Case Presentation: A 2-month-old male infant with myelomeningocele (MMC) and hydrocephalus presented with asymptomatic anal extrusion of his ventriculoperitoneal shunt (VPS) catheter, discovered by his mother. Emergency imaging revealed distal catheter migration through the rectosigmoid junction. Surgical management included (1) laparoscopic-assisted catheter removal with bowel repair using Vicryl sutures, (2) intraoperative external ventricular drain (EVD) placement, and (3) 14-day antibiotic prophylaxis. Cerebrospinal fluid analysis remained normal throughout the treatment. Following three weeks of infection monitoring, contralateral VPS replacement was performed successfully, with postoperative imaging confirming optimal shunt function and resolved hydrocephalus. This case highlighted the importance of caregiver vigilance in identifying this rare but serious complication, even in asymptomatic patients (Fig. 1).

Conclusion: Although anal extrusion of a VPS catheter is an uncommon but serious complication, primarily seen in pediatric patients, it can lead to lifethreatening infections if untreated. Prompt surgical intervention along with broad-spectrum antibiotic therapy is critical. This report highlights the need for recognizing classic symptoms of intestinal perforation and catheter migration in pediatric patients.

Case Report: A 35-year-old male patient with a known metastatic lung neuroendocrine tumor (NET) who was treated with Sunitinib for many years with partial response and tolerating the treatment well-developed recurrent DIC on Sunitinib after COVID-19 infection.

Discussion: COVID-19 infection is reported to be associated with endothelial injury and inflammation. Vascular endothelial growth factor (VEGF) receptors have a role in the protection and modulation of endothelium. Sunitinib is a multikinase inhibitor with anti- VEGF effect. It is possible that endothelial injury after COVID-19 may have triggered recurrent DIC in this patient who had previously tolerated the same drug without problems.

Conclusion:

DIC may be underreported especially with antineoplastics having anti-VEGF effects. Potential risk, interaction, and association with COVID-19 infection in the Era of the pandemic are unclear but warrants further research, and drug-induced DIC should be considered in the differential diagnosis of such cases.

Objective: Here, we present a fetus with DSM by multiple imaging methods to help better understand the imaging characteristics of this malformation.

Case Presentation: A 22-year-old primipara was referred to our hospital at 25 weeks of gestation following the detection of a fetal intracranial mass without any symptoms. A prenatal ultrasound performed in our hospital at 25 ^{+ 2} gestational weeks showed a large anechoic mass with liquid dark space, while no blood flow was detected. After the initial evaluation, this primipara received a prenatal MRI in our hospital. This examination at 25 ^{+ 5} gestational weeks delineated a fan-shaped mass in the torcular herophili, which was iso-to hyperintense on T1WI and hypointense on T2WI. At the lower part of this lesion, a quasi-circular hyperintense on T1WI and a signal slightly hyperintense on T2WI could be seen. Meanwhile, the adjacent brain parenchyma was compressed by the mass.

Conclusion: We reviewed the current literature to obtain a better understanding of the mechanisms, imaging characteristics, and survival status of DSM. Although the primipara of the present study regretfully opted for elective termination of pregnancy, the reevaluation of DSM survival deserves more attention because of the better survival data from recent studies.

Methods: Reports of suspected intracranial abnormalities were retrospectively collected on ultrasound screening (US), and MR images of fetuses were reviewed at our institution over a 5-year period on picture archiving and communication system (PACS) servers. Two experienced radiologists recorded major abnormalities and coexisting abnormalities at the reading of the census. The results of the MRI were compared against the US in each case.

Results: For prenatal MR imaging, we enlisted a total of 121 patients (mean gestational week, 24.5 ± 4.7 weeks). This included 28 cases with normal findings of MR imaging, 62 cases with findings of cerebellar hypoplasia or dysplasia, and the remaining 31 cases with other abnormities findings. Cerebral malformations cases included agenesis of the corpus callosum, cerebral hemorrhage, hydrocephalus, holoprosencephaly, ventriculomegaly, and brainstem/gyri malformation. Cerebellar abnormalities included vermis absence, cerebellar tonsil hernia, Dandy-Walker malformation, Blake’s pouch cysts, arachnoid cysts, and intracranial hemorrhage. Other systemic malformation cases included tethered cord syndromes (9 cases), cleft lip and palate (1 case), club foot (1 case), and cardiac malformation (1 case). In 12 cases (24.5%), compared to the US, MR imaging proved the value of confirming the diagnosis and/or even yielded more findings on abnormalities.

Conclusion: Prenatal MR imaging can better visualize systemic malformations coexisting with cerebellar abnormalities. MR imaging, a complementary means to the US, can aid in prenatal counseling and treatment selection for term delivery.

Case Report: In our case we describe the imaging findings of three diverse cases of schwannoma at different locations and unique presentations with acute neurological symptoms in the pediatric age group.

Conclusion: Schwannomas should be included in the differential diagnosis of intracranial or intraspinal intramedullary space-occupying lesions in pediatric patients.

Case Presentation: A 38-year-old woman presented to our hospital at a gestation age of 29 weeks due to an ultrasound that showed fetal ventriculomegaly. The fetus demonstrated ventriculomegaly, intrauterine growth restriction, and multiple cystic lesions close to the corticomedullary junction of the frontal, temporal and parietal lobes on both sides. The woman chose to terminate the pregnancy, and pathological examination confirmed the diagnosis of congenital toxoplasma encephalitis.

Conclusion: This is a rare report of MRI manifestations of fetal congenital toxoplasma encephalitis. Detailed knowledge of MRI findings in fetal congenital toxoplasma encephalitis is helpful for prenatal consultation and pregnancy management.]]> https://www.benthamscience.comarticle/130159Purpose: The cerebellar tentorium, the second-largest dural reflection in the brain, separates supratentorial and infratentorial structures. This study aimed to determine the frequency of tentorial hypoplasia (TH) and gyral herniation and their relationship with clinical findings.

Methods: The standard brain MRIs were examined retrospectively. The presence of TH and laterality were investigated. If hypoplasia was accompanied by a gyrus extending inferior to the line where the tentorium should be located, this was recorded as tentorial hypoplasia-herniated gyrus (TH-HG), while the cases with hypoplasia alone were noted as isolated TH. It was also determined which gyrus or gyri were herniated. The clinical findings of the patients were obtained, and the correlation between HG was explored.

Results: Standard brain MRIs of the 2051 patients were evaluated. Two hundred ten patients were excluded from the study due to different intracranial disorders, and 1841 patients, 739 (40.1%) males, and 1102 (59.9%) females, were included. Isolated TH or TH-HG was present in 56 patients, resulting in a prevalence of 3.04%. Of the patients with TH or TH-HG, 15 were men, and 41 were women. TH and TH-HG were significantly more common in women (p=0.038). TH-HG was unilateral in 22 (39.2%) patients and bilateral in 21 (37.5%). Left TH was found in 11 (19.6%) patients, left TH-HG in 29 (51.7%), right TH in eight (14.2%), and left TH-HG in 35 (62.5%).

Conclusion: Hypoplasia of the tentorium is a rare and unknown anomaly that can be easily diagnosed using MRI, and different gyral herniations may accompany TH.

Methods: The study includes 24 consecutive patients diagnosed with IIH and 18 consecutive patients diagnosed with secondary intracranial hypertension (SIH). The control group included 24 patients. Measurement of apparent diffusion coefficient (ADC) was performed using DWI sections obtained from subcortical white matter and the cortex of the frontal lobe in the basal ganglia plane, caudate nucleus head, thalamus, the posterior leg of the internal capsule, corpus callosum splenium; in the centrum semiovale plane, from the central white matter region. with 1.5T MRI using b=500s/mm2 and b=1000s/mm2 values both in patients and control groups. Mean ADC values were compared between IIH, SIH patients and control groups.

Results: The ADC values from the head of the caudate nucleus and the cortex were significantly higher in the IIH group compared to the control group. When the ADC values of the SIH and control groups were compared, it was found that some of the ADC measurements (subcortical white matter, cortex and semioval center) were significantly different. The comparison of the IIH and the SIH groups revealed that the ADC measurements of central white matter in the centrum semiovale, the subcortical white matter and the posterior leg of the internal capsule were significantly different.

