bluuebunny/crossref_metadata_2025 huggingface dataset:
Adductor canal block is superior to intravenous analgesia for multimodal postoperative pain management in anterior cruciate ligament reconstruction
Authors: Laksono Ristiawan Muji , Isngadi Isngadi , Siswagama Taufiq Agus , Darmawan Haris , Asmoro Aswoco Andyk , Basuki Djudjuk Rahmad
Published: October 2024

Background: Postoperative pain after reconstruction of the anterior cruciate ligament (ACL) is a source of psychological and physiological consequences, and it might be a precursor of chronic pain. We compared the effects of intravenous analgesia technique and the adductor canal block as multimodal pain management after ACL reconstruction.
Methodology: A prospective, comparative study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia. A total of 30 patients undergoing ACL reconstruction were randomly divided into two groups; Group IV received intravenous analgesia (n = 15), and Group ACB received adductor canal block (n = 15). The numerical rating scale (NRS), the length of hospital stay, and the use of rescue analgesic dose were measured until the third postoperative day. Data were analyzed using the independent T-test using SPSS 18.0.
Results: The NRS-rest and NRS-movement of the ACB group were significantly lower than in Group IV (p < 0.05). There was no significant difference in the length of hospital stay and the need for rescue analgesia in both groups (p > 0.05).
Conclusions: The adductor canal block technique is better used as multimodal pain management than intravenous analgesia in postoperative anterior cruciate ligament reconstruction under spinal anesthesia with lower NRS-rest and NRS-movement.
Keywords: Adductor canal block; Intravenous analgesia; Anterior Cruciate Ligament reconstruction; Postoperative pain
Citation: Laksono RM, Isngadi I, Siswagama TA, Darmawan H, Asmoro AA, Basuki DR. Adductor canal block is superior to intravenous analgesia for multimodal postoperative pain management in anterior cruciate ligament reconstruction. Anaesth. pain intensive care 2022;26(2): ; DOI: 10.35975/apic.v26i2.1817
Received: February 03, 2021, Reviewed: March 29, 2021, Accepted: February 25, 2022
Use of self-made midazolam mixtures in preoperative sedation of children undergoing oral surgery under general anesthesia: a prospective, randomized, control study
Authors: Xin Zhijun , Wang Huaizhou , Li Changhui , Wan Qing , Wang Ning
Published: October 2024

Objective: Pediatric patients have high tendency of anxiety and tension before going to operating room and till they are anesthetized. So they usually need to be well-sedated before shifting to the operating room. We investigated the use of self-made midazolam mixture for preoperative sedation in children before oral treatment under general anesthesia.
Methods: A total of 64 children who received intra-oral surgery under general anesthesia from January 2021 to June 2021 in the Department of Pediatric Stomatology of Yantai Stomatology Hospital were randomly divided into two groups; Group A (n = 32) received 0.5 mg/kg midazolam solution mixed with 50% glucose injection. Group B (n = 32) received 0.5 mg/kg midazolam solution mixed with jasmine honey tea. Both solutions were 10 ml mixture and the children were instructed to take it. After 30 min, Ramsay score, oral drug compliance score, oral drug success rate, any adverse reactions, PSAS score, and venipuncture compliance score were noted. Adverse reactions were also recorded at 24 h post-operatively in both groups.
Results: Oral success rate (87.5%) in Group A was higher compared to Group B (65.6%) and the difference was statistically significant (P < 0.05). Children in Group A had higher drug oral compliance compared with Group B (P < 0.05). The number of children in Group B had more bitter mouth and nausea after oral medication than in Group A, and the difference was statistically significant (P < 0.05). There were no significant differences in Ramsay scores, PSAS scores, venipuncture compliance scores, and postoperative adverse effects in the two groups (P > 0.05).
Conclusion: The mixed solution of midazolam and 50% glucose injection (Group A) was associated with a higher oral success rate, good oral compliance and venipuncture compliance, and less adverse reactions after oral administration. The Ramsay score, PSAS score and postoperative adverse reactions of children were equivalent to those of oral midazolam injection, which could provide reference for clinical use.
Key words: Administration, Oral; Child; Humans; Hypnotics and Sedatives / administration & dosage; Oral surgery; Midazolam / administration & dosage; Preanesthetic Medication; Anesthesia, General;
Citation: Xin Z, Wang H, Li C, Wan Q, Wang N. Use of self-made midazolam mixtures in preoperative sedation of children undergoing oral surgery under general anesthesia: a prospective, randomized, control study. Anaesth. pain intensive care 2022;26(2): 199-204; DOI: 10.35975/apic.v26i2.1821
Received: January 24, 2022, Reviewed: February 24, 2022, Accepted: February 24, 2022
Complete airway obstruction relieved with bilateral chest compression in a morbidly obese patient with undiagnosed hypertrophic mucosa and severe edema of arytenoids
Authors: Al-metwalli Roshdi R. , Elsayed Hitham MA , Khidr Alaa M. , Fallata Summayah M. , Abdelhadi Maha SA
Published: October 2024

We describe a case of 62 y old obese lady, with undiagnosed hypertrophic mucosa and severe edema of the arytenoid cartilages. This swollen mucosal fold got pushed into the laryngeal inlet after insertion of laryngeal mask airway (LMA), causing complete airway obstruction and eventually a ‘can’t intubate, can’t ventilate’ (CICV) crisis situation. We describe how we did succeed to restore patient’s ventilation, in a CICV scenario with an unconventional way using chest compression avoiding the use of ultimate surgical airway. This is the first reported case of a chest compression maneuver being used as a rescue technique in a CICV scenario.
Abbreviation: BMI -  body mass index; LMA - Laryngeal mask airway; CICV - Can’t intubate, can’t ventilate; DM -  Diabetes mellitus; BA - bronchial asthma; GD - Graves ‘disease; GERD - Gastro-esophageal reflux disease; OSA - Obstructive sleep apnea; BMV - Bag-mask ventilation; DMV - Difficult mask ventilation; TV - tidal volume
Key words: Morbid obesity; Cardiopulmonary Resuscitation / methods; Chest Compression; Airway Obstruction / etiology; Humans; Treatment Outcome
Citation: Al-metwalli RR, Elsayed HMA, Khidr AM, Fallata SM, Abdelhadi MSA. Complete airway obstruction relieved with bilateral chest compression in a morbidly obese patient with undiagnosed hypertrophic mucosa and severe edema of arytenoids. Anaesth. pain intensive care 2022;26(2): 246–248; DOI: 10.35975/apic.v26i2.1827
Received: December 15, 2021, Reviewed: January 10, 2022, Accepted: January 30, 2022
Complete atrioventricular block after an anesthetic induction in a patient with unknown metabolic acidosis
Authors: Ferreira L. , Santos P. , Correia F. , Vieira A. , Bernardino A. , Freitas A.
Published: October 2024

