Lack Of Awareness Research Articles

An Audit Of Post Fall Medical Reviews In Older Hospital Inpatients

Abstract Background After an older person falls in hospital, the post-fall medical review is critical to assess injury and to put a plan in place to prevent further falls. We performed an audit to assess the post fall medical review and management of patients ≥65 years in a large university teaching hospital compared to national standard “Service User Falls: A Practical Guide for Review” and NICE Guidelines. Methods In a consecutive cohort of patients with falls, the post-fall medical review note was examined for crucial details from the history (mechanism, head/hip strike, loss of consciousness, pain) and examination (confusion, vital signs, joint assessment). In addition, we audited if there was an indication for CT Brain and compared to NICE criteria. Results 49 post fall medical review notes were audited (Mean age 79 years, range 66-96). 27% of patients who fell had a CT Brain. 6% (3/49) of patients who fell met NICE criteria for CT Brain, but it was not performed. Conclusion A significant proportion of post fall medical reviews omit important details that could help diagnostically and to inform a plan to prevent further falls. There is limited guidance for clinicians as to when to order a CT Brain for inpatient falls. We plan to introduce a post fall medical review pro forma/checklist and to standardise a CT Brain decision tool. We will then re-audit post introduction of these to assess for quality improvement.

Retrospective Review of Falls in Medical Inpatients Following Introduction of a Falls Proforma at Wexford General Hospital

Abstract Background Inpatient falls are the largest category of preventable inpatient adverse events in hospitals coming at both great financial and safety cost to a healthcare system. Approximately 30% of inpatient falls result in injury, 4-6% resulting in serious injury with older patients have the highest risk of falling and injury. The aim of this retrospective audit cycle was to improve standards of falls assessments performed by junior doctors. Methods We initially conducted a retrospective review of 7 medical inpatient falls in July 2023. Standards were compared against NICE Guidelines on Assessment and Prevention of Falls in older people 2013 and NICE guidelines on Assessment and early management of head injury 2023. 15 key elements were analysed: doctor identifier, date and time, history of fall, confusion, pain, loss of consciousness, amnesia, seizure, vomiting, medication review, hip fracture, wrist fracture, skull fracture, Glasgow Coma Scale and neurological deficit. One point was given for each of the 15 key elements noted in the falls review. Following introduction of a falls proforma, we re-audited 18 falls in February 2024 to analyse differences in scores. Results Prior to proforma introduction, 7 falls reviewed had an average score of 3 points. 4 falls were reviewed by SHOs, 1 each by an SpR and Intern and 1 NCHD review was unidentifiable. Mean age was 72. Following proforma introduction, 18 falls in 13 patients were analysed. 2 patients did not have a falls review, 15 were reviewed by SHOs, 1 by an Intern. Average age was 81. Proforma was used in 7 cases with an average score of 12.7, and no proforma was used in 11 cases with an average score of 5. Conclusion These findings demonstrate improved quality of falls reviews using proformas in line with guidelines compared to those without. More education is needed to incorporate proformas into standard practice.

Improving Recruitment Of Older Patients For Patient And Public Involvement And Engagement Work (PPIE): Ensuring A Representative Voice

Abstract Background Older people are under-represented in research, despite this demographic being the biggest users of healthcare resources. Service design needs to be patient-centred and therefore engaging this underserved group is crucial, albeit challenging. We describe a quality improvement project aimed at improving recruitment of patients into a local PPIE group in a perioperative geriatric service. Methods Clinicians opportunistically consent patients for the PPIE group during their perioperative geriatric clinic consultations. A baseline level of recruitment was established before implementing a series of PDSA cycles. The interventions were firstly, to adapt the paper clinic proforma making the consent section clearer, secondly to give weekly reminders to clinicians, and finally discussing PPIE with patients while they wait for their appointment. A focus group with clinicians was run using nominal group technique to explore barriers and potential solutions to recruitment. Results An average of three patients were being recruited per month from April 2022 to September 2023. Two weeks following the first intervention, no new patients were consented. Two weeks following the second intervention, this improved to two new patients. Following the third intervention, five new patients were recruited after two clinic sessions. From the focus group, the top three barriers to recruitment were forgetting, clinical responsibilities taking priority, and lack of awareness by new staff. The highest rated solution was utilising non-clinical staff to recruit patients in the waiting room. Conclusion During busy clinics, it is easy for clinicians to forget about issues not directly related to the patient in front of them. However, PPIE is vital in co-designing healthcare. There are both staff and patient-related barriers in recruiting and maintaining a PPIE group in older patients. From our project, we found a combination of passive (e.g. a tickbox proforma) and active recruitment by dedicated staff the best way to improve PPIE.

