Evaluation of the immune system status and hematological dyscrasias, among amphetamine and cannabis abusers at Eradah Hospital in Qassim, Saudi Arabia.

This cross-sectional study aims to evaluate the immune system status and hematological disturbances among individuals who abuse amphetamines and cannabis. Substance abuse, particularly of amphetamines and cannabis, has been associated with various adverse effects on the body, including potential impacts on the immune system and hematological parameters. However, limited research has been conducted to comprehensively assess these effects in a cross-sectional design. Additionally, fungal infections are on the rise internationally, and immune-compromised people are particularly susceptible. The study will recruit a sample of amphetamine and cannabis abusers (n = 50) at the Eradah Hospital in the Qassim Region of Buraydah and assess their sociodemographic and biochemical variables, including blood indices and differential WBC indices, liver, and kidney profiles. Additionally, 50 sputum samples in total were cultured for testing for fungus infections. To obtain the descriptive statistics, the data was imported into Microsoft Excel and subjected to statistical analysis using SPSS 22.0. Amphetamine and cannabis abuser's sociodemographic variables analysis observed that the majority (52%) were aged 18-30, with 56% in secondary school. Unemployment was a significant issue, and most had no other health issues. The majority (50%) had 5-10 years of abuse, while 32% had less than 5 years, and only 18% had been drug abusers for more than 10 years. There were significant changes (p < 0.001) in all different leukocyte blood cells, including neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Furthermore, a microscopic examination of blood films from individuals who misuse the combination of the medications "amphetamine and cannabis" reveals hazardous alterations in Neutrophils. Out of 50, 35 sputum samples showed positive growth on Sabouraud dextrose agar (SDA) with chloramphenicol antibiotic, indicating a unicellular fungal growth. The present study explores the immune system and hematological disturbances linked to amphetamine and cannabis abuse, providing insights into health risks and targeted interventions. The findings complement previous research on drug users' hematological abnormalities, particularly in white blood cells. Routine hematological tests help identify alterations in homeostatic conditions, improving patient knowledge and preventing major issues. Further research is needed on multi-drug abuse prevention, early detection, and intervention. The cross-sectional design allows for a snapshot of the immune system and hematological status among abusers, laying the groundwork for future longitudinal studies. Key Words: Drug Effect, Immunity, Epidemiology, Oxidative Stress, Inflammation.

The impact of moderate versus deep neuromuscular blockade on the recovery characteristics following laparoscopic sleeve gastrectomy: A randomized double blind clinical trial.

Background: Anesthesia with deep neuromuscular block for laparoscopic surgery may result in less postoperative pain with lower intra-abdominal pressure. However, the results in the existing literature are controversial. This study aimed to evaluate the effect of deep versus moderate neuromuscular block (NMB) on the postoperative recovery characteristics after laparoscopic sleeve gastrectomy (LSG) for weight loss surgery. Methods: This is parallel-group, randomized clinical trial. The study was conducted at a tertiary care center. Patients undergoing LSG were included. Patients were randomly assigned to either deep (post-tetanic count 1-2) or moderate (train-of-four 1-2) NMB group. The primary outcomes were numeric rating scale scores of the postoperative pain at rest and postoperative shoulder pain. The secondary outcomes were the length of hospital stay (LOS) and postoperative complications. The statistics were performed using StatsDirect statistical software (Version 2.7.9). Results: Two groups were identified: Group D (deep NMB), 29 patients, and Group M (moderate NMB), 28 patients. The BMI mean values for groups D and M were 44 and 45 kg/m2 respectively (P > 0.05). The mean durations of surgery for were 46.7 min and 44.1 min for groups M and D, respectively (P > 0.05). The mean train-of-four (TOF) counts were 0.3 and 0 for groups M and D, respectively (P < 0.05). The mean times from giving reversal agent to tracheal extubation (minutes) were 6.5 and 6.58 min for groups M and D, respectively (P > 0.05). In the recovery room, the means of pain scores were 3 and 4 for groups M and D, respectively (P > 0.05). Upon admission to the surgical ward, the median values of the pain score were non-significant (P > 0.05) (95% CI: 0.4-0.7). The opioid consumption in the recovery room was non-significant between both groups (P > 0.05) (95% CI: 0.3-0.6). Postoperative shoulder pain was non-significant between both groups (P > 0.05) (95% CI: 0.4-0.7). The median values of surgeon opinion of both groups were non-significant (P > 0.05). Regarding the LOS, the mean values of groups D and M were 1.20 and 1.21 days, respectively (P > 0.05). Conclusions: There was no significant difference between moderate and deep NMB techniques in terms of duration of the surgical procedure, postoperative pain, shoulder pain, and length of hospital stay. Further studies on a larger sample size are required to investigate the long-term recovery characteristics of patients with obesity undergoing LSG.

