The Intersectoral Global Action Plan (IGAP): A unique opportunity for neurology across the globe.

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions.

Epidemic of Mucormycosis in COVID-19 Pandemic: A Position Paper.

During the second wave of COVID-19 pandemic, there is a sudden increase in number of cases mucormycosis infection in India. This communication by the Tropical Neurology subsection expert group of the Indian Academy of Neurology (IAN) describes the clinical and diagnostic features, treatment of the disease and gives recommendations about the ways forward.

Neurosyphilis, A True Chameleon of Neurology.

BACKGROUND: Neurosyphilis (NS) is a rarely encountered scenario today. Manifestations are heterogeneous, and their characteristics have changed in the antibiotic era. A differential diagnosis of NS is not commonly thought of even with relevant clinical-radiological features, as it mimics many common neurological syndromes. OBJECTIVES: To study the manifestations of NS in the present era and the process of diagnosis. METHOD: The data of ten patients with NS was collected and analyzed. Their background data, clinical features, investigations, the process of reaching the diagnosis, management and outcomes were recorded. OBSERVATIONS AND RESULTS: The manifestations of NS in our cohort included six patients with cognitive decline/encephalopathy and one each with meningitis with cranial nerve palsies, cerebellar ataxia, myelitis and asymptomatic NS. The presence of Argyll Robertson pupil helped to clinch diagnosis in one patient. Treponemal tests were ordered in two patients only after alternative etiologies were looked at, to begin with, whereas in six patients treponemal test was requested as a part of standard workup for dementia/ataxia. CONCLUSIONS: NS dementia and behavior changes are mistaken for degenerative, vascular, nutritional causes, autoimmune encephalitis or prion disease. Meningitis has similarities with infective (tubercular), granulomatous (sarcoidosis, Wegener's), collagen vascular disease and neoplastic meningitis, and myelitis simulates demyelination or nutritional myelopathy (B12 deficiency). Rarely, NS can also present with cerebellar ataxia. Contemplate NS as one of the rare causes for such syndromes, and its early treatment produces good outcomes.

An Efficient Electronic Cash System Based on Certificateless Group Signcryption Scheme Using Conformable Chaotic Maps.

Signcryption schemes leveraging chaotic constructions have garnered significant research interest in recent years. These schemes have proffered practical solutions towards addressing the vast security vulnerabilities in Electronic Cash Systems (ECS). The schemes can seamlessly perform message confidentiality and authentication simultaneously. Still, their applications in emerging electronic cash platforms require a higher degree of complexity in design and robustness, especially as billions of online transactions are conducted globally. Consequently, several security issues arise from using open wireless channels for online business transactions. In order to guarantee the security of user information over these safety-limited channels, sophisticated security schemes are solely desired. However, the existing signcryption schemes cannot provide the required confidentiality and authentication for user information on these online platforms. Therefore, the need for certificateless group signcryption schemes (CGSS) becomes imperative. This paper presents an efficient electronic cash system based on CGSS using conformable chaotic maps (CCM). In our design, any group signcrypter would encrypt information/data with the group manager (GM) and send it to the verifier, who confirms the authenticity of the signcrypted information/data using the public criteria of the group. Additionally, the traceability, unforgeability, unlinkability, and robust security of the proposed CGSS-CCM ECS scheme have been built leveraging computationally difficult problems. Performance evaluation of the proposed CGSS-CCM ECS scheme shows that it is secure from the Indistinguishably Chosen Ciphertext Attack. Finally, the security analysis of the proposed technique shows high efficiency in security-vulnerable applications. Overall, the scheme gave superior security features compared to the existing methods in the preliminaries.

A Provably Secure IBE Transformation Model for PKC Using Conformable Chebyshev Chaotic Maps under Human-Centered IoT Environments.

