Levels Of Agitation Research Articles

Drug-Induced Liver Injury from Anti-Tuberculosis Treatment in a Case of TB Meningitis

This case study revolves around a 38-year-old male patient who arrived at the Emergency department complaining of decreased levels of consciousness, agitation, and disorientation. The case follows his admittance to the ICU, while a team of doctors worked on finding a possible diagnosis for his condition.
 It was later in the course of his disease that it was found from his CSF(Cerebrospinal fluid) sample that he was suffering from tuberculous meningitis. The culture result revealed a strain of Mycobacterium Tuberculosis that was sensitive to all the major anti-tuberculous drugs. This was a favorable point for the prognosis of this patient. Once he was started on a regimen of selected anti-TB drugs, his symptoms improved to the point of successful discharge from the hospital.
 However, a few days later, the patient again started experiencing symptoms that were serious enough to justify hospital admission. It was found that it was not any primary issue causing the symptoms this time, but rather the toxicity of the anti-tuberculous drugs. However, due to timely diagnosis, intervention, and management, his condition was managed effectively and he was discharged once again.
 This case study aims to measure the importance of prescribing the most effective yet adequate treatment regimen for all patients, keeping in mind several overlooked yet highly important health-related factors that could either exacerbate or deteriorate pre-existing health concerns in a given patient. If the patient had been evaluated carefully for any underlying liver diseases or been given a short trial to see if he could withstand the high dose of anti-tuberculous drugs, he would not have faced such dreadful consequences, though they were managed quickly.
 Keywords: Cerebrospinal fluid, Mycobacterium Tuberculosis, liver diseases, anti-tuberculous drugs.

Comparing the Effect of Ketamine and Lidocaine on Agitation and Pain in Rhinoplasty: A Randomized Clinical Trial.

Emergence agitation (EA) is an important clinical problem that occurs during the initial period of recovery from anesthesia. This study aimed to determine the effects of ketamine and lidocaine administered on agitation level, postoperative pain, and hemodynamic changes in adults after rhinoplasty. Totally 72 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were randomly divided into three groups including control group (n = 24), ketamine group (n = 24), and lidocaine group (n = 24). Twenty minutes before surgery completion, 1 ml saline was administered intravenously to the saline group, while 0.5 mg/kg ketamine or 1.5 mg/kg lidocaine was administered to two other groups. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). Postoperative pain was evaluated by Numerical Rating Scale that scored (from 0 to 10) every 10 min until the patients were discharged from PACU. There was a significant difference between EA level between ketamine (P = 0.049) and lidocaine (P = 0.019) groups compared to the control group, and there was a significant difference between pain level between the ketamine (P = 0.008) and lidocaine (P = 0.035) groups compared the to control group, while there was no significant difference between the level of agitation (P = 0.922) and level of pain (P = 0.845) after extubation between the ketamine and lidocaine groups. Ketamine and lidocaine are highly effective in preventing EA and pain control. Further studies with a greater sample size and longer follow-up period are needed to confirm the current findings.

