bluuebunny/crossref_metadata_2025 huggingface dataset:
Transnasal Endoscopic Surgery for Suprasellar Meningiomas
Authors: Gupta Prasheelkumar P , Shaikh Salman T , Deopujari Chandrashekhar E , Shah Nishit J
Published: December 2021

Aim:

Endoscopic trans-nasal surgery has evolved a long way from the days of narrow corridors with high rates of cerebrospinal fluid (CSF) leak to the present state of HD optics with better tissue differentiation, extended approaches, and use of vascularized flaps for defect closure. Trans-nasal approach is an established technique for pituitary tumors practiced worldwide. However, trans-nasal endoscopic excision of suprasellar meningiomas provides a tougher challenge in terms of instrument manipulation, tumor excision with good visual outcome, and a robust defect closure to prevent CSF leaks.

Materials and Methods:

Out of 83 cases of midline anterior cranial fossa meningiomas operated over 14 years, our experience in 12 cases of suprasellar meningiomas for radical resection via the trans-nasal endoscopic route is discussed.

Results:

Amongst these, six were excised via primary extended endoscopic trans-sphenoidal surgery, four cases had a residual lesion or recurrence after primary transcranial surgery, and two cases involved a combined transcranial and extended endoscopic approach. Visual improvement along with resolution of headache was seen in all patients postoperatively. None of the patients had CSF leak requiring further repair. Syndrome of inappropriate antidiuretic hormone was found in one patient, which was transient and easily corrected.

Conclusion:

Trans-nasal endoscopic surgery for suprasellar meningiomas is an effective technique that provides results of tumor excision comparable to the transcranial approach in suitable cases. Visual outcome was found to be superior, and rates of CSF leak were remarkably reduced with vascularized flap. However, each case must be assessed individually and lateral extension beyond the optic canals with internal carotid artery encasement must be considered before planning surgery.
Cerebello-pontine and Cerebello-medullary Fissure Choroid Plexus Papilloma in a Child – Case Report and Review of Literature
Authors: Sridhar K , Subramaniam Sushanth
Published: December 2021

Choroid plexus papillomas (CPP) are commonly seen in the supratentorial compartment in children and only very rarely in the posterior fossa. CPP in the cerebello-pontine angle and cerebello-medullary fissure (CPA) in the pediatric age group are extremely rare with only seven previous cases reported in literature. The authors present the case of a 7-year-old girl who presented with neck tilt, imbalance, and headache. The MRI showed a lesion with a frond-like appearance in the CPA with heterogeneous enhancement. The tumor was excised radically using a cerebello-medullary fissure approach. The authors review and analyze the literature on this rare pediatric tumor, with specific attention to radiology and the surgical aspects.
Shunt Complications – Staying Out of Trouble
Authors: Balasubramaniam Chidambaram
Published: December 2021

Background and Objective:

To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ‘ ‘neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications.

Methods and Materials:

The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications.

Results:

Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience

Conclusions:

Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences.
Hydrocephalus Research
Authors: Mahapatra Ashok K
Published: December 2021

Objective:

This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field.

Material:

Over a period of three decades, basic research, clinical investigations, and multicentric studies were undertaken. This report will review the work mainly to emphasize the need for future generations to pursue further research. Studies that impacted hydrocephalus care (mainly in India) are described, and some of these findings may be useful in other resource-challenged situations.

Results:

Investigative studies on the effect of shunting on brainstem auditory evoked responses (BAER), transcranial Doppler (TCD), and CT-SPECT were published offering management options for patients. Participation in the International Infant Hydrocephalus Study (IIHS) study offered opportunities to compare our approaches and develop modifications in patient care. This effort proved shunting was equal or better for young children with congenital aqueductal stenosis. Shunt infection protocols and changes made in a systematic manner helped develop local protocols to reduce postoperative shunt infections.

Conclusions:

Hydrocephalus research over three decades at AIIMS, New Delhi was productive and educational, confirming that locally performed investigative work can help in decision making. Further studies and active participation in international efforts are necessary to advance the field.
Techniques and Nuances in Ventriculoperitoneal Shunt Surgery
Authors: Pillai Shibu V
Published: December 2021

Background:

Ventriculoperitoneal shunt surgery (VPS) is a simple solution to the problem of hydrocephalus. However, it is associated with significant complications. Meticulous attention to a variety of factors, techniques, and nuances in VPS can reduce these complications.

Objective:

To review the various techniques and nuances during the different stages of VPS.

Methods and Material:

PubMed search for original and review articles dealing with various techniques used during VPS.

Results:

Thorough preoperative planning for VPS reduces operative time and complications. A standardized shunt surgery protocol significantly reduces shunt infection. Good and appropriate surgical technique can enhance the safety of the procedure. Anterior entry point is better than posterior entry point. Shunt tip should be away from choroid plexus, but the exact location is not vital for shunt survival. Proper placement of the shunt in the subgaleal and subcutaneous plane reduces wound and skin breakdown over the shunt. The trocar and laparoscopic methods to access the peritoneum are associated with fewer distal obstructions compared to mini-laparotomy. Perioperative antibiotic prophylaxis, use of antibiotic-impregnated shunts, and sutures are proven techniques to reduce shunt infection.

