Framingham risk score but not framingham stroke risk profile is an independent predictor of impaired cognitive function among older people, free of cardiovascular disease

#nofulltext#Background: Vascular risk factors contribute to cognitive impairment, which may be the earlier manifestation of vascular brain injury. This study examined the relationship between 10-year risk for coronary heart disease (CHD) or stroke and cognitive function in older people, free of cardiovascular disease. Methods: Participants were consecutive attenders of a “primary vascular prevention clinic”, between 2009 -2010. The Framingham Risk Score (FRS) and Framingham Stroke Risk Profile (FSRP) were used to assess 10-year risk of CHD and stroke, respectively. Cognitive function was measured with Montreal Cognitive Assessment Scale (MoCA). Cognitive status (CS) was categorized as impaired (MoCA<=21) vs. normal as previously validated in the Turkish population. Correlations between cognitive status and FRS or FSRP were analyzed with multivariate logistic regression analyses. Age, gender, education level, other potential correlates of cognitive ability (depression, physical activity, obesity, alcohol consumption, family history of dementia) and treatment for hyperlipidemia and diabetes were included in the analyses. Results: The sample consisted of 167 individuals (40 men and 127 women). Mean age was 68 (SD: 6 Range: 28). Mean FRS and FSRP were 8(3-20) and 7(4-11) respectively. Fifty five individuals (%33) had impaired CS. Individuals with higher FRS (increment by 10% in FRS) had more impaired CS (adjusted OR:1,669, 95%CI 1,038.to2,682). No association was shown between FSRP and CS. Higher age, lower education level, absence of alcohol consumption and absence of treatment for hyperlipidemia were the other independent predictors of impaired CS. Conclusion: Our findings indicated that in older individuals, free of cardiovascular disease, global vascular risk is associated with impaired cognitive function which was accounted for by FRS rather than FSRP. This association was demonstrated with the use of a simple and standard neuropsychological test in routine clinical setting

Anesthesia and ventilation options for flex robotic assisted laryngopharyngeal surgery

© 2019 Elsevier Inc. Background: Transoral treatment of benign and malignant lesions of laryngopharynx has limitations in exposure and access, partially due to the endotracheal tube (ETT). With a proper airway control to tailor ventilation and maximize exposure, transoral Flex robotic surgery (FLEX), using its 3D camera and instruments, can expand its ability. Choosing the right ETT, including a novel concept of using jet ventilation (JV) in FLEX, and placement technique can allow augmentation of the advantages that robotic surgery offers. Methods: Chart review of FLEX assisted procedures was performed. Attention was given to demographics, all events of airway manipulation and ventilation type, procedures performed and outcomes including adverse effects. Results: Fifty-two patients underwent eighty procedures. The airway was manipulated sixty-four times to include 8 JV. All possible FLEX instruments including CO2 laser were used. Three novel possible indications for trans-oral robotic surgery including the feasibility of JV in FLEX procedures were shown. Conclusions: Lesions of the tongue base, hypopharynx, larynx and trachea have the possibility to be managed with adequate exposure with minimal obstruction from ETT. Robotic HD camera permits both the surgeon and anesthesiologist to observe surgery and safely monitor the airway. An algorithm was developed for selecting ideal ventilation method for different procedures. The FLEX and the utilization of JV allows flexibility of two instruments without obstruction

Stroke unit versus neurology ward - A before and after study

Introduction:. Few studies have tested the hypothesis of whether the beneficial effect of Stroke Units (SUs) can be reproduced in routine clinical practice and whether SU are also superior to neurological wards [NWs]. We aimed to compare the outcomes of patients of a newly implemented SU to the outcomes of patients hospitalized in a NW. Methods:. We made a before-after comparison of 352 SUs and 352 NWs patients after adjusting for case-mixes by the multivariate method. Subgroup analyses were also performed to evaluate which patient groups benefit the most. In-hospital case-fatality, proportion of independent patients at discharge, length of hospital stay (LOHS), medical complication rate were the main outcome measures. Results:. Adjusted in-hospital case fatality was significantly reduced in the SUs (OR: 0.44, 95 % CI: 0.26-0.76; p = 0.003). The proportion of independent patients at discharge and patients having medical complications was not different. Length of hospital stay was shorter in SU patients (13.76 days vs. 16.72 days, p = 0.003). Treatment in the SUs decreased case fatality in many subgroups [men, elderly, early admitted, severe stroke, co-morbidity present and ischemic stroke groups]. Discussion:. The results of randomized trials in favor of SUs can be reproduced in routine clinical practice. The benefit of SU care seems to be more apparent with advancing age and increasing stroke severity. Stroke Unit seems to be a better alternative to an experienced NW