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Background: Ring-based studies are a novel research design commonly used for research involving infectious diseases: contacts of newly infected individuals form a ring that is targeted for interventions (e.g., vaccine, post-exposure prophylaxis). Given the novelty of the research design, it is critical to obtain feedback from participants on their experiences with ring-based studies to help with the development of future trials. Methods: In 2021, we conducted 26 semi-structured interviews with adult participants of a COVID-19 ring-based post-exposure prophylaxis trial based in Canada. We applied a purposive sampling approach and electronically recruited participants who tested positive for COVID-19 (Index Cases) and either agreed or declined for the study team to contact their potentially exposed contacts. We also included individuals who participated in the trial after being potentially exposed to an Index Case (known as Ring Members), and those who declined to participate after potential exposure. The methodological design of semi-structured interviews allowed participants to share their opinions and experiences in the trial (e.g., elements they enjoyed and disliked regarding their participation in the study). Results: The majority of participants in our study were women (62%) and the average age was 37.3 years (SD = 13.2). Overall, participants reported being highly satisfied with partaking in the ring-based trial. Notably, no substantial complaints were voiced about the trial's design involving contact after exposure. The most common reason of satisfaction was the knowledge of potentially helping others by advancing knowledge for a greater cause (e.g., development of potential treatment to prevent SARS-CoV-2 infection). Other reasons were curiosity about participating in a trial, and an activity to fill free time during the pandemic. A central element of dislike was confusion about instructions with the trial (e.g., independent at home SARS-CoV-2 testing). Additionally, maintaining confidentiality was a crucial concern for participants, who sought assurance that their data would not be shared beyond the scope of the study. Conclusions: Our results have the potential to inform future research, including clinical trials such as ring-based studies, by incorporating insights from participants' experiences into the development of study protocols. Despite some protocol-related challenges, participants expressed high satisfaction, driven by the desire to advance science and potentially aid others. [ABSTRACT FROM AUTHOR]

Objective: This systematic review examined the effectiveness of Emergency Department-based and initiated youth suicide prevention interventions for suicide attempts, suicidal ideation, hospitalization, family system functioning, and other mental health symptoms. Methods: We searched five databases for randomized controlled trial (RCT) studies that examined Emergency Department-based and initiated suicide prevention interventions among youth aged 10 to 18 years old between May 2020 to June 2022. Using Cohen's d and 95% confidence interval as our standardised metrics, we followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis in Systematic Reviews (SWiM) guidelines when synthesizing, interpreting, and reporting the findings of this review. Results: Five studies were included in this review. Findings were first synthesized according to the targeted population of the study intervention and this review's outcomes. Two interventions were effective for decreasing depressive symptoms, hospitalization recidivism, and/or increasing family empowerment. There were no interventions that reduced subsequent suicide attempts. A meta-analysis was not conducted due to the heterogeneity of the data. Conclusion: A need exists to develop and evaluate Emergency Department-based and initiated youth suicide prevention interventions that can be successfully and sustainably implemented in practice. Future research should focus on evaluating the components of interventions that effectively mitigate suicide risk among high-risk youth. [ABSTRACT FROM AUTHOR]

Extensive spinal epidural abscesses (ESEAs), occupying three or more spinal regions, are rare forms of vertebral infection. Multilevel laminectomy in these cases is controversial because of the risk of vertebral instability. We report the case of a 47- year-old patient known with ureterohydronephrosis 2nd degree, admitted for severe vertebral pain (VAS 8/10) from 2 months, paraparesis (ASIA 1/5 left, 4/5 right, retention of urine and faeces) from three days. The analysis discovered Diabetes Mellitus type 2, and high levels of inflammatory tests. CT and MRI of the vertebral area with contrast revealed dorsal compression of the spinal cord and cauda equina by an epidural abscess extending from L1-L5, bilateral in the soft adjacent paravertebral tissues especially psoas muscles but sparing the intervertebral discs. Surgical treatment: alternate fenestrations L1-L5, more important on the left side. By this technique, we removed the fluid pus and also granulomatous pus from posterior epidural space L1-L5, bilateral medial foramina, interspinous and supraspinous space, and psoas muscles. The identified germ was Staphylococcus aureus ++++. Postoperatively, we used a continuous drainage washing system with Vancomicyne and diluted Betadine--a course of six-week Vancomycin 2 grams/day iv. The drainage system was blocked after 24 hours and we had to remove it and all the wires of the suture. We had to dress up every day for the surgical field and wash deep inside the field with diluted betadine for 3 weeks till the surgical field was completely cured. After 3 months postoperatively the patient was cured radiologically and clinically. Follow up 18 months. Conclusion: alternate fenestration has the advantages of removing liquid and granulomatous pus in the epidural posterior area and preserving the spine stability. [ABSTRACT FROM AUTHOR]

Neonatal diabetes mellitus is a rare genetic disease that affects 1 in 90,000 live births. The start of the disease is often before the baby is 6 months old, with rare cases of onset between 6 months and 1 year. It is characterized by low or absent insulin levels in the blood, leading to severe hyperglycemia in the patient, which requires temporary insulin therapy in around 50% of cases or permanent insulin therapy in other cases. Two major processes involved in diabetes mellitus are a deformed pancreas with altered insulin-secreting cell development and/or survival or faulty functioning of the existing pancreatic beta cell. We will discuss the cases of two preterm girls with neonatal diabetes mellitus in this research. In addition to reviewing the literature on the topic, we examined the different mutations, patient care, and clinical outcomes both before and after insulin treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Plant–animal interactions play a crucial role in the functioning of ecosystems by promoting biodiversity, maintaining ecological balance, and facilitating the provision of resources for both fauna and humans. Failure to maintain these interactions could lead to numerous plant and animal species' inability to survive, potentially resulting in ecological imbalances. We examined the effects of fruit color and the local landscape on plant–bird interactions in an agroecosystem in Southcentral Mindanao, Philippines. Using artificial fruit models, we found that the proportion of predation and risk was significantly higher in the red fruit model (ripe fruits) compared to the green model (unripe fruits). Furthermore, birds were the dominant predators and were more likely to consume ripe fruits compared to unripe ones, compared to other predators such as mammals and arthropods. Our study showed that fruit color significantly promotes mutualistic interactions, especially for birds, within an agroecosystem. The removal of fruit is a consequence of plant–animal interactions, and is a vital step in the natural regeneration cycle of plant populations. This research aimed to determine the effect of fruit color and local landscape on plant–bird interactions in an agroecosystem in Southcentral Mindanao, Philippines. We set out 1500 artificial fruit models in ten sampling locations within an agroecosystem. We measured the difference in the proportion of predated/removed (%) fruit models and the risk between sites, fruit color, and predators. Approximately a quarter (24.53%) of the artificial fruit models deployed were predated, and the proportion of predation was significantly higher in the red fruit models (mean = 18.74 ± 9.84) compared to the green fruit models (mean = 11.67 ± 6.17). Birds were the most dominant predators compared to mammals and arthropods, and contributed to at least 60% of the predation of red fruits. Our findings are consistent with previous evidence showing birds' preferences for darker fruit colors. Although landscape variables did not significantly affect fruit predation, tree cover may help increase these interactions. Overall, our study showed that agroecosystems can still support species of frugivorous birds, as indicated by high fruit predation rates, particularly by birds that can permeate different layers of the agroecosystem. Our findings demonstrate an important implication for habitat quality management within agroecosystems. Enriching agroecosystems with pioneer trees with dark-colored fleshy fruits is a sustainable greening strategy that would benefit frugivores and producers in this system. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to evaluate the outcomes of bilateral cochlear implantation in patients with severe-to-profound sensorineural hearing loss at the Timisoara Municipal Emergency Clinical Hospital ENT Clinic. The study involved 77 participants, divided into four groups based on their hearing loss characteristics and implantation history. Assessments were conducted pre- and post-implantation, focusing on speech perception, speech production, and reading achievement. Standard surgical procedures were performed, and participants were provided with a comprehensive rehabilitation program involving auditory training and communication therapy. The variables considered for analysis included demographic factors, implantation period, and quality of life assessment, with no statistically significant differences pre-implantation between the four study groups. Results revealed significant improvements in speech perception, speech production, and reading achievement after cochlear implantation. In adult patients, speech perception scores increased from 21.3% to 73.4% for WIPI and from 22.7% to 68.4% for HINT after 12 months of rehabilitation. Speech production scores improved from 33.5% to 76.8% and reading achievement scores increased from 76.2 to 106.3. Moreover, there was a significant improvement in patients' quality of life following cochlear implantation, with mean scores increasing from 2.0 to 4.2. Although it is known that bilateral cochlear implantation significantly improves speech perception, speech production, reading achievement, and quality of life in patients with severe-to-profound sensorineural hearing loss, this is the first study of its kind from Romania. Further research is warranted to optimize patient selection and rehabilitation strategies to maximize outcomes and determine better policies towards funding and access of cochlear implants for a wider range of patients in need. [ABSTRACT FROM AUTHOR]

