Preoperative Pulmonary Evaluation and Evaluation of Postoperative Pulmonary Complications in Geriatric Patients Undergoing Spinal Surgery

Background: The number of elderly (geriatric) population is increasing day by day and it becomes important in geriatric diseases and surgeries. It is predicted that approximately half of the population over the age of 65 will require surgical intervention during their lifetime in western societies in the following years. For this reason, he wanted to show that postoperative morbidity and mortality can be reduced with a careful preoperative pulmonary evaluation in this patient group, which we now encounter more frequently in pulmonology practice. Objective: We aimed to examine the preoperative pulmonary risk assessment and the type of operation performed in geriatric patients who underwent spinal surgery, and its effect on postoperative complications and mortality in relation to the geriatric age group of the patient in the light of the literature. Methods: Preoperative and postoperative consultations of 341 geriatric spinal surgery patients were retrospectively reviewed. Geriatric age group, gender, existing diseases, preoperative pulmonary risk class, type and duration of surgery, type of anesthesia (all patients were operated under general anesthesia), peroperative and postoperative complications were recorded. Results: The mean age was 75.28 ± 6.091 (65 93). . When the patients with chronic disease in the preoperative period and died in the post operative period were evaluated, a statistically significant difference was observed in the elderly group in terms of mortality rates in the presence of malignancy alone, COPD or CHF disease compared to other age groups. Postoperative respiratory complications were observed in 35 (10.3%) patients. Respectively, 13 (3.81%) patients had pneumonia, 12 (3.51%) patients had atelectasis, 7 (2.05%) patients had embolism, and 3 (0.87%) patients had respiratory failure. There was a statistically significant increase in mortality rate in postoperative complications and death rates in direct proportion to age. Conclusions: These complications can be minimized by better pulmonary preoperative risk assessment.Keywords: Spinal surgery in geriatric patients, Preoperative pulmonary evaluation, Postoperative pulmonary risk 'DOI: 10.7176/JHMN/78-0

EXCHANGE RATE DETERMINATION IN HIGH FRAGILE EMERGING COUNTRIES

There exist exchange rate determination problem together with removing the restrictions on financial capital movements after 1970’s. In the economics literature various type of models that are purchasing power parity, Mundell Fleming Model, Sticky Price Monetary Approach, Flexible Price Monetary Approach and Hibrit Model are explicated and tested for countries’ economies. There may be more threats for the high fragile emerging countries. Argentina, Russia and Chile are included to the “fragile five” countries i.e. Turkey, Brazil, India, Indonesia and South Africa. Central Bank of USA (FED) announced to reduce the bond purchases and applied this issue gradually. Mostly emerging countries but also others suffer damage to their economies because of this argument. In this study the fragile countries that are mentioned above are examined whether their exchange rates behave like one of the determination model in the 1980-2011 periods. Our hypothesis is these countries behave like Flexible Price or Sticky Price Monetary Model consistent with the literature. Unit root test and cointegration are used to test the hypothesis

Comparison of Clinical and Hemodynamic Effects of Isoflurane and Sevoflurane Anesthesia in Calves

Background: Inhalation anesthesia is the preferred method for use on many animal species, including ruminants, due to its superiority over the injectable anesthetics. The most commonly used inhalation anesthetics are isoflurane and sevoflurane The aim of the study was to investigate the effects of isoflurane and sevoflurane anesthesia on the cardiovascular system of calves.Materials, Methods & Results: A total of 20 calves (11 male, 9 female) between 1 and 6 months in age and 50 to 85 kg in body weight were used. The calves were divided randomly into two groups of 10 each, with one group being administered isoflurane and the other sevoflurane. An intramuscular dosage of 0.1 mg/kg of xylazine was administered to the calves as premedication. Induction was performed 10 min after calves were given an intramuscular dosage of 4 mg/kg of ketamine. Inhalation anesthesia was maintained with isoflurane or sevoflurane in 100% oxygen saturation. Before anesthesia, after induction and at intervals of 5, 10, 15, 20, 25, 30, 45, and 60 min of anesthesia, the body temperature, heart rate, and respiratory rate of the calves were recorded. Additionally, before anesthesia, after induction and at intervals of 15, 30, 45, and 60 min of anesthesia, serum electrolyte (Na+, Ca++, K+, Mg++) and blood gases (pH, pCO2, pO2, HCO3-, TCO2, O2Sat, HCT) were evaluated from blood samples taken from both groups. The second derivation, durations and amplitudes of the P and T waves, the durations and amplitudes of the QRS complex, and the durations of PQ and QT intervals were evaluated on the ECGs recorded before anesthesia, after induction and during anesthesia. Following anesthesia termination, the extubation time and the time it took for straightening of the head and standing up were recorded. Decrease in heart rate and body temperature were found significant in two of the groups. Decrease in respiratory rate compared to initial values after premedication was statistically significant for both groups. However, during anesthesia, an increase occurred. This incresae in respiration rate was not statistically significant compared to initial values. The incease in the values of pCO2, pO2, HCO3 and the decrease in the values of pH and Hct comparing the initial values was found statistically significant in both groups.Discussion: In ruminants, isoflurane has an induction concentration of 3-5% and an anesthetic concentration of 1.5-3%, while sevoflurane has an induction concentration of 4-6% and an anesthetic concentration of 2.5-4%. In this study, the concentration of isoflurane was 2.3% (2-5) and the of sevoflurane was 4.07% (3-5) for surgery. In the isoflurane group, extubation, straightening of the head and standing up times were 12.40 ± 3.77 min, 20.4 ± 1.57 min, and 30.80 ± 1.89 min, respectively. In the sevoflurane group, extubation, straightening of the head and standing up times were 13.40 ± 4.99, 19.2 ± 1.49, and 28.0 ± 1.83 min, respectively. Although the calves in the isoflurane group were extubated earlier than those of the sevoflurane group, the time elapsed for straightening of the head and standing up were longer than that of the sevoflurane group. The anesthesia protocol provided a smooth anesthetic administration, general anesthesia and awakening. In conclusion, the effects of isoflurane and sevoflurane anesthesia on the cardiovascular and respiratory system were similar, and although the changes that emerged during anesthesia were statistically significant, it was nonetheless found that the changes were within the physiological limits

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised