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A woman in her 40s presented with a 3-month history of intermittent bilateral daily headache of moderate intensity. She had severe headaches for almost 1 month prior to the presentation, which was aggravated by standing and relieved by lying down. She underwent a non-contrast CT of the head followed by MRI of the brain and spine. Neuroimaging of the brain showed features of intracranial hypotension and spine MRI myelography fast imaging employing steady state acquisition sequences confirmed the site of cerebrospinal fluid (CSF) leak. An epidural blood patch (EBP) was placed to close the CSF leakage site. She had significant improvement in her symptoms and repeat MRI at 4 weeks of follow-up showed resolution of imaging abnormalities. She became symptom-free without the requirement of additional EBP. Our report highlights the importance of suspecting and evaluating spontaneous intracranial hypotension in a patient presented with a typical orthostatic headache. Early intervention and keeping a low threshold for evaluation based on a few early clinical and imaging clues can lead to successful management of such cases.

Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuropathies have been diagnosed conventionally using clinical and electrophysiological findings. Physicians opt for nerve imaging in patients with ambiguous electrophysiological tests to gain additional information, identify etiology and plan management.The aim of this study was to describe the electrophysiological and the magnetic resonance neurography (MRN) findings in patients with nontraumatic ulnar neuropathy.All consecutive patients with suspected nontraumatic ulnar mononeuropathy were recruited; clinical assessment and electrophysiological studies (EPSs) were done in all. After EPS, patients with localization of lesion along the ulnar nerve underwent MRN.All 39 patients recruited had clinical findings suggestive of ulnar neuropathy; Electrophysiological confirmation was possible in 36/39 (92.30%) patients. Localization of ulnar nerve lesion to elbow and wrist was possible in 27 (75%) and 9 (25%) patients, respectively. MRN was done in 22 patients; a lesion was identified in 19 of 22 (86.36%) ulnar nerves studied. Thickening and hyperintensity in T2 W/short TI inversion recovery images of ulnar nerve at the level of olecranon, suggesting ulnar neuropathy at elbow, was the commonest (8/22) imaging finding.MRN acts as a complimentary tool to EPS for evaluating nontraumatic ulnar neuropathy. By identifying the etiology, MRN is likely to modify the management decision.

and objective: Tremor is a disabling symptom of PD that usually responds poorly to available standard pharmacological agents. This study aimed to assess the effect of Zonisamide 25 mg on tremor in tremor-dominant PD patients as compared to placebo.This was a randomized, placebo-controlled, double-blind study. Parkinson's disease patients were allocated either to the intervention group (standard treatment along with Zonisamide 25 mg add-on) or the placebo group (standard treatment along with placebo). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) and Tremor Research Group Essential Tremor Rating Scale (TETRAS) scores, as well as accelerometric tremor analysis were done and follow-up assessments of the same were done after 12 weeks of intervention. Percentage change from baseline in the UPDRS tremor score was the primary outcome whereas percentage change from baseline of total UPDRS score, UPDRS rigidity and bradykinesia scores, TETRAS score, and accelerometric tremor analysis values were the secondary outcomes.There was no significant difference in the percentage change from baseline UPDRS tremor scores between the two groups (placebo: 8.33 [-19.89-23.86] vs drug: 26.14 [-35.58 to -16.07], p-value: 0.164, CI: 0.157-0.171). Best-case analysis for missing values showed a significant improvement in the drug group, compared to the placebo group (p-value:0.001, CI:0.001 -0.001).Zonisamide at a dose of 25 mg per day did not improve tremor in tremor-dominant PD patients, however, a positive trend was seen as compared to Placebo in the UPDRS tremor score. Larger studies are required to confirm this finding.

The objective of this study is to synthesise the findings of clinical studies in order to derive evidence for use of the mesenchymal stem cell (MSC) therapy in the treatment of neurodegenerative cerebellar ataxias. In order to find relevant studies for the systematic review, we searched through Medline (1985 to July 2020), PubMed and Clinical trial register. We included both single-arm and comparative studies in which MSCs were given as intervention in neurodegenerative ataxia patients at any time after the diagnosis. We used Joanna Briggs Institute (JBI) quality scale to evaluate the methodological qualities of the included studies. Our literature search obtained 81 publications. Three articles comprising a total of 47 patients were included in the meta-analysis. None of them were randomised controlled trials (RCTs). Pooled analysis noted that there was a decrease in the Berg Balance Scale (BBS)/Scale for the Assessment and Rating of Ataxia (SARA) score from pre to post assessment; however, the difference was statistically not significant (standardised mean difference (SMD) - 0.20; 95% CI - 0.78 to 0.38). No significant side effects were reported in any of the studies. We did not observe any statistically significant difference in the pooled mean difference in the International Cooperative Ataxia Rating Scale (ICARS) score between pre and post assessment in patients with ataxia after receiving the stem cells (SMD 0.36, 95% CI - 0.08 to 0.81). Our systematic review and meta-analysis concluded that MSC cell therapy appeared safe but provided insufficient evidence to support the use of MSCs to treat patients with neurodegenerative cerebellar ataxia at present. No l RCTs was available in the literature to test efficacy; therefore, well-designed RCTs are needed to ascertain the effectiveness of MSCs in patients with neurodegenerative cerebellar ataxias.

