Letter to the editor: fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis.

This article presents a comprehensive analysis of microvascular decompression (MVD) surgery as a treatment option for hemifacial spasm (HFS). Beginning with a thorough literature review, it explores the historical context, prevalence, and underlying mechanisms of HFS, laying a robust foundation for discussing MVD. Various surgical techniques, from traditional microscopic to fully endoscopic approaches, are described, along with their procedural nuances and advantages. Clinical data, including patient demographics and surgical success rates, substantiate the efficacy of MVD in alleviating HFS symptoms. The discussion of postoperative complications provides valuable insights into practical challenges. However, limitations such as single-center design, lack of robust statistical analysis, and absence of comparative data between endoscopic and microscopic approaches diminish the article's potential impact. Recommendations for multicenter collaborations, enhanced statistical analyses, comparative studies, and discussions on surgical training could significantly enhance the article's contribution to neurosurgery practice.

Letter to the editor: A prospective cohort study on perioperative percutaneous balloon compression for trigeminal neuralgia: safety and efficacy analysis.

This study evaluated the safety and efficacy of Percutaneous Balloon Compression (PBC) for managing Trigeminal Neuralgia (TN) during the perioperative period in 400 patients. The results indicated no significant difference in postoperative pain relief between male and female patients, although female patients experienced more complications. PBC demonstrated effectiveness regardless of prior treatment, such as PBC, Microvascular Decompression (MVD), or Radiofrequency Thermocoagulation (RFT). Despite its efficacy, PBC has drawbacks, including an increased risk of complications in females and challenges in achieving standardized compression parameters. Compared to other surgical techniques for TN, PBC offers advantages in minimally invasive intervention, but has limitations, particularly in recurrent TN after MVD or RFT. While promising, the lack of standardized protocols and focus on short-term outcomes limits the generalizability of the findings. In conclusion, PBC represents a significant advancement in TN management, providing high initial pain relief rates with minimal invasiveness. However, further research is necessary to standardize procedures, address complications, and evaluate the long-term efficacy for a comprehensive understanding of its role in TN treatment.

Letter to the editor: "Management of cerebrospinal­fluid­related intracranial abnormalities in frontoethmoidal encephalocele using "Shunt algorithm for frontoethmoidal encephalocele" (SAFE), a retrospective cohort study of published cases".

This critique evaluates a recent study on the management of cerebrospinal fluid-related intracranial abnormalities in frontoethmoidal encephalocele, as explored in a retrospective cohort study titled "Shunt Algorithm for Frontoethmoidal Encephalocele (SAFE): A Retrospective Cohort Study of Published Cases." focusing on their strengths, weaknesses, and suggestions for future research. This highlights the positive impacts of the SAFE algorithm in standardizing treatment protocols, improving patient outcomes, and enhancing our understanding of the condition through collaborative data analysis. However, it also addresses limitations, such as potential biases in retrospective data analysis and the need for individualized patient care. This abstract emphasizes the significance of continued research and multidisciplinary collaboration in refining the treatment strategies for frontoethmoidal encephaloceles. Prospective, multicenter studies with standardized protocols, collaborative efforts among institutions, and innovative techniques are needed to advance our understanding and management.

Letter to the editor: "A nomogram based on radiomics and clinical information to predict prognosis in percutaneous balloon compression for the treatment of trigeminal neuralgia: a retrospective cohort study of published cases".

This critique evaluates a recent study on a nomogram based on radiomics and clinical data to predict the prognosis of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN), focusing on its strengths, weaknesses, and suggestions for future research. It acknowledges the innovative approach's potential to personalize treatment and improve outcomes, but raises concerns about the study's retrospective nature, sample size limitations, and challenges in implementing radiomics in clinical practice. Overall, although the nomogram offers promise, further validation in larger cohorts is essential to confirm its utility and reliability. Future research should prioritize prospective multicenter studies with standardized protocols, collaborative efforts among institutions, and innovative techniques to advance our understanding and management.

"Letter to the editor: traumatic atlantoaxial rotatory fixation in adults: a systematic review of published cases".

This critique evaluates a recent study on adult traumatic atlantoaxial rotatory fixation (AARF), focusing on its strengths, weaknesses, and suggestions for future research. The study provides a comprehensive examination of the anatomical and biomechanical complexities of the C1-C2 articulation, shedding light on the rare nature of adult traumatic AARF and common injury mechanisms. It categorizes AARF based on the atlanto-dental interval (ADI) and dislocation severity, aiding clinicians in assessing injury severity and treatment planning. Furthermore, the study explores conservative and surgical management approaches, offering valuable insights into treatment decision-making and outcomes. However, limitations such as its retrospective nature, reliance on reported cases, lack of standardized protocols, and limited sample size may constrain the generalizability of findings. Future research should prioritize prospective, multicenter studies with standardized protocols, collaborative efforts among institutions, and innovative techniques to advance our understanding and management of adult traumatic AARF.

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis.

BACKGROUND: Trigeminal neuralgia (TN) is a chronic condition characterized by intense facial pain akin to electric shocks, often associated with the trigeminal nerve. It can be either idiopathic or secondary, with multiple sclerosis (Ms) being a significant contributing factor. Non-responsive patients may opt for minimally invasive procedures, such as gamma knife radiosurgery (GKRS), which offers precise, non-invasive treatment and is frequently chosen as a primary approach. This meta-analysis evaluates the long-term efficacy of GKRS in TN management in Ms patients. METHODS: We conducted a focused search across various databases. Inclusion criteria encompassed studies with ≥ 30 patients using GKRS for TN in Ms, reporting pertinent clinical outcomes. Primary outcomes assessed GKRS efficacy through Barrow Neurological Institute Pain scores. Secondary outcomes encompassed bothersome numbness, facial numbness, and recurrence. Data analysis employed OpenMeta, random effect models, and odds ratios with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. RESULTS: Fourteen studies with 752 cases of GKRS for TN were included. Regarding the outcomes, 83% of patients experienced a positive initial pain response, while the overall treatment success rate was 51%. Additionally, 19.6% of patients reported facial numbness, 4.1% experienced bothersome numbness, and 40% faced recurrence. The odds ratio for positive initial pain response was 0.83 (95% CI, 0.76-0.89), while for treatment success, it was 0.51 (95% CI, 0.379-0.639). Facial numbness had an odds ratio of 0.196 (95% CI, 0.130-0.262), bothersome numbness had an odds ratio of 0.041 (95% CI, 0.013-0.069), and recurrence had an odds ratio of 0.403 (95% CI, 0.254-0.551). CONCLUSIONS: In conclusion, treating trigeminal neuralgia in multiple sclerosis patients remains challenging. GKRS shows promise, but customized treatment approaches tailored to individual patient characteristics are urgently needed to address the unique challenges of this condition.

Hepatoprotective and Antioxidant Effects of Nanopiperine against Cypermethrin via Mitigation of Oxidative Stress, Inflammations and Gene Expression Using qRT-PCR.

Cypermethrin (Cyp) is a pyrethroid that has been associated with the toxicity of various organs. The aim of our study was to evaluate the hepatoprotective and antioxidant activities of nano-piperine (NP) against Cyp toxicity. Cyp (50 mg/kg) was administered orally in all animals of groups III-VI for 15 days. Groups IV-VI each received three doses of NP (125, 250, and 500 µg/kg/day) for 10 days after receiving the Cyp dosage, which was given after 1 h. A rise in serum biomarkers (ALT, AST, ALP, total protein, and albumin), which are indicators of toxicity alongside anomalous oxidative stress indices (lipid peroxidation (LPO), glutathione (GSH), superoxide dismutase (SOD) and catalase), was detected. After Cyp treatment, we observed upregulated cytokines, caspase expression, and histological analysis that the showed distortion of cell shape. However, the administration of NP dramatically reversed all of the Cyp-induced alterations, inducing reductions in serum marker levels, stress level, the production of cytokines, and caspase expression. Additionally, all of the histopathological alterations were minimized to values that were comparable to normal levels. The present findings suggested that NP exhibits potent antioxidant and anti-inflammatory activities that can protect rats' livers against Cyp-induced liver damage through hepatoprotective activities.

