Correlation of silent brain infarcts and leukoaraiosis in middle-aged ischemic stroke patients: a retrospective study.

Background: Cerebrovascular diseases of the brain are usually defined by transient ischemic attacks and strokes. However, they can also cause brain injuries without neurological events. Silent brain infarcts (SBI) and leukoaraiosis are symptoms of both vascular and neurological abnormalities. This study aims to investigate the association between SBI, leukoaraiosis, and middle-aged patients with ischemic stroke. Methods: A single-center retrospective study of 50 middle-aged, ischemic stroke patients were studied from November 2022 and May 2023. The patients were divided into two groups based on the presence or absence of leukoaraiosis. History taking, physical examination, brain CT scan, and MRI were all part of the diagnostic process. Metabolic syndrome (MetS) was also assessed through various factors. The statistical analysis included descriptive statistics, logistic regression analysis, and chi-square test. Results: Out of the cohort comprising 50 patients, characterized by a mean age of 52.26 years (SD 5.29), 32 were male, constituting 64% of the sample. Among these patients, 26 individuals exhibited leukoaraiosis, with 17 of them (65.4%) also presenting with SBI. Moreover, within this cohort, 22 patients were diagnosed with MetS, representing 84.6% of those affected. The Multivariate logistic regression analysis showed a strong and independent association between leukoaraiosis and SBI. Individuals with leukoaraiosis were nearly five times more likely to have SBI compared to those without leukoaraiosis. Conclusion: The study highlights leukoaraiosis as a significant risk factor for SBI, alongside MetS. Advanced imaging techniques have facilitated their detection, revealing a higher prevalence among stroke patients, particularly associated with age and hypertension. Further research is needed to fully understand their complex relationship and develop better management strategies for cerebrovascular diseases, ultimately improving patient outcomes.

Headache attributed to ischemic stroke - a new scope for management: a case study.

Acute ischemic stroke may present with serious clinical manifestations. Headache attributed to ischemic stroke is one of these clinical manifestations which may be neglected and affect the functional outcome of the patients. Understanding the exact pathophysiology, and recognition of the most clinical and radiological predictors can help to provide good management and open scope for prophylactic approaches. Here, we report a case presented with acute onset of ischemic stroke and developed a new onset headache on the first day of stroke onset. According to the International Classification of Headache Disorders third edition (ICHD-3), the patient has a post-stroke headache. Using transcranial duplex ultrasound, activation of the trigeminovascular pathway could be attributed to the opening of more pain-sensitive collateral channels as the left posterior communicating artery (P Com A). In conclusion, we can predict the development of acute headache at stroke onset based on different clinical and radiological factors. Opening of the collateral channels is strongly implicated in the production of post-stroke headache.

Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial.

BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. METHODS: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). RESULTS: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively). However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). CONCLUSIONS: Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

Novel paper-based potentiometric combined sensors using coumarin derivatives modified with vanadium pentoxide nanoparticles for the selective determination of trace levels of lead ions.

Novel miniaturized Pb(II) paper-based potentiometric sensors are described using coumarin derivatives I and II as electroactive ionophores and nano vanadium pentoxide as a solid contact material for the sensitive and selective monitoring of trace lead ions. Density functional theory (DFT) confirms optimum geometries, electronic properties, and charge transfer behaviors of 1:2 Pb(II): coumarin complexes. The sensors are prepared by using two strips of 20 × 5 mm filter paper with two circular orifices. One orifice is coated with vanadium pentoxide (V2O5) nanoparticles in colloidal conductive carbon as a solid-contact, covered by a PVC membrane containing coumarin ionophore to act as a sensing probe. The other orifice is treated with Ag/AgCl in a polyvinyl butyral (PVB) film, to act as a reference electrode. Sensors with ionophores (I) and (II) exhibit Nernstian slopes of 27.7 ± 0.2 and 30.2 ± 0.2 mV/decade over the linear concentration range 4.5 × 10-7 to 6.2 × 10-3 M and 8.5 × 10-8 to 6.2 × 10-3 M, with detection limits of 1.3 × 10-7 M (26.9 ppb) and 2.1 × 10-8 M (4.4 ppb), respectively. The sensors are satisfactorily used for accurate determination of lead ions in drinking water, lead-acid battery wastewater, and electronic waste leachates. The results compare favourably well with data obtained by flameless atomic absorption spectrometry.

A novel potentiometric screen-printed electrode based on crown ethers/nano manganese oxide/Nafion composite for trace level determination of copper ion in biological fluids.

Copper levels in biological fluids are associated with Wilson's, Alzheimer's, Menke's, and Parkinson's diseases, making them good biochemical markers for these diseases. This study introduces a miniaturized screen-printed electrode (SPE) for the potentiometric determination of copper(II) in some biological fluids. Manganese(III) oxide nanoparticles (Mn2O3-NPs), dispersed in Nafion, are drop-casted onto a graphite/PET substrate, serving as the ion-to-electron transducer material. The solid-contact material is then covered by a selective polyvinyl chloride (PVC) membrane incorporated with 18-crown-6 as a neutral ion carrier for the selective determination of copper(II) ions. The proposed electrode exhibits a Nernstian response with a slope of 30.2 ± 0.3 mV/decade (R2 = 0.999) over the linear concentration range 5.2 × 10-9 - 6.2 × 10-3 mol/l and a detection limit of 1.1 × 10-9 mol/l (69.9 ng/l). Short-term potential stability is evaluated using constant current chronopotentiometry (CP) and electrochemical impedance spectroscopy (EIS). A significant improvement in the electrode capacitance (91.5 µF) is displayed due to the use of Mn2O3-NPs as a solid contact. The presence of Nafion, with its high hydrophobicity properties, eliminates the formation of the thin water layer, facilitating the ion-to-electron transduction between the sensing membrane and the conducting substrate. Additionally, it enhances the adhesion of the polymeric sensing membrane to the solid-contact material, preventing membrane delamination and increasing the electrode's lifespan. The high selectivity, sensitivity, and potential stability of the proposed miniaturized electrode suggests its use for the determination of copper(II) ions in human blood serum and milk samples. The results obtained agree fairly well with data obtained by flameless atomic absorption spectrometry.

Expectant management versus systemic methotrexate in the management of persistent pregnancy of unknown location, a seven-year retrospective analysis.

PURPOSE: To compare Expectant management to systemic methotrexate in the management of persistent pregnancy of unknown location with beta-hCG levels below the discrimination zone. METHODS: A retrospective cohort study was conducted on 71 women with persistent pregnancy of unknown location. They were divided into two groups according to the applied management; Group 1, (n = 40) who were managed expectantly and Group 2 (n = 31) who were given a single dose of methotrexate. Data variables were collected and analyzed to evaluate whether expectant management was as effective as methotrexate. RESULTS: There was no significant difference between the two groups regarding age, parity, gestational age, body mass index and day seven beta-hCG. Success rates were (32 patients (80%) and 28 patients (90.3%) in expectant management and methotrexate groups, respectively (P > 0.05). The mean values for day zero and day four beta-hCG were significantly higher and the mean duration for complete recovery was statistically shorter in the methotrexate group (P < 0.05). There were no significant differences between the two groups regarding prior ectopic, percentage of beta-hCG level drop on day four and day seven, success rate, occurrence of sequelae and patient satisfaction that area under the curve (AUC) for group 1 (expectant management) is 0.566 at 95% Confidence Interval of (0.388: 0.745). CONCLUSION: Expectant management is an effective and safe alternative to single-dose methotrexate for persistent PUL with beta-hCG levels below the discrimination zone.

Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial

Background@#and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. @*Methods@#A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). @*Results@#Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). @*Conclusions@#Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

All-solid-state paper-based potentiometric combined sensor modified with reduced graphene oxide (rGO) and molecularly imprinted polymer for monitoring losartan drug in pharmaceuticals and biological samples.

A cost-effective, highly selective and sensitive paper-based potentiometric combined sensor for losartan potassium drug (LOS) is fabricated, characterized and used for the drug monitoring. The sensor consists of 2 strips of filter paper (20 × 5 mm each) as platform, each imprinted with 4 mm diameter circular spot of carbon. One carbon spot is covered by a reduced graphene oxide (rGO) for use as a substrate for the recognition sensor and the other without rGO is used for the reference electrode. LOS molecularly imprinted drug polymer (MIP) is applied onto the graphene oxide containing strip to act as a drug recognition sensing material and a solid-state polyvinyl butyral (PVB) is applied onto the second carbon spot to act as a reference electrode. Performance characteristics of the combined sensor are examined with chronopotentiometry (CP) and electrochemical impedance spectroscopy (EIS). Increase effect of rGO on the interfacial double-layer capacitance of the sensing membrane and consequently on the potential stability is confirmed. The developed combined sensor (strip cell) displays a Nernstian slope of -58.2 ± 0.3 mV/decade (R2 = 0.9994) over the linear range 8.5 × 10-7 - 6.9 × 10-2 M with a detection limit of 2.7 ± 0.3 × 10-7 M. The sensor shows remarkable selectivity toward various related compounds especially those commonly used by the COVID-19 patients such as paracetamol, ascorbic acid and dextromethorphan. The assay method is validated and proved to be satisfactory for direct potentiometric determination of LOS-K in some pharmaceutical formulations and in spiked human urine samples. An average recovery of 96.3 ± 0.3-98.7 ± 0.6% of the nominal or spiked concentration and a mean relative standard deviation of ±0.6% are obtained. The use of an indicating and a reference electrodes combined into a single flexible disposable paper platform enables applications to a minimum sample volume due to the close proximity of the responsive membrane and the liquid junction. The efficiency of the proposed sensor in complex urine matrix suggests its application in hospitals for rapid diagnosis of overdose patients and for quality control/quality assurance tests in pharmaceutical industry.

The effect of postmenopausal hormonal drop on optic nerve head and peripapillary perfusion using optical coherence tomography angiography (OCTA).

We studied the effect of menopause with subsequent estrogen drop on optic nerve head structure and peripapillary vasculature. This cross-sectional analytic study was carried out on 100 eyes of 100 patients; patients were divided into a premenopausal group (50 eyes) and a postmenopausal group (50 eyes). Optical coherence tomography was done to evaluate retinal nerve fiber layer thickness (RNFLT) and optical coherence tomography angiography (OCTA) to assess the peripapillary capillary vessel density. RNFLT as well as the peripapillary vessel density (VD) were significantly lower in the postmenopausal group (P value < 0.001) with increasing age, hormonal drop, and higher intraocular pressure (IOP), specifically in the inferior quadrant. However, the negative correlation between IOP and VD (r = - 0.541) was stronger than its negative correlation with RNFLT (r = - 0.318). Postmenopausal hormonal changes lead to a significant rise in IOP-although still not glaucomatous- and a decrease in the RNFLT and perfusion of the optic nerve. This confirms the relation between hormonal drop and glaucoma in postmenopausal women. Changes in peripapillary vascular density were more evident than RNFL in correlation with IOP and age changes. So, OCTA can be used to detect early optic nerve affection.

A novel screen-printed potentiometric electrode with carbon nanotubes/polyaniline transducer and molecularly imprinted polymer for the determination of nalbuphine in pharmaceuticals and biological fluids.

A novel screen-printed electrode (SPE) for potentiometric determination of nalbuphine (NAL) is described. Carboxylated multi-walled carbon nano tubes/polyaniline (f-MWCNTs/PANI) nanocomposite is used as an ion-to- electron transducer and is covered by a selective polyvinyl chloride (PVC) membrane incorporated with molecularly imprinted drug polymer (MIP) beads as a recognition receptor for potentiometric determination a synthetic narcotic, nalbuphine (NAL). The SPE displays a Nernstian response with a slope of 60.3 ± 1.2 mV/decade (R2 = 0.999) over the concentration range 2.4 × 10-7 - 5.0 × 10-2 mol/L and a detection limit of 1.1 × 10-7 mol/L (0.04 µg/mL) with response time less than 20 s (<20 s). The interfacial capacitance of the proposed SPE is measured using chronopotentiometry (CP) and electrochemical impedance spectroscopy (EIS). The use of the f-MWCNTs/PANI nanocomposite layer improved the interfacial capacitance reached 52.5 µF. Besides, it eliminated the formation of the undesired thin water-layer between the sensing membrane and the conducting substrate. This prevents membrane delamination and increases potential stability. The obtained high selectivity, sensitivity and potential stability offered a great applicability of the proposed SPE for the determination of nalbuphine in hospitals for rapid diagnosis of overdose patients and for quality control/quality assurance in pharmaceutical industry.

