Delirium Research Articles

The neurological manifestations of covid-19 and their relationship with the disease severity in hospitalized patients: A single-centered, cross-sectional study on patients with co…

The Coronavirus disease (COVID-19) emerged in Wuhan city, China in December 2019 and rapidly spread as a global health pandemic. The primary presentation is respiratory and cardiac symptoms, but neurological features are also being reported. A single-centered, cross-sectional study on 168 patients with COVID-19 was conducted in Al-Mawani teaching hospital, Basra, Iraq to assess the neurological manifestations of COVID-19 and their relationship with the disease severity. 60.7% of the patients involved in the study were documented to have neurological manifestations. The most common reported symptom is the headache (39%) followed by the dizziness(lightheadedness) (28.6%). The more severe neurological manifestations as the acute confusion, cranial nerve palsies, hemiplegia are more seen among those with sever desaturation, higher lung involvement as well as those with cytokine storm syndrome and mainly distributed among older age, males and in patients with comorbidities.The acute cerebrovascular accident(stroke)present in 14.3% of patient, mainly in whom are complain from sever desaturation and aggressive lung involvement.

Descriptive and retrospective analysis of diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the pandemic.

BackgroundLittle is known about diffuse glioma patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2).MethodsWe performed a descriptive and retrospective analysis of 41 diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the COVID-19 pandemic.ResultsConfusion with or without fever was the most common neurological symptom (32%) supporting SARS-CoV2 testing in glioma patients with acute and unexplained confusion. Sixteen patients (39%) died after a median delay of 13 days. While multiple clinical, biological, and pathological features, COVID-19- or diffuse glioma-related, at hospital admission appeared to have a pejorative prognostic impact, none was significantly associated with death. Oncological treatments were interrupted at COVID-19 diagnosis and re-initiated with a median delay of 30 days after the end of COVID-19 symptoms.ConclusionsInterestingly, our retrospective study describes for the first time the characteristics of a cohort of diffuse glioma patients with symptomatic COVID-19. Diffuse glioma patients with poorly symptomatic COVID-19 did not come to the attention of physicians and were not enrolled in the study skewing the denominator for prognostic analysis. Further studies are warranted to specify prognosis of overall population of diffuse glioma patients with COVID-19, including asymptomatic patients, and interactions of prognostic factors of both COVID-19 and diffuse gliomas.

Hepatic Encephalopathy: Diagnosis and Management.

Type C hepatic encephalopathy (HE) is a brain dysfunction caused by severe hepatocellular failure or presence of portal-systemic shunts in patients with liver cirrhosis. In its subclinical form, called “minimal hepatic encephalopathy (MHE), only psychometric tests or electrophysiological evaluation can reveal alterations in attention, working memory, psychomotor speed and visuospatial ability, while clinical neurological signs are lacking. The term “covert” (CHE) has been recently used to unify MHE and Grade I HE in order to refer to a condition that is not unapparent but also non overt. “Overt” HE (OHE) is characterized by personality changes, progressive disorientation in time and space, acute confusional state, stupor and coma. Based on its time course, OHE can be divided in Episodic, Recurrent or Persistent. Episodic HE is generally triggered by one or more precipitant factors that should be found and treated. Unlike MHE, clinical examination and clinical decision are crucial for OHE diagnosis and West Haven criteria are widely used to assess the severity of neurological dysfunction. Primary prophylaxis of OHE is indicated only in the patient with gastrointestinal bleeding using non-absorbable antibiotics (Rifaximin) or non-absorbable disaccharides (Lactulose). Treatment of OHE is based on the identification and correction of precipitating factors and starting empirical ammonia-lowering treatment with Rifaximin and Lactulose (per os and enemas). The latter should be used for secondary prophylaxis, adding Rifaximin if HE becomes recurrent. In recurrent/persistent HE, the treatment options include fecal transplantation, TIPS revision and closure of eventual splenorenal shunts. Treatment of MHE should be individualized on a case-by-case basis.

