Dandy-Walker malformation associated with subarachnoid hemorrhage. A case report.

INTRODUCTION: Dandy-Walker malformation is a rare congenital brain defect characterized by vermian agenesia with cystic dilatation of the fourth ventricle, and posterior fossa enlargement. The etiology is still poorly understood but is presupposed to be multifactorial, infrequently caused by intracranial hemorrhage. We describe a case of male newborn known to have Dandy-Walker malformation associated with subarachnoid bleeding after the delivery, which is a quiet rare presentation only discussed in a few literatures before. CASE PRESENTATION: We present a rare case of a full-term male baby delivered vaginally, who was diagnosed with Dandy-Walker malformation during antenatal anomaly scan. At birth, the baby presented with a weak cry, cyanosis, respiratory distress and seizure. Post-delivery computed tomography scan revealed subarachnoid hemorrhage. In addition, a hydrocephalus was noted on the imaging and treated with ventriculoperitoneal shunt insertion with marked improvement of the posterior fossa cyst and the hydrocephalus as an outcome of early intervention. DISCUSSION: Few literature studies showed an association between intracranial bleeding during early fetal life and the development of Dandy-Walker malformation as it affects the posterior fossa components growth. However, our case highlights on an unusual presentation of the spontaneous subarachnoid hemorrhage after the delivery in a full-term baby diagnosed with Dandy-Walker malformation earlier. CONCLUSION: This report highlights the importance of early recognition and implementing appropriate management of the hydrocephalus that associated with intracerebral bleeding to prevent the complications of high intracranial pressure plus brainstem herniation and achieve the best possible outcome.

Thymoquinone induces mitochondria-mediated apoptosis in acute lymphoblastic leukaemia in vitro.

There has been a growing interest in naturally occurring compounds from traditional medicine with anti-cancer potential. Nigella sativa (black seed) is one of the most widely studied plants. This annual herb grows in countries bordering the Mediterranean Sea and India. Thymoquinone (TQ) is an active ingredient isolated from Nigella sativa. The anti-cancer effect of TQ, via the induction of apoptosis resulting from mitochondrial dysfunction, was assessed in an acute lymphocyte leukemic cell line (CEMss) with an IC50 of 1.5 µg/mL. A significant increase in chromatin condensation in the cell nucleus was observed using fluorescence analysis. The apoptosis was then confirmed by Annexin V and an increased number of cellular DNA breaks in treated cells were observed as a DNA ladder. Treatment of CEMss cells with TQ encouraged apoptosis with cell death-transducing signals by a down-regulation of Bcl-2 and up-regulation of Bax. Moreover, the significant generation of cellular ROS, HSP70 and activation of caspases 3 and 8 were also observed in the treated cells. The mitochondrial apoptosis was clearly associated with the S phase cell cycle arrest. In conclusion, the results from the current study indicated that TQ could be a promising agent for the treatment of leukemia.

Transcranial Doppler in brain death assessment. Perspective and implications in the Saudi Arabian health system.

Transcranial Doppler is a non-invasive, non-ionizing ultrasound-based imaging modality that is inexpensive with a short learning curve. It can be performed and interpreted at the bedside. This review explores the value of the transcranial Doppler technique as a confirmatory tool for brain death. The early confirmation of brain death enables the treating physicians in early decision-making and family counseling toward better care approaches, including the option of organ donation for transplantation at the appropriate time. We recommend this modality be incorporated as part of the brain death criteria in the Saudi Arabian health care system guidelines and utilized in different tiers of our hospital system.

Severe Cerebral Vasospasm Caused by Acute on Top of Chronic Spontaneous Subdural Hematoma: A Case Report and Review of the Literature.

Cerebral vasospasm is a well-known phenomenon that has been associated with subarachnoid hemorrhage due to aneurysmal bleeding. It can lead to serious outcomes if not recognized and treated promptly. It happens most frequently following cases of aneurysmal subarachnoid hemorrhage. Other causes include traumatic brain injury, reversible cerebral vasoconstriction syndrome, post-tumor resection, and non-aneurysmal subarachnoid hemorrhage. We describe a case of severe clinical vasospasm following acute on top of chronic spontaneous subdural hematoma in a patient with corpus callosum agenesis. Also, a small literature review of the possible risk factors of such occurrence is discussed.