The place of public key cryptography (PKC) in guaranteeing the security of wireless networks under human-centered IoT environments cannot be overemphasized. PKC uses the idea of paired keys that are mathematically dependent but independent in practice. In PKC, each communicating party needs the public key and the authorized digital certificate of the other party to achieve encryption and decryption. In this circumstance, a directory is required to store the public keys of the participating parties. However, the design of such a directory can be cost-prohibitive and time-consuming. Recently, identity-based encryption (IBE) schemes have been introduced to address the vast limitations of PKC schemes. In a typical IBE system, a third-party server can distribute the public credentials to all parties involved in the system. Thus, the private key can be harvested from the arbitrary public key. As a result, the sender could use the public key of the receiver to encrypt the message, and the receiver could use the extracted private key to decrypt the message. In order to improve systems security, new IBE schemes are solely desired. However, the complexity and cost of designing an entirely new IBE technique remain. In order to address this problem, this paper presents a provably secure IBE transformation model for PKC using conformable Chebyshev chaotic maps under the human-centered IoT environment. In particular, we offer a robust and secure IBE transformation model and provide extensive performance analysis and security proofs of the model. Finally, we demonstrate the superiority of the proposed IBE transformation model over the existing IBE schemes. Overall, results indicate that the proposed scheme posed excellent security capabilities compared to the preliminary IBE-based schemes.

Fractional chaotic maps based short signature scheme under human-centered IoT environments.

Introduction: The Internet of Things (IoT) comprises of various smart devices for the sharing of sensed data through online services. People will be directly contacted to check their health parameters and the reports will be collected centrally through smart devices. The requirement is protection of messages during the exchange of data between sender and receiver in order to tackle human malicious attacks. Various signature-based schemes are discussed in the literature to provide secure communication. Smart devices however require lightweight tasks by ensuring critical safety strengths. An important problem in the signature based method is that it incurs more computational expenses for signing and verification process in large numbers. Objectives: In this study, we introduced an efficient Short Signature Scheme (SSS) that uses Fractional Chaotic Map (FCM) for secure communication in IoT based smart devices, the security of which is closely related to a random oracle based on FCM assumption. Methods: In this study, we have designed new short signature scheme using FCM. The presented scheme consist of four sub-algorithm as follows: setup, key generation, signing and verification. We have used less rigorous operations based on the FCM to carry out signing and verification procedures, similar to human signing on valid documents and then verifying them as per witness. Results: The proposed SSS offers a better security assurance than currently established signature schemes. The key advantage of the SSS over the DSA schemes is that at the verification stage and signing period it takes less computation; it retains the degree of protection. The presented SSS takes less bandwidth for storage, communication, and computing resources; particularly applicable to wireless devices and smart cards. Conclusion: We concluded that the uses of fractional chaotic maps is more effective for secure communication in human-centered IoT to present a provably secure short signature technique.

Performance Measurement System and Quality Management in Data-Driven Industry 4.0: A Review.

The birth of mass production started in the early 1900s. The manufacturing industries were transformed from mechanization to digitalization with the help of Information and Communication Technology (ICT). Now, the advancement of ICT and the Internet of Things has enabled smart manufacturing or Industry 4.0. Industry 4.0 refers to the various technologies that are transforming the way we work in manufacturing industries such as Internet of Things, cloud, big data, AI, robotics, blockchain, autonomous vehicles, enterprise software, etc. Additionally, the Industry 4.0 concept refers to new production patterns involving new technologies, manufacturing factors, and workforce organization. It changes the production process and creates a highly efficient production system that reduces production costs and improves product quality. The concept of Industry 4.0 is relatively new; there is high uncertainty, lack of knowledge and limited publication about the performance measurement and quality management with respect to Industry 4.0. Conversely, manufacturing companies are still struggling to understand the variety of Industry 4.0 technologies. Industrial standards are used to measure performance and manage the quality of the product and services. In order to fill this gap, our study focuses on how the manufacturing industries use different industrial standards to measure performance and manage the quality of the product and services. This paper reviews the current methods, industrial standards, key performance indicators (KPIs) used for performance measurement systems in data-driven Industry 4.0, and the case studies to understand how smart manufacturing companies are taking advantage of Industry 4.0. Furthermore, this article discusses the digitalization of quality called Quality 4.0, research challenges and opportunities in data-driven Industry 4.0 are discussed.

Iterative classifier optimizer-based pace regression and random forest hybrid models for suspended sediment load prediction.

