Traumatic cervical posterior spondyloptosis: report of a rare case.

Traumatic spinal spondyloptosis is the extreme degree of spondylolisthesis and is not common. Traumatic cervical anterior spondyloptosis has been reported but we could not find reports of posterior traumatic cervical spondyloptosis. We present an 18-year-old female with this type of injury and cervical complete cord syndrome below C5 and explain our treatment approach.

Spontaneous regression of nonfunctioning pituitary adenoma.

Eighty percent of pituitary macroadenomas are nonfunctioning and may be treated conservatively. Spontaneous regression occurs but is rare and generally has an identifiable cause such as chemotherapy, pituitary apoplexy and viral infections. We present a 28 year-old male with a nonfunctioning pituitary macroadenoma that regressed over one year without any apparent cause.

SARS coronavirus 2 and central nervous system manifestations: causation, relation, or coexistence? a case series study and literature review.

INTRODUCTION: Recently, weeks after the COVID-19 prevalence, there were reports of brain involvement and neurologic presentations in the COVID-19. CASE PRESENTATION: We present five cases of COVID-19 and cerebrovascular events. A 34-year-old woman with IVH and ischemic stroke. A 60-year-old man with multiple small hemorrhagic foci and mild IVH in the occipital horn. A 63-year-old woman with large left parietooccipital intracerebral hemorrhage (ICH) and IVH. A 56-year-old man with left hemispheric and midbrain ICH, lateral ventricular IVH, and hydrocephalus. A 85-year-old woman with right parietal hemorrhagic infarct. The coagulation profile was normal in all of them. The chest CT scan showed the typical ground-glass appearance of COVID-19. CONCLUSIONS: Recently, there were reports of brain involvement and neurologic presentations in the COVID-19. These reports and the present study necessitate the aimed and designed studies with emphasis on neurologic presentations in COVID-19 patients to illustrate the exact effects of coronavirus-2 on the central nervous system.

Cord Herniation through the Site of Undiagnosed Thoracic Dermoid Tumour during Spinal Anaesthesia; Report of a Case and Describing Ways to Avoid.

Spinal anaesthesia (SA) is one of the most prevalent types of anaesthetic procedures. There are very few reports of cord herniation through the site of spinal canal stenosis due to tumour. A 33-year-old female presented with acute paraparesis after spinal anaesthesia for caesarean section. Magnetic resonance imaging (MRI) revealed an intradural mass from posterior of T6 to T8-T9 interface. We operated the patient and after laminectomy of T6 to T9, dermoid tumour containing hairs was totally resected and cord was completely decompressed. After 6 months, the patient is without any neurological deficit. Puncturing the dura with cerebrospinal fluid (CSF) in the presence of an extramedullary mass could cause cord herniation through the blockade. In these cases, awareness about related signs even in absence of symptoms or complaints could help us to prevent post-SA neurological deficit.

Effective factors in people's preventive behaviors during covid-19 pandemic: a systematic review and meta-synthesis.

BACKGROUND: The overwhelming outbreak of covid-19 has forced governments all over the world to consider different measures to face this challenging situation. A vitally important element to the declining transmission of viruses is changing behaviors based on reliable information. This study was designed and implemented to identify factors affecting the preventive behaviors during the covid-19 pandemic. METHODS: This thematic synthesis was carried out in order to create a set of central themes that summarize all of the issues raised in the articles reviewed in this study. We used PRISMA 2020 guidelines to direct this systematic review and meta synthesis. The process of analyzing data includes three different stages: 1) creating codes; 2) production of descriptive themes; 3) and finally, the creation of analytical themes. The Standards for Reporting Qualitative Research checklist was used to evaluate the articles' quality. RESULTS: Five central themes emerged from 8 included articles, (1) Social factors (subthemes: environmental context, political leadership, multimedia), (2) Cultural factors (subthemes: national culture, religious culture, the family beliefs, work culture, foreign culture), (3) Economic factors (subthemes: economic situation of the individual, the government supports, infrastructures), (4) Personal factors (subthemes: people experiences, cognitive ability, physical factors, different motivational level, sense of responsibility, risk management, and self-management skills), and (5) Knowledge and Education factors (subthemes: access to information, skill training). Furthermore, SRQR items that were weakly reported were "researcher characteristics and reflexivity", "Sampling strategy", "Data collection methods", "Data analysis", and "techniques to enhance trustworthiness. CONCLUSION: Health policymakers and other public health officials in various countries can use the factors listed to develop appropriate, evidence-based policies. They should investigate behavioral characteristics in their community based on their abilities, and then design and implement appropriate executive actions.

