Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol

BACKGROUND: Delirum is common in hospitalized elderly patients and may be associated with increased morbidity, length of stay and patient care costs. Delirium (acute confusional state) is defined as an acute disorder of attention and cognition. In elderly patients, delirium is often an early indicator of patho-physiological disturbances. Despite landmark studies dating back to the 1940s, the pathogenesis of Delirium remains poorly understood. Early investigators noted that Delirium was characterized by global cortical dysfunction that was associated predominantly with specific electroencephalographic changes. It's important to understand the risk factors and incidence of Delirium. Some of the risk factors are already identified in literature and can be summarized in the word "VINDICATE" which stands for: Vascular, Infections, Nutrition, Drugs, Injury, Cardiac, Autoimmune, Tumors, Endocrine. Aims of this study are: to re-evaluate the above mentioned clinical risk factors, adding some others selected from literature, and to test, as risk factors, a pattern of some genes associated to cognitive dysfunction and inflammation possibly related to postoperative Delirium. DESIGN: All patients admitted to our Emergency Unit who are meet our inclusion/exclusion criteria will be recruited. The arising of postoperative Delirium will select incidentally two groups (Delirium/non Delirium) and the forward analysis of correlate risk factors will be performed. As in a typical observational case/control study we will consider all the exposure factors to which our population are submitted towards the outcome (presence of Delirium). Our exposures are the following: ASA, Pain (SVS; VAS), Blood gas analysis (pH; Hb; pO2; pCO2), Residence pharmacological therapy (BDZ; hypnotics; narcotic drugs; alcohol; nitrous derivates), Body temperature, Arterial pressure, Heart frequency, Breath frequency, Na, K, Creatinin, Glicemia, Albumin, Hct, White blood cells, Glasgow Coma Scale (GCS), Cognitive state (SPMSQ), Functional state (ADL and IADL), Psychological Distress (HADS), Cumulative Illness Rating Scale (CIRS), Hypotension (classified in: light; moderate and severe and duration), Blood loss (classified in: < 2 lt and > 2 lt), Blood transfusions (< 2 lt and > 2 lt), Quantity of red cells and plasma transfusions, Visual VAS / SVS (timing: I-II-III post-operative day), Red cells and Plasma transfusions, Blood count evaluation and Saturation (O(2)%), Postoperative analgesia (Emilia-Romagna protocol), Presence of malignant tumoral disease, APACHE Score II. Moreover the presence of some relevant genetic polymorphisms will be studied in different genes such as IL-6, IL-10, TNF-alpha, and IL-1 cluster

El cuento popular en la cultura hassaní

We seek to explore some of the characteristics of Hassani folk culture. Given the complexity and the diversity of the components of this culture, we have opted to study the folktale since the great importance placed on this genre in the Hassani culture makes it necessary to do so.Intentaremos explorar algunas características de la cultura popular hassaní. Dada la complejidad y la diversidad de los componentes de esta cultura, hemos optado por el estudio del cuento popular, opción dictada por la gran importancia de este género literario en la cultura hassaní

Immunomodulatory effect of propofol versus sevoflurane in patients undergoing thoracic surgery using one lung ventilation technique

