bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic and legal mechanisms of material and technical support of health care institutions
Authors: DIEIEVA Nataliia , RADCHENKO Oleksandr
Published: September 2024

The paper shows that the formation of a network of state and communal health care institutions is a multifactorial process aimed at ensuring high quality, accessibility and efficiency of medical care for all citizens.
It is shown that the state plays a key role in the organization of material and technical support of the health care system in order to guarantee the population an appropriate level of medical and rehabilitation assistance. It ensures the availability of the necessary resources to provide the population with a guaranteed level of medical and rehabilitation assistance to individuals and medical institutions, including in the form of equipment, tools, medicines and other necessary materials.
The role and imperative of compliance with standards of medical care, clinical protocols, rehabilitation care protocols, as well as material and technical equipment reports in all health care institutions have been defined. It is shown that the record of material and technical equipment plays a key role in ensuring a high level of medical services, optimizing resources and increasing the efficiency of health care institutions and private medical practices.
It has been proven that under the conditions of martial law, the role of the Ministry of Defense of Ukraine in the logistical support of health care facilities increases, as it ensures constant monitoring of the effectiveness of approved standards and lists, as well as their regular updating in accordance with new technologies and changes in combat tactics and medical science Medical products and aids must be suitable for use in combat environments, including extreme conditions, mobility and speed of care. The functions of the Ministry of Defense of Ukraine are an important component of ensuring the appropriate level of medical care for servicemen in combat conditions, which contributes to increasing their safety and effectiveness on the battlefield.
A comprehensive approach to the logistical support of health care is proposed, which allows to ensure a high level of medical care, support innovations in the medical field, and promote the development of the national medical industry.
Approaches in the monetary policy of the National bank of Ukraine to curb inflation and prevent rapid devaluation of the Hryvnia in wartime conditions
Authors: MANHUSHEV Vladyslav
Published: September 2024

Introduction. Monetary policy serves as a fundamental component of the economic strategy of the National Bank of Ukraine (NBU), focused on ensuring price stability and fostering an environment conducive to economic growth, development, and increased employment levels within the country. Following the onset of large-scale military occupation in Ukraine, which inflicted significant damages on the national economy and disrupted international trade, the NBU has been compelled to take decisive actions. These measures aim to minimize the severe impacts of military operations on Ukraine’s banking and monetary systems and address multiple emerging challenges.
The purpose of this paper is to explore the approaches of the NBU's monetary policy aimed at curbing inflation and preventing the rapid devaluation of the hryvnia during wartime conditions.
Results. The strategy pursued by the NBU is directed towards securing both price and financial stability, which are essential for macroeconomic stability. The current state of Ukraine’s monetary policy reveals several institutional challenges, including unstable exchange rates, hryvnia devaluation, an expansion of the shadow economy, and a high volume of currency transactions within the country. During the conflict, the monetary and credit policies of the NBU prioritize fulfilling Ukraine’s defense needs, ensuring the functionality of financial markets, maintaining the smooth operation of banking and payment systems, controlling inflation, stabilizing the hryvnia, and safeguarding necessary levels of international reserves.
Conclusions. A key mechanism for the NBU’s influence on inflation in Ukraine is the primary interest rate, which determines the rate at which the NBU provides funds to financial institutions. This key rate significantly impacts the interest rates commercial banks offer to individuals and enterprises, which in turn affects the inflation level.
Mechanisms of interaction between banking institutions and aviation enterprises
Authors: KOSOVA Tetiana , MEKH Hanna , HORBACH Yevhen
Published: September 2024

It is shown that the main mechanisms of interaction between banks and aviation enterprises are: loans, leasing, collateral financing, risk hedging, project financing, financial consultations and services, factoring, guarantees and insurance. The global aerospace market has been proven to have significant growth potential due to an increase in global GDP, growth in global air traffic and record numbers of new aircraft orders. Innovation, efficiency gains and the development of new markets contribute to the sector's long-term positive outlook.
It is shown that the aviation industry is subject to strict regulation at the national and international levels, including requirements for safety, ecology, product quality, data protection and many other aspects. Failure to comply with these requirements can result in serious legal consequences, financial loss and reputational damage. Long supply chains have been found to be an integral part of the aviation industry, ensuring the supply of components and materials for aircraft manufacturing. They have their own advantages and challenges that require effective management and coordination. The use of modern technologies, the development of partnership relations and strategic risk management contribute to increasing the efficiency and sustainability of these chains. It has been determined that the management of the risks of execution of key contracts is extremely important for aviation enterprises. Implementation of effective risk management strategies helps reduce the possibility of problems, ensure timely and high-quality fulfillment of obligations to customers, as well as maintain financial stability and competitiveness in the market.
It has been proven that the interaction of banks and aviation companies brings numerous advantages to both parties. Aviation enterprises get access to the necessary financing, risk management and consulting services, which contributes to their development and increased efficiency. Banks, in turn, expand their customer base, increase profitability, develop new products and strengthen their reputation. Such cooperation is an important component of the success of both the aviation industry and the banking sector.
Maggot Cultivation Business Development Strategy at the Siliwangi Unit Waste Bank
Authors: Gandhy Abel , Gursida Hari , Sunarta Ketut , Marota Rochman , Zaini Oktori Kiswati
Published: September 2024

