Exploring adverse effects of deep brain stimulation: the need for personalized care and long-term monitoring.

Deep Brain Stimulation (DBS), an FDA-approved treatment for movement disorders such as Parkinson's Disease (PD), is increasingly used for various neurological and neuropsychiatric conditions. A recent systematic review and meta-analysis by Bahadori et al. highlighted a significant increase in Body Mass Index (BMI) among patients post-DBS, with most participants having PD. The study, however, noted moderate heterogeneity (I² = 67.566%) without thoroughly addressing its potential causes or proposing strategies to mitigate it. The review's limited patient diversity and short follow-up period also challenge its generalizability and long-term implications. In addition to BMI changes, DBS has been linked to motor, cognitive, and psychiatric side effects. Patients undergoing subthalamic nucleus (STN) stimulation, for example, face risks of motor complications, including speech and gait issues, while cognitive declines, particularly in verbal fluency and executive function, are also concerning. Psychiatric side effects such as depression, anxiety, and psychosis further complicate treatment outcomes. These findings underscore the importance of personalized treatment strategies, preoperative assessments, and ongoing patient education to minimize adverse effects and optimize the therapeutic potential of DBS.

Factors Influencing Parental Willingness to Consent to a Survey Study for Patients in the Pediatric Emergency Department.

OBJECTIVE: To identify factors that impact parental willingness to consent to research studies conducted for their children during visits to pediatric emergency departments (EDs). METHODS: Parents and guardians of children receiving care in our pediatric ED were approached and asked if they would be willing to let their child participate in a research study requiring the child to complete an electronic questionnaire. No such questionnaire existed, however, because the primary purpose was to ascertain the parent's willingness to let their child participate. All parents were debriefed and informed of the true purpose of the study and asked to complete a survey themselves to help understand factors that influenced their initial decision of whether to consent. Bivariate tests and logistic regression were used to evaluate unadjusted and adjusted associations between parent and patient characteristics and parental consent decision. RESULTS: We approached 431 eligible parents about the hypothetical research study involving their children, and 386 (89.6%) consented for their children to participate. After the debriefing, 392 (91.0%) parents consented to complete the parental survey. We observed statistically significant associations between shorter length of ED stay to approach for consent for the study ( P = 0.048) as well as longer travel time ( P = 0.03) and willingness to consent in bivariate analysis, though this did not hold in regression analysis. Regression analysis revealed parents of children who have previously participated in research had 79 times lower odds of consenting to participate in our study adjusted for parent race, ethnicity, actual and perceived length of stay, travel time to the ED, and altruism. CONCLUSIONS: A high proportion of parents consented to their child participating in research in our ED with previous child participation in research being associated with lower odds of parental consent even when adjusted for other factors. Our findings may inform future research practices and studies investigating parental perceptions and motivations surrounding research studies.

Entrepreneurial leadership, nurses' proactive work behavior, and career adaptability: a structural equation model.

BACKGROUND: Healthcare organizations with practitioners who exhibit proactive work behavior and career adaptability acquire a competitive advantage in the face of many adversities. Entrepreneurial leadership (EL) is a new leadership approach that has a huge impact on followers' behavior, although research into its theory and empirical evidence is still in its infancy. METHODS: A non-probability convenience sample methodology (n = 450) was utilized to choose study participants, who were equally dispersed among the two private hospitals in Alexandria. A cross-sectional study was carried out in all departments of the hospitals, which were chosen at random using a simple random procedure. Three validated scales were used in this study to measure the study variables and establish a structural equation model. RESULTS: The result of this study revealed that nurses perceived moderate mean scores of all variables; entrepreneurial leadership (140.84 ± 11.94), proactive work behavior (46.02 ± 5.85), and career adaptability (85.55 ± 10.35). In addition, the structured equation model revealed a goodness fit index and presents that entrepreneurial leadership significantly affects nurses' proactive work behavior with an estimated ß of 0.555, coefficient of regression C.R. of 4.006, at P value < 0.001. Also, it significantly affects career adaptability with an estimated ß of .834, a coefficient of regression C.R. of 3.491 at P value < 0.001. CONCLUSIONS: The developed structural equation model confirmed the significant impact of entrepreneurial leadership (EL) on nurses' proactive work behavior (PWB) and career adaptability (CA)". Therefore, this study offers important implications for nurse managers, staff nurses, hospital human resources management practice, and academics.

