A systematic review and meta-analysis of musculoskeletal disorders among firefighters.

INTRODUCTION: Due to the nature of their job, firefighters face many ergonomic risk factors and are exposed to several musculoskeletal disorders (MSDs). The aim of this systematic review and meta-analysis was to investigate the prevalence of MSDs among firefighters. MATERIALS AND METHODS: This study was conducted based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The literature search was conducted in the databases of PubMed, Scopus, Web of Science, Science Direct, SID, ISC and Google Scholar without applying a time limitation until the end of July 2022. The random effects model was used for meta-analysis, and the I2 index was used to check heterogeneity among studies. The data were analyzed using STATA version 14 software. RESULTS: The primary literature searches in the databases identified 1,291 articles, 26 of which were entered the meta-analysis stage after screening, study selection, and quality assessment, including 36,342 firefighters. Based on the results of a meta-analysis, the overall prevalence of MSDs among firefighters was 46.39% (95% CI: 32.45-60.32, I2 = 99.7%, P < 0.001). The prevalence of MSDs was also investigated at neck (18.36%), low back (34.32%), shoulder (18.68%), hands (7.43%), upper back (10.15%), knee (19.97%) and foot (6.66%). CONCLUSION: Considering the relatively high prevalence of MSDs among firefighters and their higher exposition to specific job-related risk factors of MSDs compared to other professions, it is suggested to provide firefighters with appropriate training, implement ergonomic interventions, and regularly screen them to reduce MSDs.

Post-traumatic stress disorder in medical workers involved in earthquake response: A systematic review and meta-analysis.

Introduction: Medical workers involved in responding to the earthquake are exposed to frightening scenes and witness dead bodies and severely injured moaning people, predisposing them to multiple mental health consequences. This study was aimed to determine the prevalence of Post-Traumatic Stress Disorder (PTSD) after earthquakes among medical workers using a systematic review and meta-analysis. Materials and methods: The review study was performed following PRISMA guidelines, and the study's protocol was registered in PROSPERO with the code CRD42022333069. The data resources of Google Scholar, Science Direct, Web of Science, PubMed, and Scopus were searched to specify the related studies. To perform meta-analysis, the random effects model was utilized, and the I2 index was considered to assess heterogeneity between studies. The STATA software was used for data analysis. Results: In the initial data resources search, 1399 articles were identified. From these articles, 13 were finally chosen for meta-analysis and quality assessment. The meta-analysis results indicated that the prevalence of post-earthquake PTSD among medical workers involved in the earthquake response was 16.37% (95% CI: 11.63-21.11, I2 = 97.33%, p = 0 < 0.001). Conclusion: The medical workers involved in response to the earthquake have a relatively high risk of PTSD in the short and long term. Therefore, medical workers involved in response to disasters should undergo screening for mental health disorders before and after disasters and receive the necessary training with regard to stress management, psychological resilience, and how to express their feelings and emotions.

A Novel Hardware-Software Co-Design and Implementation of the HOG Algorithm.

The histogram of oriented gradients is a commonly used feature extraction algorithm in many applications. Hardware acceleration can boost the speed of this algorithm due to its large number of computations. We propose a hardware-software co-design of the histogram of oriented gradients and the subsequent support vector machine classifier, which can be used to process data from digital image sensors. Our main focus is to minimize the resource usage of the algorithm while maintaining its accuracy and speed. This design and implementation make four contributions. First, we allocate the computationally expensive steps of the algorithm, including gradient calculation, magnitude computation, bin assignment, normalization and classification, to hardware, and the less complex windowing step to software. Second, we introduce a logarithm-based bin assignment. Third, we use parallel computation and a time-sharing protocol to create a histogram in order to achieve the processing of one pixel per clock cycle after the initialization (setup time) of the pipeline, and produce valid results at each clock cycle afterwards. Finally, we use a simplified block normalization logic to reduce hardware resource usage while maintaining accuracy. Our design attains a frame rate of 115 frames per second on a Xilinx® Kintex® Ultrascale™ FPGA while using less hardware resources, and only losing accuracy marginally, in comparison with other existing work.

Novel coronavirus 2019 pneumonia in a kidney transplant recipient.

The COVID-19 pandemic is spreading worldwide and the impact of the disease in transplant patients is evolving. In this case report, we presented a 63-year-old female kidney transplant recipient who presented with dyspnea and cough and was diagnosed with COVID-19 pneumonia. On the fourth day of admission, the patient's condition worsened. Therefore, the immunosuppressive medications were discontinued, and hydrocortisone was started. The patient died on the fifth day.

Unconsciousness After Regional Anesthesia for Arteriovenous Fistula Revision in a Patient with End-stage Renal Disease.

Chronic kidney disease can lead to different chronic complications. We describe a case where a patient with end-stage renal disease (ESRD) became unresponsive during transportation to the recovery room, following finishing an arteriovenous fistula revision. The patient had received supraclavicular block ninety minutes prior to the incident and surgery was finished under monitored anesthesia care (MAC). After five minutes of chest compression and intubation, monitoring showed normal sinus rhythm and the return of spontaneous circulation. The patient was transferred to the intensive care unit and extubated two days later while she was alert, oriented and hemodynamically stable. CT pulmonary angiogram showed no evidence of pulmonary emboli and echocardiogram did not show any further cardiac event comparing to preoperative status. Ruling out other differential diagnoses for patient's unconsciousness, we have discussed the possibility of neuraxial anesthesia after upper extremity block in this patient.

