The Role of Neurosurgical Techniques in Management of Acute and Chronic Stroke: A Comprehensive Literature Review.

Stroke is a medical condition that results from a decreased or completely diminished supply of blood to the brain, and it is considered one of the major causes of morbidity and mortality globally. Stroke is categorized as ischemic and hemorrhagic stroke, both of which demand prompt and particular timely intervention. This extensive review is done to investigate the precise management of acute and chronic manifestations of stroke in relation to neurosurgical interventions, ultimately providing a thorough analysis regarding indications, procedures, outcomes, and complications that are associated with it. In this regard, a pervasive review of literature was carried out, which was primarily sourced from literature databases such as PubMed. This paper particularly outlines a sound relative analysis of anticipating the competence of each neurosurgical technique in use. Endovascular clot retrieval (ECR) has been particularly highlighted, as its effectiveness has been profoundly observed when selected as a treatment option within a time period of 6-24 hours following an ischemic stroke. In less than a time frame of 48 hours, decompressive hemicraniectomy (DH) is usually considered the most suitable treatment for cases of intracranial hypertension resulting from middle cerebral artery (MCA) infarction. Hemorrhages that occur due to ruptured aneurysms are most commonly dealt with clipping and neuroendovascular techniques. Additionally, considering that revascularization surgery is time-sensitive, the results can ultimately vary. Competent results have been linked with stereotactic surgery, which includes deep brain stimulation (DBS) and focused ultrasound ablation (FUSA), which are also famous for being minimally invasive in nature. However, the broader application of these techniques is hindered by the absence of established protocols. This review highlights the importance of timely interventions, advanced equipment, and precise medical protocols to optimize treatment outcomes.

Red Sea Sponge Callyspongia siphonella Extract Induced Growth Inhibition and Apoptosis in Breast MCF-7 and Hepatic HepG-2 Cancer Cell Lines in 2D and 3D Cell Cultures.

Introduction: The increasing incidence of cancer diseases necessitates the urgent exploration of new bioactive compounds. One of the trends in drug discovery is marine sponges which is gaining significant support due to the abundant production of natural pharmaceutical compounds obtained from marine ecosystems. This study evaluates the anticancer properties of an organic extract from the Red Sea sponge Callyspongia siphonella (C. siphonella) on HepG-2 and MCF-7 cancer cell lines. Methods: C. siphonella was collected, freeze-dried, and extracted using a methanol-dichloromethane mixture. The extract was analyzed via Liquid Chromatography-Mass Spectrometry. Cytotoxic effects were assessed through cell viability assays, apoptosis detection, cell cycle analysis, mitochondrial membrane potential assays, scratch-wound healing assays, and 3D cell culture assays. Results: Fifteen compounds were identified in the C. siphonella extract. The extract showed moderate cytotoxicity against MCF-7 and HepG-2 cells, with IC50 values of 35.6 ± 6.9 µg/mL and 64.4 ± 8 µg/mL, respectively, after 48 hours of treatment. It induced cell cycle arrest at the G2/M phase in MCF-7 cells and the S phase in HepG-2 cells. Apoptosis increased significantly in both cell lines, accompanied by reduced mitochondrial membrane potential. The extract inhibited cell migration, with notable reductions after 24 and 48 hours. In 3D cell cultures, the extract had IC50 values of 5.1 ± 2 µg/mL for MCF-7 and 166.4 ± 27 µg/mL for HepG-2 after 7 days of treatment, showing greater potency in MCF-7 spheres compared to HepG-2 spheres. Discussion and Conclusion: The anticancer activity is attributed to the bioactive compounds. The C. siphonella extract's ability to induce apoptosis, disrupt mitochondrial membrane potential, and arrest the cell cycle highlights its potential as a novel anticancer agent. Additional research is required to investigate the underlying mechanism by which this extract functions as a highly effective anticancer agent.

NowIKnowMyABCD: A global resource hub for researchers using data from the ABCD Study.

