Background: Anemia is common among patients with acute ischemic stroke (AIS) and is associated with poorer outcomes, including higher mortality and less favorable recovery. CT-based blood attenuation measurements have been investigated as a noninvasive imaging marker of hemoglobin levels. Objectives: This study evaluates the diagnostic performance of photon-counting detector CT (PCD-CT) for anemia detection using both true non-contrast (TNC) and virtual non-contrast (VNC) images in patients with AIS. Methods: This single-center, retrospective study included 45 AIS patients from a previously investigated cohort who underwent both unenhanced head CT and CT angiography of the supra-aortic vessels on the same PCD-CT system, enabling a vessel-matched comparison of TNC and VNC attenuation measurements in intracranial venous structures. Attenuation measurements were obtained from predefined venous structures, including the great cerebral vein (VCM), superior sagittal sinus (SSS), sigmoid sinus, confluence of sinuses, and internal jugular vein. Hemoglobin levels were classified according to WHO criteria, and correlation, regression, and ROC analyses were performed. Thresholds were selected exploratorily using the Youden index. Results: Forty-five AIS patients were included (20 females, 25 males; mean age 72.2 years), of whom 16 (35.6%) were anemic. TNC measurements in the VCM showed the strongest association with hemoglobin levels (r = 0.75, R2 = 0.56, P < 0.001) and the highest intracranial diagnostic performance for anemia detection (AUC = 0.87; threshold ≤ 42 HU; sensitivity 81.3%; specificity 75.9%). VCM-VNC measurements showed a weaker but significant association with hemoglobin levels (r = 0.51, R2 = 0.26, P < 0.001) and lower diagnostic performance (AUC = 0.72; threshold ≤ 36 HU; sensitivity 87.5%; specificity 62.1%). Among intracranial VNC markers, the sigmoid sinus showed the highest diagnostic performance (AUC = 0.84; threshold ≤ 32.5 HU; sensitivity 81.3%; specificity 79.3%). In the pragmatic non-vessel-matched comparison, internal jugular VNC showed AUC values similar to those of VCM-TNC (0.869 vs. 0.865; DeLong P = 0.485). Conclusions: Attenuation measurements from TNC and VNC PCD-CT images were associated with hemoglobin levels in AIS patients. TNC, particularly in the great cerebral vein, remained the most robust marker in vessel-matched intracranial comparisons. Internal jugular VNC may offer a pragmatic, screening-oriented marker in stroke workflows; however, this non-vessel-matched comparison conflates modality and anatomical-location effects. Prospective validation with time-matched laboratory data is required before clinical implementation.
Introduction: Deep cerebral venous thrombosis primarily affects young individuals, women of reproductive age, and patients with a prothrombotic state. Unilateral thalamic lesions resulting from deep cerebral venous thrombosis are relatively unusual. We describe a rare case of unilateral basal ganglion, thalamus, and splenium of the corpus callosum lesions due to thrombus in the deep cerebral venous system. Case Presentation: A 31-year-old Asian woman presented with acute-onset headache, somnolence, and left limb weakness after a miscarriage. Subsequent investigations, including computed tomography, magnetic resonance imaging, and magnetic resonance venography, confirmed deep cerebral venous thrombosis as the underlying cause of her symptoms. Because of progressive deterioration in symptoms and consciousness, she underwent emergent endovascular treatment and anticoagulation therapy, and her symptoms subsequently resolved without complications. At the 1-year follow-up, she remained asymptomatic. Conclusions: Deep cerebral venous thrombosis can induce unilateral thalamic lesions and lesions in adjacent structures, requiring increased caution in diagnosis and invasive investigations. For patients with severe symptoms despite medical treatment, endovascular intervention may serve as a viable alternative therapeutic option.
