bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of Evoked Potential Changes Associated with Neck Extension Prior to Cervical Spine Surgery
Authors: Zhao Min , Wu Jionglin , Ji Fengtao , Li Deng , Ye Jichao , Wang Zheyu , Fu Yanni , Huang Lin , Gao Liangbin
Published: August 2023

Background:

Multimodal intraoperative monitoring (MIOM) is a useful tool to warn surgeons to intervene for intraoperative spinal cord injury in cervical spine surgery. However, the value of MIOM remains controversial before cervical spine surgery.

Objective:

To explore the value of MIOM in early detecting spinal cord injury associated with neck extension before cervical spine surgery.

Methods and Materials:

Data of 191 patients receiving cervical spine surgery with the MIOM were enrolled from June 2014 to June 2020. The subjects were divided into a group of evoked potentials (EP) changes and a group of no EP changes for analysis according to the monitoring alerts or not.

Results:

Five (2.62%) patients showed EP changes associated with neck extension during intubation or positioning. After early different interventions, such as repositioning and timely surgical decompression, none or transient postoperative neurological deficits were observed in four cases, and only one case was with permanent neurological deficits. The average preoperative Japanese Orthopaedic Association (JOA) scores of the group with EP changes were lower than those of the group with no EP changes (P= 0.037 < 0.05). There was no statistical significance in gender, average age, mean Pavlov ratio, and the minimum Palov ratio between the two groups (P> 0.05).

Conclusions:

The MIOM could identify spinal cord injury associated with neck extension before cervical spine surgery. Active and effective interventions could prevent or reduce permanent postoperative neurological deficits. Severe spinal cord compression might be a risk factor for EP changes.
Meningeal Melanomatosis with a Spinal Meningeal Melanocytoma Trigger by an in vitro Fertilization
Authors: Ramos Aida Antuña , Ferrara Paula , Fernández Vanesa Martin , Sanchez Carmen Rodriguez , Alvarez Vega Marco A Alvarez
Published: August 2023

Meningeal melanomatosis is an infrequent tumor originating from the melanocytes in the leptomeninges and one of the recognized primary melanocytic tumors of the central nervous system. The average survival has known to be about 5 months. It can be associated with solid tumors, such as meningeal melanocytomas. The patient we present was diagnosed of a meningeal melanomatosis that developed two solid tumors related to an in vitro fertilization. The clinical course was rapidly fatal. Although the use of comprehensive diagnostic procedures, usually the final diagnosis of primary diffuse meningeal melanomatosis is postmortem, it would be advisable for the appropriate management of the patient to make a differential diagnosis and to be aware of the behavior of the tumor.
Adult Intramedullary Pilocytic Astrocytomas
Authors: Yang Tao , Wu HaiBo , Xia ChengYu
Published: August 2023

Purpose:

Adult intramedullary pilocytic astrocytomas (PAs) are exceedingly rare. The aim of this study was to summarize our experiences in treating adult intramedullary PAs.

Materials and Methods:

We retrospectively reviewed the records of seven adult patients who underwent microsurgery for intramedullary PAs between 2010 and 2017. Magnetic resonance imaging was the standard radiological investigation. The diagnosis of PAs was based on pathology. All the follow-up data were obtained during office visits.

Results:

There were three males and four females with the mean age of 40.9 years. The tumors generally exhibited hypointensity on T1-weighted images (WI) and hyperintensity on T2WI. Contrast-enhanced T1WI showed heterogeneous enhancement. Gross total resection (GTR) of the tumor was achieved in four cases and subtotal resection (STR) was achieved in three cases. Two cases of STR received postoperative radiotherapy. One STR case had mildly residual tumor regrowth. At the last follow-up, neurological status was improved in six patients.

Conclusion:

The accurate diagnosis of adult intramedullary PAs depends on pathology. GTR is the best treatment and the outcome is favorable. STR increases the risk of tumor recurrence, and regular follow-up is necessary. Due to uncertain therapeutic efficacy, radiotherapy should be considered carefully for cases of STR.
A Comparative Study of Diagnosis and Treatment of Pott's Spine Amongst Specialists and Super Specialists in India
Authors: Warrier Siddharth , Chaudhary Sarvesh K , Kalita Jayantee , Tripathi Abhilasha , Misra Usha K
Published: August 2023

Background and Objective:

There is a paucity of guidelines about the diagnosis and management of Pott's spine. In this study, we report the pattern of practice of diagnosis and treatment of Pott's spine among the specialists and super-specialists in India.

Subject and Methods:

Response to a 22-item questionnaire regarding the diagnosis and treatment of Pott's spine has been reported. The responses were compared between medical and surgical specialists, residents and consultants, and specialists and super-specialists. There were 84 responders: 42 physicians and 42 surgeons; 48 residents and 36 faculty or consultants; 53 specialists and 31 super-specialists.

Results:

Thirty-eight responders rarely recommended biopsy whereas others recommended biopsy more frequently, especially the surgeons (P < 0.007). Twenty-five responders recommended immobilization even in an asymptomatic patient whereas 38 would immobilize those with neurological involvement only. All but 4 responders would repeat imaging at different time points. The response of medical treatment was judged at 1 month by 53, and 3 months by 26 responders. Surgery was recommended in a minority of patients—in those with neurological involvement or abscess. Surgeons more frequently biopsied, immobilized the patients, and recommended surgery compared to the physicians. The residents also recommended biopsy and recommended immobilization more frequently compared to consultants or faculty members. Super-specialists more frequently recommended biopsy compared to specialists.

