Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety.

OBJECTIVE: Lack of clinical trial awareness is a crucial barrier to clinical trial enrollment. The objective of this study was to examine the prevalence and factors associated with clinical trial awareness among US adults with self-reported depression and anxiety. METHODS: Data were collected from 896 adults who self-reported depression and anxiety from the 2020 Health Information National Trends Survey. Multinomial logistic regression was utilized to assess predictors of clinical trial awareness, particularly socio-demographic, health-related, and technological variables. Odds ratios (OR) for the associations were reported. RESULTS: About 60.4% of adults with self-reported depression or anxiety reported being aware of clinical trials. In the multivariable regression, education level, health-related social media use, and having access to a regular provider were all significantly associated with greater odds of clinical trial awareness among individuals with depression and/or anxiety. Specifically, individuals with at least some college education (OR 2.07, 95% confidence interval (CI); 1.28-3.34; p ​= ​0.004) were more likely to report awareness of clinical trials than those with less than a college education. Similarly, compared to those without access to health providers, individuals with depression and/or anxiety who had a regular provider had greater odds of clinical trial awareness (OR 2.23, 95% CI; 1.16-4.31; p ​= ​0.017). Additionally, those who reported two or more health-related uses of social media were significantly more likely to report clinical trial awareness than their counterparts who reported no health-related social media use (OR 3.17, 95% CI; 1.48-6.80; p ​= ​0.004). CONCLUSION: Our study shows that about six in 10 adults with depression and anxiety in the United States were aware of clinical trials. However, some sub-groups of patients, particularly those without access to a regular health provider, those with a lower education level, and those with limited use of social media for health purposes, remain inadequately informed and may lack awareness of available clinical trials. These findings are crucial and identify subgroups of people with mental disorders that may benefit from targeted interventions to improve clinical trial awareness.

Epidemiological Trends and Factors Associated With Mortality Rate in Psychoactive Substance Use-Related Mental and Behavioral Disorders: A CDC-WONDER Database Analysis.

Background The persisting challenge of substance use disorder's impact on society prompts the need for insights into its mortality trends. This study examines epidemiological patterns and factors tied to mortality rates in individuals with psychoactive substance-related mental and behavioral disorders from 1999 to 2020. Methodology This study used a retrospective observational design. The study analyzed the Centers for Disease Control and Prevention's (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database information, encompassing mortality and population-based data. Data extraction focused on specific criteria such as age, sex, race/ethnicity, and geographic location. Descriptive statistics were employed to depict the study population and reveal epidemiological trends. Results The study encompassed data from 239,573 individuals who died due to psychoactive substance use-related mental and behavioral disorders between 1999 and 2020. The overall mortality rate was 3.55 per 100,000 individuals (95% confidence interval (CI) = 3.55-3.54) across the study period. Noticeable discrepancies in mortality rates emerged among various geographic regions, genders, races, and age groups. Males (5.32 per 100,000 individuals) experienced notably higher mortality rates than females (1.80 per 100,000 individuals), while the 55-64 age group faced elevated mortality risks (8.24 per 100,000 individuals) compared to the 25-34 age group (1.71 per 100,000 individuals). Significant variations in mortality rates were also evident across different racial and ethnic groups. Conclusions Between 1999 and 2020, the study explored mortality rates in individuals with psychoactive substance use-related mental and behavioral disorders. This analysis revealed variations in mortality across genders, ages (with the 55-64 age group facing higher risks compared to the 25-34 age group), and ethnicities. Notably, males exhibited higher mortality than females. Additionally, divergent rates were observed among different geographic regions. These insights can inform public health initiatives and support the development of targeted strategies to reduce mortality rates and improve the well-being of affected individuals.

Coronavirus disease patients' views and experiences of pharmaceutical care services in Lebanon.

OBJECTIVES: This study aimed to explore the experiences and views of domiciliary coronavirus disease (COVID-19) patients towards pharmaceutical care services provided during their infection. METHODS: This was a single-centred observational study conducted among home-treated COVID-19 patients (n = 500), who were tested positive for COVID-19 in a medical centre in Lebanon. KEY FINDINGS: Out of the 500 home-treated COVID-19 patients invited to participate in the study, 279 patients completed the questionnaire. Although the participants had a good view of pharmacists caring for COVID-19 patients (mean view score: 17.79/25), their treatment experiences were unsatisfactory (mean experience score: 1.51/4). CONCLUSIONS: COVID-19 patients reported minimal involvement of pharmacists in their treatment. Therefore, in response to the COVID-19 pandemic, healthcare authorities should intervene in restructuring, guiding and reviewing unrealized new pharmaceutical services to COVID-19 outpatients.

