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Safdar M, Colosimo C, Khurshid MH, Spencer AL, Hejazi O, Castanon L, Hosseinpour H, Magnotti LJ, Bhogadi SK, Joseph B. Drugs, Delirium, and Trauma: Substance Use and Incidence of Delirium After Traumatic Brain Injury. J Surg Res 2024; 301:45-53. [PMID: 38909477 DOI: 10.1016/j.jss.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION There is a paucity of data on the effect of preinjury substance (alcohol, drugs) abuse on the risk of delirium in patients with traumatic brain injury (TBI). This study aimed to assess the incidence of delirium among patients with blunt TBI in association with different substances. METHODS We analyzed the 2020 American College of Surgeons-Trauma Quality Improvement Program. We included all adult (≥18 y) patients with blunt TBI who had a recorded substance (drugs and alcohol) screening. Our primary outcome was the incidence of delirium. RESULTS A total of 72,901 blunt TBI patients were identified. The mean (standard deviation) age was 56 (20) years and 68.0% were males. The median (interquartile range) injury severity score was 17 (10-25). Among the study population, 23.1% tested positive for drugs (Stimulants: 3.0%; Depressants: 2.9%, hallucinogens: 5.1%, Cannabinoids: 13.4%, TCAs: 0.1%), and 22.8% tested positive for Alcohol. Overall, 1856 (2.5%) experienced delirium. On univariate analysis, patients who developed delirium were more likely to have positive drug screening results. On multivariable regression analyses, positive screen tests for isolated stimulants (adjusted odds ratio [aOR]: 1.340, P = 0.018), tricyclic antidepressants (aOR: 3.107, P = 0.019), and cannabinoids (aOR: 1.326, P ≤ 0.001) were independently associated with higher odds of developing delirium. CONCLUSIONS Nearly one-fourth of adult patients with blunt TBI had an initial positive substance screening test. Patients with positive results for isolated stimulants, tricyclic antidepressants, and cannabinoids were at a higher risk of developing delirium, whereas this association was not evident with other drugs and alcohol-positive tests. These findings emphasize the need for early drug screening in TBI patients and close monitoring of patients with positive screening tests.
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Affiliation(s)
- Mohammad Safdar
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Haris Khurshid
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Omar Hejazi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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The impact of methamphetamines in patients with traumatic brain injury, a retrospective review. Clin Neurol Neurosurg 2018; 170:99-101. [PMID: 29763809 DOI: 10.1016/j.clineuro.2018.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/13/2018] [Accepted: 04/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Both neurotoxic and neuroprotective effects of methamphetamines (METH) are being studied. There are few studies evaluating the effects of METH on patients with traumatic brain injury (TBI). The objective of this study is to compare clinical outcomes after TBI in METH users versus non-METH users. PATIENT AND METHODS A retrospective review of 304 patients with severe traumatic head injury were performed. Patients were evaluated and stratified based on toxicology screening for methamphetamines (METH) or none. Of the patients reviewed with a full toxicology, 24 of those patients were positive for METH, and 60 patients were negative. Patients were evaluated based on demographics, type of injury, Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS). RESULTS METH patients were younger upon presentation (43.5 versus 55.8, p = 0.003), with a larger improvement in GCS and GOS upon discharge (P = 0.012, 0.0001 respectively). There was no significant difference in length of hospital stay, initial presenting GCS and GOS, or discharge GCS and GOS. CONCLUSIONS Our findings demonstrate an improved change in GCS and GOS for those positive with METH than those without. Surprisingly, substance positive patients did not have a worse outcome score. Further investigation is necessary to evaluate the potential neuro-protective effects of METH in TBI.