The Adolescent Brain and Cognitive Development (ABCD) Study, involving over 11,000 youth and their families, is a groundbreaking project examining various factors impacting brain and cognitive development. Despite yielding hundreds of publications and counting, the ABCD Study has lacked a centralized help platform to assist researchers in navigating and analyzing the extensive ABCD dataset. To support the ABCD research community, we created NowIKnowMyABCD, the first centralized documentation and communication resource publicly available to researchers using ABCD Study data. It consists of two core elements: a user-focused website and a moderated discussion board. The website serves as a repository for ABCD-related resources, tutorials, and a live feed of relevant updates and queries sourced from social media websites. The discussion board offers a platform for researchers to seek guidance, troubleshoot issues, and engage with peers. Our aim is for NowIKnowMyABCD to grow with participation from the ABCD research community, fostering transparency, collaboration, and adherence to open science principles.

Development of a rapid HPLC-fluorescence method for monitoring warfarin metabolites formation: In vitro studies for evaluating the effect of piperine on warfarin metabolism and plasma coagulation.

Warfarin, a widely prescribed anticoagulant, is highly effective for various coagulation disorders. However, its efficacy is limited by a narrow therapeutic index and frequent drug interactions, especially those involving metabolism by Cytochrome P450 (CYP450) enzymes. Piperine, found in black and long pepper, possesses blood-thinning properties and has been observed to inhibit CYP3A and CYP2C enzymes linked to warfarin metabolism. This study investigated the effect of piperine on warfarin metabolism in liver microsomes using a rapid and sensitive HPLC-Fluorescence method. The use of PFP (pentafluorophenyl) column with core shell particles provided the selectivity and resolution to resolve warfarin and its 4-, 6-, 7-, and 10-hydroxy metabolites in addition to the internal standard naproxen in less than 3 min. This is the fastest analytical assay for warfarin and its major metabolites reported to date, making it ideal for metabolic studies. The applicability of the method was demonstrated by monitoring the metabolism of S-warfarin in human and rat liver microsomes, and evaluating the inhibitory effect of piperine on metabolite formation. The results showed that piperine inhibited the formation of the major metabolite, 7-hydroxywarfarin, with half-maximal inhibitory concentration (IC50) 14.2 µM and 3.2 µM in human and rat liver microsomes, respectively. Furthermore, coagulation studies in vitro using rat plasma showed that piperine does not affect prothrombin time (PT) and activated partial thromboplastin time (aPTT). This study suggested that piperine may present a potential drug interaction with warfarin at the metabolism level, but has no direct effect on the activation of the extrinsic or intrinsic coagulation cascades. Further clinical investigation is therefore required, as piperine may increase the bioavailability of warfarin, thus increasing risk of serious adverse events in patients.

Global Equity in Clinical Trials: An ASCO Policy Statement.

ASCO is a global professional society representing more than 50,000 physicians, other health care professionals, and advocates in over 100 countries specializing in cancer treatment, diagnosis, prevention, and advocacy. ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented or cured, and every survivor is healthy. In this pursuit, health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. This ASCO policy statement emphasizes the urgent need for global equity in clinical trials, aiming to enhance access and representation in cancer research as it not only improves cancer outcomes but also upholds principles of fairness and justice in health care.

Diabetes-related distress and its associated factors among people with type 2 diabetes in Southeast Ethiopia: a cross-sectional study.

