and P/F ratio compared to those without metabolic syndrome (P < 0.05). Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus, and obesity significantly increased the risk of hospitalization and mortality in COVID-19 patients (P < 0.05). Conclusion: Metabolic syndrome is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Although patients with metabolic syndrome didn’t have a higher need for mechanical ventilation, they had longer duration of ICU stay and a higher mortality rate. Abbreviations: ACE-2: angiotensin-converting enzyme-2, hs-CRP: High sensitivity C-reactive protein,ICU: Intensive care unit, MV: Mechanical ventilation, MS: Metabolic syndrome, ROC: Receiver operating characteristic Key words: Metabolic Syndrome; COVID-19; ICU; Mechanical ventilation; Mortality Citation: Refaat SA, Elshaer AN, Hamza AH, Abdou AMH, SakrHAM. Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19. Anaesth. pain intensive care 2023;27(3):343−350. DOI: 10.35975/apic.v27i3.2225 Received: February 14, 2023; Reviewed: March 08, 2023; Accepted: March 16, 2023
Evaluation of cardiac operative risk and outcome using EuroSCORE II for coronary artery bypass graft surgery
Authors: Mokhtar Mohammad Nizam , Abdullah Farah Hanim , Rahman Mohd Ramzisham Abdul , Ooi Joanna Su Min
Published: February 2024

Background: The original EuroSCORE was proposed in 1995, with a predicted mortality rate of 3.9%. The study aimed to assess the validity of the European System for Cardiac Operative Risk Evaluation-II (EuroSCORE II), presented in 2012, in predicting 30-day in-hospital mortality with the observed mortality in cardiac surgical patients operated in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).Methodology: It was a retrospective study on patients who had undergone coronary artery bypass graft surgery during 6 y from January 01, 2011 to December 31, 2016, in UKMMC. Comparison between the output of the EuroSCORE II obtained and compared with the patients’ actual postoperative outcome. Results: The actual in-hospital mortality rate was 6.8%. In comparison, the predicted mortality rate by the median EuroSCORE II was 1.23%. Receiver operating characteristics (ROC) curve analysis showed an excellent discriminatory power with the area under the curve (AUC) of 0.844 (95% CI 0.705 - 0.983, P < 0.001) between the survivors and non-survivors. Conclusion: This single-center retrospective study of validation showed that the overall observed mortality was under-predicted by EuroSCORE II. However, it demonstrated a good calibration with excellent discriminatory power in predicting 30 days in-hospital mortality risk among patients undergoing coronary artery bypass graft surgery. Abbreviations: BMI: Body Mass Index; CCS: Canadian Cardiovascular Society; LVEF: Left Ventricular Ejection Fraction; NYHA: New York Heart Association; PA: Pulmonary Artery Key words: Risk assessment; Hospital mortality; Cardiac surgery Citation: Mokhtar MN, Abdullah FH, Rahman MRA, Ooi JSM. Evaluation of cardiac operative risk and outcome using EuroSCORE II for coronary artery bypass graft surgery. Anaesth. pain intensive care 2023;27(3):307−314; DOI: 10.35975/apic.v27i3.2228 Received: November 15, 2022; Reviewed: April 17, 2023; Accepted: April 19, 2023
Cerebritis as an initial presentation of systemic lupus erythematosus
Authors: Ashfaq Fahmina , Butt Nauman Ismat , Rasheed Muhammad Bilal , Ghoauri Muhammad Sohail Ajmal , Anser Aniqa
Published: February 2024

Systemic lupus erythematosus (SLE), an autoimmune disease with multi-system manifestations, has several clinical presentations varying from mild muco-cutaneous involvement to severe multi-organ involvement. We report the case of an 18-year-old girl who presented generalized tonic clonic fits. She gave a history of generalized headaches, recurrent painless oral ulcers, photosensitivity, joint pains and low-grade intermittent fever. Magnetic resonance imaging (MRI) scan of the brain revealed T2WI/FLAIR hyperintense signals in bilateral frontal, parietal and occipital regions and magnetic resonance angiography of the brain demonstrated mild areas of luminal narrowing in M1 and M2 segments of middle cerebral arteries bilaterally, suggestive of lupus cerebritis. Anti-nuclear antibody (ANA) and Anti-DsDNA antibodies were positive. She was diagnosed as SLE and was prescribed corticosteroids, cyclophosphamide and hydroxychloroquine. This case highlights cerebritis as initial presentation of SLE.

