bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical Optic Neuritis
Authors: Ojha Pawan T , Barvalia Prachi P , Singh Rakesh , Soni Girish , Kadam Nikhil , Nagendra Shashank , Aglave Vikram , Jagiasi Kamlesh
Published: November 2022

Background:

Many potential causes of optic nerve inflammation exist, including typical and atypical causes, which require different management strategies.

Objective:

The objective of this study is to identify red flags that help differentiate typical from atypical optic neuritis (ON).

Materials and Methods:

This prospective study included 66 patients (100 eyes) with immune-mediated ON from January 2016 to June 2019, carefully excluding the nonimmune causes. The clinico-radiological features, investigations, therapy, and outcome were analyzed.

Results:

We evaluated 33 cases each of typical and atypical ON. The typical group included 29 idiopathic ON and four associated with multiple sclerosis. Atypical ON included 19 neuromyelitis optica (NMO), seven MOG-associated ON (MOG-ON), and others due to Sjogren's syndrome, granulomatous polyangiitis, sarcoidosis, and IgG4 disease. Atypical ON occurred significantly and more frequently with extremes of ages (<10 or >70 years), bilateral simultaneous or severe vision loss with early disc pallor, multiple attacks, symptoms/neuro-imaging indicating non-MS disease e.g., long segment ON/myelitis, large confluent lesions, the involvement of optic tract, chiasma, area postrema or diencephalon, and (pachy) meningitis. Systemic involvement and poor outcomes despite steroids and second-line immunosuppression were observed more often in the atypical ON.

Conclusions:

The red flags indicating atypical ON are onset at extremes of age, multiple attacks, bilateral simultaneous or severe to very severe vision loss, early disc pallor, neurological symptoms, or imaging abnormalities suggesting non-MS disease, systemic involvement, and poor steroid responsiveness. The awareness might help the clinician promptly identify and escalate therapy to ensure a better outcome.
Cardiovascular Autonomic Assessment in Guillain–Barré Syndrome
Authors: Tan Cheng-Yin , Shahrizaila Nortina , Tan Hui-Ting , Goh Khean-Jin , Tan Maw-Pin
Published: November 2022

Background:

Severe dysautonomia is typically seen during acute phase of Guillain–Barré syndrome (GBS).

Objective:

To investigate the relationship of cardiovascular autonomic dysfunction with motor recovery in GBS.

Materials and Methods:

Consecutive GBS patients presented to our hospital were recruited. Clinical assessment was evaluated with the Medical Research Council (MRC) sum score and GBS disability score (GDS). All patients had series of autonomic testing on admission and after treatment at 6 and 24 weeks. Both computation-dependent tests (heart rate variability [HRV] and baroreflex sensitivity [BRS]) and autonomic maneuvers were performed. Age- and gender-matched healthy controls (HC) were recruited. The data obtained at admission, 6 weeks and 24 weeks were compared within groups for statistical difference.

Results:

Six patients (4 men; mean age 39.5 ± 14.3 years) were recruited over one year. Five had GBS and one Miller Fisher syndrome. The mean MRC sum score and GDS on admission were 52.3 ± 4.3 and 3.5 ± 0.8 respectively. During admission, time-domain average RR interval (AVNN) and BRS were significantly poorer among cases compared to HC. Active standing 30:15 ratio and cold pressor test at admission were also significantly abnormal when compared with HC. All the autonomic parameters had normalized by 6 weeks and these were significant for the high frequency-HRV, BRS, and active standing 30:15 ratio. For MRC and GDS, there were significant improvements in the scoring over a period of 24 weeks.

Conclusions:

Dysautonomia in GBS improved gradually and in keeping with motor and disability recovery.
Effect of Age, Stage, and Type of Surgical Revascularization on Clinical and Angiographic Outcome in Moyamoya Disease – Experience from a Case Series of 175 Revascularization Procedures
Authors: Sreenivasan Sanjeev A , Suri Ashish , Raheja Amol , Phuyal Subhash , Singh Manmohan , Mishra Shashwat , Tandon Vivek , Devarajan1 Leve J , Kalaivani M , Poodipedi Sarat C , Kale Shashank S
Published: November 2022

Background:

There is dearth of literature on impact of age – pediatric versus adult, Suzuki staging – early versus late, and revascularization type – indirect versus direct on clinical and angiographic outcome in moyamoya disease (MMD). Hence, we intend to comprehensively evaluate factors influencing outcome in MMD following surgical revascularization.

Methods:

MMD patients operated at our institute from January 2011 to August 2018 were followed for an average 24 months. Primary outcomes were modified Rankin score (mRS) and stroke risk reduction. Secondary outcome was angiographic outcome score (AOS).