Background: Prompt detection of acute ischemic stroke is essential for effective treatment and improved clinical outcomes. Diffusion-weighted imaging (DWI) and non-contrast computed tomography (NCCT) are commonly used imaging tools; however, their relative diagnostic accuracy within the hyperacute phase 6 hours) requires further clarification. Objectives: This study aimed to evaluate the diagnostic accuracy of NCCT compared with DWI magnetic resonance imaging (MRI) as the reference standard in patients presenting within 6 hours of symptom onset. Methods: This prospective diagnostic accuracy study included 84 consecutive eligible cases presenting with symptoms suggestive of acute ischemic stroke within 6 hours of onset. All patients underwent NCCT followed by DWI MRI. The DWI MRI was predefined as the sole reference standard. Neuroimaging was evaluated by an independent radiologist blinded to clinical data and to the findings of the alternate imaging modality. Diagnostic performance of NCCT was calculated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and 95% confidence intervals (CIs). Results: Among the 84 patients, DWI identified 53 patients as positive for acute ischemic stroke. NCCT correctly identified 45 of these 53 DWI-positive cases, yielding a sensitivity of 84.9% (95% CI: 72.4%- 92.1%). It also correctly identified 24 of 31 DWI-negative cases, resulting in a specificity of 77.4% (95% CI: 59.8%- 89.4%). There were 8 false-negative cases (15.1%) and 7 false-positive cases (22.6%). Overall diagnostic accuracy of NCCT was 82.1% (69/84). Conclusions: Diffusion-weighted imaging demonstrated higher sensitivity than NCCT for detecting hyperacute ischemic stroke. While NCCT remains essential for rapid exclusion of intracranial hemorrhage, DWI may provide complementary diagnostic value when available. These findings should be interpreted cautiously and require confirmation in larger multicenter studies.
Background: Diseases related to the brain and nervous system lead to various complications in patients. One of these diseases is bipolar disorder (BD). Bipolar disorder is a multifaceted disorder that is influenced by various factors, including environment and genetics. Objectives: For this reason, this study was conducted with the aim of bioinformatically determining gene biomarkers in BD using biomarker study methods. Methods: The methodology began by identifying candidate genes through the triangulation of evidence from animal models, in vitro cell cultures, and in silico predictions. Subsequently, high-throughput gene expression data for these candidates were systematically retrieved from public bioinformatics databases. A crucial data processing step involved rigorous standardization: Expression values from case cohorts were precisely normalized against those from healthy controls. This normalization was essential to mitigate batch effects and ensure that observed differences were reliably attributable to the disease state. This allowed for the robust investigation of the primary research hypotheses. Results: The core of the analysis involved assessing the topological importance of these genes within the inferred biological networks. Utilizing five complementary network centrality criteria -namely degree, closeness, radius, betweenness, and most neighboring -a highly conserved set of essential genes was successfully isolated. Crucially, four specific genes: CI3RN, BDNF, PPARGCIA, and TP53, exhibited the highest degree of recurrence and centrality when evaluated across the entirety of the five distinct network analysis methods. Conclusions: These findings offer a clear and data-driven mandate to suggest and prioritize complementary validation studies at both the fundamental laboratory/molecular level and the translational clinical level, focusing on their efficacy as refined diagnostic biomarkers for BD.
