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1 Effect of Renal Complications on Brain - An Overview , Shalini K Mehta and Sivakumar JT Gowder
The association between chronic kidney disease (CKD) and cardiovascular disease has been extensively studied but, at the same time, little information has been available on the relationship between kidney and brain. In this manuscript, we have evaluated the recent updates on the relation between CKD and neurological disorders based on literature review and survey. A wide spectrum of neurological disturbances and behavioral changes such as fatigue, head ache, sensory clouding, vision impairment, seizures, delirium and coma can be observed in patients with renal complications [1-4]
2 Optic Neuritis and Hypophysitis: Partial Remission after Pulse Therapy , Isabela Morales Cozeto, Lívia Norcia Zenerato, Letícia Alarcão Max-ta, Ricardo Baer Filho, Érico Paulo Heilbrun, Márcio Luis Duarte and Lucas Ribeiro dos Santos
Lymphocytic or autoimmune hypophysitis (AH) is a rare disorder characterized by inflammation of the pituitary gland. There is no consensus on treatment, but may include corticosteroid therapy and decompression surgery. Optic neuritis (ON) is an inflammati-on of the optic nerve, both of unknown etiology and autoimmune hypothesis. The association of pathologies is rare, with few reports in the literature. The diagnosis of ON is clinical and treatment with high dose corticosteroids. A case initially diagnosed as ON with pituitary macroadenoma is described: 55-year-old woman with sudden bilateral visual loss associated with nausea, vomiting, diarr-hea and hypotension, MRI with pituitary expansive lesion with optic chiasm compression and laboratory tests showing thyrotrophic, corticotrophic and gonadotropic axes deficiencies, associated with mild hyperprolactinemia. Methylprednisolone pulse therapy was performed for ON treatment. Patient presented improvement of visual acuity, decreased pituitary volume and recovery of cortico-trophic axis, raising the hypothesis of AH. The case demonstrates the importance of careful neuro-ophthalmologic and radiographic evaluation of patients with pituitary adenoma and visual loss. NO and AH should be considered in the differential diagnosis as this may prevent unnecessary invasive procedures.
3 Impact of Psycho-Social Intervention in Patient with GBS in Neurological Rehabilitation Set Up: A Case Report , Arun M and BP Nirmala
The current case report describes the psycho-social assessment carried out with a person diagnosed with Guillain-Barre syndro-me. Psycho-social assessment sheet which is developed for assessing psycho-social factors of patients with neurological disorder and hospital anxiety and depression scale has been used in the case report. This report also focuses on the caregiver’s issues and the associated interventions. The common psycho-social intervention which was used in this case has alleviated patient’s emotional distress and helped her go through rehabilitation process effectively. Findings of this case study support the fact that medical mana-gement complimented with psychosocial intervention could help the patient and family members deal with social and psychological dysfunctions effectively.
4 The Psychology of Patients Infected with COVID 19 in Tunisia during the Treatment Period , Kahna Mohamed, Cherni Bochra and Baaouni Zaineb
The COVID-19 still causes anxiety and apprehension among many patients today, which can lead to a refusal of care or difficult working conditions. It, therefore, appears prerequisite to set up conditioning and relaxation methods for patients and caregivers to optimize care and working conditions. In this regard, we assess the psychological levels of patients in their forties to detect the fac-tors in order to facilitate the treatment.
5 Coronavirus - The New Generation Influenza Psychiovirus , Vahram R Sargsyan
The paper presents a new scientific approach for interpreting the mechanisms of functioning of the influenza virus in nature. New biological theories are discussed - viral theories, on the basis of which the coronavirus known to everyone since 2019 is considered as a psycho-influenza virus. More details are given - the viral theory of biocommunication and the viral theory of signal transduction. In conclusion, modern scientific methods of protection against infectious diseases are proposed.
6 Enhancement of Function of the Prefrontal Cortex to Improve Symptoms of Schizophrenia , Prajjita Sarma Bardoloi
Schizophrenia is a chronic psychotic illness with multifactorial etiology that manifests with a constellation of positive, negative, affective and cognitive symptoms [1]. As we are learning more about the neurobiology of schizophrenia, the role of the prefrontal cortex (PFC) in schizophrenia has become more evident. While various medications are available to treat psychotic symptoms in schizophrenia, treatment of cognitive functions, residual symptoms and comorbid disorders is still a substantial challenge. Here we present a case of a young male who suffers from schizophrenia, with a previous diagnosis of ADHD and substance abuse, who showed remarkable improvement following treatment with the alpha-2A adrenergic agonist guanfacine, likely related to enhanced PFC function
7 Mental Health of Healthcare Personnel during Quarantine for Infectious Epidemic--Real-time Data , Uriel Halbreich and Fanqiang Meng
Background: The 2020 Coronavirus (COVID-19) pandemic has been causing significant fear and anxiety among the general public and demonstrate insufficient preparedness of Healthcare systems. It shed light on front-line Healthcare-personnel who should func-tion and treat others while they share the same stressful situations.Objective: To provide actual real-time data on mood and mental symptoms of Healthcare personnel in quarantined wards during the Chinese-SARS epidemic, in order to support procedures for functioning of personnel during current and future epidemics.Setting, Participants and Measurements: Cross-sectional Study was conducted during the acute exacerbation of the SARS epide-mic at quarantined wards by nurses who were embedded and quarantined with the patients. Mood and perceptions of Healthca-re-personnel infected (n = 55) and not infected (n = 149) with SARS, as well as those during quarantine “rehabilitation” (n = 62) were compared to SARS patients (n = 96), healthy quarantined students (n = 55) and healthy non-quarantined controls (n = 52).Structured interviews were conducted with the Beck Depression Inventory (BDI), Spielberger’s State-Trait inventory, symptoms Checklist-90 (SCL-90) and a situation-specific questionnaire.Results: Healthcare-personnel -- infected and not-infected, suffered as much mood, anxiety and other stress-induced symptoms as their SARS patients. Strictly enforced quarantine amplified personnel’s frustration, mental symptoms and mistrust in authorities.Limitations: Data was collected when many patients were assisted by respirators, some could not be included.Conclusion: During acute epidemics front-line Healthcare-Personnel are exposed to same and even more extreme situations as their patients. Their emotional state under tumultuous situations should be of concern.Implications: Mental well-being procedures and enhancement of Mental resilience of Healthcare teams should be an integral com-ponent of their preparedness for future disasters
8 Takotsubo Cardiomyopathy Resulting from Transient Global Amnesia Following a Sexual Encounter , Kamalpreet Dhaliwal, Sonia Randhawa, Nabihah Kabir, Yadwinder Sidhu, Harsimran Singh, Shawn Banash, Muhammed Janjua and Vib-hav Bansal
Background: Transient global amnesia (TGA) is a neurological condition described as acute onset anterograde amnesia that resolves within 24 hours. TGA is often associated with migraine history, psycho-physical stress, and cardiovascular risk factors. Takotsubo Cardiomyopathy (TTC), also known as Broken Heart Syndrome, is a reversible, stress-induced weakening of the left ventricle (LV) resulting in cardiomyopathy. Concurrent occurrence of the two syndromes have rarely been reported. To date, there have been 10 documented concurrent TGA and TTC cases, all unrelated to sexual triggers. Here we report the first patient with simultaneous TGA and TTC following a sexual encounter.Insights and Aim: Summarize a case and its associated factors to establish awareness of a possible causal relationship between TGA and TTC following a sexual encounter as a precipitating factor. Case Report: A 66 year-old woman presented to the emergency department with sudden onset confusion and forgetfulness wit-nessed by the patient’s husband immediately after sexual intercourse.Neurologic exam on admission revealed short-term memory deficits, resulting in repeated questions of similar nature regarding the peri-ictal period. Lab results revealed an elevated High Sensitivity Troponin-T of 51 ng/L (normal, < 14 ng/L); all other pertinent labs were within normal limits. The patient’s neurological manifestations of amnesia resolved 14 hours after the time of presentation. Conclusion: Although TGA is considered a primary neurologic disorder, it is important to recognize a possible relationship between TGA and TTC in order to manage the cardiac complications that may arise from TTC
9 The Transcranial Direct Current Stimulation (tDCS) and Biofeedback (BFB) as a Mixed Methods in Reducing Symptoms of Migraine , Mohammadjavad Hoseinpourfard and Masoumeh Shajarian.
