Optimizing Perioperative Care for Elderly Surgical Patients: A Review of Strategies and Evidence-Based Practices

Thailand has transitioned into an aging society characterized by a notable demographic shift toward senior citizens. This demographic trend underscores the imperative of addressing age-related challenges. The aging process accounts for the progressive deterioration of physical and cognitive functions, often necessitating medical interventions such as medications or surgical procedures. As the elderly population continues to grow, prioritizing strategies to enhance quality of life and mitigate the onset of physical and cognitive impairments becomes increasingly crucial. Prudent patient care is paramount due to the heightened vulnerability of elderly patients and the elevated risk of adverse health outcomes. This review aimed to examine perioperative evaluation and optimization strategies tailored specifically for elderly individuals scheduled for surgery. Special emphasis was placed on preserving postoperative functional capacity and cognitive acuity among this group of patients

An Overview on Postoperative Cognitive Dysfunction; Pathophysiology, Risk Factors, Prevention and Treatment

Postoperative cognitive dysfunction (POCD) is an event that alarms medical personnel owing to its adverse effects, including heightened morbidity and mortality rates, prolonged recovery times, and increased lengths of hospital stay and healthcare expenditure. The populations at high risk are elderly, critical patients, or complicated cases that need prolonged surgery in which the hemodynamics are not stable. Although guidelines have been established to facilitate the early diagnosis of POCD, its prevention is recommended for good patient outcomes. A preoperative assessment is a prerequisite for patient optimization before surgery. Intraoperative, enhanced-recovery protocols have been widely adopted to promote recovery following surgery. Frequent, postoperative assessments of patients’ vital signs and cognitive functions are required for early POCD detection. Patients diagnosed with POCD need regular follow-up, and proper patient counselling is paramount

Current state of neuroprotective therapy using antibiotics in human traumatic brain injury and animal models

TBI is a leading cause of death and disability in young people and older adults worldwide. There is no gold standard treatment for TBI besides surgical interventions and symptomatic relief. Post-injury infections, such as lower respiratory tract and surgical site infections or meningitis are frequent complications following TBI. Whether the use of preventive and/or symptomatic antibiotic therapy improves patient mortality and outcome is an ongoing matter of debate. In contrast, results from animal models of TBI suggest translational perspectives and support the hypothesis that antibiotics, independent of their anti-microbial activity, alleviate secondary injury and improve neurological outcomes. These beneficial effects were largely attributed to the inhibition of neuroinflammation and neuronal cell death. In this review, we briefly outline current treatment options, including antibiotic therapy, for patients with TBI. We then summarize the therapeutic effects of the most commonly tested antibiotics in TBI animal models, highlight studies identifying molecular targets of antibiotics, and discuss similarities and differences in their mechanistic modes of action

Health Survey of Monks Residing in Urban Areas: The Bangkok Noi Model

Objective: This study aimed to assess the prevalence of obesity and identify associated health problems and behaviors among monks residing in Bangkok Noi and its adjacent districts. Materials and Methods: Employing a cross-sectional design, this research incorporated self-report questionnaires and specialized health checkup programs at a university hospital. Eligible participants were monks aged 20 years or older, living permanently in temples within the Bangkok Noi District and its adjacent districts. Monks in shortterm ordination were excluded. Data collection occurred between February 2022 and July 2023. Results: Out of 560 monks who participated by completing both the questionnaires and health examinations, the average age was 46.49±16.97 years. Most participants resided in the Taling Chan (35.4%) and Bangkok Noi (31.8%) districts. Significant health issues included non-communicable diseases, with dyslipidemia affecting 57.8% and obesity 44.2% of the cohort. Monks over the age of 50 exhibited a remarkably higher rate of multimorbidity (50.2%) than their younger counterparts (24.2%, p < 0.001, 95% CI 20.71–27.97). Dietary habits revealed that younger monks were more prone to consuming fried, sweet and instant foods (74.5%, p < 0.001, 95% CI 70.67–78.07). Moreover, a significant proportion of younger monks demonstrated proficient e-health literacy (74.2%, p < 0.001, 95% CI 70.37–77.78). Conclusion: The study highlights a high prevalence of obesity among monks in urban settings. There is a pressing need for tailored preventive interventions that integrate health promotion and lifestyle modifications through Dhamma and Vinaya teachings. The interventions should address the distinct needs of different age groups

