30 research outputs found
An overview of third, fourth and sixth cranial nerve palsies in the setting of COVID-19: A case report and systematic review
No full textBackground: Covid-19 has serious sequelae that may be poorly understood, underreported, and, as a result, not diagnosed promptly, such as variations in clinical manifestations of hyperinflammation among people infected with SARS-CoV-2. ophthalmoplegia can be one of these manifestations.
Methods: We are reporting a 55-year-old male patient with unilateral diplopia considering it as a case of multisystem inflammatory syndrome in adults. We also reviewed the literature systematically for the previously reported studies/cases with third, fourth and sixth cranial nerve palsies due to or after Covid-19.
Results: The literature search yielded 17 studies reporting 29 patients. 71.4% of the patients were males with a mean age of 42.23 years. Ophthalmological symptoms took 9.7 days to appear after the respiratory involvement. All patients had diplopia as part of their visual symptoms. 41.4% of the patients had unilateral sixth nerve palsy, 24% had bilateral sixth nerve involvement, 17% had fourth nerve involvement, and 27.6% had third nerve involvement.
Conclusion: Ophthalmoplegia is considered presenting symptom of Covid-19. Further research is needed to detect all neuro-ophthalmological manifestations of Covid-19
Intracerebral hemorrhage associated COVID-19 patient with normal coagulation profile after ECMO treatment: A case report
No full textBACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel coronavirus-caused infectious acute respiratory disease that can progress to severe acute respiratory distress syndrome (ARDS). For severe cases, extracorporeal membrane oxygenation (ECMO) is an excellent treatment option. ECMO had a number of side effects, including bleeding. Intracerebral hemorrhage can occur in COVID patients due to a variety of mechanisms, including covid's effect on ACE-2 receptors and subsequent hypertension, coagulopathy, DIC, or medication, such as anticoagulant use. CASE: We present a case of a 53-year-old male COVID-19 patient who developed multiple, massive, severe intracerebral hemorrhages (ICH) despite a normal coagulation profile after ECMO treatment. CONCLUSION: COVID-19 can progress to severe acute respiratory distress syndrome (ARDS), necessitating the use of extracorporeal membrane oxygenation (ECMO). Although ICH is not a common complication in patients with COVID-19 disease, it is unknown why this patient had a lower threshold of ICH despite having a normal coagulation profile
Structural, Stratigraphic Geology and Pressure Compartmentalization of Feradus Field Based on 3-D Seismic Data and Subsurface Geology
No full textCurrent Updates in Gene Therapy for Multiple Sclerosis
Get PDFBackground: Multiple sclerosis (MS) is the most common demyelinating disease affecting predominantly young adults. The underlying pathogenesis isn’t fully understood although autoimmune attacks against proteins in the CNS is the most accepted theory. Oligodendrocytes seem to be the most involved resulting in demyelinated axons. Currently, the management of MS focuses on relieving symptoms during acute attacks and preventing disease progression using disease-odifying agents such as interferon-beta, dimethyl fumarate, natalizumab, and fingolimod. Studies have proven long-term improvement on these drugs. However, possible side effects and curatively inducing or improving the repair process are major challenges.Al-Quds Universit
Efficacy and safety of edaravone dexborneol in acute ischemic stroke: systematic review and meta-analysis
Get PDFBackgroundEdaravone dexborneol represents a novel neuroprotective agent utilized in the treatment of acute ischemic stroke (AIS). Preliminary studies indicate that this combination exhibits enhanced therapeutic effects when compared to the use of edaravone alone. The objective of this study was to assess the efficacy and safety of edaravone dexborneol in the management of AIS.MethodThis systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. A comprehensive search of the PubMed, Cochrane Central, Scopus, and Web of Science databases was performed on December 30, 2024. Subsequently, we screened articles for eligibility, relevant data were extracted, and the risk of bias was assessed utilizing the Cochrane Collaboration Tool 2. The primary outcome evaluated was the efficacy of edaravone dexborneol in the management of AIS, as measured by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Secondary outcomes encompassed improvements in activities of daily living (ADL), reductions in post-stroke depression, inflammation, and hemorrhagic transformation, as well as enhancements in cognitive function, as indicated by Montreal Cognitive Assessment (MoCA) scores. Extracted data from pertinent Randomized Controlled Trials (RCTs) were analyzed using R programming for Windows. All procedures outlined in this study were pre-specified, and the protocol has been registered with PROSPERO under the unique identifier CRD42024626320.ResultsA total of six randomized controlled trials (RCTs) and one