Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review.

Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

A systematic review of acute telogen effluvium, a harrowing post-COVID-19 manifestation.

This systematic review focuses on the clinical features, physical examination findings, outcomes, and underlying pathology of acute telogen effluvium (TE), a type of diffuse hair loss, occurring in coronavirus disease 2019 (COVID-19) recovered patients. MEDLINE/PubMed and Embase databases were queried till October 2021 to identify studies reporting acute TE occurring after COVID-19 recovery. Data were obtained from 19 studies, which included 465 patients who were diagnosed with acute TE. The median age of these patients was 44 years and 67.5% were females. The most common trichoscopic findings were decreased hair density, the presence of empty follicles, or short regrowing hair. The mean duration from COVID-19 symptom onset to the appearance of acute TE was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress.

Maternal and foetal-neonatal outcomes of dengue virus infection during pregnancy.

OBJECTIVE: Given that women of reproductive age in dengue-endemic areas are at risk of infection, it is necessary to determine whether dengue virus (DENV) infection during pregnancy is associated with adverse outcomes. The aim of this systematic review and meta-analysis is to investigate the consequences of DENV infection in pregnancy on various maternal and foetal-neonatal outcomes. METHODS: A systematic literature search was undertaken using PubMed, Google Scholar, and Embase till December 2021. Mantel-Haenszel risk ratios were calculated to report overall effect size using random effect models. The pooled prevalence was computed using the random effect model. All statistical analyses were performed on MedCalc Software. RESULT: We obtained data from 36 studies involving 39,632 DENV-infected pregnant women. DENV infection in pregnancy was associated with an increased risk of maternal mortality (OR = 4.14 [95% CI, 1.17-14.73]), stillbirth (OR = 2.71 [95% CI, 1.44-5.10]), and neonatal deaths (OR = 3.03 [95% CI, 1.17-7.83]) compared with pregnant women without DENV infection. There was no significant statistical association established between maternal DENV infection and the outcomes of preterm birth, maternal bleeding, low birth weight in neonates, and risk of miscarriage. Pooled prevalences were 14.9% for dengue shock syndrome, 14% for preterm birth, 13.8% for maternal bleeding, 10.1% for low birth weight, 6% for miscarriages, and 5.6% for stillbirth. CONCLUSION: DENV infection in pregnant women may be associated with adverse outcomes such as maternal mortality, stillbirth, and neonatal mortality. Hence, pregnant women should be considered an at-risk population for dengue management programmes.

Maculopapular skin eruptions associated with Covid-19: A systematic review.

In this systematic review, we anticipated in summarizing clinical features, histopathological hallmarks, and possible pathology behind the maculopapular skin eruptions occurring in Covid-19 patients. A literature search was executed using MEDLINE/PubMed and Embase databases for articles published till 20 November 2020. All eligible articles including observational studies, case reports, and case series reporting the maculopapular skin lesion in Covid-19 patients were included. Data were obtained for 354 Covid-19 patients presenting with maculopapular lesions from 40 studies. The mean age of these patients was 53 years, and with 42% of them being male. These maculopapular lesions differed considerably in terms of distribution and appearance, ranging from diffuse erythematous maculopapular lesions to scattered erythematous macules coalescing into papules to maculopapular lesions in plaques. The mean duration of the lesion was 8 days. These lesions were frequently localized on trunks and extremities. Superficial perivascular dermatitis with lymphocytic infiltrate was a histopathological hallmark of these lesions. As these skin lesions may have a possible association with diagnosis, management, prognosis, and severity of the disease, all health practitioners need to be well acquainted with these Covid-19 skin lesions. Also, in the middle of this worldwide pandemic, early identification of this eruption may help manage this infection's further spread.

Crimean-Congo haemorrhagic fever-induced liver injury: A systematic review and meta-analysis.

