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Background: Postoperative shivering is mainly associated with low body temperature. However, postoperative shivering can develop even at normal or high core temperatures. This study aimed to investigate the factors associated with postoperative shivering in patients with maintained core temperature after surgery. Methods: This retrospective study involved 537 patients who had undergone radical surgery for pancreatic cancer under general anesthesia from January 2013 to December 2023. The final analysis included 441 patients whose core temperatures after surgery were ≥ 36.5℃. Logistic regression analysis was performed to estimate the odds ratio (OR) of the incidence of postoperative shivering. Results: Postoperative shivering occurred in 119 patients. After multivariable-adjusted logistic regression, postoperative shivering was significantly associated with patient age (per 1 year increase; OR = 0.98; 95% confidence interval [CI]: 0.96–0.996; p = 0.02), operation time (per 30 min increase; OR = 1.10; 95% CI: 1.01–1.19; p = 0.03), postoperative core temperature (restricted cubic spline, p = 0.001), postoperative peripheral temperature (restricted cubic spline, p = 0.001), effect site fentanyl concentration at extubation (OR = 0.66; 95% CI: 0.24–0.99; p = 0.049), and acetaminophen use (OR = 0.32; 95% CI: 0.18–0.58; p < 0.001). Conclusions: Low peripheral temperature was a risk factor for the occurrence of shivering, even if the core temperature was maintained postoperatively. Peripheral temperature monitoring could be utilized to prevent postoperative shivering. In addition, fentanyl and acetaminophen reduced the occurrence of shivering in patients with maintained core temperature after surgery. [ABSTRACT FROM AUTHOR]

Silky shark (Carcharhinus falciformis) populations in the South Atlantic Ocean are listed as vulnerable under the IUCN. In fact, this species is classified as critically endangered in Brazil under the Ministry of the Environment. The present study reports the first opportunistic sighting of an aggregation of 250–300 silky sharks in the Alcatrazes Archipelago Wildlife Refuge. Aggregation sites are important in the life cycle of silky sharks, and identifying these sites is essential for conservation efforts. [ABSTRACT FROM AUTHOR]

Objective We report a rare case of acute hemolytic reactions caused by immunoglobulin (Ig)M anti-M antibody and present a literature review. Case Report A 61-year-old male patient who underwent blood transfusion developed fever, chills, soy sauce–colored urine, and changes in laboratory test results, including persistently decreased hemoglobin levels, neutrophilia, elevated lactate dehydrogenase level, acute kidney injury, mild acute liver injury, and activation of the coagulation system, indicating acute hemolytic transfusion reaction (AHTR). Antibody screening and major crossmatching results indicated weak positive at 37°C for both posttransfusion and pretransfusion sample. Subsequent serological examinations indicated the presence of IgM anti-M antibodies in plasma but the direct antiglobulin and elution tests were negative. Antibody hemolytic activity assay confirmed AHTR caused by anti-M. The transfused red blood cells were MM and the patient is NN. These signs and symptoms disappeared rapidly and required no additional interventions before discharge. Conclusion The accurate diagnosis of anti-M antibody–mediated acute hemolysis is essential for guiding treatment decisions. [ABSTRACT FROM AUTHOR]

Guidelines advocate that the symptomatic management of fever should prioritize alleviating the child's discomfort. We investigated the definition and assessment of discomfort in febrile children within the scientific pediatric literature. A systematic review was conducted in accordance with PRISMA 2020 guidelines and preregistered on the Prospero database (CRD42023471590). Databases including PubMed, Embase, and Cochrane were searched. Studies addressing discomfort in febrile children were eligible. Out of 794 initially identified articles, 27 original studies and seven guidelines specifically used the term 'discomfort'. Only 14 original articles provided a definition of discomfort, revealing substantial heterogeneity and no clear-cut definition. Discomfort was often assessed subjectively, predominantly through parent or self-report, and only two studies used a scoring system for assessment. The definitions varied widely, with terms such as crying, irritability, shivering and chills, pain and distress, goosebumps commonly used and evaluation of observable modifications such as facial modifications. Overall, no consensus on a single, standardized definition was available. Conclusions: This systematic review shows the absence of a standardized definition and assessment of discomfort in febrile children. The findings of the present analysis might be the basis for building a consensus and developing a new tool to evaluate discomfort. What is Known: • Discomfort is currently considered the main criterion to guide antipyretic administration in children with fever. • Despite this clear-cut recommendation, it has been questioned whether a commonly accepted understanding and assessment of this condition exists. What is New: • This systematic review identifies a significant heterogeneity in definitions and assessment of discomfort in children with fever. • Both subjective parameters and observable modifications in physiological parameters should be included in a new and shared characterization of discomfort. [ABSTRACT FROM AUTHOR]

Background: Hyperthermia is strongly associated with a worse neurological outcome in traumatic brain injury (TBI) and can be exacerbated by shivering. However, effective treatments for uncontrolled shivering have yet to be established. We successfully treated a patient with severe TBI and repeated episodes of shivering using dantrolene sodium hydrate (dantrolene). Case Report: A 28-year-old healthy male sustained an acute subdural hematoma with a midline shift following a traffic accident. He underwent emergency evacuation of the hematoma and craniectomy and was admitted to the Intensive Care Unit. The patient experienced severe shivering on the first day of hospitalization. Neuroprotective drugs were administered, and targeted temperature management at normothermia was initiated, initially controlling the shivering. On day 9 of hospitalization, shivering recurred, with a high fever. Despite the reintroduction of general anesthesia and targeted temperature management, the shivering was intractable. We administered dantrolene, which successfully eliminated the shivering. After the intervention, the patient's body temperature and intracranial pressure were well managed. The patient was subsequently transferred to a rehabilitation hospital, with a favorable neurological outcome 70 days after the injury. Conclusions: This case report demonstrates that dantrolene is an effective option for managing uncontrollable shivering in the context of intracranial pressure control after severe brain injury. This finding suggests the potential for the broader use of dantrolene in similar clinical scenarios and supports further investigation of its efficacy and mechanisms of action in TBI care. [ABSTRACT FROM AUTHOR]

Background, Aims and Objectives: Shivering is a common problem in obstetric patients undergoing cesarean section under spinal anaesthesia and its incidence is approximately 30% to 55%. Aim of our study was to compare the efficacy of intravenous Dexmedetomidine, intravenous Tramadol with placebo in prevention of post-spinal anaesthesia shivering in obstetric patients undergoing caesarean section. Secondary objective was to observe any side effects like nausea, vomiting, hypotension, bradycardia and sedation. Materials and methods: This prospective, randomized, and double-blinded study was conducted in the department of Anaesthesia, PGIMS, Rohtak . 126 Healthy pregnant women, 20-40 years of age, without any comorbid conditions requiring caesarean section under spinal anaesthesia were enrolled for the study and randomly allocated into one of the three groups according to computer generated randomisation . Group A (n=41) received 0.5 mcg/kg Dexmedetomidine, Group B (n=43) 0.5 mg/kg Tramadol and Group C (n=42) plain 100 mL normal saline IV infusion after spinal anaesthesia and delivery of baby. Shivering, sedation, blood pressure, heart rate was measured intraoperatively. Result: All data were summarised as mean ± SD for continuous variables, numbers and percentages for categorical variables. There was a significant difference between the various groups in terms of distribution of Incidence of Shivering (χ2 = 48.199, p-value < 0.001) . 9.8% (n=4) of the participants in the Group A, 53.5% (n=23) of the participants in the Group B, and 85.7% (n=36) of the participants in the Group C had shivering. Conclusion: This study showed dexmedetomidine as a better drug for the prevention of shivering after spinal anaesthesia as compared to tramadol as it has a low incidence of shivering, benefits of awake sedation and not associated with nausea and vomiting. [ABSTRACT FROM AUTHOR]

