bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility and safety of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC): A systematic review and meta-analysis
Authors: Chandragiri Pranay Sai , Tayal Anshula , Mittal Saurabh , Madan Neha Kawatra , Tiwari Pawan , Hadda Vijay , Mohan Anant , Madan Karan 
Published: July 2024

ABSTRACT

Background:
Modalities to improve tissue acquisition during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been investigated. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is a modality to obtain larger histological samples by inserting a cryoprobe into the mediastinal lesion. We aimed to study the diagnostic yield and safety of EBUS-TMC.

Methods:
We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yield of EBUS-TMC and compare it with EBUS-TBNA.

Results:
Following a systematic search, we identified 14 relevant studies (869 patients undergoing EBUS-TMC and EBUS-TBNA). We then performed a meta-analysis of the diagnostic yield of EBUS-TMC and EBUS-TBNA from studies wherein both procedures were performed. The pooled diagnostic yield of EBUS-TMC was 92% (95% confidence interval [CI], 89%–95%). The pooled diagnostic yield of EBUS-TBNA was 81% (95% CI, 77%–85%). The risk difference in yield was 11% (95% CI, 6%–15%, I
2 = 0%) when EBUS-TMC and EBUS-TBNA were compared. The only complication reported commonly with EBUS-TMC was minor bleeding. The complication rate was comparable with EBUS-TBNA.

Conclusion:
EBUS-TMC provides a greater diagnostic yield with a similar risk of adverse events compared to EBUS-TBNA. Future studies are required to clearly establish which patients are most likely to benefit from this modality.
Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024)
Authors: Koul Parvaiz A. , Vora Agam C. , Jindal Surinder K. , Ramasubramanian Venkatasubramanian , Narayanan Varsha , Tripathi Surya Kant , Bahera Digambar , Chandrashekhar Harway Bhaskar , Mehta Ravindra , Raval Narendra , Dorairaj Prabhakar , Chhajed Prashant , Balki Akash , Aurangabadwalla Rohan Ketan , Khandelwal Abhijeet , Kawedia Mahendra , Rai Satya Prakash , Grover Ashok , Sachdev Manish , Chatterjee Surajit , Ramanaprasad Velamuru V. , Das Aratrika , Modi Mahavir Madhavdas 
Published: July 2024

ABSTRACT

Introduction:
Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing.

Methods:
Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake.

Outcome:
The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms.

Conclusion:
These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.
MRI Evaluation of Microstructural and Perfusion Changes in Patients with Hemsensory Neurological Syndromes
Authors: Pandey Saurabh , Jain Neeraj , Singh Anuradha , Paliwal Vimal Kumar , Kumar Sunil 
Published: July 2024

Background:
Hemisensory syndrome is characterized by a nondermatomal sensory deficit involving one half of the body. With the conventional imaging techniques, researches find low diagnostic yield in this condition; however, with the advancements in MRI imaging, there is hope to find the pathophysiological basis of hemisensory symptoms.

Objective:
To evaluate microstructural and perfusion changes in brain parenchyma in patients with hemisensory syndrome on MRI with diffusion tensor imaging (DTI) and arterial spin labeling (ASL).

Material and Methods:
A total of 20 patients with hemisensory symptoms and 10 age-matched controls were enrolled and divided in two study groups – a) case vs. control and b) affected vs. nonaffected cerebral hemisphere in cases. Quantification of absolute cerebral blood flow (aCBF), fractional anisotropy (FA), and mean diffusivity (MD) was done in both groups.

Results:
On ASL, there was significantly increased aCBF in thalamus on the contralateral-affected side. DTI revealed significantly decreased FA in the thalamus and increased FA in corona radiata of the affected side. There was a significant difference for MD of corona radiata between affected and nonaffected hemisphere. The mean value of MD in corona radiata is decreased on the affected side.

