Faculty Bibliography

BACKGROUND:COVID-19 has been a devastating pandemic with little known of its neuropsychiatric complications. Delirium is one of the most common neuropsychiatric syndromes among hospitalized cancer patients with incidence ranging from 25% to 40% and rates of up to 85% in the terminally ill. Data on the incidence, risk factors, duration, and outcomes of delirium in critically ill cancer patients with COVID-19 are lacking. OBJECTIVE:To report the incidence, risks and outcomes of critically ill cancer patients who developed COVID-19. METHODS:This is a retrospective single-center study evaluating delirium frequency and outcomes in all critically ill cancer patients with COVID-19 admitted between March 1 and July 10, 2020. Delirium was assessed by Confusion Assessment Method for Intensive Care Unit, performed twice daily by trained intensive care unit (ICU) nursing staff. Patients were considered to have a delirium-positive day if Confusion Assessment Method for Intensive Care Unit was positive at least once per day. RESULTS:A total of 70 patients were evaluated. Of those 70, 53 (75.7%) were found to be positive for delirium. Patients with delirium were significantly older than patients without delirium (median age 67.5 vs 60.3 y, P = 0.013). There were no significant differences in demographic characteristics, chronic medical conditions, neuropsychiatric history, cancer type, or application of prone positioning between the 2 groups. Delirium patients were less likely to receive cancer-directed therapies (58.5% vs 88.2%, P = 0.038) but more likely to receive antipsychotics (81.1% vs 41.2%, P = 0.004), dexmedetomidine (79.3% vs 11.8%, P < 0.001), steroids (84.9% vs 58.8%, P = 0.039), and vasopressors (90.6% vs 58.8%, P = 0.006). Delirium patients were more likely to be intubated (86.8% vs 41.2%, P < 0.001), and all tracheostomies (35.9%) occurred in patients with delirium. ICU length of stay (19 vs 8 d, P < 0.001) and hospital length of stay (37 vs 12 d, P < 0.001) were significantly longer in delirium patients, but there was no statistically significant difference in hospital mortality (43.4% vs 58.8%, P = 0.403) or ICU mortality (34.0% vs 58.8%, P = 0.090). CONCLUSIONS:Delirium in critically ill cancer patients with COVID-19 was associated with less cancer-directed therapies and increased hospital and ICU length of stay. However, the presence of delirium was not associated with an increase in hospital or ICU mortality.

People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.

Statins are the drugs of choice for the treatment of hyperlipidemia, cardiovascular disease, and coronary disease, among others. Their safety and tolerance allows its use on multiple branches in medicine. However, its long-term use is associated with adverse effects that affect the quality of life of patients, and therefore, their adherence to treatment. Among these, myopathies are described. They represent a variety of clinical presentations ranging from mild myalgia to fatal rhabdomyolysis. In this literature review, the safety of statin use is assessed objectively in order to determine what attitude should be taken regarding the therapy for muscle disorders.

Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador. Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset. Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA. Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.

Objective: Determine the prevalence of the different epidemiological features and risk factors of stroke patients of the Regional Hospital Dr. Teodoro Maldonado Carbo. Methods: Cross-sectional study of 521 patients with diagnosis of stroke, admitted to the Neurology Service of the Social Security Hospital between the years 2007-2009. Data was recollected from the discharge notes and medical records. The measured variables were duration of hospital stay, diagnosis, mortality, non-modifiable risk factors, and modifiable risk factors. In case of hemorrhagic stroke variables that could represent its cause were also recollected. Results: Most patients were males (70.5%), the most prevalent risk factors were hypertension (81.1%), diabetes mellitus (27%) and dyslipidemia (16.88%). The mean age was 67±13 years. There was an increased tendency of hypertension in males and of diabetes mellitus in females (p=0.45, p=0.17 respectively). There was a significant difference in the presence of coagulopathy (p=0.01), valvulopathy (p=0.04) and anticoagulant use (p=0.004) in females. Ischemic stroke represented the 80.9% and hemorrhagic stroke the 19.1% of cases. Conclusions: These results are similar to those found in Latin American and North American publications. The correction of the most prevalent risk factors in our population would markedly decrease the incidence of this disabling disease.