Migraines may be induced by triggers such as fatigue, certain foods, weather, and so on. Of-course some patients with migraine report other experiencing triggers include dietary and sleep disor-ders. Many of symptoms pertaining to the migraine may start, up to 24 hours after a trigger and continue for 72 hours. In addition, the psycho-physiological aspects could consider as other important triggers.
10 Class-I MHC-Restricted T-Cell Associated Molecule (CRTAM) Expression in Cerebellum. , Esther López-Bayghen, Karla Pérez-Toledo, Leticia Ramírez- Martínez, Jacqueline Robledo,Vianney Ortiz and Arturo Ortega.
The class-I MHC-restricted T-cell associated molecule (CRTAM), an activation molecule expressed in activated Natural Killer cells (NKT) and CD8+ T cells, is highly expressed in the cerebellar cortex, both in neurons and glial cells. During cerebellar development, granule cell migration over Bergmann glia cells depends on neuronal/glia glutamatergic signaling, suggesting a regulated cell-cell in-teraction process, opening the possibility of CTRAM and Nectin-like 2 involvement. Through the use of the well-established model of chicken cerebellar Bergmann glial cells and a wound/healing assay, we describe herein that glutamate represses CRTAM expression, enhancing migration. These results reveal an unexpected function of CTRAM in the cerebellum.
11 Corona Virus (COVID-19): A Brief Status in India about its Transmission and Precaution. , Abhishek Jha, Deepak kumar Mishra, Deepika Sharma  and Suvercha Arya.
Coronaviruses were first discovered in the 1930s when an acute respiratory infection of domesticated chickens was shown to be caused by infectious bronchitis virus (IBV). Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CO-V-2), was first reported in Wuhan, Hubei province, China has now rapidly spread over 200 countries. Rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic. Current Scenario of India is also not however very good and facing a high risk despite a continuous lockdown from 22nd March - 17th May 2020. However, the lockdown is again increased from 18th May - 31st May 2020.
12 External Ventricular Drains: An Overview of Indications, Technique, and Complications. , Anudeep Yekula,  Aditya Mittal, Varun Sagi  and Mihir Gupta.
External ventricular drains (EVDs or ventriculostomies) are frequently required for acute management of intracranial hyper-tension and monitoring intracranial pressure. Patients with ventriculostomies are frequently co-managed by multiple specialists including neurologists, neuro-intensivists, trauma specialists, emergency department physicians and neurosurgeons. We provide background on the indications, placement technique, troubleshooting and complications related to this procedure. We also discuss emerging best practices for preventing complications such as ventriculostomy-related infection. We conclude with considerations regarding ventriculostomy removal and areas of ongoing study. This review serves as a primer that may facilitate collaborative care between diverse allied providers.
13 Need for Antimicrobial Agents in Daily Applications in Hygiene and Disinfection: An Opinion. , Shimon Shatzmiller.
The hygienic situation in hospitals and other health facilities have become a source of sickness that is killing thousands all over the place, and in Israel as well. A similar situation is in agricultural land. Since the ban on the use of methyl-bromide for soil disinfec-tion, agricultural products can be infected with species of dead causing microbes, germs, and viruses. Imitation of natural materials isolated from amphibians and reptiles (crocodiles) can bring relief. These natural substances act on the bacteria in a way that does not cause the resistance of the microbes. Natural like synthetic imitators can be used, which can be produced in large quantities and low economic requirements and eradicate the pathogens in the soil and hospitals.  
14 Simple Strategies for Brain Health. , Seyedeh Nasim Habibzadeh.
The brain is a major organ in human body that is made up of a large nervous system of nerve tissues which process the sensory information and controls the thoughts, memory and speech. The brain also governs the movement of the limbs and the function of many other organs within the body. The brain is very highly sensitive organ which can harm easily. Any bad news, unexpected shocks and daily pressures can affect the brain functions. However, the servers kind of negative aforementioned stresses can cause the brain waves or vibrations and even any low level of stresses can induce the brain unwanted waves afterwards. In this regards, stress management would account for a good strategy to improve the brain health. Avoiding of being in stressful environments and performing some gentle exercise like walking and listening to the music can be very beneficial approaches to protect the brain and its functionality in time.
15 Love, Bonding Phenomenon, and the Healthy Narcissism. , Ronnie Solan  and Anat Ben-Artsy.
It is common psychoanalytic knowledge that the influence deriving from childhood experiences carries well on into adulthood. This article’s main objective is to disclose the survival motive behind the influence of childhood experiences throughout life. The survival motive seems to relate to the Healthy Narcissism Processing [1-3], a process metaphorically scrutinized to an Emotional immune system. Memory traces of childhood experiences, such as intimacy with the object or Separation Anxiety, etc., reverberate all along life through the processing of Healthy Narcissism. Accordingly, the sense of the Familiar Self may be preserved, immunized and assisted. Likewise, the “Me” and its belongings (like its objects and love relations) are recognized as familiar, stimulated to be restored, revived and recharged in present experiences according to past involvements. Re-finding the familiar senses in present events, according to the models of past experiences, facilitates adaptation to daily relationships and to almost familiar occurrences.
16 Critical Evaluation of Physical Exercise on Brain Structure and Function. , Mahsa R M Mansouri and Sivakumar J T Gowder.
Physical activity or physical exercise act against the sedentary lifestyle-induced health matters such as cognitive decline or neu-rodegenerative diseases. Physical exercise and physical activity is important for people of all age groups that not only could enhance mental capacity and social interactions development of pre-school aged children, but also could maintain and ameliorate muscle strengthening and health condition such as high blood pressure of old adults. Physical exercise also, acts as gene modulator which develops brain function due to structural and functional changes such as neurogenesis, glycogenesis, brain volumes, white matter integrity, neurotrophies levels and or cognitive performance.
17 Physical Therapy in Mental Health? , Stavros Stathopoulos
The core of physical therapy in mental health is to optimize wellbeing and empowering the individual by promoting functional movement, movement awareness and physical activity, exercise, bringing together physical and mental aspects. Physical therapists in mental health play a key part in the inte-grated multidisciplinary team/interprofessional care.
18 A Neuroscientific Study of the Brain Stimulator and Simulation Model to Predict Breakfast PPG Using GH-Method: Math-Physical Medicine , Gerald C Hsu
The author interprets the brain stimulator and its associated simulation model of predicted breakfast postprandial plasma glu-cose via a food or meal segmentation analysis and Sensor PPG waveform characteristics study. He has been using a continuous glucose monitoring device applied to his left upper arm and has collected 74 glucose data each day since 5/5/2018. However, by the mid-2019, he noticed that many of his post-breakfast glucose values escalated approximately one hour after the first bite of his breakfast, even when eating pure protein such as eggs without any carbs/sugar content. Therefore, during October of 2019, he modi-fied his computer software to sort out different food contents and processed their associated PPG waveforms. By using a pure protein egg breakfast case study, this research paper offers some explanations to his speculation and hypothesis on how when eating food, this would prompt the brain to send an order to the liver to start the glucose production. This paper further links the functions of our brain, liver, and pancreas working together.
19 Centralized Pain: Status Review and Medical Management , Ihsan F Shanti, Bilal F Shanti, Ali Otom,  Ali Al Rjoub  and Khalil Al-Abbadi
Centralized pain is non-fatal disorder linked to permanent changes and chaotic imprinting of pain inputs within the central ner-vous system. This occurs without obvious logical reasons that we know of. This persistent heightened alert of the nervous system is very exhausting to the patients and their families. The magnitude of other symptom comorbidities makes this pain entity even more challenging to diagnose and treat. Fortunately, recent research discoveries have introduced a few theories such the concept of glial activation and neuroinflammation as having some plausible role in this complex syndrome. This review manuscript will seek to explain and simplify some of the non-procedural clinical medical management options available to date, as tools for us, clinicians, to fight this painful entity
20 Thermotherapy and Vibroacoustic Therapy in Preventing and Possibly Reversing Dementia and Alzheimer’s , George Grant and Jay P Vanden Heuvel
The Objective of this Literature Review is to find any published scientific evidence to correlate the use of both Thermotherapy [Hyperthermia][Heat Therapy] and Vibroacoustic therapy [Vibration + Sound] to prevent and possibly reverse chronic neurological conditions like Dementia and Alzheimer’s Disease.