A case study of 5-year-old girl was brought in to the emergency department (ED) by emergency medical services after a syncopal episode reported it to be weak and performed cardiopulmonary resuscitation. Topics include decreased oral intake and nonspecific abdominal pain for several days; and usual state of health except for an active head lice (Pediculosis capitis) infestation admitted to the pediatric intensive care unit for further observation and management.

Cladribine (CLD) treats multiple sclerosis (MS) by selectively and transiently depleting B and T cells with a secondary long-term reconstruction of the immune system. This study provides evidence of CLD's immunomodulatory role in peripheral blood mononuclear cells (PBMCs) harvested from 40 patients with untreated relapsing-remitting MS (RRMS) exposed to CLD. We quantified cytokine secretion from PBMCs isolated by density gradient centrifugation with Ficoll–Paque using xMAP technology on a FlexMap 3D analyzer with a highly sensitive multiplex immunoassay kit. The PBMC secretory profile was evaluated with and without CLD exposure. PBMCs isolated from patients with RRMS for ≤12 months had significantly higher IL-4 but significantly lower IFN-γ and TNF-α secretion after CLD exposure. PBMCs isolated from patients with RRMS for >12 months had altered inflammatory ratios toward an anti-inflammatory profile and increased IL-4 but decreased TNF-α secretion after CLD exposure. CLD induced nonsignificant changes in IL-17 secretion in both RRMS groups. Our findings reaffirm CLD's immunomodulatory effect that induces an anti-inflammatory phenotype. [ABSTRACT FROM AUTHOR]

More than 60 % of people exposed to sex trafficking access hospital emergency departments (ED), making the ED a critical setting for child sex trafficking identification. Children exposed to sex trafficking (CEST) do not always recognize that they are being exploited. With many ED leaders confirming that there are no formal processes or assessment tools to screen for human trafficking in EDs, it is especially challenging for healthcare providers to identify CEST. Accordingly, the following study sought to examine healthcare providers' child sex trafficking identification practices in Ontario pediatric EDs. We conducted interviews with healthcare providers (N = 12) who work in an Ontario pediatric ED and have provided services to CEST. Thematic analysis and intersectionality theory guided our analytic approach. Participants underscored the key role of Registered Nurses for identifying presentations of child sex trafficking in Ontario pediatric EDs. Although white, feminine presenting youth are the predominantly identified demographic of CEST in Ontario pediatric EDs, healthcare providers also described key intersections between race, poverty, child welfare agency system involvement, and adverse childhood life experiences as factors that heightened vulnerability to child sex trafficking. Common presentations to the ED were for non-specific concerns, injuries, following a sexual assault, or for mental health concerns. Suggested methods for identification varied but were centred around the principles of trauma- and violence-informed care. Identifying child sex trafficking in Ontario pediatric EDs is a complex practice, requiring human trafficking training and education for healthcare providers. The interrelated indicators of child sex trafficking, including the sociodemographic and clinical profile of the patient, must be considered jointly, using a trauma- and violence-informed approach. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis was considered a fatal condition years ago but, nowadays, it can have a favorable evolution if diagnosed and treated early. Objective: Screening clinical aspects of patients suspected for cystic fibrosis and later diagnosed by means of specific sweat and genetic tests. Methods: A retrospective descriptive study was performed on 13 patients during five years, between 2015-2020 from the Pediatric Clinic of the Emergency County Hospital in Constanta. Results: There were five patients present in ΔF508 homozygous form, which it seems to be the most frequent mutation, translated by the deletion of phenylalanine at position 508. Among the heterozygous patients, 2 patients aged 10 and 14 years have the ΔF508 del 2.3 mutation; a 10-year-old patient has the mutation ΔF508, 2183 AA>G; a 7-year-old patient has the ΔF508 R553X mutation; a 7-year-old patient has the N1303K, 394del TT mutation; a 1-year-old patient is heterozygous for the 394del TT and R347P mutations, a 3-year-old patient has the compound mutation ΔF508del and R334W, and finally, we find a 2-year-old patient heterozygous for the Δ508 mutation. Ten from 11 patients were diagnosed in the first year of life by performing the sweat test, and 2 patients based on the genetic test. In 30% of cases the onset manifestation were represented by diarrhea and growth failure, and 38% of cases had added respiratory manifestation. Singular manifestations such as respiratory disease, or respiratory disease accompanied by loss of appetite and growth failure, or chronic cough and steatorrhea followed by growth failure occurred in 8% each. If not properly diagnosed and treated, cystic fibrosis can put the patient's life at risk. The analysis between an early diagnosis and the decrease of the incidence in pulmonary complications with pathogenic agents was statistically significant. [ABSTRACT FROM AUTHOR]

Spinal dural arteriovenous fistulas (AVFs) are rare spine vascular malformations. We report a case of AVF in the epidural space of T10 and degenerative medial osteophytes leading to clinical symptoms of severe spinal stenosis operated with good evolution. [ABSTRACT FROM AUTHOR]

