Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Evaluation of baseline cardiac function by echocardiography and its association with nutritional status in pediatric cancer patients at the Indus hospital in Karachi, Pakistan

Introduction: Evidence on conducting baseline echocardiogram before starting chemotherapy in pediatric cancer patients is limited from developing countries where malnutrition and infections are common and which may result in cardiac dysfunction.Materials and Methods: A prospective, observational study was conducted from October 2016 to May 2017 at The Indus Hospital, Karachi, Pakistan, among children 1 to 16 years of age suffering from cancer. Echocardiography was performed before starting chemotherapy. Associations between body mass index and cardiac abnormalities were studied.Results: A total of 384 children met the inclusion criteria. The median (interquartile range) age was 8.0 (5.0 to 12.0) years and 62.0% (n=238) were male individuals. Twenty-two of 384 (5.7%) children had systolic dysfunction. Four of 22 had moderate-systolic and one of 22 had mild systolic dysfunction, for whom the therapy was altered, and they were treated without anthracyclines. Four of these 5 patients died, and only 1 of 5 survived through high-risk protocol. Seventeen of 22 children had low-normal systolic dysfunction. We found no evidence of an association between body mass index for age and abnormal left ventricular ejection fraction and abnormal fractional shortening (P-trend=0.587; 0.487, respectively). No associations were found of weight-for-age and height-for-age with these outcomes.Conclusions: In developing countries, echocardiograms should be expeditiously performed and technology made more accessible to rule out cardiac dysfunction and avoid delay in chemotherapy. Malnutrition was not associated with cardiac dysfunction

Prewetting Induced Hydrophilicity to Augment Photocatalytic Activity of Nanocalcite @ Polyester Fabric

To eliminate imidacloprid insecticide from wastewater, nanocalcite was grafted onto the surface of pretreated polyester fabric. The process of seeding was followed by the low temperature hydrothermal method for the growth of nanocalcite for the functionalization of fabric. The goal of this study was to improve the hydrophilicity of the nanocalcite photocatalyst that had been grafted onto the surface of polyester fabric (PF) using acidic and basic prewetting techniques. The morphological characteristics, crystalline nature, surface charge density, functional groups of surface-modified nanocalcite @ PF were determined via SEM, XRD, FTIR, and Zeta potential (ZP), respectively. Characterization results critically disclosed surface roughness due to excessive induction of hydroxyl groups, rhombohedral crystal structure, and high charge density (0.721 mS/cm). Moreover, contact angle of nanocalcite @ PF was calculated to be 137.54° while after acidic and basic prewetting, it was reduced to 87.17° and 48.19°. Similarly, bandgap of the as fabricated nanocalcite was found to be 3.5 eV, while basic prewetted PF showed a reduction in band gap (2.9 eV). The solar photocatalytic mineralization of imidacloprid as a probe pollutant was used to assess the improvement in photocatalytic activity of nanocalcite @ PF after prewetting. Response surface methodology was used to statistically optimize the solar exposure time, concentration of the oxidant, and initial pH of the reaction mixture. Maximum solar photocatalytic degradation of the imidacloprid was achieved by basic prewetted nanocalcite @ PF (up to 91.49%), which was superior to acidic prewetted fabric and as-fabricated nanocalcite @ PF. Furthermore, HPLC and FTIR findings further indicated that imidacloprid was decomposed vastly to harmless species by basic prewetted nanocalcite @ PF