The Effect of Warmed Serum on Shivering and Recovery Period of Patients Under General and Spinal Anesthesia: A Randomized Clinical Trial.

PURPOSE: Postoperative hypothermia followed by shivering is a common phenomenon in patients undergoing surgery under anesthesia, and should be prevented and treated in postoperative patient care units. This study was conducted to investigate the effect of warmed serum injection on postoperative shivering and recovery period of patients operated under general and spinal anesthesia. DESIGN: In this clinical trial, patients to be operated on under general and spinal anesthesia were randomly assigned into two groups of test and control. In the test group, patients received warmed intravenous fluids and blood products. All patients were monitored to record vital signs, incidences of hypothermia and shivering, and recovery period. METHODS: The collected data were analyzed with repeated measures analysis of variance to detect significant differences between groups and significant changes within groups over time. FINDINGS: The incidence of nausea, vomiting, and shivering in the intervention and control groups was (4.7%, 42%), (2.8%, 16.8%), and (6.6%, 43%), respectively. Patients in the intervention group had higher body temperature than the control group (<0.001). Also, patients under spinal anesthesia had higher body temperature than patients under general anesthesia (<0.001). Blood pressure reduction was also significantly higher in the control group than in the intervention group. The patients who received warm intravenous serum, and especially those who had received spinal anesthesia spent less time in the recovery room (<0.001). CONCLUSIONS: The use of warmed intravenous serum increased the patients' core temperature, reduced their postoperative shivering, and shortened their recovery period. Considering the potential risks associated with hypothermia, using such methods for hypothermia prevention can be highly effective in preventing shivering and prolongation of the recovery period and other potential complications. Anesthesia specialists and technicians are therefore encouraged to use this method as a preventive measure.

Mortality in ICU COVID-19 Patients Is Associated with Neutrophil-to-Lymphocyte Ratio (NLR): Utility of NLR as a Promising Immunohematological Marker.

Background: Achieving a suitable medical laboratory index is very important for the prediction of clinical outcome of COVID-19 patients hospitalized to the intensive care unit (ICU). The correlation between neutrophil-to-lymphocyte ratio (NLR) and unfavorable outcome of COVID-19 patients hospitalized to ICU was the aim of this study. Methods: We evaluated a cross-sectional study of 312 COVID-19 patients who were hospitalized to the ICU (confirmed by PCR and CT-Scan), in Babol city, Mazandaran province. WBC, RBC, lymphocyte, neutrophil, monocyte, platelet count, NLR, C-reactive protein (CRP), ESR, MCV, MHC, and other factors were evaluated. Results: Our findings indicated that all patients aged 56 to 69 years with COVID-19 had a significant difference (P < 0.05) in neu, lymph, PLT count, NLR, ESR, Hb, and CRP. Also, NLR was significantly (P < 0.05) correlated with the death or discharge of the ICU hospitalized patients. The cut-off of NLR was 7.02 and the mean of NLR was 11.3 ± 10.93 and 5.8 ± 7.45 in death and discharge COVID-19 patients hospitalized to ICU, respectively. ROC curve indicated that, for NLR, the area under curve was 0.76. Conclusions: Our findings showed that NLR can be utilized as a clinical laboratory predictive parameter for mortality of COVID-19 patients admitted to ICU.

An Investigation Into Quality of Recovery After General Anesthesia With Isoflurane and Propofol in Patients Undergoing Abdominal Hysterectomy.

BACKGROUND: The quality of postanesthesia recovery is among the important issues of general anesthesia that affect the patient's ability to perform daily activities. This study hence aimed to investigate the effects of general anesthesia with isoflurane and propofol on the quality of recovery (QoR) in patients undergoing an abdominal hysterectomy. METHODS: This clinical trial was conducted on 80 women aged 30-65 years who visited Ayatollah Rouhani Hospital of Babol for an elective abdominal hysterectomy in 2020. Based on a randomized block design (4 blocks of 20), the participants were equally assigned to two groups of propofol (P) and isoflurane (I). The QoR-15 scale was employed to measure the QoR in terms of physical and mental dimensions, as primary outcomes, and duration of anesthesia, duration of surgery, response time, quality of extubation, changes in blood pressure and heart rate, length of stay in the recovery unit, Aldrete score, pain score, and prevalence of postoperative nausea and vomiting (PONV), as secondary outcomes. RESULTS: The results showed that there was no significant difference between the two groups in terms of postoperative physical and mental changes (P = 0.142), except for the second night after surgery (P = 0.001). The QoR, both physically and mentally, significantly changed in both groups over time (P ＜ 0.05). The results also indicated that response time (P ＜ 0.001), quality of extubation (P = 0.01), prevalence of PONV (P = 0.001), and increase in blood pressure (P = 0.02) were significantly lower in the propofol group (P) than in the isoflurane group (I). There was no significant difference between the two groups in the length of stay in the recovery unit (P = 0.44), pre-discharge Aldrete score (P = 0.31), pain score (P = 0.18), duration of anesthesia (P = 0.30), duration of surgery (P = 0.64), and heart rate (P = 0.30). CONCLUSIONS: Propofol outperformed isoflurane in terms of response time, quality of extubation, prevalence of PONV, and increase in blood pressure. In addition, the physical and mental QoR on the second night after surgery was higher in patients anesthetized with propofol compared to those anesthetized with isoflurane.

