Journal of Acute Disease

94-100

Authors: Hesameddin Modir, Esmail Moshiri, Mehran Azami, Tayebe Sadat Sayafi-Sharifi

Objective: To compare the efficacy of midazolam, fentanyl, and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty. Methods: This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists class I or II, who needed knee arthroplasty. Patients were stratified into three intervention groups, including the midazolam group, the fentanyl group, and the magnesium sulfate group, and the patients were administered with midazolam, fentanyl, and magnesium sulfate, respectively. Hemodynamic parameters, sensory and motor block, and pain score (Visual Analogue Scale) were measured and compared among the three groups. Results: A total of 105 patients were included in this study with 35 patients in each group. There was no statistically significant difference in terms of oxygen saturation, mean blood pressure, duration of surgery, and postoperative complications, including nausea, vomiting, bradycardia, dizziness, and hypotension, as well as the time of opioid administration among the three groups (P>0.05). Statistically significant differences were found in terms of heart rate at 15, 30, 45, 60, 75, and 105 min after beginning of operation among the three groups, which was lower in the midazolam group (P<0.05). The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia, sensory block to T8 or higher and sensory block to T12 and L1 (P<0.05). Besides, the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3 (P=0.001). No significant difference was noted in pain scores among the three groups (P>0.05). Conclusion: Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher, the onset of motor block and sensory block after spinal anesthesia, and time to achieve sensory block to T12 and L1, and the pain scores were not significantly different among the groups. Thus, midazolam can be highly underlined, if a shorter onset of sensory and motor blocks is targeted. [Funded by the research deputy of Arak University of Medical Sciences (No.99258); fa.irct.ir number, IRCT20141209020258N164].

107-114

Authors: Mariam M Alwerdani, Emtenan A Said, Wesam A Dosoky, Radwa Sehsah, Abdel-Hady El-Gilany

Objectives: To assess the knowledge, attitude, and practice (KAP) towards COVID-19 and its associated factors among house officers. Methods: A multicentered crosssectional study on house officers was carried out using an online self-administered questionnaire. Sociodemographic data and data related to KAP towards COVID-19 were collected. Besides, KAP level of the house offices was recorded and factors associated with good KAP were determined. Results: This study included 555 house officers from 10 different hospitals with 128 males and 427 females. Almost half of the house officers had good knowledge and a favorable attitude (46.1% and 51%, respectively) on COVID-19. Still, 82.5% of them were committed to good practice of preventive measures. Besides, percentages of good knowledge and practice among those with chronic diseases or those who knew someone infected with SARS-CoV-2 were higher, but the differences were not statistically significant (P>0.05). In addition, the percentages of females with good practice were higher than those of males, with no statistical difference (P>0.05). Conclusion: House officers showed a good KAP towards COVID-19. Being aware of gaps in KAP can help to effectively contain the current pandemic.

120-122

Authors: Prabhat Agrawal, Ashish Gautam, Anjana Pandey, Harendra Kumar, Nikhil Pursnani

Rationale: COVID-19 usually presents with flu-like symptoms and signs, but some rare presentations like leukemoid symptoms cannot be ignored. Patient’s concerns: A 37-year-old female presented to the outpatient department with flu-like symptoms. Diagnosis: The RT-PCR test for SARS-CoV-2 infection was positive, while complete blood cell and peripheral blood smear showed leukemoid reaction. Intervention: Paracetamol and fexofenadine for flu-like symptoms and leukemoid presentation. Outcomes: On the 10th day, the patient was asymptomatic and RT-PCR was negative. So the patient was discharged and leukemoid presentation subsided after clearance of viral disease. Lessons: COVID-19 has a myriad of presentations, and unusual symptoms/signs especially in this pandemic could be induced by COVID-19 infection.

127-128

Authors: Marianne Shahsuvaryan

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