bluuebunny/crossref_metadata_2025 huggingface dataset:
La "Buena esposa" en el discurso de grandes autores del mundo griego, árabo-musulmán, judío y latino-cristiano: una tradición común
Authors: Lapiedra Gutiérrez Eva
Published: October 2024

En este artículo se analizan las similitudes que existen en relación al concepto de "la buena esposa" en autores representativos de diversas culturas del ámbito mediterráneo. Se parte de la tradición árabo-musulmana y se establecen paralelismos con la tradición judía. Los otros dos referentes son el mundo greco-romano, especialmente la civilización ateniense, y la cultura española del siglo XVI. Se establece un hilo conductor en el discurso patriarcal de reconocidos pensadores, separados por el tiempo y el espacio, pero que comparten una serie de rasgos, de tópicos e ideas sobre cómo debe ser y comportarse la mujer que empieza una nueva vida junto a su marido.
A Study on the Visibility of Jews in Ottoman Courts: The Example of Hasköy Court (1612–1643)
Authors: Ünlü Talha Kaan
Published: October 2024

This study examines the commercial, social and legal relations of Jews in the Ottoman Empire through the records of Hasköy Court Registry No. 5. Ottoman court registers are significant sources that provide valuable information in many areas such as social life, family life, economic activities and law in the Ottoman Empire. They can be used effectively in studies on the Jewish community. Contrary to common sense, Jews frequently applied to the Ottoman courts not only in their cases with other communities but also in cases involving various issues among themselves. These applications also show that Jews did not keep themselves self-enclosed and interacted with the involved society.
Enfrichement des côtes rocheuses : analyse de la dynamique du paysage et de la végétation
Authors: Libaud Pierre , Sawtschuk Jérôme
Published: October 2024

Cette étude porte sur deux secteurs littoraux enfrichés de la commune de Moëlan-sur-Mer soumis à un projet de remise en culture. Il s’agit ici d’interroger l’hétérogénéité paysagère et la diversité spécifique de ces espaces enfrichés. L’analyse des dynamiques d’ouverture et de fermeture du paysage depuis les années 1950 montre une pluralité de rythmes et de trajectoires selon les zones, l’action humaine et les contraintes écologiques. Les résultats font ressortir une diversité des formes végétales et des trajectoires, remettant en cause une uniformisation du paysage des friches littorales.
La géohistoire du royaume d’Abomey (1645-1894), dans le récit national et dans la formation territoriale du Bénin contemporain
Authors: Rieucau Jean
Published: October 2024

La géohistoire du royaume d’Abomey, appuyé sur le groupe humain, la langue des Fon et sur la religion vaudou, couvre trois siècles et demi (1645 à 1894). Ce petit État-nation guerrier, esclavagiste, partenaire des négriers européens (Français, Portugais, Anglais, Danois), perd sa souveraineté à la fin du XIXe siècle, en intégrant la colonie française du Dahomey. Il abrite une des civilisations les plus brillantes de l’Afrique subsaharienne, qui fonde le soft power culturel (restitutions de l’art africain, mémoire de l’esclavage, constructions de musées, tourisme culturel), de l’actuelle République du Bénin.
Visualisation de données issues des réseaux sociaux : une plateforme de type Business Intelligence
Authors: Masson Maxime , Sallaberry Christian , Bessagnet Marie-Noëlle , Lacayrelle Annig Le Parc , Roose Philippe , Agerri Rodrigo
Published: October 2024

TextBI est un tableau de bord interactif destiné à visualiser des indicateurs multidimensionnels sur de grandes quantités de données multilingues issues des réseaux sociaux. Il cible quatre dimensions principales d’analyse : spatiale, temporelle, thématique et personnelle, tout en intégrant des données contextuelles comme le sentiment et l’engagement. Offrant plusieurs modes de visualisation, cet outil s’insère dans un cadre plus large visant à guider les diverses étapes de traitement de données des réseaux sociaux. Bien qu’il soit riche en fonctionnalités, il est conçu pour être intuitif, même pour des utilisateurs non informaticiens. Son application a été testée dans le domaine du tourisme en utilisant des données de Twitter (aujourd’hui X), mais il a été conçu pour être générique et adaptable à de multiples domaines. Une vidéo de démonstration est accessible au lien suivant : https://maxime-masson.github.io/TextBI/
Impact of Duration of Parkinsonism and Antiparkinsonian Drugs on Coagulation Parameters in Patients with Parkinson’s Disease
Authors: Kodam Varun , Nanisetty Sandesh , Goud Sravan K , Kandadai Rukmini M , Turaga Surya P , Jabeen Shaik A , Borgohain Rupam
Published: October 2024

Background and Objectives:

Parkinson’s disease (PD) is a neurodegenerative disorder involving depletion of dopaminergic neurons. Pathogenetic mechanisms leading to striatonigral degeneration are debatable. Chronic inflammation is proposed as one of the mechanisms. In any disease with underlying inflammation, immune system mediators called cytokines are released, leading to a procoagulant state. Our aim was to study the coagulation parameters in patients with PD and find their correlation with disease duration and antiparkinsonian drugs.

Methods:

This cross-sectional study was conducted between January 2021 and December 2021 in a tertiary care center. Sixty-eight patients with PD were subcategorized based on disease duration (<5 and ≥5 years), number of antiparkinsonian drugs (one drug and ≥2 drugs), and levodopa equivalent daily dose (LEDD; <350 and ≥350 mg). Hemoglobin (Hb), prothrombin time (PT), fibrinogen, bleeding time, and platelet aggregation study with adenosine diphosphate and collagen were assessed.

