bluuebunny/crossref_metadata_2025 huggingface dataset:
Heading for the Frontline: Mood, Stress, Resilience, and Coping of Nursing Graduates during a Global Pandemic
Authors: Terry Victoria R. , Parsons-Smith Renee L. , Elliott Jessica , Roderick Geraldine , Luyke Patricia , Terry Peter C.
Published: February 2024

COVID-19 affected health and wellbeing globally. Graduating nursing students face a variety of stressors, and entering the nursing profession during the pandemic adds additional stress. Using a quantitative cross-sectional design, mood, perceived stress, resilience, and coping were assessed in an Australian sample of 112 graduating nursing students, who completed the Brunel Mood Scale (BRUMS), Perceived Stress Scale (PSS-4), and Brief Resilient Coping Scale (BRCS). Mean BRUMS scores for tension, fatigue, and confusion were significantly above population norms and vigour scores were significantly below. Mean PSS-4 scores were reflective of population norms but showed higher levels of stress among younger and on-campus students compared to those who were older or studied externally. BRCS data showed that 82.1% of graduating nursing students were medium- or high-resilient copers. Mood profiles suggested that 19.6% of participants reported moods associated with mental health issues, 23.2% reported moods associated with risk of burnout, and only 17.9% reported mood profiles associated with positive mental health. High mean tension scores reported by graduating nursing students indicated apprehension about joining the profession, although stress, resilience, and coping scores suggested they were adequately managing the additional stressors generated by the global pandemic.
The Economic Effects of Stormwater Best Management Practices (BMPs) on Housing Sale Prices in Washington, D.C.
Authors: Park Boyoung , Kweon Byoung-Suk
Published: February 2024

This study aims to investigate the economic effects of stormwater best management practices (BMPs) on housing sale prices in Washington, D.C., BMPs play a significant role in mitigating multiple threats, such as water pollution, soil erosion, and property damage. While studies on the economic value of BMPs were limited, literature addresses that housing sale prices can be affected by nearby stormwater BMPs. This study addresses the following research questions: Do stormwater BMPs positively impact housing sale prices? How do proximity and number of structural BMPs affect the housing sale prices? We used the hedonic pricing method by applying multiple linear regression models to determine whether a set of independent variables significantly improved the models. Our primary findings indicate that BMPs have positive, negative, or no effects on housing sale prices. The proximity of BMPs inside of parks increased housing sale prices in all buffers. In contrast, the proximity of BMPs outside of parks and impervious roads decreased housing sale prices in all buffers. Percent tree canopy coverage negatively linked to a 50 m buffer and had no relationship with other buffers on housing sale prices. This study implies that BMPs impact housing prices and can be improved by landscape architects, policymakers, and stakeholders.
Development in the Circular Economy Concept: Systematic Review in Context of an Umbrella Framework
Authors: Upadhayay Sugam , Alqassimi Omaima , Khashadourian Edmund , Sherm Alex , Prajapati Dinesh
Published: February 2024

Even though the traction towards a circular economy (CE) is on the rise, and the benefits a CE has across ecological, economic, and social frontiers have been undeniable, still, CE-related developments and its adoption have not been appealing. This study conducts a systematic literature review of the CE-related literature in line with the ‘umbrella framework’ to find the current state of the diffusion and diversification of CE concepts both in the academic context as well as in application. Using a thematic and content analysis of the sampled literature, the study (i) develops a comprehensive and inclusive CE definition and (ii) examines the level of diffusion of CE in the economy. The study concludes that, even though CE-related developments are positive and promising, it is still in the validity phase of the umbrella framework and recommends focusing more on the application-based intervention of the CE.
Statistical Inference of Normal Distribution Based on Several Divergence Measures: A Comparative Study
Authors: Alhihi Suad , Almheidat Maalee , Abufoudeh Ghassan , Abu Awwad Raed , Alokaily Samer , Almomani Ayat
Published: February 2024

Statistical predictive analysis is a very useful tool for predicting future observations. Previous literature has addressed both Bayesian and non-Bayesian predictive distributions of future statistics based on past sufficient statistics. This study focused on evaluating Bayesian and Wald predictive-density functions of a future statistic V based on a past sufficient statistic W obtained from a normal distribution. Several divergence measures were used to assess the closeness of the predictive densities to the future density. The difference between these divergence measures was investigated, using a simulation study. A comparison between the two predictive densities was examined, based on the power of a test. The application of a real data set was used to illustrate the results in this article.
A National Innovation System Concept-Based Analysis of Autonomous Vehicles’ Potential in Reaching Zero-Emission Fleets
Authors: Venkatesh Nalina Hamsaiyni , Raslavičius Laurencas
Published: February 2024