Conclusion:
Changes in advanced neuroimaging techniques like ASL and DTI along the pain processing pathway suggest an alteration in neuronal density and activity at the microstructural level. These findings may provide an insight into the etiopathogenesis of pain syndromes.
Clinical, Laboratory and Radiological Correlates of Xpert MTB/RIF Assay Study in Cerebrospinal Fluid in CNS Tuberculosis
Authors: Anand R Pratheesh , Tandon Ruchika , Jha Sanjeev 
Published: July 2024

Background:
Cerebrospinal fluid (CSF) Xpert MTB/RIF assay is an initial test for the diagnosis of tuberculous meningitis (TBM). Nevertheless, it is not very clear which of the factors govern CSF-Gene Xpert/MTB positivity.

Objective:
Hence, we aimed to assess the relationship, if any, between the clinical, laboratory and radiological parameters of the central nervous system (CNS) tuberculosis patients and the Gene Xpert study in CSF in such patients.

Methods and Material:
First, we studied 200 patients with CNS tuberculosis according to the case definition, and subsequently, we performed a Gene Xpert study on the CSF of these patients. Then, we correlated the clinical, radiological, and CSF criteria with the Gene Xpert positivity using the univariate binary logistic regression method via SPSS 20 (P-value <0.05).

Results:
Seventy-five (37.5%) patients (57.3% females) of median 24 years of age, were CSF-Gene Xpert/MTB-positive and 125 (62.5%) patients were negative. The mean duration of illness (P = 0.017), weight loss or failure to thrive (P < 0.001), loss of consciousness or seizure (P = 0.001), signs of meningeal irritation (P = 0.027), stage III of TBM (P < 0.001), evidence of dissemination (P = 0.003), basal exudates (P = 0.004), hydrocephalus (P = 0.018), CSF lymphocytic predominance (P < 0.001), and reduced CSF glucose (P = 0.011) correlated significantly with positive the Gene Xpert/MTB results. Also, Gene Xpert had a sensitivity of 80% and a specificity of 74.84% against culture Xpert.

Conclusions:
Xpert MTB/RIF might be more useful in the later stages of the disease and those with more severe disease.
Refractory Immune-Mediated Cysticercal Meningitis and Role of B Cell Depleting Therapy
Authors: Anadure Ravi K , Goel Jitesh , Saxena Rajeev , Mohimen Aneesh , Agrawal Palack 
Published: July 2024

Background:
Extraparenchymal neurocysticercosis (NCC) commonly presents with symptoms of raised intracranial pressure such as headache, nausea, vomiting, or delirium. Intraventricular NCC is frequently associated with obstructive hydrocephalus as well as recurrent inflammatory cascade leading to chronic meningitis.

Objective:
The aim of this study was to report the novel use and benefit of B cell depleting therapy in a case of treatment-refractory cysticercal meningoencephalitis.

Case:
In this article, we report about a young male with intraventricular NCC, who had recurrent meningitis (with encephalitis) and kept relapsing despite multiple cerebrospinal fluid diversion procedures, cysticidal therapy, and high-dose steroids. He finally showed clinical and radiological resolution with pulsed rituximab therapy.

Conclusion:
This off-label use of a monoclonal antibody against CD20 may be considered as a rescue therapy in steroid-refractory immune-mediated cysticercal meningitis.
TREADS: Target Research for Anti-epileptic Drugs Using Data Science
Authors: Chintalapati Janaki , Kumar Arvind , Hosur MV , Pal Supriya N 
Published: July 2024

Context:
Epilepsy is a common neurological disease and is classified into different types based on features such as the kind of seizure, age of onset, part of brain effected, etc. There are nearly 30 approved anti-epileptic drugs (AEDs) for treating different epilepsies and each drug targets proteins exhibiting a specific molecular mechanism of action. There are many genes, proteins, and microRNAs known to be associated with different epileptic disorders. This rich information on epilepsy-associated data is not available at one single location and is scattered across multiple publicly available repositories. There is a need to have a single platform integrated with the data, as well as tools required for epilepsy research.

Methods and Material:
Text mining approaches are used to extract data from multiple biological sources. The data is curated and populated within an in-house developed epilepsy database. Machine-learning based models are built in-house to know the probability of a protein being druggable based on the significant protein features. A web interface is provided for the access of the epilepsy database as well as the ML-based tool developed in-house.

