bluuebunny/crossref_metadata_2025 huggingface dataset:
An examination of the structural linkages between households and community health services in realization of accelerated primary healthcare delivery in Kisumu County, Kenya: a systematic review
Authors: Wakiaga James M. , Nalugala Reginald
Published: June 2024

Background The provision of community health services (CHS) is critical in accelerating primary health care delivery to vulnerable and deprived populations. This systematic review study has been conducted to interrogate the interrelationship between households and community health services in accelerating primary healthcare delivery synthesizing the available empirical studies. The findings are to inform a primary research on structural linkages between households and CHS in Kisumu County, Kenya. Methods This study applied a descriptive approach using a systematic review technique to provide context and substance to the two main research questions: (1) how does the interaction between households and CHWs affect utilization of CHS to promote equity and right to health? (2) How do health-seeking behaviours of households influence their decision-making regarding choices of CHS? We screened the literature from Google scholar, JSTOR, SAGE and EBSCO based on our inclusion criteria, resulting in 21 studies. These studies were assessed for quality and eligibility and data extracted based on relevance to the research study. Results Households place primacy on trust and confidentiality in the interaction with CHWs and this affects uptake of CHS. The social determinants of health are also critical in influencing the health-seeking behaviour of households and individuals and their choice of CHS. The successful models of CHS share the characteristic of community ownership and participation and provides for comprehensive health care teams. Conclusion CHS are critical for the acceleration of primary health care delivery. It forms an important pathway for the achievement of universal health coverage, which is an outcome required for Sustainable Development Goal 3 on health.
Auroras during extreme geomagnetic storms: Some features of mid-latitude aurora on February 11, 1958
Authors: Mikhalev Aleksandr
Published: June 2024

This paper discusses peculiarities of the great mid-latitude aurora that occurred during the extreme magnetic storm on February 11, 1958. This mid-latitude aurora had unusual optical and spectral characteristics, among which, first of all, were very high (10⁵–10⁸ R) intensities of atomic oxygen [OI] 630.0 nm emission and an unusually high ratio of the intensities of two forbidden lines of oxygen [OI] 630.0 nm and 557.7 nm (I₆₃₀/I₅₅₇.₇). In some points, this ratio was as high as 10³–10⁴. Analysis of I₆₃₀ dynamics during other extreme geomagnetic storms and associated geophysical conditions and physical processes in Earth’s ionosphere and magnetosphere allows us to assume that great mid-latitude auroras are formed during intense substorms in main phases of magnetic storms. In order to interpret the observed features of the February 11, 1958 mid-latitude aurora, we propose to examine the mechanism of level [OI] ¹D selective filling in which reactions of resonance recharge of oxygen ions O⁺(²D)+O (³P)→O⁺(⁴S)+O(³P, ¹D) and/or reactions of oxygen atom and molecule collisions with excited components of odd nitrogen can be implemented.
Toward a social justice framework in trauma-informed practice in schools
Authors: McGreer Sarah
Published: June 2024

This article explores the integration of social justice principles for a theoretical reconceptualization of trauma-informed practice (TIP) in schools. This involves exploring the role of educators and school social workers in promoting socially just TIP within primary education, a landscape that is currently dominated by the influence of neoliberal ideals. Interprofessional collaboration between social workers and educators has the potential to bring about a significant transformation in the way trauma is addressed, providing critical implications for individuals working in school settings. This article discusses how integrating social justice principles into school practices can strengthen the application of TIP.
Pakistan's Coming Crisis
Authors: Malik Adeel , Tudor Maya
Published: June 2024

Abstract: Pakistan's 2024 elections delivered a shocking surprise. Imran Khan's PTI won the largest number of seats amid heavy state repression. With this result, well-worn political patterns—whereby military favor virtually guaranteed a party's electoral success—were upended. This essay argues that Pakistan's 2024 election is not a "black swan" event but instead signals a coming crisis of governability that grows out of three structural changes: the rise of an aspirational middle class, the erosion of traditional authority patterns, and an intensifying economic and climate crisis. Consequently, a historic loss of military legitimacy is unlikely to abate in years ahead.
Diffuse optical tomography of the brain: effects of inaccurate baseline optical parameters and refinements using learned post-processing
Authors: Mozumder Meghdoot , Hirvi Pauliina , Nissilä Ilkka , Hauptmann Andreas , Ripoll Jorge , Singh David E.
Published: June 2024

Diffuse optical tomography (DOT) uses near-infrared light to image spatially varying optical parameters in biological tissues. In functional brain imaging, DOT uses a perturbation model to estimate the changes in optical parameters, corresponding to changes in measured data due to brain activity. The perturbation model typically uses approximate baseline optical parameters of the different brain compartments, since the actual baseline optical parameters are unknown. We simulated the effects of these approximate baseline optical parameters using parameter variations earlier reported in literature, and brain atlases from four adult subjects. We report the errors in estimated activation contrast, localization, and area when incorrect baseline values were used. Further, we developed a post-processing technique based on deep learning methods that can reduce the effects due to inaccurate baseline optical parameters. The method improved imaging of brain activation changes in the presence of such errors.
Contrastive Deep Encoding Enables Uncertainty-aware Machine-learning-assisted Histopathology
Authors: Sivaroopan Nirhoshan , Watawana Hasindri , Jayanga Chamuditha , Ekanayake Chalani , Rodrigo Ranga , Edussooriya Chamira U. S. , Wadduwage Dushan N.
Published: June 2024