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[Psychostimulants for late life depression]. Encephale 2017; 44:274-279. [PMID: 29195804 DOI: 10.1016/j.encep.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The use of psychostimulants in the treatment of depressive disorders is receiving renewed interest. Recent publications suggest a particular interest of psychostimulants in the treatment of depression in the elderly. The aim of this article is to review the literature on the role of psychostimulants in the treatment of depression in older adults. METHODS The literature review focused on efficacy and tolerability studies of psychostimulants in the treatment of depression for the elderly that were published between 1980 and 2016. The only inclusion criterion applied was an average age of the sample studied greater than or equal to 60 years. RESULTS Overall, 12 trials were selected: 3 controlled trials and 9 uncontrolled trials. Of the 3 controlled trials, one compared parallel groups and the other two were cross-tests. Among the psychostimulants, methylphenidate was the most studied molecule. The trials demonstrate an efficacy of this molecule in particular as an add-on therapy in old-age depression but for the most part with a level of proof that remains insufficient. CONCLUSIONS The small size of the samples and the methodological limitations of the studies obviate the possibility of extracting definitive conclusions concerning the place of psychostimulants in the treatment of depression in the elderly. Further studies are required in particular in the treatment of resistant depressive episodes.
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Rau T, Ziemniak J, Poulsen D. The neuroprotective potential of low-dose methamphetamine in preclinical models of stroke and traumatic brain injury. Prog Neuropsychopharmacol Biol Psychiatry 2016; 64:231-6. [PMID: 25724762 DOI: 10.1016/j.pnpbp.2015.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 01/06/2023]
Abstract
Methamphetamine is a psychostimulant that was initially synthesized in 1920. Since then it has been used to treat attention deficit hyperactive disorder (ADHD), obesity and narcolepsy. However, methamphetamine has also become a major drug of abuse worldwide. Under conditions of abuse, which involve the administration of high repetitive doses, methamphetamine can produce considerable neurotoxic effects. However, recent evidence from our laboratory indicates that low doses of methamphetamine can produce robust neuroprotection when administered within 12h after severe traumatic brain injury (TBI) in rodents. Thus, it appears that methamphetamine under certain circumstances and correct dosing can produce a neuroprotective effect. This review addresses the neuroprotective potential of methamphetamine and focuses on the potential beneficial application for TBI.
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Affiliation(s)
- Thomas Rau
- Dept. Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, United States
| | - John Ziemniak
- Gwynedd Pharmaceutical Consulting, Gwynedd Valley, PA, United States
| | - David Poulsen
- Neurosurgery Dept., University at Buffalo, SUNY-School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
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Liu X, Gangoso E, Yi C, Jeanson T, Kandelman S, Mantz J, Giaume C. General anesthetics have differential inhibitory effects on gap junction channels and hemichannels in astrocytes and neurons. Glia 2015; 64:524-36. [PMID: 26666873 DOI: 10.1002/glia.22946] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/16/2015] [Indexed: 11/07/2022]
Abstract
Astrocytes represent a major non-neuronal cell population actively involved in brain functions and pathologies. They express a large amount of gap junction proteins that allow communication between adjacent glial cells and the formation of glial networks. In addition, these membrane proteins can also operate as hemichannels, through which "gliotransmitters" are released, and thus contribute to neuroglial interaction. There are now reports demonstrating that alterations of astroglial gap junction communication and/or hemichannel activity impact neuronal and synaptic activity. Two decades ago we reported that several general anesthetics inhibited gap junctions in primary cultures of astrocytes (Mantz et al., (1993) Anesthesiology 78(5):892-901). As there are increasing studies investigating neuroglial interactions in anesthetized mice, we here updated this previous study by employing acute cortical slices and by characterizing the effects of general anesthetics on both astroglial gap junctions and hemichannels. As hemichannel activity is not detected in cortical astrocytes under basal conditions, we treated acute slices with the endotoxin LPS or proinflammatory cytokines to induce hemichannel activity in astrocytes, which in turn activated neuronal hemichannels. We studied two extensively used anesthetics, propofol and ketamine, and the more recently developed dexmedetomidine. We report that these drugs have differential inhibitory effects on gap junctional communication and hemichannel activity in astrocytes when used in their respective, clinically relevant concentrations, and that dexmedetomidine appears to be the least effective on both channel functions. In addition, the three anesthetics have similar effects on neuronal hemichannels. Altogether, our observations may contribute to optimizing the selection of anesthetics for in vivo animal studies.
