Inhaled Sedation with Volatile Anesthetics for Mechanically Ventilated Patients in Intensive Care Units: A Narrative Review.

Inhaled sedation was recently approved in Europe as an alternative to intravenous sedative drugs for intensive care unit (ICU) sedation. The aim of this narrative review was to summarize the available data from the literature published between 2005 and 2023 in terms of the efficacy, safety, and potential clinical benefits of inhaled sedation for ICU mechanically ventilated patients. The results indicated that inhaled sedation reduces the time to extubation and weaning from mechanical ventilation and reduces opioid and muscle relaxant consumption, thereby possibly enhancing recovery. Several researchers have reported its potential cardio-protective, anti-inflammatory or bronchodilator properties, alongside its minimal metabolism by the liver and kidney. The reflection devices used with inhaled sedation may increase the instrumental dead space volume and could lead to hypercapnia if the ventilator settings are not optimal and the end tidal carbon dioxide is not monitored. The risk of air pollution can be prevented by the adequate scavenging of the expired gases. Minimizing atmospheric pollution can be achieved through the judicious use of the inhalation sedation for selected groups of ICU patients, where the benefits are maximized compared to intravenous sedation. Very rarely, inhaled sedation can induce malignant hyperthermia, which prompts urgent diagnosis and treatment by the ICU staff. Overall, there is growing evidence to support the benefits of inhaled sedation as an alternative for intravenous sedation in ICU mechanically ventilated patients. The indication and management of any side effects should be clearly set and protocolized by each ICU. More randomized controlled trials (RCTs) are still required to investigate whether inhaled sedation should be prioritized over the current practice of intravenous sedation.

Designing a new fast solution to control isolation rooms in hospitals depending on artificial intelligence decision.

Decreasing the COVID spread of infection among patients at physical isolation hospitals during the coronavirus pandemic was the main aim of all governments in the world. It was required to increase isolation places in the hospital's rules to prevent the spread of infection. To deal with influxes of infected COVID-19 patients' quick solutions must be explored. The presented paper studies converting natural rooms in hospitals into isolation sections and constructing new isolation cabinets using prefabricated components as alternative and quick solutions. Artificial Intelligence (AI) helps in the selection and making of a decision on which type of solution will be used. A Multi-Layer Perceptron Neural Network (MLPNN) model is a type of artificial intelligence technique used to design and implement on time, cost, available facilities, area, and spaces as input parameters. The MLPNN result decided to select a prefabricated approach since it saves 43% of the time while the cost was the same for the two approaches. Forty-five hospitals have implemented a prefabricated solution which gave excellent results in a short period of time at reduced costs based on found facilities and spaces. Prefabricated solutions provide a shorter time and lower cost by 43% and 78% in average values respectively as compared to retrofitting existing natural ventilation rooms.

Impact of lockdown due to the COVID-19 pandemic on mental health among the Libyan population.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have a potentially serious effect on mental health and increase the risk of anxiety, depression, and post-traumatic stress disorders in people. In this study, we aimed to determine the prevalence of psychological illness and the impact of the COVID-19 pandemic on the Libyan population's mental health. METHOD: A cross-sectional survey, conducted in both online and paper modes and consisting of five sections, was completed in more than 30 cities and towns across Libya. The first section consisted of questions on basic demographic characteristics. The second section contained a survey related to the lockdown status, activities, related stress levels, and quarantine. The third section comprised the self-administered 9-item Patient Health Questionnaire (PHQ-9). The fourth section contained the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the fifth section contained the Impact of Event Scale-Revised (IES-R). RESULT: Of the 31,557 respondents, 4,280 (13.6%) reported severe depressive symptoms, with a mean [standard deviation (SD)] PHQ-9 score of 8.32 (5.44); 1,767 (5.6%) reported severe anxiety symptoms, with a mean (SD) GAD-7 score of 6 (4.6); and 6,245 (19.8%) of the respondents reported post-traumatic stress disorder (PTSD), with a mean (SD) score of 15.3 (18.85). In multivariate analysis, young age, being female, unmarried, educated, or victims of domestic violence or abuse, work suspension during the pandemic, and having increased workload, financial issues, suicidal thoughts, or a family member with or hospitalized due to COVID-19 were significantly associated with a high likelihood of depressive and anxiety symptoms, as well as PTSD. Internal displacement due to civil war was also associated with PTSD. CONCLUSION: To our knowledge, this is the first study to analyze the psychological impacts of the COVID-19 pandemic and civil war in Libya. Further study on the development of strategies and interventions aimed at reducing the mental disease burden on the Libyan population is warranted.

Psychological Impact of the Civil War and COVID-19 on Libyan Medical Students: A Cross-Sectional Study.

OBJECTIVE: We aim to determine the psychological status of medical students during the COVID-19 outbreak and civil war in Libya. METHODS: A cross-sectional study was conducted among medical students from 15 medical schools between April 20 and May 1, 2020. The demographic characteristics, generalized anxiety disorder 7-item (GAD-7) scale, and patient health questionnaire (PHQ-9) results were collected. RESULTS: Of the 3,500 students, 2,430 completed the survey. The mean (± SD) score of anxiety symptoms determined by the GAD-7 was 7.2 (5.1). A total of 268 (11%) students had a GAD-7 score of ≥15, which is indicative of moderate to severe anxiety. A total of 1,568 (64.5%) students showed different degrees of anxiety: mild, 910 (37.5%); moderate, 390 (16%); and severe, 268 (11%). Anxiety was significantly associated with living status and internal displacement (P < 0.05). The mean (+ SD) score of depressive symptoms determined by the PHQ-9 was 9.7 (6.3). A total of 525 (21.6%) students had a PHQ-9 score of ≥15, which is indicative of moderate to severe depression. A total of 1,896 (88%) students were diagnosed with mild (PHQ ≥ 5) depression. Suicidal ideation was present in 552 patients (22.7%). Depression was only statistically associated with the year of study (P = 0.009). CONCLUSION: These data highlight that medical students in Libya are at risk for depression, especially under the current stressful environment of the civil war and the COVID-19 outbreak.

Knowledge, preventive behavior and risk perception regarding COVID-19: a self-reported study on college students.

INTRODUCTION: There are a limited number of studies on the issues associated with the knowledge and self-practice preventive measures for COVID-19 among medical students. We aimed to determine the extent of knowledge, self-reported preventive behavior, and risk perception of the COVID-19 outbreak among college students in Libya. METHODS: A cross-sectional study was conducted from April 20 to April 30, 2020. The participants were students of medical and non-medical subjects from Libyan educational institutes. Data on participants' characteristics, knowledge, preventive behavior, and risk perception were collected. RESULTS: Approximately 3669 participants completed the questionnaire, of which 2547 (69.4) were medical students and 1122 (30.6%) were non-medical students. The mean knowledge score on COVID-19 was 8.62 (SD: 1.26, range: 0-12), corresponding to 71.8% correct answers. A significant difference was observed between medical and non-medical students in terms of knowledge (p < 0.001). Overall, the knowledge score of the students differed significantly with respect to age, current year of study, and financial source (p < 0.05). The mean score of preventive behavioral measures toward COVID-19 (out of 8) was 7.42 (SD: 0.95, range: 0-8), and the overall preventive measure score was estimated to be approximately 7.42/8*100, which corresponds to 92.7% for both medical and non-medical students. CONCLUSION: Notably, college students were observed to have substantial knowledge, preventive behavior, and a positive attitude toward COVID-19. Government programs should aim to educate individuals from other sectors of the society to ensure the proper dissemination of knowledge on preventive safety measures, as this will help restrict and control the pandemic.

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review.

The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.