Neural networks can learn features from millions of histopathology images. However, curating high-quality annotations for training is laborious. In this work, we show how such models can be trained with only 1-10% of annotated data.
Experimental demonstration of a silicon nanophotonic antenna for far-field broadened optical phased arrays
Authors: Khajavi Shahrzad , Zhang Jianhao , Cheben Pavel , Melati Daniele , Schmid Jens H. , Cheriton Ross , Vachon Martin , Wang Shurui , Atieh Ahmad , Ramos Carlos Alonso , Ye Winnie N.
Published: June 2024

Optical antennas play a pivotal role in interfacing integrated photonic circuits with free-space systems. Designing antennas for optical phased arrays ideally requires achieving compact antenna apertures, wide radiation angles, and high radiation efficiency all at once, which presents a significant challenge. Here, we experimentally demonstrate a novel ultra-compact silicon grating antenna, utilizing subwavelength grating nanostructures arranged in a transversally interleaved topology to control the antenna radiation pattern. Through near-field phase engineering, we increase the antenna’s far-field beam width beyond the Fraunhofer limit for a given aperture size. The antenna incorporates a single-etch grating and a Bragg reflector implemented on a 300-nm-thick silicon-on-insulator (SOI) platform. Experimental characterizations demonstrate a beam width of 44°×52° with −3.22  dB diffraction efficiency, for an aperture size of 3.4  μm×1.78  μm. Furthermore, to the best of our knowledge, a novel topology of a 2D antenna array is demonstrated for the first time, leveraging evanescently coupled architecture to yield a very compact antenna array. We validated the functionality of our antenna design through its integration into this new 2D array topology. Specifically, we demonstrate a small proof-of-concept two-dimensional optical phased array with 2×4 elements and a wide beam steering range of 19.3º × 39.7º. A path towards scalability and larger-scale integration is also demonstrated on the antenna array of 8×20 elements with a transverse beam steering of 31.4º.
Hybrid diffuse optical monitoring based study of cerebral autoregulation indices in hyperventilation therapy for traumatic brain injury management
Authors: Tagliabue S. , Ruiz M. Martorell , Fischer J. B. , Maruccia F. , Rey-Perez A. , Exposito L. , Baguena M. , Poca M. A. , Durduran T.
Published: June 2024

Cerebral autoregulation (CAR) assessment in traumatic brain injury during hyperventilation can be multimodally assessed by hybrid diffuse optical device combined with physiological parameters. Results indicate a heterogeneous and complex response in CAR indices.
Mosquito abundance and diversity in central Ohio, USA vary among stormwater wetlands, retention ponds, and detention ponds and their associated environmental parameters
Authors: Radl James , Martínez Villegas Luis , Smith Joseph S. , Tirpak R. Andrew , Perry Kayla I. , Wetmore Deirdre , Tunis Elena , Smithberger Jack , Schuellerman Henry , Magistrado Dom , Winston Ryan J. , Short Sarah M.
Published: June 2024

Mosquitoes (Diptera: Culicidae) are one of the most impactful pests to human society, both as a nuisance and a potential vector of human and animal pathogens. Mosquito larvae develop in still aquatic environments. Eliminating these habitats near high human density or managing them to reduce the suitability for mosquitoes will reduce mosquito populations in these human environments and decrease the overall negative impact of mosquitoes on humans. One common source of standing water in urban and suburban environments is the water that pools in stormwater control measures. Previous studies have shown that some stormwater control measures generate large numbers of mosquitoes while others harbor none, and the reason for this difference remains unclear. Our study focuses on elucidating the factors that cause a stormwater control measure to be more or less suitable for mosquitoes. During the summers of 2021 and 2022, we collected and identified mosquito larvae from thirty stormwater control measures across central Ohio to assess variation in mosquito abundance and diversity among sites. Our goal was to determine if specific types of stormwater control measures (retention ponds, detention ponds, or constructed wetlands) harbored different abundances of mosquitoes or different community structures. We also assessed environmental parameters of these sites to elucidate their effects on mosquito abundance and diversity. Overall, we recorded the highest number of mosquito larvae and species in constructed wetlands. However, these sites were dominated by the innocuous species, Culex territans. Conversely, detention ponds held fewer mosquitoes but a higher proportion of known vector species, including Culex pipiens and Aedes vexans. The total number of mosquitoes across all sites was correlated with higher vegetation, more shade, lower water temperatures, and lower pH, suggesting stormwater control measures with these features may also be hotspots for mosquito proliferation.
Normal value of neuron-specific enolase for predicting good neurological outcomes in comatose out-of-hospital cardiac arrest survivors
Authors: Kim Dongju , Kwon Hyojeong , Kim Sang-Min , Kim June-Sung , Kim Youn-Jung , Kim Won Young
Published: June 2024