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a fatal acute tick-borne viral infection and substantial emerging global public health threat. This illness has a high case fatality rate of up to 40%. The liver is one of the important target organs of the CCHF virus. OBJECTIVE: The aim of this meta-analysis to evaluate the correlation between CCHF and liver injury and draw more generalised inferences about the abnormal serum markers of liver injury such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) in CCHF patients. METHODS: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible observational studies and case series were included from around the world. The inclusion criteria were articles describing liver injury biomarkers amongst patients diagnosed with CCHF. RESULTS: Data from 18 studies, consisting of 1238 patients with CCHF were included in this meta-analysis. Overall pooled incidence of at least one raised liver injury biomarker was 77.95% (95% CI, I2  =  88.50%, P < .0001). Similarly, pooled incidence of elevated AST and ALT was 85.92% (95% CI, I2  = 85.27%, P < .0001) and 64.30% (95% CI, I2  =  88.32%, P < .0001), respectively. Both Egger and Begg-Mazumdar's tests detected no apparent publication bias in all three meta-analyses (P > .05). CONCLUSION: Our study shows that CCHF has a very detrimental effect on liver function. Abnormal liver function may lead to poor prognosis and increased morbidity and mortality in CCHF patients. Hence, Physicians must recognise and continuously monitor these biomarkers, since these markers may aid in early stratification of prognosis and the prevention of severe outcomes in infection with such a high case fatality rate.

Myocarditis associated with Covid-19 disease: A systematic review of published case reports and case series.

BACKGROUND: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. The cardiac involvement in such a public health emergency disease has not been well studied and a conflicting evidence exists on this issue. OBJECTIVE: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. METHODS: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. RESULTS: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being men. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were nonspecific and included ST-segment and T-wave changes. Echocardiogram commonly showed left ventricular systolic dysfunction with increased heart size. Cardiac magnetic resonance imaging (CMRI) exhibited myocardial edema and injury. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. CONCLUSION: Because of the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Effect of half adult dose of oral Rifampicin (300mg) in patients with idiopathic central serous chorioretinopathy.

OBJECTIVES: To evaluate the effect of half adult dose of oral Rifampicin on mean change in best corrected visual acuity and central macular thickness in patients with central serous chorioretinopathy. METHODS: Thirty-eight eyes of 31 patients with idiopathic central serous chorioretinopathy (CSCR) were registered. Unaided Visual acuity, best corrected visual acuity was documented and detailed slit lamp examination along with dilated ophthalmoscopy was performed. All subjects were treated with oral Rifampicin 300 mg (half adult dose) daily for 03 months. Patients underwent a complete ocular and systemic examination as well as central macular thickness (CMT) measurement by optical coherence tomography (OCT) every month after starting treatment until four months. Fundus fluorescein angiography (FFA) was performed in recurrent cases. Liver function tests were carried out prior to the treatment and during follow up period. RESULTS: A total of 38 eyes of 31 patients (24 males, 07 females) were included in the study. Mean age of patients was 36.16±3.19 years (range 30-44). Mean best corrected visual acuity (BCVA) before treatment was 0.56±0.11 and improved to 0.47±0.14 at 04 weeks (P<0.001) of treatment. The mean CMT at the time of presentation was 494.39±96.29 um and was decreased to 306.90±50.71 um after 04 weeks of treatment (P<0.001). The mean induced reduction in CMT was 187.48±122 um (P<0.001) while that in BCVA 0.41±0.16 at 04 weeks of treatment (P<0.001). Liver function tests were within normal range before and after the treatment. CONCLUSION: Half adult dose rifampicin (300mg) is effective and safe in treatment of central serous chorioretinopathy without causing any systemic imbalance.

The Belt and Road Initiative's impact on tourism and heritage along the Silk Roads: A systematic literature review and future research agenda.