Mathematical modeling of cholera dynamics with intrinsic growth considering constant interventions.

A mathematical model that describes the dynamics of bacterium vibrio cholera within a fixed population considering intrinsic bacteria growth, therapeutic treatment, sanitation and vaccination rates is developed. The developed mathematical model is validated against real cholera data. A sensitivity analysis of some of the model parameters is also conducted. The intervention rates are found to be very important parameters in reducing the values of the basic reproduction number. The existence and stability of equilibrium solutions to the mathematical model are also carried out using analytical methods. The effect of some model parameters on the stability of equilibrium solutions, number of infected individuals, number of susceptible individuals and bacteria density is rigorously analyzed. One very important finding of this research work is that keeping the vaccination rate fixed and varying the treatment and sanitation rates provide a rapid decline of infection. The fourth order Runge-Kutta numerical scheme is implemented in MATLAB to generate the numerical solutions.

Phase-Dependent Properties of Manganese Oxides and Applications in Electrovoltaics.

This study reports first-principles predictions as well as experimental synthesis of manganese oxide nanoparticles under different conditions. The theoretical part of the work comprised density functional theory (DFT)-based calculations and first-principles molecular dynamics (MD) simulations. The extensive research efforts and the current challenges in enhancing the performance of the lithium-ion battery (LIB) provided motivation to explore the potential of these materials for use as an anode in the battery. The structural analysis of the synthesized samples carried out using X-ray diffraction (XRD) confirmed the tetragonal structure of Mn3O4 on heating at 450 and 550 °C and the cubic structure of Mn2O3 on heating at 650 °C. The structures are found in the form of nanoparticles at 450 and 550 °C, but at 650 °C, the material appeared in the form of a nanoporous structure. Further, we investigated the electrochemical functionality of Mn2O3 and Mn3O4 as anode materials for utilization in LIBs via MD simulations. Based on the investigations of their electrical, structural, diffusion, and storage behavior, the anodic character of Mn2O3 and Mn3O4 is predicted. The findings indicated that 10 lithium atoms adsorb on Mn2O3, whereas 5 lithium atoms adsorb on Mn3O4 when saturation is taken into account. The storage capacities of Mn2O3 and Mn3O4 are estimated to be 1697 and 585 mAh g-1, respectively. The maximum value of lithium insertion voltage per Li in Mn2O3 is 0.93 and 0.22 V in Mn3O4. Further, the diffusion coefficient values are found as 2.69 × 10-9 and 2.65 × 10-10 m2 s-1 for Mn2O3 and Mn3O4, respectively, at 300 K. The climbing image nudged elastic band method (Cl-NEB) was implemented, which revealed activation energy barriers of Li as 0.30 and 0.75 eV for Mn2O3 and Mn3O4, respectively. The findings of the work revealed high specific capacity, low Li diffusion energy barrier, and low open circuit voltage for the Mn2O3-based anode for use in LIBs.

Antimicrobial Activity of Novel Ni(II) and Zn(II) Complexes with (E)-2-((5-Bromothiazol-2-yl)imino)methyl)phenol Ligand: Synthesis, Characterization and Molecular Docking Studies.