Results:

A total of 133 patients including 37.6% adults (>18 years;n= 50) underwent 175 revascularizations – 89 direct (DR) and 86 indirect (IR) subgroups. Mean mRS scores improved in pediatric DR (P< 0.001), IR (P< 0.001), adult IR (P= 0.10), and DR (P= 0.25) subgroups. Recurrent stroke rate was similar in pediatric-DR (2.7%) and IR (7.6%,P= 0.61), and adult-DR (0%) and IR (4.1%) subgroups (P= 1.00). AOS scores improved in pediatric DR (P= 0.002) and IR (P= 0.01), and adult-DR (P= 0.02) and IR (P= 0.06) subgroups. Late-stage MMD (Suzuki IV–VI) showed better improvement in mRS scores than early-stage-Suzuki (I–III;P< 0.001). Recurrent stroke rates were similar (P= 0.26) and AOS scores improved significantly in early- and late-stage MMD (P< 0.001).

Conclusions:

In pediatrics, clinical and angiographic outcome significantly improved after revascularization procedure, and in adults, angiographic improvement was more evident than clinical recovery. Late-stage Suzuki MMD patients demonstrated significantly better clinical improvement than early stage. The angiographic improvement was equivalent to early stage, irrespective of age and type of revascularization.
Serum Trace Elements in Children with Well-Controlled and Drug Refractory Epilepsy Compared to Controls
Authors: Chakrabarty Biswaroop , Dogra Ankush Singh , Toteja G S , Pandey R M , Paul Vinod K , Gulati Sheffali
Published: November 2022

Background:

Trace elements have been implicated in pathogenesis of epilepsy. Studies till date have shown altered levels of serum trace elements in children with epilepsy.

Objective:

The objective of the current was to estimate serum levels of trace elements in children with well-controlled and drug refractory epilepsy and compare it with controls.

Methodology:

In a tertiary care teaching hospital of North India, serum selenium, copper, zinc, and iron were estimated in well-controlled and drug refractory epileptic children aged 2–12 years and compared with age and gender matched controls.

Results:

A total of 106 children with epilepsy (55 drug refractory and 51 well controlled) and 52 age and gender matched controls were included in the study. Serum selenium and copper were significantly decreased in cases compared to controls. After classifying epilepsy into well-controlled and drug refractory cases, only in the latter the significant difference for serum selenium and copper levels remained compared to controls. Additionally, in the drug refractory cases, serum iron levels were significantly reduced compared to controls.

Conclusions:

Serum trace elements are altered in children with epilepsy (more so in the drug refractory group) compared to controls. Monitoring of serum trace elements in children with epilepsy should be considered. Up to one-third of epilepsy is drug refractory of which only another third are amenable to surgery. It is worth investigating the therapeutic potential of altered micronutrient status in these patients.
Nicardipine versus Labetalol for Hypertension during Acute Stroke
Authors: Hao Fang , Yin Suna , Tang Lina , Zhang Xueguang , Zhang Shubao
Published: November 2022

Background and Objective:

Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke.

Materials and Methods:

MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods.

Results:

Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112–0.438,P= 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077–2.113,I2= 0.00%,P= 0.757). The quality of included studies was found to be low.

Conclusion:

More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions.
A Practice Pilot Survey on the Current Use of Corticosteroid Therapy in Brain Tumor Patients
Authors: Panda Pankaj K , Gupta Tejpal , Jalali Rakesh
Published: November 2022

Background:

This pilot survey aims to provide an insight into the variations of corticosteroid prescription among health care professionals across the Indian subcontinent and serve as a prerequisite for the future development of corticosteroid therapy guidelines in brain tumor patients.

Materials and Methods:

Participants of this anonymized online questionnaire-based survey included health care professionals involved in treating brain tumor patients. Unique links were electronically mailed to health care professionals from a database populated from professional associations. Descriptive statistical analysis, Chi-square test, and/or exact test were used for data analysis.

Results:

Seventy-three percent of the respondents were radiation oncologists followed by neurosurgeons (23%), medical oncologists (2%), and other specialties (2%). Raised intracranial pressure (90%) was the commonest indication for prescribing corticosteroids. Fifty percent of neurosurgeons preferred corticosteroids to be given routinely for all patients undergoing surgery for brain tumors while 64% of the radiation oncologists would prescribe based on imaging findings and/or on appearance of neurologic symptoms. Most of the respondents (90%) used a flat dosage pattern for determining the starting dose of corticosteroids. Emerging data about the long-term use of corticosteroids having a negative impact on the survival of brain tumor patients were not known by 52% of the respondents. The majority of the practitioners (94%) agreed regarding the formulation of evidence-based guidelines for prescribing corticosteroids in brain tumor patients.

Conclusion:

In view of the wide variations of corticosteroid therapy practices among health care professionals across various parts of the world, our pilot survey provides significant information which can act as a suitable benchmark to form uniform practice guidelines.
Role of Bedside Transcranial Ultrasonography in the Assessment of Cerebral Hemodynamics in Decompressive Craniectomy Patients with Cranioplasty
Authors: Ravikanth Reddy , Majumdar Pooja
Published: November 2022

Background:

Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome.

Aim:

To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD.

Materials and Methods:

This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy. All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7–15 days after cranioplasty. TCD results were obtained though trans-temporal approach.

