RESUMEN
The article considers the features of the impact of epidemics on the course of hostilities and the fate of the states of Antiquity. Three cases are presented as examples. The first one is related to the invasion of the Assyrian King Sennacherib in Judea and the attempt of his troops to take Jerusalem. The second case is related to the epidemic in Athens in the early years of the Peloponnesian war. The third one - with the epidemic in the Roman Empire in the 2nd half of the 2nd century AD. The analysis, based on information from extant sources, permitted to conclude that the intensity and destructive effect of epidemics in the Ancient World increased gradually. To this fact is attributed the effect of "closing" the Oikumena into a single whole. However, the degree of influence of epidemics on the fate of ancient states is greatly exaggerated by the historical tradition, which developed under the influence of emotional descriptions of the tragedies and mass deaths of people.
Asunto(s)
Conflictos Armados , Epidemias , Conflictos Armados/historia , Epidemias/historia , Historia AntiguaRESUMEN
BACKGROUND: Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet. METHODS: Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 µg, morphine 100 µg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0-5 indicating good sleep quality, PSQI 6-21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h. RESULTS: Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p < 0.001). Women with poor sleep quality had significantly higher peak pain scores upon movement (46.7 ± 28.8 vs. 36.2 ± 25.6, respectively; p = 0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (VNPS ≥70; OR 2.64; 95% CI 1.2-6.0; p = 0.02). DISCUSSION: A significant proportion of women scheduled for caesarean delivery were identified preoperatively as having poor sleep quality, which was associated with more severe pain and increased analgesic intake after delivery. The PSQI score may therefore be a useful tool to predict increased risk for acute post-caesarean pain and higher analgesic requirements, and help tailor anaesthetic management. SIGNIFICANCE: Multiple studies have evaluated predictors for severe acute pain after caesarean delivery that may be performed in a clinical setting, however, sleep quality prior to delivery has not been included in predictive models for post-caesarean pain. The PSQI questionnaire, a simple test to administer preoperatively, identified that up to 70% of women report poor sleep quality before delivery, and poor sleep quality was associated with increased post-caesarean pain scores and analgesic intake, indicating that PSQI could help identify preoperatively women at risk for severe pain after caesarean delivery.