Background & Objective: Shivering after general as well as spinal anesthesia is a common phenomenon. Unmanaged post-anesthetic shivering can worsen postoperative pain and patient's metabolism. Various techniques including inj. tramadol, body warming, and covering have been evaluated to treat this common complication. We aimed to compare the effectiveness of tramadol administration with patient coverage as therapeutic methods for managing post-anesthesia shivering. Methodology: The study enrolled 60 patients who underwent spinal anesthesia. Patients were divided into two groups: Group A received blanket coverage as treatment for shivering, while Group B received intravenous tramadol. Shivering onset time and duration after treatment were measured. Descriptive statistics and chi-square test/independent t-test determined significance, with P < 0.05 considered statistically significant. Results: The findings of this study revealed no significant difference in the onset of shivering between patients who received intravenous tramadol and those who were covered by blankets (39.83 ± 13.21 min vs 38.60 ± 13.48 min). However, the duration of shivering after treatment was significantly shorter in patients who received intravenous tramadol compared to those who received blanket, e.g., 20.30 ± 9.62 vs. 34.83 ± 12.53; P < 0.000). Conclusion: In conclusion, intravenous tramadol is more effective than non-pharmacological methods (blankets) in managing shivering. Tramadol treatment resulted in a significantly shorter duration of shivering. [ABSTRACT FROM AUTHOR]

Background: The use of forced-air warming (FAW) blankets is widely recognized for preventing shivering and hypothermia in patients under general anesthesia. Various types of products are currently available for hospitals, and we have conducted a preliminary evaluation of insulation equipment based on expert opinions and initial parameters. However, we lack real-world experiments and accurate clinical data to validate these parameters and the accuracy of our decision-making results. This study aims to confirm the effectiveness of different FAW systems by assessing the thermal protection and operational characteristics of the equipment in both experimental and clinical settings, thereby enhancing our evaluation database. Methods: In the manikin test, we conducted six tests including heat distribution and heating rate, heater outlet temperature stability, etc. In the clinical study, patients were randomly assigned to four groups [Group A (Bair Hugger Therapy, 3 M, St. Paul, MN, USA; 63500); Group B (EQUATOR® level I, Smith Medical ASD, MN, USA; Snuggle Warm, SW-2013); Group C (Jiang Men Da Cheng Medical Devices Co., Ltd, China; IOB-006); and Group D (Shang Hai Nest Tech Medical Materials Co., Ltd, China; BH-017)], with each group comprising 30 individuals. At the start of anesthesia induction, the FAW blanket was activated and set to 43 °C until the completion of surgery. The primary endpoint was the average core body temperature during surgery. Secondary endpoints included hemodynamic and surgical variables, adverse events, and recovery metrics. Results: In the manikin test, the observed results of the experimental parameters (heat distribution, air pressure difference, and hole observation test) for Group A are superior to those of the other groups. In the clinical study, although the mean perioperative core body temperature remained above 36 °C across all groups [Group A: 36.31 ± 0.04; Group B: 36.26 ± 0.06; Group C: 36.17 ± 0.03; Group D: 36.25 ± 0.05], patients in Group A maintained higher temperatures compared to the other groups (p < 0.001). Conclusions: Among patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia, all four FAW systems effectively prevented perioperative hypothermia. However, the system in Group A minimized heat loss more effectively than the others, providing superior thermal protection. Trial registration: ChiCTR2200065394, 03/11/2022. [ABSTRACT FROM AUTHOR]

Background: Post-operative shivering after spinal anesthesia is a common issue in women undergoing cesarean section, then its management is necessary to increase patients’ satisfaction. Therefore, the current study aimed to compare the prophylactic effect of Granisetron and meperidine on post-spinal shivering in elective cesarean section. Methods: In this double-blinded clinical trial study, 100 women under elective cesarean section using block randomization were divided into two groups. The spinal anesthesia was performed in all women with 10 mg hyperbaric bupivacaine 0.5 %. Then, after the birth of the baby, the patients received 0.04 mg/kg Granisetron or 0.4 mg/kg meperidine intravenously. Mean Arterial Pressure (MAP), Heart Rate (HR), and percentage of arterial blood oxygen saturation (SpO2 ) were measured before intervention and 60 minutes after surgery using a standard monitoring device. Shivering was evaluated 30 minutes after the surgery in the recovery room according to the clinical examinations. Results: The changes in hemodynamics parameters were similar between the two groups. There was a statistically significant difference in the rate of shivering between the two groups. The rate of shivering in the Granisetron group was higher than in the meperidine group. Thus, 13 patients (26%) and 5 patients (10%) had shivering in the Granisetron and meperidine groups, respectively (p=0.037). Conclusion: Granisetron was not more effective than meperidine as routine treatment in preventing shivering after spinal anesthesia in women under elective cesarean section. [ABSTRACT FROM AUTHOR]

We present a new sorting algorithm, called adaptive ShiversSort, that exploits the existence of monotonic runs for sorting efficiently partially sorted data. This algorithm is a variant of the well-known algorithm TimSort, which is the sorting algorithm used in standard libraries of programming languages, such as Python or Java (for non-primitive types). More precisely, adaptive ShiversSort is a so-called \(k\) -aware merge-sort algorithm, a class that captures 'TimSort-like' algorithms and that was introduced by Buss and Knop. In this article, we prove that, although adaptive ShiversSort is simple to implement and differs only slightly from TimSort, its computational cost, in number of comparisons performed, is optimal within the class of natural merge-sort algorithms, up to a small additive linear term. This makes adaptive ShiversSort the first \(k\) -aware algorithm to benefit from this property, which is also a 33% improvement over TimSort's worst-case. This suggests that adaptive ShiversSort could be a strong contender for being used instead of TimSort. Then, we investigate the optimality of \(k\) -aware algorithms. We give lower and upper bounds on the best approximation factors of such algorithms, compared to optimal stable natural merge-sort algorithms. In particular, we design generalisations of adaptive ShiversSort whose computational costs are optimal up to arbitrarily small multiplicative factors. [ABSTRACT FROM AUTHOR]

Abstract Background Postoperative shivering is mainly associated with low body temperature. However, postoperative shivering can develop even at normal or high core temperatures. This study aimed to investigate the factors associated with postoperative shivering in patients with maintained core temperature after surgery. Methods This retrospective study involved 537 patients who had undergone radical surgery for pancreatic cancer under general anesthesia from January 2013 to December 2023. The final analysis included 441 patients whose core temperatures after surgery were ≥ 36.5℃. Logistic regression analysis was performed to estimate the odds ratio (OR) of the incidence of postoperative shivering. Results Postoperative shivering occurred in 119 patients. After multivariable-adjusted logistic regression, postoperative shivering was significantly associated with patient age (per 1 year increase; OR = 0.98; 95% confidence interval [CI]: 0.96–0.996; p = 0.02), operation time (per 30 min increase; OR = 1.10; 95% CI: 1.01–1.19; p = 0.03), postoperative core temperature (restricted cubic spline, p = 0.001), postoperative peripheral temperature (restricted cubic spline, p = 0.001), effect site fentanyl concentration at extubation (OR = 0.66; 95% CI: 0.24–0.99; p = 0.049), and acetaminophen use (OR = 0.32; 95% CI: 0.18–0.58; p

