bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Acute Pulmonary Thromboembolism and Stroke – A Management Dilemma
Authors: Jayalakshmi Sita , Khandalia Harsh , Vooturi Sudhindra , Jiwani P A , Kaul Subhash
Published: September 2024

The management of established pulmonary thromboembolism (PTE) coexisting with acute ischemic stroke (AIS) is quite challenging. We report the case of a 52-year-old man with concurrent massive right middle cerebral artery AIS and acute PTE, who was successfully managed despite the contradictory guidelines to manage them simultaneously. The patient underwent decompression craniotomy followed by anticoagulant therapy. The current case report demonstrates that full-dose heparin, despite being relatively contraindicated in an AIS, can achieve a good outcome when given under close monitoring. The transesophageal echo with bubble contrast during the Valsalva maneuver demonstrated patent foramen ovale with a right to left shunt as a cause of AIS and PTE in this patient.
Clinical and Molecular Features of First Mexican Friedreich's Ataxia Patients with Compound Heterozygous FXN Mutations
Authors: Boll Marie Catherine , Gasca-Saldaña Dianela , Mayén-Lobo Yerye Gibrán , Dávila-Ortiz de Montellano David José , Monroy-Jaramillo Nancy
Published: September 2024

Background:

Friedreich's ataxia (FRDA) is caused by homozygous GAA repeat expansions or compound heterozygous (CH) mutations in FXN gene. Its broad clinical spectrum makes it difficult to identify, thus an accurate diagnosis can only be made by genetic testing.

Objective:

This study aims to present data on FXN variants observed in patients with sporadic or recessive ataxia, including detailed data of the first CH Mexican patients.

Materials and Methods:

One hundred and eight patients with recessive or sporadic cerebellar ataxia were referred to our institution between 2009 and 2019 for FXN molecular testing. This was achieved using a combined methodology of triplet repeat-primed PCR (polymerase chain reaction), long PCR, FXN sequencing and multiplex-ligation probe-amplification.

Results:

Eighteen patients had a homozygous FXN genotype; whereas five were CH patients with a slow progression and phenotypic variability, including a late-onset case with spastic paraparesis, and a Charcot-Marie-Tooth-like case.

Conclusions:

These first Mexican CH patients pose important implications for genetic counseling and FRDA management.
Effect of Yogasanas Versus Gaze Stability and Habituation Exercises on Dizziness in Vestibular Dysfunction
Authors: Gazbare Preeti S , Rawtani Namrata D , Rathi Manisha , Palekar Tushar J
Published: September 2024

Background:

Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols.

Objective:

Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers.

Materials and Methods:

Participants were recruited (n = 32) after screening using the Dix–Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the Motion Sensitivity Quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale.

Results:

In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05).

Conclusion:

Both yogasanas and gaze stabilization along with habituation exercises are effective in improving the symptoms in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.
A Role for Electroconvulsive Therapy in the Management of New Onset Refractory Status Epilepticus (NORSE) in a Young Child
Authors: Nath Manan , Shah Yash D , Theroux Liana M , Petrides Georgios , Karkare Shefali , Sanghani Sohag N , Kothare Sanjeev V
Published: September 2024

New-onset refractory status epilepticus (NORSE) describes prolonged or recurring new onset seizures which fail to respond to antiseizure medications. NORSE poses a challenge in diagnosis and treatment, and limited high-quality evidence exists to guide management. The efficacy of Electroconvulsive therapy (ECT) in aborting refractory status epilepticus has been described in case reports, but its application remains uncommon, particularly in young children. We describe a case of NORSE in a 3-year old child in which ECT played an important role in aborting status epilepticus, facilitating the diagnosis and surgical excision of an underlying focal cortical dysplasia. Although further research is needed, our case suggests that ECT can be a valuable tool in the treatment of refractory status epilepticus in children.
MITLIF Operative Nuances- Step by Step
Authors: Yerramneni Vamsi K , Kanala Ramanadha R , Kolpakawar Swapnil , Yerragunta Thirumal
Published: September 2024

Background:

MITLIF is popular among minimally invasive lumbar interbody fusion procedures. The common indications of MITLIF are Grade I and selected cases of Grade II spondylolisthesis, Failed Back Surgery Syndrome, spondylodiscitis and deformity correction.

Objective:

To describe the technical nuances of MITLIF along with an operative video of a case of L4-L5 Grade I Spondylolisthesis.

Surgical Procedure:

Two incisions of 2.5 cm length are made on either side, at the level to be operated and further access is created by muscle splitting. Screws, rods and cage(s) are placed through this corridor under fluoroscopic guidance.

Results:

This procedure has the advantages of minimal blood loss, less muscular trauma, retention of intact posterior ligamentous anatomy, shorter hospital stay, lesser CSF leak and infection rates when compared to the open approaches.

Conclusions:

MITLIF has emerged as the standard procedure replacing open approaches. Mastery of this approach is strongly recommended to spine surgeons.
Catastrophic Presentation of COVID-19 with Solitary Large Denovo Tumefactive Demyelination
Authors: Panda Samhita , Patel Pratik , Jain Saksham , Sharma Sanjiv , Vegda Monalisa , Patel Apoorv , Tiwari Sarbesh , Anne Puneeth Babu , Suthar Navratan , Kumar Bharat , Nag Vijaya Lakshmi
Published: September 2024

Background:

The ongoing Coronavirus disease-19 (COVID-19) pandemic has revealed a plethora of extrapulmonary manifestations including neurological presentations. To date, nervous system demyelination has been relatively infrequently reported in this setting. Also, while most data point toward immune activation as a causative process, few studies propound a direct effect.