Discussion Guide for the Golino Article

Between their underlying illness and the intensive care unit (ICU) environment, patients receiving mechanical ventilation (MV) are exposed to numerous stressors. Stress often elicits negative emotional symptoms, such as anxiety—reported by 80% of MV patients—and predisposes patients to posttraumatic stress disorder. Mainstay treatments for managing stress responses among MV patients (antipsychotics, analgesics, and sedatives) have not changed in more than 2 decades. Yet these medications increase the risk of adverse effects (eg, respiratory depression, hemodynamic instability, delirium) that ultimately impede liberation from MV and contribute to long-term disability. Nonpharmacologic interventions are emerging as a promising means of alleviating stress responses among MV patients. For example, live music therapy (LMT) interventions diminish physiological stress responses and reduce pain intensity in MV patients. But these findings were from an isolated study and should be replicated in more rigorous study conditions. Therefore, the authors examined the influence of LMT on physiological stress parameters, pain, and agitation of critically ill adults receiving MV.Once the patient’s legally authorized representative gave consent, participants were randomized into 2 groups: LMT and usual care. Those assigned to the LMT group received a needs assessment from a board-certified music therapist that was used to tailor a 30-minute LMT intervention. Usual care was defined as care that would typically occur during the 30-minute study period. Immediately before and after the study period, critical care nurses would record the patient’s heart rate, respiratory rate, oxygen saturation level, pain intensity, and agitation level. Notably, the investigators stopped study recruitment prematurely owing to a salient change in patient characteristics and research limitations related to the COVID-19 pandemic—with 61 patients randomized to the LMT group and 57 patients to the usual care group. Once preintervention scores were adjusted for, MV patients in the LMT group had significantly lower heart rates and agitation levels than patients in the usual care group. Patients in the LMT group had 6 times higher odds of having less pain than patients in the usual care group. The authors conclude that LMT is a low-risk, cost-effective nonpharmacological treatment that can be used as a supplemental intervention to mitigate pain, anxiety, and agitation in MV patients.Amanda J. Golino, MSN, RN, CCRN, CCNS, PMGT-BC, TCRN, first started her research journey in 2015 as a subinvestigator for her current mentors: Drs Mary Ann Friesen and Theresa M. Davis (coauthors). Around that time, the hospital where Ms Golino worked pilot tested the addition of a board-certified music therapist, Ray Leone. As a critical care nurse specialist certified in pain management, Ms Golino “wanted to explore the benefit of this nonpharmacologic integrative modality, having … observed the powerful impact Ray had when he worked with critically ill patients.” Mr Leone and Ms Golino ultimately partnered to conduct a pilot study examining the feasibility and benefits of using an MT intervention for critically ill adults.1 This initial study, however, excluded MV patients. After completing the pilot study and publishing her team’s findings, Ms Golino planned the present study, which included only MV patients: “I was curious to learn whether this population would respond to MT like the nonvented group [did]…”Although Ms Golino and her team had experience conducting similar research, conducting this work still presented valuable learning opportunities. “An initial challenge

Management of Agitation in Behaviours That Challenge in Dementia Care: Multidisciplinary Perspectives on Non-Pharmacological Strategies.

NICE guidelines recommend non-pharmacological interventions as the first-line approach for the management of behaviours that challenge. Recent work, however, highlights dissatisfaction with the lack of detailed guidance in the national guidelines regarding non-drug interventions. This study examines the views of practitioners regarding non-pharmacological treatments. It further explores perspectives on non-pharmacological strategies used in the management of agitation occurring within episodes of behaviours that challenge. Forty-two experienced practitioners attended a workshop where behaviours that challenge were described as occurring in three phases of agitation, using a framework adapted from the Positive Behaviour Support framework (pre-agitation, triggering and escalating, high level). The participants were asked to populate a template derived from the adapted framework. The completed templates recorded the clinical strategies the participants found useful to (i) prevent the occurrence of agitation, (ii) de-escalate distress and (iii) deal with perceived high levels of agitation. The Positive Behaviour Support conceptual framework was perceived by participants as helpful in organising their clinical work. A number of interventions were suggested as preventative strategies: music therapy, doll therapy, physical activity and generic person-centred communication skills to enhance wellbeing. In contrast, de-escalation strategies identified by the participants focused on reducing emotional distress. The approaches for dealing with continued high levels of agitation involved a number of "control and restraint" techniques as well as medication. The template allowed specialist multidisciplinary professionals to identify skills for the management of distress and agitated behaviour linked to the respective phase of arousal. The template has scope to guide practitioners to identify the detail needed for the management of behaviours that challenge. The findings have the potential to influence the contents of forthcoming guidelines on alternatives to psychotropics in dementia care.

A prospective observational single center study evaluating emergence agitation in the early postoperative period in adult patients undergoing elective craniotomies under general anesthesia.

