The Assessment of Immediate Postoperative Delirium in Neurologically Intact Adult Patients Admitted to the Post-anesthesia Care Unit: A Cross-Sectional Study.

Background Immediate postoperative delirium (IPD) in the post-anesthesia care unit (PACU) can cause significant morbidity affecting everyday activities and length of stay with cost implications. This study was undertaken to find the proportion of IPD in PACU and its association with anesthesia and other perioperative factors. Methods After obtaining ethical approval and informed consent, this cross-sectional study was conducted in the PACU. A total of 600 consecutive adult patients (American Society of Anesthesiologists (ASA) 1-3) posted for surgery were approached between January and March 2019, of which 402 patients without neurological diseases and language and hearing discrepancies were studied. All patients had the intervention of surgery under anesthesia in a usual manner. Delirium was assessed preoperatively, postoperatively at 15 and 30 minutes, and before discharge from the PACU. IPD was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, while sedation/agitation was assessed using the Richmond Agitation-Sedation Scale (RASS). The primary outcomes were the proportion of IPD, association with anesthesia, and perioperative risk factors. The secondary outcomes were the length of stay, delirium treatment, and mortality. Results Overall, the IPD proportion was 14.7%. A significant association was demonstrated with premedication with midazolam (odds ration (OR): 3.2; 95% confidence interval (CI): 1.42-7.35; P=0.003), general anesthesia (GA) (OR: 6.3; 95% CI: 2.23-17.8; P<0.001), duration of anesthesia (126 versus 95 minutes; P=0.001), laparoscopic mode of surgical access (OR: 3.4; 95% CI: 1.8-6.4; P<0.001), and postoperative RASS >/< 0 (OR: 10.6; 95% CI: 4.69-24.11; P<0.001) at 30 minutes and before discharge from the PACU. Multivariate analysis showed the strongest association of RASS at 30 minutes with IPD. Conclusion The proportion of IPD was found to be 14.7% in this study, and the chances of developing IPD are high if the patient is not awake and calm in the PACU, especially if midazolam is administered as premedication, followed by general anesthesia (GA) for a long duration.

Airway and Anaesthetic Challenges in a Child With Bronchus Suis and Superimposed Double Aortic Arch: A case report.

Bronchus suis or tracheal bronchus is an accessory bronchus arising from the trachea above the carina. Double aortic arch is a congenital vascular anomaly with persistence of both left and right aortic arches beyond fetal life which can form a vascular ring compressing the major airways and may be symptomatic. We report the case of a 16-month-old girl who had recurrent episodes of respiratory distress requiring multiple hospitalisations and was diagnosed at the Sultan Qaboos University Hospital, Muscat, Oman in 2019 with a double aortic arch compressing upon a tracheal bronchus causing symptomatic emphysema of the right upper lobe. This report presents anaesthetic and airway challenges during the patient's lobectomy. A single lumen cuffed endotracheal tube was successfully used as a bronchial blocker to occlude the origin of the aberrant bronchus. The position of the tube was confirmed intraoperatively using fibreoptic bronchoscopy. Following her discharge, she continued to have recurrent episodes of respiratory distress and three months after her last appointment she succumbed to her illness. To the best of the authors' knowledge, this is the first such reported case in Oman.

Gastrointestinal Migration of a Pharyngeal Pack During Functional Endoscopic Sinus Surgery (FESS): A Case Report and Preventive Strategies.

The pharyngeal pack is routinely used in many nasopharyngeal surgeries to reduce the spillage of secretions into the trachea and esophagus. Here we report a case of migration of a pharyngeal pack into the stomach of a patient undergoing functional endoscopic sinus surgery and review risks of delayed recognition and the management of this complication. In this case report, we share our experience to reinforce and highlight the importance of proper documentation of pharyngeal pack insertion and removal to prevent easily avoidable morbidity and mortality. It also highlights the importance of an immediate esophago-gastro-duodenoscopy (OGD) to retrieve the migrated pharyngeal pack as soon as its migration to the gastrointestinal tract is suspected.

Thermophilic bacteria in Moroccan hot springs, salt marshes and desert soils.

The diversity of thermophilic bacteria was investigated in four hot springs, three salt marshes and 12 desert sites in Morocco. Two hundred and forty (240) thermophilic bacteria were recovered, identified and characterized. All isolates were Gram positive, rod-shaped, spore forming and halotolerant. Based on BOXA1R-PCR and 16S rRNA gene sequencing, the recovered isolates were dominated by the genus Bacillus (97.5%) represented by B. licheniformis (119), B. aerius (44), B. sonorensis (33), B. subtilis (subsp. spizizenii (2) and subsp. inaquosurum (6)), B. amyloliquefaciens (subsp. amyloliquefaciens (4) and subsp. plantarum (4)), B. tequilensis (3), B. pumilus (3) and Bacillus sp. (19). Only six isolates (2.5%) belonged to the genus Aeribacillus represented by A. pallidus (4) and Aeribacillus sp. (2). In this study, B. aerius and B. tequilensis are described for the first time as thermophilic bacteria. Moreover, 71.25%, 50.41% and 5.41% of total strains exhibited high amylolytic, proteolytic or cellulolytic activity respectively.