Research on prognostic factors for good outcomes in out-of-hospital cardiac arrest (OHCA) survivors is lacking. We assessed whether normal levels of normal neuron-specific enolase (NSE) value would be useful for predicting good neurological outcomes in comatose OHCA survivors treated with targeted temperature management (TTM). This registry-based observational study with consecutive adult (≥18 years) OHCA survivors with TTM who underwent NSE measurement 48 hours after cardiac arrest was conducted from October 2015 to November 2022. Normal NSE values defined as the upper limit of the normal range by the manufacturer (NSE <16.3 μg/L) and guideline-suggested (NSE < 60 μg/L) were examined for good neurologic outcomes, defined as Cerebral Performance Categories ≤2, at 6 months post-survival. Among 226 OHCA survivors with TTM, 200 patients who underwent NSE measurement were enrolled. The manufacturer-suggested normal NSE values (<16.3 μg/L) had a specificity of 99.17% for good neurological outcomes with a very low sensitivity of 12.66%. NSE <60 μg/L predicted good outcomes with a sensitivity of 87.34% and specificity of 72.73%. However, excluding 14 poor-outcome patients who died from multi-organ dysfunction excluding hypoxic brain injury, the sensitivity and specificity of normal NSE values were 12.66% and 99.07% of NSE < 16.3 μg/L, and 87.34% and 82.24% of NSE < 60 μg/L. The manufacturer-suggested normal NSE had high specificity with low sensitivity, but the guideline-suggested normal NSE value had a comparatively low specificity for good outcome prediction in OHCA survivors. Our data demonstrate normal NSE levels can be useful as a tool for multimodal appropriation of good outcome prediction.
The impact of social participation on the health status of the older adult: An empirical study based on CGSS 2021 data
Authors: Zhang Zebo , Jin Lei , Liu Jiajun , Liao Dongling , Zhang Xiaolin
Published: June 2024

Introduction

With the rapid pace of population aging, the health issues of the older adult have garnered widespread attention. Social participation plays a pivotal role in the health of the older adult. This study aims to explore the impact of social participation on the health status of the older adult.

Methods

Using a binary logistic regression model, this study analyzes the influence of social participation methods on the health status of older adult individuals in China based on cross-sectional data from the "China Comprehensive Social Survey" in 2021. The study sample comprises individuals aged 60 to 99 years.

Results

It was found that participation in physical activities [P<0.001, OR = 1.907], social and recreational activities [P<0.001, OR = 1.387], and online activities [P<0.001, OR = 1.808] were significantly positively correlated with the health status of the older adult.

Conclusions

The health of older adults is influenced by a combination of physical activities, social and recreational activities, and online activities. Good health is closely associated with high levels of physical activity. Engaging in physical exercise promotes physiological health, while participating in social and recreational activities has a significant impact on cognitive and depressive states. Additionally, involvement in online activities helps alleviate feelings of loneliness and enhances overall well-being.

Recommendations

1)Promote the development of physical activities for the older adult: Create an integrated environment for physical exercise. 2)Expand the social circle of the older adult: Construct diverse and structured communities to enhance well-being. 3)Develop online activities for the older adult: Facilitate their integration into the digital age. 4)Foster interdisciplinary collaboration for older adult health: Build partnerships across various domains to promote older adult health.
Investigation of antimicrobial resistance and antimicrobial resistance genes in Staphylococcus aureus and coagulase-negative staphylococci isolated from rabbit
Authors: Suriyakhun Nawarat , Jangsangthong Arunee , Tunyong Witawat , Kong-Ngoen Thida , Santajit Sirijan , Indrawattana Nitaya , Buranasinsup Shutipen
Published: June 2024

Background and Aim: Staphylococci, which inhabit skin and mucous membranes in humans and animals, are opportunistic pathogens. Coagulase-positive and coagulase-negative staphylococci (CoNS) are the two main groups. Clinical abscesses in rabbits often harbor Staphylococcus aureus and CoNS. This study estimated S. aureus and CoNS prevalence, resistance profiles, antimicrobial-resistant genes, and the accessory gene regulator (agr) group in rabbit clinical abscesses.

Materials and Methods: Sixty-seven abscesses were gathered from 67 rabbits who visited Prasu-Arthorn Animal Hospital in Nakornpathom, Thailand, from January 2014 to October 2015. Thirty-four subcutaneous, 29 dental, 2 ocular, 1 mammary gland, and 1 uterine abscess were present. Conventional methods, including Gram staining, mannitol fermentation, hemolysis on blood agar, catalase testing, and coagulase production, identified and isolated S. aureus and CoNS from all abscesses. All S. aureus and CoNS isolates underwent antimicrobial susceptibility testing using the disk diffusion method. Polymerase chain reaction was used to detect the presence of blaZ, aacA-aphD, msrA, tetK, gyrA, grlA, dfrG, and cfr antimicrobial-resistant genes. Methicillin resistance was identified through the detection of a cefoxitin -resistant phenotype and the presence of mecA gene. Further investigation was conducted on the agr group of S. aureus isolates.

Results: In 67 abscesses, we found 19 S. aureus isolates in 9 abscesses (13.43%) and 37 CoNS isolates in 18 abscesses (26.87%), both majorly located at subcutaneous sites. About 59.46% of CoNS isolates were methicillin-resistant compared to 5.26% of S. aureus isolates. Methicillin-resistant S. aureus (MRSA) and methicillin-resistant CoNS (MRCoNS) both displayed multidrug resistance (MDR). Both MRSA and MRCoNS expressed multiple antimicrobial resistance genes, including blaZ, aacA-aphD, gyrA, grlA, msrA, tetK, and dfrG. Approximately 73.68% of the agr groups were agr I, 15.79% were agr III, and 10.53% were agr II.

Conclusion: This study found a high prevalence of MRCoNS with antimicrobial resistance and multiple antimicrobial-resistant genes in rabbits with clinical abscesses. The effectiveness of antibiotics against infections caused by such strains is a matter of concern. Owners should be educated about the importance of good hygiene practices and judicious antibiotic use to prevent widespread antimicrobial resistance.