Hepatoprotective Effect of Curcumin Nano-Lipid Carrier against Cypermethrin Toxicity by Countering the Oxidative, Inflammatory, and Apoptotic Changes in Wistar Rats.

This study investigated the potential hepatoprotective activity of curcumin-incorporated nano-lipid carrier (Cur-NLC) against cypermethrin (Cyp) toxicity in adult Wistar male rats. All animals in groups III, IV, V, and VI were subjected to Cyp (50 mg/kg) toxicity for 15 days. Three different doses of Cur-NLC (1, 2.5, and 5 mg/kg/day) were administered orally for 10 days. The toxic effects were evaluated considering the increases in serum hepatic biomarkers alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and albumin, and lipid peroxidation (LPO), as well as a decrease in antioxidative activity (reduced glutathione (GSH), superoxide dismutase (SOD), and catalase) and the upregulation of inflammatory cytokines (IL-1ß, IL-6, and TNF-α). Immunohistochemistry studies of proteins (NF-κB, Apaf-1, 4-HNE, and Bax) showed enhanced expression, and histopathological examination revealed architectural changes in liver cells, indicating liver toxicity in animals. Toxicity was determined by quantitative and qualitative determinations of DNA fragmentation, which show massive apoptosis with Cyp treatment. The administration of Cur-NLC significantly ameliorates all changes caused by Cyp, such as a decrease in the levels of serum liver markers, an increase in antioxidative parameters, a decrease in expression of inflammatory cytokines (IL-1ß, IL-6, TNF-α, and NF-κB), and apoptosis (caspases-3, 9, Apaf-1, 4-HNE, and Bax), according to calorimetric and immunohistochemistry studies. The smear-like pattern of DNA is ameliorated similarly to the control at a high dose of Cur-NLC. Furthermore, all histopathological changes were reduced to a level close to the control. In conclusion, Cur-NLC could be a potent nutraceutical that exhibits a hepatoprotective effect against Cyp-induced hepatotoxicity in rats.

Epidemiology of premalignant and malignant upper gastrointestinal lesions among patients presenting from a rural community in Karachi, Pakistan.

Objective: Understanding the epidemiology of upper gastrointestinal cancers in Pakistan may help in identifying important demographic risk factors for upper gastrointestinal malignancies in a particular rural population group. This will benefit in implementing tailored prevention approaches as well as effective management of health services. Method: A secondary data analysis of 1193 patients was conducted who went through diagnostic upper GI endoscopy between December 2016 to May 2019 at Fatima Hospital. The endoscopies were performed at Fatima Hospital which is the main health resource for the specifically targeted rural community. Data was analyzed using SPSS version 21. Results: The median age of patients included in the sample was 35 years (IQR=20 years). One third of all endoscopic findings were concluded as normal. The frequency of malignant upper gastrointestinal lesions was relatively higher among male and patients with age 65 years or more. The study didn't find any significant differences in the distribution of malignancies on the basis of ethnicity. Adenocarcinoma of esophagus was the most common malignant lesion. Conclusion: The average age of patients undergoing upper gastrointestinal endoscopy among rural community of Karachi was relatively low. The burden of upper GI malignancies was significantly higher among elderly. Male patients had significantly greater burden of premalignant and malignant lesions as compared to females. No differences in the distribution of diagnostic outcomes were observed on the basis of ethnicity.

Role of cinnamon oil against acetaminophen overdose induced neurological aberrations through brain stress and cytokine upregulation in rat brain.