Background: Aluminum chloride (A1C13) exposure is implicated in Alzheimer's disease (AD) pathogenesis, inducing cognitive deficits, oxidative stress, and neuroinflammation. Pyroptosis, an inflammatory form of cell death driven by the NLRP3 inflammasome, is a critical link between these pathologies. Objectives: This study investigated the combined efficacy of melatonin (MEL), an antioxidant and anti-inflammatory agent, and methylphenidate (MPH), a cognitive enhancer, against AlC13-induced neurotoxicity. Methods: Male BALB/c mice were divided into six groups (n = 6): Control, sham (MEL 10 mg/kg + MPH 10 mg/kg), A1C13 (300 mg/kg), and AlC13-treated groups with MEL, MPH, or their combination. After 15 days of treatment, cognitive function was assessed via a passive avoidance test. Hippocampal tissues were analyzed for oxidative stress markers [reactive oxygen species (ROS) and myeloperoxidase (MPO)] and key pyroptosis proteins [NLRP3, cleaved caspase4, gasdermin D (GSDMD)] using biochemical assays. Results: The A1C13 administration significantly induced cognitive impairment in the passive avoidance test, increased ROS production and MPO activity, and upregulated hippocampal levels of NLRP3, cleaved caspase4, and GSDMD. While MEL and MPH monotherapies showed modest benefits, their combination produced the most robust effects. The combined treatment significantly reduced oxidative stress markers and markedly suppressed the expression of all measured pyroptosis-related proteins compared to the A1C13 group. Conclusions: The combination of MEL and MPH demonstrates a superior protective effect against AlC13-induced neurotoxicity compared to either drug alone. The therapeutic mechanism appears to involve the synergistic inhibition of the NLRP3/caspase4/GSDMD pyroptosis pathway and the mitigation of MPOmediated oxidative stress, presenting a novel combinatorial strategy for alleviating neuroinflammation in AD-like pathology.
Background: Pain and discomfort in the lower back and cervical regions are common symptoms of many musculoskeletal and non-musculoskeletal diseases, and these conditions have a high prevalence in society. Such problems can significantly affect patients' quality of life, including their sexual function (SF). Objectives: This study aimed to determine and compare the status of SF in patients with cervical and lumbar discopathy (LD) and healthy individuals. Methods: This case-control study was conducted in Ilam city in 2025. The study population comprised individuals with LD (48), cervical discopathy (CD) (48), and healthy controls (48), aged 18-60 years. Data were collected using questionnaires on personal characteristics, the Female Sexual Function Index (FSFI), the Brief Sexual Function Inventory (BSFI) for men, and the Visual Analog Scale (VAS) for pain intensity. Data analysis was performed using SPSS version 18, with descriptive and inferential statistical tests. Results: Among women, the mean +/- SD SF score in the CD group was 27.81 +/- 3.82, in the LD group was 22.31 +/- 5.89, and in the control group was 30.26 +/- 2.76. Among men, the mean +/- SD SF score was 26.80 +/- 5.83 in the CD group, 24.60 +/- 4.57 in the LD group, and 36.29 +/- 1.98 in the control group. Statistically significant differences were observed in the overall SF scores (P < 0.001) and all dimensions (P < 0.05) among the three groups in both men and women. Conclusions: Given that SF scores were lower in patients with cervical and lumbar disc disorders than in healthy individuals, it is recommended to implement appropriate interventions to improve SF in these patients. Furthermore, consultation with a midwife or gynecologist should be included in the treatment process to enhance patients' sexual health.
Background: Identifying key brain regions implicated in Parkinson's disease (PD) can enhance both diagnostic accuracy and our understanding of disease mechanisms. Objectives: This study aims to compare three machine learning methods - least absolute shrinkage and selection operator (LASSO), random forest (RF), and recursive feature elimination (RFE) - for selecting influential regions of interest (ROIs) from functional magnetic resonance imaging (fMRI) data to distinguish PD patients from healthy controls. Methods: This retrospective analysis used fMRI data from 15 patients with PD and 15 matched healthy controls, sourced from an open-access database. Three machine learning approaches were applied to identify significant ROIs associated with PD. The selected ROIs were subsequently evaluated using logistic regression models, assessing classification performance through area under the curve (AUC), sensitivity, and specificity. A comparative analysis of model performance was conducted using DeLong's test. Results: The LASSO identified 9 ROIs, RF selected 10, and RFE identified 4 key ROIs. Logistic regression models constructed with these ROIs yielded AUC values of 0.96, 0.94, and 0.88 for LASSO, RF, and RFE, respectively. Both sensitivity and specificity were highest for LASSO (0.92 for both). DeLong's test revealed statistically significant differences among the methods (P < 0.001), with LASSO outperforming RF and RFE. Conclusions: This study demonstrates that LASSO, RFE, and RF machine learning techniques are promising for identifying key brain regions, showing preliminary alignment with clinical observations. Focusing on patients with PD, it highlights regions associated with executive function, memory, motor skills, and sensory processing. Early detection of abnormal connectivity in these areas may potentially inform exploratory preventive strategies for PD.