Prior trauma experiences among state patients charged with murder: A retrospective records review.

Background: Trauma experiences, particularly in childhood, have been associated with criminality and mental illness. There is a paucity of research into the crime of murder, trauma and mental illness. Aim: This research study focused on state patients charged with murder and sought to determine associations with prior trauma experiences, and specific types of traumas (sexual, physical and emotional). Setting: The study was conducted at a forensic psychiatric hospital in Johannesburg, South Africa. Methods: The records of state patients admitted over a 21-year period on a charge of murder were reviewed and analysed with respect to sociodemographic variables, clinical profiles, trauma experience and victim characteristics. Results: Experience of trauma in this population, with a much higher number of males compared with females, was lower than previous studies. Neurocognitive disorder was significantly associated with physical trauma. Physical trauma was found to have a significantly negative association with psychotic disorders, compared with other mental disorders. Conclusion: Although trauma is common in psychiatric patients, the study's findings are lower than previous studies. Noting the male bias in state patients that commit murder, greater sample sizes are needed to adequately address issues of specific types of traumas, the development of mental illness and murder. Contribution: Exploring and managing prior trauma in state patients who commit murder is important while considering rehabilitation efforts, such that reintegration into the community and non-recidivism are encouraged.

ASSOCIATION BETWEEN LEUKOCYTES COUNT AND THE SEVERITY OF COVID-19 INFECTION.

OBJECTIVE: The aim: To find an association of COVID-19 on different types of leukocytes either count increasing or decreasing. PATIENTS AND METHODS: Materials and methods: A cross sectional study conducted from October /2020 to January /2021. Eighty patients out of 170 were enrolled in this study, who were attended a private clinic for clinical investigation and a private laboratory for laboratory diagnosis of COVID-19 who were divided into two groups, asymptomatic or mild (group 1), and moderate or severe (group 2). Five milliliter of blood samples were collected from patients with COVD-19 by venipuncture using a syringe for evaluation of different cells. RESULTS: Results: The current study revealed a significant difference in white blood cells count, neutrophils count, monocytes count, basophils count, and neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio between group 1 and group 2. While lymphocytes, and eosinophil showed no significant difference. CONCLUSION: Conclusion: The current study concluded that COVID-19 may affect the count of some leukocytes in patient with severe infection.

An Assessment of the Knowledge, Attitudes, and Practices of Patients and Families with Diagnoses of Hereditary Neuromuscular Disorders.

BACKGROUND: Hereditary neuromuscular disorders (NMDs) result in progressive disability with no definitive disease modifying treatments. There is a delay in diagnosis, and lack of awareness among affected individuals about these disorders, which can affect quality of life of patients. OBJECTIVE: The aim of this study is to identify gaps in patient knowledge, factors affecting attitudes toward the diagnoses, and specific practices to create better awareness among patients and healthcare providers to improve care and overall outcomes. METHODS: This is a cross-sectional study of 130 patients diagnosed with an NMD, recruited from the outpatient neurology clinics at the Aga Khan University Hospital. After telephonic consent, a 28 item survey questionnaire was administered. Knowledge, attitude, and practice scores were measured. RESULTS: One hundred and thirty of 198 study participants responded. The average age was 26.3 years; 75% were male. More than 38% (n = 50) had a middle grade or less education. The average knowledge, attitude, and practice scores were 7.9, 2.7, and 3.8 respectively. There was a low but statistically significant correlation between knowledge-attitude and attitude-practice scores. Almost 80% of respondents believed that dystrophy or spinal muscular atrophy is curable, while a majority considered that physical activity should be avoided. CONCLUSIONS: Our study presents new insights into the role of clarifying misconceptions about NMD and to correct attitudes among patients, their families and communities. It underscores the need for early interventions with demonstrably positive effects on disease progression such as physical therapy, as well as emphasizes the provision of accessible and affordable centers for such services.