Conclusions:

Preoperative planning, a standardized shunt surgery protocol, good surgical technique, gentle tissue handling, and short surgery duration are essential to reduce VPS complications. Specifically, use of anterior entry point, correct tunneling of the shunt in the subgaleal and subcutaneous plane, appropriate antibiotic prophylaxis, use of antibiotic-impregnated shunts, and meticulous skin closure using antimicrobial sutures can lead to a reduction in shunt malfunction and infection.
Normal-Pressure Hydrocephalus - Patient Evaluation and Decision-Making
Authors: Vibha Deepti , Tripathi Manjari
Published: December 2021

Background:

Normal-pressure hydrocephalus (NPH) presents with the triad of gait difficulty, urinary incontinence, and cognitive decline. However, the definitive diagnosis and treatment may be challenging at times due to secondary causes of NPH (sNPH) versus idiopathic NPH (iNPH), co-existing other degenerative, vascular, and metabolic causes of similar clinical presentations.

Objective:

The objective of this narrative review is to outline the approach to patient evaluation and decision-making in cases where there is clinical suspicion of iNPH.

Methods:

This review article intends to provide a practical approach to the patients with a suspected diagnosis of iNPH.

Results:

The cardinal clinical features with a guide from investigations like magnetic resonance imaging (MRI) brain and cerebrospinal fluid (CSF) analysis, and CSF tap assessment have been outlined. The interpretation of conflicting MRI brain findings or CSF analysis may need resolution by further tests. The decision algorithm following the examination and investigations has been included to address the dilemma in the case of a non-supportive MRI and/or CSF tap test.

Conclusion:

iNPH is a treatable cause of the cognitive decline and gait disorder. While neurodegenerative causes may accompany iNPH, any patient with improvement after CSF drainage deserves therapeutic intervention.
Controversies in Hydrocephalus
Authors: Udayakumaran Suhas , Pattisapu Jogi V
Published: December 2021

Background:

Hydrocephalus is a complex issue characterized by increased intracranial pressure secondary to obstruction of cerebrospinal fluid flow and occasionally due to overproduction. As a result, the entity has challenges of different dimensions at the level of understanding and management.

Methods:

A literature search, systematic review, and meta-analysis of eligible studies were conducted in the major databases. The literature review included relevant articles on hydrocephalus published until June 1, 2021 (no starting date), databases being the only limitation considering the broadness of the subthemes. Controversies themes were chosen among the literature, not including treatment dilemmas and hydrocephalus research. The further detailed search included these selected themes and an updated literature review on the subjects.

Results and Discussion:

Controversies are a hallmark of incomplete science; most complex concepts harbor several debates at various levels. This article reviews controversies in hydrocephalus, offering some updates on popular discussions. It is not meant to be an exposition of the topics themselves but to collect the status quo of unresolved concepts in hydrocephalus.

Conclusions:

As with most chronic and complex disorders, hydrocephalus welcomes controversy as a healthy discussion platform to exist until we understand the disorder to its minutest.
Clinical Outcome, Cognitive Function, and Quality of Life after Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt in Non-Tumor Hydrocephalus
Authors: Dhandapani Manju , Yagnick Nishant S. , Mohanty Manju , Ahuja Chirag K. , Dhandapani Sivashanmugam
Published: December 2021

Background:

Endoscopic Third Ventriculostomy (ETV) is increasingly being accepted as the treatment of choice in place of Ventriculo-Peritoneal (VP) Shunt for hydrocephalus. However, their differences in cognitive and Quality of Life (QOL) scores have not been studied much in children.

Objective:

To compare the outcome, cognitive function, and QOL between ETV and VP shunt.

Methods:

Patients of non-tumor hydrocephalus treated with ETV or/and VP shunt underwent cognitive assessment (using modified child MMSE standardized as per the age group) and QOL (using PedsQL as per the age group in Physical, Emotional, Social, and School Functioning domains) in addition to the outcome of not requiring additional intervention.

Results:

Out of 139 patients, there were 29 infants and 40 children upto 14 years. Among these children, ETV was the primary intervention in 45, VP shunt in 24, and could be studied for a mean follow-up of 1.7 years. Though ETV required lesser additional intervention than VP shunt (19.2% vs. 28.6%) in toddlers and older children, there was no overall significant difference. Subnormal cognitive scores were noted in 25%, 40%, and 50% after ETV, single shunt procedure, and multiple shunt procedures, respectively, with no statistically significant difference. Among the different domains of QOL, the child reported scores in the social domain were significantly better after ETV than VP shunt (475[+13] vs. 387[+43], P value 0.03), whereas most other scores were non-significantly better following ETV.

Conclusion:

Patients who underwent ETV show a trend for better clinical outcome, cognitive function, and QOL with significantly better child-reported QOL scores in the social domain.
Post-Infective Hydrocephalus
Authors: Garg Kanwaljeet , Gupta Deepak
Published: December 2021

Background:

Post-infective hydrocephalus (PIH) arises as a complication of any CNS infection, and can be either communicating or noncommunicating.