Emergence agitation is a significant clinical issue during recovery from general anesthesia. Patients after intracranial operations are even more vulnerable to the stress resulting from emergence agitation. Due to the limited data available in neurosurgical patients, we evaluated the incidence, risk factors, and complications of emergence agitation. 317 consenting eligible patients undergoing elective craniotomies were recruited. The preoperative Glasgow Coma Scale (GCS)) and pain score were recorded. Bispectral Index (BIS) guided balanced general anesthesia was administered and reversed. Immediate postoperatively, the GCS and the pain score were noted. The patients were observed for 24 hours following extubation. The levels of agitation and sedation were evaluated by the Riker's Agitation-Sedation Scale. Emergence Agitation was defined as Riker's Agitation score of 5 to 7. In our subset of the patient population, the incidence was 5.4%, mildly agitated in the first 24 hours and none required sedative medication as therapy. The sole risk factor identified was prolonged surgery beyond 4 hours. None of the patients in the agitated group had any complications. Early objective assessment of risk factors in the preoperative period with objective validated tests and shorter duration of surgery maybe the way forward in patients at high risk for emergence agitation, to reduce the incidence and mitigate the undesirable consequences.

The Effect of Keroncong Music Therapy on Reducing Agitation in the Elderly with Dementia

Dementia naturally occurs along with the aging process, the thing that is most avoided from the symptoms of dementia is agitation. This condition causes feelings such as irritation or excessive anxiety. This can trigger a decline in intellectual capacity which is characterized by cognitive, emotional, and psychomotor disturbances. A continuous therapy with minimal side effects is required before the use of medical therapy which is known to be high in side effects. This study aims to analyze the effect of keroncong music therapy in reducing the level of agitation in the elderly with dementia. Elderlies with dementia using simple random sampling technique. The sample was divided into 29 treatment groups and 29 control groups. The statistical test used was Mann-Whitney. The treatment group was given keroncong music therapy at a dose of 15 minutes a day for 14 consecutive days. At the pre-test, there was no significant difference in agitation levels between the two groups (p=0.748), but at the post-test, a significant difference in agitation levels was found between the two groups (p <0.05). Keroncong music therapy can reduce the level of agitation in the elderly with dementia. Future researchers are expected to be able to conduct research by comparing the effectiveness of keroncong music therapy with other non-pharmacological interventions in reducing agitation levels.

Influence of mechanical agitation on the conformal coating of powders

Agitation is required to produce conformal coatings onto powders when line-of-sight deposition is used. In this work, a piston-crank agitation system has been utilized to deposit W coatings onto Al, yttria stabilized zirconia (YSZ), and Cu powder beds with varying levels of agitation. Based on the agitated powder charge characteristics, agitation was found to fall into one of three visual categories: limited, partial, or full agitation. Limited agitation was found to be insufficient for providing conformal coatings to the entire powder bed and occurred below a maximum acceleration of 17.8 m/s2 for all the powders tested. Above 17.8 m/s2, partial agitation was observed and identified by visual features that denote mixing of the powder charge, in particular the formation of spatially varied amplitudes of powder oscillations within the container. Full agitation is then categorized by maximizing the presence of these amplitude features that appear as ‘ridges’ in the powder charge morphology. This was found to occur at different maximum accelerations based on the material type: Al (22.6 m/s2), YSZ (27.9 m/s2), and Cu (33.7 m/s2). Both partial and full agitation allowed for conformal coverage of the entire powder bed with coating thicknesses ranging from approximately 170 to 220 nm for approximately 3.6 kW·h depositions, while limited agitation provided insufficient conformal coatings.

Antipsychotic prescriptions and neuropsychiatric symptoms (NPS) in nursing home (NH)residents with dementia: a comparison of pre‐ and during COVID pandemic.