Research on maggot farming business development strategies is still relatively limited. This research is important because it provides recommendations for business strategies that can maximize the development of the company's business. The Black Soldier Fly (BSF) larval cultivation business at the Siliwangi Unit Waste Bank has the potential to grow bigger. Business strategy provides sustainable planning to manage resources comprehensively and identify conditions for achieving future business success and gaining maximum profit. This research was conducted at the Siliwangi Unit Waste Bank, Bogor City, which was selected purposively because the BSF larval cultivation activities there have the potential to be developed further. This research uses quantitative and qualitative data sourced from primary and secondary data. Primary data were collected through surveys and direct observations by researchers, while secondary data were obtained from institutional reports, journals, books, news articles, and other library sources. Internal environment (IFE) and external environment (EFE) analysis were conducted to identify factors that could influence business success. The results of this analysis were used in the Internal-External Matrix (IE) which produced three main strategies: Growth, Stability, and Reduction Strategies. These strategies are the basis for developing the maggot cultivation business at the Siliwangi Unit Waste Bank.
Prevailing Organizational Culture Strategies in Public Primary Schools in Rorya District Council, Tanzania
Authors: Ntale Athanas , Amos Onesmo
Published: September 2024

The study investigated the prevailing organizational culture strategies in public primary schools in Rorya District. The study was guided by cultural dimensions theory and organizational culture model. The study employed pragmatism research philosophy and concurrent triangulation mixed research design. The target population comprised Chairpersons of School Management Committees, teachers, and heads of schools. Questionnaires and interviews were used for data collection. To ensure validity and reliability, various strategies were implemented, including expert reviews, member checking, Cronbach’s Alpha, and pilot studies. Data analysis involved descriptive statistics and thematic analysis. Ethical considerations were addressed through obtaining approvals from relevant authorities. The study found that the organizational culture in public primary schools in Rorya District is generally perceived positively by teachers, with strong support for collaboration, shared values, teamwork, and effective communication. The culture also fosters a sense of belonging and commitment to school goals. However, areas such as continuous learning and professional development were rated slightly lower, indicating potential opportunities for improvement. The study recommends strengthening collaboration, teamwork, and a sense of belonging in Rorya District's public primary schools while enhancing continuous learning and professional development to further support teachers and align with effective organizational culture practices.
The Relationship Between Project-Based Assessments and Students’ Creativity in Secondary Schools
Authors: Mcharo Henry Bornege , Wandela Euginie Lucas
Published: September 2024

This study investigates the relationship between the frequency of project-based assessments and the enhancement of creativity among secondary school students. Employing a mixed-methods approach, data were collected from a sample of 100 students, 55 teachers and 02 academic masters across two secondary schools. The findings reveal a significant positive correlation between the regular implementation of project-based assessments and elevated levels of creativity in students. Specifically, students who frequently engaged in project-based tasks demonstrated higher creative thinking and problem-solving skills compared to those with less exposure. The results suggest that project-based assessments are a valuable tool in fostering creativity, an essential skill in today’s dynamic educational landscape. However, challenges such as time constraints and resource limitations were identified, indicating a need for further support and resources to maximize the effectiveness of these assessments. The study concludes by recommending increased professional development for teachers and more structured integration of project-based learning into the curriculum to enhance student creativity further.
Needs Assessment for the Enhancement of Academic Library Products and Services: A University of Jos Review
Authors: Igboechesi Gilbert Paul , Adigun Thomas Akinbayo
Published: September 2024

Users remain the defining force in academic libraries; the core relevance of the 21st Century academic library is anchored on its ability to meet the needs of its ever evolving users. This means that the any present vibrant academic library is largely determined by the pedigree of library management and the librarians in place; those who understand the merit and demerit of every service rendered at the library or potential service to be rendered. They are tenacious in offering every service with the view to developing the confidence needed at the library. This paper looks at the needs assessment for the enhancement of academic library products and services in the University of Jos library. Dwelling on the current issues it is facing arising from the changing contexts of librarianship and the clientele in its daily operations. This research involved collaborative and participatory/case study approaches in the investigation and addressing the practical issues with the UJLib and generating of solutions in several departments of the library like circulation/readers services, acquisition, cataloging, system unit, feedback and evaluation of service, training and retraining of staff etc. Among the diverse propositions, the paper concluded by recommending that there is a need to approach these identified issues with creativity and intentional steps towards realigning UJLib to greater heights.
Carga Laboral como Factor de Influencia en el Clima Organizacional Departamento Administrativo Empresa SOFI Chihuahua 2023
Authors: Gutiérrez García Juan Javier , González Quintero Naira Cristina , Rivera Dozal Gabriela
Published: September 2024