Abbreviations: ANA- Anti-nuclear antibody; CRP- C-reactive protein; FLAIR- Fluid attenuated inversion recovery; SLE- Systemic lupus erythematosus;

Key words: ANA; Cerebritis; Headache; Systemic Lupus Erythematosus

Citation: Ashfaq F, Butt NI, Rasheed MB, Ghoauri MSA, Anser A. Cerebritis as initial presentation of systemic lupus erythematosus. Anaesth. pain intensive care 2023;27(4):604−608; DOI: 10.35975/apic.v27i4.2214

Received: May 23, 2023; Reviewed: May 28, 2023; Accepted: July 08, 2023
Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery
Authors: Wahid Witri Rahmania , Pradian Erwin , Prihartono Mohamad Andy
Published: February 2024

Background & Objective: Postanesthetic shivering is one of the many complications during recovery that is marked by vasoconstriction and involuntary movements in several muscle groups and psychologically is an incredibly uncomfortable experience for the patient. The 5-HT3 receptor antagonist granisetron can potentially be used to manage postanesthetic shivering through the thermoregulation neurotransmission system. This study aims to compare the effects of administering 10 µg/kg or 40 µg/kg of granisetron intravenously on the grade of shivering post spinal anesthesia in lower abdominal surgeries. Methodology: This study was a single-blind experimental study conducted on 30 patients who underwent spinal anesthesia for lower abdominal surgeries in Dr. Hasan Sadikin Hospital Bandung. There were no statistical differences of age, weight, height, BMI, core temperature before anesthesia, block height, room temperature, total bleeding, input volume, duration of surgery, and use of ephedrine between the two intervention groups. Results: Administration of 40 µg/kg intravenous granisetron could maintain the body temperature above 36.56 °C , better than the 10 µg/kg intravenous granisetron with the lowest temperature at 35.31 °C. Regarding the grade of shivering, administration of 40 µg/kg granisetron IV was able to improve postanesthetic shivering up to grade 2 in 3 (20%) patients, while 10 µg/kg intravenous granisetron improved grade of shivering to grade 3 in 5 (33%) patients, these results were statistically significant (P < 0.05). Conclusion: In conclusion, administration of granisetron 40 µg/kg IV reduces the incidence and severity of shivering post spinal anesthesia, and maintains a better core temperature compared to granisetron 10 µg/kg IV.Keywords: 5-Ht3 Receptor Antagonist; Granisetron; Postanesthetic Shivering; Prophylaxis

Citation: Wahid WR, Pradian E, Prihartono MA. Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery. Anaesth. pain intensive care 2023;27(4):553−557; DOI: 10.35975/apic.v27i4.2265

Received: October 20, 2021; Reviewed: March 19, 2023; Accepted: June 22, 2023
The impact of hypoalbuminemia and its correlation with D-dimer and IL-6 on severity and 14-day mortality in COVID-19 patients
Authors: Utariani Arie , Hamzah Hamzah , Semedi Bambang Pujo , Wijaya Markus Gatot Sura
Published: February 2024

Background & Objective: COVID-19 took the world by storm, but it also allowed the healthcare professionals to conduct big studies regarding various molecular and biochemical changes produced by the disease. We analyzed the impact of hypoalbuminemia on the severity and 14-day mortality in COVID-19 patients.