Objective:

The aim of this article is to study the various causes of PIH and its pathophysiology and treatment.

Material and Methods:

The literature was searched for articles describing the causes of PIH.

Results:

Common causes of PIH are CNS tuberculosis (TB), neurocysticercosis, and perinatal or neonatal infection. TBM is most likely to result in hydrocephalus out of all these manifestations of CNS TB, and hydrocephalus is more likely to occur early in the course, typically 4–6 weeks after the onset of TBM, and is more common among children as compared to adults. A trial of medical management (antitubercular therapy, steroids, and decongestants) can be given to patients with communicating hydrocephalus. Ventriculoperitoneal shunt is the most employed method of CSF diversion in these patients. Though traditionally considered contraindicated, many recent studies have found ETV to be a reasonable option in patients with PIH. HCP in patients with neurocysticercosis can be associated with intraventricular cysts and racemose cysts in the basal subarachnoid cisterns. Surgical intervention is required either for cyst removal or CSF diversion. Endoscopic approaches can be used to remove the intraventricular cysts, which takes care of the HCP. PIH in infants can result either from antenatal infections (TORCH infections) or postnatal infections such as meningitis.

Conclusions:

Management of PIH can be challenging. Management has to be individualized.
Hydrocephalus in Tuberculous Meningitis - Pearls and Nuances
Authors: Paliwal Vimal K , Garg Ravindra K
Published: December 2021

Tuberculous meningitis (TBM) is associated with high mortality. A large proportion of patients with TBM, who survive, live with disabling neurological sequelae. Hydrocephalus is one of the common complications of TBM, seen in up to 80% of patients. Hydrocephalus may be a presenting feature or may develop paradoxically after the commencement of antituberculosis treatment. The Hallmark pathological feature of TBM is a thick gelatinous exudate, dominantly present at basal parts of the brain. Exudate encases and strangulates cranial nerve trunks like optic nerve, optic chiasma, and vessels of the circle of Willis. Basal exudate also blocks the cerebrospinal fluid (CSF) flow in the brain, resulting in ventriculomegaly. It is often difficult to differentiate between two common types (communicating and obstructive) of hydrocephalus on basis of routine neuroimaging. Progressive hydrocephalus, clinically manifests with a potentially life-threatening high intracranial pressure. Patients with deteriorating vision loss and deteriorating consciousness, often need a surgical CSF diversion procedure (ventriculoperitoneal shunt or endoscopic third ventriculostomy) to be performed. CSF diversion may be life-saving. However, the long-term benefits of CSF diversion are largely unknown.
Lamotrigine-Associated Movement Disorder
Authors: Rissardo Jamir Pitton , Caprara Ana L Fornari
Published: December 2021

Background:

Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug.

Objective:

This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders.

Methods:

Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included.

Results:

In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal.

Conclusions:

In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done.
The Relationship between Patterns of Remodeling and Degree of Enhancement in Patients with Atherosclerotic Middle Cerebral Artery Stenosis
Authors: Zhang Dan-Feng , Wu Xin-Ying , Zhang Wei-Dong , Wang Mi , Yin Xindao , Chen Yu-Chen
Published: December 2021

Purpose:

The aim of this research was to investigate the relationship between remodeling patterns and degree of enhancement in patients with atherosclerotic middle cerebral artery (MCA) stenosis using high-resolution magnetic resonance imaging (HR-MRI).

Materials and Methods:

From August 2015 to May 2016, 38 consecutive patients with unilateral MCA stenosis on time-of-flight (TOF) MR angiography were prospectively enrolled. The routine MR scan and cross-sectional images of the stenotic MCA vessel wall on HR-MRI were performed in all patients. Among them, 17 patients displayed positive remodeling (PR) and the other 21 patients displayed negative remodeling or non-remodeling (non-PR). The patients displaying hyperintense on diffusion-weighted imaging (DWI) in the territory of ipsilateral stenotic MCA were considered to have had acute stroke. Subsequently, the differences in the degree of enhancement and the number of acute stroke patients between the PR group and the non-PR group were compared. The Spearman rank correlation analysis of the enhancement degree (ED) and the remodeling index (RI) was calculated. Then, receiver operating curve (ROC) was used to evaluate diagnostic efficiency of RI and ED for acute infarction.

Results:

The PR group had more obvious enhancement plaques than the non-PR group (10 versus 3, P = 0.006). The PR group also had a larger number of acute stroke patients than the non-PR group (15 versus 4, P = 0.000). The spear-man rank correlation analysis showed that the degree of enhancement had a weak positive correlation with the remodeling index (r = 0.379, P = 0.019). The area under the curve (AUC) of RI and ED was higher than that of RI (0.924: 0.842).

