Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in Thoracic Surgery Patients

Background Obstructive sleep apnea (OSA) is associated with higher rates of postoperative delirium. The relationship between preoperative OSA risk and postoperative delirium and coma in thoracic surgery patients hospitalized in the intensive care unit (ICU) is not well understood. This study tests the hypothesis that thoracic surgery patients hospitalized in ICU with a higher preoperative risk for OSA are more likely to develop postoperative delirium and coma, resulting in longer hospital stays. Methods Preoperative OSA risk was measured using the STOP-BANG questionnaire. STOP-BANG scores of ≥ 3 were defined as intermediate-high risk for OSA. 128 patients who underwent major thoracic surgery completed the STOP-BANG questionnaire preoperatively. The Richmond Agitation and Sedation Scale was used to assess level of consciousness. The Confusion Assessment Method for the ICU was used to assess for delirium. Linear regression was used to assess the relationship between risk of OSA and outcome measures. Results were adjusted for age, gender, body mass index, Charlson Comorbidity Index, instrumental activities of daily living, and surgery type. Results 96 out of 128 patients (76%) were in the intermediate-high risk OSA group. Adjusted analyses showed that the intermediate-high risk OSA group had a longer duration of postoperative ICU delirium and coma compared to the low risk OSA group (1.4 days ± 1.3 vs 0.9 days ± 1.4; P = 0.04). Total number of hospital days was not significantly different. Conclusions Higher preoperative risk for OSA in thoracic surgery patients was associated with a longer duration of postoperative delirium and coma

Perioperative Risk Factors for Postoperative Delirium in Patients Undergoing Esophagectomy

Background Postoperative delirium affects up to 50% of patients undergoing esophagectomy and is associated with negative outcomes. The perioperative risk factors for delirium in this population are not well understood. We conducted this study to assess perioperative risk factors for postoperative delirium among esophagectomy patients. Methods We performed a secondary data analysis of patients enrolled in a randomized controlled trial evaluating the efficacy of haloperidol prophylaxis postoperatively in reducing delirium among esophagectomy patients. Postoperative delirium was assessed twice daily using the Confusion Assessment Method for the ICU. Univariate and logistic regression analyses were performed to examine the association between perioperative variables and development of postoperative delirium. Results Of 84 consecutive esophagectomy patients, 27 (32%) developed postoperative delirium. Patients who developed postoperative delirium had higher APACHE II scores [22.1 (6.5) versus 17.4 (6.8); p=0.003], longer mechanical ventilation days [1.7 (1.4) versus 1.0 (1.1); p=0.001], and longer ICU days [5.1 (2.6) versus 2.6 (1.6); p<0.001]. In a logistic regression model, only ICU length of stay was found to have significant association with postoperative delirium [OR 1.65; 95% CI 1.21-2.25]. Conclusions ICU length of stay was significantly associated with postoperative delirium. Other perioperative factors including duration of surgery, blood loss, and hemoglobin levels were not significantly associated with postoperative delirium

Cohort-based kernel principal component analysis with Multi-path Service Routing in Federated Learning

Federated Learning (FL) is a machine learning (ML) strategy that is performed in a decentralized environment. The training is performed locally by the client on the global model shared by the server. Federated learning has recently been used as a service (FLaaS) to provide a collaborative training environment to independent third-party applications. However, the widespread adoption in distributed settings of FL has opened venues for a number of security attacks. A number of studies have been performed to prevent multiple FL attacks. However, sophisticated attacks, such as label-flipping attacks, have received little or no attention. From the said perspective, this research is focused on providing a defense mechanism for the aforesaid attack. The proposed approach is based on Type-based Cohorts (TC) with Kernel Principal Component Analysis (KPCA) to detect and defend against label-flipping attacks. Moreover, to improve the performance of the network, we will deploy Multi-path Service Routing (MSR) for edge nodes to work effectively. The KPCA will be used to secure the network from attacks. The proposed mechanism will provide an effective and secure FL system. The proposed approach is evaluated with respect to the following measures: execution time, memory consumption, information loss, accuracy, service request violations, and the request’s waiting time

Students' Feedback of Written Examination: A Public Sector Medical University Experience

Objective: To determine the students’ perceptions regarding the examination in a public sector medical university. Methodology: This cross-sectional study was conducted at Shaheed Zulfiqar Ali Bhutto Medical University Islamabad. An examination feedback proforma was developed to collect the feedback from students appearing for the written exam for MD/MS/MTA during 2015. Multiple variables were assessed and descriptive analysis was done. Results: The feedback proforma was distributed to 98 candidates with response rate was 68.36%. Overall feedback from students about the examination was positive. Majority of the students were satisfied with the process and arrangements of the examination. However a large number of students did not comment on some important issues. Conclusion: Collecting students’ feedback about examination was a good effort to identify our deficiencies and indication for areas of improvement. This study revealed a positive response from students regarding overall management of the examination process

Influence of β-galacto-oligosaccharide on growth performance and components of intestinal barrier in broilers during heat stress

