bluuebunny/crossref_metadata_2025 huggingface dataset:
Probing the Structure and Evolution of BASS Active Galactic Nuclei through Eddington Ratios
Authors: Ananna Tonima Tasnim , Urry C. Megan , Ricci Claudio , Natarajan Priyamvada , Hickox Ryan C. , Trakhtenbrot Benny , Treister Ezequiel , Weigel Anna K. , Ueda Yoshihiro , Koss Michael J. , Bauer F. E. , Temple Matthew J. , Baloković Mislav , Mushotzky Richard , Auge Connor , Sanders David B. , Kakkad Darshan , Sartori Lia F. , Marchesi Stefano , Harrison Fiona , Stern Daniel , Oh Kyuseok , Caglar Turgay , Powell Meredith C. , Podjed Stephanie A. , Mejía-Restrepo Julian E.
Published: November 2022

We constrain the intrinsic Eddington ratio (λ
Edd) distribution function for local active galactic nuclei (AGN) in bins of low and high obscuration

[
log
(

N

H

/

cm

−
2

)
≤
22

and

22
<
log
(

N

H

/

cm

−
2

)
<
25

], using the Swift Burst Alert Telescope 70 month/BASS DR2 survey. We interpret the fraction of obscured AGN in terms of circumnuclear geometry and temporal evolution. Specifically, at low Eddington ratios (

log

λ

Edd

<

−2), obscured AGN outnumber unobscured ones by a factor of ∼4, reflecting the covering factor of the circumnuclear material (0.8, or a torus opening angle of ∼34°). At high Eddington ratios (

log

λ

Edd

>

−1), the trend is reversed, with <30% of AGN having

log
(

N

H

/

cm

−
2

)
>
22

, which we suggest is mainly due to the small fraction of time spent in a highly obscured state. Considering the Eddington ratio distribution function of narrow-line and broad-line AGN from our prior work, we see a qualitatively similar picture. To disentangle temporal and geometric effects at high λ
Edd, we explore plausible clearing scenarios such that the time-weighted covering factors agree with the observed population ratio. We find that the low fraction of obscured AGN at high λ
Edd is primarily due to the fact that the covering factor drops very rapidly, with more than half the time spent with <10% covering factor. We also find that nearly all obscured AGN at high-λ
Edd exhibit some broad lines. We suggest that this is because the height of the depleted torus falls below the height of the broad-line region, making the latter visible from all lines of sight.
Two new species of the genus Macrothele Ausserer, 1871 (Araneae, Macrothelidae) from China
Authors: Wu Yaying , Li Zhimin , Yang Yan , Yang Zizhong
Published: November 2022

The family Macrothelidae Simon, 1892 belongs to the infraorder Mygalomorphae, currently contains two genera and 47 described species, from South Europe, South, and East Southeast Asia, Central, West, and North Africa.

Two new species of the funnel-web spider genus Macrothele Ausserer, 1871 from Yunnan Province, China are described: Macrothele washanensis Wu & Yang, sp. n. (♂♀), and M. wuliangensis Wu & Yang, sp. n. (♂♀). Detailed descriptions, diagnostic illustrations and distribution map are provided. All specimens are deposited in the Institute of Entomoceutics Research, Dali University (DUIER).
Rhagophthalmidae Olivier, 1907 (Coleoptera, Elateroidea): described genera and species, current problems, and prospects for the bioluminescent and paedomorphic beetle lineage
Authors: Kundrata Robin , Hoffmannova Johana , Hinson Kevin R. , Keller Oliver , Packova Gabriela
Published: November 2022

Rhagophthalmidae are a small beetle family known from the eastern Palaearctic and Oriental realms. Rhagophthalmidae are closely related to railroad worms (Phengodidae) and fireflies (Lampyridae) with which they share highly modified paedomorphic females and the ability to emit light. Currently, Rhagophthalmidae include 66 species classified in the following 12 genera:BicladodrilusPic, 1921 (two spp.),BicladumPic, 1921 (two spp.),DioptomaPascoe, 1860 (two spp.),DiplocladonGorham, 1883 (two spp.),DodecatomaWestwood, 1849 (eight spp.),FalsophrixothrixPic, 1937 (six spp.),HaplocladonGorham, 1883 (two spp.),MenghuoiusKawashima, 2000 (three spp.),MimoochotyraPic, 1937 (one sp.),MonodrilusPic, 1921 (two spp. in two subgenera),PseudothilmanusPic, 1918 (two spp.), andRhagophthalmusMotschulsky, 1854 (34 spp.). The replacement nameHaplocladon gorhamiKundrata,nom. nov.is proposed forDiplocladon hasseltiiGorham, 1883b (described in subgenus Haplocladon) which is preoccupied byDiplocladon hasseltiiGorham, 1883a. The genusReductodrilusPic, 1943 is tentatively placed in Lampyridae: Ototretinae. Lectotypes are designated forPseudothilmanus alatusPic, 1918 andP. marginalisPic, 1918. Interestingly, in the eastern part of their distribution, Rhagophthalmidae have remained within the boundaries of the Sunda Shelf and the Philippines demarcated by the Wallace Line, which separates the Oriental and Australasian realms. This study is intended to be a first step towards a comprehensive revision of the group on both genus and species levels. Additionally, critical problems and prospects for rhagophthalmid research are briefly discussed.
Physician Perspectives on Vaccination in Patients With Autoimmune Inflammatory Rheumatic Diseases: An International Survey
Authors: Seo Philip , Winthrop Kevin , Sawalha Amr H. , Choi Serim , Park Hyun Ah , Hwang Woochang , Lee Eun Bong , Park Jin Kyun
Published: November 2022

Objective

To evaluate the perspective of physicians who care for patients with autoimmune inflammatory rheumatic disease (AIIRD) toward vaccination.