Change management for technology adoption in the transportation sector is often used to address long-term challenges characterized by complexity, uncertainty, and ambiguity. Especially when technology is still evolving, an analysis of these challenges can help explore different alternative future pathways. Therefore, the analysis of development trajectories, correlations between key system variables, and the rate of change within the entire road transportation system can guide action toward sustainability. By adopting the National Innovation System concept, we evaluated the possibilities of an autonomous vehicle option to reach a zero-emission fleet. A case-specific analysis was conducted to evaluate the industry capacities, performance of R&D organizations, main objectives of future market-oriented reforms in the power sector, policy implications, and other aspects to gain insightful perspectives. Environmental insights for transportation sector scenarios in 2021, 2030, and 2050 were explored and analyzed using the COPERT v5.5.1 software program. This study offers a new perspective for road transport decarbonization research and adds new insights to the obtained correlation between the NIS dynamics and achievement of sustainability goals. In 2050, it is expected to achieve 100% carbon neutrality in the PC segment and ~85% in the HDV segment. Finally, four broad conclusions emerged from this research as a consequence of the analysis.
Imaging Characteristics of Embedded Tooth-Associated Cemento-Osseous Dysplasia by Retrospective Study
Authors: Nishimura Shun , Oda Masafumi , Habu Manabu , Takahashi Osamu , Tsurushima Hiroki , Otani Taishi , Yoshiga Daigo , Wakasugi-Sato Nao , Matsumoto-Takeda Shinobu , Nishina Susumu , Yoshii Shinji , Sasaguri Masaaki , Yoshioka Izumi , Morimoto Yasuhiro
Published: February 2024

Background: Since there are many differential diagnoses for cemento-osseous dysplasia (COD), it is very difficult for dentists to avoid misdiagnosis. In particular, if COD is related to an embedded tooth, differential diagnosis is difficult. However, there have been no reports on the characteristics of the imaging findings of COD associated with embedded teeth. The aim of the present study was to investigate the occurrence and imaging characteristics of cemento-osseous dysplasia (COD) associated with embedded teeth, in order to appropriately diagnose COD with embedded teeth. Methods: The radiographs with or without histological findings of 225 patients with COD were retrospectively analyzed. A retrospective search through the picture archiving and communication system (PACS) of the Division of Oral and Maxillofacial Radiology of Kyushu Dental University Hospital was performed to identify patients with COD between 2011 and 2022. Results: Fifteen COD-associated embedded mandibular third molars were identified in 13 patients. All 13 patients were asymptomatic. On imaging, COD associated with embedded mandibular third molars appeared as masses that included calcifications around the apex of the tooth. On panoramic tomography, COD showed inconspicuous internal calcification similar to that of odontogenic cysts or simple bone cysts, especially in patients with COD only around the mandibular third molar region. Those with prominent calcification resembled cemento-ossifying fibroma, calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, adenomatoid odontogenic tumor, and so on, as categories of masses that include calcifications on panoramic tomography and computed tomography. Conclusions: The current investigation is the first to report and analyze the imaging characteristics of COD associated with embedded teeth. It is important to consider the differences between COD and other cystic lesions on panoramic tomography, and the differences between COD and masses that include calcifications on CT.
Fungal Species and Mycotoxins Associated with Maize Ear Rots Collected from the Eastern Cape in South Africa
Authors: Price Jenna-Lee , Visagie Cobus Meyer , Meyer Hannalien , Yilmaz Neriman
Published: February 2024

Maize production in South Africa is concentrated in its central provinces. The Eastern Cape contributes less than 1% of total production, but is steadily increasing its production and has been identified as a priority region for future growth. In this study, we surveyed ear rots at maize farms in the Eastern Cape, and mycotoxins were determined to be present in collected samples. Fungal isolations were made from mouldy ears and species identified using morphology and DNA sequences. Cladosporium, Diplodia, Fusarium and Gibberella ear rots were observed during field work, and of these, we collected 78 samples and isolated 83 fungal strains. Fusarium was identified from Fusarium ear rot (FER) and Gibberella ear rot (GER) and Stenocarpella from Diplodia ear rot (DER) samples, respectively. Using LC-MS/MS multi-mycotoxin analysis, it was revealed that 83% of the collected samples contained mycotoxins, and 17% contained no mycotoxins. Fifty percent of samples contained multiple mycotoxins (deoxynivalenol, 15-acetyl-deoxynivalenol, diplodiatoxin and zearalenone) and 33% contained a single mycotoxin. Fusarium verticillioides was not isolated and fumonisins not detected during this survey. This study revealed that ear rots in the Eastern Cape are caused by a wide range of species that may produce various mycotoxins.
COVID-19 Outcomes and Vaccinations in Swedish Solid Organ Transplant Recipients 2020–2021: A Nationwide Multi-Register Comparative Cohort Study
Authors: Søfteland John Mackay , Li Huiqi , Magnusson Jesper M. , Leach Susannah , Friman Vanda , Gisslén Magnus , Felldin Marie , Schult Andreas , Karason Kristjan , Baid-Agrawal Seema , Wallquist Carin , Nyberg Fredrik
Published: February 2024

Increased COVID-19-related morbidity and mortality have been reported in solid organ transplant recipients (SOTRs). Most studies are underpowered for rigorous matching. We report infections, hospitalization, ICU care, mortality from COVID-19, and pertinent vaccination data in Swedish SOTRs 2020–2021. We conducted a nationwide cohort study, encompassing all Swedish residents. SOTRs were identified with ICD-10 codes and immunosuppressant prescriptions. Comparison cohorts were weighted based on a propensity score built from potential confounders (age, sex, comorbidities, socioeconomic factors, and geography), which achieved a good balance between SOTRs and non-SOTR groups. We included 10,372,033 individuals, including 9073 SOTRs. Of the SARS-CoV-2 infected, 47.3% of SOTRs and 19% of weighted comparator individuals were hospitalized. ICU care was given to 8% of infected SOTRs and 2% of weighted comparators. The case fatality rate was 7.7% in SOTRs, 6.2% in the weighted comparison cohort, and 1.3% in the unweighted comparison cohort. SOTRs had an increased risk of contracting COVID-19 (HR = 1.15 p < 0.001), being hospitalized (HR = 2.89 p < 0.001), receiving ICU care (HR = 4.59 p < 0.001), and dying (HR = 1.42 p < 0.001). SOTRs had much higher morbidity and mortality than the general population during 2020–2021. Also compared with weighted comparators, SOTRs had an increased risk of contracting COVID-19, being hospitalized, receiving ICU care, and dying. In Sweden, SOTRs were vaccinated earlier than weighted comparators. Lung transplant recipients had the worst outcomes. Excess mortality among SOTRs was concentrated in the second half of 2021.
Plaque Psoriasis Exacerbation and COVID-19 Vaccination: Assessing the Characteristics of the Flare and the Exposome Parameters
Authors: Karampinis Emmanouil , Papadopoulou Myrto-Maria , Chaidaki Kleoniki , Georgopoulou Konstantina-Eirini , Magaliou Stavroula , Roussaki Schulze Angeliki Viktoria , Bogdanos Dimitrios P. , Zafiriou Efterpi
Published: February 2024