One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

Prevalence of telogen effluvium hair loss in COVID-19 patients and its relationship with disease severity.

COVID-19 is a concerning global pandemic. Common manifestations are fever and respiratory symptoms. In addition, recent studies reported dermatological manifestations as extrapulmonary signs. One of these is telogen effluvium which is related to post COVID-19 comorbidities. The aim of this study was to assess the prevalence of telogen effluvium among COVID-19 patients. This observational cross-sectional study included 198 patients who were admitted for COVID-19. The PCR test was performed to detect positive cases. After discharge, all patients were interviewed about hair loss. Of these patients, 79 were male (39.9%), and 119 were female (60.1%). The age ranged from 18 to 85 years old. 48 patients showed hair loss. Telogen effluvium (TE) is one of the consequences of the COVID-19 pandemic. COVID-19 leads to more medications and stress situations, which trigger TE.

The relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and diastolic heart failure in patients with COVID-19.

Diastolic dysfunction has been reported in patients with COVID-19. Due to the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of heart failure, this study investigated the relationship between serum NT-proBNP levels and diastolic heart failure in patients with COVID-19. This descriptive-analytical study was performed at Ayatollah Rouhani Hospital in Babol. Fifty-two patients with confirmed COVID-19 diagnosis, who were admitted to the ICU, were included in this study. The primary outcome was about the relationship and predictive role of NT-proBNP and diastolic heart failure in patients with severe SARS-CoV-2 infection. Patients with pro BNP > 125 pg/ml underwent echocardiography, and the relationship between echocardiographic indices and NT-proBNP was assessed as the secondary outcome. Our study showed that plasma NT-proBNP levels in patients with increased diastolic dysfunction were associated with disease severity. It was also found that the cut-off point of NT-proBNP = 799 pg/ml could be a predictor of diastolic dysfunction grades two and three. In this study, patients with a serum NT-proBNP level > 799 had 37 times higher chance of having diastolic dysfunction than those with a serum NT-proBNP < 799. Patients with NT-proBNP > 556 had RV_EA > 2 in echocardiography, indicating increased right-sided filling pressures. Despite the confounding factors in the interpretation of the NT-proBNP level in COVID-19, its level can be used to estimate the presence of high-grade diastolic heart failure on the left side and the right side of the heart and the presence of high filling pressures. Lower levels of NT-proBNP are associated with right-sided diastolic failure.

Comparing the outcomes of treatment with INF-ß 1-a (interferon beta-1a) and IFN-ß 1-b (interferon beta-1b) among COVID-19 inpatients.

BACKGROUND: IFNßs are known as one of the most promising drugs used for COVID-19 treatment. This study aimed to investigate the effects of treatment with INF-ß 1-a (interferon beta-1a) and IFN-ß 1-b (interferon beta-1b) on COVID-19 inpatients. METHODS: In this study, we retrospectively evaluated the clinical treatment outcomes of 100 patients with COVID-19 who received IFN-ß 1-a and IFN-ß 1-b during their hospitalization period. The rate of discharge from the hospital was considered equal to the clinical improvement and then evaluated as a primary outcome. Moreover, mortality, ICU admission and length of ICU stay, frequency of intubation and use of mechanical ventilation, duration of hospitalization, laboratory factors, and medications were assessed as secondary outcomes. RESULTS: The median discharge time of IFN-ß 1a recipients was approximately equal to that of IFN-ß 1-b recipients as 9 (5-10) days and 7 (5-11) days, respectively (HR = 2.43, P = 0.75). Mortality rate was also estimated as 10% among IFN-ß 1-a recipients and 14% among IFN-ß 1-b recipients, which was not statistically significant (p = 0.190). ICU hospitalization rate for the IFN-ß 1-a recipients and IFN-ß 1-b recipients was 26% and 36%, respectively. In addition, no significant difference was found between these two intervention groups in terms of ICU length of stay (1 (0-2) vs. 1 (0-4.25(, respectively,) P = 0.357). There was no significant difference between the two study groups in terms of frequency of mechanical ventilation and length of hospital stay. CONCLUSION: There was no significant difference between the two groups in terms of shortening the disease time, clinical improvements and other outcomes.