In order to address the challenges associated with antibiotic resistance by bacteria, two new complexes, Ni(II) and Zn(II), have been synthesized using the conventional method based on Schiff base ligand (E)-2-((5-bromothiazol-2-yl) imino) methyl) phenol. The Schiff base ligand (HL) was synthesized using salicylaldehyde and 5-(4-bromophenyl)thiazol-2-amine in both traditional and efficient, ecologically friendly, microwave-assisted procedures. The ligand and its complexes were evaluated by elemental analyses, FTIR spectroscopy, UV-Vis spectroscopy, nuclear magnetic resonance (NMR), thermogravimetric analysis (TGA) and magnetic susceptibility. The ligand and its complexes were tested for antibacterial activity against three Gram-positive bacteria (Staphylococcus aureus ATCC 25923, Methicillin-resistant Staphylococcus aureus ATCC 43300 and Enterococcus faecalis ATCC 29212) and three Gram-negative bacteria (Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922 and Klebsiella pneumoniae ATCC 700603). The findings demonstrate the potent activity of the ligand and its complexes against selective bacteria but the Ni(II) complex with MIC values ranging from 1.95 to 7.81 µg/mL outperformed all other compounds, including the widely used antibiotic Streptomycin. Furthermore, the docking study provided evidence supporting the validity of the antimicrobial results, since the Ni complex showed superior binding affinity against to E. coli NAD synthetase, which had a docking score (-7.61 kcal/mol).

Procedural sedation analgesia in the elderly patient.

Elderly patients are perceived as a high-risk group for procedural sedation. Procedural sedation analgesia (PSA) is generally safe in older adults. What is not acceptable is undertreating pain or inadequately sedating a stable patient. All the usual precautions should be taken. One should consider any comorbidities that could make the patient more at risk of adverse reactions or complications. Older patients may be at higher risk for oxygen desaturation, but they usually respond quickly to supplemental oxygen. Geriatric patients usually require lower doses of medications. They tend to be more sensitive to medications, with slower metabolism, less physiologic reserve to handle side effects, and a smaller volume of distribution. The use of drugs for sedation in elderly patients requires careful consideration of their age-related changes in physiology and pharmacokinetics. The choice of drug should be based on the patient's medical condition, comorbidities, and potential adverse effects. Moreover, the administration should be done by trained personnel with close monitoring of vital signs and level of consciousness to prevent complications such as respiratory depression.

New Method Based on the Direct Analysis in Real Time Coupled with Time-of-Flight Mass Spectrometry to Investigate the Thermal Depolymerization of Poly(methyl methacrylate).

In this work, the isothermal decomposition of poly(methyl methacrylate) synthesized in bulk by the radical route of methyl methacrylate in the presence of azobisisobutyronitrile as the initiator was carried out and monitored for the first time with the DART-Tof-MS technique at different temperatures. Nuclear magnetic resonance (NMR) analysis revealed a predominantly atactic microstructure, and size-exclusion chromatography (SEC) analysis indicated a number average molecular weight of 3 × 105 g·mol-1 and a polydispersity index of 2.47 for this polymer. Non-isothermal decomposition of this polymer carried out with thermogravimetry analysis (TGA) showed that the weight loss process occurs in two steps. The first one starts at approximately 224 °C and the second at 320 °C. The isothermal decomposition of this polymer carried out and monitored with the DART-Tof-MS method revealed only one stage of weight loss in this process, which begins at approximately 250 °C, not far from that of the second step observed in the case of the non-isothermal process conducted with the TGA method. The results obtained with the MS part of this technique revealed that the isothermal decomposition of this polymer regenerates a significant part of methyl methacrylate monomer, which increases with temperature. This process involves radical chain reactions leading to homolytic chain scissions and leading to the formation of secondary and tertiary alkyl radicals, mainly regenerating methyl methacrylate monomer through an unzipping rearrangement. Although they are in the minority, other fragments, such as the isomers of 2-methyl carboxyl, 4-methyl, penta-2,4-diene and dimethyl carbate, are also among the products detected. At 200 °C, no trace of monomer was observed, which coincides with the first step of the weight loss observed in the TGA. These compounds are different to those reported by other researchers using TGA coupled with mass spectrometry in which methyl isobutyrate, traces of methyl pyruvate and 2,3-butanonedione were detected.