Results:

In our cohort of 68 patients, 53 were men and 15 were women. Mean disease duration was 5.97 ± 4.37 years. Hb was negatively associated with LEDD (P = 0.012) and duration of the disease (P = 0.02). Similarly, PT was negatively associated with disease duration (P = 0.041) and number of antiparkinsonian drugs (P = 0.03). LEDD showed a positive association with collagen-induced platelet aggregation (P = 0.03).

Conclusions:

In our study, patients using multiple antiparkinsonian drugs and higher LEDD were observed to have a prothrombotic state. Further studies are needed to confirm these findings.
Optic Neuritis – The Evolving Spectrum
Authors: Al-Ani Abdullah , Costello Fiona
Published: October 2024

Optic neuritis (ON) is an inflammatory condition that affects the optic nerve and may be associated with various central nervous system demyelinating conditions, infectious diseases, and systemic autoimmune syndromes. This manuscript sheds light on the epidemiologic patterns and diverse clinical features of ON, emphasizing the importance of early detection and prompt treatment. Various studies have revealed geographic and ethnic variations across ON subtypes, which are likely related to the incidence and prevalence of co-associated disorders. Distinguishing ON subtypes may be challenging and requires use of paraclinical tools. Treatment strategies differ depending on the etiology, further highlighting the importance of accurately identifying specific ON subtypes in a timely manner.
Body Mass Index and Surgical Diagnosis of Endometriosis: Do Obese Patients Experience an Operative Delay?
Authors: Markowitz Melissa A. , Doernberg Molly , Li Howard J. , Cho Yonghee K.
Published: October 2024

Objectives:

The objective of this study was to quantify the time to diagnosis of endometriosis by laparoscopy for patients of varying body mass index (BMI), as well as the safety of laparoscopy for endometriosis by BMI.

Materials and Methods:

We performed a retrospective cohort study of reproductive-age women receiving a primary laparoscopic diagnosis of endometriosis at an academic tertiary hospital from January 2017 to December 2020. Patients excluded were those undergoing repeat laparoscopy, with previously histologically diagnosed endometriosis, asymptomatic endometriosis, an unknown first gynecologic encounter, or an unknown initial BMI. Our primary outcome was time to surgical diagnosis of endometriosis by BMI class. Our secondary outcome was the evaluation of peri/postoperative risk of laparoscopy for endometriosis.

Results:

A total of 152 patients received a primary surgical diagnosis of endometriosis, including 44% normal or underweight patients, 29% overweight patients, and 27% obese patients. Obese patients experienced a delay from gynecologic presentation to diagnostic laparoscopy (18.4 months, interquartile range [IQR] 3.1–42.8) compared to overweight patients (9.0 months, IQR 2.5–23.2) and normal and underweight patients (3.8 months, IQR 1.1–17.0) (P = 0.02). Although a higher percentage of overweight and obese patients was Hispanic and non-Hispanic Black, multiple linear regression maintained a significant relationship between time to surgery and BMI (P = 0.03). Perioperative and postoperative complications did not differ by BMI class. There were no differences in repeat laparoscopy for endometriosis within 3 years by BMI (P = 0.99).

Conclusion:

BMI is independently associated with time to surgical diagnosis of endometriosis in our retrospective study. Diagnostic laparoscopy appears safe in obese patients, without significant perioperative morbidity.
Spontaneous Parasitic Pedunculated Myoma Presenting the Absence of Uterine Smooth Muscle Cells in the Stalk — A Case Report
Authors: Shibata Naoki , Shiro Michihisa , Oki Noriyoshi , Watanabe Takahiro , Futaki Hitomi , Yoshida Shigeki
Published: October 2024

A few cases of spontaneous parasitic myoma have been reported. However, its cause remains unidentified. We report a case of spontaneous parasitic pedunculated subserosal myoma with pathological findings presenting with the absence of uterine smooth muscle cells in the stalk observed during robotic-assisted laparoscopic hysterectomy. A 51-year-old patient (G1P0) with no prior surgical history underwent a robotic-assisted laparoscopic hysterectomy. An approximately 3 cm-pedunculated subserosal myoma was found attached to the retroperitoneum. The stalk was sealed and separated and the myoma with retroperitoneal adipose tissue was resected. The stalk was pathologically identified to lack uterine smooth muscle cells and contain only muscular arteries and fibrous connective tissues. Thus, it might be hypothesized that after the myoma received collateral parasitic blood flow from the attached retroperitoneum, the stalk degenerated, and uterine smooth muscle cells were lost through an unknown mechanism, possibly underlying the development of spontaneous parasitic myomas.
Feasibility and Safety of ArtiSential for Minimally Invasive Surgery in Early-stage Gynecologic Cancer: Results from the KGOG 4002/GYANT Study
Authors: Kang Ok-Ju , Kim Kidong , Lee Keun Ho , Kim Min Kyu , Hwang Jong Ha , Kim Taehun , Lee Nak Woo , Chun Kyoung Chul , Seong Seok Ju , Kim Tae-Joong , Oh Dasol , Park Jeong-Yeol
Published: October 2024

Objectives:

The objective is to evaluate the feasibility and safety of ArtiSential for performing minimally invasive surgeries for gynecological cancers.