‘I Just Felt A Bit Faint’: The Role Of Physiotherapists In Older Adults Presenting With Transient Loss Of Consciousness (T-LOC)

Abstract Background Clinical presentation of transient loss of consciousness (T-LOC) in older adults presents significant diagnostic challenges, especially in those with frailty or multi-morbidity. This study analysed T-LOC presentations in individuals over the age of 75 and assess the impact of physiotherapy in this cohort. Methods A retrospective review was conducted on 56 older adults (>75 years), who presented with T-LOC to a large academic teaching hospital, over a six-month period in 2023. Data on demographics, presenting complaints, diagnostic tests, physiotherapy input and discharge diagnoses was collected and analysed. Results The analysis included 56 older adults, 57% (N=32) were male, with an average age of 81.6 years (75 – 94 years). The average length of stay was 9.1 days (1-64 days). Physiotherapy was provided to 59% (n=33) of the patients, with those in the physiotherapy group more likely to have a history of falls (55% compared to 4%) and a diagnosis of dementia (27% compared to 9%). Patients with T-LOC presentations were five-times more likely to be referred to physiotherapy if they had at least two diagnoses of recurrent falls, dementia or stroke (24% vs 4%). Of those who received physiotherapy, the number of sessions ranged from 1-25 (averaging 4.5 sessions per patient). Outcome measures were completed for 73% (n=24) of these patients, and 70% were discharged at their mobility baseline. Education on syncope, orthostatic hypotension or falls was documented for only 12% (N=4). 79% (N=26) were discharged directly home and 50% (N=13) were referred for community follow up. Conclusion Physiotherapy is often required for older adults with T-LOC, particularly those with a history of falls and dementia. Physiotherapy should be considered a fundamental component in the multi-disciplinary management strategy to improve healthcare efficiency and clinical outcome for this cohort.

Hypoxia Pathways in Parkinson’s Disease: From Pathogenesis to Therapeutic Targets

The human brain is highly dependent on oxygen, utilizing approximately 20% of the body’s oxygen at rest. Oxygen deprivation to the brain can lead to loss of consciousness within seconds and death within minutes. Recent studies have identified regions of the brain with spontaneous episodic hypoxia, referred to as “hypoxic pockets”. Hypoxia can also result from impaired blood flow due to conditions such as heart disease, blood clots, stroke, or hemorrhage, as well as from reduced oxygen intake or excessive oxygen consumption caused by factors like low ambient oxygen, pulmonary diseases, infections, inflammation, and cancer. Severe hypoxia in the brain can manifest symptoms similar to Parkinson’s disease (PD), including cerebral edema, mood disturbances, and cognitive impairments. Additionally, the development of PD appears to be closely associated with hypoxia and hypoxic pathways. This review seeks to investigate the molecular interactions between hypoxia and PD, emphasizing the pathological role of hypoxic pathways in PD and exploring their potential as therapeutic targets.

Diagnostic Challenges and Outcomes in Transient Loss of Consciousness: A Retrospective Analysis

Abstract Background Transient loss of consciousness (T-LOC) is a common presenting complaint, posing significant diagnostic challenges. This study explores outcomes for T-LOC. Methods Using the Hospital Inpatient Enquiry System, data on patients with T-LOC were collected at a large academic teaching hospital over six months, including demographics, length of stay (LOS), diagnostic tests, and discharge diagnoses. Results A total of 160 T-LOC patient visits were analysed, divided into three age cohorts: under 65 (n=66), 65-74 (n=38), and over 75 (n=56). Of the 94 patients aged over 65 (58.75% of the sample), mean age was 76.07 years; 47% were female. Diagnostics varied by age, with higher rates of computed tomography of the brain (87.23%) and lying-standing blood pressure (37.23%) in those over 65. Conversely, those over 65 were less likely to receive electrocardiograms (86.17% vs. 96.97%), telemetry (51.06% vs. 59.09%), magnetic resonance imaging of the brain (21.28% vs. 25.76%), transthoracic echocardiograms (14.89% vs. 25.76%), and exercise stress tests (3.19% vs. 10.61%) compared to those under 65. Carotid ultrasound and electroencephalography were infrequently performed across all age groups. Patients aged over 75 were most likely to have a diagnosis (78.57% vs 60.53% in 65-74 and 60.61% in under 65). Orthostatic hypotension was the most common diagnosis 8.51% (8/94) of those over 65. 33.13% (53/160) of patients had no diagnosis documented. LOS increased with age: averaging 6 days (range 1-19) for those under 64, 7.45 days (range 1-36) for those 65-74, and 9.09 days (range 1-64) for those over 75. Older adults were less likely to receive cardiology (19.15%) and neurology consultations (11.70%) compared to those under 65 (27.27% and 36.36%, respectively). Conclusion A considerable number of patients lacked a diagnosis, highlighting the diagnostic complexities of T-LOC. The development of a specialist syncope assessment pathway is underway to improve diagnostics, potentially reducing unnecessary tests and hospital stays.