The Primary Brain Eosinophilic Angiocentric Fibrosis, A Rare Case Report.

Eosinophilic angiocentric fibrosis (EAF) is a rare progressive fibrosing lesion involving the nasal cavity, paranasal sinuses, and the upper respiratory tract. There are few reports that it rarely involves the orbit; however, there is no report of intracranial involvement. Here, we report and share our experience with a rare case of primary intracranial EAF. A 33-year-old woman with a history of a suprasellar mass and unsuccessful surgical and medical treatment referred to us. Physical examination demonstrated right-sided blindness and ptosis, left-sided decreased visual acuity, and visual field defect. The brain imaging revealed an extra-axial intradural well-defined large suprasellar mass with parasellar (more on the right side) and retrosellar extension. Via pterional craniotomy and subfrontal approach, a very firm creamy-brownish well-defined fibrotic mass was encountered. The tumour texture was too firm to be totally resected. The microscope exited the surgical field off, and the tumour was incompletely resected using a rongeur. The histopathology finding favoured EAF. Further histopathology evaluation failed to show histologic features of IgG4-related disease. Although the preoperative diagnosis of EAF is impossible, in the setting of an indolent slow-growing lesion demonstrating hypointensity on the T2 image sequence of MRI (magnetic resonance imaging), EAF should be considered a differential diagnosis. In the setting of this diagnosis, the systemic and other organ involvement for a diagnosis of IgG4-RD should be evaluated. However, more cases are needed to illustrate the relation between these two entities.

Effect of Microscopic Third Ventriculostomy (Lamina Terminalis Fenestration) on Shunt-needed Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage.

There are reports that in patients with aSAH (aneurysmal subarachnoid hemorrhage), LTF (lamina terminalis fenestration) reduces the rate of shunt-needed hydrocephalus via facilitation of CSF (cerebrospinal fluid) dynamic, diminished leptomeningeal inflammation, and decreased subarachnoid fibrosis. Regarding the conflicting results, this study was conducted to evaluate the effects of LTF on decreased shunt-needed hydrocephalus in patients with aSAH. A cross-sectional retrospective study was carried out to survey all patients with confirmed aSAH operated from March 2011 to September 2016 in an academic vascular center (Rasool Akram Hospital in Tehran, Iran). Of a total of 151 patients, 72 patients were male and 79 were female. The mean age of the participants was 51 years. A transiently CSF diversion (EVD - external ventricular drainage) was performed (the acute hydrocephalus rate) on 21 patients (13.9%). In 36 patients (23.8%), aneurysm occlusion with LTF and in 115 patients (76.2%) only aneurysm occlusion surgery was performed. In hydrocephalus follow-up after surgery, 13 (12%) patients needed shunt insertion (the rate of shunt-needed hydrocephalus). The statistical analysis demonstrated no significant relation between LTF and shunt-needed hydrocephalus. Confirmation of the hypothesis that LTF may decrease the rate of shunt-needed hydrocephalus can significantly decrease morbidity, mortality, and treatment costs of shunting (that is a simple, but a potentially dangerous procedure). So, it is advised to plan and perform an RCT (randomized controlled trial) that can remove the confounding factors, match the groups, and illustrate the exact effect of LTF on shunt-needed hydrocephalus.

A Large Solitary Hemangioblastoma of the Lateral Ventricles: A Case Report and Literature Review.

Hemangioblastoma (HB) in the supratentorial region of the brain is rare and only a few cases are reported on intraventricular HB. HB of the lateral ventricles is even rarer. We present a case of a 30-year-old man with generalized tonic clonic seizures. The brain computed tomography showed a 5.5 cm heterogeneous mass extending into both lateral ventricles with partial enhancement. Based on the size and imaging features, we present the fourth documented case of a large solitary intraventricular HB. Our approach to this unique case and some treatment complexities are also described. Considering the rarity of the case and the patient's imaging features, the present study provides a better understanding of HB and recommends HB to be considered in the differential diagnosis of masses in the lateral ventricles. In addition, some preventable pitfalls in the treatment of such complex cases are described.