Acceptability of the Cognition Test Battery in Astronaut and Astronaut-Surrogate Populations.

BACKGROUND: Sustained high levels of astronaut cognitive performance are a prerequisite for mission success. A neuropsychological battery of 10 brief cognitive tests (Cognition) covering a range of cognitive domains was specifically developed for high performing astronauts to objectively assess cognitive performance. Extended mission durations require repeated cognitive testing and thus high acceptability of the Cognition software to the astronaut population. The aim of this qualitative study was to evaluate acceptability of Cognition to astronauts and astronaut surrogate populations. METHODS: Cognition was administered repeatedly to N=87 subjects (mean age ±SD 35.1 ±8.7 years, 52.8% male) on a laptop or iPad across five individual studies on the International Space Station or in space analog environments on Earth. Following completion of each study, participants were interviewed regarding their experience using Cognition in a semi-structured debrief. Participant comments were analyzed using a qualitative conventional content analysis approach. RESULTS: The majority of participants' comments (86.1%) were coded as positive or neutral in valence, with most positive comments relating to software usability, engagement, and overall design. Among the 10 Cognition tests, subjects liked the Visual Object Learning Test most (28 likes, 32.2% of participants), while the Emotion Recognition Test was liked least (44 dislikes, 50.6% of participants). Some subjects (36.8%) were frustrated with the level of difficulty of some of the 10 Cognition tests, especially during early administrations, which was by design to avoid ceiling effects in repeated administrations of high-performers. Technical difficulties were rare (20.7% of participants), and most often observed in environments with restricted internet access. Most participants (82.3% of those who commented) liked the feedback provided by Cognition after each test, which includes a graph showing performance history. CONCLUSION: Cognition was found to be acceptable to astronaut and astronaut-surrogate populations across a variety of settings and mission durations. Participant feedback provided was used to further improve Cognition and increase its acceptability during sustained space missions.

Metabolic depletion of synaptosomal enzymes linked with neurotoxicity and ovarian dysfunction by phenolic antioxidants of Croton zambsicus leaves in rats exposed to chronic mixture of anthropogenic toxicant.

A complex mixture of organic contaminants and metals is associated with neuron-fertility disorders and studies have demonstrated that phenolic antioxidants from herbal origin, possesses a strong protective potential. This study aimed to investigate the protection of phenolic croton zambesicus (C-ZAMB) leaves against neuro-ovarian damage in rats exposed to chronic mixture of anthropogenic toxicants (EOMABRSL). The animals were divided into five groups (n = 10): Group I was given 0.5 ml of distilled water only; Group II received 0.5 ml of EOMABRSL for 98 days; Group III received 0.5 ml of EOMABRSL for 70 days and withdrew for 28 days; Group IV received 0.5 ml of EOMABRSL for 70 days +400 mg/kg phenolic C-ZAMB for 28 days; Group V received 400 mg/kg C-ZAMB only for 28 days via oral route. Both non-withdrawal and withdrawal EOMABRSL-exposed animals exhibited neuro-ovarian impairment by up-regulating neuronal 51 eco-nucleotidase (51ENT), acetylcholinesterase (AChE), butrylcholinesterase (BuChE), synaptosomal monoamine oxidase-A (MAO-A) with altered cerebral antioxidants. Similarly, exposure to EOMABRSL for 98 and 70 days caused ovarian injury by amplifying the activity of 51ENT with corresponding decline of fertility index, lactate dehydrogenase (LDH) and Δ5 17ß-hydroxyl steroid dehydrogenase (Δ517ß-HSD). EOMABRSL intoxication also increased the neuro-ovarian MDA content with reduced numbers of neonates. Phenolic antioxidants from C-ZAMB leaves identified by High Pressure Liquid Chromatography (HPLC) ameliorated the chronic EOMABRSL intoxication. The treatment also prevented ovarian lesions by depleting MDA content and improved antioxidant status. Thus, confirming its neuro-ovarian protection.

The effect of nitrogen-fertilizer and optimal plant population on the profitability of maize plots in the Wami River sub-basin, Tanzania: A bio-economic simulation approach.

