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Noufi P, Anderson KM, Crowell N, White Y, Molina E, Rao SD, Groninger H. Prognostic implications of delirium after Left Ventricular Assist Device (LVAD) implantation: A retrospective study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00048-X. [PMID: 38705515 DOI: 10.1016/j.jaclp.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION In critically ill patients, delirium is a prognostic indicator of morbidity and mortality. This study investigates the impact of a delirium diagnosis on outcomes after Left Ventricular Assist Device (LVAD) implantation. METHODS This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared pre-implantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as re-intubation rate, length of stay (LOS), discharge disposition, and readmission rates. RESULTS In total, 361 patients (26.7% women, 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Pre-implantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P=0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P=0.007), 6-month (P=0.004), and in-hospital mortality (P<0.001), unplanned re-intubations (P<0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and ICU LOS were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant. CONCLUSIONS In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse post-surgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.
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Affiliation(s)
- Paul Noufi
- Palliative Care, MedStar Harbor Hospital, Baltimore, MD, USA; Georgetown University School of Medicine, Washington, DC, USA.
| | | | - Nancy Crowell
- Georgetown University School of Nursing, Washington, DC, USA
| | - Yasmine White
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC, USA
| | - Sriram D Rao
- MedStar Heart and Vascular Institute, Washington Hospital Center, Washington, DC, USA
| | - Hunter Groninger
- Georgetown University School of Medicine, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA
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Boanca K, Borris J, Noufi P. Alpha(α)-2 Receptor Agonists in Palliative Care. J Palliat Med 2024. [PMID: 38686515 DOI: 10.1089/jpm.2024.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
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Issa M, Naja A, Ghanem A, Shayya S, Noufi P, Faddoul A, Saghieh S. Regional versus general anesthesia in knee arthroplasty in patients with different classes of BMI: A matched analysis of the NSQIP database. J Orthop Sci 2024; 29:188-193. [PMID: 36464543 DOI: 10.1016/j.jos.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Knee arthroplasty for knee arthritis is a commonly performed surgery yielding excellent functional results and good pain relief. It is associated with post-surgical complications according to the type of anesthesia and BMI class. METHODS The National Surgical Quality Improvement Project database for the years 2005-2012 for patients >18 years of age who underwent knee arthroplasty, condyle and plateau, medial and/or lateral compartment. The surgical site complications, bleeding occurrences necessitating transfusion, unplanned readmissions, and mortality stratified according to anesthesia type and BMI class over a period of 30-days were examined. RESULTS A total of 78,275 patients were included for analysis; regional anesthesia showed a consistent protective effect from surgical site complications more prominent with increasing obesity class with respective ORs and their corresponding 95% CI for pre-obesity, class I, II, and III obesity being 0.95 [0.89-1.09], 0.75 [0.68-0.83], 0.64 [0.57-0.72], and 0.61 [0.54-0.7]. CONCLUSIONS Higher BMI values are a protective factor for the risk of bleeding requiring transfusion in patients undergoing total knee arthroplasty. Moreover, regional anesthesia is the preferred choice of anesthesia as well if postoperative complications are considered. A significant decrease in the rate of post-operative blood transfusions was seen in patients with high BMI and regional anesthesia.
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Affiliation(s)
- Mohamad Issa
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Naja
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sami Shayya
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Paul Noufi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Annibal Faddoul
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Said Saghieh
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Noufi P, Anderson K, Crowell N, White Y, Rao S, Groninger H. Prognostic Implications of Delirium After Left Ventricular Assist Device (LVAD) Implantation: A Retrospective Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Non-Alzheimer's dementias constitute 30% of all dementias and present with major cognitive and behavioral disturbances. Cholinesterase inhibitors improve memory by increasing brain acetylcholine levels and are approved symptomatic therapies for Alzheimer's disease (AD). They have also been investigated in other types of dementias with potential cholinergic dysfunction. There is compelling evidence for a profound cholinergic deficit in Lewy Body dementia (LBD) and Parkinson's disease dementia (PDD), even to a greater extent than AD. However, this deficit is difficult to objectivize in vascular dementia (VaD) given the increased comorbidity with AD. Furthermore, there is minimal to no evidence for cholinergic loss in frontotemporal dementia (FTD). Although cholinesterase inhibitors showed significant improvement in cognitive, behavioral, and functional measures in both LBD and PDD clinical trials, only rivastigmine is approved for PDD, due to the heterogeneity of the scales used, the duration of trials, and the limited sample sizes impacting data interpretation. Similarly, the interpretation of findings in VaD trials are limited by the lack of pre-defined inclusion criteria for 'pure VaD' and the wide heterogeneity of patients enrolled with respect to location and extent of cerebrovascular disease. In FTD patients, cholinesterase inhibitors were mostly associated with worsening of cognitive and behavioral symptoms. In non-AD dementias, cholinesterase inhibitors were well tolerated, with increased reports of mild to moderate cholinergic side effects and a non-significant trend for increased cardio and cerebrovascular events with rivastigmine in VaD, justifying their cautious use on a case-by-case basis, especially when there is evidence for cholinergic deficit.