AbstractBackgroundThe COVID‐19 pandemic has put tremendous pressures on nursing homes, but there is limited direct data evaluating the impact on residents or prescribing practicesMethodAs part of our clinical trial programme in nursing homes we have baseline data from 971 residents across 69 nursing homes collected in 2016/17 prior to the pandemic, and from 747 participants across 149 nursing homes from the baseline assessment of our COIVD WHELD RCT collected in 2021/22. In both studies the frequency if antipsychotic prescriptions was recorded and the Neuropsychiatric Inventory Nursing Home version was completed.ResultsThe average age of residents (84.5 v 85.1) and gender balance (71%F v 69% F) was similar in both cohorts. In the current study 64% of participating nursing homes had experienced a COVID‐19 outbreak. There were fewer people with severe dementia in the COVID WHELD Cohort (6.7% v 23%). Antipsychotic usage was 55% higher in the COVID WHELD cohort compared to the original WHELD cohort (28% v 18%), with 25% of nursing homes having prescription rates >40%, but the rates of neuropsychiatric symptoms were similar in the 2 studies. To ensure that the results were not confounded by the lower number of people with severe dementia in the COVID WHELD cohort, a further comparison was undertaken for people with moderate/moderately severe dementia, with very similar results. We undertook an additional analysis comparing nursing homes above and below prescription rates of 20% (the pre‐COVID level of prescribing). Nursing homes with increased antipsychotic prescribing had significantly higher levels of overall neuropsychiatric symptoms on the NPI (p = 0.02), and significantly higher levels of agitation (p = 0.02) compared to nursing homes with lower prescribing rates. There were also 31% more staff sick days in the higher prescribing nursing homes.ConclusionThere is a substantial increase in antipsychotic prescriptions in 50% of nursing homes since the onset of the COVID‐19 pandemic, associated in those nursing homes with an increase in neuropsychiatric symptoms. This will need to be a major focus as we begin to move forward from the pandemic.

Cryoablation in lung transplantation: Its impact on pain, opioid use, and outcomes

ObjectiveTo assess the effect of intraoperative cryoablation on postoperative patient-reported pain, opioid use, and clinical outcomes in lung transplantation. MethodsWe performed a single-center retrospective cohort study of adult lung transplant recipients from August 2017 to September 2018. We compared outcomes of patients who received intraoperative cryoablation of the intercostal nerves with those who did not. Primary outcomes were postoperative patient-reported pain scores and opioid use. Secondary outcomes included postoperative sedation and agitation levels and perioperative outcomes. Data were abstracted from patients' electronic health records. ResultsOf the 102 patients transplanted, 45 received intraoperative cryoablation (intervention group) and 57 received the standard of care, which did not include intercostal or serratus blocks or immediate postoperative epidural placement (control group). The intervention group had significantly lower median and maximum postoperative pain scores at days 3 and 7 and significantly lower oral opioid use at days 3, 7, and 14 compared with the control group. Chronic opioid use at 3 and 6 months' posttransplant was lower in the intervention group. Differences in perioperative outcomes, including length of mechanical ventilation, sedation and agitation levels, and hospital stay, were not clinically meaningful. Survival at 30 days and 1 year was superior in the intervention compared with the control group. ConclusionsFindings suggest that use of intraoperative cryoablation is an effective approach for treating pain and reducing opioid use in patients who undergo lung transplant, but a randomized study across multiple institutions is needed to confirm these findings.

Optimization and Kinetic Study of the Electrochemical-Assisted Leaching of Valuable Metals in Lithium-Ion Batteries

Efficient recycling of lithium-ion batteries (LIB) is required to meeting future demand of materials and support sustainable decarbonized energy systems. At the center of the recycling process is the recovery of valuable active metals in LIBs. Hydrometallurgical recovery processes are considered cleaner and less expensive than pyrometallurgical processes, and we previously reported a hydrometallurgical process for the leaching of valuable metals in mixed shredded LIBs. [1] In this process the reductant Fe2+, at low concentration, is electrochemically regenerated to complete the leaching of metals of interest Co, Ni, Li, Mn, and removal of Cu from LIB black mass, eliminating the need of H2O2. To accelerate this process and reduce chemical and energy consumption, the effect of process variables needs to be better understood. In this work, we study the effect of added electrochemical mediator concentration (Fe), total current and agitation level on the kinetics and leaching efficiency the EC-leaching process. Moreover, we propose a new multi-stage leaching scheme for the adjustment of final pH and recirculation of iron in the system.