Clinical case of an 84-year-old female patient who developed a complete heart block a few minutes after anesthetic induction associated with hemodynamic instability, nonresponsive to vagolytic and adrenergic medication. Transcutaneous pacing was started with hemodynamic improvement. After the event, a decompensated metabolic acidosis was detected which was promptly corrected, leading to a normalization of the heart rhythm. Metabolic acidosis is a described but uncommon cause of atrioventricular block. The authors are not aware of previous report of complete heart block in this context. We would like to draw attention to the importance of choosing carefully which anesthetic drugs should be used in these cases.
Key words: Atrioventricular block; General anesthesia; Metabolic acidosis; Bradycardia
Citation: Ferreira LS, Santos P, Correia F, Vieira A, Freitas A. Complete atrioventricular block after an anesthetic induction in a patient with unknown metabolic acidosis. . Anaesth. pain intensive care 2022;26(2): ; DOI: 10.35975/apic.v26i2.1828
Received: December 18, 2021, Reviewed: January 27, 2022, Accepted:  February 2, 2022
Equipment related critical incident in anesthesia: leaking HME filter
Authors: Munasinghe B.M.
Published: October 2024

HME (heat and moist exchanger) filters are used ubiquitously in anesthesia and intensive care, especially during the current COVID-19 pandemic.1 Inherent adverse events associated with HME filters such as blockade, disconnections, increased dead space and delayed gas induction have been described and discussed.2-3 Here, we describe a case of an intraoperative leak of an HME filter that was detected timely preventing desaturation or related sinister consequences. The significance of systematic check of anesthesia-related equipment and keeping an open mind during critical incidents are further reinforced by this brief, yet interesting report.
Key words: Critical incidents; HME filter; Leak
Citation: Munasinghe BM. Equipment related critical incident in anesthesia: leaking HME filter. Anaesth. pain intensive care 2022;26(2): 265–266; DOI: 10.35975/apic.v26i2.1830
Received: January 10, 2022, Reviewed: January 17, 2022, Accepted: February 03, 2022
Acknowledgment: Dr. Nishanthan Subramaniam, Medical Officer in Anesthesiology & Intensive Care, for his involvement during the patient management.
A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery
Authors: Ibrahim Salem Islam Mostafa , Mohamed Elkadi Galal Adel , Anis Said Sherif George , Ammar Mona Ahmed Abdelmotaleb , Rashed Mohamed Mohsen
Published: October 2024

Background & Objective: Ultrasound-guided 4-in-1 block has been suggested as a good alternative to various other nerve blocks to control pain after total knee replacement (TKR) surgery. We compared the three regional techniques; 4-in-1 block, femoral nerve block (FNB) and adductor canal block (ACB) following TKR regarding pain scores, opioid consumption, quadriceps muscle strength and early ambulation.
Methodology: We enrolled 93 patients and divided them into three equal groups of 31 each. Patients received either 4-in-1 block (Group A), FNB (Group B) or ACB (Group C) under ultrasound guidance. Outcome measures included assessment of VAS scores at 2, 4, 8, 12, 16, and 24 h). Nalbuphine consumption was calculated in the first 24 h. We also evaluated quadriceps muscle strength and early ambulation using straight leg raising (SLR) test at 12 and 24 h, and timed up-and-go (TUG) test at 24 h postoperatively.
Results: Patients received 4-in-1 block showed lower pain scores and lower nalbuphine consumption compared to FNB or ACB. Also, the SLR test values at 12h were higher (p-value<0.001), and TUG test values were lower (p-value0.005) in 4-in-1 block and ACB groups compared to FNB group.
Conclusion: The results of our study conclude that 4-in-1 block was found to be superior in pain control after TKR surgeries compared to FNB or ACB alone. It also facilitates early ambulation as it preserves quadriceps muscle strength.
Trial Registration: PACTR202110830502351.
Abbreviations: ACB - Adductor canal block; TKR - Total knee replacement; SLR - Straight leg raising test; FNB - Femoral nerve block; TUG test - Timed up-and-go test
Key words: Total knee replacement; Nerve block; Nerve Block / methods; Pain Management / methods; Pain, Postoperative / complications; Pain, Postoperative / drug therapy;  Four in one block; Femoral nerve block; Adductor canal block
Citation: Salem IMI, Elkadi GAM, Said SGA, Ammar MAA, Rashed MM. A comparative study between ultrasound-guided four-in-one block vs. femoral nerve block vs. adductor canal block to enhance recovery after knee replacement surgery. Anaesth. pain intensive care 2022;26(2):191–198; DOI: 10.35975/apic.v26i2.1834
Received: December 25, 2021, Reviewed: January 19, 2022, Accepted: January 28, 2022
Depression, anxiety and stress among healthcare workers in COVID-19 ICUs
Authors: Sadaf Sairah , Mussrat Ranna , Bashir Babar
Published: October 2024

Background & Objective: In most of the countries, the intensive care, airway management, and emergency resuscitation teams are largely constituted of the anesthetists, laying a great deal of physical, mental, and emotional pressure on them. In the ongoing COVID-19 outbreak, the anesthetists have been on the fore-front. We compared the level of anxiety, depression, and stress among healthcare workers (HCWs) of COVID-19 ICU and non-COVID ICUs in the tertiary care hospitals of south Punjab.
Methodology: It was a cross-sectional study that included DASS-21 and GHQ-12 online questionnaires.
Results: Out of 100 participants, 31% were in the COVID ICU group and 69% in the non-COVID ICU group. Females were 54% of the total. 55% of the participants were below 30 y of age, 77% were married, and 48% were post-graduates. Overall 50% of HCWs had a probable psychological illness, while 25% had anxiety, 21% depression and 12% had stress. Anxiety, depression, and stress were more in COVID ICU group as compared to the non-COVID group [(35% vs. 20%), (32% vs. 16%) and (31% vs. 3%) respectively].
Conclusion: Coronavirus pandemic has affected the mental health of healthcare workers. Those working in COVID ICUs are more prone to develop psychological distress than non-COVID ICU healthcare workers.
Key words: Depression; Anxiety; Stress; COVID-19; Mental distress; Healthcare workers; ICU
Citation: Sadaf S, Mussrat R, Bashir B. Depression, anxiety and stress among healthcare workers in COVID-19 ICUs. Anaesth. pain intensive care 2022;26(2): 217-223; DOI: 10.35975/apic.v26i2.1835
Received: Jan 23, 2021, Reviewed: July 16, 2021, Accepted: July 19, 2021
Faculty development in low- and middle-income countries – Part I
Authors: Shibli Khalil Ullah , Shibli Safina
Published: October 2024