Suspended sediment load is a substantial portion of the total sediment load in rivers and plays a vital role in determination of the service life of the downstream dam. To this end, estimation models are needed to compute suspended sediment load in rivers. The application of artificial intelligence (AI) techniques has become popular in water resources engineering for solving complex problems such as sediment transport modeling. In this study, novel integrative intelligence models coupled with iterative classifier optimizer (ICO) are proposed to compute suspended sediment load in Simga station in Seonath river basin, Chhattisgarh State, India. The proposed models are hybridization of the random forest (RF) and pace regression (PR) models with the iterative classifier optimizer (ICO) algorithm to develop ICO-RF and ICO-PR hybrid models. The recommended models are established using the discharge and sediment daily data spanning a 35-year period (1980-2015). The accuracy of the developed models is examined in terms of error; by root mean square error (RMSE) and mean absolute error (MAE); and based on a correlation index of determination coefficient (R2). The proposed novel hybrid models of ICO-RF and ICO-PR have been found to be more precise than their stand-alone counterparts of RF and PR. Overall, ICO-RF models delivered better accuracy than their alternatives. The results of this analysis tend to claim the appropriateness of the implemented methodology for precise modeling of the suspended sediment load in rivers.

The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries.

A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, and less frequently cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage, usually occur as part of a thrombotic state induced by viral attachment to ACE2 receptors in endothelium causing widespread endotheliitis, coagulopathy, arterial and venous thromboses. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. A frontal hypoperfusion syndrome has been identified. There are isolated reports of seizures, encephalopathy, meningitis, encephalitis, and myelitis. The neurological diseases affecting the PNS and muscle in COVID-19 are less frequent and include Guillain-Barré syndrome; Miller Fisher syndrome; polyneuritis cranialis; and rare instances of viral myopathy with rhabdomyolysis. The main conclusion of this review is the pressing need to define the neurology of COVID-19, its frequency, manifestations, neuropathology and pathogenesis. On behalf of the World Federation of Neurology we invite national and regional neurological associations to create local databases to report cases with neurological manifestations observed during the on-going pandemic. International neuroepidemiological collaboration may help define the natural history of this worldwide problem.

An Efficient Mobile-Healthcare Emergency Framework.

Mobile technologies are capable of offering individual level health care services to users. Mobile Healthcare (m-Healthcare) frameworks, which feature smartphone (SP) utilizations of ubiquitous computing made possible by applying wireless Body Sensor Networks (BSNs), have been introduced recently to provide SP clients with health condition monitoring and access to medical attention when necessary. However, in a vulnerable m-Healthcare framework, clients' personal info and sensitive data can easily be poached by intruders or any malicious party, causing serious security problems and confidentiality issues. In 2013, Lu et al. proposed a mobile-Healthcare emergency framework based on privacy-preserving opportunistic computing (SPOC), claiming that their splendid SPOC construction can opportunistically gather SP resources such as computing power and energy to handle computing-intensive Personal Health Information (PHI) with minimal privacy disclosure during an emergency. To balance between the risk of personal health information exposure and the essential PHI processing and transmission, Lu et al. presented a patient-centric privacy ingress control framework based on an attribute-based ingress control mechanism and a Privacy-Preserving Scalar Product Computation (PPSPC) technique. In spite of the ingenious design, however, Lu et al.'s framework still has some security flaws in such aspects as client anonymity and mutual authentication. In this article, we shall offer an improved version of Lu et al.'s framework with the security weaknesses mended and the computation efficiency further boosted. In addition, we shall also present an enhanced mobile-Healthcare emergency framework using Partial Discrete Logarithm (PDL) which does not only achieve flawless mutual authentication as well as client anonymity but also reduce the computation cost.

Guidelines versus ground lines: Tuberculosis of the central nervous system.

AIM: This questionnaire-based national survey is aimed at understanding the patterns of practice of various aspects of central nervous system (CNS) tuberculosis (TB) among neurologists. SETTINGS AND DESIGN: Neurology department of a tertiary medical college. MATERIALS AND METHODS: A questionnaire was sent through email to all practicing neurologists in India. The responses were analyzed. STATISTICAL ANALYSIS: Inferential statistics. RESULTS: In all, 144 responses were received (out of the 853 questionnaires sent). The major discrepancies were in the primary antitubercular drug regimen (HRZE + HR), duration for tubercular meningitis (TBM) [12 months] and tuberculoma (12-18 months) to develop, follow-up (varied), linezolid use (varied), proportion of drug-resistant cases (<25%), and not taking histological aids (91%). The cerebrospinal fluid (CSF) TB polymerase chain reaction (PCR) utility (75%), not using CSF adenosine deaminase [ADA] (58%), the strategy to stop antitubercular drugs, and the use of steroids (77%) were according to guidelines. CONCLUSION: The present survey, for the first time, provides ground-level evidence of various aspects of CNS TB as practiced by neurologists in India. The major diversity was observed in therapeutics such as the choice of antitubercular drugs, its duration, linezolid use beyond the recommended duration, and knowledge of drug resistance. The monitoring aspects of CNS TB also showed variations. The investigational aspects of CNS TB such as using TB PCR, not using CSF ADA, and regular neuroimaging revealed a good clinical practice. Other CSF parameters require uniformity. This survey thus helps to identify areas of future work in CNS TB in India.