Keywords: antimicrobial resistance, antimicrobial resistance genes, coagulase-negative staphylococci, rabbit, Staphylococcus aureus.
The effectiveness of different hormone protocols for improving ovarian function before ovum pick-up in crossbred Japanese black cattle
Authors: Kajaysri Jatuporn , Intrarapuk Apiradee
Published: June 2024

Background and Aim: Producing and transferring embryos in vitro are profitable for enhancing premium beef genetics. Reducing costs and enhancing the effectiveness of hormone protocols before ovum pick-up (OPU) yield advantages. This study aimed to confirm that estradiol benzoate (EB) treatment resulted in more medium- and large-sized follicles before OPU and of higher oocyte quality after OPU than non-hormonal treatments, comparable to those undergoing gonadotropin-releasing hormone (GnRH) with follicle-stimulating hormone (FSH) plus prostaglandin F2α (PGF2α) and progesterone-releasing controlled internal drug release (CIDR) or EB with progesterone-releasing CIDR hormonal treatments.

Materials and Methods: 30 crossbred Japanese black cows were divided into five equal groups, which were either untreated or treated with different hormone protocols before OPU. Group 1 (cows in estrus) and group 2 (cows in diestrus) were the untreated controls. Cows in group 3 were treated with GnRH + FSH + CIDR + PGF2α. Cows in group 4 received EB, and those in group 5 received EB + CIDR + PGF2α. After administering the protocols, all cow follicles were examined through ultrasonography and categorized by size. Subsequently, all cows underwent OPU, and the oocytes were collected and graded from A to D according to standard criteria.

Results: Group 3 presented the highest large follicle numbers, and groups 3–5 had more medium follicle numbers, not different among groups but they had this parameter more than those of control groups 1 and 2. Moreover, groups 3–5 did not differ in combined grades A + B oocytes (good-quality oocytes). Groups 3 and 4 had more A + B oocytes than control groups 1 and 2, whereas group 5 was not different in this parameter from group 1.

Conclusion: Among the three hormone protocols, EB treatment proved the most cost-effective and efficient, yielding more high-quality oocytes compared to the non-treatment protocols. To reduce the limitations of EB use in the future, this study suggests researching natural EB phytoestrogens as alternative treatments for improving ovarian function before OPU in other cattle breeds.

Keywords: estradiol benzoate, follicle-stimulating hormone, gonadotropin hormone-releasing hormone, Japanese black cow, ovum pick-up.
First-Generation African Americans in English Language Education
Authors: Charles Quanisha
Published: June 2024

First-Generation (FG) African Americans enrolled in English language education programs, such as Teaching English as a Second Language, requires further exploration. This article raises awareness to challenges but also explores support systems that may be recognized as recruitment strategies and retention measures for leaders who are under-prepared to support FG African Americans in the English language education profession.
Chronic musculoskeletal low back pain: mistakes in patient management and optimization issues
Authors: Golovacheva V. A. , Golovacheva A. A. , Tarshilova A. R.
Published: June 2024

We present a clinical observation of a patient with chronic musculoskeletal low back pain (CMLBP), one of the most common conditions in neurological practice. Common mistakes in the management of such patients are highlighted. The patient had previously been incorrectly diagnosed with "osteochondrosis of the spine", the back pain was by mistake associated with "age-related" organic, degenerative-dystrophic changes in the spine, and only passive treatment methods were used in the treatment — various medications, massages, physiotherapy. The factors for the development and chronification of back pain were not evaluated or corrected, therapeutic exercises were not prescribed, the rules of ergonomics and physical activity during the day were not discussed, i.e. methods that have proven to be effective and are recommended for the treatment of CMLBP. Due to an inappropriate management, the patient developed misconceptions about the disease, catastrophizing the pain and incorrect and ineffective strategies for coping with the pain, which perpetuated the chronic course of the back pain. At the Clinic for Nervous Diseases at Sechenov University, the patient was offered a comprehensive treatment approach that included educational counselling, kinesiotherapy and pharmacotherapy. Based on the patient's medical and life history and the data of an objective examination, factors for the development and chronification of back pain were identified: long-term static postures at work at a computer, physical inactivity, increased body weight, neuro-orthopedic features (“flat back”), anxiety, catastrophizing of pain, pain behavior pattern. During the treatment process, all of the above factors were considered and corrected. Kinesiotherapy included therapeutic exercises, recommendations on ergonomics and daily activity, training in correct posture and kinesio-taping. The patient took dexketoprofen as a non-steroidal anti-inflammatory drug, which is effective and relatively safe for patients with back pain. As a result of the complex treatment, the patient's pain syndrome regressed, daily activity increased and her emotional state improved; observation over 6 months showed a lasting positive effect, increasing working capacity.
Impact of COVID-19 on mild vascular cognitive impairment in patients with atrial fibrillation: results of a three-year observational study
Authors: Vorob'eva O. V. , Shindryaeva N. N. , Fateeva V. V.
Published: June 2024

The relationship between vascular cognitive impairment (VCI) and atrial fibrillation (AF) is mediated by multiple mechanisms, including vascular risk factors associated with a more severe course of COVID-19.

Objective: to investigate the impact of COVID-19 on the dynamics of cognitive status parameters in patients with AF over an observation period of 36 months.