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Affiliation(s)
- Paul Noufi
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S Grand Blvd, St. Louis, MO, 63104, USA.
| | - Sajeeka Jeyakumar
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S Grand Blvd, St. Louis, MO, 63104, USA
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S Grand Blvd, St. Louis, MO, 63104, USA
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El Khoury J, Noufi P, Ahmad A, Akl E, El Hayek S. Attitudes, beliefs, and knowledge of substance use amongst youth in the Eastern Mediterranean region: A systematic review. Drug Alcohol Depend 2019; 196:71-78. [PMID: 30716567 DOI: 10.1016/j.drugalcdep.2018.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance use has a tremendous impact on the burden of disease. This is particularly true in the Eastern Mediterranean region (EMR), where many countries serve as suppliers of drugs. As risk perception and frequency of use are inversely correlated, targeting perception during adolescence becomes essential for prevention. In this study, we systematically reviewed the literature on attitudes, beliefs, and knowledge of substance use amongst youth in the EMR. METHODS We reviewed quantitative articles addressing attitudes, beliefs, and knowledge of youth aged between 13 and 25 years towards substance use in the EMR. We searched MEDLINE, PubMed, Cochrane, PsycInfo, and PsycArticles then applied a duplicate independent method for study selection and screening. Two reviewers completed data abstraction and a narrative summary of findings. RESULTS Our search generated 12,810 articles. Five cross-sectional studies were eligible (two analytic and three descriptive). The analytic studies described a significant correlation between intention to use and both attitudes and subjective norms. The descriptive studies portrayed a negative attitude towards use with a low threshold for considering it as serious. Beliefs pertaining to reasons for use included stress and sleeping, whereas thoughts on treatment were restricted to traditional methods based on personal resilience and religious support. Knowledge about substance use symptoms, withdrawal, and treatment was low. CONCLUSION Our review ascertains the role of sociocultural moral prohibition and awareness of mental health as major influencers in shaping the perception of substance use. Further research is needed to elaborate culturally-tailored survey tools.
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Affiliation(s)
- Joseph El Khoury
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Paul Noufi
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Amanda Ahmad
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Elie Akl
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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Abstract
Addiction is an international public health problem. It is a polygenic disorder best understood by accounting for the interplay between genetic and environmental factors. A recent way of perceiving this interaction is through epigenetics, which help grasp the neurobiological changes that occur in addiction and explain its relapsing-remitting nature. It is now known that every cell has a different way of expressing its phenotype, despite a universal DNA sequence. This is particularly true in the central nervous system where environmental factors influence this expression. Three major epigenetic processes have been found to participate in the perpetuation of addiction by changing the state of the chromatin and the degree of gene transcription: histone acetylation and methylation, DNA methylation, and noncoding RNAs. In the animal model literature, substantial evidence exists about the role of these epigenetic changes in the different phases of substance use disorders. This book chapter is a non-systematic literature review of the recent publications tackling the topic of epigenetics in addiction. Even though this evidence remains scarce and relatively poorly systematized, it is a promising foundation for future research of molecules that target specific brain regions and their functions to address core behavioral changes seen in addiction.
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Affiliation(s)
- Antoine Beayno
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Paul Noufi
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Tarabay
- Faculty of Pedagogy, Lebanese University, New Rawda, Lebanon.,Faculty of Natural and Applied Sciences, Notre Dame University, Louaize, Lebanon
| | - Wael Shamseddeen
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon. .,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
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