Antioxidant for Neurological Diseases and Neurotrauma and Bioengineering Approaches

Antioxidants are a class of molecules with an innate affinity to neutralize reactive oxygen species (ROS), which are known to cause oxidative stress. Oxidative stress has been associated with a wide range of diseases mediated by physiological damage to the cells. ROS play both beneficial and detrimental roles in human physiology depending on their overall concentration. ROS are an inevitable byproduct of the normal functioning of cells, which are produced as a result of the mitochondrial respiration process. Since the establishment of the detrimental effect of oxidative stress in neurological disorders and neurotrauma, there has been growing interest in exploring antioxidants to rescue remaining or surviving cells and reverse the neurological damage. In this review, we present the survey of different antioxidants studied in neurological applications including neurotrauma. We also delve into bioengineering approaches developed to deliver antioxidants to improve their cellular uptake in neurological applications.

STANDARDS OF MEDICAL CARE “INVASIVE CANDIDIASIS IN NEWBORNS”

Candida infection (candidiasis) is an important clinical problem in newborns who need treatment in modern intensive care units. Organ and/or systemic infections caused by these fungi are called invasive candidiasis (IC). Newborns are especially vulnerable to IC, and their incidence is 3-5 times higher than the corresponding rates in children or adults. Invasive fungal infections caused by Candida are the third most common late-onset infection in infants born with a birth weight <1500 g. IC in newborns is associated with approximately 20% mortality, and about half of survivors have serious long- term neurological damage. In recent years, new data have been obtained on the diagnosis, prevention and treatment of IC in newborns, which has determined a change in treatment recommendations. Accordingly, the need arose to ensure the compliance of our clinical practice with modern evidence-based approaches. Early diagnosis of candidiasis and prompt treatment with effective antifungal agents such as fluconazole, amphotericin B, and micafungin, when indicated, are critical to improving outcomes.

Bioaccumulation of Fluoride in Plants and Its Microbially Assisted Remediation: A Review of Biological Processes and Technological Performance

Fluoride is widely found in soil–water systems due to anthropogenic and geogenic activities that affect millions worldwide. Fluoride ingestion results in chronic and acute toxicity, including skeletal and dental fluorosis, neurological damage, and bone softening in humans. Therefore, this review paper summarizes biological processes for fluoride remediation, i.e., bioaccumulation in plants and microbially assisted systems. Bioremediation approaches for fluoride removal have recently gained prominence in removing fluoride ions. Plants are vulnerable to fluoride accumulation in soil, and their growth and development can be negatively affected, even with low fluoride content in the soil. The microbial bioremediation processes involve bioaccumulation, biotransformation, and biosorption. Bacterial, fungal, and algal biomass are ecologically efficient bioremediators. Most bioremediation techniques are laboratory-scale based on contaminated solutions; however, treatment of fluoride-contaminated wastewater at an industrial scale is yet to be investigated. Therefore, this review recommends the practical applicability and sustainability of microbial bioremediation of fluoride in different environments.

Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review

Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients.Methods: A systematic consultation of literature was carried out. Search terms included: “CA and sepsis,” “CA and surgery,” and “CA and non-brain injury.”Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated.Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients.

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

Ecology of Powassan Virus in the United States

Zoonotic viruses threaten the lives of millions of people annually, exacerbated by climate change, human encroachment into wildlife habitats, and habitat destruction. The Powassan virus (POWV) is a rare tick-borne virus that can cause severe neurological damage and death, and the incidence of the associated disease (Powassan virus disease) is increasing in the eastern United States. The mechanisms by which POWV is maintained in nature and transmitted to humans are complex and only partly understood. This review provides an overview of what is known about the vector species, vector-host transmission dynamics, and environmental and human-driven factors that may be aiding the spread of both the vector and virus.

Abstract 1122‐000240: The Effect of COVID‐19 on Stroke Treatment in Africa

Introduction : One of the most common neurological sicknesses in healthcare today is acute ischemic stroke. Stroke is associated with symptoms such as neurological damage, and can only be effectively treated with a few methods. One such treatment is mechanical thrombectomy, and in this study, research was done on how the COVID‐19 pandemic affected stroke treatments (specifically MT) in Africa. Methods : Initially, data of 58 countries in Africa was compiled and put in a spreadsheet. Soon after, the countries that would be most desirable for the study were found. These “target countries” had the highest populations (as of 2020), number of COVID‐19 cases (as of October 2020) and number of incident stroke cases (in 2016) in Africa. This group consisted of countries such as Nigeria, Ethiopia, Egypt, and South Africa. Afterwards, neurologists, neurosurgeons, professors of neurology, and neurointerventionalists from the “target countries” were contacted via email. This email invited these individuals to hold an interview or fill out a survey regarding the impact COVID‐19 on stroke treatment in their hospital. After sending approximately 50 emails, 3 survey responses were received and 3 interviews were held. Results : Following the interviews and after reading survey responses, impairments to mechanical thrombectomy appeared to be the frontrunner of the barriers mentioned. Other important barriers mentioned were: time barriers, rehabilitation barriers, as well as fear of seeking treatment in places of high COVID‐19 concentration. The practice of MT is well‐ established in North America and Europe; however, it is still rather undeveloped in Africa. All doctors interviewed and surveyed indicated that the pandemic practically brought operations to a halt (only one doctor recorded two successful procedures during the pandemic). In Egypt specifically, there has been a lack of equipment and PPE. This is mainly because hospitals are dedicating staff and equipment to COVID‐infected patients. The secondary barriers also contributed to problems in hospitals. Due to more screenings and less staff during the pandemic, time for patients to receive treatment has increased. Rehabilitation for stroke patients has been impacted by a lack of prescriptions from pharmacies. Finally, in certain parts of Africa people are too afraid to visit hospitals due to the risk of possibly being infected with COVID‐19. The barriers imposed by the pandemic have made stroke treatment significantly more difficult. Conclusions : In conclusion, the COVID‐19 pandemic has negatively affected stroke treatment in certain areas of Africa. Doctors have faced several key barriers that has limited the effectiveness of stroke treatment during the time period. Based on doctor recommendations, improving in the practice of mechanical thrombectomy is the most effective solution to ensuring stroke treatment is proficient. This could be done through awareness, education, and better equipment.