Alteration in cerebrospinal fluid (CSF) markers associated with α-synucleinopathies.

Rapid eye movement sleep behavior disorder (RBD) is linked to other α-synucleinopathies such as Parkinson's disease and Lewy body dementia. It is essential to consider and exclude RBD while studying CSF markers in the latter two to avoid confounding bias and improve test results' specificity.

Prevalence of depression, anxiety and stress in china during COVID-19 pandemic: A systematic review with meta-analysis.

BACKGROUND: The novel coronavirus disease which is believed to have initially originated in Wuhan city of China at the end of 2019 was declared as pandemic by March 2020 by WHO. This pandemic significantly impacted the mental health of communities around the globe. This project draws data from available research to quantify COVID-19 mental health issues and its prevalence in China during the early period of the COVID-19 crisis. It is believed that this pooling of data will give fair estimate of the effects of the COVID-19 pandemic on mental health. METHODS: We conducted this study in accordance with PRISMA guidelines 2009. The protocol for this review is registered and published in PROSPERO (CRD42020182893). The databases used were Pubmed, Medline, Google scholar and Scopus. The studies were extracted according to pre-defined eligibility criteria and risk of bias assessment was conducted. The Meta-analysis was done using OpenMeta [analyst]. RESULTS: Total of 62382 participants in nineteen studies fulfilled the eligibility criteria. Stress was the most prevalent (48.1%) mental health consequence of Covid-19 pandemic, followed by depression (26.9%) and anxiety (21.8%). After performing subgroup analysis, prevalence of depression and anxiety in both females and frontline health care workers were high as compared to the prevalence in general Chinese population. CONCLUSION: The prevalence of depression and anxiety is moderately high whereas pooled prevalence of stress was found to be very high in Chinese people during this Covid-19 crisis.

Resolving mystery behind autonomous retrogression of low-grade gliomas: A systematic review.

OBJECTIVE: To review evidence-based data on spontaneous retrogression of low-grade gliomas with respect to interval till regression, type of glioma and patient outcome. METHODS: The systematic review comprised medical literature in English language published from January 1997 to January 2017 on Scopus, PubMed and Google Scholar databases to establish consensus about the possible mechanism of spontaneous regression, the role of therapeutic intervention and failure of management strategies in low-grade gliomas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed during the review. RESULTS: Of the 176 articles identified, 73(41.5%) were shortlisted for detailed assessment. Of them, 10(13.7%) were included; 5(50%) case reports and 5(50%) case series. There were 23 cases of spontaneous regression; 15(65.2%) males and 8(34.7%) females. The interval of regression varied from 3 months to 15.5 years, and the most commonly presenting low-grade glioma type was optic pathway glioma 11(47.4%). CONCLUSIONS: The phenomenon of regression was most evident in optic pathway glioma. Literature suggested that low-grade gliomas should undergo serial imaging before implying any therapeutic intervention. However, the evidencebased proof, large-scale experimental studies and ethical considerations are still required to standardise this strategy.

Choice of therapeutic anti-seizure medication in patients with brain tumour.

Seizures are common in patients with brain tumours, even though prophylactic anti-seizure treatment for all patients with brain tumours is not recommended. Newer anti-epileptic drugs have shown benefits that outweigh the side effects of treatment and can also be given in combination with traditional anti-epileptic drugs. The authors have reviewed the literature on the various combinations of anti-epileptics in patients with seizures and brain tumours.

Morphometric features of Linea aspera on dry femur bones.