Th17 cells, known as a highly pro-inflammatory subtype of Th cells, are involved very early in numerous aspects of multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) neuropathology. A crucial event for the formation and accumulation of MS lesions is represented by the disruption of the blood brain barrier (BBB) in relapsing-remitting MS. Th17 cells also contribute to the progression of MS/EAE. These events will allow for the passage of inflammatory cells into the brain. Secondary to this, increased recruitment of neutrophils occurs, followed by increased protease activity that will continue to attract macrophages and monocytes, leading to brain inflammation with sustained myelin and axon damage. This review focuses mainly on the role of Th17 cells in penetrating the BBB and on their important effects on BBB disruption via their main secretion products, IL-17 and IL-22. We present the morphological aspects of Th17 cells that allow for intercellular contacts with BBB endothelial cells and the functional/secretory particularities of Th17 cells that allow for intercellular communications that enhance Th17 entry into the CNS. The cytokines and chemokines involved in these processes are described. In conclusion, Th17 cells can efficiently cross the BBB using pathways distinct from those used by Th1 cells, leading to BBB disruption, the activation of other inflammatory cells and neurodegeneration in MS patients. [ABSTRACT FROM AUTHOR]

Suboccipital decompression with duraplasty is a widely accepted method for treating patients with Chiari malformation type I. However, important details of the duraplasty technique are still controversial. This retrospective study analyzes clinical and radiological outcomes after surgery depending upon the type of graft and methods of graft fixation. Seventy consecutive decompressions with duraplasty were analyzed. Two types of grafts, nonautologous (Non-AutoG; 60.0%) and autologous (AutoG; 40.0%), and two methods of graft fixation, suturing (S; 67.1%) and gluing (G; 32.9%), were used in four different combinations: (Non-AutoG+S: 31.4%; Non-AutoG+G: 28.6%; AutoG+S: 35.7%; AutoG+G: 4.3%) according to surgeon preference. The mean follow-up was 63.4 months. According to gestalt and Chicago Chiari Outcome Scales, satisfactory results were obtained in 72.9% and 78.6% of cases, respectively, in the long term. The outcomes were not related to the kind of graft (p = 0.44), fixation method (p = 0.89) or duraplasty pattern (p = 0.32). Decreased syringomyelia was observed in 88.9% of cases, and no associations with the kind of graft (p = 0.84), fixation method (p = 1) or duraplasty pattern were found (p = 0.96). Pseudomeningocele occurred 5 times more often in the Non-AutoG group than in the AutoG group (52.4% vs. 10.7%; p < 0.05), whereas their formations were not related to the fixation method (p = 0.34). Three cases (12.0%) required reoperation with reduraplasty. Autologous and nonautologous dural grafts can be sutured or glued with similar clinical results; however, the use of nonautologous grafts is linked with a much higher risk of pseudomeningocele formation. [ABSTRACT FROM AUTHOR]

We admitted a unique case of right lumbar disc herniation at L4L5 who presented with contralateral symptoms and was successfully treated with a right large L4/L5 fenestration and microdiscectomy. When the operation is considered, intervention only from the herniation side is sufficient. In the case presented, it is probable that Kernohan notch-like phenomenon, venous engorgement and congestion at the contralateral side of the herniated lumbar disc and the contralateral migrated epidural fat are responsible for the emergence of contralateral symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral infections (frontoparietal extradural and subdural empyema) following a dental abscess and multiple sinusitis is a rare and potentially devastating entity even in the era of modern diagnosis and treatment. Case presentation: We present a patient with parietal epidural and subdural empyema and intracerebral frontal abscess, sinusitis and dental abscess, chronic consumer of alcohol and with neglected diabetes mellitus. He was initially diagnosed with encapsulated hematoma and sinusitis. The pus obtained at the intervention was certified by our laboratory as sterile with the consequent difficulty in antibiotic treatment and who induced a longer antibiotic treatment, a second surgical intervention for an encapsulated frontal abscess, a longer hospitalisation and favoured contamination with Covid 19. Despite these, the patient had a finally good evolution. Conclusions: A frontoparietal extradural and subdural empyema and an intracerebral frontal abscess produced by a dental abscess and sinusitis is a rare and potentially lethal complication. The multidisciplinary approach between radiologist, neurosurgeon, otolaryngologist, dentist, microbiologists is mandatory for a proper diagnosis and treatment of these pathologies. [ABSTRACT FROM AUTHOR]

Hypertrophic pyloric stenosis (HPS) is a gastrointestinal condition that affects newborns and young infants and is characterized by progressive, non-bilious projectile vomiting. This study aimed to investigate the demographics and clinical manifestations of HPS. A retrospective, non-randomized study was conducted over a period of three years (2019-2022) and included 29 patients diagnosed with HPS at the Pediatric Clinic of the County Clinical Emergency Hospital of Constanta. The results showed a significant male predilection, with a ratio of 1:4.8, and a seasonal variation with a higher incidence of HPS in the summer months. The primary symptom of HPS was non-bilious forceful vomiting after feeding, observed in nearly all cases. Other symptoms included dehydration, stagnation and decrease in weight. The thickness of the pyloric muscle was measured using ultrasonography and was found to be an average of 54.5 mm, with a range between 30 mm and 79 mm, which is considered a strong indication of HPS. This study highlights the importance of considering HPS as a possible diagnosis in newborns and young infants presenting with symptoms of projectile vomiting, and emphasizes the need for further research into the seasonal variation of HPS and its underlying causes. [ABSTRACT FROM AUTHOR]

Introduction: Vomiting is one of the most common symptoms in children and a common reason for seeing a doctor. The causes are very numerous and unusually diverse, but in most cases, vomiting is of organic origin. Objective: This paper is a retrospective case study - control, performed in the Pediatric Clinic of Spitalul Clinic Judeţean Constanţa, which aims to evaluate the clinical and etiological aspects of vomiting in infants. Material and method: The statistical study was performed over a period of 6 months (January 1st, 2019 - June 30th, 2019), on a group of 1091 infants selected from a total number of 3943 children hospitalized during this period in the Pediatric Clinic. The patients in the study group ranged in age from 0 to 12 months. The data were extracted from the patient observation sheets in the archives of the Pediatrics Department. Results and discussions: The retrospective study carried out resulted in the following important aspects related to the etiological particularities of vomiting. Of the total number of infants admitted during the study period, vomiting was a symptom in 29.60% of cases.The analysis of the study revealed the predominance of organic etiology (79.57%), with clear predominance in newborns and infants of cases of vomiting with organic etiology (79.56%). Cases of vomiting with functional etiology occurred in the newborn and infant are represented by eating errors.Within the organic etiology, the digestive pathology predominates, accumulating a percentage of 53.86% of the total cases of vomiting occurred at this age. Of the diseases with extradigestive organic etiology, most were represented by respiratory diseases and ORL. The functional etiology registered a percentage of 20.43%, this predominating in infants, age group 7 - 11 months. Conclusions: The idea that emerges from the study is that infants with vomiting are in large numbers and have a very varied etiology, so is necessary to apply a clear investigation algorithm, with the correct establishment of the diagnosis in each case, which leads to the best therapeutic conduct. [ABSTRACT FROM AUTHOR]