Conclusions: We have found increased diffusion of IIH and SIH patients, which supports the development of brain edema. Even though the mechanism of the brain edema in IIH is not entirely clear, it is thought that the mechanism is different from the brain edema caused by a mass or a sinus thrombosis.

Case Presentation: A 33-year-old Asian primipara at 14 weeks and 2 days of gestation visited the emergency room with a fever and headache. Initial blood pressure was 140/70 mm Hg, temperature 38.5°C, heart rate 130 beats/min with tachycardia. Her prenatal examination has been unremarkable, and fetal ultrasonography was within normal range. The laboratory results showed low platelet count with elevated liver enzymes, D-dimer, and fibrinogen but no sign of jaundice. Her WBC differential suggested a bacterial infection. Thus, we diagnosed early HELLP syndrome and immediately started conservative treatments. One day after admission, symptoms and laboratory results showed aggravation of the disease. We performed termination, followed by dilation and curettage for retained placenta. Her general condition improved rapidly after the operation. Placental biopsy showed both acute and chronic inflammation. She also had anticardiolipin antibody IgM, and after discharge, she was referred to a rheumatology specialist to address the antiphospholipid syndrome issue.

Discussion: Although the triggers of HELLP syndrome are unclear, a recent inflammatory hypothesis suggests that placenta-derived inflammatory cytokines are involved. In our case, the anti-cardiolipin antibody may have triggered microangiopathy of the placenta. Our analysis of published HELLP cases revealed that, apart from the three diagnostic criteria, the most common abnormal laboratory finding was antiphospholipid antibodies. Therefore, despite its rarity, if a sign of inflammation is present in a patient, it is important to consider HELLP syndrome regardless of gestational age.

Objective: This study aimed to assess the correlation between the length of the xiphoid to the fundus and the cervical dilation in the active phase of labor.

Methods: This cross-sectional study was conducted on 180 pregnant women in Varamin, Iran. The participants were recruited using convenience sampling. Data were collected using a researcher- made questionnaire that included specific items regarding demographic characteristics, health status, and a checklist to record the results of examinations and labor progress. The collected data were analyzed using descriptive statistics, correlation tests, and multiple linear regression with SPSS 22 software. The significance level was considered to be p <0.05.

Results: A total of 174 eligible women participated in the study, with a mean age of 25.90 ± 4.56 years (mean ± SD) and a mean gestational age of 39.71 ± 1.03 weeks. There was a significant negative correlation between the length of the xiphoid to the fundus and cervical dilatation (p = 0.0001, r = -0.568).

Conclusions: The study revealed a significant negative correlation between the length of the xiphoid to the fundus and the cervical dilation. Therefore, the xiphoid to fundus measurement can serve as an alternative and complementary examination in cases that need frequent vaginal examinations.

Materials and Methods: This cross-sectional study was carried out in a tertiary neonatal intensive care unit of a maternal and neonatal hospital from September 2018 to August 2019. Premature infants under 34 weeks of age and with birth weight < 1500 grams who did not have significant congenital anomalies participated in the study. A brain ultrasound was performed by a sonologist during the first week. The infants were subsequently categorized into two groups: those with and without IVH. A comparative analysis was conducted using the chi-square test and logistic regression. A significance level of p<0.05 was considered statistically significant.

Results: Of the 205 premature infants who completed the study, IVH was reported in 107 cases (52.1%), of which 97.3% of ventricular hemorrhages were grade I and II and 2.7% accounted for severe bleeding (grade III and IV). Gestational age less than 28 weeks, weight less than 1000 g, vaginal delivery, asphyxia and resuscitation, history of intubation and mechanical ventilation, cord blood acidity, dopamine infusion, and history of fever and chorioamnionitis in the mother have been found to be significantly associated with increased risk of IVH (p<0.001). Antenatal corticosteroids decreased the risk (OR=10.63).

Conclusion: In this study, IVH has been found to be common in infants under 1500 g of weight, but the severe form was low in frequency and was observed significantly in high-risk pregnancies.

Poor patient compliance and adherence are major issues with the conventional line of therapy. This burden may be more significant in resource-constrained settings, necessitating the creation of simple formulations that are both geriatric and child-friendly. An extensive literature survey has been conducted in this study using databases of Google Scholar, PubMed, and Research Gate, with a focus on specific research works on oro-dispersible films, tablets, and wafer technology loaded with anti-tuberculosis drugs from 2022 to 2010.

Mouth dissolving formulation technology is a very novel approach in the arena of tuberculosis therapy. This may pave the way for future researchers to develop different mouth dissolving formulations to treat both pulmonary and extra-tuberculosis. This review paper has summarized all the formulation approaches alongside the present state of the art in tuberculosis therapy using mouth dissolving formulations.

Case Presentation: We present two rare cases of Leptospirosis with peripheral dry gangrene of the lower extremities. A 25-year-old male, farmer by occupation without any significant past medical history had been diagnosed with a case of Leptospirosis that complicated to digital gangrene on 15 days of illness during hospitalization. Another 21-year-old male student was admitted for leptospirosis and developed digital gangrene on 19 days of illness. All clinical findings were resolved on the steroid.

Conclusion: Apart from a high index of suspicion and awareness of unusual manifestations, serology plays a vital role in making an accurate and quick diagnosis to initiate appropriate therapy.

Methods: Children aged between one to 18 years with seizure episodes were included. Clinical details, including historical as well as physical findings, were evaluated along with EEG and neuroimaging (Magnetic resonance imaging). Details were noted on pre-designed proforma. Variables were analysed by using appropriate statistical methods.

Results: A total of 110 children with seizures were enrolled in the study. Male to female ratio was 1.6: 1, and the mean age of the study children was 8 years. The majority of the children were symptomatic for more than one year. The most common seizure type was Generalised Tonic Clonic Seizure (GTCS), and Hypoxic-ischemic Encephalopathy (HIE) sequelae was the most commonly attributed etiology, followed by neurocysticercosis. EEG and neuroimaging findings were found to correlate well with seizure semiology from history. The incidence of febrile seizures was 10% in this study, with nearly three-fourths of them being simple febrile seizures.

Conclusion: Microcephaly and developmental delay were the most distinctive clinical correlates in children with seizures. There was a fair agreement between the types of seizures described in history and depicted on EEG with Cohen’s kappa of 0.4. Also, there was a significant association between the type of seizures on EEG and the duration of symptoms.

Objectives: An attempt has been made to summarise the prenatal interventions, if available, the optimal route, mode and time of delivery and discuss the minimum delivery room preparations that should be made if expecting to deliver a fetus with a congenital anomaly.

Methods: The recent literature related to the perinatal management of the fetus with prenatally detected common congenital anomalies was searched in English peer-reviewed journals from the PubMed database to work out an evidence-based approach for their management.

Results: Fetuses with prenatally detected congenital anomalies should be delivered at a tertiary care centre with facilities for neonatal surgery and paediatric intensive care if needed. There is no indication for preterm delivery in the majority of cases. Only a few congenital malformations, like highrisk sacrococcygeal teratoma, congenital lung masses with significant fetal compromise, fetal cerebral lesions or neural tube defects with Head circumference >40 cm or the biparietal diameter is ≥12 cm, gastroschisis with extracorporeal liver, or giant omphaloceles in the fetus warrant caesarean section as the primary mode of delivery.

Conclusion: The prognosis of a fetus with congenital anomalies can be significantly improved if planning for delivery, including the place and time of delivery, is done optimally. A multidisciplinary team should be available for the fetus to optimize conditions right from when it is born.

Methods: We performed proteomic analyses of cerebrospinal fluid (CSF) from 7 congenital hydrocephalus and 5 arachnoid cyst patients who underwent surgical treatment. Differentially expressed proteins (DEPs) were identified by label-free Mass Spectrometry followed by differential expression analysis. The GO and GSEA enrichment analysis was performed to explore the cancer hallmark pathways and immune-related pathways affected by DEPs. Then, network analysis was applied to reveal the location of DEPs in the human protein-protein interactions (PPIs) network. Potential drugs for hydrocephalus were identified based on drug-target interaction.