OBJECTIVE: To observe and describe the features of line a aspera in dry femurs. METHODS: The prospective observational study was conducted from October to December 2017 at Darul Sehat Hospital, Karachi, and comprised dry femurs. Data was collected by trained medical students. Observations of landmarks of linea aspera were taken using classical measuring techniques. Data was analysed using SPSS 21. RESULTS: There were 48 dry femurs with mean maximum length of linea aspera 133.4±22.4 mm, and mean minimum length 188±79 mm. The mean diameter of antero posterior thickness was 2.7±1.1 mm. Linea aspera was widest at its lower one third 30(62.5%) and narrowest at its middle one-third 5 (10.4%). The most common pattern on linea aspera was three ridges 26 (54.2%). Majority of bones had at least one uninterrupted ridge 32(66.7%). The most prominent ridge on linea aspera was lateral in 20 (41.7%) bones. The largest nutrient foramen in 19 (42.2%) bones was located at the level of proximal one-third of linea aspera.. CONCLUSIONS: linea aspera was widest at its lower one-third. In majority of bones the lateral ridge was the most prominent, and the largest nutrient foramen of femur was most commonly located at the level of proximal one-third of linea aspera.

Successful pregnancy in a patient with Ebstein's anomaly; a case report from a developing country.

Ebstein anomaly is a rare malformation of the tricuspid valve of the heart. The malformed tricuspid valve may be incompetent, stenotic, or rarely, imperforate. Pregnant patients with Ebstein anomaly become a challenge for the physician in terms of management. We report a case in which patient delivered successfully with Ebstein anomaly. The only complication was breathlessness. Authors concluded that women with Ebstein anomaly can have successful outcomes of pregnancy with close monitoring.

Treatment options for Primary CNS Lymphoma.

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Robotics in neurosurgery: A literature review.

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of virtual procedures which turn out to be of great succour for young apprentice surgeons to practise their surgical skills in a safe environment. It also allows senior professionals to rehearse difficult cases before involving into considerable risky procedures.

Maternal morbidity and associated factors at a tertiary care Centre in Karachi: A critical analysis.

AIM: The study was conducted to identify maternal morbidity and associated factors such intensive care unit admission and surgical intervention. METHODS: Pregnant and six-week post-partum women without any other comorbidy were recruited from January 2014 to December 2015 from the Department of Gynaecology and Obstetrics at Liaquat National Hospital, Karachi. A structurally designed questionnaire was used to record demographic data and factors related to the management and intervention of maternal conclusions. RESULTS: A total of 213 patients were included in the study, with an average age of 27.87 ± 5.26 years, mean parity of 2.02 ± 1.88 and mean gestational period of 32.48 ± 7.93. The details of 186 neonatal cases were also recorded: 47 neonates were admitted to the intensive care unit, while 23 were kept on ventilation. The primary complication was post-partum hemorrhage. The most common intervention methods used was lower segment cesarean section. CONCLUSION: The concept of maternal morbidity is developing as a new indicator for the assessment of maternal healthcare services. Public health awareness programs should be conducted for health professionals to combat the high incidence of maternal morbidity.

Role of surgery in brain metastases.

Brain metastases remain the commonest type of brain tumour, being four times more common than primary brain tumours. Although surgical intervention may be recommended for one of various reasons in the management of these tumours, including but not limited to conformation of diagnosis, relief of mass effect, improvement of neurological status and prolongation of survival, the guidelines for management of brain metastases remain largely subjective and therefore controversial. Herein the authors have attempted to review some of the existing evidence on role of surgery in the management of brain metastases and have presented their selected guidelines for the readers.

Prodromal depression and subsequent risk of developing Parkinson's disease: a systematic review with meta-analysis.

Aim: Parkinson's disease (PD) is a progressive neurological disorder that predominately affects dopaminergic neurons. We believe that this pooling of data will help to better understand the prodromal nature of depression in PD. Materials & methods: We conducted this study in accordance with PRISMA guidelines 2020. Fifteen eligible articles were shortlisted for final analysis. Risk of bias assessment was also conducted Results: The random-effect model revealed that the risk of subsequent PD in patients with prodromal depression was twice as likely (odds ratio, 2.04; 95% CI, 1.02-4.08) as compared with a healthy population. Conclusion: Our meta-analysis concluded that the subsequent risk of PD is significantly higher in patients with depression as compared with healthy individuals.