Introduction: One lung ventilation (OLV) has become a standard procedure for many interventions in thoracic surgery with a need for deflation of the lung to facilitate the surgical procedure. Mechanical ventilation can induce a proinflammatory reaction in the non-deflated ventilated lung. However only limited data exist on inflammatory alterations in the temporarily deflated, non-ventilated lung in patients undergoing thoracic surgery. Aim of the work: The aim of this work is to compare between the effects of propofol and sevoflurane as regards: the systemic inflammatory response, the pulmonary inflammatory response, C-reactive protein, leucocyte count, and recovery status, in patients undergoing thoracic surgery using OLV technique. Patients and methods: This study include 40 adult patients, who were randomly classified into two groups: group (I) 20 patients received total intravenous anesthesia with propofol. Group (II) 20 patients received inhalational anesthesia with sevoflurane. Every patient was subjected to a careful pre-anaesthetic assessment, anaesthesia, bronchoalveolar lavage (BAL) analysis for human inflammatory mediators (IL-6 and TNF-α), serum analysis for systemic inflammatory mediators (IL-6 and TNF-α) (Both were measured before OLV and 15 min after OLV ended and resumption of two lung ventilation (TLV) at the end of surgery, and C-reactive protein and leukocyte count in blood (before OLV, 15 min after OLV ended and resumption of (TLV) at the end of surgery and on the 2nd postoperative day). Results: According to IL-6 and TNF-α, there was no statistically significant difference between the two groups before OLV, however they were significantly increased in both groups in serum and BAL after OLV in relation to before OLV with significant increase in group I relative to group II. A significant correlation was present between increased level of IL-6 and TNF-α in BAL and their levels in serum after OLV in the group II but this correlation was not present in the group I. Also no significant correlation between duration of OLV and inflammatory mediators (IL-6 and TNF-α) in serum and BAL in both groups. As regarding to CRP, there was no statistically significant difference between the two groups before OLV. After OLV and on the 2nd postoperative day the level of CRP increased significantly in both groups with significant increase in group I relative group II. According to WBC count there was no statistically significant difference between the two groups as regards the level of WBC before OLV. After OLV the level of WBC increased significantly in group I only. On the 2nd postoperative day the level of WBC increased significantly in both groups with significant increase in group I relative to group II. Also no significant correlation between duration of OLV with the increased levels of CRP and WBC count in both groups. Conclusion: Propofol increased pulmonary and systemic cytokine release more than sevoflurane during OLV. Propofol has increased CRP level and WBC count more than sevoflurane during OLV

Mass Spectral Fragmentation of Pelargonium graveolens Essential Oil Using GC–MS Semi-Empirical Calculations and Biological Potential

The volatile constituents of the essential oil of local Pelargonium graveolens growing in Egypt was investigated by gas chromatography&ndash;mass spectrometry (GC&ndash;MS), and the main constituents were citronellol (27.67%), cis-Menthone (10.23%), linalool (10.05%), eudesmol (9.40%), geraniol formate 6.87%, and rose oxide (5.77%), which represent the major components in the obtained GC total ion chromatogram. The structural determination of the main constitutes based on their electron ionization mass spectra have been investigated. The MS of these compounds are absolutely identical in mass values of peaks of fragment ions, where their relative intensities have minor differences. In the spectra of all studied compounds, the observed characteristic ions were [M-H2O]+ and [M-CH3]+. The latter has a structure with m/z 69, 83. Different quantum parameters were obtained using Modified Neglect of Diatomic Overlap (MNDO) semi-empirical method as total energy, binding energy, heat of formations, ionization energy, the energy of highest occupied molecular orbital (HOMO), the energy of the lowest unoccupied molecular orbital (LUMO), energy gap &Delta;, and dipole moment. The antibacterial and antifungal activities of P. graveolens essential oil and identified compounds were tested against wide collection of organisms. The individual identified compounds in the essential oil&mdash;citronellol, cis-Menthone, and linalool (except eudesmol)&mdash;showed comparable activity to antibiotics. The most active isolated compound was the citronellol and the lowest MIC was found against E. coli. The essential oil showed high antifungal effects and this activity was attributed to cis-Menthone, eudesmol, and citronellol (excluding linalool). cis-Menthone was the most active compound against selected fungi followed by the eudesmol The study recommends local P. graveolens and identified active compounds for further applications in the pharmaceutical industries

Kitab al-ʿikd al-farid fîl-taʾrikh wal-adab al-shadid, traité par l'imam Shihab al-Din Ahmad ibn Mohammad ibn Abd Rabbihi al-Andalousi al-Maliki († 328 de l'hégire). Arabe 5825

Al-ʿIkd al-farid fil-taʾrikh wal-adab al-shadidNumérisation effectuée à partir d'un document de substitution