Background: Trauma is a common cause of mortality and disability in humans, occurring in various parts of the body. Objectives: Given the importance of patients with rheumatoid arthritis (RA), this study was conducted with the aim of determining the clinical characteristics and outcomes of spinal and orthopedic traumas in patients with RA. Methods: In this study, patients admitted to Imam Khomeini Hospital from the beginning of 2022 to the end of 2024 due to spinal cord injury and/or orthopedic trauma were enrolled. To collect data, researchers, by studying other published articles, designed a researcher-made checklist. This checklist contained patients' demographic information as well as questions regarding spinal cord injuries, orthopedic injuries, and common injuries, which were completed as yes/no responses. Quantitative data analysis was performed using descriptive and inferential statistical tests, entered into SPSS 16 software. Results: According to the findings, out of 155 patients with RA, 36 patients were hospitalized due to SCI, 91 patients due to orthopedic trauma, and 28 patients due to orthopedic and SCI trauma. According to the findings, a significant relationship was observed between the type of trauma and the mortality status of the patients. In such a way that in patients with RA who were hospitalized due to orthopedic and SCI, the mortality rate was higher than in other patients. There was also a correlation between infection and VAP in patients with mortality, and the mortality rate in patients with infection and VAP was higher than in other patients. Conclusions: Given that the mortality rate in patients with both orthopedic trauma and spinal cord trauma is higher than in other patients, it is essential that these patients be given higher priority.
Background: While the incidental detection of idiopathic intracranial hypertension (IIH) imaging findings is common during brain MRIs, the existing literature dedicated to the neuroimaging relevance remains limited. Objectives: This study aims to determine the prevalence and clinical significance of incidental MRI indicators suggestive of raised intracranial hypertension in outpatients undergoing brain imaging, with a particular focus on their association with papilledema. Methods: This prospective cohort study was conducted at an academic hospital's radiology department between 2020 and 2022. A total of 178 adult patients referred for outpatient brain MRI participated in the study. MRIs were conducted with established protocols and criteria utilized for identifying IIH radiographic signs. Ocular fundoscopy was performed as part of the examination protocol. A comparison was then made between imaging findings in two groups of patients with and without papilledema. Results: The MRI assessments revealed that 73.5% of patients (n=131) exhibited at least one indication of IIH, with 4.24% showing at least four signs. The prevalence of papilledema varied, ranging from 2.8% in cases with at least one MRI sign of IIH to 40.0% in those displaying at least four signs. Papilledema demonstrated a significant correlation with prominent Meckel caves and optic nerve tortuosity. Conversely, other imaging findings exhibited negligible associations. A notable correlation was identified between the presence of papilledema and the quantity of IIH indicators detected in brain MRIs. Notably, when three or more MRI features associated with IIH were present, a statistically significant correlation with papilledema emerged. Conclusions: The MRI results in this study frequently revealed indications of IIH, whereas occurrences of papilledema were infrequent. In cases where there are no alarming symptoms or the presence of papilledema, invasive procedures may not be deemed necessary for patients incidentally diagnosed with IIH.
