Search

High intensity resistance training (HIRT) effect on both cortisol and testosterone and contributes to improved performance in football players. The purpose of this study was to determine the effect of eight-week HIRT intervention on cortisol and testosterone of male university football players. For this purpose, 24 football players between the ages of 19 and 25 were recruited. Blood Samples of 12 players were collected before and after eight weeks of HIRT. While, remaining 12 players were considered as controls and did not underwent HIRT. The collected data were subjected to statistical analysis using GraphPad Prism version 6.0 software. The findings of current study revealed that cortisol had significantly declined after HIRT group. Whereas, testosterone levels demonstrated significant elevation after eight weeks of HIRT intervention. The results also showed that there was no significant difference in cortisol and testosterone in the control group. This study's results concluded that eight weeks of high-intensity resistance training (HIRT) improved the performance of university male football players. [ABSTRACT FROM AUTHOR]

In graph theory, a "dominating vertex set" is a subset of vertices in a graph such that every vertex in the graph is either a member of the subset or adjacent to a member of the subset. In other words, the vertices in the dominating set "dominate" the remaining vertices in the graph. Dominating vertex sets are important in graph theory because they can help us understand and analyze the behavior of a graph. For example, in network analysis, a set of dominant vertices may represent key nodes in a network that can influence the behavior of other nodes. Identifying dominant sets in a graph can also help in optimization problems, as it can help us find the minimum set of vertices that can control the entire graph. Now that there are theories about vagueness, it is important to define parallel ideas in vague structures, such as intuitionistic fuzzy graphs. This paper describes a better way to find dominating vertex sets (DVSs) in intuitive fuzzy graphs (IFGs). Even though there is already an algorithm for finding DVSs in IFGs, it has some problems. For example, it does not take into account the vertex volume, which has a direct effect on how DVSs are calculated. To address these limitations, we propose a new algorithm that can handle large-scale IFGs more efficiently. We show how effective and scalable the method is by comparing it to other methods and applying it to water flow. This work's contributions can be used in many areas, such as social network analysis, transportation planning, and telecommunications. [ABSTRACT FROM AUTHOR]

Preemptive analgesia with intravenous ketamine has been utilized as a part of multi-modal analgesia for acute postoperative pain following laparoscopic cholecystectomy with mixed outcomes. We tested the effectiveness of low-dose ketamine for acute and chronic postoperative pain after laparoscopic cholecystectomy in a randomized controlled experiment. The study involved 50 individuals who had a laparoscopic cholecystectomy under general anesthesia. All the patients were separated into two equal groups. The ketamine and control groups were given 0.5 mg/kg ketamine and 2 mL of normal saline, respectively, at 15 minutes before incision. Patients in the ketamine group had a significantly lower numeric pain rating scale score at 0 minutes than those in the control group. The numeric pain rating scale score of the ketamine group was considerably greater than the control group after a half-hour interval. At other time periods, there was no significant difference in numeric pain rating scale scores between the two groups. The ketamine group had a greater duration of analgesia and sedation score than the control group. The cumulative tramadol demand at 24 hours and the incidence of chronic pain did not differ significantly across the groups. Substantial analgesic effect of intravenous ketamine lasted only up to 30 min postoperatively. There was no discernible effect in terms of chronic pain prevention. [ABSTRACT FROM AUTHOR]

Background: Distress amongst health care providers is nowadays a topic of interest globally, however in Pakistan, the link between stress and medical profession during COVID-19 pandemic is still understudied. Objective: To assess the level of stress, resilience and moral distress among health care workers during COVID-19 pandemic. Study type, settings & duration: A cross sectional study was carried out at Allied hospital, DHQ Hospital and Government General Hospital, Faisalabad affiliated with Faisalabad Medical University from March to June 2020. Methodology: A total of 106 health care professionals participated who worked during COVID-19 pandemic. Results: About 25 (23.6%) of frontline workers had mild, 78 (73.6%) moderate and 3 (2.8%) severe level of anxiety. However, 45.3% of participants reported higher resilience. Similarly, regarding moral distress, 45 (42.5%) experienced mild, 19 (17.9%) distressed and 6 (5.6%) had worst moral distress. Conclusion: During COVID-19 pandemic, the health care providers reported higher extent of stress and moral distress. Moreover, resilience showed an inverse relationship with stress and moral distress highlighting importance of resilience building to lower the intensity of stress and moral distress faced by health care providers. [ABSTRACT FROM AUTHOR]