The diverse patient population and widespread vaccination in the COVD-19 era make vaccine-triggered episodes of psoriasis an ideal model of exposome research. This scenario explores the fine balance between protective and exacerbating factors, providing insights into the complex relationship between environmental exposure and psoriasis immunopathogenesis when a trigger appears, such as that of the hyperinflammatory state induced by the COVID-19 vaccine. Analyzing interactions between vaccine-induced phenomena and exposome parameters may provide clinically relevant information important for personalized medicine decision-making. We performed a literature review seeking patients with plaque psoriasis flares or new onset or change in plaque psoriasis into another psoriasis subtype, such as pustular or erythrodermic flare, focusing on the inner and external exposome traits of patients. We identified 71 patients with plaque psoriasis flares, 12 patients with new-onset psoriasis, and 17 with plaque psoriasis subtype change, and assessed the COVID-19 vaccine-induced plaque psoriasis in terms of clinical presentation, post-vaccination flare period and treatment status, as well as inner exposome parameters (genomics, oxidative stress, hormonal impact due to gender, aging, skin color) and external parameters (UV, infectomics). Novel data on psoriasis flares following COVID-19 vaccination are primarily obtained by combining exposome and vaccine-triggered episode features and characteristics and comparing them with similar psoriasis flares unrelated to COVID-19 vaccination.
Wastewater Surveillance of SARS-CoV-2 in Minnesota
Authors: Osborn Mark J. , Champeau Shannon , Meyer Carolyn , Hayden Mason , Landini Laura , Stark Stacey , Preekett Stephanie , Vetter Sara , Zirnhelt Zachary , Meyer Stephanie , Huff Daniel , Schacker Timothy W. , Doss Charles R.
Published: February 2024

Wastewater-based epidemiology provides an approach for assessing the prevalence of COVID-19 in a sewer service area. In this study, SARS-CoV-2 RNA was measured in 44 wastewater-treatment plants of varying sizes that sampled approximately 67% of the population of Minnesota, from September 2020 through December 2022. Various linear regression models were investigated to predict the weekly case count from SARS-CoV-2 RNA concentrations under various transformation and normalization methods which we validated via cross-validation averaged across all treatment plants. We find that the relationship between COVID-19 incidence and SARS-CoV-2 RNA in wastewater may be treatment plant-specific. We study storage and time-to-analysis for RNA wastewater data and find large effects of storage temperature, indicating that collection methods may have an important effect on the utility and validity of wastewater data for infectious disease monitoring. Our findings are important for any large-scale wastewater surveillance program.
Evaluating Effective Particle Size Distributions of Cohesive Sediment under Varying Shear Stress and Bed Configurations in a Rotating Annular Flume
Authors: Maltauro Rafaela , Stone Micheal , Collins Adrian L. , Krishnappan Bommanna G.
Published: February 2024

Despite the environmental significance and ecological importance of cohesive sediment (<63 μm), improved knowledge of how effective particle size distributions (EPSDs) change due to flocculation under different conditions of shear stress and bed configuration is required to better understand in situ transport and storage properties and refine existing sediment transport models. Here, a rotating annular flume was used to (i) evaluate EPSDs under different shear stress and bed types (plane-impermeable and -porous gravel bed) for deposition and erosion experiments; (ii) assess flocculation processes with EPSDs; and (iii) compare flume and field EPSDs observations with respect to measured shear stress. While deposition experiments over the impermeable bed led to an EPSD equilibrium in all shear conditions (constant EPSD percentiles), the ingress experiment over the gravel bed resulted in varying EPSDs, and no equilibrium was observed. During the erosion experiment, deposited flocs became coarser due to bed consolidation, and no particle breakage was observed once particles were resuspended. The ingress experiment showed high efficiency in entrapping suspended particles (~95% of initial suspended sediment), and no exfiltration or resuspension was recorded. Flocculation ratios calculated using EPSDs showed negative correlations with shear stress, indicating that increasing flow energy promoted flocculation for flume and field observations. Our results showed that both suspended and bed sediments can flocculate into coarser flocs that, in turn, are preferentially ingressed and stored in the substrate when in suspension. These findings have important implications regarding legacy impacts, as substrate-stored particles can potentially extend the effects of upstream landscape disturbances.
Research on Energy Management Strategy of Fuel Cell Tractor Hybrid Power System
Authors: Zhao Sixia , Gao Zhi , Li Xianzhe , Li Yanying , Xu Liyou
Published: February 2024