Recurrent delirium over 12 months predicts dementia: results of the Delirium and Cognitive Impact in Dementia (DECIDE) study

BackgroundDelirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over time by prospectively ascertaining delirium in a cohort aged ≥ 65 years in whom baseline cognition had previously been established.MethodsFor 12 months, we assessed participants from the Cognitive Function and Ageing Study II-Newcastle for delirium daily during hospital admissions. At 1-year, we assessed cognitive decline and dementia in those with and without delirium. We evaluated the effect of delirium (including its duration and number of episodes) on cognitive function over time, independently of baseline cognition and illness severity.ResultsEighty two of 205 participants recruited developed delirium in hospital (40%). One-year outcome data were available for 173 participants: 18 had a new dementia diagnosis, 38 had died. Delirium was associated with cognitive decline (−1.8 Mini-Mental State Examination points [95% CI –3.5 to –0.2]) and an increased risk of new dementia diagnosis at follow up (OR 8.8 [95% CI 1.9–41.4]). More than one episode and more days with delirium (>5 days) were associated with worse cognitive outcomes.ConclusionsDelirium increases risk of future cognitive decline and dementia, independent of illness severity and baseline cognition, with more episodes associated with worse cognitive outcomes. Given that delirium has been shown to be preventable in some cases, we propose that delirium is a potentially modifiable risk factor for dementia.

Inpatient Diagnosis of Delirium and Encephalopathy: Coding Trends in 2011-2018

Physicians have long debated the diagnosis of acute confusional states as delirium or encephalopathy, often based on specialty. Recently, CMS assigned a lower severity to the nonspecific behavioral diagnosis of delirium than for the pathophysiological diagnosis of encephalopathy, potentially exacerbating these disagreements. Therefore, we sought to evaluate trends in these two diagnoses among hospitalized adults. Using 2011-2018 IBM MarketScan datasets, we identified delirium/encephalopathy patients who were ≥ 18 years and enrolled with medical and pharmacy coverage for each calendar year. Delirium/encephalopathy were defined using validated ICD-9/10 codes among hospitalized patients. We identified the physician specialties associated with the hospitalization and comorbidities using ICD9/10 inpatient/outpatient diagnosis codes within one year prior to the diagnosis of delirium or encephalopathy. Log-binomial models were used to evaluate the trends adjusting for age, gender, insurance and comorbidities. We identified 10,418 delirium and 87,393 encephalopathy hospitalized patients in 2011-2018. Of these patients, the total number of patients with either diagnosis increased, but the proportion of patients with delirium for each year decreased from 20% in 2011 to 9% in 2018. During the 8 years, neurologists and internists increased their use of both diagnoses, whereas psychiatrists only increased for delirium. Patients with encephalopathy are more likely to be older, female, and have more comorbidities. These shifts in diagnosis complicate the study of delirium and encephalopathy, and can lead to erroneous conclusions about trends in the incidence and prevalence of these disorders unless properly understood.

Delirium Incidence, Duration and Severity in Critically Ill Patients with COVID-19

Background: COVID-19 is associated with severe respiratory failure and high mortality in critically ill patients.2,4,5 Neurologic manifestations of the disease, including delirium and coma, may also be associated with poor clinical outcomes. Delirium is associated with prolonged mechanical ventilation and mortality.3 this study sought to describe the rates, duration, and severity of delirium in patients admitted to the ICU with COVID-19. Methods: A retrospective, observational study was conducted from March 1stto April 27th, 2020, at Indiana University Health Methodist and Eskenazi Health Hospitals. The delirium measurements were extracted in the first 14 days of the ICU stay, using the Richmond Agitation and Sedation Scale (RASS) and the CAM-ICU and CAM-ICU7, for those with a positive COVID-19 diagnosis. The primary outcomes were delirium rates and duration; the secondary outcome was delirium severity. Descriptive statistics and median group comparisons were done using SAS v9.4. Results: Of 144 patients in the study, 73.6% experienced delirium and 76.4% experienced delirium or coma. The median delirium or coma duration was 7 days (IQR: 3-10), and the median delirium duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 2-7) signifying severe delirium. Mechanical ventilation was associated increased risk of developing delirium (OR: 22.65, 95% CL: 5.24-97.82). Mortality was also more likely in patients experiencing delirium: 26.4% compared to 15.8% in patients without delirium. Conclusion: Of the 144 patients included, 73.6% experienced delirium lasting on average 5 days: the median delirium score being severe. Mechanical ventilation was also associated with greater odds of developing delirium. Because Covid-19 is associated with high rates of delirium, leading to increased rates of functionality disability, more resources and attention are needed to prevent and manage delirium in patients.1 References Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine. 2014;42(2):369-377. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020. Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment. Anesthesiology. 2016;125(6):1229-1241. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020. Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain, behavior, and immunity. 2020:S0889-1591(0820)30357-30353.

Unusual presentation of basilar artery thrombosis

Strokes in the territory of the posterior cerebral artery (PCA) may rarely cause acute confusion or delirium, especially when bilateral or the dominant PCA are involved. Delirium as the only initial presentation of basilar artery thrombosis (with no brainstem or long tract findings) is an extremely rare occurrence. In this article, the clinical presentation of our case was an acute confusion with septic shock-like features (tachycardia, hypotension, and leukocytosis) for a few days without any focal deficit. These symptoms pointed more toward a non-focal neurological cause, especially meningoencephalitis. This case highlights the importance of detailed history and thorough evaluation of high-risk patients who present with an acute devastating neurological syndrome. In addition, knowledge of the atypical presentation of stroke should be acquired, and the limitation of an unenhanced computed tomography scan of the brain without vascular imaging should be known. Investigating patients with a sudden acute confusion should be directed toward the evaluation of the etiology in a stepwise manner. However, the pace of investigations should be fast to establish the diagnosis and optimize the outcome.

Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up.

BACKGROUNDPre- and postoperative cognitive deficits have repeatedly been demonstrated in patients with glioblastoma (GBM).OBJECTIVETo identify presurgical risk factors that facilitate the identification of GBM patients at risk for postoperative cognitive impairment.METHODSPatients underwent neuropsychological assessment using Central Nervous System Vital Signs 1 d before (T0) and 3 mo after surgery (T3). Patients’ standardized scores on 7 cognitive domains were compared to a normative sample using one-sample z tests. Reliable change indices with correction for practice effects were calculated to assess cognitive changes in individual patients over time. Logistic regression models were performed to assess presurgical sociodemographic, clinical, psychological, and cognitive risk factors for postoperative cognitive impairments.RESULTSAt T0, 208 patients were assessed, and 136 patients were retested at T3. Patients showed significantly lower performance both prior to and 3 mo after surgery on all cognitive domains compared to healthy controls. Improvements and declines over time occurred respectively in 11% to 32% and 6% to 26% of the GBM patients over the domains. The regression models showed that low preoperative cognitive performance posits a significant risk factor for postoperative cognitive impairment on all domains, and female sex was a risk factor for postoperative impairments in Visual Memory.CONCLUSIONWe demonstrated preoperative cognitive risk factors that enable the identification of GBM patients who are at risk for cognitive impairment 3 mo after surgery. This information can help to inform patients and clinicians at an early stage, and emphasizes the importance of recognizing, assessing, and actively dealing with cognitive functioning in the clinical management of GBM patients.

Catecholamine activity in delirium with and without pre‐existing dementia

AbstractBackgroundDelirium “acute confusion” is an unpleasant but common complication of acute illness in the aged population associated with prolonged hospitalization. Dementia is a substantial risk factor for delirium that may be apparent already in preclinical Alzheimer’s disease, but a delirium is also a risk factor for dementia. Effective agents for preventing and treating delirium are therefore searched. This include administration of antipsychotics targeting anticipated excessive dopaminergic activity in delirium and alpha‐2‐receptor (α2) agonists reducing noradrenergic activity. Data of noradrenergic and dopaminergic activity in delirium is however limited. We therefore aimed to characterize the cerebrospinal fluid (CSF) levels of dopamine and noradrenaline (norepinephrine) in delirium, with or without pre‐existing dementia.MethodCSF levels of dopamine and noradrenaline were determined by high‐performance‐liquid‐chromatography (HPLC) in: 1) cognitively healthy (controls; n=122) 2) Hip fracture patients (n=118) with and without delirium and pre‐fracture dementia 3) Patients with delirium precipitated by another medical condition (n=26). Non‐parametric statistical analyzes were applied.ResultPatients with delirium following a hip fracture and another medical condition had lower CSF dopamine levels relative to hip fracture patients without delirium and controls respectively. Stratified analyzes of hip fracture patients according to dementia status and separating patients with delirium before and after surgery showed differences in the two stratas. Interestingly there was a trend for higher levels of noradrenaline in incident delirium among those without pre‐fracture dementia, but there were few patients in this group (n=7).ConclusionThe lower levels of dopamine in CSF in delirium align with recent meta‐analyzes not recommending use of antipsychotics. Further evaluation of α2‐agonists for delirium prevention, in particular in those without pre‐existing dementia is supported, although the data should be reproduced in larger studies.

The Relationship Between Perioperative Regional Cerebral Oxygen Saturation and Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis

Objective: Postoperative cognitive dysfunction (POCD) and neurologic deficit continues to be an important neuropsychological adverse affecting patients' outcome. We conducted this systematic review to investigate the relationship between regional cerebral oxygen saturation (rSO2) and early POCD in postoperative patients. Materials and Methods: Our search included MEDLINE (PubMed) and Cochrane library, from inception to October 31, 2018. We included studies reporting values of rSO2 at the beginning of and/or during surgery, and the primary outcome was POCD, and excluded articles who do not put postoperative cognitive function as the main observation. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale and extracted the data. Results: Seven prospective cohort studies that included 532 patients incorporate into this systematic review. About 37.78% (201/532) patients achieved POCD. POCD was associated with significantly lower overall values of rSO2 during surgery compared to the population that did not achieve POCD (mean difference [MD] −1.98; 95% confidence interval [CI] −3.30 to −0.66; P = 0.003). In the subgroup, the lowest rSO2 values intraoperative period were a better predictor of POCD (MD −2.91; 95% CI −4.37 to − 1.46; P

Posterior bilateral lens luxation in an agitated patient: Cause or consequence?

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases. Las luxaciones posteriores completas del cristalino son entidades clínicas poco frecuentes. Los traumatismos son la principal causa de luxación secundaria del cristalino no iatrogénica. La mayor parte de los casos son unilaterales, siendo los casos de luxación bilateral muy poco frecuentes. Presentamos el inusual caso clínico de una mujer de 70 años que presentó una luxación bilateral posterior del cristalino en el contexto de un cuadro de instauración aguda de síndrome confusional. Discutimos acerca de la privación sensorial como un factor desencadenante de cuadros de confusión aguda y agitación en pacientes con enfermedades predisponentes. Además, describimos los beneficios que, en nuestra experiencia, nos aporta la técnica de reflotamiento con perfluorocarbono para el abordaje quirúrgico de estos casos.

Peripheral nerve blocks for hip fractures in adults.

This review was published originally in 1999 and was updated in 2001, 2002, 2009, 2017, and 2020. Updating was deemed necessary due tothe high incidence of hip fractures, the large number of official societies providing recommendations on this condition, the possibility that perioperative peripheral nerve blocks (PNBs) may improve patientoutcomes, and the major role that PNBs may play in reducing preoperative and postoperative opioiduse for analgesia. To compare PNBs used as preoperative analgesia, as postoperative analgesia, or as a supplement to general anaesthesia versus no nerve block (or sham block) for adults withhip fracture.Outcomes werepain on movement at 30 minutesafter block placement, acute confusional state, myocardial infarction, chest infection, death, time to first mobilization, and costs of an analgesic regimen for single-injection blocks. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards. For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), in the Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2019); Embase (Ovid SP, 1974 to November 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to November 2019), as well as trial registers and reference lists of relevant articles. We included randomized controlled trials (RCTs) assessing use of PNBs compared with no nerve block (or sham block) as part of the care provided for adults16 years of age and older with hip fracture. DATA COLLECTION AND ANALYSIS: Two review authors independentlyscreened new trials for inclusion, assessed trial quality using the Cochrane Risk of Bias-2 tool, and extracted data. When appropriate, we pooled results of outcome measures. We rated the certainty of evidence using the GRADE approach. We included 49 trials (3061 participants; 1553randomized to PNBs and 1508 to no nerve block (or sham block)). For this update, we added 18 new trials. Trials were published from 1981 to 2020.Trialists followed participants for periods ranging from 5 minutes to 12 months.The average age of participants ranged from 59 to 89 years. People with dementia were often excluded from the included trials. Additional analgesia was available for all participants. Results of 11 trials with 503 participants show that PNBsreduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.05, 95% confidence interval (CI) -1.25 to -0.86; equivalent to -2.5 on a scale from 0 to 10; high-certainty evidence). Effect size was proportionate to the concentration of local anaesthetic used (P =0.0003). Based on 13 trials with 1072 participants, PNBs reduce the risk of acute confusional state (risk ratio (RR) 0.67, 95% CI 0.50to 0.90;number needed to treat for an additional beneficial outcome(NNTB) 12,95% CI 7 to 47; high-certainty evidence). For myocardial infarction, there wereno events in one trial with 31 participants (RR not estimable; low-certainty evidence). From three trials with 131 participants, PNBs probably reduce the risk for chest infection(RR 0.41, 95% CI 0.19 to 0.89; NNTB7, 95% CI 5 to 72; moderate-certainty evidence).Based on 11 trials with 617 participants, the effects of PNBs on mortality within six months are uncertain due to very serious imprecision (RR 0.87, 95% CI 0.47 to 1.60; low-certainty evidence). From three trials with 208 participants, PNBs likely reduce time to first mobilization (mean difference (MD) -10.80 hours, 95% CI -12.83 to -8.77 hours; moderate-certainty evidence).One trial with 75 participants indicated there may be a small reduction in the cost ofanalgesic drugs with a single-injection PNB (MD -4.40 euros, 95% CI -4.84 to -3.96 euros; low-certainty evidence). We identified 29 ongoing trials, of which 15 were first posted or at least were last updated after 1 January 2018. AUTHORS' CONCLUSIONS: PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization. There may be a small reduction in the cost of analgesic drugs for single-injection PNB. Wedid not find a difference for myocardial infarction and mortality, but the numbers of participants included for these two outcomes were insufficient.Although randomized clinical trials may notbe the best way to establish risks associated with an intervention,our review confirmslow risks of permanent injury associated withPNBs, as found by others. Some trials are ongoing, but it is unclear whether any further RCTs should be registered, given the benefitsfound.Good-quality non-randomized trials with appropriate sample size may help to clarify the potential effects of PNBs on myocardial infarction and mortality.