Results:
The epilepsy-associated data is made accessible through a web browser. For a protein of interest, the platform provides all the feature values, and the results generated using different machine learning models are displayed as visualization plots.

Conclusions:
To meet these objectives, we present TREADS, a platform for epilepsy research community, having both database and an ML-based tool for the study of AED targets.

To access TREADS:
https://treads-aer.cdacb.in
Anterior Communicating Artery Aneurysms: Surgical Strategy and Outcome based on Proposed Newer Classification
Authors: Singh Suyash , Bhaisora Kamlesh Singh , Chheda Rushabh Mulchand , Dixit Priyadarshi , Srivastav Arun Kumar , Das Kuntal Kanti , Mehrotra Anant , Kumar Ashutosh , Maurya Ved Prakash , Verma Pawan Kumar , Jaiswal Awadesh , Rajkumar  , Behari Sanjay 
Published: July 2024

Background:
The ruptured anterior communicating artery aneurysm is the most frequent intra-cranial aneurysm treated at any neurosurgical department. These aneurysms arise from either the A1-A2-Acom artery junction or Acom artery. The surgical outcome depends on the age of the patient, time duration between ictus and surgery, and Hunt and Hess grade at admission. In this article, we intend to analyze the surgical outcome based on our proposed classification with our overall experience of Acom aneurysm.

Methods:
A retrospective review of our surgical database with 250 patients of ruptured Acom was done, and the location, morphology, and direction of aneurysm, along with other clinical parameters including the demographic profile, radiological findings, and intra-operative details, were studied. We classified the Acom based on both site of origin and morphology (Type I, junctional on the dominant side; Type II, fusiform with an ill-defined neck and branching pattern; Type III, saccular true Acom A) and secondarily as described in the literature on the basis of the direction of fundus (Type A–E). The clinical parameters were compared among the above groups using Fischer-exact and one-way analysis of variance test.

Results:
A total of 250 patients (M: F =113:137) were included (mean age 52.1 ± 11.5 standard deviation years). 55.2% patients had left A1 dominance. Type I Acom A was commonly found on the left dominant circulation (P = 0.00). The difference in aspect ratio of Type I (2.0 ± 0.8) and Type II (1.8 ± 0.52) aneurysms was insignificant (P = 0.28). However, a significant difference in post-operative vasospasm among different types of aneurysms was found (P < 0.05). The Type I Acom A were anteriorly directed, while Type II and III were posteriorly directed (P = 0.001). The mean follow-up of the study was 44.4 ± 25.7 months, with age (P = 0.007) and Hunt and Hess grade (P = 0.001) at admission correlating with surgical outcome.

Conclusion:
Classifying the Acom A pre-operatively based on site and morphology, location, and direction of fundus helps in surgical planning and prognosis. The junctional ‘Type IA aneurysms’ are most common and possess a high intra-operative rupture rate. The anteriorly directed aneurysms have a better prognosis, and visual complaints are usually associated with anterior-inferiorly directed aneurysms.
Comparison of Response First Technique with Reversal First Technique for Quality of Extubation in Patients Undergoing Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial
Authors: Kapil Sonia , Jain Divya , Ganesh Venkata , Panda Nidhi B , Arya Virendra K , Grover Vinod K , Mukherjee Kanchan K , Bhagat Hemant 
Published: July 2024

Background and Objective:
Early and smooth extubation following anesthesia is an important concern in patients undergoing transsphenoidal pituitary surgery to permit early neurological evaluation and prevent complications. The aim was to compare the RESPONSE FIRST and REVERSAL FIRST techniques for quality of extubation (QOE) in patients undergoing endoscopic transsphenoidal pituitary surgery.

Methods:
Fifty-six patients aged 18–60 years, with American Society of Anesthesiologists Physical Statuses I–II, and undergoing transsphenoidal surgery for pituitary tumors were randomized into either the RESPONSE FIRST group, in which neuromuscular reversal was given following the patient’s response to oral commands, or the REVERSAL FIRST group, in which reversal of neuromuscular blockade (NMB) was given at the return of spontaneous respiration. QOE was the primary outcome. Hemodynamic response, jugular venous oxygen saturation (SjVO2), time to extubation, and awareness during emergence were assessed as secondary outcomes.

