Pub Date : 2021-03-31DOI: 10.25284/2519-2078.1(94).2021.230608
D. Surkov, O. Kapustina
Objective. To investigate the structure, antenatal and intranatal risk factors and results of treatment of neonatal sepsis.Materials and methods. This study used analysis of 137 case histories of newborns from 2015 to 2019. We evaluated maternal risk factors, intrapartum asphyxia, duration of treatment, number of days on mechanical ventilation, the presence of sepsis, necrotic enterocolitis, mortality.Results and discussion. Most children were over 2500 g (69.3%). In infants with a birth weight lower than 1500 g were 10.9%. 70.8% of newborns received in the first 24 hours after birth. From the moment of admission to the department, among all infected children was 71%, mortality was 14%. In children under 29 weeks of gestation, the risk of developing sepsis is 17.2 times higher. (р˂0.001) In children under 1 kg of weight, the risk of manifestation of sepsis is 42.2 times higher. (р˂0.001)The maternal colonization have the risk of developing a child’s infection is 4.36 times higher. (р˂0.001)With a diagnosis of sepsis most infants were more than 2.5 kg and mortality remained significantly high 31.6-36.8% in all weight groups (0.00001), depending on birth weight.The majority of the applicants were children over 37 weeks, but mortality was significantly higher in the group from 29-37 weeks (0.00001), depending on the term of gestation.Among the studied mothers, up to 53% were maternal colonization and in this group the mortality of children was significantly higher than 23% (p=0.020).However, in the group of children where there were signs of ascending infection of the placenta (there were 25%) mortality was still significantly higher by 1.4 times, 32% (p=0,008).Conclusions. The risk of developing neonatal sepsis was increased in ascending infection (clinical chorioamnionitis) in 6.65 times, (р˂0.001), the presence of a coagulase-negative culture by 5.83 (р˂0.011) and invasive respiratory therapy by 18.52 times. (р˂0.002) Mortality rates are affected by gestational age OR=13.81 (р˂0.001), birth weight 1-1.5 kg OR=13.15 (р˂0.001), 1.5-2.5 kg OR=2.86 (р=0.043), maternal factors (vaginal colonization, ascending infection) OR=3,22 (р˂0.023), infection of placental membranes OR=4,32 (р˂0.008), the presence of sepsis OR=15,56 (р˂0.001), necrotic enterocolitis OR=8,06 (р˂0.001) and CoNS OR=4,98 (р˂0.033).
目标。目的探讨新生儿脓毒症的结构、产前及产后危险因素及治疗效果。材料和方法。本研究分析了2015年至2019年137例新生儿的病史。我们评估了产妇的危险因素，分娩时窒息，治疗持续时间，机械通气天数，败血症的存在，坏死性小肠结肠炎，死亡率。结果和讨论。大多数儿童超过2500克(69.3%)。在出生体重低于1500克的婴儿中为10.9%。70.8%的新生儿在出生后24小时内接受治疗。从入院的那一刻起，在所有感染儿童中占71%，死亡率为14%。在妊娠29周以下的儿童中，患败血症的风险高出17.2倍。(r小于0.001)体重低于1公斤的儿童出现败血症的风险高出42.2倍。(r小于0.001)母体感染的风险是母体感染的4.36倍。根据出生体重的不同，诊断为败血症的婴儿大多数体重超过2.5 kg，死亡率仍然很高，在所有体重组中均为31.6-36.8%(0.00001)。大多数申请人是37周以上的儿童，但29-37周组的死亡率明显更高(0.00001)，具体取决于妊娠期。在被研究的母亲中，高达53%的母亲定植，在这一组中，儿童死亡率显著高于23% (p=0.020)。然而，在有上升胎盘感染迹象的患儿组(25%)，死亡率仍显著高于1.4倍，为32% (p=0,008)。上升感染(临床绒毛膜羊膜炎)发生新生儿败血症的风险增加了6.65倍(小于0.001)，凝固酶阴性培养增加了5.83倍(小于0.011)，有创呼吸治疗增加了18.52倍。死亡率受胎龄OR=13.81(小于0.001)、出生体重1-1.5 kg OR=13.15(小于0.001)、1.5-2.5 kg OR=2.86(小于0.043)、母体因素(阴道定菌、上升感染)OR=3,22(小于0.023)、胎盘膜感染OR=4,32(小于0.008)、脓毒症OR=15,56(小于0.001)、坏死性小肠结肠炎OR=8,06(小于0.001)和CoNS OR=4,98(小于0.033)的影响。
{"title":"MICROBIAL LANDSCAPE OF THE NEONATAL INTENSIVE CARE UNIT: A RETROSPECTIVE ANALYSIS","authors":"D. Surkov, O. Kapustina","doi":"10.25284/2519-2078.1(94).2021.230608","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230608","url":null,"abstract":"Objective. To investigate the structure, antenatal and intranatal risk factors and results of treatment of neonatal sepsis.Materials and methods. This study used analysis of 137 case histories of newborns from 2015 to 2019. We evaluated maternal risk factors, intrapartum asphyxia, duration of treatment, number of days on mechanical ventilation, the presence of sepsis, necrotic enterocolitis, mortality.Results and discussion. Most children were over 2500 g (69.3%). In infants with a birth weight lower than 1500 g were 10.9%. 70.8% of newborns received in the first 24 hours after birth. From the moment of admission to the department, among all infected children was 71%, mortality was 14%. In children under 29 weeks of gestation, the risk of developing sepsis is 17.2 times higher. (р˂0.001) In children under 1 kg of weight, the risk of manifestation of sepsis is 42.2 times higher. (р˂0.001)The maternal colonization have the risk of developing a child’s infection is 4.36 times higher. (р˂0.001)With a diagnosis of sepsis most infants were more than 2.5 kg and mortality remained significantly high 31.6-36.8% in all weight groups (0.00001), depending on birth weight.The majority of the applicants were children over 37 weeks, but mortality was significantly higher in the group from 29-37 weeks (0.00001), depending on the term of gestation.Among the studied mothers, up to 53% were maternal colonization and in this group the mortality of children was significantly higher than 23% (p=0.020).However, in the group of children where there were signs of ascending infection of the placenta (there were 