BACKGROUND: Diabetes-related distress lowers the motivation for self-care, often leading to lowered physical and emotional well-being, poor diabetes control, poor medication adherence and increased mortality among individuals with diabetes. OBJECTIVE: To assess factors associated with diabetes-related distress among people living with type 2 diabetes in Southeast Ethiopia. DESIGN: Institution-based cross-sectional study was conducted. SETTING: Six diabetic follow-up care units at public hospitals in Southeast Ethiopia. PARTICIPANTS: All adult people living with type 2 diabetes from the diabetic follow-up clinic. THE MAIN OUTCOME MEASURES: Diabetes Distress Scale-17 questionnaire was used to assess diabetes-related distress. RESULTS: Out of the total 871 study participants intended, 856 participated in the study with a response rate of 98.3%. The findings showed that about 53.9% (95% CI 50.4% to 57.2%) of the patients have diabetes-related distress. Physical activity (adjusted OR, AOR 2.22; 95% CI 1.36 to 3.63), social support (AOR 4.41; 95% CI 1.62 to 12.03), glycaemic control (AOR 2.36; 95% CI 1.35 to 4.12) and other comorbidities (AOR 3.94; 95% CI 2.01 to 7.73) were factors that significantly associated with diabetes-related distress at p<0.05. CONCLUSION: This study demonstrated that more than half of the participants had diabetes-related distress. Therefore, the identified factors of diabetes-related distress need to be a concern for health institutions and clinicians in the management of people living with type 2 diabetes.

Evaluation of Cytotoxicity of the Methanolic Extract of Red Sea Marine Sponge Xestospongia Testudinaria and Its Related Compounds Against MCF-7 Human Breast Cancer Cells.

Background: Breast cancer is a leading cause of death and one of the most common fatal medical conditions in the world. Chemical compounds of various types have been identified in the Red Sea marine sponge Xestospongia testudinaria, including sterol esters, sterols, indole alkaloids, and brominated polyunsaturated fatty acids. These compounds have demonstrated promising biological features, which in cludes anti-inflammatory, cancer preventive, and antioxidant capacities. Methods: The cytotoxic potential of Xestospongia testudinaria was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and morphological alterations in MCF-7 cell line. Furthermore, the flow cytometry was also utilized to assess apoptosis and identify changes in the cell cycle; besides, cell migration was assessed by scratch wound-healing assay. Results: A significant dose-dependent decrease in the percentage of MCF-7 cell viability was observed with IC50 39.8 ug/mL. Functional studies were performed on MCF-7 to show that Xestospongia testudinaria raises apoptotic cell death and induces growth arrest at the G1/G0 while inhibiting cell migration in scratch assay. Conclusion: These results demonstrated that Xestospongia testudinaria extract has an inhibitory effect on breast cancer cells proliferation, migration and induce apoptosis. Thus, it holds great promise as a potential treatment for breast cancer.

Acetyl barlerin from Barleria trispinosa induces chemopreventive NQO1 and attenuates LPS-induced inflammation: in vitro and molecular dynamic studies.

Extraction and fractionation of Barleria trispinosa growing in Saudi Arabia yielded four iridoid compounds identified by spectroscopic techniques as acetylbarlerin (1), barlerin (2), shanzhiside methyl ester (3) and 6-⍺-L-rhamnopyranosyl-8-O-acetylshanzihiside methyl ester (4). Preliminary experiments confirmed that compound 1 acts as an inducer of chemopreventive NAD(P)H:Quinone oxidoreductase 1 (NQO1) enzymatic activity in a murine hepatoma (Hepa1c1c7) chemoprevention model. It also demonstrated the ability to inhibit the lipopolysaccharides (LPS)-induced nitric oxide (NO) production in the RAW264.7 macrophage model. Western blotting revealed the ability of compound 1 to up-regulate the protein expression of the NQO1 marker. Furthermore, compound 1 elicited NO suppression in RAW264.7 macrophages by inhibiting iNOS protein expression. Molecular docking and molecular simulation studies of 1 supported its experimental results as an inhibitor of the nuclear factor erythroid 2-Kelch-like ECH-associated protein 1 (Nrf2-KEAP1) complex, resulting in Nrf2-mediated induction of chemopreventive NQO1.Communicated by Ramaswamy H. Sarma.

The Impact of Negative Emotions on Binge Eating and BMI Among Medical Students.