Results: We identified 148 up-regulated proteins and 82 down-regulated proteins, which are potential biomarkers for clinical diagnosis of hydrocephalus and arachnoid cyst. Functional enrichment analysis revealed that the DEPs were significantly enriched in the cancer hallmark pathways and immunerelated pathways. In addition, network analysis uncovered that DEPs were more likely to be located in the central regions of the human PPIs network, suggesting DEPs may be proteins that play important roles in human PPIs. Finally, we calculated the overlap of drug targets and the DEPs based on drugtarget interaction to identify the potential therapeutic drugs of hydrocephalus.

Conclusion: The comprehensive proteomic analyses provided valuable resources for investigating the molecular pathways in hydrocephalus, and uncovered potential biomarkers for clinical diagnosis and therapy.

Case Presentation: Our patient is a 12-day-old neonate presenting with lethargy, vomiting with severe symptomatic hypoglycaemia; a critical sample suggestive of hyperinsulinism and raised lactate levels. A TMS-GCMS for metabolic abnormality screening was normal, however, a whole genome sequencing (nuclear + mitochondrial) revealed heterozygous missense variants (c.763A>C) in exon 9 of the DLD gene that results in the amino acid substitution from Methionine to Leucine at codon 255 (p.Met255Leu) and another heterozygous mutation of heterozygous missense variant (c.5277A>T) in exon 34 of the LAMB1 gene that results in the amino acid substitution from Glutamine to Histidine at codon 1759 (p.Gln1759His).

Conclusion: There is no effective treatment for PDCD but reports of treatment with supplements like thiamine, biotin, and coenzyme Q may play a role in preventing the severity of the disease.

Methods: A total of 122 patients diagnosed with aSAH within 72h of onset were retrospectively enrolled. The serum levels of LDH between 7:00-8:00 am on day 1, day 3 and day 7, patients’ demographics, and clinical features were collected. Computed tomography perfusion was performed within 7 days after aSAH. The occurrence of DCI was recorded during the hospitalization.

Results: Among all the enrolled patients, 43 (35.2%) developed DCI during hospitalization. Patients occurred DCI were always accompanied by more serious clinical features and found with higher serum LDH levels. LDH levels on day 3 and day 7 after onset were independently associated with the occurrence of DCI and showed high predictive value according to the receiver operating characteristic (ROC) curve. Moreover, there was a strong correlation between LDH and mean cerebral blood flow, transit time, and mean time to peak.

Conclusion: Serum LDH level on day 3 and day 7 may be a valuable, convenient, and rapid predictive indicator for the occurrence of DCI in aSAH patients.

Methods: This is a retrospective three-center case series study of 5 patients with a confirmed parenchymal form of DLGTs, out of which 4 patients were adults. Brain and spinal cord MR imaging were performed in all patients at either 1.5 or 3T. The patients' age ranged from 5 years to 50 years with a mean age of 27.6 years at presentation.

Results: Four of the tumors were located in the frontal lobe, and one in the tectum. They were usually solid-cystic enhancing tumors as the other mixed neuronal-glial tumors. All of the tumors had an extension to the superficial surface of a cerebral hemisphere. One had systemic bone metastases. The clinical signs and symptoms of the parenchymal form varied based on the location of the mass, in contrast to the leptomeningeal form associated with hydrocephalus. In one case, the tumor’s initial grade was defined as intermediate. The initial histopathology of the two cases was low-grade and no upgrade occurred in the follow-up period. In two cases, although the tumors were low grade initially, they progressed to an anaplastic form in the follow-up period.

Conclusion: The parenchymal form of DL-GNTs is common in adults. Extension to the superficial surface of a cerebral hemisphere is a distinctive imaging feature. Systemic osseous metastasis may occur. Due to the presence of common histopathological features, including the biphasic composition of glial and neuronal cell elements and oligodendroglioma-like cells, a proposed classification approach might be more beneficial for the histopathological and imaging description, and management of the glioneuronal tumors with oligodendroglioma-like features.

Case Report: Here, we describe a rare case of SFT of the pineal region in a 25-year-old man with a literature review. After the first surgery, the tumor reappeared as a local low-grade recurrence, followed by metastasis to the right parietal lobe, and then hyperacute intraparenchymal hematoma at the metastatic site, and later presentation of widespread intracranial intra-axial and extra-axial metastases during the follow-up period. Systemic metastases were not detected. The histopathological evaluation of the resected tissues confirmed the malignant progression of the tumor.

Conclusion: The diagnosis of SFT of the pineal region through clinical and imaging features can be considerably challenging. Large size, intratumoral cystic areas, and intense contrast enhancement are the main conventional imaging characteristics of the tumor. Surgery is the first preferential treatment. All recurrent or metastatic cases were grade II or grade III tumors. Adjuvant radiotherapy should be added to surgical treatment in high-grade tumors. Gamma knife radiosurgery is a treatment option for intracranial metastases.

Methods: Together with the relevant literature, we retrospectively studied the clinical and imaging data of two patients (mother and child) with CSF rhinorrhea caused by patent meningoencephalocele of Sternberg’s canal of the sphenoid sinus, analyzed their diagnostic and treatment procedures, and proposed a potential, feasible treatment method.

Results: On the 2^nd day after surgery, the expansive sponge and iodoform gauze in the nasal cavity were removed in both patients, and the lumbar subarachnoid drainage was removed 3 days after the operation, as no nasal discharge was observed. One week after the operation, head magnetic resonance imaging (MRI) showed that the abnormal tissue in the sphenoid sinus had disappeared, and no accumulation of the CSF was observed. Both patients were discharged after 2 weeks. At the time of discharge, both patients were without nasal drip, fever, headache, and other discomforts, and they had grade 5 muscle strength in their extremities, with normal muscle tension.

Conclusion: CSF rhinorrhea is usually caused by secondary factors. Spontaneous CSF rhinorrhea caused by encephalocele of the skull base due to congenital dysplasia of the skull base is very rare and easily misdiagnosed. The presence of brain tissue or CSF signal in the sphenoid sinus on preoperative MR images is an important imaging feature of the disease. Conditional cisternography can be used to further detect CSF leaks. Endoscopic transnasal transsphenoidal repair of CSF leaks combined with short-term postoperative lumbar subarachnoid drainage is an effective treatment method. According to previous literature, the possible causes of meningoencephalocele with patent Sternberg’s canal of the sphenoid sinus include abnormal development of the sphenoid sinus or the craniopharyngeal canal and bone defects of the skull base. There are no related reports on patent meningoencephalocele caused by Sternberg’s canal in direct blood relatives, such as mother-son; therefore, the possibility of this disease having a genetic origin should be considered in future studies on its pathophysiological mechanisms.

Case: Here, we report a case of a 30-year-old woman in the 33rd PW who had experienced a severe headache, dizziness, vomiting, and limb weakness. Cesarean section was performed in the 34th PW, followed by neurosurgery under multidisciplinary discussion.

Discussion: The pathological exam suggested hemangioblastomas. Finally, both the pregnancy and the fetus had a good outcome.

Conclusion: This case emphasizes that the timing of surgery should be determined according to the neurological symptoms of the pregnancy and the gestational age (GA) and condition of the fetus.

Background: Recent advances in neuroimaging have led to improved detection of subtle insults associated with neurodevelopmental outcomes, beyond more historically described lesions such as large hemorrhages and hydrocephalus.

Objective: In this study, we compare cranial ultrasound to MRI for the evaluation of suspected HIE in preterm infants.

Methods: 147 premature infant patients with paired ultrasound and MRI exams were retrospectively analyzed to compare imaging finding accuracy and clinical value.

Result: We confirm that ultrasound is highly sensitive and specific for hydrocephalus, ventricular prominence, and gross structural abnormalities. Ultrasound is not a substitute for MRI in cases of small hemorrhages or white matter injury, however, certain US findings were associated with Apgar score and MRI sequelae of HIE.