Peripheral neuropathy, a form of nerve damage brought on by diabetes and abnormally high blood sugar, was one of the chronic consequences. Studies reveal that the prevalence of Diabetes Peripheral Neuropathy (DPN) is high and riskier in Males than Females. Also, DPN participants have been examined crucially for physiological variables such as systolic and diastolic blood pressure and body mass index. This study aimed to analyze the potency of Yoga therapy on physiological variables in Males of the age group 35 to 70 having DPN. Yoga connects a person's physical, mental, and spiritual aspects to enhance their health and well-being. It has been proven to treat neurological diseases using Yoga therapy by combining the practice of focused posture (asana), controlled breathing (Pranayama), and meditation. Studies proved 30 males with DPN, 15 in each group, were chosen for the study from the Chennai & Chengalpattu district, Tamilnadu, India. The Experimental Group, Group-I, received a Yoga therapy practice and the control group, Group II, underwent it without any practice. The 12-week training period, six days per week, an hour in the morning. Paired sample t-test was conducted to analyze the data. The calculated 't' value of systolic, diastolic and BMI are 3.486, 2.828, and 1.060, respectively, for Group I and -0.371, -1.547, and -1.792 for Group II. The result shows that the negative t value of Group II shows no significant change in the physiological variables, and Group I data shows a significant improvement in the physiological variables. The calculated 't' value is greater than the table value of 2.14 with a degree of freedom of 14, except for BMI. An extension of the training period is suggested to improve the BMI value. This research study reveals that Yoga Therapy was a significantly more effective treatment for DPN.

Background and objectivesOne year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.MethodsWe searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with I2, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.ResultsOf 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11–2.91).DiscussionUp to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind.Systematic Review RegistrationPROSPERO CRD42020181867.

AIM In this study, the effect of frozen storage on the inhibition of microbial population in coconut neera for shelf life extension was analysed. METHODS AND RESULTS The aliquots of fresh neera were frozen at -6 and -20°C. The microbial reduction and chemical qualities were analysed during storage days, and were compared with the control. The highest reduction in microbes was obtained at -20°C for lactic acid bacteria, yeast and total viable count. Moreover, the fluorescence cell staining and cell density analysis exhibited a decline at -20°C, however it showed higher at -6°C. At the end of 28 days, neera exhibited a pH of 5·37, total soluble solid of 14·0 °Brix and total acidity of 0·82 mg l-1 at -20°C. Besides, color, viscosity, total protein and ethanol showed a less difference with control and better sensory attribute up to 21 days at -20°C. CONCLUSIONS Frozen storage at -20°C resulted in a better inhibition of lactic acid bacteria, which preserves neera from the metabolic conversion. The physicochemical qualities of neera were preserved for a longer period when stored at -20°C than at atmospheric storage. SIGNIFICANCE AND IMPACT OF THE STUDY Frozen storage reduced microbial population and preserves the chemical properties with acceptable sensory attributes and increases the shelf life of coconut neera, making it fit for consumption.

Spark plasma joining of nanostructured ferritic 14YWT alloys has been carried out at 800°C, 1020 °C and 1030 °C in vacuum. The characteristics of joining as a function of temperatures were investigated using bulk density, nanoindentation and electron backscattered diffraction techniques. Joining performed at 1020 °C and 1030 °C shows a complete, uniform bonding of the samples, whereas the samples joined at 800 °C showed a visible crack that runs along the entire sample length. Bulk density measurements indicate that the reduction in density of samples joined at 800 °C is due to the presence of voids at the interface. The presence of columnar grains only close to the interface at 800 °C suggests the possibility of a steep temperature rise locally at the interface that is attributed to high electrical contact resistance at the interface.

