Assessing and Enhancing the Adequacy of Radiology Request Forms at a Tertiary Care Hospital in Sudan: A Clinical Audit.

BACKGROUND: Clinical auditing is one method of improving the quality of patient care. Radiology request forms (RRFs) are crucial for the purpose of facilitating communication between the radiologist or radiographer and the referring clinician. METHODS: A two-cycle clinical audit was conducted at the Radiology Department of Atbara Police Hospital in Khartoum, Sudan. A total of 100 forms were collected, with 50 forms from each cycle. As an intervention, the existing blank paper format for radiology requests was replaced with a structured form based on the standards of the Royal College of Radiologists (RCR). This new form was distributed hospital-wide, and doctors were educated on its use through presentations and briefings. The collected forms were then compared against the RCR standards for completeness and accuracy. Data were entered into Microsoft Excel 2016 for analysis. RESULTS:  The interventions led to notable improvements in several areas. Accuracy in recording the patient's address, phone number, and location increased from 0 (0%) in the first cycle to 50 (100%) in the second cycle, marking a 100% improvement. In addition, referencing the patient's age improved from 15 (30%) in the first cycle to 50 (100%) in the second cycle, indicating a 70% increase. The mean score for RRF documentation was 25.33% in the first cycle and significantly increased to 97.77% in the second cycle. CONCLUSION: The audit shows significant improvement in RRFs post-intervention, highlighting the importance of standardization. However, deficiencies point to the need for orientation and follow-up training for physicians to ensure accurate form completion. Integrating quality assurance, including periodic audits and real-time feedback, can help sustain these gains. Collaboration between radiologists and referring physicians is also essential for ongoing improvement.

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review.

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

Hope amidst neglect: Mycetoma Research Center, University of Khartoum. A holistic management approach to achieve the United Nations' Sustainable Development Goals.

Mycetoma is a debilitating neglected tropical disease that affects individuals worldwide, particularly in regions where there is poverty and limited health care access. The Mycetoma Research Center (MRC), based in Khartoum, Sudan, provides a sustainable, holistic approach to patient care as the only World Health Organization collaborating center for mycetoma. We describe MRC activities that align with the United Nations' Sustainable Development Goals to control mycetoma in Sudan and globally.

Thiazolidinone-linked-1,2,3-triazoles with (R)-Carvone as new potential anticancer agents.

Aim: This study explores the cytotoxic and apoptotic effects of novel thiazolidinone-1,2,3-triazole hybrids on HT-1080, A-549, and MDA-MB-231 cancer cell lines.Methods & results: The synthesized compounds underwent comprehensive characterization (NMR and HRMS) to confirm their structures and purity. Subsequent anticancer activity screening across diverse cancer cell lines revealed promising antitumor potential notably, compounds 6f and 6g. Mechanistic investigations unveiled that compound 6f triggers apoptosis through the caspase-3/7 pathway. In terms of in silico studies, the compound 6f was identified as a potent inhibitor of caspase-3 and caspase-7.Conclusion: The present study underscores the therapeutic potential of thiazolidinone-1,2,3-triazole hybrids against certain cancer cells. These findings highlight a promising avenue for the development of cancer treatment strategies utilizing these (R)-Carvone-based derivatives.

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Occupational stress and associated sources and risk factors among nurses in Gaza strip, Palestine: A cross-sectional survey.

AIM: To determine the occurrence of occupational stress among Palestinian nurses, and their associated sources and risk factors. DESIGN: A cross-sectional descriptive design. METHODS: A total of 250 registered nurses from eight governmental hospitals, using a convenience sampling method. Data collection were conducted using the 30-items self-reported Occupational Stress Scale from December 2022 to March 2023. Descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis were applied to analysis data. Data analysis included descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis. RESULTS: The prevalence of high occupational stress levels was 64.8% (Mean = 3.9 out of 5). The main sources of stress are too much responsibility and work, understaffing, lack of promotion and recognition, inadequate pay, time pressure, and management style. The results regression analysis demonstrated that male nurses with a Masters or PhD degree and those working in fixed shifts experienced higher occupational stress. Moreover, participants who worked overtime hours were more susceptible to stress. CONCLUSIONS: The research indicates that occupational stress presents a notable challenge for nurses in the Gaza Strip, Palestine. It suggests that in order to alleviate this stress, decision-makers in healthcare policy and hospital management should prioritize the execution of strategies aimed at addressing the primary stressors and risk factors identified. REPORTING METHOD: This study adhered to the STROBE guidelines. PUBLIC CONTRIBUTION: A total of 250 registered nurses were taken part in this study by answering a self-administered study survey.

The Mycetoma Research Center, University of Khartoum, Sudan's experience in community engagement initiatives spans 3 decades.

