Risk Factors for Postoperative Cognitive Dysfunction in Older Adults Undergoing Major Noncardiac Surgery

Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had the apolipoprotein-E4 (ApoE4) allele, as potential inflammatory and genetic biomarkers for POCD, respectively. A nonsurgical control group, that is similar to patients in age, education level, and computer familiarity, was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Patients were classified as having POCD if they had less than -1.96 in the individual Z-scores of two or more tests or in the composite Z-score. Results: A total of 69 patients and 54 controls completed the study. The mean age for patients was 71 ± 5.4 (65–88) years old and 66.7% of them were females. The majority of patients (78.3%) had above high school education. There was no difference between the surgical and nonsurgical groups in demographics except for age which was marginally higher in the nonsurgical group [73 ± 6.3 (65-92)]. The incidence of POCD was 15.9% three months after surgery. Multivariable logistic regression showed that carrying the ApoE4 allele (OR = 4.74, 95% CI = 1.09 – 22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35 – 30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49 – 34.66) were risk factors for POCD. Conclusion: The incidence of POCD in older adults is 15.9% three months after major noncardiac surgery. Risk factors for POCD were carrying the ApoE4 allele, using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery, and receiving sevoflurane for anesthesia

STRUCTURAL OF SUPRAMOLECULAR HYDROGEN BONDING DIOXOURANIUM (VI) COMPLEXES

The azodye ligands were synthesized from the coupling of 3-methyl-1-phenyl-1H-pyrazol-5(4H)-one with aniline derivatives and characterized by elemental analyses, IR and NMR spectroscopy. Dioxouranium (VI) complexes of the prepared ligands were characterized by elemental analyses, conductance, thermal analysis and spectral (UV, IR and NMR) results. IR spectra show that the ligands behave as a monobasic bidentate coordinating via the hydrazo nitrogen atom and CO of the pyrazole ring. Thermal studies to verify the status of water molecules inside or outside the coordination sphere of the central metal ion. The optimized bond lengths, bond angles and the calculated quantum chemical parameters for the ligands were investigated. The coordination geometries and electronic structures are determined from a framework for the modeling of the complexes. The force constants, FUO (10-8 N/Ao) and the bond lengths, RUO (Ao) have been calculated from an asymmetric stretching frequency of O-U-Ogroup

Investigation on Effects of Avocado Extract as Eco-friendly Inhibitor for 201 Stainless Steel corrosion in Acidic Environment

The inhibitory effect of using avocado extract (AE) on the corrosion of stainless steel type 201 (201SS) in 1M hydrochloric acid has been studied. Chemical tests such as mass loss test (ML) and electrochemical such as electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PP) were used in this investigation. The results of these approaches showed that as the concentration of AE extract increase, their adsorption on the 201SS surface increases, and therefore the corrosion process lower. The Langmiur isotherm was observed to represent the adsorption of this extract on the surface of 201-SS. The inhibitory efficiency percent (%IE) and activation energy (Ea) were calculated in the presence and absence of AE. The corrosion rate was calculated and revealed that AE has good inhibition effect on 201-SS alloy surface inspection methods such as SEM, AFM, and FT-IR have also been used. It was found that all of these used methods are in agreement with each other

Efficacy of tadalafil in Egyptian and Turkish men with erectile dysfunction

A randomised, double-blind, parallel, placebo-controlled, 12-week study was carried out to evaluate the efficacy and safety of 20-mg tadalafil taken ‘as needed’ in a population of men with erectile dysfunction (ED) from Egypt and Turkey. One hundred and thirty-two patients were randomised in this study. Tadalafil was superior to placebo on all three co-primary efficacy end points. The mean change from baseline for the erectile function domain of the International Index of Erectile Function was 9.3 ± 0.8 for the tadalafil group and 2.3 ± 1.6 for the placebo group. Tadalafil-treated patients reported a significantly greater improvement in the mean percentage of successful penetrations (tadalafil: 34.5 ± 4.1; placebo: −4.6 ± 8.1) and successful intercourse attempts (tadalafil: 52.2 ± 3.8; placebo: 16.8 ± 7.8) than placebo-treated patients as measured by the Sexual Encounter Profile. Tadalafil was generally well tolerated with 82% of adverse events being mild in severity. Tadalafil 20-mg taken ‘as needed’ significantly improved the erectile function in Egyptian and Turkish men with ED

Pharmacy students’ perceptions and attitudes toward face-to-face vs. virtual team-based learning (TBL) in the didactic curriculum: A mixed-methods study