Medicine is a dynamic subject, in the sense that the medical practitioners can never seize to learn; the new discoveries, new therapeutic agents, new diagnostic and interventional procedures and new knowledge continuously evolve with the passage of time. Similarly, teaching and training of new entrants into the specialty and grooming of the existing practitioners is a perpetual task. One of the prime duties of the educators and trainers of today is to prepare educators and trainers for the next generation. In this context, faculty development has gained much importance and is now known to be established in the developed world. However, this concept has not gained its due priority in low and middle income countries due to various reasons. This invited editorial sheds light on this vital issue.
Key words: Faculty; Faculty development; Faculty development program; Low and Middle-Income CountriesCitation: Shibli KU, Shibli S. Faculty development in low- and middle-income countries – Part I. Anaesth. pain intensive care 2022;26(2):133-136; DOI: 10.35975/apic.v26i2.1842Invited: January 31, 2022; Received: March 14, 2022, Accepted: March 18, 2022
Published- Post cervical spine surgery hyperpyrexia (108°F) in a patient with COVID-19: a case report
Authors: Cherunghattil Nimisha , Panda Chinmaya K. , Karim Habib M. R. , Dhawan Mishal
Published: October 2024

Perioperative hyperpyrexia raises many questions and can cause permanent brain damage if left untreated. Malignant hyperthermia (MH), although uncommon, but sporadic cases continue to happen and it is potentially life-threatening. It is characterized by sudden rise of body temperatures to above 106° F or even more, and hypercapnia. It is usually associated with anesthetic exposure. However, not every hyperpyrexia is MH; a clinical examination, risk stratification, scoring, and logical approach are required to exclude MH in the postoperative patient. We present a case of rare postoperative hyperpyrexia caused by COVID-19. The patient underwent uneventful spine surgery under general anesthesia and developed hyperpyrexia on the first postoperative day. The case highlights the importance of a logical and systematic approach for excluding the causes of postoperative hyperpyrexia and aggressive management.
Abbreviations:  CCU - Critical Care Unit; FiO2 - Inspired fraction of oxygen; GA - General anesthesia; MH - Malignant hyperthermia; PCR - Polymerase chain reaction
Key words: Hyperpyrexia; Malignant Hyperthermia; COVID-19; Spine Surgery
Citation: Cherunghattil N, Panda CK, Karim HMR, Dhawan M. Post cervical spine surgery hyperpyrexia (108°F) in a patient with COVID-19: a case report. Anaesth. pain intensive care 2023;27(2):276−279; DOI: 10.35975/apic.v27i2.2045
Received: October 31, 2022; Reviewed: February 06, 2023; Accepted: February 15, 2023
The Role of CRRT in the Management of Sepsis Associated AKI : Case Report
Authors: Aji Ilham Anggito , Sugiarto Adhrie , Irawany Vera
Published: October 2024

Sepsis is an uncontrolled immunological host reaction to infection that causes organ dysfunction. Mortality related to sepsis-associated acute kidney injury (SA-AKI) is 30%−60%. A 62−year-old woman presented to emergency room (ER) of Fatmawati Hospital with decreased consciousness for one day. Complaints of productive cough, fever, and shortness of breath were noted. We found hypotension with cold extremities, fever, tachycardia, and labored breathing. Her SOFA score was 12, blood glucose level was very high, urine production was less than 0.5 ml/kg/h in 6 h, high creatinine level (1.69 mg/dL), fluid balance +643 ml/6 h, and chest X-ray showing bilateral infiltrates. The patient was intubated to reduce work of breathing and stabilize hemodynamics. Management of the sepsis bundle was initiated by administration of vasopressors despite adequate fluid intake and two broad-spectrum antibiotics (meropenem and levofloxacin). On the second day, continuous renal replacement therapy (CRRT) was performed due to oliguria and worsened AKI caused by septic shock. After 48 h of CRRT, the patient clinically improved. The patient was extubated successfully on the fifth day of treatment.
Abbreviations: AKI - acute kidney injury; CRRT - Continuous Renal Replacement Therapy; ER - Emergency room;
Key words: Acute kidney injury; CRRT; Sepsis; SOFA score;
Citation: Aji IA, Sugiarto A, Irawany V. The role of CRRT in the management of sepsis-associated acute kidney injury: case report. Anaesth. pain intensive care 2023;27(2):285−288; DOI: 10.35975/apic.v27i2.2090
Received: December 15, 2022; Reviewed: December 22, 2022; Accepted: February 15, 2023
Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques
Authors: Mathew Anita , Lukachan Gincy Ann , Varughese Deepak , Raju Nimmy , Mathai Ashu Sara , Johnson Abel Samuel
Published: October 2024