Purpose: To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice. Methods: We conducted semi‐structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article. Findings: Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice. Conclusion: This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies. [ABSTRACT FROM AUTHOR]

The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from − 5 to − 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies. [ABSTRACT FROM AUTHOR]

This article is co-authored by a patient living with cystic fibrosis, and her treating physician. The first section of this commentary article is authored by a patient, who describes their experience of living with cystic fibrosis. The following section is authored by the patient's physician, who discusses the management of cystic fibrosis in the context of the patient's experiences. [ABSTRACT FROM AUTHOR]

Hypokalemic periodic paralysis is a rare skeletal muscle channelopathy characterized by intermittent episodes of acute flaccid paralysis with associated hypokalemia. We present here the case of a first-onset hypokalemic periodic paralysis triggered by lumbar spinal surgery for tumor resection. A 37-year-old male without any known prior medical conditions presented with a first-onset attack of hypokalemic paralysis 1.5 days after lumbar spinal surgery for myxopapillary ependymoma. Initially, the patient presented paraparesis mimicking a spinal cord compression, and while en route for imaging there was an abrupt onset of flaccid paralysis with significant respiratory distress. The emergency blood tests revealed extreme hypokalemia with a serum potassium of 1.42 mm/L. The patient was transferred to the intensive care unit, intubated, sedated, and administered intravenous reperfusion with an infusion dose of 20 mEq/hour potassium in a solution of 5% mannitol. Following reperfusion, the patient recovered completely in 12 hours. Renal potassium hyperexcretion and hyperthyroidism were excluded by laboratory tests. The diagnosis was confirmed by genetic tests showing mutation of the CACNA1S gene. To the best of our knowledge, this is the first described case with the first onset triggered by a neurosurgical intervention and the second case following any kind of surgery. Neurosurgeons should consider hypokalemic periodic paralysis when encountering a rapidly evolving tetraparesis, even in an apparently healthy patient. [ABSTRACT FROM AUTHOR]

The emergence of the novel coronavirus, SARS-CoV-2, has startled the entire world and created a genuine chaos inside the medical system. As the infection is spreading, the manifestations are becoming more diverse. The number of SARS-CoV-2-induced neurological cases described in the literature is increasing and the neurologists are experiencing disturbing times in managing their patients, especially those diagnosed with autoimmune diseases, namely multiple sclerosis (MS). Disease-modifying therapies (DMTs) seem to enhance the susceptibility of MS patients to develop severe form of infections. Therefore, their utilization during COVID-19 pandemic is controversial. This review aims to summarise the available recommendations regarding the neurological management of MS patients, with an emphasis on the changes this pandemic has brought in the MS treatment. [ABSTRACT FROM AUTHOR]

Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist. Patient safety, surgeon's comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of incipient symptomatic stages of early-onset dementia is challenging. The magnetic resonance imaging (MRI) is an easy-access biomarker.Objective: We aim to determine the distribution and diagnostic performance of the existing atrophy visual rating scales on MRI in initial stages of the most frequent neurodegenerative early onset dementias.Methods: We evaluated the visual atrophy scales usefulness in two hundred subjects: seventy sporadic early onset Alzheimer's disease (AD) patients (48 amnestic and 22 non-amnestic), 14 patients with autosomal-dominant AD (ADAD), 25 sporadic frontotemporal dementia patients [11 with behavioral variant (bvFTD), nine with semantic variant of primary progressive aphasia (svPPA), and 5 with non-fluent primary progressive aphasia (nfvPPA)], 7 with genetically determined FTD (genetic FTD), 25 mild cognitive impairment due to non-degenerative disorders, and 59 healthy controls. All had MMSE≥18, 3T-brain MRI, and biomarker-supported diagnosis. Two raters evaluated six frontal, temporal, and parietal scales. Inter-rater reliability and diagnostic performance in terms of area under the receiver-operator curves and balanced accuracy were analyzed.Results: Best scales to discriminate AD from controls were the anterior cingulate scale for amnestic and the posterior atrophy scale for sporadic non-amnestic AD and ADAD. The anterior temporal scale was the best for sporadic bvFTD and svPPA and the anterior cingulate scale was for nfvPPA. All scales performed well for the genetic FTD. However, no scale demonstrated good performance at discriminating AD from FTD or non-degenerative disorders.Conclusions: The clinicians should interpret with caution atrophy scale assessment in subjects with early-onset cognitive impairment given that none of the evaluated scales met the requirements for being a diagnostic biomarker. [ABSTRACT FROM AUTHOR]

Aging spine may include complex degenerative lesions: spine stenosis, spondylolisthesis, kyphosis, scoliosis, lumbar disc hernias and osteoporosis. We present a case of a patient with multiple level degenerative severe lumbar spine stenosis, degenerative spondylolisthesis, lumbar disc hernia, who was treated succesfully with multilevel spine decompresion,discectomy and multilevel stabilization with transpedicular titan screws. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension (PH) is a progressive disease in which the mean pulmonary arterial pressure is greater than 20 mmHg. There are 5 main groups explaining the underlying cause of the disease: 1 - pulmonary arterial hypertension; 2- left heart disease; 3- pulmonary disease; 4- chronic pulmonary thromboembolism; and 5- multifactorial pathology. The Reveal Lite 2 score is used to assess patients' risk for 1 year mortality. Objective: This study aims to assess risk in patients depending on their age, pulmonary hypertension group and functional class, and Reveal Lite 2 score. Material and methods: We designed a retrospective, observational study, on 65 patients from 2016 to 2023. All the patients included in the study were diagnosed with pulmonary hypertension and were being monitored and using targeted medical therapy in the Internal Medicine II - Cardiology Department, Emergency Clinical County Hospital of Targu Mures. Results : Patients' data were computed according to their etiology. In PH group 1.1, the mean age is 59,87 y.o., +/-SD of 14,07 years, the mean functional class is 2,366 and the Reveal Lite 2 mean is 6,155; in PH group 1.2, the mean age is 48,33 y.o., +/-SD of 9,56 years, the mean functional class is 2 and the Reveal Lite mean is 4,33; in PH group 1.4.1, the mean age is 54,86 y.o., +/-SD of 6,5 years, the mean functional class is 2,85 and the Reveal Lite 2 mean is 7; in PH group 1.4.4, the mean age is 35,93 y.o., +/-SD 15,65 years, the mean functional class is 2,153 and the Reveal Lite 2 mean is 5,441; in PH group 4.1, the mean age is 62,95 y.o., +/-SD 9,963 years, the mean functional class is 2,42 and the Reveal Lite 2 mean is 7,26. Preliminary statistical analysis showed a statistically significant difference between Reveal Lite 2 scores calculated for each group (p <0,0001). Conclusions: Different PH groups have different predictions of risk based on etiologic factors. Further analysis will determine if these findings correlate with the TAPSE/PASP ratio, an echocardiographic parameter which has been previously used to predict pulmonary hypertension prognosis in patients. [ABSTRACT FROM AUTHOR]