21 Defeating the Devil in the Waste: Remediation of Infectious Covid-19 Waste. , Sachin Kumar and Pinky Kain
The Covid-19 infectious-biomedical waste generated from the health care and research activities are posing a huge invisible threat. The waste containing many deadly microorganisms, their toxins and particularly Corona Virus are posing a risk of infection relapse and occurrence of future infection waves. Workers who are involved in taking care of this waste are at risk of getting exposed to Covid-19 and other dangerous biological agents by punctures/cuts (contaminated sharps), skin-mucous contact/projection of blood or biological fluids, ingestion or inhalation of contaminated particles.
22 COVID 19 Pandemic Anxiety and its Management , Suprakash Chaudhury, Pooja V, Mahesh Thakur and Daniel Saldanha
The COVID-19 Pandemic is likely to evoke questions within the minds of a vast number of individuals across the globe due to its high degree of communicability and an apparently greater fatality rate compared to many other flu-causing viruses. No specific medi-cations against COVID 19 are available presently. A vaccine against it has also not been developed thus far. The only known methods to prevent the disease are non-pharmacological measures like avoiding contact with infected person, social distancing, use of face masks, through hand-washing with soap and water or alcohol based sanitizers, etc.
23 Brain Imaging and Aging , Shimon Shatzmiller, Galina M Zats and Inbal Lapidot
Brain imaging is one of the main obstacles of modern disease diagnostics since it has to allow accurate and quantitative mea-surements on a living organ that is placed in adults (in neonatal humans skull penetration is somewhat easier) inside a bone cage. Inside is the brain, the main function controller of our body that has to be done in a non-invasive way on the living operation brain. Many spectroscopic methods are trying to overcome the difficult access to the brain: Photoacoustic microscopy, Confocal microsco-py, Two-photon microscopy, Optical coherence tomography, Scan-ning Laser Acoustic Microscopy, Acoustic microscopy, Ultrasonog-raphy, positron tomography, fluorescence methods, photo caustic microscopy and multy (two) photon imaging spectroscopy.
24 Distal Catheter Migration to Mediastina in Ventricular-peritoneal Shunt, a Case Report , Amir Kamalifar, Samar Kamalifar , Amir Rezakhah  and Firooz Salehpoor
Ventricular-peritoneal shunting (VPS) is common neurosurgical procedure in childhood and have many complication like mal-function infection and malposition, we present a case with a positioning of distal catheter in thoracic region.
25 Schizo-obsessive Disorder - Diagnostic and Therapeutic Difficulties - Case Report , Anna Urbańska, Aneta Perzyńska-Starkiewicz, Łukasz Proć, Agnieszka Lis, Aleksandra Kordyga-Proć and Marcin Olajossy
A case of patient with schizo-obsessive disorder is presented. Schizo-obsessive disorder causes many diagnostic difficulties. The patients may not respond to the basic treatment regimens for schizophrenia or schizo-affective disorder and they may need poly-pharmacotherapy more often than usual.
26 Concussion in Older Population , Oyeneyin Babatunde David, Opeyemi Oluwasanmi Adeloye  and Oyeneyin Oluwatosin
Concussion present with many symptoms but the most common is headache. Other symptoms include dizziness, nausea, imbalance or vertigo, fatigue or drowsiness, sensitivity to light and noise, amnesia (which is a typical feature), abnormal behavior and seizure. At old age, the human skull has an increased space as the brain begin to shrink just like the other body tissues which experience the same physical changes due to ageing. Subdural hematoma, easily occur in the aged brain vessels following an accident and could be worsened when patient is on anti-inflammatory drugs. In this study, we critically review the current knowledge of concussion in the older populations.
27 “Haquapathy” - The Most Natural Holistic Approach to Weight Loss , Faris Al Hajri
Haquapathy is one of the basic methods of revitalization in the system of natural medicine, which we also coined it as Haqua Re-vitalize® Therapy (HART), otherwise known as; Hot Aqua Therapy (HAT), Hot Water Therapy (HOWT), Hydrothermal Therapy (HTT), Aqua Calidum Therapy (ACT), Maysakhin Therapy (MST), and Majimoto Therapy (MMT), that we instigated, being the origina-tor and founder of this therapy since we discovered its significant health benefits to the human body in August 2007, until the pres-ent moment.
28 The Brain and Consciousness , Mette Mouritsen
A “knee experience” is a complicated process that requires coordination of the skin cell’s recording of touches and the mus-cle-tendon’s registration of position and more in order to bring a mental image to the brain. The brain cannot by itself generate the experience "knee," it requires a lived experience of the knee at the cellular level, which in all provides an awareness and remem-brance of “knee.” The experience of knee thus requires informa-tion from several different cells and direct contact. There must be something or someone that relate to the knee by touching it, before the knee can be experienced to its full, otherwise it will just be a mental image, which also is an experience of “knee,” however it is entirely a mental image.
29 Death and Consciousness , Mette Mouritsen
When observing a dead body, it is obvious that something is missing. The glow, warmth and movement that characterizes a liv-ing human being are obviously lacking. “The thing”, which is lack-ing is the formless energy that makes a person alive. The entire physical body including the brain and the heart and the genes are left back, they are no longer self-propelled as they seemed to be when the body was fully alive. In a metaphor the notes and the instruments that contributed to the orchestra of the body are still there, but the conductor and the sound has left the orchestra. It all happens in a breath, one moment alive the next moment dead.
30 “KD Ear Blow Sign” in Rabies , Vinod Kumar Tewari, Abhishek Gupta, Devesh Johari and Lori Tewari
In rabies patient on blowing on any ear, the respiratory muscle spasms is increased. This “KD EAR BLOW SIGN IN RABIES” is due to increase in humidity (examiners moist air blow) in the auditory canal which in turn sends impulses via those auditory nerves to temporal lobe thus stimulating reflex.
31 COVID-19 and Nervous Relation , Vijay Kumar
The COVID-19 predominantly affects the respiratory system, causes alveolar damage, edema, and inflammation [1]. However, many experimental studies and case reports on coronaviruses (CoVs) highlighted their potential neurotropism. The neuro-inva-sive propensity has been illustrated as a common feature of CoVs. The SARS-CoV and SARS-CoV-2 showed the greater similarity, it is quite possible that they also possess similar potential. The neuro-trophic viruses may enter the brain by direct infection injury, hy-poxic injury, blood circulation pathway, immune-mediated injury, neuronal pathway, and include other mechanisms [2]. After the invasion, the impact of SARS-CoV-2 on neurological manifestation and complications can be seen in central and peripheral nervous system.
32 Preterm Births and Cognitive Development , Frolli A, Ricci MC, Valenzano L, Cavallaro A, Pastorino GMG and Operto FF.
The birth of a premature baby is a decisive factor in determining long-term consequences on cognitive development. Considering the Wechsler Intelligence Scale for Children (WISC) as a reference, there are several evidences resulting from numerous studies that show a variation in the cognitive profile: preterm-born children have been shown to have an increased risk of cognitive impairment and have consistently shown lower results than control groups on standardized tests of general intellectual functioning. In our study we expand the sample age and evaluate the cognitive profile of adolescents and understand if cognitive abilities had specific effects, comparing a group of adolescents born preterm (group 1) with a group of adolescents born on term (group 2). Broadening the study population age, we may conclude that the impairment of WM’s abilities persists during the course of development, and therefore subjects with a preterm birth history continue to present difficulties in global cognitive functioning, also impacting lifestyle.
33 Rare Case of Inflammatory Pseudotumour of Central Nervous System - A Case Report , Siddharth Gautam
Inflammatory Pseudotumours (IPT) are mostly benign lesions, mimicking malignant lesions and affecting almost all organ systems and are characterised by fibrotic ground tissue and polyclonal mononuclear infiltrate on histopathology. It is a disease of unknown pathogenesis and the brain is a rare site of occurrence. Here we present one such case we operated recently in our department.