Background: Pneumomediastinum is a rare complication associated with acute respiratory distress syndrome secondary to other viral pneumonias. However, it has been on a rise in COVID-19 patients with severe disease. Case presentation: We present three cases to highlight that isolated pneumomediastinum can complicate the course of illness in patients on non-invasive ventilation. In our case series, two COVID-19 diagnosed cases with no previous history of intubation developed pneumomediastinum. They were managed conservatively with a successful outcome. The third patient developed PM with subcutaneous emphysema post-intubation, although managed conservatively succumbed to the disease. Conclusions: Clinicians need to be alert to the development of such a complication in the event of sudden onset dyspnoea with chest pain. Conservative management, with low pressure settings on the ventilator results in gradual improvement of patient. [ABSTRACT FROM AUTHOR]

Background and aims: We compared the effectiveness of non-invasive ventilation (NIV) provided by helmet mask vs face mask in patients with COVID-19. Methods and materials: Between March and May 2021, a single-center, prospective, open-label randomized controlled research was undertaken. Sixty patients were randomly assigned to one of two groups based on the NIV delivery interface. In group I (n = 30) helmet mask was used and in group II (n = 30) face mask was used for delivery of NIV. The proportion of patients in each group who required endotracheal intubation was the primary outcome. The duration of NIV, length of stay in the intensive care unit (ICU), hospital mortality, ratio of partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2), respiratory rate, patient comfort, and complications were all documented as secondary outcomes. Results: In both groups, demographics, clinical characteristics, and treatment received were comparable. Around 10% of patients in the helmet mask group were intubated, while 43.3% of patients in the face mask group were intubated (p = 0.004). The two groups demonstrated similar hemodynamic patterns. The use of a helmet mask, on the other hand, resulted in enhanced oxygenation (263.57 ± 31.562 vs 209.33 ± 20.531, p = 0.00), higher patient satisfaction (p = 0.001), a lower risk of complications, and a shorter NIV and ICU stay (p = 0.001) (4.53 ± 0.776 vs 7.60 ± 1.354, p = 0.00 and 6.37 ± 0.556 vs 11.57 ± 2.161, p = 0.00). Conclusion: Helmet mask could be a reliable interface for delivery of NIV in COVID-19 and results in a lower rate of endotracheal intubation, better oxygenation with greater patient comfort and shorter ICU stay as compared to face mask used for NIV. [ABSTRACT FROM AUTHOR]

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the impact of BMI on critically ill COVID-19 patients. Secondary outcomes include development of respiratory failure, shock, acute cardiac injury, acute kidney injury, acute liver injury, secondary infection and sepsis. Materials and Methods: This retrospective study of 6 months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health-care organization. The medical records were reviewed at least 14 days after admission. Results: A total of 484 patients were included, and BMI data were available for 306 patients. About 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30–34.9 Kg/m², and 15.03% had BMI ≥35 Kg/m². Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity Class I (RR 2.03, 95% CI 1.07–3.85, P=0.030) and patients with obesity Classes II and III (RR 2.83, 95% CI 1.54–5.22, P<0.001) compared with those with normal BMI. Conclusion: Obesity was associated with an unfavorable outcome among patients with COVID-19. Patients with obesity should be more closely monitored when hospitalized for COVID-19 as there is increasing evidence of relation of severity of COVID-19 and obesity which appears to be a factor in the health risks. [ABSTRACT FROM AUTHOR]