Background: Celiac disease is a chronic autoimmune disorder that primarily targets the small intestine, triggered by gluten consumption. The golden standard in its diagnosis involves a combination of serological tests, a duodenal biopsy following the MARSH criteria of disease classification, and genetic testing. Currently, there is no cure for celiac disease, the only way of managing being the adoption of a gluten-free diet. Objective: This study aims to compare clinical and hematological parameters with the MARSH stages of celiac disease, providing insight into diagnostic markers and their correlation with disease severity. In conducting this study, we strive to achieve an easier detection of the disease, as it is often overlooked in patients with asymptomatic or atypical presentations. Material and methods: We conducted a retrospective study on 55 patients diagnosed with celiac disease, that were in the care of the Gastroenterology department of the Emergency Clinical County Hospital of Targu Mures, Romania. The data was collected over a period of 5 years (2018-2023) from the endoscopy registries, which highlighted the patients diagnosed with celiac disease, and we correlated the findings with the results of the attached pathology reports of the duodenal biopsies. The paraclinical laboratory investigations have been extracted from the computerized hospital database. Results : Our study shows that celiac disease is more prevalent in younger females, with a distribution of 43 females and 12 males, with a mean age of 46.5 years. Significant findings include a prevalence of microcytic anemia above 50% in MARSH stages 2, 3B, and 3C, thrombocytosis peaking at 66.67% in stage 3B, hypoalbuminemia highest at 36.71% in stage 3C, hypocalcemia reaching 33.33% in stage 3A, and elevated INR levels most notable at 66.67% in stage 3B. Conclusions: Early indications suggest that microcytic anemia, iron deficiency, thrombocytosis, hypoalbuminemia, hypocalcemia and elevated INR are frequently encountered in celiac disease, especially in its more advanced stages. This could potentially lead to improved diagnostic protocols and targeted management strategies for patients. We conclude that undiagnosed patients presenting with the studied hematological and nutritional abnormalities should undergo a duodenal biopsy, with the purpose of raising the detection rate of celiac disease. [ABSTRACT FROM AUTHOR]

Background: Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission. Exacerbations may involve increasing bulbar weakness and/or sudden respiratory failure, both of which can be critically disabling. Management of MG exacerbations includes plasma exchange and intravenous immunoglobulin (IVIG); they are equally effective, but patients experience fewer side effects with IVIG. The objective of this study was to assess the efficacy and safety of immune globulin caprylate/chromatography purified (IGIV-C) in subjects with MG exacerbations. Methods: This prospective, open-label, non-controlled 28-day clinical trial was conducted in adults with MG Foundation of America class IVb or V status. Subjects received IGIV-C 2 g/kg over 2 consecutive days (1 g/kg/day) and were assessed for efficacy/safety on Days 7, 14, 21, and 28. The primary efficacy endpoint was the change from Baseline in quantitative MG (QMG) score to Day 14. Secondary endpoints of clinical response, Baseline to Day 14, included at least a 3-point decrease in QMG and MG Composite and a 2-point decrease in MG-activities of daily living (MG-ADL). Results: Forty-nine subjects enrolled. The change in QMG score at Day 14 was significant (p < 0.001) in the Evaluable (–6.4, n = 43) and Safety (–6.7, n = 49) populations. Among evaluable subjects, Day 14 response rates were 77, 86, and 88% for QMG, MG Composite, and MG-ADL, respectively. IGIV-C showed good tolerability with no serious adverse events. Conclusions: The results of this study show that IGIV-C was effective, safe, and well tolerated in the treatment of MG exacerbations. [ABSTRACT FROM AUTHOR]

Recurrent radiculopathy after anterior cervical discectomy with fusion (ACDF) occurs in approximately 4% of cases. The main obstacles of revision surgery after ACDF via the same approach are scar tissue and arthrodesis. We present two patients with recurrent symptoms after ACDF who underwent revision surgery using an alternative, less invasive lateral approach (LA). These two patients both presented with recurrent unilateral cervical radiculopathy due to progression of intervertebral foraminal stenosis. The second patient also presented with paraparesis of the lower limbs and central stenosis. Anterior foraminotomy in the first case and oblique corpectomy in the second were performed via the LA. The previously implanted interbody cages were left intact and no new fusion procedures were needed. No spinal instability or symptom relapse was observed in follow-up. The lateral approach to the cervical spine enables direct and effective decompression of neural structures without violation of previously achieved interbody fusion. [ABSTRACT FROM AUTHOR]

Background The main concern with the posterior approach is the risk of postoperative segmental instability. The most commonly cited rule is that removal of the medial half of the articular facet provides adequate surgical exposure and has no effect on stability. The aim of this study was to define the areas of the articular processes in the cervical spine that can be safely removed. Methods Computed tomography scans of 50 cervical spines were analyzed. Measurements were analyzed for bone removal assuming the standard technique of posterior laminoforaminotomy. The width of the facet was measured at the level of the widest dimension. The height of the articular process was taken from the bottom (in the case of inferior process) or top (in the case of superior process) of the process. Results The mean width of the articular process ranged from 11.8 ± 1.5 mm (range, 8.3–15.7 mm) at the C2-C3 level to 14.6 ± 1.7 mm at the C6-C7 level. At the cervicothoracic junction (C7-T1 level), the mean width decreased to 14.0 ± 1.7 mm. The mean value for both sides when the inferior articular process was measured at all levels was 5.0 ± 1.4 mm (range, 4.5–5.8 mm). The mean height of the superior articular process was 7.7 ± 1.5 mm (range, 6.8–8.3 mm). Conclusions Based on our findings, our "5-5-7 mm rule" corresponds to the amount of bone removal for each step of the laminoforaminotomy. [ABSTRACT FROM AUTHOR]

Creating dense and shallow nitrogen-vacancy (NV) ensembles with good spin properties is a prerequisite for developing diamond-based quantum sensors exhibiting better performance. Ion implantation is a key enabling tool for precisely controlling spatial localization and density of NV color centers in diamond. However, it suffers from a low creation yield, while higher ion fluences significantly damage the crystal lattice. In this work, we realize N2+ ion implantation in the 30–40 keV range at high temperatures. At 800 °C, NV's ensemble photoluminescence emission is three to four times higher than room temperature implanted films, while narrow electron spin resonance linewidths of 1.5 MHz, comparable to well-established implantation techniques, are obtained. In addition, we found that ion fluences above 2 × 1014 ions/cm2 can be used without graphitization of the diamond film, in contrast to room temperature implantation. This study opens promising perspectives in optimizing diamond films with implanted NV ensembles that could be integrated into quantum sensing devices. [ABSTRACT FROM AUTHOR]