Analysis of anti-microbial and anti-biofilm activity of hand washes and sanitizers against S. aureus and P. aeruginosa.

OBJECTIVE: To analyse the biofilm-forming potential of clinical isolates of Staphylococcus aureus and Pseudomonas aeruginosa, and to assess antimicrobial activity of commonly used sanitizers in hospital and laboratory settings. METHODS: The study was conducted at Aga Khan University Karachi from August 2016 to January 2017. The biofilm-forming potential of Staphylococcus aureus and Pseudomonas aeruginosa clinical isolates were evaluated qualitatively using air-liquid interface tube method, and air-liquid interface cover slip assay. The antimicrobial activity of commonly-used hand-washes and sanitizers were assessed using agar well diffusion method, while the anti-biofilm activity of the hand-washes and sanitizers was qualitatively assessed using air-liquid interface covers lip as s ay. RESULTS: Of the eight hand-washes and sanitizers, 2(25%) showed antimicrobial activity against both Staphylococcus aureus and Pseudomonas aeruginosa, while 2(25%) exhibited antimicrobial activity against either S. aureus or P. aeruginosa. Also, 4 (50%) of them showed no inhibitory activity against S. aureus and P. aeruginosa. CONCLUSIONS: The findings shall have important consequences with regards to infection control in hospital and laboratory settings.

What Degree of Radiological Compression Predicts Cauda Equina Syndrome: A Retrospective Study at a National Tertiary Center.

OBJECTIVE: Cauda equina syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on magnetic resonance imaging that correlates with cauda equina compression, facilitating reliable decision-making for CES symptoms. METHODS: A single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse group. CES cases were identified using International Classification of Diseases, 10th Revision code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 magnetic resonance imaging scans, using the IC Measure software on Windows. RESULTS: CES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67-85.71), significantly higher than in disc prolapse cases, 48.08% (31.33-55.56) (P < 0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve of 0.923. CONCLUSIONS: Simple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.

The Impact of Virtual Residency Interviews on the Geographic Distribution of Integrated Interventional and Diagnostic Radiology Residency Matches.

PURPOSE: To characterize how the adoption of virtual residency interviews (2020-2021 cycle) has impacted the geographic distribution of radiology resident matches. METHODS: University-based interventional (IR) and diagnostic radiology (DR) residency programs from 2017 to 2021 were identified using a national residency database (FRIEDA). Public applicant data were obtained from official residency program websites. Medical schools and residency programs were categorized by US census regions. Geographic applicant distribution before and after the initiation of virtual interviews was statistically assessed using Chi-square tests. The effect of virtual interviews on the probability of matching within the same geographic region as one's medical school was evaluated with multivariate logistic regression. RESULTS: 4358 radiology residents (88% diagnostic, 12% interventional) matched at 102 radiology programs during the study period. 71% (n = 3115 residents) had data available for analysis. 56.3% of DR and 49.3% of IR residents matched in the same geographic region as their medical school. The geographic distribution of applicants who matched at Southern IR residency programs significantly changed after implementation of virtual interviews (p < 0.0001). Virtual interviews did not increase the odds of matching in the same region as one's medical school for IR (OR 1.11, p = 0.08) or DR (OR 1.01, p = 0.58) applicants. Top-20 ranked DR programs had lower odds of in-region matches (OR 0.87, p < 0.001). CONCLUSION: With few exceptions, shifting to virtual residency interviews did not significantly affect the geographic distribution of IR or DR residency matches. Top-ranked DR programs match more regionally diverse applicants.

Cerebellar abscess secondary to metastatic lung adenocarcinoma: a case report.