25%) mortality was still significantly higher by 1.4 times, 32% (p=0,008).Conclusions. The risk of developing neonatal sepsis was increased in ascending infection (clinical chorioamnionitis) in 6.65 times, (р˂0.001), the presence of a coagulase-negative culture by 5.83 (р˂0.011) and invasive respiratory therapy by 18.52 times. (р˂0.002) Mortality rates are affected by gestational age OR=13.81 (р˂0.001), birth weight 1-1.5 kg OR=13.15 (р˂0.001), 1.5-2.5 kg OR=2.86 (р=0.043), maternal factors (vaginal colonization, ascending infection) OR=3,22 (р˂0.023), infection of placental membranes OR=4,32 (р˂0.008), the presence of sepsis OR=15,56 (р˂0.001), necrotic enterocolitis OR=8,06 (р˂0.001) and CoNS OR=4,98 (р˂0.033).","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"10 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89078085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-28DOI: 10.35975/APIC.V25I2.1477
A. Siddiqui, Usman Bashir
Assessment and management of patients with chronic pain is a challenging task due to its complex multidimensional nature and biopsychosocial impact. It requires a collaborative effort by an interdisciplinary team. Evidence showed that in low and middle-income countries (LMICs), 33% patients among general adult population, and 56% of general elderly population, suffer from chronic painful conditions. Women are more likely to report chronic pain than men. In this narrative review, we attempted to search published literature to know the status of assessment and management of patients with chronic pain in low resource countries and to know the most appropriate chronic pain management strategies used in developed countries. We used broad electronic database (January 2010- December 2020) through common search engines. Lack of trained pain physicians and staffs, lack of interest, empathy and lack of integrated multidisciplinary approach are some of the barriers to achieve teamwork in chronic pain management. Authors strongly recommend the need of further research in this area, improvement in training programs for physicians and nursing staff for proper pain assessment and management of patients with chronic pain in low resource countries. Key words: Chronic pain management; Teamwork; Low resource; Multidisciplinary team; Interdisciplinary approach; Low and middle-income countries Citation: Siddiqui AS, Usman B. Teamwork in chronic pain management and the way forward in low and middle-income countries. Anaesth pain intensive care 2021;25(2):229-235. DOI: 10.35975/apic.v25i2.1477 Received: 18 January 2021, Reviewed: 20 January, 10 February 2021, Accepted: 9 March 2021
{"title":"Teamwork in chronic pain management and the way forward in low and middle-income countries","authors":"A. Siddiqui, Usman Bashir","doi":"10.35975/APIC.V25I2.1477","DOIUrl":"https://doi.org/10.35975/APIC.V25I2.1477","url":null,"abstract":"Assessment and management of patients with chronic pain is a challenging task due to its complex multidimensional nature and biopsychosocial impact. It requires a collaborative effort by an interdisciplinary team. Evidence showed that in low and middle-income countries (LMICs), 33% patients among general adult population, and 56% of general elderly population, suffer from chronic painful conditions. Women are more likely to report chronic pain than men. In this narrative review, we attempted to search published literature to know the status of assessment and management of patients with chronic pain in low resource countries and to know the most appropriate chronic pain management strategies used in developed countries. We used broad electronic database (January 2010- December 2020) through common search engines. \u0000Lack of trained pain physicians and staffs, lack of interest, empathy and lack of integrated multidisciplinary approach are some of the barriers to achieve teamwork in chronic pain management. Authors strongly recommend the need of further research in this area, improvement in training programs for physicians and nursing staff for proper pain assessment and management of patients with chronic pain in low resource countries. \u0000Key words: Chronic pain management; Teamwork; Low resource; Multidisciplinary team; Interdisciplinary approach; Low and middle-income countries \u0000Citation: Siddiqui AS, Usman B. Teamwork in chronic pain management and the way forward in low and middle-income countries. Anaesth pain intensive care 2021;25(2):229-235. DOI: 10.35975/apic.v25i2.1477 \u0000Received: 18 January 2021, Reviewed: 20 January, 10 February 2021, Accepted: 9 March 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47378760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-03DOI: 10.35975/APIC.V25I1.1433
Mohammad Amin Younesieh Heravi, A. Gazerani, M. Yaghubi, Zakiehe A. Amini, P. Salimi, Zahra Z. Falahi