Methods

Physicians who care for patients with AIIRD were invited to participate in an online survey regarding their vaccination perspectives in adult patients with AIIRD.

Results

Survey responses of 370 physicians from Asia (41.1%), North America (41.6%), Europe (13.8%), and other countries (3.5%) were analyzed. Participants stated that rheumatologists (58.2%) should be primarily responsible for vaccination coverage, followed by general internists (19.3%) and family medicine practitioners (12.8%). Additionally, 96.7% of participants considered vaccination very important (≥ 4/5 rating) for patients with AIIRD. Despite these sentiments, only one-third (37%) reported vaccinating the majority (≥ 60%) of their patients.

Conclusion

Physicians who care for patients with AIIRD agree that vaccines are effective and safe in patients with AIIRD. Unfortunately, they often do not ensure that their patients are adequately vaccinated. Further studies are needed to investigate how to improve vaccination coverage for this high-risk patient population.
How to Provide Sexual and Reproductive Health Care to Patients: Focus Groups With Rheumatologists and Rheumatology Advanced Practice Providers
Authors: Mitchell Daiva , Lesoon Leslie , Edens Cuoghi , Kazmerski Traci M. , Stransky Olivia M. , Cameron Flor A. , Clowse Megan E.B. , Borrero Sonya , Hamm Megan , Talabi Mehret Birru
Published: November 2022

Objective

Rheumatologists have identified challenges to providing sexual and reproductive health (SRH) care to patients with gestational capacity. We conducted focus groups with rheumatologists and rheumatology advanced practice providers (APPs) to elicit their solutions to overcoming barriers to SRH care.

Methods

Qualitative focus groups were conducted with rheumatologists (3 groups) and APPs (2 groups) using videoconferencing. Discussions were transcribed and 2 trained research coordinators developed a content-based codebook. The coordinators applied the codebook to transcripts, and discrepancies were adjudicated to full agreement. The codes were synthesized and used to conduct a thematic analysis. Differences in codes were also identified between the clinician groups by provider type.

Results

A total of 22 clinicians were included in the sample, including 12 rheumatologists and 10 APPs. Four themes emerged: (1) clinicians recommended preparing patients to engage in SRH conversations before and during clinic visits; (2) consultation systems are needed to facilitate rapid SRH care with women’s health providers; (3) clinicians advised development of training opportunities and easy-to-access resources to address SRH knowledge gaps; and (4) clinicians recommended that educational materials about SRH in the rheumatology context are provided for patients. Although similar ideas were generated between the APP and rheumatologist groups, the rheumatologists were generally more interested in additional training and education, whereas APPs were more interested in electronic health record prompts and tools.

Conclusion

Providers identified many potential solutions and facilitators to enhancing SRH care in rheumatology that might serve as a foundation for intervention development.
The Positive Predictive Value of a Very High Serum IgG4 Concentration for the Diagnosis of IgG4-Related Disease
Authors: Baker Matthew C. , Cook Claire , Fu Xiaoqing , Perugino Cory A. , Stone John H. , Wallace Zachary S.
Published: November 2022

Objective

Serum IgG4 concentrations are used to evaluate a diagnosis of IgG4-related disease (IgG4-RD), but the positive predictive value (PPV) of a very high IgG4 level is uncertain. This study evaluated the PPV of a very high IgG4 concentration for diagnosing IgG4-RD.

Methods

The data warehouses of 2 large academic healthcare systems were queried for IgG4 concentration test results. Cases with serum IgG4 concentrations > 5× the upper limit of normal (ULN) were included. Cases of IgG4-RD were determined using the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria. The PPV for IgG4-RD of an IgG4 concentration > 5× ULN was estimated. Other conditions associated with very high IgG4 concentrations and specific features of IgG4-RD cases were characterized.

Results

IgG4 concentrations were available in 32,206 cases. Of these, 3039 (9.4%) had elevated IgG4 concentrations, and a final cohort of 191 (0.6%) cases had IgG4 concentrations > 5× ULN (median age 66 yrs, 72% male). The PPV of an IgG4 concentration > 5× ULN for a diagnosis of IgG4-RD was 75.4% (95% CI 68.7-81.3). In the remaining cases, elevated IgG4 concentrations were observed among patients with malignancies, autoimmune diseases, and infections.

Conclusion

The majority of cases with serum IgG4 concentrations > 5× ULN in this study had IgG4-RD. These data support the high weight placed on very high serum IgG4 concentrations in the ACR/EULAR classification criteria. However, 25% of cases with very high IgG4 concentrations had an alternative diagnosis, underscoring the importance of considering the broad differential of etiologies associated with an elevated IgG4 concentration when evaluating a patient.
IgA Vasculitis Following COVID-19 Vaccination: A French Multicenter Case Series Including 12 Patients
Authors: Ramdani Yanis , Bettuzzi Thomas , Bouznad Amel , Delaitre Léa , Nassarmadji Kladoum , Didier Kevin , Paul Carle , Liozon Eric , Tieu Ashley , Richard-Colmant Gaëlle , Terrier Benjamin , Moulis Guillaume , Lafaurie Margaux , Pillebout Evangeline , Maillot François , Audemard-Verger Alexandra
Published: November 2022

Objective

The worldwide coronavirus disease 2019 (COVID-19) vaccination campaign triggered several autoimmune diseases. We hereby aimed to describe IgA vasculitis (IgAV) following COVID-19 vaccination.