Acetaminophen (APAP) is a well-known antipyretic and analgesic medicine. It is safe at therapeutic suggested level while overdose initiates oxidative stress and inflammation mediated neurochemical alteration in the brain. The aim of this study was to investigate the role of cinnamon oil (CO), which possesses potent antioxidant and anti-inflammatory activities against an overdose of APAP that induced oxidative stress and inflammation in male albino rats. APAP treated rats showed significant elevation of thiobarbituric acid-reactive substances (TBARS) and decreased level of GSH in brain tissue, which is recognized as a biomarker of oxidative stress. Antioxidant enzymes GPx, GR, SOD, and CAT activity was depleted in APAP group along with neurotoxicity biomarkers such as Na+-K+-ATPase and increased activity of acetylcholinesterase (AchE), monoamine oxidase (MAO), and upregulated pro-inflammatory cytokine was observed. CO significantly protected the diminished activity of the antioxidant enzyme and suppressed the upregulated cytokines in brain tissue. CO also attenuated the activity of neurotoxicity biomarker enzyme, decreased TBARS content, and an increased level of GSH. The present findings perceptibly confirmed that the nutraceutical property of CO ameliorates APAP induced oxidative stress and inflammation. Therefore, our findings suggested that CO could be an alternative nutraceutical substitute in APAP overdose poisoning.

Platelet-Neutrophil Association in NETs-Rich Areas in the Retrieved AIS Patient Thrombi.

Histological structure of thrombi is a strong determinant of the outcome of vascular recanalization therapy, the only treatment option for acute ischemic stroke (AIS) patients. A total of 21 AIS patients from this study after undergoing non-enhanced CT scan and multimodal MRI were treated with mechanical stent-based and manual aspiration thrombectomy, and thromboembolic retrieved from a cerebral artery. Complementary histopathological and imaging analyses were performed to understand their composition with a specific focus on fibrin, von Willebrand factor, and neutrophil extracellular traps (NETs). Though distinct RBC-rich and platelet-rich areas were found, AIS patient thrombi were overwhelmingly platelet-rich, with 90% of thrombi containing <40% total RBC-rich contents (1.5 to 37%). Structurally, RBC-rich areas were simple, consisting of tightly packed RBCs in thin fibrin meshwork with sparsely populated nucleated cells and lacked any substantial von Willebrand factor (VWF). Platelet-rich areas were structurally more complex with thick fibrin meshwork associated with VWF. Plenty of leukocytes populated the platelet-rich areas, particularly in the periphery and border areas between platelet-rich and RBC-rich areas. Platelet-rich areas showed abundant activated neutrophils (myeloperoxidase+ and neutrophil-elastase+) containing citrullinated histone-decorated DNA. Citrullinated histone-decorated DNA also accumulated extracellularly, pointing to NETosis by the activated neutrophils. Notably, NETs-containing areas showed strong reactivity to VWF, platelets, and high-mobility group box 1 (HMGB1), signifying a close interplay between these components.

Renoprotective effects of cinnamon oil against APAP-Induced nephrotoxicity by ameliorating oxidative stress, apoptosis and inflammation in rats.

Acetaminophen (APAP) is used as a primary medication in relieving moderate pain and fever. However, APAP is associated with toxic effects in renal tissue that appear because of its free radicals property. The principle goal of the present work is to assess the kidney damage by APAP and its restore antioxidative property of cinnamon oil (CO). Animals were distributed into six animals each in six groups. Rats were administered with three varying doses of CO from 50 to 200 mg/kg b.w. respectively and only a single dose of APAP. APAP induced an alteration in serum biochemical markers, imbalance in oxidative parameters, morphological changes in kidney tissue along with increased interleukins cytokines (IL-1ß & 6) and caspase (3, 9) levels. CO administration significantly ameliorates all the parameters and histopathological changes were restored. Moreover, it also restored the activities of antioxidative enzymes. Our work proved that an variance of oxidative markers in the kidney by APAP is ameliorated by CO in rats. Thus, CO could be used in reducing APAP-induced nephrotoxicity.