Background: Coronary angiography is gold standard method to diagnose coronary arteries diseases. The aim of this study was to estimate pain after coronary angiography based on vital signs for determining best position by using artificial neural networks ANN. Methodology: This study used a database containing 86 subjects that refer to angiography center. For each subject Vital signs were measured that included blood pressure, percent of blood oxygen saturation, heart rate, respiratory rate and temperature. The Numeric Rating scale (NRS) was used to determine pain intensity. The vital signs were the inputs and the pain value was the corresponding output. These data were applied to train the ANN in the learning process. The model was implemented in MATLAB software. The results of pain estimation were compared with the results of NRS method and the error rate was calculated. Results: The absolute error and error percentage between NRS method and the present method were 5.41 ± 2.63 mmHg, 4.09 ± 1.59%. The results indicated that the pain measurement by NRS method and pain value predicted with trained ANN differ by only less than 11%. It is obvious that the neural network prediction fit properly to the NRS results. Conclusion: The results of proposed method were closely in agreement with the results of the NRS. so this method can be suggested for reliving the pain and determining the best patient's position after the angiography procedure. Key words: Artificial neural network; Coronary angiography; Pain Citation: Heravi MAY, Yaghubi MS, Amini ZA, Salimi PS, Falahi ZZ, Gazerani AG. Pain estimation after coronary angiography based on vital signs by using artificial neural networks. Anaesth. pain intensive care 2021;25(1):27–32. DOI: 10.35975/apic.v25i1.1433 Received: 21 November 2020, Reviewed: 2 December 2020, Accepted: 12 December 2020
{"title":"Pain estimation after coronary angiography based on vital signs by using artificial neural networks","authors":"Mohammad Amin Younesieh Heravi, A. Gazerani, M. Yaghubi, Zakiehe A. Amini, P. Salimi, Zahra Z. Falahi","doi":"10.35975/APIC.V25I1.1433","DOIUrl":"https://doi.org/10.35975/APIC.V25I1.1433","url":null,"abstract":"Background: Coronary angiography is gold standard method to diagnose coronary arteries diseases. The aim of this study was to estimate pain after coronary angiography based on vital signs for determining best position by using artificial neural networks ANN. \u0000Methodology: This study used a database containing 86 subjects that refer to angiography center. For each subject Vital signs were measured that included blood pressure, percent of blood oxygen saturation, heart rate, respiratory rate and temperature. The Numeric Rating scale (NRS) was used to determine pain intensity. The vital signs were the inputs and the pain value was the corresponding output. These data were applied to train the ANN in the learning process. The model was implemented in MATLAB software. The results of pain estimation were compared with the results of NRS method and the error rate was calculated. \u0000Results: The absolute error and error percentage between NRS method and the present method were 5.41 ± 2.63 mmHg, 4.09 ± 1.59%. The results indicated that the pain measurement by NRS method and pain value predicted with trained ANN differ by only less than 11%. It is obvious that the neural network prediction fit properly to the NRS results. \u0000Conclusion: The results of proposed method were closely in agreement with the results of the NRS. so this method can be suggested for reliving the pain and determining the best patient's position after the angiography procedure. \u0000Key words: Artificial neural network; Coronary angiography; Pain \u0000Citation: Heravi MAY, Yaghubi MS, Amini ZA, Salimi PS, Falahi ZZ, Gazerani AG. Pain estimation after coronary angiography based on vital signs by using artificial neural networks. Anaesth. pain intensive care 2021;25(1):27–32. \u0000DOI: 10.35975/apic.v25i1.1433 \u0000Received: 21 November 2020, Reviewed: 2 December 2020, Accepted: 12 December 2020","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43595715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-26DOI: 10.35975/APIC.V25I1.1444
H. MahmoodSyed, Amara Nasir
Introduction: New digital health technologies provide accessible adjuncts to alleviating pain in the general population. The advent novel digital pain interventions have resulted in a rapidly evolving learning environment. Improving knowledge and understanding of these digital patient-centric approaches to treating pain is vital for our current practitioners and new cadre of trainees. The objective of this manuscript is to initiate a discussion about digital pain intervention educational needs of residents as well as attendings in PM&R, anesthesia and neurology. Methodology: After reviewing Accreditation Council Graduate Medical Education (ACGME) and relevant American Board of Medical Specialties policies and best available evidence, including grey literature, we interviewed a group of practicing physicians in physiatry, anesthesiology and neurology, including program directors, to provide expert opinion, guidance and formulate recommendations on educational requirements, research endeavors, and learning techniques and opportunities in utilizing digital health interventions for management of pain. IRB approval was not required. Conclusions: We hope that this manuscript will serve as the basis of designing a comprehensive educational program and outlining opportunities for research that prioritizes optimal care for pain patients and leverages the unique and complementary knowledge base within our fields. Key words: Digital pain; Physiatry; anesthesiology; Neurology; Competency; Accreditation Council Graduate Medical education Citation: Nasir A, Mahmood SH. Optimizing training programs and opportunities for professional development in the era of digital pain interventions: A unique opportunity for collaboration. Anaesth. pain intensive care 2021;25(1): 76–80. D0I: 10.35975/apic.v25i1.1444 Received: 24 October 2020; Reviewed: 22 November 2020; Accepted: 5 December 2020
