Background: Severe dengue is associated with significant challenges, with high morbidity and mortality rates globally, including in Malaysia. This study aimed to determine the risk and prognostic factors associated with severe dengue in adult patients admitted to the intensive care unit (ICU). Methodology: This retrospective cross-sectional study included 129 adult patients with laboratory-confirmed dengue fever who were admitted to the intensive care unit (ICU) between January 2014 and December 2015. The patients were categorized into two groups: the severe dengue group and the non-severe dengue group. Medical records of all enrolled patients were reviewed to collect data on demographic characteristics, clinical manifestations, laboratory results, treatments administered, ICU-related complications, and clinical outcomes. Results: Among the factors analyzed, seven variables demonstrated a significant association with dengue severity in univariable analysis: platelet count (P = 0.020), AST (P = 0.006), ALT (P = 0.009), ALP (P = 0.006), urea (P = 0.031), creatinine (P = 0.002), and INR (P = 0.05). However, in the multivariable analysis, only two variables remained independently significant: aspartate aminotransferase (AST) (P = 0.021) and creatinine (P = 0.019). Regarding poor outcomes in dengue fever, seven variables were significantly associated at the univariable level: SOFA score (P < 0.001), SAPS II score (P < 0.001), pulmonary hemorrhage (P = 0.016), liver dysfunction (P < 0.003), acute kidney injury (P < 0.001), gastrointestinal bleeding (P < 0.001), and altered mental status (P = 0.011). After multivariable adjustment, only the SOFA score remained a significant predictor (P < 0.001). Conclusion: Elevated AST and creatinine levels increase the risk of the development of severe dengue. Patient with higher SOFA scores was associated with poor dengue outcomes.
Objective: To compare pregabalin versus gabapentin as pre-emptive analgesic in patients undergoing orthopedic surgeries under spinal anesthesia. Methodology: This randomized controlled trial was conducted at the Anesthesia Department, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from July 2025 to December 2025. A total of 142 patients (71 per group), aged 20-60 years, ASA Ito II, undergoing lower limb orthopedic surgery under spinal anesthesia were randomly allocated to receive gabapentin 300 mg, or pregabalin 150 mg orally 1-hour before spinal anesthesia. Pain was assessed using VAS at predefined intervals, and tramadol was given for VAS >3. Data were analyzed in SPSS v26 using appropriate parametric or non-parametric tests, taking p<0.05 as significant. Results: In a total of 142 patients, 84 (59.2%) were male and 58 (40.8%) were female. The median age was 42.0 years (IQR 35.5 to 50.0), and above-knee procedures were performed in 84 (59.2%) patients. The baseline VAS was 2.10 +/- 0.95. The median duration of surgery was 80.6 minutes (IQR 65.5 to 100.9). Mean duration of postoperative analgesia was longer with pregabalin than gabapentin, 2.84 +/- 0.39 hours versus 2.26 +/- 0.32 hours (p<0.001). Mean VAS scores were lower with pregabalin at awakening, 1.18 +/- 0.99 versus 1.69 +/- 0.73 (P = 0.001), at 30 minutes, 1.44 +/- 0.97 versus 2.08 +/- 0.98 (p<0.001), at 6 hours, 3.89 +/- 1.26 versus 4.48 +/- 0.92 (P = 0.002), at 12 hours, 2.93 +/- 1.00 versus 3.32 +/- 1.12 (P = 0.030), and at 24 hours, 2.14 +/- 0.52 versus 2.48 +/- 0.86 (P = 0.005). Conclusion: Preoperative pregabalin was associated with longer postoperative analgesia and lower postoperative pain scores compared with gabapentin.