Introduction: Behcet's disease (BD) is a systemic vasculitis that can affect the gastrointestinal system. Case Presentation: This report discusses a 41-year-old woman with a history of bariatric surgery who later developed gastrointestinal symptoms and arthralgia consistent with BD. Diagnosing BD is challenging because there are no specific diagnostic tests; instead, diagnosis is based on the constellation of clinical signs and symptoms such as recurrent oral and genital ulcers, uveitis, and multisystem involvement, which can overlap with other diseases. It remains unclear whether surgical procedures influence the onset or progression of the disease. Conclusions: The relationship between surgical interventions and the onset of BD requires further investigation. This case underscores the importance of considering BD in the differential diagnosis of post-surgical GI symptoms and highlights the role of tailored immunosuppressive therapy in achieving resolution of GI ulceration or arthralgia. Future studies must clarify the interplay between surgical procedures and immune-mediated diseases like BD.
Background: Diethylene glycol (DEG) is a prevalent organic solvent with numerous industrial applications. Limited research exists regarding the potential toxicological consequences of low-dose DEG exposure on cognitive functions within the nervous system. Objectives: The present study aimed to determine the impact of low-dose DEG administration on cognitive abilities in rats. Methods: For this experimental investigation, twenty male Wistar rats were allocated randomly to a DEG treatment group (1.6 mg/kg/day for 30 days) and a control group. The cross-modal visual-tactile object recognition (CMOR) task was performed employing four variants of the spontaneous object recognition (SOR) test, encompassing standard SOR, tactile SOR, visual SOR, and CMOR tests. To evaluate the animals' preference for novelty, a discrimination ratio was calculated. The Morris water maze (MWM) and shuttle box tests served to assess spatial learning, memory function, and avoidance behavior, respectively. Additionally, the elevated plus maze (EPM) test served to evaluate anxiety-related behaviors in the rats. Results: The findings indicated no statistically significant differences between the DEG and control groups across all CMOR tasks, passive avoidance, spatial learning and memory, and anxiety-like behaviors in rats. Conclusions: In conclusion, low-dose DEG exposure was not associated with detectable impairments in memory, learning, or anxiety-like behaviors in rats.
Background: Upper limb dysfunction in stroke reflects layered impairments - from impaired motor execution to maladaptive plasticity and disrupted white matter architecture. Unlike the more resilient recovery of lower limbs, fine motor restoration remains limited. Although electromyographic (EMG) biofeedback is clinically validated, its influence on central structural substrates of motor recovery remains poorly understood. Objectives: This exploratory feasibility study examined EMG biofeedback as a potential neuromodulatory input influencing white matter architecture, assessed with diffusion tensor imaging (DTI). The findings are hypothesis-generating and provide preliminary indications rather than definitive evidence of structural change. Methods: Twelve individuals (aged 50-70) with ischemic stroke (6-22 months post-onset) and upper limb spasticity [Modified Ashworth Scale (MAS) >= 3] underwent an 8-week EMG biofeedback intervention targeting distal extensor activation. In this single-arm, exploratory assessment, functional outcomes were measured using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), MAS, and Barthel Index. Microstructural plasticity was assessed via DTI, with extraction of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) across motor pathways. Due to the limited sample size and exploratory nature of the study, we employed both frequentist and Bayesian methods to assess pre-post changes and brain-behavior associations, allowing for prior-informed estimation and improved uncertainty characterization. Results: Motor performance showed improvement (FMA-UE: +12.4; P < 0.01), accompanied by increases in EMG tension amplitudes (P < 0.001), consistent with enhanced motor unit activation. The DTI analyses indicated a marginal FA increase in the corticospinal tract [CST, P = 0.05; posterior mean: 0.045 (CI: 0.0039-0.0877)] and an RD increase in the internal capsule [P < 0.01; posterior mean: 0.027 (CI:-0.0034-0.0584)], which appeared to correlate with motor gains. By contrast, functional independence measured by the Barthel Index showed no clear improvements in this cohort. Conclusions: The current preliminary findings suggest that EMG biofeedback may modulate motor function and corticospinal microstructure in stroke. Observed clinical, electrophysiological, and imaging trends warrant cautious interpretation given the pilot design. Larger, controlled studies are required to validate efficacy and clarify underlying neuroplastic mechanisms.