Conclusion: Choosing between ultrasound and MRI for preterm neonates at risk for intracranial abnormalities based on their strengths can reduce cost and maximize clinical utility. MRI provides a highly sensitive identification of subtle brain injury, yet ultrasound is correlated with the peripartum clinical picture as measured by Apgar score.

Objective: The aim of this study was to determine the prevalence of early toxoplasmosis infection in bone marrow transplant patients by PCR.

Methods: The blood samples of 50 patients with hematological disorders who had received bone marrow transplants were collected using a standard phlebotomy technique. To evaluate antitoxoplasma antibodies, we utilized the enzyme-linked immunosorbent assay (ELISA) method using a specific commercial kit (Akon) based on the manufacturer’s instructions. Genomic DNA extracted from toxoplasma tachyzoite was used as the template for PCR.

Results: 22 (44%) patients were women, and 28 (56%) were men. There were no significant differences in the distribution of genders and age groups in patients with various cancers. Antitoxoplasma IgG was positive in 39 patients, while none of them were IgM positive.

According to PCR results, 5 patients were positive for toxoplasmosis. All of the PCR-positive cases (2 with AML, 2 with HL, and 1 with AA) had successful engraftment at 40 days post-transplantation.

Conclusion: Because of the higher efficacy of PCR in the diagnosis of toxoplasmosis, using this method along with other routine diagnostic modalities in this condition is recommended. PCR-based techniques can also be utilized to periodically determine parasite load in blood after transplantation.

Objective: Like in many other neurodegenerative disorders, there is still no effective disease-modifying drug therapy in CBD. Therefore, the development of new treatment methods is of great importance. In this study, we aimed to assess the stimulating effects of high-frequency DLPFC rTMS on the motor, cognitive and behavioral disturbances in four CBD patients.

Methods: Four (three females, one male) CBD patients who had been diagnosed as CBD were enrolled in this study. Patients were evaluated before and after the rTMS procedure regarding the motor, neuropsychometric and behavioral tests. The results of statistical analysis of behavioral and neuropsychometric evaluation were assessed via SPSS 18.0 package program. Data are expressed as mean, standard deviation. Before and after values of the groups were compared with the Wilcoxon sign rank test, and p<0.05 was considered significant.

Results: We have provided strong preliminary evidence that the improvement in clinical parameters was associated with the normalizations of the theta activity and glucose metabolism.

Conclusion: Our current results are consistent with some previous trials showing a strong association between DLPFC targeted rTMS and electrophysiological normalizations in the left DLPFC.

Results: Experimental results show that t-Test and ReliefF feature selection is capable of selecting 10 relevant features that give the same accuracy when all features are considered. In addition to it, the accuracy obtained using k-NN with an ensemble approach is 99.96%. The statistical significance of the method has been established using Friedman’s statistical test.

Conclusion: The new ranking criteria computed by the ensemble method efficiently eliminate the insignificant features and reduces the computational cost of the algorithm. The ensemble method has been compared to the other approaches for ensuring the superiority of the proposed model.

Discussion: The percentage gain in accuracy for all three classifiers, Naïve Bayes, k-NN, and Random Forest shows a remarkable difference noted down for the percentage gain in the accuracies after applying feature selection using Naïve Bayes and k-NN. Using univariate filter selection methods, the t-test is outshining among all the methods while selecting only 10 feature subsets.]]> https://www.benthamscience.comarticle/113011 Case: We report two cases of neonatal bacteraemia and meningitis among low birth weight premature neonates admitted in neonatal intensive care units (NICU) by E. meningoseptica, a high alert organism associated with such conditions.

Conclusions: E. meningoseptica, a high alert organism associated with meningitis among premature underweight neonates. High degree of resistant to most of the broad-spectrum antibiotics makes its management a challenging task. A good communication between the clinician and the microbiologist becomes very important for the proper management of the patients.]]> https://www.benthamscience.comarticle/117143 Methods: Seventy-seven patients were included in the study. The diagnosis accuracy of the HR-3D-HT2W, Sag TSE-T2W and VFA-3D-TSE sequences, was classified into three grades by two experienced neuroradiologists: grade 0 (the sequence has no diagnostic ability), grade 1 (the sequence diagnoses stenosis but does not show focal stenosis itself or membrane formation), and grade 2 (the sequence makes a definitive diagnosis of stenosis and shows focal stenosis itself or membrane formation). Stenosis localizations were divided into three as Cerebral Aquaduct (CA), Superior Medullary Velum (SMV) and SMV+CA. In the statistical analysis, the grades of the sequences were compared without making a differentiation based on localization. Then, the effect of localization on diagnosis was determined by comparing the grades for individual localizations.

Results: In the sequence comparison, grade 0 was not detected in the VFA-3D-TSE and HR-3DHT2W sequences, and these sequences diagnosed all cases. On the other hand, 25.4% of grade 0 was detected with the Sag TSE-T2W sequence (P<0.05). Grade 1 was detected by VFA-3D-TSE in 23% of the cases, while grade 1 (12.5%) was detected by HRH-3D-T2W in only one case, and the difference was statistically significant (P<0.05). When the sequences were examined according to localizations, the rate of grade 0 in the Sag TSE-T2W sequence was statistically significantly higher for the SMV localization (33.3%) compared to CA (66.7%) and SMV+CA (0%) (P<0.05). Localization had no effect on diagnosis using the other sequences.

Conclusion: In our study, we found that the VFA-3D-TSE and HR-3D-HT2W sequences were successful in the diagnosis of PAS and SMV-S contrary to the Sag TSE-T2W sequence and especially SMV localization decreases the diagnostic accuracy of Sag TSE-T2W sequence.]]> https://www.benthamscience.comarticle/115817 Objective and Methods: This paper shows the importance of early diagnosis and the most important imaging features of the disease on CT and MR scans. PubMed database was searched from January 1972 to September 2020. Papers including imaging findings of NCM, clinical, follow-up, and treatment features were collected, selecting only 89 studies.

Discussion: NCM is a term used for the first time by van Bogaert in 1948. It refers to a condition caused by an error during morphogenesis and migration leading to leptomeningeal melanocytic accumulation. Although histological findings are the gold standard for diagnosis confirmation, neuroimaging and clinical features strongly support the suspect of NCM. Localization and extension of the lesions are predictive of neurological manifestations related to increased intracranial pressure, mass lesions, or spinal cord compression. CT demonstrates sites of increased density in the anterior temporal lobe, mainly the amygdala, thalami, cerebellum, and frontal lobes base. However, MRI is the best imaging method to diagnose central nervous system lesions, often appearing as T1-short signal areas of the cerebral parenchyma, indicative of central nervous system melanosis. MRI can also reveal associated intracranial and intraspinal abnormalities.

Conclusion: Early imaging, when available, is helpful if NCM suspect is raised and may be of guidance in comparing later studies. NCM requires a multidisciplinary approach since it is a multisystem disease with a genetic component.]]> https://www.benthamscience.comarticle/117751Introduction: Paget bone disease (PBD) is characterized by a disorder in the bone remodeling activity at sites of involvement. This can produce dramatic alterations of local bone architecture and causes most of the complications. We aimed to focus on the characteristics of complications of PDB among hospitalized patients.

Material and Methods: A retrospective study was conducted, on PBD patients hospitalized in two rheumatology centers from 1994 to 2019. Characteristics of the PBD complications were studied.

Results: Sixty-nine patients were collected with a sex ratio of 0.76 and a mean age of 75.4±6.4 years [43-101]. The diagnosis of PBD was established in the average age of 64.2±11.5 years. The primary reason for consultation was pain (78.3%). The PBD was localized in the pelvis (58%), lower limb (42%), spine (36.2%), skull (23.2%) and upper limb (5.8%). It was polyostotic in 44.9% of cases. Dosage of ALP was 324 [68-8390].

The PDB complication rate was 52.2% and it decreased over time. The main complication was osteoarthritis (23.2%), followed by deafness (17.4%), fracture (15.9%), hydrocephalus (7.2%), neurological disease (7.2%) and osteosarcoma (1.4%). The presence of complications was significantly associated with the polyostotic form (p=0.01), the skull localization (p=0.04), an increased ALP (p=0.02).