Results:
The QOE in the RESPONSE FIRST group was significantly better than the REVERSAL FIRST group (mean (interquartile range (IQR)), 18 (17–19) vs 14 (12–14.75), P < 0.001). Heart rate (HR) and mean arterial pressure (MAP) were better in the RESPONSE FIRST group when compared to the REVERSAL FIRST group at the time of extubation, at 5 minutes, and 15 minutes following extubation (P < 0.05). SjVO2values were higher in the REVERSAL FIRST group as compared to the RESPONSE FIRST group during extubation and at 5 minutes after extubation (P < 0.01). There was no significant difference in the time to extubation between the groups (P = 0.73).

Conclusion:
The RESPONSE FIRST technique is associated with better QOE and preservation of systemic and cerebral hemodynamics during extubation in patients undergoing transsphenoidal pituitary surgery when compared to the REVERSAL FIRST technique.
Intentional Insertion of Air to Predict the Diagnostic Accuracy of Stereotactic Biopsy and a Uniform Grading System for Reporting
Authors: Deora Harsh , Nadeem Mohammed , Shashidhar Abhinith , Arivazaghan A , Rao Malla Bhaskara 
Published: July 2024

Background and Objectives:
Stereotactic biopsies are a relatively safe and reliable way of tissue diagnosis and characterization of eloquent area lesions/neoplasm. However, predicting the accuracy of the site of biopsy with the desired/planned site is not always possible. We describe a technique to identify the precise location of the biopsy site in the post-operative computed tomography (CT) scan using the injection of a low volume of air into the biopsy cannula.

Methods:
Hundred consecutive biopsies were performed in 80 adults/20 children (59 males/41 females, median age 51 years) over 3 years, consisting of 75 frameless and 25 frame-based stereotactic biopsies. After the biopsy specimens had been collected, a small volume of air (median 1 cc) was injected into the site. Post-operative CT was done within 4 hours of the biopsy to see the site of the air bubble, and the same was correlated with the histopathological accuracy.

Results:
Intra-cranial air in the selected target was present in 95 patients (Grade 1 and 2), while the air was seen in the track (Grade 3) in 3% and at an unrelated site (Grade 4) in 2% of cases. Both Grade 4 biopsies were negative on histopathology (diagnostic yield = 98%). Two negative biopsies were reported, which were both predicted with the Grade 4 biopsy. The grading allowed uniform reporting across series and eliminated the chance of upgrading/downgrading the report due to wrong site sampling within the lesion/neoplasm.

Conclusion:
The air-injection manoeuvre proposed for use in stereotactic biopsies of intra-cranial mass lesions is a safe and reliable technique that allows the exact biopsy site to be located without any related complications.
Audit of Presentation, Primary Site, and Pattern of Treatment in 778 Indian Patients with Brain Metastasis in 15 Years (2007–2022)
Authors: Dutta Debnarayan , Surendran Haripriya P , Kalavagunta Sruthi , Sasidharan Ajay , Narmadha M P 
Published: July 2024

Background and Aim:
Audit of brain metastasis (BM) patients treated with radiation therapy (RT) in a tertiary cancer center from South India was carried out to assess the incidence of BM by site with a specific focus on their primary origin, with an aim to evaluate the relationship between the primary site and the site of metastases, pattern of care, and RT over the years.

Materials and Methods:
All consecutive BM patients who received RT with whole-brain radiation therapy (WBRT), hippocampal avoidance WBRT (HA-WBRT), and radiosurgery SRS between 2007 and 2022 after radiologic confirmation of a known case of malignancy or histology-proven BM were audited.

Results:
From January 2007 to December 2022, hospital information system (HIS)-identified 778 patients with BM treated with RT were audited. Incidence of BM was 0.64% in 2008 and over the years, it had increased to 0.89% in 2020, 0.93% in 2021, and 1.24% in 2022. Usage of SRS was almost nil in 2007, whereas in 2022, it was 40%. Also, 593 (76%) patients were treated with WBRT, 157 (20%) with SRS, and only 23 (3%) received HA-WBRT. Lung and breast cancers (40%) were the most common primary, and among rare primary tumors were those of larynx (two), tonsil (one), tongue (three), pancreas (one), and blood disorders (two). Lung primary presented with frontal lesion in 51%, parietal lesion in 43%, cerebellar lesion in 38%, and temporal lesion in 33% of cases.

