Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses.

Background: Gestational diabetes mellitus (GDM) is a transient elevation of blood glucose during pregnancy. It is typically not associated with diabetic retinopathy. However, certain investigators revealed retinal microvascular injury. In this study, we aimed to assess the ophthalmic findings, optical coherence tomography (OCT) parameters, and retinal vascular thickness and macular density through fundus autofluorescence (FAF). Methods: Prospectively, women diagnosed with GDM were enrolled in this study. All the participants underwent comprehensive ophthalmic examination. Furthermore, macular OCT with analysis of the central subfield thickness (CST) and total thickness was carried out. Moreover, FAF was performed, and the macular density and retinal vascular thickness were extracted using ImageJ software. Results: Thirty-four women were enrolled. The mean maternal age was 32.7 years. No participant had diabetic retinopathy, nine eyes had early cataract, and two eyes had keratoconus. Higher levels for the 1 h oral glucose tolerance test (OGTT) were associated with a drop in the CST and total thickness. Moreover, women who underwent CS had higher levels of total thickness. Higher levels for the fasting OGTT were associated with a thinner inferior temporal retinal artery. Pregnant women with miscarriages had lower macular density on FAF, as represented by lower values of integrated density and mean gray values. Higher levels for the fasting OGTT were associated with higher values of integrated density. Conclusions: Although GDM is typically not associated with diabetic retinopathy, microscopic changes involving the microvascular environment and the macula may occur. Regular ophthalmic screening for women with GDM may be advised. Larger studies with more investigations may reveal further findings.

Background: It has been recognized that the type of anesthetic and analgesic technique and the relative pain degree may have an influence on hyperglycemic-stress response to surgery. This comparative study aimed to assess glucose levels in both mothers and infants during normal vaginal delivery. This study aimed to investigate this stress response between mothers who received parenteral analgesia versus epidural analgesia (EA) as an objective reflection for pain response. Methods: One hundred and seventeen patients participated in this prospective comparative study. They were categorized into two groups: parenteral analgesia group (who received subcutaneous morphine) and EA group. The primary outcome was to measure the difference in blood glucose level before delivery (at 3 cm cervical dilation), at full dilation, and at the third stage of labor and compare these values between both groups. The secondary outcome was to assess the factors affecting the glycemic stress response in mothers and neonates. Results: The change in maternal glucose level at full dilation and after delivery were significantly lower in the EA group. Neonatal glucose levels were not significantly different between the two groups. The change in maternal glucose level was influenced by the number of gravity and miscarriages. Neonatal glucose levels were associated with the gestational age of delivery, birth weight, and maternal glucose level at full cervical dilation. Conclusion: EA appears superior to parenteral opioids analgesia, providing better pain management and subsequent lower stress response levels for mothers during vaginal delivery. These findings highlight the importance of the choice of analgesia during labor to optimize maternal well-being. Optimizing maternal factors (such as glycemic response) and neonatal factors (such as prematurity and birth weight) may influence the stress response of the neonates.

Background: The influence of obstetric anesthesia on neonates is still under investigation. We aimed to investigate the influence of type of anesthesia; either general anesthesia (GA) or spinal anesthesia (SA); during elective or emergency cesarean section (CS) on neonatal outcomes. Methods: A retrospective cohort study was conducted and all neonatal admissions to the neonatal intensive care unit for mothers who underwent elective or emergency CS as the mode of delivery during the period from 2017 to 2021 were enrolled in the study. The primary outcome of the study was to investigate the difference between SA and GA. The enrolled cohort was divided into two groups: GA and SA groups. Results: A total of 997 patients were included in the study cohort. Among these, 628 patients underwent CS under SA. On univariate analysis, it was revealed that SA was associated with better Apgar score (8.56 ± 0.04 vs 8.16 ± 0.05, P =0.0001), less incidence of respiratory distress syndrome (RDS) (35.5% vs 42.3%, P =0.02), intraventricular hemorrhage (IVH) (0.8% vs 13.6%, P =0.0001), and neonatal thrombocytopenia (12.4% vs 17.3%, P =0.021). Moreover, GA was linked to higher mortality rates (10.8% vs 4%, P =0.0001) and more birth depression (10.6% vs 4.3%, P =0.0001). On the other hand, GA was related to less incidence of transient tachypnea of the newborn (TTN) (6.2% vs 12.6%, P =0.001). On multivariate logistic regression analysis, mode of anesthesia was related to RDS, TTN, IVH, birth depression and neonatal death. Conclusion: GA use may be related to more adverse and worse neonatal outcomes. This is related to the utilization of GA more frequently in higher-grade emergencies and is associated with more adverse baseline predictors including lower gestational age, lower birth weight, and greater obstetric complications. SA could offer a localized effect for the anesthetic drugs. Further prospective trials are needed to justify the risk of both types of anesthesia.