Anal squamous cell carcinoma patients often present with significant symptoms, including pain, bleeding, and obstructive symptoms. This requires palliation-directed therapy as a first-line treatment to alleviate symptoms. The proportion of patients receiving first-line palliative treatments is unknown. We aimed to study the factors associated with the use of first-line palliative treatments in stage II-IV anal squamous cell carcinoma patients.We used the National Cancer Database to identify adult patients diagnosed with stage II-IV anal squamous cell carcinoma between 2004 and 2016. We performed univariable and multivariable logistic regression analysis to determine the clinical and sociodemographic variables associated with the utilization of palliative treatment in the first-line setting, including palliative radiotherapy, chemotherapy, surgery, and pain management.Among 16,944 patients diagnosed with stage II-IV anal squamous cell carcinoma, only a small proportion of 492 (2.9%) required first-line palliative treatments to control symptoms. The majority of these patients received palliative radiotherapy (32%), followed by palliative surgery (25%), palliative chemotherapy (19%), combination therapies (14%), and pain management (10%). On multivariable analysis, higher stage disease, lower income, Medicare and Medicaid insurance, and life expectancy6 months were associated with higher odds of use of first-line palliative therapy.First-line use of palliative treatments to control symptoms is needed in a small proportion of anal squamous cell cancer patients. It was utilized in all stages, but it was most frequently observed in patients with stage IV disease and patients with6 months life expectancy. First-line palliative therapy was also more frequent in lower-income patients and patients with Medicare and Medicaid insurance which highlights the disparities in anal cancer management.

The kinetochore establishes the linkage between chromosomes and the spindle microtubule plus ends during mitosis. In vertebrates, the spindle-kinetochore-associated (Ska1,2,3) complex stabilizes kinetochore attachment with the microtubule plus ends, but how Ska is recruited to and stabilized at the kinetochore-microtubule interface is not understood. Here, our results show that interaction of Ska1 with the general microtubule plus end-associated protein EB1 through a conserved motif regulates Ska recruitment to kinetochores in human cells. Ska1 forms a stable complex with EB1 via interaction with the motif in its N-terminal disordered loop region. Disruption of this interaction either by deleting or mutating the motif disrupts Ska complex recruitment to kinetochores and induce chromosome alignment defects, but it does not affect Ska complex assembly. Atomic-force microscopy imaging revealed that Ska1 is anchored to the C-terminal region of the EB1 dimer through its loop and thereby promotes formation of extended structures. Furthermore, our NMR data showed that the Ska1 motif binds to the residues in EB1 that are the binding sites of other plus end targeting proteins that are recruited to microtubules by EB1 through a similar conserved motif. Collectively, our results demonstrate that EB1-mediated Ska1 recruitment onto the microtubule serves as a general mechanism for formation of vertebrate kinetochore-microtubule attachments and metaphase chromosome alignment.

Background: Teleneurology consultations can be highly advantageous since neurological diseases and disabilities often limit patient's access to health care, particularly in a setting where they nee...

Restacked two-dimensional (2D) materials represent a new class of membranes for water-ion separations. Understanding the interplay between the 2D membrane's structure and the constituent material's surface chemistry to its ion sieving properties is crucial for further membrane development. Here, we reveal, and tune via covalent functionalization, the structure of MoS2-based membranes. We find features on both the ∼1 nm (interlayer spacing) and ∼100 nm (mesoporous voids between layers) length scales that evolve with the hydration level. The functional groups act as permanent molecular spacers, preventing local impermeability caused by irreversible restacking and promoting the uniform rehydration of the membrane. Molecular dynamics simulations show that the choice of functional group tunes the structure of water within the MoS2 channel and consequently determines the hydrated interlayer spacing. We demonstrate that MoS2 membranes functionalized with acetic acid have consistently ∼92% rejection of Na2SO4 with a flux of ∼1.5 lm-2 hr-1 bar-1.

A single specimen of a gravid female of the stripenose guitarfish, Acroteriobatus variegatus was landed as by-catch by a tuna hook and line at Sakthikulangara, Kerala from a depth of 110-130 m. The species is categorized as ‘critically endangered’ by IUCN. The morphometric characteristics of A. variegatus are described for the first time since its original description by Nair and Lal Mohan (1973) from Gulf of Mannar. The present study provides preliminary insights into its reproductive biology. The mode of reproduction in A. variegatus is aplacental yolk sac viviparity with low uterine fecundity

Primary CNS Vasculitis (PCNSV) is a rare inflammatory disorder affecting the blood vessels of the central nervous system. Patients present with a combination of headaches, seizures, and focal neurological deficits. There is usually a diagnostic delay. Treatment is based on observational studies and expert opinion. Our objective was to identify clinical, laboratory, neuroimaging, pathologic or management-related associations with 2 year outcome in patients with primary CNS vasculitis. We conducted a cohort study at a single tertiary care referral centre of prospectively (2018-2019) and retrospectively (2010-2018) identified individuals with primary CNS vasculitis (diagnosis was proven by either brain biopsy or cerebral digital subtraction angiography). Clinical, imaging and histopathologic findings, treatment, and functional outcomes were recorded. Univariate and stepwise multiple logistic regression were applied. P-valueStudy registration: CTRI/2018/03/012721.