{"title":"Optimizing training programs and opportunities for professional development in the era of digital pain interventions: A unique opportunity for collaboration","authors":"H. MahmoodSyed, Amara Nasir","doi":"10.35975/APIC.V25I1.1444","DOIUrl":"https://doi.org/10.35975/APIC.V25I1.1444","url":null,"abstract":"Introduction: New digital health technologies provide accessible adjuncts to alleviating pain in the general population. The advent novel digital pain interventions have resulted in a rapidly evolving learning environment. Improving knowledge and understanding of these digital patient-centric approaches to treating pain is vital for our current practitioners and new cadre of trainees. The objective of this manuscript is to initiate a discussion about digital pain intervention educational needs of residents as well as attendings in PM&R, anesthesia and neurology. \u0000Methodology: After reviewing Accreditation Council Graduate Medical Education (ACGME) and relevant American Board of Medical Specialties policies and best available evidence, including grey literature, we interviewed a group of practicing physicians in physiatry, anesthesiology and neurology, including program directors, to provide expert opinion, guidance and formulate recommendations on educational requirements, research endeavors, and learning techniques and opportunities in utilizing digital health interventions for management of pain. IRB approval was not required. \u0000Conclusions: We hope that this manuscript will serve as the basis of designing a comprehensive educational program and outlining opportunities for research that prioritizes optimal care for pain patients and leverages the unique and complementary knowledge base within our fields. \u0000Key words: Digital pain; Physiatry; anesthesiology; Neurology; Competency; Accreditation Council Graduate Medical education \u0000Citation: Nasir A, Mahmood SH. Optimizing training programs and opportunities for professional development in the era of digital pain interventions: A unique opportunity for collaboration. Anaesth. pain intensive care 2021;25(1): 76–80. \u0000D0I: 10.35975/apic.v25i1.1444 \u0000Received: 24 October 2020; Reviewed: 22 November 2020; Accepted: 5 December 2020","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41919150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-24DOI: 10.35975/APIC.V25I1.1440
M. Shoghi, M. Ahmadi, Mahboubeh Rasouli
Introduction: Arterial blood sampling is a painful procedure, and is frequently performed in PICUs. Listening to mother's voice may be effective in reducing pain during arterial blood sampling in children. This study was aimed to determine the effect of mother’s recorded voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Methodology: This study was a single blind randomized clinical trial with crossover design. Fifty children hospitalized in PICUs participated in this study. The participants were selected through “sequential sampling” and randomly allocated into two groups; e.g., Group AB (n = 25) and Group BA (n = 25). Physiological parameters and pain in each child were measured before and during arterial blood sampling with (B) and without (A) listening to their mothers’ voices with a minimum of 24 hrs interval. To measure the pain, COMFORT pain scale was used and the physiological parameters were measured using the monitoring devices connected to the children. Data were analyzed with SPSS version 22, repeated measure test, paired and non-paired t-test, Wilcoxon and Mann-Whitney test. Results: Means of pain scores and physiologic parameters did not show a significant difference before the intervention on the first and second day between the two groups (AB-BA). The results showed the period effect (f = 0.581 and p = 0.89) and carry over effect (f = 0.055, p-value = 0.881) were not significant. Results of paired t-test showed that the mean pain score during arterial blood sampling with (B: 21.82 ± 5.53) and without (A: 22.40 ± 4.76) listening to their mothers’ voices was significantly different (p = 0.002). That is, with the mother’s voice, the children felt a lower level of pain. The SpO2 decline during the sampling was less with the mother’s voice. Additionally, the heart rate declined less during the sampling compared to the rate before the sampling with the mother’s voice; still, the difference was not significant (p > 0.05). Conclusion: Listening to mothers’ recorded voice was effective to alleviate pain during arterial blood sampling in children hospitalized in PICUs. The use of this method to reduce pain during this painful procedure is effective even in the absence of the mother. Key words: Pain; Mother’s voice; Arterial blood sampling; Physiological indices; PICU Citation: Shoghi M, Ahmadi M, Rasouli M. The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Anaesth. pain intensive care 2021;25(1):40-47.DOI: 10.35975/apic.v25i1.1440 Received: 20 June 2020, Reviewed: 16 September 2020, Accepted: 25 November 2020
