The Accuracy of Breast Cancer Diagnostic Tools.

Background Breast cancer (BC) remains a significant health concern, leading to illness and death among women globally. It is essential to detect BC early using imaging techniques that accurately reflect the final pathology, guiding suitable intervention strategies. Objectives This study aimed to evaluate the agreement between radiological findings and histopathological results in BC cases. Methods We conducted a retrospective review of breast core needle biopsies (CNBs) in women over a six-year period (2017-2022) at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The pathological diagnoses were compared with the findings from preceding radiological investigations. We also compared the tumour sizes in the resection specimens with their radiological counterparts. Results A total of 641 cases were included in the study. Ultrasound (US), mammography, and magnetic resonance imaging (MRI) yielded diagnostic accuracies of 85%, 77.9%, and 86.9%, respectively. MRI had the highest sensitivity at 72.2%, while US had the lowest at 61%. MRI provided the best agreement with the final resected tumor size. By contrast, mammography tended to overestimate the size (41.9%), and US most frequently underestimated it (67.7%). The connection between basal-like molecular subtypes and the Breast Imaging Reporting and Data System (BIRADS)-5 classifications was only statistically significant for MRI (p = 0.04). The luminal subtype was more likely to show speculation in mammography. Meanwhile, BIRADS-4 revealed a considerable number of benign pathologies across all the three modalities. Conclusions MRI demonstrated the highest accuracy, sensitivity, specificity, and positive predictive value (PPV) for diagnosing and estimating the tumor size. Mammography outperformed US in terms of sensitivity and yielded the highest negative predictive value (NPV). US, meanwhile, offered superior specificity, PPV, and accuracy. Therefore, combining these diagnostic methods could yield significant benefits.

The Relationship Between COVID-19 and the Development of Depression: Implications on Mental Health.

Initially, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease-2019 (COVID-19), was predominantly considered to primarily affect the respiratory system. However, later studies revealed that it also affects brain function through its ability to bind to the angiotensin-converting enzyme type 2 (ACE2) receptors expressed on neural cells. Our study involved a comprehensive review of literature aiming to investigate the relationship between COVID-19 and the development of depression. Our analysis shows a connection between these 2 conditions, as a consequence of the inflammatory response in the nervous system to the COVID-19 virus and the psychophysiological effects of the pandemic. In COVID-19 patients, depression can arise either due to the direct viral infection of the brain or as a result of an indirect immune response triggering neuroinflammation after a cytokine storm. The resulting depression can be treated with non-pharmacological therapies such as psychotherapy, antidepressant medications, or a combination of these treatments depending on the severity of the symptoms.

Neuromuscular Disorders Associated With COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on practically every aspect of daily life, and those with neuromuscular disorders have certainly not been spared. The effects of COVID-19 infection are far-reaching, going well beyond respiratory symptoms alone. From simple myalgias to debilitating critical illness neuromyopathies, we continue to learn and catalog the diverse pathologies presented by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as it relates to the neuromuscular system. Complications have been documented both as a direct result of primary infection but also in those with pre-existing neuromuscular disorders from myasthenia gravis to devastating critical illness neuromyopathies. In this review, we will discuss the relationship between COVID-19 infection and critical illness neuromyopathy, peripheral nerve palsies, myalgias, positional compressive neuropathy, myasthenia gravis, and Guillain-Barré syndrome.

Neurological and Neurodegenerative Disorders: Novel Concepts and Treatment.

The journal "Aging and Disease" has released a special issue focused on novel concepts in understanding the pathophysiology and treatment of neurological and neurodegenerative disorders. The special issue comprises review and original research articles discussing the various disease mechanisms and/or treatment updates on aging, mild cognitive impairment, dementia, acute stroke, pediatric stroke, super-refractory status epilepticus, reflex epilepsy, drug-resistant epilepsy, Parkinson's disease, and traumatic brain injury. This editorial discusses the highlights from these articles.

Acute Stroke Management: Overview and Recent Updates.