Insular lobe surgery and cognitive impairment in gliomas operated with intraoperative neurophysiological monitoring.

For a long time, surgery of insular gliomas was considered at high risk for postoperative cognitive deficits, but recent studies highlighted the feasibility of the surgical approach. The aims of our study were to investigate the presence of language impairment before and after surgery and the relationship between language impairment and tumor volume preoperatively and extent of resection (EOR) 3 months after surgery. Thirty-five patients with insular gliomas underwent an extensive language assessment before and few days after surgery, and after 3 months. Intraoperative neurophysiological monitoring (IOM) and brain mapping with direct electrical stimulation (DES) were used in all the cases; 8 patients underwent awake craniotomy. Statistical analysis was performed on the language tests administered. Patients with pure left insular lesion showed language impairment before and after surgery. Overall, patients with a left lesion showed a drop of performance after surgery followed by a partial recovery. Moreover, when the tumor involved the insula and adjacent networks, we observed a more severe deficit. No correlations were found between tumor volume, EOR, and language impairment. Left insular lobe is an important hub in language networks; its involvement determines pre- and postsurgical deficits, together with the involvement of white matter connections. Tumor volume and EOR are not risk factors per se directly related to language functioning. Surgery of insular gliomas is possible with a pre- and intraoperative extensive study of the patient with IOM and awake surgery, and encouraged by the trend of cognitive recovery highlighted.

The relation between delirium and malnutrition in hospitalized geriatric patients

Rationale: Delirium which is an acute confusional state with fluctuating course during the day is frequently observed in elderly patients experiencing acute stress such as hospitalization.In our study, which we conducted on the delirium awareness day, we determined the point prevalence of delirium in geriatric inpatients in our country and revealed its relationship with malnutrition

Delirium in intensive care: violence, loss and humanity

Delirium in intensive care is an altered state that can bring with it persecutory paranoias, and sometimes expressions of violence on the part of the patient; it can be deeply...

