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Effect of preoperative anxiety on postoperative pain in patients undergoing elective lower-segment cesarean section under spinal anesthesia: A cross-sectional study in South India 术前焦虑对脊髓麻醉下择期剖宫产术后疼痛的影响:南印度的一项横断面研究
Pub Date : 2022-07-01 DOI: 10.4103/jcrsm.jcrsm_39_22
Y. Suresh, Aswini Lakshminarasimhan
Background: Anxiety is often encountered but overlooked in patients undergoing elective surgery. Anxiety may influence the perception of postoperative pain which is one of the major concerns for all patients. This study aimed to evaluate the effect of preoperative anxiety on postoperative pain and to find if any relation exists between demographic variables and anxiety in cesarean patients. Methodology: One hundred and twelve patients undergoing elective cesarean section under spinal anesthesia were evaluated for preoperative anxiety on the day before surgery using the Amsterdam Preoperative Anxiety and Information Scale questionnaire-based face-to-face interview, and postoperative pain was recorded every 6 h after surgery for 24 h using the Visual Analog Scale (VAS). Results: The prevalence of preoperative anxiety in the study subjects was 36%. The need for high information was 22%. The mean for anesthesia-related anxiety, information desire component, combined anxiety score, and VAS scores was 4.21 ± 2.63, 3.23 ± 2.15, 8.72 ± 4.60, and 5.30 ± 1.86, respectively. Postoperative pain was found to be correlating with higher levels of preoperative anxiety (r = 0.25, P < 0.01). Information desire component was found to have a positive, moderate, and significant correlation with anxiety score (r = 0.49, P < 0.01). No statistically significant relationship was found between sociodemographic characteristics and preoperative anxiety. Conclusion: This study demonstrated a positive and statistically significant correlation between preoperative anxiety and postoperative pain. Well-conducted randomized controlled studies are required to determine whether reducing anxiety before a surgery results in reduced postoperative pain response. Anxiety-reducing measures can be employed throughout the preoperative period in the surgical population to reduce postoperative pain in addition to analgesics.
背景:焦虑是择期手术患者经常遇到但被忽视的问题。焦虑可能会影响对术后疼痛的感知,这是所有患者主要关注的问题之一。本研究旨在评估术前焦虑对剖宫产患者术后疼痛的影响,并探讨剖宫产患者的人口学变量与焦虑之间是否存在关系。方法:采用阿姆斯特丹术前焦虑与信息量表(Amsterdam术前焦虑与信息量表)面对面访谈法,于术前1天对112例脊髓麻醉下择期剖宫产患者进行术前焦虑评估,术后每6 h采用视觉模拟量表(VAS)记录术后疼痛,持续24 h。结果:研究对象术前焦虑患病率为36%。对高信息的需求占22%。麻醉相关焦虑、信息渴望成分、综合焦虑评分和VAS评分的平均值分别为4.21±2.63、3.23±2.15、8.72±4.60和5.30±1.86。术后疼痛与术前焦虑水平升高相关(r = 0.25, P < 0.01)。信息渴望成分与焦虑得分呈正、中、极显著相关(r = 0.49, P < 0.01)。社会人口学特征与术前焦虑之间无统计学意义的关系。结论:本研究显示术前焦虑与术后疼痛呈正相关且有统计学意义。需要进行良好的随机对照研究来确定手术前减少焦虑是否会减少术后疼痛反应。在手术人群中,除了使用镇痛药外,还可以在整个术前采取减轻焦虑的措施来减少术后疼痛。
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引用次数: 0
Antimicrobial resistance surveillance among patients with sepsis in intensive care units of a tertiary care center 某三级保健中心重症监护病房脓毒症患者的抗微生物药物耐药性监测
Pub Date : 2022-07-01 DOI: 10.4103/jcrsm.jcrsm_28_22
KSandhya Bhat, C. Sanjeevan