Stroke is a leading cause of morbidity and mortality in the United States. Whether hemorrhagic or ischemic, stroke leads to severe long-term disability. Prior to the mid-1990s, the treatment offered to a patient who presented with an acute stroke was mainly limited to antiplatelets. The lack of adequate treatment, in particular, one without reperfusion contributed to the disability that ensued. There have been many advances in stroke care within the past two decades, especially with the acute management of ischemic stroke. Even with these advances, it is quite alarming that only a fraction of patients receives acute stroke treatment. Numerous trials were conducted to broaden treatment eligibility in hopes that more patients can be treated acutely and safely. These trials have tested both the time window for IV tPA and endovascular therapy (EVT). Acute stroke management is moving from a universal time window approach to a concept of tissue preservation. Specifically, preserving cerebral blood flow, the penumbra, and reducing the risk of a second event. This movement is being executed through the use of multimodal CT and MRI, as well as individualizing treatment to our patients. Minimizing the initial effect of stroke changes the outcome and leads to an increased likelihood of functional independence. In this review, we discuss the recent updates of acute ischemic stroke management in regards to mechanical thrombectomy as well as thrombolytics including tenecteplase.

Pediatric Stroke: Overview and Recent Updates.

Stroke can occur at any age or stage in life. Although it is commonly thought of as a disease amongst the elderly, it is important to highlight the fact that it also affects infants and children. In both populations, strokes have a high rate of morbidity and mortality. Arguably, it is more detrimental in the pediatric population given the occurrence at a younger age and therefore, a longer duration of disability, potentially over the entire lifespan. The high rate of morbidity and mortality in pediatrics is attributed to significant delays in diagnosis, as well as misdiagnosis. Acute stroke management is time dependent. Patients who receive acute treatment with either intravenous (IV) tissue plasminogen activator (tPA) or mechanical thrombectomy, have improved mortality and functional outcomes. Additionally, the earlier treatment is initiated, the higher the likelihood of preserving penumbra, restoring cerebral blood flow and potentially reversing symptoms, thereby limiting disability. Prompt identification is essential as it leads to improved patient care in such a narrow therapeutic window. It enhances the care received during hospitalization and reduces the risk of early stroke recurrence. Despite limited data and lack of large randomized clinical trials in pediatrics, both IV tPA and mechanical thrombectomy have been successfully used. Bridging the gap of acute stroke management in the pediatric population is an essential part of minimizing adverse outcomes. In this review, we discuss the epidemiology of pediatric stroke, the diverse etiologies, presentation as well as both acute and preventative management.

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management.

Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as "status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawal of anesthesia." This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.

Feeding ecology of blue rock pigeon (Columba livia) in the three districts of Punjab, Pakistan / Ecologia de alimentação do pombo-da-rocha-azul (Columba livia) nos três distritos de Punjab, Paquistão

Abstract Present paper provides information on the feeding regimens of the two genders of the blue-rock pigeon (Columba livia Linn.) in the sampled habitats of the three districts viz. Rawalpindi, Faisalabad and Bahawalpur of the Punjab province, Pakistan. This feral pigeon, considered ubiquitous species, inhabits both the grasslands and clumped environments to establish their roosts and nests. The study explored about comparable feeding proportions from three major habitats of the pigeons which were captured with medium sized mist-nets. For Rawalpindi in the winter season, the Zea mays was one of the predominant food item (30.6%) for males, and other ranked major food contents were (26.7%, 22.4% and 20.2%), and fairly similar feeding proportions were also recorded for the females (50.4%, 33.3%, 36.4% and 23.9%) for Carthamus oxyacantha, Hordeum vulgare, Triticum aestivum and Zea mays respectively. Evidently, no significant deviations in the existing food crops for the three sites for the feral pigeon were detected, which strongly suggested that the, modes of feeding habits among the sustainable roosts and nests which were closely located to food crops, exerted negligible impacts during intermittent pigeon foraging movements in the diurnal conditions.