Conclusion:

There is marked variation in investigations and treatment of Pott's spine patients, suggesting the need for consensus or evidence-based guidelines.
Vision Loss Following Vertebral Artery Injury during Surgery for Atlantoaxial Instability
Authors: Goel Atul , Bhambere Sagar , Shah Abhidha , Darji Hardik , Biswas Chandrima , Hawaldar Akshay
Published: August 2023

Background:

A number of complications following surgery aimed at atlantoaxial fixation have been reported. However, there is no report in the literature describing visual loss following vertebral artery injury.

Objective:

Vision loss as a complication of vertebral artery injury during surgery for atlantoaxial fixation is reported.

Material and Methods:

This is a report of two patients who were operated for atlantoaxial instability by the Goel technique of atlantoaxial fixation. During surgery, there was an injury to the vertebral artery and the artery had to be sacrificed.

Results:

Both patients suffered severe visual loss following surgery. One patient had a partial visual recovery that started within few days of surgery while the other patient remained completely blind.

Conclusions:

Although rare, visual loss can be a complication of vertebral artery sacrifice during surgery for atlantoaxial stabilization.
Endoport-Assisted Endoscopic Surgery for Removal of Lateral Ventricular Tumors
Authors: Sankhla Suresh K , Warade Anshu , Khan Ghulam M
Published: August 2023

Background:

Endoscopic surgery has emerged in recent years as an alternative to conventional microsurgical approaches for removal of intraventricular tumors. Endoports have enhanced tumor access and visualization with a significant reduction in brain retraction.

Objective:

To evaluate the safety and efficacy of endoport-assisted endoscopic technique for the removal of tumors from the lateral ventricle.

Methods:

The surgical technique, complications, and postoperative clinical outcomes were analyzed with a review of the literature.

Results:

Tumors were primarily located in one lateral ventricular cavity in all 26 patients, and extension to the foramen Monro and the anterior third ventricle was observed in seven and five patients, respectively. Except for three patients with small colloid cysts, all other tumors were larger than 2.5 cm. A gross total resection was performed in 18 (69%), subtotal in five (19%), and partial removal in three (11.5%) patients. Transient postoperative complications were observed in eight patients. Two patients required postoperative CSF shunting for symptomatic hydrocephalus. All patients improved on KPS scoring at a mean follow-up of 4.6 months.

Conclusions:

Endoport-assisted endoscopic technique is a safe, simple, and minimally invasive method to remove intraventricular tumors. Excellent outcomes comparable to other surgical approaches can be achieved with acceptable complications.
Post-Traumatic Stress Disorder after Subarachnoid Hemorrhage
Authors: Tang W. K. , Wang Lisha , Tsoi Kelvin K. F. , Kim J. S.
Published: August 2023

Background:

Post-traumatic stress disorder (PTSD) frequently follows neurological disorders such as non-traumatic subarachnoid hemorrhage (SAH) and has debilitating consequences.

Objective:

The aim of this systematic review was the critical appraisal of the literature on the frequency, severity, and temporal progression of PTSD in patients with SAH, the etiology of PTSD, and its effect on patients' quality of life (QoL).

Material and Methods:

Studies were obtained from three databases: PubMed EMBASE, PsycINFO, and Ovid Nursing. The inclusion criteria were English-language studies on adults (defined as at least 18 years of age) in which ≥10 of the participants received a diagnosis of PTSD following SAH. Applying these criteria, 17 studies (N = 1,381) were included.

Results:

Between 1% and 74% of the participants in each study had PTSD, with a weighted average of 36.6% across all studies. Post-SAH PTSD showed significant correlations with premorbid psychiatric disorders, neuroticism, and maladaptive coping styles. The risk of PTSD was also higher in participants with comorbid depression and anxiety. Stress related to post-ictal events and fear of recurrence were associated with PTSD. However, the risk of PTSD was lower in participants with effective social support networks. The participants' QoL was negatively affected by PTSD.

Conclusions:

This review highlights the high occurrence of PTSD in SAH patients. The temporal progression and chronicity of post-SAH PTSD warrant further research, as do its neuroanatomical and neurochemical correlates. We call for more randomized controlled trials investigating these aspects.
Institutional Patterns of Care of Diffuse Intrinsic Pontine Glioma
Authors: Krishnatry Rahul , Mani Shakthivel , Manjali Jifmi J. , Rane Pallavi P. , Chatterjee Abhishek , Goda Jayant S. , Janu Amit , Sahu Arpita , Gupta Tejpal , Jalali Rakesh
Published: August 2023

Background and Aim:

Despite recent advances, the outcomes of diffuse intrinsic pontine glioma (DIPG) remain dismal. This is a retrospective study to understand the pattern of care and its impact on DIPG patients diagnosed over 5 years in a single institute.

Subjects and Methods:

DIPGs diagnosed between 2015 and 2019 were retrospectively reviewed to understand the demographics, clinical features, patterns of care, and outcomes. The usage of steroids and response to treatment were analyzed as per the available records and criteria. The re-irradiation cohort was propensity matched with patients with a progression-free survival (PFS) >6 months treated with supportive care alone based on PFS and age as a continuous variable. Survival analysis was performed using the Kaplan–Meier method, and Cox regression model was used to identify any potential prognostic factors.

Results:

One hundred and eighty-four patients were identified with demographic profiles similar to western population-based data in the literature. Of them, 42.4% were residents from outside the state of the institution. About 75.2% of patients completed their first radiotherapy treatment, of which only 5% and 6% had worsening clinical symptoms and persistent need for steroids 1 month posttreatment. On multivariate analysis, Lansky performance status <60 (P = 0.028) and cranial nerve IX and X (P = 0.026) involvement were associated with poor survival outcomes while receiving radiotherapy with better survival (P < 0.001). In the cohort of patients receiving radiotherapy, only re-irradiation (reRT) was associated with improved survival (P = 0.002).