Maize (Zea mays L.) is the essential staple in sub-Saharan Africa (SSA) and Tanzania in particular; the crop accounts for over 30% of the food production, 20% of the agricultural gross domestic product (GDP) and over 75% of the cereal consumption. Maize is grown under a higher risk of failure due to the over-dependence rain-fed farming system resulting in low income and food insecurity among maize-based farmers. However, many practices, including conservation agriculture, soil and water conservation, resilient crop varieties, and soil fertility management, are suggested to increase cereal productivity in Tanzania. Improving planting density, and the use of fertilizers are the immediate options recommended by Tanzania's government. In this paper, we evaluate the economic feasibility of the improved planting density (optimized plant population) and N-fertilizer crop management practices on maize net returns in semi-arid and sub-humid agro-ecological zones in the Wami River sub-Basin, Tanzania. We introduce a bio-economic simulation model using Monte Carlo simulation procedures to evaluate the economic viability of risky crop management practices so that the decision-maker can make better management decisions. The study utilizes maize yield data sets from two biophysical cropping system models, namely the APSIM and DSSAT. A total of 83 plots for the semi-arid and 85 plots for the sub-humid agro-ecological zones consisted of this analysis. The crop management practices under study comprise the application of 40 kg N-fertilizer/ha and plant population of 3.3 plants/m2 . The study finds that the use of improved plant population had the lowest annual net return with fertilizer application fetching the highest return. The two crop models demonstrated a zero probability of negative net returns for farms using fertilizer rates of 40 kg N/ha except for DSSAT, which observed a small probability (0.4%) in the sub-humid area. The optimized plant population presented 16.4% to 26.6% probability of negatives net returns for semi-arid and 14.6% to 30.2% probability of negative net returns for sub-humid zones. The results suggest that the application of fertilizer practices reduces the risks associated with the mean returns, but increasing the plant population has a high probability of economic failure, particularly in the sub-humid zone. Maize sub-sector in Tanzania is projected to continue experiencing a significant decrease in yields and net returns, but there is a high chance that it will be better-off if proper alternatives are employed. Similar studies are needed to explore the potential of interventions highlighted in the ACRP for better decision-making.

Willingness and readiness to test for COVID-19; A qualitative exploration of community pharmacists.

OBJECTIVES: The present study aimed to exploring community pharmacists' willingness and readiness to test for COVID-19 in Jordan. METHODS: Purposeful sampling was used to identify a list of 30 community pharmacies, which were approached to participate in the study. Twenty interviews were needed to reach data saturation. In-depth interviews were conducted, recorded, transcribed, and analysed using NVivo 11 Software. Interviews followed a previously prepared and validated 10-item interview guide. The interview guide discussed pharmacists' willingness and readiness to test for COVID-19. RESULTS: Twenty community pharmacists were interviewed for the purpose of the present study. Interviews took place during April 2020 and the mean interview duration was 23.30 minutes. Respondents had a mean age of 36.4 years and a mean experience of 8.8 years. The majority were female (70%) and 50% held a BSc in Pharmacy. Regarding respondents' willingness to test for COVID-19 emerging themes were helping other healthcare professional, willingness to contribute to official efforts in fighting COVID-19, acting as an accessible testing cite, willingness to carry out home testing. Regarding respondents' readiness to test for COVID-19 emerging themes were Pharmacists lack basic testing skills, pharmacies are not ready to preform tests and the need for training and certifying. CONCLUSION: Jordanian pharmacists are willing to test patients for COVID-19 in community pharmacies, however, they thought they are not ready enough to undergo such tests and needed extra training and better safety precautions.

Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study.

OBJECTIVE: To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. DESIGN: Prospective observational cohort study. SETTING: Single tertiary multidisciplinary antenatal clinic in Malaysia. POPULATION: A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT. METHODS: Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. MAIN OUTCOME MEASURES: Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile. RESULTS: Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m2 and 61% had a pre-gravid BMI of ≤ 25 kg/m2 , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile. CONCLUSION: Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. TWEETABLE ABSTRACT: Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

Prognostic Impact of Lymphoid Enhancer Factor 1 Expression and Serum Galectin.3 in Egyptian AML Patients.