Parkinson's disease (PD) is a nervous system disease that predominantly affects neurons of the brain that controls voluntary movement and behavioral processes such as mood, reward, addiction and stress. There is a wide spectrum of problems that can present in patients with PD, however, there are few that can precede the beginning of the illness. Previous studies have evaluated the relation of psychiatric symptoms with PD. However, many aspects need to be studied to understand this relationship. The main emphasis of this systemic review is to establish the association of prodromal depression before the development of PD. Our study showed that there is a strong association between depression and PD and suggests an increased risk of developing PD in formerly depressed patients. Though, it is still unclear if depression is either an early prodromal symptom of PD or a causative risk factor for PD and warrants further studies to determine the causality relationship between the two.

Covid-19-Related Suicides in Pakistan, India, and Bangladesh: Can we Rely on Reporting System? A Rapid Systematic Review.

Purpose of Review: With other life-altering changes, Covid-19 pandemic has brought a mental health crisis upon the global community. Untreated psychological disturbances can lead to tragic outcomes such as suicide. Currently, the most feasible way to know the true burden of Covid-related suicides is through media reports. However, the standards of media-reported suicide cases and their compliance to WHO checklist of suicide reporting in Pakistan, India, and Bangladesh are concerning. The question that arises here is if we can truly rely on the media reporting system of these countries to establish exposure-causality relationship. We've attempted to gather the evidence of reporting sources of Covid-related suicide cases in Pakistan, India, and Bangladesh. We've conducted a systematic review in accordance with the PRISMA guidelines to identify the media-reported cases of COVID-related suicides. Recent Findings: After compilation of the results, it was observed that most of the reported cases were from India (74.2%) whereas males died of suicide more often than females. When risk of bias was assessed using Pierson's method, it was observed that 70% of the studies had high risk of bias. Summary: We've attempted to gather the evidence of reporting sources of Covid-related suicide cases in Pakistan, India, and Bangladesh and found that nearly all media reports hadn't followed the WHO reporting guidelines for suicide cases. This could lead to a false sense of panic among the general population.

Neurotoxicity: A Rare Side Effect of Programmed Cell Death 1 (PD-1) Inhibitors.

Immunotherapy is a biological therapy that helps the body's immune system to fight against cancer cells. The Food and Drug Administration (FDA) approved the first immune checkpoint inhibitor in 2011. Since 2011, many immune checkpoint inhibitors have been approved. Programmed cell death 1 (PD-1) inhibitors are now commonly used in multiple malignancies due to their remarkable response. Thus, immune-related adverse events are now coming into the limelight due to the increasing use of PD-1 inhibitors. Here, we present a case of a 54-year-old female with non-small cell lung cancers (NSCLC) treated with pembrolizumab and later presented with severe neurotoxicity.

Bibliometric Analysis of Publication Activity in the Field of GIANT Cell Arteritis: A SCOPUS-based Study.

Objective Giant cell arthritis (GCA) is a type of vasculitis which is more common in female gender and is closely associated with Polymyalgia rheumatic. One of its important complication include visual impairment. The burden of disease is expected to be very high by 2050 and there is a need to compile the data on most influential studies on GCA to define future strategy to deal with this dangerous disease. Bibliometrics is a statistical analysis of published literature that reflects the value and impact of a particular publication within the specific field. Aim of our study is identify the most significant contributors and their quality of contribution in the field. Method We conducted this analysis utilizing SCOPUS database using different related MeSH terms. After a detailed screening, the list of top-50 articles were presented in the results in descending order of their ranks on the basis of their total number of citation. Most of our data comprises of publications from 1971-2012. Result The top-50 most cited articles on GCA were published between 1971 and 2012 with the median number of citations 274 ranging from 598-187. Annals of Internal Medicine was the top ranked journal with 13 publications from the list. The highly ranked author based on the number of publications was Hunder GG (20 publications) with h-index of 40, retaining affiliation with Mayo Clinic, Rochester, United States. Mayo Clinic was the most frequently mentioned institute among the affiliations. The United States was found to be the most productive country rendering most of the articles (64%). Conclusion Our bibliometric analysis on Giant cell arteritis identifies the information which may direct future research contributions, identify field experts, guide researchers to fill knowledge gaps, and assist in research fund allocation.

