Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients.

OBJECTIVE: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. METHODS: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves. RESULTS: 209 patients were included with a mean age of 76 ± 7.3 years. American Society of Anesthesiologists (ASA) classification, age, indication and type of surgery, hypotension, transfusion requirement and current malignancy proved to be statistically significant predictors of 30-day mortality. P-POSSUM mortality was statistically significant in the backward stepwise regression (incidence rate ratio=1.58, 95% CI: 1.16-2.15, p=0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83). CONCLUSION: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

Leukemia in Patients with Klinefelter Syndrome: A Report of Two Cases.

Klinefelter syndrome (KS) is a chromosome abnormality characterized by a 47, XXY karyotype associated with hypogonadism and infertility. We present two cases of leukemia in patients with KS. The first patient presented with acute promyelocytic leukemia. He relapsed after the end of treatment. The second patient was diagnosed with chronic myeloid leukemia. Treatment with imatinib failed and the patient presented with myeloid blast crisis.

Epidemiological profile of health-care-associated infections in the central-east area of Tunisia.

This study aimed to estimate the prevalence and risk factors for health-care-associated infection (HAl) in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% (95% CI: 4.2%-6.6%). The prevalence was significantly higher in the intensive care units (18.4%) and neonatal departments (12.7%). There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAl and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAl was linked to diabetes (OR = 2.0), immunosuppression (OR = 3.3), length of stay (OR = 4.5), central venous catheter (OR = 2.5) and peripheral venous catheter (OR= 10.2). We conclude that HAls are of concern in this area of Tunisia.

Epidemiological profile of health-care-associated infections in the central-east area of Tunisia

This study aimed to estimate the prevalence and risk factors for health-care-associated infection [HAI] in all 9 hospitals of the central-east area of Tunisia in 2005. Of 1373 patients admitted for more than 48 hours, 74 developed HAI, a prevalence of 5.4% [95% Cl: 4.2%-6.6%]. The prevalence was significantly higher in the intensive care units [18.4%] and neonatal departments [12.7%]. There were 79 infections and the most frequent sites of infection were respiratory tract and urinary tract. Microbiological examination was performed for 25 cases of HAI and Pseudomonas aeruginosa was identified in 8 cases. Multiple logistic regression analysis indicated that HAI was linked to diabetes [OR = 2.0], immunosuppression [OR = 3.3], length of stay [OR = 4.5], central venous catheter [OR = 2.5] and peripheral venous catheter [OR = 10.2]. We conclude that HAI sare of concern in this area of Tunisia

[Prospects for family planning in 1991 in Tunisia]. / Les perspectives de la planification familiale en 1991 en Tunisie.

PIP: Tunisia's National Office of the Family and Population has stated certain specific objectives that parallel those of the 7th economic and social development plan for the period 1987-91. 1 objective is to limit births to 240,000 in 1991, a lower figure than the 260,000 in the development plan. The strategy for attaining this goal will be to estimate the required number of contraceptive acceptors and to allocate the required number according to contraceptive method, geographic area, and intermediate plan years. In 1986, an estimated 66,000 births were averted and 230,000 actually occurred. In 1991, an estimated 91,000 births will need to be averted to reach the goal of 240,000. Without an additional family planning effort, an estimated 251,000 births would occur under conditions observed in 1986. An estimated 141,000 new acceptors will need to be recruited to meet the 1991 goal, compared to 112,000 in 1986. Abortion aside, the proportion of acceptors using each method in 1986 and the 1991 objective for that method respectively were 49% and 51% for IUDs, 9% and 10% for tubal ligation, 20% and 18% for oral contraceptives (OCs), and 22% and 20% for other methods. Other objectives of the office are to modify the characteristics of contraceptive acceptors, to reduce regional disparities in contraceptive usage, and to exert a greater influence on indirect fertility determinants. In order to reduce regional disparities in contraceptive prevalence, specific goals for OCs, IUDs, and tubal ligation have been set for each of the 7 regions. A greater effort will be required in the South East and South West, the Center East, and to a lesser degree the Center West. The Office will maintain the basic principle of availability of all methods, while encouraging the methods most accepted by the Tunisian population and the simplest to use, which are the IUD and tubal ligation. Without setting quantified objectives, the Office will strive to reduce the average age and parity of new acceptors through appropriate messages. In 1986, for acceptors of the pill, IUD, and tubal ligation respectively, the average ages were 28.5, 27.7, and 34.9 years and the average numbers of living children were 3.06, 2.80, and 5.52. Interventions to influence indirect fertility determinants will consist of such actions as improving educational programs in gouvernorates with relatively low marriage ages and improving health care in those with high infant and child mortality rates.^ieng