Results:

Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side. After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side. Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere.

Conclusion:

Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres. Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.
Effect of Early Bedside Arm and Leg Cycle Ergometry on Sitting and Standing ability in Hospitalized acute Stroke Patients
Authors: Bharti Archana , Balaji Gandhi Karunanithi , Agrahara Sahana
Published: November 2022

Objectives:

The objective of this study was to evaluate the effect of early bedside arm and leg cycle ergometer exercises as compared to routine physiotherapy on sitting and standing ability in hospitalized acute stroke patients.

Materials and Methods:

Thirty-four consecutive patients with acute stroke were included in the randomized controlled trial. Patients were divided into two groups based on 1:1 simple randomization Experimental group (n= 18) and control group (n= 16). Experimental Group received arm and leg cycle ergometry along with conventional physiotherapy exercises, while the patients in the control group received conventional physiotherapy exercises. Both the groups received treatment for a total duration of 50 min session, twice a day for 7 days. Preintervention and postintervention measurements were taken for both groups using performance-oriented mobility assessment, postural assessment scale for stroke, Motricity Index, and Trunk control scale.

Results:

Statistically significant improvement (P< 0.05) was observed in the experimental group and control groupafter intervention among all the outcome measures.

Conclusions:

Early bedside intervention of cycle ergometer along with routine physiotherapy is effective in improving the sitting and standing abilities, trunk control, and motor function in acute stroke survivors.
Incidence and Prevalence of Neuromyelitis Optica Spectrum Disorders in the Background of International Consensus Diagnostic Criteria – A Systematic Review
Authors: Pandit Lekha , D'Cunha Anitha , Malapur Puneeth U
Published: November 2022

Introduction of international consensus criteria (2015 IPND criteria) for neuromyelitis optica spectrum disorders (NMOSDs) has improved diagnostic accuracy for aquaporin 4 (AQP4)-IgG-associated and seronegative NMOSDs. This study aimed to review relevant publications related to the incidence and prevalence of NMOSDs and provide an updated review of the global epidemiology of NMOSDs in the light of new diagnostic criteria. A comprehensive literature search was performed from January 2015 to June 2021 by using appropriate keywords in PubMed, Scopus, and Web of Science. Relevant papers that fulfilled inclusion criteria were shortlisted and reviewed. Twenty-one papers were selected for this review. Incidence of NMOSDs was 0.04–0.25/100,000 in predominantly white and 0.34–1.31/100,000 in nonwhite populations. Prevalence was 0.70–1.91/100,000 in white and 0.86–4.52/100,000 in nonwhite populations. The 2015 IPND criteria significantly improved the incidence and prevalence rates for NMOSDs when compared to the Wingerchuk 2006 criteria. Incidence of MOG-IgG-associated NMOSDs was 0.12–0.13/100,000, with prevalence in children 0.03–1.4/100,000 and in adults 0.65–2/100,000. In this systematic review, studies that used uniform diagnostic criteria and confirmed cases after testing for AQP4-IgG were included. The prevalence of NMOSDs was estimated to be <5/100,000 globally. A clear bias was seen in favor of nonwhite and indigenous populations. This review highlights the need for prospective population-based epidemiological studies and the importance of surveys in nonwhite populations around the globe.
Serum Magnesium Levels During the Ictal and Interictal Phase in Patients of Migraine
Authors: Mahajan Rahul , Anand Kuljeet Singh , Mahajan Rakesh Kumar , Garg Jyoti , Juneja Abhishek
Published: November 2022

Background:

Migraine is one of the primary headaches having a global prevalence of 15%. It is characterized by neurovascular dysfunction and recurrent episodes of headache. The hyperexcitability of the cerebral cortex has been recognized as an important factor in the pathogenesis of migraine, and magnesium (Mg) being a regulator of neuronal excitability is thought to participate in migraine pathogenesis.

Objectives:

To determine the serum levels of Mg in patients of migraine during the attack and in between attacks as compared to healthy controls.

Methods:

A total of 50 patients of migraine who fulfilled inclusion criteria were enrolled in the study along with the same number of healthy controls. International Classification of Headache Disorders 3rd Edition, 2013 (ICHD-III) criteria was used for the diagnosis of migraine.

Results:

The mean serum Mg in migraine cases during the interictal phase was lower than healthy controls (1.849 ± 0.135 vs 2.090 ± 0.205, P < 0.001), which was statistically significant. It was also found that mean serum Mg during attacks was significantly lower than in between attacks (1.822 ± 0.149 vs 1.849 ± 0.135, P = 0.003). Serum Mg levels in migraine cases showed an inverse linear relationship with the frequency of attacks.

Conclusion:

Relatively low serum Mg in migraine cases when compared with healthy controls and inverse relation of serum Mg levels with the frequency of migraine attacks suggests that Mg is significantly involved in mechanisms underlying migraine pathogenesis, which can be explored as a therapeutic option.
Laterality of Posterior Cerebral Artery and White Matter Hyperintensities in Patients with Severe Internal Carotid Artery Stenosis
Authors: Qiu Jianting , Ye Huirong , Wu Qing , Liang Caihong , Wang Jian , Wang Yujie
Published: November 2022

Background:

Collateral status of the circle of Willis was associated with white matter hyperintensities (WMHs) in patients with internal carotid artery (ICA) stenosis, but few have investigated the effect of leptomeningeal anastomoses.