La carga laboral es un elemento crítico en cualquier organización, ya que influye directamente en la productividad y el bienestar de los colaboradores. Por lo tanto, comprender esta situación es esencial para garantizar un ambiente de trabajo saludable y eficiente. El objetivo del presente estudio fue determinar cómo influye la carga laboral en el clima organizacional en el departamento administrativo de la empresa SOFI de Chihuahua 2023. La presente investigación es de forma aplicada, no experimental, relacional y de enfoque cuantitativo. Para la recolección de los datos se desarrolló una encuesta con 23 preguntas que se aplicó a 50 colaboradores de la organización. Se obtuvo un coeficiente de correlación de Spearman de .618 y un p de < .01, por lo que se evidencia que existe una relación positiva moderada a alta en las dos variables; concluyendo que existe una asociación estadísticamente significativa.
Tratamentos sistêmicos de Psoríase e a comparação do perfil de eficácia: uma revisão da literatura
Authors: Ferreira Francisco Carlos Gomes , Silva Tallyson Menezes Bento da
Published: September 2024

Introdução: A psoríase é uma doença inflamatória crônica que afeta a pele, unhas e articulações. Não há cura definitiva para a doença, tornando o tratamento desafiador. O papel do farmacêutico no manejo da psoríase é auxiliar no controle dos sintomas, orientar sobre o uso adequado de medicamentos e promover a adesão ao tratamento. Objetivo: O objetivo da pesquisa é comparar a eficácia dos tratamentos sistêmicos para psoríase através de uma revisão da literatura. Método: Pesquisa descritiva e retrospectiva, elaborada a partir de uma revisão narrativa dos artigos encontrados nas bases de dados Scielo (Electronic Library Online) e BDTD (Biblioteca Digital de Teses e Dissertações). Na coleta de dados, foram utilizados as palavras-chave "Psoríase" e "Tratamento Medicamentoso", traduzidas para "Psoriasis" e "Drug Therapy". abrangendo o período de 2019 a 2024. Resultados: O farmacêutico pode fornecer informações sobre medidas não farmacológicas, como cuidados com a pele. Desta forma, o estudo busca contribuir para o aprofundamento e disseminação do conhecimento sobre a psoríase, identificando novas abordagens terapêuticas e desenvolvendo medicamentos mais eficazes e personalizados. Conclusões: A pesquisa conseguiu fornecer compreenssão atualizadas aos profissionais de saúde, incluindo os farmacêuticos, sobre as últimas intervenções farmacêuticas para a doença, onde verificou-se a importância dos tratamentos sistêmicos, buscando-se contribuir na disseminação do conhecimento acerca dos tratamentos disponíveis.
Future-Proofing Road Safety: Adapting ISO 26262 for Advanced V2X Integration
Authors: Thomas Jherrod
Published: September 2024

This study investigates the integration of ISO 26262 with Vehicle-to-Everything (V2X) communication technologies. Emphasize the necessity of expanding this safety standard to include vehicle-to-infrastructure integration and addressing additional safety measures to accommodate current vehicles’ complex and rapidly evolving networks. The study uses an extensive review approach, which considers existing safety pro-tocols and a qualitative literature synthesis to evaluate current standards and anticipate future requirements from them. It also looks at developments in V2X communication technology while identifying gaps within the present scope of ISO 26262 concerning autonomous and connected cars. The findings indicate a significant improvement in road safety plus efficiency in traffic management by integrating ISO 26262 with V2X communication. Further, the research points out areas such as security lapses, real-time data processing deficiencies, interoperability hitches, and scalability limits. These findings call for amendments to current safety standards so that they can take care of those problems. Failure to include V2X into ISO 26262 may com-promise reliability altogether, hence posing a grave danger to future intelligent transportation systems (ITS)’s dependability. The research concludes that integrating them will help lower risks brought about by the dynamic nature of vehicles’ environment, thereby facilitating the establishment of globally solid and safe systems for communicating between vehicles.
Tele-Orthodontics: A Lifesaver during COVID-19 Second Wave
Authors: R Rajesh. , K Balaji. , R.S Senkutvan. , Kumar. A. Mohan , S Aswathi. , S Hanisha
Published: September 2024

