Frailty efficacy as a predictor of clinical and cognitive complications in patients undergoing coronary artery bypass grafting: a prospective cohort study.

BACKGROUND: Frailty is proposed as a predictor of outcomes in patients undergoing major surgeries, although data on the association of frailty and coronary artery bypass grafting (CABG) are lacking. We assessed the association between frailty and cognitive and clinical complications following CABG. METHODS: This prospective study included patients aged over 60 years undergoing elective CABG at Tehran Heart Center from 2020 to 2022. Baseline and three-month follow-up data on frailty using the Frail scale and clinical Frail scale, functional status using the Lawton Instrumental Activities of Daily Living Scale (IADL), cognitive function by Montreal Cognitive Assessment (MoCA), and depression by the Geriatric Depression Scale (GDS) were obtained. The incidence of adverse outcomes was investigated at the three-month follow-up. Outcomes between frail and non-frail groups were compared utilizing T-tests and Mann-Whitney U tests, as appropriate. RESULTS: We included 170 patients with a median age of 66 ± 4 years (75.3% male). Of these, 58 cases were classified as frail, and 112 individuals were non-frail, preoperatively. Frail patients demonstrated significantly worse baseline MOCA scores (21.08 vs. 22.41, P = 0.045), GDS (2.00 vs. 1.00, P = 0.009), and Lawton IADL (8.00 vs. 6.00, P < 0.001) compared to non-frail. According to 3-month follow-up data, postoperative MOCA and GDS scores were comparable between the two groups, while Lawton IADL (8.00 vs. 6.00, P < 0.001) was significantly lower in frail cases. A significantly higher rate of readmission (1.8% vs. 12.1%), sepsis (7.1% vs. 19.0%), as well as a higher Euroscore (1.5 vs. 1.9), was observed in the frail group. A mildly significantly more extended ICU stay (6.00 vs. 5.00, p = 0.051) was shown in the frail patient. CONCLUSION: Frailty showed a significant association with a worse preoperative independence level, cognitive function, and depression status, as well as increased postoperative complications.

Glioblastomas at the white matter of temporo-parietal junction cause a poor postoperative independence level.

INTRODUCTION: Right cerebral hemispheric glioblastomas (GBMs) often decrease the Karnofsky performance status (KPS) score postoperatively, despite the patient having sufficient patient function while performing daily living. This study aimed to evaluate the factors that could cause poor KPS scores during the postoperative chronic phase in patients with right cerebral hemispheric GBMs. METHODS: Data of 47 patients with newly diagnosed right cerebral hemispheric GBMs were analyzed. All patients were assessed preoperatively and 3 months postoperatively to determine KPS and brain function. To determine tumor location related to the postoperative KPS scores, we used voxel-based lesion symptom mapping (VLSM). The patients were divided into two groups (involvement and non-involvement groups) based on whether their lesion involved a significant region identified by VLSM. We then compared functional factors and prognosis between the groups using the chi-squared and log-rank tests, respectively. RESULTS: The KPS score significantly decreased after surgery compared to that preoperatively measured (p = 0.023). VLSM revealed that tumors in the white matter of temporo-parietal junction (WM-TPJ) caused a significant decline in the KPS score at three months postoperatively. The patients in the involvement group had a higher probability of impaired attention, visuospatial cognition, emotion recognition, and visual field than did those in the non-involvement group. In addition, tumor in the WM-TPJ were associated with shorter progression-free survival and overall survival (p = 0.039 and 0.023, respectively). CONCLUSIONS: GBMs involving the right WM-TPJ are more likely to result in poor postoperative KPS scores and prognoses. Impairments of several kinds of brain functions caused by tumor invasion to the WM-TPJ may be associated with lower KPS scores.

Determination of Independence and Life Satisfaction Level of Individuals with Mental Disorder.

AIM: The study aimed to determine the level of independence and life satisfaction of individuals with diagnosed mental disorder. METHOD: The descriptive study was conducted with 108 inpatients in two public universities, medical faculty hospitals mental health and psychiatric clinics. Personal information form, Life Satisfaction Scale, and Psychiatric Patient Independence Level Scale were used for data collection tool. RESULTS: Mean age of the participants was 41.8±14.1 years. 60.2% (n=65) were male, 57.4% (n=62) were 34 years and older, 58.3% (n=63) were single, and 33.3% (n=36) were diagnosed with depression. When the distribution of the mean score of the independence level was analyzed according to the individuals' characteristics, a statistically significant difference was found in terms of age, marital status, education status, medical diagnosis, and duration of treatment (p<0.05). When the distribution of life satisfaction score averages of the individuals diagnosed with mental disorder were examined according to the individuals' characteristics, there was a statistically significant difference according to the variables of medical diagnosis (p<0.05). Thus, patients with mental disorders, had moderate dependency, had a moderate level of life satisfaction, and a negative and poor correlation was found between life satisfaction and dependence (rho=-0.306; p<0.01). As a result of the regression analysis, 10.5% of the increase in life satisfaction was determined by the independence level (R=0.324; R2=0.105; p<0.01). CONCLUSION: It was concluded that the participating individuals had moderate independent and life satisfaction. The variables such as diagnosis, age, life satisfaction, and independence levels increased, and the level of dependence decreased.