The Effect of Provision of Information and Supportive Nursing Care on Blood Gas, Vital Signs, Anxiety, Stress, and Agitation Levels in COPD Patients Treated with NIV: A Randomized Controlled Trial.

ABSTRACTBackgroundInformative and supportive nursing care is essential to reduce complications and improve outcomes in people with chronic obstructive pulmonary disease (COPD) treated with noninvasive ventilation (NIV). The aim of this study was to determine the effect of provision of information and supportive nursing care on blood gas, vital signs, anxiety, stress, and agitation levels in people with COPD treated with NIV.Materials and methodsA randomized controlled design was used between September and December 2019. Patients with COPD treated with NIV in the intensive care unit (ICU) in a state hospital were included. A total of 60 patients, composed of 30 interventions and 30 controls, were randomly included in the sample. Provision of information and supportive nursing care was applied to the patients in the intervention group.ResultsFollowing the intervention, the findings showed that the provision of information and supportive nursing care has a positive effect on the blood gas, vital signs, anxiety, stress, and agitation levels of patients. It was determined that the change in the averages of DASS-Anxiety, DASS-Stress, and RASS-Agitation of the intervention and control groups were statistically significant in terms of group × time (respectively, F = 41.214, p = 0.003; F = 7.561, p = 0.008; F = 65.004, p = 0.000) interaction (p <0.05).ConclusionThe provision of information and supportive nursing care is recommended to alleviate anxiety, stress, and agitation in people with COPD treated with NIV.How to cite this articleCekic Y, Yilmaz Bulut T, Aydin Avci İ. The Effect of Provision of Information and Supportive Nursing Care on Blood Gas, Vital Signs, Anxiety, Stress, and Agitation Levels in COPD Patients Treated with NIV: A Randomized Controlled Trial. Indian J Crit Care Med 2022;26(9):1011–1018.

The tissue dust analysis system: a new device and methodology to quantify dusting and linting propensity in hygiene tissue papers

Paper dusting, which occurs when a tissue web releases unbound and loosely bound fibers or filler particles during tissue-making or product manufacturing, has an overall negative impact, causing safety hazards, machine runnability difficulties, and product quality issues. To date, there are no well-established industry standards to quantify dusting/linting propensities in finished tissue products, thus evaluating the effectiveness of dust/lint control programs is challenging yet intriguing. This research aims to fill this gap by developing a methodology to characterize dusting in tissue papers. We have developed a device prototype (named the Tissue Dust Collector) and a methodology that together have been named the Tissue Dust Analysis System (TDAS), which aims at quantifying the propensity for tissue-grade paper products to generate dust/lint in a controlled and reproducible manner. Two samples, corresponding to commercial products with a low and high linting propensity, were tested using the proposed device and methodology, and the released particles were quantified and characterized. The device and methodology provided reproducible results for simulated consumer handling and product manufacturing scenarios. By changing the instrument's motor frequency, the force of agitation changes, mimicking/simulating consumer (60 strokes per min, spm) and producer/manufacturing (180 spm) handling scenarios (though manufacturing processes are much faster in practice). Particle counts at each level for each product showed reproducible values differentiable at different agitation levels. Adopting the proposed Tissue Dust Analysis System may help to characterize and understand the mechanisms behind dusting to create dust-control strategies that can alleviate this issue at its various sources or simply allow tissue paper manufacturers to compare and advertise their products based on dusting propensity.

Sensory Garden for Occupational Therapy and Improving Quality of Life

A sensory garden is a self-contained garden or garden area that has a collection of plants that are appealing to one or more of the five senses. The major senses like sight, smell, sound, taste, and touch; are mainly enhanced in these kinds of gardens so that people of various ages can benefit from it and it can act as a therapy. This kind of garden has also been reported to be an amazing way for young people to explore their senses and learn about their surroundings and the people suffering from dementia and children requiring special needs. In both cases, it has proved to improve their overall health and decreased their agitation level to normal. The idea behind the sensory garden design was that the gardens should aim to stimulate users' senses and improve their physical abilities. These types of gardens have a huge impact on people's mental and physical health and it helps in improving their way of living as well. In this review paper, the elements and benefits of the sensory garden and its scenario in India have been discussed in detail.