动脉采血是一个痛苦的过程，经常在picu中进行。倾听母亲的声音可能有效地减轻儿童动脉采血时的疼痛。本研究旨在确定母亲录音对picu住院儿童动脉采血期间疼痛和生理参数的影响。方法:本研究为单盲随机临床试验，采用交叉设计。50名picu住院儿童参与了本研究。通过“序贯抽样”的方式选择参与者，随机分为两组;例如，AB组(n = 25)和BA组(n = 25)。在(B)和(A)不听母亲声音的情况下，每个孩子在动脉采血前和采血过程中测量生理参数和疼痛，间隔至少24小时。疼痛测量采用COMFORT疼痛量表，生理参数测量采用连接患儿的监测装置。数据分析采用SPSS 22、重复测量检验、配对和非配对t检验、Wilcoxon和Mann-Whitney检验。结果:两组患者干预前第1天、第2天的疼痛评分和生理参数平均值(AB-BA)无显著差异。结果显示，周期效应(f = 0.581, p = 0.89)和结转效应(f = 0.055, p值= 0.881)均不显著。配对t检验结果显示，倾听母亲声音组(B: 21.82±5.53)与未倾听母亲声音组(A: 22.40±4.76)动脉采血时平均疼痛评分差异有统计学意义(p = 0.002)。也就是说，当听到母亲的声音时，孩子们感受到的疼痛程度较低。在采样过程中，SpO2随母亲声音的下降幅度较小。此外，与母亲声音采样前相比，采样期间的心率下降幅度较小;但差异无统计学意义(p < 0.05)。结论:聆听母亲录音可有效减轻picu住院患儿动脉采血时的疼痛。在这个痛苦的过程中，使用这种方法来减轻疼痛，即使在母亲不在的情况下也是有效的。关键词:疼痛;母亲的声音;动脉采血;生理指标;引用本文:Shoghi M, Ahmadi M, Rasouli M.母亲声音对PICU住院儿童动脉采血过程中疼痛和生理参数的影响。Anaesth。疼痛重症监护2021;25(1):40-47。收稿日期:2020年6月20日，审稿日期:2020年9月16日，录用日期:2020年11月25日
{"title":"The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs","authors":"M. Shoghi, M. Ahmadi, Mahboubeh Rasouli","doi":"10.35975/APIC.V25I1.1440","DOIUrl":"https://doi.org/10.35975/APIC.V25I1.1440","url":null,"abstract":"Introduction: Arterial blood sampling is a painful procedure, and is frequently performed in PICUs. Listening to mother's voice may be effective in reducing pain during arterial blood sampling in children. This study was aimed to determine the effect of mother’s recorded voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. \u0000Methodology: This study was a single blind randomized clinical trial with crossover design. Fifty children hospitalized in PICUs participated in this study. The participants were selected through “sequential sampling” and randomly allocated into two groups; e.g., Group AB (n = 25) and Group BA (n = 25). Physiological parameters and pain in each child were measured before and during arterial blood sampling with (B) and without (A) listening to their mothers’ voices with a minimum of 24 hrs interval. To measure the pain, COMFORT pain scale was used and the physiological parameters were measured using the monitoring devices connected to the children. Data were analyzed with SPSS version 22, repeated measure test, paired and non-paired t-test, Wilcoxon and Mann-Whitney test. \u0000Results: Means of pain scores and physiologic parameters did not show a significant difference before the intervention on the first and second day between the two groups (AB-BA). The results showed the period effect (f = 0.581 and p = 0.89) and carry over effect (f = 0.055, p-value = 0.881) were not significant. Results of paired t-test showed that the mean pain score during arterial blood sampling with (B: 21.82 ± 5.53) and without (A: 22.40 ± 4.76) listening to their mothers’ voices was significantly different (p = 0.002). That is, with the mother’s voice, the children felt a lower level of pain. The SpO2 decline during the sampling was less with the mother’s voice. Additionally, the heart rate declined less during the sampling compared to the rate before the sampling with the mother’s voice; still, the difference was not significant (p > 0.05). \u0000Conclusion: Listening to mothers’ recorded voice was effective to alleviate pain during arterial blood sampling in children hospitalized in PICUs. The use of this method to reduce pain during this painful procedure is effective even in the absence of the mother. \u0000Key words: Pain; Mother’s voice; Arterial blood sampling; Physiological indices; PICU \u0000Citation: Shoghi M, Ahmadi M, Rasouli M. The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Anaesth. pain intensive care 2021;25(1):40-47.DOI: 10.35975/apic.v25i1.1440 \u0000 Received: 20 June 2020, Reviewed: 16 September 2020, Accepted: 25 November 2020","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45193917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35975/apic.v25i5.1651
Y. Morimoto
COVID-19 has engulfed the continents into a pandemic, filling the hospitals with this viral disease, heavily taxing the healthcare facilities and claiming thousands of lives in almost every country. In the absence of a known evidence based remedy, many treatment options have been tried with variable results. Multiple vaccines have been developed by the drug industry, but none can be claimed to be 100% effective in prevention of the disease. There has been some evidence about the beneficial effects of ivermectin - an anthelmintic drug. This editorial discusses the various aspects of the use of ivermectin for the treatment of active COVID-19.