Conclusion:

The PR, obvious enhancement predicted vulnerable plaques that were more prone to causing acute stroke. RI and ED had valuable diagnostic efficiency for acute infarction.
Science and Art of Reviewing Papers to Maintain Standards in Academia
Authors: Ganapathy Krishnan
Published: December 2021

This review article highlights the necessity and importance of peer review of articles submitted to journals. Publication in a peer reviewed, good impact indexed journal is an indirect endorsement of the article contents. The editor and the readership depend on the integrity and total involvement of reviewers. What is expected of the reviewer and the authors is discussed. Reviewers need to be sensitive to authors' reactions. Authors should also respond, not react or be hypersensitive.
Skull Base Chordoma
Authors: Roy Amrit , Warade Anshu , Jha Ashish K , Misra Basant K
Published: December 2021

Background:

Skull base chordoma (SBC) is relatively rare and data on its clinical outcome after surgical resection and adjuvant radiotherapy are still limited.

Objective:

Analyzing the clinical postoperative outcome of SBC patients and defining prognostic factors regarding current treatment modalities.

Methods and Material:

In this study, 41 SBC patients from 2001 to 2017 were retrospectively analyzed in this single-center study.

Results:

The most common clinical symptoms were headache (63%) and problems concerning vision (54%) like diplopia. The follow-up controls took place from 1 to 192 months. The mean survival time for the patients was 123.37 months (95% CI 90.89–155.86). The 5- and 10-year survival rates were 73.3 and 49%, respectively. Regarding the Karnofsky-Performance Scale (KPS), Cox regression showed a significant relationship between the survival rates in the overall study population and pre-surgery KPS (P = 0.004). This was further supported with a positive significant correlation between the pre-surgery KPS and the KPS at the last follow-up (P = 0.039).

Conclusion:

Statistical analysis showed that repeat surgical resection and radiotherapy could be prognostic factors. Furthermore, we were able to show that mortality decreased by 4.5% with each 10 points increase of pre-surgery KPS. This could be a major prognostic factor when deciding treatment modalities. Nevertheless, further standardized clinical studies with a larger patient population should be carried out to extrapolate prognostic factors and improve treatment modalities.
CHADS2 and CHA2DS2-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke
Authors: Ekizoglu Esme , Atmaca Murat M , Çinar-Balcıoglu Çagla , Yesilot Nilufer , Çoban Oguzhan
Published: December 2021

Background and Aims:

Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy.

Material and Methods:

We calculated CHADS2 and CHA2DS2-VASc scores in patients with first ever CIS; those previously managed with antiplatelets (AP group) and in those without antiplatelets (non-AP group), using the prospectively recorded data of the Istanbul Medical School Stroke Registry from 1996-2014.

Results:

Of the 4466 IS patients, 886 patients with first ever IS had complete data for score calculation. Seventy-five (39 women) of them were diagnosed with CIS. CHADS2 and CHA2DS2-VASc scores were significantly higher in the AP group of 19 patients in comparison to the non-AP group of 56 patients (P = 0.005 and P = 0.009, respectively). ROC curve analyses showed an area under curve (AUC) of 0.705 (CI: 0.57-0.84; P = 0.008) for CHADS2 score ≥3 and AUC of 0.699 (CI: 0.57-0.82; P = 0.01) for CHA2DS2-VASc score ≥4. Vascular diseases were more frequent in the AP group and these patients were older than the patients in the non-AP group (P = 0.025, P = 0.024; respectively).

Conclusions:

CHA2DS2-VASc score ≥ 4 and CHADS2 score ≥3 may be used as a predictor of the occurrence of IS despite regular antiplatelet use and suggest an embolic source which will respond better to anticogulation. Our results support that CHADS2 and CHA2DS2-VASc scores may be useful to identify subgroups among patients with CIS for individualizing diagnostic approach, planning future workup and preventive treatment.
Morphometric Analysis of parameters of Internal Carotid Artery—Potential Clinical Implications
Authors: Sharma Suyashi , Dixit Shilpi G , Khera Pushpinder S , Nayyar Ashish K , Ghatak Surajit
Published: December 2021

Background:

The study in consideration aimed to do morphometry of internal carotid artery (ICA) and substantiate any differences significant in relation to sex and age on digital subtraction angiography (DSA) imaging.

Objectives:

Our study aims to ascertain morphometric parameters of ICA through DSA evaluation and to build a normative data which is accurate enough for the neurovascular procedures to be performed. The study will also carry out correlation of morphometry of intracerebral blood vessels with sex, age, and side-related dimorphism.

Material and Methods:

Our study, cross-sectional in design was done on 70 patients (>20 years). Diameter of different segments of ICA were measured after imaging was done on DSA using a Philips biplane system clarity (Allura FD20/20). Statistical analysis was done.

Result and Conclusion:

In males, mean diameter of petrous, cavernous, supraclinoid, and choroidal segments of ICA were more when compared to females. Statistically significant differences were found in supraclinoid segment of ICA between males and females. The mean diameter of supraclinoid and choroidal segments of ICA showed a decreasing trend from younger to older age groups. The difference in the mean diameter of petrous segment of ICA with increasing age was statistically significant. The results of our study show that differences were statistically significant in supraclinoid segment of ICA in males and females. Neurosurgeons in order to be confident in tackling the various emergencies in this region need to have in-depth knowledge of morphometery of cerebral arterial circle.
Real-Time 2D Ultrasound Guided Frameless Biopsy of a Multifocal Glioma
Authors: Yeole Ujwal , Singh Vikas , Shetty Prakash , Moiyadi Aliasgar
Published: December 2021

Background and Introduction:

Intraoperative ultrasound imaging can be a multi-dimensional tool with various applications, including localization, resection control, and biopsy of brain tumors.