Background Binge eating disorder (BED) is a condition characterized by episodes of consuming large amounts of food and feeling a lack of control over eating behavior. Stress, anxiety, and depression are risk factors for developing BED, which may be particularly relevant for medical students who experience high levels of academic pressure and stress. This study aims to investigate the prevalence of binge eating behaviors among medical students, as well as the types of negative emotions that are most strongly associated with binge eating. Methodology This cross-sectional study employed convenience sampling and included 332 medical students from Almaarefa University in Riyadh, Saudi Arabia. All medical students of all academic levels were eligible to participate in this study. Students from other colleges such as pharmacy students or students from other universities were excluded from this study. The research questionnaire collected information about negative emotions, BMI, number of meals, consumption of fast food, overeating behavior, and relevant demographic data. Descriptive and inferential statistics were used to analyze the data using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). Results The descriptive analysis showed that the majority of students reported consuming two meals per day and having snacks twice a day. Fast food consumption was reported by 58.1% of students. The study found that negative emotions such as stress, depression, and loneliness were significantly associated with binge eating behavior and had an impact on weight and BMI. The findings suggest the need for interventions to address negative emotions and promote healthy eating habits among medical students. Conclusion The study concludes that negative emotions such as stress, aggression, and boredom are significantly associated with binge eating behaviors among medical students. Depression, disappointment, and thoughts about difficult tasks were linked to detrimental effects on BMI and weight loss.

Safety preparedness in arab public schools.

Background: A proper and adequate school environment is important for an effective learning process and for the maintenance of students' health, given that they spend a considerable amount of time at school. Safety preparedness in schools includes, for example, protection from biological, physical, and chemical risks and physical hazards associated with poor construction and maintenance practices. Objectives: This study aims to evaluate safety preparedness in girls' public schools in the Kingdom of Saudi Arabia (KSA). Methods: Seventeen girls' schools were randomly selected in the Eastern Province of KSA. A designed checklist was used for this study, composed of two main parts. The first part included general information about the school, while the second part was composed of 6 items with a total of 58 questions, evaluating the school's safety preparedness. Results: The safety preparedness in the studied schools ranged between 70 and 90%. Some safety practices were found to be adequately applied, others were poorly applied, and certain items were completely absent. Generally, some examined schools were not compliant several safety and emergency preparedness recommendations. Conclusion: Collaboration between the School Safety Committee and schools is essential to reach a satisfactory standard in terms of school safety. Therefore, it is recommended that the School Safety Committee engages with schools more actively, especially in terms of the preparation of a school safety management plan.

Long COVID syndrome: psychological and sexual dysfunction among survivors of COVID-19 infection.

Background: To explore the neuropsychiatric symptoms, sleep disturbances, and sexual dysfunction in patients with long COVID syndrome, which can help in building better follow-up strategies for coronavirus disease 2019 (COVID-19) survivors. Material and methods: A cross-sectional research was undertaken at the premises of a psychiatry unit at a tertiary care unit in Karachi, Pakistan, between August 2022 and April 2023. All individuals aged 18 years or older, who had a history of contracting COVID-19 infection in the last 12 months presented to the department of Psychiatry with neuropsychiatric symptoms were recruited. Using a predefined questionnaire, data was collected from the participants. A linear logistic regression was used to find the impact of age, sex, hospitalization, and duration of home isolation on the likelihood of persistent neuropsychiatric symptoms or sexual dysfunction. Results: A total of 457 patients were included. It was found that individuals were less likely to experience neuropsychiatric symptoms as age increased (OR=0.968, 95% CI: 0.949-0.986, P=0.001). Females were 4.8 times more likely to experience neuropsychiatric symptoms than males, and the association was extremely significant (OR=4.851, 95% CI: 3.085-7.626, P<0.0001). An increase in age raised the odds of having sleep disturbances among the survivors by 2.7 times (OR=2.672, 95% CI: 2.654-2.684, P<0.0001). The odds of having sleep disturbances were three times more likely in female participants as compared to male participants (OR=3.00, 95% CI: 1.771-5.094, P<0.0001). Conclusion: The majority of the COVID-19 survivors are presenting with persistent neuropsychiatric and sexual symptoms in our setting. Therefore, it is necessary to maintain proper follow-up with the survivors of COVID-19 and counsel the patients to inform the family physician if these symptoms persist for longer than a month. Increasing such practices of regular follow-ups with COVID-19 survivors can help in detecting early neuropsychiatric and sexual changes.