Conclusion: According to our study, the incidence rate of PBD among hospitalized cases is higher among elderly women and decreases over time. Complications related to PDB are frequent (52%). It concerns patients with a polyostotic form, skull localization and high ALP.

Objective: The purpose of this study is to investigate the relationship of the KEAP-1/NRF-2/HO-1 pathway, one of the main regulators of the antioxidant system in the hydrocephalus pathology, on oxidative stress and tau protein level.

Methods: The study included 32 patients with hydrocephalus and 32 healthy controls. KEAP-1, NRF-2, HO-1, TAU, and MPO levels are measured using ELISA method TAS, TOS, and Total THIOL colorimetric method.

Results: KEAP-1, TAS, and Total THIOL levels were found significantly lowerer in the hydrocephalus group than in the control group. Nevertheless, it was identified that in the hydrocephalus group that the NRF-2, HO-1, TAU, MPO, TOS, and OSI levels were significantly elevated.

Conclusion: In conclusion, although the KEAP-1/NRF-2/HO-1 pathway is activated in patients with hydrocephalus, it is identified that the antioxidant defense system is insufficient and ultimately leads to elevated oxidative stress. The elevation in the tau level may be an indicator of oxidative stress induced neurodegenerative damage.

Objective: In this narrative review, we provide a comprehensive approach to experimental and clinical data regarding RAS molecule expression and their possible roles in the physiology and physiopathology of CNS diseases.

Methods: This non-systematic review summarizes evidence on RAS implications in CNS diseases and their possible relationships with COVID-19.

Results: We divided the possible RAS mechanisms in distinct conditions during the lifespan, approaching from congenital infections to neurodegenerative alterations, passing through mood disorders and cerebrovascular diseases. We also gathered current evidence about the possible effects of RAS in Covid-19, particularly in cases with neurological manifestations.

Conclusion: Although there are limitations and controversies, the analysis of RAS mechanisms in the CNS certainly represents an interesting field of research. However, further investigation is necessary to support the noteworthy interactions and provide a better comprehension of the cross-talk between RAS and the CNS. Investigations in this research field may shed light on the novel therapeutic targets.

Methods: A total of 510 patients treated with neuro-intervention for aneurysmal SAH and with data for admission HbA1c (glycated hemoglobin) were included. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 3 months. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of HbA1C for unfavorable clinical outcomes. Logistic regression was used to evaluate the association between HbA1C level and outcomes.

Results: The optimal cutoff value of HbA1C was identified as 6.0% (P < 0.001), and patients with a high HbA1C (≥ 6.0%) had a lower prevalence of favorable clinical outcomes than patients with low HbA1C (< 6.0%) (P < 0.001). High HbA1C (≥ 6.0%) was independently associated with unfavorable clinical outcome (OR 2.84; 95% CI: 1.52-5.44; P = 0.004). The risk of unfavorable clinical outcome was significantly increased in patients with HbA1C (≥ 7.0%, < 8%) and HbA1C (≥ 8.0%) compared with lower baseline HbA1C (≥ 6.0%, < 7%) values (OR 2.17; 95% CI: 1.87-5.13; P = 0.011 and OR 4.25; 95% CI: 3.17-8.41; P = 0.005).

Conclusion: Our study showed that HbA1C could be an independent predictor of worse outcomes following neuro-intervention for aneurysmal SAH. High HbA1C (≥ 6.0%) was associated with unfavorable clinical outcomes, and gradual elevation of HbA1C contributed to an increase in the risk of worse clinical outcomes after SAH.

Methods: 120 healthy volunteers and 60 patients with hydrocephalus were included in this study. SPACE sequence was used to evaluate intracranial CSF with a 3.0T magnetic resonance machine. The total volume of intracranial CSF and the amount of CSF in the ventricle were obtained using a software, and the volume ratio of CSF in the subarachnoid space, the ventricle and the subarachnoid space were calculated.

Results: The mean volume of intracranial CSF, ventricular CSF, and subarachnoid CSF of male volunteers were (206.9±47.7) cm3, (33.0±10.7) cm3, (173.9±37.9) cm3 respectively. The average volume of intracranial CSF, ventricular CSF, and subarachnoid CSF of female volunteers were (199.7±44.9) cm3, (30.8±9.4) cm3, and (168.9±37.0) cm3, respectively. Thus, no significant statistically (P>0.05) difference between males and females was found. (3) The mean values of intracranial CSF, ventricle CSF and subarachnoid CSF, ventricle and subarachnoid CSF volume ratio in patients with hydrocephalus were significantly greater than health volunteers. Thus, the difference between the two groups was statistically significant (P<0.05).

Conclusion: SPACE sequence can quantitatively determine the content of CSF. The change of CSF volume has nothing to do with gender but with age. It is feasible to use SPACE sequence to evaluate the spatial distribution and volume of intracranial CSF.

Objective: The current study aimed to evaluate the differential diagnostic value of CA and EI in Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD).

Methods: Five-hundred and two subjects were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, which included 168 Normal Controls (NC), 233 MCI and 101 AD patients. The structural MR images were interactively applied with multiplanar reconstruction to measure the CA and EI.

Results: CA presented no significant difference among NC, MCI and AD groups (H value = 3.848, P value = 0.146), and EI demonstrated higher value in MCI and AD groups than that in NC groups (P = 0.000 and 0.001, respectively). MCI group had significant larger EI (0.29±0.04) than (0.27±0.03) NC group in 70-75 years old sub-groups. ROC showed that the area under the curve was 0.704±0.045 for NC-MCI in 70-75 years old groups. The correlation analysis indicated that EI was significantly negatively related to MMSE scores of MCI patients (r = -0.131, P = 0.046).

Conclusion: EI might serve as a screening imaging biomarker for MCI in 70-75 years old patients, and show limited differential value for the diagnosis of AD. CA could present no diagnostic value for MCI and AD in the current study.

Case Series: In this article, we recorded 5 cases of extramedullary-intradural lumbar spinal cysticercosis, in which one case displayed cystic lesions in both brain and spine, one case showed an independent cystic lesion in the spine, and three remaining cases showed diffuse lesions in the spinal canal.

Conclusion: Thus, in any case of single or numerous cystic lesions or dispersed lesions entering the spinal canal, spinal cysticercosis should be considered.

Case Presentation: We present a case of late-onset neonatal sepsis in a premature infant caused by an uncommon pathogen; a premature infant of extremely low birth weight had in his 4th week of life severe clinical deterioration with lethargy, fever, pallor, mottling, abdominal distention, tachycardia, and worsening respiratory impairment. Full septic screen was performed, broad-spectrum antibiotic therapy was initiated and supportive care per needs was provided. Blood cultures (endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp. are aerobic, Gram-negative, lactose non-fermenting, oxidaseand catalase-positive bacilli, thriving in water and soil. Ralstonia spp. are identified only sporadically as causative agents of neonatal sepsis; to our knowledge, this is the second report of neonatal sepsis due to R. mannitolilytica in the literature so far. Our patient was eventually treated (per sensitivity pattern) with intravenous ciprofloxacin and recovered well from the infection.

Conclusion: We intend to raise awareness among neonatologists with regard to early detection of unusual pathogens, the emergence of antibiotic resistance patterns, and the obligation for adherence to infection control policies.

Methods: A sample of 71 amnestic MCI patients (age 74 ± 7.3 years, Mini Mental State Examination 24.2 ± 5.3) underwent cerebral [¹⁸F]Florbetaben PET/CT. Images were visually scored as positive or negative independently by three certified readers blinded to clinical and neuropsychological assessment. Amyloid positivity was also assessed by semiquantitative approach by means of a previously published threshold (SUVr ≥ 1.3). Fleiss kappa coefficient was used to compare visual analysis (after consensus among readers) and semi-quantitative analysis. Statistical significance was taken at P<0.05.