Background: The procedures related to airway can be associated with increased risk of aerosolization of SARS-CoV-2 virus posing a high risk to the personnels involved. Novel methods like the intubation box have been developed to increase the safety of healthcare workers during intubation. Methods: In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS) 4 times using a King Vision ® videolaryngoscope and TRUVIEW PCD TM videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first- pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors measured with a pressure sensing device. Results: Intubation time and the pressure exerted on the incisors (detected by a click sound) were considerably higher in both groups when an intubation box was used. (Table 1) When comparing the two laryngoscopes, intubation time with the King Vision ® video laryngoscope was lower than that of TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both groups, rate of first pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO Score was not affected by intubation box but higher score was observed with King Vision « laryngoscope. (Table 1,2). Conclusion: This study indicates that use of an intubation box makes intubation difficult and increases the time. King Vision ® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope. [ABSTRACT FROM AUTHOR]

We present a case report of an inadvertent administration of intravenous carboprost in a COVID-19-positive parturient who was taken up for an emergency caesarean section for meconi um-stained liquor. Unintentionally, the patient was administered intravenous carboprost instead of ondansetron. The patient developed breathlessness, uneasiness and hypertension. Despite the mishap, the patient fully recovered and was discharged after 15 days. Although the medical error in the present case was non-harmful, the treating doctor discussed the case with the patient. Conclusion: A case with inadvertent intravenous administration of carboprost in a COVID-19-positive parturient is reported with a good outcome. [ABSTRACT FROM AUTHOR]

WHO declared the novel coronavirus disease 2019 (COVID-19) as pandemic on 11 March 2020 because of its rapid worldwide spread (World Health Organization, [11]). Preparation of a COVID operating room (OR) for a suspected or confirmed case of COVID undergoing emergency surgery and preparation of COVID ICU for suspected and confirmed COVID cases. Operating theatre departments identified operating theatre(s) to be used to manage COVID-19 patients ensuring a clear protocol for patient flow into the operating theatre. [Extracted from the article]

Objectives: To explore the preventable cause of epilepsy. Study Design: Cross Sectional study. Setting: Monthly Epileptic Camp, Mujahid Hospital Madina Town & Psychiatry OPD of Government General Hospital Ghulam Muhammad Abad, Faisalabad. Period: Jan to December 2019. Material & Methods: 121 epileptic patients participated. A questionnaire was developed. For the analysis of results descriptive statistics was used. Results: During the prenatal period 50.2% mothers of patients had checkup by doctor, 40.6% of patients exposed ultrasonic waves. Percentage of normal birth mode was 90.9 and 70.2% of participants born at home. Among patients 89.3% were vaccinated. Daily functioning was disturbed in 29.8%, academics disturbance was in 78.5% patients. Mental illness was present in 62% patients. Mental and physical illness is same in both gender but age is significant risk factor. Conclusion: Regarding the causes of epilepsy findings depicts that almost half of the patient's mothers had checkup during their pregnancy. A large number of participants had normal delivery at home. Three fourth of the patients were vaccinated. Around two fourth of the patients had history of physical illness during childhood, fewer patients had history of head injury and family history of epilepsy. Epileptic patient's cognitive functions and abstract thinking is impaired. [ABSTRACT FROM AUTHOR]

Background and Aims: Low-volume high-concentration bupivacaine irrigation of the peritoneal cavity has been reported to be ineffective for short-term analgesia after laparoscopic cholecystectomy (LC). This study was conducted to evaluate the effectiveness of intraperitoneal instillation of high-volume low-concentration bupivacaine for post-operative analgesia in LC. Methods: Sixty patients undergoing LC were included in this prospective, double-blind, randomised study. Patients were divided into two (n = 30) groups. In Group S, intraperitoneal irrigation was done with 500 ml of normal saline. In Group B, 20 ml of 0.5% (100 mg) bupivacaine was added to 480 ml of normal saline for intraperitoneal irrigation during and after surgery. Post-operative pain was assessed by numeric pain rating scale (NRS) at fixed time intervals. Duration of analgesia (DOA), total rescue analgesic requirement (intravenous tramadol), presence of shoulder pain, nausea and vomiting were recorded for the initial 24 h post-operatively. Results: Mean DOA in Group S was 0.06 ± 0.172 h (3.6 ± 10.32 min) and that in Group B was 19.35 ± 8.64 h (P = 0.000). Cumulative requirement of rescue analgesic in 24 h in Group S was 123.33 ± 43.01 mg and that in Group B was 23.33 ± 43.01 mg (P = 0.000). There was no significant difference in incidence of shoulder pain, nausea and vomiting between the groups. Conclusion: High-volume low-concentration of intraperitoneal bupivacaine significantly increases post-operative DOA and reduces opioid requirement after LC. [ABSTRACT FROM AUTHOR]