Background: Post-spinal anesthesia shivering in cesarean section is a common complication owing to sympatholysis, resulting in vasodilation and heat redistribution from the core to peripheral parts of the body. The physiological consequences of shivering include an increase in cardiac and systemic energy expenditure, oxygen consumption, and carbon dioxide production. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been reported to have anti-shivering effects. The aim of this study is to determine the effectiveness of prophylactic low-dose intravenous (IV) ketamine (0.25 mg/kg) in preventing shivering after spinal anesthesia as compared to placebo in elective cesarean sections. Methods: A randomized, double-blind study was conducted on 80 patients aged 18 to 40 years and American Society of Anesthesiologists grade II undergoing elective cesarean section under spinal anesthesia. Groups K and group S received IV ketamine 0.25 mg/kg diluted to 5 ml in normal saline and 5 ml normal saline IV, respectively, 10 minutes after spinal anesthesia. The incidence and duration of shivering, tympanic membrane temperature, sedation score, hemodynamic parameters, and side effects were recorded. Results: The incidence of shivering in group K was 12.5% compared to 32.5% in group S (P = 0.030). The mean duration of shivering was only 0.75 ± 2.02 min in group K as compared to 2.38 ± 3.57 min in group S (P = 0.014). Mean arterial pressure and heart rate were stable in group K without any significant sedative effect. Conclusion: The use of prophylactic low-dose ketamine (0.25 mg/kg) significantly reduces the incidence and duration of spinal anesthesia-induced shivering compared to placebo.

Background: Shivering is a common post-anaesthesia adverse event with multiple etiologies. The aim of this study was to compare the efficacy of two different dosages of dexmedetomidine in the treatment of post‑spinal anaesthesia (SA) shivering as well as to compare their side‑effect profile. Materials and Methods: This prospective, double‑blind, randomized controlled trial was conducted in the department of anaesthesia, Vinayaka Mission Medical College and Hospital, Karaikal. A total of 100 patients having shivering after SA were enrolled, out of which 50 received dexmedetomidine 0.5 mcg/kg (Group A) and 50 received dexmedetomidine 1 mcg/kg (Group B). The response rate, time to cessation of shivering and side effects (if any) were noted. All the results were analyzed using Student’s t‑test and Chi‑square test. Results: All patients who received both the dosages of dexmedetomidine had cessation of shivering. The time to cessation of shivering was significantly less with dexmedetomidine 1 mcg/kg (168 ± 23.3 s) than with dexmedetomidine 0.5 mcg/kg (174±14.5s) (P=0024). The recurrence rate of shivering with dexmedetomidine 1 mcg/kg was less as compared to dexmedetomidine 0.5mcg/kg. Nausea and vomiting were found to be higher in the group of dexmedetomidine 1 mcg/kg. On the other hand, dexmedetomidine 0.5 mcg/kg caused moderate sedation (modified Ramsay sedation score = 3 – 4) from which the patient could be easily waken up. Conclusion: Dexmedetomidine 0.5 mcg/kg offers better results than dexmedetomidine 1 mcg/kg with fewer side effects. [ABSTRACT FROM AUTHOR]

This trial was carried out to investigate the effect of forced air warming in various body areas of women on hypothermia during cesarean delivery. The patients in the study groups (n = 76) were assigned to the full-body warming group, upper-extremity warming group, lower-extremity warming group, and control groups. The intervention groups received forced-air warming 30 min before the surgery and continued until 30 min after surgery. The incidence of hypothermia was significantly higher in the control group than in the other groups at the 60th minute of the operation (p < 0.01). The intervention and control groups showed significant differences in the frequency of shivering at the entrance to the PACU (p = 0.001). Thermal comfort scores have significant difference between the control group and all of the intervention groups (p<.001). It is said that the full-body forced-air warming technique prevents hypothermia, shivering, and thermal discomfort in women Cesarean Section (CS). [ABSTRACT FROM AUTHOR]

BACKGROUND Shivering is distressing for the patients undergoing surgery under both regional and general anaesthesia. The aim of this randomized study is to compare the efficacy of intravenous tramadol and ketamine in controlling shivering after spinal anaesthesia in infraumbilical surgery. AIM To study the efficacy of tramadol and ketamine in preventing intraoperative shivering after spinal anaesthesia. METHODS A total of 76 patients in the age group 18–65 years of age from ASA physical grades I and II were randomized into two equal groups of 36 each: group T (tramadol) patients received 0.5 mg/kg of i.v. tramadol and group K (ketamine) patients received 0.5 mg/kg of i.v. ketamine after development of shivering (grade 3 and more) under spinal anaesthesia. RESULTS There was no significant difference in terms of age (p = 0.125), gender (p = 0.475), or comorbidities (22.3% in ketamine and 30.6% in tramadol had comorbidities, and hypertension was the most common comorbidity in both groups). Weight (p = 0.356), height (p = 0.081), sites of surgery (16.7% in the ketamine group and 36.1% in the tramadol group had abdominal surgeries,,66.6% in the ketamine group and 41.7% in the tramadol group had lower limb surgeries, 16.7% in the ketamine group and 22.2% in the tramadol group had urological surgeries), and ASA status (p = 0.637) between the groups. There was no significant difference in grade of shivering between the two groups at the time of recruitment (p = 0.691), after 5 minutes (p = 0.276), or at the time of recurrence (p = 0.343) of shivering. The time taken to stop shivering (in ketamine it was 9.85+0.84 min, while in tramadol it was 10.28+0.78) was less in ketamine but was not significant (p = 0.029). CONCLUSION We thus concluded that tramadol, when given for shivering that developed after spinal anaesthesia, more efficaciously reduced shivering than ketamine, with fewer recurrences and minor side effects that could be prevented, and there was no sedation in the group that was seen with ketamine. Hence, tramadol showed a benefit over ketamine when used for shivering postspinal anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Shivering is often encountered in patients undergoing targeted temperature management (TTM) after cardiac arrest. The most efficient, safe way to prevent shivering during TTM is not clearly defined. Objective: The purpose of this study was to evaluate the impact of shivering management using a stepwise shivering protocol on time to target temperature (TT), medication utilization and nursing confidence. Methods: Single-center, retrospective chart review of all post-cardiac arrest patients who underwent TTM between 2016 and 2021. The primary outcome is a comparison of time to TT pre- and post-protocol implementation. Secondary objectives compared nursing confidence and medication utilization pre- and post-shivering protocol implementation. Results: Fifty-seven patients were included in the pre-protocol group and thirty-seven were in the post-protocol group. The median (IQR) time to TT was 195 (250) minutes and 165 (170), respectively (p = 0.190). The average doses of acetaminophen was 285 mg pre- vs 1994 mg post- (p <0.001, buspirone 47 mg pre- vs 127 mg post- (p < 0.001), magnesium 0.9 g pre-vs 2.8 g post- (p < 0.001), and fentanyl 1564 mcg pre- vs 2286 mcg post- (p=0.023). No difference was seen for midazolam and cisatracurium. Nurses reported feeling confident with his/her ability to manage shivering during TTM 38.5% of the time pre-protocol compared to 60% post-protocol (p = 0.306). Conclusion: Implementation of a stepwise approach to prevent and treat shivering improved time to TT in our institution, although this finding was not statistically significant. The stepwise protocol supported a reduced amount of high-risk medication use and increased nursing confidence in shivering management. [ABSTRACT FROM AUTHOR]

