Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era.

BACKGROUND: COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS: An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS: Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS: These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.

Deep learning-assisted radiomics facilitates multimodal prognostication for personalized treatment strategies in low-grade glioma.

Determining the optimal course of treatment for low grade glioma (LGG) patients is challenging and frequently reliant on subjective judgment and limited scientific evidence. Our objective was to develop a comprehensive deep learning assisted radiomics model for assessing not only overall survival in LGG, but also the likelihood of future malignancy and glioma growth velocity. Thus, we retrospectively included 349 LGG patients to develop a prediction model using clinical, anatomical, and preoperative MRI data. Before performing radiomics analysis, a U2-model for glioma segmentation was utilized to prevent bias, yielding a mean whole tumor Dice score of 0.837. Overall survival and time to malignancy were estimated using Cox proportional hazard models. In a postoperative model, we derived a C-index of 0.82 (CI 0.79-0.86) for the training cohort over 10 years and 0.74 (Cl 0.64-0.84) for the test cohort. Preoperative models showed a C-index of 0.77 (Cl 0.73-0.82) for training and 0.67 (Cl 0.57-0.80) test sets. Our findings suggest that we can reliably predict the survival of a heterogeneous population of glioma patients in both preoperative and postoperative scenarios. Further, we demonstrate the utility of radiomics in predicting biological tumor activity, such as the time to malignancy and the LGG growth rate.

Avaliação do extrato etanólico de Ottonia martiana Miq. para o controle de duas doenças florestais / Evaluation of Ottonia martiana Miq. alcoholic extract to control two forest diseases

Metabólitos secundários presentes em plantas medicinais apresentam várias propriedades biológicas incluindo a atividade antifúngica. Esse estudo avaliou o potencial antifúngico da planta medicinal Ottonia martiana no controle da pinta-preta em erva-mate (Ilex paraguariensis) e do mofo-cinzento em eucalipto (Eucalyptus dunnii). Extrato etanólico (EBEtOH) dos órgãos totais (raízes, caules, folhas e frutos) foi preparado e testado na concentração de 1000 μg mL-1 contra os patógenos Cylindrocladium spathulatum (pinta-preta) e Botrytis cinerea (mofo-cinzento). Bioensaios in vitro (germinação de esporos e bioautografia direta) e in vivo (teste de patogenicidade em mudas) mostraram que o EBEtOH reduziu o crescimento micelial dos patógenos testados e a germinação dos esporos de C. spathulatum e estimulou a germinação de esporos de B. cinerea. O teste de patogenicidade mostrou que o controle da pinta-preta em erva-mate e do mofo cinzento em eucalipto não é viável usando-se a concentração testada de EBEtOH de O. martiana. Na bioautografia direta, foram detectadas zonas de inibição de crescimento micelial dos fungos e que foram relacionadas com a presença de piperovatina.

Secondary metabolites from medicinal plants have several biological properties, including antifungal activity. This study evaluated the antifungal potential of the medicinal plant Ottonia martiana to control maté leaf spot (Ilex paraguariensis) and eucalypt gray mould (Eucalyptus dunnii). Ethanol extract (EBEtOH) of the total parts (roots, stems, leaves and fruits) was prepared at the concentration of 1000 μg mL-1 and tested against Cylindrocladium spathulatum (maté leaf spot) and Botrytis cinerea (eucalypt gray mould). In vitro bioassays (spore germination and direct bioautography) and in vivo bioassays (pathogenicity test in seedlings) showed that EBEtOH reduced the mycelial growth of the tested pathogens and the germination of C. spathulatum spores and stimulated the germination of B. cinerea spores. The pathogenicity test showed that the control of maté leaf spot and eucalypt gray mould is not viable using the tested concentration of O. martiana EBEtOH. Zones of mycelial growth inhibition were detected in direct bioautography and were related to the presence of piperovatine.

Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi.