In recent years, more and more attention has been paid to fuel cell-based hybrid tractors. In order to optimize the global power distribution of tractors and further improve the fuel economy and fuel cell durability of the system, this paper designs an energy management strategy to maximize external energy efficiency based on fuel cell/lithium battery/supercapacitor hybrid tractors. This strategy aims to reduce the real-time hydrogen consumption of the system while maximizing the external energy output so as to reduce the impact of load randomness on the output power of the fuel cell. Under the typical ploughing conditions of the tractor, the simulation is compared with the state machine strategy and the equivalent hydrogen consumption minimization strategy. The results show that the proposed strategy meets the power requirements of a given ploughing condition, and compared with the two traditional strategy systems, the performance characteristics of auxiliary energy are more fully exerted. It reduces the burden on fuel cells and improves the durability of fuel cells. The hydrogen consumption of the system was reduced by 11.03 g and 16.54 g, respectively, improving the overall economy of the hybrid system.
CALIDAD DEL CUIDADO DE ENFERMERÍA Y SATISFACCIÓN EN PACIENTES POSTOPERADOS DEL SERVICIO DE CIRUGÍA DEL HOSPITAL SANTA MARÍA DEL SOCORRO, ICA 2021
Authors: Ramírez Palomino Karen Alexandra , Urure Velazco Isabel Natividad
Published: February 2024

El estudio tuvo por Objetivo: Determinar la relación entre la calidad del cuidado de enfermería y la satisfacción en pacientes postoperados del servicio de cirugía del Hospital Santa María del Socorro, Ica 2021. Material y métodos: Estudio descriptivo, cuantitativo y transversal, no experimental-correlacional, con muestra de 147 pacientes postoperados, empleándose la técnica de encuesta y como instrumento 2 cuestionarios validados, y con alta confiabilidad. Resultados: La calidad del cuidado de enfermería fue de nivel regular 49%, nivel deficiente 28.6% y nivel bajo 22,4%; según sus dimensiones, se encontró mayor predominio de calidad de nivel regular en accesibilidad 73,5%, explica y facilita 69,4%, conforta 71,4%, se anticipa 59,9%, mantiene relación de confianza 61,2%, y monitorea-hace seguimiento 73,5%. La satisfacción fue de nivel medio 46,3%, nivel bajo 26,5% y nivel alto 27,2%; según sus dimensiones se encontró mayor proporción nivel medio en el trato recibido 52,4%, continuidad del cuidado 42,9%. y resultado del cuidado 41,5%. Se halló relación significativa entre la calidad del cuidado de enfermería y la satisfacción del paciente postoperado (r=0.434; p=0.000), y con las dimensiones trato recibido (r=0,257; p=0,002), continuidad del cuidado (r=0,493; p=0,000), y resultado del cuidado (r=0,353; p=0,001). Conclusiones: La calidad del cuidado de enfermería se relaciona significativamente con la satisfacción en los pacientes postoperados del servicio de cirugía del Hospital Santa María del Socorro de Ica, 2021.
Kontribusi Tenaga Kerja Perempuan Pada Usahatani Jahe Merah Di Desa Mokobang Kecamatan Modoinding Kabupaten Minahasa Selatan
Authors: Maleke Reginal Francois , Waney Nordy Fritsgerald Lucky , Wariki Barce A.F.
Published: February 2024

This study aims to determine the contribution of female labor to ginger farming in Mokobang Village, Modoinding Sub-district, South Minahasa Regency. The research was conducted for three months from May to July 2023. The location was determined purposively, the research was conducted in Mokobang Village, Modoinding Sub-district, South Minahasa Regency. The data used in this research are primary and secondary data. Primary data was obtained from direct interviews with farmers using a list of questions that had been prepared. Secondary data were obtained from relevant agencies, as well as other literature related to the research. The method used in sampling is by purposive sampling. Intentional sampling or purposive sampling based on criteria. Some of the farmer criteria taken such as red ginger farmers in Mokobang Village who employ female labor. The number of samples in this study was 15 respondents from a population of 105 farmers. The data analysis method used in this research is descriptive analysis. The contribution of female labor to red ginger farming in Mokobang Village is 51.98%. The contribution of female labor in red ginger farming is greater than male labor.
Persepsi Mahasiswa Jurusan Sosial Ekonomi Fakultas Pertanian Universitas Sam Ratulangi Tentang E-Commerce Melalui Facebook
Authors: Sereh Didit Saputra , Waney Nordy Fritsgerald Lucky , Baroleh Jenny
Published: February 2024

This study aims to describe students' perceptions of e-commerce through Facebook. The research was conducted at during to Juni 2023. The data collected is primary data obtained from direct interviews with student of the Department of Socio-Economics Faculty of Agriculture Sam Ratulangi University. Secondary data is obtained from journals, research reports taken from the internet. The data collected of the study were analyzed by descriptif. The results showed that the perceptions on the doubling of Facebook functions as social media into e-commerce facilities received good appreciation because it made it easier and helped save time, money and energy.  Student’s perceptions of using Facebook e-commerce, namely buying and selling goods through Facebook e-commerce is very easy because the transaction method is the same as using Facebook in general, so they have almost no obstacles in carrying out e-commerce activities through Facebook. Students' perceptions of e-commerce services through Facebook are very good because in conducting e-commerce activities through Facebook, buyers and sellers always prioritize friendliness and courtesy when interacting in terms of bargaining activities.
Kepuasan Konsumen Pada Usaha Cafe Encasa Di Kelurahan Malalayang Satu Timur Kota Manado
Authors: Deba Jarot , Baroleh Jenny , Wariki Barce
Published: February 2024