Postoperative shivering control without lengthening recovery time and worsening cardiovascular system is important and necessary. The main objective of the present study was to evaluate the efficiency of Meperidine and Oxycodone in preventing shivering in patients who underwent inguinal hernia repair with spinal anesthesia. The present study consisted of patients with herniorrhaphy in the Fatemi and Imam Hospital of Ardabil who were studied through a double-blind clinical trial. with spinal anesthesia from 2017 through 18. In the study110 cases with hernia were included. In both studied groups of Meperidine or oxycodone, patients were allocated randomly. Interventions began half an hour before spinal anesthesia in the operating room. Each groups had their own structured treatment plan so that the first and the second groups received 5 mg of oxycodone and placebo respectively. After the patients being stable, Meperidine 0.4 mg/kg (2 CC) was injected to the second group following the spinal anesthesia. Normal saline (2 CC) injected to the first group as placebo. Patients were evaluated for shivering, nausea, vomiting and other complications up to 4 hours after surgery. After the operation, an uninformed questioner asked for shivering, nausea and vomiting and other complications of the operation, including dizziness and headache, for up to 4 hours (at intervals of 0, 2 and 4 hours), filling the relevant questionnaire and then the data were entered into SPSSv 21 and analyzed using Chi Square, T test and Fisher exact tests. A significance Level of 0.05 was considered for all the tests. The incidence of shivering in the oxycodone group at zero time (in recovery room) was significantly lower than the Meperidine group. But in other times, oxycodone had no significant effect on shivering compared to Meperidine. In both studied groups, there was not significant differences between rate of nausea and vomiting. We showed that oxycodone pills immediately after surgery may reduce the incidence of shivering significantly and also effective in shivering control as much as Meperidine at the other times of recovery. [ABSTRACT FROM AUTHOR]

The article titled "Conversation between the Sword and the Neck" is a poem written by Nathan Mcilroy, a musician, poet, and lyricist based in Manchester, Britain. The poem explores themes of power, justice, and freedom through a conversation between a sword and a neck. The neck, representing resilience and defiance, challenges the sword's hubris and calls for justice for all. The poem concludes with a call for action and solidarity, advocating for freedom in Palestine. [Extracted from the article]

Fournier's gangrene is a rapidly spreading gangrene predominantly affecting the genital and perianal region. It has the highest mortality and is more common in immunocompromised and diabetic patients. Poorly controlled diabetes is one of the common risk factors for Fournier's gangrene. Delayed diagnosis and treatment increase mortality by nearly 100%. In our case, the patient was initially managed for a perianal abscess and later progressed to Fournier's gangrene. A 48-year-old male diabetic presented with erythematous swelling in the right-side scrotal region for one-week duration. He had a recent perianal abscess and underwent incision and drainage at another hospital He also reported fever with chills and rigors for the past two days. The patient is now in a state of septic shock. He has a history of irregular medication for type 2 diabetes mellitus. Clinical examination confirmed Fournier's gangrene resulting from a perianal abscess in the context of uncontrolled diabetes. The patient underwent an emergency wound debridement under spinal anesthesia. Extensive wound debridement was performed on the right hemiscrotum. Necrotic tissue was debrided on the right perianal region. The patient was initiated on empirical antibiotics, receiving a calculated dose of cefoperazone with sulbactam and metronidazole. Additionally, the patient underwent sitz baths and received regular wound dressing. Following wound debridement and glycemic control with insulin, the patient showed signs of improvement. Four weeks post-debridement, the patient underwent split-skin grafting for the raw area on the scrotum, while the fistula site was allowed to heal by secondary intention. The cornerstone in managing perianal abscess with Fournier's gangrene in diabetic patients is extensive wound debridement, antibiotic coverage, and proper management of diabetes. Early diagnosis and prompt surgery of perianal abscess can reduce the risk of developing Fournier's gangrene in diabetic patients. Post-surgical raw areas can be effectively managed with split-skin grafts. [ABSTRACT FROM AUTHOR]

Meijuan Yang,1,&ast; ShuXi Li,1,&ast; Dan Drzymalski,2 Xinzhong Chen1 1Department of Anaesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Anaesthesiology and Perioperative Medicine, Tufts Medical Centre, Boston, MA, USA&ast;These authors contributed equally to this workCorrespondence: Xinzhong Chen, Tel +86-571-87061501, Fax +86-571-87061878, Email chenxinz@zju.edu.cnPurpose: Shivering occurs frequently after caesarean delivery. The present study aimed to investigate the ED50 and ED95 of an intravenous (i.v.) bolus of dexmedetomidine for treating severe shivering after caesarean delivery under combined spinal-epidural anaesthesia.Patients and methods: Seventy-five parturients with severe shivering after caesarean delivery were randomized into one of the five groups to receive an i.v. bolus of 0.2 (Group D1), 0.25 (Group D2), 0.3 (Group D3), 0.35 (Group D4) or 0.4 (Group D5) μg/kg of dexmedetomidine. Effectiveness of shivering treatment was defined as a standardized shivering score decreasing to ≤ 1 within 10 min of dexmedetomidine injection. The ED50 and ED95 were determined by probit regression. Adverse effects were also compared among the groups.Results: The ED50 and ED95 of i.v. dexmedetomidine to treat severe shivering were 0.23 (95% CI, 0.16– 0.26) μg/kg and 0.39 (95% CI, 0.34– 0.52) μg/kg, respectively. No difference in the incidence of adverse effects was found between groups.Conclusion: An i.v. bolus of 0.39 μg/kg of dexmedetomidine will treat 95% of parturients experiencing severe shivering after caesarean delivery.Keywords: dexmedetomidine, shivering, caesarean delivery

Abstract Background Accurate prediction of bacteremia is essential for guiding blood culture collection and optimal antibiotic treatment. Shaking chills, defined as a subjective chill sensation with objective body shivering, have been suggested as a potential predictor of bacteremia; however, conflicting findings exist. To address the evidence gap, we conducted a systematic review and meta-analysis of studies to assess the diagnostic accuracy of shaking chills for predicting bacteremia among adult patients. Methods We included studies reporting the diagnostic accuracy of shaking chills or chills for bacteremia. Adult patients with suspected bacteremia who underwent at least one set of blood cultures were included. Our main analysis focused on studies that assessed shaking chills. We searched these studies through CENTRAL, MEDLINE, Embase, the World Health Organization ICTRP Search Portal, and ClinicalTrials.gov. Study selection, data extraction, evaluation for risk of bias, and applicability using the QUADAS-2 tool were conducted by two independent investigators. We estimated a summary receiver operating characteristic curve and a summary point of sensitivity and specificity of the index tests, using a hierarchical model and the bivariate model, respectively. Results We identified 19 studies with a total of 14,641 patients in which the accuracy of shaking chills was evaluated. The pooled sensitivity and specificity of shaking chills were 0.37 (95% confidence interval [CI], 0.29 to 0.45) and 0.87 (95% CI, 0.83 to 0.90), respectively. Most studies had a low risk of bias in the index test domain and a high risk of bias and a high applicability concern in the patient-selection domain. Conclusions Shaking chills are a highly specific but less sensitive predictor of bacteremia. Blood cultures and early initiation of antibiotics should be considered for patients with an episode of shaking chills; however, the absence of shaking chills must not lead to exclusion of bacteremia and early antibiotic treatment.