Results: After the consensus reading, 43/71 (60.6%) patients were considered positive. Cases that were interpreted as visually positive had higher SUVr than visually negative patients (1.48 ± 0.19 vs 1.11 ± 0.09) (P<0.05). Agreement between visual analysis and semi-quantitative analysis was excellent (k=0.86, P<0.05). Disagreement occurred in 7/71 patients (9.9%) (6 false positives and 1 false negative). Agreement between the two analyses was 90.0% (18/20) for SUVr < 1.1, 83% (24/29) for SUVr between 1.1 and 1.5, and 100% (22/22) for SUVr > 1.5 indicating lowest agreement for the group with intermediate amyloid burden.

Conclusion: Inter-rater agreement of visual analysis of amyloid PET images is high. Agreement between visual analysis and SUVr semi-quantitative analysis decreases in the range of 1.1< SUVr <=1.5, where the clinical scenario is more challenging.

Objective: The aim of this study was to evaluate the levels of S-100, CK-18, and NSE brainspecific proteins in patients with hydrocephalus. We examined the levels of these proteins in the blood samples of hydrocephalic patients.

Methods: The study was conducted on the hydrocephalus (n = 31) patients and a healthy control group (n = 30). A Receiver Operating Characteristic (ROC) curve was used to assess the validity of the NSE, CK-18, and S100B to differentiate between the hydrocephalus and the control groups. The suitability of the data to the normal distribution was tested with the Shapiro Wilk test, and the Student t-test was used to compare the characteristics of the normal distribution in two independent groups. The individuals in the hydrocephalus and control groups had similar values in terms of age, height, and weight.

Results: It was observed that NSE, CK-18, and S100B mean values of the individuals in the hydrocephalus group were significantly higher than NSE, CK-18, and S100B mean values of the control group.

Conclusion: Experiments have shown that the levels of these proteins increase significantly in hydrocephalus patients compared to the healthy group. These three parameters can be considered as important markers in the diagnosis of hydrocephalus.

Methods: The current review was designed to provide a general overview of the normal anatomy and notable variants of the cerebral venous system as surveyed from the available literature. The pros and cons of different multimodal imaging methods for investigating DVS are also outlined. Finally, cases of various pathological entities are illustrated from our clinical practice.

Conclusion: There are many anatomical variations and lesions involving the DVS. MRI examination can provide essential information both on anatomical variation and morphological or functional change of the offending DVS in most circumstances. Multimodal non-invasive venography protocols may become a feasible alternative to the classical digital subtraction angiography and would improve the diagnostic accuracy in future studies.

Background: Encephalocele (E) is a defect of the neural tube that refers to congenital malformations featured by skull defect and dura with extracranial spread of intracranial structures. Occipital encephalocele (OE) are the most common form of this congenital disorder and are manifested as a swelling of different sizes over the occipital bone in the midline. Proper diagnosis and treatment is highly important in the management of this congenital malformation of brain.

Objective: To review and present the current knowledge of incidence, signs and symptoms, diagnosis and treatment of the occipital encephalocele.

Methods: We conducted a search of case reports or case-series of patients by the use of electronic databases: Pub Med, Medline, Index Medicus, Scorpus. The key words were: encephalocele, occipital encephalocele, neural tube defect, congenital malformation. The search was updated to December 31, 2018. Papers published in English were the only source of information.

Results: Occipital encephalocelle are more frequent in females than in males. The incidence is between 1 in 3000 to 1 in 10,000 live births; approximately 90% of them involve the midline. Magnetic resonance imaging is the method of choice in diagnosis and surgery is the best option for the treatment of OE. Overall morbidity and mortality is still high in spite of advenced surgical management, but have been significantly improved in recent years thanks to sophisticated highresolution imaging, adequate and proper surgical treatment and decent post-operative care.

Conclusion: Occipital encephalocele is the most common form of encephalocele. The diagnosis is mostly based by the use of neuroimaging techniques. Operation is the best option for treatment. Overall morbidity and mortality is still high, but have been significantly improved in recent years thanks to sophisticated high-resolution imaging, adequate and proper surgical treatment and decent post-operative care.

Discussion: This review focuses on different imaging techniques such as X-rays, PET, CT- Scan, and MRI. This survey identifies a different approach with better accuracy for tumor detection. This further includes the image processing method. In most applications, machine learning shows better performance than manual segmentation of the brain tumors from MRI images as it is a difficult and time-consuming task. For fast and better computational results, radiology used a different approach with MRI, CT-scan, X-ray, and PET. Furthermore, summarizing the literature, this paper also provides a critical evaluation of the surveyed literature which reveals new facets of research.

Conclusion: The problem faced by the researchers during brain tumor detection techniques and machine learning applications for clinical settings have also been discussed.

Methods: 1459 non-demented, clinic-based individuals were recruited from a monocentric memory clinic from 1/1/2016/ to 1/1/2018 and classified as Cognitively Normal (NC), Slight Cognitive Symptom (SCS), SSubtle Cognitive Decline (SCD) or Mild Cognitive Impairment (MCI) via different diagnostic strategies, which varied the composition of objective cognitive assessments involved in the diagnostic process.

Results: We compared two methods of criteria proposed by Jak/Bondi and Petersen/Winblad to classify individuals with CIND. A substantial range of differences in the percentages recognized as NC, SCS, SCD, and MCI was presented, depending on the classification criteria adopted. Our data revealed that the application of a set of six neuropsychological scores dividing CIND into 4 subgroups (NC, SCS, SCD, and MCI) was able to classify all non-demented individuals without overlap or omission.

Conclusion: Our study provided clinical support for an operational framework of the CIND classification system and underlined the value of applying comprehensive neuropsychological assessments for definition. The concept of SCS, considered appropriate for a preclinical stage, was proposed as the symptomatic definition for early intervention.

Objective: The aim of this audit is to obtain a comprehensive idea about patients presented with headaches in the Outpatient Department (OPD) clinics, including patient's age, gender, primary management and subsequent referral to specialty clinics in Hatta hospital in order to re-evaluate and improve our clinical approach in dealing with patients having a headache.

Methods: This study is a retrospective study based on hospital settings and was conducted in 2015 for over one year in Hatta hospital, Dubai. We collected information about patients who attended the OPD with headache as the primary complaint.

Results: One hundred and eighty patients above the age of 4 years were selected. Female patients were 125(69.4%), while male patients were 55(30.6%). The age of most patients suffering from headache range from 15 – 40 years. Hypertension was found in 20 cases, while diabetes mellitus was diagnosed in 6 cases. Radiological studies (Plain X-ray and/or Computerized Tomography) were done in 114 patients (63.3%). The most common causes of headaches encountered in this study were tension headache, migraine and sinusitis.

Conclusion: The history and clinical examinations usually permit a definitive diagnosis for patients with headaches. Radiological and blood investigations were overused in the assessment of patients. Change of lifestyle is important as part of the management plan.

Objective: The purpose of this study was to investigate the intake of folic acid in the preconception period and its related knowledge among Iranian women.

Materials and Methods: In this cross-sectional study, 230 married women who had decided to become pregnant were selected from health centers using the multistage cluster sampling method in Urmia-Iran, in 2018. The data collection tool was a self-structured, valid, reliable questionnaire consisting of the following parts: women’s demographic data, use of folic acid, and knowledge regarding the use of folic acid and its related benefits. Data analysis was carried out using SPSS v21 software. A P value < 0.05 was considered statistically significant.

Results: In this study, the mean age of the participants was 30.73±6.77 years. About 49 (21.3%) women used folic acid supplements in the correct way. The mean score of women's knowledge was 6.20 ± 2.15. The minimum and maximum scores for knowledge were 1-10. There was a statistically significant relationship between taking folic acid with the subject's knowledge about folic acid (p=0.035), family income (p=0.027), women's job (p=0.046), education level (p=0.001) and the number of children (p=0.026).

Conclusion: The study revealed that the status of taking folic acid among women and their knowledge concerning folic acid and its related importance were not satisfactory. This finding suggests that there is a need to give emphasis and deliver health education about preconception folic acid supplementation for women.

Methods: Consecutive patients with PIVH from a single center in China were enrolled over a 7- year period. Gender differences in demographics, risk factors, etiological subtypes, treatment, and outcomes were examined. The logistic regression models were used in the study to identify the predictors of poor outcome.