Objective:

The aim of this study was to observe the association between WMHs and the laterality of the posterior cerebral artery (PCA) that presents leptomeningeal anastomoses in patients with severe ICA stenosis.

Materials and Methods:

WMHs and ipsilateral PCA laterality were evaluated in patients with unilateral ICA stenosis ≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis. Ipsilateral PCA laterality was compared between two groups of no/mild and severe score of global, deep and periventricular WMHs, respectively.

Results:

We included 115 patients with unilateral ICA stenosis ≥70%. There were 60 patients with no/mild and 55 with severe global WMHs. The patients with severe global WMHs were older (OR = 1.849, 95% CI: 1.058–3.229,P= 0.031) and had higher incidence of negative PCA laterality (OR = 3.301, 95% CI: 1.140–9.558,P= 0.028). The patients with severe deep WMHs were also older (OR = 2.031, 95% CI: 1.130–3.651,P= 0.018) and had higher incidence of negative PCA laterality (OR = 4.250, 95% CI: 1.501–12.032,P= 0.006). There was no significant difference between the patients with no/mild and severe periventricular WMHs in the incidence of negative PCA laterality.

Conclusions:

The incidence of negative PCA laterality was higher in patients with severe global and deep WMHs, but not higher in patients with severe periventricular WMHs. The leptomeningeal anastomoses may affect the deep WMHs in patients with severe ICA stenosis.
Clinical Profile of Tension Type Headache in a Medical College with Special Emphasis on Triggering Factors
Authors: Guruswamy Anantha , Swamy Sreekanta , Kurpad Krishna Prasad
Published: November 2022

Background and Objectives:

Tension type headache is one of the costliest primary headaches which can cause a significant impact on an individual's life. Healthcare professionals are exposed to multiple trigger factors which give rise to an increase in headache frequency, most notable reasons being sleep disturbances, stress and untimely food habits. With this background, we conducted this study of detailed clinical profile and trigger factors among the 2050 subjects (MBBS students: 909, BDS students: 323, nursing students: 268, postgraduates students and staff: 550) in our medical institute.

Materials and Methods:

Subjects were given questionnaires on headache and were instructed to give the details of their clinical symptoms along with relevant questions on trigger factors. The assessment tools used were the Visual Analogue Scale (VAS) and Migraine Disability Assessment Scale (MIDAS).

Results:

Out of 2050 subjects, 464 patients suffered from tension type headache. Overall prevalence of tension type headache was 22.6%. Prevalence was higher in females (57.9%) as compared to males (42.1%). Headache experienced by majority of the student population was unilateral (31.4%), pulsating type (51.6%) and of moderate intensity (77.1%). Common associated symptoms were nausea associated with other factors (40%) and photophobia and phonophobia (18.6%). Stress (72.1%) and decreased sleep (49.4%) were the most common triggering factors. Practice of self-medication was reported by 80.2% of subjects.

Conclusion:

Our study noted a high frequency of trigger factors in medical professionals, the most common triggering factors being stress and disturbed sleep. To our knowledge this is the first large study to evaluate headache and specifically tension type headache among medical professionals.
Folate Receptor Alpha is Decreased in Pregnancy Affected with Fetal Neural Tube Defect
Authors: Singh Neeta , Mishra Richa , Misra Prabhaker , Shaleen Archita , Pradhan Mandakini
Published: November 2022

Background:

Neural tube defect (NTD) is a multifactorial disorder. Decrease transfer of folate to the developing embryo is one of the etiologies. It could be due to decrease folate receptors resulting in NTD in fetus.

Objective:

To analyze serum folate receptor alpha (FOLR1) concentration in women having fetus with NTD and compare it with women having normal fetus during and after pregnancy.

Material and Methods:

This was a prospective case control study conducted in a tertiary care hospital. Pregnant women with detected isolated NTD in fetus were enrolled as cases and equal number of matched pregnant women without any fetal congenital malformation were recruited as controls. Serum FOLR1 levels were analyzed in cases and controls during pregnancy and 6 weeks after delivery.

Results:

Mean serum FOLR1 concentration during pregnancy was 70.5 pg/mL (range: 23.8–98.5 pg/mL) and 103.9 pg/mL (range: 70-110 pg/mL) in cases and controls, respectively. Serum level of FOLR1 was 448.9 pg/mL (range: 133.5–475) and 414.5 pg/mL (range: 269.7–412.5) in cases and controls at 6 weeks postpartum, respectively. There was statistically significant difference (P< 0.001) between cases and control during pregnancy but not in postpartum (P= 0.092). There was significant increase in level of FOLR1 in both cases and control at 6 weeks postpartum as compared to antenatal period.