Methods

We conducted a national, multicenter, retrospective study in France of new-onset adult IgAV diagnosis following COVID-19 vaccination.

Results

In total, 12 patients with new-onset IgAV were included. Of these, 5 (41.7%) were women, and the median age was 52.5 (IQR 30.75-60.5) years. Of the 12 patients, 10 had received an mRNA vaccine and 2 had received a viral vector vaccine. The median time from vaccination to onset of symptoms was 11.5 (IQR 4.25-21.25) days. Vasculitis occurred after the first vaccine dose in most patients (n = 8). All patients had skin involvement, with skin necrosis in 4 patients. In total, 7 patients had joint involvement and 2 had arthritis. A total of 4 patients had nonsevere gastrointestinal involvement and 2 had nonsevere renal involvement. The median C-reactive protein level was 26 (IQR 10-66.75) mg/L, the median creatininemia level was 72 (IQR 65-81) μmol/L, and 1 patient had an estimated glomerular filtration rate of less than 60 mL/min at management. All patients received treatment, including 9 patients (75%) who received glucocorticoids. In total, 5 patients received a vaccine dose after developing IgAV, 1 of whom experienced a minor cutaneous relapse.

Conclusion

The baseline presentation of IgAV following COVID-19 vaccination was mild to moderate, and outcomes were favorable. Thus, a complete COVID-19 vaccination regimen should be completed in this population. Of note, a fortuitous link cannot be ruled out, requiring a worldwide pharmacovigilance search to confirm these findings.
Implementing a Nurse-Driven Protocol for Pneumococcal Vaccination in an Academic Rheumatology Clinic
Authors: Joerns Elena K. , Pokala Nagendra , Bermas Bonnie , Reisch Joan , Wang Dan (Clarie) , Arasaratnam Reuben , Bajaj Puneet
Published: November 2022

Objective

Rheumatology patients are at high risk for complications from pneumococcal infections. The goal of this study was to assess the feasibility of implementing a nurse-driven pneumococcal vaccination protocol based on the 2012 Advisory Committee on Immunization Practices (ACIP) guidelines within an academic rheumatology clinic. Our aims were to increase (1) pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) monthly vaccination rates in immunosuppressed patients aged 19 to 64 years, and (2) the overall proportion of immunosuppressed patients aged 19 to 64 years who have received both PCV13 and PPSV23 vaccinations by ≥ 10% over a 2-year period.

Methods

We identified eligible adults in the electronic medical record using a search protocol based on preset medication group. We obtained baseline pneumococcal vaccination rates in 2019, calculating the proportion of patients who were unvaccinated, partially vaccinated (received either PCV13 or PPSV23), or fully vaccinated. We created a pneumococcal vaccination protocol based on 2012 ACIP guidelines and converted it into a standing medical order to be implemented by the nursing staff. Postintervention vaccination rates were calculated monthly and at the end of the study period. Multiple comparison testing was performed to assess for significant postintervention changes.

Results

The average rate of monthly vaccination with either PCV13 or PPSV23 increased from 4.3% in 2019 to 12.6% in 2021. The proportion of patients who were fully vaccinated increased from 14.6% in 2019 to 26.2% in 2021. Both changes were statistically significant.

Conclusion

It is feasible to employ a nurse-driven protocol for improving pneumococcal vaccination rates in immunosuppressed patients, despite difficulties posed by coronavirus disease 2019 (COVID-19) pandemic disruptions.
Learning From Non-Practicing Registered Nurses
Authors: Reed Janet M.
Published: November 2022

One way to increase the number of RNs during a global nursing shortage is to recruit those currently not working in health care to rejoin the workforce. The goal of this project was to assess the attitudes and perceived learning needs of nurses who are not working in health care. An online survey was distributed via social media nursing groups to a self-selected sample of nurses not working in health care for the previous 2 years. Although the response rate was low (
n
= 18), there was interesting discussion on re-entry to nursing practice. Top reasons stated for not re-entering the workforce included burnout/stress, workplace conditions, lack of education/skills, and pay. Pharmacology, skills, and technology were the top three self-identified learning needs of the participants. Limited programs offer education for re-entry to practice. Nurse educators should develop learning materials to meet the needs of this special population.

[
J Contin Educ Nurs
. 2022;53(11):486–490.]
Cultural Misconceptions, Attitudes, Knowledge, and Beliefs About Mental Illness Among Jordanian Nurses Working in Psychiatric Units
Authors: Rayan Ahmad
Published: November 2022

Background

This study examined cultural misconceptions and attitudes about mental illness and their correlates among Jordanian nurses working in psychiatric units.

Method

A descriptive, cross-sectional, correlational research design was used. A sample of 157 mental health nurses completed the study. Participants provided information about their demographics and attitudes, knowledge, and cultural misconceptions regarding mental illness.

Results

Negative attitudes toward mental illness were associated with sex, workplace, marital status, age, income, and years of experience. Stigma toward mental illness was associated with sex, workplace, marital status, age, years of experience, and knowledge regarding mental illness. Various cultural myths and beliefs regarding mental illness were reported. Attitudes and stigma toward mental illness differed based on cultural myths and beliefs.