Utility of Initial Arterial Blood Gas in Neuromuscular versus Non-Neuromuscular Acute Respiratory Failure in Intensive Care Unit Patients.

Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32−7.43), 7.33 (7.22−7.39), p < 0.001), PaO2 (86.9 (71.4−123), 79.6 (64.6−99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9−27.8), 23.4 (19.4−26.8) mmol/L, p = 0.006). We found differences in the median of PaCO2 in NMRF (41.5 mmHg) versus PPD (63.3 mmHg), PaO2 in NMRF (86.9 mmHg) versus pneumonia (74.3 mmHg), and HCO3 in NMRF (24.8 mmol/L) versus pulmonary edema (20.9 mmol/L) (all p < 0.01). NMRF compared to non-NMRF patients had a lower frequency of hypercarbia (24.6% versus 39.9%) and hypoxia (33.8% versus 50.5%) (all p < 0.05). NMRF compared to PPD patients had lower frequency of combined hypoxia and hypercarbia (13.2% versus 37.8%) but more frequently isolated high bicarbonate (33.8% versus 8.9%) (all p < 0.001). Conclusions: The ranges of ABG changes in NMRF patients differed from those of non-NMRF patients, with a greater reduction in PaO2 in non-NMRF than in NMRF patients. Combined hypoxemia and hypercarbia were most frequent in PPD patients, whereas isolated high bicarbonate was most frequent in NMRF patients.

Road map toward establishing fellowship programs in an academic anesthesia department.

An impactful fellowship management should provide fellows with: Strong commitments and engagement from senior teams, ample and diverse opportunities to interact with mentors, strong exposure and sufficient access to the latest in academic training and experience, flexibility to fit the fellow's area of specialty and research, and extensive opportunities for professional development. One of the important features of our fellowship programs curriculum will be the use of simulation based training programs for the courses and workshops of the target fellowship.

Poly(ethylene-Co-vinyl Alcohol)/Titanium Dioxide Nanocomposite: Preparation and Characterization of Properties for Potential Use in Bone Tissue Engineering.

A series of poly(ethylene-co-vinyl alcohol)/titanium dioxide (PEVAL/TiO2) nanocomposites containing 1, 2, 3, 4 and 5 wt% TiO2 were prepared by the solvent casting method. These prepared hybrid materials were characterized by Fourier-transform infrared (FT-IR), X-ray diffraction (XRD), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and scanning electron microscopy (SEM). The pores and their interconnections inside these nanocomposites were created using naphthalene microparticles used as a porogen after having been extracted by sublimation under a high vacuum at temperatures slightly below the glass transition temperature. A cellular activity test of these hybrid materials was performed on human gingival fibroblast cells (HGFs) in accordance with ISO 10993-5 and ISO 10993-12 standards. The bioviability (cell viability) of HGFs was evaluated after 1, 4 and 7 days using Alamar Blue®. The results were increased cell activity throughout the different culture times and a significant increase in cell activity in all samples from Day 1 to Day 7, and all systems tested showed significantly higher cell viability than the control group on Day 7 (p < 0.002). The adhesion of HGFs to the scaffolds studied by SEM showed that HGFs were successfully cultured on all types of scaffolds.

Copolymer Involving 2-Hydroxyethyl Methacrylate and 2-Chloroquinyl Methacrylate: Synthesis, Characterization and In Vitro 2-Hydroxychloroquine Delivery Application.