Conclusions:

Maternal serum FOLR1 is significantly reduced in pregnancy with fetal NTD as compared to normal pregnancy. The level is significantly increased in postpartum period in both groups. FOLR1 level being similar in both groups in postpartum indicates that it is not influenced by the history of fetal NTD.
Rituximab in Myasthenia Gravis- Experience from a Low- and Middle-Income Country (LMIC) Setting
Authors: Shivaram Sumanth , Nagappa Madhu , Varghese Nibu , Seshagiri Doniparthi V , Duble Shishir , Siddappa Shreedhara Anjanapura , Hesarur Nagabushan , Sinha Sanjib , Taly Arun B
Published: November 2022

Background:

Myasthenia gravis (MG) is an immune-mediated disorder of the neuromuscular junction. About 10% are refractory to immunosuppressive therapy.

Aims:

To analyze the response of patients with generalized MG to rituximab.

Methods and Materials:

A retrospective review of patients with MG who received rituximab was carried out (n = 13, M:F = 6:7, mean age: 44.84 ± 15.73 years). Myasthenia Gravis Foundation of America (MGFA), MGFA post-intervention status (MGFA-PIS), and Myasthenia Gravis Status and Treatment Intensity (MGSTI) were assessed before and after rituximab.

Results:

The duration of MG was 104.07 ± 92.25 months. Before rituximab, the MGFA was IIA/IIB/IIIA/IIIB/IVB/V in 1/1/2/6/2/1 patients and MGSTI was four in eight patients and six in three patients. The mean duration of follow up was 20.92 ± 14.06 months (range, 4 to 42 months). Dose reduction or discontinuation of cholinesterase inhibitors could be achieved 12 patients. Complete stable remission (CSR) and pharmacologic remission (PR) were achieved in one and four patients respectively and five patients had minimal manifestations. Most patients attained level 0, 1 or 2 MGSTI at last follow up. No rituximab infusion-related adverse events were noted. Three patients had exacerbation of MG between one to five weeks after rituximab administration. Three patients died, one each due to a cardiac event unrelated to MG or treatment, complications related to myasthenic crisis, and coronavirus disease.

Conclusions:

Rituximab was effective in bringing about remission in MG and can be considered as a first-line agent. However, it has to be administered under close supervision as some patients develop exacerbation of MG akin to steroid-induced worsening.
Three Novel ARID1B Variations in Coffin-Siris Syndrome Patients
Authors: Tan Yuxia , Chen Jun , Li Yutang , Liu Yedan , Wang Yu , Xia Shungang , Chen Liping , Wei Wei , Chen Zongbo
Published: November 2022

Coffin-Siris syndrome (CSS) (OMIM #135900) involves multiple congenital malformations, including hypotonia, short stature, sparse scalp hair, a coarse face, prominent eyebrows, a wide mouth, delayed bone age, and hypoplastic or absent fifth fingers/toes or nails, together with developmental delay. The cause of CSS is suggested to be related to alterations in the BRG- or HRBM-associated factor (BAF) pathway in humans. In this gene family, pathogenic variations in the AT-rich interactive domain-containing protein 1B (ARID1B) gene are revealed to be a significant element causing neurodevelopmental disability in patients with CSS. Herein, we describe the clinical features and gene variations in four Chinese patients with CSS. All the patients shared common features of short fifth fingers/toes or hypoplastic nails, coarse facial features, thick eyebrows, long cilia, a flat nasal bridge, a broad nose, a wide mouth, a high palate, and hypotonia. Besides, they had an intellectual disability, language, and motor developmental delay. Candidate genes were screened for variations using polymerase chain reaction (PCR) and sequencing. The variations were sequenced by next-generation sequencing and confirmed by first-generation sequencing. Exome sequencing suggested four de novo variations in theARID1Bgene in four unrelated patients. These included two frameshift variations (c.3581delC, c.6661_6662insG) and two nonsense variations (c.1936C>T, c.2248C>T). Of the four variations, three variations were novel. The results in our present study broaden the understanding of the disease and further interpret the molecular genetic mechanism of these rare variations in CSS.
Post-Traumatic Stress Disorder after Stroke
Authors: Tang Wai Kwon , Wang Lisha , F Tsoi Kelvin KF , Rutovic Stela , Kim Jong S
Published: November 2022

Background:

Post-traumatic stress disorder (PTSD) is a common and debilitating illness that accompanies many neurological disorders, including stroke.

Objective:

The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity, and time course of PTSD after stroke, the factors associated with its development, and its impact on patients' lives.

Material and Methods:

The PubMed EMBASE, PsycINFO, and Ovid Nursing databases were searched for studies published in English that had recruited at least 10 patients (>18 years old) after stroke and who were also diagnosed with PTSD.