This study aims to determine customer service satisfaction at the Encasa Café business in Malalayang Satu Timur Village, Malalayang District, Manado City. The research was conducted for 2 months from June to July 2023. The research place was held at Café Encasa which is located at Jalan Krida, Malalayang Satu Timur Village, Malalayang District, Manado City. The data collected in this study were obtained through primary data and secondary data. The sample was determined using accidental sampling technique as many as 30 respondents. The data analysis method used is descriptive data analysis, using Likert Scale measurements. Based on the results of the study, it can be concluded that customer satisfaction at Café Encasa in Malalayang Satu Timur Village, Manado City is 72.8% or consumers are in the satisfied category. The highest category in the catchability variable with a value of 80.9% with a very satisfied category, for the lowest category with a value of 66.2% with a satisfied category is in the reliability variable.
Plasma-enabled electrification of chemical processes toward decarbonization of society
Authors: Nozaki Tomohiro , Kim Dae-Yeong , Chen Xiaozhong
Published: February 2024

Since the last decade, research on plasma catalysis has attracted keen attention as an emerging type of low-carbon technology. An advantage of plasma is to facilitate non-equilibrium reaction fields on a large scale, which is inaccessible by conventional thermal approaches. Stable molecules such as CO2 and CH4 are activated by electrical energy, paving the way for low-temperature chemistry that departs from energy-intensive heat-dependent systems. Moreover, the power-to-chemical concept could gain momentum with plasma technologies that are driven by renewable energy. Currently, research is accelerating with application initiatives, but at the same time the importance of scientific understanding of plasma catalytic reactions is being recognized more than ever. This review article offers an overview of various plasma technologies in the “plasma alone” and “plasma–catalyst combination” context. Plasma–catalyst combination technology, known as “plasma catalysis”, is discussed further to dry methane reforming (CH4 + CO2 = 2CO + 2H2) and the reverse water gas shift reaction (CO2 + H2 = CO + H2O) for a mechanistic insight.
Different regional anesthesia techniques for modified radical mastectomy- A case series
Authors: Botta Bhagya Vardhan , Nithyasundar Kannan , Balasubramanian Kala , T. Kamalakannan , Sethuraman Raghuraman M.
Published: February 2024

General anesthesia (GA) is the most common form of anesthesia provided to patients who need radical mastectomy, because surgery in this area is painful and most of the patients demand complete sleep during the surgical procedure. Significant interventions have been made in the recent years, especially in the regional anesthetic techniques using the ultrasonogram. Hence, most of these surgeries, nowadays, are being performed by combined GA and regional techniques. However, some patients might pose greater risks for GA thereby making the anesthesiologists think of regional techniques as a sole mode of anesthesia. Here, we present a case series of three patients with major co-morbidities who successfully underwent radical mastectomies under regional anesthesia. We used combined thoracic spinal/epidural for two patients while one patient had pectoral nerve block II (PECS II) with additional subcutaneous infiltrations. Only a few studies or case reports are available in the literature using regional techniques as surgical anesthesia for radical mastectomies while we used different combinations which have not been described in the literature.

Key words: Modified radical mastectomy, regional techniques, combined thoracic spinal epidural, PECS blocks.

Citation: Botta BV, Nithyasundar K, Balasubramanian K, Kamalakannan T, Sethuraman RM. Different regional anesthesia techniques for modified radical mastectomy; a case series. Anaesth. pain intensive care 2023;27(3):426−428; DOI: 10.35975/apic.v27i3.1974

Received: August 16, 2022; Reviewed: February 06, 2023; Accepted: April 20, 2023
Effect of pressure support ventilation vs. spontaneous ventilation on lung atelectasis during recovery from anesthesia for laparoscopic gastric sleeve surgery
Authors: Aboelsuod Mohamed Abdelgawad Abdelhalim , Farhat Abeer Elsayed Abdellatif , Abdalla Abdalla Mohamed , Hassnin Fareed Shawky Basiony
Published: February 2024

Background & Objective: Pressure support ventilation (PSV) is a target pressure mode that offers breath by breath mode of ventilation support, started by patients, and timed to respiratory effort. The fundamental idea behind PSV is to assist spontaneous breathing in response to the patient-initiated breaths. We evaluated the effects of PSV and spontaneous ventilation during awakening from anesthesia on lung atelectasis in the patients following laparoscopic gastric sleeve surgery. Methodology: Following clearance from the institutional ethical council, we enrolled 64 patients and divided them into two groups at random; pressure support group (Group PS) to receive PSV, and control group or spontaneous group (Group S) to continue with spontaneous ventilation mode during awakening from anesthesia in the patients following laparoscopic gastric sleeve surgery. Results: In the pressure support group, atelectasis was less common than in the control group at PACU (P = 0.042). Over the first 48 h following surgery, there were substantial differences between the groups in the level of oxygen saturation as determined by pulse oximetry ≤ 92%. The incidence of SpO2 ≤ 92% during 48 h postoperatively in the Group S and Group PS was 34% vs 12% respectively. No patient needed mechanical ventilatory support during the 48 h postoperatively. Conclusions: Pressure support ventilation during the recovery from general anesthesia to patients after laparoscopic gastric sleeve surgery resulted in reduced incidence of postoperative atelectasis than those who were allowed spontaneous ventilation with occasional manual support. Abbreviations: PACU: Post-Anesthesia Care Unit; PEEP: Positive End Expiratory Pressure; PSV: Pressure support ventilation; VT: Tidal Volume. Key words: Gastric sleeve surgery; Laparoscopy; Lung atelectasis; Pressure support ventilation; Spontaneous ventilation. Citation: Aboelsuod MAA, Farhat AEA, Abdalla AM, Hassnin FSB. The effect of pressure support ventilation vs. spontaneous ventilation on lung atelectasis during recovery from anesthesia for laparoscopic gastric sleeve surgery. Anaesth. pain intensive care. 2023;27(3):301−307.DOI: 10.35975/apic.v27i3.2166 Received: March 09, 2023; Reviewed: March 20, 2023; Accepted: April 16, 2023.
Video laryngoscopy: a double-edged sword
Authors: MD Taizoon Q. Dhoon , MD Linsey Wilson , FAACD, FASA Govind RC Rajan, MBBS,
Published: February 2024