This is a systematic review of the literature on the Belt and Road Initiative (BRI) and its impact on tourism and heritage in participating countries along the Silk Roads. China launched the BRI in 2013 with the aim of promoting global trade and stimulating economic growth through the development of infrastructure and cultural cooperation. This review examines studies for the period from 2013 to 2023, focusing on key themes such as tourist flows, destination development, urban renewal, heritage preservation, and cultural route revival. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, incorporating 56 relevant documents that cover both tourism and heritage domains. The findings highlight substantial potential for the development of new tourism products and destinations, improved urban renewal, and the preservation of cultural heritage, provided that integrated policies, public-private collaboration, and equitable community participation frameworks are implemented with attention to ecological limits. However, the review also identifies significant challenges, including financial imbalances, uneven access to benefits, social disruption, cultural commodification, and environmental degradation. Addressing these issues requires careful, context-specific planning. The study concludes with a proposal for a future research agenda that includes exploring underrepresented regions, developing sustainable tourism models, and fostering interdisciplinary research to ensure a balanced approach to economic development and heritage preservation. This review's findings provide valuable insight for policymakers, tourism officials, and cultural heritage managers, guiding the development of policies that balance economic growth with the preservation of cultural and natural heritage sites. This research contributes to the academic discourse by elucidating the complex interplay between the BRI and the Silk Roads' tourism and heritage, offering a pathway for sustainable and inclusive growth.

An updated systemic review and meta-analysis on human papillomavirus in breast carcinogenesis.

Background: Breast Cancer (BC) stands out as the widely prevalent malignancy among all the types of cancer affecting women worldwide. There is significant evidence that the pathogenicity of BC may be altered by Human Papillomavirus (HPV) infection; however, conclusive data are not yet available. Methods: By searching five databases, including EMBASE, IBECS, PubMed, Scopus, Science Direct, Google Scholar, and Web of Science, a thorough systematic analysis was conducted on the prevalence of HPV in BC patients from 1990 to June 30, 2022. After applying extensive eligibility criteria, we selected 74 publications for further analysis based on the prevalence of HPV infections in breast tissues. All of the data were analyzed using a random-effects meta-analysis, Cochran Q test and I2 statistic were used to calculate the heterogeneity of the prevalence among these studies using subgroup analysis. Variations in the HPV prevalence estimates in different subgroups were evaluated by subgroup meta-analysis. Results: In total, 3156 studies were initially screened, resulting in 93 full-text studies reviewed, with 74 meeting inclusion criteria. Among a total of 7156 BC biopsies, the pool prevalence of HPV was 25.6% (95% CI= 0.24-0.33, τ2 = 0.0369 with significant heterogeneity between estimates (I 2 = 97% and p< 0.01). Consequently, 45 studies with available controls were further studied, and the prevalence of HPV in case-control studies was 26.2% with overall odds 5.55 (95% CI= 3.67-8.41, I 2 = 38%, τ2 = 1.4878, p< 0.01). Further subgroup analysis of HPV revealed HPV-16 had a maximum prevalence of 9.6% (95% CI= 3.06-11.86, I 2 = 0%, τ2 = 0.6111, p< 0.01). Among different geographical regions, Europe reported the maximum prevalence of HPV, i.e., 39.2% (95% CI=1.29-7.91, I 2 = 18%, τ2 = 1.2911, p< 0.01). Overall distribution showed HPV-18 was a frequent HPV subtype reported in Australia. Conclusion: Current study provides a global estimate of HPV prevalence in BC patients and demonstrates a significant association between this virus and BC etiology. Nevertheless, we recommend further investigation into the underlying mechanism is essential to validate this hypothesis.

Efficacy and Safety of Colchicine in Prevention of Secondary Cardiovascular Outcomes Among Patients With Coronary Vessel Disease: A Meta-Analysis.

Coronary vessel disease (CVD) is a class of diseases that impacts the blood vessels and heart and is one of the leading causes of disability and death. CVD includes cerebrovascular disease and coronary heart disease, both illnesses of the vessels transporting the oxygenated blood to the brain or heart. Colchicine is an inexpensive and old drug with strong anti-inflammatory effects. Numerous randomized control trials (RCTs) have demonstrated the effectiveness of low-dose colchicine for the prevention of severe cardiovascular events without showing any signs of serious adverse effects within the regime of treatment. In the current meta-analysis, we aim to assess the efficacy and safety of colchicine for secondary cardiovascular outcome prevention among patients with clinically proven CVD. The current meta-analysis was carried out using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PUBMED, Cochrane, and EMBASE databases were used to search for RCTs comparing colchicine and placebos for the prevention of secondary cardiovascular outcomes. The primary efficacy endpoint was mortality due to cardiovascular disease, stroke, urgent coronary revascularization, and myocardial infarction. Secondary efficacy outcomes included death due to all-cause mortality. Seven RCTs were reviewed, with a pooled sample size of 12114, out of which 6099 were randomized to the colchicine group, and 6015 were randomized to the control group. The decrease in cardiovascular events, including myocardial infarction, stroke, urgent coronary revascularization, and cardiac-related death, was significantly lower in patients randomized to colchicine (p-value<0.05). The incidence of safety outcomes did not vary significantly different between groups (p>0.05). In patients with CVD, compared to standard medical therapy, colchicine significantly decreases the risk of cardiovascular events such as cardiovascular-related death, myocardial infarction, stroke, and urgent coronary revascularizations.