Background: Rising antimicrobial resistance (AMR) rate is a challenge for treating patients in health-care settings globally. Most intensive care unit (ICU) patients are frequently on antimicrobial agents; this induces selective antibiotic pressure and increases the threat of the development of AMR. The objective of this study was to document the microbiological profile and antimicrobial susceptibility pattern of the isolates from blood culture-confirmed cases of sepsis from ICUs at a tertiary care center. Materials and Methods: A retrospective data collection was conducted after obtaining a waiver of consent from the institute ethics committee. A total of 151 patients, aged 18 years and above, admitted to the ICUs between January and December 2019 with blood culture-proven sepsis were included in the study. Data on demographic details, ICU stay, underlying risk factors, infecting organisms, and antimicrobial susceptibility reports were collected and analyzed using Microsoft Excel. Results: A total of 1020 clinically suspected sepsis patients were admitted to the ICUs during the study period. Of these, 151 patients (14.8%) had blood culture-proven sepsis. Gram-negative bacteria were the most frequent isolates (63.6%), among which Escherichia coli was the most common pathogen (25%), followed by Klebsiella pneumoniae (15%), and Acinetobacter baumannii (13.6%). The rate of resistance was more against cephalosporins as compared to carbapenems and tigecycline. Commonly documented gram-positive bacterial isolates were coagulase-negative staphylococci (8.6%), viridans streptococci (7.1%), and Staphylococcus aureus (5%). About 65.2% of penicillin-resistance and 15.8% of methicillin-resistant staphylococci were documented. Conclusion: This study on AMR was useful to know the prevalence of sepsis among ICU inpatients and the microbiological profile with their AMR pattern in our tertiary care hospital. This may help to generate local antibiograms which may further contribute to formulating the national data. Based on available antibiogram data, the choice of antibiotics for empiric treatment becomes easier. It may also guide the clinicians to escalate or de-escalate the antibiotics wherever possible.
背景:抗菌素耐药性(AMR)率上升是全球卫生保健机构治疗患者面临的挑战。大多数重症监护病房(ICU)患者经常使用抗菌药物;这导致选择性抗生素压力,并增加了抗菌素耐药性发展的威胁。本研究的目的是记录从三级医疗中心icu血培养确诊脓毒症病例中分离的微生物学特征和抗菌药物敏感性模式。材料和方法:在获得研究所伦理委员会的放弃同意后进行回顾性数据收集。2019年1月至12月期间,共有151名18岁及以上的血培养证实败血症患者被纳入研究。收集人口统计资料、ICU住院时间、潜在危险因素、感染微生物、抗菌药物敏感性报告等数据,并使用Microsoft Excel进行分析。结果:研究期间共有1020例临床疑似脓毒症患者入住icu。其中151例患者(14.8%)有血培养证实的败血症。革兰氏阴性菌最多(63.6%),其中大肠杆菌最多(25%),其次是肺炎克雷伯菌(15%)和鲍曼不动杆菌(13.6%)。与碳青霉烯类和替加环素相比,头孢菌素的耐药率更高。常见的革兰氏阳性细菌分离物为凝固酶阴性葡萄球菌(8.6%)、翠绿链球菌(7.1%)和金黄色葡萄球菌(5%)。65.2%的葡萄球菌耐青霉素,15.8%的葡萄球菌耐甲氧西林。结论:本研究有助于了解我院三级医院ICU住院患者脓毒症的流行情况及其微生物学特征。这可能有助于生成当地抗生素图,从而进一步有助于制定国家数据。根据现有的抗生素谱数据,选择抗生素进行经验性治疗变得更加容易。它也可以指导临床医生在可能的情况下增加或减少抗生素的使用。
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引用次数: 0
Mucinous cystadenoma in a 15-year-old girl: An incidental finding 15岁女孩粘液囊腺瘤:偶然发现
Pub Date : 2022-07-01 DOI: 10.4103/jcrsm.jcrsm_37_22
M. Rashmi, A. Bhaskar
Ovarian tumors in children and adolescents are rare. We present a case of a 15-year-old girl with mucinous cystadenoma (MCA) which was diagnosed incidentally when evaluating for anemia and reduced appetite. The scan reports suggested a large ovarian cyst with a few thick enhancing septa. Serological markers were within normal limits. She underwent a cystectomy with salpingo-oophorectomy. The cyst was reported as MCA on histopathology. The child is on regular follow-up for 6 months with no adverse events.
