The effect of delirium preventive measures on the occurrence of postoperative cognitive dysfunction in older adults undergoing cardiovascular surgery. The DelPOCD randomised controlled trial.

STUDY OBJECTIVE: This trial examines the effect of delirium preventive measures on the incidence of postoperative cognitive dysfunction in older adults. DESIGN: In a randomised approach, a delirium prevention and a standard care group were compared regarding manifestation of postoperative cognitive dysfunction at seven days, three and twelve months postoperatively (primary outcome). To correct for practice effects and age-depended cognitive decline, a control group of age-matched healthy subjects was included. SETTING: The trial was conducted at the University Medical Centre Hamburg between 2014 and 2018, data assessment took place in the Anaesthesia Outpatient Clinic and on the surgical ward. PATIENTS: A total of 609 patients ≥60 years scheduled for cardiovascular surgery were enrolled, allocated treatment was received by 284 patients in the delirium prevention and 274 patients in the standard care group. INTERVENTION: The intervention consisted of a delirium prevention bundle including reorientation measures, sleeping aids and early mobilisation. MEASUREMENTS: Cognitive functions were assessed via neuropsychological testing of attention, executive functions including word fluency, and verbal memory utilizing a computerised test of attentional performance, the trail making test, the digit span subtest from the Wechsler Adult Intelligence Scale-IV, the verbal learning and memory test, and the Regensburg Word Fluency Test. Assessments were performed preoperatively and at three time points postoperatively (one week, three months and 12 months). MAIN RESULTS: Postoperative cognitive dysfunction was defined as a clinically meaningful decline in at least two out of nine chosen test parameters compared to the preoperative level (reliable change index ≤ - 1.96). The rates of postoperative cognitive dysfunction were 25.9% (delirium prevention group, n = 284) vs. 28.1% (standard care group, n = 274) [X2(1,n = 433) = 0.245;p = 0.621] at postoperative day seven and declined to 7.8% vs. 6.8% [X2(1,n = 219) = 0.081;p = 0.775] and 1.3% vs. 5.6% (p = 0.215, Fisher's exact test) at three and 12 months following surgery, respectively. The postoperative delirium rates did not differ between the two groups (delirium prevention group: 13.4% vs. standard care group: 17.3%). Attentional performance was impaired shortly after surgery, whereas verbal delayed recall was most frequently affected over the whole postoperative period. CONCLUSION: These findings suggest that an intervention combining specific measures extracted from established postoperative delirium prevention programs did not reduce the rate of postoperative cognitive dysfunction in older adults.

[When the resting membrane potential becomes restless. Acute hyperkalemia in the perioperative phase]. / Wenn das Ruhemembranpotenzial aus der Ruhe kommt. Akute Hyperkaliämie in der perioperativen Phase.

Acute hyperkalemia is a life-threatening event and often occurs abruptly and without warning in the perioperative field. Risk factors are found on multiple levels as they can derive from a patients pre-existing condition or result from the surgical intervention or management of anesthesia. The therapy of hyperkalemia depends on the dimensions of electrolyte disturbance and a distinction can be made between therapeutic measures with a rapid and those with a long-term effect.

[Fluorescein aspiration during induction of anaesthesia : complication preceding surgical treatment of cerebrospinal fluid fistula]. / Fluoreszeinaspiration während der Narkoseeinleitung : Komplikation vor operativer Sanierung einer Liqourfistel.

This case history deals with an 85-year-old patient who underwent surgery to treat rhinoliquorrhea. The patient aspirated a lutescent fluid shortly after anesthesia was administered. However, this fluid was not gastric juice but cerebrospinal fluid (CSF) running down the nasopharynx. The CSF had been stained with fluorescein prior to surgery in order to help localize the CSF fistula. This case of top down aspiration is discussed and preventive measures which can be employed in order to avoid similar complications in patients with rhinoliquorrhea are presented.

Prevalence of malnutrition and vitamin A deficiency in Nigerian preschool children subsisting on high intakes of carotenes.

The prevalence of malnutrition and vitamin A deficiency was determined in 204 preschool children of both sexes aged 3-57 months. The children were recruited from 2 rural communities of Atakumosa Local Government Area of Osun State in South West Nigeria. Dietary vitamin A intake was estimated from frequency of consumption of locally available vitamin A containing food items. Vitamin A status of the children was assessed from concentration of retinol in plasma. Nutritional status was assessed from height and weight compared with international reference standards. The results indicate widespread malnutrition among the children. The prevalence of stunting (low height for age) was 60.8% while prevalence of wasting (low weight for height) was 7.4% and of underweight (low weight for age) 27.5%. Dietary vitamin A intake appeared to be adequate in the children. Intake of vitamin A is predominantly from plant sources. At least 43% of the children consumed the carotene rich red palm oil 6 or more times per week in contrast to less than 1% who consumed eggs or milk for 6 or more times per week. Vitamin A deficiency was low in the children. Only 11.3% of the children had plasma retinol concentration < 0.70 mumol/L. The results indicate that childhood malnutrition of public health magnitude can coexist with adequate dietary vitamin A intakes or vitamin A status.

A two-year review of intestinal parasites in the Jos University Teaching Hospital patients

An analysis of stools samples examined during a period of two years; from January; 1988 to December; 1989 in Jos University Teaching Hospital was carried out. Of the 15634 people examined during this period; 6698 were males; while 8936 were females. Monoparasitism occured in 4364 persons; while polyparasitism occured in 240 persons. Several parasites were identified in these cases