This study aimed to investigate the influence of β-galacto-oligosaccharides (β-GOS) on growth performance, organ development and intestinal microarchitecture of broilers during heat stress. Day-old chicks (n = 125) were divided into five groups. The control or thermoneutral zone group (TNZ) was raised under standard management until the 35th day. Four groups were exposed to cyclic heat stress (35 °C 8 h/d) from the 22nd to the 35th day. The TNZ and heat stress control (HSCT) groups were fed a corn-based diet and HS + 0.1% β-GOS; HS + 0.2% β-GOS; and HS + 0.5% β-GOS were fed a corn-based diet supplemented with β-GOS (0.1%, 0.2%, and 0.5%), respectively. Exposure to heat stress reduced feed consumption, feed efficiency and the relative weight of the liver, bursa of Fabricius, and small intestine, compared with the TNZ group. Morphometric evaluation of the small intestine revealed reduced villus surface area, villus height to crypt depth ratio (VH : CD) and intraepithelial lymphocytes (IELs) in all segments, and reduced acidic goblet cells (AGCs) in the ileum of the HSCT group compared with the TNZ group. Compared with the HSCT group, dietary β-GOS (0.2% and 0.5%) improved the feed efficiency and relative weight of the small intestine. Furthermore, dietary β-GOS (0.1%) increased villus surface area in the duodenum and IEL count in the small intestine compared with the HSCT group. Dietary β-GOS 0.5% increased villi surface area (VSA) in the jejunum and ileum, whereas the IEL count in the small intestine and acidic goblet cells (AGCs) in the jejunum and ileum were reduced compared with the HSCT group. In conclusion, dietary supplementation of β-GOS (0.2% and 0.5%) improved the growth performance and intestinal microarchitecture of broilers during heat exposure, along with partial immune stimulation. Keywords: Feed efficiency, goblet cell, intraepithelial lymphocytes, mucosal architecture, prebiotics, poultry, villus morphometr

Drug resistance profile and biofilm forming potential of Pseudomonas aeruginosa isolated from contact lenses in Karachi-Pakistan

BACKGROUND: The contaminated contact lens provides Pseudomonas aeruginosa an ideal site for attachment and biofilm production. Continuous contact of the eye to the biofilm-infested lens can lead to serious ocular diseases, such as keratitis (corneal ulcers). The biofilms also prevent effective penetration of the antibiotics, which increase the chances of antibiotic resistance. METHODS: For this study, 22 Pseudomonas aeruginosa isolates were obtained from 36 contact lenses and 14 contact lens protective fluid samples. These isolates were tested against eight commonly used antibiotics using Kirby-Bauer disk diffusion method. The biofilm forming potential of these isolates was also evaluated using various qualitative and quantitative techniques. Finally, a relationship between biofilm formation and antibiotic resistance was also examined. RESULTS: The isolates of Pseudomonas aeruginosa tested were found resistant to most of the antibiotics tested. Qualitative and quantitative biofilm analysis revealed that most of the isolates exhibited strong biofilm production. The biofilm production was significantly higher in isolates that were multi-drug resistant (p < 0.0001). CONCLUSION: Our study indicates that multi-drug resistant, biofilm forming Pseudomonas aeruginosa isolates are mainly involved in contact lens associated infections. This appears to be the first report from Pakistan, which analyzes both antibiotic resistance profile and biofilm forming potential of Pseudomonas aeruginosa isolates from contact lens of the patients with contact lens associated infections

Effects of music intervention on inflammatory markers in critically ill and post-operative patients: A systematic review of the literature

BACKGROUND: Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear. OBJECTIVES: We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients. METHODS: A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion. RESULTS: Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias. CONCLUSIONS: Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed

Effect of garlic supplementation on zootechnical performance and hepato-renal functions in nitrate-treated rabbits

The effect of garlic supplementation on zootechnical performance and hepato-renal functions of rabbits exposed to experimental nitrate poisoning was evaluated. Adult male 6-8 week-old albino rabbits (n= 24) were randomly divided into four groups (A - D) and subjected to nitrate intoxication through the oral administration of sodium nitrate solution at 2 ml/kg bodyweight per day for 40 days. Group A was a control that received no treatment except sodium nitrate. Rabbits in groups B and C were treated with 1% methylene blue solution (2 mg/kg bodyweight per day) and aqueous garlic extract (500 mg/kg bodyweight per day) through intraperitoneal and oral routes, respectively. Rabbits in group D were treated with both 1% methylene blue solution (2 mg/kg bodyweight per day, intraperitoneally) and aqueous garlic extract (500 mg/kg bodyweight per day, orally). On completion of the treatment period, the groups were compared in growth performance, biochemical profile and histopathological changes of hepato-renal tissues. Although the total feed consumption of the groups remained comparable, Group C showed relatively better weight gain and feed conversion ratio (FCR). Likewise, garlic extract significantly increased the serum bilirubin concentration and reduced the level of other biochemical attributes in comparison with control animals. The hepatic and renal tissues of Groups C and D remained normal, whereas those of the control group exhibited distinct histopathological alterations. It was concluded that garlic supplementation ameliorated the deleterious effects of nitrate intoxication on production performance and hepato-renal functions of rabbits

Effects of Bacillus subtilis on performance, immune system and gut in Salmonella-challenged broilers

The goal of this study was to compare the effects of Bacillus subtilis and the antibiotic enrofloxacin on growth performance, immune response, intestinal histomorphometry and cecal Salmonella numbers in broilers challenged with S. gallinarum. Salmonella-free chicks (n = 240) were allocated to four groups, comprising six replicates (n = 10) each. Group NN was not infected and received no treatment. Group SN was infected with Salmonella and received no treatment. Group SE was infected with Salmonella and treated with the antibiotic enrofloxacin. Group SP was infected with Salmonella and treated orally with the probiotic B. subtilis. Initially the groups that were infected with Salmonella had reduced growth performance compared with NN. By the fourth week, SE and SP had recovered and weighed as much as or more than NN. The SP group had greater cellular immunity and relative weights of the bursa and thymus than the other groups. SN had the lowest villus height in all the segments of the small intestine and a larger Salmonella population in the ceca. Probiotic supplementation reduced the pathological outcomes more than enrofloxacin. Prophylactic use of B. subtilis-type probiotics had similar effects to the use of antibiotics, alleviated the stress related to infection of S. gallinarum, and improved the growth performance, immune function, and gut mucosal development in broilers. Keywords: growth promoters, immunity, probiotics, poultry villi lengt