REPEATED EXPOSURE OF SODIUM TELLURITE ON THE RAT LIVER AND ON THE POTENTIAL MECHANISMS OF THE METALLOID-INDUCED HEPATOTOXICITY.

Tellurium (Te) is a semiconductor and is frequently doped with copper, tin, gold or silver. It is also used to color glass and ceramics and is one of the primary ingredients in blasting caps. Te is little known about its biological activity but it is well known for toxic to human and animals. It has inhibited the lipids profiles and oxidative stress in the brain of the mice. Sodium tellurite 4.15, 8.3 and 16.6 mg/kg (1/20, 1/10 and 1/5 of LD50, respectively) was given to male Wistar rats orally in saline for a period of 15 days. On day 16, the blood was collected and the livers were dissected out for biochemical assays. The hepatotoxicity biomarkers [biliru- bin, aspartate aminotransferase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP)] were ele- vated significantly and dose dependently in the serum of Te treated groups as compared to control group. The content of thiobarbituric acid reactive substances in Te treated groups was increased significantly and dose- dependently as compared to control group. Conversely, the content of glutathione and activities of antioxidant enzymes (glutathione peroxidase, glutathione reductase, glutathione-S-transferase, superoxide dismutase and catalase) were decreased significantly in Te treated groups as compared to control group. No data of effect of inorganic Te compounds on the liver toxicity of rats are available. The aim of the present study was to evalu- ate the hepatotoxicity of inorganic Te compounds. In conclusion, Te accelerated hepatotoxicity and oxidative stress in liver tissue of rats.

Comparative efficacy of epigallocatechin-3-gallate against H2O2-induced ROS in cervical cancer biopsies and HeLa cell lines.

AIM OF THE STUDY: Antioxidants play an important role in maintaining physiological homeostasis. Recent literature emphasises the potential therapeutic effects of natural antioxidants that play anti-inflammatory and antioxidant effects applicable in preventing oxidative stress-induced injury, which characterises their pathogenesis. The goal of this study was to evaluate the protective role of EGCG on the HeLa cell line and cancerous cells. MATERIAL AND METHODS: The HeLa cell line and cervical cancer biopsies (CCB) were treated with varying doses of antioxidants to determine their effects. Thereafter, hydrogen peroxide (0-10 nM) - an ROS-generating compound - was co-cultured with varying doses of epigallocatechin-3-gallate (EGCG). The effect of this compound on superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity was assessed. RESULT: The activity of SOD and GPx was protected significantly in the treatment of EGCG in cervical cancer biopsies and HeLa cell line. HYPOTHESIS: It is hypothesised that EGCG has free radical scavenging properties. CONCLUSIONS: EGCG protected the activity SOD and GPx equally in cervical cancer biopsies (CCB) and HeLa cell line.

REPEATED EXPOSURE OF SODIUM TELLURITE ON THE RAT LIVER AND ON THE POTENTIAL MECHANISMS OF THE METALLOID-INDUCED HEPATOTOXICITY.

Tellurium (Te) is a semiconductor and is frequently doped with copper, tin, gold or silver. It is also used to color glass and ceramics and is one of the primary ingredients in blasting caps. Little is known about Te biological activity but it is well known for toxicity to human and animals. It has inhibited the lipids profiles and oxidative stress in the brain of mice. Sodium tellurite 4.15, 8.3 and 16.6 mg/kg (1/20, 1/10 and 1/5 of LD50, respectively) was given to male Wistar rats orally in saline for a period of 15 days. On day 16, the blood was collected and the livers were dissected out for biochemical assays. The hepatotoxicity biomarkers [bilirubin, aspartate aminotransferase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP)] were elevated significantly and dose dependently in the serum of Te treated groups as compared to control group. The content of thiobarbituric reactive substances in Te treated groups was increased significantly and dose-dependently as compared to control group. Conversely, the content of glutathione and activities of antioxidant enzymes (glutathione peroxidase, glutathione reductase, glutathione-S-transferase, superoxide dismutase and catalase) were decreased significantly in Te treated groups as compared to control group. No data of inorganic Te compounds on the liver toxicity of rats are available. The aim of the present study was to evaluate the hepatotoxicity of inorganic Te compound. In conclusion, Te accelerated hepatotoxicity and oxidative stress in liver tissue of rats.