卵巢肿瘤在儿童和青少年是罕见的。我们提出一个15岁的女孩粘液囊腺瘤(MCA)是偶然诊断时评估贫血和食欲减退。扫描报告提示一个大卵巢囊肿,有几个厚的强化隔。血清学指标在正常范围内。她接受了膀胱和输卵管卵巢切除术。组织病理学报告囊肿为MCA。患儿随访6个月,无不良事件发生。
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引用次数: 0
Clinical spectrum and Cytogenetic characterization of patients with Turner Syndrome – Twin case report 特纳综合征患者的临床谱和细胞遗传学特征-双胞胎病例报告
Pub Date : 2022-07-01 DOI: 10.4103/jcrsm.jcrsm_71_21
Sriambika Kumar, Rema Devi
Diagnosis of Turner syndrome (TS) is usually made in mid-childhood, where 50% of the patients have 45, X karyotype in peripheral lymphocytes, which results from haploinsufficiency of the genes that commonly escape X-inactivation. 30%–40% have mosaicism of different forms, like 45,X/46,X,dic(Xp)/46,X,idic(Xq) and less commonly 45,X/46,XY. The goal of this case report is to analyze the cytogenetic and molecular characterization of two cases with dicentric X chromosomal abnormalities with varying degrees of mosaicism, demonstrating shared clinical features of TS. Combined conventional cytogenetic analysis, centromere banding, and fluorescence in situ hybridization (FISH) was done for the patients who presented with short stature and irregular menstrual cycles. Chromosome studies showed two cell lines: one with a single copy of X chromosome (45,X) and the other with a structural variation in X chromosome (isodicentric X chromosome), which is described as a Turner variant. C-banding also revealed the presence of two centromeres. Metaphase FISH with centromere probes for X revealed two mosaic cell lines: one with 45,X and a second one showing isodicentric X chromosome. The accurate diagnosis and characterization of a genomic imbalance in patients with sex chromosome disorders are essential for evaluating phenotype–karyotype correlations, genetic counseling, and having a clinical follow-up.
特纳综合征(TS)的诊断通常在儿童中期进行,其中50%的患者外周血淋巴细胞具有45x核型,这是由于通常逃避X失活的基因的单倍性不足造成的。30%-40%有不同形式的马赛克,如45、X/46、X、dic(Xp)/46、X、idic(Xq)和较少见的45、X/46、XY。本病例报告的目的是分析两例具有不同程度嵌合体的双中心X染色体异常的细胞遗传学和分子特征,显示TS的共同临床特征。对表现为身材矮小和月经周期不规律的患者进行常规细胞遗传学分析,着丝粒带带和荧光原位杂交(FISH)。染色体研究显示了两种细胞系:一种细胞系具有X染色体的单一拷贝(45,X),另一种细胞系具有X染色体的结构变异(等心X染色体),这被描述为特纳变异。c带也显示了两个着丝粒的存在。用着丝粒探针检测X的中期FISH发现了两种嵌合体细胞系:一种是45x染色体,另一种是等心X染色体。性染色体疾病患者基因组失衡的准确诊断和表征对于评估表型-核型相关性、遗传咨询和临床随访至关重要。
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引用次数: 0
Can Alveolar-Arterial Oxygen Pressure Difference be used to Diagnose Acute Respiratory Distress Syndrome in Pneumonia Patients? 肺泡-动脉氧压差能否用于诊断肺炎患者急性呼吸窘迫综合征?