Conclusion:

Many patient families still do not choose radiotherapy treatment, although it has a consistent and significant positive association with survival and steroid usage. reRT further improves outcomes in the selective cohorts. Involvement of cranial nerves IX and X needs improved care.
Delayed Complication of a Retained Microcatheter during Neurovascular Intervention Presenting as Limb Ischemia
Authors: Mundhe Vijay Madhukar , Singh Rakesh , Singh Neeraj , Karapurkar Anil , Warawdekar Gireesh , Deshmukh Narayan , Reddy Jagdish
Published: August 2023

Background:

Retained microcatheter after endovascular embolization of brain vascular malformation lesions poses serious risks. Long-term complications have been sparsely described in the literature.

Material and Methods:

We report a rare complication of limb ischemia following the complete migration of a retained microcatheter. The literature review was performed using the mesh terms “complications,” “endovascular interventions,” “retained catheter,” and “Onyx” on PubMed.

Result:

The patient had undergone embolization of dural AV fistula (DAVF) at the craniovertebral junction (CVJ) 5 years before presentation using ethylene vinyl alcohol (Onyx). He presented with acute right lower limb ischemia. Emergency endovascular removal of the catheter and thrombus aspiration were done.

Conclusion:

Migrated catheters confined within vascular lumen can be effectively treated by an endovascular approach. Patient education about complications may help in seeking medical care for timely intervention.
Is Popularity of Fibrin Glue a Misrepresentation? A Comparative Study with Fibrin Glue and Suture Anastomosis in Rat Sciatic Nerve Injury Analysing Functional, Histological, Electrophysiological Parameters
Authors: Siroya Hardik L , Kumar Vinod B , Bhat Dhananjaya I , Shukla Dhaval P , Devi Bhagavatula I
Published: August 2023

Background:

Fibrin glue as an adjunct in peripheral nerve injuries has gained recent popularity. Whether fibrosis and inflammatory processes which are the major hindrances in repair reduce with fibrin glue has more of theoretical support than experimental.

Methodology:

A prospective nerve repair study was conducted between two different species of rats as donor and recipient. Four comparison groups with 40 rats were outlined with or without fibrin glue in immediate post-injury period with fresh or cold preserved grafts were examined based on histological, macroscopic, functional, and electrophysiological criteria.

Results:

There was suture site granuloma along with neuroma formation and inflammatory reaction and severe epineural inflammation in allografts with immediate suturing (Group A), whereas suture site inflammation and epineural inflammation were negligible in cold preserved allografts with immediate suturing (Group B). Allografts with minimal suturing and glue (Group C) had less severe epineural inflammation with less severe suture site granuloma and neuroma formation as compared to first two groups. Continuity of nerve was partial in later group as compared to other two. In fibrin glue only group (Group D), suture site granuloma and neuroma were absent, with negligible epineural inflammation, but continuity nerve was partial to absent in most of the rats with some showing partial continuity. Functionally, microsuturing with or without glue demonstrated significant difference with better SLR and toe spread (p = 0.042) as compared with only glue. Electrophysiologically, NCV was maximum in Group A and least in Group D at 12 weeks. We report significant difference in CMAP and NCV between microsuturing group vs. only glue group (p < 0.05) and also between microsuturing with glue group vs. only glue group (p < 0.05).

Conclusion:

There may be more data required with proper standardization for adept usage of fibrin glue. Though our results have shown partial success, it nonetheless highlights the lack of sufficient data for widespread glue usage.
Sinonasal and Olfactory Quality of Life in Endoscopic Pituitary Surgery and Time Interval to Olfactory Recovery
Authors: Sah Monali , Mohindra Satyawati , Mohindra Sandeep , Bal Amanjit , Mahendru Shaurya , Dhaliwal Avondeep
Published: August 2023

Background and Objective:

Superior turbinate manipulation is often required in cases of narrow cavities and expanded endonasal approaches with concern for olfaction. The objective of the study was to compare the pre- and postoperative olfactory function in patients undergoing endoscopic endonasal transsphenoidal pituitary excision with and without superior turbinectomy, using the Pocket Smell Identification Test and the quality of life (QOL) and Sinonasal Outcome Test-22 (SNOT-22) scores, irrespective of the extension (Knosp grading) of pituitary tumors. We also aimed to identify olfactory neurons in the excised superior turbinate with immunohistochemical (IHC) stains and correlate them with clinical findings.

Materials and Methods:

The study was a prospective, randomized study performed in a tertiary center. Two groups A and B, with superior turbinate preserved and resected, respectively, during endoscopic pituitary resection, were compared using pre- and postoperative Pocket Smell Identification Test and QOL and SNOT-22 scores. The superior turbinate was subjected to IHC staining to identify the presence of olfactory neurons in patients with tumors of pituitary gland requiring endoscopic trans-sphenoid resection.

Results:

Fifty patients with sellar tumors were enrolled. The mean age of patients in this study was 46.15 years. The minimum age was 18 years and the maximum was 75 years. Of the 50 patients in the study, 18 were female and 32 were male. Eleven patients had more than one presenting complaint. Loss of vision was the commonest and altered sensorium was the rarest symptom.