34 Epilepsy and its Management in Unani Medicine , Azma Waseem, Anwar Jamal, Usama Akram and M Fazil.
Epilepsy is one of the oldest ailments that have been affecting the human beings. As per World Health Organization (WHO), epi-lepsy is a chronic non communicable brain disease that may affects people of all ages. It is characterized by two or more provoked seizures, which are brief episodes of involuntary movement that may involve the whole body or a part of the body. Near about 50 mil-lion people is suffering from epilepsy worldwide, and approximately 5 million people are diagnosed with epilepsy each year making it the most common neurological disease globally. Discrimination and social stigma is still associated with epilepsy in the world and it impact on the patient’s quality of life and their families as well. Most of epilepsy patients live in developing countries and unable to get the proper treatment for the disease. In Unani system of medicine, epilepsy is described as Sar‘. Classification of epilepsy in this ancient system of medicine has been done on the basis of temperament, predominance of humor involved, internal and external factors etc. In this paper an attempt has been made to explore the concept of epilepsy in Unani medicine, its type, etiology and management through various modes of Unani treatment. This article will help in reducing the burden of this common neurological problem and development of new intervention for the disease
35 Complications of the Anterior Cervical Discectomy and Fusion , Muthana Ibrahim Jameel, Liwa Abdullah Ali, Ihssan S Nema and Zahraa F Al-Sharshahi
Background: Anterior cervical discectomy and fusion (ACDF) means removing the symptomatic disc by an anterior approach with placement of a bone graft or a synthetic cage. Many studies have shown the procedure to be effective, but associated with complica-tions.Objective: To document and record the type and incidence of complications associated with ACDF, and to find any predisposing fac-tors or associated medical illnesses and other demographic factors or conditions that increase the complications.Patients and Methods: A prospective review of 48 patients who underwent an anterior cervical discectomy and fusion between (May\2012 - July\2014) in two hospitals with an average 6 months follow up.Results: The sample of patients was classified according to age, gender, diagnosis, complications, associated medical illnesses, level of the operation. Then the complications were analyzed according to these parameters trying to find any predisposing factors or as-sociations. Hoarseness of voice was 79%, Dysphagia 54%, Neurapraxia 14.6%, Other medical illnesses 12%, Infection 4%, Reopening 4%, wrong diagnosis 4%, worsening 4% and Death 2%.Conclusion: The complication rate for ACDF is low in experienced hands. Hoarseness is the most common reported complication. Dysphasia, laryngeal edema or a sensation of a lump in the throat are also reported. Associated medical illnesses especially asth-matics and smokers and any patient with chronic cough or respiratory problems are the major cause of complication. Also there is marked association of complications in patients with multisystemic chronic diseases.
36 Use of Dopamine Agonist in Tetanus Spasms - A Novel Approach to Revert the Respiratory Spasm - The Cause of Mortality , Vinod Kumar Tewari, Abhishek Gupta, Devesh Johari and Lori Tewari.
In tetanus patients Levodopa and Carbidopa combination (which is usually used to relieve the signs of extrapyramidal) causes respiratory muscles spasm relief thereby the need for sedatives is decreased and patient saved later on via central nervous system mechanism, by providing the inhibitory neurotransmitters at Anterior Horn cells.
37 Post-intensive Care Syndrome in COVID 19: Monitoring from the Physical Medicine and Rehabilitation and Clinical Psychology , Espinosa-Gil Rosa María and Monteagudo-Santamaría María
The Covid-19 has been a great challenge. At this time, it is interesting to approach patients with severe COVID who have required prolonged admission to the Critical Care Unit (ICU), intubation with connections to mechanical respiration, even connection to the extracorporeal oxygenation membrane (ECMO), because our hospital (Virgen de la Arrixaca, University Hospital, in Murcia), is reference for connection to ECMO.We have elaborated a process/protocol for offering physical and psychological care (assessment, diagnosis and treatment) from the hospital environment and specifically from Rehabilitation Service. This constitutes a challenge and we consider that it will have a significant improvement in both physical and psychological symptoms. We are working in the context to Post ICU Syndrome.The sample is reduced by the severity of the patients.We cannot offer results due to the recent pandemic and because in our region it occurred one month later than in the rest of the most affected regions in Spain (Madrid, Barcelona, Bilbao). We are in the first medical and psychological evaluations and treatment in the actuality.
38 The Bitter Truth: Lessons from Pandemic Covid-19 , Pinky Kain
The pandemic is treating everybody equal. Current rise in Co-vid-19 cases in USA has taught that no country is a super power or leading now. Nobody is as educated as we think. We all are proving failures. Even the wealthiest are hiding and isolating. Riches having less immunity is a weaker and most vulnerable class. Lack of tis-sues rolls, grocery, medical supply, health insurance and food has driven the upper class crazy. The poor class is actually more on the safer side where having no money is a blessing in disguise. Their strong will powers and immunity is shielding them.
39 COVID-19 and the Brain , Maria Elena López and Sofia Isea
During the present pandemic of COVID-19 disease, interest has shifted from the respiratory system affectation to involvement of other organs and systems. Recently pre-eminence of neurological symptoms and signs has emerged. We have done a comprehen-sive review of the literature published as open access in various databases with the purpose of increasing our understanding of the disease and aid in the identification of patients with these neurological conditions. We have reviewed articles reporting neurologic manifestations in young individuals and children. Although there is nor enough data to establish prevalence of the conditions affect-ing pediatric population, as the number of worldwide cases increases we expect to find an increase in these reports. it is considered of utmost importance to urge clinicians to document symptoms and neurological signs in the context of the disease in order to contribute to a better understanding of Neurocovid and to generate a body of knowledge that influences the optimization of the diagnosis and approach of this entity, taking as a premise that the early installation of individualized and reasoned treatments will translate in a better survival rate of those affected and lower the occurrence of eventual ongoing deficits.
40 Coronation's Disturbing Effect: Even After they Recuperate - The Sense of taste and Smell did not Return to Some of the Adhesives , Shimon Shatzmiller
A Wall Street Journal study claims that a high percentage of re-covering Corona researchers already claimed that the loss of taste and smell is one of the symptoms of those infected with the virus. Some patients experience this sensory loss along with other symp-toms, such as high fever, cough, or shortness of breath. According to a study published in the Wall Street Journal, some patients have recovered from Coronavirus SARS-COV-2 and most of its many effects on the human body. But have reported that their sense of taste and smell has not returned to this day.
41 Impact of the COVID 19: Losses and Mourning , Eva María Esparza Meza
At birth we humans are in a situation of absolute deviation, to survive we depend on the physical and psychic care that is provid-ed to us. The state of helplessness resulting from the immaturity with which we are born, is compensated by the devoted care of the mother, who, with the support of her partner, family and society in general, lends the baby a kind of external nesting that subjudges this first catastrophe called birth
42 Mental Health through Unani Medicine , Usama Akram, Neelam Quddusi, Azma Kausar, Mohammed Fazil and A A Khan.
Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. In 2017, there were an estimated 46.6 million adults aged 18 or older in the United States with mental disorder. Young adults aged 18-25 years had the highest prevalence of mental disorder (25.8%) compared to adults aged 26-49 years (22.2%) and aged 50 and older (13.8%). In low and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder.Unani system of medicine is the only system which intervenes with six essential factors (Asbab-e-Sitta Zarooriya) especially by Bodily AND Psychic movement (Harkat wa Sukoon Nafsani) and sleep AND wakefulness (Naum wa yaqza). In this regard, Tadeel-e-Ruh is the basic concept to keep away mental disorders. Equilibrium between these two causes of health (Asbab-e-Sehat) is enough to keep away mental problems. In spite of that there are a number of Unani single (Mufradat) and compound (Murakkabat) drugs for examples Sedative (Musakkinat), exhilarants (Mufarrihat), Mubrridat (cold inducers) and brain strengthener (Muqwaiy-e-Demagh) keep away mental disorder such as Dementia, Insomnia, Headache, Depression and other mental disorders.
43 Proper Names and Repression. A Freudian Finding , Araceli Colín
I intend to locate Freud's contributions in relation to personal names and repression. His most spreaded idea of the unconscious is a consequence of repression. Repression operates in three stages described in his metapsychology. In order to articulate his findings, it is necessary to highlight the way in which the personal name is tied to a lack. Without lack the reality-test could not be installed and the separation between conscious and unconscious could not be established. For Freud, the core of the unconscious is made up of agents of the representation (Vorstellungrepräsentanz). They are of the order of nonsense. In my opinion those representatives are letters. Letters of personal names are one of the first fixation materials (Fixierung). Fixation constitutes the first time of repres-sion: It is a necessary but not sufficient condition for the psychic apparatus to be founded. I also analyze another Freudian idea of the unconscious: the inherited unconscious. Freud deployed this idea in his last work.