The Effect of Spinal versus General Anesthesia on Quality of Life in Women Undergoing Cesarean Delivery on Maternal Request.

Introduction The proportion of women electing for cesarean delivery has increased in both developed and developing countries. Cesarean delivery on maternal request (CDMR) refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of standard medical/obstetrical indications. Several studies compared anesthesia modalities in cesarean section regarding clinical outcomes such as maternal mortality, post-operative pain and bleeding, but only a few compared health-related quality of life (HRQoL) of women undergoing general anesthesia versus spinal anesthesia. The aim of this study was to determine whether pregnant women who undergo general anesthesia (GA) for cesarean delivery compared with spinal anesthesia (SA) differ regarding their perceived HRQoL. Methodology We enrolled 160 pregnant women with American Society of Anesthesiologists (ASA) class II, scheduled for CDMR with GA or SA. Anesthesia modality was based on patient's preference. Participants assessed their state of health with the EuroQoL-5 Dimensions-3 Levels (EQ-5D-3L) self-administered questionnaire at four time points: six hours before cesarean delivery, 24 hours after cesarean delivery, one week and one month after cesarean delivery. Patients also rated their health on the EQ visual analog scale (EQ-VAS) from 100 mm "best imaginable health state" to 0 mm "worst imaginable health state". Results More women who underwent spinal anesthesia reported "no problem" with regards to "mobility' (64% vs. 30%, p = 0.00), "usual activities" (90% vs. 38%, p = 0.00), and "pain/discomfort" (20% vs. 5%, p = 0.007). Repeated measurement analysis showed that the two groups started off with the same EQ-VAS score, however, both decreased over time with different slope resulting in different scores at 24 hours after CS. Then the scores increased in both groups over time and ended up being rather close at one month after CS. Discussion Unless there is a contraindication, neuraxial anesthesia is the anesthetic technique of choice for cesarean delivery in all parturient in general. This concept is based on more mortality and morbidity that have been seen with general anesthesia in this particular population. Our study demonstrated significant advantages of spinal anesthesia compared to general anesthesia in cesarean section regarding postoperatively perceived HRQoL. We showed that more pregnant women who chose spinal anesthesia as their anesthesia modality reported "no problem" with respect to "mobility" and "Self-care" 24 hours after cesarean section. On the top of that, more women in this group had "no problem" in their "usual activities" at one week and one month after cesarean delivery time points. Moreover, EQ-5D general health score was higher 24 hours after cesarean delivery with regional anesthesia comparing to general anesthesia. Conclusion We determined that compared to general anesthesia, spinal anesthesia is the technique of choice for cesarean section because not only it avoids a general anesthetic and the risk of failed intubation, but also because it provides effective pain control, mobility and fast return back to daily activities for new mothers and increase their quality of life.

Urethral catheter traction reduces bleeding compared with suturing of prostatic vesical junction during suprapubic prostatectomy: a randomized clinical trial study.

OBJECTIVES: To determine whether catheter traction during suprapubic prostatectomy can be beneficial in reducing intraoperative and postoperative bleeding. METHODS: A total of 156 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from September 2004 to January 2006. Of the patients, 78 underwent open prostatectomy with suturing at the prostatic vesical junction (group 1) and 78 were treated with urethral catheter traction to control bleeding (group 2). The duration of operation, duration of hospital stay, intraoperative blood loss, hemoglobin decrease, and weight of resected prostate were recorded in both groups. Three months later, we followed up patients with the International Prostate Symptom Score questionnaire, maximal flow rate measurement, and cystoscopic examination. RESULTS: The mean operative time was 59 +/- 7 minutes and 40 +/- 9 minutes (P = .015) and the mean hospital stay was 3.7 +/- 0.24 days and 4.4 +/- 0.46 days (P = .09) in groups 1 and 2, respectively. The mean blood loss during surgery was 279 +/- 155 mL and 219 +/- 139 mL (P = .04) and the mean hemoglobin decrease was 2.3 +/- 1.4 g/dL and 1.6 +/- 1.5g/dL (P = .04) in groups 1 and 2, respectively. The mean weight of the prostate was not significantly different statistically between the 2 groups at 63 +/- 23 g and 64 +/- 19 g in groups 1 and 2, respectively (P = .8). The urethrocystoscopy examination at 3 months postoperatively revealed bladder neck contractures in 6.41% of the patients in group 1 and 3.85% in group 2. CONCLUSIONS: The results of our study have shown that urethral catheter traction diminishes bleeding compared with suturing at the prostatic vesical junction during suprapubic prostatectomy.

Difficult ventilation from increased abdominal pressure.

Airway management is one of the most important responsibilities of every anesthesiologist. A problematic situation arises when a patient is intubated correctly but not being ventilated. A case of a 4-year-old child who was involved in a car accident, presented for an exploratory laparotomy. Although she was successfully intubated, she could not be ventilated. The situation only improved after a large volume of fluid (urine) was drained from the abdomen.