Infected Ruptured Pseudo-aneurysm in Descending Aorta; a Case Report.

Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC). In order to investigate the possibility of sepsis, a non-contrast chest computed tomography (CT) scan was performed, which showed a soft tissue density surrounded by gas in the posterior mediastinum; for which the rupture of esophagus and infected aorta pseudoaneurysm were among differential diagnoses. To confirm the diagnosis, CT angiography was ordered. The infected ruptured pseudo-aneurysm(s) was confirmed and patient underwent thoracotomy surgery.

Language Abnormalities in Alzheimer's Disease Arise from Reduced Informativeness: A Cross-Linguistic Study in English and Persian.

INTRODUCTION: This research investigates the psycholinguistic origins of language impairments in Alzheimer's Disease (AD), questioning if these impairments result from language-specific structural disruptions or from a universal deficit in generating meaningful content. METHODS: Cross-linguistic analysis was conducted on language samples from 184 English and 52 Persian speakers, comprising both AD patients and healthy controls, to extract various language features. Furthermore, we introduced a machine learning-based metric, Language Informativeness Index (LII), to quantify informativeness. RESULTS: Indicators of AD in English were found to be highly predictive of AD in Persian, with a 92.3% classification accuracy. Additionally, we found robust correlations between the typical linguistic abnormalities of AD and language emptiness (low LII) across both languages. DISCUSSION: Findings suggest AD linguistics impairments are attributed to a core universal difficulty in generating informative messages. Our approach underscores the importance of incorporating biocultural diversity into research, fostering the development of inclusive diagnostic tools.

Impaired language in Alzheimer's disease: A comparison between English and Persian implicates content-word frequency rather than the noun-verb distinction.

This study challenges the conventional psycholinguistic view that the distinction between nouns and verbs is pivotal in understanding language impairments in neurological disorders. Traditional views link frontal brain region damage with verb processing deficits and posterior temporoparietal damage with noun difficulties. However, this perspective is contested by findings from patients with Alzheimer's disease (pwAD), who show impairments in both word classes despite their typical temporoparietal atrophy. Notably, pwAD tend to use semantically lighter verbs in their speech than healthy individuals. By examining English-speaking pwAD and comparing them with Persian-speaking pwAD, this research aims to demonstrate that language impairments in Alzheimer's disease (AD) stem from the distributional properties of words within a language rather than distinct neural processing networks for nouns and verbs. We propose that the primary deficit in AD language production is an overreliance on high-frequency words. English has a set of particularly high-frequency verbs that surpass most nouns in usage frequency. Since pwAD tend to use high-frequency words, the byproduct of this word distribution in the English language would be an over-usage of high-frequency verbs. In contrast, Persian features complex verbs with an overall distribution lacking extremely high-frequency verbs like those found in English. As a result, we hypothesize that Persian-speaking pwAD would not have a bias toward the overuse of high-frequency verbs. We analyzed language samples from 95 English-speaking pwAD and 91 healthy controls, along with 27 Persian-speaking pwAD and 27 healthy controls. Employing uniform automated natural language processing methods, we measured the usage rates of nouns, verbs, and word frequencies across both cohorts. Our findings showed that English-speaking pwAD use higher-frequency verbs than healthy individuals, a pattern not mirrored by Persian-speaking pwAD. Crucially, we found a significant interaction between the frequencies of verbs used by English and Persian speakers with and without AD. Moreover, regression models that treated noun and verb frequencies as separate predictors did not outperform models that considered overall word frequency alone in classifying AD. In conclusion, this study suggests that language abnormalities among English-speaking pwAD reflect the unique distributional properties of words in English rather than a universal noun-verb class distinction. Beyond offering a new understanding of language abnormalities in AD, the study highlights the critical need for further investigation across diverse languages to deepen our insight into the mechanisms of language impairments in neurological disorders.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Acute effects of sodium citrate supplementation on competitive performance and lactate level of elite fitness challenge athletes: A crossover, placebo-controlled, double-blind study.

Purpose: The performance of sodium citrate has been investigated in high-intensity exercises, but fewer studies have addressed the role of citrate in weight-bearing exercises. Methods: Twenty fitness challenge athletes, aged 24-32 years, volunteered to participate in this crossover, placebo-controlled, double-blind study. Initially, ten athletes were given a placebo and asked to complete a fitness challenge (i.e., chin-ups, squat jumps, dips, walking lunges, sit-ups, and burpees-devil press). Another ten athletes were supplemented with sodium citrate 0.5 g/kg body mass supplements 3 h prior to performing the fitness challenges. The same procedures were completed two days later with the supplement and placebo dextrose groups switched in a cross-over design. Athletes and assessors were blinded for the experimental condition (placebo vs. verum). Lactate levels were measured 5 min after exercise. The athletes' performance on each item of the fitness challenge as well as their lactate levels, were compared. Differences between the means of the measured variables were contrasted using a dependent t-test. Results: Supplementing sodium citrate substantially improved athletes' performance in all six fitness challenge items (p < 0.05, 0.69

Outcome after Neuro-interventional Treatment of Intracranial Aneurysm (as a First Treatment Modality).

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P<0.001). Similar to previous studies, the present study demonstrates that neurovascular intervention can treat ruptured aneurysms as the first therapeutic modality with favourable outcomes. A double-blind, randomized clinical trial is needed to eliminate the confounding factors and better demonstrate the outcome.

A human pilot study on positive electrostatic charge effects in solid tumors of the late-stage metastatic patients.

Background: Correlative interactions between electrical charges and cancer cells involve important unknown factors in cancer diagnosis and treatment. We previously reported the intrinsic suppressive effects of pure positive electrostatic charges (PEC) on the proliferation and metabolism of invasive cancer cells without any effect on normal cells in cell lines and animal models. The proposed mechanism was the suppression of pro-caspases 3 and 9 with an increase in Bax/Bcl2 ratio in exposed malignant cells and perturbation induced in the KRAS pathway of malignant cells by electrostatic charges due to the phosphate molecule electrostatic charge as the trigger of the pathway. This study aimed to examine PECs as a complementary treatment for patients with different types of solid metastatic tumors, who showed resistance to chemotherapy and radiotherapy. Methods: In this study, solid metastatic tumors of the end-stage patients (n = 41) with various types of cancers were locally exposed to PEC for at least one course of 12 days. The patient's signs and symptoms, the changes in their tumor size, and serum markers were followed up from 30 days before positive electrostatic charge treating (PECT) until 6 months after the study. Results: Entirely, 36 patients completed the related follow-ups. Significant reduction in tumor sizes and cancer-associated enzymes as well as improvement in cancer-related signs and symptoms and patients' lifestyles, without any side effects on other tissues or metabolisms of the body, were observed in more than 80% of the candidates. Conclusion: PECT induced significant cancer remission in combination with other therapies. Therefore, this non-ionizing radiation would be a beneficial complementary therapy, with no observable side effects of ionizing radiotherapy, such as post-radiation inflammation.

Diagnostic yield of prenatal exome sequencing in the genetic screening of fetuses with brain anomalies detected by MRI and ultrasonography: A systematic review and meta-analysis.

BACKGROUND: Brain anomalies (BAs) have been the focus of research, as they have a high impact on fetal health but therapeutic and diagnostic approaches are limited. OBJECTIVES: In this study, the application and efficiency of exome sequencing (ES) in detecting different cases of BAs in fetuses were evaluated and compared with chromosomal microarray analysis (CMA). SEARCH STRATEGY: To conduct this study, three databases including PubMed, Web of Science and Embase were utilised with the keywords 'prenatal', 'diagnoses', 'brain anomalies' and 'exome sequencing'. SELECTION CRITERIA: Studies were included based on the STARD checklist, for which the ES and CMA diagnostic yields were calculated. DATA COLLECTION AND ANALYSIS: Meta-analysis was performed on the included studies using a random-effects model and subgroup analysis to define the risk difference between them. MAIN RESULTS: We included 11 studies representing 779 fetuses that implemented ES along with imaging techniques. The pooled ES diagnostic yield in fetuses with BAs detected through magnetic resonance imaging (MRI) and ultrasonography was 26.53%, compared with 3.46% for CMA. The risk difference between ES and CMA for complex BAs was 0.36 [95% confidence interval (CI) 0.24-0.47], which was higher than for single BAs (0.22; 95% CI 0.18-0.25]. CONCLUSIONS: ES is a useful method with a significantly higher diagnostic yield than CMA for genetic assessment of fetuses with complex BAs detected by imaging techniques. Moreover, ES could be applied to suspected fetuses with related family histories to predict congenital diseases with high efficiency.

Comparative Study of the Long-Term Impact of the COVID-19 Pandemic on Mental Health and Nutritional Practices Among International Elite and Sub-Elite Athletes: A Sample of 1420 Participants from 14 Countries.

BACKGROUND: Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior. RESULTS: The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p < .001), as well as a lower REAP-S score indicating lower diet quality (p = .013). CONCLUSION: In conclusion, two years into the pandemic, elite athletes were likelier to have better mental health profiles than sub-elite athletes but surprisingly had lower diet quality.

Large-scale sporting events during the COVID-19 pandemic: insights from the FIFA World Cup 2022 in Qatar with an analysis of patterns of COVID-19 metrics.

The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.

Spinal Versus General Anesthesia for Spine Surgery During the COVID-19 Pandemic: A Case Series.

Background: Hospitals are one of the primary resources for disease transmission, so many guidelines were published, and neurosurgeons were advised to postpone elective spine surgeries during the COVID-19 pandemic. Objectives: To avoid pulmonary complications and reduce the risk of spreading the virus and contracting the disease during the COVID-19 era, we operated a group of our patients under spinal anesthesia rather than general anesthesia. Methods: We retrospectively analyzed all patients who underwent discectomy surgery for lumbar spinal disc herniation under SA between September 2020 and 2021. Results: Sixty-four patients diagnosed with lumbar disc herniation underwent lumbar discectomy with SA. All patients except three were male. The mean age was 44.52 ± 7.95 years (28 to 64 years). The mean procedure time for SA was 10 minutes. The duration of the surgery was 40 to 90 minutes per each level of disc herniation. The mean blood loss was 350 cc (200 to 600 cc). The most common involved level was L4/L5 intervertebral disc (n = 40 patients; 63.5%). The mean recovery time was 20 minutes. Only three patients requested more analgesics for relief of their pain postoperatively. All patients with discectomy were discharged a day after surgery, and in the case of fusion, two days after surgery. All the patients were followed up for six months, showing no recurrence symptoms, good pain relief, satisfaction with the surgery, and no bad memory of the surgery. Conclusions: Spinal anesthesia is a good alternative or even the main anesthesia route for patients with lumbar disc herniation. More studies are needed to elucidate the best candidate for SA in patients with lumbar pathology.

Mental health, eating habits and physical activity levels of elite Iranian athletes during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has changed life styles of millions of people worldwide. This study investigated changes in the health, physical activity levels and eating habits of elite athletes during the COVID-19 pandemic lockdown in Iran. METHODS: 383 (248 female and 135 male) elite athletes (168.82 ± 0.07 cm; 63.92 ± 7.42 kg; the body mass index (BMI): 22.3 ± 0.78 kg/m2) participated in this study. The International Physical Activity Questionnaire (IPAQ), Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) study tools were used to measure levels of physical activity and mental health status, respectively. The Emotional Eater Questionnaire (EEQ) was used to assess food consumption related to emotion. Pearson and Spearman correlation analysis test were used in data analysis. RESULTS: Levels of depression and stress were mild and moderate, while levels of anxiety were severe and very severe in most elite athletes. There were levels of low emotional eating by elite athletes during the COVID-19 pandemic. Physical activity levels were negatively correlated with psychological mood measures (p≤0.05), while there were positive correlations between emotional eating behaviours and psychological mood measures (moderate correlation; p≤0.01) and light physical activity levels (weak correlation; p≤0.05). CONCLUSION: This study provides the first preliminary evidence showing that the COVID-19 lockdown conditions negatively influenced the eating habits and levels of physical activity and mental health in elite athletes. Regular high intensity physical activity as health strategy in elite athletes and the general population remains a strategy to improve overall health during the COVID-19 pandemic. Additionally, these findings suggest the need to devise strategies to improve the life styles of elite athletes during pandemics such as the Covid-19 pandemic.

CONTEXTE: La pandémie de COVID-19 a changé les modes de vie de millions de personnes dans le monde. Cette étude a examiné certains indicateurs de bonne santé, les niveaux d'activité physique et les habitudes alimentaires d'athlètes Elite iraniens pendant le confinement lié à la pandémie de COVID-19.Méthodes : 383 (248 femmes et 135 hommes) athlètes élites (168,82 ± 0,07 cm ; 63,92 ± 7,42 kg ; indice de masse corporelle (IMC) : 22,3 ± 0,78 kg/m2) ont participé à cette étude. Le questionnaire international sur l'activité physique (IPAQ), l'échelle DASS-21 (Depression Anxiety Stress Scales) et les scores de l'auto-questionnaire Impact of Event Scale-Revised (IES-R) ont été utilisés pour mesurer les niveaux respectifs d'activité physique et de l'état de santé mentale. L'Emotional Eater Questionnaire (EEQ) a été utilisé pour évaluer les altérations de la prise alimentaire liées à l'émotion. Le test d'analyse de corrélation de Pearson et Spearman a été utilisé pour l'analyse des données.Résultats : Les niveaux de dépression et de stress étaient légers et modérés, tandis que les niveaux d'anxiété étaient sévères à très sévères chez la plupart des athlètes élites. Il y avait des niveaux de faible alimentation d'origine émotionnelle chez ces athlètes pendant la pandémie de COVID-19. Les niveaux d'activité physique étaient corrélés négativement avec les mesures de l'humeur psychologique (p≤0,05), tandis qu'il y avait des corrélations positives entre les comportements alimentaires émotionnels et les mesures de l'humeur psychologique (corrélation modérée ; p≤0,01) et les niveaux d'activité physique légère (faible corrélation ; p≤0,05). CONCLUSION: Cette étude apporte une preuve préliminaire que les conditions de confinement liées au COVID-19 ont influencé négativement les habitudes alimentaires et les niveaux d'activité physique et de santé mentale chez des athlètes élites. L'activité physique régulière à haute intensité aussi bien chez les athlètes élites que pour la population générale reste une stratégie pour améliorer la santé globale pendant la pandémie de COVID-19. De plus, ces résultats suggèrent la nécessité de concevoir des stratégies pour améliorer les styles de vie des athlètes élites lors de pandémies, telles que celle de Covid-19.

Effects of home confinement on physical activity, nutrition, and sleep quality during the COVID-19 outbreak in amateur and elite athletes.

Introduction: Despite the progress in the management of the pandemic caused by COVID-19, it is necessary to continue exploring and explaining how this situation affected the athlete population around the world to improve their circumstances and reduce the negative impact of changes in their lifestyle conditions that were necessitated due to the pandemic. The aim of this study was to analyze the moderating influence of physical activity (PA) and dietary habits on the impact of the COVID-19 pandemic experience on sleep quality in elite and amateur athletes. Materials and methods: A total of 1,420 elite (40.1%) and amateur (59.9%) athletes (41% women; 59% men) from 14 different countries participated in a cross-sectional design study. Data were collected using a battery of questionnaires that identified sociodemographic data, sleep quality index, PA levels, dietary habits, and the athletes' perception of their experience during the COVID-19 pandemic. Means and standard deviations were calculated for each variable. The analysis of variances and the correlation between variables were carried out with non-parametric statistics. A simple moderation effect was calculated to analyze the interaction between PA or dietary habits on the perception of the COVID-19 experience effect on sleep quality in elite and amateur athletes. Results: The PA level of elite athletes was higher than amateur athletes during COVID-19 (p < 0.001). However, the PA level of both categories of athletes was lower during COVID-19 than pre-COVID-19 (p < 0.01). In addition, amateurs had a higher diet quality than elite athletes during the pandemic (p = 0.014). The perception of the COVID-19 experience as controllable was significantly higher (p = 0.020) among elite athletes. In addition, two moderating effects had significant interactions. For amateur athletes, the PA level moderated the effect of controllable COVID-19 experience on sleep quality [F (3,777) = 3.05; p = 0.028], while for elite athletes, the same effect was moderated by dietary habits [F (3,506) = 4.47, p = 0.004]. Conclusion: Elite athletes had different lifestyle behaviors compared to amateurs during the COVID-19 lockdown. Furthermore, the relevance of maintaining high levels of PA for amateurs and good quality dietary habits by elite athletes was noted by the moderating effect that both variables had on the influence of the controllable experience during the COVID-19 pandemic on sleep quality.

Is early or late biological maturation trigger obesity? A machine learning modeling research in Turkey boys and girls.

Biological maturation status can affect individual differences, sex, height, body fat, and body weight in adolescents and thus may be associated with obesity. The primary aim of this study was to examine the relationship between biological maturation and obesity. Overall, 1,328 adolescents (792 boys and 536 girls) aged 12.00 ± 0.94-12.21 ± 0.99 years, respectively (measured for body mass, body stature, sitting stature). Body weights were deter-mined with Tanita body analysis system and adolescent obesity status was calculated according to the WHO classification. Biological maturation was determined according to the somatic maturation method. Our results showed that boys mature 3.077-fold later than girls. Obesity was an increasing effect on early maturation. It was determined that being obese, overweight and healthy-weight increased the risk of early maturation 9.80, 6.99 and 1.81-fold, respectively. The equation of the model predicting maturation is: Logit (P) = 1/(1 + exp. (- (-31.386 + sex-boy * (1.124) + [chronological age = 10] * (-7.031) + [chronological age = 11] * (-4.338) + [chronological age = 12] * (-1.677) + age * (-2.075) + weight * 0.093 + height * (-0.141) + obesity * (-2.282) + overweight * (-1.944) + healthy weight * (-0.592)))). Logistic regression model predicted maturity with 80.7% [95% CI: 77.2-84.1%] accuracy. In addition, the model had a high sensitivity value (81.7% [76.2-86.6%]), which indicates that the model can successfully distinguish adolescents with early maturation. In conclusion, sex and obesity are independent predictors of maturity, and the risk of early maturation is increased, especially in the case of obesity and in girls.

Severe skull deformity in a child with shunted hydrocephalus.

INTRODUCTION: We report a rare case of skull deformity in a child with shunted hydrocephalus. CASE REPORT: A 2.5-year-old boy with a history of cerebral palsy (CP), shunted hydrocephalus and seizures was admitted to our children's hospital with status epilepticus. This was initially controlled with anesthesia. He referred to us intubated. Head examination found a skull deformity (brachycephaly). Head CT revealed a remarkable deformity and bilateral chronic subdural hematomas. MRI demonstrated voluminous extra-axial masses over the cerebral convexities with high signal on T1 and T2 sequences in favor of hematoma. The patient had a bilateral frontoparietal craniotomy and evacuation of subdural/epidural hematomas. Neurological status improved on the next day but because of co-existent medical problems, the patients gradually deteriorated and died. CONCLUSION: Shunt-induced craniosynostosis is rarely seen nowadays thanks to early detection and treatment of infantile hydrocephalus. But in the setting of child neglect or low socioeconomic culture, it can occur. Although it usually results in a skull deformity similar to the primary craniosynostosis such as scaphocephaly, brachycephaly, it can induce a macrocephalic skull and subsequently associated chronic haematomas.

SARS coronavirus 2 and central nervous system manifestations: causation, relation, or coexistence? a case series study and literature review.

INTRODUCTION: Recently, weeks after the COVID-19 prevalence, there were reports of brain involvement and neurologic presentations in the COVID-19. CASE PRESENTATION: We present five cases of COVID-19 and cerebrovascular events. A 34-year-old woman with IVH and ischemic stroke. A 60-year-old man with multiple small hemorrhagic foci and mild IVH in the occipital horn. A 63-year-old woman with large left parietooccipital intracerebral hemorrhage (ICH) and IVH. A 56-year-old man with left hemispheric and midbrain ICH, lateral ventricular IVH, and hydrocephalus. A 85-year-old woman with right parietal hemorrhagic infarct. The coagulation profile was normal in all of them. The chest CT scan showed the typical ground-glass appearance of COVID-19. CONCLUSIONS: Recently, there were reports of brain involvement and neurologic presentations in the COVID-19. These reports and the present study necessitate the aimed and designed studies with emphasis on neurologic presentations in COVID-19 patients to illustrate the exact effects of coronavirus-2 on the central nervous system.