Case Description:

A 35-year-old man presented with severe new-onset headache, hemiparesis, and focal seizures culminating in deeply altered sensorium. Radiological evaluation showed a large expansile demyelinating lesion in the right cerebral hemisphere. Nasopharyngeal swab COVID reverse transcription–polymerase chain reaction (RT-PCR) was positive. After initial non-response to steroids, the patient responded well to plasma exchange leading to complete recovery.

Conclusions:

This report highlights a case of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with tumefactive demyelination and subsequent response to therapy. It is important to recognize atypical presentations at this juncture as it may be crucial for planning treatment strategies.
Intracranial Large Artery Disease is Independently Associated with Poor Functional Outcome in a Cohort of Ethnic South Asian Ischemic Stroke Patients
Authors: De Silva Deidre A , Wee Chee-Keong , Woon Fung-Peng , Chang Hui-Meng , Wong Meng-Cheong
Published: September 2024

Background:

Intracranial large artery disease (ICLAD) in ischemic stroke patients is associated with an increased risk for recurrent stroke; however, it is not known if ICLAD influences functional status following stroke. We studied the 6-month functional outcome in south Asian ischemic stroke patients and compared those with and without ICLAD.

Materials and Methods:

This is a prospective cohort study of consecutive south Asian ischemic stroke patients. ICLAD was assessed with transcranial color-coded Doppler ultrasound or magnetic resonance angiography. Functional outcomes were obtained via telephone interviews with poor outcome defined as modified Rankin scale of 3–6.

Results:

Of 216 ischemic stroke patients studied, 203 (93.9%) had follow-up data, of whom 50.7% (103) had ICLAD. Patients with ICLAD had a higher prevalence of hypertension (P < 0.001), hyperlipidemia (P = 0.047), ischemic heart disease (P = 0.030), and extracranial carotid disease (P = 0.005). A higher proportion of patients with ICLAD had poor functional outcome at 6 months (30.1%) versus those without ICLAD (13.0%) (P = 0.004). After adjusting for age, sex, hypertension, hyperlipidemia, diabetes, ischemic heart disease, atrial fibrillation, extracranial carotid stenosis, and recurrent vascular events, patients with ICLAD were 3.01 (95% confidence interval: 1.35–7.10) times more likely than those without ICLAD to have poor functional outcome.

Conclusions:

The presence of ICLAD rendered poorer functional prognosis after stroke. These findings support the specific evaluation of the benefits of known acute stroke treatments such as thrombolysis, as well as investigation of potential novel strategies such as acute stenting.
Polymyositis Presenting with Respiratory Symptoms
Authors: Singh Yashpal , Laskar Sanghamitra , Mittal Manish , Shirazi Nadia , Gupta Sumit
Published: September 2024

Polymyositis is a group of muscle disease characterised by progressive muscle inflammation and predominantly muscle weakness. It usually presents subacutely with proximal weakness and mild diffuse muscular pain. Some patients have atypical presentation like early respiratory difficulty, Motor neuron disease (MND), or isolated dysphagia which leads to delay in diagnosis and treatment. We present one such case.
Correlation of DTI-Derived Measures to Therapy-Mediated Recovery after Stroke
Authors: Bhasin Ashu , Srivastava Padma , Kumaran Senthil S
Published: September 2024

Introduction:

Corticospinal tracts (CST) forms the basis of motor neurophysiology after stroke. Motor skill recovery has been correlated well to the microstructural properties of CST in both hemispheres. Functional imaging has opened up new possibilities of imaging functionality of cortex and fiber tracts in the brain. We studied therapy-induced changes in blood oxygenation level-dependent (BOLD) and DTI imaging on 20 chronic stroke patients at baseline, 8, and 24 weeks.

Settings and Design:

All the patients were subjected to MR imaging on a 1.5 T MR scanner. We used block design for BOLD with alternate baseline and activation cycles (repetition time (TR) =4520 ms, echo time (TE) = 44 ms, slices = 31, slice thickness = 4 mm). DTI parameters were as follows: TE = 76 ms, TR = 10,726 ms, EPI factor = 127, resolution = 128 × 128 matrix, field of view = 230 mm and a slice thickness of 4.0 mm.

Statistical Analysis Used:

The data was analyzed on SPSS software and tractography/DTI processing software (M/s. Siemens Medical Solutions, Erlangen Germany.

Results:

The mean axial diffusivity (λ[INSIDE:1]) and radial diffusivity (λ[INSIDE:2]) in the affected hemisphere were 0. 30 and 0.18, respectively. The mean number (FN) ratio (± SD) was 0.27 ± 0.14 at baseline, 0.33 ± 0.19 at 8 weeks, and 0.41 ± 0.23 at 24 weeks. Multivariate regression analysis at baseline showed that rFA was well-correlated to the Fugl-Meyer score (regression coefficient: 0.198, F = 10.382, P = 0.001), MI followed by signal intensity.