Purpose: The aim of this study is to compare the analgesic efficacy of quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block versus caudal block for postoperative analgesia after pediatric inguinal hernia repair. Methods: In a prospective, randomized, controlled study, 180 children of age 2-8 years and ASA grade I and II, scheduled for elective inguinal hernia surgery, were randomly allocated into 3 groups: Group Q (n = 60) patients received US-guided QL block with 1 mL/kg of 0.25% bupivacaine, Group T (n = 60) patients received US-guided TAP block with 1 mL/kg of 0.25% bupivacaine; and Group C (n = 60) patients received caudal block with 1 mL/kg of 0.25% bupivacaine. All the patients were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, duration of postoperative analgesia, variation in rescue analgesics and adverse effects, if any. Results: No significant differences were detected between group Q and group T (P = 0.1), while highly significant values were detected between group Q and group C, and group T and group C (P < 0.001), as regards to the time to first rescue analgesic requirement. The longest duration of postoperative analgesia was detected in group Q which showed statistically significant difference in comparison to the other two groups (P< 0.0 01). Number of patients who needed paracetamol as a first rescue analgesia in the first 24 hours was significantly lower in group Q as compared to the other two groups with (P < 0.001with 95% CI), while no significant difference was recorded between group T and group C (P < 0.205). The total paracetamol consumption in the first 24 hours was significantly lower in group Q (2.17 +/- 4.9) mg/kg as compared to group T (12 +/- 6.84 mg/kg) and group C (15.83 +/- 8.29 mg/kg) with (P < 0.001). Number of patients needed pethidine as a second rescue analgesia in the first 24 hours was significantly lower in group Q as compared to the other two groups. The total pethidine consumption in the first 24 hours, was significantly lower in group C as compared to group Q and group T (P < 0.001). Conclusion: The QL block provides more effective and sustained postoperative analgesia time in pediatric patients undergoing inguinal hernia repair surgery than TAP block and both are superior to caudal block.
Background & objective: Supraclavicular brachial plexus block (SCBPB) is a cornerstone for upper limb surgeries, providing adequate regional anaesthesia with minimal systemic involvement. Ultrasound guidance enhances its precision and safety. While ropivacaine is a commonly used local anaesthetic, its efficacy can be augmented with adjuvants such as dexmedetomidine and clonidine, which have shown promise in enhancing block characteristics. We compare the efficacy of dexmedetomidine and clonidine as adjuvants to 0.5% ropivacaine in ultrasound-guided SCBPB for elective upper limb surgeries. Methodology: In this prospective, randomized, double-masked study, 60 ASA I/II patients aged 18-60 were assigned to two groups (n = 30 each). Group RD received ropivacaine with dexmedetomidine (0.5 mcg/kg), and Group RC received ropivacaine with clonidine (0.5 mcg/kg). Parameters included onset and duration of sensory and motor block, time to first analgesia, VAS score, hemodynamic trends, and adverse effects. Results: Group RD exhibited significantly faster onset and longer sensory and motor block duration than Group RC (p < 0.05). Time to first rescue analgesia was significantly longer in Group RD (720.5 +/- 45.3 min) than in Group RC (580.2 +/- 38.6 min; p < 0.0001). VAS scores were consistently lower in Group RD at 2, 6, and 12 hours postoperatively. Hemodynamic parameters remained stable in both groups. The incidence of adverse effects was low and comparable between groups. Conclusion: Dexmedetomidine, as an adjuvant to ropivacaine in ultrasound-guided SCBPB, provides superior block characteristics and prolonged analgesia compared to clonidine, without compromising hemodynamic stability.
Background & objective: Regional spinal anesthesia is an anesthetic technique that has been implemented since the early 19th century. Its application extends to various surgical procedures as well as the management of non-operative acute pain. Over time, this technique has undergone significant advancements in terms of methodology, equipment, and pharmaceuticals used. The primary focus of all regional spinal anesthesia practices is to ensure effectiveness and efficiency in managing patients undergoing cesarean sections in Indonesia. Methodology: This study was categorized into four groups based on height and weight using the Enhanced Regional Anesthesia for Cesarean Section (ERACS) method (n = 21) and height and weight using the non-ERACS method (n = 79). Additionally, cases were evaluated without considering height and weight using the ERACS method (n = 16), and without height and weight using the non-ERACS method (n = 34). The assessment included the duration of analgesia and the impact or side effects of regional anesthesia. Results: Data collected during September-October 2025, showed that patients who used spinal regional anesthesia based on height and BMI with the ERACS method had better effectiveness than those who did not use height and BMI with ERACS or non-ERACS. Conclusion: The study results indicate that utilizing regional anesthesia based on height and BMI, particularly in ERACS patients, offers superior effectiveness and efficiency compared to patients who do not use height and BMI metrics, thereby reducing healthcare costs in Indonesia.