Examining within- and between-person facets of negative affect and associations with daily craving among young adults in substance use disorder recovery

The role of negative affect in precipitating drug craving and relapse among young adults in recovery from substance use disorder (SUD) is well documented. However, most studies focus on negative affect as a trait-level congregate of multiple negative emotion states. The present study examined the associations between specific facets of negative affect, college stressors, and craving among young adult college students in SUD recovery. Data were drawn from a three-week daily diary study of 50 students participating in a collegiate recovery community at a U.S. university (M age = 21.42, 76% males). At the within-person level, craving was higher on days when young adults experienced higher than usual anger, fear, and sadness, but not guilt. At the between-person level, individuals higher in agitation reported greater levels of craving on average. Moderation analyses further showed that college stressors heightened the within-person association between anger and craving. Findings demonstrate that negative affect is not monolithic and that its different aspects are uniquely associated with craving at both between- and within-person levels. Findings from this study could guide collegiate SUD recovery programs that wish to provide greater support to their members by helping them identify both individual- and time-specific relapse risks, such as generally high levels of agitation or days when anger, fear, or sadness are higher than usual for a particular individual. Our findings also suggest that future research should consider distinct features and implications of affective structures at between- and within-person levels, and how these may be uniquely associated with craving.

Modelling Nucleation during Electrodeposition By MODEL Method. Parametric Identification Considering Agitation By Rde or Ultrasound

Nowadays, 40% of the world wide used energy is provided by electric power and this share should reach about 60% by 2040. For environmental reasons, it is crucial to ensure low dissipation loss in power electronic devices by optimizing energy conversion. In the field of renewable energies and automotive electronics, possible energy savings are estimated to be between 20 and 35%. For that purpose, innovative power components and modules are required, with a growing interest for fast and simple joining processes in their fabrication management, in the case for example of the assembly of large-size double-side cooled modules. Several options are possible, including free sintering of metallic pastes or electroforming welding. In all cases, this requires a great control of both surfaces to be joined, mostly prepared by electrodeposition (microstructure, porosity, alloy composition). But the final properties of electrodeposited coatings are strongly dependent of the first nucleation steps, which influence the whole layer structure. In this frame, the modelling of a nucleation process followed by diffusion limited three dimensional growth is an area of promising interest. The study of potentiostatic current transients is a relevant methodology, allowing the determination of several parameters such as nucleation rate, nucleus density, and number of active sites. Different competing models are available, such as Scharifker and Hills [1] and Scharifker and Mostany [2]. By using the model method i.e. the identification of the model parameters by error minimization, it is possible to reach an accurate description of the first layer growth in the case of different metals such as silver and copper. Nevertheless, little attention have been paid to changes in hydrodynamic conditions, for example in the study of current response under forced convection [3]. The present work describes the extension of the model method to the modelling of the first steps of nucleation growth in the case of a sample exposed to an ultrasonic irradiation, which was compared to forced convection induced by a rotating disc electrode at the very same agitation level (equivalent velocity [4,5]. Eventually, the case of electrodeposited alloys was examined, as a function of their Brenner classifications (anomalous and normal codeposition [6]). The limitation of the data processing by the numerical approach are also discussed.[1] Scharifker, B. & Hills, G. Theoretical and experimental studies of multiple nucleation. Electrochimica Acta 28, 879–889 (1983).[2] Scharifker, B. R. & Mostany, J. Three-dimensional nucleation with diffusion controlled growth. J. Electroanal. Chem. Interfacial Electrochem. 177, 13–23 (1984).[3] Hyde, M. E. & Compton, R. G. Theoretical and experimental aspects of electrodeposition under hydrodynamic conditions. J. Electroanal. Chem. 581, 224–230 (2005).[4] Pollet B.G., Hihn J.-Y., Doche M.L, Mandroyan A., Lorimer J.P., Mason T.J “Transport limited currents close to an ultrasonic horn: equivalent flow velocity determination”, Journal of Electrochemistry Society, 154(10), E131-E138, (2007)[5] A. Nevers, L. Hallez, F. Touyeras, J.-Y. Hihn, Effect of ultrasound on silver electrodeposition: Crystalline structure modification, Ultrason. Sonochem. 40 (2018)[6] Brenner, A. Electrodeposition of alloys. Principles and practice Volume II, (1963).