Functions of LncRNAs, exosomes derived MSCs and immune regulatory molecules in preeclampsia disease.

Modulatory signaling pathway such as T cell immunoreceptor with Ig and ITIM domains (TIGIT), Cytotoxic T-Lymphocyte Associated Protein 4 (CTLA-4), P53 signaling and TIM (T-cell immunoglobin and mucin domain) are important in normal pregnancy and loss of their functions or dysregulation of related genes can lead to some disorders. Inflammation is a process by which your body's white blood cells and the things they make protect you from infection from outside invaders, such as bacteria and viruses. Some cellular and molecular signaling have been categorized to demonstrate the mechanism that protects tolerance to antigens. lncRNAs significantly impact physiological processes like immunity and metabolism, and are linked to tumors, cardiovascular diseases, nervous system disorders, and nephropathy.In this review article, we summarized recent studies about the role of TIGIT, CTLA-4, P53 and TIM regulatory molecules and reviewed dysregulation of these pathway in diseases.We will also talk about the role of lncRNAs and mesenchymal stem cells.

HPLC methods for studying pharmacokinetics of tivozanib and in vitro metabolic interaction with dexamethasone in rat.

Tivozanib is a recently approved tyrosine kinase inhibitor for the treatment of renal cell carcinoma. In this work, two new HPLC methods coupled with fluorescence (FLD), or photodiode array detectors (PDA) were developed and used for the first time for tivozanib quantification in rat plasma and liver microsomes. The described methods were efficient with a 4-min runtime employing a Gemini-NX C18 column (50 × 2.1 mm, 3 µm) and a mobile phase of acetonitrile and ammonium acetate buffer (pH 4.7, 10 mM) (40:60, v/v) delivered at a flow rate of 0.4 mL/min. The use of HPLC-FLD allowed the quantification of 50 ng/ mL tivozanib using only 100 µL rat plasma. The HPLC-FLD method was validated according to the US food and drug administration (FDA) bioanalytical guidelines and was applied successfully in a rat pharmacokinetic study (n = 7) following oral administration of 1 mg/ kg tivozanib. Furthermore, HPLC-PDA was used for monitoring the depletion of 1 µM (454.9 ng/mL) tivozanib in rat liver microsomes and was applied to study the effect of dexamethasone induction on tivozanib metabolism in vitro. Results showed that dexamethasone enhanced the intrinsic clearance of tivozanib by 60 % suggesting a potential drug-drug interaction at the metabolism level. Dexamethasone is commonly used in the management of cancer disease and thus coadministration with tivozanib therapy may cause treatment failure in patients. The simplicity, speed and cost-effectiveness of the reported methods are ideal for supporting in vivo and in vitro tivozanib studies, including drug-drug interaction studies, particularly in bioanalytical labs lacking LC-MS/MS capabilities.

Volumetric changes in the size of odontogenic keratocysts after decompression followed by enucleation, peripheral ostectomy, and Carnoy's solution: A retrospective study.