Thermophilic bacteria in Moroccan hot springs, salt marshes and desert soils

The diversity of thermophilic bacteria was investigated in four hot springs, three salt marshes and 12 desert sites in Morocco. Two hundred and forty (240) thermophilic bacteria were recovered, identified and characterized. All isolates were Gram positive, rod-shaped, spore forming and halotolerant. Based on BOXA1R-PCR and 16S rRNA gene sequencing, the recovered isolates were dominated by the genus Bacillus (97.5%) represented by B. licheniformis (119), B. aerius (44), B. sonorensis (33), B. subtilis (subsp. spizizenii (2) and subsp. inaquosurum (6)), B. amyloliquefaciens (subsp. amyloliquefaciens (4) and subsp. plantarum (4)), B. tequilensis (3), B. pumilus (3) and Bacillus sp. (19). Only six isolates (2.5%) belonged to the genus Aeribacillus represented by A. pallidus (4) and Aeribacillus sp. (2). In this study, B. aerius and B. tequilensis are described for the first time as thermophilic bacteria. Moreover, 71.25%, 50.41% and 5.41% of total strains exhibited high amylolytic, proteolytic or cellulolytic activity respectively.

Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia.

Carotid endarterectomy (CEA), as a prophylactic operation is becoming more popular. It is performed in patients who are at risk of stroke from dislodged atheromatous plaque at the carotid bifurcation. The major concern during CEA is the detection of cerebral hypoperfusion or ischemia during carotid cross clamping. Some studies have shown that the introduction of loco-regional anesthesia has lowered the incidence of major complications compared with general anesthesia since ischemia detection is easier in conscious patient.

Effect of organic and mineral fertilizers on N-use by wheat under different irrigation frequencies.

A field trial was established in Errachidia, southern Morocco, to investigate the interaction between wheat residue management and mineral 15N-labelled ammonium sulphate, under different irrigation treatments, applied to wheat (Triticum durum var. Karim). In treatments I1, I2, I3 and I4, plots were irrigated every 10, 15, 21 and 30 days. Each plot contained three sub-plots that received three fertilization treatments: T1 received 42 kg N ha-1 of ammonium sulphate before seedling, 42 kg N ha-1 of ammonium sulphate labelled with 9.764 at % 15N excess at tillering and 84 N kg ha-1 of ammonium sulphate at flowering; T2 received 42 kg N ha-1 of ammonium sulphate labelled with 9.764 at % 15N excess at seedling, 42 kg N ha-1 at tillering and 42 kg N ha-1 at flowering; T3 received 4800 kg ha-1 of wheat residue labelled with 1.504 at % 15N excess and 42 kg N ha-1 of ammonium sulphate before seedling and 42 kg N ha-1 of ammonium sulphate at flowering. Nitrogen fertilization with 168 kg N ha-1 did no significantly increase grain and straw yields in comparison to the 126 kg N ha-1 application. The combination of the organic input and supplementary application of mineral fertilizer N has been found as a more attractive management option. For all irrigation treatments, the % recovery of N in the whole plant was higher in plants that received 15N at tillering (63%, 49% respectively for irrigation intervals between 10 and 30 d) than in plants that received 15N just after seeding (28% for irrigation each 10- and 30-d intervals). For the irrigation treatment each 10 and 15 days, the 15N was mainly recovered by the grain for all fertilization treatments, whereas for irrigation treatment each 30 days, the grain and straw recovered nearly equal amounts of fertilizer. For grain and straw of wheat, nitrogen in the plant derived from the fertilizer was low, while most of the N was derived from the soil for all irrigation and fertilization treatments. The % nitrogen in the plant derived from the fertilizer values showed no significant difference between the different plant parts. The results suggested a dominant influence of moisture availability on the fertilizer N uptake by wheat. Under dry conditions the losses of N can be allotted to denitrification and volatilisation.

[Decomposition and nitrogen dynamics of wheat residues and impact on wheat growth stages]. / Décomposition et dynamique de l'azote de résidus de blé et impact sur les stades de croissance du blé.

N mineralisation and immobilisation were quantified in field conditions in the presence or in the absence of wheat residues. The incubation study was conducted in cylinders placed in microplots (no plants were grown in cylinders), and the rest of each microplot was sowed with the wheat crop (Triticum durum var. Massa). N mineralisation and immobilisation depend on the presence or the absence of wheat residues. In absence of residues, a linear model of regression was developed to follow the clear nitrogen mineralisation at different soil levels. Nitrogen mineralisation (mg kg-1), during the five months of wheat development, showed the following decreasing order: 0-15 cm (132.6) > 15-30 cm (120.6) > 30-45 cm (91.3). The mineralisation rate was 24.1, 22.9 and 18.9 mg kg-1 d-1 for 0-15, 15-30 and 30-45 cm levels, respectively. The supply of wheat residues resulted in a five months N immobilisation process. At level 0-15 cm the immobilisation (mg kg-1) showed the following decreasing order: (61.6) > (46.4) > (30.0) for the supply of wheat residues at seeding time, and 15 and 30 d before seeding respectively. At the other levels, the same decreasing order was recorded. The supply of 8 t ha-1 of wheat residues at seeding time, and 15 or 30 d before seeding, decreased the dry matter yield and N accumulation in wheat crop. In consequence, there was no synchronism between the nitrogen liberated by wheat residues decomposition and the wheat growth.