Background: Spinal anesthesia often causes more post-operative nausea and vomiting (PONV). Cesarean-section patients have a significantly more PONV rate. Therefore, evidence-based knowledge about PONV prevention and care for high-risk individuals is urgently needed to reduce the consequences. Aims and Objectives: The aim of the study was to compare the efficacy and safety of granisetron with that of ondansetron in the prevention of PONV in patients undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 86 pregnant women with American Society of Anesthesiologists grade I–II scheduled for cesarean delivery under spinal anesthesia were enrolled. Patients were divided into two equal groups (n=43): Ten minutes before spinal anesthesia, patients in group B (granisetron) received 2 mg granisetron intravenously diluted to 10 mL with normal saline, whereas patients in group A (ondansetron) received 4 mg ondansetron. Results: There was no significant difference between Groups A and B in terms of the number of vomiting episodes between 0 and 6 h. Group A had significantly more episodes of nausea after 2 h than Group B after 0–2 h. After 2–6 h, however, the nausea was similar in all groups. Of the patients in Group A, 4 (9.3%) required antiemetic medication, in Group B, it was 2 (4.7%). In Group A, 8 patients (18.6%) and 6 patients (14%) complained of headache and dizziness, respectively; in Group B, 3 patients (7.0%) and (0%), respectively. Dizziness was significantly more pronounced in Group A than in Group B. Conclusion: The results of the study show that granisetron (2 mg) was more effective than ondansetron (4 mg) in minimizing PONV episodes in women undergoing spinal anesthesia for cesarean section. There were no significant side effects and both drugs were comparatively safe.

Background: Mesenteric arterial thrombosis is an extremely rare thrombotic event, especially during pregnancy, that can cause rapid fatal consequences unless the patient receives early definitive treatment. Case presentation: We report the case of a 34-year-old female presenting in her seventh week of gestation with severe abdominal pain who was promptly diagnosed with mesenteric artery occlusion amidst incipient miscarriage. The patient underwent a successful mesentery artery embolectomy, recovered and was later diagnosed with elevated factor VIII activity. Conclusion: The diagnosis of mesenteric ischemia should be considered in pregnant women presenting with severe abdominal pain and any prior predisposing factors. Our case highlights the pivotal role of the emergency physician in maintaining a high index of suspicion coupled with timely and determined action. The prognosis of this high mortality condition depends on prompt diagnosis, early definite management and successful multidisciplinary cooperation. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction of bacteremia is essential for guiding blood culture collection and optimal antibiotic treatment. Shaking chills, defined as a subjective chill sensation with objective body shivering, have been suggested as a potential predictor of bacteremia; however, conflicting findings exist. To address the evidence gap, we conducted a systematic review and meta-analysis of studies to assess the diagnostic accuracy of shaking chills for predicting bacteremia among adult patients. Methods: We included studies reporting the diagnostic accuracy of shaking chills or chills for bacteremia. Adult patients with suspected bacteremia who underwent at least one set of blood cultures were included. Our main analysis focused on studies that assessed shaking chills. We searched these studies through CENTRAL, MEDLINE, Embase, the World Health Organization ICTRP Search Portal, and ClinicalTrials.gov. Study selection, data extraction, evaluation for risk of bias, and applicability using the QUADAS-2 tool were conducted by two independent investigators. We estimated a summary receiver operating characteristic curve and a summary point of sensitivity and specificity of the index tests, using a hierarchical model and the bivariate model, respectively. Results: We identified 19 studies with a total of 14,641 patients in which the accuracy of shaking chills was evaluated. The pooled sensitivity and specificity of shaking chills were 0.37 (95% confidence interval [CI], 0.29 to 0.45) and 0.87 (95% CI, 0.83 to 0.90), respectively. Most studies had a low risk of bias in the index test domain and a high risk of bias and a high applicability concern in the patient-selection domain. Conclusions: Shaking chills are a highly specific but less sensitive predictor of bacteremia. Blood cultures and early initiation of antibiotics should be considered for patients with an episode of shaking chills; however, the absence of shaking chills must not lead to exclusion of bacteremia and early antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background: Ondansetron and Dexmedetomidine are recently used effectively to prevent shivering following spinal anesthesia. Objectives: This study compares the effects of weight-adjusted doses of Ondansetron and Dexmedetomidine in preventing post-spinal shivering and its subsequent hazards in cases who underwent elective transurethral resection of the prostate (TURP). Methods: In this prospective randomized double-blind controlled trial, 132 ASA (I, II) patients who were scheduled to undergo TURP were divided into 3 equal groups (44 each): Control group: received 5 ml of normal saline (0.9%) intravenously after SA; Group D: received 1 ug/kg. Dexmedetomidine was intravenously diluted in 5 mL of normal saline after SA. Group O received (0.1 mg/kg) Ondansetron intravenously diluted in 5 mL of normal saline after SA. Shivering occurrences, intensity, and duration (primary outcome), hemodynamics and core temperature changes, sedation level, total consumed rescue pethidine, and intraoperative complications were evaluated. Results: There was a statistically non-significant difference between Ondansetron and Dexmedetomidine as regard to shivering occurrences, intensity, and duration, while it was significant when compared to the control group. Hemodynamics showed a significant decrease in heart rate in Dexmedetomidine while compared to the Ondansetron and Control groups. Additionally, sedation levels were significantly higher in the dexmedetomidine group compared to other groups. However, there was a significant increase in total consumed rescue pethidine in the control group when compared to other groups. When compared to both the Dexmedetomidine and control groups, the Ondansetron group had a significantly lower risk of hypotension. Conclusions: The prophylactic IV weight-adjusted dose of Ondansetron is as effective as IV Dexmedetomidine in reducing the shivering occurrences, intensity, duration, and total of rescue pethidine doses in patients undergoing TURP. The IV weight-adjusted dose of Ondansetron is associated with more hemodynamic stability compared to IV Dexmedetomidine, with fewer incidences of bradycardia and hypotension. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Human metapneumovirus (hMPV) and parainfluenza virus type 3 (PIV3) are common respiratory illnesses in children. The safety and immunogenicity of an investigational mRNA-based vaccine, mRNA-1653, encoding membrane-anchored fusion proteins of hMPV and PIV3, was evaluated in hMPV/PIV3-seropositive children. METHODS: In this phase 1b randomized, observer-blind, placebo-controlled, dose-ranging study, hMPV/PIV3-seropositive children were enrolled sequentially into 2 dose levels of mRNA-1653 administered 2 months apart; children aged 12 to 36 months were randomized (1:1) to receive 10-mg of mRNA-1653 or placebo and children aged 12 to 59 months were randomized (3:1) to receive 30-mg of mRNA-1653 or placebo. RESULTS: Overall, 27 participants aged 18 to 55 months were randomized; 15 participants received 10-µg of mRNA-1653 (n = 8) or placebo (n = 7), whereas 12 participants received 30-µg of mRNA-1653 (n = 9) or placebo (n = 3). mRNA-1653 was well-tolerated at both dose levels. The only reported solicited local adverse reaction was tenderness at injection site; solicited systemic adverse reactions included grade 1 or 2 chills, irritability, loss of appetite, and sleepiness. A single 10-µg or 30-µg mRNA-1653 injection increased hMPV and PIV3 neutralizing antibody titers (geometric mean fold-rise ratio over baseline: hMPV-A = 2.9-6.1; MPV-B = 6.2-13.2; PIV3 = 2.8-3.0) and preF and postF binding antibody concentrations (geometric mean fold-rise ratio: hMPV preF 5 5.3-6.1; postF = 4.6-6.5 and PIV3 preF = 13.9-14.2; postF = 11.0-12.1); second injection did not further increase antibody levels in these seropositive children. Binding antibody responses were generally preF biased. CONCLUSIONS: mRNA-1653 was well-tolerated and boosted hMPV and PIV3 antibody levels in seropositive children aged 12 to 59 months, supporting the continued development of mRNA- 1653 or its components for the prevention of hMPV and PIV3. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether the combination of intrathecal dexamethasone and dexmedetomidine in combination with bupivacaine in spinal anesthesia is effective for reducing nausea, vomiting, shivering, and pain. A retrospective review of records was used to examine the outcomes of patients undergoing cesarean delivery under spinal anesthesia with dexamethasone, dexmedetomidine, and bupivacaine. The records of 11 consecutive patients who underwent cesarean delivery under spinal anesthesia with intrathecal dexamethasone and dexmedetomidine in combination with bupivacaine were evaluated. Data collected included patient demographics, medications and fluids administered, presence of nausea, vomiting, shivering, intraoperative breakthrough pain, and postoperative pain. There were no reported complications related to the administration of intrathecal dexamethasone and dexmedetomidine in combination with bupivacaine in this case series of patients. No patients required treatment for intraoperative vomiting, shivering, or breakthrough pain. One patient required opioid pain medication postoperatively. This case series demonstrates that the administration of intrathecal dexamethasone and dexmedetomidine in combination with bupivacaine for patients undergoing elective cesarean section appears to be safe and offers some advantages as to traditional methods of intrathecal delivery for this surgical procedure. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia often causes more post-operative nausea and vomiting (PONV). Cesarean-section patients have a significantly more PONV rate. Therefore, evidence-based knowledge about PONV prevention and care for high-risk individuals is urgently needed to reduce the consequences. Aims and Objectives: The aim of the study was to compare the efficacy and safety of granisetron with that of ondansetron in the prevention of PONV in patients undergoing cesarean section under spinal anesthesia. Materials and Methods: A total of 86 pregnant women with American Society of Anesthesiologists grade I-II scheduled for cesarean delivery under spinal anesthesia were enrolled. Patients were divided into two equal groups (n=43): Ten minutes before spinal anesthesia, patients in group B (granisetron) received 2 mg granisetron intravenously diluted to 10 mL with normal saline, whereas patients in group A (ondansetron) received 4 mg ondansetron. Results: There was no significant difference between Groups A and B in terms of the number of vomiting episodes between 0 and 6 h. Group A had significantly more episodes of nausea after 2 h than Group B after 0-2 h. After 2-6 h, however, the nausea was similar in all groups. Of the patients in Group A, 4 (9.3%) required antiemetic medication, in Group B, it was 2 (4.7%). In Group A, 8 patients (18.6%) and 6 patients (14%) complained of headache and dizziness, respectively; in Group B, 3 patients (7.0%) and (0%), respectively. Dizziness was significantly more pronounced in Group A than in Group B. Conclusion: The results of the study show that granisetron (2 mg) was more effective than ondansetron (4 mg) in minimizing PONV episodes in women undergoing spinal anesthesia for cesarean section. There were no significant side effects and both drugs were comparatively safe. [ABSTRACT FROM AUTHOR]