Objective:

We demonstrate a frameless biopsy technique by using real-time 2D ultrasound (RT-2DUS) for localizing and guiding the biopsy of cranial tumors.

Technique:

A 60-year-old male presented with progressive right hemiparesis, memory, and behavioral disturbances. MRI brain showed a multifocal lesion in the left temporal, parietal, and occipital lobes with extension into the splenium. He underwent left parietal mini-craniotomy with frameless RT-2DUS-guided biopsy.

Result:

Postoperative US scan showed a small biopsy site hematoma. Histopathology confirmed it to be IDH-negative primary glioblastoma. For multifocal glioma, the patient underwent adjuvant WBRT with concurrent and adjuvant temozolomide.

Conclusion:

RT-2DUS improves the sampling accuracy of the tumor by detecting the solid component of the lesion intraoperatively. In addition, the detection of operative site hematoma can be picked up immediately, avoiding post-procedure imaging.
Multiple Sclerosis-Minimizing Errors in Radiological Diagnosis
Authors: Boski Neha , Gulati Vaibhav , Raj Rohan , Gulati Parveen
Published: December 2021

Background:

Multiple sclerosis is a chronic demyelinating disorder with a myriad of imaging and clinical features that overlap with number of other neurological conditions. Incorrect diagnosis poses a significant risk to patients, it may lead to delays in management, increased morbidity, and also adds to the financial cost.

Objective:

The aim of this study was to highlight strategies for the efficient differentiation of multiple sclerosis from other diseases which may masquerade as MS clinico-radiologically.

Material and Methods:

A systematic literature review was conducted through online databases including PubMed and Medline. Relevant publications on radiological aspects of multiple sclerosis, white matter diseases and mimickers of Multiple sclerosis were included in the analysis.

Results:

Common mimickers of MS include small vessel disease, acute disseminated encephalomyelitis, neuromyelitis optica, anti-MOG encephalomyelitis, vasculitis, and CADASIL. Contrast-enhanced MRI study performed using MS protocol on high strength MRI system evaluated following a structured protocol along with clinical correlation is effective in differentiating MS from its mimickers.

Conclusions:

Contrast-enhanced MRI performed on a high strength scanner using MS protocol with structured protocol for evaluation along, with a better collaboration between radiologists and clinicians may help in minimizing errors in diagnosis of multiple sclerosis.
Recurrent Spontaneous Cerebrospinal Fluid Leaks at Multiple Levels
Authors: Bhoi Sanjeev Kumar , Naik Suprava , Gupta Devendra , Pradhan Prasanta K , Kalita Jayantee , Misra Usha K
Published: December 2021

Intracranial hypotension due to multiple spinal epidural cerebrospinal fluid (CSF) leak is rare and has multiple etiologies. These patients require epidural blood patches (EBP). We report a patient with recurrent paraplegia due to intracranial hypotension following recurrent epidural CSF leak. Cerebrospinal fluid leak was noted at D1, D10, D11, and L2 levels. Autologous epidural blood patch (EBP) at lower thoracic (3 ml) and lumbar region (4 ml) was performed. The patient developed paraplegia with sensory level at D2 for which 3 ml of EBP was done at D1 level after two months. Following EBP, the patient developed quadriplegia and root pain, which recovered in one month. The patient was free of symptoms for 18 months. Spinal epidural CSF leak should be suspected in patients with features of low pressure headache and recurrent paraplegia at multiple levels. Nuclear scintigraphy and CT myelography help in localizing the site of leak.
New Onset Refractory Status Epilepticus as a Manifestation of Tuberculosis of the Central Nervous System
Authors: Shah Preet M , Deshmukh Varun , Poncha Fali , Dhakre Vijay
Published: December 2021

A 28-year-old male presented to us with new onset refractory status epilepticus. Prior to his seizures, he had a history of fever, headache and blurring of vision, for which he was admitted elsewhere. No cause was found; he was treated symptomatically and was discharged as his symptoms had abated. Post-discharge, he started having multiple seizures. Neuro-imaging suggested encephalitis. He progressed to status epilepticus and was referred to our center. We intensified the anti-epileptic medications but owing to no response, he had to be put under coma with thiopental, yet the seizures persisted. Workup for the etiology of his seizures was negative except for CSF TB-PCR (Gene Xpert) being positive and hence anti-tuberculous therapy was initiated. By this time, he developed rhabdomyolysis, and thereafter renal failure with dyselectrolytemia, and thus there was a plan to initiate dialysis. But before this could be done, he succumbed to a cardiac arrest secondary to ventricular tachyarrhythmias. We believe this to be the first reported case of new onset refractory status epilepticus secondary to tuberculosis of the central nervous system.
Surgical Management of Tuberculum Sellae Meningioma
Authors: Sankhla Suresh K , Jayashankar Narayan , Khan Maqsood A , Khan Ghulam M
Published: December 2021

Background:

Tuberculum sellae (TS) meningiomas are benign lesions that produce neurological deficits through a mass effect on vital neurovascular structures. The treatment of choice is surgical removal with the ultimate goal to improve vision and achieve total tumor removal.