Falciparum malaria with haemorrhagic stroke in a 26-year male patient: report of a rare case

BackgroundMalaria continues to cause unacceptably high levels of disease and death despite increased global efforts and is still significant public health problem. African countries are disproportionately affected by malaria. The objective of this study was to describe a rare case of haemorrhagic stroke as a possible complication of malaria in a 26-year-old male patient.Case presentationA 26-year-old male from southwest Ethiopia presented with complaint of loss of consciousness (LOC) of 12 h duration. He had fever, headache, vomiting, chills, rigors and shivering three days prior to the loss of consciousness. On physical examination, pulse rate 116 beats/min, blood pressure of 120/90 mmHg, respiratory rate was 24 breaths/min, a temperature of 38.9◦C and oxygen saturation of 94%. Nervous system examination; stuporous with Glasgow Coma Scale (GCS) 10/15(M5, E3, V2). Blood film and RDT confirmed a Plasmodium falciparum infection and a non-contrast CT scan found a right cerebral parenchymal haemorrhage.Discussion and conclusionThe presented case described a very rare case of a 26-year-old male patient who was diagnosed with left side hemiparesis secondary to a haemorrhagic stroke, associated with P. falciparum malaria. This report highlights the fact that malaria with stroke should be considered a differential diagnosis in a patient presenting with body weakness in a malaria endemic area and in individuals who had travel history to malaria endemic areas.

The Effectiveness of Familiar Auditory Sensory Training (FAST) in Increasing Consciousness Levels among Stroke Patients

Stroke is a leading cause of death worldwide, along with myocardial infarction and cancer. Stroke often results in loss of consciousness and neurological deficits that affect sensory perception. To support recovery, non-pharmacological therapies like auditory sensory stimulation are crucial. Familiar Auditory Sensory Training (FAST) is one such intervention. This study assessed the effectiveness of FAST in improving consciousness levels in stroke patients using a one-group pretest-posttest design. It involved 35 stroke patients aged 35-75, who were selected through purposive sampling and underwent three FAST sessions. Consciousness levels were measured using the Glasgow Coma Scale (GCS) before and after the intervention. Data analysis with the Wilcoxon rank test at α=0.05 revealed a significant increase in consciousness from a mean of 6.77 to 10.83 post-intervention (p=0.001), demonstrating FAST's effectiveness in enhancing consciousness in ICU stroke patients.

Insights into Pharmacists' Participation in Professional Certification Programs in Saudi Arabia.

Professional certification programs play a crucial role in helping pharmacists develop specialized skills and establish their expertise in the field. This study explores how pharmacists in Saudi Arabia engage with these programs by examining their levels of awareness, attitudes, and participation. It also identifies the key barriers and motivators that influence their decision to pursue certification. An online survey was conducted among pharmacists in Saudi Arabia to assess participants' knowledge of certification programs, their perceived benefits, the actual participation rates, and their preferences regarding certification areas and assessment methods. Out of 394 participating pharmacists, around 47% had never participated in a professional certification program, and about 27% of our sample were unaware of such programs in Saudi Arabia. Financial constraints and a lack of awareness were noted as the primary barriers to participation. Almost 55% showed an interest in Clinical Pharmacy Specialties certification, while 54% were inclined toward Pharmacy Management and Leadership certifications. A preference for practical assessments in certification programs was suggested by 55% of participants. This study highlights a significant need for increased awareness and accessibility to professional certification programs among pharmacists in Saudi Arabia. Addressing participation barriers is vital to foster professional development and meet the healthcare sector's evolving demands in Saudi Arabia.