44 Evidence of a Neuroprotective Function for Niclosamide in Human SH-SY5Y Neuroblastoma and Rat PC12 Neural Cells , Kevin C Bermea, Edgar A Casillas, Liza D Morales, Laura L Valdez, Brenda Bin Su, Andrew Tsin and Benxu Cheng
Neurodegenerative disease is a debilitating and incurable condition that affects millions. It results in the loss of function and eventual death of neural cells. It has been established that exposure of model neuronal-derived cell lines to the proteasome inhibitor MG132 emulates in vitro neurodegeneration as evidenced by a marked decrease in protein degradation concomitant with an increase in aggregate intracellular ubiquitinated proteins and endoplasmic reticulum (ER) stress (via upregulation of CHOP/GADD153). Consequently, apoptosis ensues corresponding to the upregulation of p53, activation of caspase-3, cleavage of poly (ADP-ribose) polymerase (PARP), and DNA condensation/fragmentation. In this study, we investigated the potential neuroprotective function of niclosamide and its associated signaling mechanisms in SH-SY5Y and PC12 neural cells exposed to MG132. All markers of MG132-induced neurodegeneration, including the accumulation of ubiquitinated proteins, were prevented by exposure to niclosamide. In addition, niclosamide was shown to induce autophagy independently and to enhance autophagy induced by MG132. These results show that niclosamide may serve as a potential neuroprotective agent through its ability to inhibit proteasome dysfunction-induced protein ubiquitination.
45 10,000-fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Duchenne Muscular Dystrophy (DMD) Via Intrathecal Superfusion and Oral Tadalafil - A Case Report , Vinod Kumar Tewari, Neeraj, Devesh Johari and Lori Tewari
Duchenne Muscular Dystrophy (DMD) is a slow, progressive and fatal X-linked neuromuscular disorder due to loss of dystrophin that links the contractile apparatus to the sarcolemma via the dystrophin-associated protein complex (DPC). The NOD (Nitric Oxide Donor) causes release of Nitric Oxide (NO) by nitric oxide synthase (NOS) and then via 10,000-fold effect NOR (Nitric Oxide Receptor) it acts to release cGMP thus modulates DPC and improves the skeleton muscle functionality. We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in DMD (diagnosed by muscle biopsy) and oral Tadalafil as NODs and well checked by AL-TENS (acupuncture like transepidermal neu-ral stimulation) in pre ITSNP and post ITSNP phase
46 Peduncular Hallucination Status Secondary to Thalamic Stroke: Brief Case Report and Review of the Literature , Carmen Maura Carrillo de Albornoz Calahorro, Margarita Guerrero-Jiménez and Luis Gutiérrez-Rojas.
Background: The role of thalamus in the pathogenesis of visual and auditory hallucinations has been described as “Peduncular Hal-lucinosis”. This kind of hallucinations has been reported to be associated with thalamic injury joined to midbrain structures damage. Hallucinations are filled with vivid images of animals and colorful characters in motion and in many cases are associated with sleep disorders. Despite these characteristics, patients generally distinguish them as not real. Case Report: The present case has the distinction of having characteristics somewhat different from those described in published cases. In the first place, it is the case of the longest duration published up to date, 5 years, secondly, contrary to what usually happens, the patient does not criticize the objects and understands them as realConclusions: We present an updated review about literature published and redefinition of the concept the particular characteristics of this rare syndrome. When facing hallucinatory cases of an organic type, especially in patients with cardiovascular risk factors, it is important to rule out rare syndromes such as Charles Bonnet or hallucinations of thalamic origin.
47 Estrogen Detoxification and Neuroendocrinological Activation and Balancing Via Hormonal Yoga , Vidhu Gill, Kritanjali Singh and Ashok Kumar.
Estrogen is the major sex hormone formed in both males and females and is responsible for development of reproductive organs as well as secondary sexual characters. In females, its major function is to maturation and regulation of ovaries and uterus. Its major forms are Estrone (E1), Estradiol (E2), and Estriol (E3), but E2 is the most effective form of estrogen and is formed from cholesterol (steroid) ring. Most of the estrogen formed along with other hormones like progesterone is utilized in maintenance of menstrual cycle, uterine health and pregnancy by number of feedback mechanisms. Major detoxification of this chemical messenger occurs in liver by two phase mechanism: hydroxylation and methylation and usually take 2-OH pathway of detoxification which is the safest and the most efficient at molecular levels. This pathway also reduces the chances of formation of estrogen adducts which leads to abrupt DNA processing, mutation, and base exclusion. 4-OH and 16-OH pathways of detoxification is usually neglected but if there is disturbances in feedback mechanisms and estrogen load increases it might leads to blockage of energy channels by overlapping them with steroid hormone. These blocked energy channels can be healed and reopened by yoga and naturopathic interventions along with dietary and lifestyle modifications. Yoga kriyas, asanas, bandhas, mudras and relaxation reactivates and balances hormones by suppressing over-processing or rejuvenating endocrine glands to form more of these chemical messengers, without any synthetic chemicals or invasive interventions
48 Sacral Nerve Stimulation for Neurogenic Bladder: Our Experience , R Ramnarayan and H Krishna Moorthy.
Introduction: Neurogenic bladder is a condition causing significant effect on the quality of life of the patient. Sacral nerve stimula-tion (SNM) has a good role in these patients. We report our experience with sacral neuromodulation. Methods: 15 patients with refractory urinary bladder were included in this study. The aetiology of the neurogenic bladder included 7 spinal cord injury, 3 meningomyelocele, 2 failed back surgery syndromes, two multiple sclerosis and one mixed bowel/bladder (aetiology unknown). All 15 underwent test stimulation.Results: Only 10 out the 15 had a positive trial and proceeded to the next stage of implantation. The 3 patients with failed trial were all patients with complete cord injury or injuries below T12 (vertebral level) and more than 8 years duration. Of the other two one was a meningomyelocele and other was a case of advanced multiple sclerosis. Follow up period was upto four years; all 10 patients doing well. One of early cases had lead migration and had to be repositioned. One patient used to develop shock like sensation in perineum; the stimulation was stopped for six weeks and restarted at lower frequency. Conclusion: SNM is a very effective therapy for neurologic bladder in selected patients. Detailed preoperative assessments and trial are very important in this selection.
49 Concomitant Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Myasthenia Gravis-A Two-Case Report , Nan Jiang and Mohamed Kazamel
Few cases of co-existing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and seropositive myasthenia gravis (MG) were reported. However, there is no reports on co-existence of CIDP with seronegative MG or on the responses to treatment of both diseases. We report two cases with diagnosis of CIDP and MG. The first case is 38-year-old African American female with initial diagnosis of CIDP and later onset bulbar symptoms. She was diagnosed with seronegative MG by clinical suspicion and single fiber electromyography (SFEMG). The other case is a 65-year-old British male who initially diagnosed as seropositive MG then he devel-oped paresthesia and difficult walking a few months later. CIDP was confirmed by electrodiagnostic study and albuminocytologic dissociation in cerebrospinal fluid analysis. The first case underscores the importance of performing SFEMG on cranial muscles in cases of CIDP with cranial nerve involvement even if serological testing for MG is negative. In both cases, bulbar symptoms were more responsive to immunomodulatory treatment than limb symptoms.
50 Unusual Occurrence of Spinal Chondromyxoid Fibroma of the C2 Odontoid: A Case Report of a Rare Tumor at an Extremely Uncommon Site , Jean Marie Vianney Hope, Jean Paul Bitega, Edmond Mukimbili, Francis Mugabo and Albert Ndata.
Chondromyxoid fibroma is a rare benign cartilaginous bone tumor that is uncommonly found in the spine. To date, among 13 cas-es reported in the cervical spine, only two cases involve the C2 vertebra and all arise from the body. We report the first case occurring in the odontoid process of a 26-year-old woman. Firstly, because of the craniocervical instability, fusion from the occipital condyles to the posterior elements of C1 through C3 was performed. Secondarily, an expansile tumor of the C2 odontoid process was resected along with phenolization and synthetic processed bone grafting via a transoral approach. The postoperative course was uneventful without recurrence at 3-year-follow up. Then, she has returned to full-time employment
51 Typical and Atypical NMOSD - Its Implications , Venkata Krishna Chaitanya Koduri, Venkata Sundarachary Nagarjunakonda, Veeramma Uppala and Ramakrishna Gajula.