Cardioprotective Effect of Olive Oil Against Ischemia Reperfusion-induced Cardiac Arrhythmia in Isolated Diabetic Rat Heart.

Background Olive oil is rich in monounsaturated fatty acids and has been reported for a variety of beneficial cardiovascular effects, including blood pressure lowering, anti-platelet, anti-diabetic, and anti-inflammatory effects. Diabetes is a major risk factor for cardiac dysfunctions, and olive oil prevents diabetes-induced adverse myocardial remodeling. Objective The study aimed to evaluate the effects of olive oil against streptozotocin-induced cardiac dysfunction in animal models of diabetes and ischemia and reperfusion (I/R)-induced cardiac arrhythmias. Methods Diabetes was induced in male rats with a single intraperitoneal injection of streptozotocin (60 mg/kg i.p), rats were treated for five, 15, or 56 days with olive oil (1 ml/kg p.o). Control animals received saline. Blood glucose and body weight were monitored every two weeks. At the end of the treatment, rats were sacrificed and hearts were isolated for mounting on Langedorff's apparatus. The effect of olive oil on oxidative stress and histopathological changes in the cardiac tissues were studied. Results The initial blood glucose and body weight were not significantly different in the control and olive-treated animals. Streptozotocin (60 mg/kg i.p) caused a significant increase in the blood glucose of animals as compared to saline-treated animals. The control, saline-treated diabetic animals exhibited a 100% incidence of I/R-induced ventricular fibrillation, which was reduced to 0% with olive oil treatment. The protective effects of olive oil were evident after 15 and 56 days of treatment. Diltiazem, a calcium channel blocker (1 µm/L) showed similar results and protected the I/R-induced cardiac disorders. The cardiac tissues isolated from diabetic rats exhibited marked pathological changes in the cardiomyocytes, including decreased glutathione (GSH) and increased oxidative stress (malondialdehyde; MDA). Pretreatment of animals with olive oil (1 ml/kg p.o) increased GSH and decreased MDA levels. Olive oil also improved the diabetic-induced histopathological changes in the cardiomyocytes. Conclusion Olive oil possesses cardiac protective properties against I/R-induced cardiac arrhythmias in rats. It attenuated oxidative stress and diabetes-induced histopathological changes in cardiac tissues. The observed cardiac protectiveness of olive oil in the present investigation may be related to its antioxidant potential.

The longitudinal impact of COVID-19 pandemic on neurosurgical practice.

OBJECTIVE: This observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice. METHODS: We included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time. RESULTS: During the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5-8). The number of cases declined from 72 in the first week and plateaued at the 30's range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4-18) to 6 (IQR: 3-13) to 5 days (IQR: 2-8). There was no significant among-period difference with respect to institution type, complications, or mortality. CONCLUSION: Our study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.

Comprehensive Review on Phytochemicals, Pharmacological and Clinical Potentials of Gymnema sylvestre.

Gymnema sylvestre is a plant included in Apocynaceae family and is located in many regions of Asia, Africa and Australia. This plant is widely used as a traditional therapy for different purposes. Even now it is being used as a dietary supplement due to its numerous therapeutic uses. It is known to have blood glucose lowering potential and, thus, is widely used in traditional and Ayurvedic systems of medicine. It renders glucose lowering activity due to the presence of phytochemicals, such as gurmarin, gymnemic acid as well as gymnemasaponins. Gymnema sylvestre is also known to have anti-oxidant, antibiotic, anti-inflammatory, antiviral, gastro and hepatoprotective, anticancer and lipid-lowering activities. This review discusses in details on different pharmacological and clinical potentials of Gymnema sylvestre and its chemical constituents associated with its therapeutic potentials.

Prophetic medicine as potential functional food elements in the intervention of cancer: A review.