Resumo O presente artigo fornece informações sobre os regimes de alimentação dos dois sexos do pombo-da-rocha-azul (Columba livia Linn.) nos habitats amostrados dos três distritos, a saber: Rawalpindi, Faisalabad e Bahawalpur, da província de Punjab, Paquistão. Este pombo-doméstico, considerado espécie onipresente, habita tanto as pastagens quanto os ambientes agrupados para estabelecer seus poleiros e ninhos. O estudo explorou proporções comparáveis ​​de alimentação de três grandes habitats dos pombos que foram capturados com redes de neblina de tamanho médio. Para Rawalpindi no inverno, Zea mays foi um dos itens alimentares predominantes (30,6%) para os machos, e outros alimentos classificados como principais foram (26,7%; 22,4% e 20,2%), e proporções bastante semelhantes foram registradas para as fêmeas (50,4%, 33,3%, 36,4% e 23,9%) para Carthamus oxyacantha, Hordeum vulgare, Triticum aestivum e Zea mays, respectivamente. Evidentemente, não foram detectados desvios significativos nas culturas alimentares existentes nos três locais para o pombo-doméstico, sugerindo fortemente que os modos de alimentação entre os poleiros e ninhos sustentáveis, que estavam estreitamente localizados em culturas alimentares, exerceram impactos não significativos durante os períodos intermitentes dos movimentos de forrageamento dos pombos-domésticos nas condições diurnas.

Feeding ecology of blue rock pigeon (Columba livia) in the three districts of Punjab, Pakistan.

Present paper provides information on the feeding regimens of the two genders of the blue-rock pigeon (Columba livia Linn.) in the sampled habitats of the three districts viz. Rawalpindi, Faisalabad and Bahawalpur of the Punjab province, Pakistan. This feral pigeon, considered ubiquitous species, inhabits both the grasslands and clumped environments to establish their roosts and nests. The study explored about comparable feeding proportions from three major habitats of the pigeons which were captured with medium sized mist-nets. For Rawalpindi in the winter season, the Zea mays was one of the predominant food item (30.6%) for males, and other ranked major food contents were (26.7%, 22.4% and 20.2%), and fairly similar feeding proportions were also recorded for the females (50.4%, 33.3%, 36.4% and 23.9%) for Carthamus oxyacantha, Hordeum vulgare, Triticum aestivum and Zea mays respectively. Evidently, no significant deviations in the existing food crops for the three sites for the feral pigeon were detected, which strongly suggested that the, modes of feeding habits among the sustainable roosts and nests which were closely located to food crops, exerted negligible impacts during intermittent pigeon foraging movements in the diurnal conditions.

Management of Autoimmune Status Epilepticus.

Status epilepticus is a neurological emergency with increased morbidity and mortality. Urgent diagnosis and treatment are crucial to prevent irreversible brain damage. In this mini review, we will discuss the recent advances in the diagnosis and treatment of autoimmune status epilepticus (ASE), a rare form of the disorder encountered in the intensive care unit. ASE can be refractory to anticonvulsant therapy and the symptoms include subacute onset of short-term memory loss with rapidly progressive encephalopathy, psychiatric symptoms with unexplained new-onset seizures, imaging findings, CSF pleocytosis, and availability of antibody testing makes an earlier diagnosis of ASE possible. Neuroimmunomodulatory therapies are the mainstay in the treatment of ASE. The goal is to maximize the effectiveness of anticonvulsant agents and find an optimal combination of therapies while undergoing immunomodulatory therapy to reduce morbidity and mortality.

Feeding ecology of blue rock pigeon (Columba livia) in the three districts of Punjab, Pakistan

Abstract Present paper provides information on the feeding regimens of the two genders of the blue-rock pigeon (Columba livia Linn.) in the sampled habitats of the three districts viz. Rawalpindi, Faisalabad and Bahawalpur of the Punjab province, Pakistan. This feral pigeon, considered ubiquitous species, inhabits both the grasslands and clumped environments to establish their roosts and nests. The study explored about comparable feeding proportions from three major habitats of the pigeons which were captured with medium sized mist-nets. For Rawalpindi in the winter season, the Zea mays was one of the predominant food item (30.6%) for males, and other ranked major food contents were (26.7%, 22.4% and 20.2%), and fairly similar feeding proportions were also recorded for the females (50.4%, 33.3%, 36.4% and 23.9%) for Carthamus oxyacantha, Hordeum vulgare, Triticum aestivum and Zea mays respectively. Evidently, no significant deviations in the existing food crops for the three sites for the feral pigeon were detected, which strongly suggested that the, modes of feeding habits among the sustainable roosts and nests which were closely located to food crops, exerted negligible impacts during intermittent pigeon foraging movements in the diurnal conditions.