Background: Non-invasive biomarkers for endometriosis remain a clinical need. This study evaluated the diagnostic potential of serum CA-125 and MMP-9, individually and combined, alongside reproductive hormonal profiles in Iraqi women with endometriosis. Methods: A case-control study was conducted on 60 laparoscopically confirmed endometriosis patients and 60 healthy controls. Serum CA-125 and MMP-9 were measured by ELISA, and prolactin, FSH, and LH were assessed using Cobas e411. Diagnostic accuracy was evaluated by ROC curve analysis. Results: CA-125 (P = 0.012), MMP-9 (P = 0.015), prolactin (P = 0.0001), and FSH (P = 0.010) were significantly elevated in patients. Both markers increased with disease stage (P = 0.006 and P = 0.001, respectively). The combined CA-125/MMP-9 model yielded the highest AUC (0.716), with 65.0% sensitivity and 80.0% specificity. Conclusion: The combined CA-125/MMP-9 panel showed moderate diagnostic accuracy, suggesting potential as a supplementary non-invasive tool, though further validation in larger cohorts is needed.
Background: Ultrasound-guided regional anesthesia (UGRA) is increasingly used for upper limb surgery due to improved block success and patient-centered benefits. However, real-world data integrating block effectiveness, postoperative pain trajectory, patient satisfaction, and short-term safety remain limited in routine clinical settings. Methods: This cross-sectional observational study included 60 adult patients (ASA I-III) undergoing elective upper limb surgery under UGRA as the primary anesthetic technique. Ultrasound-guided brachial plexus blocks were performed using an approach selected according to surgical site. Block effectiveness was assessed intraoperatively by the need for supplementation or conversion to general anesthesia. Postoperative pain was measured using the Numerical Rating Scale (NRS) at 0, 2, 4, and 8 hours. Patient satisfaction was evaluated using a 5-point Likert scale at 4 and 8 hours. Adverse events were monitored for 8 postoperative hours. Data were analyzed descriptively. Results: Complete surgical anesthesia without supplementation was achieved in 55 patients (91.7%), with 4 patients (6.7%) requiring mild supplementation and 1 patient (1.6%) converted to general anesthesia, yielding an overall block success rate of 98.4%. Postoperative pain was predominantly mild in the early period; 85% of patients reported mild pain at 2 hours. Severe pain remained uncommon but increased modestly to 8.3% at 8 hours, consistent with block regression. Patient satisfaction was high across domains, particularly for anesthetist interaction (91.7%) and overall satisfaction (88.3%). No major UGRA-related complications were observed; minor injection-site discomfort occurred in 5% of patients. Conclusions: In routine clinical practice, UGRA for elective upper limb surgery demonstrated high intraoperative effectiveness, clinically acceptable postoperative analgesia, high patient satisfaction, and a favorable short-term safety profile. These findings support the continued use of UGRA as a primary anesthetic technique when expertise and ultrasound guidance are available.
Background: Pediatric patients are more susceptible to peri-anesthesia complications due to unique physiological characteristics. The present study assessed peri-anesthesia morbidity and its predictors at a national referral mother-and-child hospital in Indonesia. Methodology: A prospective observational cohort study (January to June 2024), enrolling children aged 0-15 years undergoing diagnostic or surgical procedures under general anesthesia. Standardized data on patient characteristics, anesthetic practices, critical events, and postoperative disposition were analyzed using descriptive and multivariate analysis. Results: Among the 825 patients, most were classified as low risk (ASA II, 79.2%) and underwent elective procedures (97.9%). Critical events were rare, including bronchospasm (0.1%), laryngospasm (0.4%), and cardiovascular instability (0.6%), with no reported cases of aspiration, anaphylaxis, medication errors, or cardiac arrest. The majority of patients (92%) were transferred to the ward, while 4.1% required admission to the pediatric intensive care unit (PICU). Emergency procedures and after-hours anesthesia were strongly associated with increased rates of post-anesthesia care unit (PACU) or PICU admissions, with odds ratios of 14.82 and 14.89, respectively. Independent predictors of morbidity included younger age, ASA III-IV status, chronic medication use, disability, emergency procedures, and after-hours anesthesia. Conclusion: Overall peri-anesthesia morbidity was low; however, vulnerable patient and off-hours or emergencies procedures carried significantly higher risk. Enhancing system preparedness and monitoring during high-risk conditions is essential to improve pediatric anesthesia safety.