Amounting scientific evidences have revealed the antitumor, antimetastatic, antiangiogenic, antiproliferative, chemopreventive and neo-adjuvant efficacy of Prophetic Medicine in various in vitro, in vivo and clinical cancer models. Prophetic Medicine includes plants, dietary materials or spices that were used as remedy recipes and nutrition by the great Prophet Mohammed (peace be upon him) to treat various ailments. Prophetic medicine is the total authentic Hadith narrated by the Prophet (PBUH) in relation to medicine, whether Qur'anic verses or honourable Prophetic Hadith. The ability of functional foods from Prophetic Medicine to modulate various signalling pathways and multidrug resistance conferring proteins with low side-effects exemplify their great potential as neo-adjuvants and/or chemotherapeutics. The present review aims to provide the collective in vitro, in vivo, clinical and epidemiology information of Prophetic Medicines, and their bioactive constituents and molecular mechanisms as potential functional foods for the management of cancer.

Antiproliferative and apoptosis inducing effects of citral via p53 and ROS-induced mitochondrial-mediated apoptosis in human colorectal HCT116 and HT29 cell lines.

Despite various anticancer reports, antiproliferative and apoptosis inducing activity of citral in HCT116 and HT29 cells have never been reported. This study aimed to evaluate the cytotoxic and apoptosis inducing effects of citral in colorectal cancer cell lines. The citral-treated cells were subjected to MTT assay followed by flow cytometric Annexin V-FITC/PI, mitochondrial membrane potential and intracellular reactive oxygen species (ROS) determination. The apoptotic proteins expression was investigated by Western blot analysis. Citral inhibited the growth of HCT116 and HT29 cells by dose- and time-dependent manner without inducing cytotoxicity in CCD841-CoN normal colon cells. Flow cytometric analysis showed that citral (50-200µM; 24-48h) induced the externalization of phoshpotidylserine and reduced the mitochondrial membrane potential in HCT116 and HT29 cells. Citral elevated intracellular ROS level while attenuating GSH levels in HCT116 and HT29 cells which were reversed with N-acetycysteine (2mM) pre-treatment indicating that citral induced mitochondrial-mediated apoptosis via augmentation of intracellular ROS. Citral induced the phosphorylation of p53 protein and the expression of Bax while decreasing Bc-2 and Bcl-xL expression which promoted the cleavage of caspase-3. Collectively, our data suggest that citral induced p53 and ROS-mediated mitochondrial-mediated apoptosis in human colorectal cancer HCT116 and HT29 cells.

Simple and safe method of cranial reconstruction after posterior fossa craniectomy.

BACKGROUND: Reconstructing the posterior fossa after surgical intervention in this region is important both for prevention of postoperative complication such as headache and for cosmetic purposes. Several methods have been reported that use either synthetic or natural graft, the latter being either autograft or allograft. The previously described methods require either surgical intervention on a second setting or an additional procedure that prolongs the time of the surgery and may contribute to morbidity. The present report describes a simple modified method of reconstructing the postcraniectomy defect by using the patients' own bone dust, tissue glue, and gel foam sheets. METHODS: The method of reconstruction requires collection of as much as possible of the produced bone dust at the time of craniectomy, adding tissue glue, placing in between 2 sheets of gel foam, and shaping it to match the surgical defect. RESULTS: Ten cases of various posterior fossa pathologies managed at King Faisal hospital of the university between January 2000 and September 2004 had reconstruction of the posterior fossa after craniectomy during the same operative setting using the described method of cranial reconstruction. No complication was noted. Patients did not have any delayed postcraniectomy pain at reconstruction site. Postoperative plane x-ray of the skull and computed tomography showed good healing and shaping of the suboccipital bone at the surgical defect. CONCLUSIONS: Reconstructive cranioplasty is an important part of any posterior fossa exposure. The present report describes a safe and simple method that gives acceptable results both clinically and radiologically.

Huge occipital myxomatous plexiform neurofibroma in the absence of neurofibromatosis.