Objective: Assessment of predictive values of clinical symptoms for COVID-19 diagnosis in young adults. Participants: Nonresidential university students (ages 18–25) participating in surveillance testing and mandatory symptom survey between 9/9/2020 and 11/25/2020. Methods: Retrospective study of test results and symptom survey data. Results: Among 6,489 individuals, 288 (4.4%) tested positive for COVID-19, 90 (31.3%) of whom reported symptoms. COVID-19 prevalence among individuals reporting and not reporting symptoms was 17.2% and 3.3%, respectively. The four symptoms with highest positive predictive values (PPVs) were smell/taste loss (PPV = 38.5%), chills (PPV = 31.5%), muscle/joint pain (PPV = 26.0%), and fever (PPV = 25.9%). Conclusions: Institutions should emphasize COVID-19 risk for highly predictive symptoms in public health messaging to inform individuals on when to seek testing or self-isolation. However, low COVID-19 diagnostic accuracy of clinical symptoms and the high pre-symptomatic/asymptomatic rate (69%) highlight the limitations of voluntary testing strategies employed by higher education institutions during the original strain of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Background: Various medications with different efficacy and safety are used to relieve postoperative shivering. The present study aimed to determine the effectiveness and speed of treatment of shivering after general anesthesia with meperidine and doxapram. Methods: This randomized double-blinded clinical trial was performed on patients with ASA I-II and aged 20 years and 60 years with shivering during the first 10 minutes of recovery after general anesthesia following routine orthopedic or urology surgery. Patients were randomly assigned to receive meperidine (25 mg, intravenously) or doxapram (0.7 mg/kg, intravenously) in recovery and the shivering score was recorded every minute for 10 minutes. Results: In the two groups receiving doxapram and meperidine, the mean time of shivering relief (shivering score less than 1) was 4.54 minutes ± 2.04 minutes and 4.50 minutes ± 2.08 minutes, respectively with no difference (p=0.945). In both groups a significant decrease in the shivering score was observed during ten minutes, but there was no difference between the trend of changes in mean pain score in the two groups (p=0.489). Conclusion: Doxapram at a dose of 0.7 mg/kg is as effective as 25 mg of meperidine in controlling shivering after general anesthesia. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of dexmedetomidine on shivering and hemodynamics during spinal anesthesia in pregnant and postpartum women. Methods A total of 384 cases of cesarean section women with shivering during operation admitted to the Fifth Affiliated Hospital of Guangzhou Medical University were selected as the study subjects and randomly divided into the observation group (n=192) and the control group (n=192). The control group was treated with pethidine for chills, while the observation group was treated with dexmedetomidine. For the anesthesia effect, occurrence of chills, the therapeutic effect of shivering treatment, hemodynamic indicators and serum levels of hypersensitive C-reactive protein (hs-CRP), prostaglandin E2 (PGE2) and cortisol (Cor) were compared between two groups. Results Compared to the control group, the observation group had a shorter stopping time for shivering and better control of shivering (P＜0.05). Both groups showed changes in hemodynamic indicators such as diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR) and oxygen saturation (SpO2), but the fluctuation amplitude of the observation group was significantly smaller than that of the control group (P＜0.05). Stress indicators increased in both groups (P＜0.05), but levels of hs-CRP, PGE2 and Cor showed a smaller increase in the observation group compared to those of the control group (P＜ 0.05). The total incidence of adverse reactions was lower in the observation group than that in the control group (P＜0.05). Conclusion The clinical application of dexmedetomidine for spinal anesthesia has a good effect in the treatment of shivering in cesarean section women, which can stabilize the hemodynamic level of body and has high clinical application value. [ABSTRACT FROM AUTHOR]