Resumo O presente artigo fornece informações sobre os regimes de alimentação dos dois sexos do pombo-da-rocha-azul (Columba livia Linn.) nos habitats amostrados dos três distritos, a saber: Rawalpindi, Faisalabad e Bahawalpur, da província de Punjab, Paquistão. Este pombo-doméstico, considerado espécie onipresente, habita tanto as pastagens quanto os ambientes agrupados para estabelecer seus poleiros e ninhos. O estudo explorou proporções comparáveis de alimentação de três grandes habitats dos pombos que foram capturados com redes de neblina de tamanho médio. Para Rawalpindi no inverno, Zea mays foi um dos itens alimentares predominantes (30,6%) para os machos, e outros alimentos classificados como principais foram (26,7%; 22,4% e 20,2%), e proporções bastante semelhantes foram registradas para as fêmeas (50,4%, 33,3%, 36,4% e 23,9%) para Carthamus oxyacantha, Hordeum vulgare, Triticum aestivum e Zea mays, respectivamente. Evidentemente, não foram detectados desvios significativos nas culturas alimentares existentes nos três locais para o pombo-doméstico, sugerindo fortemente que os modos de alimentação entre os poleiros e ninhos sustentáveis, que estavam estreitamente localizados em culturas alimentares, exerceram impactos não significativos durante os períodos intermitentes dos movimentos de forrageamento dos pombos-domésticos nas condições diurnas.

Efficacy of N-Acetylserotonin and Melatonin in the EAE Model of Multiple Sclerosis.

Melatonin and N-acetylserotonin (NAS) are tryptophan metabolites that have potent anti-oxidant, anti-inflammatory and neuroprotective properties in several animal models of neurological injury and disease including multiple sclerosis (MS). The therapeutic effect of NAS has not been reported previously in experimental autoimmune encephalomyelitis (EAE), a commonly used animal model of MS. Using a MOG-peptide induced EAE mouse model we examined the effects of melatonin and NAS on clinical score, inflammatory markers, free radical generation, and sparing of axons, oligodendrocytes and myelin. We found that NAS and melatonin reduced clinical scores when administered prior to or after symptom onset. This effect was more pronounced when melatonin and NAS were administrated prior to symptom onset whereby the appearance of motor symptoms was significantly delayed. Activated microglia and CD4+ T-cells were increased in the white matter of untreated EAE mice, with a return to near control levels after melatonin or NAS treatment. The expression of the NADPH oxidase component p67phox and inducible nitric oxide synthase (iNOS) was increased in the EAE mice as compared with controls, and both drug treated groups had significant reductions in their expression. Melatonin and NAS treatment significantly reduced the loss of mature oligodendrocytes, demyelination and axonal injury. Both compounds also significantly attenuated iNOS induction and reactive oxygen species (ROS) generation in lipopolysaccharide-activated microglia in culture. Our results show for the first time the therapeutic effects of NAS and confirm previous reports on the effectiveness of melatonin in the EAE model of MS.

Role of Anticonvulsants in the Management of Posttraumatic Epilepsy.

Posttraumatic seizures (PTS) have been recognized as a major complication of traumatic brain injury (TBI). The annual incidence of TBI in the United States is 1.7 million. The role of anticonvulsants in the treatment of posttraumatic epilepsy (PTE) remains uncertain. Based on current studies, however, anticonvulsants have been shown to reduce early PTS occurring within the first 7 days, but little to no benefits have been shown in late PTS occurring after 7 days. In this paper, we provide a mini review of the role of anticonvulsants and current advances in the management of PTE.

Psychogenic nonepileptic spells in chronic epilepsy patients with moderate cognitive impairment: the need for video EEG monitoring for adequate diagnosis.