Aim: The study aims to evaluate the outcome of orthodontic treatment during the COVID-19 Pandemic using Tele-Orthodontics.  Objective: To explain how Tele-orthodontics represents an excellent way to perform orthodontic follow-ups during a period of restriction and to assess the effectiveness of follow-up using Tele-Orthodontics during the COVID-19 Pandemic.  Materials and Methods: Study design: Our study involves 30 patients in total, where 15 patients did not receive any further therapy and 15 patients had Tele-orthodontics treatment, with 10 patients receiving bonding treatment, 10 receiving mid- treatment treatment, and 10 receiving retention appliances. The communication tools used in our study and proposed in our model of tele-orthodontics include an online questionnaire using Google form once every 15 days, Tele-calling with Google Meet once a month, and frontal, side profile, and occlusal view (if possible) photos via WhatsApp messenger.  Results: Tele-orthodontics proved to be the only option to complete some orthodontic tasks during COVID-19 because it provided a means of communication between the dentist and the patient. Most of the patients who underwent bonding (66.7%), on retainer (96.7%), and during mid-treatment (93.3) maintained good oral hygiene during treatment. 93.3% of the patients’ appliances on retainer were holding tight in place with no discomfort and during the treatment, 70% of the patients were comfortable while speaking and 63.3% noticed changes in their appearance. Overall, Tele orthodontics was more time-saving and more desirable economically to both practitioners and patients.  Conclusion: Tele-Orthodontics is experiencing rapid growth and fierce competition. Most of the patients maintained good oral hygiene, and also had a positive perception of the use of Tele-Orthodontics.
Ethical Considerations for Companies Implementing LLMs in Education Software
Authors: Kontche Steve Mekam
Published: September 2024

Large Language Models (LLMs) have revolutionized natural language processing, offering significant advancements in educational software through applications like personalized learning and virtual tutoring. This position paper investigates the ethical considerations for companies integrating LLMs into educational tools. Key issues include data privacy, with a focus on safeguarding sensitive student information against breaches while ensuring transparency and consent. The paper highlights the risk of misinformation, as LLMs might generate incorrect or misleading content that could affect students’ learning. It also addresses concerns about algorithmic bias, which can lead to unfair treatment of students from diverse backgrounds, and the potential over-reliance on AI, which may undermine critical thinking and human oversight. Additionally, the paper explores the challenge of equitable access to LLM- based technologies, particularly in underserved communities. The analysis concludes with practical recommendations for companies, including robust data protection measures, balanced AI integration with human oversight, and strategies to enhance access for all students. By emphasizing these ethical challenges, the paper aims to guide responsible AI implementation in education, ensuring that technological advancements benefit all learners fairly and effectively.
Measures to Support Ukrainian Refugees' Education
Authors: DIT TALLAJ Lama AL RIHANI
Published: September 2024

The aggression of Russia in Ukraine concerning the conflict has displaced more than 4 million Ukrainians, many of whom are women and children, who are now refugees in other countries. This remains one of the biggest challenges in providing continued access to education. Schools all across Europe have embraced the challenge of receiving many students from Ukraine into their institutions. Some key actions taken for their educational needs are as follows: Ukrainian assistants and translators, the arrival of Ukrainian language teachers, provision of Ukrainian books, online learning, a welcome point at the schools, trauma-sensitive education to tutors, social inclusion through extra curriculum activities, grants from local and state level, inter-municipal and with Ukraine authority for reports, transfer certificates, bridging programs and no document required for school enrollment. Counseling, as well as anti-bullying programs, must also be strengthened to provide safe settings for refugee youths to be successful academically and psychologically during this tremendous transformation. That said, the task has not been easy. Still, European education systems have shown empathy and operational flexibility in tackling this challenge to ensure that the academic needs of young displaced Ukrainians are not compromised.
Factors That Influence Binge Watching Behavior
Authors: Qonita Nabila , Wibowo Mas Wahyu
Published: September 2024

This research aims to determine the influence of enjoyment, efficiency, and escape on binge-watching behavior. This study uses a quantitative method with a correlational approach to identify the relationships between variables without the influence of extraneous variables. The subjects of this research are consumers who subscribe to OTT video streaming services and engage in watching activities for more than 2 hours in one sitting. The sample size used in this study is 142 respondents with data analysis techniques using SEM- PLS. The results indicate a positive and significant relationship between enjoyment, efficiency, and escape with binge-watching behavior.
Digital Economy: Citizens Awareness and Expectations of E-Government in DRC
Authors: BIMBALA NGWABA Joseph , MUKENDI Mathieu MWAMBA , Augustin TADIAMBA , MPIA Reagan TONGO , Joris ZOLA , KABAMA Junior NTIAMA , Jospin KENGO
Published: September 2024

E-Government provides with e-services to enhance the way citizens can interact with government agencies. Citizens are first consumers of public services as users of the systems therefore it is important to understand their awareness and expectations before implementing new services. In this research, we have focused on e-DRC practices. The research used the mix method approach. The qualitative study was conducted through literature review. At the same time, the quantitative study was conducted through a survey with 858 answers from citizens. The survey results from citizens was interpreted and e-services of their interest was listed down. A total of 26 services were suggested by respondents and clustered into 15 categories.
A map without guarantees: Stuart Hall and Palestinian geographies
Authors: Associate Professor of Human Geography at the
Published: September 2024

