Disfungsi Kognitif Post Operatif pada Geriatri

Postoperative Cognitive Dysfunction (POCD) is a neurocognitive disorder characterized by decreased cognitive performance after surgery and anesthesia. POCD is a complication characterized by memory impairment, decreased information processing and reduced attention, accompanied by changes in mood and personality. The incidence of POCD in elderly patients (> 60 years) was approximately 25.8% within seven days after surgery and 10% within three months after surgery. The risk factors and etiology that lead to POCD can be reduced by good patient education, patient care and proper sanitation can prevent the tendency of POCD symptoms in these patients. Examination can be done with the learning test, the word learning test, the tracing test, the manual dexterity test, the ability test to remember a sequence of numbers. Mini Mental Status Examination (MMSE) as a screening test for dementia. MMSE is sometimes used to measure POCD. MMSE can be used in routine clinical practice to identify preoperative subclinical dementia that would put patients at a higher risk of developing POCD. Management in POCD includes two approaches, namely rapid diagnosis and prevention of POCD symptoms. Prevention by knowing the risk factors preoperative, intraoperative and postoperative. In patients with persistent POCD, it has a negative impact on quality of life, subjective memory performance, emotional symptoms, and possible health consequences such as dementia and premature death.

Effect of willingness of exercise on learning, memory and motor skills- An observational study

Cognition and motor skills both play a foundational role in the development of healthy perceptual, social life. Due to lack of exercise motor dysfunction and cognitive impairment is seen in young adults. Aerobic exercise has emerged as a lowcost treatment to improve neurocognitive function. Hence this study was undertaken to study the effects of willingness to exercise on cognition and motor skills. To measure learning, memory and motor skills in medical students. Department of physiology. An observational study. In this study the one hundred fifty students were given a self-prepared questionnaire which gives information about willingness to exercise. Among these students two groups were made based on inclusion and exclusion criteria each consisting 15 students. One group willing to exercise and other not willing to exercise. Every week a set of students were examined for learning, memory and motor skills by star mirror drawing apparatus,Recall and recognition testTweezer Dexterity testrespectively. The data obtained was entered in master chart and analysed using Student’s paired t test for statistical significance. The mean scores for the willingness to exercise group in recall -recognition and tweezer dexterity were higher. In star mirror tracing test the number of errors made by both the groups were same but standard deviation was less in willingness to exercise group than in normal control group. Willingness to exercise improves learning, memory and motor skills. WHO defines exercise is a subset of physical activity that is planned, structured and repetitive improvement or maintenance of physical fitness. There is a positive relationship between physical activity and cognition in children aged 4-18 years. Hence it is responsibilities of parents and teachers to teach about importance of exercise.

Normalisation of the psychometric encephalopathy score within the Cameroonian population

Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

Tracking deaths can provide an indicator of latent COVID19 cases

Background: With countries across the world facing repeated epidemic waves, it becomes critical to monitor, mitigate and prevent subsequent waves. Common indicators like active case numbers can flatter to deceive in the presence of systemic inefficiencies like insufficient testing or contact tracing. Test positivity rates are sensitive to testing strategies and cannot estimate the extent of undetected cases. Reproductive numbers estimated from logarithms of new incidences are inaccurate in dynamic scenarios and not sensitive enough to capture changes in efficiencies. Systemic fatigue results in lower testing, inefficient tracing and quarantining thereby precipitating the onset of the epidemic wave. Methods: We propose a novel indicator for detecting the slippage of test-trace efficiency based on the numbers of deaths/hospitalizations resulting from known and hitherto unknown infections. This can also be used to forecast an epidemic wave that is advanced or exacerbated due to drop in efficiency. Results: Using a modified SEIRD epidemic simulator we show that (i) Ratio of deaths/hospitalizations from an undetected infection to total deaths converges to a measure of systemic test-trace inefficiency. (ii) This index forecasts the slippage in efficiency earlier than other known metrics. (iii) Mitigation triggered by this index helps reduce peak active caseload and eventual deaths. Conclusions: Deaths/hospitalizations accurately track the systemic inefficiencies and detect latent cases. Based on these results we make a strong case that administrations use this metric in the ensemble of indicators. Further hospitals may need to be mandated to distinctly register deaths/hospitalizations due to previously undetected infections. Keywords: Covid19 Epidemic Epidemiology Mathematical model Death rates

Conduit and fracture flow characteristics of Pınarbaşı spring, Central Taurus Region, Seydişehir, Turkey

This study was conducted to investigate the flow and storage mechanisms of a karst aquifer located at the central Taurus Mountains, Turkey. As the biggest discharge point of the aquifer system, the flow characteristics are investigated at Pinarbaşi spring by using recession and time-series analyses. Continuous water level measurements are taken from the spring and are converted to flow rate by using a rating curve. The spring flows for 7 months (December 2014 – July 2015) and dries up for the rest of the year. Six individual recession periods are investigated and analyzed in the discharge time series. The recession coefficients (between 0.029 day-1 and 0.695 day-1) show that the flow within the aquifer system is mainly controlled by large open conduit and partly fracture porosity. The peak discharge is measured as 7.08 m3/s, and the maximum storage within the aquifer is calculated as 3.15 million m3. The continuous discharge data of the spring were evaluated combined with daily rainfall, temperature, electrical conductivity, and amount of suspended sediment in the water. Also a dye-tracing test was also applied to obtain the recharge-discharge relationship and porosity type of the aquifer system. Statistical tests on discharge hydrograph and tracer test showed that the memory of the karst aquifer was found to be about 3 days in the DJF period and about 15 days in the MAM period. The average elevation of the recharge area of the spring was determined to be 1,490 m by using stable isotope data of snow samples and was validated by dye tracer test made via the swallow hole in the recharge area. The total discharge for the year 2015 is estimated at 16.2 million m3 that approximately 25% of the total discharge is caused by snowmelt.