Material and methods. The observational study included 51 patients (19 men and 32 women; age ranged from 46 to 73 years, mean age 57.7 years) who met the inclusion criteria. All study participants were tested at baseline and after 36 months using Montreal Cognitive Assessment (MoCA). The study took place during COVID-19 pandemic, and 25.5% of patients had documented SARS-CoV-2-associated pneumonia. During the observation period, patients received stable background therapy to prevent modifiable vascular risk factors. Two groups were formed: group 1 (n=13) — COVID-19 “+”, group 2 (n=38) — COVID-19 “-”. Patients in group 1 were more likely to have stage IIIarterialhyper-tension (46.2% vs. 17.9% in group 2; p<0.05), had a history of ischemic stroke (38.5% vs. 5.3% in group 2; p<0.05), were not vaccinated with Gam-COVID-Vac vaccine (23.1% vs. 73.7% in group 2; p<0.05).

Results. Patients with AF after SARS-CoV-2 virus infection experienced deterioration of VCI from 22.7±2.1 to 20.2±1.6 points according to MoCA (p<0.05) due to impairments in executive functions, attention, memory and speech. After 36 months of observation, the number of patients with a memory index score <7 points, which indicates a high risk of conversion of mild cognitive impairment to dementia, increased by 30.7% in group 1 and by 5.3% in group 2 (p<0.05).

Conclusion. Patients with atrial fibrillation who had COVID-19 showed a more pronounced progression of cognitive impairment despite the constant use of stable background therapy aimed at correcting modifiable vascular risk factors.
Psychotic disorders in Parkinson's disease: phenomenology, pathogenesis, therapeutic approaches (modern view on the problem)
Authors: Alizade Kh. I. , Ragimova A. A. , Fedotova E. Yu. , Illarioshkin S. N.
Published: June 2024

Psychotic disorders in Parkinson's disease (PD) are common non-motor manifestations that have a negative impact on the quality of life of patients and are associated with an unfavourable prognosis. The development and progression of psychotic symptoms in patients with PD is due to a combination of exogenous and endogenous mechanisms, such as an imbalance of neurotransmitter systems, the effect of antiparkinsonian drugs, individual characteristics of the disease course and structural neurodegenerative changes in the brain. Given the heterogeneity of psychotic symptoms and the lack of standardized diagnostic criteria, issues of timely identification and choice of therapeutic tactics are important and require special attention from neurologists and psychiatrists in clinical practise. This review highlights modern ideas on phenomenology, risk factors, pathogenesis and therapeutic approaches.
Treatment of the early stages of Parkinson's disease. Differences in approaches to the choice of therapy in different countries
Authors: Bril E. V. , Fedorova N. V. , Kulua T. K. , Zimnyakova O. S.
Published: June 2024

The review addresses an approach to the treatment of early stages of Parkinson's disease (PD) and also provides data on the real-life use of different classes of drugs for the treatment of PD in comparison with other countries, as well as data from an all-Russian survey of patients with PD. In our country, dopamine receptor agonists (DRAs) are currently one of the most commonly prescribed groups of drugs in the treatment of early stages of PD. According to international studies, there is still insufficient information on the use of different classes of drugs in practice for the treatment of PD and studies on the real-life practice of prescribing them. Prescribing the first drug for the treatment of early PD should be the result of an informed shared decision between doctor and patient, in which the patient plays a crucial role. Piribedil, one of the oldest drugs for the treatment of PD and still one of the most commonly prescribed drugs for the treatment of early stages of PD, was found to be superior to other DRAs in a recent meta-analysis (2023).
Isolated head tremor
Authors: Zalyalova Z. A. , Ermakova M. M. , Khayatova Z. G.
Published: June 2024

Isolated head tremor (IHT) is a pathological condition characterized by tremor of the head without dystonic posturing or tremor in other parts of the body. In the past, head tremor was commonly referred to as essential tremor because it is very common in families of patients with essential tremor and may precede hand tremor. Several recent observations cast doubt on this theory. The irregular character of the tremor, the low efficacy of the drugs used for essential tremor and the use of botulinum neuroprotein type A with good response point to the dystonic character of the tremor. Neurophysiological evidence for a relationship between IHT and dystonia includes an altered somatosensory temporal discrimination threshold, metabolic changes according to DAT spectrography (positron emission spectrography to determine changes in dopamine levels) and a change in the blink reflex.
Clinical and neurophysiological features of the augmentation phenomenon in restless legs syndrome
Authors: Gorbachev N. A. , Obukhova A. V. , Fedeneva L. A. , Poluektov M. G.
Published: June 2024

Anxiety and depressive disorders are common in restless legs syndrome (RLS); in some cases, the disease is accompanied by cognitive impairment and a deterioration in quality of life. The most important treatment method for RLS is the use of dopaminergic medications. In some cases, the use of these drugs leads to a complication - the phenomenon of augmentation, which manifests itself in an increase in RLS symptoms as the dose of medication increases.

Objective: to determine the clinical and neurophysiological characteristics of RLS patients with the augmentation phenomenon.

Material and methods. 40 patients with RLS were examined: 20 with augmentation (main group, MG; 5 men and 15 women) and 20 without augmentation (comparison group, CG; 7 men and 13 women). The median age of the patients in the MG was 63.5 [56; 71] years, and 62.0 [43.5; 71.5] years in the CG. Clinical assessment was performed using the RLS Severity Rating Scale (RS), Montreal Cognitive Assessment Scale (MoCA), Beck Anxiety Inventory, Beck Depression Inventory, Quality of Life Scale (SF-36), Insomnia Severity Index (ISI), Trail Making Test (Part A), Trail Making Test (part B), phonemic and semantic speech activity tests. All patients underwent suggested immobilization test (SIT) to assess the urge to move on a 10-point numerical rating scale (NRS) and periodic limb movements (PLM) while awake, as well as a polysomnographic examination.