The study aimed to retrospectively analyze the reduction pattern of odontogenic keratocysts (OKCs) after decompression, followed by enucleation (EN), peripheral ostectomy (PO), and Carnoy's solution (CS) to establish the appropriate time for inserting implants, along with assessing the long-term success of conservative treatment with adjunctive therapy. The predictable variables were the reduction pattern and the study's treatment option. The outcome variable was the volumetric changes in the size of bony defects. These changes were determined using a percentage difference and a reduction rate. They were recorded after decompression and one, three, six, twelve, and eighteen months after EN. P-values of .05 were considered significant. The study included 66 patients with 71 OKCs. Males, younger ages, and mandibular OKCs significantly predominated. The decompression significantly changed the initial volume from 135.40 ± 1.2 cm3 to 101.55 ± 0.1 cm3 with 28.6 percentage difference and 25% reduction rate. At the end of the first and third months after EN, the reduction pattern is 50.0%-75.5% of the initial volume, with no significant prediction for the direction of the reduction pattern. After 18 months, all bony defects disappeared, with no recurrences for the next 18 years. In conclusion, the reduction pattern is 75.5% of its initial volume at the end of the third month after OKC management. Therefore, within the limitations of the study, its treatment approach seems to be an option amongst other protocols that includes a view to early implant based dental rehabilitation.

Cavernous sinus thrombosis with bilateral orbital vein involvement and diffuse ischemic retinopathy / Trombose do seio cavernoso com envolvimento bilateral das veias orbitais e retinopatia isquêmica difusa

ABSTRACT A 53-year-old man with a 3-day history of periorbital swelling and vision loss in the left eye was found to have septic cavernous sinus thrombosis with bilateral orbital vein involvement causing congestive orbitopathy. He was treated with an emergent canthotomy and cantholysis, intraocular pressure-lowering drops, antibiotics, anticoagulation, and serial examinations. Optical coherence tomography ultimately revealed diffuse ischemic destruction of both layers of the retina, which suggested occlusion of the ophthalmic artery or the short posterior ciliary arteries and central retinal artery without intracavernous internal carotid artery involvement. The patient remained without light perception in the left eye after treatment.

RESUMO Um homem de 53 anos, com história de 3 dias de edema periorbital e perda de visão no olho esquerdo, apresentou trombose séptica do seio cavernoso com envolvimento bilateral das veias orbitais, causando uma orbitopatia congestiva. O paciente foi tratado com uma cantotomia e cantólise de emergência, colírios para redução da pressão intraocular, antibióticos, anticoagulantes e exames seriados. A tomografia de coerência óptica finalmente demonstrou destruição isquêmica difusa de ambas as camadas da retina, sugerindo uma oclusão da artéria oftálmica ou das artérias ciliares posteriores curtas e da artéria retiniana central, com ausência de envolvimento do segmento intracavernoso da artéria carótida interna. O paciente permaneceu sem percepção luminosa no olho esquerdo.

Video coding deep learning-based modeling for long life video streaming over next network generation.

Availability is one of the primary goals of smart networks, especially, if the network is under heavy video streaming traffic. In this paper, we propose a deep learning based methodology to enhance availability of video streaming systems by developing a prediction model for video streaming quality, required power consumption, and required bandwidth based on video codec parameters. The H.264/AVC codec, which is one of the most popular codecs used in video steaming and conferencing communications, is chosen as a case study in this paper. We model the predicted consumed power, the predicted perceived video quality, and the predicted required bandwidth for the video codec based on video resolution and quantization parameters. We train, validate, and test the developed models through extensive experiments using several video contents. Results show that an accurate model can be built for the needed purpose and the video streaming quality, required power consumption, and required bandwidth can be predicted accurately which can be utilized to enhance network availability in a cooperative environment.

Mohs Micrographic Surgery for Facial Merkel Cell Carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumor with frequent metastases. They often appear in the face where cosmetic and functional outcome is critical. Mohs micrographic surgery (MMS) is a controlled intervention that optimizes negative margins without sacrificing tissue. OBJECTIVE: A comprehensive assessment of outcomes of MMS-treated facial MCC will help guide clinicians in surgical and medical management. METHODS & MATERIALS: Retrospective review identified facial MCC cases treated with MMS at a single institution from January 2005 to August 2020. Tumor characteristics and outcomes were recorded and descriptive and predictive analyses were performed. RESULTS: 34 cases were reviewed with a mean followup of 34.4 months. The most common sites were the forehead, cheek-jaw region, and nasal ala. 2 (5.9%) patients had local recurrence by a mean of 4.3 months. No documented variables were significantly associated with local recurrence. 8 (23.5%) patients had progression to metastasis by a mean of 9.4 months. Younger age at biopsy and surgery, male sex, and intraoperative detection of in-transit disease were significantly associated with progression to metastasis. CONCLUSIONS: In summary, the tissue-sparing approach of MMS may be beneficial for MCC in cosmetically and functionally sensitive facial locations as it preserves tissue without compromising outcomes.