Novel magnetic nickel ferrite nanoparticles modified with poly(aniline-co-o-toluidine) for the removal of hazardous 2,4-dichlorophenol pollutant from aqueous solutions.

Chlorinated organic and phenolic compounds are still purely studied by many researchers because of their severe damage to the aquatic environment and their carcinogenic effect on many living organisms. Therefore, there is a great interest in removing these environmental pollutants from aqueous mediums by easy and inexpensive methods. Herein, novel nickel ferrite (NiFe2O4) nano composite modified with poly(aniline-co-o-toluidine) (PAOT) is prepared, characterized, and used for the removal of 2,4-dichlorophenol (2,4-DCP) as an organic chlorinated environmental pollutant. The morphological properties of the composite are characterized by Fourier transform infrared spectrometry (FTIR), X-ray diffraction (XRD), high-resolution transmission electron microscopy (HR-TEM), and Brunauer-Emmett-Teller (BET) methods. The prepared composite is tested for the removal of the hazardous dichlorophenol pollutant from aqueous solutions. Under optimized conditions and with effective control of parameters including, contact time, pH of the test solution, adsorbent dose, and temperature, over 83% of the pollutant is adsorbed and removed. The adsorption capacity is 162 mg g-1. Adsorption kinetics, adsorption isotherm and some physicochemical parameters of the reaction are evaluated. The Redlich-Peterson isothermal model is the appropriate model for describing the adsorption process. These results indicate that NiFe2O4/PAOT nanocomposites are promising adsorbents for the removal of persistent organic pollutants (e.g., DCP) from aqueous solutions. The results also reveal that modification of NiFe2O4 particles with poly(aniline-co-o-toluidine) (PAOT) significantly enhances the adsorption capacity of the adsorbent. This is probably due to the electrostatic attraction and non-covalent interactions (e.g. π-π) between the aromatic rings in both dichlorophenol and poly(aniline-co-o-toluidine) copolymer. Advantages offered by using NiFe2O4/PAOT nanocomposites are the high stability, reasonable efficiency, reusability for at least five adsorption-desorption cycles and the ability to remove the adsorbent from aqueous solutions for reuse using an external magnetic field.

Prognostic significance of LRIG2 and LRIG3 proteins in urothelial bladder carcinoma.

Bladder carcinoma is the second most frequent cancer in Egyptian males. Leucine-rich and immunoglobulin-like domains (LRIGs) are usually dysregulated in various human tumors. The aim of this study is to explore the immunohistochemical expression of LRIG2 and LRIG3 in urothelial bladder carcinoma (UBC) and their relationship to patients clinicopathological data including survival. The study cohort included 79 UBC cases (14 non muscle invasive (NMI) and 65 muscle invasive (MI)). We assessed the associations of LRIG2 and LRIG3 expression with clinicopathological data, as well as progression-free and overall survival. Most of studied cases (>50%) express LRIG2 and LRIG3. Statistically significant association was observed between positivity for LRIG3 and muscle invasion (P = 0.001), high grade (P = 0.03), and female gender (P = 0.02). Moreover, positive LRIG2 staining was associated with early stage (T2) (P = 0.03), lymphovascular invasion (P = 0.004), and tendency to non-muscle invasive stage (P = 0.07). Grouping of cases according to positivity/negativity of both markers showed that cases with dual positivity for both proteins are associated with muscle invasion (P = 0.001) and paradoxically with prolonged overall survival (P = 0.037). We conclude that although the association of LRIG3 with MI and high-grade tumors, its expression is related to better survival. LRIG3 has the dominant role even if it coexists with LRIG2. The role of LRIG2 remains to be further investigated.

Chitosan/MCM-48 nanocomposite as a potential adsorbent for removing phenol from aqueous solution.