Interleukin-18 signaling system links to agitation in severe mental disorders

ObjectiveAgitation is a challenging clinical feature in severe mental disorders, but its biological correlates are largely unknown. Inflammasome-related abnormalities have been linked to severe mental disorders and implicated in animal models of agitation. We investigated if levels of circulating inflammasome-related immune markers were associated with agitation in severe mental disorders. MethodsIndividuals with a psychotic or affective disorder (N = 660) underwent blood sampling and clinical characterization. Plasma levels of interleukin (IL)‐18, IL-18 binding protein (IL-18BP), IL-18 receptor 1 (IL-18R1), IL-18 receptor accessory protein (IL-18RAP), and IL-1 receptor antagonist (IL-1RA) were measured. Agitation levels were estimated with the Positive and Negative Syndrome Scale Excited Component. Multiple linear- and logistic regression were used to investigate the associations between agitation and the immune markers, while controlling for confounders. The influence of psychotic and affective symptoms was assessed in follow-up analyses. ResultsAgitation was positively associated with IL-18BP (β = 0.13, t = 3.41, p = 0.0007) after controlling for multiple confounders, including BMI, smoking, medication, and substance use. Adjustment for psychotic, manic, and depressive symptoms did not affect the results. There were no significant associations between agitation and the other investigated immune markers (IL-1RA (β = 0.06, t = 1.27, p = 0.20), IL-18 (β = 0.05, t = 1.25, p = 0.21), IL-18R1 (β = 0.04, t = 1.01, p = 0.31), IL-18RAP (odds ratio = 0.96, p = 0.30)). In a subsample (N = 463), we also adjusted for cortisol levels, which yielded unaltered results. ConclusionOur findings add to the accumulating evidence of immune system disturbances in severe mental disorders and suggest the IL-18 system as a part of the biological correlate of agitation independent of affective and psychotic symptoms.

Factors That Affect Methane Yield Using Raw Olive Alperujo (Unhydrolyzed) as Substrate in BMP Assays

The olive alperujo (OA) corresponds to the solid waste generated in the olive oil extraction process using the two-phase centrifugation method. OA is produced in large quantities (800 kg OA/ton olives processed) and is characterized by its high moisture content, organic matter, and low pH. In Chile, the olive oil industry is recent, and one of its main challenges is to be able to manage OA to reduce the impact caused by its disposal. In this sense, its valorization as biogas by means of anaerobic digestion is an economically attractive option. For this, it is previously necessary to evaluate the biomethane potential (BMP) of the raw OA using batch assays. This study was focused on evaluating the factors that most affect the methane yield (MY) when using OA as substrate in BMP tests. First, a sweep analysis (Plackett–Burman) was applied to determine those factors that, according to the literature, would have an influence on the BMP tests. Among the factors studied, the most significant were preincubation, OA concentration, and agitation level. Subsequently, a 23 factorial experimental design was applied to evaluate the effect of these factors on MY at different levels. Results show that the OA concentration was the most significant factor affecting MY.

Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran.

ABSTRACTBackground/aimPatients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran.Materials and methodsIn this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses.ResultsData from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5% of patients. Restrained patients had more severe disease [mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1)], longer length of stay [mean of 10 (5.5) vs 5.5 (4.6) days], and lower level of consciousness [mean of GCS score, 8.7 (3.5) vs 13.5 (3.3)] than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs [odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04–7.82], presence of delirium (OR, 15.13; 95% CI: 4.61–49.65), deep sedation (OR, 0.04; 95% CI: 0.00–0.45), and GCS score (OR, 0.69; 95% CI: 0.53–0.9).ConclusionThis study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors.How to cite this articleNomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022;26(2):192–198.