SETTING: TB control programmes in Bangladesh, India and Malawi. OBJECTIVE: To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries. DESIGN: Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives. RESULTS: Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh. CONCLUSION: Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.

Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data.

BACKGROUND: If medical treatment fails in uveitic glaucoma a surgical approach should be considered. Classical trabeculectomy is known to have a less favourable outcome in uveitis. Our intention is to report the first series of uveitis patients with glaucoma resistant to medical therapy who were treated with deep sclerectomy (DS). PATIENTS AND METHODS: Fourteen eyes of 13 patients (mean age 39.0 +/- 18.5 years; range 8 to 76 years) with chronic uveitis underwent non-penetrating filtering surgery from 1995 to 2003. All patients had their uveitis controlled before and after surgery by immunomodulatory therapy. Non-penetrating filtering surgery consisted of DS with collagen implant (Staar(R)) in 4 eyes, DS with draining device (T-Flux Ioltech(R)) in 2 patients, DS without implant in 7 patients and with viscocanalostomy in 1 patient. Nine eyes (65 %) received mitomycin C peri-operatively. RESULTS: Intra-ocular pressure (IOP) was reduced from a mean pre-operative value of 42.8 +/- 13.6 mmHg to a 1-year mean post-operative value of 12.1 +/- 4.0 (71.7 % reduction). Eleven of the 14 eyes completed 12 months of follow-up, resulting in complete success in 5 (45.4 %) and in qualified success in 5 (45 %) and in failure in one patient (9.2 %), later controlled by a second operation. Anti-glaucomatous medication was reduced from a mean of 3.7 +/- 0.5 medications preoperatively to 1.2 +/- 0.8 medications (71.4 % reduction) at the 12 month follow-up. Nine of the 14 patients achieved a 24 month follow-up with a mean IOP of 14.1 +/- 3.8 mmHg and mean of anti-glaucomatous medications of 1.6. Four patients have been examined 4 years after the DS: mean IOP was 13.2 +/- 2.2 mmHg and mean medication 1.7 +/- 1.0. Post-operative complications included one case of lens opacity and 2 cases of hypotony lasting for five months and four weeks after the intervention respectively. CONCLUSION: Non-penetrating filtering surgery controlled the intra-ocular pressure in 90 % of eyes with uveitic glaucoma resistant to medical therapy at 12 months. Surgical complications were low which may explain the high success rate of the procedure, compared to classical penetrating surgery.

Avaliação da atividade antibacteriana de Ottonia martiana Miq., Piperaceae / Evaluation of antibacterial activity of Ottonia martiana Miq., Piperaceae

Ottonia martiana Miq., arbusto da família Piperaceae, é conhecida na medicina popular brasileira como "anestésica". Raízes e partes aéreas são utilizadas em alcoolaturas para aliviar dores de dente, devido à ação anestésica sobre a mucosa bucal. Avaliou-se a atividade antibacteriana "in vitro" dos extratos desta planta medicinal contra duas bactérias presentes na placadentária: Staphylococcus aureus (ATCC 6538) e Staphylococcus epidermis (ATCC 12228). Extratos de caules e raízes de Ottonia martiana exibiram uma baixa atividade inibitória sobre o crescimento de Staphylococcus aureus, não apresentaram ação antimicrobiana sobre a outra bactéria testada e exibiram frações que inibiram o desenvolvimento de Staphylococcus aureus.

Contribuição ao estudo da atividade antifúngica de Maytenus ilicifolia Mart. ex Reiss., Celastraceae / Study of antifungal activity of Maytenus ilicifolia Mart. ex Reiss., Celastraceae