Israel has imposed different forms of settler colonialism across the map of historic Palestine, but there is no inevitability about future outcomes Thinking about space as an entry point, this article traverses multiple spaces within historic Palestine to explore how Israeli settler
colonialism unfolds as a set of contingent and differentiated relations, practices and processes. It uses a theoretical diary, photographs, and countermaps to bring into sharp relief both the sedimented nature of settler colonial domination and its vulnerability to Palestinian practices of
resistance. Moving from the refugee camp in the West Bank to the village and the city in the territories Israel occupied in 1948, the article draws on Stuart Hall’s approach to ‘conjunctural analysis’ to demonstrate how there exist multiple Palestinian geographies; how such
geographies stand in relations of domination and subordination vis-??-vis one another and the Israeli state; and how such geographies remain prone to rupture and transformation. The article insists on a conjunctural reading that refutes teleological understandings of settler colonialism: there
are no guarantees that its dominant modes of dispossession and elimination will succeed.
Queer Ukraine perspectives
Authors: Grayson Debs , Vlada
Published: September 2024

Debs Grayson talks to T and Vlada, the DViJKA collective Why Ukrainians need solidarity from the British left The DViJKA collective, a duo of Kyiv‐born, UK‐based, artist researchers, discuss the reception in the UK of their collection of essays Queer Ukraine. Since
the full‐scale invasion, queer Ukrainians have embraced anti‐colonial nationalism and the concept of homonationalism, not least because Russia is one of the most notoriously openly queer-phobic empires: the fate of LGBTQIA+ people in Chechnya predicts what will happen under
a Russian occupation. When a state occupies or invades, it creates a sense of a collective struggle: people with whom you’ve never had a connection become people with whom you’re serving. The difficulties of navigating the state and being queer are nevertheless many: for example
being affiliated with entities like the nation state or the military industrial complex; being associated with NATO or the EU. But addressing these issues has to wait until after Ukraine has freed itself from the nuclear‐armed and militarised state on its border. Yet some left sectarians
criticise this stance and align themselves with any anti‐Western power ‐ just because they’re anti‐western.
The return of public ownership amidst neoliberal mutation
Authors: Cumbers Andrew
Published: September 2024

The pursuit of a distinctive agenda around democratic public ownership under the Corbyn leadership was symbolic of the departure from the largely neoliberal economic governance perspective that dominated Labour Party policy in and out of government during the New Labour years. In contrast
to some of the more dismissive critiques of the Corbyn‐McDonnell moment, which either want to caricature it as stuck in a ‘hard left’ groove from the 1980s, or as identifiable as a more traditional social-democratic project of the post 1945 era, it argues that the proposed
programme of democratic public ownership (DPO) was genuinely transformative in its framing around economic democracy as an alternative to neoliberal governance. It was different from past radical Labour programmes in its commitment to decentred and pluralist institutions and ownership forms,
yet still concerned with achieving radical change through the state.
Has ‘the great moving right show’ stopped?
Authors: Rustin Michael
Published: September 2024

How will the new Labour government compare to its New Labour predecessors? This article revisits ‘New Labour’s Double Shuffle’, the critique of the New Labour government that Stuart Hall wrote in 2003, to see how this might provide guidance in understanding the
conjuncture of the Labour government elected in July 2024. Hall???s article had followed on from his pre-election analysis of the Thatcher project in ‘The Great Moving Right Show’, in 1978. His argument was that the dominant agenda of the New Labour governments was one of subordination
to pressures emanating from capital, with the demands of Labour’s supporters being subordinated to this. It is proposed that the relations between the dominant and subordinate elements in these structures should be seen in dialectical terms, as an ongoing struggle between conflicting
social forces. The question is raised of whether the current Labour government is essentially a continuation of the New Labour project, or whether it might be something different. The argument is made that to achieve a favourable outcome in a new struggle for hegemony it is essential that
Labour remain in office for several parliamentary terms, and that there be a critical engagement with what its government does.
The Cerebrospinal Fluid Concentration of Methyltetrahydrofolate and Serum Folate in Children with Developmental Delay, Regression, and/or Refractory Epilepsy
Authors: Nemati Hamid , Boroujeni Anahita Farahzad , Inaloo Soroor , Katibeh Pegah , Shahriari Mahdi
Published: September 2024

Background and Objectives:

Folate is an important vitamin with a significant role in cell metabolism processes, and its deficiency is associated with several diseases. In addition, cerebral folate deficiency is associated with neurodevelopmental disorders. Studying the association of serum and cerebral folate deficiency with childhood neurodevelopmental disorders such as refractory epilepsy, developmental delay, and regression can be an important step towards the improvement of symptoms of such disorders.

Materials and Methods:

In this cross-sectional study, from February to October 2018, 60 children aged 6 months to 5 years; known cases of idiopathic refractory epilepsy; were selected randomly. After recording demographic, and clinical characteristics, cerebrospinal fluid (CSF) and blood samples were taken from the patients and sent to a laboratory for measurement of 5-methyltetrahydrofolate (5MTHF), folate, and homocysteine levels.