A 69-year-old patient, with a long history of lung tuberculosis, with lymphopenia was emergently admitted in our hospital for bronchopneumonia, ventriculitis, acute internal hydrocephalic. He was aggressively treated with iv Meropenem and Vancomycin, intraventricular high doses of Vancomycin, aerosols, Dexametazone with healing of internal hydrocephalus, ventriculitis and improvement of bronchopneumonia. [ABSTRACT FROM AUTHOR]

Background: BIOMARKAPD seeks to diminish the barriers associated with the clinical use of cerebrospinal fluid (CSF) biomarker analysis by reducing variation in CSF laboratory methodologies and generating consensus recommendations on their clinical interpretation and application for dementia diagnosis.Objective: To examine the disparity in practitioner attitudes and clinical practice relating to the use of CSF biomarkers for dementia diagnosis across Europe.Methods: Clinical dementia experts were surveyed on the prevalence of national consensus guidelines and analytical reimbursement across Europe, their biomarker platform preferences, lumbar puncture methodologies and application of reference values and cut-offs for CSF analysis.Results: 74% of respondents (total n = 51) use CSF biomarkers in clinical practice and 69% perform lumbar punctures on an outpatient basis. Most use CSF biomarkers to diagnose atypical (84%) and early-onset cases of cognitive impairment (71%) and for the differential diagnosis of other dementias (69%). 82% state they are sufficiently informed about CSF biomarkers yet 61% report a lack of national consensus guidelines on their use for dementia diagnosis. 48% of countries represented do not reimburse clinical CSF analysis costs. 43% report using normal reference ranges derived from publications.Conclusion: Variations in attitude and practice relating to CSF biomarkers, widely recognised as barriers to their clinical acceptance, remain evident within and between countries across Europe, even in expert centres. These shortcomings must be addressed by developing consensus guidelines on CSF-related methodologies and their clinical application, to further their use for the diagnostic evaluation of dementia. [ABSTRACT FROM AUTHOR]

Offspring of murine dams chronically fed a protein-restricted diet have an increased risk for metabolic and neurobehavioral disorders. Previously we showed that adult offspring, developmentally exposed to a chronic maternal low-protein (MLP) diet, had lower body and hind-leg muscle weights and decreased liver enzyme serum levels. We conducted energy expenditure, neurobehavioral and circadian rhythm assays in male offspring to examine mechanisms for the body-weight phenotype and assess neurodevelopmental implications of MLP exposure. C57BL/6J dams were fed a protein restricted (8%protein, MLP) or a control protein (20% protein, C) diet from four weeks before mating until weaning of offspring. Male offspring were weaned to standard rodent diet (20% protein) and single-housed until 8–12 weeks of age. We examined body composition, food intake, energy expenditure, spontaneous rearing activity and sleep patterns and performed behavioral assays for anxiety (open field activity, elevated plus maze [EPM], light/dark exploration), depression (tail suspension and forced swim test), sociability (three-chamber), repetitive (marble burying), learning and memory (fear conditioning), and circadian behavior (wheel-running activity during light-dark and constant dark cycles). We also measured circadian gene expression in hypothalamus and liver at different Zeitgeber times (ZT). Male offspring from separate MLP exposed dams had significantly greater body fat (P = 0.03), less energy expenditure (P = 0.004), less rearing activity (P = 0.04) and a greater number of night-time rest/sleep bouts (P = 0.03) compared to control. MLP offspring displayed greater anxiety-like behavior in the EPM (P<0.01) but had no learning and memory deficit in fear-conditioning assay (P = 0.02). There was an effect of time on Per1, Per 2 and Clock circadian gene expression in the hypothalamus but not on circadian behavior. Thus, transplacental and early developmental exposure of dams to chronic MLP reduces food intake and energy expenditure, increases anxiety like behavior and disturbs sleep patterns but not circadian rhythm in adult male offspring. [ABSTRACT FROM AUTHOR]

Cow's milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth. In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta. The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow's Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed. We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), the remaining (17,5%) being represented by exclusively breastfed infants. The most frequent clinical manifestations were rashes (87,5%), failure to thrive (82,5%), regurgitation (50%) and diarrhea (35%). Further data should be collected to prove if the association between a CoMiSS score higher than 12 and specific IgE-mediated CMPA is clinically relevant, and can predict, based on clinical examination and anamnesis, high serum levels of specific immunoglobulin E. The prognosis can depend on the titre of specific IgE at the time of diagnosis, as they are more likely to develop several crossed allergies and less prone to become tolerant to cow milk proteins than those with non-IgE-mediated CMPA. [ABSTRACT FROM AUTHOR]

Intracranial haemorrhage is a devastating complication of immune thrombocytopenic purpura [1]. The occurrence of a spontaneous subdural hematoma in immune thrombocytopenia (ITP) is rare [2], affecting 1% or less of patients [3]. In ITP contrary to traumatic SDH the brain parenchyma is well preserved [3]. We present the case of a patient with immune thrombocytopenia, subdural haemorrhage and asymptomatic parietal parasagittal meningioma. Neurological parameters were closely monitored, including the level of consciousness, pupillary size, motor or sensorial deficit. He was managed successfully medically (platelet-rich plasma and steroids) and then surgically (craniotomy, subdural hematoma aspiration). [ABSTRACT FROM AUTHOR]

Wegener's granulomatosis WG) classically involves the upper respiratory tract, lungs and kidneys. Rarely, it also affects the gastrointestinal tract and heart. Symptomatic conduction defects in WG are quite uncommon and acute pancreatitis is rarely reported as the first presentation. This can result in diagnostic difficulty and may allow a potentially poor outcome. We report a case in which WG started with gastrointestinal tract problems, was suspected after an heart and ear implication and diagnosed after a peripheral facial paresis with repeated negative ANCA test, and a fatal end by renal impairment after 3 months of starting immunosuppression therapy. [ABSTRACT FROM AUTHOR]