BACKGROUND: Deregulation of the Wnt signaling pathway had a role in haematological malignancies. Previous studies reported that lymphoid enhancer factor 1 (LEF1) expression and serum Galectin-3 level could affect clinical parameters and outcome in acute myeloid leukemia patients, but as far as we know, no study has addressed their combined effect on AML patients. AIM: We studied the expression of LEF1 by real-time qPCR and measured serum level of Gal.3 by ELISA technique in peripheral blood of 69 AML patients and correlated it with different clinicopathological criteria of patients, response, PFS and OS. RESULTS: We found high expression (LEF1high) was associated with better OS (p = 0.02) and EFS (p = 0.019) compared to LEF1low, low serum Gal.3 level had better OS (p = 0.014) and EFS (p = 0.02) compared to high serum Gal.3 level. LEF1high less likely to carry a FLT3-ITD (p = 0.047) compared to LEF1low patient, also LEF1high characterized by favorable risk (p = 0.02) than LEF1low patients. While patients with higher Gal-3 levels characterized by poor risk (p = 0.02) than lower Gal.3 lels, also more likely to carry a FLT3-ITD with borderline significance (p = 0.054). Combined LEF1high/Gal.3 low patients had lower baseline blast percentages (p = 0.02), favorable risk (p = 0.01), less likely to carry FLT3-ITD (p = 0.02), higher CR rate (p = 0.055), shorter time to CR (0.001) than other groups. Among high Gal.3 level group, LEF1highexpression improved OS and EFS (20 and 15 months respectively) vs LEF1low expression (13 and 8 months respectively). CONCLUSION: We conclude that high LEF1 expression was a favorable prognostic marker which can define AML patient risk and outcome independent from assessing the serum galectin.3 level.

Continuous glucose monitoring results in lower HbA1c in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial.

AIMS: To determine if therapeutic, retrospective continuous glucose monitoring (CGM) improves HbA1c with less hypoglycaemia in women with insulin-treated gestational diabetes mellitus (GDM). METHODS: This prospective, randomized controlled, open-label trial evaluated 50 women with insulin-treated GDM randomized to either retrospective CGM (6-day sensor) at 28, 32 and 36 weeks' gestation (Group 1, CGM, n = 25) or usual antenatal care without CGM (Group 2, control, n = 25). All women performed seven-point capillary blood glucose (CBG) profiles at least 3 days per week and recorded hypoglycaemic events (symptomatic and asymptomatic CBG < 3.5 mmol/l; non-fasting < 4.0 mmol/l). HbA1c was measured at 28, 33 and 37 weeks. In Group 1, both CGM and CBG data were used to manage diabetes, whereas mothers in Group 2 were managed based on CBG data alone. RESULTS: Baseline characteristics (age, pre-pregnancy BMI, HbA1c , total insulin dose) were similar between groups. There was a lower increase in HbA1c from 28 to 37 weeks' gestation in the CGM group [∆HbA1c : CGM + 1 mmol/mol (0.09%), control + 3mmol/mol (0.30%); P = 0.024]. Mean HbA1c remained unchanged throughout the trial in the CGM group, but increased significantly in controls as pregnancy advanced. Mean HbA1c in the CGM group was lower at 37 weeks compared with controls [33 ± 4 mmol/mol (5.2 ± 0.4%) vs. 38 ± 7 mmol/mol (5.6 ± 0.6%), P < 0.006]. Some 92% of the CGM group achieved an HbA1c ≤ 39 mmol/mol (≤ 5.8%) at 37 weeks compared with 68% of the control group (P = 0.012). Neither group experienced severe hypoglycaemia. CONCLUSION: CGM use may be beneficial in insulin-treated GDM because it improves HbA1c compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).

Evaluating Scientific Research Knowledge and Attitude Among Medical Representatives in Jordan: A Cross-sectional Survey.

BACKGROUND: Pharmaceutical companies provide a broad range of different mandatory trainings to their medical representatives to keep the business running; however research related training has often been neglected by these companies. Thus, this study was developed to assess the amount of scientific research knowledge and interest among pharmacy medical representatives in Jordan. METHOD: A cross sectional study was conducted in Jordan in 2016. During the study period, a questionnaire was administered to 250 medical representatives working in pharmaceutical companies to evaluate their scientific research knowledge and attitudes. RESULTS: The majority of medical representatives had positive attitudes towards clinical trials and research communication and believe that it will increase the value of their work, but a considerable number of medical representatives did not detail clinical trials on every visit and found difficulty in answering clinical trials and research related questions asked by health care professionals. Most of the medical representatives did not have a complete understanding of some basic research terminologies. Medical representatives working in multinational companies seemed to have a significantly better understanding of research and terminologies compared to local companies (P-value= 0.000). Also Medical representatives with higher educational degrees seemed to have significantly better understanding of basic research terminologies (P-value= 0.023). CONCLUSION: The majority of medical representatives had positive attitudes towards clinical trials and research communication and found that it will increase the value of their work, but still there is a gap in their frequency of detailing. Thus, local pharmaceutical companies need to invest more in research and clinical trials knowledge kind of training. Also, universities need to include research related courses and subject in their bachelors' program curriculum in order to make pharmacists equipped in terms of research knowledge, regardless of the career path they choose.