The objective of our study was to emphasize the importance of intensive video EEG monitoring in patients with a well-established diagnosis of epilepsy with moderate cognitive impairment. The idea was to diagnose new onset frequent atypical events prompting the need for frequent emergency room and clinic visits and hospital admissions. Retrospective chart reviews were conducted on patients with chronic epilepsy with moderate cognitive impairment who had an increased incidence of new onset episodes different from the baseline seizures. Data were acquired from electronic medical records. The hospital's Institutional Review Board gave approval for this retrospective analysis of patient records. We retrospectively analyzed data from three patients with an established diagnosis of epilepsy. Extensive chart reviews were performed with emphasis on type and duration of epilepsy and description of baseline seizures and description of new events. There were two men and one woman with moderate cognitive impairment. One subject had generalized epilepsy and other two had temporal lobe epilepsy. The patients were on an average of two to three antiepileptic medicines. The duration of follow-up in our neurology clinic ranged from 9 months to 5 years. The occurrence of increased frequency of these atypical events as described by the caregivers, despite therapeutic anticonvulsant levels, prompted the need for 5-day intensive video EEG monitoring. New atypical spells were documented in all three patients and the brain waves were normal during those episodes. The diagnosis of pseudoseizures was made based on the data acquired during the epilepsy monitoring unit stay. Our data analysis showed that intensive video EEG monitoring is an important tool to evaluate change in frequency and description of seizures even in cognitively impaired patients with an established diagnosis of epilepsy for adequate seizure management.

Selection of antiepileptic drugs in older people.

OPINION STATEMENT: Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug-drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug-drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.

Role of anticonvulsants in the management of AIDS related seizures.

Seventy percent of the AIDS patients have neurological complications. Seizures are one of the complications and can occur at any stage. Seizures can be life-threatening and treatment with anticonvulsants is warranted. The therapeutic dilemma occurs in this case because of the interactions between the anticonvulsants, especially the first generation anticonvulsants, with antiretroviral agents resulting in significant side-effects including toxicity. The non-availability of second-generation anticonvulsants and cost constraints further limit the choices for the physicians. In this mini-review, we discuss the management of AIDS related seizures with emphasis on the drug-drug interactions between anticonvulsants and antiretroviral agents. We will also address the future directions and the need for prospective studies with second-generation anticonvulsants.

Neurobehavioral effects of levetiracetam in patients with traumatic brain injury.

Moderate to severe traumatic brain injury (TBI) is one of the leading causes of acquired epilepsy. Prophylaxis for seizures is the standard of care for individuals with moderate to severe injuries at risk for developing seizures, though relatively limited comparative data is available to guide clinicians in their choice of agents. There have however been experimental studies which demonstrate potential neuroprotective qualities of levetiracetam after TBI, and in turn there is hope that eventually such agents may improve neurobehavioral outcomes post-TBI. This mini-review summarizes the available studies and suggests areas for future studies.

Role of intravenous levetiracetam in seizure prophylaxis of severe traumatic brain injury patients.

Traumatic brain injury (TBI) can cause seizures and the development of epilepsy. The incidence of seizures varies from 21% in patients with severe brain injuries to 50% in patients with war-related penetrating TBI. In the acute and sub-acute periods following injury, seizures can lead to increased intracranial pressure and cerebral edema, further complicating TBI management. Anticonvulsants can be used for seizure prophylaxis according to the current Parameters of Practice and Guidelines in a subset of severe TBI patients, and for a limited time window. Phenytoin is the most widely prescribed anticonvulsant in these patients. Intravenous levetiracetam, made available in 2006, is now being considered as a viable option in acute care settings if phenytoin is unavailable or not feasible due to side-effects. We discuss current data regarding the role of intravenous levetiracetam in seizure prophylaxis of severe TBI patients and the need for future studies.

Importance of Video-EEG Monitoring in the Diagnosis of Refractory Panic Attacks.

Partial seizures can be misdiagnosed as panic attacks. There is considerable overlap of symptoms between temporal lobe seizures and panic attacks making the diagnosis extremely challenging. Temporal lobe seizures can present with intense fear and autonomic symptoms which are also seen in panic disorders. This results in delay in diagnosis and management. We report an interesting case of a young woman who was diagnosed with right temporal lobe seizures with symptoms suggestive of a panic attack.