Neurological Medical Conditions Research Articles

Evaluation of the Efficacy and Safety of Quetiapine in the Treatment of Delirium in Adult ICU Patients: A Retrospective Comparative Study

Background: Quetiapine is commonly prescribed off-label to manage delirium in intensive care unit (ICU) patients. However, limited studies comparing its efficacy and safety to those of other antipsychotics exist in the literature. Method: A retrospective, single-center chart review study was conducted on adults admitted to the ICU between January 2017 and August 2022, who were diagnosed with delirium and treated with a single antipsychotic and had no neurological medical conditions, active alcohol withdrawal, or prior use of antipsychotics. Data were analyzed using SPSS software version 28, with p-values of <0.05 indicating statistical significance. Results: In total, 47 patients were included, of whom 22 (46.8%), 19 (40.4%), 4 (8.5%), and 2 (4.3%) were on quetiapine, haloperidol, risperidone, and olanzapine, respectively. The median number of hours needed to resolve delirium were 12 (21.5), 23 (28), 13 (13.75), and 36 (10) (p = 0.115) for quetiapine, haloperidol, risperidone, and olanzapine, respectively, with haloperidol being used for a significantly shorter median number of days than quetiapine (3 (2.5) days vs. 7.5 (11.5) days; p = 0.007). Of the medication groups, only quetiapine-treated patients received a significantly higher median maintenance compared to the initiation dose (50 (50) mg vs. 50 (43.75) mg; p = 0.039). For the length of stay in the ICU and hospital, delirium-free days, % of ICU time spent in delirium, ventilator-free days, the difference between the highest and baseline QTc intervals, and ICU and hospital mortalities, no significant difference was observed between the groups. Conclusions: Overall, the use of quetiapine in our retrospective study seems to not be advantageous over the other drugs in terms of efficacy and safety outcomes.

Association between glyphosate exposure and cognitive function, depression, and neurological diseases in a representative sample of US adults: NHANES 2013–2014 analysis

Glyphosate, the most widely used herbicide globally, has been linked to neurological impairments in some occupational studies. However, the potential neurotoxic effects of glyphosate exposure in the general population are still not fully understood. We conducted analyses on existing data collected from 1532 adults of the 2013–2014 National Health and Nutrition Examination Survey (NHANES) to explore the possible relationship between glyphosate exposure and cognitive function, depressive symptoms, disability, and neurological medical conditions. Our results showed a significant negative association between urinary glyphosate levels and the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Test (CERAD-WLT) trial 3 recall and delayed recall scores in both models, with ß coefficients of −0.288 (S.E. = 0.111, P = 0.021) and −0.426 (S.E. = 0.148, P = 0.011), respectively. Furthermore, the odds ratio did not show a significant increase with the severity of depressive symptoms with a one-unit increase in ln-glyphosate levels. However, the odds ratio for severe depressive symptoms was significantly higher than for no symptoms (odds ratio = 4.148 (95% CI = 1.009–17.133), P = 0.049). Notably, the odds ratio showed a significant increase for individuals with serious hearing difficulty (odds ratio = 1.354 (95% CI = 1.018–1.800), P = 0.039) with a one-unit increase in ln-glyphosate levels, but not for other neurological medical conditions. In conclusion, our findings provide the first evidence that glyphosate exposure may be associated with neurological health outcomes in the US adult population. Additional investigation is necessary to understand the potential mechanisms and clinical significance of these correlations.