The Poly(2-chloroquinyl methacrylate-co-2-hydroxyethyl methacrylate) (CQMA-co-HEMA) drug carrier system was prepared with different compositions through a free-radical copolymerization route involving 2-chloroquinyl methacrylate (CQMA) and 2-hydroxyethyl methacrylate) (HEMA) using azobisisobutyronitrile as the initiator. 2-Chloroquinyl methacrylate monomer (CQMA) was synthesized from 2-hydroxychloroquine (HCQ) and methacryloyl chloride by an esterification reaction using triethylenetetramine as the catalyst. The structure of the CQMA and CQMA-co-HEMA copolymers was confirmed by a CHN elementary analysis, Fourier transform infra-red (FTIR) and nuclear magnetic resonance (NMR) analysis. The absence of residual aggregates of HCQ or HCQMA particles in the copolymers prepared was confirmed by a differential scanning calorimeter (DSC) and XR-diffraction (XRD) analyses. The gingival epithelial cancer cell line (Ca9-22) toxicity examined by a lactate dehydrogenase (LDH) assay revealed that the grafting of HCQ onto PHEMA slightly affected (4.2-9.5%) the viability of the polymer carrier. The cell adhesion and growth on the CQMA-co-HEMA drug carrier specimens carried out by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) (MTT) assay revealed the best performance with the specimen containing 3.96 wt% HCQ. The diffusion of HCQ through the polymer matrix obeyed the Fickian model. The solubility of HCQ in different media was improved, in which more than 5.22 times of the solubility of HCQ powder in water was obtained. According to Belzer, the in vitro HCQ dynamic release revealed the best performance with the drug carrier system containing 4.70 wt% CQMA.

The effect of low versus high tidal volume ventilation on inflammatory markers in animal model undergoing lung ventilation: A prospective study.

BACKGROUND AND AIMS: Mechanical ventilation (MV) with high tidal volume (Vt.) may induce or aggravate lung injury in critically ill patients. It might also cause an overwhelming systemic inflammation leading to acute lung injury (ALI), diffuse alveolar damage (DAD) and multiple organ failure (MOF) with subsequent high mortality. The objective of this study was to compare the effects of different Vt. on the inflammatory markers of the broncho-alveolar lavage (BAL) fluid and lung biopsy in a group of animal model (Beagle dogs). METHODS: A two-phased prospective study involving 30 Beagle dogs (15 dogs/phase), each phase divided into three groups (each 5 dogs/group). In the first phase each group received MV with Vt. of 8 (low), 10 (normal, control group), and 12 (high) ml/kg body weight (b.w.) respectively. BAL fluid was obtained at the time of induction of anesthesia immediately following tracheal intubation and one hour later following MV to count the macrophages, neutrophils and lymphocytes. In the second phase of the experiment, in addition to obtaining (BAL) fluid similar to the phase one, mini thoracotomy and lung biopsy obtained from the upper lobe of the right lung at same timings for histopathological examination study. Mann-Whitney-Wilcoxon test was used for statistical analysis of the data obtained. RESULTS: BAL fluid analysis showed increase in the counts of macrophages and lymphocytes with Vt. of 12 ml/kg b.w. compared to the control group (10 ml/kg b.w.) (P < 0.05). in the second phase, similar findings obtained. The histopathological study of the lung tissue obtained in the second phase of the study from the group that received a high Vt. of 12 ml/kg b.w. showed significant inflammatory changes with presence of neutrophil infiltration and edema in the bronchial wall compared to the control group (10 ml/kg b.w.) (P < 0.05). CONCLUSIONS: The use of high Vt. in ventilated animal lung model may increase the risk of inflammation and subsequent damage in healthy lungs, these findings may help physicians to avoid using high Vt. in short-term mechanically ventilated patients in the operating room setting.

Mathematical model for the dynamics of Savanna ecosystem considering fire disturbances.