Results: In total, 174 patients were analyzed, and 77 (44.3%) of them were women. Women with PIVH were younger (p = 0.047), with lower systolic and diastolic blood pressure (p = 0.02 and p = 0.004, respectively). They had more cases caused by Moyamoya disease (p = 0.038). There were fewer patients with hypertension (p = 0.008), smoking (p＜0.001), chronic alcoholism (p＜0.001), harbored lower hemoglobin (p＜0.001) and Absolute Monocyte Count (AMC) (p = 0.04) at admission compared with men. There were no differences between female and male patients regarding the mortality and poor outcome in the multivariable-adjusted models ((OR = 0.57; 95% CI, 0.15-2.14) and (OR = 0.86; 95% CI, 0.32-2.37), respectively). In subgroup analysis after adjustment, the gender specific independent predictors for unfavorable outcome were higher with a Graeb score (OR = 1.78; 95% CI, 1.01-3.13) or AMC (OR = 9.66; 95% CI, 1.20-12.87) in women, and lower Glasgow coma scale (GCS) score (OR = 0.64; 95% CI, 0.47-0.87) or acute hydrocephalus (OR = 0.17; 95% CI, 0.03-0.86) in men.

Conclusion: Women with PIVH exhibit some distinctive baseline features compared with men. The gender difference of the PIVH does not appear to affect the neurological outcome. The predictors of poor outcomes are Graeb score and AMC in women and GCS score and acute hydrocephalus in men.

Objective: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.

Results: Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.

Conclusion: Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.

Objective: Advancing the knowledge of AD physiopathological mechanisms, improving early diagnosis and developing effective treatments from omics-based biomarkers.

Methods: Studies using omics technologies to detect early AD, were reviewed with a particular focus on the metabolites/lipids, micro-RNAs and proteins, which are identified as potential biomarkers in non-invasive samples.

Results: This review summarizes recent research on metabolomics/lipidomics, epigenomics and proteomics, applied to early AD detection. Main research lines are the study of metabolites from pathways, such as lipid, amino acid and neurotransmitter metabolisms, cholesterol biosynthesis, and Krebs and urea cycles. In addition, some microRNAs and proteins (microglobulins, interleukins), related to a common network with amyloid precursor protein and tau, have been also identified as potential biomarkers. Nevertheless, the reproducibility of results among studies is not good enough and a standard methodological approach is needed in order to obtain accurate information.

Conclusion: The assessment of metabolomic/lipidomic, epigenomic and proteomic changes associated with AD to identify early biomarkers in non-invasive samples from well-defined participants groups will potentially allow the advancement in the early diagnosis and improvement of therapeutic interventions.

Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes.

Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders.

Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator.

Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients.

Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

Discussion: The BDNF levels are found to be downregulated in many neurodegenerative disorders and are found to be upregulated in various kinds of cancers. The lower level of BDNF in Alzheimer’s and Parkinson’s disease has been found to be related to cognitive and other neuropsychological impairments, whereas, its higher levels are associated with the tumour growth and metastasis and poor survival rate in the cancer patients.

Conclusion: In this review, we propose that variance in BDNF levels is critical in determining the course of cellular pathophysiology and the development of cancer or neurodegenerative disorder. We further propose that an alternative therapeutic strategy that can modulate BDNF expression, can rescue or prevent above said pathophysiological course. Larger studies that examine this link through animal studies are imperative to understand the putative biochemical and molecular link to wellness and disease.

Objectives: To assess the diagnostic impact of a CDSS, the PredictND tool, for differential diagnosis of dementia in memory clinics.

Methods: In this prospective multicenter study, we recruited 779 patients with either subjective cognitive decline (n=252), mild cognitive impairment (n=219) or any type of dementia (n=274) and followed them for minimum 12 months. Based on all available patient baseline data (demographics, neuropsychological tests, cerebrospinal fluid biomarkers, and MRI visual and computed ratings), the PredictND tool provides a comprehensive overview and analysis of the data with a likelihood index for five diagnostic groups; Alzheimer´s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and subjective cognitive decline. At baseline, a clinician defined an etiological diagnosis and confidence in the diagnosis, first without and subsequently with the PredictND tool. The follow-up diagnosis was used as the reference diagnosis.

Results: In total, 747 patients completed the follow-up visits (53% female, 69±10 years). The etiological diagnosis changed in 13% of all cases when using the PredictND tool, but the diagnostic accuracy did not change significantly. Confidence in the diagnosis, measured by a visual analogue scale (VAS, 0-100%) increased (ΔVAS=3.0%, p<0.0001), especially in correctly changed diagnoses (ΔVAS=7.2%, p=0.0011).

Conclusion: Adding the PredictND tool to the diagnostic evaluation affected the diagnosis and increased clinicians’ confidence in the diagnosis indicating that CDSSs could aid clinicians in the differential diagnosis of dementia.]]> https://www.benthamscience.comarticle/95202

Method: A double-blind, randomized-control trial (perilla seed oil versus placebo) in patients with mild to moderate dementia was conducted. Perilla seed oil or placebo was added on with standard treatment for six months. Cognitive function was compared at nine months after enrollment.

Result: 182 patients, with 94 in the experimental group and 88 in the placebo group, were able to complete the study. Cognitive function is not significantly different compared between groups. However, the total cholesterol and LDL cholesterol were significantly lower in the experimental group. Perilla seed oil had no adverse effect to kidney, liver, blood components or glucose metabolism.

Conclusion: Perilla seed oil as additional neuroprotective therapy in patients with mild to moderate dementia does not improve cognitive function. Perilla seed oil significantly reduced total cholesterol and LDL cholesterol. A clinical trial is needed to prove the benefit of cholesterol-lowering effects with perilla seed oil in human.]]> https://www.benthamscience.comarticle/84807

Conclusion: for five decades, the model of CPZ-induced demyelination is a good experimental approach to study demyelinating diseases that has maintained its validity, and is a suitable pharmacological model for reproducing some key features of demyelinating diseases, including multiple sclerosis.]]> https://www.benthamscience.comarticle/83549

Methods: Studies related to the expression patterns of ectonucleotidases and their known features during brain development are reviewed, highlighting involvement of these enzymes in synapse formation and maturation in physiological as well as in pathological states.

Results: During brain development and in adulthood all ectonucleotidases have diverse expression pattern, cell specific localization and function. NPPs are expressed at early embryonic days, but the expression of NPP3 is reduced and restricted to ependymal area in adult brain. NTPDase2 is dominant ectonucleotidase existing in the progenitor cells as well as main astrocytic NTPDase in the adult brain, while NTPDase3 is fully expressed after third postnatal week, almost exclusively on varicose fibers. Specific brain AP is functionally associated with synapse formation and this enzyme is sufficient for adenosine production during neurite growth and peak of synaptogenesis. eN is transiently associated with synapses during synaptogenesis, however in adult brain it is more glial than neuronal enzyme.

Conclusion: Control of extracellular adenine nucleotide levels by ectonucleotidases are important for understanding the role of purinergic signaling in developing tissues and potential targets in developmental disorders such as autism.]]> https://www.benthamscience.comarticle/92788

Conclusion: The recent hypothesis based on glucose and ATP as sources of energy presents numerous contradictions and controversies. The discovery of the unsuspected intrinsic ability of melanin to dissociate and reform water molecules, similar to the role of chlorophyll in plants, was confirmed in the study of ISF and CSF biology.]]> https://www.benthamscience.comarticle/91410

Objective: We enhance these works by evaluating the relationship between the presence of cardiovascular risk factors and the rate of cognitive decline, measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SUM) on four common dementia subtypes (AD, dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VaD), as well as non-demented elderly individuals (normal)).

Method: We used generalized linear mixed models with random intercepts to account for correlation at the patient and center levels for each dementia subtype adjusting for time since initial visit, baseline cognitive score, age, and demographic factors. The cardiovascular risk factors evaluated included body mass index, diabetes, years of smoking, atrial fibrillation, hypertension, and hypercholesterolemia.