BACKGROUND: Cerebellar abscesses are rare, life-threatening infections often originating from bacterial sources, while metastatic brain lesions from lung adenocarcinoma are relatively common. However, the coexistence of a cerebellar abscess secondary to metastatic lung adenocarcinoma is exceedingly rare and presents unique diagnostic and management challenges. CASE PRESENTATION: We report a case of a 35 year-old Pakistani female patient with persistent headaches, nausea, and vertigo, who was found to have a large cerebellar mass with features suggestive of metastatic lung adenocarcinoma. Further investigation revealed a concomitant cerebellar abscess. Surgical excision and broad-spectrum antibiotics were initiated, resulting in a favorable outcome. CONCLUSION: This case showcases the rarity and complexity of cerebellar abscesses due to metastatic lung adenocarcinoma. Timely intervention, including surgery and targeted therapy, is crucial for successful management. Further research is needed to enhance treatment strategies.

Outcomes with distal transradial access in patients with advanced chronic kidney disease.

Radial artery occlusion (RAO), a complication of transradial access, has an incidence of 4.0% to 9.1% in patients with advanced chronic kidney disease (CKD) and may preclude its use creation of arteriovenous fistula. Distal transradial access (dTRA) has lower rates of RAO compared with TRA, but prior studies excluded patients with advanced CKD. This was a single center study of patients with advanced CKD who underwent coronary procedures with dTRA from January 1, 2019 to May 12, 2022 who were retrospectively evaluated for radial artery patency in follow-up with reverse Barbeau testing or repeat access of the artery. Of 71 patients, 66% were on hemodialysis and the remainder had CKD 3 to 5. Access was ultrasound-guided, and all received adequate spasmolytic therapy and patent hemostasis. Proximal radial arteries were patent in 100% of the patients at follow-up. Our data suggest that dTRA is safe for patients with advanced CKD and preserves radial artery patency.

Nanotechnology in action: silver nanoparticles for improved eco-friendly remediation.

Nanotechnology is an exciting area with great potential for use in biotechnology due to the far-reaching effects of nanoscale materials and their size-dependent characteristics. Silver and other metal nanoparticles have attracted a lot of attention lately because of the exceptional optical, electrical, and antimicrobial characteristics they possess. Silver nanoparticles (AgNPs) stand out due to their cost-effectiveness and abundant presence in the earth's crust, making them a compelling subject for further exploration. The vital efficacy of silver nanoparticles in addressing environmental concerns is emphasized in this thorough overview that dives into their significance in environmental remediation. Leveraging the distinctive properties of AgNPs, such as their antibacterial and catalytic characteristics, innovative solutions for efficient treatment of pollutants are being developed. The review critically examines the transformative potential of silver nanoparticles, exploring their various applications and promising achievements in enhancing environmental remediation techniques. As environmental defenders, this study advocates for intensified investigation and application of silver nanoparticles. Furthermore, this review aims to assist future investigators in developing more cost-effective and efficient innovations involving AgNPs carrying nanoprobes. These nanoprobes have the potential to detect numerous groups of contaminants simultaneously, with a low limit of detection (LOD) and reliable reproducibility. The goal is to utilize these innovations for environmental remediation purposes.