BACKGROUND: Early evidence suggests good response to pallidal deep brain stimulation (DBS) in DYT‐KMT2B. OBJECTIVES: We aimed to conduct a systematic review and meta‐analysis to assess outcomes and identify predictors of good outcome following GPi‐DBS in DYT‐KMT2B. METHODS: We searched MEDLINE, Cochrane and MDS‐abstracts databases using the MeSH terms “KMT2B and DYT28”. We included studies that reported objective outcomes following GPi‐DBS in DYT‐KMT2B. The BFMDRS‐M (Burke‐Fahn‐Marsden Dystonia Rating Scale‐ Movement) total scores pre‐ and post‐surgery were used to quantify outcomes. We calculated pooled effects using a random effects meta‐analysis and used meta‐regression to identify potential effect modifiers. Multiple linear regression using individual patient data was used to identify predictors of good outcome (>50% improvement from baseline on BFMDRS‐M). RESULTS: Initial searches screened 132 abstracts of which 34 full‐text articles were identified to be of potential interest. Ten studies reporting 42 individual patients, met the inclusion/exclusion criteria and were included in the final review. The mean age at onset was 6.4 ± 5.7 years and 40% were male. The median follow‐up was 12 months (range: 1–264 months). GPi‐DBS resulted in median BFMDRS‐M improvement of 42.7% (range: −103.5% to 95.9%) postoperatively. Pooled proportion of patients experiencing clinical improvement >50% on BFMDRS‐M was 41% (95% CI: 27%–57%). Male gender [β: 22.6, 95% CI: 8.0–37.3, P = 0.004), and higher pre‐operative BFMDRS‐M score [β: 0.62, 95% CI: 0.36–0.87, P

Context. The focal-plane contrast of exoplanet imagers is affected by non-common path aberrations (NCPAs) that the adaptive optics system cannot correct for because they occur after the wavefront has been measured. NCPA estimation is commonly based on the long-exposure science image. Phase retrieval algorithms are often used, and they mostly assume that the residual phase error right after the adaptive optics system and averaged over the integration time is zero. This assumption is not always correct, for instance when controlling the adaptive optics to maximize the focal-plane contrast at the location of an exoplanet, that is to say in an adaptive coronagraph. For such cases, we present a method to calculate the NCPA using the phase information derived from the wavefront sensor (WFS) data and the science focal-plane image. Aims. We aim to accurately estimate the NCPA phase in the presence of (residual) atmospheric turbulence with a nonzero average wavefront. We then aim to take the NCPA into account in the adaptive coronagraph controller and achieve a higher contrast. Methods. The WFS measures the wavefront throughout the integration time of the science image. We combine information from the recorded WFS phases to remove the effects of the nonzero average phase from the Point Spread Function (PSF) and to remove the effects of the residual turbulence averaging over time. Then we estimate the NCPA by applying a phase-diversity-based algorithm to the resulting images. Our method is currently limited to imagers with pupil-plane coronagraphs. Results. We are able to recover the NCPA in an adaptive coronagraph setting with 0.01 radian RMS residuals and with a residual turbulence phase error of approximately 0.4 radian RMS. When accounted for in a contrast-control scheme, the NCPA correction leads to an order of magnitude improvement of contrast and a 50% increase in Strehl ratio, in numerical simulations.

The association of spinal muscular atrophy (SMA) with progressive myoclonic epilepsy, also known as “SMA plus,” is a unique syndrome linked to non-survival motor neuron (non-SMN) genes. The disease starts in childhood with progressive weakness and atrophy of muscles; myoclonic epilepsy develops during later childhood, after the onset of motor symptoms. In this report, we describe a case of SMN gene unrelated SMA and myoclonic epilepsy, supported by electrophysiological and neuropathological evidences.

A 42-year-old Indian woman presented with a slowly progressive and painless swelling in the superomedial aspect of right orbit over past 5 years. She succumbed to homeopathic treatment which controlled the swelling for some time, but eventually recurred. The swelling led to protrusion of her right eye down and out. The patient's vision in her right eye was reduced, with restricted movement on elevation and adduction. The right eye pupil was sluggishly reacting to light. The fundus examination of the right eye revealed hyperemic disc with disc edema and retinal folds. Whereas, left ocular examination was normal. The computed tomography and magnetic resonance imaging scans of the right orbit revealed an intraconal, multiloculated lesion in the superomedial aspect of the orbit, adhering to the optic nerve, giving us an array of differential diagnosis. She underwent right anterolateral orbitotomy under general anesthesia; the masses excised were sent for histopathological examination, which gave the definitive diagnosis of a schwannoma.