Methodology: It was an analytical observational, prospective cohort study design. Clinical and laboratory data collection was carried out in the COVID-19 isolation room of Dr. Soetomo Hospital, between July and October 2020. Serum albumin, D-dimer, and interleukin 6 (IL-6) levels were measured on the day of admission. Statistical analysis using Kolmogorov-Smirnov, Mann-Whitney test, regression test, ROC curve, and 14-day risk of mortality were tested using Univariate Cox Regression and Multivariate Cox Regression tests. The Kaplan Meier test was used to analyze life expectancy.

Results: Of the 119 study subjects, 71 (59.7%) were categorized as severe, and 48 (40.3%) as not severe. Out of the total, 36 (30.25%) patients expired within 14 days of admission, and 83 (69.75%) survived. Regression analysis showed the effect of age on albumin (P < 0.001), albumin on D-dimer (P = 0.003), albumin on disease severity (P < 0.001), and albumin on 14-day mortality (P < 0.001). Albumin was not significantly associated with IL-6 (P = 0.126). The value of albumin as a predictor of severity was 3.28 g/dL, with a sensitivity of 74.6% and a specificity of 77.1%.

Conclusion: The state of hypoalbuminemia affects the disease severity and mortality of COVID-19; albumin is significantly associated with D-dimer. Poor prognosis is expected if the albumin value < 3.28 in geriatric and obese patients with a high 14-days mortality.

Key words: Albumin; COVID-19; D-dimer; Hypoalbuminemia; IL-6; Severity; Mortality.

Citation: Utariani A, Hamzah H, Semedi BP, Sura Wijaya MG. The impact of hypoalbuminemia and its correlation with D-dimer and IL-6 on severity and 14-day mortality in COVID-19 patients. Anaesth. pain intensive care 2023;27(5):440−450; DOI: 10.35975/apic.v27i5.1795

Received: February 12, 2022; Reviewed: May 23, 23; Accepted: July 08, 2023
Anesthetic implications in managing a case of placenta percreta: A case report
Authors: Rubab Um I.
Published: February 2024

Placenta percreta is the extreme end of the placenta accreta spectrum. It involves the placenta which invades through out the wall of the myometrium, crossing the uterus and getting adherent to other pelvic or abdominal organs. Surgical and anaesthetic management of placenta percreta can be challenging in such scenarios, especially in the cases where placenta percreta is getting a direct feed from aorta. It carries a high risk of maternal and fetal mortality and morbidity. I present a case of placenta percreta, G5P4, with a history of previous 3 Caesarean sections and placenta previa. Admitted with severe abdominal pain at 23 weeks. Imaging was suggestive of placenta percreta with placenta extending beyond the uterus, getting adherent to the urinary bladder, and getting direct feed from the aorta along with neovascularisation in the pelvis. She was managed by a multidisciplinary approach, caesarean delivery followed by a hysterectomy, and urinary bladder dome repair was carried out. The intraoperative course was complicated by severe obstetric haemorrhage which was successfully managed with fluids and blood products.

Keywords: Placenta Accreta Spectrum; Placenta Percreta; Massive Obstetric Hemorrhage; Massive Transfusion Protocol

Citation: Rubab UI. Anesthetic implications in managing a case of placenta percreta: A case report. Anaesth. pain intensive care 2023;27(5):614−618; DOI: 10.35975/apic.v27i5.2240

Received: April 07, 2023; Reviewed & Accepted: July 01, 2023
Evaluation of the effect of dexmedetomidine versus magnesium sulphate as an adjuvant to bupivacaine in ultrasound guided erector spinae block; a prospective randomized trial
Authors: Refaat Sameh Ahmed , Abdelmageed Walid Mohammed , Alwedeny Hadil Magdy , Soliman Ehab Hussein , Fouly Mohammed Abdelmoneim
Published: February 2024

Background & Objectives: Since the introduction of erector spinae plane block (ESPB) in 2016 it has been used with success in various thoracic, abdominal, and spine surgeries. Spine surgeries result in significant postoperative pain. Postoperative opioids provide adequate pain control in most of the cases, but some patients continue to suffer from uncontrolled pain. Patients receiving multiple doses of opioids suffer from various side effects including postoperative nausea and vomiting, constipation, and delayed ambulation. We aimed to compare effect of dexmedetomidine and magnesium sulfate given as adjuvants with bupivacaine 0.25% for ESPB.