Conclusion:

Superior turbinectomy is a viable option to gain wider access to sella without affecting the sinonasal function, quality of life, and olfaction. There was doubtful presence of olfactory neurons in superior turbinate. The extent of tumor resection and postoperative complications were unaffected and statistically nonsignificant in both the groups.
Safety and Efficacy of Gamma Knife Radiosurgery for the Management of Trigeminal Neuralgia
Authors: Okunlola Abiodun I , Pattankar Sanjeev , Warade Anshu , Khandhar Alay , Mistry Varun , Misra Basant K
Published: August 2023

Background:

Medical management is the first line of care for patients with trigeminal neuralgia (TN), and carbamazepine is the drug of choice used alone or in combination with other drugs. Gamma knife radiosurgery (GKRS) has been an established option in the management of refractory TN based on its noninvasiveness and robust safety profile. Our study aims to confirm the safety and assess the efficacy of GKRS in the management of TN.

Material and Methods:

A retrospective review of the patients with refractory TN treated with GKRS from 1997 to March 2019 by the senior author was carried out. Out of 194 eligible patients, detailed clinical information was not available in 41 patients. The remaining 153 patients' case files (post-GKRS cohort) were reviewed, and data obtained were collated, computed, and analyzed. An additional cross-sectional analysis was carried out telephonically in the post-GKRS cohort in January 2021 using Barrow Neurological Institute (BNI) pain scoring, to obtain the long-term efficacy of GKRS in TN.

Results:

The majority of the patients (96.1%) received a radiation dose of 80 Gy. At 6 months, 94.8% of patients had satisfactory response to GKRS. Follow-up ranged between 1 and 7.5 years. The recurrence rate was 9.2% and the complication rate was 4.6%. Facial numbness was the commonest complication. No mortality was reported. The cross-sectional arm of the study had a response rate of 39.2% (60 patients). Adequate pain relief (BNI I/II/IIIa/IIIb) was reported in 85% of patients.

Conclusion:

GKRS is a safe and effective modality of treatment for TN without any major complications. Both short-term and long-term efficacies are excellent.
Development, Validation, and Impact of Patient Information Booklet for Gamma Knife Radiosurgery
Authors: Tripathi Manjul , Jani Parth , Bhatta Rajkumar , Batish Aman , Yagnick Nishanth S , Madan Renu , Ahuja Chirag K , Mohindra Sandeep , Kaur Rupinder , Kaur Parwinder , Chauhan Rajeev
Published: August 2023

Background:

The inadequate awareness in the general population is a primary concern for the management of various neurosurgical ailments treated with gamma knife radiosurgery (GKRS).

Objective:

Our study aimed to assess the written patient information by focusing on readability, recall, communication, compliance, and patient satisfaction.

Methodology:

The senior author formulated disease-specific patient information booklets. The booklets comprised two segments: general information about GKRS and disease-specific information. The common themes for discussion were “What is your disease?”, “What is gamma knife radiosurgery?”, “What are the alternatives to gamma knife radiosurgery,” “The benefits of gamma knife radiosurgery,” “About gamma knife radiosurgery,” “Recovering from gamma knife radiosurgery,” “Follow up,” “What are the risks,” and “Contact.” The booklet was emailed after the first consultation to 102 patients. Patients' socioeconomic status and comprehensibility were assessed on validated scoring. Post-GKRS, we emailed a custom-made Google feedback survey of 10 leading questions about the role of patient information booklet in educating and decision-making process. We tried to assess if the booklet helped the patient understand the disease and treatment options.

Results:

In total, 94% of patients read it thoroughly and understood it to their satisfaction. They also shared and discussed the information booklet with their family members and relatives (92%). Furthermore, 96% of patients found the disease-specific information informative. For 83% of patients, the information brochure cleared the doubts regarding the GKRS completely. For 66% of patients, their expectations met the reality. In addition, 94% of patients still recommended giving the booklet to the patients. All high, upper- and middle-class responders were happy and content with the patient information booklet. In contrast, 18 (90%) of the lower middle class and 2 (66.7%) of the lower class considered the information useful to the patients. Also, 90% patients found the language of the patient information booklet comprehensible and not too technical to understand.

Conclusions:

An essential component of disease management is to relieve the anxiety and confusion in the patient's mind and help one choose a treatment modality among the available options. A patient-centric booklet helps impart knowledge, clears doubts, and provides an opportunity to discuss options with family members.
Early Gamma Knife Therapy (Without EBRT) in Operated Patients of Glioblastoma Multiforme
Authors: Rai Hitesh I S , Agrawal Deepak , Singh Manmohan , Kale Shashank S
Published: August 2023

Background:

The standard therapy for glioblastoma (GBM) has been external beam radiotherapy (EBRT) with concomitant temozolomide (TMZ) given for six cycles, after maximum possible surgical resection although recurrences after chemoradiation are mostly in-field.

Objective:

To compare the effects of early GKT (without EBRT) along with TMZ to those receiving standard chemoradiotherapy (EBRT + TMZ) after surgery.

Methods:

This was a retro-prospective study on histologically proven GBMs operated at our center between January 2016 and November 2018. The EBRT group consisted of 24 patients who received EBRT + TMZ for six cycles. The GKT arm consisted of 13 consecutive patients who received Gamma Knife within 4 weeks of surgery along with lifelong temozolomide. Patients were followed up every 3 months with CEMRI brain and PET-CT. The primary endpoint was overall survival (OS) with progression-free survival (PFS) being the secondary endpoint.