Background: Addiction, particularly to synthetic stimulants like mephedrone, poses significant challenges for both treatment and societal health. Mephedrone, a cathinone derivative, is increasingly misused and has been shown to affect brain function. While the neurotoxic effects of mephedrone are well-documented in adolescents, limited research exists on its effects during pregnancy, particularly on cerebellar development in offspring. Objectives: This study examines the effect of mephedrone exposure during gestation on the morphometrical parameters of the cerebellum in Balb/C mouse offspring. Methods: In this experimental study,10 one-day-old male mouse pups were divided into a control and an experimental group, whose mothers received daily subcutaneous mephedrone injections (50 mg/kg) from days 5 to 18 of pregnancy. Cerebellar tissue from the pups was processed and stained with cresyl violet, and cerebellar layers and cell characteristics were assessed using histological methods. Results: A significant reduction was observed in the thickness of the outer granular, molecular, Purkinje, and inner granular layers compared to the control group (P < 0.05). However, no significant differences were observed in white matter (WM) thickness, cell counts, or Purkinje cell morphology, including their area, perimeter, or diameters. Conclusions: Exposure to mephedrone during pregnancy resulted in altered cerebellar development in mouse pups, specifically reducing the thickness of cerebellar layers.
Background: Olanzapine is a drug effective in reducing delirium and is used in psychotic disorders, mood disorders, and acute restlessness in psychotic or bipolar patients. Objectives: The present study aimed to determine the effect of olanzapine administration on the delirium status of patients hospitalized in the intensive care unit (ICU). Methods: This retrospective study involved extracting information from the files of patients hospitalized in the internal ICU Department of Ilam city. Researchers obtained the necessary information by visiting the hospital and reviewing medical records. Initially, a list of all patients prescribed olanzapine and other drugs used for the treatment of delirium was obtained from the hospital's information technology unit. Subsequently, data related to the patients' files were extracted, and the effect of olanzapine on delirium recovery and its complications were compared. Data analysis was conducted using SPSS version 16, employing descriptive and analytical statistical methods. Results: The findings indicated that most patients prescribed olanzapine were female (64.2%), admitted from other hospitals (373%), and hospitalized due to general medical conditions (47.8%). Additionally, in the group prescribed olanzapine, the majority of patients (85.1%) underwent whole monitoring. Conclusions: Given the effect of olanzapine on delirium improvement and its relatively low side effects compared to other drugs, it is recommended that this medication be prescribed for patients with delirium.
Background: In children, risk factors for delirium include anesthetics such as sevoflurane, surgeries such as dentistry and ENT, autism, and ADHD. Objectives: The present study was conducted to determine the rate of delirium in children and adolescents hospitalized for surgery. Methods: In this cross-sectional study, 75 children and adolescents hospitalized for surgery were evaluated for delirium. The instrument used was the Cornell Assessment of Pediatric Delirium (CAPD), which has 2 sections and 4 questions in each section. The Kernel tool was scored by an anesthesiologist once per shift and every 12 hours until the patient was discharged. In all cases, ethical codes were observed in the research. Data analysis was performed in SPSS 16 software. Results: Results showed a total of 75 patients were studied, of which 56% were in the adolescent age range and female gender, 84% had surgery duration less than 45 minutes, and 53.3% were hospitalized due to non-emergency surgeries. The incidence of delirium in patients was 11 (14.7%), which in Table 1 showed that there is a relationship between delirium and gender (P = 0.003), type of inpatient ward (P = 0.02), surgery duration (P = 0.02), coexisting disease (P = 0.000), and type of surgery (P = 0.006). Also, out of 86 patients studied, 11 patients had delirium and 64 patients did not. It was also related to gender 0.04 [4.16 (1.00-17.8)], type of inpatient ward 0.02 [0.27 (0.073-1.06)], surgery duration 0.04 [4.00 (0.95-16.79)], and type of surgery 0.006 [0.088 (0.011-0.73)]. Conclusions: Although the incidence of delirium was low in this study, it is necessary to identify factors affecting the occurrence of delirium and to implement interventions to prevent delirium in patients undergoing surgery.