Conclusion

Educational programs to raise awareness of and reduce stigma toward mental illness are required not only for the general public but also for some health care providers working in psychiatric units.[J Contin Educ Nurs. 2022;53(11):513–520.]
Optimal investment-reinsurance strategy with derivatives trading under the joint interests of an insurer and a reinsurer
Authors: Zhao Xia , Li Mengjie , Si Qinrui
Published: November 2022

Considering the common interests of an insurer and a reinsurer, the optimal investment-reinsurance problem with derivatives trading is studied. Suppose that both parties would invest a stock and a risk-free asset for capital appreciation, the insurer could purchase reinsurance and trade derivatives, the optimization problem is formulated by maximizing the expected exponential utility of two parties' wealth processes. The corresponding HJB equations are built for optimal strategy through the dynamic programming principle. In addition, derivatives trading is evaluated based on the certainty-equivalence principle. A numerical study directly illustrates how model parameters influence optimal strategies.
An improved finite-time stabilization of discontinuous non-autonomous IT2 T-S fuzzy interconnected complex-valued systems: A fuzzy switching state-feedback control method
Authors: Jian Xiong , Wang Zengyun , Xin Aitong , Chen Yujing , Xie Shujuan
Published: November 2022

Based on the type-2 Takagi-Sugeno (IT2 T-S) fuzzy theory, a non-autonomous fuzzy complex-valued dynamical system with discontinuous interconnection function is formulated. Under the framework of Filippov, the finite-time stabilization (FTS) problem is investigated by using an indefinite-derivative Lyapunov function method, where the derivative of the constructed Lyapunov function is allowed to be positive. By designing a fuzzy switching state feedback controller involving time-varying control gain parameters, several sufficient criteria are established to determine the considered system's stability in finite time. Correspondingly, due to the time-varying system parameters and the designed time-dependent control gain coefficients, a more flexible settling time (ST) is estimated. Finally, an example is presented to confirm the proposed methodology.
Local minimizers for variational obstacle avoidance on Riemannian manifolds
Authors: Goodman Jacob R.
Published: November 2022

This paper studies a variational obstacle avoidance problem on complete Riemannian manifolds. That is, we minimize an action functional, among a set of admissible curves, which depends on an artificial potential function used to avoid obstacles. In particular, we generalize the theory of bi-Jacobi fields and biconjugate points and present necessary and sufficient conditions for optimality. Local minimizers of the action functional are divided into two categories—called $ Q $-local minimizers and $ \Omega $-local minimizers—and subsequently classified, with local uniqueness results obtained in both cases.
An unusual presentation of left sided ruptured appendix in a child with situs inversus totalis
Authors: Ravindrakumar S. , Thalahitiyage N. , Veerasingam K. , Jayarajah U. , Rodrigo V. S. D.
Published: November 2022

No abstract available
Peyton’s approach to clinical skills training in medical education
Authors: Liyanarachchi N. D.
Published: November 2022

No abstract available
Transcranial Surgery for Pituitary Tumors
Authors: Mishra Shashwat , Mishra Ramesh C , Gurjar Hitesh K , Garg Kanwaljeet
Published: November 2022

Background:

Despite the evolution of endoscopic techniques, large pituitary adenomas with unfavorable characteristics and irregular anatomical configurations continue to pose a challenge for the dexterity, skills, and patience of endoscopic surgeons. Transcranial surgery retains a significant role in these situations where the tumor access, hemostasis, and dissection around adjoining neurovascular tissues can be controlled efficaciously.

Objective:

In this report, we describe our experience with transcranial surgery for pituitary adenomas highlighting its safety and versatility in peripheral centers.

Methods:

We accessed the case files and imaging records of pituitary tumors operated between 2001 and 2019 at a private hospital in a major Indian city. The records were analyzed with emphasis on postoperative clinical course, visual, and endocrinological outcomes. The data was analyzed with respect to differences between transcranial and transsphenoidal procedures. Categorical variables were compared with Chi-square test/Fischer's exact test and difference in means evaluated with Welch's t-test.

Results:

A total of 178 procedures were performed in 173 patients with pituitary adenoma, who were the subjects of this study. Ninety-eight (56.7%) patients were treated by transsphenoidal excision whereas 80 (46.2%) underwent transcranial procedures (75 primary and five secondary). In the patients operated transcranially, we observed three deaths and nine patients suffered from significant morbidity. Visual outcomes were similar to the group operated transsphenoidally. However, incidence of panhypopituitarism was significantly higher in transcranial procedures; the extent of resection was poorer than transsphenoidal surgeries owing to more extensive nature of tumors.

Conclusions:

In low-volume centers, the endoscopic skills required for transsphenoidal resection of large and complex pituitary adenomas may be scarce. Transcranial surgery, dependent on familiar microsurgical techniques and equipment, may still be viable, safe, and an effective option.
Country-Made Firearm (Desi-Katta)-Related Cranial Injuries
Authors: Mahakul Dibyajyoti , Doddamani Ramesh S , Meena Rajesh K , Sawarkar Dattaraj , Sharma Rajeev , Kedia Shweta , Gupta Deepak , Verma Satish , Singh Pankaj K , Agrawal Deepak , Singh Manmohan , Chandra Poodipedi S , Kale Shashank S
Published: November 2022

Background:

Approximately, 80% of civilian cranial gunshot injuries in India are mainly due to unlicensed mostly country-made guns, called the “Desi-Kattas,” manufactured by the traditional gunsmiths. These injuries constitute a unique subgroup, with respect to the make and design along with the unique wound ballistics compared to the factory-made firearms.