Results:

Twenty studies covering a total of 1785 patients met the study inclusion criteria. The frequency of PTSD ranged from 3% to 31%, with a weighted proportion of 16.5%. PTSD runs a chronic course. PTSD after stroke was associated with premorbid neuroticism, negative affect, and maladaptive coping styles. Comorbid depression and anxiety also increased the risk of PTSD. Psychological factors such as negative appraisal and perceived high risk of recurrence and distress were associated with PTSD. Good social support reduced the risk of PTSD. PTSD reduced patients' quality of life, physical functioning, and medication compliance.

Conclusions:

PTSD is common after stroke. Further research is needed to clarify its time course and identify the neurochemical factors and brain circuits associated with the development of post-stroke PTSD. Randomized controlled treatment trials targeting PTSD in stroke are warranted.
Regional location of lymph node metastases predicts survival in patients with de novo metastatic prostate cancer
Authors: Wang Zhi-Peng , Chen Jun-Ru , Zhao Jin-Ge , Zhu Sha , Zhang Xing-Ming , Liang Jia-Yu , He Ben , Ni Yu-Chao , Sun Guang-Xi , Shen Peng-Fei , Zeng Hao
Published: November 2022

To report the regional locations of metastases and to estimate the prognostic value of the pattern of regional metastases in men with metastatic hormone-sensitive prostate cancer (mHSPC), we retrospectively analyzed 870 mHSPC patients between November 28, 2009, and February 4, 2021, from West China Hospital in Chengdu, China. The patients were initially classified into 5 subgroups according to metastatic patterns as follows: simple bone metastases (G1), concomitant bone and regional lymph node (LN) metastases (G2), concomitant bone and nonregional LN (NRLN) metastases (G3), lung metastases (G4), and liver metastases (G5). In addition, patients in the G3 group were subclassified as G3a and G3b based on the LN metastatic plane (below or above the diaphragm, respectively). The associations of different metastatic patterns with castration-resistant prostate cancer-free survival (CFS) and overall survival (OS) were analyzed by univariate and multivariate analyses. The results showed that patients in G1 and G2 had relatively favorable clinical outcomes, patients in G3a and G4 had intermediate prognoses, and patients in G3b and G5 had the worst survival outcomes. We observed that patients in G3b had outcomes comparable to those in G5 but had a significantly worse prognosis than patients in G3a (median CFS: 8.2 months vs 14.3 months, P = 0.015; median OS: 38.1 months vs 45.8 months, P = 0.038). In conclusion, metastatic site can predict the prognosis of patients with mHSPC, and the presence of concomitant bone and NRLN metastases is a valuable prognostic factor. Furthermore, our findings indicate that the farther the NRLNs are located, the more aggressive the disease is.
Functional Characterization of Posttraumatic Heterotopic Ossification of Tibiofibular Syndesmosis with Dynamic Bone Scan and Single-Photon Emission Computed Tomography/Computed Tomography
Authors: Shyamanur Bhavana , Ahmed Najeeb , Usmani Sharjeel
Published: November 2022

A 53-year-old man was investigated for ongoing right ankle pain and lateral malleolus swelling following a traumatic inversion injury 12 weeks prior. The initial ankle radiograph was normal with no evidence of fracturing. The follow-up radiograph showed bridging ossification in the distal tibiofibular syndesmosis. As the pain did not subside, posttraumatic heterotopic ossification (HO) was suspected, and triple-phase dynamic bone imaging with technetium 99m-methylene diphosphonate was performed to guide further management. The bone scan revealed intense focal tracer activity centered on the HO of the tibiofibular syndesmosis, with no evidence of occult fracturing confirming HO as a pain generator.
Corticomedullary Mixed Tumor of the Adrenal Gland with Apparent 18 F-Fluorodeoxyglucose Activity But No 68 GA-DOTATATE Uptake on Positron Emission Tomography/Computed Tomography
Authors: Engur Ceren Ozge , Apaydın Tugce , Ones Tunc , Gozu Hulya Iliksu , Ozguven Salih
Published: November 2022

Corticomedullary mixed tumor (CMT) is a single adrenal tumor mass composed histologically by an admixture of adrenal cortical and medullary cells. It is a rare condition, with approximately 20 cases reported to date. To our knowledge, the positron emission tomography (PET) imaging findings of this mostly benign tumor have not been reported in the literature. We present a case of CMT who was evaluated with both 18F-fluorodeoxyglucose (18F-FDG) and 68Ga-DOTATATE. The hypermetabolic tumor seen on 18F-FDG PET/computed tomography scan showed no abnormal uptake by 68Ga-DOTATATE.
Utility of Fluorine-18-Labeled Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis of Erdheim–Chester Disease with Multisystemic Involvement
Authors: Gauthaman Dinesh Kumar , Subramanyam Padma , Yesodharan Jyotsna , Palaniswamy Shanmuga Sundaram
Published: November 2022