Mycetoma profoundly affects marginalised communities, especially in impoverished and remote areas with limited access to healthcare. This chronic and debilitating inflammatory disease highlights the typical issues of neglected tropical diseases (NTDs), such as insufficient attention, funding, and resources, which perpetuate neglect and suffering. Patients often delay seeking medical help, leading to advanced disease stages, severe complications, and lasting disabilities. The lack of medical infrastructure and skilled healthcare professionals worsens the situation, causing delays in diagnosis and inadequate treatment. Engaging affected communities in tailored interventions is essential to tackle these challenges, promote collaboration, raise awareness, and mobilise resources to improve healthcare access and enhance diagnostic and treatment capabilities. Since 1991, the Mycetoma Research Center (MRC) at the University of Khartoum, Sudan, has led community engagement initiatives aimed at improving the quality of life for mycetoma-affected individuals through education, advocacy, and local collaboration. In this communication, the MRC shares its extensive experience in community engagement to benefit mycetoma-affected communities.

Headache attributed to ischemic stroke - a new scope for management: a case study.

Acute ischemic stroke may present with serious clinical manifestations. Headache attributed to ischemic stroke is one of these clinical manifestations which may be neglected and affect the functional outcome of the patients. Understanding the exact pathophysiology, and recognition of the most clinical and radiological predictors can help to provide good management and open scope for prophylactic approaches. Here, we report a case presented with acute onset of ischemic stroke and developed a new onset headache on the first day of stroke onset. According to the International Classification of Headache Disorders third edition (ICHD-3), the patient has a post-stroke headache. Using transcranial duplex ultrasound, activation of the trigeminovascular pathway could be attributed to the opening of more pain-sensitive collateral channels as the left posterior communicating artery (P Com A). In conclusion, we can predict the development of acute headache at stroke onset based on different clinical and radiological factors. Opening of the collateral channels is strongly implicated in the production of post-stroke headache.

Exploring Community Perspectives on Functional Paediatric Habitual Constipation.

(1) Background: Functional habitual constipation (FC) in children is a common gastrointestinal problem. This study aimed to explore the local community's view on this problem, emphasising the challenges that parents face in managing the condition and its impact on the child's quality of life. (2) Methods: A prospective, cross-sectional, community-based study was conducted between March and July 2023. The survey received 933 responses. The target population was adults over 18 years of age living in the Eastern Province of Saudi Arabia. An electronically distributed questionnaire was designed in the Arabic language. (3) Results: The mean knowledge scores were significantly higher in females than males, with t (931) = -2.701 and p = 0.007. The Bonferroni post hoc test results indicated that participants between 20 and 29 years exhibited significantly higher levels of knowledge scores compared to those between 30 and 39 years. Furthermore, the results revealed that those with three or more children had significantly higher knowledge scores compared to those with only one child. (4) Conclusions: This study demonstrated that parents in the local community have a good perceived knowledge of FC, but it needs to be linked with practice. They tended to report high levels of perception and demonstrated better practices. These results emphasise the importance of exploring the local community's view on constipation among children.

Emerging therapeutics: The imidazo[1,2-b]pyridazine scaffold as a novel drug candidate for eumycetoma, a neglected tropical disease.

Mycetoma is a neglected invasive infection endemic in tropical and subtropical regions, presenting as a chronic subcutaneous inflammatory mass that can spread to deeper structures, leading to deformities, disabilities, and potentially mortality. The current treatment of eumycetoma, the fungal form of mycetoma, involves antifungal agents, such as itraconazole, combined with surgical intervention. However, this approach has limited success, with low cure rates and a high risk of recurrence. This study addresses to the urgent need for more effective therapeutics by designing and synthesising 47 diversely pharmacomodulated imidazo [1,2-b]pyridazine derivatives using a simple synthetic pathway with good yields and purity. Of these, 17 showed promising in vitro activity against Madurella mycetomatis, the prime causative agent of eumycetoma, with IC50 ≤ 5 µM and demonstrated significantly lower cytotoxicity compared to standard treatments in NIH-3T3 fibroblasts. Notably, compound 14d exhibited an excellent activity with an IC50 of 0.9 µM, in the same order then itraconazole (IC50 = 1.1 µM), and achieved a favourable selectivity index of 16 compared to 0.8 for itraconazole. These promising results warrant further research to evaluate the clinical potential of these novel compounds as safer, more effective treatments for eumycetoma, thus addressing a profound gap in current therapeutic strategies.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

BACKGROUND: Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. AIM OF STUDY: This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. MATERIAL AND METHODS: This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. RESULTS: There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. CONCLUSION: Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

Double Decker anterior cruciate ligament avulsion.