cohort study, all conducted in China and involving 2,942 patients with ischemic stroke (65.6% male), were included. Treatment regimens consisted of intravenous or sublingual edaravone dexborneol administered for 10–14 days. The pooled analysis of functional outcomes at 90 days, based on five studies, demonstrated a significant benefit, with a 39.5% higher likelihood of achieving favorable mRS scores (OR = 1.40, 95% CI: 1.18–1.65, p = 0.0001), without evidence of heterogeneity (I2 = 0%). In contrast, pooled analysis of NIHSS outcomes across seven studies using a random-effects model was not significant (SMD = −0.113, 95% CI: −0.333 to 0.107, p = 0.314), with substantial heterogeneity (I2 = 72.7%). However, under the common-effect model, a small but statistically significant benefit was observed (SMD = −0.083, 95% CI: −0.159 to −0.008, p = 0.030). Sensitivity analyses indicated that several studies (Fu 2024, Hu 2023, Xu 2019, Xu 2024) attenuated the pooled effect, while exclusion of Li 2024 and Hu 2023 reduced heterogeneity to 40.7% but resulted in only borderline significance. Secondary endpoints consistently demonstrated favorable effects, including improved activities of daily living, enhanced cognitive function (MoCA scores), and reduced rates of post-stroke depression, inflammation, and hemorrhagic transformation. Safety analyses revealed that adverse events were generally mild and comparable to controls, with some evidence suggesting a reduction in serious complications such as hemorrhagic transformation.ConclusionEdaravone dexborneol exhibits considerable potential as a neuroprotective agent in the context of AIS, providing both functional and cognitive advantages, alongside a favorable safety profile. The promising efficacy of this compound underscores the necessity for further comprehensive global studies aimed at optimizing its application and enhancing its relevance across diverse populations.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024626320
Effect of Everolimus on Prognosis of Neurofibromatosis Type 1 Lesions: a Systematic Review and Meta Analysis
No full textAbdelkader, Rem/0009-0000-0900-3978; Hanen, George Magdy Halim/0000-0002-8946-2046; Alhamad, Mohammad/0000-0002-2175-1597; Meshref, Mostafa/0000-0003-0692-6309; Nashwan, Abdulqadir/0000-0003-4845-4119; Ibrahim, Ismail/0000-0002-0805-8181Purpose: This study addresses the effectiveness of oral everolimus in treating various malignancies associated with Neurofibromatosis Type 1 (NF1). The purpose is to determine whether everolimus reduces lesion size in NF1 patients, considering the controversial findings from previous clinical trials. The scientific hypotheses and questions involve evaluating the impact of everolimus on NF1-associated lesions and understanding the variability in treatment outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA and Cochrane Collaboration guidelines. The study included four-phase II, single-arm, nonrandomized trials investigating the effect of oral everolimus on NF1-associated lesion size. The search covered multiple databases, and data extraction involved evaluating studies for inclusion criteria and assessing quality using the Cochrane Collaboration's Risk of Bias in Nonrandomized Studies tool. Statistical analysis utilized Open Meta(Analyst). Findings: The search yielded 388 studies, with 10 selected for full-text review and four included in the final analysis. The quality of the studies ranged from low to moderate. The meta-analysis indicated no observed heterogeneity (I2 = 0%), and the overall estimate suggested no significant reduction in NF1-associated lesion size with everolimus ( P = 0.069). Implications: The findings reveal a varied and inconsistent picture of everolimus efficacy in NF1 treatment. The study highlights the need for personalized approaches, considering individual genetic and clinical differences. The limitations, including small sample sizes and nonrandomized trials, call for larger, more standardized research efforts. The study emphasizes ongoing trials and the importance of future research in understanding predictors of everolimus response and optimizing treatment strategies for NF1 patients. Conclusion: While everolimus shows promise in reducing lesion size in a subset of NF1 patients, the study cannot draw conclusive results due to limitations in the included studies. Ongoing, adequately powered trials are crucial for advancing the evidence base and informing the potential role of everolimus in NF1 treatment. Others: There was no funding for this review and no conflicts of interest.Science Citation Index Expande
Amoebic Hepato-Pericardial Fistula Complicating Amoebic Liver Abscess Treated With Pericardiotomy: A Case Report
Get PDFParasitic infections like amoebiasis are often asymptomatic in the tropics, but the invasive disease can cause an amoebic liver abscess. During pericardiocentesis, amoebiasis is more noticeable in left lobe abscesses with chocolate-like pus drainage. Here, we present an unusual amoebic liver abscess that erupted into the pericardial cavity via a diaphragmatic fistula. An emergency pericardiotomy was performed to relieve cardiac tamponade, and the liver abscess was evacuated through a diaphragmatic rent identified during the surgery. This illustrates the catastrophic complications of an amoebic liver abscess