Hypopituitarism in a Dengue Shock Syndrome Survivor without known Pituitary Adenoma.

Dengue infection is endemic in South East Asia and parts of the Americas. Dengue hemorrhagic fever is characterized by vascular permeability, coagulation-disorders and thrombocytopenia, which can culminate in hypotension i.e. dengue shock syndrome. Hypopituitarism arising as a complication of dengue is extremely rare. Hemorrhagic pituitary apoplexy of pre-existing pituitary adenomas has been rarely reported in dengue. We describe an uncommon case of hypopituitarism in a dengue shock syndrome survivor without known pituitary adenoma. A 49 years old nulliparous lady (from Kuala Lumpur, Malaysia) presented with typical symptoms of hypocortisolism. Postural hypotension was evident with normal secondary sexual characteristics. Further history revealed that she survived an episode of dengue shock syndrome 6 years ago where premature menopause developed immediately after discharge, and subsequently insidious onset of multiple hormonal deficiencies indicative of panhypopituitarism. There were no neuro-ophthalmological symptoms suggestive of pituitary apoplexy during hospitalization for severe dengue. Magnetic resonance imaging of the pituitary 6 years later revealed an empty sella. Autoimmune screen and anti-thyroid peroxidase antibodies were negative. We describe a rare possible causative association of severe dengue with panhypopituitarism without known pituitary adenoma, postulating pituitary infarction secondary to hypotension (mimicking Sheehan's syndrome), or a direct viral cytopathic effect. Subclinical pituitary apoplexy secondary to asymptomatic pituitary hemorrhage however cannot be excluded. Future research is required to determine the need for and timing of pituitary axis assessment among dengue shock syndrome survivors.

Hypothalamic pituitary dysfunction amongst nasopharyngeal cancer survivors.

PURPOSE: Radiation fields for nasopharyngeal cancer (NPC) include the base of skull, which places the hypothalamus and pituitary at risk of damage. We aimed to establish the prevalence, pattern and severity of hypothalamic pituitary (HP) dysfunction amongst NPC survivors. METHODS: We studied 50 patients (31 males) with mean age 57 ± 12.2 years who had treatment for NPC between 3 and 21 years (median 8 years) without pre-existing HP disorder from other causes. All patients had a baseline cortisol, fT4, TSH, LH, FSH, oestradiol/testosterone, prolactin and renal function. All patients underwent dynamic testing with insulin tolerance test to assess the somatotroph and corticotroph axes. Baseline blood measurements were used to assess thyrotroph, gonadotroph and lactotroph function. RESULTS: Hypopituitarism was present in 82% of patients, 30% single axis, 28% two axes, 18% three axes and 6% four axes deficiencies. Somatotroph deficiency was most common (78%) while corticotroph, gonadotroph and thyrotroph deficiencies were noted in 40% (4 complete/16 partial), 22 and 4% of the patients respectively. Hyperprolactinaemia was present in 30% of patients. The development of HP dysfunction was significantly associated with the time elapsed from irradiation, OR 2.5 (1.2, 5.3), p = 0.02, for every 2 years post treatment. The use of concurrent chemo-irradiation (CCRT) compared to those who had radiotherapy alone was also significantly associated with HP dysfunction, OR 14.5 (2.4, 87.7), p < 0.01. CONCLUSION: Despite low awareness and detection rates, HP dysfunction post-NPC irradiation is common. Use of CCRT may augment time related pituitary damage. As these endocrinopathies result in significant morbidity and mortality we recommend periodic assessment of pituitary function amongst NPC survivors.