Discussion:

All patients had high % signal intensity after 8 weeks of physiotherapy regime with a greater percentage change in rFA as compared at follow-up suggesting that a focused exercise regime in stroke patients helps in the reconnection of neural and myelin networks.

Conclusion:

Clinical and functional recovery after stroke is well-correlated with the DTI and BOLD parameters i.e., rFA ratios, CST involvement fiber numbers, and % signal intensity of the ipsilesional cortex.
A Hypopituitarism Patient with Bickerstaff's Brainstem Encephalitis Overlapped by Guillain-Barré Syndrome
Authors: Deng Chu-Xin , Wu Zhi-Bing , Yu Zheng-Miao
Published: September 2024

We present a rare case of Bickerstaff's brainstem encephalitis (BBE) overlapped with Guillain-Barré syndrome (GBS), which might be triggered by the patient's hypopituitarism condition. A 36-year-old woman with a history of hypopituitarism presented with a headache on the first day. Gradually, diplopia, ataxia, dysarthria, dysphagia, hypoesthesia, limb weakness, hypersomnolence, and respiratory muscle paralysis were developed in less than ten days. Based on brain computed tomography scan, magnetic resonance imaging scan, nerve conduction studies, cerebrospinal fluids analysis, anti-ganglioside antibodies and hormones tests, and clinical investigations, we diagnosed the patient with BBE overlapped with GBS. Treatment with corticosteroids and immunoglobulin resulted in clinical improvement. To our knowledge, this is the first case report of a hypopituitarism patient with BBE overlapped by GBS in English literature. Hypopituitarism patients have immune dysfunction. Based on previously reported autoimmune diseases associated with triggering GBS and its subtypes, hypopituitarism could be considered a noninfectious trigger.
Frontotemporal Dementia – Current Concepts
Authors: Puppala Goutham Kumar , Gorthi Shankar Prasad , Chandran Vijay , Gundabolu Gautham
Published: September 2024

Frontotemporal dementia (FTD) is an entity that includes a group of neurodegenerative disease with symptoms predominantly pertaining to deficits in behavior, executive function (or) language. FTD is one of the most common type of dementia before 65 years of age and is one of the most underdiagnosed dementia as most often the symptoms overlap with psychiatric manifestations. Based on the clinical features, FTD is further subdivided into behavioral variant FTD (Bv-FTD) and primary progressive dementia (PPA). We searched PubMed, MEDLINE, and Google Scholar for articles about FTD disease published in English between January 1, 1975 till 2018. We used the search terms “frontotemporal dementia,” “Fronto temporal dementia-motor neuron disease,” “dementia,” “cognition,” “behavioral variant,” and “primary progressive aphasia.
What Happens after Therapy? Quality of Life and Neurocognitive Functions of Children with Malignant Posterior Fossa Tumors after Adjuvant Therapy
Authors: Yeole Ujwal , Hegde Shantala , Gothwal Mohit , Prabhuraj A R , Somanna Sampath , Thennarasu K , Arimappamagan Arivazhagan
Published: September 2024

Purpose:

The health-related quality of life (HRQoL) is an important endpoint in modern clinical practice with improved survival of pediatric posterior fossa malignant brain tumors (PFMBTs). We evaluated the effect of environmental and psychosocial milieu on QoL and cognitive functioning (CF) of Indian children with PFMBT.

Methods:

In a cross-sectional study, 47 children <18 years of age with medulloblastoma or anaplastic ependymoma were evaluated ≥6 months after completion of adjuvant therapy. All clinical and socioeconomic details, educational status of child and family members, socioeconomic status, environmental factors affecting QoL were documented. Children underwent HRQoL evaluation using Pediatric quality of life Inventory (PedsQL) questionnaire and neuropsychological evaluation.

Results:

The median age of the cohort at presentation was 7 years (1–18) and median duration of evaluation after adjuvant therapy was 16 months. In 47 families, 72.34% had low monthly income and 76.6% of mothers took formal education. QoL scores were above median values. Parents reported scores highlighted that Lansky performance score (P = 0.001) and maternal education (P = 0.043) significantly influenced the cognitive component of QoL. Twenty-seven children had below-average IQ. Young age at presentation (P = 0.020), maternal education (P = 0.032), high socioeconomic status (P = 0.001) influenced the IQ score. Even though the majority of children (57.44%) had below-average IQ, they had a score of more than 50 on the cognitive functioning scale. A total of 72.5% of the eligible children in our cohort went back to school following therapy, though often with a delay of one academic year.

Conclusions:

Overall cognitive functioning scores of these children are good, but they are not representative of actual neurocognitive tasks based performance or IQ scores. Children should remain under regular follow-up with a neurocognitive assessment and psychological counseling at regular intervals.
Association of Stressful Life Events with Dementia in North Indian Populations
Authors: Manoj Shalini , Nehra Ashima , Dalal Krishna , Sagar Rajesh , Tripathi Manjari
Published: September 2024

Background:

Chronic stress is known to be associated with dementia.

Aim:

This study looked for major stressors and their associations with dementia in the elderly demented population.