Background & objective: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease. The chemokine CXCL1 and interleukin-34 (IL-34) are implicated in inflammatory and immune responses, but their combined role and genetic regulation in SLE remain unclear. This study aimed to investigate serum levels of CXCL1 and IL-34, and the association of IL-34 gene polymorphism (rs7193968) with these markers and disease parameters in SLE patients. Methodology: A case-control study was conducted on 50 SLE patients and 50 healthy controls. Serum levels of CXCL1 and IL-34 were measured by ELISA. Genotyping for the IL-34 rs7193968 G/C polymorphism was performed using PCR and sequencing. Statistical analyses included t-tests, chi-square tests, ROC analysis, and logistic regression. Results: Serum levels of CXCL1 (125.42 +/- 97.55 vs. 53.36 +/- 34.60 pg/mL, (P < 0.0001) and IL-34 (23.30 +/- 14.16 vs. 12.58 +/- 9.89 pg/mL, P < 0.0001) were significantly elevated in SLE patients. The GG genotype and G allele of rs7193968 were significantly more prevalent in patients (P = 0.0020) and correlated with elevated levels of CXCL1, ANA, and anti-dsDNA. ROC analysis demonstrated significant diagnostic capability for CXCL1 (AUC=0.85) and IL-34 (AUC=0.81). Multivariate regression analysis identified all three biomarkers as autonomous predictors of SLE. Conclusion: Elevated serum CXCL1 and IL-34 are significantly associated with SLE, and the IL-34 rs7193968 G allele is linked to increased disease susceptibility and severity. These molecules represent promising biomarkers and highlight a potential genetic-immunological axis in SLE pathogenesis.
Background & objective: Post-operative pain management is crucial for recovery and daily function. The transversus abdominis plane (TAP) block is a common regional anesthesia technique that effectively relieves abdominal wall pain. This study evaluates the effect of combining dexmedetomidine and bupivacaine in TAP blocks for pain control in abdominal surgery patients and the need for rescue analgesia. We assessed the effect of combining dexmedetomidine into bupivacaine in the TAP block on postoperative analgesia. Methodology: A randomized controlled trial was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, including 80 patients undergoing abdominal surgeries: exploratory laparotomy (20), ileostomy reversal (25), laparoscopic cholecystectomy (12), open cholecystectomy (10), and paraumbilical hernia mesh repair (13). Patients were randomized into Group A (20 mL of 0.25% bupivacaine with 0.25 mcg/kg dexmedetomidine) and Group B (20 mL of 0.25% bupivacaine alone). Ultrasound-guided TAP blocks were performed, and postoperative pain, hemodynamics, sedation, nausea, and rescue analgesia requirements were monitored. Results: Age and gender were comparable between groups, while BMI was significantly lower in Group A (P = 0.001). Group A showed better pain control on VAS at 6 hours (P = 0.002) and 12 hours (P = 0.025). Sedation levels and rescue analgesia use were similar in both groups; however, patient satisfaction was higher in Group A (70.1% vs. 37.4%, P = 0.003), with a lower incidence of hypertension (10.0% vs. 25.0%, P = 0.011). Group A exhibited elevated SpO2 values prior to TAP block injection (P = 0.048), although no significant differences were seen at subsequent time intervals. The incorporation of dexmedetomidine did not influence postoperative nausea or sedation. Conclusion: This study illustrates that the combination of dexmedetomidine and bupivacaine in TAP blocks yields improved analgesia and increased patient satisfaction relative to bupivacaine alone in individuals undergoing abdominal surgery.
