Impact of Melatonin as a Premedication Agent in Caesarean Section on Blood Loss and Postoperative Pain Level

Background. Postpartum hemorrhage (PPH) is a serious postdelivery condition with a high incidence of morbidity and mortality for women who undergo childbirth with or without a caesarean section. Melatonin has been suggested to increase the contractility of myometrium and reduce the pain score postoperatively, therefore it is believed that the use of melatonin before surgery may decrease blood loss, reduce pain score, and decrease the need for postoperative opioids. Objectives. The main objectives of this study are focused on the investigation of melatonin as a premedication agent to reduce blood loss and decrease pain score postoperatively in patients undergoing cesarean section under spinal anesthesia. Methods. 80 patients were scheduled for spinal anesthesia-based cesarean sections and randomly assigned to two groups, melatonin group (M) 40 patients and placebo group (P) 40 patients to receive either 10 mg of sublingual melatonin or a placebo of 90 minutes preoperatively. Hemoglobin levels were been measured preoperative and 12 hrs. Postoperatively, blood loss volume was calculated by measuring both the weight of used materials before and after the surgery and the volume sucked in the suction bottle after placental delivery. Postoperative visual pain score and analgesic requirements were used to evaluate pain levels. Results. Analyzed collected data showed a significant decrease in blood loss in the melatonin group in comparison with the placebo group as measured by the hemoglobin level. On the other hand, there is a significant decrease in pain score and analgesia requirement with the melatonin group compared to the placebo group. Conclusion. Melatonin is a promising premedication drug that has a significant impact on postpartum hemorrhage by reducing blood loss and pain levels of mothers who have undergone C-sections

Occupational Noise Exposure and Diabetes Risk

Introduction. Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim. To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods. This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results. The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference (p=0.08). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion. Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion

Effects of music therapy on occupational stress and burn-out risk of operating room staff

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is to assess the impact of music therapy on stress levels and burn-out risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased signifi- cantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool