Postoperative shunt failure following hemispherectomy in pediatric patients with pre-existing hydrocephalus.

OBJECTIVE: The risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts. METHODS: We performed a retrospective chart review at our center to identify pediatric patients diagnosed with DRE who were treated with ventricular shunt prior to their first hemispherectomy surgery. Demographic and perioperative data were obtained including shunt history, hydrocephalus etiology, epilepsy duration, surgical technique, and postoperative outcomes. Univariate analysis was performed using Fisher's exact test and Pearson correlation, with Bonferroni correction to a = 0.00625 and a = 0.01, respectively. RESULTS: Five of nineteen (26.3%) patients identified with ventriculoperitoneal shunting prior to hemispherectomy experienced postoperative shunt malfunction. All 5 of these patients underwent at least 1 shunt revision prior to hemispherectomy, with a significant association between pre- and post-hemispherectomy shunt revisions. There was no significant association between post-hemispherectomy shunt failure and valve type, intraoperative shunt alteration, postoperative external ventricular drain placement, hemispherectomy revision, lateralization of shunt relative to resection, postoperative complications, or postoperative aseptic meningitis. There was no significant correlation between number of post-hemispherectomy shunt revisions and age at shunt placement, age at hemispherectomy, epilepsy duration, or shunt duration prior to hemispherectomy. CONCLUSIONS: Earlier shunt revision surgery may portend a subsequent need for shunt revision following hemispherectomy. These findings may guide neurosurgeons in counseling patients with pre-existing ventricular shunts prior to hemispherectomy surgery.

The role of astrocytes in the glymphatic network: a narrative review.

To date, treatment of Central Nervous System (CNS) pathology has largely focused on neuronal structure and function. Yet, revived attention towards fluid circulation within the CNS has exposed the need to further explore the role of glial cells in maintaining homeostasis within neural networks. In the past decade, discovery of the neural glymphatic network has revolutionized traditional understanding of fluid dynamics within the CNS. Advancements in neuroimaging have revealed alternative pathways of cerebrospinal fluid (CSF) generation and efflux. Here, we discuss emerging perspectives on the role of astrocytes in CSF hydrodynamics, with particular focus on the contribution of aquaporin-4 channels to the glymphatic network. Astrocytic structural features and expression patterns are detailed in relation to their function in maintaining integrity of the Blood Brain Barrier (BBB) as part of the neurovascular unit (NVU). This narrative also highlights the potential role of glial dysfunction in pathogenesis of neurodegenerative disease, hydrocephalus, intracranial hemorrhage, ischemic stroke, and traumatic brain injury. The purpose of this literature summary is to provide an update on the changing landscape of scientific theory surrounding production, flow, and absorption of cerebrospinal fluid. The overarching aim of this narrative review is to advance the conception of basic, translational, and clinical research endeavors investigating glia as therapeutic targets for neurological disease.

Perception of Nepalese nursing students toward E-learning in Nepal.

BACKGROUND: E-learning is the delivery of learning and training through digital resources. Although e-learning is based on formalized learning, it is provided through computers, tablets, and even cellular phones those are connected to the Internet. This makes it easy for users to learn anytime, anywhere, with few, if any restrictions. MATERIAL AND METHODS: A cross-sectional study was done, and data was obtained through an online survey method from September 14, 2020 to October 08, 2020. Questions were created in "Google Forms." The targeted population was all nursing students from all over Nepal. There were a total of 365 respondents. A pilot study was done on 10 students. After the pilot study, the same question was distributed to all the respondents. RESULTS: Almost half (40.8%) got disturbed in their online class because of electricity; around half of the respondents (41.9%) are disturbed in their online class because of Internet problems. Moreover, around half of the respondents (44.4%) use the data pack daily, and 38.6% use the data sometimes. CONCLUSION: The study concludes that most students suffered from Internet disturbance and electricity problems during online classes. Because of electricity and Internet problems, most students feel anxious during class, and most of the students are not able to attend classes. Most students are compelled to use data packs for online classes. However, the course may not be completed if the problems arising during online classes are not solved.

Knowledge regarding Basic Life Support among Health Care Workers of the Hospital of Nepal.

Basic life support refers to a sequence of care provided to patients who are experiencing respiratory arrest, cardiac arrest, or airway obstruction. It is a specific level of prehospital medical care provided by the trained responders, including emergency medical technicians, in the absence of advanced medical care to maintain the patient's life. BLS course trains participants to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations, and provide early use of an AED. According to American Heart Association (AHA) guidelines, every missed minute in applying defibrillation in a cardiac arrest decreases the survival rate by 70%-10%. According to European Resuscitation Council (ERC), early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival. A quantitative, descriptive study design is used in this study. A purposive sampling technique was used, and the sample size was 95. A self-structuredclose-ended questionnaire was used to assess the level of knowledge of the participants. The finding revealed that among 95 participants, only 12% had adequate, 55% had moderate, and 32% had inadequate knowledge about Basic Life Support. The study showed that knowledge among healthcare workers about basic life support is insufficient for the majority of participants. There is a significant association between dependent and independent variables.

Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population.

Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow-up of six months. Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit-lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications. Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically. Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries.

Impact of COVID-19 pandemic on learning status of student in Nepal.

BACKGROUND: This study was designed to evaluate the impact of the COVID-19 pandemic on the learning status of students from different educational boards and universities of Nepal. An online survey was conducted from tenth to twentieth of September 2020 to record the data. MATERIAL AND METHODS: A self-designed questionnaire link, using "Google form" was sent to the students via social networks. A total of 589 participants shared their complete information. The simple percentage distribution was employed to evaluate the learning status of the students. RESULTS: During the lockdown period, >70% of the students were engaged in online classes, most commonly by using the Zoom app. The majority of the students were using WIFI as an internet source to attend online classes. Students have been suffering from various problems related to anxiety, stress, economic crises, poor internet connectivity, deprivation of study materials, required e-learning accessories, and an unsuitable study environment. Mainly, students from remote areas and middle income families suffered enormously. Among those participants, who were able to attend the online classes, the majority of students (70%) were dissatisfied with the ongoing online classes. Only 23.3% of the participants suggested the feasibility of online classes in the near future. CONCLUSION: Our study recommended that training teachers and students about online classes might create effectiveness toward e-learning. The government needs to provide free internet services to the remote areas and the poor students since in the current scenario, huge numbers of the population are struggling with the economic burden.

Evaluation of Styrylbenzene analog- FSB and its affinity to bind parenchymal plaques and tangles in patients of Alzheimer's disease.

Although several histochemical markers for senile plaques (SP) and neurofibrillary tangles (NFTs) have been synthesized since the discovery of plaques in Alzheimer's disease (AD), only a handful of these markers stain both lesions in the human brain. Despite discovery of its ability to stain both SP and NFT over 13 years ago, the styrylbenzene derivative, (E,E)-1-fluoro-2,5-bis-(3-hydroxycarbonyl-4-hydroxy)styrylbenzene (FSB), has only recently gained attention, primarily due to its ability to function as a contrasting agent for MRI imaging of AD pathology in vivo. The structure of the compound is a nuclide with quantized angular momentum, which explains its value as a contrast agent. In the current study, modification of the established staining procedure produced meaningful improvement in the labeling of plaques and tangles in the human brain. We utilized two rodent models of AD to show FSB's value in labeling both Aß and tau lesions. Furthermore, our current modification allows us to detect SP in rodent brains in 15 min and both SP and NFT in human brains within 20 min. The study presents new evidence regarding potential binding targets for FSB as well as optimization protocols in which various parameters have been manipulated to show how section thickness, use of frozen versus paraffin-embedded sections, and selection of staining media can affect the intensity of the plaque and tangle staining in the brain. To determine the target FSB potentially binds, we performed double immunolabeling of FSB with mOC64 (a conformational antibody that label Aß1-42). Results indicated that all plaques in the brain colocalized with mOC64, suggesting that FSB has the potential to bind all Aß containing plaques, making it a very sensitive detector of multiple forms of SP... All antibodies were assessed for the degree of colocalization with FSB in order to better understand potential binding targets. We found more than 90% hyperphosphorylated Tau against AT8, AT180 and S214 colocalized with FSB labeled tangles. On the other hand, more than 90% of the mOC64 containing plaques colocalized with FSB stained plaques. Our results indicate that FSB is a valuable marker that can be used to detect AD pathologies in human and rodent brains with greater fluorescence intensity relative to other conventional fluorescence markers.

