Determination of diagnostic criteria of postoperative neurocognitive dysfunction: analytical, prospective, cohort study

Introducere. Disfuncţia neurocognitivă postoperatorie (DCPO) este o entitate demult observată şi descrisă, însă puţin studiată. Nu există, deocamdată, o definiţie clară şi criterii exacte de diagnostic pentru ea. Scopul studiului a fost de a încerca stabilirea unor criterii diagnostice pentru DCPO în baza rezultatelor date de 5 teste neurocognitive standardizate, validate, aplicate pre- şi postoperator. Material şi metode. Studiu de cohortă prospectiv, analitic. Aviz pozitiv al CEC. Înrolaţi după un acord informat semnat şi analizate 176 de dosare complete. Pacienţi tineri (18-60 de ani), fără comorbidităţi (ASA I-II), care au beneficiat de intervenţii chirurgicale de amploare mică şi medie pe abdomen, au trecut preoperator şi în ziua a 7-ea postoperator 5 teste neurocognitive (Statutul Mini-Mental, Testul de Conectare a Numerelor, Testul de Substituire a Simbolurilor, Testul Wechsler şi Testul Redley de Interferenţă a Culorilor). Comparate rezultatele pre- şi postopertorii ale testării. Au fost identificaţi şi analizaţi subiecţii cu devieri pre- şi postoperatorii de 1, 1,5, 2 SD de la medie în unul până la toate cele 5 teste neurocognitive aplicate. Argumentate criterii de diagnostic al DCPO în baza rezultatelor şi analizei efectuate. Rezultatele sunt prezentate drept medie şi (95%CI) sau mediană şi [extreme]. Rezultate. Statutul Mini-Mental, 30 [21 – 30] vs. 30 [22 – 30] puncte, p=0,5622; Testul de Conectare a Numerelor, 34,2 [14,5 – 122,0] vs. 30,0 [14,0 – 101,0] sec., p<0,0001; Testul de Substituire a Simbolurilor, 37,5 (35,2-39,7) vs. 40,0 (37,6- 42,3) puncte, p<0,0001; Testul Wechsler (înainte), 6,0 [4,0- 9,0] vs. 6,0 [4,0-9,0] puncte, p=0,738; Testul Wechsler (înapoi), 4,0 (3,8-4,2) vs. 4,1 (3,9-4,3) puncte, p=0,448; Testul Wechsler (total), 9,9 (9,5-10,4) vs. 10,0 (9,6-10,5) puncte, p=0,547; Testul Wechsler (diferenţe înainte-înapoi), 2,0 [0,0 – 6,0] vs. 2,0 [1,0 – 5,0] puncte, p=0,806; Testul Redley de Interferenţă a Culorilor (culori şi denumire identice), 9,9 [4,3 – 67,6] vs. 9,3 [5,0 – 61,6] msec., p=0,014; Testul Redley de Interferenţă a Culorilor (culori şi denumire diferite), 27,8 [15,8 – 116,0] vs. 25,4 [13,8 – 98,8] msec., p<0,0001; Testul Redley de Interferenţă a Culorilor (mărimea interferenţei), 17,7 [2,5 – 48,8] vs. 16,0 [0,6 – 68,3] msec., p=0,002 (toate comparările: preoperator vs. postoperator). Diminuarea proporţiei de pacienţi cu valori alterate ale testelor neurocognitive mai mult de 1 SD, 1,5 SD sau 2 SD de la medie este exponenţială. Proporţia pacienţilor cu 2 şi mai multe teste alterate cu 1 SD de la medie, a fost de 23% în preoperator şi de 15,4% în postoperator; cu 1,5 SD de la medie – 8,6% şi 6,0%, iar cu 2 SD de la medie – 2,6% şi 3,4%, respectiv, preoperator şi postoperator. Concluzii. Prevalenţa DCPO la pacienţii tineri, operaţi pe cavitatea abdominală, este cuprinsă, în limitele de 3,4%-6,0%. Diagnosticul de DCPO trebuie stabilit în baza devierii de cel puţin 1,5 SD de la medie a valorii postoperatorii faţă de valoarea preoperatorie în cel puţin 2 teste neurocognitive dintr-o baterie de 5 teste diferite aplicate.Introduction. Postoperative neurocognitive dysfunction (POCD) is an entity observed and described long time ago, but less studied. No clear definition exists, neither exact diagnostic criteria. The aim of the study was to try to establish diagnostic criteria for POCD based on the results of 5 neurocognitive standard tests, validated, and used pre- and postoperatively. Material and methods. Analytical, prospective, cohort study. Approval from Ethical Research Committee. Informed consent was signed and 176 complete files were analyzed. Young patients, aged 18-60 y.o., no comorbidities (ASA I-II), that underwent minor and medium abdominal surgeries, took 5 neurocognitive tests on the day before surgery and on day 7 after the surgery (Mini-Mental State Examination, Digit Connection Test, Digit Symbol Substitution Test, Wechsler` Test and Ridley Colour Stroop Test). Pre- and postoperative results were compared. Patients with 1, 1.5, and 2 Standard Deviations in 1 to all 5 tests used in pre and postoperative testing were identified and analyzed. Diagnostic criteria were settled for POCD based on the results and analysis. Results are presented as mean values and 95%CI or median and [extreme values]. Results. Mini-Mental Status, 30 [21 – 30] vs. 30 [22 – 30] points, p=0.5622; Digit Connection Test, 34.2 [14.5 – 122.0] vs. 30.0 [14.0 – 101.0] seconds, p<0.0001; Symbol Substitution Test, 37.5 (35.2-39.7) vs. 40.0 (37.6-42.3) points, p<0.0001; Wechsler Test Forwards, 6.0 [4.0 – 9.0] vs. 6.0 [4.0 – 9.0] points, p=0.738; Wechsler Test Backwards, 4.0 (3.8- 4.3) vs. 4.1 (3.9-4.3) points, p=0.448; Wechsler Test Total, 9.9 (9.5-10.4) vs. 10.0 (9.6-10.5) points, p=0.547; Wechsler Test (difference between forwards and backwards), 2.0 [0.0 – 6.0] vs. 2.0 [1.0 – 5.0] points, p=0.806; Ridley Test of Colors (stroop color test) (interference magnitude), 17.7 [2.5 – 48.8] vs. 16.0 [0.6 – 68.3] msec., p=0.002 (all comparison: prevs postoperative). The proportion of patients with altered values more than 1 SD, 1.5 SD or 2 SD from mean values has diminished exponentially. The proportion of patients with 2 or more altered tests by 1 SD from mean value was 23% preoperative and 15.4% postoperative; by 1.5 SD from mean value was 8.5% and 6.0%, and altered tests by 2 SD from mean values were found in 2.6% and 3.4% pre- and postoperatively respectively. Conclusions. Prevalence of POCD in young patients, that underwent abdominal surgery, varies between 3.4% and 6.0%. POCD diagnosis should be established based on 1.5SD from mean postoperative value in a number of 2 out of 5 different tests applied