Background: Lung cancer is a leading cause of cancer mortality, linked to anti-oxidant and oxidative stress and epithelial damage. Biomarkers like superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), and cytokeratin fragment 21-1 (CYFRA 21-1) may indicate tumor progression. Objective: To assess serum levels of oxidative stress markers (SOD, GPx, MDA) and CYFRA 21-1 in lung cancer patients versus controls used to monitoring and prognosis tool for the oxidative stress status. Methodology: This case-control study was carried out from November 2024 to April 2025 at Nassiriya Teaching Hospital in Thi-Qar, Iraq. Sixty patients with lung cancer and 60 age-matched controls were included in the study. Venous blood samples were obtained, and serum was separated and stored to determine the concentrations of SOD, Gpx, MDA and CYFRA 21-1 using enzyme-linked immunosorbent assay (ELISA). Results: There were no significant differences in age or BMI between the two groups. Lung cancer patients had significantly elevated levels of MDA (193.2 +/- 18.6 vs. 158.6 +/- 21.09 nmol/mL), SOD (90.15 +/- 34.9 vs. 42.07 +/- 13.78 ng/mL), GPx (65.4 +/- 29.4 vs. 9.98 +/- 5.6 & micro;U/mL), and CYFRA 21-1 (15.1 +/- 6.5 vs. 5.9 +/- 2.7 ng/mL) compared to controls (P < 0.001 for all). Oxidative stress markers and CYFRA 21-1 levels did not differ significantly among age subgroups in patients with lung cancer. Conclusions: This study highlights a significant elevation in oxidative stress markers and CYFRA 21-1 in patients with lung cancer, supporting their potential role as diagnostic and prognostic biomarkers. Monitoring these biomarkers may enhance early detection and management of lung cancer in clinical settings.
Rheumatologic diseases present very specific but often unnoticed complexities for anesthesiologists, pain management specialists and critical care providers. The varied systemic consequences of rheumatologic diseases, chronic inflammation, pain processing abnormalities and immunosuppression impact perioperative care, pain management and critical care outcome. Patients with rheumatoid arthritis, axial spondyloarthropathy, systemic lupus erythematosus, systemic vasculitis and systemic sclerosis possess a high risk of perioperative complications related to intricate airway, cardiopulmonary and infectious disease issues, as well as chronic pain. This editorial focuses on the interplay between rheumatology and anesthesia as an ever-evolving field, with particular regard to the importance of a multi-disciplinary approach to perioperative pain management and critical care outcome.
Background & objective: Despite an international effort lead by the World Health Organization (WHO) many cardiac centers still continue the practice of empirical blood product transfusion. Current guidelines and published evidence strongly support the use of transfusion algorithms that are guided by point-of-care coagulation testing. The aim of this study is to determine the proportion of patients with normal coagulation parameters who still received empirical blood products during cardiac surgery. Secondary end point is the occurrence of transfusion-related adverse events. Methodology: This is a retrospective observational study of 100 pediatric patients scheduled for cardiac surgery. As part of the rotational thromboelastometry (ROTEM) introduction to the operating theatre, two ROTEM samples were collected, before and after blood products. The empirical blood products practice continued as usual and did not change based on those ROTEM samples. Results: Among patients who received empirical blood products, 16% had normal fibrinogen levels (did not need Cryoprecipitates), 24% had normal clotting factors (did not need fresh frozen plasma) and 60% had normal platelets assessment. No significant adverse events attributable to blood products were observed. Conclusion A proportion of pediatric patients had normal coagulation parameters prior to the administration of empirical blood products. The study highlights the value of viscoelastic point-of-care testing to avoid unnecessary transfusion during cardiac surgery. It underscores the urgent need to transition institutional practice towards algorithm-based approach and appropriate use of blood components.
Immune checkpoint inhibitors have been termed a revolution in cancer treatment, with long-lasting benefits showing in a few cases, but recurrence and resistance are common. These constraints are seen to be associated with the tumor microenvironment (TME), which has been considered a complicated ecosystem that has an influence on immune activity in a suppressive manner. The phenomenon of escape from immunity has not been associated just with the presence of inhibitory receptors on Thymus-derived lymphocytes (T cells) but also with nutrient deprivation and stromal barriers, as well as the presence of suppressive immune cells. Provided that the receptor-ligand blockade continues to be taken as the sole solution, structural and functional obstacles in tumors can be neglected. In the case where the tumor microenvironment is viewed as the actual checkpoint, treatments can be guided towards more sustainable results.