Methods:

Case group consisted of 60 subjects (age group 55-75 years; M:F = 7:3) with postscreening for mild cognitive impairment (MCI) and mild Alzheimer's type dementia. Control group consisted of two subgroups: related (N = 60) and not-related (N = 60) subjects screened and confirmed not to be suffering from cognitive impairment. Sociodemographic variables were collected using a personal data sheet. The severity of cognitive impairment was assessed using the Clinical Dementia Rating (CDR) Scale. Subjects with a CDR score of range 0.5-1 were included in mild cognitive impairment and mild Alzheimer's type dementia. Stressful life events were evaluated using the Presumptive Stressful Life Event Scale (PSLES). A present stress level of caregivers was evaluated using Depression Anxiety Stress Scales (DASS). Assessed stress level scores were compared and validated with serum and plasma levels of cortisol and ACTH respectively.

Results:

Different groups exhibited distinct PSLES and DASS scores with statistical significance. It was also observed that Cortisol and ACTH levels were elevated in case group as compared with that of both sub-group controls.

Conclusions:

The outcome measures of this study projected that neural degeneration leading to mild cognitive impairment and dementia may be due to accumulative cortisol hormone associated with stressful life events.
Levothyroxine-Induced Pseudotumor Cereberi
Authors: Abbas Farhat , Latief Muzamil
Published: September 2024

Rise in intracranial tension (ICT) has varied clinical presentation which can range from subtle disturbances like headache to frank neurologic impairment. An important aspect is rapidity of rise of ICT. Pseudotumor cerebri is associated with many syndromes, toxication, and drugs. Our case is a unique one given the rarity of eltroxin, which is otherwise relatively safe drug and commonly used in this part of the world, induced Pseudotumor cerebri. Our patient had dramatic response to discontinuation of levothyroxine.
NBIA Syndromes
Authors: Svetel Marina , Dragašević Nataša , Petrović Igor , Novaković Ivana , Tomić Aleksandra , Kresojević Nikola , Stanković Iva , Kostić Vladimir
Published: September 2024

A disturbed iron metabolism may damage brain and trigger disorders known as neurodegeneration with brain iron accumulation (NBIA). NBIAs are rare, inherited disorders in which responsible mutations affect the function of proteins that participate in tissue iron homeostasis. Accumulated iron, which may be recognized as a low signal intensity on T2-weighted MRI images, oftentimes points to a diagnosis. Recent genetic discoveries confirm that NBIA is not a homogenous group of diseases. Fifteen different NBIAs have been described to date; among these, autosomal recessive inheritance was reported in 13, and autosmal dominant and X-linked dominant inheritance in one disease, respectively. Among NBIAs, the most common is pantothenate kinase-associated neurodegeneration (PKAN-NBIA 1) (30%–50% of all NBIA cases), that occurrs as a consequence of the autosomal recessive mutation in PANK2 gene, followed by phospholipase 2-associated neurodegeneration (PLAN, NBIA 2), due to mutation in PLA2G6 gene, and mitochondrial membrane protein-associated neurodegeneration (MPAN) with the underlying C19orf12 mutation [Table 1]. NBIAs are characterized by complex motor presentations from early-onset degeneration and premature fatality to adult-onset parkinsonism and dystonia. Epileptic seizures, pyramidal signs, visual disorders, and cognitive deterioration can develop. NBIAs are often refractory to therapeutical strategies, although certain interventions may provide significant symptomatic relief in selected patients. In this review, we discuss the expanding clinical spectrum of these complex and rare syndromes, their genetic and imaging features, and potential therapeutical targets and strategies.
Cost of Illness of Major Neurocognitive Disorders in India
Authors: Malapur Puneeth U , Kumar Nripendra , Khandelwal Sudhir K , Tripathi Manjari
Published: September 2024

Background:

Major neurocognitive disorders (major NCD) predominantly affect the elderly. Major NCD results in significant morbidity and socioeconomic burden.

Objectives:

To estimate the individual cost of care of a person with major NCD according to disease severity and component costs.

Methods and Material:

Fifty patients of major NCD with primary caregivers attending memory clinic of tertiary care center were included. A detailed questionnaire administered after inclusion provided demographic and clinical information. Caregivers were interviewed about details of care provided. Cognitive function was assessed by Hindi mental state examination (HMSE), and major NCD severity was determined by clinical dementia rating scale (CDR).

Results:

The annual cost of care per patient with mild to moderate and severe major MCD was INR 78288 and INR 167808, respectively. Costs increased with increasing severity of the disease. Direct nonmedical costs were significantly higher than direct medical costs in severe major NCD group and vice versa was found in mild to moderate major NCD group.

Conclusion:

Increasing population of elderly and prevalence of major NCD suggest an economic burden on caring families and hence the government. Comprehensive health policy toward providing affordable care to people with major NCD is the need of the hour.
Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects
Authors: Arya Kamal Narayan , Pandian Shanta , Bhatnagar Nidhi , Sharma Abhishek
Published: September 2024

Background:

Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods.

Objectives:

To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery.

Materials and Methods:

Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months.

Results:

Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21.

Conclusion:

The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.
Geometrical and Hemodynamic Characteristic Changes of Small Anterior Communicating Artery Aneurysms during Follow-ups in a Retrospective Analysis
Authors: Xu Lijian , Zhu Yueqi , Zhang Ruijian , Zhu Tingzhun , Wan Jieqing , Liang Fuyou , Zhao Bing
Published: September 2024

Background:

Small intracranial aneurysms have a low risk of rupture. However, ruptured anterior communicating artery (ACoA) aneurysms are usually smaller in clinical practice. The retrospective study aimed to investigate the geometrical and hemodynamic changes of small unruptured ACoA aneurysms during serial follow-ups.