Background & Objective: Elderly patients sustaining hip fractures often are physically very frail and have multiple co-morbidities that might significantly affect their clinical outcomes after surgery. We evaluated the effect of frailty and co-morbidities on the functional outcomes, morbidity and mortality among elderly patients undergoing hip fracture surgeries under regional anesthesia.
Methodology: Elderly patients who underwent hip fracture surgeries under regional anesthesia between 1 April 2021 to 30 April 2022 were included in this non-concurrent cohort study. Besides basic demographic and perioperative data, the Charlson Comorbidity Index (CCI), length of hospital stay, length of ICU stay and 30-day readmission rates were noted. Telephonic interviews were conducted at 3 months following surgery and a note was made of their pre-operative Clinical Frailty Score (CFS), ability to walk within 3 months of discharge, Activities of Daily Living (ADL) using Katz Index (KI) and 90-day mortality.
Results: Of the 109 patients included in the final analysis, forty belonged to the prefrail and sixty-nine to the frail group. Forty-five had moderate CCI while sixty-four belonged to severe CCI. Patients with severe co-morbidities had a significantly lower KI score (P = 0.023) and longer length of ICU stay (P = 0.005). Frail patients had significantly higher mortality rates at 30, 60 and 90 days compared to prefrail, (mortality at 30-days P = 0.029, 60-days P = 0.006, 90-days P < 0.001)
Conclusions: Presence of Frailty and multiple co-morbidities result in significantly worse outcomes (both mortality and functional outcomes) among elderly patients undergoing hip fracture surgeries. This underlines the importance of routine assessment of frailty and CCI scores during preoperative screening.
Abbreviations: ADL - Activities of daily living; CCI - Charlson Comorbidity Index; CFS - Clinical Frailty Score; ICU – Intensive Care Unit; KI - Katz Index; MI - Myocardial Infarction
Key words: Hip Fracture; Elderly; Frailty; Comorbidity; Mortality; Functional Outcome; Clinical Frailty Scale; Charlson Comorbidity Index
Citation: Mathew A, Lukachan GA, Varughese D, Raju N, Mathai AS, Johnson AS. Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques. Anaesth. pain intensive care 2023;27(2):161−169; DOI: 10.35975/apic.v27i2.2132
Received: January 16, 2023; Reviewed: February 19, 2023; Accepted: February 28, 2023
Farewell to opioids
Authors: Zahid Muhammad Arslan
Published: October 2024

Up till recent times, various opioid products have been the main stay for pain management during surgeries and in the postoperative period. The clinicians had to adopt multiple ways to control the troublesome side effects associated with opioid use; especially the ileus and nausea / vomiting.  Wide spread use of in-hospital and prescription use of opioids lead to an alarming rise in the addiction rates, ultimately termed as opioid epidemic. The clinicians had to think about other effective but safe methods to control pain. This invited editorial throws some light on this topic with an aim to involve clinicians in this debate.
Key words: Addiction; Opioids; Opioid epidemic; Pain
Citation: Zahid MA. Farewell to opioids (Editorial). Anaesth. pain intensive care 2023;27(1):150−153.
DOI: 10.35975/apic.v27i2.2179
Received: February 19, 2023; Reviewed: February 28, 2023; Accepted: February 28, 2023
Noninvasive hemoglobin monitoring by spectrophotometry in blunt abdominal trauma patients for conservative management
Authors: Hafez, MD Amr Fouad , Ibrahim, MD Ibrahim Al Shahat , MD Ramy Helmy , Ibrahim, MD Waleed Abdalla
Published: October 2024

Background & Aim: Nonoperative management is considered the treatment of choice in patients with blunt abdominal trauma, serial clinical assessment and hemoglobin (Hb) measurements is the cornerstone for their evaluation. While automated laboratory analysis is the reference method for measuring Hb, spectrophotometry may be better by allowing non-invasive instant readings. This study aimed to evaluate the accuracy of spectrophotometric non-invasive Hb monitoring (SpHb) and whether it’s possible to rely upon in making the decision for operative management or not.
Methodology: a cross-sectional observational study at which 39 patients admitted to our surgical intensive care unit (ICU) following blunt abdominal trauma were subjected to serial measurements of SpHb using an oximeter probe (Radical-7™; Masimo Corp., Irvine, CA), and simultaneous blood samples analyzed using Coulter LH 750 Cell Counter, measurements were done every 8 hours till discharge or admission to operation room, the accuracy and precision of SpHb were evaluated.
Results: The limits of agreement between conventional and noninvasive Hb assays were clinically unacceptable and ranging from -6.45 g/dl (95% CI = -7.54 to -5.37 g/dl) to 4.82 g/dl (95% CI = 3.74 to 5.91 g/dl). The mean difference (bias) was -0.82 g/dl (95% CI = -1.45 to -0.19), the correlation between SpHb and laboratory values was statistically insignificant (r = 0.19, 95% CI = -0.03 to 0.39, P = 0.095, R2 = 0.03).
Conclusion: Spectrophotometric noninvasive hemoglobin measurement didn’t offer enough accuracy nor precision and shouldn’t be relied upon in deciding operative management of blunt abdominal trauma patients admitted to ICU under observation.
Abbreviations: CBC - Complete Blood Count; ICU - Intensive Care Unit; PI - Perfusion index; SpHb - spectrophotometric non-invasive hemoglobin monitoring
Key words: Blunt abdominal trauma; Masimo; Radical-7™; Hemoglobin; Non-invasive; Perfusion index.
Citation: Hafez AF, Ibrahim AI, Helmy R, Ibrahim WA. Noninvasive hemoglobin monitoring by spectrophotometry in blunt abdominal trauma patients for conservative management. Anaesth. pain intensive care 2023;27(2):170−178; DOI: 10.35975/apic.v27i2.2180
Received: December 22, 2022; Reviewed: January 26, 2023; Accepted: January 26, 2023
The effect of aromatherapy with rose water on the deep sleep status of premature infants admitted to NICU: A randomized clinical trial
Authors: Ghaljaei Fereshteh , Mahmoodi Nasrin , Zeinabadi Faezeh Zare
Published: October 2024

Introduction: Sleep, as a biological process, plays an essential role in the brain development and of sensory and motor systems. Studies show different psychological effects of complementary medicine including aromatherapy on patients. We investigated the effect of aromatherapy with rose water on the deep sleep status of premature infants admitted to neonatal intensive care unit (NICU).
Methodology: This randomized clinical trial study was conducted on 64 infants hospitalized in NICU. Infants were randomly divided into an intervention group and a control group. Two drops of rose water or two drops of distilled water were poured on gas and placed next to the heads of the babies, respectively. Activity level scale (ALS) was used to assess the sleep status.
Results: Out of 66 infants in this study, 30 were female and 36 were male. The average gestational age of the infants was 32.59 ± 1.99 weeks. The results showed that the duration of deep sleep (type A and B) in the intervention group was significantly longer than the control group during and after the intervention. (P = 0.001).
Conclusions: Considering the positive impact of rose water, it can be used to improve the sleep quality in premature babies in hospitals along with the main treatment.
Keywords: Infant; Intensive Care Units; Aromatherapy; Sleep Quality
Citation: Ghaljaei F, Mahmoodi N, Zeinabadi FZ. The effect of aromatherapy with rose water on the deep sleep status of premature infants admitted to NICU: A randomized clinical trial. Anaesth. pain intensive care 2022;27(2):179−184; DOI: 10.35975/apic.v27i2.2181
Received: November 14, 2022; Reviewed: December 17, 2022; Accepted: January 26, 2023
Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study
Authors: Budisulistyo Trianggoro , Husni Amin , Pramukarso Dodik Tugasworo , Pudjonarko Dwi
Published: October 2024