Introduction Virtual TBL is an online adaptation of the team-based learning (TBL) instructional strategy, emphasizing collaborative learning and problem-solving. The emergency shift to virtual TBL during the COVID-19 pandemic presented unique challenges. This study aims to 1) compare overall pharmacy students’ perceptions and attitudes toward face-to-face (FTF) TBL vs. virtual TBL in the didactic curriculum and stratify their perceptions and attitudes by various students’ characteristics; 2) evaluate students’ perceptions of the strengths and weaknesses of virtual TBL. Methods This mixed-methods, pre-post, cross-sectional study utilized an anonymous survey to collect the data. Pharmacy students completed a survey to compare their perceptions and attitudes toward learning, class experience, learning outcomes achieved, and satisfaction with FTF TBL vs. virtual TBL using a 5-point Likert-type scale. Additionally, the survey included two open-ended questions to gather students’ perceptions of the strengths and weaknesses of virtual TBL. Quantitative survey data were analyzed using the Wilcoxon matched-pairs signed rank exact test, while qualitative survey data were analyzed using thematic analysis. Results A total of 117 students (response rate of 59.4%) completed the study survey. Pharmacy students perceived FTF TBL to be superior to virtual TBL in their attitudes toward learning, class experience, learning outcomes achieved, and overall satisfaction across various students’ characteristics. While the students identified some unique strengths of using virtual TBL, they also highlighted several weaknesses of using this learning modality compared to FTF TBL. Conclusions Pharmacy students perceived FTF TBL to be superior to virtual TBL across various students’ characteristics. These findings can be helpful to pharmacy programs considering the implementation of virtual TBL in their didactic curricula. Future research should explore whether a purposefully designed virtual TBL environment, as opposed to the pandemic-driven emergency TBL planning, can influence students’ perceptions and attitudes toward virtual TBL

Diabetes is associated with risk of postoperative cognitive dysfunction: a meta-analysis

BACKGROUND: Postoperative cognitive dysfunction (POCD) occurs frequently after surgery, particularly among older people. Diabetes, chronic hyperglycemia, and a history of hypoglycemia are related to cognitive impairment, but little is known about their roles in POCD. Here, we estimated their associations with risk of POCD on the basis of published epidemiological research. METHODS: The PubMed and Cochrane databases were searched for longitudinal studies of adults undergoing surgery with reporting of associations of diabetes status, glycemic levels, and/or a history of hypoglycemia with risk of POCD as relative risks or odds ratios. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. RESULTS: The search identified 246 publications of which 14 met inclusion criteria, reporting on a total of 2642 patients (mean age 64 y). Follow-up periods spanned 1 day to 5 years. Overall, patients with diabetes had a 1.26-fold higher risk of POCD compared with diabetes-free patients (95% CI, 1.12-1.42). A single study assessed glycemic control in patients with diabetes and identified a higher hemoglobin A1c (HbA1c) level as associated with higher POCD risk (relative risk per percent higher HbA1c, 2.0; 95% CI, 1.4-2.6). We did not find studies on glycemic levels in the nondiabetic range or on hypoglycemia as potential predictors of POCD. CONCLUSION: Patients with diabetes appear to have a higher risk of POCD compared with diabetes-free persons. Among patients with diabetes, POCD risk may further increase with poorer glycemic control as indexed by higher HbA1c. The roles of HbA1c levels among nondiabetic persons in POCD risk warrant further research

Obesity and post-operative cognitive dysfunction: a systematic review and meta-analysis

Background: Post-operative cognitive dysfunction (POCD) occurs frequently after surgery, and is related to dementia and premature death. Obesity increases the risk of late-life cognitive impairment, but little is known about its role in POCD. We conducted a systematic review and meta-analysis of studies on the association between obesity and risk of POCD. Methods: PubMed and the Cochrane Library were systematically searched. Studies were included if they had prospective designs, reported on human adults undergoing surgery, if cognitive function was measured pre- and post-surgery, if obesity, body mass index (BMI) and/or body weight were ascertained, and if associations with POCD were reported as relative risks or odds ratios. Underweight, weight loss, and post-operative delirium were not considered. Results: Inclusion criteria were met by six articles. Samples totaled 1432 older patients (mean age ≥62 years) who were followed up for 24 hours to twelve months after surgery. Analysis of studies with obesity defined as a categorical measure found a non-significantly higher risk of POCD among persons with BMI > 30 kg/m2 versus ≤30 kg/m2 (RR 1.27; 95% CI 0.95, 1.70; p = 0.10). No such associations were found for studies that analyzed BMI or body weight continuously as predictors of POCD (RR 0.98 per kg/m2; 95% CI 0.93, 1.03, p = 0.45; RR 0.99 per kg; 95% CI 0.89, 1.09; p = 0.83, respectively). Conclusions: Few studies have addressed the topic, and the results of these studies provide only limited support for an increased risk of POCD in patients who are obese. Further large-scale, prospective investigations are necessary for clarification

Tris(β-ketoiminato)ruthenium(III) complexes: Electrochemical and computational chemistry study

© 2019 Elsevier Ltd The electronic and electrochemical properties are reported here for the first time for a series of five tris(β-ketoiminato)ruthenium(III) complexes. Since the β-ketoiminato ligand is unsymmetrical, both fac and mer isomers are theoretically possible for these octahedral complexes. Density functional theory calculations show that for complexes containing an H on the imino position, both the fac and mer are energetically possible, while for complexes with a Ph on the imino position, the mer isomer is energetically favoured, due to the steric hindrance caused by the Ph group in the fac isomer. Electrochemistry, utilizing cyclic voltammetry, showed RuIII/IV oxidation, RuIII/II reduction, as well as ligand based reduction of the RuII complex. Different RuIII/IV and RuIII/II redox couples were observed for the different fac and mer isomers of the tris(β-ketoiminato)ruthenium(III) complexes