Results: Patients diagnosed with AD (n=1899), DLB (n=65), FTD (n=168), or VaD (n=13); or lacked cognitive impairment (normal) (n=3583) were evaluated using data from the National Alzheimer’s Coordinating Centers. Cardiovascular risk factors were associated with select dementia subtypes including AD and FTD. Using MMSE and CDR-SUM, recent or active hypertension and hypercholesterolemia were associated with a slower cognitive decline for AD patients, while higher body mass index and years of smoking were associated with a slower cognitive decline for FTD patients. However, several cardiovascular factors demonstrated associations with more rapid cognitive decline.

Conclusion: These results demonstrate disease specific associations and can provide clinicians guidance on predicted cognitive changes at the group level using information about cardiovascular risk factors.]]> https://www.benthamscience.comarticle/84044

Methods: Initial damage force results in Primary brain injury, causing tissue destruction and distortion in the early post-injury period. These secondary injuries from TBI cause changes in cell performance and dissemination of trauma via activities like free-radical generation, depolarization, and formation of edema, excitotoxicity, and disruption of blood brain barrier, calcium homeostasis, and intracranial hematoma. The expectation for developing effect in TBI sufferers is the best knowledge of these activities and enhancement of remedies that restrict secondary brain damage.

Results: The focal point of this study is on knowing the complex outburst of secondary impairments and studying the pathophysiology of TBI which provides alternative treatment benefits.

Conclusion: While injured persons demonstrate dissimilar levels of harm and every case is novel with specific recovery profiles, this article strengthens the recent pathophysiological sight of TBI mainly attention on oxidative stress, excitotoxicity, cerebral oxygenation and cerebral blood flow (CBF), development of edema, and inflammatory activities. For initial research acknowledgment of these recurring factors could permit clarification of possible beneficial targets.]]> https://www.benthamscience.comarticle/91154 https://www.benthamscience.comarticle/87084

Methods: The English CSP instrument has a good internal validity and consistency. We used a standardized procedure for the linguistic validation of the translated scale. For the psychometric validation, we recruited 215 individuals with ACM and calculated the Cronbach&339;s alpha for the sample. The construct was validated by analyzing the age, sex, and presence of syringomyelia, as well as by correlating the results with the sickness impact profile 30 (SIP-30) questionnaire, which can also evaluate quality of life in this type of patient.

Results: The Spanish version of the CSP has good internal consistency and validity (Cronbach’s alpha of 0.90); age, sex, and the presence of syringomyelia does not significantly affect the quality of life of patients with ACM. There was a direct and significant correlation between the Spanish CSP and the validated SIP-30 questionnaire results (p < 0.05). Further analysis showed a positive correlation for the physical and psychological scopes of the CSP and SIP-30 questionnaires, but not for their functional and social scopes.

Conclusion: This version of the CSP is a valid and reliable instrument for measuring quality of life in patients with ACM in the Spanish context.]]> https://www.benthamscience.comarticle/83272

Conclusion: We present a review of the neuroradiological manifestations of neonatal and paediatric encephalopathies which will aide paediatricians and radiologists in their assessment of children with this condition.]]> https://www.benthamscience.comarticle/84369

Methods: We used a proteomic approach to analyze nitrated plasma proteins in patients diagnosed with acute PE. Nitrotyrosine (NO2Tyr)-containing proteins were immunoprecipitated with a NO2Tyr affinity sorbent. Precipitated proteins were separated by SDS-PAGE and visualized by either Coomassie Blue staining or western blotting with mouse monoclonal anti-NO2Tyr antibody. Immunoreactive bands observed in disease patients were in-gel digested and analyzed by MALDI-TOF mass spectrometry (MS).

Results: Mass fingerprint data sets obtained from the 138 kDa peptide fragment ions matched human collagen alpha-1 (III) chain (CO3A1) with Mascot algorithm analysis giving a score of 65 (p< 0.05). Mass fingerprint data sets obtained from the 250 kDa peptide fragment ions matched human chondroitin sulfate proteoglycan 4 (CSPG4) with Mascot algorithm analysis giving a score of 57 (p< 0.05). Nitration-induced alterations of CSPG4 activity can thus possibly lead to decreased fibrin degradation and enhanced complement system activity.

Conclusion: In vivo characteristics of these nitroproteins could be significant with regards to biomarker studies and understanding of disease mechanism in patients with PE. Future studies are aimed to understand the relevance of NO2Tyr modifications in CO3A1 and CSPG4 relating to changes in protein structure and function.]]> https://www.benthamscience.comarticle/82903

Objective: The aim of the present work was to evaluate the protective effects of CAP loaded nano-emulsomes (EML) against the oxidative stress of rat livers induced through sodium fluoride (NaF).

Method: EML was prepared by thin film hydration method that is development of thin lipid film followed by hydration and sonication. EML was characterized by Fourier transform infrared (FT-IR) spectroscopy and X-ray diffraction (XRD) techniques. EML was evaluated for drug entrapment, in vitro drug release, and in vivo study.

Results: In vitro drug release study of optimized formulation showed that 50% of CAP was released within 50.21 min while 85% CAP was released in 227.4 min. Single oral dose of free CAP and CAP loaded EML were given to rats 2 hour after NaF administration. Membrane of hepatic cells was damaged by NaF and it was judged by the estimation of lipid peroxidation, reactive oxygen species (ROS), and catalase activity. The administration of CAP loaded EML 2 hr after NAF consumption showed significant decrease in ROS level compared to free CAP. EML containing CAP was more effective in comparison to free CAP in controlling the lipid peroxidation that is thiobarbituric acid substance augmentation in liver by the treatment of NaF. The administration of CAP loaded EML showed significant increase in catalase activity compared to free CAP administration.

Conclusion: The results clearly demonstrated that CAP loaded EML may be accepted as an effective therapeutic formulation in preventing oxidative damage.]]> https://www.benthamscience.comarticle/85944 https://www.benthamscience.comarticle/84300

Objective: Mitochondria-targeted antioxidant SkQ1 can suppress the development of AD signs, but its therapeutic potential in AD at clinical stages is currently unknown.

Method: Using OXYS rats that simulate key characteristics of sporadic AD, we evaluated effects of SkQ1 treatment from the age of 19 to 24 months on the locomotor and exploratory activities, signs of neurodegeneration detectable by magnetic resonance imaging (MRI), amyloid-β (Aβ) protein levels in the hippocampus and serum, and structure of the mitochondrial apparatus in hippocampal neurons.

Results: Treatment with SkQ1 increased behavioral activity in OXYS and Wistar (control) rats. According to MRI, SkQ1 decreased the percentage of animals with demyelination only among Wistar rats. At the same time, the antioxidant reduced hippocampal Аβ1-40 and Аβ1-42 protein levels in both rat strains and did not affect serum Аβ levels. The number of mitochondria was significantly lower in OXYS rats; SkQ1 had no effect on this parameter but significantly reduced the destructive changes in mitochondria of both rat strains. As a result, in OXYS rats, the proportion of severely damaged mitochondria decreased, whereas in Wistar rats, the proportion of intact mitochondria increased.

Conclusion: According to our past and present results, the repair of the mitochondrial apparatus by SkQ1 is a promising strategy against AD.]]> https://www.benthamscience.comarticle/82856

Objective: To conduct a systematic review on the prevalence of frailty and to combine the data to synthesize the pooled prevalence of physical frailty among patients with Alzheimer's disease.

Method: Five electronic databases (Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library) were searched for studies providing cross-sectional data on physical frailty among patients with Alzheimer's disease published from 2000 to January 2016.

Results: Of 2,564 studies identified through the systematic review, five studies incorporating 534 patients with Alzheimer's disease were included for the meta-analysis. The prevalence of frailty varied with a wide range from 11.1% to 50.0% and the pooled prevalence was 31.9% (five studies, 95% confidence interval (CI)=15.7%-48.5%). The high degree of heterogeneity was observed in all analyses. A borderline publication bias was detected.

Conclusion: The current study showed that frailty is highly prevalent in older patients with Alzheimer's disease in the community with the pooled prevalence of 31.9%. The true prevalence may be much higher given that end-stage patients may not be included. This information is important for clinicians and researchers.]]> https://www.benthamscience.comarticle/80174 https://www.benthamscience.comarticle/78494