{"title":"Ivermectin for COVID-19;to use or not to use?","authors":"Y. Morimoto","doi":"10.35975/apic.v25i5.1651","DOIUrl":"https://doi.org/10.35975/apic.v25i5.1651","url":null,"abstract":"COVID-19 has engulfed the continents into a pandemic, filling the hospitals with this viral disease, heavily taxing the healthcare facilities and claiming thousands of lives in almost every country. In the absence of a known evidence based remedy, many treatment options have been tried with variable results. Multiple vaccines have been developed by the drug industry, but none can be claimed to be 100% effective in prevention of the disease. There has been some evidence about the beneficial effects of ivermectin - an anthelmintic drug. This editorial discusses the various aspects of the use of ivermectin for the treatment of active COVID-19.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"46 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76373537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35975/apic.v25i4.1567
Olayinka Rasheed Ibrahim, T. Oloyede, H. Gbadamosi, Y. Musa, R. Aliu, S. Bello, M. Alao, B. Suleiman, O. Adedoyin
Background & objective: Despite available data from developed countries, suggesting a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19), there is scarce data from African countries, including Nigeria. We conducted this study to determine and document the incidence, the associated factors and the outcome (in-hospital mortality) of AKI among COVID-19 patients managed in a center in Nigeria. Methodology: It was a retrospective review of confirmed COVID-19 cases managed at a center in Nigeria. AKI was defined using 2012 Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. We extracted relevant data from the electronic records of the COVID-19 patients admitted to our hospital and analyzed. Fischer's exact tests were used to test factors associated with AKI for discrete variables, Mann-Whitney U test was used for skewed continuous data, and T-test for continuous normal distribution variables. Results: This study involved 41 of the 56 confirmed COVID-19 cases. The mean age was 45 +/- 17.94 y. A majority of the patients were males (33;80.5%). AKI occurred in 6 (14.6%) of the patients. Of the 6 AKI;4 (66.7%) and 2 (33.3%) were in stages 1 and 3 respectively. One patient (16.7%) had had hemodialysis. Of the 6 with AKI, 3 died with a mortality rate of 50.0%. Factors associated with AKI included age above 45 years, body weakness, severe and critical COVID, urea > 10 mmol/l, and serum creatinine > 1.5 mg/dl. Only severe and critical disease was predictive of AKI (adjusted odds ratio 1.777, 95% CI 1.028, 3.074). Conclusion: The results of our study show that AKI is common in severe and critical COVID-19 and is associated with a poor outcome.
背景与目的:尽管来自发达国家的现有数据表明，2019年冠状病毒病(COVID-19)中急性肾损伤(AKI)的发生率很高，但来自包括尼日利亚在内的非洲国家的数据很少。我们进行了这项研究，以确定和记录尼日利亚一家中心管理的COVID-19患者的AKI发病率、相关因素和结果(院内死亡率)。方法:对尼日利亚一个中心管理的COVID-19确诊病例进行回顾性审查。AKI的定义采用2012肾脏疾病:改善全球预后(KDIGO)肌酐标准。我们从我院收治的COVID-19患者电子病历中提取相关数据进行分析。离散变量使用Fischer精确检验来检验与AKI相关的因素，偏态连续数据使用Mann-Whitney U检验，连续正态分布变量使用t检验。结果:本研究涉及56例新冠肺炎确诊病例中的41例。平均年龄45±17.94岁，男性居多(33;80.5%)。6例(14.6%)患者发生AKI。6例AKI患者中，分别有4例(66.7%)和2例(33.3%)处于1期和3期。1例患者(16.7%)曾做过血液透析。6例AKI患者中，3例死亡，死亡率为50.0%。与AKI相关的因素包括年龄大于45岁、身体虚弱、重症和危重型COVID、尿素> 10 mmol/l、血清肌酐> 1.5 mg/dl。只有重症和危重症可预测AKI(校正优势比1.777,95% CI 1.028, 3.074)。结论:我们的研究结果表明，AKI在重症和危重型COVID-19中很常见，并与不良预后相关。
{"title":"Acute kidney injury in COVID-19: A single-center experience in Nigeria","authors":"Olayinka Rasheed Ibrahim, T. Oloyede, H. Gbadamosi, Y. Musa, R. Aliu, S. Bello, M. Alao, B. Suleiman, O. Adedoyin","doi":"10.35975/apic.v25i4.1567","DOIUrl":"https://doi.org/10.35975/apic.v25i4.1567","url":null,"abstract":"Background & objective: Despite available data from developed countries, suggesting a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19), there is scarce data from African countries, including Nigeria. We conducted this study to determine and document the incidence, the associated factors and the outcome (in-hospital mortality) of AKI among COVID-19 patients managed in a center in Nigeria. Methodology: It was a retrospective review of confirmed COVID-19 cases managed at a center in Nigeria. AKI was defined using 2012 Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. We extracted relevant data from the electronic records of the COVID-19 patients admitted to our hospital and analyzed. Fischer's exact tests were used to test factors associated with AKI for discrete variables, Mann-Whitney U test was used for skewed continuous data, and T-test for continuous normal distribution variables. Results: This study involved 41 of the 56 confirmed COVID-19 cases. The mean age was 45 +/- 17.94 y. A majority of the patients were males (33;80.5%). AKI occurred in 6 (14.6%) of the patients. Of the 6 AKI;4 (66.7%) and 2 (33.3%) were in stages 1 and 3 respectively. One patient (16.7%) had had hemodialysis. Of the 6 with AKI, 3 died with a mortality rate of 50.0%. Factors associated with AKI included age above 45 years, body weakness, severe and critical COVID, urea > 10 mmol/l, and serum creatinine > 1.5 mg/dl. Only severe and critical disease was predictive of AKI (adjusted odds ratio 1.777, 95% CI 1.028, 3.074). Conclusion: The results of our study show that AKI is common in severe and critical COVID-19 and is associated with a poor outcome.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"26 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72520731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35975/apic.v25i4.1553
M. S. Islam, D. Bhowmick, M. Parveen, M. Kamal, A. Akhtaruzzaman
Background: Emergence of current pandemic caused by novel SARS-COV-2 has already caused over 963000 deaths. Case fatality rate (CFR) estimation helps understanding the disease severity and the lethality trend, high risk population and subsequently, optimization of quality healthcare facilities. Our observational study aimed to find out existing trends in treating the most vulnerable group with scarce medical resource allocation and to implement necessary support services to comply with the ensuing need for best possible outcomes in our ICU. Methodology: In this observational study, all COVID-19 diagnosed patients admitted in our ICU from July 4, 2020 to September 22, 2020, were enrolled. Data were obtained from the core ICU register of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Information accumulated on predesigned data sheets comprised of particulars of patients, co-morbidities, duration of ICU stay, mode of oxygenation, organ support and quick SOFA scores. Total deaths in ICU (in hospital or referred from outside of BSMMU) were recorded. Results: The results revealed that all patients were either very severe or critically sick with COVID-19 pneumonia at the time of ICU admission. Out of 174 patients, 46 (26.44%) were put on invasive ventilation and the rest received noninvasive ventilation in the form of NRM, high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP or BiPAP), CTEX CPAP and non-invasive ventilation (NIV) as appropriate. Male and female ratio was 74:26. Age of patients ranged between 19-95y. The median age of patients was 65 y (IQR: 57-70).Quick SOFA scores were more than 2 in 65.37% of patients. Regarding co-existing organ dysfunction 13.8% had 3 or more co-morbidities;while 74.1% had 2 and 9.8% had a single systemic illness along with COVID-19. Most common diseases encountered among 135 deceased were hypertension (64%), IHD (49%), diabetes mellitus (45%), bronchial asthma or COPD (32%), renal failure (either ARF or CRF) (20%). Overall CFR due to COVID-19 pneumonia associated with co-morbidities was 77.6%. Relatively higher CFR (82.6%) was evident harboring multi-organ dysfunction especially among COVID-19 patients aged 50y or more. Gender linked CFR were 81.4% and 66.7% in males and females respectively. Conclusion: High CFR demonstrates significant correlation with increasing age and co-morbidities and survival functions. Late presentation to the hospital and invasive mechanical ventilation also contributed to high CFR.
{"title":"Case fatality rate and survival functions of severe COVID-19 patients in intensive care unit of Bangabandhu Sheikh Mujib Medical University in Bangladesh: an observational study","authors":"M. S. Islam, D. Bhowmick, M. Parveen, M. Kamal, A. Akhtaruzzaman","doi":"10.35975/apic.v25i4.1553","DOIUrl":"https://doi.org/10.35975/apic.v25i4.1553","url":null,"abstract":"Background: Emergence of current pandemic caused by novel SARS-COV-2 has already caused over 963000 deaths. Case fatality rate (CFR) estimation helps understanding the disease severity and the lethality trend, high risk population and subsequently, optimization of quality healthcare facilities. Our observational study aimed to find out existing trends in treating the most vulnerable group with scarce medical resource allocation and to implement necessary support services to comply with the ensuing need for best possible outcomes in our ICU. Methodology: In this observational study, all COVID-19 diagnosed patients admitted in our ICU from July 4, 2020 to September 22, 2020, were enrolled. Data were obtained from the core ICU register of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Information accumulated on predesigned data sheets comprised of particulars of patients, co-morbidities, duration of ICU stay, mode of oxygenation, organ support and quick SOFA scores. Total deaths in ICU (in hospital or referred from outside of BSMMU) were recorded. Results: The results revealed that all patients were either very severe or critically sick with COVID-19 pneumonia at the time of ICU admission. Out of 174 patients, 46 (26.44%) were put on invasive ventilation and the rest received noninvasive ventilation in the form of NRM, high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP or BiPAP), CTEX CPAP and non-invasive ventilation (NIV) as appropriate. Male and female ratio was 74:26. Age of patients ranged between 19-95y. The median age of patients was 65 y (IQR: 57-70).Quick SOFA scores were more than 2 in 65.37% of patients. Regarding co-existing organ dysfunction 13.8% had 3 or more co-morbidities;while 74.1% had 2 and 9.8% had a single systemic illness along with COVID-19. Most common diseases encountered among 135 deceased were hypertension (64%), IHD (49%), diabetes mellitus (45%), bronchial asthma or COPD (32%), renal failure (either ARF or CRF) (20%). Overall CFR due to COVID-19 pneumonia associated with co-morbidities was 77.6%. Relatively higher CFR (82.6%) was evident harboring multi-organ dysfunction especially among COVID-19 patients aged 50y or more. Gender linked CFR were 81.4% and 66.7% in males and females respectively. Conclusion: High CFR demonstrates significant correlation with increasing age and co-morbidities and survival functions. Late presentation to the hospital and invasive mechanical ventilation also contributed to high CFR.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74393040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35975/apic.v25i5.1649
K. Shibli, S. Shibli
Anesthesia is an acute care specialty with a much wider scope in the current clinical practice. The addition of new clinical subspecialties puts additional pressure on already demanding workload with limited global anesthesia workforce. Doctors' burnout reports and currently exhausted doctors struggling with their clinical duties during COVID-19 pandemic are ample evidence of it. Due to COVID-19 crisis, a lot of subspecialty crossover care is provided by the anesthetists, and they have to work outside their normal clinical comfort zones. Anesthesiologists have been entrusted with the responsibilities of perioperative physicians in the last two decades. An anesthesiologist has to adopt several roles in a healthcare institution, including 'administrative', 'academic', 'clinical' and 'research' attributes. An ideal anesthesiologist is expected to have a fine blend of all of these traits, though the proportion of each will vary according to the work environment and the personal choices and preferences.