Risk factors for death among children with severe malaria, Ivukula sub-county, Namutumba district, Eastern Uganda, september 2021–february 2022

BackgroundIn February 2022, the Ministry of Health received reports of more than 100 child deaths from a ‘strange disease’ in Namutumba District over a period of 6 months from politicians through the media. Preliminary investigations by the district rapid response team confirmed the strange disease to be severe malaria. The scope of severe malaria deaths was investigated, associated factors identified, and recommendations made for control measures to inform early malaria treatment strategies in Namutumba District.MethodsA retrospective study was conducted in March 2022 in the most affected subcounty (Ivukula Subcounty) involving cases and controls. A case was defined as a death with a positive malaria test, fever and any of the following: convulsions, difficulty breathing, yellowing of eyes or palms, tea-coloured urine, anaemia (evidenced by pale eyes or palms, or clinically-identified in medical records), loss of consciousness, or reduced urine output (very little or no urine in a day) in a child ≤ 12 years from September 2021 to February 2022 in Ivukula Subcounty, Namutumba District. Controls were survivors with the same signs and symptoms, recruited in a 2:1 ratio with cases. Cases and controls were actively searched using a door-to-door approach with the help of community health workers. Caretakers were interviewed to obtain data on signs and symptoms, socio-demographic information, health-seeking behaviours and health system risk factors. Drugs and bloodstock status information was obtained from health workers using an interview guide. Factors associated with death were identified using multivariate logistic regression and thematic analysis for qualitative data.ResultsAmong 46 cases, 29 (63%) were < 5 years, and 23 (50%) were female. Death among children with severe malaria was significantly associated with treatment non-completion (aOR = 9.7, 95%CI 1.8–53) and inability to receive blood transfusion for anaemic patients (aOR = 7.1, (95%CI 1.4–36). Healthcare workers reported that inability to reach referral sites due to transport costs, stockouts of anti-malarials and blood products at health facilities, and absence of integrated community case management of childhood illnesses (iCCM) contributed to deaths among children with severe malaria.ConclusionLack of access to anti-malarial treatment and to blood transfusions among anaemic patients due to stockouts were associated with severe malaria deaths among children ≤ 12 years in Ivukula Subcounty. Recommendations made were: accurate quantification of anti-malarials for health facilities, offering transport support to severe patients referred to higher-level facilities, and increasing access to blood products. Activation of iCCM could facilitate public health efforts against severe malaria in the district.

Functional seizure semiology and classification in a public and private hospital

PurposeOur understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. MethodsThe study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital. ResultsA total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (N = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients. ConclusionWhile the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation.

Development and validation of a survey instrument for reusable sanitary products toward sustainable menstrual hygiene.

The predominant use of disposable, non-organic menstrual products has significant environmental impacts due to waste and resource depletion. Concerns over the environmental, economic, and health implications of menstrual hygiene management (MHM) have highlighted the need to explore sustainable options like reusable sanitary pads (RSPs). Despite their benefits, the adoption of RSPs is limited by a lack of awareness, availability, cost, and research. This study emphasizes the need for the development of an instrument that can capture the effectiveness, safety, and user satisfaction of RSPs, addressing a significant gap in the literature. Using a convenient sampling method, data were collected through a structured offline survey and the sample comprised 446 South Asian women of reproductive age. The instrument included 15 items designed to measure factors such as comfort, hygiene, convenience, and environmental consciousness. The instrument's reliability and validity are thoroughly assessed using reliability and factor analysis to ensure its effectiveness in capturing the multifaceted dimensions of MHM product choices. The study revealed that the overwhelming majority of women would prefer the option of RSPs that are comfortable, accessible, and easy to use and dispose of. The findings aim to provide a validated tool for manufacturers, policymakers, and researchers to evaluate reusable pads, promoting their broader acceptance and adoption of a sustainable and equitable approach to menstrual hygiene.