Analysis of underground river network connectivity in Barat Cave, Karst Karangbolong, Central Java, using the Artificial Tracer Test Method

The connectivity of the Barat Cave underground river system needs to be known to support the implementation of proper environmental management so that water resources can be maintained sustainably. However, the mapping of underground river paths is often hindered by conditions of narrow cave passages, a barrier blocking the flow of water (siphon), deep underground lakes, underground waterfalls, as well as paths filled with water. This research was conducted in Barat Cave, Karangbolong Karst Area. The purpose of this study is to determine the upstream-downstream connectivity system in this underground river and define the characteristics of the passageway based on quantitative analysis of the transport parameters from the tracer test results. This underground river network analysis needs to be done because previous research has never analyzed this underground river network. The research method used in this study is divided into three stages, namely the pre-field stage, the field stage, and the post-field stage. The pre-field step includes determining the location of the study, collecting secondary data, and studying the literature. The field stage consists of a hydrogeological survey to find information on the presence of caves, springs, sinking stream ponors, or luweng in the study area, instantaneous discharge measurements, and tracer tests. The post-field stage includes data processing and analysis. The results showed that the Barat underground river system originated from the Kalimas sinking stream, Mblabak Cave, Pendok Cave, and Pagilangan sinking streams, then merged into a single tunnel without a flow breaker to the Barat Cave, Pengantin Cave, and appeared in the Kalikarak springs to become a surface river, with a tunnel pattern in the form of curvilinear branchwork. The transport parameters for the underground system tracing of the Barat cave have an advection value of 86.528 m/hour, a dispersion of 0.092 m2/second, a dispersivity of 3.38 meters, and a recovery of 63%. The transport value of the tracing test parameter is influenced by the characteristics of the passageway and underground river flow conditions.

Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

Background: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. Aim: To standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods: This was a prospective, multicentric study from December 1st, 2018 to July 31st, 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) were expressed in seconds and those of the Digit Symbol Test (DST) in points. Results: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3±15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62±3,9 years in cirrhotic patients. The PHES of the healthy volunteer group was -0.08 ± 1.28 and the cut-off between normal and pathological values was set at −3 points. PHES of the cirrhotic patients was -7.66 ± 5.62 points and significantly lower than that of volunteers (p <0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE.Conclusion: PHES cut-off value in Cameroonians is -3, with MHE prevalence of 74% among cirrhotic patients.

Application, limits, scoring and improvements of Groffman Visual Tracing test

The Groffman Visual Tracing (GVT) test is a psychometric oculomotor test comprising two cards with five contorted and intersected lines, and which is available for the clinical evaluation of ocular movements. The participant starts from the letter at the top, follows the line, and reports the corresponding number at the bottom of each line. The aim of this study is to evaluate two claims made when details of the GVT test were originally reported: whether it is a developmental test, and the feasibility of its application starting from primary school children up to adults. This was achieved by using the GVT test and a simplified version of it. In two consecutive experiments, we tested two groups of children and adults. In the first experiment, 75 children (1st, 3rd, and 5th grade) and 25 adults underwent the GVT test. In the second experiment, 115 children from 1st to 5th grade underwent a simplified version of the test. Total scoring, accuracy and time to complete the test were evaluated. In the first experiment, 24% of children in the 1st and 3rd grades did not follow any lines correctly due to the difficulty of the test. In the second experiment, all participants were able to perform the test with both cards, and the accuracy improved significantly with age (p<0.0001). The time required to follow the lines was found to decrease with age (p<0.0001), and the accuracy improves (p<0.0001) compared with the standard version. The standard version of the GVT test has proven to be too difficult for younger children and a modified version produced improved results. Children at or below the 5th grade should to be tested using the modified version. Older children and adults can be tested with the standard version. Specific norms based on execution times and accuracy should to be established.

New Insight on Motor Behavior: The Link Between the Hopping Task and the Tracing Performance as Hint of Gross and Fine Motor Functions

The gross motor coordination tasks are thought to be likely not linked to the fine motor coordination tasks. The authors aimed to investigate this matter through a network analysis linking graphomotor (by tablet PC tracing), gross coordination (by Körperkoordinationstest für Kinder items), and strength (by handgrip) parameters in school children. Interestingly, the authors found that “Hopping” was the strongest central node, with linkages to “Quality” and “Speed” on tracing test. Handgrip strength did not link to gross coordination and graphomotor parameters, except with “Pressure.” Graphomotor performances suggested substantial peculiarities in developmental trajectories. Sport participation did not influence gross coordination nor graphomotor performances. The authors suggest considering the functional link between hopping and graphomotricity both in planning physical education and in understanding coordination impairments, through the developmental trajectories.