Pub Date : 2022-05-28 DOI: 10.14302/issn.2766-8681.jcsr-22-4162
Ling Wang, Wanling Wang
Alveolar-arterial oxygen pressure difference (P(Aa)O2) can reflect pulmonary ability to exchange oxygen; it shows good correlation with the oxygenation index (OI), which is important in diagnosing acute respiratory distress syndrome (ARDS). This study explored the ability of P(Aa)O2 in diagnosing ARDS in pneumonia patients.MethodsWe selected patients with community-acquired pneumonia and sepsis in the intensive care unit (ICU) of the People’s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture; we measured P(Aa)O2 and the OI under anoxic conditions upon their admittance to the ICU. We divided the patients into ARDS and non-ARDS groups. We compared the differences in P(Aa)O2 and OI; we analyzed the correlation between P(Aa)O2 and ARDS. To assess the diagnostic ability of P(Aa)O2 for ARDS, we drew the receiver operating characteristic (ROC) curve.ResultWe found that P(Aa)O2 in the ARDS group was greater than in the non-ARDS group (t = 8.875, P <0.001); the OI in the ARDS group was smaller than in the non-ARDS group (t = –6.956, P <0.001). There was a positive correlation between P(Aa)O2 and ARDS (r = 0.718, P <0.001). The area under the ROC curve for P(Aa)O2 in the diagnosis of ARDS was 0.931 (0.873–0.988); the cutoff value was 214.70 mmHg, the sensitivity was 89.50%, and the specificity was 85.00%.ConclusionWe conclude that P(Aa)O2 is a good reference index in diagnosing ARDS
肺泡-动脉氧压差(P(Aa)O2)可反映肺氧交换能力;与氧合指数(OI)有良好的相关性,对诊断急性呼吸窘迫综合征(ARDS)有重要意义。探讨P(Aa)O2在肺炎急性呼吸窘迫综合征(ARDS)诊断中的价值。方法选择黔东南苗族侗族自治州人民医院重症监护病房(ICU)社区获得性肺炎脓毒症患者;在患者入ICU时,我们测量了缺氧条件下的P(Aa)O2和OI。我们将患者分为ARDS组和非ARDS组。比较P(Aa)O2和OI的差异;分析P(Aa)O2与ARDS的相关性。为了评估P(Aa)O2对ARDS的诊断能力,我们绘制了受试者工作特征(ROC)曲线。结果ARDS组P(Aa)O2高于非ARDS组(t = 8.875, P <0.001);ARDS组OI小于非ARDS组(t = -6.956, P <0.001)。P(Aa)O2与ARDS呈正相关(r = 0.718, P <0.001)。P(Aa)O2诊断ARDS的ROC曲线下面积为0.931 (0.873 ~ 0.988);临界值为214.70 mmHg,敏感性为89.50%,特异性为85.00%。结论P(Aa)O2是诊断ARDS较好的参考指标
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引用次数: 0
Design of Stopwatch based on STC89C52 Single Chip Microcomputer 基于STC89C52单片机的秒表设计
Pub Date : 2022-03-23 DOI: 10.14302/issn.2766-8681.jcsr-22-4126
Wen Wang, Yongjian Sun
This design is according to the requirements of the wide rider, and the Multi-function bike computer has the function of velocity measurement, display, timing, lighting, buzzer warning, which could satisfy the requirements of cycling enthusiasts. This design is based on STC89C52 SCM (Single Chip Microcomputer) smallest system and uses hall sensor receives the bicycle wheel rotation numbers date, and then transmit the received data into the SCM. After the SCM’s calculation and processing, it gets the bicycle’s instantaneous speed, mileage, riding time through the LED display the date. The part of software programming use C language, which compiles and downloads by the Keil and STC-ISP. This design uses Proteus to make the circuit diagram drawing and system simulation. The overall program adopted modular approach, and each module has a special function. The idea which makes the program more clear, is advantageous to the optimization of code logic and modification.