Objective:

This study is aimed at defining the prognostic factors in predicting the outcomes related to cranial gunshot injuries due to these desi-kattas.

Methods:

Ten patients with kata-related cranial gunshot injury underwent surgical intervention at our institution, between 2014 and 2018. Their clinical status, imaging features, and outcomes were retrospectively analyzed.

Results:

Ten patients with kata-related gunshot injuries to the head were identified. Homicidal injuries were documented in six cases. Five had a GCS of 13–15 at presentation. Exit wounds were noted in 50% of the suicidal cases. Multilobar involvement was seen in 70% of cases, with the bullet crossing the midline in only 40% cases. Decompressive craniectomy was required in five cases. Eight patients had a Glasgow Outcome Score of four or more at 6 months of follow-up. There was one death during the follow-up period, while the other patient remains to be in vegetative state.

Conclusion:

The Katta-related cranial injuries constitute low-muzzle velocity injuries with the majority of the patients sustaining nonfatal injuries, especially homicidal. The presence of positive CT findings and the crossing of the bullet across the midline on CT brain predicts dismal prognosis. Optimal neurosurgical approach should consist of minimal local debridement and attain water seal dural closure.
Satisfaction With Telemedicine Consultation as Follow-Up Visit in Patients with Parkinsonism and Essential Tremor in during the Covid-19 Pandemic
Authors: Mayela Rodrıguez-Violante , Yamil Matuk , Amin Cervantes-Arriaga , Yazmín Riós-Solís , Arturo Abundes-Corona , Daniel Martinez-Ramirez , Lorena Zuazua-Vidal , Karla Salinas-Barboza , Manuel del Río Quiñones
Published: November 2022

Background:

Telemedicine (TM) consultations have shown to be feasible for the management of neurological conditions including movement disorders. In contrast, satisfaction with such consultations have been less studied.

Objective:

To assess the satisfaction of persons with a movement disorder with a TM consultation in comparison to previous experiences in face-to-face visits.

Subjects and Methods:

A cross-sectional multicenter study was carried out. Persons with a diagnosis of a movement disorder underwent a TM consultation. After the consultation concluded, a satisfaction survey was sent for the subject to fill out anonymously. The survey included ease of use-related items, setup-related items, and quality-of-service-related items.

Results:

A total of 175 survey responses were received (response rate of 71.4%), all of which were included for analysis. A total of 102 subjects considered that the TM consultation involved much less time in comparison to their previous experience with face-to-face visits. Overall, 96% reported to be satisfied with the consultation. In addition, 92% were satisfied or very satisfied with the neurologist ability to communicate recommendations. Furthermore, 93.7% indicated that the consultation was valuable, and 90.9% considered that they would recommend teleconsultation to another patient.

Conclusion:

Patients with a diagnosis of a movement disorder consider TM as a convenient and potential tool for health services with a high level of satisfaction.
Sixteen-Syndrome in a Young Patient with Systemic Lupus Erythematosus
Authors: Ain Masnon Nurul , Kiang Teo Shee , Wan Hitam Wan Hazabbah , Tan Hui Jan , Remli Rabani , Wan Asyraf Wan Zaidi , Othman Othmaliza
Published: November 2022

Sixteen syndrome is rare variant of one and a half syndrome resulting from lesion affecting bilateral dorsal pontine structures. This report describes a case of 16 syndrome in systemic lupus erythematosus (SLE). A 28 year old woman with underlying lupus was presented with sudden left side body weakness and diplopia. Examination showed features of 16 syndrome with one and a half syndrome, facial diplegia and left hemiparesis. Neuroimaging revealed an acute infarct of bilateral dorsal pons. The patient was placed on antiplatelet therapy. However, she developed left leg deep vein thrombosis and pulmonary embolism after one week. She was then given subcutaneous low molecular weight heparin, followed by warfarin and cycles of cyclophosphamide. Her hemiparesis, ocular symptoms, and facial diplegia improved after one year. SLE increases the risk of stroke and thrombotic events in a young patient. Achieving disease remission is important to prevent stroke in SLE patients.
Development and Validation of a New Stroke Outcome Scale (Stroke Impact Assessment Questionnaire)
Authors: Sasikumar Asha , Iype Thomas , Sivaram Rema D
Published: November 2022

Background:

Stroke affects the quality of life through its devastating effects on physical, psychological, social, and economic domains. Patient-reported outcome measures help to capture the patient's perspective to changes in the quality of life. The available stroke-specific outcome measures of stroke do not comprehensively measure all the domains.

Objective:

We describe the development and validation of the Stroke Impact Assessment Questionnaire (SIAQ) an interviewer-administered new instrument developed using patient-centered approaches to assess the long-term problems of stroke survivors.

Materials and Methodology:

We used a sequential exploratory mixed methods approach (QUAL → QUAN) to develop the SIAQ. The design involves an initial qualitative phase aimed at generating the item pool and a subsequent second phase aimed at testing of items using quantitative techniques (Psychometric evaluation).