A new hybrid mesoporous nanocomposite (CMCM-48) based on chitosan and silica MCM-48 was considered as a potential adsorbent for removing phenol from aqueous solutions (toxic liquid waste) in a batch process. The new composite adsorbent was characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), and nitrogen adsorption-desorption isotherms. The adsorption isotherm studies were analyzed using linear and nonlinear Langmuir, Freundlich and Dubinin-Radushkevich models for the optimum conditions when the initial phenol concentration, pH, adsorption temperature and time were 10-500 mg L-1, 3-10, 25.5 °C and 300 min, respectively. It was revealed that the experimental results agree well with the Dubinin-Radushkevich model, i.e. the correlation coefficient R 2 was 0.983085. The adsorption kinetics was modeled with linear and nonlinear pseudo-first-order, pseudo-second-order and intra particle diffusion kinetic models. The pseudo-second-order model was the best for describing the adsorption process with a correlation coefficient R 2 = 0.99925. The stability of the equilibrium data was studied for a phenol sorbent with a maximum adsorption capacity of 149.25 mg g-1. The results verified that the synthesized CMCM-48 was an efficient adsorbent for removing phenol from aqueous solutions.

Synthesis and applications of CaCO3/HPC core-shell composite subject to heavy metals adsorption processes.

Core-shell particles are a class of materials from nanostructures that have received increased attention recently due to their interesting properties and wide range of applications in catalysis, biology, chemistry of materials and sensors. Simple and cost-effective one-pot synthesis route to directly prepare CaCO3@highly porous carbon microsphere in a core-shell structure (denoted as CaCO3/HPC) had been developed as a high-performance heavy metals sorbent. XRD (X-Ray Diffraction), SEM (scanning electron microscopy), Raman, FTIR (Fourier Transform Infrared Spectroscopy) and BET tools were used in structure characterization of the products. The adsorption properties of the products obtained were studied. From this study the adsorption performances of CaCO3/HPCwere found to be optimal by comparing the maximum adsorption capacity of heavy metal ions (Pb (II) and Co(III)) with CaCO3/HPC.The adsorption of CaCO3/HPCtest to Pb(II) and Co(III), in particular Pb(II) had a good effect over a wide pH range (pH 2-7). The maximum adsorption capacitiesof CaCO3/HPC for Pb (II) and Co(III) were 677.6 mg/g, and 308.5 mg/g, respectively, at pH = 6 (lead ion was 5.5) and 25 °C, and the adsorption rate was fast. The lead ions can be adsorbed almost entirely in 5 minutes and only 0.2 g/L was the best effective doseof adsorbent. The prepared and carefully testednanocomposites had been found to be of excellent performances in adsorption and in analytical regeneration. The adsorption processof Pb(II) and Co(III) through core shell of the preparednanocomposite adsorbent was found to be a second-order chemical adsorption and fit for Langmuir and Freundlich isotherms, in the form of amonomolecular and multi-layer heavy metal adsorptionprocesses. The (CaCO3/HPC)-based sorbents (with and without) pelletization shows superior heavy metals adsorption performances compared to a CaCO3-based sorbent.

Outcomes of patient education practices to optimize the safe use of lithium: A literature review.

INTRODUCTION: Lithium is commonly used to treat various psychiatric disorders and is particularly effective in the maintenance phase of bipolar disorder. Unfortunately, this drug has a narrow therapeutic index and, if not monitored regularly, can result in toxicity. Therefore, for lithium to be prescribed safely, clinicians must ensure that patients are well educated on lithium toxicity, its prevention, and symptom recognition. This article summarizes studies that investigated lithium education strategies to help promote the safe use of lithium. METHODS: Four electronic databases were searched using key terms and subject headings. Reference lists of relevant papers were also reviewed. The search was limited to literature published in English, without year limits. Eligible studies examined lithium patient education and the impact on patients' knowledge of safe lithium use. RESULTS: Of a total of 517 citations that were retrieved from the electronic database search, 12 were selected for inclusion in this review. Most of the studies included assessed the effect of lithium education on various aspects of patients' knowledge, including but not limited to, lithium toxicity. Of the studies assessing the correlation between lithium knowledge and lithium levels, most demonstrated a positive correlation between lithium knowledge and lithium levels that were more stable and within the higher end of the recommended therapeutic range. CONCLUSIONS: Studies evaluating lithium patient education and its effect on improving the safe use of lithium are limited. Nevertheless, this literature review highlights that lithium patient education is critical to promote its safe use.