Endotracheal intubation revolutionized anesthesia and allowed prolonged surgical procedures to be performed. It also made positive pressure ventilation possible in patients in respiratory insufficiency and being managed in intensive care units. But successful intubation required the development of laryngoscopes. A variety of blades were developed to be used in different sets of patients. A laryngoscope came to be known as a symbol of the specialty of anesthesiology. But it was not always safe, nor successful, necessitating more sophisticated instruments. Video laryngoscopes were introduced with a sigh of relief for the anesthesiologists in difficult airway cases. Many variations of video laryngoscopes with slight differences have been marketed. But cases of video laryngoscope related injuries have been reported. This paper gives an over-view of the possible mechanism and preventive measures.

Abbreviations: DL - Direct laryngoscopy; ETT – Endotracheal intubation; IDL - indirect laryngoscopy; VL - Video laryngoscopy;  

Key words: Airway management; Instrumentation; Intubation, endotracheal; Laryngoscope; Laryngoscopy

Citation: Dhoon TQ, Wilson L, Rajan GRC. Video laryngoscopy: a double-edged sword. Anaesth. pain intensive care 2023;27(3):413−416; DOI: 10.35975/apic.v27i3.2219

Received: March 30, 2023; Reviewed: April 11, 2023; Accepted: April 15, 2023
Anesthetic management of omphalopagus twins with pentalogy of Fallot undergoing separation surgery
Authors: Purwoko Purwoko , Santosa Sugeng Budi , Novianto Bambang , Ganitafuri Handayu
Published: February 2024

The management of conjoined twins has several special aspects, mostly linked to the parents of the twins, such as communication, ethics and trust issues. A multidisciplinary team approach plus high level of vigilance at each perioperative stage is required. Conjoined omphalopagus twins, aged one year, were planned for separation surgery. They had fused liver, fused portal and hepatic veins, and partially fused intestines. Patient B appeared with complications of pentalogy of Fallot (PoF). The patient also had polycythemia (hemoglobin 14.7 g/dL, hematocrit 50%). Radiological features showed anterior abdominal wall with images of interconnected intestinal system between the two. In thoracoabdominopagus conjoined twins, the possibility of shared circulation becomes important especially associated with injection of intravenous drugs. The goal of anesthesia in PoF is to maintain cardiac output by maintaining heart rate, contractility and preload; and preventing right to left shunting via ventricular septal defect (VSD). Induction can cause vasodilation and the resultant decrease in systemic vascular resistance (SVR) can exacerbate right-to-left shunts. Monitoring end tidal CO2 (EtCO2) is needed. We present a report of anesthesia for such a case.

Abbreviations: ASD: Atrial Septal Defect; PoF: Pentalogy of Fallot; VSD: Ventricular Septal Defect; SVR: Systemic Vascular Resistance

Key words: Conjoined Twins; Pentalogy of Fallot; Congenital Heart Disease; Cyanosis; Anesthesia

Citation: Purwoko, Santosa SB, Novianto B, Ganitafuri H. Anesthetic management of omphalopagus twins with pentalogy of Fallot undergoing separation surgery. Anaesth. pain intensive care 2023;27(3):434−440.

DOI: 10.35975/apic.v27i3.2224

Received: May 24, 2022; Reviewed: Sep 18, 2022; Accepted: Jan 04, 2023
Dexmedetomidine related apnea and desaturation during awake craniotomy: a case report
Authors: Hasyizan Hassan Mohamad , Mohd Nazaruddin Wan Hassan Wan , Laila Ab Mukmin , Zamzuri Idris , Zulfakar Mazlan Mohd
Published: February 2024

Dexmedetomidine (Dex) is regarded as a novel sedative agent since the drug preserves respiration and makes ‘conscious sedation’ possible. This drug is widely used for monitored anesthesia care (MAC). We report a case of apnea and desaturation in awake craniotomy surgery under MAC after loading of Dex with 1 mg/kg over 10 min and discuss possible explanations. We advocate using Dex with a lower loading dose over a prolonged duration and the up-titration of the drug according to the patient’s response particularly in those who are underweight or elderly. Meticulous judgement for possible interactions of Dex with antiepileptics, opioids and other sedative agents is essential during MAC.