Iron, Copper, and Zinc Homeostasis: Physiology, Physiopathology, and Nanomediated Applications

Understanding of how the human organism functions has preoccupied researchers in medicine for a very long time. While most of the mechanisms are well understood and detailed thoroughly, medicine has yet much to discover. Iron (Fe), Copper (Cu), and Zinc (Zn) are elements on which organisms, ranging from simple bacteria all the way to complex ones such as mammals, rely on these divalent ions. Compounded by the continuously evolving biotechnologies, these ions are still relevant today. This review article aims at recapping the mechanisms involved in Fe, Cu, and Zn homeostasis. By applying the knowledge and expanding on future research areas, this article aims to shine new light of existing illness. Thanks to the expanding field of nanotechnology, genetic disorders such as hemochromatosis and thalassemia can be managed today. Nanoparticles (NPs) improve delivery of ions and confer targeting capabilities, with the potential for use in treatment and diagnosis. Iron deficiency, cancer, and sepsis are persisting major issues. While targeted delivery using Fe NPs can be used as food fortifiers, chemotherapeutic agents against cancer cells and microbes have been developed using both Fe and Cu NPs. A fast and accurate means of diagnosis is a major impacting factor on outcome of patients, especially when critically ill. Good quality imaging and bed side diagnostic tools are possible using NPs, which may positively impact outcome

The Role of Depression and Anxiety in Frail Patients with Heart Failure

An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF

Trends in Molecular Diagnosis of Nosocomial Pneumonia Classic PCR vs. Point-of-Care PCR: A Narrative Review

Nosocomial pneumonia is one of the most frequent hospital-acquired infections. One of the types of nosocomial pneumonia is ventilator-associated pneumonia, which occurs in endotracheally intubated patients in intensive care units (ICU). Ventilator-associated pneumonia may be caused by multidrug-resistant pathogens, which increase the risk of complications due to the difficulty in treating them. Pneumonia is a respiratory disease that requires targeted antimicrobial treatment initiated as early as possible to have a good outcome. For the therapy to be as specific and started sooner, diagnostic methods have evolved rapidly, becoming quicker and simpler to perform. Polymerase chain reaction (PCR) is a rapid diagnostic technique with numerous advantages compared to classic plate culture-based techniques. Researchers continue to improve diagnostic methods; thus, the newest types of PCR can be performed at the bedside, in the ICU, so-called point of care testing—PCR (POC-PCR). The purpose of this review is to highlight the benefits and drawbacks of PCR-based techniques in managing nosocomial pneumonia

Linezolid Administration to Critically Ill Patients: Intermittent or Continuous Infusion? A Systematic Literature Search and Review

A judicious antibiotic therapy is one of the challenges in the therapy of critically ill patients with sepsis and septic shock. The pathophysiological changes in these patients significantly alter the antibiotic pharmacokinetics (PK) and pharmacodynamics (PD) with important consequences in reaching the therapeutic targets or the risk of side effects. The use of linezolid, an oxazolidinone antibiotic, in intensive care is such an example. The optimization of its therapeutic effects, administration in intermittent (II) or continuous infusion (CI) is gaining increased interest. In a systematic review of the main databases, we propose a detailed analysis of the main PK/PD determinants, their relationship with the clinical therapeutic response and the occurrence of adverse effects following II or CI of linezolid to different classes of critically ill patients or in Monte Carlo simulations