Major surgery is frequently associated with significant blood loss, and allogeneic transfusion remains standard therapy. Jehovah's Witness patients may refuse blood products for religious reasons, creating major perioperative challenges. Acute normovolemic hemodilution (ANH) is a blood conservation strategy that may be acceptable to these patients when performed using a closed-circuit system. A 65-year-old woman with acute right lower-limb ischemia, initially classified as Rutherford grade IIA (marginally threatened limb), with rapid clinical progression requiring emergency above-knee amputation under general anesthesia. The patient, aJehovah's Witness, refused allogeneic blood transfusion. Preoperative hemoglobin was 9.7 g/dL with a hematocrit of 32.1%. After induction of general anesthesia and achievement of hemodynamic stability, acute normovolemic hemodilution was performed using a sterile closed-circuit system via a right internal jugular large-bore catheter. Atotal of 500 mL of whole blood (approximately 12% of estimated total blood volume) was withdrawn gradually with simultaneous colloid infusion to maintain normovolemia, and autologous blood was reinfused after surgical hemostasis. Surgery lasted 4 hours with an estimated blood loss of 1,000 mL. Intraoperative management included balanced general anesthesia, antifibrinolytic therapy, strict hemodynamic control, active warming, and reinfusion of autologous blood after surgical hemostasis. Hemodynamics and oxygenation remained stable throughout. Postoperative hemoglobin was 8.4 g/dL, and the patient remained hemodynamically stable without vasopressor support, with an uncomplicated clinical course. ANH reduces red blood cell loss while preserving oxygen delivery through physiologic compensatory mechanisms. In patients with cardiovascular risk factors, conservative hemodilution targets are recommended. This case highlighting the importance of meticulous anesthetic planning, a conservative and reproducible ANH protocol, objective outcome reporting, explicit adverse-event monitoring, and formal ischemia severity classification to define urgency and perioperative risk. Acute normovolemic hemodilution can be a feasible and safe blood conservation strategy in selected Jehovah's Witness patients undergoing high-risk surgery, provided it is carefully planned, performed using a closed-circuit system, and supported by meticulous anesthetic management and close perioperative monitoring.
Peroral endoscopic myotomy (POEM) is a novel technique that utilizes natural orifice transluminal endoscopy to address esophageal motility disorders. This method, which is performed under general anesthesia in an endoscopy suite, has shown effectiveness similar to that of Heller myotomy. A pivotal part of the POEM procedure involves the creation of a submucosal tunnel within the esophageal wall. However, the ongoing insufflation of CO? can inadvertently extend into nearby tissues, leading to Complications such as capnomediastinum, capnothorax, capnoperitoneum, and subcutaneous emphysema. An anesthesiologist faces several challenges, including administering anesthesia in remote locations, managing the heightened risk of aspiration during induction, and promptly identifying and addressing these complications with specific emergency measures. Consequently, the anesthesiologist on duty must be knowledgeable about these frequent complications and the necessary emergency responses, such as compensatory hyperventilation, percutaneous needle decompression, and thoracic drainage. While peroral endoscopic myotomy (POEM) is generally conducted under general anesthesia, there is a scarcity of reports that elaborate on its anesthetic management and associated complications.
Adhesive capsulitis, commonly known as frozen shoulder, is a progressive painful condition characterized by limited active and passive range of motion (ROM) in all planes ofglenohumeraljoint movement due to inflammation, fibrosis, and capsular contracture. Frozen shoulder is divided into 3 main phases: freezing, frozen, and thawing. Conventional management of frozen shoulder often yields suboptimal results. Severe pain intensity can hinder the patient's rehabilitation process, necessitating innovative analgesic methods. A 50-year-old male with a history of frozen shoulder phase adhesive capsulitis for one month, experiencing rest pain VAS 6/10 and active movement pain VAS 9/10, had received conventional therapy including intra-articular steroid injections and nerve blocks with PRF. The patient experienced severe pain during rehabilitation, so a Continuous Interscalene Brachial Plexus Block (CISB) guided by ultrasound, connected to patient controlled analgesia (PCA) as an analgesic modality, was performed. Rehabilitation continued with passive and active shoulder manipulation. CISB with PCA represents a valuable analgesic strategy in adhesive capsulitis, allowing early physiotherapy and functional recovery when conventional therapies fail.
Background & objective: Restless legs syndrome (RLS) is a common sensory and motor issue in patients on regular hemodialysis that contributes to sleep disturbances and impairs quality of life. This study aimed to find out whether vibration therapy improves RLS and related sleep quality in patients receiving hemodialysis. Methodology: This clinical randomized controlled trial included 70 patients undergoing hemodialysis equally distributed into a study (interventional) group (receiving vibration therapy) and a control group (receiving routine care only) using a block randomization technique. Arabic version of the Restless Legs Syndrome Rating Scale was used to assess the RLS severity, and the Brief Pittsburgh Sleep Quality Index was used to assessed the sleep quality. These scales were used over three period of measurements (pretest, posttest one and posttest two). Results: the study results demonstrate that the vibration therapy had a consistent and significant effect in reducing the RLS severity (P < 0.001) as well as enhancing sleep quality (P < 0.001) within the study group over time. While the control group did not present significant improvement across all three measures. Conclusion: The study results demonstrates that vibration therapy was effective in significantly reducing the severity of RLS and improving sleep quality among the study group participants, while the control group showed no meaningful change over time.
Background & objective: Children with hearing impairment face multiple challenges affecting their behavioral development due to limitations in communication and social integration. Hearing impairment may lead to increased emotional symptoms and withdrawal or aggression compared to hearing children. This study compares the impact of psychological factors on emotional and behavioral outcomes in children with hearing impairment and their hearing peers. Methods: A comparative study was conducted on a sample of 309 participants, including children and their parents. The sample was divided into two groups: the first group consisted of 100 children with hearing impairments enrolled in hearing and speech centers, and the second group consisted of 209 children with normal hearing enrolled in mainstream schools. The study used modified and developed questionnaire for the purpose of study. Data was collected through interviews and analyzed electronically by using SPSS 27. Results: The study results indicated statistically significant differences in the levels of psychological factors between the two groups. A high percentage of children with normal hearing (88.5%) demonstrated good levels of psychological factors, while 59% of children with hearing impairments showed moderate levels. Furthermore, the emotional and behavioral outcomes were good for 79.4% of children with normal hearing and moderate for 55% of those with hearing impairments. Conclusions: This study confirms that psychological factors play a crucial role in shaping the emotional and behavioral outcomes of hearing-impaired children compared to their hearing peers. It highlights the urgent need to develop psychosocial intervention programs aimed at improving self-esteem and enhancing self-efficacy.
Introduction: Intravenous catheterization is challenging in neonates, especially in the low-birth-weight population. Most patients were referred to the anesthesiologist after several failed attempts at central vein catheterization. In this case report, we would like to share an unusual approach with a higher success rate. A one-day old female child, 1.7 kg, with gastroschisis and neonatal sepsis. The patient's general condition was weak and lethargic, with HR 135 bpm, RR 50 tpm, SpO2 95% on ventilator and prolonged hemostatic function. The patient was prepared for central venous catheter insertion. The right neck was disinfected, and lidocaine (2%, 0.1 ml) was administered. It started with the insertion of a 24 G IV catheter, which was then aspirated with blood. Guidewire was advanced then dilated before the insertion of CVC 3 Fr for 10 cm. The catheter was then fixed using a 3.0 silk suture. Postoperatively, the patient was radiographed without further bleeding. The patient was given midazolam 1,5 mg, fentanyl (30 mcg), and sevoflurane (8 vol%) in 100% oxygen with a face mask size 2 until an adequate level of anesthesia with spontaneous ventilation was achieved. The patient was then placed in the left lateral decubitus position. The insertion site was marked at L1 to cover T6-S2. A catheter was inserted 10 cm before the test dose and an incremental dose of ropivacaine 0.2% 7 ml, then maintenance at 3 ml/h. Hemodynamics were stable with SpO2 97-100%, HR 97-103 bpm, SBP 80-90/45-47 mmHg. Postoperatively, the patient was transferred to the PACU. The supraclavicular approach can be used for neonates in whom it is difficult to find other sites for CVC insertion, as it is easier for the physician to reach the deeper vein from easier approach.