The Thai version of the nursing delirium screening scale-Thai:Adaptation and validation study in postoperative patients

Background: The Nursing Delirium Screening Scale (Nu-DESC) is an effective instrument for assessing postoperative delirium (POD). This study translated the Nu-DESC into Thai (“Nu-DESC-Thai”), validated it, and compared its accuracy with the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Methods: The translation process followed the International Society for Pharmacoeconomics Outcome Research guidelines. Recruited participants were ≥ 70 years old, fluent in Thai, and scheduled for surgery. The exclusion criteria were cancellation or postponement of an operation, severe visual or auditory impairment, and patients with a Richmond Agitation Sedation Scale score of –4 or less before delirium assessment. Post-anesthesia care unit (PACU) nurses and residents on wards each used the Nu-DESC to assess delirium in 70 participants (i.e., 140 assessments) after the operation and after patient arrival at wards, respectively. Geriatricians confirmed the diagnoses using video observations and direct patient contact. Results: The participants’ mean age was 76.5 ± 4.6 years. The sensitivity and specificity of the Nu-DESC-Thai at a threshold of ≥ 2 were 55% (95% CI, 31.5–76.9%) and 90.8% (84.2–95.3%), respectively, with an area under a receiver operating characteristic curve (AUC) of 0.73. At a threshold of ≥ 1, the sensitivity and specificity were 85% (62.1–96.8%) and 71.7% (62.7–79.5%), respectively (AUC, 0.78). Adding 1 point for failing backward-digit counting (30–1) to the Nu-DESC-Thai and screening at a threshold of ≥ 2 increased its sensitivity to 85% (62.1–96.8%) with the same specificity of 90.8% (84.2–95.3%). Conclusion: The Nu-DESC-Thai showed good validity and reliability for postoperative use. Its sensitivity was inadequate at a cutoff ≥ 2. However, the sensitivity improved when the threshold was ≥ 1 or with the addition of backward counting to Nu-DESC-Thai and screening at a threshold of ≥ 2.</p

Antagonism of the complement component C4 by flavivirus nonstructural protein NS1

The complement system plays an essential protective role in the initial defense against many microorganisms. Flavivirus NS1 is a secreted nonstructural glycoprotein that accumulates in blood, is displayed on the surface of infected cells, and has been hypothesized to have immune evasion functions. Herein, we demonstrate that dengue virus (DENV), West Nile virus (WNV), and yellow fever virus (YFV) NS1 attenuate classical and lectin pathway activation by directly interacting with C4. Binding of NS1 to C4 reduced C4b deposition and C3 convertase (C4b2a) activity. Although NS1 bound C4b, it lacked intrinsic cofactor activity to degrade C4b, and did not block C3 convertase formation or accelerate decay of the C3 and C5 convertases. Instead, NS1 enhanced C4 cleavage by recruiting and activating the complement-specific protease C1s. By binding C1s and C4 in a complex, NS1 promotes efficient degradation of C4 to C4b. Through this mechanism, NS1 protects DENV from complement-dependent neutralization in solution. These studies define a novel immune evasion mechanism for restricting complement control of microbial infection

Binding of complement regulator C4b binding protein to Flavivirus Nonstructural Protein NS1 modulates its function in solution and on the cell surface (154.22)

Abstract The complement system plays an important role in the innate immune response to many pathogens including Flaviviruses. Flavivirus NS1 is a secreted glycoprotein that is absent from viral particles but accumulates at high levels in the blood of infected patients where it may also bind back to the cell surface. Our previous work defined an immune evasion role of Flavivirus NS1 in limiting classical/lectin pathway activation by forming a complex with C1s and C4 to promote the cleavage of C4 to C4b. Herein, we demonstrate a second mechanism by which NS1 antagonizes complement activation. In this case, dengue virus (DENV), West Nile virus (WNV), and yellow fever virus (YFV) NS1 directly associate with C4b binding protein (C4BP), a plasma complement regulatory protein that attenuates the classical/lectin pathway. C4BP is a cofactor for the serine protease factor I to cleave C4b and thereby inhibits classical/lectin pathway C3 convertase (C4b2a) activity. Specifically, binding of NS1 to C4BP results in more efficient factor I-mediated degradation of C4b by C4BP in solution. Furthermore, NS1 recruits C4BP to the surface of cells to inactivate C4b on the plasma membrane. These studies define immune evasion mechanisms by which NS1 reduces C4’s activating capacity. They point to the classical/lectin pathway activation being critical in host defense against Flavivirus infections.</jats:p