Distal anterior cruciate ligament avulsion from tibial side is an unusual injury. It can be either bony avulsion, which is more common, or rarely a soft tissue peeling of tibial spine with no bone injury. This case report represents a very infrequent injury of combined soft tissue peeling of distal anterior cruciate ligament along with bony avulsion of tibial spine in a 12-years-old boy after falling from his bike.

Endoscopic Evaluation after Conventional Adenoid Curettage.

Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.

The Role of Alternative Medicine in Managing Type 2 Diabetes: A Comprehensive Review.

Diabetes, a chronic metabolic disorder marked by elevated blood glucose levels, is increasingly prevalent globally, significantly impacting health-related quality of life. Type 2 diabetes (T2DM), characterized by insulin resistance and inadequate insulin production, presents a substantial public health challenge, necessitating comprehensive management strategies. Conventional treatments, including lifestyle modifications and pharmacotherapy, are essential for glycemic control and preventing complications. However, adherence to these treatments is often limited, highlighting the need for alternative strategies. Complementary and alternative medicine (CAM) offers potential cost-effective and accessible approaches for managing T2DM. Key herbal remedies like cinnamon, fenugreek, and bitter melon, along with dietary supplements like chromium, magnesium, and vanadium, have shown promise in glycemic control. Mind-body therapies, including yoga, tai chi, and meditation, contribute to improved hemoglobin A1c and fasting blood glucose levels. Research supports the integration of CAM with conventional therapies, demonstrating enhanced clinical efficacy and reduced economic burden. However, challenges such as standardization, quality control, and potential risks of herbal medicines need careful consideration. Regulatory frameworks and ethical considerations are essential to ensure patient safety and informed decision-making. Patient education and effective communication between healthcare providers and patients are crucial for integrating CAM into diabetes management. Empowerment-based interventions and collaborative approaches can enhance self-management skills and clinical outcomes. Overall, integrating CAM with conventional treatments offers a holistic approach to managing T2DM, potentially improving patient outcomes and reducing healthcare costs.

Unusual Presentation of Pleural Space Ascariasis Infection from Eastern Sudan: A Case Report.

Background: Ascaris lumbricoides is a common infectious parasite of the gastrointestinal tract worldwide, but the invasion of the pleural cavity is rare. Case Report: A 45-year-old man from Eastern Sudan presented to the emergency department complaining of breathlessness, cough stained with blood, and chest pain one month before his presentation. Also, he complained of high-grade fever for two weeks associated with sweating. Diagnosis of hydropneumothorax was made and a chest tube was inserted, two days later we found three adult A. lumbricoides worms in the chest drain. Conclusion: The patient was treated with Albendazole 200 mg, orally twice, daily for seven days, he improved and was referred to a cardiothoracic surgeon for more assessment. Our study highlights that internal medicine specialists should know about pleural ascariasis when patients present with respiratory signs and symptoms, especially in A. lumbricoides endemic regions like Eastern Sudan.

Prevalence, and types of overuse injuries in gym centers: A cross-sectional study in Saudi Arabia.

Physical activity has numerous health benefits, enhancing overall wellbeing. However, it can also lead to injuries, impeding exercise capacity and hindering work. Limited knowledge exists about the prevalence of overuse gym injuries and whether they vary across different gym activities. This study aims to estimate sport injuries at fitness centers in Saudi Arabia, comparing injuries between various activities and session durations. This is a cross-sectional, questionnaire-based study surveyed regular gym-goers in Saudi Arabia with overuse injuries. The online survey, distributed through social media apps, collected data using a validated Google form questionnaire. Questioanire consists of 3 parts. First part of the questionnaire included demographic characteristics of participants. Second part contains characteristics related to gym as gym session's duration, frequency of attending gym per week, sport types, type of injuries and site of injuries. Third part contains Oslo Sports Trauma Research Centre (OSTRC) Overuse injury questionnaire that included 4 questions about difficulties in participation, reduction of training, affection of performance and symptoms. Study included 1012 participants, majority male (76.2%), with age range of 18 to 50 years, and significant proportion falling between 26 and 30 years (52.6%). Majority of participants were from Central Province (42.9%). Gym sessions typically lasted 1 to 2 hours (68.3%), and most common attendance frequency was 4 days/week (39.6%). Common injury sites were shoulder (25.2%), knee (20.2%), and lower back (17.7%). Bodybuilding (50.6%), running (45.8%), and weightlifting/powerlifting (45.1%) were predominant sports. Strain/muscle rupture/tear (35.70%) and muscle cramps/spasm (19.3%) were commonest injury types. Longer gym sessions (>2 hours) were associated with higher prevalence of strain/muscle rupture/tear, dislocation, and subluxation (P < .001). Shorter sessions (<1 hour) had higher prevalence of muscle cramps/spasm and contusion/hematoma/bruise (P < .001). Gym sessions lasting 1 to 2 hours had high prevalence in tendinosis/tendinopathy. Strain/muscle rupture/tear was significantly higher in bodybuilding, weightlifting/powerlifting, swimming, cycling, and running. Tendinosis/tendinopathy was higher in crossfit. (OSTRC) Overuse injury questionnaire revealed decreased participation, training volume, performance, and increased pain with longer gym sessions. In conclusion, gym-related injuries are common, with bodybuilding and running being prevalent activities. Preventative measures should be taken, and individuals are advised to undergo a physical and medical examination before engaging in physical activity at fitness centers.