Results:

At a mean follow-up of 13.7 months, the median overall survivals in GKT and EBRT groups were 11.07 and 13.03 months, respectively (HR = 0.59; P value = 0.19; 95% CI: 0.27-1.29). The median PFS for GKT group was 7.03 months (95% CI: 4.17-17.3) as compared to 11.07 months (95% CI: 5.33-14.03) for the EBRT group. There was no statistical difference in the PFS or OS between the GKT and EBRT groups.

Conclusion:

Our study shows that Gamma Knife therapy (without EBRT) to residual tumor/tumor bed after primary surgery with concurrent temozolomide has similar progression-free (PFS) and overall survival (OS) rates when compared to conventional treatment (EBRT).
Frameless Gamma Knife Radiosurgery with Leksell ICON
Authors: Gill Maneet , Sharma Manish , Ratan Raj
Published: August 2023

Gamma knife radiosurgery saw the light of the day when the Swedish physician “Lars Leksell” postulated the salient first principles of stereotactic radiosurgery. Prior to being realized in its new 'avatar' “The ICON”, Leksell Gamma Knife (LGK) “Perfexion” has been the most practiced model and is still in practice in most of the centers in India. The Gamma Knife ICON (the sixth generation model) utilizes the concept of the Cone-Beam Computed Tomography (CBCT) module, thus allowing non-invasive immobilization of the skull employing frameless treatments without jeopardizing accuracy to sub-millimeters. The LGK ICON however has the same stereotactic delivery and patient positioning system as Perfexion and mesmerizes the care givers with the added technically sound feature of the CBCT imaging arm, that is, CBCT and an intra-fraction motion management system. The experience with ICON on both the sub-sets of patients has been intriguing and awe-inspiring. Despite its challenges of being detected with significant intra-fraction errors, we realized that the non-invasive thermoplastic mask fixation system has its own set of specific characteristics: fairly simple dosimetry; short radiation delivery times; and calm, composed, co-operative patients. We have been successful in conducting frameless gamma knife surgeries in ~25% of patients planned for gamma knife surgery. We look forward to witness this avant-garde pioneering scientific automation being practiced in a higher number of patients.
Gamma Knife Radiosurgery for Uveal Melanoma
Authors: Phalak Manoj , Lomi Neiwete , Ganeshkumar Akshay , Singh Simranjeet , Garg Kanwaljeet , Natanasabhapathi Gopishankar , Singh Manmohan , Kumar Rajinder , Kale Shashank Sharad
Published: August 2023

Background:

Various therapies ranging from plaque brachytherapy to enucleation have been applied in uveal melanomas (UM). A gamma knife (GK) is the gold standard modality for head and neck radiation therapy with enhanced precision owing to the paucity of moving parts. The literature on GK usage in UM is rich with the methodology and nuances of GK applications undergoing constant change.

Objectives:

This article reports on the authors' experience in using GK for tackling UM followed by a thematic review of the evolution of GK therapy for UM.

Materials and Methods:

Clinical and radiological data of patients with UM treated with GK at the All India Institute of Medical Sciences, New Delhi, from March 2019 to August 2020 was analyzed. A systematic search for comparative studies and case series evaluating GK usage in UM was performed.

Results:

Seven UM patients underwent GK, with the median dose being 28 Gy at 50%. All patients underwent clinical follow-up and 3 patients had a radiological follow-up. Six (85.7%) eyes were preserved at follow-up, and 1 (14.28%) patient developed radiation-induced cataract. There was a reduction in tumor volume in all patients with radiological follow-up with the minimum being a 33.06% reduction in size compared to the presenting volume and the maximum being the complete disappearance of tumor at follow-up. A total of 36 articles presenting various facets of GK usage in UM have been thematically reviewed.

Conclusion:

GK can be a viable and effective eye-preserving option for UM with catastrophic side effects becoming rare owing to progressive reduction in radiation dose.
Comparison of Phenytoin and Fosphenytoin in Treatment of Active Seizures in the Emergency Department
Authors: Madhiyazhagan Mamta , Roshan Ramgopal , Dhanapal Sudhakar G , Joseph Joshua V , Ganesan Priya , Mathew Vivek , Kundavaram Paul P A
Published: August 2023

Background and Objective:

Ongoing seizure in the Emergency Department is a medical emergency and its aggressive management is essential. Prompt antiepileptic therapy with early cessation of seizure would minimize the morbidity and risk of recurrence. To compare time to seizure control with fosphenytoin to phenytoin protocol in the ED

Materials and Methods:

We conducted an observational study on patients with active seizure in the Emergency Department comparing phenytoin versus fosphenytoin protocol over one year.

Results:

During the study period, we recruited 121 patients in the phenytoin group and 124 patients in the fosphenytoin group. Generalized tonic-clonic seizure (73.5% in phenytoin vs. 68.5% in fosphenytoin arm) was the most common type of seizure in both the arms. The mean time taken for cessation of seizure in the fosphenytoin arm (17.48 ± 49.24) was less than half of that in the phenytoin arm (37.20 ± 58.17) (mean difference: 19.72, P = 0.004, 95% CI: −33.27 to −6.17). There was a significant decrease in recurrence rates of seizure with phenytoin compared to the fosphenytoin arm (17.7% vs. 31.4%: OR: 0.47, P = 0.013; 95% CI: 0.26–0.86). Favorable STESS (≤2) was higher with phenytoin compared to fosphenytoin (60.3% vs. 48.4%). The overall in-hospital mortality rate in both arms was negligible (0.8%).