本设计是根据广大骑行者的要求设计的,多功能自行车电脑具有测速、显示、计时、照明、蜂鸣器报警等功能,能够满足骑行爱好者的要求。本设计是基于STC89C52单片机的最小系统,利用霍尔传感器接收自行车车轮的转速数据,然后将接收到的数据传输到单片机中。经过单片机的计算和处理,通过LED显示屏显示自行车的瞬时速度、行驶里程、骑行时间等数据。软件部分使用C语言编写,通过Keil和STC-ISP进行编译和下载。本设计使用Proteus进行电路图绘制和系统仿真。整个程序采用模块化的方式,每个模块都有一个特殊的功能。这种思路使程序更加清晰,有利于代码逻辑的优化和修改。
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引用次数: 0
Functional State Hardware Evaluation System in Educational Medium 教育媒体功能状态硬件评价系统
Pub Date : 2022-01-31 DOI: 10.14302/issn.2766-8681.jcsr-21-3762
Evgeny Moos, Elena V. Moos
Diagnosis of heart rate variability as an indicator of the impact of external and internal media can serve to make changes in the educational environment. The approach to the organization of the educational process is developed on the basis of quantitative indicators of the students’ functional state using the hardware-software complex " Varikard ".
心率变异性的诊断作为外部和内部媒体影响的一个指标,可以帮助改变教育环境。组织教育过程的方法是在学生功能状态的定量指标的基础上,利用硬件-软件复合体“Varikard”开发的。
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引用次数: 1
Utility of biomarkers in predicting the severity and mortality of coronavirus disease 2019 infection: A retrospective observational study 生物标志物在预测2019冠状病毒感染严重程度和死亡率中的应用:一项回顾性观察性研究
Pub Date : 2022-01-01 DOI: 10.4103/jcrsm.jcrsm_72_21
Sapna S Deshpande, Namrata B Mestri, M. Halgale, Pradnya M Chimankar
Context: The clinical course of Coronavirus Disease 2019 (COVID-19) infection is variable and subjective. Hence, there is a dire need for objective interpretation of severity. The utilization of biomarkers categorizes these patients into nonsevere, severe, or critical categories. Aim: This study aims to assess the role of different biomarkers in predicting the severity and mortality of COVID 19. Materials and Methods: Case records of 247 patients of a designated COVID center in Kolhapur, Maharashtra, India, were included in this observational study. Biomarkers such as total leukocyte count, C-reactive protein, lactate dehydrogenase, D-Dimer, interleukin-6 (IL-6), procalcitonin, and serum ferritin were studied in different categories of severity of the disease. Results: The median serum ferritin levels among nonsevere cases, severe, and critical cases were 187.95 ng/mL (interquartile range [IQR] = 93.05 ng/mL to 382.50 ng/mL), 230 ng/mL (156 ng/mL to 670 ng/mL), and 412.33 ng/mL (234 ng/mL to 689 ng/mL), respectively and this difference was statistically significant (P < 0.001). The average values of IL-6 were significantly higher (P < 0.001) among the patients who died (19.12 pg/mL) when compared to those which were alive (3.74 pg/mL). Based on the receiver operating characteristic analysis, the interpretation of the severity of the disease was excellent through the evaluation of levels of serum ferritin (Area under curve = 0.755 [95% confidence interval = 0.635–0.875; P = 0.001]). Conclusions: Serum ferritin among the biomarker panel studied was the best test that predicted the severity of COVID-19 infection. The IL-6 levels were significantly higher among the patient who succumbed when compared to those who survived the disease.