Results:

Sixty patients completed the study, including 33 boys (55%) and 27 girls (45%). Mean ± SD of the studied population was 26.93 ± 19.97 months. Eighteen children (30%) had refractory epilepsy, 11 (18.3%) had developmental delay, 12 (20%) had refractory epilepsy and developmental delay, and 19 (31.7%) had refractory epilepsy and developmental regression. The results of brain magnetic resonance imaging (MRI) were normal in 47 (78.3%) children and atrophic in 13 (21.7%) children. Mean ± SD of serum level of homocysteine was 9.14 ± 8.58 μmol/L, that of folate was 11.60 ± 6.89 nmol/L, and that of 5MTHF was 69.23 ± 54.16 nmol/L.

Conclusion:

Measurement of serum folate, homocysteine, and CSF level of 5MTHF are of great importance in patients with developmental disabilities.
Prevalence and Pattern of Leptomeningeal Pigmentation in the Human Brain and Its Role in the Safe Surgical Excision of Extra-Axial Brain Tumors
Authors: Gupta Ankush , Chacko Geeta , Chacko Ari G
Published: September 2024

Background:

Although leptomeningeal melanin pigmentation is well-known, it is not described in the neurosurgical literature. Dark pigmentation native to these transparent membranes might have microsurgical relevance in identifying a plane of dissection.

Objective:

To describe the prevalence of leptomeningeal pigmentation and determine whether its recognition helps during microsurgical excision of extra-axial brain tumors.

Materials and Methods:

This was a prospective cross-sectional observational study in cadavers and neurosurgical patients. Eight adult cadaveric brains were examined for leptomeningeal pigmentation and biopsies taken for histological studies. A total of 126 patients undergoing surgery for cerebellopontine angle and suprasellar lesions were included in the clinical study. The surgeon determined whether the recognition of pigmentation was useful during microneurosurgical arachnoid dissection.

Results:

Seven of 8 cadavers (87.5%) had leptomeningeal pigmentation on the ventral pons, optic chiasm, lamina terminalis, olfactory tract, and gyrus rectus and infrequently on the cerebral convexities. The prevalence of pigmentation was 76.9% in the clinical study, was seen in all pediatric patients, and was significantly higher in males (P = 0.009), with no significant association with skin color. Immunochemistry identified the pigmentation as melanin. Recognition of this pigmentation was deemed to be useful during tumor excision in 78% of the cases.

Conclusions:

Leptomeningeal melanin pigmentation has a prevalence of 76% to 87% in the Indian population and is more often seen in younger males. It is most commonly identified overlying the ventral brain stem and optic chiasm. Recognition of its presence is helpful during arachnoid dissection during most cerebellopontine angle and suprasellar tumor resections.
Isolated Enhancement Effect is the Only MRI Finding for Wernicke's encephalopathy
Authors: He Shuang , Xu Yin-Yan , Chen Shuai , Chen Xi-Ling , Zhang Jie-Wen
Published: September 2024

Wernicke's encephalopathy (WE) is an acute neuropsychiatric disorder that results from thiamine (vitamin B1) deficiency. The typical clinical manifestations, which occur as triads in 20% of patients with the disorder, are acute mental status changes, ophthalmoplegia, and ataxia. Brain magnetic resonance imaging (MRI) has important value in diagnosis as it can reveal abnormalities in the thalamus, mammillary body, third and fourth ventricles, and periaqueductal area. Here we describe a 44-year-old female patient with WE, in the context of fasting following bowel surgery. The unique neuroimaging findings were symmetrical mammillary body and dorsal midbrain abnormalities, only evident on contrast-enhanced brain MRI.
Surgical Outcome of Encephaloduroarteriomyosynangiosis for Moyamoya Disease
Authors: Furtado Sunil V , Basu Eilene , Mehta Anish , Vala Kuldeep , Mohan Dilip
Published: September 2024

Objective:

Indirect bypass surgeries for moyamoya disease have included modifications of procedures involving placement of the superficial temporal artery on the brain pial surface. We evaluate the functional and angiographic outcomes of patients treated with encephaloduroarteriomyosynangiosis (indirect) revascularization and examine the outcome in relation to demographic and radiological factors.

Materials and Methods:

Patients treated surgically for moyamoya disease over a 14-year period were identified. Demographics, clinical presentation, and radiology were analyzed to assign a stage for the disease (Suzuki staging) and the extent of revascularization (Matsushima grade) at the last follow-up. A modified Rankin score was used to assess the clinical status at presentation and the functional outcome at follow-up.

Results:

There were 46 patients operated on by a single surgeon over a 14-year period. A higher incidence of motor deficits, seizures, and speech deficits was seen in the pediatric population. Age, sex, preoperative Suzuki disease stage, and hemispheric involvement had no bearing on angiographic outcome at last follow-up. Three of 46 patients (6.5%) developed immediate postoperative complications. Among 43 patients on follow-up, 39 had stable disease or showed improvement in clinical symptoms with 90% event-free status at last follow-up.