Abbreviations: BIS- Bispectral Index; Dex- Dexmedetomidine; DBS- Deep Brain Stimulation; MAC- Monitored Anesthesia Care; TCI- Targeted-Controlled Infusion

Key words: Dexmedetomidine; Craniotomy; Apnea; Conscious sedation; Balanced anesthesia; Anticonvulsant

Citation: Hasyizan HM, Mohd Nazaruddin WHWM, Laila AM, Zamzuri I, Zulfakar MM. Dexmedetomidine related apnea and desaturation during awake craniotomy: a case report. Anaesth. pain intensive care 2023;27(4):609−612; DOI: 10.35975/apic.v27i4.1901

Received: May 30, 2022; Reviewed: December 28, 2022; Accepted: May 22, 2023
Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial
Authors: Tawadros Safaa Ishak Ghaly , El Mageed Azza Mohammed Shafik Abd , El Taher Waleed Abd El Mageed Mohammed , Salama Mariam Gamal Motawashleh , Ansary Amin Amin Mohamed Al
Published: February 2024

Background & Objective: Opioids and α2 adrenergic receptor agonists are commonly used as adjuvants to intrathecal local anesthetics to improve the quality and duration of spinal anesthesia (SA). Fentanyl and dexmedetomidine (DEX) are the most commonly used opioid and α2 agonist respectively. We compared the efficacy of these two when used as adjuvants to hyperbaric bupivacaine for SA for lower limb surgeries.

Methods: A total of 54 patients were randomly assigned to receive unilateral spinal anesthesia with bupivacaine 2.5 ml. Group F (n = 27) received 25 μg fentanyl, and Group D received 10 μg DEX added to the spinal bupivacaine. Time to first analgesic request was the primary outcome, while sensory and motor block characteristics, nalbuphine consumption as rescue analgesic, pain scores, side effects and sedation levels were the secondary outcomes.

Results: Patients receiving dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia for lower limb surgeries had a significantly longer time to rescue analgesia than those receiving fentanyl. The mean time to rescue analgesia in Group D was 409.63 ± 74.60 min vs. 295.93 ± 36.72 min (P = 0.000) in the Group F. Also, patients in Group D had significantly longer sensory and motor blocks.

Conclusion: Intrathecal dexmedetomidine 10 μg seems to be a good alternative to fentanyl 25 μg when used as an adjuvant in unilateral spinal anesthesia for lower limb orthopedic surgeries with better quality postoperative analgesia and with minimal side effects.

Abbreviations: DEX - Dexmedetomidine; NYHA - New York Heart Association; BMI - Body mass index; MBP - Mean blood pressure; SBP- Systolic blood pressure; DBP- Diastolic blood pressure; VAS - Visual Analog Scale

Key words: Dexmedetomidine; Fentanyl; Bupivacaine; Anesthesia, Spinal

Citation: Ghaly SI, Shafik AM, AlTaher WAMM, Motawashleh MG, Alansary AM. Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial.      Anaesth. pain intensive care 2023;27(4):456−463. DOI: 10.35975/apic.v27i4.2191

Received: March 30, 2023; Reviewed: April 22, 2023; Accepted: April 22, 2023
Anesthetic management of a patient with pheochromocytoma and peripartum cardiomyopathy for cesarean section
Authors: Ayesha Kiran , Khan Javeriah , Sikander Rana Imran , Fatima Naheed
Published: February 2024

Pheochromocytoma and peripartum cardiomyopathy is associated with significant maternal mortality. Cause of death can be heart failure, myocardial infarction, arrhythmias and thromboembolism. Pheochromocytoma can be one of the causes of dilated cardiomyopathy. Anesthesia in an obstetric patient with pheochromocytoma and peripartum cardiomyopathy is challenging. Early diagnosis and a multidisciplinary management is required to improve outcome. Elective cesarean section must be planned and epidural anesthesia should be the preferred technique. We present a case of 34 y old female patient with pheochromocytoma and peripartum cardiomyopathy who underwent cesarean section under epidural anesthesia and had uneventful recovery.

Key words: Pheochromocytoma; Peripartum Cardiomyopathy; Cesarean Section; Epidural Anesthesia

Citation: Ayesha K, Khan J, Sikander RI, Fatima N. Anesthetic management of a patient with pheochromocytoma and peripartum cardiomyopathy for cesarean section. Anaesth. pain intensive care 2023;27(4):596−599.

DOI: 10.35975/apic.v27i4.2208

Received: April 16, 2023; Reviewed: May 09, 2023; Accepted: June 06, 2023
The impact of simulation-based training on the knowledge and skills of postgraduate medical students in the management of cardiac arrest
Authors: Patil Archita , Kadam Sandeep , Monnaiah Pradhan , Patil Sanket , Sethiya Srishti , Singh Srashti
Published: February 2024

Background: Use of simulation as a teaching learning method is said to improve the learners’ skills and clinical decision making in a risk-free environment. The effectiveness of simulation in imparting protocol-based training of a critical situation like cardiac arrest to postgraduate students, needs to be evaluated. We aimed to train students in a simulation-based training session for Advanced Cardiac Life Support (ACLS) in the management of in-hospital cardiac arrest, and assess the effect on the pre-training efficacy.

Methodology: Thirty post-graduate students were subjected to a pre-test in knowledge and skills regarding ACLS, followed by a didactic lecture and a training session on a high-fidelity mannequin for the same. The assessment was conducted one week later. A self-perception questionnaire from the students was obtained at the end of the whole program. Mean score of knowledge, skill, time to initiating CPR and time to defibrillation in pre-test and post-test were compared using the paired-t test. P < 0.05 was considered statistically significant.