Effects of remifentanil on the recovery quality among pediatric candidates for dental procedures under general anesthesia.

Background:Remifentanil is a short-acting synthetic opioid, seems to facilitate hospital discharge, induce less agitation and better recovery quality. The aim of this study was to investigate the effects of remifentanil on the quality of recovery among healthy children who were candidate for dental procedures under general anesthesia.Materials and Methods:This study was a double blind randomized controlled clinical trial on healthy children who referred to the Department of Pediatric dentistry, School of Dentistry, Isfahan University of Medical Sciences. Both groups were anaesthetized using 5 mg/kg thiopental sodium, 1 μg/kg fentanyl and 0.6 μg/kg atracurium. The first group received propofol to maintain anesthesia and the second group was given remifentanil along with propofol. Then, the time span to regain consciousness, level of agitation during recovery and time of discharge were monitored and compared between the two groups. Data were analyzed using the Mann-Whitney U-test, and the Kruskal–Wallis test at P < 0.05 level of significance.Results:Findings showed that the propofol + remifentanil group recovered faster than the propofol group. Chi-square test showed a significant difference in recovery time between the two groups (P < 0.05). About 45 min after regaining consciousness, the mean pediatric anesthesia emergence delirium score in the propofol group was 4.02 ± 2.19 and was significantly higher than the propofol + remifentanil group (3.02 ± 2.83) (P < 0.05). In addition, the mean Postanesthetic Discharge Scoring System score in the propofol group was 6.04 ± 1.74 and was significantly higher than the propofol + remifentanil group (7.58 ± 2.14) (P < 0.05).Conclusion:Combination of propofol and remifentanil significantly reduced the time taken for recovery, discharge and agitation level compared to propofol.

Emergence agitation in paediatric day case surgery

Postoperative emergence agitation remains a significant challenge in paediatric anaesthesia. Although short-lived, it may cause harm to the patient and negative experiences for all. Differentiating agitation, delirium and pain is difficult. Electroencephalography allows precise titration of anaesthetic depth, and heart rate variability monitoring permits immediate intervention regarding nociception and pain. We examined if one of these measures could be used to reduce postoperative agitation in an unselected paediatric day surgical population. The primary outcome was postoperative agitation with a Richmond Agitation-Sedation Scale greater than 0. Secondary outcomes were: length of stay, postoperative nausea and vomiting, fentanyl and propofol consumption, pain scores and use of postoperative analgesics. A randomised, single-blinded study constituting children aged 1 to 6 years, undergoing minor general day surgical procedures. Paediatric day surgical department 29th March 2019 to 12th June 2020. Ninety-eight children (ASA 1 or 2) were enrolled, and 93 children were included in the final analysis. Children received standard monitoring (n=31), standard monitoring plus either Narcotrend (n=31), or Anaesthesia Nociception Index monitoring (n=31). Sevoflurane or fentanyl was titrated immediately according to monitor thresholds. Kaplan-Meier analysis yielded a statistically significant difference between the groups (P = 0.016) with the lowest agitation levels in the Anaesthesia Nociception Index group, intermediate levels in the control group and the highest agitation levels in the Narcotrend monitored group. Intergroup pairwise comparison however, showed no difference. The Anaesthesia Nocioception Index group received slightly more fentanyl (P = 0.277). The control group patients had the highest pain scores despite receiving more caudal blocks and the Narcotrend group had more sevoflurane adjustments. Other secondary outcomes were comparable. Children in the Anaesthesia Nociception Index group were the least agitated with the highest fentanyl doses, without increasing the length of stay in the PACU or postoperative nausea and vomiting. The study was registered in REDCap online trial database 1/11/2018 trial registration nr. OP720. https://open.rsyd.dk/OpenProjects/openProject.jsp?openNo=720&lang=da.