Matrix metalloproteinase-9 gene polymorphism in hepatocellular carcinoma patients with hepatitis B and C viruses.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide. In Egypt, the incidence of HCC has doubled over the last decade. Matrix metalloproteinase-9 (MMP-9) plays a key role in cancer invasion and metastasis by degrading the extracellular matrix and basement membrane barriers. A cytosine (C)/thymidine (T) single nucleotide polymorphism at position -1562 in the MMP-9 promoter is reported to influence the expression of the MMP-9 gene. The association between MMP-9 gene polymorphisms and HCC patients with hepatitis C and B viruses (HCV and HBV) was examined in 91 patients with HCC and viral hepatitis (55 HCV and 36 HBV). The results were compared with those of 42 HCC patients without viral hepatitis and 60 healthy individuals with no liver infection. Polymorphisms of the MMP-9 gene were investigated by polymerase chain reaction amplification followed by restriction fragment length polymorphism analysis. The serum MMP-9 level was quantitatively determined using a human MMP-9 enzyme-linked immunosorbent assay, which showed that homozygosity of the MMP-9 promoter (TT) was more frequent in patients with HCC and chronic HCV or HBV infection when compared with the control group (49.1, 52.8, and 35.7%, respectively). In addition, we observed significant elevation of serum MMP-9 levels in all HCC groups compared to controls. It was concluded that patients with the MMP-9 TT genotype are at risk of developing HCC and HBV or HCV. People with significantly elevated serum levels of MMP-9 are at risk of developing HCC.

Expanding the clinical spectrum of central pontine myelinolysis.

Central Pontine Myelinolysis (CPM) is a clinical entity first described by Adams et all in 1958 in the context of malnourishment and alcoholism. Classically, this demyelinating disease arises from the rapid correction of hyponatraemia, resulting in profound neurological deficits such as spastic quadraplegia and pseudobulbar palsy. Diagnosis is usually made on the presence of a symmetrical, centralized and well-circumscribed lesion in the pens, seen on MRI. Extrapontine lesions have also been described, frequently affecting the midbrain, thalamus, cerebellum and rarely extends to the medulla. We present a case of a 41 year old lady who presented with acute neurological deterioration, with physical signs to suggest a disease process involving the whole brainstem. However, MRI brain showed a lesion similar to that found in CPM, at the junction of the pons and medulla.

MR imaging of cerebral and cerebellar hypervascularity associated with status epilepticus: case report.

A 20 year old male presented to the emergency department with generalized tonic clonic convulsions and up rolling of eye balls. He had history of seizure disorder for three years and on regular medical treatment and is compliant to medication. A non-contrast CT scan of the head was only done on 14th day of admission which showed hypodense areas in the right and left cerebellar hemisphere. MR imaging was performed four days later revealed high signal intensity in the both cerebellar hemispheres, both external capsules, both occipital and right parietal regions on fluid-attenuated inversion recovery (FLAIR). The post contrast MR imaging revealed diffuse cerebral and cerebellar hypervascularity in the similar region. This change of diffuse hypervascularity of both cerebral and cerebellar associated with seizure activity on post-contrast magnetic resonance imaging (MRI) has not been reported in any literature.

A three-dimensional computed tomographic analysis of the cervical spine in unoperated infants with cleft lip and palate.

OBJECTIVE: To investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate. DESIGN: Retrospective cross-sectional investigation of infants born with nonsyndromic cleft lip and palate using computed tomography scans acquired for investigation of a spectrum of clinical conditions. SETTING: Computed tomography scan data were obtained from 29 unoperated cleft lip and palate infants and 12 noncleft infants of Malay origin, ages 0 to 12 months. METHODS: Observational study of cervical spine computed tomography scans. Heights of cervical vertebral bodies (C2-C7) and intervertebral spaces were measured from landmarks identified from computed tomography reformats and three-dimensional computed tomography reconstructions. Linear modeling of heights and spaces, with age as a covariate, was undertaken to identify differences between the samples. RESULTS: Anomalous features observed in the cleft lip and palate sample included short posterior arch of C1 (2/29), abnormal development of the anterior arch of C1 (2/29), and fusions of the posterior arch of C2 and C3 (2/29). No anomalies of the cervical spine were observed in the noncleft sample. Although the heights of three cervical vertebral bodies were significantly smaller and two intervertebral spaces were significantly larger in infants with cleft lip and palate compared with noncleft infants (p < .05), overall length of the cervical spine did not differ significantly between the samples. CONCLUSION: There was evidence for subtle upper spinal anomalies in the infant cleft lip and palate population. Our finding of reduced size of some cervical vertebral bodies may reflect delayed upper spinal development in infants with cleft lip and palate.