Switchable aqueous catalytic systems for organic transformations.

In living organisms, enzyme catalysis takes place in aqueous media with extraordinary spatiotemporal control and precision. The mechanistic knowledge of enzyme catalysis and related approaches of creating a suitable microenvironment for efficient chemical transformations have been an important source of inspiration for the design of biomimetic artificial catalysts. However, in "nature-like" environments, it has proven difficult for artificial catalysts to promote effective chemical transformations. Besides, control over reaction rate and selectivity are important for smart application purposes. These can be achieved via incorporation of stimuli-responsive features into the structure of smart catalytic systems. Here, we summarize such catalytic systems whose activity can be switched 'on' or 'off' by the application of stimuli in aqueous environments. We describe the switchable catalytic systems capable of performing organic transformations with classification in accordance to the stimulating agent. Switchable catalytic activity in aqueous environments provides new possibilities for the development of smart materials for biomedicine and chemical biology. Moreover, engineering of aqueous catalytic systems can be expected to grow in the coming years with a further broadening of its application to diverse fields.

Alginate-Based Smart Materials and Their Application: Recent Advances and Perspectives.

Nature produces materials using available molecular building blocks following a bottom-up approach. These materials are formed with great precision and flexibility in a controlled manner. This approach offers the inspiration for manufacturing new artificial materials and devices. Synthetic artificial materials can find many important applications ranging from personalized therapeutics to solutions for environmental problems. Among these materials, responsive synthetic materials are capable of changing their structure and/or properties in response to external stimuli, and hence are termed "smart" materials. Herein, this review focuses on alginate-based smart materials and their stimuli-responsive preparation, fragmentation, and applications in diverse fields from drug delivery and tissue engineering to water purification and environmental remediation. In the first part of this report, we review stimuli-induced preparation of alginate-based materials. Stimuli-triggered decomposition of alginate materials in a controlled fashion is documented in the second part, followed by the application of smart alginate materials in diverse fields. Because of their biocompatibility, easy accessibility, and simple techniques of material formation, alginates can provide solutions for several present and future problems of humankind. However, new research is needed for novel alginate-based materials with new functionalities and well-defined properties for targeted applications.

Role of metals in Alzheimer's disease.

Metal homeostasis in the central nervous system (CNS) is a crucial component of healthy brain function, because metals serve as enzymatic cofactors and are key components of intra- and inter-neuronal signaling. Metal dysregulation wreaks havoc on neural networks via induction and proliferation of pathological pathways that cause oxidative stress, synaptic impairment, and ultimately, cognitive deficits. Thus, exploration of metal biology in relation to neurodegenerative pathology is essential in pursuing novel therapies for Alzheimer's Disease and other neurodegenerative disorders. This review covers mechanisms of action of aluminum, iron, copper, and zinc ions with respect to the progressive, toxic accumulation of extracellular ß-amyloid plaques and intracellular hyperphosphorylated neurofibrillary tau tangles that characterizes Alzheimer's Disease, with the goal of evaluating the therapeutic potential of metal ion interference in neurodegenerative disease prevention and treatment. As neuroscientific interest in the role of metals in neurodegeneration escalates-in large part due to emerging evidence substantiating the interplay between metal imbalances and neuropathology-it becomes clear that the use of metal chelating agents may be a viable method for ameliorating Alzheimer's Disease pathology, as its etiology remains obscure. We conclude that, although metal therapies can potentially deter neurodegenerative processes, the most promising treatments will remain elusive until further understanding of neurodegenerative etiology is achieved. New research directions may best be guided by animal models of neurodegeneration, which reveal specific insights into biological mechanisms underlying dementia.