Review on Different Vesicular Drug Delivery Systems (VDDSs) and Their Applications.

BACKGROUND: Colloidal dispersions, also known as vesicular drug delivery systems (VDDSs), are highly ordered assemblies composed of one or more concentric bilayers formed by the self-assembly of amphiphilic building blocks in the presence of water. OBJECTIVE: VDDSs are important to target the entrapped drugs at specific sites inside the body, control the drug release, enhance the drug bioavailability, and reduce undesired side effects. METHODS: There are different types of VDDSs suitable for the entrapment of both hydrophilic and lipophilic drugs. According to the patent composition, VDDSs are classified into lipid-based and nonlipid- based VDDSs. RESULTS: There are different types of VDDSs which include liposomes, ethosomes, transferosomes, ufasomes, colloidosomes, cubosomes, niosomes, bilosomes, aquasomes, etc. Conclusion: This review article aims to address the different types of VDDSs, their advantages and disadvantages, and their therapeutic applications.

Cavernous sinus thrombosis with bilateral orbital vein involvement and diffuse ischemic retinopathy.

A 53-year-old man with a 3-day history of periorbital swelling and vision loss in the left eye was found to have septic cavernous sinus thrombosis with bilateral orbital vein involvement causing congestive orbitopathy. He was treated with an emergent canthotomy and cantholysis, intraocular pressure-lowering drops, antibiotics, anticoagulation, and serial examinations. Optical coherence tomography ultimately revealed diffuse ischemic destruction of both layers of the retina, which suggested occlusion of the ophthalmic artery or the short posterior ciliary arteries and central retinal artery without intracavernous internal carotid artery involvement. The patient remained without light perception in the left eye after treatment.

Contributions of Parasympathetic Arousal-Related Activity to Cognitive Performance in Patients With First-Episode Psychosis and Control Subjects.

BACKGROUND: Cognitive impairment is integral to the pathophysiology of psychosis. Recent findings implicate autonomic arousal-related activity in both momentary fluctuations and individual differences in cognitive performance. Although altered autonomic arousal is common in patients with first-episode psychosis (FEP), its contribution to cognitive performance is unknown. METHODS: A total of 24 patients with FEP (46% male, age = 24.31 [SD 4.27] years) and 24 control subjects (42% male, age = 27.06 [3.44] years) performed the Multi-Source Interference Task in-scanner with simultaneous pulse oximetry. First-level models included the cardiac-blood oxygen level-dependent regressor, in addition to task (congruent, interference, and error) and nuisance (motion and CompCor physiology) regressors. The cardiac-blood oxygen level-dependent regressor reflected parasympathetic arousal-related activity and was created by convolving the interbeat interval at each heartbeat with the hemodynamic response function. Group models examined the effect of group or cognitive performance (reaction times × error rate) on arousal-related and task activity, while controlling for sex, age, and framewise displacement. RESULTS: Parasympathetic arousal-related activity was robust in both groups but localized to different regions for patients with FEP and healthy control subjects. Within both groups, arousal-related activity was significantly associated with cognitive performance across occipital and temporal cortical regions. Greater arousal-related activity in the bilateral prefrontal cortex (Brodmann area 9) was related to better performance in healthy control subjects but not patients with FEP. CONCLUSIONS: Autonomic arousal circuits contribute to cognitive performance and the pathophysiology of FEP. Arousal-related functional activity is a novel indicator of cognitive ability and should be incorporated into neurobiological models of cognition in psychosis.