Burden of migraine among Egyptian people: prevalence and comorbidities
No full textAbstract Introduction Migraine is a prevalent debilitating neurological illness that stands among the top causes of disability and significantly impacts the quality of life. Migraine-related functional impairment involves physical, emotional, and economic consequences that frequently impact occupational, academic, social, and familial aspects of life. Depression, anxiety, and sleep disturbances are among the most common comorbid conditions associated with migraine. Objective This study aimed to assess the prevalence of migraine among the Egyptian population and associated comorbidities. Methods we conducted a cross-sectional study using a validated Arabic self-administered questionnaire distributed to the general population. The questionnaire was used to collect data on sociodemographic characteristics, migraine frequency, characteristic associated disability, insomnia, and psychological factors. Convenience snowball sampling method was utilized. Univariate and multivariate regression analyzes were applied. Results A total of 2,533 participants were included in the final analysis from five Egyptian regions. Females represent 57%. More than one-half of participants (59.1%) aged 20–30 years. The prevalence of migraine was 20.9%. The most common triggers were sleep disorders (76.9%), followed by perceived noise (65%), and anxiety (59%). Among the participants diagnosed with migraine, 46.7% had a severe disability, 22% had clinical insomnia of moderate severity, 20.5% had severe depression, 29% had severe anxiety, and 20.6% had severe stress. Females, older age, and urban residents were the key predictors of migraine. Lifestyle factors including regular physical activity and good hydration were linked to reduced migraine risk. Comorbid conditions including insomnia, stress, and anxiety significantly impacted migraine severity. Conclusion Our results showed a 20.9% prevalence of migraine, with nearly one-half of cases associated with severe disability, along with comorbidities like depression, anxiety, and insomnia. Female gender, older age, and urban residence are key predictors, while lifestyle factors such as physical exercise and good hydration reduce the risk of migraine
Association of serum leptin and ghrelin levels with smoking status on body weight: a systematic review and meta-analysis
Get PDFBackground and aimsSmoking cigarettes is a major global health problem that affects appetite and weight. The aim of this systematic review was to determine how smoking affected plasma leptin and ghrelin levels.MethodsA comprehensive search of PubMed, Scopus, Web of Science, and Ovid was conducted using a well-established methodology to gather all related publications.ResultsA total of 40 studies were included in the analysis of 11,336 patients. The overall effect showed a with a mean difference (MD) of −1.92[95%CI; −2.63: −1.20] and p = 0.00001. Subgroup analysis by study design revealed significant differences as well, but with high heterogeneity within the subgroups (I2 of 82.3%). Subgroup by sex showed that there was a significant difference in mean difference between the smoking and non-smoking groups for males (MD = −5.75[95% CI; −8.73: −2.77], p = 0.0002) but not for females (MD = −3.04[95% CI; −6.6:0.54], p = 0.10). Healthy, pregnant, diabetic and CVD subgroups found significant differences in the healthy (MD = −1.74[95% CI; −03.13: −0.35], p = 0.01) and diabetic (MD = −7.69[95% CI, −1.64: −0.73], p = 0.03). subgroups, but not in the pregnant or cardiovascular disease subgroups. On the other hand, the meta-analysis found no statistically significant difference in Ghrelin serum concentration between smokers and non-smokers (MD = 0.52[95% CI, −0.60:1.63], p = 0.36) and observed heterogeneity in the studies (I2 = 68%).ConclusionThis study demonstrates a correlation between smoking and serum leptin/ghrelin levels, which explains smoking’s effect on body weight.Systematic review registrationhttps://www.crd.york.ac.uk/ prospero/display_record.php, identifier (Record ID=326680)
Herpes simplex viral encephalitis with acute memory impairment and low cellular cerebrospinal fluid: A case report with systematic review literature
No full textHerpes simplex encephalitis (HSVE) is a potentially fatal infectious central nervous system (CNS) disorder. Thus, early detection is critical in determining the case's fate. Clinical history and examination, brain computed tomography, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and lumbar puncture have been used to establish a diagnosis. This report describes a case of HSVE with hypocellular cerebrospinal fluid (CSF) and an uncommon form of memory impairment. However, MRI results were consistent with HSVE, and CSF PCR tested positive for HSV-1 DNA that responded to treatment. We routinely advise patients to begin antiviral therapy as soon as possible to avoid complications