Methodology: It was a prospective randomized single-blinded study including 52 patients divided into 2 groups; one receiving ESPB with a combination of bupivacaine 0.25% plus magnesium sulfate and the other receiving the same block with a combination of bupivacaine 0.25% plus dexmedetomidine.

Results: The group receiving bupivacaine and dexmedetomidine had a prolonged postoperative analgesia duration as well as a decreased total opioid consumption (P < 0.05) compared to group receiving bupivacaine 0.25% plus magnesium sulfate, but had a significant decrease in intraoperative pulse rate and blood pressure compared to the group receiving bupivacaine 0.25% plus magnesium sulfate (P < 0.05).

Conclusion: Although dexmedetomidine results in prolonged postoperative analgesia duration compared to magnesium sulfate when combined with bupivacaine 0.25% in ESPB, its negative effects on hemodynamics should be considered.

Trial registration: This trial was registered on clinicaltrials.gov registry (NCT05694897) on 23/1/2023.

Abbreviations: ASA: American Society of Anesthesiologist; ESPB: Erector Spinae Block; ERAS: Enhanced recovery After Surgery; SPSS: Statistical Package for Social Sciences; VAS: Visual Analog Score

Key words: Erector Spinae Plane Block; Dexmedetomidine; Bupivacaine; Visual Analog Scale

Citation: Refaat SA, Abdelmageed WM, Alwedeny HM, Soliman EH, Fouly MA. A randomized comparative trial of ultrasound guided erector spinae block with bupivacaine-magnesium sulphate vs. bupivacaine-dexmedetomidine for lumbar spine surgeries. Anaesth. pain intensive care 2023;27(5):425−430; DOI: 10.35975/apic.v27i5.2292

Received: July 15, 2023; Reviewed: August 16, 2023; Accepted: August 16, 2023
Good correlation between necessary remifentanil concentrations in individual patients determined from sedative-analgesic interactions using pharmacokinetic simulations and the remifentanil concentrations used at anesthesiologists’ discretion
Authors: Matsuki Yuka , Nagata Osamu , Shigemi Kenji
Published: February 2024

Background: Analgesic and sedative agents interact with each other, and their relationship is explained in a curve convex below. In the automated control anesthesia system based on this relationship that we developed, the dose of analgesic is adjusted with the necessary remifentanil concentration, determined with propofol-remifentanil interactions, as an estimated maximal individual concentration (esMIC). With the system, a study in patients under anesthesia management by an anesthesiologist was conducted to compare the effect-site concentration (ESC) of remifentanil administered at the anesthesiologist’s discretion and the esMIC calculated with drug-drug interactions for their relationship and to assess whether the analgesic dose administered based on esMIC is appropriate.

Methodology: In the present study involving 20 patients, anesthesiologists changed the propofol (P) infusion rate and remifentanil (R) infusion rate to maintain BIS value of 45. The estimated target-effect-site concentration of propofol for maintaining BIS 45 and the ESC of remifentanil (ESC_R) based on the model by Minto et al. were calculated. Moreover, with these data sets, the isodynamic curve of ESC of propofol (ESC_P) for maintaining BIS 45 (Y) and ESC_R (X) was determined to be an equilateral hyperbola (Y = c/(X-a) + b). With the ESC_R at which even raising ESC_R would result in small decreases in ESC_P considered the esMIC, the ESC_R at the point at which the slope of this curve is apos;1 (neutral point) and at the point of the curve where the y-component deviation of the asymptote (y = b) is 20% (esMIC20) calculated every 6 sec. The ESC_R at the time point of an adequate analgesic state as deemed by the anesthesiologist after anesthesia had been started for 15 min was compared with the esMIC20 determined by objective calculations.