Results. Augmentation significantly more frequently resulted in an expansion of the area of distribution of the urge to move and other unpleasant sensations over the entire surface of the legs (p=0.01), painful discomfort in the legs (p=0.001), early onset of symptoms (04:00—18:00; p=0.04), shortening of the latency period for the onset of symptoms (p=0.001), twitching in the legs while awake (p=0.04), taking higher doses of dopaminergic medications (p=0.004). In augmentation, the MoCA score is lower (p=0.01), such patients use fewer words in the semantic speech activity test (p=0.049), have a higher score on the RS (p=0.001) and ISI (p=0.02), a greater number of PLMs while awake according to SIT (p=0.01) compared to CG. No significant differences were found between groups in terms of age, gender, ferritin level, total score on the Beck Anxiety and Depression Inventory, SF-36 Quality of Life Scale, Trail Making Test (Part A), Trail Making Test (part B), phonemic speech activity test, polysomnography indicators (including motor activity during sleep).

Conclusion. From a clinical and neurophysiological point of view, the phenomenon of augmentation is not simply a manifestation of a more severe course of RLS but has features that reflect the pathogenesis of this disorder. During augmentation, patients tend to describe the sensations as painful and their involuntary motor activity increases. This reflects changes in the activity of the diencephalospinal tract due to excessive dopaminergic stimulation.
Diffusion tensor tomography with tractography in assessment of the pyramidal system in patients with highly active multiple sclerosis
Authors: Peshkin A. N. , Toniya G. T. , Stepanova E. A. , Lizhdvoi V. Yu. , Kotov S. V.
Published: June 2024

Objective: to study the pyramidal tract in patients with highly active multiple sclerosis (HAMS) during treatment switching from first-line MS therapy to second-line therapy due to suboptimal response.

Material and methods. 24 patients with HAMS were analyzed. Depending on the severity of pyramidal functional system (PFS) impairment according to EDSS, patients were divided into 2 groups; group 1 — 17 patients with an EDSS score of 0—2.5 points, group 2 — 7 patients with an EDSS score of ≥3 points. All patients underwent MRI of the brain according to the standard protocol. The diffusion tensor images (DTI) were processed using the DTI FiberTrak software.

Results. The volume of the pyramidal tract was decreased in patients in group 2 (p<0.001), asymmetry of the indicator was noted, in several patients a decrease in volume on the clinically intact side, which may indicate visually undetectable signs of damage of pyramidal tract. There was a clear tendency for a decrease in fractional anisotropy and a decrease in pyramidal tract length with increasing pyramidal deficit (p<0.001). Negative correlations were found between indicators of neurological deficit and pyramidal tract volume and length (Spearman's Rho=-0.5246; p<0.001) and a direct correlation between duration of MS and apparent diffusion coefficient (ADC) and inversely — with fractional anisotropy (Pearson's R=-0.290; p=0.039).

Conclusion. The observed decrease in pyramidal tract volume and length, increase in ADC, asymmetry of these indicators, correlations with the degree of pyramidal insufficiency, EDSS and duration of MS can obviously serve as additional criteria for evaluation of disease dynamics and efficacy of therapy.
Rhythmic transcranial magnetic stimulation in the treatment of cervical dystonia and comorbid mental disorders
Authors: Ragimova A. A. , Petelin D. S. , Galyautdinova A. N. , Tolmacheva V. A. , Volel B. A.
Published: June 2024

Cervical dystonia (CD) is a common form of movement disorder with a high incidence of comorbid mental disorders. Rhythmic transcranial magnetic stimulation (rTMS) is effective in depression and other mental disorders, but its efficacy in CD with comorbid mental disorders has been poorly studied.

Objective: to investigate the efficacy of rTMS in CD and comorbid mental disorders.

Material and methods. Seventeen patients with CD underwent a course of 10 rTMS sessions (protocol: 1 Hz, 600 pulses to the left primary motor cortex). The severity of mental disorders, quality of life and severity of cervical dystonia were assessed using the HADS, SF-36 and CDQ-24 scales.

Results. After transcranial magnetic stimulation treatment, a significant reduction in anxiety (from 12.2±4.1 to 6.3±2.1 points; p<0.01) and depression (from 8.4±3.7 to 5.2±3.2 points; p<0.01) on the HADS scale were noted, and a significant improvement in both physical (from 37±15.2 to 45±17.3 points; p=0.017) and mental (from 31±11.2 to 38±9.6 points; p=0.008) quality of life components according to SF-36. The severity of CD according to CDQ-24 also decreased significantly (from 60.2±11.7 to 51±12.4 points; p=0.022), and there were improvements in the subscales of emotional well-being and social and family life.