Materials and Methods:

We retrospectively collected patients with small unruptured ACoA aneurysms that were not repaired, who had serial follow-ups from the Electronic Medical Record System in four tertiary hospitals. The geometrical parameters of ACoA aneurysms were measured using a three-dimensional reconstructed model. Intra-aneurysmal hemodynamic parameters were computed using a high-resolution computational fluid dynamics model. Geometrical and hemodynamic changes of the aneurysms were evaluated at each follow-up.

Results:

Five patients with small unruptured ACoA aneurysms that were not repaired were identified and included in this analysis. Aneurysms rupture occurred in two patients with aneurysm growth. The formation and enlargement of an irregular bleb at the aneurysm neck or dome were observed before the rupture. Ruptured aneurysms showed high wall shear stress (WSS) in the high inflow zone of aneurysm neck while low WSS and high oscillatory shear index (OSI) in the flow-recirculating region of aneurysm dome. Three unruptured aneurysms maintained a stable morphology and a physiological level of WSS.

Conclusions:

Aneurysm growth, low WSS, and high OSI at the dome and/or high WSS at the neck potentially contribute to the rupture of small ACoA aneurysms. These aneurysms should be considered for the treatment regardless of the small size.
Factors Affecting Time to Emergence From General Anesthesia Following Clipping of Ruptured Aneurysms
Authors: Bhairwa Devendra P , Kapil Sonia , Mahajan Shalvi , Bhardwaj Avanish , Dhandapani Sivashanmugam , Bhukal Ishwar , Tewari Manoj K , Bhagat Hemant
Published: September 2024

Introduction:

Early emergence from anesthesia is valuable, especially among neurosurgical patients for postoperative neurological evaluation and appropriate interventions. However, the factors affecting the emergence in patients undergoing clipping of ruptured aneurysms have not been studied.

Materials and Methods:

This was a prospective observational study on patients of aneurysmal subarachnoid hemorrhage with World Federation of Neurological Surgeons (WFNS) Grades I to III, undergoing surgical clipping. All relevant preoperative and intraoperative details were collected and analyzed to assess the factors affecting emergence time.

Results:

A total of 67 patients with a median age of 46 years were included in the study. The number of patients with Fisher Grades I, II, III, and IV was 6, 20, 25, and 16, respectively. The median time to emergence was 17 minutes (interquartile range 10–240 minutes). On univariate analysis, the factors that were found to have a significant relationship with time to emergence were preoperative Glasgow Coma Score (GCS; P = 0.02), WFNS grade (P = 0.005, temporary clipping time (P = 0.03), and the temperature at the end of surgery (P < 0.001) In the multivariate analysis using generalized linear model, preinduction GCS (P < 0.001), patient's temperature at the end of surgery (P < 0.001), and temporary clipping time (P = 0.01) had a significant impact on the emergence time, independent of age, American Society of Anesthesiologists grade, Fisher grade, duration of anesthesia and of each other, with GCS and temperature having the maximum impact. ROC curve for temperature had a cutoff value at 35.3°C with an 83% probability of awakening beyond 15 minutes if the temperature decreased below 35.3°C.

Conclusion:

The preinduction GCS, the temperature of patients at the end of surgery, and the duration of temporary clipping have a significant independent impact on the time to emergence from neurosurgical anesthesia, in the order of the strength of the association.
Idiopathic Normal Pressure Hydrocephalus Presenting as Psychosis
Authors: Mathew Robert , Archana N U , Sheetal S
Published: September 2024

Background:

Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, dementia, urinary incontinence, and dilation of ventricular system with normal opening cerebrospinal fluid pressure. Idiopathic NPH (i NPH) presenting as psychosis is uncommon.

Objectives:

The objective of this study is to describe idiopathic NPH presenting as Psychosis.

Subjects and Methods:

Patients availing dementia care service from three tertiary care hospitals, across Kerala, with a diagnosis of psychosis were evaluated.

Results:

Three patients with NPH, diagnosed as per the consensus criteria, presenting as psychosis are described. Patient 1: Fifty-five-year-old lady with psychosis was found to have iNPH. She gave history of psychosis relieved with successful shunting of the hydrocephalus. She developed recurrence of psychosis each time the hydrocephalus recurred due to shunt malfunction and was relieved with correction of hydrocephalus with shunting. Patient 2 was a 67-year-old gentleman with long history of pyschosis with paranoid ideas. Five years after onset of illness, he developed gait apraxia, and a CT scan done showed normal pressure hydrocephalus. Patient 3 had bipolar illness since age of 60 years of age. He also developed gait apraxia 5 years into the illness and was diagnosed as having iNPH following imaging.