Background:Neuromyelitis optica (NMO) has evolved from Devic’s classical description to a broader disease spectrum of NMO Spectrum Disorder (NMOSD), from monophasic illness to a polyphasic illness with multiple recurrences, disease confined to optic nerve and spinal cord to now brain stem, cerebrum and even with endocrinopathy due to hypothalamic involvement [1], coexisting infections [2] and a variety of autoimmune diseases, including non-organ specific autoimmune diseases and co-existent autoanti-bodies without diseases [3].Objectives:To report, the epidemiological characteristics, clinical presentations, recurrence rate, treatment and response to therapy in 23 patients with NMO spectrum disorder among the Indian population.Materials and Methods:An observational, retrospective analysis of our prospectively maintained data base of patients during the period of May 2018 - June 2018 who satisfied International Panel for NMO Diagnosis (IPND) revised criteria [4] of NMOSD was done.Results:1. 23 case records of NMOSD were retrieved. 14 cases were aquaporin4 positive and 9 were aquaporin4 negative.2. Mean age is 39.6 years. Median age is 42 years (Range 17 - 64). Female to male ratio is 1:2.8.3. Clinical presentations included longitudinally extensive transverse myelitis being the most common followed by optic neuri-tis, area postrema syndrome, seizures and brainstem encephalitis.4. Two had associated herpes simples virus encephalitis, one CSF VDRL positivity. Two had associated retro viral disease. 5. Two had ANA, Anti ds DNA antibody positive vasculitis.6. One had CSF oligoclonal bands in CSF and an open ring enhancement on MRI suggestive of tumefactive demyelination.Discussion and Conclusion:• Contrary to current literature an unusual there is male preponderance in our study population [1,5,6].• Atypical lesions or course(Red flags)should suggest additional work up for associated diseases and prompt treatment of which can lead to significant recovery.• Aquaporin 4 antibody positivity, severity at presentation, associated diseases and relapse rate determine the prognosis.
52 PLEDs and NCSE: To Split or Lump them Together? , Keni Ravish Rajiv, Deepak Menon and Ashalatha Radhakrishnan.
Periodic lateralised epileptiform discharges are electrophysiological biomarkers of acute and sometimes chronic brain injury. A major controversy through the years has been whether PLEDs are truly ictal or just interictal or post-ictal epiphenomenon, and whether these discharges warrant any treatment. In this review, we aimed to critically analyze this issue of whether to actively treat or wait and watch PLEDs in various situations. We conclude that the etiology of PLEDs, depth of encephalopathy and presence of clinical seizures is associated with poor outcome rather than presence of PLEDs per se. Continuous EEG monitoring is warranted to recognise ictal or high risk interictal EEG patterns akin to NCSE before treating aggressively with antiepileptic drugs.
53 Therapeutic Applications of Repetitive Transcranial Magnetic Stimulation in Neurology , Suprakash Chaudhury and Daniel Saldanha
Some neurological and psychiatric disorders present with dis-abling symptoms for which presently effective, mechanism-based treatments are lacking. As a result, researchers all over the world are searching and evaluating newer drugs and also more advanced non-invasive therapeutic methods. One of these methods that modulate brain activity and may be useful in clinical practice is repetitive transcranial magnetic stimulation (rTMS). In this non-invasive procedure stimulation of electrical activity in the brain takes place through a pulsed magnetic field. rTMS is being evalu-ated for number of disorders all over the world.
54 Transient Blindness due to Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient of Beta-thalassemia Major , Muhtamim Chowdhury, Purushuttom Baniya, Vijay Kumar Raut, Fahtiha Nasreen, Tonazzina Hossain Sauda, Zakia Jabin Loskor, Md Moshiur Rahman and Asifur Rahman.
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnosis with a wide variety of eti-ologies that is commonly underdiagnosed and missed due to the complete reversibility of its course. The pathophysiology lies in the raised blood pressure that disrupts the internal autoregulation within brain. Ours is a patient who presented as such, is a diagnosed case of B-thalassemia major. One previous author reported of PRES in gravid women with abnormal blood picture which being a rarity interested us in reporting this case [1]. Diagnosis now is more MR based but treatment yet remains elusive and mostly symptomatic.
55 Trigeminal Nerve Atrophy due to Vertebrobasilar Dolichoectasia: A Rare Entity. , Ahmad Al Ali, Ihsan F Shanti, Zaynab I Shanti, Bilal F Shanti and Hani Al-Ali.
The term dolichoectasia implies abnormal dilatation and elongation of an artery or vein. In the brain, this condition most com-monly affects the vertebrobasilar system. The exact etiologic mechanism of the disease is unknown. However, many theories are sug-gested such as hypertension, atherosclerosis, and congenital factors (Marfan’s disease, Ehlers Danlos disease, autosomal recessive polycystic kidney disease, Fabry disease and sickle cell anemia).
56 Brain Organoids and the New Context of Bioethical Redefinition. , Antonio Bartolomeu Jácomo Ferreira
The development of the use of organoids, as well as adult stem cells, is the expression that the origin of the relationship between science ethics is complementarity.The ethical challenge of organoids lies in the fact that their cells in their development differ and form structures related to those seen in embryonic tissues.One of the challenges that bioethics faces in the area of organoids is the fact that today we are able to use cells in ways that we might not have imagined until a few years ago.The consequences of using this technique in the animal model is the need to change the degree of ethical commitment in using the animal model. The enhancement of animal faculties.
57 Patient Management Strategy and Resilience in COVID-19 Era. , Mohammad Noor A Alam, Ruma Parvin, Jalal Mohsin Uddin, AQM Omar Sharif, Umme Kulsum Sharmin Zaman, Md Moshiur Rahman and Mohammad Shahidullah.
The COVID-19 worldwide pandemic has profoundly affected our everyday lifestyle, yet in addition to human services conveyance and wellbeing frameworks around the world. Each pandemic begins suddenly, unusually and it surpasses the limit of medical frameworks [1]. Throughout this current year, wellbeing frameworks reacted to the pandemic danger with a lifestyle of general wellbeing estimates intended to both treat and sort the disease, yet additionally to forestall contaminations and critically, to set up the wellbeing framework itself for a surge of contaminated patients. One of the most well-known components to build a wellbeing framework and medical clinic limit has been the wiping out or postponement of planned and elective medical procedures.
58 Surgical Management of Metastatic Spinal Lesions in National Cancer Center of Belarus. , Ivan Papkou and Siarhei Zaretski.
According to different publications, nearly 96% of all spinal neoplasms are metastatic tumors. It is observed that majority (nearly 80%) of patients with disseminated malignant tumors develop spinal metastases.
59 10,000-Fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Motor Neuron Disease Via Intrathecal Superfusion. , Vinod Kumar Tewari, Neeraj, Devesh Johari and Lori Tewari.
Motor Neuron Disease (MND) or Amyotrophic lateral sclerosis (ALS) is a slow fatal neurodegenerative disease characterized by selective and gradual motor neuronal death with unknown aetiology. The insufficient clearance of glutamate through the glutamate transporter and the specific distribution of Ca2+-permeable AMPA receptors in spinal motor neurons, indicates that glutamate-in-duced neurotoxicity is involved in its pathogenesis. NO is generated by nitric oxide synthase (NOS) which acts via 10000-fold effect to reverse the neuronal death. NO is destructive within 5 to 7 days as noted in earlier study by various authors. We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in MND.
60 The Tipping Point: How Little Things Can Make a Big Difference , Chaturvedi Surbhi, Kalia Anchin, Capoor Shekhar and Tank ML.
Stroke is a common neurological complication of cardiac arrhythmias and is associated with increased morbidity and mortality unless diagnosed and treated. Sometimes it becomes difficult to discover cardiac arrhythmias in absence of ECG and 2-D echo findings. Here, we are reporting a similar unique case of recurrent stroke who initially was labelled as a case of cryptogenic stroke later found out to have cardioembolic stroke.
61 Deregulated Homocysteine Metabolism in Friedreich’s Ataxia Patients: A Risk Factor? , Deepti Pathak, Achal K Srivastava, Sheffali Gulati and Moganty R Rajeswari.
Friedreich’s ataxia (FRDA) is a progressive neurodegenerative disorder primarily caused by sub-optimal levels of mitochondrial protein, frataxin, and is characterized by hypersensitivity to oxidative stress. Homocysteine (Hcy) is well acknowledged to mediate oxidative stress-induced toxicity and mitochondrial dysfunction in pathogenesis of several cardiovascular and neurological diseases.Here, we tried to explore the correlation between plasma Hcy levels with various biochemical, genetic and clinical parameters in FRDA. Assessment of Hcy levels in blood plasma of FRDA patients (N = 25) and healthy controls (N = 25) showed that mean levels of Hcy were significantly elevated (9.78 ± 2.7 μmol/l) in FRDA as compared to those of controls (7.0 ± 2.05 μmol/l). The clinical severity of FRDA, as reflected by the (GAA) expansion number in DNA (extent of genetic error), the decreased levels of frataxin protein (pri-mary pathogenic marker), longer disease duration and the high score of Friedreich’s Ataxia Rating Scale (measure of neuromuscular activity) revealed positive correlation with plasma Hcy levels in FRDA patients.