 

Results: The ESC_R and esMIC were 11.9 ± 2.4 and 11.6 ± 2.0 ng/ml, respectively. Moreover, the median ESC_R and esMIC in the patients showed a very good correlation (correlation coefficient R² = 0.88, p < 0.01).

Conclusion: The necessary analgesic concentrations estimated with drug-drug interactions did not contradict those determined at anesthesiologists’ discretion and are considered to assure a reasonable analgesic state.

Key words: Analgesia; Sedation; Remifentanil; Effect-Site Concentrations

Citation: Matsuki Y, Nagata O, Shigemi K. Good correlation between necessary remifentanil concentrations in individual patients determined from sedative-analgesic interactions using pharmacokinetic simulations and the remifentanil concentrations used at anesthesiologists’ discretion. Anaesth. pain intensive care 2023;27(5):491−494;  DOI: 10.35975/apic.v27i5.2300

Received: April 04, 2023; Reviewed: May 13, 2023; Accepted: June 16, 2023
The effect of a combination of functional electrical stimulation and cycle ergometer (FES-cycling) on physiological changes and functional ability in patients with ICU-acquired weakness
Authors: Nazir Arnengsih
Published: February 2024

Intensive care unit-acquired weakness (ICU-AW) is the most common complication found in the intensive care unit (ICU) patients, especially those on prolonged use of mechanical ventilation (MV). It is known to cause poor long-term outcomes, and early rehabilitation (ER) intervention has been proved to be useful in improving muscle strength, physical function, and quality of life of ICU survivors. Several obstacles, such as patients’ medical condition and limited availability of equipment or trained personnel, interfere with ER. Passive ER including functional electrical stimulation (FES) and cycling were found to be effective. The combination of FES with a cycle ergometer (FES cycling) can be implemented, but research on using this modality in the ICU is still limited. This review aimed at providing information on the use of FES cycling in ICU patients to explain its effect on physiological changes and functional abilities. The physiological effects of FES cycling are obtained through local metabolic changes in muscles due to FES and increased cardiovascular responses due to muscle contraction during cycling. Its effects on muscle strength, cross-section area, days free of MV, mobilization, cognitive ability, delirium, and quality of life were positive, and only rarely adverse events occurred during the intervention. To conclude, the use of FES cycling in the prevention and treatment of ICU-AW can be considered since this modality causes positive physiological effects and has proven safe.

Abbreviations: EM – Early Mobilization; ER- early rehabilitation; FES - functional electrical stimulation; ICU-AW - Intensive Care Unit-Acquired Weakness; MV - mechanical ventilation; NMBA - neuromuscular blocking agents; PICS - post-intensive care syndrome; NMES - neuromuscular electrical stimulation;

Key words: Electrical Stimulation; Intensive Care Unit; Muscle Contraction; Muscle Strength; Quality of Life

Citation: Nazir A. The effect of a combination of functional electrical stimulation and cycle ergometer (FES-cycling) on physiological changes and functional ability in patients with ICU-acquired weakness. Anaesth. pain intensive care 2023;27(5):599−606; DOI: 10.35975/apic.v27i5.2315

Received: July 03, 2023; Reviewed & Accepted: August 18, 2023
The role of early rehabilitation in the ICU management of a severe COVID-19 patient: a case report
Authors: Rosyalynda Happy , Sugiarto Adhrie , Manggala Sidharta Kusuma
Published: February 2024

