Background: Caregiver awareness and positive attitudes are essential for the early recognition and effective management of Parkinson’s disease. This study aimed to examine the factors associated with caregivers’ knowledge and attitudes toward the disease. Methods: A descriptive cross-sectional study was conducted among caregivers of patients with Parkinson’s disease across three clinical settings in Alexandria, Egypt. A stratified probability sampling technique was used to recruit 383 formal and informal caregivers between 1/2025 and 6/2025. Data were analyzed using SPSS version 23.0. Results: Most of the respondents were females (72.1%), and about half were between 18–30 years (50.9%). Generally, the participants had generally low knowledge and positive attitudes toward PD. The mean knowledge score was 4.52 ± 1.37 out of 10 and the mean attitude score was 27.62 ± 3.49 out of the maximum score of 35. Several key characteristics were significantly associated with knowledge levels. Marital status was significantly associated with knowledge scores. Unmarried participants had higher knowledge scores (mean rank = 221.75). Knowledge score was also associated with educational level, monthly income, household type and primary source of information (p < 0.05 for all); after false discovery rate correction, marital status, household type and source of information remained significant. Sleep duration was the only factor associated with attitude scores, with participants reporting more than six hours of sleep per day exhibiting more positive attitudes (mean rank = 201.88 vs. 178.52, p = 0.039); this association did not remain significant after correction for multiple comparisons. In multiple linear regression, monthly income and marital status were associated with knowledge scores, whereas education level and sleep duration were associated with attitude scores; however, the models explained only 6.4% and 5.1% of the variance, respectively. Conclusions: Caregivers of individuals with PD in Alexandria, Egypt, demonstrated positive attitudes but generally low knowledge of Parkinson’s disease. The caregiver characteristics examined explained little of the variation in knowledge and attitudes, so the associations identified should be regarded as exploratory. Existing knowledge gaps and misconceptions highlight the need for targeted educational interventions.
Heart rate variability (HRV) has been proposed as an autonomic marker of cancer prognosis, but its independent prognostic value in brain tumors and relationship with systemic inflammation remain uncertain. We retrospectively analyzed 242 adults with histopathologically graded brain tumors. Standard deviation of normal-to-normal intervals (SDNN), root mean square of successive normal-to-normal differences (RMSSD), and relative RR-HRV (rrHRV) were derived from routine 10 s 12-lead electrocardiograms (ECGs) obtained within ±14 days of diagnosis, and C-reactive protein (CRP) within ±28 days. During follow-up, 192 patients (79.3%) died, and median overall survival was 20.5 months. In univariate Cox models, a doubling of rrHRV was nominally associated with lower mortality hazard (HR = 0.886, 95% confidence interval (CI) 0.788–0.996, p = 0.043), whereas SDNN and RMSSD were not. After adjustment for age, sex, World Health Organization (WHO) grade, log2(CRP + 1), and metabolic/systemic comorbidity, no HRV measure was independently associated with mortality (all p ≥ 0.850), and HRV did not improve model fit. Small inverse HRV–CRP associations (Spearman ρ = −0.180 to −0.217) survived false-discovery-rate correction. In this cohort, we found no evidence that routine 10 s ECG-derived HRV was independently associated with mortality or improved the fit of the specified clinical models; prospective studies with standardized pre-treatment recordings are warranted.
Decompressive craniectomy (DC) is a vital intervention for severe traumatic brain injury (TBI), especially in refractory intracranial hypertension. While effective in lowering intracranial pressure (ICP), its impact on long-term functional outcomes and survival with disability remains debated. This study aimed to analyze clinical outcomes for TBI patients who underwent DC at a Greek tertiary hospital and identify prognostic factors. This retrospective study included 144 patients who underwent DC from 2014 to 2024. Univariate analyses evaluated associations with early and late outcomes and in-hospital mortality. Exploratory multivariable logistic regression models were also constructed. The mortality rate was 41%, with 32.4% of patients achieving a favorable early outcome and 31.4% achieving a favorable late outcome. Both age and initial neurological status were significantly associated with early and late outcomes (p ≤ 0.01). Abnormal pupillary response was significantly associated with unfavorable outcome and in-hospital mortality in a univariate analysis. In exploratory multivariable models, older age and lower Glasgow Coma Scale–Pupils (GCS-P) scores were independently associated with unfavorable early and 12-month outcomes and in-hospital mortality. Treatment during the coronavirus disease 2019 (COVID-19) pandemic period was associated with higher in-hospital mortality, an association that may reflect pandemic-related healthcare system pressures rather than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Larger multicenter studies are needed to develop and validate reliable prognostic models.
Environmental enrichment (EE) is a well-established preclinical model of neurorehabilitation after traumatic brain injury (TBI). However, most paradigms initiate EE immediately after injury and provide it continuously, unlike clinical rehabilitation, which is typically delayed until medical stabilization and delivered for defined periods. We hypothesized that early aquatic therapy (AQT), an exercise-based intervention, would enhance the benefits of delayed EE, providing a rehabilitative bridge during the early post-injury period. Adult male rats received a cortical impact or sham injury and were housed under standard (STD) conditions. Beginning 1 day after surgery, bridge groups received daily AQT for 7 days, while comparison groups remained in STD housing. On post-injury day 8, EE (6 h/day) was initiated in bridge and EE-only groups. Motor, cognitive, and anxiety-like behaviors were assessed. AQT alone and AQT + EE improved motor performance versus STD (p < 0.05), with AQT + EE producing the fewest foot slips and outperforming EE alone. EE improved spatial learning, while AQT + EE produced the strongest acquisition among TBI groups (p < 0.05); memory retention improved only in EE-treated groups. AQT + EE outperformed STD on the first and third reversal stages of executive function, whereas EE alone outperformed STD on the third reversal. Reduced anxiety-like behavior occurred only in EE-treated groups. Overall, the hypothesis was partially supported as sequential AQT + EE produced greater improvements than EE alone on selected motor, spatial learning, and executive outcomes, but EE alone improved memory retention and anxiety-like behavior. These findings support early AQT as a rehabilitative bridge to delayed EE and warrant further investigation of staged rehabilitation paradigms after TBI.
Prolonged gestational antibiotic exposure was previously reported to impair EEG reactivity in adult offspring after perinatal asphyxia. It remained unclear to what extent the effect depended on perinatal insult. We assessed adult EEG reactivity after uncomplicated birth using the same gestational treatment paradigm. Pregnant Wistar rats received antibiotics (AB), probiotics (P), combined treatment (AB&P), or control (C). Adult offspring (AB: 5; P: 8; AB&P: 7; C: 9; 14 males) underwent intermittent photic stimulation during chloral-hydrate-induced EEG burst suppression. Reactivity to 60 s stimulation was quantified in 180 s trials using burst count reactivity (BCR) and the burst-suppression reactivity index (BSRi). After baseline burst count filtering, 200 trials were retained across groups. BCR did not differ significantly between groups. No multiplicity-corrected pairwise comparison identified a specific treatment-associated difference in BCR or BSRi. Mixed-effects models accounting for repeated trials likewise showed no significant overall group effect. Our small cohort did not provide evidence for a long-term effect of gestational antibiotic or probiotic exposure following uncomplicated birth. Together with the previous report, we suggest that gestational antibiotic administration could impair resilience to perinatal asphyxia at an exposure level without a readily detectable effect after uncomplicated birth.