Conclusion. The efficacy of rTMS in reducing the severity of both manifestations of CD and comorbid mental disorders was established.
Epilepsy and pregnancy
Authors: Vlasov P. N. , Azhigova A. M. , Efimkova E. B. , Petrukhin V. A.
Published: June 2024

There are currently about 15 million women of childbearing age worldwide who suffer from epilepsy. Overall, 0.3–0.4% of newborns are born to mothers with epilepsy, and almost half of these women experience recurrent seizures. The article discusses issues related to pregnancy planning, the prognostic impact of seizure frequency, type and course of epilepsy on pregnancy outcomes, and potential risks associated with this condition. Summarized data from the latest recommendations for correction of therapy and data on changes in the pharmacokinetics of antiepileptic drugs during pregnancy are presented. A classification of antiepileptic drugs according to their teratogenic potential and their effect on the development and behaviour of the child is presented. Various approaches to pregnancy management are discussed. In addition, scenarios for pregnancy management in poorly controlled epilepsy and status epilepticus are discussed as well as adjustment of therapy in the postpartum period and measures for the safe care of newborns.
Analyzing the predictors of relapse in drug-induced headache: a prospective clinical and psychological study
Authors: Guziy E. A. , Sergeev A. V. , Tabeeva G. R.
Published: June 2024

The prevalence of drug-induced headache (DIHA) in the population is about 7%, and the relapse rate of DIHA after successful treatment is about 40% within 5 years.

Objective: to analyze the risk factors for recurrence of DIHA and to develop a prognostic model for the probability of relapse after treatment.

Material and methods. The characteristics of 117 patients with DIHA were analyzed on the basis of clinical data and questionnaire data using headache scales (MMAS-8, MIDAS, HALT, HIT-6, mTOQ-5), psycho-emotional profiles (PCS, Spielberger-Hanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, LDQ) that were performed at the time of admission to the clinic and 9 months after the start of therapy. All patients enrolled in the study received a complex treatment that included an educational conversation, “detoxification” and symptomatic therapy during the withdrawal period along with a preventive treatment for chronic migraine (CM).

Results. It was shown that there is still a low level of diagnosing of CM and DIHA. By creating a prediction model for the likelihood of recurrence of DIHA, we were able to identify the most important factors for an unfavorable course and recurrence of excessive analgesics use: frequency of analgesic use per day (OR 15.8; 95% C113.1—23.4), degree of alexithymia (score on TAS-26 scale: OR 11.3; 95% CI 6.3—18.1), frequency of combined analgesic use per month (OR 7.1; 95% CI 4.3—11.7), degree of pain catastrophizing on the PCS scale (OR 4.7; 95% CI 1.2—7.3), duration of symptomatic drug abuse (OR 3.2; 95% CI2.1—5.7).

Conclusion. A high level of concomitant psychoemotional disorders, especially alexithymia and impulsive behaviour, is a significant risk factor for relapse and should be considered in the treatment of comorbid pathologies. It can be assumed that monoclonal antibodies against calcitonin gene-related peptides, botulinum therapy or combined treatment may be the treatment of choice in cases of ineffective prevention and detoxification attempts in the past as well as in cases of prolonged analgesic abuse.
Optic neuritis in various demyelinating diseases
Authors: Kalashnikova A. K. , Eliseeva D. D. , Andreeva N. A. , Zhorzholadze N. V. , Ronzina I. A. , Bembeeva R. Ts. , Venediktova N. N. , Kalganova M. R. , Sheremet N. L.
Published: June 2024

The discovery of antibodies against aquaporin-4 (AQP4) and against myelinoligodendrocyte glycoprotein (MOG) confirmed the existence of two disease entities distinct from multiple sclerosis (MS) — neuromyelitis optica spectrum disorders (NMOSD) and myelinoligodendrocyte glycoprotein-associated disease (MOGAD). Demyelinating optic neuritis (ON) can be either idiopathic (iDON) or a manifestation of MS, NMOSD (AQP4-ON) or MOGAD (MOG-ON).

Objective: to determine the clinical features of ON and to evaluate the diagnostic value of optical coherence tomography (OCT) in demyelinating diseases of the central nervous system.

Material and methods. The study included 43 patients with demyelinating ON who were divided into three groups according to the underlying disease (NMOSD, MOGAD and MS/iDON). We assessed visual acuity (VA) in the acute phase and analyzed VA and average values of retinal nerve fiber layer thickness (RNFL) and retinal ganglion cell complex (RGC) thickness using OCT data 6 months after the onset of ON.

Results. ON was observed in the onset of the disease in 75% of NMOSD patients, 62% of MOGAD patients and 86% of MS/iDON patients. In the MOGAD and NMOSD groups, bilateral ON was predominantly observed. In 65% of patients with MOGAD (MOG-ONr), a recurrent course of ON was observed. VA was significantly lower in patients with AQP4-ON in acute phase and comparable to the MOG-ONr group in the long-term phase. VA in the onset of MOG-ON with a single episode was comparable to that of MS/iDON (p=0.2), but recovery was less pronounced (p=0.03). The most significant thinning of the RNFL and RGC complex was observed in the AQP4-ON and MOG-ONr groups. In AQP4-ON and MOG-ON groups, restoration of VA up to 0.5 and higher was observed significantly more frequently in the group of patients receiving pulse therapy with glucocorticoids (p=0.018).

Conclusion. The study showed the most pronounced structural and functional disturbances in the long-term phase of AQP4-ON and MOG-ONr. MOG-ON was characterized by a high frequency of relapses with the influence of this factor on VA and thinning of the retinal layers in the long-term.
The influence of the mental state of women with infertility on their reproductive status
Authors: Nikolaevskaya A. O. , Tyuvina N. A. , Balabanova V. V.
Published: June 2024

Mutual influence between women's mental health and their reproductive capacity are not clearly understood. In particular, psychogenic factors and mental disorders affect sexual, menstrual and reproductive functions, which in turn can lead to infertility. Improving the mental state of women, on the other hand, helps to restore reproductive function.

Objective: to develop dynamic ideas about the reproductive status of mentally ill and mentally healthy women with infertility based on the results of the follow-up.