Erdheim[FIGURE DASH]Chester disease (ECD) is a rare non-Langerhans' cell histiocytic proliferative disorder of unknown origin with multisystemic predilection. It commonly affects adults in the fifth–seventh decades of life, with male preponderance, and has nonspecific clinical manifestations. Presence of characteristic radiological findings and demonstration of CD68 positive xanthogranulomatous infiltrates in histology clinches the diagnosis. Nevertheless, being a nonmalignant condition, it might be fatal due to multiorgan dysfunction. Hence, timely diagnosis and initiation of treatment with corticosteroids, immunosuppressants, or tyrosine kinase inhibitors are of paramount importance. We present a case of ECD with multisystemic involvement, who was initially evaluated for the left lung mass and treated as tuberculosis, where fluorine-18-labeled fluorodeoxyglucose positron emission tomography/computed tomography aided in targeting the metabolically active site for biopsy as well as assessing the multisystemic involvement.
Fluoro-2-Deoxyglucose-Positron Emission Tomography/Computed Tomography in the Diagnosis and Management of Adrenocortical Carcinoma
Authors: Krishnaraju Venkata Subramanian , Kumar Rajender , Subramanian Karthikeyan , Mittal Bhagwant Rai , Singh Harmandeep , Chatterjee Debajyoti , Walia Rama
Published: November 2022

Purpose:

Adrenocortical carcinoma (ACC) is a rare primary malignancy of the adrenal gland. The present study was aimed to compare the performance of fluoro-2-deoxyglucose-positron emission tomography–computed tomography (FDG-PET-CT) compared to contrast-enhanced computed tomography (CECT) in diagnosis and management of ACC.

Materials and Methods:

A retrospective analysis of the PET-CT studies from January 2010 to October 2020 was performed. Patients with adrenal lesions suspicious of ACC and diagnosed cases of ACC who underwent PET-CT for staging, restaging, and surveillance were reanalyzed. The PET-CT parameters were compared with the clinical, biochemical, histopathological, and CECT parameters.

Results:

The study included 96 scans performed in 77 patients (36 males, aged 40.4 ± 17.9 years). Of these, 55 scans were performed to diagnose and stage suspected ACC (30 of them diagnosed as ACC), 31 for restaging, and 10 scans for surveillance of ACC. PET/CT revealed metastases from an extra-adrenal primary in 5/55 patients. FDG-PET-CT had a sensitivity and specificity of 100% and 70% to diagnose ACC. Standardized uptake value-peak more than 5.4 had a sensitivity of 90.9% and specificity of 91.7% for differentiating ACC from non-ACC lesions, while tumor-to-liver ratio peak (TLRpeak) of 3.3 was most specific. PET-CT changed the staging in 23.3% of the patients with an accuracy of 100%. PET-CT changed the management plan in 25.8% of the patients during restaging with a sensitivity and specificity of 95.6% and 100%, respectively. For surveillance, CECT was as sensitive as PET-CT; however, PET-CT was more specific (100% vs. 97.9%).

Conclusion:

FDG-PET-CT performs better than CECT in the diagnosis, staging, restaging, and surveillance of ACC.
Unusual presentation of cribriform adenocarcinoma of salivary glands: A case report
Authors: Kamal Noura M. , Nahla Mohamed F. , Mahmoud Sarah A.M.
Published: November 2022

According to the last edition of the World Health Organization classification, cribriform adenocarcinoma of salivary glands (CASGs) was considered a variant of polymorphus adenocarcinoma although many authors proposed CASG as a distinct neoplasm. The aim of this study was to report an unusual presentation of CASG in the buccal mucosa of a 63-year-old male patient that showed signs of encapsulation and no evidence of lymph node metastasis. The lesion was composed of lobules of tumoral cells arranged in solid nests, sheets, papillary, and cribriform or glomeruloid patterns. Most of the peripheral cells show palisaded arrangement with peripheral clefting from the adjacent stroma. Surgical resection of the lesion was done and further neck dissection was recommended.
Psychological distress and coping styles among baccalaureate nursing students
Authors: Sharma Ankita , Kumar Rajesh
Published: November 2022

BACKGROUND:

Coronavirus disease (COVID-19) causes significant psychological distress among nursing students. College-bound nursing students might have preferred different types of coping strategies to deal with psychological distress. This study aims to measure the psychological distress and role of coping styles to mediate the stress level among the baccalaureate nursing students amid the COVID-19 pandemic.

MATERIAL AND METHODS:

A cross-sectional online survey was conducted in December 2020 at a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate nursing students completed the Impact of Event Scale-Revised (IES-R) and Coping Orientation to Problems Experienced Inventory (Brief-COPE) scale to report their psychological distress and coping styles, respectively. Chi-square test, independent sample t-test followed by binary and multivariable regression were used to identify the factors associated with distress in students during the pandemic.

RESULTS:

Students' mean age was 22.22 ± 1.24 years. The mean IES-R was 19.59 ± 12.45 in nursing students. Psychological distress found a significant association with age (P = 0.022), academic class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription–polymerase chain reaction (RT-PCR) for COVID-19 status of self (P = 0.018) and family members in the medical profession (P = 0.013). In binary logistic regression, stress level found a significant association with first-year academic level (OR: 3.250, 95% CI: 1.429–7.390, P = 0.005) and family members in the medical profession (OR: 4.44, 95% CI: 1.019–19.382, P = 0.047). Adaptive coping styles were more frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001) and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress in students, respectively.