Conclusion:

The mean time for cessation of active seizure with fosphenytoin was less than half that of phenytoin. Despite its higher cost and minor adverse effects when compared to phenytoin, benefits seem to outweigh its limitation.
Soft Palate Malignant Melanoma as an Adverse Effect of Fingolimod in Multiple Sclerosis
Authors: Mozhdehipanah Hossein , Safdarian Farshid , Paybast Sepideh
Published: August 2023

Fingolimod has been approved as a disease-modifying drug in multiple sclerosis since 2010. There are a few reports of melanoma as a side effect of Fingolimod in the literature. Herein we aim to report a known case of multiple sclerosis under Fingolimod presenting with persistent nasal congestion who was eventually diagnosed with soft palate malignant melanoma.
Neuromelanin-Sensitive Magnetic Resonance Imaging as a Measure for Differential Diagnosis of Essential Tremor and Parkinson's Disease
Authors: Xuan Tingting , Fang Xue , Xu Ting , Ma Tingting , Zhang Junmei , Wang Zhenhai , Li Haining
Published: August 2023

We sought to evaluate whether the neuromelanin-sensitive magnetic resonance imaging (NM-MRI) features of the substantia nigra (SN) have utility in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). This study enrolled 23 patients with PD, 20 patients with ET, and 18 healthy participants. All subjects underwent clinical examination, motor and cognitive assessments, and NM-MRI scans. The area and contrast-to-noise ratio (CNR) values of SN were defined according to NM-MRI images. Then, receiver operating characteristic (ROC) analysis was conducted to characterize the diagnostic power of the SN area and CNR values of SN. Compared with ET and control groups, the PD group showed a significant reduction of the area of SN (P = 0.003, PD vs. ET; P = 0.001, PD vs. control) and in the SN to midbrain area ratio in the same layer (P = 0.006, PD vs. ET; P = 0.005, PD vs. control). The SN area had a sensitivity of 65% and a specificity of 87% for distinguishing ET from PD, with an area under the curve (AUC) of 0.7630 and a Youden index of 0.5200, whereas the ratio of the SN area to midbrain area in the same layer had a sensitivity of 60% and a specificity of 87% for distinguishing ET from PD, with an AUC of 0.7478 and a Youden index of 0.4700. Compared with the ET group, the mean CNR value of the SN and the respective CNR values of the three subregions were all weakened in the PD group, and only the CNR in the middle part was significantly different from the control group (P = 0.006). The sensitivity of the CNR value of the middle part of the SN for differentiating ET from PD was 65%, the specificity was 87%, the AUC was 0.7500, and the Youden index was 0.5200. Based on our findings, we conclude that NM-MRI can improve diagnostic accuracy in PD and can be used as a specific and sensitive potential diagnostic biomarker for PD.
Postoperative Seizure Control in Adult Diffuse Insular Gliomas Presenting with Seizures
Authors: Das Kuntal K. , Singh Amanjot , Mishra Prabhakar , Khatri Deepak , Deivasigamani Balachandar K. , Datta Aanchal , Bhaisora Kamlesh S. , Mehrotra Anant , Srivastava Arun K. , Jaiswal Awadhesh K. , Behari Sanjay , Kumar Raj
Published: August 2023

Background:

Studies on insular gliomas (IGs) generally focus on the oncological endpoints with a relative scarcity of literature focusing on the seizure outcomes.

Objectives:

To study the predictors of long-term postoperative seizure control in IG and propose a novel risk scoring system.

Methods:

Histopathologically proven, newly diagnosed adult IGs (>18 years) operated over a 10-year period were studied for postoperative seizure control as per International League Against Epilepsy (ILAE) grades at 6 weeks and at last follow-up (minimum of 6 months, median 27 months). Logistic regression analysis was performed and regression coefficients with nearest integers were used to build a risk prediction model. Receiver operator curve (ROC) analysis determined the predictive accuracy of this model.

Results:

The 6-week postoperative seizure freedom dropped to 41% at the last follow-up. The seizure-free group lived longer (100.69 months, 95% CI = 84.3–116.99 (60%)) than those with persistent postoperative seizures (27.92 months, 95% CI = 14.99–40.86). Statistically significant predictors (preoperative seizure control status, extent of resection, tumor extension to temporal lobe, and lack of postoperative adjuvant therapy) were used to compute a risk score, the score ranging from 0 to 9. A score of four most optimally distinguished the risk of postoperative seizures with an area under the ROC of 91.4% (95% CI: 84.1%, 98.7%, P < 0.001).

Conclusion:

In our experience, around 60% of patients obtained seizure freedom after surgery, which reduces over time. Control of seizures paralleled survival outcomes. Our proposed scoring system may help tailor management strategies for these patients.
Cuteness and the Power of Emotion
Authors: Paz Esteban Vaucheret , Leis Mariana , Garcia Basalo María José , Giacchino Mariana , Agosta Guillermo
Published: August 2023

Background:

There is an agreement among individuals from different cultures in how they judge the cuteness of a face. There are observations suggesting that some preferences may be neurobiological rather than cultural. Most of the studies conducted use adult faces with a neutral expression; however, the mechanisms involved in rating cuteness are not exactly the same as those involved in the perception of attractiveness. Furthermore, it is not always taken into account that emotional expressions influence the impression on the beauty of a face. The objective of the study is to evaluate the influence of the different emotions on the perception of cuteness of children's faces.

Materials and Methods:

We included 60 adults and 21 children who observed 150 photographs of children's faces expressing the six basic emotions and had to rate facial cuteness.

Results:

Participants gave the highest cuteness score to faces with happy emotions (mean [M] = 6.89, 95% confidence interval [CI] 6.48–7.30) and the lowest to those that expressed negative emotions (M = 5.32, 95% CI 4.87–5.78, t(160) = 5.08, P <.001). This was evidenced in adults and children of both genders, regardless of the gender of the stimulus.