Conclusions:

All the patients had psychosis much before other features of iNPH developed. One of the patient's psychosis was temporally associated with onset and offset of hydrocephalus, thereby strongly supporting the causative nature of iNPH. iNPH though rare can be one of the causes for late onset secondary psychosis.
Nonobstructive azoospermia: an etiologic review
Authors: Hubbard Logan , Rambhatla Amarnath , Glina Sidney
Published: September 2024

Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation. Nonobstructive azoospermia (NOA) represents the most severe form of male factor infertility accounting for 10%–15% of cases and stems from an impairment to spermatogenesis. Understanding of the hypothalamic–pituitary–testicular axis has allowed NOA to be subcategorized by anatomic and/or pathophysiologic level. The etiologies of NOA, and therefore, the differential diagnoses when considering NOA as a cause of male factor infertility, can be subcategorized and condensed into several distinct classifications. Etiologies of NOA include primary hypogonadism, secondary hypogonadism, defects in androgen synthesis and/or response, defective spermatogenesis and sperm maturation, or a mixed picture thereof. This review includes up-to-date clinical, diagnostic, cellular, and histologic features pertaining to the multitude of NOA etiologies. This in turn will provide a framework by which physicians practicing infertility can augment their clinical decision-making, patient counseling, thereby improving upon the management of men with NOA.
Comparative evaluation of continuous and sequential chelation on the dentinal tubule penetration of bioceramic-based sealer – A confocal laser scanning microscopic study
Authors: Gupta Komal , Shetty Soumya S. , Tandale Anita B. , Srikurmam Manisha , Nihalani Harsha
Published: September 2024

Context:

Effective endodontic treatment relies heavily on proper instrumentation, thorough disinfection, and precise three-dimensional obturation of the root canal system.

Aims:

This study aims to evaluate and compare continuous chelation (etidronic acid and sodium hypochlorite [NaOCl]) and sequential chelation (citric acid and NaOCl) on the dentinal tubule penetration of bioceramic-based sealer (Bio-C)-A confocal laser scanning microscopic study.

Settings and Design:

In vitro experimental study.

Subjects and Methods:

Sixty extracted permanent single-rooted teeth were selected and decoronated below cementoenamel junction to get a standardized length of 12 mm across all samples followed by enlargement of root canals till rotary ProTaper F3. The samples were randomly divided into three groups: Group I (control): Canals were irrigated with 3 mL 17% ethylenediaminetetraacetic acid/3 mL 3% NaOCl; Group II: Canals were irrigated with 10 mL etidronic acid + NaOCl solution; and Group III: Canals were irrigated with 3 mL 10% citric acid followed by 3 mL 3% NaOCl. 0.1% rhodamine B dye was mixed with Bio-C sealer followed by obturation. All the samples were subjected to confocal laser scanning microscopy evaluation.

Statistical Analysis Used:

One-way analysis of variance with the Bonferroni post
hoc test was used for the statistical analysis. The level of significance was set at P < 0.05.

Results:

The pairwise comparison of depth of penetration showed statistically significant results in all the coronal, middle, and apical thirds. Group II showed better depth of penetration than Groups I and III.

Conclusions:

Continuous chelation protocol using etidronic acid and NaOCl showed greater and statistically significant sealer penetration depth when compared to the sequential chelation protocol, i.e., citric acid at all three levels.
Comparison of proximal contact and contours of class II restoration in premolars and molars restored with three different matrix systems using FDI criteria: An in vivo study
Authors: Sankhyan Vanshish , Makkar Sameer , Negi Shabnam , Gupta Simran , Jain Ayushi , Arora Garima
Published: September 2024

Context:

Sectional matrix systems, namely, Garrison and Bioclear with contact rings, are valuable aids to establish proximal contact tightness and contours in Class II composite restorations when compared with the circumferential matrix system Tofflemire.

Aims:

This study aimed to compare the proximal contact and contours of Class II restoration in premolars and molars restored with Tofflemire, Garrison, and Bioclear matrix system by FDI criteria of approximal anatomical form using floss or 25-µm metal blade and radiographic examination.

Subjects and Methods:

Sixty Class II patients were selected, and a preoperative bitewing radiograph was taken. Initially, caries removal was done by round diamond bur, followed by 245 carbide bur. Samples were divided randomly into three groups based on the type of matrix system used for restoration. Group 1 (n = 20): Tofflemire, Group 2 (n = 20): Garrison matrix system, and Group 3 (n = 20): Bioclear matrix system. Matrix systems were applied according to the manufacturer’s instructions, and composite restoration was done. The clinical evaluation of proximal contact and contour was done by a blinded observer immediately after placement of composite restoration using FDI criteria by passing dental floss or 25-µm metal blade, whereas marginal gaps and overhangs were checked using a radiograph. Results were statistically analyzed.

Statistical Analysis Used:

The statistical analysis was done using the Statistical Package for the Social Sciences (SPSS for Windows, Version 19.0). Descriptive statistics was calculated as frequency and percentage. The comparison of characteristics of the contact points, contour, and radiographic examination was carried out using the Chi-square test. Multiple comparisons were done by comparing column proportions with Bonferroni adjustments. The level of significance for the present study was fixed at P < 0.05.

Results:

There were significantly higher proportions of normal contacts in Garrison (60%) and Bioclear (70%) compared to that in the Tofflemire (20%) matrix system (Bioclear > Garrison > Tofflemire). Comparison of contours showed normal contours with Garrison (50%), Bioclear (50%), and Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire). In radiographic examination, harmonious transitions between the restoration and the tooth were similar in Garrison (30%) and Bioclear (30%) compared to the Tofflemire (15%) matrix system (Bioclear = Garrison > Tofflemire).