Letter to the Editor: Ross procedure: Valve function, clinical outcomes and predictors after 25 years' follow-up.

The following letter presents a critique of the study titled "Ross procedure: valve function, clinical outcomes and predictors after 25 years' follow-up," recently published in your esteemed journal. This study provides a comprehensive analysis of the long-term outcomes of the Ross procedure, focusing on survival rates and incidence of valve dysfunction over a 25-year period. Despite revealing excellent overall survival rates and promising outcomes in pediatric patients, concerns regarding valvular failure and reintervention are underscored. While acknowledging limitations, such as sample size and observational biases, this study highlights the significance of surgeon experience in mitigating adverse outcomes. This critique emphasizes the study's contribution to understanding the efficacy and challenges of the Ross procedure, advocating further research to optimize patient outcomes.

Comment on: Severe pulmonary hypertension in pulmonary alveolar microlithiasis: A comprehensive literature review.

This letter commends the study "Severe pulmonary hypertension in pulmonary alveolar microlithiasis: A comprehensive literature review" for its thorough exploration of Pulmonary Alveolar Microlithiasis (PAM) and its association with pulmonary hypertension (PH). The study offers insights into PAM's genetics, clinical manifestations, diagnostic approaches, and treatment modalities. It highlights the importance of early diagnosis and management while discussing limitations such as its retrospective nature and small sample size. Despite these limitations, the study contributes significantly to understanding PAM and PH, emphasizing the need for larger prospective studies to validate findings and explore novel therapeutic avenues.

Comment on, "Systematic literature review and critical analysis of RDW in patients with aortic pathologies".

Recent medical research has explored Red Cell Distribution Width (RDW) as a potential biomarker for predicting adverse clinical outcomes in patients with aortic pathologies. The study "Systematic literature review and critical analysis of RDW in patients with aortic pathologies" conducted a pooled analysis of 704 patients, revealing a consistent association between elevated RDW levels and adverse clinical progression. While the study provides valuable insights into RDW's diagnostic and prognostic potential, limitations include the inclusion of a limited number of articles and the lack of direct comparison with established biomarkers or imaging techniques. Further research is needed to validate RDW's clinical utility and elucidate underlying biological mechanisms. RDW shows promise as a cost-effective marker for risk stratification and monitoring in clinical practice, but further validation and refinement are necessary for its full clinical impact in aortic diseases.

Comment on "Inclisiran siRNA technology in the management of dyslipidemia: A narrative review of clinical trials".

The study "Inclisiran siRNA technology in the management of dyslipidemia: A narrative review of clinical trials" evaluates inclisiran's efficacy and safety in reducing LDL cholesterol levels across diverse patient populations. Twelve clinical trials were reviewed, demonstrating consistent LDL-C reduction, even in statin intolerance or resistance cases, with sustained efficacy observed over various durations, some extending up to four years. Inclisiran exhibited a favorable safety profile, suggesting its potential as a well-tolerated treatment option. Despite promising findings, the limitations include the short duration of some trials and the exclusion of non-English language studies, warranting further research. Future studies should focus on the long-term safety and efficacy in diverse patient populations and explore the broader clinical implications of inclisiran. Although inclisiran shows promise in dyslipidemia management, comprehensive research is needed to understand its full potential in cardiovascular medicine.