A case of huge occipital myxomatous plexiform neurofibroma is presented. The lesion slowly enlarged since childhood and was associated with suboccipital bone hypoplasia. At operation the lesion was clearly originating from the occipital nerve and was totally excised. The case represents a rare occurrence of occipital myxomatous plexiform neurofibroma and suboccipital bone hypoplasia in the absence of evidence of neurofibromatosis.

Anti-proliferative effect and phytochemical analysis of Cymbopogon citratus extract.

The antiproliferative and antioxidant potential of Cymbopogon citratus (Lemon grass) extracts were investigated. The extracts were isolated by solvent maceration method and thereafter subjected to antiproliferative activity test on five different cancer cells: human colon carcinoma (HCT-116), breast carcinoma (MCF-7 and MDA-MB 231), ovarian carcinoma (SKOV-3 and COAV), and a normal liver cell line (WRL 68). The cell viability was determined using MTT assay. The DPPH radical scavenging assay revealed a concentration dependent trend. A maximum percentage inhibition of 45% and an IC50 of 278 µg/mL were observed when aqueous extract was evaluated. In contrast, 48.3% and IC50 of 258.9 µg/mL were observed when 50% ethanolic extract was evaluated. Both extracts at concentration of 50 to 800 µg/mL showed appreciative metal chelating activity with IC50 value of 172.2 ± 31 µg/mL to 456.5 ± 30 µg/mL. Depending on extraction solvent content, extract obtained from 50% ethanolic solvent proved to be more potent on breast cancer MCF-7 cell line (IC50 = 68 µg/mL). On the other hand, 90% ethanolic extract showed a moderate potency on the ovarian cancer (COAV) and MCF-7 cells having an IC50 of 104.6 µg/mL each. These results suggested antiproliferative efficacy of C. citratus ethanolic extract against human cancer cell lines.

Determining the critical size of intracranial aneurysm predisposing to subarachnoid hemorrhage in the Saudi population.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) is a devastating event with a high rate of morbidity and mortality. With the improvement of diagnostic modalities and the adoption of different screening strategies, more aneurysms are being diagnosed prior to rupture. Based on large multi-center trials, size has become the most important determinant of treatment decisions. Unfortunately, these studies did not take into account the regional and racial variations, challenging the generalizability of their results. MATERIAL AND METHODS: We conducted a retrospective analysis on a series of 192 patients harboring 213 aneurysms. RESULTS: The critical finding in our study is that the majority of patients presenting with SAH due to ruptured aneurysms are <10 mm in size. CONCLUSION: Decision to treatment of a given unruptured intracranial aneurysm should be individually assessed and not taken from general international literature as this may mistakenly apply factors from one population to another.

Efficacy of acrylate tissue adhesive as vascular repair and hemostatic material.

The objective of the study was to determine the efficacy of utilizing n-butyl cyanoacrylate (NBCA) tissue adhesive glue as a vascular repair and hemostatic material in the closure of vascular wounds using a prospective, animal-based design. The study was performed on the carotid arteries of 22 goats. The experiment was performed on bilateral carotid arteries (44 procedures). In each animal, both carotid arteries were opened by a procedure simulating carotid endarterectomy. On one side, the repair material was conventional sutures; on the other side, NBCA tissue glue was utilized. The main outcome measures were duration of total flow arrest (clamping time), duration of time from start of arterial repair to complete hemostasis after clip removal (repair time), any additional stitches required after repairing either by stitch or by NBCA, and hematoxylin and eosin histopathology preparations. Forty-four simulated carotid endarterectomy and repair procedures were performed in 22 adult goats. The average repair time on the stitch side was 437 sec and on the NBCA side, 169 sec (P < 0.001). The average clamping time on the stitch side was 716 sec and on the NBCA side, 477 sec (P < 0.001). Macroscopic pathological study did not reveal any significant luminal stenosis. Foreign body microscopic changes were similarly present in both the NBCA and stitch groups, with no significant difference. This is a prospective animal-based controlled study looking into the efficacy of NBCA tissue glue as a material for arterial repair in comparison to classical suture repair. NBCA tissue adhesive glue may be of value especially when fast control of bleeding is required.