Conclusions:

Garrison and Bioclear sectional matrix systems established superior contacts and contours than the Tofflemire circumferential system.
Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A randomized controlled clinical trial
Authors: Pandey Ruchika , Kararia Nitin , Sharma Deepak Kumar , Rathod Vishal , Bansod Anand Vilas , Desai Dhaval
Published: September 2024

Aims:

A randomized controlled clinical trial to evaluate postoperative pain and investigate periapical healing after root canal treatment using eugenol, resin-based, and calcium silicate-based sealers (CSBSs) sealers.

Materials and Methods:

Sixty-three individuals diagnosed with apical periodontitis confirmed using cold test and electronic pulp tester, periapical pathology with periapical index score of 2 or more, previous endodontic treatment failure exhibiting a visual analog scale pain score of 3 or above, were enrolled in this investigation. The patients were randomly allocated into three groups and following biomechanical preparation, the canals were obturated using Meta CeraSeal, AH plus, and eugenol-based sealers. Postprocedural pain intensity was assessed at 24 h, 48 h, and 7 days, while periapical healing was evaluated at 3- and 6-month follow-ups. Statistical analysis was done using the Chi-square and Friedman’s test.

Results:

The mean of periapical lesions for Meta CeraSeal (4.7, 1.6), AH Plus (4.68, 3.19), 24 and eugenol-based (2.66, 1.75) at 3 months and 6 months, respectively. The mean & std. deviation of pain scores at 24 h for Meta CeraSeal (0.62 ± 1.857), AH Plus (1.62 ± 1.962), and eugenol-based (0.48 ± 1.250). At 48 h for Meta CeraSeal (0.33 ± 1.528), AH Plus (1.33 ± 1.798). On the 7th day, Meta CeraSeal (0.24 ± 1.091) and AH Plus (0.71 ± 1.384) for eugenol-based at 48 h, and on the 7th day, none of the patients had pain. Evaluation of the apical sealer puff displayed no suggestive variations (P = 0.634). Notably, no analgesics were taken.

Conclusions:

No suggestive dissimilarity was noted between eugenol, resin-based, and CSBSs sealers.
Estimation of the effect of acetone- or ethanol-based solvents on shear bond strength of composite resin using air- and blot-dry techniques
Authors: Jain Deepti , Kunhappan Sanjeev , Maheshwari Diksha , Goyal Manisha , Agarwal Arushi , Roy Ankita
Published: September 2024

Background:

An adequate amount of water is necessary to maintain the shape of collagen fibrils while excess water hampers dentin–resin bonding. Air-drying lacks control while blot-drying displaces water in a controlled manner. Solvents in adhesives affect the configuration of collagen fibrils. Thus, the present study aimed to compare the influence of air- or blot-drying methods on shear bond strength (SBS) of acetone- and ethanol-based adhesives.

Materials and Methods:

Thirty-six extracted noncarious third molars with similar crown heights were selected. Teeth were decoronated and randomly divided into two groups: after acid etching, Group I was treated with acetone-based adhesives and Group II with ethanol-based adhesives. They were again subdivided into subgroups A (blot-dried) and B (air-dried) containing nine samples each. Dentin surfaces were etched and rinsed. After the respective drying method, adhesive application and composite buildup were done. SBS was measured. The data were subjected to statistical analysis.

Results:

Acetone-based adhesive showed the highest SBS in both drying methods. Further, blot-dried dentin produced significantly higher SBS than air-dried dentin.

Conclusion:

Solvent type and drying methods have an effect on the bond strength of total-etch adhesives to dentin. Acetone-based adhesives used with blot-drying techniques showed the best results.
Evaluation of compressive and diametral tensile strength of novel bioactive material with conventional glass ionomer cement and silver amalgam: An in vitro study
Authors: Murali Rao H , Rajkumar Krishnan , Shankar Suryanarayanan , Janani Krishnamachari
Published: September 2024

Aim:

The aim of this study was to compare the compressive and tensile strength of two different brands of conventional glass ionomer cement (GIC), with new zirconia-reinforced GIC and silver amalgam.

Materials and Methodology:

Eighty specimens with 20 samples in each group were prepared (Group 1-Fuji IX GIC, Group 2-FX-II Shofu GIC, Group 3-Amalgam, and Group 4-Zirconia-reinforced glass ionomer [Zirconomer]) for compressive strength (CS) using cylinder molds with dimensions 6.0 mm diameter × 12.0 mm height. Eighty specimens using cylinder molds with dimensions 6.0 mm diameter × 3.0 mm height were prepared for testing diametral tensile strength (DTS). CS test was carried out using Micro Universal Testing Machine (Mecmesin, PPT Group, UK) having a crosshead speed of 1.0 mm/min. DTS was determined using Instron universal testing machine at a crosshead speed of 1.0 mm/min. The data were submitted to two-way analysis of varianceand post hoc Tukey tests (alpha = 0.05). The mean CS value was more for Group III (256.2), followed by Group IV (181.2 Megapascals [MPa]), Group II (129.8 MPa), and the least was Group I (117.9 MPa).

Result:

The mean DTS value was high in Group III (73.7 MPa), followed by Group IV (58.0 MPa), Group II (36.0 MPa), and the least was seen in Group I (23.2 MPa).