Conclusions:

Indirect revascularization procedures are an effective alternative to direct cerebral revascularizations in the early or advanced stages of moyamoya disease. This is effective in a predominant ischemic presentation as noted in our series.
Retroperitoneal Migration And Transgluteal Extrusion of a Distal Lumboperitoneal Shunt Catheter
Authors: Jivko Surchev K
Published: September 2024

Cerebrospinal fluid shunts provide many and different complications. Only 1–3% of them are rare, related to migration, and perforation of hollow organs. Even more unusual are the complications associated with the distal catheter leaving the peritoneal cavity and the tip migrating through some of the anatomical foramens to the muscle layers on the back. We present a rare complication, migration of the distal lumboperitoneal shunt catheter through the retroperitoneum and the gluteal muscles to the hypoderma. The peritoneal catheter entered the retroperitoneal area, passed through the greater sciatic foramen below the piriformis, and through the gluteal muscles, before it reached the hypodermal area. Despite the continuous improvement of the material of flexible silicone catheters, injuries of hollow organs with subsequent migration to unusual areas still occur. Our case is the only one that has been reported, in which the catheter made its way through the retroperitoneum and the gluteal muscles.
Hypnic Headache
Authors: Rammohan K , Shyma M M , Das Soumitra , Shaji C Velayudhan
Published: September 2024

Context:

Hypnic headache (HH) is a rare primary headache syndrome first described by Raskin in 1988.

Aim:

To describe the occurrence of HH in Indian patients and compare its clinicoepidemiological features to those published in the literature and attempt to trace some of the evolving concepts regarding its etiology and clinical features since it was first described.

Materials and Methods:

Patients attending the neurology outpatient department of a tertiary referral teaching hospital from 01-05-2011 to 30-04-2016 who were identified to have HH as per ICHD 3 beta criteria were included in the study. A meticulous history of the headache and comorbidities, clinical examination, Epworth Sleepiness Scale, blood counts, blood biochemistry, magnetic resonance imaging (MRI) scans of the brain and polysomnography (in selected patients) were done and the results were compared to selected international literature.

Results:

A total of 11 patients with HH were identified during the study period, of which 8 (72.72%) were males and 3 (27.27%) were females. The age of the patients varied from a minimum of 53 years to a maximum of 78 years (Mean: 63.36, SD: 8.09). The frequency of attacks per month ranged from 5 to 46(Mean: 20.36, SD: 11.67). The duration of each headache episode ranged from a minimum of 30 minutes to a maximum of 4 hours (Mean: 1.93, SD: 1.23). The occurrence of the headaches was maximum during the time periods of 0.00–2.00am and 2.00–4.00am (38% and 36%, respectively). The pain was dull in a majority of patients, 7 (63.63%). Trigeminal autonomic features such as lacrimation, ptosis, or rhinorrhea were not recorded from our cohort. Motor activity was noted in 7 (63.63%) cases. Two (18.18%) patients had associated migraine headaches whereas 3 (27.27%) had associated tension-type headaches. None of the patients in our series had chronic obstructive pulmonary disease. Four (36.36%) patients had systemic hypertension and 1 patient (9.09%) had diabetes mellitus. Two (18.18%) patients had symptoms of obstructive sleep apnea syndrome. Three (27.27%) patients had symptoms of excessive daytime sleepiness according to the Epworth Sleepiness Scale. Blood examinations and MRI were normal in all patients, except for the findings of a few lacunar infarcts and nonspecific T2 weighted hyperintensities in 3 patients (27.27%).

Conclusion:

Our study proves the existence of the newly described primary headache syndrome called HH in the Indian population. On comparing our results with the international literature, the similarities are much greater than the differences. MRI voxel-based morphometry to demonstrate the loss of gray matter in the posterior hypothalamus may prove to be a reliable test to diagnose primary HH in the future.
Observations in a Virtual Telephone and WhatsApp Video-Enabled Neurology Clinic During Lockdown in Varanasi, India – A Preliminary Report
Authors: Mishra Vijaya Nath , Pathak Abhishek , Chaurasia Rameshwar Nath , Kumar Anand , Joshi Deepika , Singh Varun Kumar
Published: September 2024

Background:

Globally, social distancing has been practiced during the ongoing coronavirus disease 2019 (COVID-19) pandemic to prevent the transmission of the virus. One of the measures to ensure social distancing and restricting the movements has been national lockdown, to break the chain of transmission. Telemedicine is a cost-effective measure to provide medical services to remote underserved areas.

Objective:

The present study aimed to evaluate the efficacy and acceptability of teleconsultation as an alternative option to in-person consultation in providing continued medical care for neurology patients during the national lockdown period of the COVID-19 pandemic.

Materials and Methods:

The clinical demographic profile, frequency of different neurological disorders, and treatment details of the patients attending the teleneurology consultation (TNCO) outpatient department (OPD) at Sir Sunderlal Hospital (S.S.H.), Institute of Medical Sciences (I.M.S.), BHU, Varanasi, India, were recorded in a prespecified pro forma.

Results:

A total of 1,567 patients attended the TNCO OPD over 90 days. The average patient attendance was 35 per day, and 72% were males. Out of these, 77% of patients were from the same district, and the majority of patients (68%) were regularly followed up in-person by the neurology OPD. The most common illness for consultation was epilepsy (19%) followed by low backache and stroke (18% each). The satisfaction rate among the patients with respect to teleservices was high (90%).