The effect of low- dose tranexamic acid on postoperative blood loss in patients treated with clopidogrel and aspirin.

BACKGROUND: Clopidogrel in combination with aspirin increases bleeding, allogeneic red cell transfusion and reoperation rates after CABG. Tranexamic acid, an antifibrinolytic agent, has been approved for use in cardiac surgery to reduce bleeding. In the present study, we evaluated the impact of tranexamic acid on the transfusion and post-operative blood loss after CABG in patients treated with clopidogrel less than 5 days before surgery. METHODS: This study was a prospective, randomized, double-blinded clinical trial. Patients undergoing on-pump CABG with their last dose of clopidogrel and aspirin less than 5 days preoperatively were randomly assigned to receive tranexamic acid (10 mg/kg before surgical incision and 10 mg/kg after protamine neutralization) or a corresponding volume of saline solution. The incidence of allogeneic red cell transfusion and 48h postoperative blood loss were recorded. RESULTS: The average volume of blood loss was 776.92±459.81mL for the TXA group and 1075.00±670.91mL for the control group (P=0.03) in the patients with clopidogrel exposure within 48 h before surgery. The average volume of blood loss was not different between two groups in the patients with clopidogrel exposure within 5 days before surgery and also transfusion rate. CONCLUSION: The result of this study shows that tranexamic acid reduced blood loss in the patients with clopidogrel exposure within 48 h before surgery. So, it is better that we use tranexamic acid before surgery in all patients.

New modalities for non-invasive positive pressure ventilation: A review article.

Efficiency of non-invasive positive pressure ventilation in the treatment of respiratory failure has been shown in many published studies. In this review article, we introduced new modalities of non-invasive ventilation (NIV), clinical settings in which NIV can be used and a practical summary of the latest official guidelines published by the European Respiratory Clinical Practice. Clinical trials and review articles in four databases up to 25 February 2018 about new modalities of non-invasive positive pressure ventilation were reviewed. Commonly used modalities for treatment of respiratory failure include: CPAP (continuous positive airway pressure) and BiPAP (bilevel positive airway pressure) or NIPSV (noninvasive pressure support ventilation). The limitations of the BiPAP method are the trigger and cycle asynchrony, inadequate volume delivery and increased respiratory rate. Newer methods, such as adaptive servo-ventilation, have been developed to treat central and complex sleep apnea and the NAVA (neutrally adjusted ventilatory assist) to improve the trigger and cycle asynchrony. In the proportional assist ventilation, unlike the pressure support ventilation, with increased patient effort (flow) the tidal volume increases and it prevents the increase in the respiratory rate and respiratory distress. High-flow nasal cannula is a non-invasive technique that does not provide respiratory support, but provides a mixture of oxygen to the patient. The use of non-invasive pursed-lip breathing ventilation in chronic obstructive pulmonary disease (COPD) patients reduces dyspnea (decreases respiratory rate) and increases blood oxygen saturation. New modalities of NIV improve patient comfort and patient-ventilator interactions, and are recommended in patients with respiratory failure.

Analgesic effects of lidocaine-ketorolac compared to lidocaine alone for intravenous regional anesthesia.

BACKGROUND: Intravenous regional anesthesia is a simple and reliable method for upper extremity surgery. In order to increase the quality of blocks and reduce the amount of pain, many drugs are used with lidocaine. In this study, the effect of ketorolac-lidocaine in intravenous regional anesthesia was investigated. METHODS: 40 patients undergoing elective upper limb with America Society of Anesthesiologists class I and II were selected and randomly divided into two groups. The first group of 20 patients received 200 mg of lidocaine, and the second group, 200 mg of lidocaine with 20 mg of ketorolac. In both groups, the drug was diluted to 40 ml. In both groups, the onset of sensory block, onset of tourniquet pain, the onset of pain after opening the tourniquet, score of postoperative pain and analgesic prescription in the first 24 hours, during 1, 6, 12 and 24 hours were studied. A measure of the quality of analgesia was evaluated by VAS. RESULTS: The mean onset of tourniquet pain in the two groups was not significantly different (P=0.443). In the ketorolac group, the onset of pain after opening the tourniquet was significantly longer than lidocaine group (p<0.001). The mean postoperative pain score during the first 24 hours after surgery in the ketorolac group was significantly lower than lidocaine group (p<0.001). The average number of analgesia prescription during the 24 hours after operation was significantly lower in ketorolac group than lidocaine group (p<0.001). CONCLUSIONS: Adding ketorolac to lidocaine for regional anesthesia can reduce the postoperative pain for up to 24 hours after opening the tourniquet.