Conclusion:

It can be concluded that although Zirconomer has mechanical properties greater than that of unmodified GICs, additional studies are essential to evaluate its long-time ability.
Potential application of a combined extract of Channa striata and calcium hydroxide for inhibiting lymphocytes and interleukin-1β cells in the asymptomatic irreversible pulpitis of Wistar rats (Rattus norvegicus)
Authors: Nugroho Juni Jekti , Taha Risnawati , Trilaksana Aries Chandra , Dwiandhany Wahyuni Suci
Published: September 2024

Aim:

This study aimed to evaluate the effectiveness of combining Channa striata extract with calcium hydroxide (Ca(OH)2) in reducing lymphocyte counts and interleukin (IL)-1β levels in inflamed pulp teeth.

Materials and Methods:

A laboratory experimental setup with a posttest control group (CG) design was employed. Thirty-two rat incisor teeth were divided into four groups: a positive CG (100% Ca(OH)2), treatment 1 (25% C. striata extract + 75% Ca(OH)2), treatment 2 (50% C. striata extract + 50% Ca(OH)2), and treatment 3 (75% C. striata extract + 25% Ca(OH)2). These test materials were applied to Class 1 cavities extending to the pulp roof, with samples collected on days 1, 3, 5, and 7. Data were analyzed using analysis of variance and post hoc least significant difference tests.

Results:

In all the groups, the highest levels of lymphocytes and IL-1β were observed on day 3, followed by a decline on days 5 and 7. The combination of C. striata extract with Ca(OH)2 significantly reduced inflammatory markers, particularly lymphocyte and IL-1β levels.

Conclusion:

The extract of C. striata holds significant potential as an innovative therapeutic approach for managing inflamed dental pulp.
Fracture resistance of postendodontic restoration using self-adhesive bioactive resin and a bulk-fill composite with or without resin-impregnated glass fibers: An in vitro study
Authors: Paul Aishika , Dubey Rohit , Joshi Sonal B. , Patil Anand C. , Narvekar Pranjali S.
Published: September 2024

Context:

Due to advancements in adhesive technology and the introduction of fiber reinforcement, there has been a paradigm shift towards a more minimally invasive approach in coronal restoration of endodontically treated teeth.

Aims:

This research aimed to evaluate and compare fracture resistance of postendodontic restoration using a self-adhesive bioactive resin and a bulk-fill composite with or without resin-impregnated glass fibers.

Materials and Methods:

Mesio-occlusal-distal cavities were prepared on 80 extracted human maxillary premolars. Root canal treatment was completed following standard access cavity preparation. Then, the teeth were divided into two groups based on the composite used for postendodontic restoration. Group I: Bulk-fill composite (Tetric N-Ceram). Group II: Activa BioActive. Group I and Group II were then divided into two subgroups depending on fiber incorporation (n = 20). Subgroup IA: Bulk-fill composite. Subgroup IB: Bulk-fill composite with fiber incorporation. Subgroup IIA: Activa BioActive. Subgroup IIB: Activa BioActive with fiber incorporation. The force required to fracture the teeth was recorded using the universal testing machine.

Statistical Analysis Used:

Two-way ANOVA and Tukey’s multiple post hoc test.

Results:

Activa BioActive with fiber incorporation showed the highest mean fracture resistance (988.52N). Bulk-fill composite without fiber incorporation had the least mean fracture resistance (669.87N).

Conclusions:

Activa BioActive bulk-fill restorative material when used with the incorporation of resin-impregnated glass fibers can be a preferred material of choice for restoring endodontically treated teeth.
Evaluation of magnesium levels in serum and saliva by calmagite method in individuals with tobacco habits with or without potentially malignant disorders
Authors: Singhal Ishita , Arora Manpreet , Dave Aparna , Bansal Sanjiv K. , Saluja Pulin , Rai Radhika
Published: September 2024

Aim:

To evaluate and compare the magnesium levels in serum and saliva of individuals with tobacco habits with and without potentially malignant disorders (PMDs).

Materials and Methods:

A total number of 60 patients were taken in the study, which included group A: 20 healthy patients without any tobacco or alcohol habits, without any PMDs, and without any systemic diseases; group B: 20 patients with tobacco habits and without PMDs; and group C: 20 patients with tobacco habits and with PMDs. The serum and salivary samples were collected from the patients and were subjected to magnesium level estimation using the calmagite method. Statistical analysis was performed using the Shapiro–Wilk W test and Mann–Whitney test.

Results:

The mean salivary magnesium levels were increased in group B (1.442 mg/dl), followed by group C (0.551 mg/dl), and then group A (0.463 mg/dl). The mean serum magnesium levels were increased in group B (1.891 mg/dl), followed by group C (1.608 mg/dl), and then group A (1.589 mg/dl). The salivary and serum magnesium levels were significantly high in patients with tobacco habits and without PMDs compared to the control group. The salivary and serum magnesium levels were significantly decreased in patients with tobacco habits with PMDs compared to the patients with tobacco habits and without PMDs.

Conclusion:

The study established a significant correlation between the salivary and serum magnesium levels in patients with tobacco habits, with or without PMDs, and showed that as the disease progressed, the salivary and serum magnesium levels decreased.