Recognition and comprehension of breast awareness among hospital staff: a questionnaire survey using the explanatory leaflet in Japan

BackgroundThis study aimed to assess the recognition and understanding of breast awareness (BA) among hospital staff, a group considered influential in disseminating information about health. Compared to the traditional approach of breast self-examination (BSE), BA has gained prominence as a concept focused on early detection. The study also explored the effectiveness of an informational leaflet in conveying BA concepts.MethodsWe conducted an online, voluntary, and anonymous questionnaire survey at St. Luke’s International Hospital in Japan, where approximately 1,000 breast cancer surgeries are performed annually. The survey comprised three sections: pre-leaflet questions, the informational leaflet, and post-leaflet questions.ResultsFrom a pool of 500 completed questionnaires, 499 were deemed suitable for the analysis. Notably, 78% of respondents were unfamiliar with “BA” before the survey. However, 89.1% expressed interest in adopting daily practices for early breast cancer detection. Following the leaflet exposure, 98.4% of respondents claimed to have understood BA, either completely or partially. The leaflet aided 93.2% of these individuals in differentiating between BA and the traditional BSE method. These outcomes remained consistent across various demographic segments such as occupation, age, and experience with breast cancer care.ConclusionsThe study underscores a concerning lack of awareness regarding BA among hospital staff within the surveyed institution. This highlights the need to engage medical professionals in promoting BA within the community. The informational leaflet proved effective in enhancing comprehension of BA across diverse groups, indicating its potential as a widely applicable educational tool. The leaflet facilitated the comprehension of BA among respondents across all demographic groups, indicating its potential for widespread utility.

Acceptance and use of mobile health technology in post-abortion care

BackgroundAbortion and its complications have always been associated with challenges such as the lack of awareness, high cost of receiving in-person services, lack of access to the skilled healthcare workers, distance from healthcare centers in remote areas, and cultural sensitivities. Therefore, the use of mobile health technology in post-abortion care has been suggested. This study aimed to investigate factors influencing the acceptance and use of mhealth technology in post-abortion care.MethodA mixed-methods study was completed in 2023. Initially, a literature review was conducted. Then, a five-point Likert-scale questionnaire was designed based on the results of the literature review. The research participants were gynecologists (n = 24), midwives (n = 38), and women who had experience of abortion (n = 183). Data were analyzed using descriptive and inferential statistics.ResultsThe findings revealed that the participants had different opinions about the importance of motivating and inhibiting factors which included individual, technical, economic, organizational, and ethico-legal aspects. It seems that the individual, organizational, economic, and ethico-legal motivating factors as well as the ethico-legal inhibiting factors were more important than other factors and had higher mean values. In addition, there was a statistically significant difference between the mean values of gynecologists and patients regarding the individual motivating (P = 0.014) and technical inhibiting factors (P = 0.016). The gynecologists’ opinions regarding the technical motivating factors were also significantly different from midwives (P = 0.044) and patients (P = 0.010).ConclusionMultiple factors may influence the acceptance and use of mhealth technology in post-abortion care. Therefore, mhealth service developers must consider these factors to improve the quality of services and increase technology adoption. This will lead to saving costs, improving health, reducing abortion complications, and ultimately improving quality of life for women. However, further research in patient engagement and health interventions tailored to diverse cultural contexts are recommended.

An exploratory cross-sectional study of awareness and barriers to adoption of telemedicine services among patients in Bangladesh

Objectives Telemedicine has emerged as a promising solution to address healthcare challenges, particularly in resource-constrained settings such as Bangladesh. Understanding patient perspectives on telemedicine adoption is vital for improving healthcare delivery in such contexts. Material and Methods This cross-sectional study surveyed 120 patients in Bangladesh to explore awareness, acceptance, and barriers to telemedicine adoption. Data were collected using structured surveys administered face-to-face in 2024. Descriptive statistical techniques were employed for data analysis. Results Most respondents demonstrated awareness of telemedicine services, primarily learning about them through friends or online sources. They viewed telemedicine positively, especially for follow-up appointments and mental health services, expressing satisfaction with the services used. However, concerns regarding its effectiveness for emergency consultations were noted. Barriers to adoption included limited internet connectivity, trust/security issues, lack of awareness, regulatory challenges, and cultural resistance. Conclusion Despite positive attitudes towards telemedicine, challenges such as internet connectivity, trust concerns, and cultural barriers persist in Bangladesh. Addressing these challenges is essential for the successful implementation and widespread adoption of telemedicine, ultimately improving access to quality healthcare services. Future research should explore the perspectives of healthcare providers and policymakers and employ longitudinal and qualitative methods to gain deeper insights.

The dose of remimazolam combined with sufentanil for the induction of general anesthesia in obese patients undergoing bariatric surgery: an up-and-down sequential allocation trial.