Background: Spinal anesthesia is a widely used technique in orthopedic and other surgical procedures due to its safety and effectiveness. Bupivacaine is the most commonly used local anesthetic, but its use alone is limited by the duration and depth of sensory and motor blockade. To enhance anesthetic quality and minimize adverse effects, adjuvants such as epinephrine and fentanyl are often added. Objectives: The objective of this study was to compare the efficacy, safety, and clinical outcomes of epinephrine versus fentanyl as intrathecal adjuvants to bupivacaine in orthopedic surgeries, focusing on motor block duration, hemodynamics, and postoperative pain control. Methods: This quasi-experimental study was conducted on 100 patients undergoing femur and tibia surgeries under spinal anesthesia at a tertiary hospital in Iran. Participants were randomized into two groups: One received intrathecal bupivacaine with epinephrine, and the other received bupivacaine with fentanyl. Outcomes compared included the duration of anesthesia, postoperative pain scores, and incidence of complications. Results: The combination of bupivacaine with epinephrine resulted in a significantly longer duration of anesthesia (222.38 +/- 17.48 minutes vs. 169.88 +/- 15.57 minutes; P = 0.001) and higher rates of complete muscle relaxation (84% vs. 46%; P < 0.001). However, this group showed increased incidences of hypotension (16% vs. 0%; P < 0.001) and bradycardia (10% vs. 0%; P < 0.001). The bupivacaine-fentanyl group reported lower pain scores at all time points (e.g., 1.0 +/- 0.0 vs.13 +/- 0.73 at 30 minutes; P = 0.005) but had higher pruritus rates (14% vs. 0%; P = 0.001). Conclusions: While bupivacaine combined with epinephrine extends the duration of anesthesia, it is associated with more hemodynamic disturbances. Bupivacaine with fentanyl offers superior postoperative analgesia and a more favorable safety profile, making it a suitable option for spinal anesthesia in lower limb surgery.
Background: Interscalene block (ISB) is a gold-standard regional anesthetic for upper extremity procedures, particularly shoulder surgery, offering superior perioperative analgesia, reduced opioid use, shorter PACU stays, and higher patient satisfaction compared to general anesthesia. Objectives: This study investigates the effects of 0.5% ropivacaine and bupivacaine on motor blockade and recovery following ISB in shoulder surgery. Methods: In a randomized, single-blind study with 12O participants, muscle strength reduction and recovery were measured using a handgrip dynamometer over one week. The ISB was performed under ultrasound and nerve stimulator guidance. Muscle strength was recorded before and after ISB. Statistical analysis included repeated measures ANOVA and Pearson correlation. Results: Statistical analysis (repeated measures ANOVA) confirmed significant differences in motor blockade kinetics between groups (P < O.OO1). Ropivacaine showed slower onset (peak reduction: Sixty-six percent at 3 hours) but faster recovery (8O% baseline strength at 1 week) versus bupivacaine (peak reduction: Seventy-two percent at 3 hours; 70% recovery at 1 week; P < O .O O1 for all comparisons). Age-stratified analysis revealed greater motor block persistence in older patients (P < O.O1). Conclusions: Bupivacaine provides stronger motor blockade, making it more effective in older adults, whereas ropivacaine offers faster functional recovery and adequate analgesia, favoring early mobilization post-surgery.