背景:2019冠状病毒病(COVID-19)感染的临床过程是可变的、主观的。因此,迫切需要客观地解释严重性。利用生物标志物将这些患者分为非严重、严重或危急三类。目的:本研究旨在评估不同生物标志物在预测COVID - 19严重程度和死亡率中的作用。材料与方法:本观察性研究纳入印度马哈拉施特拉邦科尔哈布尔指定的COVID中心的247例患者的病例记录。生物标志物如白细胞总数、c反应蛋白、乳酸脱氢酶、d -二聚体、白细胞介素-6 (IL-6)、降钙素原和血清铁蛋白在不同疾病严重程度的分类中进行了研究。结果:非重症、重症、危重症患者血清铁蛋白水平中位数分别为187.95 ng/mL(四分位数范围[IQR] = 93.05 ng/mL ~ 382.50 ng/mL)、230 ng/mL (156 ng/mL ~ 670 ng/mL)、412.33 ng/mL (234 ng/mL ~ 689 ng/mL),差异有统计学意义(P < 0.001)。死亡组患者IL-6的平均值(19.12 pg/mL)明显高于存活组(3.74 pg/mL) (P < 0.001)。基于受试者工作特征分析,通过评价血清铁蛋白水平对疾病严重程度的解释非常好(曲线下面积= 0.755[95%可信区间= 0.635-0.875;P = 0.001])。结论:血清铁蛋白是预测COVID-19感染严重程度的最佳指标。死亡患者的IL-6水平明显高于存活患者。
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引用次数: 0
Pedestrian fatality: Price paid for zero individual travel carbon footprint!! 行人死亡:为零个人出行碳足迹付出的代价!!
Pub Date : 2022-01-01 DOI: 10.4103/2455-3069.350137
A. Radjou, Muthandavn Uthrapathy, S. Sevel, G. Sriramulu
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引用次数: 0
A comparative study of students' perception of flipped classroom teaching and traditional classroom teaching among final-year medical students 医学生对翻转课堂教学与传统课堂教学认知的比较研究
Pub Date : 2022-01-01 DOI: 10.4103/jcrsm.jcrsm_69_21
Kavitha Balasubramanian, Vinoth Kumar Sethuraman, Balasubramanian Ramachandran
Introduction: Recently, flipped classrooms (FCs) have emerged as a new pedagogical method in which students are given study resource material to develop a basic understanding of the topic before class, and in-class precious time is used for learner-centric activities. Accordingly, the study objective was to determine the student's perception of flipped and traditional teaching methods. Materials and Methods: In this analytical cross-sectional study, students attending medicine clinics were divided into two groups of roughly forty students each. One group received FC teaching and the other traditional lecture on hypo- and hyperthyroidism topics. A structured questionnaire on students' perception of FC teaching and traditional teaching technique was used for both groups. Different parameters related to the learning process about hypothyroidism and hyperthyroidism were considered as primary outcome variables. Coguide software was used for statistical analysis. Results: The students' age range was between 21 and 23 years. The majority were males (>55%). Among the students who attended FCs, the majority (>60%) agreed to follow the same method in future. Majority (>75%) of the students agreed that the reading materials were useful. Overall, a positive perception was observed in the FCs compared to that of the traditional classroom method. Conclusion: FC compared with traditional teaching methods had a good response from the medical students. Students' perception of FC method was positive.
近年来,翻转课堂(FCs)作为一种新的教学方法出现了,在这种教学方法中,学生在课前获得学习资源材料,以发展对主题的基本理解,并利用课堂上的宝贵时间进行以学习者为中心的活动。因此,研究的目的是确定学生对翻转和传统教学方法的看法。材料与方法:在本分析性横断面研究中,在医学诊所就诊的学生被分为两组,每组约40名学生。一组接受FC教学,另一组接受甲状腺功能减退和甲状腺功能亢进的传统讲座。两组采用结构化问卷调查学生对FC教学和传统教学技术的看法。与甲状腺功能减退和甲状腺功能亢进学习过程相关的不同参数被视为主要结局变量。采用Coguide软件进行统计分析。结果:学生年龄在21 ~ 23岁之间。大多数是男性(>55%)。在参加fc的学生中,大多数(>60%)同意在未来采用相同的方法。大多数学生(>75%)认为阅读材料是有用的。总体而言,与传统课堂方法相比,在FCs中观察到积极的看法。结论:与传统教学方法相比,FC教学方法在医学生中的反响较好。学生对FC方法的认知是积极的。
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引用次数: 0
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Journal of Current Research in Scientific Medicine
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