Lymphangioma of the Thoracic Spine with Epidural Compression: A Case Report.

Lymphangiomas are benign lesions consisting of abnormal proliferations of lymphatic vessels. Lymphangiomas associated with bone involvement, particularly in vertebral bodies, accompanied by cord compression, are extremely rare, and our literature review yielded only a few relevant reports. We describe a 61-year-old man presenting with progressive paraparesis and sphincter disturbance of 5 months' duration. Magnetic resonance imaging (MRI) revealed an enhancing T8 vertebral body involvement as well as a homogeneously enhancing posterior epidural mass at the T7-T8 level, with severe cord compression and cerebrospinal fluid (CSF) blockade. The patient underwent surgery via T7-T8 laminectomy, and after the removal of the epidural mass, the surgical procedure was stopped due to severe bleeding. Histopathologic examination reported a lymphangioma. After 10 days, the patient was able to walk. In the sixth postoperative month, MRI showed complete relief of the mass effect. The wide spectrum of the preoperative differential diagnosis of lymphangiomas renders a definite preoperative diagnosis impossible; therefore, histopathologic examination is the sole definite route for their diagnosis. In case of the solitary lymphangiomas of the spine with epidural compression, preoperative angiography and embolization should be considered to reduce intraoperative bleeding and enhance the chance of total resection and total surgical resection should be performed to decrease the likelihood of recurrence.

A Small Meningioma with Extensive Peritumoral Brain Edema: A Case Report.

Meningioma is the second most common brain tumor. The extent of peritumoral brain edema (PTBE) is one of the important prognostic factors in patients with meningioma. A 55-year-old female patient suffering from a progressive severe headache and mild left hemiparesis was referred to the Department of Neurosurgery, Rasool Akram Hospital (Tehran, Iran). The preoperative imaging revealed a 2×2 cm solid extra-axial mass with bright enhancement at the outer third of the right sphenoid wing. In addition, there was a disproportionately extensive peritumoral brain edema in the right cerebral hemisphere that even involved the right internal capsule. The patient was operated through the right pterional approach and the mass was totally resected. Twenty-one days after surgery, the brain CT scan surprisingly showed only mild frontal edema and the patient was asymptomatic 1 year after the surgical treatment. According to the literature, the size and extension of the PTBE are correlated with the prognosis of meningioma. A larger edema is associated with a larger tumor, higher grade, and a more invasive meningioma with a higher recurrence rate. Our patient had a very large hemispheric PTBE which was disproportionate to the small size of the meningioma and the tumor had not directly invaded the adjacent brain tissue. We believe that the visible compression of the tumor on major veins of the Sylvian fissure was the reason for the PTBE in our patient. The presence of a large PTBE concomitant with a meningioma does not necessarily indicate a poor prognosis. Hence, we recommend a preoperative venogram to be performed in such patients.

The effects of amantadine on traumatic brain injury outcome: a double-blind, randomized, controlled, clinical trial.

INTRODUCTION: Amantadine, as a dopamine receptor agonist, may stimulate and help the recovery of the nervous system after traumatic brain injury (TBI). METHODS: We performed this study as a double-blind, randomized, controlled clinical trial with target population including all patients with TBI who scored nine or lower on the Glasgow Coma Scale (GCS), admitted to our hospital between January 2013 and April 2014. The protocol included administration of the drug (placebo or amantadine) for 6 weeks and patient evaluation using the GCS and FOUR score on the first, third and seventh days after the drug was started. After 6 months from starting study drug, the patients were evaluated on the Mini-Mental State Examination, Glasgow Outcome Study, Disability Rating Scale and Karnofsky Performance Scale. RESULTS: We included 40 patients in the study. The mean age of the patients was 36.77 ± 18.21. As an only important finding, the amantadine group registered an important rise between the first and the seventh day of study drug (∆GCS7-GCS1) with p-value = 0.044. CONCLUSION: Based on our findings during the first week and the 6 months (since starting drug) follow-ups, prescribing amantadine did not lead to reportable effects on the patients' level of consciousness, memory, disability, cognition, mortality and performance.

Our experience with using a uniform prophylactic protocol in neurosurgery: surgical-site infection did not occur in 272 operations.