Materials and Methods:

We conducted a prospective observational study at 10 Tertiary Institutional Hospitals in Korea between November 2021 and April 2022. Eligible patients were 18 years or older and planned to undergo minimally invasive surgery for gynecologic cancer. We collected baseline characteristics, surgical information, and postoperative outcomes. The primary endpoint was to compare the operation time required for gynecologic cancer surgery using ArtiSential with the reported operation time for surgery using conventional laparoscopic instruments or robots. The secondary endpoints were to evaluate the surgical outcomes of gynecologic cancer surgery using ArtiSential compared to conventional laparoscopic instruments or robots and collect operator feedback on equipment improvements during surgery.

Results:

Forty patients were enrolled in this study, including 19 with endometrial cancer, 15 with cervical cancer, and 6 with ovarian cancer. The average operation time was 187.0 ± 49.2 min, with no complications encountered during surgery. Pelvic lymph nodes were assessed in 34 patients, with the ArtiSential device utilized in 22 (64.7%) of these patients, at an average assessment time of 40.3 ± 19.4 min. Most surgeons using the ArtiSential device reported that it performed slightly better than conventional laparoscopic instruments.

Conclusion:

The use of the ArtiSential device in minimally invasive surgery has been demonstrated to be both feasible and safe for the treatment of early-stage gynecologic cancer.
Successful Microablative Fractional Carbon Dioxide Laser Therapy for Vulvar Lichen Sclerosus: A Case Report and Mini-review
Authors: Hsieh Wen-Lin , Ding Dah-Ching
Published: October 2024

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disorder affecting the vulvar region. VLS predominantly affects women, and most cases occur after menopause. Common symptoms include itching, skin-whitening, pain, discomfort, fissures, and scarring. Treatment options include topical steroids, emollients, lifestyle modifications, regular follow-up, and surgical interventions. Carbon dioxide (CO2) laser treatment is a therapeutic option for managing lichen sclerosus. We report a case of VLS successfully treated with a fractional microablative CO2 laser. A 72-year-old female presented with a dry vagina and vulvar itching for 6 months. She visited a local medical clinic, and oral anti-itching medication and topical anti-itching ointment were administered. However, the condition did not improve, and she felt itching. She visited our outpatient department, and a pelvic examination showed bilateral labia minor, revealing a white skin color change and a hardening sensation. The patient was diagnosed with VLS. Microablative fractional CO2 laser therapy was subsequently administered. The treatment course comprised three laser therapy sessions (treatment day, 1 month, and 2 months after the first therapy). The vulvovaginal symptoms questionnaire-21 scores were 14, 6, and 2 for the first, second, and third courses of treatment, respectively. Vulvar itching improved significantly after laser treatment – no more steroid treatment needed. After 10 months of follow-up, the condition of the vulva was maintained well. Although the treatment protocol requires further exploration, CO2 laser treatment could be considered for VLS if topical steroids are ineffective.
Dizziness after cochlear implantation: Is the age an independent risk factor?
Authors: Forli Francesca , Lazzerini Francesco , Marconi Ottavia , Bruschini Luca , Berrettini Stefano
Published: October 2024

Background:

Hearing loss and imbalance are the prevalent chronic conditions in the elderly, significantly impacting their quality of life (QoL). The relationship between otologic surgery, particularly cochlear implant (CI) procedures, and postoperative dizziness remains a critical area of investigation. Understanding this relationship is essential, especially given the rising number of older adults undergoing CI surgery.

Materials and Methods:

This retrospective, observational study, conducted between January 2016 and August 2021, assessed the influence of age on chronic dizziness following CI surgery. Sixty adults with postlingual sensorineural hearing loss who underwent unilateral CI surgery were evaluated. Comprehensive preoperative and postoperative assessments included the Dizziness Handicap Inventory (DHI) and QoL measures.

Results:

The study found a significant improvement in speech perception postimplantation, regardless of the age at surgery. However, postoperative dizziness, as measured by the DHI, increased significantly compared to preoperative levels. This increase in dizziness was not correlated with the age at implantation but was strongly associated with preexisting dizziness.

Conclusions:

These findings emphasize the need for thorough preoperative evaluations and patient counseling, particularly for those with preexisting balance disturbances, to optimize the outcomes and manage expectations regarding postoperative dizziness. This study contributes to the understanding of dizziness post-CI in older adults, highlighting the importance of considering individual patient conditions in the management of CI recipients.
Awareness, knowledge, and practice among regular primary school teachers about hearing impairment
Authors: Dsouza Nilisha Angelin , Ranjan Rajesh
Published: October 2024

Purpose:

Children will develop communication, cognitive, language, and social skills, and early academic achievement more effectively like their other typical hearing children if they are identified and intervened early. This study aimed to investigate the awareness, knowledge, and practices of regular school teachers regarding hearing impairment and its influencing factors. With the evolution of education for hearing-impaired children toward inclusive practices, teachers play a pivotal role in identifying and supporting students with hearing loss.

Methods:

Employing a questionnaire-based cross-sectional design with convenient sampling, 270 participants were recruited. The self-administered questionnaire investigates teachers’ awareness, knowledge, and practices concerning various aspects of hearing impairment. These aspects included etiology, effects, identification, management, audiology, communication methods/modifications, teacher support, noise, and prevention.

Results:

The study revealed a limited understanding among regular school teachers regarding the causes of hearing loss and the working and benefits of amplification devices. While the overall knowledge level regarding hearing impairment was deemed fair, notable gaps were identified. However, overall good awareness and practice were observed.