Conclusion:

TNCO seems to be as effective as in-person OPD in the management of neurological disorders. During the lockdown due to the COVID-19 pandemic, avoiding physical visits through TNCO may reduce the spread of the virus. Parallel tele-OPD with routine OPD is a good option in the future.
Pineal Parenchymal Tumor of Intermediate Differentiation (PPTID) and Papillary Tumor of Pineal Region (PTPR)
Authors: Sadashiva Nishanth , Deora Harsh , Arumalla Kirit , Rao Shilpa , Saini Jitender , Shukla Dhaval , Santosh Vani
Published: September 2024

Background:

Pineal parenchymal tumors account for less than 0.3% of all CNS tumors and “Pineal parenchymal tumor of intermediate differentiation” (PPTID; World Health Organization (WHO) grades II and III) exhibit intermediary differentiation and prognosis. However “Papillary tumor of the pineal region” (PTPR; WHO grades II and III) is a distinct entity.

Objectives:

This combination of rarity and apparent similarity often leads to perplexity regarding the treatment and prognosis among neurosurgeons. In this review, we have tried to elucidate the differences in clinical as well as treatment modalities and outcomes of these two entities.

Methods:

We used the PubMed Database to search for all relevant articles using the keywords “pineal parenchymal tumor of intermediate differentiation” and “Papillary tumor of the pineal region.” Articles having details regarding demographic and clinical variables along with treatment and outcomes were chosen for this study. Full text of these articles was analyzed, and data tabulated.

Results:

A total of 25 articles for PPTID and 45 for PTPR were found suitable for inclusion in this study. The studies were either case reports or small retrospective series with only one systemic review for each pathology. Despite the poor quality of data, some trends were apparent. Surgical resection offered a survival benefit in both pathologies. Radiotherapy was effective in increasing the survival in PPTID, while there was little to no effect in PPTR. Chemotherapy was not found to be beneficial in either.

Conclusion:

Both of these tumors have moderate growth rate and potential for malignant behavior. This continuum of characteristics makes their optimal treatment strategy difficult and confusing. The discussion on comprehensive literature review should give information for neurosurgeons to decide on optimal treatment strategies.
A Novel Mutation in KMT2B Gene Causing Childhood-onset Generalized Dystonia with Expanded Phenotype from India
Authors: Padmanabha Hansashree , Awati Akash M , Thomas Kurian , Sarma Gosala R K
Published: September 2024

Mutations in KMT2B (lysine-specific methyltransferase 2B) gene, which is primarily involved in methylation of Histone3lys4 (H3K4), has been recently described to cause early-onset generalized progressive dystonia (DYT28) by two independent researchers. Unlike other primary dystonias, mutations in KMT2B gene is associated with additional features like dysmorphism (elongated face, bulbous nose), microcephaly, short stature, and multisystemic involvement. Herein, we describe a 13-year-old boy with early-onset, generalized, progressive complex severe dystonia, along with mild intellectual disability, dysmorphism, and dermatological manifestations associated with a novel missense variation in KMT2B gene and also expand the phenotypic spectrum of the same.
Neuro-Behçet's Disease Mimicking Low-Grade Glioma Presenting with Drop Foot
Authors: Sarac Mustafa Emre , Oktay Kadir , Guzel Ebru , Mammadov Mansur , Sari Ibrahim , Guzel Aslan
Published: September 2024

Behçet's disease is a multisystem inflammatory disease that manifests with oral–genital ulcers, skin lesions, arthritis, and ophthalmologic and neurovascular findings. Neurological involvement of Behçet's disease is called neuro-Behçet's disease, and it is a difficult entity to diagnose because of insufficient symptoms. We present a 26-year-old male patient with complaints of headache, dizziness, and drop foot in the right lower extremity. He underwent gross total tumor resection with the preliminary diagnosis of low-grade glioma, according to the preoperative magnetic resonance imaging. Histopathological examination and further investigation revealed an interesting neuro-Behçet's disease case because of the localization and clinical occurrence of the lesion.
Primary Spinal Intradural Ewing's Sarcoma
Authors: Karthigeyan Madhivanan , Malik Puneet , Sahoo Sushanta K , Salunke Pravin , Vankipuram Sidharth , Sagar Mala , Das Ashim
Published: September 2024

Extraosseous primary spinal intradural Ewing's sarcoma (ES) is an unusual entity. Bleed within such tumors with acute neurological worsening is extremely rare, especially in the pediatric age. In this article, we present two children with intradural-extramedullary ES who had sudden decline in their neurological status consequent to an intratumoral hemorrhage. We discuss their clinical course and also briefly review the pertinent literature. Spinal intradural Ewing's sarcomas possibly have a tendency to bleed. A short clinical symptomatology along with an acute neurological deterioration and radiologic evidence of intratumoral hemorrhage in a spinal intradural tumor should raise the suspicion of an ES.