Background: Thrombophilia has previously been identified as a potential etiologic factor in Legg-Calve-Perthes disease. We prospectively studied the association between Legg-Calve-Perthes disease and coagulation abnormalities by comparing seventy-two children who had the disease with 197 healthy controls.Methods: A nonselected, consecutive series of seventy-two patients with Legg-Calve-Perthes disease (mean age [and standard deviation], 6.6 +/- 2.6 years) was studied in their order of referral and compared with 197 healthy controls (mean age, 7.6 +/- 5.1 years). Assays were done for factor-V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase C677T, and plasminogen activator inhibitor-1 4G/5G gene mutations. Levels of anticardiolipin antibodies immunoglobulin G and M (IgG and IgM), homocysteine, protein C, protein S, antithrombin III, and plasminogen activator inhibitor-1 were also measured.Results: The factor-V Leiden mutation was more common in the patients (eight of seventy-two) than in the controls (seven of 197) (chi-square = 5.7, p = 0.017). After we controlled for the false-discovery rate, the case-control difference remained significant (p = 0.017). The odds ratio for the development of Legg-Calve-Perthes disease in the presence of the factor-V Leiden mutation was 3.39 with a 95% confidence interval of 1.18 to 9.73. A high level of anticardiolipin antibodies (IgG and/or IgM) was found in nineteen of the seventy-two patients compared with twenty-two of the 197 controls (chi-square = 9.5, p = 0.002). After we controlled for the false-discovery rate, the case-control difference remained significant (p = 0.002). The odds ratio of patients with Legg-Calve-Perthes disease having one or more abnormalities in factor V, anticardiolipin antibody IgG, or anticardiolipin antibody IgM as opposed to normal values for all three variables was 3.29 (95% confidence interval, 1.73 to 6.24; p = 0.0003).Conclusions: Two thrombophilic risk factors, the factor-V Leiden mutation and anticardiolipin antibodies, are associated with Legg-Calve-Perthes disease, an association that may reflect causality.Level Of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

We present a patient with left compressive L5-S1 lumbar disc hernia in lateral reces and foramina revealed by high intensity pain (Visual Autologus Scale 7/10) and paresthesias on the left S1 dermatoma for 5 months. He refused surgery and followed conservative treatment with very good results after 6 months. The radicular S1 pain became of a small intensity (Visual Autologus Scale 2-3/10) and intermitent and after one year it completely disapeared. After 4 years he repeated the lumbar magnetic resonance imaging which proved the disapearance of the L5-S1 lumbar disc hernia. [ABSTRACT FROM AUTHOR]

Mature teratoma of the vermis is a rare entity in neurosurgical adulthood pathology. We present the case of a 65 years old patient, admited as an emergency for intense headache (VAS 8/10), nausea, vomiting, gait ataxia, orizontal nistagmus, dismetria, disdiadocokinezia, predominant on the left side, long tracts signs, predominant on the left side. Native and contrast CT and MRI scan of the head revealed a tumoral lesion, in the vermian, paravermian and in the fourth ventricle, with the aspect of a teratoma with intratumoral subacute haemorrhage including a giant lesion 5,5/5/4,5 cm, compressive on mesencephalon, and with suprajacent acute internal hidrocephalus. Emergency neurosurgery was performed (occipital infratentorial craniectomy, microneurosurgical total tumoral resection and haematoma evacuation). Postoperative, the patient recovered progressivelly, subtotal neo and arhicerebellar symptoms. The motor long tract signs recovered slower and persisted incomplete. [ABSTRACT FROM AUTHOR]

In this study we evaluated the association of celiac disease in 81 children with autoimmune disease and genetic syndromes over a two years periods (January 2014 to July 2016) in Pediatric Clinic in Constanta. Because the extraintestinal symptoms are an atypical presentation of celiac disease we determined in these children the presence of celiac disease antibodies: Anti-tissue Transglutaminase Antibody IgA and IgA total serum level as a screening method followeds in selective cases by Anti-tissue Transglutaminase Antibody IgG, anti-endomysial antibodies, deamidated gliadin antibodies IgA and IgG and intestinal biopsia. In our study 8 patients had been diagnosed with celiac disease with extraintestinal symptoms, of which 4 with type 1 diabetes, 1 patient with ataxia, 2 patients with dermatitis herpetiformis and 1 patient with Down syndrome that associate also autoimmune thyroiditis, alopecia areata, enamel hypoplasia. [ABSTRACT FROM AUTHOR]

An association between delayed ruptured lumbar disc hernia, L5 vertebral wedge fracture and posttraumaticL4 pincer vertebral fracture (A2.3-AO clasification) at different levels is a very rare entity. We present the case of a 55 years old male who falled down from a bicycle. 2 months later because of intense and permanent vertebral lumbar and radicular L2 and L3 pain (Visual Scal Autologus of Pain7-8/10) the patient came to the hospital. He was diagnosed with pincer vertebral L4 fracture (A2.3-AO clasification) and L2-L3 right ruptured lumbar disc hernia in lateral reces. The patient was operated (L2-L3 right fenestration, and resection of lumbar disc hernia, bilateral stabilisation, L3-L4-L5 with titan screws and postero-lateral bone graft L4 bilateral harvested from iliac crest). [ABSTRACT FROM AUTHOR]

Spinal epidural haematoma (SEH) is a rare entity. We present the case of a 45 years old patient with lumbar epidural hematoma produced by a L3 vertebral tumoral (metastatic) fracture. Neurological status: cauda equina syndrome with sphincterian deficits, incomplete paraplegia (Frankel C), with neurological level L1. Emergency surgery was performed (L3-L2-bilateral laminectomy, L1 left laminectomy, posterior stabilization L2-L4 by titan screws) offering the possibility to progressive motor, sensitive and sphincterian deficites recovery. Abbreviations: Computer Tomography -CT, Magnetic resonance Imaging-MRI, Spinal epidural haematoma-SEH, Visual analogue scale of pain-VAS. Conclusion: We present a patient with a compressive subacute extradural haematoma, due to a traumatic fracture on a vertebral metastatic tumor who produced cauda equina syndrome. Surgical emergency intervention was mandatory for a good neurological outcome. [ABSTRACT FROM AUTHOR]

Generally, according to international literature, cerebral ischemia is a secondary posttraumatic lesion produced by direct compression in the context of a cerebral herniation syndrome or indirect by vasospasm produced by posttraumatic subarachnoid, subdural or intraventricular hemorrhages. We present the case of a patient with an acute MCA ischemia with severe head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematoma which evolved with acute left uncal, parahipocampal and subfalcinecerebral herniation (coma, GCS 6, left mydriasis, right severe hemiparesis). Surgical emergency aspiration of the hematomas was performed. Postoperative treatment of cerebral ischemia and residual hematomas was properly done. We consider important and underdiagnosed the association of cerebral ischemia and secondary posttraumatic brain injuries. Abbreviations: MCA-middle cerebral artery, GCS- Glasgow Coma Scale, ICA-internal carotid artery, PCA-posterior cerebral artery, ACA-anterior cerebral artery. Conclusion: We present a case of a patient with an acute MCA ischemia with secondary head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematomas. Surgical emergency aspiration of the hematomas was performed. The treatment was performed for both lesions (cerebral ischemia and posttraumatic hematomas) with vitamins B, neurotrophycs, pain killers, antibiotics. Unfortunately, due to aggravation of the Mendelson syndrome, the patient died 7 days later. [ABSTRACT FROM AUTHOR]