Conclusions:
Audit of BM in the Indian population suggests a shift in treatment paradigm from WBRT to SRS as a primary modality in oligo-brain metastasis with a good performance status. This audit provides us information regarding geographic variation in presentation and primary site.
Safety and Efficiency of Anlotinib in Patients with Recurrent Grade 4 Glioma: A Single-Center Retrospective Analysis
Authors: Wang Qiang , Wei Wuting , Ji Xiangjun , Li Jianrui , Wu Nan , Li Jing , Sun Kangjian , Ma Chiyuan , Pan Hao 
Published: July 2024

Purpose:
Anlotinib is a multi-target TKI which has been used in different advanced tumors. However, its efficiency and safety in patients with glioblastoma are still not well discussed. This retrospective study aimed to discover the safety and efficiency of anlotinib in recurrent grade 4 glioma.

Methods:
The clinical data of patients with recurrent grade 4 glioma treated with anlotinib in our center were collected and analyzed. The progression-free survival (PFS), overall survival (OS), and OS after recurrence were calculated by Kaplan–Meier method and compared by log-rank test. Sub-group analysis was used to find possible variables that affect survival.

Results:
From October 2017 to December 2020, seventeen patients with recurrent grade 4 glioma treated with anlotinib were enrolled. The median age was 50 with 13 males. The median KPS was 70. All patients received standard STUPP mode treatment before recurrence. The median PFS was 7 months [95% confidence interval (CI) 5.3–8.6]. The median OS after first diagnosis was 17 months (95% CI 15.7–18.3). The median OS after recurrence was 10 months (95% CI 7.6–12.4). The objective response rate was 33.33% (5/15), and the disease control rate was 60% (9/15). The existence of target genes was identified as a variable affecting the survival after recurrence. The median OS after recurrence in patients with target genes was 12 months (95% CI 6.9–17.1), whereas for patients without targets, the median OS was 4 months (95% CI 1.9–6.1) and for patients with an unknown status, the median OS was 10 months (95% CI 8.4–11.6) (P = 0.013).

Conclusion:
For recurrent grade 4 glioma, anlotinib can be considered as a supplement to the standard STUPP treatment, especially for the patient with anlotinib target genes.
Truncal Ataxia: An Overlooked Symptom in Patients with Lambert–Eaton Myasthenic Syndrome in the Early Stage
Authors: Özenç Betül , Işık Kübra , Odabaşı Zeki 
Published: July 2024

ABSTRACT

Background:
The classic triad in LEMS is proximal muscle weakness, areflexia, and autonomic dysfunction. We have frequently observed truncal ataxia as the first complaint in LEMS patients. In this study, we aimed to show the presence of ataxia in 10 newly diagnosed LEMS patients in the past 3 years and what factors influence it.

Methods:
We present the clinical findings, voltage-gated calcium channels antibody positivity, and electrophysiologic findings of newly diagnosed LEMS patients who presented to our tertiary care center during the past 3 years.

Results:
Of the 10 LEMS patients examined, 60% (6) were males and 40% (4) were females. The first and most dysfunctional symptoms were gait disorder and loss of balance in seven of the patients. These patients had ataxia, a gait disturbance that was disproportionate to the proximal weakness. Although the patients had mild proximal weakness in the lower extremities, they had considerable difficulty walking. Proximal muscle weakness was present in six patients, speech disorders in three patients, dysphagia in three patients, dry mouth in three patients, ptosis in two patients, diplopia in two patients, and nystagmus in one patient.

Conclusion:
We believe that more caution is needed in patients with truncal ataxia when LEMS is suspected. This is because we have seen that the first complaints in 7 out of 10 LEMS patients were truncal ataxia, loss of balance, and gait disturbance.