Result:

SIAQ, a thirty-item tool, under the eight domains (sensory, motor, social, economic, emotional, behavioral, cognitive, and communication) emerged from Principal Component Analysis. The factor loadings ranged from 0.421 to 0.880. The intraclass coefficient in test–retest reliability r is 0.958 (95% CI 0.9249-0.9799) and in interobserver reliability is 0.9473 (95% CI 0.9125 – 0.9733). The internal consistency Cronbach's alpha for the final 30 item tool was 0.88.

Conclusion:

SIAQ is a culturally appropriate psychometrically robust questionnaire assessing the long-term outcome of stroke. However, SIAQ is applicable only in stroke survivors for up to 65 years.
The Effect Of Small Bone Window Craniotomy Removal on Lactic Acid and CRP in Patients with Hypertensive Intracerebral Hemorrhage in the Basal Ganglia
Authors: Xu Zhanyi , Sun Zhaosheng , Xu Min , Zhao Baoshuai , Wei Jianhui , Guo Hong , Li Yongqian , Mao Jianhui
Published: November 2022

Background:

Hypertensive intracerebral hemorrhage (HICH) seriously endangers the quality of life of patients and can even lead to death. Craniotomy is a common treatment method for HICH.

Objective:

The aim of this study was to investigate the efficacy of two different sizes of craniotomy in patients with HICH, as well as to evaluate their effects on C-reactive protein (CRP) and blood lactate levels.

Materials and Methods:

A total of 72 patients with HICH in the basal ganglia were operated on in our hospital from February 2017 to March 2019 and randomly divided into two groups: the small bone window (SBW) group (n = 37) and the large bone flap group (n = 35). The curative effects of the two kinds of operations were evaluated by the length of operation, the days of hospitalization, the rate of hematoma clearance, the rate of rebleeding, and the incidence of complications. Additionally, the levels of CRP and lactate were compared between the two groups.

Results:

The results showed that the average intraoperative time, hospital stay, rebleeding rate, and postoperative complications of patients in the SBW group were less than those in the large bone flap group. Moreover, the number of patients in the SBW group with good postoperative recovery, including class V and class IV, was higher than that in the large bone flap group. Minimally invasive craniotomy with SBW reduced the lactic acid and CRP levels more quickly than the large bone flap group.

Conclusions:

An SBW was superior to a large bone flap in terms of the operative effect and lactate and CRP levels. It is concluded that an SBW has significant advantages over a large bone flap.
Insights from Magnetic Evoked Field Analysis in Patients with Wilson's Disease
Authors: Aruna R , Mariyappa N , Sinha S , Nagappa M , Velmurugan J , Saini J , Bindu P S , Mathuranath P S , Thennarasu K , Satishchandra P , Taly A B
Published: November 2022

Aims:

To study the latency, amplitude, and source localization of magnetic evoked field (MEF) responses to visual, auditory, and somatosensory stimuli in Wilson's disease (WD) using magnetoencephalography (MEG) and compare it with “healthy” controls, and correlate the observations with disease severity and brain MRI.

Methods:

MEF of 28 patients with neurological WD (age: 22.82 ± 5.8 years; M:F = 12:16) and 21 matched controls (age: 25.0 ± 4.6 years; M:F = 10:11) were recorded using MEG. Source localization was performed using standard models on the components of M100, M20, and M100 for visual, somatosensory, and auditory evoked fields, respectively and its latency/amplitude was correlated with disease severity.

Results:

There were significant differences in source location between control and WD during visual evoked field (VEF) and auditory evoked field (AEF) studies. Latencies of M20 (right-p = 0.02; left-p = 0.04) and M32 (right-p = 0.01) components of SSEF were significantly prolonged. The amplitude of M20 was significantly reduced in patients bilaterally (P= 0.001). There was a trend for the prolonged latency of M100 of VEF in patients (P= 0.09). Five patients had reduced right M145 compared to 8 controls. The left somatosensory evoked fields (SSEF) latency correlated with disease severity (P= 0.04). There was no significant correlation between major components of other MEF with disease severity or MRI score.

Conclusions:

This study, first of its kind to use MEF analysis in a large cohort of patients with WD, detected subclinical but a variable degree of abnormalities, most consistently of SSEF. It provides valuable insights of functioning and localization of various pathways in a disease known to have protean clinical manifestations and widespread MRI changes.
Serum Inflammatory Markers in Patients with Guillain Barre Syndrome
Authors: Dash Sambit , Kamath Ullas , Pai Aparna R. , Rao Pragna
Published: November 2022

Background:

Guillain Barre syndrome (GBS) is an immune-mediated peripheral neuropathy characterized by the demyelination and axonal damage of the peripheral neurons. The pathogenesis of GBS involves the breakdown of the blood-brain barrier after which pro inflammatory cytokines attack the neurons in the peripheral nervous system.

Aims:

This study aims to evaluate five markers, namely matrix metalloproteinase(MMP)-2 and MMP-9, vascular endothelial growth factor (VEGF)-A, basic fibroblast growth factor (bFGF), and SFLT-1, which could have a role in the inflammatory response in patients with GBS and healthy controls.

Settings and Design:

In this prospective study, patients diagnosed with GBS at the department of neurology, Kasturba Medical College, Manipal, Karnataka were enrolled.

Methods and Material:

The markers selected for this study were analyzed using the ELISA method and expressed as given in the kit provided by the company. Ethical clearance was obtained from the Institutional Ethical Committee.

Statistical Analysis:

Results were evaluated using SPSS version 17.0 and expressed as mean ± SD. Error bars for each were drawn.

Results:

The levels of all five parameters showed a significant increase in patients as compared to controls.