In this article, the stability of equilibrium solutions of a recently formulated mathematical model of Savanna ecosystem is analytically and numerically analyzed. The mathematical model is formulated by generalizing all plant life into three components; trees, tree saplings, and grass under ecologically valid effects of fire, rainfall and competition for space. Fire has a considerable effect on trees by delaying the recruitment of saplings to trees and the recruitment rate is a piecewise linear decreasing function of grass with a sigmoidal shape. This leads to there existing different equilibria in the plant community of a Savanna ecosystem. It is rigorously demonstrated that the local stability of equilibria depends on the slope and value of the recruitment function. Moreover, it is found that the composition of high grass cover and low tree cover or low grass cover and high tree cover are the stable equilibria, while intermediate cover results in unstable equilibria. In analyzing the global stability of solutions, it is found that the limit set is an equilibrium solution. Several numerical simulations are provided to validate the analytical studies of the behavior of the equilibrium solutions. The numerical solutions are generated using a Python ordinary differential equation(ODE) solver. The analytical and numerical solutions presented in this work are very important for further developments in the area of mathematical ecology.

Efficacy of height-based formula to predict insertion depth of left-sided double lumen tube: A prospective observational study.

The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height0.916) could predict the accurate insertion depth of a left-sided double-lumen tube. After obtaining ethical approval, 66 patients who underwent thoracic surgery were included. A left-sided double-lumen tube was advanced blindly to the predicted depth of insertion calculated using our formula. The optimal position of the left-sided double-lumen tube was confirmed using a fibreoptic bronchoscope. The primary outcome was the percentage of tubes placed in the optimal position without the need for further adjustments. The secondary outcomes included the need for bronchoscopic adjustments and the final correct insertion depth of the left-sided double-lumen tube. The formula resulted in an optimum position of the left-sided double-lumen tube without further adjustments in 45 patients (70%) (95% confidence interval 58%-80%). The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.

Anesthesia management of ophthalmic surgery for patient with suspected/confirmed COVID-19 -Saudi Anesthesia Society guidelines.

The outbreak of the novel coronavirus (COVID-19) has been declared a global pandemic. With a mortality rate reaching up to 5%, healthcare professionals treating patients with COVID-19 are at a significantly higher risk for exposure themselves. Given the rapidly progressing rate of COVID-19, there is an urgent need for developing guidelines within each specialty. This article discusses guidelines specifically for anesthesiologists dealing with ophthalmic surgeries with suspected or confirmed COVID-19 patients. Anesthesiologists always work in the proximity of the patient's face while performing either ocular regional anesthesia or while managing the airway in the process of intubation/extubation. Within these guidelines, the emphasis is provided on thorough preoperative screening to identify COVID-19 patients and to prevent the exposure of healthcare staff by following standard personal protective equipment (PPE) precautions.

Anesthesia management of thoracic surgery in a patient with suspected/confirmed COVID-19: Interim Saudi Anesthesia Society guidelines.

The Saudi Anesthesia Society (SAS) has developed interim guidelines on perioperative care of COVID-19 patients who undergo surgery and anesthesia.[1] Patients with "suspected/confirmed" COVID-19 might be scheduled for emergency thoracic procedures either during the acute or convalescence phases of the disease. There is a demanding need to develop the SAS recommendations on the perioperative care of thoracic surgery patients during the COVID-19 outbreak. There are no relevant publications on perioperative care of thoracic surgery in COVID-19 patients. These recommendations were developed from the previous experience of management of patients during the MERS-CoV outbreak in 2012-2013 and literature available on the general airway and anesthesia care for patients with COVID-19, SARS, MERS-CoV.

Airway management and COVID-19 patient -Saudi Anesthesia Society guidelines.

The Saudi Anesthesia Society (SAS) in line with the Mission and Vision of the Kingdom of Saudi Arabia to contain the new coronavirus disease (COVID-19) is pleased to develop a statement regarding airway management of suspected/confirmed patients with this virus, to ensure the safe practice in dealing with the patient as well as protecting the medical staff from getting the infection. In this report, we have summarized the guidelines necessary for airway management of suspected/confirmed COVID-19 patient. Since the COVID-19 outbreak is up to date existed, therefore this report is considered as interim guidelines for airway management of the suspected/confirmed patients. The guidelines will be revisited and modified in the future, if necessary.