Introduction: Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance. Methodology: This was a prospective, randomized, double-blind study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t-test with SPSS 16.0 software. Results: In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000), shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000). Conclusion: Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA. [ABSTRACT FROM AUTHOR]

BACKGROUND: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to find out the effect of adding dexmedetomidine to bupivacaine for supraclavicular block. METHODS: In this randomized, double-blind study, 70 ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35) received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for, onset of motor and sensory block, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. RESULTS: In group D, the onset was faster (P< 0.001), durations of sensory and motor block duration of and analgesia were prolonged as compared to group C (P < 0.0001).There was a significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min. However, none of the patients dropped HR below 50/min. Mean Arterial Pressure (MAP) remained unaffected. The patients in group D were more effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. CONCLUSION: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation. [ABSTRACT FROM AUTHOR]

Introduction: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA&#8482) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA&#8482) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™; and ETT/OPA™ exchange technique. Material and Methods: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia. These patients were randomly divided into two groups i.e. OPA group and LMA group of 50 patients each. Hemodynamic parameters i.e. systolic blood pressure (SBP) and heart rate (HR) were recorded during exchange of ETT with OPA™ or LMA™. Coughing / bucking during removal of OPA™ and LMA&#8482, and presence of post operative sore throat for both the groups were also graded and recorded. Data within the groups have been analyzed using paired "t" test while those between the groups were analyzed using unpaired "t" test. Chi square test was used to analyze grades of coughing and post operative sore throat. Results: In both groups, hemodynamic parameters rose significantly as OPA™/LMA™ was placed (P < 0.05) and then started declining. Hemodynamic parameters continued to fall in LMA group after extubation. However in OPA group, hemodynamic parameters continued to rise even after extubation and declined only when OPA™ was removed. There was no statistical significant difference between the LMA and OPA group in respect to coughing and post operative sore throat. Conclusion: LMA™ is superior to OPA™ for exchange of ETT as it provides greater hemodynamic stability. [ABSTRACT FROM AUTHOR]

Context: The precision of an arbitrary face-bow in accurately transferring the orientation of the maxillary cast to the articulator has been questioned because the maxillary cast is mounted in relation to arbitrary measurements and anatomic landmarks that vary among individuals. Aim: This study was intended to evaluate the sagittal inclination of mounted maxillary casts on two semi-adjustable articulator/face-bow systems in comparison to the occlusal cant on lateral cephalograms. Materials and Methods: Maxillary casts were mounted on the Hanau and Girrbach semiadjustable articulators following face-bow transfer with their respective face-bows. The sagittal inclination of these casts was measured in relation to the fixed horizontal reference plane using physical measurements. Occlusal cant was measured on lateral cephalograms. SPSS software (version 11.0, Chicago, IL, USA) was used for statistical analysis. Repeated measures analysis of variance and Tukey's tests were used to evaluate the results (P < 0.05). Results: Comparison of the occlusal cant on the articulators and cephalogram revealed statistically significant differences. Occlusal plane was steeper on Girrbach Artex articulator in comparison to the Hanau articulator. Conclusion: Within the limitations of this study, it was found that the sagittal inclination of the mounted maxillary cast achieved with Hanau articulator was closer to the cephalometric occlusal cant as compared to that of the Girrbach articulator. Among the two articulators and face-bow systems, the steepness of sagittal inclination was greater on Girrbach semi-adjustable articulator. Different face-bow/articulator systems could result in different orientation of the maxillary cast, resulting in variation in stability, cuspal inclines and cuspal heights. [ABSTRACT FROM AUTHOR]