Conclusions:

Disruption of the basement membrane of endoneurium by MMP-2 and MMP-9, recruitment and migration of macrophages and other cytokines by VEGF-A, bFGF, and soluble fms-like tyrosine kinase-1 (SFLT-1) are plausible, which leads to inflammation process and thus neuronal damage leading to the development of GBS.
Gait Characteristics Following Stroke
Authors: Sannyasi Gourav , Ojha Rajdeep , Prakash Navin B , Isaac Joyce , Maheswari V , Mahasampath G S , Tharion George
Published: November 2022

Background:

Management of foot-drop following stroke can be addressed with ankle-foot orthosis (AFO) or functional electrical stimulation (FES) of the peroneal nerve. There is limited evidence regarding the efficacy of FES as a substitute for a conventional ankle-foot orthosis.

Objective:

The aim of this study was to compare efficacy of FES against AFO in management of foot-drop in patients following stroke.

Materials and Methods:

Twenty patients (ten per group) were enrolled in this prospective crossover trial. Group A patients received gait training with AFO during first week followed by training with FES during second week and vice-versa for group B. Outcome parameters following AFO/FES training included Ten-meter, Six-minute walk test and spatiotemporal gait parameters. Patient satisfaction level was assessed using feedback questionnaire. Friedman test and Wilcoxon signed-rank test were performed to compare outcomes between barefoot, AFO and FES. ThePvalue < 0.05 was considered statistically significant.

Results:

Nineteen males and one female aged 45.5 ± 9.45 years were recruited. Statistically significant improvement was observed in Ten-meter and Six-minute walk tests, gait speed, Timed up and go test (TUG), stance-swing ratio and single-limb support among users of FES as compared to AFO and barefoot. There was no statistical difference observed in other gait parameters. Physiological cost index (PCI) showed trend in improvement among FES users. Patient satisfaction scores were higher for FES users.

Conclusions:

Quantitative and qualitative results were in favour of FES as compared to AFO and barefoot suggesting that FES can be a potential orthotic intervention in hemiplegic patients.
An Audit of the Quality of Reporting and Bias of Studies on Yoga in Epilepsy
Authors: Das Saibal , Tiwari Sayali , Xaviar Suja
Published: November 2022

Background:

Yoga is increasingly being used as a complementary mode of treatment for epilepsy along with pharmacotherapy; however, the quality of reporting and bias of studies on yoga in epilepsy is uncertain.

Objective:

This study was performed to systematically evaluate the reporting quality and bias of the published studies on yoga in epilepsy.

Materials and methods:

PubMed and Cochrane databases were searched for studies investigating the efficacy of yoga in epilepsy or describing the patients' or caregivers' knowledge, attitude, influence, and practice of yoga in epilepsy. The reporting qualities of the studies were appraised by standard reporting checklists (CONSORT, STROBE, COREQ, and modified CONSORT) and the risks of bias were assessed using standard tools (Cochrane Collaboration's risk of bias tool, Newcastle-Ottawa scale, and ROBINS-I tool) according to the study designs.

Results:

Fifteen studies (four randomized control trials, seven observational studies, three non-randomized interventional studies, and one was a mixed-method study) were included. The reporting qualities of the studies which evaluated the role of yoga in epilepsy were comparatively poor from the methodological perspective and the risks of bias were comparatively high than those which described the knowledge, attitude, influence, and practice of yoga in epilepsy.

Conclusion:

The reporting qualities of studies in relation to yoga and epilepsy were not satisfactory and the risks of bias were high. Hence, it is imperative to be cautious before widely recommending yoga in epilepsy.
Prognostic Significance of Serial Nerve Conduction in GB Syndrome
Authors: Kalita Jayantee , Kumar Mritunjai , Misra Usha K
Published: November 2022

Background and Aims:

We evaluated dynamic changes in neurophysiology of Guillain-Barré syndrome (GBS) at different time points and the role of demyelination and axonal burden in predicting outcome.

Methods:

Nerve conduction study (NCS) was done in 44 GBS patients at admission and at 1 and 3 months, and were categorized into acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), equivocal and in-excitable motor nerve (IMN). The demyelinating and axonal burden on motor NCS at admission, 1 and 3 months were computed and correlated with disability at 3 and 6 months. Disability was assessed using Clinical Grading Scale.

Results:

Twenty-four (54.3%) had AIDP, 5 (11.4%) AMAN, 12 (27.3%) equivocal and 3 (6.8%) had IMN at admission. Maximum instability was noted in equivocal group; majority of whom became AIDP at three months. Neurophysiological subtypes at different time points did not correlate with 6 months disability, but demyelination burden at admission (r = -0.42;P= 0.005) and axonal burden at one month (r = 0.43;P= 0.04) correlated with six months disability.

Conclusion:

Inverse correlation of axonal burden at one and three months with disability suggests role of secondary axonal damage in predicting outcome. Repeat NCS at one month helps in categorizing GBS and also in prognostication.
Risk Factors for Postoperative Brain Contusion and Early Outcomes in Patients with Anterior Skull Base Meningiomas Undergoing Unifrontal Surgery
Authors: Nair Bijesh Ravindran , Ganesh Swaminathan , Moorthy Ranjith Krishna , Rajshekhar Vedantam
Published: November 2022

Background:

Though frontal lobe contusion is a major cause for morbidity and prolonged hospitalization following excision of anterior skull base meningiomas, there is only limited literature on this complication. This study aimed to find out the incidence of postoperative frontal lobe contusion, identify the risk factors for its development and its impact on early postoperative outcome.