Conclusion:

From the above study, it can be concluded that teachers with special training (prior training related to education to hearing impaired children through seminar and online mode) were substantial better on awareness and knowledge skills compared to nontrained teachers.
Apocrine adenocarcinoma of the breast: A rare special subtype with divergent theranostic markers
Authors: Sujata Sarangi , Sudeep Khera , Taruna Yadav , Mahendra Lodha
Published: October 2024

Carcinoma of the breast with apocrine differentiation also known as apocrine adenocarcinomas is special histological subtypes comprising approximately 1% of breast cancers. They are estrogen receptor/progesterone receptor-negative and androgen receptor-positive tumors having more than 90% population of tumor cells with apocrine morphology. We present a 49-year-old woman with a breast lump in the right upper outer quadrant clinically and radiologically diagnosed as malignancy and histologically proven as apocrine adenocarcinoma of the breast owing to the morphology comprising tumor cells having abundant granular cytoplasm, central to the eccentric nucleus and prominent nucleoli. On immunohistochemistry, it was a triple-negative tumor with AR positivity. As apocrine adenocarcinoma of the breast has an uncertain prognosis, variable HER2/neu overexpression, debatable responses to neoadjuvant therapy, and probable response to androgen therapy, the onus of diagnosing and reporting these tumors accurately lies with the pathologist. Moreover, as the presentation of these tumors is similar to invasive breast carcinoma, no special type but with potentially different and useful theranostic markers, an emphasis on specifying this histological subtype is becoming increasingly essential.
Imaging findings, clinical and pathological characters of 28 patients with Xp11.2/TFE3 translocation renal cell carcinoma
Authors: Dong Haiping , Ni Yang , Liu Zhiling , Wang Zhou , Hu Bo , Xu Hongzhi , Cai Shifeng
Published: October 2024

Purpose:

To analyze the imaging characteristics of Xp11.2/TFE3 translocation renal cell carcinoma and explore the relationship between the pathological features and imaging findings.

Materials and Methods:

Imaging, pathological, and clinical data of 28 patients with Xp11.2 RCC were studied from August 2013 to November 2019. The imaging characteristics and morbidity of different group were also explored meanwhile.

Results:

Patients ranged from 3 to 83 years old and the median age was 47 years. Bilateral renal tumors were detected in 1 patient and unilateral in the rest 27 patients. Out of 29 tumors, 13 were in the left kidneys and 16 in the right. Tumor size ranged from 2.2 cm × 2.5 cm to 20.0 cm × 9.7 cm. Tumors were cystic component/necrosis (29/29,100%), renal capsule breakage (16/29, 55%), capsule (18/29, 62%), calcification (15/29, 52%), fat (4/29, 14%), and metastasis (10/29, 34%). Tumors showed moderate enhancement during renal corticomedullary phase and delayed enhancement during nephrographic and excretory phase. The solid parts showed hypointense on T2WI. The imaging characteristics did not have significant correlation with the age, the incidence of adolescent and children group was higher than adult group.

Conclusion:

Xp11.2 RCC is a well-defined mass with cystic component, the solid part of tumor showed hypointense on T2WI. Xp11.2 RCC showed moderate enhancement during the renal corticomedullary phase and delayed enhancement during the nephrographic phase and excretory phase. Xp11.2 RCC has a higher incidence in children.
Endoscope-Assisted Revision Surgery after Lumbar Fusion with Pedicle Screw Fixation: A Case Series and Literature Review
Authors: Zhang Jia-xuan , Ke Zhen-yong , Zhong Dian , Liu Yang , Wang Li-yuan , Wang Yang
Published: October 2024

Background:

Lumbar internal fixation and fusion can be subject to failure requiring revision surgery. Endoscopic revision surgery with minimal invasiveness may be a helpful therapeutic intervention in the management of certain fusion-related complications. According to the author’s knowledge, there are few references to this technique in English literature.

Objective:

This study aimed to investigate the efficacy of endoscope-assisted revision surgery in patients with recurrent radiculopathy after lumbar fusion surgery, discuss the necessity of revision surgery, and review the relevant literature.

Material and Methods:

We report a case series and review relevant literature. Information was gathered from the electronic medical record in our hospital. A total of 231 patients who underwent endoscopic spine procedures from January 2021 to October 2022 were reviewed. Three patients who underwent endoscopic decompressive procedures after lumbar fusion surgeries at a correspondence segment were identified, and the clinical courses and radiological findings of these patients were retrospectively reviewed.

Results:

The average interval from initial to revision surgery was 30.74 (range 10.50–48.00) months. The patients include one man and two women with an average age of 75.67 (range 68–81) years at the initial operation. Three patients developed symptoms of recurrent myelopathy after their initial surgery due to canal stenosis in the fusion segment and hyperostosis. All patients experienced symptom relief after revision surgery. At a mean follow-up time of 0.96 months, endoscopic decompression resulted in the average numerical rating scale (NRS) score for lower limb pain on the symptomatic side being reduced by 2.67. Patients rated their leg pain on average as 4.5 ± 0.5.

Conclusions:

Endoscope-assisted revision surgery after lumbar fusion with pedicle screw fixation is a promising therapeutic strategy in treating recurrent radiculopathy. Spinal stenosis and hyperostosis are two of the most significant reasons for revision surgery. Resection of intraspinal lesions and endoscopic foraminal decompression appear to have promising outcomes. Certain fusion-related complications may be effectively treated with endoscope-assisted revision surgery. Further research should be conducted to investigate the clinical efficacy of revision surgery.
Thoracic Dorsal Spinal Cord Herniation: Brief Report and Review of Literature with an Attempt at Hypothesizing the Possible Pathogenesis
Authors: Murali Sanjay H. , George Tobin , Kesavapisharady Krishnakumar , Divakar Ganesh , Venkat Easwer H.
Published: October 2024

Spontaneous dorsal cord herniations are very rare, with only 3 reported cases published in the literature. We report a case of a 15-year-old girl, presenting with progressive symptoms of myelopathy, diagnosed with dorsal cord herniation. She was managed surgically. The herniated arachnoid forming the cyst wall was opened to find a dorsally herniated mass of the dorsal spinal cord. The dura was opened above and below the herniation and then around it to free the herniating nodule of the spinal cord. The nodule was not reducible and was partially amputated for biopsy, and to facilitate dural closure. The patient’s post-operative course was uneventful with no fresh deficits. Lower limb weakness improved to 5/5 power with normal gait at 3 months follow-up. We speculate, after a literature review, that the dorsal cord herniation is a ‘dorsal trans-dural appendage of the spinal cord’ possibly resulting from (a) abnormal migration of neural crest cells during formation of dorsal meninges; or (b) abnormal differentiation of neural crest cells; or (c) abnormal signaling by the neural crest cells.
Socioeconomic Risk Factors in Neurocysticercosis
Authors: Choudhary Aditya , Balaini Neeraj , Goyal Manoj , Modi Manish , Mahesh Karthik V , Lal Vivek
Published: October 2024

NCC is responsible for around 30% of active epilepsy in endemic countries such as India. Knowing socioeconomic factors associated with NCC can help in decreasing the incidence of this disease. We intend to study socioeconomic risk factors in NCC patients and how these factors are different from patients without NCC. Consecutive 100 adult patients of NCC presenting to neurology services with probable NCC (symptomatic or asymptomatic) along with age- and sex-matched controls were interviewed with preset proforma and then data was compiled and analyzed statistically. The NCC group had significantly more people with lesser education level (53%) as compared to control group (42%) (P = 0.002), lower socioeconomic status, poor hand hygiene practices, and use of contaminated vegetables (40% NCC group, 1% control group, P < 0.0001). Open defecation practice was also more among NCC cases. Lower education and socioeconomic status, poor hand hygiene, and eating undercooked contaminated vegetables are modifiable factors that are more prevalent in patients of NCC compared to controls. Social interventions aiming at these will help to reduce NCC patients in our country.
Bilateral Neuralgic Amyotrophy with Multiple Cranial Nerve Involvement and Deep Vein Thrombosis in a Known Case of Celiac Disease
Authors: Nagasrinivas P. S , Sowmini P. R , Sakthivelayutham S , Jeyaraj Malcolm K. , Saravanan R Viveka , Vellaichamy Kannan , Krishnan Mugundhan
Published: October 2024

Neuralgic amyotrophy (NA) is a syndrome of abrupt onset severe pain in the shoulder usually on one side, followed by rapidly progressive weakness and wasting in the upper limb in asymmetric, patchy distribution due to multifocal neuropathy of brachial plexus. Atypical forms may present with involvement of other peripheral nerves including lumbosacral plexus, intercostal and phrenic nerves, and less frequently cranial nerves (CN) which can also be involved.[1] Here we presenting a case of atypical NA affecting bilateral upper limbs with CN involvement in a known patient of celiac disease.
MR Imaging in Covid-19–Associated Invasive Fungal Sinusitis
Authors: Pabbisetti Divya , Gudipati Anantaram , Kaul Subhash , Nalla Sahithi
Published: October 2024

Background and Aim:

We witnessed a sharp peak in the incidence of invasive fungal sinusitis, particularly mucormycosis, in patients with history of coronavirus disease 2019 (COVID-19) infection in India. Rhino-orbito-cerebral mucormycosis (ROCM) is a fulminant rapidly progressive disease. Early diagnosis significantly improves patient survival and outcomes. Hence, neuroimaging plays a very important role. We studied the magnetic resonance (MR) imaging manifestations of invasive fungal sinusitis and established an imaging protocol, which helps in early diagnosis of the disease per se as well as its complications. We evaluated the differences between COVID-19–associated and non-COVID-19–associated ROCM.

Materials and Methods:

We retrospectively analyzed the MR imaging manifestations of 91 histopathologically proven cases of post-COVID-19–invasive fungal sinusitis.

Results:

We observed stage I disease limited to sinuses in 25.2%, stage II disease with intraorbital spread in 23%, and stage III disease with intracranial spread in 51.6% of our patients. Dural involvement was the commonest and earliest sign of stage III disease. Direct parenchymal invasion from the adjacent paranasal sinuses was the commonest pattern of cerebral involvement, involving basifrontal lobe (14.2%) followed by anteromedial temporal lobe (5.4%). We observed orbital and intracranial complications including subperiosteal orbital abscess (1%), cavernous sinus involvement (29.6%), angioinvasion (15.3%), perineural spread (9.8%), and osteomyelitis of skull base and craniofacial bones (45%). Contrary to non-COVID-19–associated ROCM, we did not observe any case with superior ophthalmic vein/dural venous sinus thrombosis or basilar artery angioinvasion in our study.

Conclusions:

In our study, stage III disease was most commonly due to direct parenchymal invasion into frontal and temporal lobes from the adjacent frontal and sphenoid sinuses, respectively. The commonest vascular complications in our study were cavernous sinus involvement followed by angioinvasion into the cavernous ICA leading to watershed infarcts.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis Following Fourth Dose of COVID-19 Vaccination: A Case Report
Authors: Sayadnasiri Mohammad , Layeghi Fereydoun
Published: October 2024

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis has been reported after severe acute respiratory disease coronavirus 2 (SARS-CoV-2) vaccination rarely. We report the second known case of anti-NMDAR encephalitis after receiving fourth dose of SARS-CoV-2 vaccine in a middle-aged male presenting with stroke-like symptoms, highlighting a rare potential neuroinflammatory complication of vaccination against SARS-CoV-2 that is currently being distributed worldwide. Despite the occurrence of such rare adverse events, the benefits of COVID-19 vaccination outweigh concerns over neurologic complications.
Diagnostic Dilemma between Scrub Typhus Meningoencephalitis and Dengue Encephalopathy Resolved! – A Novel Prediction Score
Authors: Alam Areesha ,   Fellowship Pediatric Neurology, Agarwal Pranshi , Jain Amita , Kalyan Raj K , Kumar Rashmi
Published: October 2024

Background:

Scrub typhus and dengue, common etiologies of acute encephalitis syndrome, present with similar clinico-laboratory profiles but differ in management protocol.

Objective:

We aimed to devise a score differentiating between scrub typhus meningoencephalitis (STM) and dengue encephalopathy (DE).

Methods:

A prospective cohort of 204 children, (aged 6 months to 14 years) presenting with acute encephalitis syndrome in a public teaching hospital in northern India was subjected to standardized workup including serum IgM against Orientia tsutsugamushi and Dengue virus. Clinico-laboratory features were compared between STM and DE using univariate and multivariate analysis. Area under the receiver operating characteristic (ROC) curve (AUROC) for the score derived from independent predictors and its sensitivity, specificity, predictive values was calculated at cutoffs.

Results:

STM and DE IgM ELISA were positive in 38 (18.6%) and 41 (20.1%) children, respectively. Longer duration of fever, prodromal stage, respiratory complaints and pneumonia were significantly frequent in STM; however, swelling, petechiae and myalgia were significantly prevalent in DE. STM had higher blood total leukocyte count (TLC), higher CSF protein and lower CSF sugar compared to DE. At admission, TLC >10,000/mm3, pneumonia, absence of myalgia and petechiae were independent predictors for differentiating STM from DE. AUROC of novel score (range: −5 to 5) was 0.879 (95% CI: 0.805–0.952). Score at cutoff ≥5 had 100% specificity and 100% PPV for differentiating STM from DE.

Conclusions:

Prediction score may benefit physicians to differentiate between these two infections and treat them accordingly.
Gowers Intrasyringeal Hemorrhage with Syringomyelia and Syringocephaly
Authors: Kumar Ishan , Siddiqui Zeeshan , Verma Ashish
Published: October 2024

A 30-year-old man patient presented with the progressive weakness and pain in the back, arms and legs, sensory loss, facial weakness, diplopia, difficulty of speech and swallowing since 4 months. MRI revealed syringomyelia and syringocephaly involving medulla (syringobulbia), pons (syringopontia) and midbrain (syringomesencephaly) with intrasyringeal hemorrhage.
Postural Orthostatic Tachycardia Syndrome (POTS) as a Cause of Dizziness – Expanding the Etiological Spectrum
Authors: Baskar Dipti , Mailankody Pooja , Sathyaprabha Talakad Narasappa , Mathuranath P S , Mahale Rohan R , Padmanabha Hansashree
Published: October 2024

Background and Objectives:

Dizziness is a frequent complaint encountered in neurology clinics. Dizziness can be spontaneous or triggered, which includes orthostatic dizziness. Orthostatic dizziness can be acute (reflex/vasovagal syncope), chronic (orthostatic hypotension (OH), or postural orthostatic tachycardia syndrome (POTS). Since dizziness has numerous causes, these patients undergo extensive investigations before a diagnosis is made. Here, we describe five patients who presented with dizziness and were diagnosed to have POTS on evaluation.

Materials and Methods:

We conducted a retrospective study of patients who presented to the Department of Neurology from August 2020 to November 2021 with the complaint of dizziness and were diagnosed with POTS. The clinical history, neurological examination, treatment response, routine blood investigations, magnetic resonance imaging (MRI) brain, and autonomic function tests (AFTs) of the patients were reviewed from patients’ clinical records. Patients with dizziness and with diagnosis other than POTS were excluded from the study.

Results:

Among the five patients, males were predominant with a male to female ratio of 3:2. All the patients were in their early fourth decade with a mean age of 35.4 years. The presenting symptom was dizziness, and the key associated symptoms were anxiety and headache. Due to the orthostatic nature of symptoms and absence of orthostatic fall in blood pressure (BP), a detailed AFT was carried out, leading to the diagnosis of POTS. Patients were assessed at 3–6 months after treatment and there was a moderate response in one and no response in the remaining four patients.

Conclusion:

POTS should be considered a possible etiology when patients present with orthostatic dizziness in the absence of orthostatic fall in BP. Anxiety and headache may be associated with this type of dizziness.
Spectrum of Clinical Variability with SEPT9 Gene Mutation in Hereditary Neuralgic Amyotrophy: Understanding the Pathogenesis Using Molecular Dynamics Simulation Study
Authors: Bhatti Amit , Ravat Sangeeta , Desai Karan , Shekhar Bipin R , Menon Shyla R , Kumbhar Bajarang V , Kunwar Ambarish , Jain Neeraj , Das Dhanjit K
Published: October 2024

Background:

Hereditary Neuralgic Amyotrophy (HNA) is an autosomal dominant disorder characterized by episodes of severe pain and amyotrophy affecting the brachial plexus as well as other sites. Mutations in the SEPTIN9 gene have been identified as genetic abnormality for HNA. Although the genetic mutations are known, their pathogenesis for the causation of this disorder is not exactly elucidated.

Objective:

In this study, we have investigated the phenotypic and genetic features in a large pedigree with HNA.

Methods:

We report the clinical spectrum and genetic analysis of a family with 9 affected members. Clinical heterogeneity has been reported in the individuals having mutations in SEPTIN9 gene. After taking informed consent, we have done genetic analysis of 6 affected and 4 unaffected members of the family to identify the molecular abnormalities of SEPTIN9 gene.

Results and Conclusions:

Genetic analysis has identified the presence of NM_001113491.2:p.Arg106Trp mutation in SEPTIN9 gene. The same mutation has been identified in 6 affected members of the family. Molecular simulation study has revealed that the mutation has significantly altered the conformation of septin-9 protein, thereby impairing the microtubule binding and bundling ability. Although the affected members shared a common recurrent mutation, they have a wide spectrum of clinical variability. This may be due to the variable penetrance of the mutation and different epigenetic influences in the family. This is the first genetically confirmed case series of HNA reported from India.
Restricted Cortical Activity Involving Parietal Lobe and Sublobar Region Leads to Generalized Spike-Wave Discharges of Juvenile Myoclonic Epilepsy: Evidence from an EEG Source Localization Study
Authors: Muthukrishnan Suriya Prakash , Anand Kuljeet Singh
Published: October 2024

Background:

Previous studies have localized the origin of “generalized” spike-wave discharges of idiopathic generalized epilepsies to specific brain regions. Although there are studies in juvenile myoclonic epilepsy (JME) which have investigated the origin of spike-wave discharges, reports on the propagation of discharges are sparse.

Objective:

The current study investigated the propagation of spike-wave discharges in JME, which was investigated by statistically comparing the electroencephalography (EEG)-derived cortical source activity during (a) various phases of spike-wave discharge versus background (eyes closed) activity, and (b) various phases of the first spike wave versus the corresponding phase of subsequent spike waves.

Material and Methods:

Fourteen patients with JME who had generalized spike/polyspike and slow wave discharges in interictal EEG were included in the study. A total of 179 spike waves (first discernible spike wave – 55; subsequent spike waves – 124) were selected for source localization. Source analysis was carried out using exact low-resolution electromagnetic tomography (eLORETA). Statistical analyses to estimate the probability distribution of differences in cortical activity between (a) eight phases of epileptic discharge versus background (eyes closed) activity and (b) phases of the first spike wave versus the corresponding phases of subsequent spike waves were performed by paired t-tests and corrected for multiple testing using LORETA-KEY software.

Results:

Widespread activation of cortical voxels (more than 94%) was observed during all phases of epileptic discharge except the initial phase (pre-first spike) and terminal phase (post-peak of the subsequent wave). The parietal lobe, which was the most activated lobe during the pre-first spike, was found to be the least activated during the post-peak of first and subsequent waves. More than 93% of voxels in the sublobar region were consistently activated during all eight phases of discharge.

Conclusion:

The study findings suggest that the activity generated from the restricted brain network involving parietal lobe could be propagated through sublobar structures to cause widespread cortical activation during the subsequent phases of the spike-wave cycle.
Effects of Early and Late Cranioplasty on Neurocognitive Outcome and Cerebral Glucose Metabolism using PET Scan – A Comparative Study
Authors: Sharma Vivek , Rameshchandra Venkata Vemula , Prasad Bodapati Chandramouliswara , Dwivedi Rinu
Published: October 2024

Background:

Brain protection and cosmetic aspects are the major indications of cranioplasty (CP) after decompressive craniectomy. CP can avoid the recurrence of brain damage, achieve the plastic effect, protect the patient from seizures, and relieve the syndrome of trephine.

Materials and Methods:

This was a prospective, observational study done over a period of 2 years from April 2017 to April 2019 in the Department of Neurosurgery at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Patients of age group 20–60 years who underwent CP after decompressive craniectomy for traumatic brain injury or cerebrovascular accidents with refractory intracranial hypertension were included. The study population was divided into two groups: early and late CP groups. Neurocognitive assessment was done 72 h before and 3 months after CP by mini-mental state examination (MMSE), Glasgow outcome score (GOS), and PGI battery of brain dysfunction (PGIBBD) scores. Cerebral glucose metabolism was assessed by 18F-FDG PET scan.

Results:

In both early and late CP groups, there was a highly significant difference between the mean pre- and postoperative values of MMSE, GOS, and PGIBBD, suggesting significant improvement in neurocognitive parameters of patients postoperatively. There was no significant difference between early and late CP groups for mean standard uptake values (SUVs) on PET scan for both affected (P-value- 0.40) and nonaffected (P-value- 0.30) sides.

Conclusion:

CP improves the cerebral metabolism and neurocognitive outcome, weather it is done early or late.
Liver cell cancer surveillance practice in Nigeria: Pitfalls and future prospects
Authors: Musa Yusuf , Ifeorah Ijeoma M , Maiyaki Abubakar Sadiq , Almustapha Rahama Mohammad , Maisuna Yussuf Abdulkadir , Saleh Habib Tijjani , Yakubu Abdulmumini
Published: October 2024

Hepatocellular carcinoma (HCC) is a disease of public health concern in Nigeria, with chronic hepatitis B and C infections contributing most to the disease burden. Despite the increasing incidence of HCC, surveillance practices for early diagnosis and possible cure are not deeply rooted in the country. This article aims to review the current status of HCC surveillance in Nigeria, stressing the encounters, breaches, and potential prospects. Several factors, such as limited tools for screening and diagnostics, insufficient infrastructure, and low cognizance among the doctors, and the general public affect the surveillance practices for HCC in Nigeria. Moreover, the lack of standardized guidelines and protocols for HCC surveillance further intensifies the suboptimal diagnosis and treatment. Nevertheless, there are opportunities for refining surveillance practices in the country. This would be achieved through boosted public health sensitization campaigns, integrating HCC screening into routine clinical services, and leveraging technological developments for early detection and monitoring. Furthermore, collaboration between government agencies, healthcare providers, and international organizations can facilitate the development of comprehensive HCC surveillance programs personalized to the Nigerian setting. Thus, HCC surveillance practice faces substantial challenges. By addressing the drawbacks and leveraging prospects, Nigeria can improve HCC surveillance, with subsequent improved outcomes for individuals at risk of developing the disease.
Prevalence and risk factors associated with metabolic dysfunction-associated steatohepatitis in patients with Helicobacter pylori infection: A population-based study
Authors: Abdel-Razeq Rashid , Bitar Lynn , Bitar Elio R , Onwuzo Chidera , Abu-Hammour Mohamad-Noor , Eren Barish , Mohamed Islam , Johnson Adejoke , Boustany Antoine , Onwuzo Somtochukwu , Asaad Imad
Published: October 2024

BACKGROUND

Helicobacter pylori (H. pylori ) is associated with the development of gastrointestinal disorders ranging from gastritis to gastric cancer. The evidence of the association between metabolic dysfunction-associated steatohepatitis (MASH) and H. pylori infection in the literature is scarce. Therefore, we aim to evaluate the risk of developing MASH in patients who have had a diagnosis of H. pylori infection independently of any confounding variables.

AIM

To evaluate the risk of developing MASH in patients who have had a diagnosis of H. pylori infection.

METHODS

This study used a validated multicenter research database of over 360 hospitals across 26 healthcare systems across the United States from 1999 to 2022. Multivariate regression analysis assessed the risk of developing MASH, adjusting for confounders including H. pylori infection, obesity, type 2 diabetes, hypertension, dyslipidemia, and male gender. A two-sided P value < 0.05 was considered as statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008).

RESULTS

A total of 79476132 individuals were screened in the database and 69232620 were selected in the final analysis after accounting for inclusion and exclusion criteria. Smokers (14.30%), patients with hyperlipidemia (70.35%), hypertension (73.86%), diabetes mellitus type 2 (56.46%), and obese patients (58.15%) were more common in patients with MASH compared to control. Using a multivariate regression analysis, the risk of MASH was increased in diabetics [odds ratio (OR): 3.55; 95%CI: 3.48-3.62], obese (OR: 5.93; 95%CI: 5.81-6.04), males (OR: 1.49; 95%CI: 1.46-1.52), individuals with hyperlipidemia (OR: 2.43; 95%CI: 2.38-2.49) and H. pylori infection (OR: 2.51; 95%CI: 2.31-2.73).

CONCLUSION

This is the largest population-based study in the United States illustrating an increased prevalence and odds of developing MASH in patients with H. pylori infection after adjusting for risk factors.
Platelet counts to spleen diameter ratio: A promising noninvasive tool for predicting esophageal varices in cirrhosis patients
Authors: Mossie Getnet Yigzaw , Nur Abdulsemed Mohammed , Ayalew Zekarias Seifu , Azibte Gebeyehu Tessema , Berhane Kaleb Assefa
Published: October 2024

BACKGROUND

Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation, wherein the standard hepatic architecture is replaced by regenerative hepatic nodules, which eventually lead to liver failure. Cirrhosis without any symptoms is referred to as compensated cirrhosis. Complications such as ascites, variceal bleeding, and hepatic encephalopathy indicate the onset of decompensated cirrhosis. Gastroesophageal varices are the hallmark of clinically significant portal hypertension.

AIM

To determine the accuracy of the platelet count-to-spleen diameter (PC/SD) ratio to evaluate esophageal varices (EV) in patients with cirrhosis.

METHODS

This retrospective observational study was conducted at Tikur Anbessa Specialized Hospital and Adera Medical Center from January 1, 2019, to December 30, 2023. Data were collected via chart review and direct patient interviews using structured questionnaires. The data were exported to the SPSS software version 26 for analysis and clearance. A receiver operating characteristic curve was plotted for splenic diameter, platelet count, and PC/SD ratio to obtain sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.

RESULTS

Of the 140 participants, 67% were men. Hepatitis B (38%) was the most common cause of cirrhosis, followed by cryptogenic cirrhosis (28%) and hepatitis C (16%). Approximately 83.6% of the participants had endoscopic evidence of EV, whereas 51.1% had gastric varices. Decompensated cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63 (95%CI: 3.16-67.58, P = 0.001) and 0.14 (95%CI: 0.037-0.52, P = 0.004), respectively. A PC/SD ratio < 1119 had a sensitivity of 86.32% and specificity of 70% with area under the curve of 0.835 (95%CI: 0.736-0.934, P < 0.001).

CONCLUSION

A PC/SD ratio < 1119 predicts EV in patients with cirrhosis. It is a valuable, noninvasive tool for EV risk assessment in resource-limited settings.