A post hoc analysis of the long-term safety and efficacy of perampanel in Asian patients with epilepsy.

This post hoc analysis assessed the long-term safety, tolerability, and efficacy of perampanel in Asian patients with refractory focal seizures; an additional analysis assessed the effect of perampanel on focal impaired awareness seizures (FIAS) with focal to bilateral tonic-clonic (FBTC) seizures. In this subanalysis, data from Asian patients ≥12 years of age who had focal seizures with FBTC seizures despite taking one to 3 concomitant antiepileptic drugs at baseline, and who had entered either the long-term extension phase of 3 phase-3 perampanel trials (study 307) or the 10-week extension phase of study 335, were analyzed for the effect of perampanel on duration of exposure, safety, and seizure outcomes. Of 874 Asian patients included in the analysis, 205 had previously received placebo during the double-blind phase-3 trials and 669 had previously received perampanel 2-12 mg/day; 313 had FIAS with FBTC seizures at core study baseline. The median duration of exposure to perampanel was 385.0 days, and the retention rate at one year was 62.6%. Overall, during the first 52 weeks of perampanel treatment, 777 patients (88.9%) had treatment-emergent adverse events (TEAEs), most of which were mild to moderate in severity. The most frequent TEAEs were dizziness (47.1%), somnolence (22.3%), and nasopharyngitis (17.4%). During the first 52 weeks of perampanel treatment, median percent change in seizure frequency per 28 days from pre-perampanel baseline for all focal seizures was -28.1%, and -51.7% for FIAS with FBTC seizures. The 50% responder rate relative to pre-perampanel baseline for all focal seizures was 33.8%, and 51.1% for FIAS with FBTC seizures. Long-term treatment with perampanel in Asian patients had safety, tolerability, and efficacy similar to that of the global population in the phase-3 trials and extension study 307. The safety profile and response rate suggest benefit for an Asian population of patients with refractory epilepsy.

Two-year, randomized, controlled study of safinamide as add-on to levodopa in mid to late Parkinson's disease.

In a 6-month double-blind, placebo-controlled study of Parkinson's disease patients with motor fluctuations, safinamide 50 and 100 mg/d significantly increased ON-time without increasing dyskinesia. Further long-term safinamide use in these patients was evaluated over an additional 18 months. Patients continued on their randomized placebo, 50, or 100 mg/d safinamide. The primary endpoint was change in Dyskinesia Rating Scale total score during ON-time over 24 months. Other efficacy endpoints included change in ON-time without troublesome dyskinesia, changes in individual diary categories, depressive symptoms, and quality of life measures. Change in Dyskinesia Rating Scale was not significantly different in safinamide versus placebo groups, despite decreased mean total Dyskinesia Rating Scale with safinamide compared with an almost unchanged score in placebo. Ad hoc subgroup analysis of moderate to severe dyskinetic patients at baseline (36% of patients) showed a decrease with safinamide 100 mg/d compared with placebo (P = 0.0317). Improvements in motor function, activities of daily living, depressive symptoms, clinical status, and quality of life at 6 months remained significant at 24 months. Adverse events and discontinuation rates were similar with safinamide and placebo. This 2-year, controlled study of add-on safinamide in mid-to-late Parkinson's disease with motor fluctuations, although not demonstrating an overall difference in dyskinesias between patients and controls, showed improvement in dyskinesia in patients at least moderately dyskinetic at baseline. The study additionally demonstrated significant clinical benefits in ON-time (without troublesome dyskinesia), OFF-time, activities of daily living, motor symptoms, quality of life, and symptoms of depression.