PURPOSE: Surgical site infection (SSI) is a source of concern in any surgical procedure. Although studies with high numbers of patients are available, most of these studies were performed by different surgeons and the exact anti-SSI protocol is not mentioned or is not homogeneous in all patients. MATERIALS AND METHODS: We present the results of 272 cases where SSI was successfully prevented in our neurosurgical units and in this study we explain our institutional protocol for achieving this positive result. We included all neurosurgical procedures in our two centers that needed an operating room, undertaken between 9 November 2015 and 6 December 2016, retrospectively. Then we compare our results with the existing literature. RESULTS: We performed 272 neurosurgical procedures on 245 patients. 155 patients were male and 90 were female. We re-operated on 24 patients and 3 of them operated on three times in each instance case and others were operated on twice. The patient's ages ranged from 2 to 86years with the mean being 42.39 ± 19 years. The cranial site of surgery was more common (129 procedures, 47.4%) and overall 118 operations (43.4%) were accompanied with a prosthetic device placement. We performed 96 emergency procedures. The mean hospitalization time was 6.19 ± 6.77 days. We followed all patients for at least six months. There were no reports of SSI in our neurosurgical units. CONCLUSION: With a fixed protocol of antisepsis, hand protection and prophylactic antibiotics, there were achieved good results. We recommend the current protocol as an effective measure in the control of infection in the neurosurgical ward. However, further studies are needed with more patients and a stronger study design.

Effectiveness of acceptance and commitment therapy upon distress, emotion regulation, and self-compassion in patients with cardiovascular disease: a randomized clinical trial.

INTRODUCTION: Cardiovascular patients experience various psychological problems due to the conditions caused by their disease, which make it worse if left untreated. OBJECTIVE: The purpose of the current study was to evaluate the effects of acceptance and commitment therapy on distress, emotion regulation, and self-compassion in patients with cardiovascular disease. METHODS: This study was a randomized clinical trial with pre-test, post-test and two-month and four-month follow-up periods accompanying a control group. At four stages, patients filled out questionnaires on depression, anxiety, stress (DASS-21), emotion regulation (ERQ), and self-compassion (SCS). The experimental group underwent a treatment protocol based on acceptance and commitment therapy. Data were then analyzed using SPSS-25 with repeated measures analysis of variance. RESULTS: Act significantly reduced depression, anxiety, and stress, enhanced self-compassion, and improved emotion regulation in cardiac patients. Between-subjects (Group) partial etas for depression, anxiety, stress, reappraisal, suppression, and self-compassion were 0.61, 0.64, 0.66, 0.62, 0.66, and 0.65, respectively. Treatment efficacy was maintained during the 2- and 6-month follow-up visits. CONCLUSION: The results of this study suggest that treating cardiac patients' psychological problems in a way focused on acceptance and commitment therapy may have an impact on how well they respond to their treatment.

Our experiences in patients with atlanto-occipital dislocation: A case series with literature review.

Atlanto-occipital dislocation (AOD) is an injury to the upper cervical spine that occurs after trauma. This injury is associated with a high mortality rate. According to studies, 8%-31% of deaths caused by accidents are due to AOD. Due to the improvement in medical care and diagnosis, the rate of related mortality has decreased. Five patients with AOD were evaluated. Two cases had type 1, one case had type 2, and two other patients had type 3 AOD. All patients had weakness in the upper and lower limbs and underwent surgery to fix the occipitocervical junction. Other complications in patients were hydrocephalus, 6 nerve palsy, and cerebellar infarction. All patients improved in follow-up examinations. AOD damage is divided into four groups: anterior, vertical, posterior, and lateral. The most common type of AOD is type 1 and the most instability is type 2. There are neurological and vascular injuries due to pressure on regional components; vascular injuries are associated with high mortality rate. In most patients, their symptoms improved after surgery. AOD requires early diagnosis and immobilization of the cervical spine along with maintaining the airway to save the patient's life. It is necessary to consider AOD in cases with neurological deficits or loss of consciousness in the emergency unit because earlier diagnosis could cause a wonderful improvement of the patient's prognosis.

The Impact of the Surface Modification on Tin-Doped Indium Oxide Nanocomposite Properties.