Results: There was statistically significant improvement in the post-test knowledge score (13.5 ± 2.87; P < 0.0001) and skills score (6.066 ± 1.25; P < 0.0001). Objective improvement was noticed in time to start cardiopulmonary resuscitation (pre-test 60 ± 19.76 sec vs. post-test 26.56 ± 16.07 sec; P = 0.0001). Time to defibrillation was markedly reduced (pre-test 118.6 ± 28.28 sec vs. post-test 93 ± 33.38 sec; P = 0.0022). Majority of the students strongly agreed that the training session resulted in improved confidence (76.7%), which enhanced clinical decision making in emergency situations (83.3%).

Conclusion: The simulation-based training session significantly increases the knowledge and psychomotor skills of the post-graduate students with enhanced confidence to manage a victim of cardiac arrest as self-judged by the participants.

Abbreviations: ACLS – Advanced Cardiac Life Support; CBME - Competency Based Medical Education CPR - Cardiopulmonary Resuscitation; CVR - Content Validity Ratio

Key words: Simulation Training; Cardiopulmonary Resuscitation

Citation: Patil A, Kadam S, Monnaiah P, Patil S, Sethiya S. Singh S. The impact of simulation-based training on the knowledge and skills of medical postgraduate students in the management of cardiac arrest. Anaesth. pain intensive care 2023;27(4):496−501. DOI: 10.35975/apic.v27i4.2258

Received: October 13, 2022; Reviewed: June 09, 2023; Accepted: June 13, 2023
Risk assessment of biological hazards to the nurses using ‘Failure Modes and Effects Analysis’ (FMEA) in the intensive care unit
Authors: Hosseni Leila , Karampourian Arezou , Azami Hiva
Published: February 2024

Background: Nursing staff in the intensive care unit (ICU) is exposed to multiple biologic hazards. We aimed to identify biological hazards threatening the health of nurses in the ICU using the technique of Failure Modes and Effects Analysis (FMEA) tool.
Methodology: A cross-sectional study by Focus Discussion Group (FDG) was performed in the ICU. Participants were familiar with the processes in ICU. The sampling method was purposeful and discrete and the researcher selected FDG group members. The study instrument was standard worksheet. Data analysis was performed by FMEA technique and based on Risk Priority Number (RPN).
Results: 53 possible errors were identified in 14 common activities in the ICU. Error cases with unacceptable risk were identified, including "lack of hand hygiene" (RPN 177.75), "needle stick injuries” (RPN 167.62), “lack of personal protective equipment" (RPN 133.92) and "absence of N95 or FFP2 mask during CPR of COVID-19 patients" (RPN 111.60).
Conclusion: The causes and effects of the errors were identified, and corrective measures were presented in three areas: reducing the frequency and severity and increasing the error detection capability. It was suggested that retraining courses for nurses be held to prevent errors and ensure the health of nurses.
Abbreviations: FMEA - Failure Modes and Effects Analysis; FDG - Focus Discussion Group; ICU - intensive care unit; RPN - Risk Priority Number
Key words: Biological Hazards; FMEA; Intensive Care Unit; Risk Assessment
Citation: Hosseni L, Karampourian A, Hiva Azami H. Risk assessment of biological hazards to the nurses using ‘Failure Modes and Effects Analysis’ (FMEA) in the intensive care unit. Anaesth. pain intensive care 2023;27(6):646−651; DOI: 10.35975/apic.v27i6.2200
Received: April 11, 2023; Revised: October 08, 2023; Accepted: : October 08, 2023
Association of low back pain with the use of high heel in ladies: a systematic review
Authors: Younas Ali Shehvaiz , Tanveer Fahad , Sharif Faiza , Waseem Iqra , Mahmood Wajeeha , Ahmad Ashfaq
Published: February 2024

Background & Objective: High heels of shoes are preferred for attractiveness, but are detrimental to health regarding their biomechanics. High heel changes the joint mechanics during walking which may result in abnormal stress and pressure at certain points and thus lead to painful knee, foot, hip or low back pain. The objective of this systematic review was to evaluate the literature addressing the association between the high heeled shoes and low back pain among females.
Methodology: It was a systemic review conducted during 2014-2020 on databases including Cochrane Library, PubMed, Medline, PEDro and Scopus, with key words ‘Low back pain’ OR ‘Back pain OR Lumbago’, ‘Low back pain in females OR Back pain in females OR Lumbago in females’, ‘High heeled shoes OR High heels’, ‘Association OR relationship’. Available full-length papers in English language were explored, after the screening and quality assessment using Axis critical appraisal tool for the studies.
Results: We found 32 articles, but the inclusion criteria were met only by 11 studies in quality score of 16. 27/20. The eligible studies enrolled a total of 1334 female participants with an average age of 18-32 y. Nine studies explained that low back pain was associated with high heeled shoes but none specified height of the heel, and only a range of 2.5-11 cm was suspected to be associated with changes in lumber biomechanics or lordosis, that can exert extra pressure for postural adjustments and lead to low back pain.
Conclusion: Out of 11 studies, nine studies favored that low back pain was associated with high heeled shoes, there was no specific height mentioned; but only a range of 2.5-11 cm was found to be associated with biomechanical changes due to postural adjustments, being a possible cause of low back pain among females.
Key words: Association; Females; High Heel; Low Back Pain; Shoes
Citation: Younas AS, Tanveer F, Sharif F, Waseem I, Mahmood W, Ahmad A. Association of low back pain with the use of high heel in ladies: a systematic review. Anaesth. pain intensive care 2023;27(6):681−688.
DOI: 10.35975/apic.v27i6.2339
Received: June 20, 2022; Revised: July 07, 2023; Accepted: November 08, 2023