CAE-ResVGG FusionNet: A Feature Extraction Framework Integrating Convolutional Autoencoders and Transfer Learning for Immature White Blood Cells in Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) is a highly aggressive cancer form that affects myeloid cells, leading to the excessive growth of immature white blood cells (WBCs) in both bone marrow and peripheral blood. Timely AML detection is crucial for effective treatment and patient well-being. Currently, AML diagnosis relies on the manual recognition of immature WBCs through peripheral blood smear analysis, which is time-consuming, prone to errors, and subject to inter-observers' variation. This study aimed to develop a computer-aided diagnostic framework for AML, called "CAE-ResVGG FusionNet", that precisely identifies and classifies immature WBCs into their respective subtypes. The proposed framework leverages an integrated approach, by combining a convolutional autoencoder (CAE) with finely tuned adaptations of the VGG19 and ResNet50 architectures to extract features from CAE-derived embeddings. The process begins with a binary classification model distinguishing between mature and immature WBCs followed by a multiclassifier further classifying immature cells into four subtypes: myeloblasts, monoblasts, erythroblasts, and promyelocytes. The CAE-ResVGG FusionNet workflow comprises four primary stages, including data preprocessing, feature extraction, classification, and validation. The preprocessing phase involves applying data augmentation methods using geometric transformations and synthetic image generation using the CAE to address imbalance in the WBC distribution. Feature extraction involves image embedding and transfer learning, where CAE-derived image representations are used by a custom integrated model of VGG19 and ResNet50 pretrained models. The classification phase employs a weighted ensemble approach that leverages VGG19 and ResNet50, where the optimal weighting parameters are selected using a grid search. The model performance was assessed during the validation phase using the overall accuracy, precision, and sensitivity, while the area under the receiver characteristic curve (AUC) was used to evaluate the model's discriminatory capability. The proposed framework exhibited notable results, achieving an average accuracy of 99.9%, sensitivity of 91.7%, and precision of 98.8%. The model demonstrated exceptional discriminatory ability, as evidenced by an AUC of 99.6%. Significantly, the proposed system outperformed previous methods, indicating its superior diagnostic ability.

Assessing the impacts of L-carnitine and modafinil on fatigue in Iraqi multiple sclerosis patients.

Fatigue is a prevalent symptom experienced by individuals diagnosed with multiple sclerosis (MS), which greatly affects their daily activities and causes frustration and depression, thus affecting their lives and society. This can be prevented through the use of medicines such as L-carnitine and modafinil. The study aimed to examine the effect of L-carnitine and modafinil on fatigue and which one is better for MS patients. This was a clinical trial. This clinical trial was conducted in cooperation between Al-Kut University College and an MS consultant at Al-Zahraa Teaching Hospital in addition to the private neurological clinic from October 1, 2022, to March 15, 2023. Forty participants were split into two groups; both of which were almost identical characteristics regarding age, disease duration, and degree of fatigue. Group I (n = 20): relapsing-remitting MS patients with fatigue received modafinil. Group II (n = 20): relapsing-remitting MS patients with fatigue received L-carnitine. Fatigue was evaluated according to the Modified Fatigue Impact Scale (MFIS). The statistical work was done in SPSS (IBM Corp., Chicago, IL, USA, version 24). P values were calculated by the t-test. Significant data have P = 0.05. After 2 months of treatment, the results show a significant decrease in MFIS in both groups with a higher reduction in patients who use L-carnitine. Both modafinil and L-carnitine show a significant influence on fatigue in MS patients, and these effects are more in L-carnitine.

A novel automated Parkinson's disease identification approach using deep learning and EEG.

The neurological ailment known as Parkinson's disease (PD) affects people throughout the globe. The neurodegenerative PD-related disorder primarily affects people in middle to late life. Motor symptoms such as tremors, muscle rigidity, and sluggish, clumsy movement are common in patients with this disorder. Genetic and environmental variables play significant roles in the development of PD. Despite much investigation, the root cause of this neurodegenerative disease is still unidentified. Clinical diagnostics rely heavily on promptly detecting such irregularities to slow or stop the progression of illnesses successfully. Because of its direct correlation with brain activity, electroencephalography (EEG) is an essential PD diagnostic technique. Electroencephalography, or EEG, data are biomarkers of brain activity changes. However, these signals are non-linear, non-stationary, and complicated, making analysis difficult. One must often resort to a lengthy human labor process to accomplish results using traditional machine-learning approaches. The breakdown, feature extraction, and classification processes are typical examples of these stages. To overcome these obstacles, we present a novel deep-learning model for the automated identification of Parkinson's disease (PD). The Gabor transform, a standard method in EEG signal processing, was used to turn the raw data from the EEG recordings into spectrograms. In this research, we propose densely linked bidirectional long short-term memory (DLBLSTM), which first represents each layer as the sum of its hidden state plus the hidden states of all layers above it, then recursively transmits that representation to all layers below it. This study's suggested deep learning model was trained using these spectrograms as input data. Using a robust sixfold cross-validation method, the proposed model showed excellent accuracy with a classification accuracy of 99.6%. The results indicate that the suggested algorithm can automatically identify PD.