SURG-38. SEIZURE OUTCOME AFTER EPILEPSY SURGERY IN CHILDREN WITH BRAIN TUMORS

Abstract INTRODUCTION Epilepsy is a common chronic neurological complication of childhood brain tumors and seizures are refractory to medical therapy in up to 10% of patients. Referral for a diagnostic evaluation is recommended in patients with seizures refractory to ≥2 anti-epileptic drugs (AED). Utility of epilepsy surgery is not established in children with brain tumors. OBJECTIVE Primary aim of this study was to determine seizure outcome after epilepsy surgery in children with childhood brain tumors. METHODS Institutional Review Board’s approval was obtained for this retrospective study. A diagnosis of childhood brain tumor and a referral to the epilepsy monitoring unit (EMU) were required to be included in this study. Seizure outcome was defined according to International League Against Epilepsy (ILAE) outcome scale. Pre and post-operative MRIs were reviewed. RESULTS Forty-two children were referred to the EMU from May 2004 to July 2019. Of the 10 patients that underwent epilepsy surgery, 7 (70%) had pre-surgery frequency of >10 seizures/month and 3(30%) of these had multiple daily seizures; the rest had 3-4 seizures/month. All were taking ≥3 AEDs. Median time from first seizure to surgery was 83.7 months (range 24.3-151.6). At a median follow-up of 67.5 months (range 4.9-133.5) after epilepsy surgery, 60% reported no seizures in the 6-months before the last follow-up. Three (30%) had ILAE class-1 outcome, 4 (40%) class-3, and 3 (30%) were class-4. One child was off AEDs and the others were on a single AED at last follow-up. No post-operative neurological or cognitive deficits were recognized. Focal cortical atrophy was present in 40% of children before and in 30% after surgery. CONCLUSION Epilepsy surgery improved seizure outcome in all children that had epilepsy surgery and reduced the number of AEDs needed to treat seizures. Children with brain tumors and intractable seizures should be referred for epilepsy surgery evaluation.

COVID-19 in older adults: A focus on clinical characteristics and frail status

Worldwide attention has been drawn to the recent COVID-19 outbreak Many studies have shown that under the pandemic, elderlies, especially those with chronic diseases, are more vulnerable than youths Upon infection, older people tend to endure a higher hospitalization and mortality rate, and the mortality rate after acute hospitalization appears even higher for frail elderlies than non-frail ones Moreover, older COVID-19 patients can exhibit different, atypical clinical manifestations such as falls, delirium, general weakness, functional decline, and other geriatric syndromes indicating frailty Therefore, this review suggests that the most effective way to improve the prognosis of COVID-19 infection in the elderly is to avoid the occurrence of frailty

Gustave Étoc–Demazy (1806–1893) : l’aliéniste manceau élève de Guillaume Ferrus

Gustave Étoc–Demazy (1806–1893), one of the brilliant students of Guillaume Ferrus (1784–1861) at Bicêtre Hospital, spent his long career as an alienist directing the asylum in Le Mans, recently constructed when he arrived in 1834. His modest posthumous fame, reaching beyond the Sarthe region, is worth highlighting, on the basis of his doctoral thesis on stupidity, for example, which was an early milestone of his research throughout the 19th century on acute (mental) confusion. Following a short biography and an analysis of his inaugural work, we review some of his publications on subjects such as suicide and the alienist's role in the administration of justice.

The protective effect of hypothermia on postoperative cognitive deficit may be attenuated by prolonged coronary artery bypass time: Meta-analysis and meta-regression.

There is controversy about whether hypothermia during coronary artery bypass grafting (CABG) surgery is effective in reducing postoperative cognitive deficit (POCD). The objective of this study was to determine the effect of hypothermia on POCD and to undertake a meta-regression to determine whether moderator variables mediate the relationship between hypothermia and POCD. We searched the Web of Science, PubMed database, Scopus, and the Cochrane Library database (up to June 2017), and systematically reviewed a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared administration of hypothermia (34°C). Statistical analysis of the risk ratio (RR) and corresponding 95% confidence interval (95% CI) was used to report the overall effect. Mantel-Haenszel risk ratio (MH RR) and corresponding 95% CI was used to report the overall effect and meta-regression analysis. Eight RCTs were included in this study, with a total of 1,474 patients. The POCD occurred in 36.06% of all cases. A wide range of hypothermia (28-34°C) did not reduce the occurrence of POCD (RR = 0.983 (95% CI = 0.881-1.143); Z = -0.304; P = 0.761; I2 = 38%). Shorter CPB time reduced the occurrence of POCD (MH log risk ratio = -0.011 (95% CI = -0.021--0.0008); Z = -2.123; P = 0.033). Postoperative cognitive deficit is a common event among CABG patients. Contrary to deep hypothermia, mild hypothermia was significantly effective in reducing the risk of POCD. The neuroprotective effect of hypothermia on POCD may be attenuated by prolonged cardiopulmonary bypass (CPB) time.

Annals for Educators - 6 October 2020.

Annals for Educators - 6 October 2020.