A bibliometric analysis of top 50-most cited articles on repetitive trans-cranial magnetic stimulation (rTMS) for treatment of depression.

BACKGROUND: Citation count can be used as a key tool to assess the quality of the published literature and because of its immense advantages it is now widely used in ranking the articles on specific topics. OBJECTIVE/HYPOTHESIS: To extract and assess the top cited work on repetitive transcranial magnetic stimulation (rTMS) for depression treatment. METHODS: Scopus Library Database was searched and two independent authors produced a list of 50 most cited articles on repetitive transcranial magnetic stimulation (rTMS) for treatment of depression. All the relevant articles having key-terms within their titles, abstract and keywords were included in our search. Our list was categorized into two categories, "mixed" and "focused". RESULTS: The articles in the produced list of top 50 most cited articles on rTMS for treatment of depression belong to the time period 1993-2012 with total citation count 12078. George MS was prominent in the list. 'Biological Psychiatry' published most number of articles (n = 13) among the list. Articles were categorized on the basis of primary population and intervention into 'Focused' and 'Mixed' categories. LIMITATIONS: Articles that were published before 1993 and after 2012 on rTMS for depression couldn't made it to the final list of top-50 most cited article. CONCLUSION: We attempted to conduct a topic-specific citation analysis considering the paucity of specified bibliometrics in medical literature. Our research provides an insight on emerging trends in rTMS for depression and highlights the characteristics, quality and dynamics of frequently cited articles in the field.

Does Bupropion Impact More than Mood? A Case Report and Review of the Literature.

Sexual side effects are often an unintended consequence of antidepressant treatment. Given antidepressants of different classes are frequently paired together in order to improve therapeutic response, understanding their interplay in regards to sexual functioning is important. Bupropion is an atypical antidepressant which is often used as a Selective Serotonin Reuptake Inhibitors adjunct in the treatment of depression, as well as in the amelioration of decreased libido. The following case highlights the importance of understanding antidepressant medications and their combined potential effect on sexual function to prevent unnecessary complications in cases involving the history of paraphilic disorders and hypersexuality.

Risk of Multiple Sclerosis in Epstein-Barr Virus Infection.

Multiple sclerosis (MS) is a chronic neuro-inflammatory, immune-mediated disorder of the central nervous system; however, less is known about its cause. It causes neurological disability in young adults, more commonly in women. Several risk factors including environmental, genetics, and infections have been identified, which contribute to the abnormal immune response. Viruses belonging to the Herpes family have been indicated as a potential risk for MS; their biological mechanisms are not known but several possibilities have been discussed. Epstein-Barr virus (EBV) is the leading and most common virus associated with MS. It is a potential oncogenic virus that hosts the B lymphocytes and has been associated with numerous cancers such as Burkitt's lymphoma, Hodgkin's lymphoma, and nasopharyngeal carcinoma. The risk of MS is low in patients who are EBV negative but increases by several folds in individuals who have a history of infectious mononucleosis (IM). Several ecological studies, co-occurring pathologies, and experimental laboratory-based research provide evidence to support the relationship between EBV and MS.

A Patient of Multiple Myeloma with Absent M-spike on Serum Protein Electrophoresis and Elevated Serum-Free Light Chains: A Case Report and Literature Review.