62 An Overview of Conversion Disorder: Prevalence, Causes, and Treatment , Dhruv Beri  and K Jayasankara Reddy.
This paper reviews an overall picture of conversion disorder to develop a clear and systematic understanding of its etiology, causes, and treatment.
63 The Role of Cytokins in Some Viral Infectious Diseases , Shimon Shatzmiller, Galina Zats, Inbal Lapidot and Rami Krieger
Cytokines are small glycoproteins produced by several cell types, mainly leukocytes, which regulate immunity, inflamma-tion and hematopoiesis. They control several physiological and pathological roles, including innate immunity, acquired protec-tion, and an abundance of inflammatory responses. The research of cytokines starts in the 1950s. However, the exact identification of the structure and its function took many years to explore. The original findings were those of IL-I, IFN, and neurodevelopment factors (NGFs); However, these cytokines were purified and trans-ferred in their name years later.
64 Role of Artificial Intelligence in Management of Covid19 Patients: An Editorial Note , Piush Choudhry
Artificial intelligence has now become an integral part of our healthcare infrastructure such as precision medicine in cancer diagnosis, radiological analysis, digital pathology reporting, surgi-cal robots to name a few besides finding brain activity in clinically unresponsive patients. Neural networks are now trained to detect changes in chest x-rays that can predict mortality upto twelve years in advance using parameters such as aortic calcification and heart size. Covid19 is a global pandemic and a life threatening condition that would largely benefit by a software that can cope with unpredictable mutations in viruses which are often beyond routine human observation.
65 COVID-19 in Real Time in a Population of Alamar , Clara Perez Cardenas
Introduction: COVID 19 is a pandemic that currently affects 183 countries. So far it has caused threats to people’s physical health and lives. Has triggered a variety of psychological problems and the field of assistance and research for psychology professionals.Objectives: To specify population information on COVID 19, sources of information used and their evaluation; identify emotional reactions as a result of living in real time this pandemic and point out behaviors assumed food achieve the time of oscillation in the house.Materials and Methods:Qualitative research, developed inthehealth area of the Teaching Polyclinic Dr. Mario Escalona Reguera, in Alamar, Municipality Habana del Este,during the month of April 2020.The interview (telephone) is usedas an information collectiontool, doing content analysis of the responses.
66 A Clinicopathological Correlation of Pineal Region Tumours , Prabal Deb and Gurpreet Kaur
A variety of lesions involve the pineal region these include both neoplastic processes and congenital lesions. Tumors of the pineal region are classified into those arising from the pineal parenchyma, germ cell neoplasms, metastasis, and lesions arising from adja-cent structures. They make up less than 1% of intracranial tumors in adults and are commoner in children.Knowledge of the variety of lesions that occur in the pineal region, their imaging appearances, and their clinical features assists in narrowing the differential diagnosis and optimizing patient treatment of these rare tumors. Pineal gland lesions as it is are rare, with only a few cytologic de-scriptions occurring in the literature. We hereby present 04 cases of pineal region tumours with a radiology cytology and histopatho-logical correlation.
67 Role of 10000-Fold Effect in Improving Urodynamic Parameters with Supra Spinal Cord Injury , Vinod Kumar Tewari, Devesh Johari, Lori Tewari and Neeraj
Background: Spinal cord injury (SCI), whether complete or incomplete of supra-above D6 (SSCI as the autonomic supply of spinal cord is usually controlled and is situated here at D6 level) usually also presents with urinary problems of UMN type. Nitric oxide by virtue of its 10000-fold effect at synapse and neuromuscular junction has been shown excellent results in ASIA grading and also its predictability of improvements has been well demonstrated with the use of ALTENS (Acupressure Like Transcutaneous Epidermal Stimulation). Objectives: To access the urodynamic urinary bladder parameter improvements via 10000-fold effect by Intrathecal Sodium Nitro-prusside (ITSNP) superfusion, on patients with supra spinal cord injury cases.
68 Does Estrogen Therapy Prevent Late Onset Alzheimer's Disease? , Thekkuttuparambil Ananthanarayanan Ajith
Neurodegenerative diseases such as Alzheimer’s disease, Par-kinson’s disease, Amyotrophic lateral sclerosis and Huntington’s disease remain a major challenge to human. Among the neuro-degenerative diseases, Alzheimer's disease (AD) and Parkinson’s disease are two major forms. According to the recent survey in US, more than 5.5 million (age 65 or older) people have dementia caused by Alzheimer’s and remain the 5th leading cause of death among the elders. World Health Organization (WHO) expected ~ 16.2% prevalence of AD among people over 65 years worldwide by 2050. The median survival of AD patients who diagnosed at age 65 years is estimated to be 9 years.
69 Possible Applications of Noisy Synthetic Systems in Covid-19 , Sisir Roy and Sarangam Majumdar
Noise is usually thought as an unwanted signal in the study of science and technology. The introduction of stochastic resonance in nonlinear dynamical systems change our view of the role of noise (in living systems) from the destructive nature to constructive one. We highlight some recent time observations on the role of noise in synthetic systems. Finally, we address the possible application of synthetic systems in a Covid-19 situation along with the role of noise in the systems.
70 Executive Functions and Cannabis Use in Adolescents , Frolli A, Ricci M C, Cavallaro A, Lombardi A, Bosco A, Operto FF and Franzese L
Adolescence is a development stage characterized by multiple neuro-cognitive and psychosocial changes and therefore consid-ered a critical phase of human development. At this stage, is when young adults start consuming substances, consequently the ad-diction process begins. Several studies show that chronic cannabis abuse can cause neurofunctional and neuro-cognitive changes. Particularly it would negatively impact on divided attention, short-term verbal memory and working memory performance. In this study we investigate how abuse of cannabis can affect global cognitive functioning, also through the evaluation of executive functions. Sample population that took part in this study was grouped by the frequency of use of cannabinoid substances (chronic, occasional, and absent consumption). Statistical analysis showed a significant decrease in performance in working memory tasks by subjects who used chronic cannabis (group 1) compared to subjects who did not use it at all (group 3). Future studies could verify the extent of the neuro cognitive alterations through re-evaluations with controlled follow-ups.
71 Knowledge, Attitude, and Practices Towards Covid-19 in Nepal: A Cross-sectional Study , Pooja Prakash, Ayush Chandra, Nabina Shanrma and Avinash Chandra.
Background:The recently surfaced infectious disease SARS-CoV-2 caused by novel corona virus was first reported in Wuhan, China in December 2019. Despite the entire endeavor, it has rapidly infected nearly 200 countries and millions of deaths while many more is counting.In Nepal, the first case had appeared in late January 2020. Till now the lack of knowledge and lack of safe practices are main reason of the spread the pandemic world-wide. Our study aims to assess the Nepalese’s knowledge, attitude regarding COVID-19 and its preventive practices. Methods:A cross-sectional survey was conducted from March 28th to April 8th, 2020. A total of 114 Nepalese residents were selected using convenience sampling method. An anonymous, self-administered questionnaires (SAQ) containing 16 knowledge questions and 3-point Likert scale to acknowledge attitude and practices regarding COVID-19 was used for data collection. Chi-square test as Bivariate analysis and Linear regression models as multivariate analysis were used to assess association between KAP
72 Nutritional Epigenetic Support for Fighting Viral and Toxin Exposure , Jennifer Gantzer
Extrinsic epigenetic influences alter the physiological function and body habitus response to transient as well as long-term expo-sures and more importantly, the outcome of the response. We must prepare nutritionally and epigenetically to sustain and support optimal function which then allows the body’s intrinsic mechanisms to do their job, including fighting foreign invaders (i.e. bacte-ria, virus, parasite, fungus) and eliminating toxins (i.e. chemicals, pollutants, xenobiotic medications and OTC drugs, heavy metals, volatile gases) each requiring bioavailable essential nutrients that power and support enzymatic reactions that are the physiological machinery behind these immune and toxic battles.