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Affiliation(s)
- Xinhe Liu
- Collège De France, Center for Interdisciplinary Research in Biology (CIRB)/Centre National De La Recherche Scientifique, Unité Mixte De Recherche 7241/Institut National De La Santé Et De La Recherche Médicale U1050, Paris Cedex 05, France.,University Pierre Et Marie Curie, Paris, France.,MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University, Paris, France
| | - Ester Gangoso
- Collège De France, Center for Interdisciplinary Research in Biology (CIRB)/Centre National De La Recherche Scientifique, Unité Mixte De Recherche 7241/Institut National De La Santé Et De La Recherche Médicale U1050, Paris Cedex 05, France.,University Pierre Et Marie Curie, Paris, France.,MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University, Paris, France
| | - Chenju Yi
- Collège De France, Center for Interdisciplinary Research in Biology (CIRB)/Centre National De La Recherche Scientifique, Unité Mixte De Recherche 7241/Institut National De La Santé Et De La Recherche Médicale U1050, Paris Cedex 05, France.,University Pierre Et Marie Curie, Paris, France.,MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University, Paris, France
| | - Tiffany Jeanson
- Collège De France, Center for Interdisciplinary Research in Biology (CIRB)/Centre National De La Recherche Scientifique, Unité Mixte De Recherche 7241/Institut National De La Santé Et De La Recherche Médicale U1050, Paris Cedex 05, France.,University Pierre Et Marie Curie, Paris, France.,MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University, Paris, France
| | - Stanislas Kandelman
- Département D'anesthésie Et De Réanimation, HUPNVS, Université Paris Diderot, Paris, France
| | - Jean Mantz
- Service D'anesthésie Réanimation, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France.,Unité D'histopathologie Humaine Et Modèles Animaux Département Infection Et Epidémiologie Institut Pasteur 25, Rue Du Docteur Roux, Paris, France
| | - Christian Giaume
- Collège De France, Center for Interdisciplinary Research in Biology (CIRB)/Centre National De La Recherche Scientifique, Unité Mixte De Recherche 7241/Institut National De La Santé Et De La Recherche Médicale U1050, Paris Cedex 05, France.,University Pierre Et Marie Curie, Paris, France.,MEMOLIFE Laboratory of Excellence and Paris Science Lettre Research University, Paris, France
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Wang XY, Ba YC, Xiong LL, Li XL, Zou Y, Zhu YC, Zhou XF, Wang TH, Wang F, Tian HL, Li JT. Endogenous TGFβ1 Plays a Crucial Role in Functional Recovery After Traumatic Brain Injury Associated with Smad3 Signal in Rats. Neurochem Res 2015; 40:1671-80. [PMID: 26253398 DOI: 10.1007/s11064-015-1634-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 12/19/2022]
Abstract
Transforming growth factor-β 1 (TGFβ1) has a diverse role in astrogliosis and neuronal survival, but the underlying mechanism remains to be elucidated, especially in traumatic brain injury (TBI). Here, we show that the expression of TGFβ1 was increased in the pericontusional region, accompanied with astrogliosis and neuronal loss in TBI rats. Moreover, TGFβ1 knockdown not only reduced the number of neurons and inhibited astrogliosis but also resulted in a significant neurological dysfunction in rats with TBI. Subsequently, Smad3, a key downstream signal of TGFβ1, was involved in pericontusional region after TBI. These findings therefore indicate that TGFβ1 is involved in neuroprotection and astrogliosis, via activation of down stream Smad3 signal in the brain after injury.
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Affiliation(s)
- Xu-Yang Wang
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, 200233, China
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