Background & Objective: The management of lumbar disc herniation (LDH) may involve the surrounding tissues, and attract neovascularization facilitated macrophage aggregates. Epidural triamcinolone might have a half-life ranging from 10−31 days; 80 mg methylprednisolone might improve the pain up to 1 week. The higher doses of steroids will lead to adrenal cortex suppression and osteopenia. We evaluated the effect of treatment with 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at 2 weeks, and 3 and 6 months follow-up.
Methodology: We enrolled seven males (38.9%) and 11 females (61.1%) with mean age 44 ± 23 y in the study. Eight (44.44%) subjects were younger than 51 y old, whereas the 10 (55.56%) subjects were ≥ 51 y old. Twelve (66.7%) subjects had had a bulged disc, and 6 (33.3%) subjects had disc protrusion. We injected 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at the site of disc lesion. Pain scores were measured with NRS scale and Oswestry Disability Index (ODI) scores at 2 weeks, and 3- and 6-months follow-up.
Results: The NRS score improved at 2 weeks, 40% to 71.43%, at 3 months 60% to 100%, and 6 months 80% to 100%. And the Oswestry Disability Index (ODI) score was improved at 2 weeks from 23.5% to 68.18%), at 3 months from 39.13% to 100%, and at 6 months 82.35% to 100%. A significant association was observed between age older than 50 y old and ODI scores at 2 weeks followed up.
Conclusions: The intra-epidural 1500 IU hyaluronidase before triamcinolone brings better results even though using a lower dose of triamcinolone. This approach showed the lower-cost better pain scores as compared to the routine use of heavy doses of triamcinolone for managing bulged and protruding LDH.
Abbreviations: ACTH: Adrenocorticotropic hormone; CRH: Corticotropin releasing hormone; CSF: Cerebrospinal fluid; HPA: Hypothalamus-Pituitary-Adrenal; ESI: Epidural steroid injection; LDH: Lumbar disc herniation; MRI: Magnetic resonance imaging; NRS: Numerical Rating Scale; ODI: Oswestry Disability Index; TNF-α: Tumor necrosis factor-alpha; VAS: Visual analogue scale
Key words: Bulged disc; Disc protrusion; Lumbar disc herniation; NRS; ODI; Caudal epidural; Adhesiolysis
Citation: Budisulistyo T, Husni A, Pramukarso DT, Pudjonarko D. Effect of caudal epidural adhesiolysis on pain and daily activities among chronic lumbar disc herniation patients. Anaesth. pain intensive care 2022;26(6):198−203.
 DOI: 10.35975/apic.v27i2.2184
Received: Sep 06, 2022; Reviewed: Oct 09, 2022; Accepted: Oct 21, 2022
Epidural versus low-dose spinal for analgesia of late first stage of labor: a randomized clinical trial
Authors: MD Amin M. Alansary , Ali,MD Mohamed Mourad , Elbeialy, MD Marwa A. K.
Published: October 2024

Background & Objectives: Epidural analgesia is the most effective method of reducing pain during normal delivery. However, it may not be a suitable choice in parturients presented in the late first stage of labor due to lack of time and lack of cooperation by the parturients. Spinal analgesia could be a suitable alternative. We compared epidural with spinal anesthesia for pain relief during late first stage of labor.
Methodology: 100 parturient, who presented in the late first stage of labor and requested neuraxial analgesia, were randomized to receive either epidural analgesia or single-shot spinal analgesia. The time needed to perform the block, onset and duration of analgesia, sensory level, hemodynamic effects, maternal side effects, and neonatal outcomes were recorded in both groups.
Results: The time needed to perform the block was significantly shorter in the spinal group (5.2 ± 0.9 min) than in the epidural group (17.3 ± 1.5 min) (P < 0.001). The onset of analgesia and time to reach adequate analgesia were significantly faster in the spinal group (P < 0.001). Pain scores decreased significantly in the spinal group until 15 min after the block. After that point, there were no significant differences in both groups. Regarding MAP, there was no significant difference except at 5 min after the block in the spinal group, with a significant reduction in MAP (P < 0.001). There were no significant changes between the two groups as regards maternal side effects and neonatal outcomes.
Conclusion: Although epidural analgesia is the most reliable method for pain control in normal labor. however, spinal analgesia may be a good alternative, especially in parturients presenting in late first stage of labor.
Abbreviations: GA- General Anesthesia; MAP - Mean Arterial Pressure; HR- Heart Rate
Key words: Neuraxial analgesia; Spinal; Epidural Analgesia; Normal labor
Citation: Alansary AM, Ali MM, Elbeialy MAK. Epidural versus low-dose spinal for analgesia of late first stage of labor: a randomized clinical trial. Anaesth. pain intensive care 2023;27(2):227−235; DOI: 10.35975/apic.v27i2.2193
Received: December 24, 2022; Reviewed: January 18, 2023; Accepted: February 08, 2023
Ultrasound in pain and regenerative medicine: the emerging stethoscope for the interventional pain sonographer
Authors: Pauzi Mohd Faeiz , Juhari Siti Norazlina , Idris Nur Aiza , Yusof Nurul Azreen
Published: October 2024