Material and methods. The study included 348 patients with infertility over a period of 2 years, 228 were mentally healthy women and 120 women with mental disorders. All women were consulted by a gynecologist, women with mental disorders by a psychiatrists, and treatment of existing disorders was carried out.

Results. Mentally healthy women have a significantly higher number of pregnancies, which is mainly due to the in vitro fertilization procedure. They have a rational approach to pregnancy planning, are characterized by a high referral rate to obstetricians and gynecologists and undergo a large number of gynecological procedures to overcome infertility. Pregnancy occurs spontaneously in mentally ill patients and is associated with an improvement in mental state and normalization of menstrual, sexual and therefore reproductive function, but is characterized by a complicated course (fetal growth retardation, miscarriage, intrauterine infection of the fetus, oedema, hypertension, lipid metabolism disorders, gestational diabetes mellitus, placental disorders) and fewer births.

Conclusion. The reproductive function of women depends on their mental state. In women with mental disorders, disturbances of menstrual and sexual function and family adaptation lead to infertility. Improving the mental state contributes to the restoration of reproductive function and spontaneous pregnancy.
Fremanezumab in real-life clinical practice: specialized headache center experience
Authors: Azimova Yu. E. , Skorobogatikh K. V. , Osipova V. V. , Korobkova D. Z. , Vashchenko N. V. , Mamkhegov E. Z. , Galanina A. S. , Guziy E. A.
Published: June 2024

Anti-CGRP monoclonal antibodies (mAb) have been approved and successfully used in Russia since 2020.

Objective: to investigate the efficacy and safety of fremanezumab (FRE) therapy (225 mg monthly or 675 mg quarterly) in real-life clinical practice in patients with migraine who referred to a specialized Russian headache center.

Material and methods. This open-label, retrospective study involved 202 patients (mean age 39.4±12.2 years) with frequent episodic (EM) or chronic migraine (CM) who received at least three injections of FRE 225 mg or three injections with a total dose of 675 mg and regularly completed the Migrebot headache diary one month before starting therapy and throughout the course of treatment.

Results. The mean number of migraine days per month decreased in the whole group from 20.1±8.2 (before treatment) to 8.5±7.9 after 12 weeks (p<0.0001), in the EM group from 10.9±4.1 to 3.6±3.7 (p<0.0001) and in the CM group - from 24.4±5.7 to 10.8±8.3 (p<0.0001). Adverse events were observed in 13 (6.4%) patients (most frequently local reactions: itching, rash, redness, induration at the injection site).

Conclusion. The study showed a favourable efficacy and safety profile of FRE in the Russian population, where anti-CGRP mAbs are considered the first-line treatment for migraine.
Therapeutic outcomes in patients with acute non-specific (musculoskeletal) pain according to the FORTE (ФОРТЕ) observational study
Authors: Parfenov V. A.
Published: June 2024

Treatment of acute non-specific back pain (ANSBP) is one of the current issues of modern medicine, as ANSBP is one of the most common causes of temporary disability in the population. Non-steroidal anti-inflammatory drugs (NSAIDs) are used in ANSBP , with the drug Nalgesin® forte (naproxen 550 mg) being widely used in clinical practice.

Objective: to evaluate the efficacy and safety of the drug Nalgesin® forte in patients with ANSBP.

Material and methods. The observational study “Nalgesin® forte (naproxen) in real-life clinical practice: treatment outcomes in patients with acute non-specific (musculoskeletal) pain” included 12,434 patients (46.51% men, 53.49% women; mean age of patients – 47.3±13.8 years) with ANSBP. Pain in the lumbar region and in the neck prevailed (lumbodynia – 25.5%, lumboischialgia – 26.28%, cervicalgia – 33.03%), less frequently the pain was localized in the thoracic region (thoracalgia – 15.18%). We assessed pain intensity using numeric rating scale (NRS), indicators of the Russian version of the Kiel questionnaire, duration of therapy with Nalgesin® forte, satisfaction with the therapy and tolerability of the treatment. The patients were informed about the benign nature of the ANSBP and took the medication Nalgesin® forte 550 mg 1–3 times a day for pain relief; the medication was discontinued when the pain resolved or decreased significantly.

Results. The majority (75.9%) of patients received Nalgesin® forte at a dose of 550 mg twice daily, 14.3% – 550 mg once daily and 9.8% – 550 mg three times daily. The duration of therapy was 6–14 days in the majority (80.03%) of patients, while it did not exceed 1 week in more than one third of patients (37.2%). During treatment, the average pain intensity decreased from 6.6±1.60 to 1.82±1.32 points according to the NRS (p<0.001), the proportion of patients with initially unbearable pain decreased from 2.79 to 0.28%, with severe pain – from 27.16 to 1.10%, with moderate pain – from 60.42 to 2.82%, and the proportion of patients with mild pain increased from 9.63 to 95.8% (p<0.001). Most physicians (91.7%) were satisfied with the treatment results, and most patients (94.5%) and physicians (95.7%) were satisfied with the tolerability of the treatment. Patients with a high and medium risk of chronic pain according to the Kiel questionnaire required longer treatment than patients with a low risk of chronic pain (p=0.002). A low incidence of adverse events (AEs) was observed when taking Nalgesin® forte; no serious AEs were recorded.

Conclusion. Favourable therapeutic outcomes in ANSBP, efficacy and safety of the drug Nalgesin® forte in ANSBP of different localisations were noted.