Background and purpose: Remimazolam is a newly developed benzodiazepine drug with water-soluble, esterase degradation, and ultra-short-acting properties. The dose for general anesthesia induction in obese patients was not known. This study aimed to determine the optimal dose of remimazolam in combination with sufentanil for the induction of general anesthesia in obese patients. Methods: It was a prospective observational study. We recruited 46 patients scheduled for bariatric surgery from October 2022 to December 2023. One patient refused to provide informed consent, and six patients were receiving psychotropic medication. Thirty-nine patients were enrolled. The Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale was used to assess the patient's response. The dose of sufentanil was 0.5 µg/kg (lean body weight [LBW]). The initial dose of remimazolam was 0.3mg/kg (LBW). The dose of remimazolam was modified using the up-and-down allocation technique. Successful sedation (negative group) was characterized by achieving a MOAA/S score ≤ 1 within 3min of commencing remimazolam infusion. If negative, the next patient received a low-level dose at a ratio of 0.9. Failed sedation (positive group) was defined as a MOAA/S score of >1 within 3min of commencing remimazolam infusion. The patients in the positive group received propofol 0.5mg/kg as a remedial measure, and the next dose was increased to a higher level. The primary outcome was to determine the half-effective dose (ED50) and 95% effective dose (ED95) of remimazolam in combination with sufentanil 0.5 µg/kg for induction in obese patients. The secondary outcome was to determine the occurrence of adverse effects such as hypotension, hypertension, and intraoperative awareness. Results: The ED50 and ED95 values of remimazolam (LBW) combined with sufentanil (0.5 µg/kg) (LBW) were 0.115mg/kg (95% CI: 0.072-0.137) and 0.179mg/kg (95% CI: 0.150-0.434), respectively, and the time of loss of consciousness in the negative group was 120.13 ± 25.03s. The cardiovascular system was stable during the induction period. The incidence of post operative nausea and vomiting (PONV) was 38.5% in 39 patients. Respiratory depression, allergic reaction, intraoperative awareness, and delayed emergence were not observed in any patient. Conclusion: Remimazolam combined with sufentanil (0.5 µg/kg) (LBW) can be effectively used for general anesthesia induction in obese patients. The ED50 and ED95 values of remimazolam (LBW) were 0.115mg/kg and 0.179mg/kg, respectively. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2200065602.

SYNCOPE - AN AYURVEDA PERSPECTIVE

In present era increase of Manasika Vikara or mental illnessis the matter of paramount concern in today world. In Ayurvedic literature Murccha is considered as Vyadhi of nervous system which result due to intake of un-wholesome diet and with mind covered with Mansika dosha ie, Rajas and Tamas which ultimately blocks Rak-tha, Rakthavaha srothas, and Sanjavaha srotas and imbalance in three Dosha which disturbs the mind and brings unconsciousness. Syncope is a common chief complaint encountered in the emergency department. Syn-cope is caused by decreased cerebral blood flow leading to transient loss of consciousness and postural tone as-sociated with spontaneous recovery. The cause of syncope ranges from benign to life threatening conditions. The most common causes of syncope seen in the emergency department are due to reflex syncope followed by or-thostatic hypotension and cardiac syncope. Hence this paper is an effort to understand syncope and its Ayurveda perspective.

Local wakefulness-like activity of layer 5 cortex under general anaesthesia.

Consciousness, defined as being aware of and responsive to one's surroundings, is characteristic of normal waking life and typically is lost during sleep and general anaesthesia. The traditional view of consciousness as a global brain state has evolved toward a more sophisticated interplay between global and local states, with the presence of local sleep in the awake brain and local wakefulness in the sleeping brain. However, this interplay is not clear for general anaesthesia, where loss of consciousness was recently suggested to be associated with a global state of brain-widesynchrony that selectively involves layer 5 cortical pyramidal neurons across sensory, motor and associative areas. According to this global view, local wakefulness of layer 5 cortex should be incompatible with deep anaesthesia, a hypothesis that deserves to be scrutinised with causal manipulations. Here, we show that unilateral chemogenetic activation of layer 5 pyramidal neurons in the sensorimotor cortex of isoflurane-anaesthetised mice induces a local state transition from slow-wave activity to tonic firing in the transfected hemisphere. This wakefulness-like activity dramatically disrupts layer 5 interhemispheric synchrony with mirror-image locations in the contralateral hemisphere, but does not reduce the level of unconsciousness under deep anaesthesia, nor in the transitions to/from anaesthesia. Global layer 5synchrony may thus be a sufficient condition for anaesthesia-induced unconsciousness, but is not a necessary one, at least under isoflurane anaesthesia. Local wakefulness-like activity of layer 5 cortex can be induced and maintained under deep anaesthesia, encouraging further investigation into the local vs. global aspects of anaesthesia-induced unconsciousness. KEY POINTS: The neural correlates of consciousness have evolved from global brain states to a nuanced interplay between global and local states, evident in terms of local sleep in awake brains and local wakefulness in sleeping brains. The concept of local wakefulness remains unclear for general anaesthesia, where the loss of consciousness has been recently suggested to involve brain-wide synchrony of layer 5 cortical neurons. We found that local wakefulness-like activity of layer 5 cortical can be chemogenetically induced in anaesthetised mice without affecting the depth of anaesthesia or the transitions to and from unconsciousness. Global layer 5synchrony may thus be a sufficient but not necessary feature for the unconsciousness induced by general anaesthesia. Local wakefulness-like activity of layer 5 neurons is compatible with general anaesthesia, thus promoting further investigation into the local vs. global aspects of anaesthesia-induced unconsciousness.