Norwegian moose CWD induces clinical disease and neuroinvasion in gene-targeted mice expressing cervid S138N prion protein.

Chronic wasting disease (CWD) is a prion disease affecting deer, elk and moose in North America and reindeer, moose and red deer in Northern Europe. Pathogenesis is driven by the accumulation of PrPSc, a pathological form of the host's cellular prion protein (PrPC), in the brain. CWD is contagious among North American cervids and Norwegian reindeer, with prions commonly found in lymphatic tissue. In Nordic moose and red deer CWD appears exclusively in older animals, and prions are confined to the CNS and undetectable in lymphatic tissues, indicating a sporadic origin. We aimed to determine transmissibility, neuroinvasion and lymphotropism of Nordic CWD isolates using gene-targeted mice expressing either wild-type (138SS/226QQ) or S138N (138NN/226QQ) deer PrP. When challenged with North American CWD strains, mice expressing S138N PrP did not develop clinical disease but harbored prion seeding activity in brain and spleen. Here, we infected these models intracerebrally or intraperitoneally with Norwegian moose, red deer and reindeer CWD isolates. The moose isolate was the first CWD type to cause full-blown disease in the 138NN/226QQ model in the first passage, with 100% attack rate and shortened survival times upon second passage. Furthermore, we detected prion seeding activity or PrPSc in brains and spinal cords, but not spleens, of 138NN/226QQ mice inoculated intraperitoneally with the moose isolate, providing evidence of prion neuroinvasion. We also demonstrate, for the first time, that transmissibility of the red deer CWD isolate was restricted to transgenic mice overexpressing elk PrPC (138SS/226EE), identical to the PrP primary structure of the inoculum. Our findings highlight that susceptibility to clinical disease is determined by the conformational compatibility between prion inoculum and host PrP primary structure. Our study indicates that neuroinvasion of Norwegian moose prions can occur without, or only very limited, replication in the spleen, an unprecedented finding for CWD.

Genome-wide analysis of MYB transcription factor family and AsMYB1R subfamily contribution to ROS homeostasis regulation in Avena sativa under PEG-induced drought stress.

BACKGROUND: The myeloblastosis (MYB) transcription factor (TF) family is one of the largest and most important TF families in plants, playing an important role in a life cycle and abiotic stress. RESULTS: In this study, 268 Avena sativa MYB (AsMYB) TFs from Avena sativa were identified and named according to their order of location on the chromosomes, respectively. Phylogenetic analysis of the AsMYB and Arabidopsis MYB proteins were performed to determine their homology, the AsMYB1R proteins were classified into 5 subgroups, and the AsMYB2R proteins were classified into 34 subgroups. The conserved domains and gene structure were highly conserved among the subgroups. Eight differentially expressed AsMYB genes were screened in the transcriptome of transcriptional data and validated through RT-qPCR. Three genes in AsMYB2R subgroup, which are related to the shortened growth period, stomatal closure, and nutrient and water transport by PEG-induced drought stress, were investigated in more details. The AsMYB1R subgroup genes LHY and REV 1, together with GST, regulate ROS homeostasis to ensure ROS signal transduction and scavenge excess ROS to avoid oxidative damage. CONCLUSION: The results of this study confirmed that the AsMYB TFs family is involved in the homeostatic regulation of ROS under drought stress. This lays the foundation for further investigating the involvement of the AsMYB TFs family in regulating A. sativa drought response mechanisms.

The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion.

Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline. The authors propose the "MINUTES" acronym which summarizes essential interventions which should be performed within the first 30 min following shock recognition. All the interventions in the MINUTES bundle are suitable for any patient with undifferentiated shock. In addition to the acronym, we suggest a timeline for each step, balancing the feasibility and urgency of each intervention. The MINUTES acronym includes seven sequential steps which should be performed in the first 30 min following shock recognition: Maintain "ABCs", INfuse vasopressors and/or fluids (to support hemodynamic/perfusion) and INvestigate with simple blood tests, Ultrasound to detect the type of shock, Treat the underlying Etiology, and Stabilize organ perfusion.

Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial.

BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. METHODS: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). RESULTS: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively). However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). CONCLUSIONS: Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.