Few cases of transcatheter aortic valve implantation (TAVI) following infective endocarditis (IE) have been reported. In this presentation, we discuss the feasibility of TAVI in a degenerated bioprosthetic valve affected by IE. We examine a rare case involving an elderly man with a degenerated bioprosthetic aortic valve complicated by IE 6 months after a COVID-19 infection. The patient was successfully treated with valve-in-valve intervention following antibiotic therapy for the acute phase of the infection. This resulted in excellent outcomes with no complications in the early postprocedural period and during follow-up visits. For patients with a destructed bioprosthetic aortic valve due to IE and residual dysfunction after healing, valve-in-valve intervention can be a safe and effective treatment option, particularly for those at high risk for surgery. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. Methods: A prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared. Results: The numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days. Conclusions: The incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Vaccines during the pandemic COVID-19 were the best solution to overcome the pandemic. The aim of this study was to evaluate and compare Sputnik V, Sinopharm, and AstraZeneca vaccins' side effects. Material and Methods: A cross-sectional study was designed among healthcare workers in a teaching hospital. The checklist was prepared for collecting data of demographic variables, respondents' medical history, and vaccines side effects. Results: More than half of participants received Sinopharm, while the development of COVID-19 following AstraZeneca was significantly among smaller proportion of respondents than other vaccines (P< 0.0001). There was no significant difference between age group and general side effects. The prevalence of serious side effects was higher in healthcare workers younger than 40 years old (P< 0.0001). The emergence of oral side effects was higher in participants who received two doses of vaccines in comparison to individuals who received one dose (P< 0.0001). Conclusion: The prevalence of serious side effects was higher in sputnik V in comparison to the other vaccines. The vaccines serious side effects were linked to the age of vaccinated people and immune system responses. [ABSTRACT FROM AUTHOR]

We present an extremely rare case of multivalvular endocarditis in an immunocompetent host which is not observed in routine clinical practice. Multivalvular endocarditis is extremely rare to find in today's era due to the widespread use of broad-spectrum antibiotics to treat pyrexia of unknown origin (PUO). Multivalvular involvement is usually encountered in immunocompromised individuals and is most often due to staphylococcal in origin. It is scarce to find our case of a 73-year-old elderly nondiabetic female with PUO who was diagnosed to be having endocarditis of both aortic and mitral valves showing large friable vegetations. In contrast, her urine and blood culture both had grown Enterococcus species. We successfully treated the patient with parenteral ampicillin and gentamycin for eight weeks, which made the patient afebrile and resolved the vegetation. [ABSTRACT FROM AUTHOR]

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P

Background and Aims: Dexmedetomidine has been used as an anti-shivering agent in the perioperative period in pregnant patients undergoing caesarean section (CS), but its effectiveness remains inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of intravenous Dexmedetomidine in the management of shivering. Methods: PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were explored for the randomised controlled trials (RCTs), which compared intravenous administration of Dexmedetomidine with normal saline (placebo) or other anti-shivering agents for the prevention or treatment of shivering in pregnant patients undergoing CS under central neuraxial blockade. The primary outcome was either incidence and/or severity (for prevention) and duration and/or success rate (for treatment) of shivering between the two groups. The secondary outcome measures were adverse effects (bradycardia, hypotension, sedation, nausea and vomiting, and effect on the APGAR scores of the baby) if observed. Data were synthesised using a random effect model. We calculated the odds ratio (95% CI) for presenting the categorical outcome and standardized mean difference (95% CI) for continuous outcomes. Heterogeneity was assessed using I2 statistics and was investigated using sensitivity analysis. Results: A total of 15 RCTs were included in the present systematic review and data from 10 RCTs comparing Dexmedetomidine with normal saline were pooled into the meta-analysis for primary outcome measure. The incidence and severity of shivering at 30 and 60 minutes weresignificantly less in the Dexmedetomidine group compared to the normal saline group [OR = 0.30, 95% CI: 0.19 to 0.47, P < 0.0001; MD = -0.54, 95% CI: -0.81 to -0.26, Z = 3.78, P = 0.0002 and MD = -1.06, 95% CI: -1.46 to -0.66, Z = 5.23, P < 0.0001 respectively]. Similarly, the time to reduce shivering was significantly lower and the success rate of treatment was higher in the Dexmedetomidine group compared to the normal saline group [MD = -13.55, 95% CI: −17.78 to -9.12, Z = 6.0, P < 0.0001 and OR = 0.03, 95% CI: 0.02 to 0.07, P < 0.0001 respectively]. There was no heterogeneity among the studies for incidence, severity at 60 minutes, and success rate of treatment outcome, while the severity of shivering at 30 minutes and time to reduce shivering demonstrated moderate heterogeneity. The side effect profile was comparable between the Dexmedetomidine and control (active and passive) group. Conclusion: This meta-analysis shows that intravenous administration of Dexmedetomidine for both prophylaxis and treatment is superior to normal saline in the management of perioperative shivering during CS, but is comparable to other most commonly used anti-shivering agents. There is no statistically significant difference in the incidence of side effects between the two groups.

The article presents a case study of a 34-year-old patient with autoimmune Glial Fibrillary Acidic Protein (GFAP) astrocytopathy, a rare central nervous system inflammatory disorder. Topics discussed include the diagnostic challenges and imaging findings related to autoimmune GFAP astrocytopathy, the impact of the condition on neurological and functional abilities, and the effectiveness of a multidisciplinary rehabilitation approach in improving patient outcomes.

Surgical emergencies in patients with hemophilia A represent a major risk of mortality without proper multidisciplinary management and require prompt and effective treatment to prevent complications and improve patient outcomes. We present a short number of cases that were hospitalized in the I–II Surgery Clinic of the Emergency County Hospital "St. Spiridon" from Iasi, Romania, with hemophilia A requiring surgical emergencies. The timing of surgical intervention is very important, so the indication for surgical intervention must be made judiciously and without delay. Consequently, it is vital to ensure access to hemostatic support so surgery can be performed on these patients, ultimately saving their lives. [ABSTRACT FROM AUTHOR]

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019–2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered. [ABSTRACT FROM AUTHOR]

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P<0.001). The additional tramadol requirement was significantly lower in Group T versus I and in Group T versus C but comparable among Group I versus C. Conclusion: The addition of 25 mg tramadol to IT 0.5% bupivacaine heavy is effective in preventing intraoperative shivering in patients undergoing urological surgeries like URSL. [ABSTRACT FROM AUTHOR]