Current state of neuroprotective therapy using antibiotics in human traumatic brain injury and animal models

Abstract TBI is a leading cause of death and disability in young people and older adults worldwide. There is no gold standard treatment for TBI besides surgical interventions and symptomatic relief. Post-injury infections, such as lower respiratory tract and surgical site infections or meningitis are frequent complications following TBI. Whether the use of preventive and/or symptomatic antibiotic therapy improves patient mortality and outcome is an ongoing matter of debate. In contrast, results from animal models of TBI suggest translational perspectives and support the hypothesis that antibiotics, independent of their anti-microbial activity, alleviate secondary injury and improve neurological outcomes. These beneficial effects were largely attributed to the inhibition of neuroinflammation and neuronal cell death. In this review, we briefly outline current treatment options, including antibiotic therapy, for patients with TBI. We then summarize the therapeutic effects of the most commonly tested antibiotics in TBI animal models, highlight studies identifying molecular targets of antibiotics, and discuss similarities and differences in their mechanistic modes of action

N-linked glycosylation of dengue virus NS1 protein modulates secretion, cell-surface expression, hexamer stability, and interactions with human complement

AbstractDengue virus (DENV) NS1 is a versatile non-structural glycoprotein that is secreted as a hexamer, binds to the cell surface of infected and uninfected cells, and has immune evasive functions. DENV NS1 displays two conserved N-linked glycans at N130 and N207. In this study, we examined the role of these two N-linked glycans on NS1 secretion, stability, and function. Because some groups have reported reduced yields of infectious DENV when N130 and N207 are changed, we analyzed glycosylation-deficient NS1 phenotypes using a transgenic expression system. We show that the N-linked glycan at position 130 is required for stabilization of the secreted hexamer whereas the N-linked glycan at residue 207 facilitates secretion and extracellular protein stability. Moreover, NS1 mutants lacking an N-linked glycan at N130 did not interact efficiently with complement components C1s and C4. In summary, our results elucidate the contribution of N-linked glycosylation to the function of DENV NS1

Factors influencing preoperative chest radiography request for elective endoscopic procedures among medical personnel

BackgroundChest radiography is not routinely recommended before elective endoscopies. A high incidence of perioperative chest radiography requests was observed at our institution. This study aims to investigate factors influencing preoperative chest radiography request for patients undergoing elective gastrointestinal (GI) endoscopies.MethodsThis cross-sectional clinical study recruited 264 participants from different medical specialties who were responsible for preoperative endoscopic chest x-ray (CXR) ordering including anesthesiologists, surgeons and gastroenterologists. They completed questionnaires exploring their general knowledge and attitudes about preoperative chest radiography. Demographic characteristic of the participants affecting the knowledge on preoperative chest radiography was determined. A Structural Equation Model (SEM) was constructed from validated conceptual framework to find causal relationships between hypothesized factors and intention for preoperative endoscopic chest radiography request. Statistical analyses were performed using the SPSS software version 18.0 and Analysis of Moment Structures (AMOS) version 18.0.ResultsThe questionnaire response rate was 53.79%. Baseline general knowledge on preoperative chest radiography of the participants was comparable. The SEM results showed unsupported relationship between hypothesized factors and the intention for preprocedural GI endoscopic CXR request (p &lt; 0.1).ConclusionsGeneral knowledge of medical personnel on tuberculosis needs improvement. To rectify the unnecessary chest radiography request before elective GI endoscopic procedures, awareness of the patients’ health conditions, adherence to the hospital’s policy and realizing of possible patient-related mishaps are not the determinants for preprocedural endoscopic chest radiography request. Future works are required to explore other alternative factors involved for reducing chest radiography requests which are not indicated.</jats:sec