Comparison of Fentanyl and Dexmedetomidine in Preventing an Increase in Heart Rate During Intubation Among Patients Undergoing General Anesthesia: A Meta-Analysis.

General anesthesia induction, tracheal intubation, extubation, and laryngoscopy are associated with specific hemodynamic changes. Tracheal intubation and laryngoscopy are related to sympathetic stimulation and lead to hypertension and tachycardia. Recent studies have shown that dexmedetomidine is safe and effective as it does not depress respiratory function. This meta-analysis aims to compare the efficacy of dexmedetomidine and fentanyl in preventing an increase in heart rate (HR) during intubation among patients undergoing general anesthesia. A systematic literature search was done using PubMed, Cochrane Library, and Embase to assess studies comparing the efficacy of dexmedetomidine and fentanyl in preventing an increase in HR during intubation. A meta-analysis was done utilizing a random-effects model, and mean differences of HR were determined between fentanyl and dexmedetomidine at baseline, one minute, five minutes, and 10 minutes of intubation. In this meta-analysis, eight randomized control trials were included, involving 548 patients (274 in the fentanyl group and 274 in the dexmedetomidine group). The findings showed that significant difference of HR was significantly lower in the dexmedetomidine group than the fentanyl group at one minute of intubation (mean difference = -8.46; P-value = 0.003), at five minutes of intubation (mean difference = -7.51; P-value = 0.001), and at 10 minutes of intubation (mean difference = -5.15; P-value = 0.030). In the current meta-analysis, dexmedetomidine was better than fentanyl in preventing tachycardia following endotracheal intubation. HR was significantly lower at one minute, five minutes, and 10 minutes after intubation in the dexmedetomidine group compared to the fentanyl group.

Retraction: Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial.

[This retracts the article DOI: 10.7759/cureus.20710.].

Association of Gastrointestinal System With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis.

At present, the novel coronavirus disease (COVID-19) is causing a major pandemic. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In COVID-19, the patient usually presents with fever, dry cough, and respiratory manifestations. However, the involvement of other systems has also been reported in the literature. Abdominal pain, diarrhea, vomiting, and nausea are the predominant gastrointestinal (GI) manifestations underlined in the literature. We conducted a literature search using four databases (PubMed, Web of Science, Google Scholar, and Clinicaltrials.gov). Our search strategy included Medical Subject Headings (MeSH) terms and keywords for COVID-19, SARS-CoV-2, and GI system from inception to October 2020. After excluding duplicates, review articles, and non-relevant articles, we included 20 studies out of 842 articles reporting GI manifestations in COVID-19 patients. Using Cochrane RevMan version 5.4 (Cochrane, London, UK), a compute pooled analysis using a random-effect model was performed. Our study included 6,022 patients with a median age of 49.5 years. Pooled analysis via random effect model revealed an increased risk of severe COVID-19 in patients manifesting GI symptoms with an odds ratio (OR) of 2.07 (95% Confidence Interval [CI]: 1.34-3.18) with I2=41%). Odds of mortality in COVID-19 with GI manifestation and hepatic abnormalities included 0.92 (95% CI: 0.50-1.69) (I2=57%) and 1.26 (95% CI: 0.67-2.37) (I2=0%), respectively. Severe COVID-19 may have a strong association with GI manifestations and have a significant impact on GI practice. Holistic knowledge of the spectrum of the GI consequences in COVID-19 is crucial to get a hold of virus spread. In this article, we have summarized the association of GI manifestations in severe COVID-19 patients.

Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial.

INTRODUCTION: Statin use in secondary prevention after acute coronary syndrome (ACS) can play an important role in enhancing clinical outcomes, this has been proven in several randomized trials. This study was conducted to compare the efficacy of moderate-intensity and high-intensity statins in controlling low-density lipoprotein (LDL) after ACS. METHODOLOGY: A randomized control trial was conducted at the Cardiology Department of Liaquat National Hospital, Karachi, Pakistan, from July 2020 to September 2021. During admission, patients were either started on a high-intensity statin dose (rosuvastatin 20 mg) or moderate-intensity statin (rosuvastatin 10 mg) by a computer-generated allocation sequence. Patients were followed-up in the outpatient department (OPD) after 3 months, and a lipid profile at follow-up was obtained. The percentage of LDL change was determined on 3 months of follow-up. RESULTS: A total of 590 patients were enrolled in the study. Out of all participants enrolled, 334 (80.48%) completed the 3-month follow-up. The mean age of participants was 58.08 (+12.06) years. High-intensity statin therapy is positively associated with positive LDL change (adjusted odds ratio [AOR]=4.45, P-value=0.001). CONCLUSION: Our data implies that high-intensity statin medication may be an initial therapeutic option to decrease LDL. However, future randomized clinical trials should corroborate these findings.

Synthesis, spectroscopic characterization and biological activity of the metal complexes of the Schiff base derived from phenylaminoacetohydrazide and dibenzoylmethane.

A new series of mono and binuclear Mn(II), Fe(III), Co(II), Ni(II), Cu(II), Zn(II), La(III), Ru(III), Hf(IV), ZrO(II) and UO2(II) complexes of phenylaminodibenzoylhydrazone have been synthesized and characterized by elementals analyses, IR UV-vis spectra, magnetic moments, conductances, thermal analyses (DTA and TGA) and electron spin resonance (ESR) measurements. The IR spectral data show that, the ligand behaves as a neutral bidentate type (15 and 16), monobasic bidentate type (6), or monobasic tridentate type (5, 7, 8, 10, 11, 13, 14, 17-21) or dibasic tridentate type 2-4, 9 and 12 towards the metal ion. Molar conductances in DMF solution indicate that, the complexes are non-electrolytes. The ESR spectra of solid complexes (9 and 10) show axial and non-axial types indicating a d(x2-y2) ground state with significant covalent bond character. However, complexes (11 and 12), show isotropic type, indicating manganese(II) octahedral geometry. Antibacterial and antifungal tests of the ligand and its metal complexes are also carried out and it has been observed that the complexes are more potent bactericides and fungicides than the ligand.

In vitro availability of metformin in presence of h(2) receptor antagonists.

Metformin is a guanidine derivative used for the treatment of NIDDM. As it is used for a long-term therapy, it may be coadministered with other drugs. Present paper deals with the in vitro availability studies of metformin in presence of commonly used H(2) receptor antagonists. The later drugs compete with histamine for H(2) receptors and block gastric acid secretion and some cardiovascular effects of histamine. These studies were carried out in simulated gastric juices, simulating empty and full stomach, simulated intestinal juice and buffers of pH 7.4 simulating blood pH at 37 degrees C on a B.P. 2003 dissolution test apparatus. Commonly prescribed H(2) receptor antagonists like cimetidine, ranitidine and famotidine were used in these studies. The present study clearly indicated that availability of metformin can be altered in presence of most of the H(2) receptor antagonists studied except in presence of famotidine at pH 4 where the drug concentration remains unaltered. The availability of metformin was increased in simulated gastric juice, pH 7.4 and pH 9 (except ranitidine at pH 9) whereas the decrease in availability was observed in presence of cimetidine and ranitidine at pH 4 and ranitidine at pH 9. On the basis of these results, it is can be suggested that metformin should be coadministered with care along with H(2) receptor antagonists especially in case of ranitidine; although chances of adverse reactions are rare but decrease availability of metformin may result in delayed effect. On the other hand, increase in metformin concentration may result in hypoglycemic effects.