Maytenus ilicifolia Mart. ex Reiss, Celastraceae, espinheira-santa, é nativa em muitas partes da América do Sul, sendo encontrada no sul do Brasil. É utilizada no tratamento de gastrite, úlceras e outras desordens do estômago, na forma de decocção das folhas ou extrato liofilizado em cápsulas. Neste trabalho, estudou-se a atividade antifúngica do seu extrato etanólico sobre o crescimento micelial dos fungos fitopatogênicos Colletotrichum acutatum, Fusarium oxysporum e Cylindrocladium spathulatum. Na comparação do crescimento micelial de isolados desses fungos em BDA (Batata Dextrose Agar), adicionados do extrato etanólico da espinheira-santa, foi observado que o mesmo inibiu em mais de 10 por cento o crescimento micelial de Fusarium oxysporum, nas três concentrações avaliadas (0,2; 0,4 e 0,6mg/mL), estimulou o crescimento micelial de Colletotrichum acutatum em mais de 30 por cento na concentração de 0,2mg/mL, e algumas de suas frações inibiram o desenvolvimento de Cylindrocladium spathulatum.

Study of antifungal activity of Maytenus ilicifolia Mart. ex Reiss., Celastraceae. Maytenus ilicifolia Mart. ex Reiss., Celastraceae, known as espinheira-santa, is native to South America, and in southern Brazil its leaves decoction is traditionally used for the treatment of gastritis, ulcers and other gastrointestinal disorders. The objective of this work was to investigate the effect of the crude ethanolic extract of espinheira-santa on the mycelial growth of three phytopathogenical fungi: Colletotrichum acutatum, Fusarium oxysporum and Cylindrocladium spathulatum. It was observed that this extract inhibited in more than 10 percent the mycelial growth of Fusarium oxysporum at all used concentrations (0.2; 0.4 and 0.6 mg/mL), stimulated the Colletotrichum acutatum mycelial growth in more than 30 percent at 0.2 mg/mL and some of its fractions inhibited the Cylindrocladium spathulatum development.

[The "heme"-sequence (T2*-weighted gradient echo magnetic resonance tomography). Value in differential spontaneous intracerebral hemorrhage diagnosis]. / Die "Häm"-Sequenz (T2*-gewichtete Gradienten-Echo-Magnetresonanztomograpie). Stellenwert in der Differentialdiagnose spontaner intrazerebraler Blutungen.

In four patients presenting with acute non-traumatic intracerebral or intraspinal hemorrhage, T2*-weighted gradient-echo MRI showed numerous residual hemosiderin deposits due to old intracerebral hemorrhages that were missed on initial CT and spin-echo MRI. The demonstration of additional chronic bleedings and their anatomical distribution provided important diagnostic information. In a hypertensive patient, the hemosiderin deposits were most pronounced within deep brain structures suggesting hypertensive cerebral microangiopathy. In a second patient, the cortico-subcortical distribution of the hemorrhages was typical of cerebral amyloid angiopathy. In a third patient, the diffuse distribution including spinal bleeding, the marked calcification, and the characteristic appearance on spin-echo MRI were consistent with multiple cavernomas. In another patient with cerebral and spinal hemorrhage, T2*-weighted gradient-echo MRI revealed new subclinical hemorrhages during follow-up. Based on these findings, we recommend that T2*-weighted gradient-echo MRI of the brain should be performed in all patients with acute intracranial and spinal bleedings.

Anatomy of shoots and tumors of in vitro habituated Rhododendron 'Montego' (Ericaceae) cultures with tissue proliferation.