Background: Determination of Alzheimer's disease (AD) by cerebrospinal fluid (CSF) biomarkers - 42-amino-acid amyloid-β (Aβ42), total tau and phosphorylated tau (p-tau) - has demonstrated high validity for detecting AD neuropathological changes. However, their prognostic utility to predict the onset of dementia in predementia subjects is still questioned. We aimed to study the prospective clinical evolution of a group of subjects with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and to determine the prognostic capacity of AD CSF biomarkers. Methods: 149 subjects with MCI or SCD, not meeting dementia criteria, underwent a prospective clinical, neuropsychological and CSF biomarker study. Patients were initially classified as SCD or MCI following internationally accepted criteria. CSF sampling was obtained and analysed following consensus protocols. Neuropsychological and clinical evaluations were conducted at the follow-up. Statistical analysis considering the final clinical diagnosis, regression analysis to define risk factors and survival curves for progression were made. Results: 72.4% of subjects (83% MCI and 27% SCD) with a pathological CSF ratio (Aβ42/p-tau) met criteria for dementia during the 5-year follow-up versus 18.7% of subjects from the group with a normal ratio. The pathological CSF ratio was a powerful marker of risk for AD dementia (OR 27.1; 95% CI 10.3-71.2). Kaplan-Meier survival curves showed that only 15% of subjects with a pathological CSF ratio remained free of AD dementia at 5 years of follow-up. All subjects who reverted to normal cognition presented a normal CSF profile at baseline. Conclusion: An abnormal AD CSF biomarker profile in predementia subjects is a powerful predictor of cognitive and/or functional decline in the medium term. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims The aims of this study were to assess the sensitivity of the International Behavioural Variant FTD Criteria Consortium ( FTDC) revised criteria of behavioural variant frontotemporal dementia ( bvFTD) in a pathological cohort and to determine their predictive values in a clinical context suggestive of bvFTD. In addition, the study aimed to assess the influence of the age at onset and underlying pathology in the clinicopathological correlations. Methods Retrospective, blinded review of the clinical and neuropathological data from the Neurological Tissue Bank of the Biobank Hospital Clinic- IDIBAPS, Barcelona ( Spain) was conducted, assessing the fulfilment of the diagnostic criteria on a case-by-case basis. Two separate nonexclusive cohorts were selected: Cohort 1 ( n = 58) subjects with pathological diagnosis of frontotemporal lobar degeneration ( FTLD) and Cohort 2 ( n = 66) subjects with the premortem diagnosis of bvFTD. Results The FTDC criteria reached a sensitivity of 93% for possible and 80% for probable bvFTD. Early-onset cases displayed significantly more disinhibition, loss of empathy and compulsive behaviour with respect to late-onset bvFTD, leading to a slightly higher sensitivity of the diagnostic criteria (97% vs. 91%). There were no differences in the diagnostic performance between tau-positive and tau-negative cases. In subjects clinically diagnosed as bvFTD, a 'possible bvFTD' diagnosis reached a positive predictive value for FTLD pathology of 90%, irrespective of underlying proteinopathy. False-positive clinical diagnoses were mainly Alzheimer's disease. These cases were significantly older, had less family history of dementia and had a predominantly apathetic clinical picture. Conclusions The revised bvFTD criteria present good sensitivity and positive predictive value in both early- and late-onset cases and regardless of the underlying FTLD pathology. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, there has been increased focus on individualizing treatment for persons with hemophilia including pharmacokinetic‐guided (PK) dosing. Aims: In this retrospective study clinical outcomes before and after PK‐guided prophylaxis were examined. Materials and methods: Eight Haemophilia Treatment Centres from the United States participated in the study and included 132 patients classified into two cohorts: those undergoing a PK‐assessment for product switch (switchers) or to optimize treatment (non‐switchers). Subset analyses for the two most common products and patients with dosing per prescription label were included for annual bleeding rates (ABR), mean weekly consumption outcomes, and annualized cost of prophylaxis. Results: The most common products before and after index date were octocog alfa, rurioctocog alfa pegol, and efmoroctocog alfa. Seventy‐four (56%) patients were identified as switchers and 58 (44%) patients were classified as non‐switchers. The majority of patients (78.0%) experienced either a decrease in ABR post‐index or maintained 0 ABR during pre‐ and post‐index time periods, with similar proportions identified in both switchers (77.0%) and non‐switchers (79.3%) populations. Non‐switchers were identified as having no significant change in cost of therapy, while switchers experienced increased cost of therapy driven by higher price of extended half‐life products. Within subset analyses, patients receiving rurioctocog alfa pegol and efmoroctocog alfa had mean ABR under 1 after index date. Conclusion: PK‐guided prophylaxis has the potential to improve clinical outcomes without increase in cost of therapy for patients maintaining product and can aid in maintaining effective protection against bleeds in those switching product. [ABSTRACT FROM AUTHOR]

Objectives: Establishing the frequency of pleurisy from the total number of admissions in the Paediatrics Department, as well as the frequency of pleurisy from the total number of respiratory ailments that required hospitalization; evaluating age group distribution and determining the influence of environmental factors; describing clinical manifestations, laboratory, radiologic, and bacteriological investigations in patients with pleurisy; quantifying clinical manifestations and investigations so as to establish an appropriate therapeutic approach; identifying clinical aspects that indicate a favourable/unfavourable evolution; analyzing the evolution of cases after treatment as revealed by radiologic imaging. Method: Retrospective study on 47 patients diagnosed with pleurisy and admitted in the Paediatrics Department of Constanta Clinical Emergency Hospital, over a span of 3 years (2011-2013), based on data collected from observation sheets. Results: A downward trend in what regards the frequency of pleurisy can be observed from 2011 to 2013. Rural provenience and other environmental factors continue to play an important role. Clinical manifestations tend to be more significant for younger patients and they are directly related to the specific pathogen identified during laboratory investigations. Conclusion: Following an early diagnosis and a subsequent adequate treatment, evolution tends to be favourable in most cases, although certain post-hospitalization measures still need to be implemented in order to ensure full recovery and restitution ad integrum. [ABSTRACT FROM AUTHOR]

Objective. This study was conducted to analyze the effect of certain environmental factors on clinical and laboratorial variables in a cohort of multiple sclerosis patients. Material and methods. Serum vitamin 25(OH) D, smoking habits and oral contraceptive use were evaluated in 36 relapsing-remitting MS female patients between ages 29-45 under Interferon beta-1a therapy. Clinical variables included annualized relapse rate and Expanded Disability Status Scale (EDSS). The effect of sun exposure, dietary and smoking habits and oral contraceptive use on 25(OH) D levels was also examined. Results. Patients with higher 25(OH) D serum levels and consumers of oral contraceptives (OC) had better clinical outcomes, but not in a statistically signifi cant extent. The practice of artifi cial tanning, consumption of alternative sources of vitamin D (cod liver oil, omega-3 fatty acids) and the use of oral contraceptives were associated with signifi cantly higher vitamin D levels. Conclusions. Smoking seems to have less effect on disease progression and vitamin D levels than anticipated. Oral contraception use could be benefi c and maintaining a high plasma D level is also encouraged in MS patients. [ABSTRACT FROM AUTHOR]