Usefulness of subtraction images for accurate diagnosis of pituitary microadenomas in dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of pituitary microadenomas; however, it may be associated with a relatively high false-negative rate, especially in small lesions. PURPOSE: To evaluate the usefulness of subtraction images for enhancing the visual detection of pituitary microadenomas. MATERIAL AND METHODS: In total, 50 patients with clinically established diagnosis hyperprolactinemia, acromegaly, and Cushing's disease were enrolled. Ten patients referred for brain MRI for reasons other than pituitary abnormality were selected as control group. Routine dynamic MRI of the pituitary gland and obtained subtraction MRI scans were scrutinized separately on different sessions by an experienced radiologist blinded to the study design and patient's data. The investigator's opinion on the presence or absence of a lesion and lesion size were collected. RESULTS: In patients with pituitary microadenoma, dynamic MRI images were reported positive in 42 (84%) patients and negative in 8 (16%). Subtraction images were described as positive in all patients (100%)-including all patients with negative dynamic MRI-and the difference was statistically significant (P=0.016). Undetected lesions on dynamic MRI had a mean size of 2.84 ± 1.79 mm (median= 2.20 mm, interquartile range=1.62-4.62 mm) and a significant inverse correlation was noted between lesion size and negative report of dynamic MRI (P=0.018). Brain MRI scans in the control group were reported negative for pituitary microadenoma in both dynamic contrast-enhanced and subtraction images. CONCLUSION: Subtraction images can successfully identify all lesions detectable with conventional dynamic MRI as well as improving visualization of lesions undetected on dynamic MRI, especially in small lesions.

High intensity interval training and L-Arginine supplementation decrease interleukin-6 levels in adult trained males.

OBJECTIVE: To evaluate the effect of six weeks of high intensity interval training (HIIT) and L-Arginine supplementation on interleukin-6 (IL-6) levels and body composition in Iranian adult trained males. METHODS: This experimental study was performed as an intervention with a pretest-posttest design in three experimental groups and one control group. Fortyeight young males from Qazvin province (Iran) were selected voluntarily based on convenience sampling. Participants were randomly divided into four groups (12 participants in each group): "HIIT"; "L-Arginine supplementation"; "HIIT + L-Arginine supplementation", and "HIIT + placebo". At 7 a.m., when the level of inflammation was at its lowest, a blood sample was taken from the participants, and body mass index (BMI), body fat percentage (BFP), and lean body mass (LBM) were determined. IL-6 analysis was performed using STATE FAX device and ELISA method. Training sessions were conducted for six consecutive weeks, three sessions a week. Analysis of covariance and Bonferroni post hoc test were used to analyze the data. RESULTS: i) There were no significant differences between groups in BMI, BFP, or LBM. ii) There was a significant difference in IL-6 levels between the groups (p < 0.05), so that the inflammatory levels in the "HIIT + L-Arginine supplementation" and "HIIT + placebo" groups were lesser than the "HIIT" (0.002 and <0.001, respectively) and "L-Arginine supplementation" (<0.001and <0.001, respectively) groups. HIIT "seems" to reduce the level of inflammation. CONCLUSION: HIIT had no significant effect on body composition indices. Plasma IL-6 levels decreased after six weeks of HIIT and L-Arginine supplementation. The level of IL-6 in the "HIIT + L-Arginine supplementation" and "HIIT + placebo" groups were lower than the control group (i.e.; "HIIT") and supplement control group (i.e.; "L-Arginine supplementation").

COVID-19 lockdown: Impairments of objective measurements of selected physical activity, cardiorespiratory and sleep parameters in trained fitness coaches.

The COVID-19 outbreak resulted in the shutdown of athletic training facilities. Although the effects of these restrictions on daily activity and sleep patterns have been widely analyzed, the employed tools often lacked accuracy, and were based on subjective measures. This study assessed the effects of home confinement on objective physical activity (PA), physiological and sleep parameters in active individuals. Sixteen male elite fitness coaches (age: 29±3 years; height: 183±6 cm; body mass: 82±5 kg, body mass index: 24.7±1.8 kg/m2) participated in this retrospective study. One-way analysis of variance was conducted to analyze selected PA, physiological and sleep parameters collected by smartwatch (Garmin Fenix 6 pro, USA) data during four consecutive months [i.e., pre-confinement, 1st and 2nd months of confinement, and post-confinement, year 2020]. Ramadan intermittent fasting (RIF) month occurred during the 2nd month of confinement. Compared to pre-confinement, significant changes were registered for almost all parameters during the 1st and/or the 2nd month of confinements (p<0.001), with (i) higher values for resting heart rate, sleep latency, and total, light and rapid eye movements sleep times (% change=7-523 %), and (ii) lower values for PA parameters, calories/day spent, average and highest respiratory rates, and deep sleep time during the home confinement period (% change=5-36 %). During the post-confinement month, all parameters regained pre-confinement values. In conclusion, home confinement-induced detraining negatively influenced the objective measurements of cardiorespiratory and sleep parameters among fitness coaches with a deeper effect during the 2nd month of home confinement, possibly due to the effect of RIF.