Tissue proliferation (TP) is characterized primarily by the formation of galls or tumors at the crown of container-grown rhododendrons that were initially propagated in vitro. In the cultivar 'Montego', TP-like symptoms are first observed in vitro as shoot clusters with small leaves and nodal tumors. In addition, unlike the normal in vitro non-TP (TP-) shoots, in vitro TP (TP+) shoots proliferate rapidly without the presence of the plant growth regulator cytokinin in the tissue culture medium. Comparisons of the anatomy of TP+ and TP- shoot tips showed that TP+ shoots had a less developed vascular system, longer cells in the pith and cortex, and altered internodal elongation at the shoot apex. In addition, TP+ axillary buds were abnormal in that they were displaced onto the stem above the leaf axil, and a small group of proliferating cells replaced the shell zone at the base of the bud. Initiation of tumor formation began with the expansion of this region of cell proliferation (RCP) and shoot growth from the abnormal axillary bud (tumor bud). Organization of the tumor bud and extension of the RCP characterized the further development of two types of tumors. In polar shoot tumors, shoot growth continued from the persistent tumor bud and the tumor at the base of the shoot remained small in size. The RCP extends downward to the vascular junction of the subtending leaf and the stem of the TP+ shoot. In nonpolar tumors, continuous de novo meristem formation led to the development of large tumors with or without shoots. The RCP is present throughout the tumor and is associated with de novo meristem formation. Comparisons to the anatomy of other tumor-like structures showed that TP tumors of Rhododendron 'Montego' are most similar to tobacco genetic tumors.

U.S. EPA regulatory perspectives on the use of QSAR for new and existing chemical evaluations.

As testing is not required, ecotoxicity or fate data are available for approximately 5% of the approximately 2,300 new chemicals/year (26,000 + total) submitted to the US-EPA. The EPA's Office of Pollution Prevention and Toxics (OPPT) regulatory program was forced to develop and rely upon QSARs to estimate the ecotoxicity and fate of most of the new chemicals evaluated for hazard and risk assessment. QSAR methods routinely result in ecotoxicity estimations of acute and chronic toxicity to fish, aquatic invertebrates, and algae, and in fate estimations of physical/chemical properties, degradation, and bioconcentration. The EPA's Toxic Substances Control Act (TSCA) Inventory of existing chemicals currently lists over 72,000 chemicals. Most existing chemicals also appear to have little or no ecotoxicity or fate data available and the OPPT new chemical QSAR methods now provide predictions and cross-checks of test data for the regulation of existing chemicals. Examples include the Toxics Release Inventory (TRI), the Design for the Environment (DfE), and the OECD/SIDS/HPV Programs. QSAR screening of the TSCA Inventory has prioritized thousands of existing chemicals for possible regulatory testing of: 1) persistent bioaccumulative chemicals, and 2) the high ecotoxicity of specific discrete organic chemicals.

The application of structure-activity relationships (SARs) in the aquatic toxicity evaluation of discrete organic chemicals.

The Office of Pollution Prevention and Toxics (OPPT), United States Environmental Protection Agency (USEPA) routinely uses structure-activity relationships (SAR) for the aquatic hazard assessment of new chemicals submitted under Section 5 of the Toxic Substances Control Act (TSCA). With 15 years of experience and the general acceptance of toxicity predictions based on SARs, OPPT has expanded the use and application of the methodology to include existing chemicals used in printing, dry cleaning, and paint stripping. SAR analysis has also been used in the hazard evaluation of the U.S. and EU/OECD high production volume (HPV) chemicals. This paper describes the assumptions, limitations, and methodology for the use of SARs to evaluate large sets of discrete organic chemicals.

Predictions for existing chemicals-a multilateral QSAR project.

Abstract Following a previous collaborative EU/EPA project focussed on QSAR predictions for a selection of new chemicals which had been notified in the EU, a similar exercise was started in 1993 on existing chemicals. In a first phase, the project addresses the High Production Volume (HPV) chemicals which are produced or imported at levels above a 1000t/year in the EU and 454t/year in the US. The relevant EU (Annex 1 of Existing Chemicals Regulation No. 793/93) and US-EPA lists contain 1036 and 2881 organic substances respectively of which HPV 749 chemicals are in common. The joint project aims at an estimation through validated QSAR models of the physical-chemical, ecotoxicity and toxicity endpoints which are included in the regulation and where experimental data will become available in IUCLID (International Unified Chemicals Information Database). Next to EC-JRC (ECB) and US-EPA, various laboratories in the EU are contributing to the project and recently, two institutes in Japan have joined in this project.

Comparison of Benzyl Adenine Metabolism in Two Petunia hybrida Lines Differing in Shoot Organogenesis.