Objective:

We analyzed clinical features, tumor characteristics, and surgical approaches in 62 consecutive patients with TS meningiomas to identify factors influencing the postoperative outcome.

Methods:

The authors reviewed the medical records of all patients of TS meningiomas who underwent surgery at our institute between 2005 and 2018. Pre- and postoperative clinical data, including the operative findings, of these patients were analyzed.

Results:

Sixty-two patients who underwent surgery for removal of TSM, transcranial (TCA) in 38, and endoscopic endonasal (EEA) in 24, were identified. Gross total resection was performed in 84% and 87.5% patients in the TCA and EEA groups, respectively. A significantly higher rate of visual improvement was observed in the EEA group as compared to TCA (96% versus 79%). Visual worsening after surgery was greater with TCA than EEA (21% versus 4%). Fourteen (37%) patients in the TCA group experienced different postoperative complications, and CSF leak was the main complication in the EEA group.

Conclusions:

TCA and EEA are both associated with higher rates of GTR and visual improvement without compromising the safety of the procedure. An optimal outcome, however, depends on the careful selection of cases based on the tumor location and morphology, and the surgeon's familiarity with the surgical approach.
Recurrent Ischemic Strokes
Authors: Mathew Thomas , John Saji K , Souza Delon D , Nadig Raghunandan , Badachi Sagar , Sarma GRK
Published: December 2021

Background:

Antiplatelet therapy (APT) is an integral part of secondary stroke prevention. Noncompliance to APT is an important factor in stroke recurrence. In this study, we have evaluated the reasons for noncompliance to APT.

Objective:

The aim of this study was to identify the various causes of nonadherence to APT in recurrent stroke patients.

Material and Methods:

The study was conducted in a tertiary care hospital in south India with a huge stroke burden. The study period was from October 2017 to September 2018. A total of 60 consecutive patients of recurrent stroke who were nonadherent to antiplatelet therapy were evaluated for various factors that prevented compliance.

Results:

During the 12-month study period among 604 ischemic stroke patients, 128 (21%) had recurrent strokes. Of this 128, 60 (46.8%) were due to discontinuation of APT. The main factor for nonadherence to APT was lack of awareness about the need for lifelong medication (41/60; 68.3%). 10 patients (16.7%) stopped treatment as they opted for alternative therapy and 4 (6.7%) discontinued antiplatelets due to side effects. A small proportion of the patients (3.3%) cited financial constraints and forgetfulness as the issue, while 1.7% had difficulty in finding assistance to administer medicine. 27 (45%) patients had recurrent stroke within 2-15 days of stopping APT.

Conclusions:

The main reason for nonadherence to antiplatelet therapy is lack of awareness about the need for lifelong antiplatelet therapy. Stroke patients should be educated about the importance of lifelong antiplatelet therapy to prevent recurrent strokes.
Neoadjuvant chemotherapy for patients with locally advanced penile cancer
Authors: Yi Xian-Yan-Ling , Cao De-Hong , You Ping-Hong , Xiong Xing-Yu , Zheng Xiao-Nan , Peng Ge , Liao Da-Zhou , Li Hong , Yang Lu , Ai Jian-Zhong
Published: December 2021

Neoadjuvant chemotherapy (NAC) has shown promising results in patients with locally advanced penile cancer. However, no consensus exists on its applications for locally advanced penile cancer. Thus, it is unclear which kind of chemotherapy regimen is the best choice. Consequently, a systematic search of PubMed, Web of Science, and EMBASE was performed in March 2021 to assess the efficacy and safety of NAC for the treatment of patients with locally advanced penile cancer. The Newcastle–Ottawa Scale was used to assess the risk of bias in each study. This study synthesized 14 published studies. The study revealed that patients who achieved an objective response to NAC obtained a better survival outcome compared with those who did not achieve an objective response. In addition, the objective response rates (ORRs) and pathological complete response (pCR) rates were 0.57 and 0.11, respectively. The incidence of grade ≥3 toxicity was 0.36. Subgroup analysis found that the ORR and pCR of the taxane–platinum (TP) regimen group performed better than those of the nontaxane–platinum (NTP) regimen group (0.57 vs 0.54 and 0.14 vs 0.07, respectively). Moreover, the TP regimen group had more frequent toxicity than the NTP regimen group (0.41 vs 0.26). However, further studies were warranted to confirm the findings.
Case Report
Authors: Xie Haiyang
Published: December 2021

A patient suffered from recurrent episodes of palpitations and documented wide QRS complex tachycardia. Echocardiography revealed no obvious abnormal heart structure. A diagnostic electrophysiological study was performed and fast-slow atrioventricular nodal reentrant tachycardia with aberrancy was diagnosed. Successful slow pathway ablation rendered the tachycardia noninducible.
Proportion of rapid eye movement sleep related obstructive sleep apnea (REM related OSA) in patients with sleep disordered breathing: A cross sectional study
Authors: Nair Sharada C , Arjun Padmanabhan , Azeez Ameer Kavarathukudy , Nair Sanjeev
Published: December 2021

Background and Objectives:

Obstructive sleep apnea (OSA) during rapid eye movement (REM) stage of sleep is gaining importance in recent years. This study was done to determine the proportion of REM-related OSA and its associated polysomnographic features.

Methods:

One hundred forty-two patients were included in the study. REM-related OSA was defined based on previously established broad and strict criteria (REM apnea–hypopnea index [AHI]/non-REM [NREM] AHI ratio ≥2 and REM AHI >5 with NREM AHI <5, respectively), and its association with polysomnographic features was studied using appropriate statistical tools.

Results:

The proportion of REM-related OSA in the study was 56.3% and 25.3% as per broad and strict criterion, respectively. The REM-related OSA group had a mean younger age (47.4 ± 13.2 years) as compared to NREM-related OSA group (52.6 ± 15.8 years). Females (34 out of 45; 75.6%) were more likely to have REM-related OSA as compared to males (46 out of 107; 47.4%). Supine AHI, arousal index, oxygen desaturation index, length of the longest event, and the lowest oxygen saturation recorded during sleep had a significant association with REM-related OSA. 74% of patients with overall AHI <5 and 87% patients with overall AHI 5 to 15 satisfied the criteria for REM-related OSA as per broad criterion.

Conclusion:

REM-related OSA was quite prevalent in the study population (56.3%) and was more common in the mild and moderate severity subgroups of OSA.
The clinical experience of macitentan in pulmonary hypertension in Indian cohort: 12-month follow-up
Authors: Jariwala Pankaj , Maturu Venkata Nagarjuna , Jadhav Kartik Pandurang , Punjani Arshad , Boorugu Harikishan
Published: December 2021

Background:

The effectiveness and safety of macitentan, an endothelin-receptor antagonist (ERA) in the treatment of pulmonary arterial hypertension (PAH), has been demonstrated in numerous randomized clinical trials including SERAPHIN, focused on the reduction of morbidity and mortality.

Objectives:

Our aim was to demonstrate the clinical and echocardiographic progression using macitentan in Indian patients with PAH.

Settings and Design:

It was a retrospective study of 20 patients with multiple etiologies of PAH who had begun macitentan in routine clinical practice from a single center. There were 55% of patients with existing PAH therapies.

Subjects and Methods:

The World Health Organization functional class (WHO-FC), 6-min walking distance, N-terminal prohormone of brain natriuretic peptide level (NT-pro-BNP), and echocardiographic data such as tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the occurrence of pericardial effusion were collected at baseline and 12-month follow-up. The statistical analysis was performed using SPSS software.

Results:

Of the 20 PAH patients, 70% were women. The majority were in WHO FC II (50%), while 35% were in FC III and 15% were in FC IV. The mean age was 43.4 years at the start of the therapy with macitentan. After 6 months of macitentan therapy, 85% showed substantial improvement in their FC, each increased its 6-min walking distance test (P < 0.0001), and there was a significant reduction in plasma levels of NT-pro BNP (P < 0.0001). There has also been an improvement in echocardiographic parameters such as TAPSE and sPAP (P < 0.0001).

Conclusions:

Our findings indicate that macitentan has been well tolerated and beneficial in Indian patients with PAH and further, future research is required to verify these results.
Combined diffuse alveolar hemorrhage and venous thrombosis in a patient with granulomatosis with polyangiitis: Case report and systematic review of literature
Authors: Madan Manu , Iyer Hariharan , Tiwari Pawan , Mohan Anant , Madan Karan , Hadda Vijay , Mittal Saurabh , Guleria Randeep
Published: December 2021

Antineutrophil cytoplasmic antibody-associated vasculitis has associations with both thrombosis and diffuse alveolar hemorrhage (DAH). Management of patients having coexistence of both thrombotic and hemorrhagic manifestations is challenging. Thrombotic conditions require anticoagulation, which can theoretically increase the risk of bleeding and thereby worsen DAH. In this review, we highlight the management of a patient of granulomatosis with polyangiitis with DAH who developed deep vein thrombosis. A systematic review of the literature was also performed summarizing and discussing the issues pertaining to the management of such patients.
The Subject of Holodomor in the Ukrainian Artistic Space
Authors: Vasylenko Olha , Mudretska Lilіia , Okner Irene
Published: December 2021

The Great Famine (Holodomor) is man-made famine that convulsed the Soviet republic of Ukraine in the 1930s. Since 2006, the Holodomor has been recognized as a genocide of the Ukrainian people carried out by the Soviet government. The article aims to highlight specific historical, cultural and social conditions that contributed to the dynamics of the Holodomor theme in music. It focuses especially on the musical compositions of this historical tragedy performed at the Kyiv Music Fest Competition. We can observe the linguistic and musical semantics of the opus of tragic imagery, along with the ethnic motifs of the Ukrainian cultural space, including musical rhetorical figures of the Baroque period, Christian symbolism of suffering and salvation, infernal stylistics.
The Contribution of Anton Pogačar and Vida Matjan to the Music Culture of Montenegro
Authors: Martinović Bogojević Jelena , Marković Vedrana
Published: December 2021

The prominent Slovenian musicians Anton Pogačar and Vida Matjan made an exceptional contribution to the development of the music culture of Montenegro in the second half of the twentieth century. The paper aims to highlight the most important segments of their professional activities in this context and present them to the wider musicological public.
The Music of Larisa Vrhunc
Authors: O’Loughlin Niall
Published: December 2021

The Slovene composer Larisa Vrhunc has pursued an adventurous and impressive range of music, unashamedly modernist in its techniques and constantly innovative, with new techniques deriving from varied sources of inspiration.
Assessing the Pro-environmental Behaviour Associated with Small-scale Sport Tourism Events
Authors: Mchunu Ayanda , Nyikana Siyabulela , Tichaawa Tembi Maloney
Published: December 2021

This study examined the pro-environmental behaviour that is associated with small-scale sporting events in the context of South Africa. To achieve this aim, the study employed a mixed-method research strategy, wherein face-to-face questionnaire surveys (n=316) were conducted with small-scale sporting event attendees. These were complemented by in-depth, semi-structured interviews with key informants who are involved in the organisation and management of such events (n=9). The key findings indicated that small-scale sport event attendees are environmentally conscious and practice pro-environmental behaviour at small-scale sport events to a large extent. However, the study observed certain nuances relating to behavioural differences at different events, with regards to environmental management. Moreover, there seemed to be a misalignment of environmental management from the event organisers and environmental behaviour by the attendees of small-scale sporting events, especially when looking into intended future behaviour at the events. The study advocates for a more comprehensive planning and management approach for small-scale events, particularly from the viewpoint of the organisers in order to promote responsible behaviour by attendees of the events going forward.
Religious perspectives on Vaccination: Mandatory Covid-19 vaccine for SA Churches
Authors: Thinane Jonas Sello
Published: December 2021

In public health history, vaccinations have been seen as very helpful as they help protect societies from preventable diseases and save many lives around the world. Despite the fact that few religious groups oppose vaccination for a variety of reasons, almost all major religions in the world support vaccination as long as it complies with religious precepts for the preservation, protection, or well-being of livelihoods. However, during the surge of Covid-19 outbreak in South Africa and elsewhere, governments witnessed unprecedented hesitancy and opposition to the Covid-19 vaccination by the general public. Those who opposed the Covid-19 vaccine cited multiple concerns or reasons, ranging from possible side effects, adverse events, vaccine safety, vaccine effectiveness, conspiracy theories, and religious or cultural reasons. Based on a literature search, this paper attempts to discuss various religious views on the subject of vaccination in general and subsequently make use of such perspectives to support calls for a compulsory Covid-19 vaccination, especially for South African churches. This is a timely topic of central concern as it seeks to politely dispel religious
misunderstandings and confusion that could arise as a result of debates on mandatory
vaccines for Covid-19. Health and religion will be brought together to shape the ongoing
discussions about the moral urgency of a mandatory Covid-19 vaccination in South Africa.
Правовые позиции Верховного Суда РФ применительно к определению доминирующего положения на товарном рынке
Authors: Хохлов Е.С.
Published: December 2021

Автор анализирует Постановление Пленума Верховного Суда РФ «О некоторых вопросах, возникающих в связи с применением судами антимонопольного законодательства» в части определения доминирующего положения хозяйствующих субъектов на товарных рынках. Раскрываются правовые позиции по вопросам критериев доминирующего положения, индивидуального и коллективного доминирования, особенностей определения доминирующего положения с участием группы лиц.
Yi He Yuan (Summer Palace Parkı) Koruma Çalışmalarının Peyzaj Tasarımı Açısından Değerlendirilmesi
Authors: ÖZÇALIK Mahİre
Published: December 2021

Saray bahçelerinin M.Ö. 3.yüzyıla uzanmakta olup, biçimsel düzene sahip olan bahçeler zamanının ihtişam ve saltanatının önemli bir hale gelmiş ve saray bahçelerinin olgunlaşması organizasyonları belli dönemleri yansıtmıştır. Bu, Pekin'deki Yi He Yuan'ın kullanım tarihi, planlamasının uygulanması, Çin parkının tasarımında değerlendirilmesi ve tasarımın tasarımı ile ve bahçelerinin tasarımlarının tasarımına yönelik bir çalışmadır. Çevrede bulunanların satın aldığı Parki Yuan (Yaz Sarayı)'nın – yeşil alan çizelgeleri, açıklamaların açıklanması ve araştırma mimarlığı ile Çin Park ve bahçe tasarım araştırmalarının araştırmalarının hedeflenmesi amaçlanmaktadır.