Conclusions:

In our study, we found that facial expression generates an impact on the perception that a subject has on the cuteness of the face. The faces that show happiness were scored as more cute compared to those that expressed anger, disgust, or sadness. We suggest that expression of positive emotions, like a smile, could increase the conducts associated with caring, placing the child in a more favorable situation for the future.
Infraclavicular Catheter in MELAS Syndrome for Analgesic Purposes
Authors: Onay M , Kiremitçi T Tanyel , Kayhan G Erdoğan , Algın D Ilhan , Güleç MS
Published: August 2023

MELAS syndrome is defined as mitochondrial myopathy accompanied by encephalopathy, lactic acidosis, myoclonus, stroke-like episodes. It has a progressive course, multi-systemic effects and severe complications. Myoclonic contractions are unresponsive to many anti-epileptic drugs; these contractions and spasms may lead to severe pain. Systemic analgesic drugs are not sufficient to control pain. Therefore, continuous brachial plexus blockage may be preferred. Infraclavicular brachial plexus catheter is placed in our case. Local anesthetic injections through this catheter may be effective in pain management and results are to be discussed here.
Newer botanicals in melasma: A review
Authors: Sawarthia Saloni , Sardesai Vidyadhar R. , Lunge Snehal B. , Chandwani Bhavna H.
Published: August 2023

Melasma is a common acquired pigmentary disorder predominantly affecting women of childbearing age and Fitzpatrick skin types IV–VI. It negatively impacts the quality of life due to its chronic and relapsing nature. It occurs due to a complex interplay between genetics, hormonal influences, inflammation, oxidative stress, and chronic photodamage. Therefore, a multimodality approach is essential for its treatment. It encompasses photoprotection, topical and oral therapy, and various procedures such as chemical peels, microneedling, lasers, and light treatment. The gold-standard treatment remains topical modified Kligman’s formula, consisting of hydroquinone, corticosteroid, and retinoid, in different concentrations. However, it may cause various adverse effects due to its unsupervised and chronic use. Therefore, novel treatment modalities should not only focus on reducing melanin synthesis and other influencing factors but also have a high safety profile. Among them, botanicals or plant-based extracts have gained massive popularity in the recent past. These compounds have been investigated extensively for their therapeutic activity against pigmentation, efficacy, and safety. Currently, they act as adjuncts to existing topicals. However, there is a paucity of data for their use as monotherapy. This review focuses on newer as well as existing botanicals for the treatment of melasma. Data extraction was done by searching words like botanicals, plant extracts, melasma, and depigmenting agents in databases: Pubmed, Google Scholar, Scopus, and others over the last 20 years.
Comparing T2-T3 staging of penile cancer according to the American Joint Committee on cancer 8th edition with two modified staging systems in predicting survival outcome
Authors: Kakoti Shitangsu , Sureka Sanjoy Kumar , Pathak Abhishek , Shah Utsav Shailesh , Mishra Navneet , Puneeth Kumar K. M. , Srivastava Aneesh , Singh Uday Pratap
Published: August 2023

Introduction:

Penile cancer is a rare malignancy of the genitourinary tract. We aimed to validate the recent changes in the T2 and T3 stages of penile cancer in the American Joint Committee on Cancer (AJCC) 8th edition and to compare its predictive ability with two other modified staging systems for survival outcomes.

Methods:

This is a retrospective study of patients diagnosed with penile cancer from June 2015 to March 2020. The AJCC 8th edition and two other newly proposed systems by Li et al. and Sali et al. were used for staging the tumor. All variables were categorized and correlated with lymph node (LN) metastases and overall survival (OS).

Results:

Fifty-four patients were eligible for this study. The mean age was 58 years (range 46–72 years). The tumor stage (P = 0.016), clinical LN stage (P = 0.001), the involvement of the spongiosa (P = 0.015) and the cavernosa (P = 0.002), lymphovascular invasion (LVI) (P = 0.000), and PNI (P = 0.021) were found to be the significant predictors of LN metastases. When the 5 year OS was compared between the T2 and T3 stages of the AJCC 8th edition, Li staging and the Sali staging systems, it was 91% and 50.1% (P = 0.001), 97.5% and 10.3% (P = 0.000), 94.4% and 14.7% (P = 0.000), respectively. The presence of LVI (P = 0.001) was the most significant independent predictor of OS.

Conclusions:

The recent changes in the AJCC 8th edition pertaining to the T2-T3 stage are relevant, although the other two newly proposed staging systems were more precise in predicting the survival outcomes.
Pediatric robotic urologic procedures: Indications and outcomes
Authors: Hou Sean W. , Xing Monica H. , Gundeti Mohan S.
Published: August 2023

Introduction:

Robotic-assisted laparoscopic surgery (RALS) has revolutionized minimally invasive surgery in pediatric urology. The robotic platform allows surgeons to maintain the benefits of laparoscopic surgery while having enhanced three-dimensional view, dexterity, range of motion, and control of high-resolution cameras. In this review, we summarize the indications and recent outcomes for various pediatric urologic RALS procedures to illustrate the current state of robotics in pediatric urology.

Methods:

We systematically searched the PubMed and EMBASE databases. We extrapolated and summarized recent evidence on RALS in pediatric urology patients, with an emphasis on indications and outcomes, with regard to the following procedures and search terms: pyeloplasty, kidney stone surgery, partial nephrectomy, nephroureterectomy, ureteral reimplantation, appendico-vesicostomy, augmentation cystoplasty, bladder neck reconstruction, and Malone antegrade continence enema. Additional Medical Subject Headings terms used to augment the search included “Treatment Outcome” and “Robotic Surgical Procedures.”