The uptake and metabolism of the cytokinin benzyl adenine (BA) was compared in two lines of Petunia hybrida Vilm. differing in their shoot organogenic response. Leaf transfer experiments using shoot induction medium containing 4.4 micromolar BA showed that leaf explants from petunia line St40 required a shoot induction period of 6 to 10 days for commitment to shoot organogenesis; whereas leaf explants from petunia TLV1 required 12 to 28 days. The short induction period of petunia St40 and the higher organogenic response was positively associated with a threefold higher absorption of BA from the medium, an increased BA ribotide metabolite pool, the presence of BA within the explant during the shoot induction period, and the production of an unidentified metabolite C. However, the study of petunia TLV1 leaf explants showed that neither BA nor metabolite C are required during the shoot induction period for eventual shoot development. The longer shoot induction period of TLV1 was associated with low BA uptake during 24 days, a decreasing ribotide metabolite pool, the absence of benzyl adenosine triphosphate and metabolite C throughout the study, and the absence of BA within the explant during the shoot induction period. Differences in the shoot organogenic response of these related plant lines have been shown to be associated with differences in exogenous cytokinin uptake and the subsequent metabolism of that hormone.

The crystalline lens after vitrectomy for diabetic retinopathy.

We reviewed the records of 596 consecutive cases of vitrectomy performed for complications of diabetic retinopathy at the Wilmer Eye Institute. Accidental lens damage occurred during surgery in three eyes. Fourteen (8%) of 180 phakic eyes underwent later cataract removal. Follow-up of at least six months and detailed description of the lens at final examination were available in 151 eyes. Of these, visually significant opacities occurred in 32 eyes (21%), and the lens opacities accounted for substantial loss of final vision in 6 (19%) of these 32 eyes. Moderate or severe lens opacities that developed postoperatively were as follows: anterior subcapsular or cortical changes in 2 eyes (1%), nuclear sclerosis in 11 eyes (7%), posterior subcapsular changes in 25 eyes (17%). One hundred twenty-five preoperative, operative and postoperative factors were analyzed for each patient to detect correlations with postoperative lens changes. Nuclear sclerotic changes correlated with older patient age. Posterior subcapsular changes correlated with three intraoperative factors: longer duration of the operation, use of intravitreal gas, and use of a gas bubble filling more than 50% of the vitreous cavity. Posterior subcapsular changes were progressive with longer follow-up.

Cystoid macular edema in pseudophakia.

Cystoid macular edema after cataract surgery, with or without intraocular lens implantation, has been reported to develop in more than 50% of patients as detected by fluorescein angiography. It is associated with reduced visual acuity in up to 8% of cases. Analysis of ongoing clinical trials at the Wilmer Institute indicates that clinically significant cystoid macular edema develops in a lower percentage of cases (2% total incidence and 0.3% persistent cystoid macular edema) if the intraocular lens implantation was uncomplicated. The factors associated with cystoid macular edema and the importance of considering clinically significant rather than just fluorescein-proven cystoid macular edema are discussed. Results of intraocular lens studies reported to the Federal Drug Administration are updated, and results of an ongoing study of prostaglandin inhibitors at the Wilmer Institute are reported.

Pars plana vitrectomy for complicated retinal detachments.

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.

Lung function among employees of a copper mine smelter: lack of effect of chronic sulfur dioxide exposure.

Lung function among 599 white male employees of a southeastern Tennessee copper mine/smelter operation was compared according to smoking history and occupational experience. The job categories compared included employees with work histories in low sulfur dioxide [SO2] environments (both underground mining and non-mining), in high SO2 exposure work areas, and in those with transient exposure to SO2. Miners with low SO2 exposure were found to have lower lung function indices (both FVC AND FEV1) than did employees in other job categories. Smoking history was strongly associated with low FEV1. After adjusting for smoking history, cumulative long-term exposure to SO2 was not demonstrated to contribute to decreased lung function.