Appearance of Population, Intervention, Comparison, and Outcome as research question in the title of articles of three different anesthesia journals: A pilot study.

BACKGROUND: It is well known in the evidence-based medicine practice that framing the research question is the most important and crucial part of the research integrity. Population, Intervention, Comparison, and Outcome (PICO) is a specialized framework used by most researchers to formulate a research question and to facilitate literature review. The aim of this study is to investigate the representation of the PICO frame in the title of published articles in three different anesthesia journals. METHODS: We performed this double-blind, pilot study on papers published in three anesthesia journals, including Anesthesia and Intensive care (a), Saudi Journal of Anaesthesia (b), and Anesthesia Analgesia (c) from January 2016 to September 2017. We randomly selected 30 randomized controlled trials from each journal to check for the PICO frame in the title of each article. We used Chi-square test to compare the met variables in the three journals with respect to PICO frame. Met variables are those who met the PICO frame and not met are not. We assumed a statistically significant difference when P was <0.05. RESULTS: Ninety randomized controlled trials articles (n = 90) were included in this study (n = 30 each journal A, B, and C). Corresponding estimates of the percent of papers that failed (not met) to adopt PICO elements were as follow for journal A, B, and C, respectively: Population: 30%, 30%, and 20%; Intervention: 50%, 30%, and 26.7%; Comparison: 53.3%, 60%, and 53.3%; and Outcome: 30%, 6.7%, and 0.0% with significant differences between journals A and C (P < 0.05). CONCLUSION: Researches adopting PICO elements usually receive higher citation percentages. There is a need to further investigate the PICO framework in a larger study to determine whether it can be well represented in the titles of different research designs. That, in turn, will help the precision of searches performed on a PICO-formatted screen to receive relevant citations.

Using fentanyl and propofol for tracheal intubation during sevoflurane induction without muscle relaxants in children: A randomized prospective study.

CONTEXT: Tracheal intubation is frequently facilitated with sevoflurane induction without the use of muscle relaxants in children. AIM: The aim of this study was to compare the effects of two different doses of propofol preceded by a fixed dose of fentanyl during sevoflurane induction on quality of tracheal intubation in children. SETTINGS AND DESIGN: This was a prospective randomized study. SUBJECTS AND METHODS: Ninety American Society of Anesthesiologists I-II children aged 2-6 years were randomly assigned to one of two equal groups to receive 2 µg/kg of fentanyl with 2 mg/kg of propofol (Group I) or 2 µg/kg of fentanyl with 3 mg/kg of propofol (Group II) during sevoflurane induction. The intubating conditions and hemodynamic responses were evaluated. The time from sevoflurane induction to loss of consciousness, to intravenous line insertion, and to intubation was measured. The occurrence of any adverse effect was recorded. STATISTICAL ANALYSIS USED: Results were analyzed using Student's t-test, paired t-test, and Chi-square test. P < 0.05 was considered statistically significant. RESULTS: The incidence of excellent intubating conditions was achieved more significantly in Group II (41/45 patients, 91%) than that in Group I (31/45 patients, 69%) (P = 0.008) (95% confidence interval [CI] =0.39-0.8). Whereas, there were no significant differences between the two groups in terms of the overall acceptable intubating conditions in Group I (40/45 patients, 89%) and Group II (43/45 patients, 96%) (P = 0.81) (95% CI = 0.71-1.31). No patient developed any adverse effect. CONCLUSION: The administration of 3 mg/kg propofol preceded by 2 µg/kg fentanyl provided a higher proportion of excellent intubating conditions compared with 2 mg/kg propofol preceded by 2 µg/kg fentanyl during sevoflurane induction in children without muscle relaxants.

Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program.

The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.