Results:

Increasing usage of RALS has shown many benefits in perioperative and postoperative outcomes. In addition, there is growing evidence that robotic procedures in pediatric urology result in similar or better surgical outcomes when compared to the standard of care.

Conclusions:

RALS has shown considerable effectiveness in pediatric urologic procedures and may achieve surgical outcomes comparable to the standard approaches of open or laparoscopic surgery. However, larger case series and prospective randomized controlled trials are still necessary to validate the reported outcomes, in addition to cost analyses and studies on the surgical learning curve. We believe that the continuous evolution of robotic platforms will allow for enhanced care and quality of life for pediatric urology patients.
Giant pouch stones as a surgical challenge decades after a continent ileal pouch
Authors: Abdulla Adil , Venugopalan A V , Farzana T C
Published: August 2023

Continent cutaneous urinary diversion pouches are prone to complications like stoma blockage by mucus, metabolic derangements, infection, renal derangements and urolithiasis. Pouch urolithiasis is not uncommon, but presentation of a huge stone burden is rare. We report a case of giant pouch stones in a continent pouch which was a surgical challenge. We also highlight the need for adequate hydration, pouch irrigation and drainage by clean intermittent catheterization and regular follow-up, to prevent such a condition from arising.
A rare case of air cysto-uretero-pyelogram due to emphysematous cystitis
Authors: Sarangi Shakti Swarup , Bhirud Deepak Prakash , Navriya Shiv Charan , Sandhu Arjun Singh
Published: August 2023

Emphysematous infection of the urinary tract is a hazardous condition and is life-threatening if not managed quickly. We report an 82-year-old woman with uncontrolled diabetes mellitus and urethral stricture who presented with emphysematous cystitis with the gas reaching up to the pelvicalyceal system on the left side (emphysematous pyelonephritis) and appearing in X-ray as air pyelogram. The patient was managed with drainage and intravenous antibiotics and she recovered.
A Comparative Study of Mixed Connective Tissue Disease and Overlap Syndromes – A Single-Center Study from India
Authors: Maikap Debashis , Deosale Shreyansh , Singh Pratima , Panda Sudhansu Sekhar , Padhan Prasanta
Published: August 2023

Introduction:

Mixed connective tissue disease (MCTD) a classical overlap syndrome with four different defining criteria. The present study attempts to compare the clinical features and autoantibodies for MCTD and overlap syndromes.

Methods:

In this observational study from October 2018 to August 2020, we included all the patients of MCTD and overlap syndromes. Alarcon–Segovia criteria was used as defining criteria for MCTD patients while the patients meeting diagnostic criteria for more than 1 of 6 classical autoimmune rheumatic diseases were selected in the overlap syndromes group. We compared their clinical features, laboratory parameters, and autoantibody profiles. MS Excel, STATA were used for statistical analysis, and comparison between the groups was done with t-test, Chi-square test, and Wilcoxon rank sum test. P < 0.05 was considered as statistically significant.

Results:

The study consisted of 60 consecutive patients (MCTD, n = 30 and overlap syndromes, n = 30) with higher female population in both groups (90% in MCTD and 84% in the overlap syndromes group) compared to males. The incidence of fever (83.3% vs. 46.6%), weight loss (60% vs. 26.6%), trigeminal neuralgia (76.6% vs. 13.3%), and myositis (63.3% vs. 20.0%) was significantly higher in MCTD than overlap syndromes whereas the incidence of cough (66.6% vs. 90.0%) and dry mouth (20.0% vs. 53.3%) was higher in overlap syndromes than MCTD (P < 0.05). Anti-U1 RNP antibodies were seen in all MCTD (100.0%) patients while anti-Scl 70 antibodies (60%) and anti-ribosomal-p-protein antibodies (13.3%) were seen in overlap syndromes.

Conclusion:

Fever and weight loss, trigeminal neuralgia, and myositis were more common in MCTD than overlap syndromes. Anti-U1 RNP antibodies seen in MCTD while Anti-Scl 70 antibodies and anti-ribosomal-P antibodies were commonly were seen in overlap syndromes.
Induction of alopecia areata after COVID-19 vaccination
Authors: Lin Deborah A. , Zaken Ghufran Abo , Sanz Jessika , Miteva Mariya
Published: August 2023

Alopecia areata (AA) is an autoimmune disorder that results in patchy hair loss. There have been increasing reports, though limited, in the medical literature of relapse of AA in affected patients and sudden onset of AA in previously unaffected patients after COVID-19 infection or vaccination. We describe a unique case of a middle-aged woman in the United States with sudden onset of severe AA immediately after receiving the Pfizer-BioNTech vaccine. We explain our case’s trichoscopic findings, review the literature surrounding AA and COVID-19, and discuss the pathogenesis of how COVID-19 vaccination and infection may induce AA in patients without previous history of alopecia.
Case series of variants of angiokeratoma
Authors: Somashekhar Sachin , Ramesh Heera , Loganathan Eshwari , Gowda Varsha
Published: August 2023

Angiokeratomas are vascular lesions that display an epidermal proliferative reaction with ectatic capillaries in the papillary dermis and are described histologically as one or more dilated blood vessels lying directly subepidermal. Presentation of angiokeratomas varies from a single lesion to generalized involvement. The diagnosis of angiokeratoma is mainly clinical as the histopathology of all variants are identical. In this case series, we discuss the variants of angiokeratoma and their presentations.