{"title":"Anesthesiologist as a perioperative physician, clinician, administrator, educator, and a researcher","authors":"K. Shibli, S. Shibli","doi":"10.35975/apic.v25i5.1649","DOIUrl":"https://doi.org/10.35975/apic.v25i5.1649","url":null,"abstract":"Anesthesia is an acute care specialty with a much wider scope in the current clinical practice. The addition of new clinical subspecialties puts additional pressure on already demanding workload with limited global anesthesia workforce. Doctors' burnout reports and currently exhausted doctors struggling with their clinical duties during COVID-19 pandemic are ample evidence of it. Due to COVID-19 crisis, a lot of subspecialty crossover care is provided by the anesthetists, and they have to work outside their normal clinical comfort zones. Anesthesiologists have been entrusted with the responsibilities of perioperative physicians in the last two decades. An anesthesiologist has to adopt several roles in a healthcare institution, including 'administrative', 'academic', 'clinical' and 'research' attributes. An ideal anesthesiologist is expected to have a fine blend of all of these traits, though the proportion of each will vary according to the work environment and the personal choices and preferences.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78611788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35975/apic.v25i4.1563
Faraz Mansoor
Y A pandemic is defined as an epidemic of an infectious etiology that crosses the international boundaries and infects a large number of people. This has happened several times in the human history;influenza, smallpox, bubonic plaque and cholera being some of the examples. Smallpox alone has resulted in death of 300-500 million people. As a frontline healthcare professional fighting against the COVID-19 pandemic, the author has experienced its socioeconomic and psychological consequences. In addition, critical care units faced ethical challenges to meet with the bed requirement. Dedicated and modified COVID-19 critical care services were started in both the public and private sectors. Because of high workload and lack of trained medical and nursing staff, extra staff ha to be recruited on temporary basis. Some commonly performed procedures were modified to decrease the risk of infection spread. ICUs faced shortage of personal protective equipment and ventilators. Training programs were developed to help improve the understanding of novel COVID-19 infection. ICU staff was probably at lower risk of acquiring this infection as compared to other hospital staff.
Y .大流行的定义是一种具有传染性的流行病，它跨越了国际边界，感染了大量的人。这种情况在人类历史上发生过几次，流感、天花、淋巴腺斑块和霍乱就是其中的一些例子。光是天花就造成3 -5亿人死亡。作为抗击新冠肺炎疫情的一线医护人员，笔者亲身经历了疫情带来的社会经济和心理后果。此外，重症监护病房在满足床位需求方面面临道德挑战。在公共和私营部门都启动了专门和改进的COVID-19重症监护服务。由于工作量大，缺乏训练有素的医务和护理人员，必须临时征聘额外的工作人员。一些常用的手术被修改以降低感染传播的风险。重症监护室面临个人防护装备和呼吸机短缺的问题。制定了培训计划，以帮助提高对新型COVID-19感染的了解。与其他医院工作人员相比，ICU工作人员获得这种感染的风险可能较低。
{"title":"The impact of corona pandemic on critical care medicine","authors":"Faraz Mansoor","doi":"10.35975/apic.v25i4.1563","DOIUrl":"https://doi.org/10.35975/apic.v25i4.1563","url":null,"abstract":"Y A pandemic is defined as an epidemic of an infectious etiology that crosses the international boundaries and infects a large number of people. This has happened several times in the human history;influenza, smallpox, bubonic plaque and cholera being some of the examples. Smallpox alone has resulted in death of 300-500 million people. As a frontline healthcare professional fighting against the COVID-19 pandemic, the author has experienced its socioeconomic and psychological consequences. In addition, critical care units faced ethical challenges to meet with the bed requirement. Dedicated and modified COVID-19 critical care services were started in both the public and private sectors. Because of high workload and lack of trained medical and nursing staff, extra staff ha to be recruited on temporary basis. Some commonly performed procedures were modified to decrease the risk of infection spread. ICUs faced shortage of personal protective equipment and ventilators. Training programs were developed to help improve the understanding of novel COVID-19 infection. ICU staff was probably at lower risk of acquiring this infection as compared to other hospital staff.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82892798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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