Does a Gluten-Free Diet Improve Quality of Life and Sleep in Patients with Non-Coeliac Gluten/Wheat Sensitivity?

INTRODUCTION: The role of a gluten-free diet (GFD) in Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is unclear. We present the largest study comparing adherence to a GFD in patients with Coeliac Disease (CD) and NCGWS and assess its impact on quality of life (QoL) and sleep in patients with NCGWS. METHODS: Patients with NCGWS at a tertiary centre completed the Coeliac Disease Adherence Test (CDAT), Coeliac Symptom Index (CSI) and Sleep Condition Indicator (SCI). Higher CDAT scores indicate worse adherence, higher CSI scores indicate poorer QoL, and higher SCI scores indicate better sleep. CDAT scores were correlated with CSI and SCI scores. A second group of patients with CD completed the CDAT questionnaire only. Results were compared with the CDAT responses from the NCGWS group. RESULTS: For the NCGWS cohort (n = 125), the median CDAT score was 17/35, indicating poor adherence. The median CSI score was 44/80, with 40% of scores associated with a poor QoL. The median SCI score was 14/32, and DSM-V criteria for insomnia was met by 42% of patients. There was a positive correlation between CSI and CDAT scores (r = 0.59, p < 0.0001) and a negative correlation between SCI and CDAT scores (r = -0.37, p = 0.0002). In the CD cohort (n = 170), the median CDAT score was 13/35. Patients with NCGWS had poorer adherence compared to CD (CDAT: 17.0 vs. 13.0, respectively, p = 0.0001). CONCLUSION: Patients with NCGWS adhere to a GFD less than those with CD. Poorer adherence to a GFD in patients with NCGWS correlates with a worse QoL and sleep performance.

Ebolavirus Species-Specific Interferon Antagonism Mediated by VP24.

Members of the Ebolavirus genus demonstrate a marked differences in pathogenicity in humans with Ebola (EBOV) being the most pathogenic, Bundibugyo (BDBV) less pathogenic, and Reston (RESTV) is not known to cause a disease in humans. The VP24 protein encoded by members of the Ebolavirus genus blocks type I interferon (IFN-I) signaling through interaction with host karyopherin alpha nuclear transporters, potentially contributing to virulence. Previously, we demonstrated that BDBV VP24 (bVP24) binds with lower affinities to karyopherin alpha proteins relative to EBOV VP24 (eVP24), and this correlated with a reduced inhibition in IFN-I signaling. We hypothesized that modification of eVP24-karyopherin alpha interface to make it similar to bVP24 would attenuate the ability to antagonize IFN-I response. We generated a panel of recombinant EBOVs containing single or combinations of point mutations in the eVP24-karyopherin alpha interface. Most of the viruses appeared to be attenuated in both IFN-I-competent 769-P and IFN-I-deficient Vero-E6 cells in the presence of IFNs. However, the R140A mutant grew at reduced levels even in the absence of IFNs in both cell lines, as well as in U3A STAT1 knockout cells. Both the R140A mutation and its combination with the N135A mutation greatly reduced the amounts of viral genomic RNA and mRNA suggesting that these mutations attenuate the virus in an IFN-I-independent attenuation. Additionally, we found that unlike eVP24, bVP24 does not inhibit interferon lambda 1 (IFN-λ1), interferon beta (IFN-ß), and ISG15, which potentially explains the lower pathogenicity of BDBV relative to EBOV. Thus, the VP24 residues binding karyopherin alpha attenuates the virus by IFN-I-dependent and independent mechanisms.