This review provides an analysis of the theoretical methods to study the effects of surface modification on structural properties of nanostructured indium tin oxide (ITO), mainly by organic compounds. The computational data are compared with experimental data such as X-ray diffraction (XRD), atomic force microscopy (AFM) and energy-dispersive X-ray spectroscopy (EDS) data with the focus on optoelectronic and electrocatalytic properties of the surface to investigate potential relations of these properties and applications of ITO in fields such as biosensing and electronic device fabrication. Our analysis shows that the change in optoelectronic properties of the surface is mainly due to functionalizing the surface with organic molecules and that the electrocatalytic properties vary as a function of size.

Geographic Distribution and Estimating the Childhood Cancer Incidence in Iran: Three-Source Capture-Recapture Analysis on National Registries Data.

Background: Cancers seldom happen in childhood age and awareness of accurate cancer incidence is essential in order to preventive programs. This study aimed to estimate the childhood cancer incidence in Iran using the three-source capture -recapture method. Methods: Total new cases of childhood cancer reported by three national data sources of MAHAK charity database, pathology reports and clinical records in Iran were enrolled in this study. The common cases among three sources were determined using data linkage method. The childhood incidence rate per 1 million populations was estimated based on three-source capture-recapture method. We used BIC, G2 and AIC statistics to select the best-fit model. Arch GIS was used to determine geographic distribution. Results: Overall, 2567 childhood cancer was included by three sources of registries. The total estimated number of childhood cancer was 5388 (95% CI: 4742.15-6228,14). The higher estimated incidence rate was Leukemia, Lymphoma by 94.91 and 24.80 per 1 million populations and the lower incidence was liver and retinoblastoma with 2.35 and 7.01 per 1 million populations. Provinces of Ardabil and Kohgiluyeh with an incidence rate of 420.01 and 404.61 per 1 million populations had a higher incidence rate and Mazandaran and Ilam with an incidence rate of 60.87 and 66.88 per 1 million populations had the lowest incidence. The overall completeness of the childhood cancer registry based on three-source was 48%. Conclusion: The low-quality childhood cancer registration system highlights the needs for urgent screening programs for early detection in the high prevalent area in Iran.

Pathogenic cis p-tau levels in CSF reflects severity of traumatic brain injury.

Traumatic brain injury (TBI) is the main cause of death and disability among young people. Following TBI, immune system activation and cytokine release induce kinase activity and hyperphosphorylation of tau protein, a structural molecule in axonal microtubules. The cis configuration of phosphorylated tau at Th231 is extremely neurotoxic and is having a prion nature, spreads to brain areas as well as CSF.We examined the cerebrospinal fluid (CSF) cis p-tau levels in 32 TBI patients and 5 non-TBI controls to find out the correlation with TBI severity.   CSF samples were drained 5-7 days after TBI and subjected for ELISA analysis with anti cis p-tau and ß-amyloid antibodies.We had no patients with mild TBI, two patients with moderate (6.2%), 23 patients with severe (71.9%), and 7 patients with critical TBI (21.9%). While mean CSF ß-amyloid in TBI and control groups did not show a statistically significant difference, the mean CSF cis p-tau level was significantly higher in the TBI group than the control samples. Also, intergroup analysis demonstrated that CSF cis p-tau levels were statistically different according to the head injury severity.Although CSF cis p-tau increased in the TBI patients, ß-amyloid did not show a significant difference between patients and controls. Also, we observed an obvious negative correlation between CSF cis p-tau levels and GCS scores. Therefore, future researches on suppression of cis P-tau production or removing previously produced cis P-tau could be a suitable approach in treating TBI in order to prevent tauopathies and future neurodegeneration.

Posttraumatic C2-C3 spondyloptosis without focal neurological deficit, treated with anterior and posterior approaches: A case report.

BACKGROUND: Cervical spondyloptosis is usually caused by trauma, and correlated with significant neurological deficits that can include quadriplegia, respiratory disorders, vertebral artery injury, and death. CASE DESCRIPTION: A 34-year-old male presented with C2-C3 spondylolisthesis after a fall from a tree. Although he had no neurological deficits, CT and X-ray studies confirmed C2-C3 a spondyloptosis. He was treated with emergent anterior and posterior cervical reduction, decompression, and fixation, remaining neurologically intact in the postoperative period. CONCLUSION: Patients with C2-C3 spondyloptosis documented on X-ray/CT studies should be considered for circumferential decompression/fusion to preserve neurological function.