0575 Characterization of the Prevalence of Sleep Disturbances in Cardiovascular and Neurological Patients from the Rush Heart Center for Women

Abstract Introduction Anecdotally, patients with cardiovascular and neurological medical conditions present with sleep disturbances in duration, efficiency, and timing, or with sleep disorders such as obstructive sleep apnea. The frequency of such disturbances remains unknown as does whether they result from cardiovascular and neurological conditions or contribute to the development of these conditions. Thus, characterizing the prevalence of sleep disturbances in this unique clinical population is a first step to establishing the important role of sufficient, healthy sleep for patient care and treatment. Methods We conducted a retrospective electronic chart review of patients from the Rush Heart Center for Women (RHCW) based on the following: age, sex, race, body mass index (BMI), blood pressure (BP), sleep studies, cardiac testing, and neurologic testing. Patients were also characterized based on prevalent disease (cardiac, neurologic, or both) including the following: cardiac—coronary artery disease, ischemic vs. non-ischemic heart disease, atrial fibrillation, heart failure, etc; neurologic—vascular etiology, mild cognitive impairment, dementia, Alzheimer’s Disease, etc. We then performed a database search to identify patients who also met the criteria for sleep apnea or for whom a sleep study was ordered due to sleep disturbances. Results 103 patients (mean age±SD, 68.71±12.55 years; 78 females; mean BMI±SD, 28.65±5.28; 79 White, 14 African American, 4 Asian, 1 Native Hawaiian, 5 Other; mean BP±SD, 128/72±20/9; mean±SD Mini-Mental State Examination (MMSE), 27.47±3.24) had cardiovascular and/or neurological conditions. Of these, 53 patients (mean age±SD, 68.31±9.35 years; 40 females; mean BMI±SD, 29.91±5.73; 39 White, 7 African American, 2 Asian, 1 Native Hawaiian, 4 Other; mean BP±SD, 129/73±21/9; mean MMSE±SD, 27.67±2.99) also presented with sleep apnea symptoms or sleep disturbances. Conclusion A strikingly high percentage (51.5%) of patients at the RHWC who had cardiovascular and/or neurological conditions also presented with sleep apnea or sleep disturbance symptoms. The prevalence of this trifecta of disease (cardiovascular, neurological, and sleep apnea/disturbance) demonstrates the criticality of considering the interplay between these various domains when administering clinical care to patients. Future research capitalizing on the physiological and neurobehavioral benefits of adequate, healthy sleep in this population is warranted. Support (If Any) RMC Dean’s Award Summer Research Fellowship; NASA NNX14AN49G and 80NSSC20K0243; NIH R01DK117488

Ultrasound in the presence of microbubbles in a dynamic invitro microfluidic blood-brain barrier model

Controllable, localized permeability of the blood-brain barrier (BBB) has been a goal of health professionals for enhanced delivery of drugs and therapeutic compounds for cancer and other neurological medical conditions. The transient permeability induced by transcranial ultrasound exposure in the presence of microbubbles has been shown to be a promising option, but little is known about the exact mechanism and response on a cellular level. A microfluidic device developed to recreate the in vivo microenvironment, including physiological fluid flow, was seeded with human cerebral microvessel endothelial cells surrounded by a matrix of astrocytes. The devices were exposed to ultrasound with and without the presence of microbubbles. The ultrasound parameters ranged in frequency from 0.5 to 1.55 MHz, duty factor from 0.0001–0.001 and pulse repetition frequency of 1 Hz–10 Hz. Microbubble size, composition, and concentration within the pumped fluid were also varied, along with varied flow rate. The transepithelial electrical resistance (TEER) and cell morphology were monitored throughout and post ultrasound exposure to understand the effects on permeability and cell viability. With this controlled variation of the ultrasound and microbubble parameters, a greater understanding of the induced permeability could lead to more success for clinical utilization.

Application of Cannabinoids in Neurosciences: Considerations and Implications.

Medicinal cannabinoid use continues to evolve across the United States, although legitimate federal recognition for medicinal purpose is lacking. Variability exists across states within the United States with respect to legislation, and health care institutions encounter challenges when patients present with a history of medicinal cannabinoid use. Emerging evidence in the field of neurosciences suggests a role of cannabinoids for neurologic medical conditions such as Parkinson disease, multiple sclerosis, and epilepsy. We aim to provide an overview of cannabinoids including a historical perspective, pharmacology, applications in neurosciences, and challenges in health care and academia. Knowledge of the appropriate role of cannabinoids in the clinical setting is essential for all health care practitioners including nursing.