Headache is a common symptom of influenza infection; however, its causes and consequences remain uncertain. In this manuscript, we analyzed which demographic and clinical factors were associated with the presence of headache during the course of influenza infection and whether patients with headache had a different prognosis, evaluated by need of hospitalization, sick leave or school absenteeism. The influence study (NCT05704335) was an observational study that analyzed data routinely collected from the Health Sentinel Network between 2010 and 2020. During the study period, 7832 cases were considered, among which, 5275 (67.4%) reported headache. The presence of headache was independently associated with myalgia (2.753; 95%CI: 2.456–3.087, P < 0.001), asthenia (OR: 1.958; 95%CI: 1.732–2.214, P < 0.001), shivering (OR: 1.925; 95%CI: 1.718–2.156, P < 0.001), nasopharyngeal erythema (OR: 1.505; 95%CI: 1.293–1.753, P < 0.001), fever (OR: 1.469; 95%CI: 1.159–1.861; P = 0.001), sudden onset of symptoms (OR: 1.380; 95%CI: 1.120–1.702, p = 0.004), female sex (OR: 1.134; 95%CI: 1.023–1.257, P = 0.018), and gastrointestinal symptoms (OR: 1.169; 95%CI: 1.039–1.315; P = 0.01). Patients with headache had a sex and age adjusted lower odds of being referred to the hospital (OR: 0.463; 95%CI: 0.264–0.812, P = 0.007) and a higher odd of having a sick leave and/or school absenteeism (absenteeism (OR: 1.342; 95%CI: 1.190–1.514, P < 0.001). In conclusion, the presence of headache seems associated with symptoms caused by the innate immune response. These findings support a headache pathophysiology linked with the innate immune response. Due to the potential negative consequences and its treatable nature, clinicians should systematically evaluate it and, whenever necessary, treat it too. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening hypersensitivity reaction with cutaneous presentation and internal organ involvement. We herein present a case of phenytoin induced DRESS syndrome in a 56- year-old male who presented with high-grade fever and chills, cough with expectoration and generalized maculopapular rash. Laboratory findings revealed eosinophilia, leukocytosis, thrombocytopenia, transaminitis and elevated inflammatory markers. Further clinical, radiological and histopathological assessments confirmed the diagnosis. Phenytoin was discontinued, and patient was started on intravenous dexamethasone, which was later switched to oral prednisone. Rapid resolution of fever, eosinophilia and progressive improvement in skin rash and liver dysfunction was observed. Our report highlights the importance of prompt recognition of DRESS syndrome and the need for a guideline directed therapy for the management of this adverse drug reaction. [ABSTRACT FROM AUTHOR]

Shivering occurs more frequently for women having caesarean section under neuraxial anaesthesia compared to other patient groups and causes an increase in pain and interrupts bonding with her newborn. This study aimed to report the evidence on non-pharmacological methods to treat shivering, defined as uncontrollable shaking, because of being cold, frightened, or excited, post neuraxial anaesthesia; the use of local anaesthesia inserted around the nerves of the central nervous system such as spinal anaesthesia and epidural in women having a caesarean section. A scoping review was conducted using six electronic health databases that were searched with no restrictions placed on language, date, or study type. Of the 1399 studies identified, following screenings only one study was deemed suitable for inclusion. The study, a randomised controlled trial, compared forced air warming blankets (intervention) with the usual care of warmed cotton blankets (control) and its impact on maternal and newborn outcomes. The only statistically significant difference found was the perceived thermal comfort of the mother. Non-pharmacological treatments for shivering are underrepresented in the literature; only one study identified where the impact of active warming was compared to warmed cotton blankets (usual care) for the measures of: oral temperature; degree of shivering; and thermal comfort pain scores. There was a decline in temperature in both groups at odds with some women reporting feeling too warm such that they asked for the active warmer to be turned down. Social engagement strategies are interventions that send a signal of safety to the nervous system leading to a sense of calm and wellbeing and have biological plausibility and warrant evaluation. Recommendations for further research: design a robust study to test the effectiveness of social engagement strategies on shivering for women having caesarean section under neuraxial anaesthesia. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative shivering is an involuntary, oscillatory muscular activity during early recovery after anaesthesia. Postoperative shivering is a frequent complication of anaesthesia; it has been reported to range from 20 to 70% in general anaesthesia. Shivering is believed to increase oxygen consumption and increase the risk of hypoxemia; it might also increase postoperative complications. dexmedetomidine might provide a simple pharmacological intervention to suppress shivering and improve comfort without producing respiratory compromise in patients. Methods: The study was conducted in department of anaesthesiology at Pt. B. D. Sharma PGIMS, Rohtak. Total one hundred thirty-two patients of either sex between 18-60 years of age having physical status of grade I and II according to American Society of Anaesthesiologists (ASA) scheduled for elective laproscopic cholecystectomy under general anaesthesia were included in this study. It was a prospective, randomized and double blinded study. All the patients were randomly divided into four groups of 33 each. Group-I(DN)(n=33) Administration of 20 ml of normal saline over 10 min. Group-II(D0.5)(n=33) Administration of 0.5 mcg kg-1 dexmedetomidine over 10 min. Group-III(D0.75)(n=33) Administration of 0.75 mcg kg-1dexmedetomidine over 10 min. Group-IV(D1.0)(n=33) Administration of 1.0 mcg kg-1 dexmedetomidine over 10 min. Results: After studying various factors, we found from our study that i.v dexmedetomidine in the dose range of 0.5 mcgkg-1, 0.75 mcgkg-1 and 1.0 mcgkg-1reduces the rise in heart rate, systolic blood pressure, diastolic blood pressure during general anaesthesia. Thus, dexmedetomidine provides better perioperative haemodynamic stability in ASA I and II grade patients during general anaesthesia as dexmedetomidine has sedative, anxiolytic and sympatholytic properties. The decrease in pain and shivering was greater in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo and time of first rescue analgesic was more in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo. Conclusion: we recommend dexmedetomidinedose 0.75mcgkg-1 as an anaesthetic adjuvant can be used during general anaesthesia as an optimal dose to reduce post operative shivering in patients undergoing laproscopic cholecystectomy, because it significantly attenuates heart rate and blood pressures, it decreases pain and shivering and it facilitates smooth emergence from anaesthesia and the sedation and complication rate of dexmedetomidinedose 0.75mcgkg-1 is lower than other doses. [ABSTRACT FROM AUTHOR]

Background: Post-spinal anesthesia shivering is a common complication during cesarean deliveries, affecting maternal comfort and potentially impacting neonatal outcomes. Various preventive measures exist, but their efficacy remains uncertain, prompting exploration of alternative strategies such as tramadol. Objective: This study aims to evaluate the effectiveness of tramadol in preventing postspinal anesthesia shivering during cesarean deliveries compared to standard methods. Methods: A randomized controlled trial was conducted involving 150 of parturients scheduled for elective cesarean sections under spinal anesthesia. Participants were randomized into two groups: tramadol and placebo. Shivering incidence, severity, and duration were assessed using a standardized scale. Maternal and neonatal parameters were secondary outcome measures. Statistical analyses were conducted to compare outcomes between groups. Results: Tramadol significantly reduced post-spinal anesthesia shivering incidence (12% vs. 30% placebo) and severity scores (0.8 vs. 1.5 immediately post-delivery). Maternal vital signs remained stable. Neonatal Apgar scores (1 & 5 mins) showed no significant differences, indicating tramadol's efficacy without adverse neonatal effects. Conclusion: Tramadol showed efficacy in reducing post-spinal anesthesia shivering during cesarean deliveries without significant adverse effects on mothers or newborns. These findings suggest tramadol could serve as a potential preventive measure in this clinical setting, although further studies are warranted to validate its long-term safety and costeffectiveness. [ABSTRACT FROM AUTHOR]

We investigated how young people comprehend stories of trauma through their immediate expressions after listening to personal testimonies of Holocaust survivors. The material included 747 drawings and 182 texts by 10–16-year-old Swedish pupils from 14 schools. Qualitative analyses and cross-tabulations showed that the testimonies elicited complex patterns of emotions and cognitive processing. Personal testimonies can thus be a powerful way of teaching about historical trauma, although complex cognitive meaning making might often require additional time and adult-facilitated conversation. Also, as the testimonies aroused strong emotions, they should be used in a well-informed way. [ABSTRACT FROM AUTHOR]

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. 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. The collected data were analyzed with repeated measures analysis of variance to detect significant differences between groups and significant changes within groups over time. 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). 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. [ABSTRACT FROM AUTHOR]