Methods:

Data from 110 patients who underwent excision of anterior skull base meningiomas through a unilateral supraorbital craniotomy from 2001 to 2018 were retrospectively analyzed. The risk factors analyzed for development of postoperative contusion were tumor location, size, volume, peritumoral edema, tumor consistency, extent of resection, tumor grade and type of retraction used.

Results:

Simpson grade II excision was achieved in ninety-two patients (83.6%). There was no frontal lobe contusion in eighty-two patients (74.5%). Frontal lobe contusion was noted in twenty-eight patients (25.5%), but was severe in only four patients (3.6%). On multivariate analysis, fixed retractor use (OR 11.56 [1.21–110.03];P=0.03) and WHO grade II tumor (OR 3.29 [1.11–9.77];P=0.03) were independently associated with postoperative frontal lobe contusion. Patients with higher contusion grade had significantly longer postoperative hospitalization (P=.02) and lower KPS score at discharge (P=.01).

Conclusions:

Unilateral supraorbital craniotomy and lateral subfrontal approach is an excellent procedure for excision of anterior skull base meningiomas with minimal postoperative complications related to frontal lobe retraction. Frontal lobe contusion should be avoided with the use of dynamic retraction, since postoperative contusion prolongs hospitalization and worsens the functional outcome at discharge.
Initial Experience with the Contour Device in the Treatment of Ruptured Intracranial Wide-necked Bifurcation Aneurysms
Authors: Dange Nitin Narayan , Roy Joanna Mary
Published: November 2022

Background:

Intrasaccular flow diverters are a new modality in the treatment of intracranial aneurysms. The Contour device has been designed to offer a variety of advantages over existing endovascular treatment options for wide-necked bifurcation aneurysms. There is no available literature describing its use in treating ruptured aneurysms.

Objective:

To assess the safety, outcome, and efficacy of the Contour device as a primary modality in treating ruptured intracranial aneurysms.

Materials And Methods:

A retrospective analysis of 14 aneurysms in 13 patients treated with the Contour device was studied. Data pertaining to demographics, clinical presentation on arrival, aneurysmal characteristics, and follow-up outcome was collected. The Hunt–Hess scale and modified Rankin scale were used to grade severity of clinical presentation.

Results:

Of the 14 aneurysms treated, one was unruptured and 13 were ruptured. Six middle cerebral artery aneurysms, six anterior communicating artery, one basilar top and one distal anterior cerebral artery aneurysm were treated. Coiling was required in two patients due to the large size of their aneurysms. No thromboembolic complications or intraoperative rupture was reported following device placement. Two patients required antiplatelet therapy for 6 weeks. A median follow-up at 3 months revealed stable placement of the device within the aneurysm and no sign of residual aneurysm or rebleed.

Conclusion:

Initial experience with Contour in treating ruptured aneurysms has shown favorable immediate and short-term follow-up outcome. However, long-term follow-up studies are required to assess its safety and long-term efficacy.
Analysing Correlation Between the Facial Nerve Notch at the Root Exit Zone and Long-term Effect in Patients with Hemifacial Spasm After Microvascular Decompression
Authors: Fang Li , Haidong Song , Jianfeng Liang , Ruen Liu
Published: November 2022

Background:

Microvascular decompression (MVD) has become widely accepted for hemifacial spasm (HFS). The significance of facial nerve notch (FNN) for the outcome after MVD is still unknown.

Objective:

To investigate the correlative analysis between the FNN at the root exit zone (REZ) and the curative effect of MVD for HFS.

Method:

A prospective study was performed, which included 232 patients with Cohen score ≥2 who had undergone MVD. The patients were divided into two groups: the group with facial nerve notch (FNN) and the group without FNN, according to whether there is FNN caused by the offending vessels during the MVD operation. All the patients were followed up for 24 months.

Results:

The group with FNN caused by offending vessels at the REZ area was confirmed in 119 patients, of which 117 patients were immediately cured and two patients received partial relief on the 1st day of postoperation. The group without FNN at the REZ area was confirmed in 113 patients, of which 43 patients were immediately completely cured while 70 patients were not immediately completely cured after MVD operation. After 24 months of follow-up, 119 patients with FNN were all completely cured, 71 patients without FNN were completely cured, and 42 patients without FNN were not completely cured. Multivariate logistic regression analysis shows that compared with without FNN group, the FNN group had statistical significance for the clinical results both on the-1st -day (P < 0.01) and 2 years of follow-up (P < 0.05) after MVD operation.

Conclusions:

FNN is an important reference factor to evaluate both the short-term and long-term curative effect of microvascular decompression for hemifacial spasm. The postoperative effect of patients with FNN is much better than that of patients without FNN.
Role of Positron Emission Tomography/Computed Tomography in Gastrointestinal Malignancies
Authors: Sharma Anshul , Ravindra Shubha G , Singh Tejesh Pratap , Kumar Rakesh
Published: November 2022

Positron emission tomography/computed tomography (PET/CT) is increasingly becoming a mainstay in diagnosis and management of many malignant disorders. However, its role in the assessment of gastro-intestinal lesions is still evolving. The aim of this review was to demonstrate the areas, where PET/CT is impactful and where it has limitations. This will allow for us to reduce unnecessary investigations and develop methods to overcome the limitations.