CONCLUSIONS:

Coronavirus pandemic causes significant distress among nursing students. Students were able to manage stress using acceptance and religious/spiritual coping strategies. During the pandemic, stress management to support mental health is highly recommended.
An overview and analogy of pedagogical approaches in online–offline teaching tactics in COVD-19 pandemic
Authors: Daulatabad Vandana , Kamble Prafull , John Nitin , John Jyoti
Published: November 2022

BACKGROUND:

Learning helps acquire knowledge or skills. COVID-19 outbreak severely affected the progress of education all across the globe. Pandemic-induced alternative methods of teaching promoted the progress of online education. Hence, this study is undertaken to assess an overview of teaching learning strategies in the COVID-19 pandemic so as to explore the direction of medical education and help perk up the teaching learning methods in medical education.

MATERIAL AND METHODS:

The cross-sectional study involves first year medical undergraduate students of 2020–2021 batch studying at Dr. VMGMC, Solapur. It involves complete enumeration of students of 2020-2021 batch. Due to the second wave of COVID-19 pandemic hematology, classes were continued and completed by the same faculty by online live teaching using Microsoft teams. As this being an online survey, it was ethically exempted. A comparison of questionnaires between offline and online classes was done by using χ2test and a P value less than 0.05 was considered as significant. Quantitative data generated by the dichotomous question and five-point Likert scale questions were analyzed using descriptive statistics and frequency analysis. Out of 189 respondents, majority of students preferred traditional offline classes over online classes. Self-directed learning was feasible in both methods of teaching.

DISCUSSION:

Traditional offline classes were more interactive and enthusiastic than online classes. Offline classes helped students to revise, recollect, and reproduce necessary information as their attention span was better in offline teaching than online teaching.

CONCLUSION:

Holistic understanding and better learning were experienced through traditional offline classes. Although teachers take double efforts for online teaching, the overall learning effect and impact of traditional offline classes were much better than online classes. It definitely motivates andrgaogy and helps understand the concept on their own.
Use of simulated patients for formative assessment of moral competence in medical students
Authors: Saber Mahboobeh , Ebrahimi Sedighe , Farzane Neda , Shakeri Aliakbar
Published: November 2022

BACKGROUND:

During the course of their education, medical students must attain moral competence. The current study aims at designing a formative structured examination that would create the opportunity for learners to practice and interact with simulated patients under expert supervision.

MATERIALS AND METHODS:

This article reports an experience in developing and implementation of a formative assessment of moral competence and the point of view of medical students. In this study, the formative structured examination of medical ethics for 80 medical students in 2 rounds with eight stations was designed. In each station, a scenario was proposed, and the opportunity was provided to the learners to interact with a simulated patient under the supervision of a medical ethics expert. Then, the learners would receive structured feedback in accordance with their performance. All learners expressed their experience in reflective writing, and their opinions were put under content analysis.

RESULTS:

The content analysis of this reflective writing revealed three main categories, namely “Deeper understanding of ethical subjects,” “Collaborative thinking and synergy with peers,” and “Effective feedback of supervisors.”

CONCLUSION:

Within the framework of a formative structured examination of medical ethics, a safe space was created for interacting with simulated patients and practicing ethical reasoning, as well as dimensions of moral competence.
Effect of sense of coherence on oral health behavior and status
Authors: Poursalehi Roksana , Najimi Arash , Tahani Bahareh
Published: November 2022

The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOC are better at dealing with stressful situations, psychological stress, and problems and are more able to manage them, leading to better general health. The purpose of this study was to evaluate the effect of SOC on the oral health status of people in different age groups. A systematic search up to May 2019 was carried out in PubMed,Scopus, Psycho info, and Persian sources. Studies were included if they evaluated the relationship between SOC and oral health behaviors (OHBs) or oral health status including dental caries. The Newcastle-Ottawa checklist was used to appraise the selected articles and meta-analysis of included studies were performed using Comprehensive Meta-Analysis software. Value of P < 0.05 was considered to be statistically significant. Odds ratio (OR) was used to measure effect size with 95% confidence interval (CI). The random-effects model was chosen in the presence of heterogenicity. I
2 index and Q index were used to measure the heterogeneity present between the studies. Fifteen articles received the minimum score of criticism. In general, SOC could significantly affect the oral health and OHBs of adults independently of the underlying factors. There was a significant relationship between SOC and tooth decay in adolescents, but this association was poor after adjusting for the underlying factors. In children, only one article revealed an association with OHBs. Meta-analysis revealed that SOC was significantly associated with the caries rate (OR = 0.78, CI 95% = 0.9–0.67, P = 0.001) and tooth brushing frequency (OR = 1.22, CI 95% = 1.1–1.31 and P < 0.001). Sense of coherence appears to be one of the effective factors in predicting oral health behaviors and ultimately oral health, especially in adults. The number of articles available for children and adolescents was not sufficient in this regard.