Introduction: Ultrasonography (USG) has been one of the greatest discoveries by the anesthesiologists, pain specialists, emergency medicine specialists, and in fact every physician and surgeon during the last two decades. No more, it is the sole domain of the radiologist or rarely by an obstetrician. Apicare Journal has been on the fore-front to create awareness about the divers uses of USG in the medical field, both in diagnosis and as a useful aid in the therapeutic interventions. More than 80 papers have been published so far, and can be searched and freely downloaded on our open access website: www.apicareonline.com
Key words: Anesthesia; Emergency Medicine; Pain management; Point-of-care ultrasound; Ultrasonography
Citation: Pauzi MF, Juhari SN, Idris NA, Yusof NA. Ultrasound in pain and regenerative medicine: the emerging stethoscope for the interventional pain sonographer (Correspondence). Anaesth. pain intensive care 2023;27(2):289−290; DOI: 10.35975/apic.v27i2.2195
Received: ; Reviewed: ; Accepted:
Local wound infiltration with fentanyl vs ketamine after open abdominal hysterectomy: a prospective, randomized, double-blind study
Authors: Afify Noha , Mahdy Wafiya
Published: October 2024

Background & Objective: Local wound infiltration with local anesthetics is known to be an efficacious analgesic modality with minimal side effect. We evaluated the comparative analgesic effect of fentanyl with ketamine as an additive to 0.25% bupivacaine for local wound infiltration during open abdominal hysterectomy.
Methodology: Ninety female patients with ASA class I or II, aged 20–60 y, who underwent elective open abdominal hysterectomy under spinal anesthesia, were allocated randomly to one of the three groups. Patients of Group C received 30 ml of 0.25% bupivacaine, Group F received 30 ml of 0.25% bupivacaine plus 2 ml of fentanyl (100 µg), and Group K received 30 ml of 0.25% bupivacaine plus 2 mg/kg ketamine. The time to first analgesic demand and the total analgesic consumption in the first 24 h postoperatively were noted. Postoperative sedation score was also noted in all patients.
Results: Total analgesic consumption in the first 24 h postoperatively was significantly less in both Group K and F, in comparison to Group C (P = 0.001); however, there was no statistically significant difference between Group K and Group F (P = 0.706). The first call for analgesia was significantly earlier in the Group K in comparison to Groups C and F (P = 0.001). The sedation score was higher in Group K than the other two groups (P > 0.001). 
Conclusion: Local wound infiltration with ketamine as an adjuvant to bupivacaine appears to be a promising analgesic modality in open abdominal hysterectomy surgery. It has comparable analgesic effect to fentanyl when added to bupivacaine in local wound infiltration with longer duration of analgesia and minimal sedative effects.
Key words: Analgesia; Fentanyl; Hysterectomy Ketamine
Citation: Afify N, Mahdy W. Local wound infiltration with fentanyl vs ketamine after open abdominal hysterectomy: a prospective, randomized, double-blind study. Anaesth. pain intensive care 2023;27(2):250−255; DOI: 10.35975/apic.v27i2.2196
Received: February 05, 2023; Reviewed: February 20, 2023; Accepted: March 31, 2023
Crecimiento personal para la transformación social a través del aprendizaje-servicio. Una guía de acompañamiento para el alumnado
Authors: Fernández Torres María Mercedes , Andrés Romero Magdalena P. , SALVADOR CARMEN , Salguero Garcia Dario
Published: October 2024

Este libro está diseñado como una herramienta educativa para estudiantes de universidad o enseñanza posobligatoria que participan en proyectos basados en la metodología de aprendizaje-servicio (ApS). Su contenido ha sido desarrollado a partir del sustento teórico con el objetivo de acompañar al alumnado en su crecimiento personal, y no solo académico, durante las distintas fases de desarrollo de un proyecto de ApS. Así, se proponen actividades y dinámicas prácticas, centradas en la reflexión y toma de conciencia del alumnado para promover el desarrollo de competencias cognitivas, emocionales y sociales. La guía está diseñada para ser utilizada sin la intermediación constante del profesor, sino directamente por el alumnado, con el fin de promover su rol activo y protagonista en su aprendizaje y en la implementación de los proyectos sociales. Además, el libro también puede ser útil para educadores y profesionales interesados en incorporar la metodología ApS en sus currículos o en sus prácticas de trabajo comunitario. La principal intención de esta guía de acompañamiento es capacitar a los estudiantes para que se conviertan en agentes de cambio social, por lo que se les proporciona las herramientas necesarias para reflexionar sobre su papel en la sociedad y para desarrollar proyectos que aborden problemas y necesidades sociales concretas.
SISTEM PENGELOLAAN REKAM MEDIS DI PUSKESMAS BAURENO
Authors: Amelia Rahmawati Mitha , El-syafa'ah Sukma Lathifa , Mae Vannesa
Published: October 2024

Pengelolaan  Rekam  Medis  di  Puskesmas adalah  untuk menunjang  tercapainya  tertib  administrasi  dalam  rangka  upaya  mencapai  tujuan puskesmas yaitu  peningkatan  mutu  pelayanan  kesehatan . Berdasarkan hasil dari studi pendahuluan, ditemukan beberapa permasalahan di Puskesmas Baureno yang kurang efektif yaitu pengelolaan  rekam medis belum  sesuai  dengan tatakerja  dan  organisasi  sarana  pelayanan  kesehatan.  Hal ini terlihat dari kurangnya jumlah SDM rekam medis, sering terjadi duplikasi nomor rekam medis, penggunaan tracer yang tidak maksimal, sering terlambat dalam pelaporan rekam medis,  kurang efektifnya komunikasi yang terjadi antara petugas rekam medis dengan petugas lainnya di Puskesmas tersebut. Tujuan penelitian ini untuk mengetahui sistem pengelolaan rekam medis di Puskesmas Baureno. Hasil penelitian didapatkan bahwa sistem pengeloaan rekam medis Puskesmas Baureno antara lain untuk SP2TP masih belum sesuai karena kurangnya koordinasi pada setiap bagian puskesmas sehingga sering terjadi keterlambatan, sistem pelayanan rekam medis sudah sesuai dengan SPM yaitu mulai dari pendaftaran sampai dengan pasien pulang rekam medis pasien selalu lengkap serta tepat waktu. Sistem pengolahan rekam medis yang terdiri dari TPP, assembling, indexing, coding, dan filling sudah berjalan sesuai dengan SOP. Proses pengelolaan rekam medis pada puskesmas  harus tetap meningkatkan dan mempertahankan sistem pengelolaan rekam medis yang sesuai guna untuk menunjang  tercapainya  tertib  administrasi rekam medis yang efektif dan efisien.
ANALISIS FAKTOR-FAKTOR YANG MEMENGARUHI KETIDAKAKURATAN KODE DIAGNOSIS PENYAKIT RAWAT JALAN DI PUSKESMAS PANDANWANGI KOTA MALANG
Authors: Zein Eiska , Gholiyahita Afifah , Wijaya Avid
Published: October 2024