The efficacy and safety of remimazolam tosilate compared with propofol for endoscopic retrograde cholangiopancreatography under monitored anesthesia care: A single-center randomized controlled clinical trial

BackgroundAlthough remimazolam tosilate is an ultra-short-acting benzodiazepine that causes less respiratory and circulatory depression than propofol, studies evaluating its efficacy and safety during endoscopic retrograde cholangiopancreatography (ERCP) are limited. This study aimed to compare the efficacy and safety of remimazolam and propofol for ERCP performed under monitored anesthesia care (MAC). MethodsThis study is a randomized controlled clinical trial featuring a noninferiority design. A total of 102 eligible patients undergoing ERCP under MAC were randomly assigned to either the remimazolam tosilate group (R group) or the propofol group (P group) in a 1:1 ratio. Patients in the R group were sedated with remimazolam tosilate, while those in the P group received propofol, both under MAC. The primary efficacy endpoint was the success rate of ERCP completion under MAC. Secondary outcomes included the time to loss of consciousness, sedative effects, and perioperative adverse events at various time points for patients in both groups. ResultsBaseline characteristics of both groups were similar. The successful completion rate for ERCP under MAC was 100 % in the R group and 96.1 % in the P group, resulting in a difference of 3.92 % (95 % CI: −2%, 10 %). This difference met the pre-established criterion of being greater than −8%. The total number of norepinephrine infusions, as well as the incidence of intravenous injection pain, post-induction hypotension, post-induction bradycardia, intraoperative hypotension, respiratory depression, and hypoxemia, were significantly lower in the R group compared to the P group. Conversely, the total number of phloroglucinol uses, body movements, and instances of rapid gastrointestinal peristalsis were significantly higher in the R group than in the P group. DiscussionRemimazolam-based MAC for ERCP exhibited non-inferior efficacy compared to propofol-based MAC, while also resulting in fewer circulatory and respiratory adverse events during the procedures. Nevertheless, future studies with larger sample sizes are required to evaluate the utility of remimazolam in elderly patients.

Key Challenges to Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Southeast Asia, the Middle East, and North Africa: An Expert Perspective.

Respiratory syncytial virus (RSV) is a common, highly contagious pathogen and a leading cause of serious illness among infants and older adults. While existing scientific evidence has predominantly focused on the epidemiology and disease burden of RSV in infants, data in older adults remain limited in some countries, including those in Southeast Asia (SEA) and the Middle East and North Africa (MENA) region. Here, we outline the key challenges for understanding the burden of RSV in older adults in SEA and the MENA region and we propose opportunities for improving understanding and eventually reducing the impact of RSV. A key challenge identified by the expert group, particularly in older adults, is a lack of awareness (among healthcare professionals, policy makers, and the public) of RSV burden and the associated risks for severe outcomes. This is often confounded by the complexities of underdiagnosis, surveillance limitations, and comorbidities. To address these issues, we suggest medical education initiatives for physicians in SEA and the MENA region to better understand the need to protect older adults from RSV, and encourage more widespread routine testing to better understand the burden of RSV. We also recommend surveillance studies in these regions to provide comprehensive and accurate epidemiological data on RSV inolder adults. Finally, in the absence of current surveillance data in these regions, we propose extrapolating existing global data and local pediatric data to inform the likely burden of RSV in older adults. A graphical abstract is available with this article.