Patients admitted to the intensive care unit (ICU) with severe COVID-19, are at high risk of developing ICU acquired weakness and deconditioning syndrome. Early rehabilitation is a critical therapeutic intervention to reduce the complications of immobilization. We present the case of a 51-year-old woman with acute respiratory distress syndrome (ARDS) due to COVID-19. The patient underwent early rehabilitation program, starting from her fourth day after ICU admission. The rehabilitation program included: (1) prone and semi- prone positioning; (2) respiratory exercises, such as diaphragmatic deep breathing, chest stretch, and effective coughing; (3) other exercises which included mobilization, range of motion exercises, and joint relaxation. The patient’s respiratory function eventually improved (as indicated by improved SpO2. Her ability to perform activities of daily living also improved so that she was able to walk independently to the toilet without respiratory distress. Although further research is required, this report suggests that patients with severe COVID-19 admitted to the ICU will benefit from early rehabilitation program.
Key words: SARS CoV-2; COVID-19; Early Rehabilitation; Mobilization; Breathing Exercises
Citation: Rosyalynda H. The role of early rehabilitation in the ICU management of a severe COVID-19 patient: a case report. Anaesth. pain intensive care 2023;27(6):783−785; DOI: 10.35975/apic.v27i6.2092
Received: September 03, 2023; Reviewed: September 16, 2023; Accepted: September 16, 2023
Remimazolam tosilate infusion has a lower incidence of hypotension than propofol infusion during painless colonoscopy
Authors: Li Sitong , Zhang Yi , Wang Hongbai , Ye Gang , Yao Nana , Zhu Xianlin
Published: February 2024

Background: Remimazolam tosilate is an ultra-short-acting sedative drug with the advantages of rapid onset and recovery, mild respiratory, and circulatory inhibition. This study primarily investigated the effect of remimazolam on incidence of intraoperative hypotension compared to the widely used propofol in patients undergoing outpatient painless colonoscopy.
Methodology: This was a double-blinded, randomized, controlled trial. We randomly divided the eligible patients with outpatient appointment for painless colonoscopy in our hospital into the remimazolam group and the propofol group. The modified observer’s assessment of alert/sedative was used to evaluate the depth of the patient's sedation. The Narcotrend score was monitored throughout the whole process. In the propofol group, propofol 0.5-1.5 mg/kg was infused intravenously as a loading dose, followed by 3-5 mg/kg/h to maintain a satisfied sedation depth during operation. While, with regarding to the patients in remimazolam group, remimazolam 0.05-0.15 mg/kg was induced intravenously as a loading dose, and continuously pumped at a rate of 0.3-0.5 mg/kg/h. SPSS 23.0 software was used to analyze the data.
Results: From December 2020 to March 2021, we enrolled 116 eligible patients. The incidence of hypotension during sedation (13.8%) in the remimazolam group was significantly lower than that in propofol (37.9%), and the success rate of remimazolam (98.3%) was slightly lower than propofol (100.0%), but the awakening time was significantly shorter (P < 0.001); The incidence of respiratory inhibition, nausea, vomiting and other adverse events during colonoscopy, remimazolam was significantly lower than that of propofol (P < 0.05).
Conclusion: Remimazolam tosilate still has higher circulatory stability than propofol in painless colonoscopy under continuous administration with a loading dose.
Trial registration: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000040557), data of registration: December 2020.
Abbreviations: BMI- Body Mass Index; MOAA/S- Modified Observer’s Assessment of Alert Scale; MAP- Mean Arterial Pressure; Rem- Remimazolam; Pro- Propofol
 
Key words: Remimazolam tosilate; Propofol; Painless Colonoscopy; Hypotension
Citation: Li S, Zhang Y, Wang H, Ye G, Yao N, Zhu X. Continuous remimazolam tosilate infusion has a lower incidence of hypotension than propofol infusion for sedation in painless colonoscopy. Anaesth. pain intensive care 2022;27(6):697−705; DOI: 10.35975/apic.v27i6.2341
Received: Aug 27, 2023; Revised: October 16, 2023; Accepted: October 16, 2023