Keakuratan kode diagnosis penyakit pasien memiliki peran penting dalam kelancaran pelayanan kesehatan. Kode yang tidak akurat akan berdampak terhadap pembuatan laporan dan kualitas pelayanan kepada pasien karena mempunyai tingkat validasi data yang rendah. Ketidakakuratan kode diagnosis penyakit dipengaruhi oleh beberapa faktor sesuai kondisi dari fasilitas pelayanan kesehatan. Penelitian ini menggunakan jenis penelitian kuantitatif dengan pendekatan deskriptif. Penelitian ini bertujuan untuk menganalisis tingkat keakuratan dan ketidakakuratan kode diagnosis penyakit serta faktor-faktor yang memengaruhi ketidakakuratan kode diagnosis penyakit di Puskesmas Pandanwangi yang meliputi petugas kodefikasi, kelengkapan dokumen rekam medis, kebijakan pengkodean dan sarana prasarana. Populasi dalam penelitian ini sebanyak 4702 dokumen rekam medis dengan jumlah sampel yang diambil 98 dokumen rekam medis. Cara pengumpulan data dengan melakukan observasi dan wawancara. Hasil penelitian menunjukkan persentase keakuratan kode diagnosis penyakit sebesar 40,8% (40 berkas) dan persentase ketidakakuratannya sebesar 59,2% (58 berkas). Faktor-faktor yang memengaruhinya yaitu petugas kodefikasi pada poli umum masih dilakukan oleh dokter dan perawat, semua petugas kodefikasi belum pernah mengikuti pelatihan pengkodean, pengalaman kerja petugas kodefikasi sekitar 3 tahun, kelengkapan dokumen rekam medis belum sepenuhnya 100%, penggunaan SOP dan buku ICD-10 belum digunakan secara maksimal, serta belum adanya surat keputusan penetapan petugas kodefikasi dan kamus bahasa inggris untuk menerjemahkan kata asing.
FAKTOR-FAKTOR YANG MEMPENGARUHI SIKAP PERAWAT RAWAT INAP TERHADAP PERALIHAN REKAM MEDIS KONVENSIONAL KE REKAM MEDIS ELEKTRONIK (RME) DI RSUD KABUPATEN KLUNGKUNG
Authors: Dewi Ni Wayan Eka Budi Opriana , Romansyah Deva Eddy , Adiningsih Luh Yulia , Putra Gede Wirabuana , Putri Putu Chrisdayanti Suada
Published: October 2024

Nurses are the largest potential group of RME users in healthcare facilities, therefore it is very important to understand nurses' interaction with RME and its subsequent impact on nurses' activities and routines. Nurses being the largest part of the health workforce, nurses' attitudes towards computer use are likely to have a major impact on the process of implementing information technology systems in health services. This type of research is observational analytic with a quantitative approach. The study population was inpatient nurses who served at Klungkung Regency Hospital with a total of 189 nurses. The sample in this study amounted to 120 respondents taken by purposive sampling. Data collection was carried out by distributing questionnaires filled in by nurses. Data analysis using univariate analysis and bivariate analysis. The results showed that there were 4 factors that influenced nurses' attitudes in switching conventional medical records to electronic medical records (RME), namely perceived usefulness (p-v=0.000), perceived convenience (p-v=0.000), social influence (p-v=0.000). And facilitating conditions (p-value=0.000). Age, gender, employment status, and nurse education do not moderate the relationship between perceived usefulness, perceived convenience, social influence and facilitating conditions on attitudes towards using RME.
PEMANFAATAN APLIKASI MY HOSPITAL X UNTUK PROSES RETENSI REKAM MEDIS DI RUMAH SAKIT WANGAYA DENPASAR
Authors: Mahardika Ida Bagus Putra , Pradnyani Putu Erma , Murcittowati Putu Ayu Sri , Putri Putu Chrisdayanti Suada , Adiningsih Luh Yulia , Putra Gede Wirabuana , Vergantana I Wayan Septa Malan , Romansyah Deva Eddy , Paramita Ida Ayu Putu Feby , Ariwanta I Putu Yesha Agus
Published: October 2024

RSUD Wangaya saat ini masih belum memiliki sistem retensi khususnya belum adanya sistem yang dapat membantu petugas rekam medis dalam pemindahan rekam medis aktif menjadi rekam medis in-aktif serta memungkinkan untuk dilakukan pemilahan formulir. Penelitian ini bertujuan untuk mengetahui pemanfaatan Aplikasi My Hospital X untuk proses retensi rekam medis di RSUD Wangaya. Rancangan penelitian ini adalah pengembangan dengan menggunakan Desain Eksperimental untuk implementasi teknis menggunakan Balsamiq dan Visio. Hasil perancangan menunjukkan bahwa rancangan fungsional dari diagram konteks, Data Flow Diagram (DFD), Entity Relationship Diagram (ERD) serta implementasi antar muka. Simpulan dari penelitian ini Rumah sakit harus melakukan retensi rekam medis untuk mengurangi jumlah arsip rekam medis yang terus bertambah. Dengan adanya sistem retensi memudahkan untuk dapat memilah berkas rekam medis yang akan dilakukukan retensi.
اختبار العلاقة بين أنموذج هندسة السلوك والجدارة الثقافية
Authors: البغدادي عادل , راضي نغم
Published: October 2024

تهدف الدراسة الى اختبار العلاقة بين أنموذج هندسة السلوك والجدارة الثقافية في شركات السياحة في النجف الاشرف.
استهدفت الدراسة أسلوب الحصر الشامل على مجتمع الدراسة المتمثلة بمدراء ومسؤولي الشركات السياحية ومعاونيهم, إذ تم توزيع (111) استبانة وبعد فرز البيانات وتدقيقها تبين أن الاستبانات الصالحة للتحليل هي (95) استبانة من أصل (101) استبانة مسترجعة, وتم تحليلها وفقاً لأسلوب نمذجة المعادلات الهيكلية / طريقة المربعات الصغرى.
وتوصلت الدراسة الى مجموعة من النتائج وأهمها وجود علاقة تأثير وارتباط بين أنموذج هندسة السلوك والجدارة الثقافية .
الشعر الحرّ في معيار النقد
Authors: الساعدي رحيم
Published: October 2024