Multiple myeloma is a neoplasm described as an abnormal growth of plasma cells that outnumbers the other normal hematopoietic cells inside the bone marrow. Patients are diagnosed at a median age of 66-77 years with 37% of those with age less than 65. Unexplained bone pain (most commonly in back and ribs), pathologic fractures, fatigue, and weight loss are common initial symptoms at presentation. Here, we report a rare presentation of multiple myeloma with normal serum protein electrophoresis but elevated serum-free light chains. The absence of monoclonal gammopathy on protein electrophoresis or normal immunofixation does not negate the diagnosis of multiple myeloma. Therefore, all the sub types of multiple myeloma need to be comprehensively studied to aid in reaching an accurate diagnosis.

Surgical Outcome of Decompression and Fixation of Degenerative Lumbosacral Spondylolisthesis Surgery in Pakistani Population.

Background Spondylolisthesis is characterized by the slipping of one vertebra, compared with the underlying one, due to structural and degenerative changes. Its origin is multifactorial which includes disc degeneration, facet joint anatomic orientation, iliolumbar configuration, and ligament hyperlaxity. The most common operative treatment is decompression and may require an individualized surgical plan. However, only decompression may progress the slippage which can result in pain or recurrence of neurological complaints. Therefore, lumbar fusion and fixation are considered appropriate to stabilise the spine and prevent delayed deterioration. The aim of our study was to find out the outcome of posterior decompression, with reduction and fixation of lumbosacral spondylolisthesis by Oswestry Disability Index (ODI) to improve further our results. Methods This study was conducted from July 2013 to February 2017 including 94 patients with lumbosacral spondylolisthesis. The Meyerding classification was used to grade the extent of vertebral slippage. The assessment was done using the ODI. Results There were 50 (53.19%) males and 54 (46.80%) females with a mean age of 44 years ± 10.49 SD. Backache was present in all patients and claudication in 85 (90.42%) patients. There were 10 (10.63%) patients with spondylolisthesis at L3-L4, 36 (38.29%) at L5-S1 and 48 patients (51.06%) at L4-L5 level. In 48 patients with L4-L5 level, 38 (79.16%) were in grade II while six (12.5%) were in grade III. According to the preoperative ODI score, 38 patients were placed in moderate disability, 42 patients were severely disabled while four patients were disabled. Good outcome was achieved in a total of 79 (84.04%) patients. In 40 (42.55%) patients, with complete reduction, the good outcome achieved in 35 (83.33%) while in 22 (23.40%) patients there was no reduction and a good outcome was achieved in 17 (77.27%) patients. In 38 (40.42%) patients with moderate disability, 32 (84.04%) patients had a good outcome. Post-operative cerebrospinal fluid (CSF) leak occurred in five (5.31%) and wound infection in seven (7.44%) patients while there was no mortality. Conclusion Reduction with decompression can have a good outcome in spondylolisthesis, and ODI should be used as a predictor of outcome. It also shows that proper decompression is required and not a complete reduction.

Lymphocytic Pleural Effusion and an Enzyme Involved in Purine Metabolism: A Tertiary Care Experience in Karachi, Pakistan.

BACKGROUND: The levels of adenosine deaminase (ADA) are increased in tubercular pleural effusion and its determination has acquired popularity as a diagnostic test which is inexpensive and is readily accessible. Pleural fluid ADA showed sensitivity (86.36%), specificity (61.54%), diagnostic accuracy (80.70%), positive predictive value (88.37%), and negative predictive value (82.42%) confirmed by pleural biopsy as a gold standard. METHODOLOGY: Our study was a prospective cross-sectional study which was conducted for three years at a tertiary care center in Karachi, Pakistan. The data were collected and analyzed using IBM statistics SPSS vs21. RESULTS: There were 52 patients included in our study. Twenty one were males and thirty one were females. Most patients presented with shortness of breath. There was a significant association found between raised ADA levels and pulmonary tuberculosis (p < 0.05). The ADA levels are 12 times more likely to be raised in tubercular pleural effusion. CONCLUSION: The ADA level is an important marker for diagnosis of pulmonary tuberculosis in lymphocytic pleural effusion. It is a convenient and an inexpensive method. The ADA levels assessment is economical when compared to other diagnostic methods.