Background: Multiple sclerosis (MS) is a debilitating neurodegenerative condition characterized by various symptoms, particularly fatigue, which can significantly impact mental health and quality of life. Evidence regarding the efficacy of pulsed electromagnetic field (PEMF) therapy in managing certain symptoms of MS remains controversial. Objectives: This systematic review aimed to evaluate randomized clinical trials (RCTs) assessing the effects of PEMF therapy on fatigue, depression, and quality of life in individuals with MS. Methods: The electronic databases PubMed, Scopus, and Web of Science were searched for articles published between 1990 and 2023 using the keywords magnetic field therapy and MS. Two independent reviewers conducted the processes of screening, data extraction, and quality assessment. Fatigue was analyzed as the primary outcome, while depression and quality of life were considered secondary outcomes. Results: The search yielded 1,768 articles, of which 8 met the inclusion criteria for this review. A total of 372 participants were analyzed, 267 (71.7%) of whom were women. The intervention duration ranged from 3 to 12 weeks. Fatigue levels were reported in all included studies, while depression and quality of life were assessed in three studies. Conclusions: Compared to placebo, beneficial effects of PEMF therapy on fatigue severity were observed in only two studies, while the remaining studies showed no significant differences between groups. Furthermore, quality of life improved in only one study, and depression scores were comparable between groups at the end of all three studies. Additional trials with longer intervention durations, larger sample sizes, advanced technological devices, and objective assessment tools are needed to resolve this controversy.
Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by difficulties in cognitive flexibility (CF) and emotion regulation (ER). Objectives: The present study aimed to assess the effectiveness of a computer game-based intervention in enhancing CF and ER among children diagnosed with ADHD. Methods: A quasi-experimental design was utilized, involving 60 boys aged 7 to 11 years who were referred to rehabilitation centers and diagnosed with the combined type of ADHD based on clinical interviews and the Conners Rating Scale (parent form). Of these, 40 participants with a Conners score of 60 or higher and an IQ of 85 or greater, as evaluated through Raven’s progressive matrices (RPM), were selected. Thirty boys were randomly assigned to either the experimental or control group. The experimental group participated in 10 individual sessions featuring computer game-based tasks, while the control group engaged in standard games available at the centers. Evaluations were conducted pre-intervention, post-intervention, and at a five-week follow-up using the Wisconsin Card Sorting Test (WCST) and the Emotion Regulation Checklist (ERC). Data were analyzed using repeated measures ANOVA in SPSS, version 25. Results: The analysis using repeated measures ANOVA revealed significant improvements in CF and ER in the experimental group. The intervention accounted for 56% of the variance in CF and 47%, 46%, and 47% in overall ER, adaptive emotion regulation (AER), and lability/negativity (L/N), respectively. These improvements were sustained at the five-week follow-up. Conclusions: The findings suggest that computer game-based tasks and similar interventions can effectively enhance CF and ER in children with ADHD, potentially addressing challenges associated with the disorder.
Introduction: Cerebral invasive aspergillosis is a rare but potentially fatal condition, predominantly affecting immunocompromised individuals. It affects 10% - 15% of patients who have disseminated aspergillosis. The distinctive ability of Aspergillus to break down elastin in the vessel wall makes it highly angioinvasive, resulting in a broad range of neurological complications. Case Presentation: We report the case of a 57-year-old female with poorly controlled diabetes mellitus and hypertension, who presented with right-sided hemiparesis and facial paresis. Initial imaging revealed small vessel disease and a midline hyperdensity extending into the paranasal sinuses (PNS), prompting further evaluation with magnetic resonance imaging (MRI) and paranasal computed tomography (CT), which demonstrated a mass-like lesion in the sphenoidal sinuses and an acute brainstem infarction. The patient's medical history and imaging findings led to the suspicion of an invasive fungal infection, confirmed by biopsy, which revealed aspergillosis. The patient underwent endoscopic surgical debridement to reduce the fungal burden, followed by antifungal therapy. Amphotericin B was initially administered, but treatment was later switched to voriconazole, and the patient's neurological condition partially improved after treatment. Conclusions: This case highlights the importance of early diagnosis and appropriate management, including antifungal therapy and surgical debridement, to reduce mortality in cerebral aspergillosis. The successful outcome highlights the importance of maintaining a high index of suspicion in immunocompromised patients presenting with neurological symptoms, even in the absence of pulmonary involvement.