يخوض هذا البحث في دراسة الشعر الحرّ، الذي شكّل ظاهرة كبيرة في الشعر العربي، وقد أدّت "إرهاصات" كبيرة إلى بروزه، منها اختلاط العرب بالغرب، ويأس الشعراء من الأنظمة الحاكمة، وإثقال الشعر القديم بمضامين لمْ تعد مطلوبة كالمديح والهجاء. وقد رافقت الشعر الحرّ ضبابيّة أنتجت اضطراباً في تسميته ما بين الشعر المرسل أو المنطلق أو قصيدة التفعيلة، ثمّ استقرّ الشعراء على النظم بوزن من دون قافية. وقد شكّل "التدوير" ظاهرة واضحة في هذا الشعر تدل على التواصل، وتنهي قضية نقدية كانت سائدة في الشعر العربي هي قضية التضمين التي تعدّ ضعفاً في الشاعر الذي يكمل بيته في بيت يليه!
ولأنّ الشعر الحرّ يقتصر على السطر الشعري القائم على التفعيلة؛ ضحّى بأوزان ذات التفاعيل المختلطة وأبقى على الأوزان ذات التفاعيل الصافية بحكم السطر الشعري الذي حتّم على الشاعر التزام التفعيلة الصافية. وقد أفرز البحث نتائج مهمّة، منها أنّ الشعر الحرّ قدّم مضامين جديدة لمْ تكن موجودة في الشعر التقليدي.
توازن القوى والتنافس الأمريكي الصيني- الحرب الأوكرانية دراسة حالة
Authors: محمد رائد
Published: October 2024

يسعى البحث لمقاربة التنافس الصيني الأمريكي وذلك بالوقوف على طبيعة هذا التنافس وبحث مستوياته وأثره في توازن القوى الدولية واستقرار النظام الدولي، وتحدد مسار البحث بدراسة الحرب الأوكرانية الروسية كنموذج عملي تطبيقي للتنافس الصيني الأمريكي في الصعيد الدولي وأثر ذلك على إعادة ترتيب القوى بين الدول. ومن ثم تدور إشكالية الدراسة حول سؤال رئيسي مؤداه: ما هي مستويات ومؤشرات وميكانيزم التنافس الصيني الأمريكي في النظام الدولي؟ وما تأثير هذا التنافس على استقرار النظام الدولي؟ وكيف يمكن مقاربة هذا التنافس من خلال حرب روسيا على أوكرنيا؟. وجاءت الأزمة الروسية الأوكرانية كاشفة لطبيعة التنافس الحذر القائم بين الصين والولايات المتحدة وسعى كل طرف لاستثمار الأزمة لصالحه، فبينما سعت الصين إلى تحصين موقفها الدولي وتعزيز تحالفاتها ووضع أسس لنظام دولي جديد تكون لها فيه مساهمة أكبر، حاولت الولايات المتحدة مواجهة التمدد الصيني ومواجهة روسيا بحشد الدعم الأوربي المالي والاستخباراتي واللوجستي وكذلك العسكري لأوكرانيا عبر الناتو.
تقويم نظام الرقابة الداخلية في ظل قانون المحافظات غير المنتظمة بإقليم (21) لسنة/ 2008 المعدل-بحث تطبيقي في الإدارة المحلية لمحافظة النجف الأشرف
Authors: الرماحي حيدر
Published: October 2024

تناول البحث الرقابة الداخلية وفق قانون المحافظات غير المنتظمة بإقليم 21/2008 المعدل والإجراءات التي قامت بها دائرة الشؤون الإدارية والمالية بمحافظة النجف الاشرف اذ كانت مشكلة البحث في حداثة هذا الموضوع وعدم وجود بحوث بخصوص تقييم الرقابة الداخلية بعد نفاذ قانون المحافظات غير المنتظمة بإقليم رقم 21/لسنة 2008 المعدل والحاجة الى زيادة اجراءات فعالية الرقابة الداخلية لمواكبة تلك التطورات وتطبيق أحدث أساليب الرقابة لتقديم المعلومات بدقة والوقت المطلوب للكشوفات والتقارير المالية.
وتم اختيار عينة البحث في الدائرة الادارية والمالية قي محافظة النجف الاشرف بهدف الوصول الى مستوى جيد في اداؤها كونها من الوحدات الحديثة التكوين وذو كادر كبير جدا ويهدف البحث الى تقويم إجراءات الرقابة الداخلية في الإدارات المحلية المعمول بها والتأكد من الالتزام بالسياسات والإجراءات المتخذة بعد تطبيق قانون المحافظات غير المرتبطة بإقليم.
العلاقة بين القوى التنظيمية وديناميكية الجماعة دراسة استطلاعية لآراء عينة من طلبة الأقسام الداخلية
Authors: الدليمي علي
Published: October 2024

الغرض من الدراسة هو المساهمة في تقليص الفجوة المعرفية بين متغيري القوى التنظيمية وديناميكية الجماعة، باستخدام أسلوب المسح الاستطلاعي، بدءا من فكرة أساسية مفادها أن القوى التنظيمية لأنشطة إدارة قسم شؤون الاقسام الداخلية بجامعة الكوفة هي العامل الرئيسي الذي يؤثر على ديناميكيات المجموعة (طلبة الاقسام الداخلية)، وتحقيقا لهذه الغاية، اعتمد الباحث على بشكل رئيسي في جمع البيانات على الاستبيان الذي استطلع آراء عدد من طلبة الاقسام الداخلية بجامعة الكوفة باستخدام طريقة العينة العشوائية حيث كان حجم العينة (120) طالبا، وكان عدد الاستبانات التي تم استرجاعها (119)، وكلها صالحة للتحليل الإحصائي التي تم تحليلها بواسطة البرنامج الإحصائي (SPSS 21). وأظهرت نتائج التحليل الإحصائي انتشارا لمتغيرات (القوى التنظيمية وديناميكية الجماعة) في قسم شؤون الاقسام الداخلية قيد البحث وأظهرت نتائج التحليل أن هناك علاقة مباشرة وهامة بين المتغيرات، فضلا عن التأثير المباشر للقوى التنظيمية في ديناميكية الجماعة.