73 Young People in the Face of Remote Schooling Imposed by the Pandemic , Eva María Esparza Meza
A fundamental task of young people is to achieve sufficient au-tonomy and maturity to actively insert the social community; for this purpose, the school represents a device of both learning and socialization, which allows the young person to gradually detach himself from family dependence and form a new system of ideas about the world. Data from recent research [1-3] report that both education and socialization have been adversely affected by the pandemic, since due to the globally recommended confinement to prevent the spread of the COVID-19 virus, students moved away from classrooms untimely to continue their education at home through classes taught online.
74 The Protective Role of Self-Efficacy for Resilience in the COVID-19 Period , Andrea Kovesdi, Krisztina Toro, Éva Hadhazi, Szabolcs Takacs, Sandor Rozsa, Gabor Csikos and Rita F Foldi
The aim of our research group is to examine the protection of mental health during a pandemic. In our April 2020 study, we ana-lyzed the association between stress, health anxiety and self-efficacy in terms of resilience. The study included 684 persons, arranged by parents and their children. Women are overrepresented in the sample. Based on the results, we can say that parental health anxi-ety and perceived stress reduce resilience. And self-efficacy is a protective factor for both parental and child resilience
75 A New Definition of Body Schema with Respect to Body-Centered Vs External Frames of Reference , Rodrigues MRM PT MSc
Moving is a way of experiencing the world and the way we move, as well as the way we perceive the environment around us, is rel-evant to this experience. The world we live in, however, is more than an ensemble of coordinates and the body is more than a passive machine ruled by laws of mechanics. A pragmatic view arised in 1920, when Held implied that body schema plays an important role in the control of action, involving aspects of both central and peripheral nervous systems. This is typically a non-conscious process and is used primarily for spatial organization of action.
76 A Brief Review between the Relationship of Chronic Pain with Brain , Abhishek Jha and Suvercha Arya
Pain comprises a multidimensional encounter that incorporates intellectual, full of feeling and tangible qualities in light of noxious stimuli. Numerous frameworks for ordering pain exist. These incorporate multidimensional arrangement frameworks, for example, the International Association for the Study of Pain (IASP) Classification of Chronic Pain, and frameworks dependent on a solitary ele-ment of the pain insight. Of the last frameworks, those dependent on basic pathophysiology and agony term (i.e. intense versus ongo-ing pain) are most ordinarily utilized and structure the premise of this review. Constant agony is a condition where pain advances from an intense to persistent state and continues past the healing process. Ongoing agony disables capacity and diminishes patients’ personal satisfaction. Lately, endeavors have been made to extend our comprehension of persistent agony and to grow better thera-pies to ease constant torment. In this survey, we sum up the aftereffects of past investigations, zeroing in on the systems hidden ongo-ing torment improvement and the distinguishing proof of neural areas related to chronic pain.
77 Burnout among Doctors during the COVID-19 Pandemic , Suprakash Chaudhury, Pushpa V and Daniel Saldanha
There are situations when a doctor is overwhelmed by the sheer number of patients he has to deal with viz. following natu-ral or man-made disasters, accidents or war. Fortunately, most of these occur at one time or over a short period. Though wars may last longer, their intensity and the consequent casualties usually wax and wane. Pandemics however are different; there is a spate of patients who are critically ill and this continues for months on end without let up. Doing duties under severe stress for prolonged periods is going to take its toll on the mental health of doctors, Manifesting with depletion of affective reserves, a sense of unreal-ity along with a negative evaluation of one’s expertise as a spe-cialist. This abnormal mental state was described as “Burnout” by Freudenberger and subsequently by Maslach [1,2]. In addition, during the COVID-19 pandemic, doctors are finding themselves in combat with a new virus about which very little is known and the management of the disorder is being learnt on the job. Almost ev-ery day contradictory evaluations of various treatment regimens are published, which adds to the stress.
78 Impact of COVID-19 Pandemic on Academia , Uriel Halbreich
The COVID-19 Pandemic has been impacting all aspects of life. Scientific publications related to the Pandemic flooded the profes-sional literature. They reflect current focus of public interest as well as academic endeavors and funding. It is of interest when the acute short-term academic interest would give way to long-term pursuits.
79 Realigning Minds and Mental Health Resilience during Covid-19 , Pinky Kain
The ongoing pandemic Covid-19 is impacting lives of millions of people daily by mental health conditions. The current unprec-edented situation demands to highlight mental issues more often and find solutions to deal with stress, anger, setting boundaries in and out of the workplace. A mandatory exhaustive list should pro-vide solutions of how and where one can get mental health coun-seling probably through free E- mental health counselling, health insurances or personal at home and workplaces. A commitment towards building our understanding of mental illness, increasing access to treatment and ensuring support to those who are strug-gling to know they are not alone is required
80 10,000-Fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Essential Tremor Via Intrathecal Superfusion , Vinod Kumar Tewari, Devesh Johari, Lori Tewari, Neeraj, Rajeev Gupta and SD Mishra
Essential tremor (ET) is involuntary tremors at upper part of body specially. The pathological neural circuits of GABAergic neuron of cerebellar dentate nucleus, brain stem (locus ceruleans and inferior olives) and thalamus is involved causes tremulous activity within the cerebellothalamocortical circuits. Nitric oxide donors, like Sodium nitroprusside, modulates the antegrade neurotransmis-sion via retrograde neuroregulation by 10000-fold effect. The GABAergic neurons are in turn controlled by the very sensitive 10,000-fold effect circuits via Nitric Oxide. We have utilised intrathecal sodium nitroprusside superfusion (ITSNP) to induce 10000-fold effect after 2 years of failed routine conservative treatment by oral drugs like gabapentin, topiramate, trihexiphenedyl, or other drugs recommended in one ET cases. We have utilised various clinical parameters like spiral drawing (T-CALM TEST) and video recordings of routine daily activities in pre ITSNP and post ITSNP phase
81 The Effect on Histo-morphology of Lungs in Fluconazole and Vitamin E Treated Sprague Dawley Albino Rats with Septic Shock , Nasir Mustafa, Hina Zahoor and Kanza Shamim
Fluconazole is a subclass of triazole antifungal agents, is available as oral tablets, powder or for oral suspension, and as a sterile solution for intravenous administration. Fluconazole is designated chemically as 2,4-difluoro-α,α1-bis benzyl alcohol in the form of white crystalline solid which is slightly soluble in water and saline. Fluconazole oral suspension contains 350 mg or 1400 mg contains sucrose, citric acid anhydrous, sodium benzoate, sodium citrate, colloidal, silicon dioxide, titanium dioxide, xanthan gum, and natural orange flavor. After reconstitution with 24 ml of distilled water or purified water each ml of reconstituted suspension contains 10 mg or 40 mg of fluconazole. Animals are divided into 4 groups. The rats of group A were taken as control group. In group B rats are kept nil per orally at 12 hours prior to induction of septic shock produce by Candida albicans s. Group C animals are administrated with fluconazole at doses of 3mg/kg, 10mg/kg and 30mg/kg after the septic shock produce by Candida albicans s. Since fluconazole at a higher dose had clearly shown to decrease tissue injury. We decided to keep fluconazole dose as constant and vitamin E would be administered in dose of 10mg/100gm of body weight in group D
82 Preventing and Possibly Reversing Dementia and Alzheimer’s Using Thermotherapy and Vibroacoustic Therapy in 12 Subjects Over 3 Months , George Grant and Jay Vanden Heuvel
The Objective of this study is to find the possibility of the use of both Thermotherapy [Hyperthermia][Heat Therapy] and Vibro-acoustic therapy [Vibration + Sound] to prevent and possibly reverse chronic neurological conditions like Dementia and Alzheimer’s Disease in 12 subjects over 3 months using Pre/Post Biofeedback Testing, Oximeter, Wellness IQ Questionnaire [www.academyof-wellness.com] and CBC blood test results including HBA1C. Overall Results were positive suggesting possible prevention and reversal of Dementia and Alzheimer’s using Thermotherapy and Vibroacoustic Therapy.
83 COVID-19 on Mental Health Crisis in Developing Countries. An Overview , Solomon I Damilare and Sivakumar J T Gowder.
Mental Health has been considered as an important dimen-sion of human health since the origin of Homo sapiens. Other di-mensions such as physical, social and economic factors have also an influence on human health [1]. Mental health refers to fluid contributions of culture, religion, and socio-economic concerns; a psychological conceptualization will still recognize some basic ingredients of mental health such as presence of mental fitness, availability (both real and perceived) of certain qualities, com-petencies, resources, that are potentially available to mobilize as their need arises “and not merely the absence of abnormal behav-ior”. According to Henderson [2], mental health signifies the ope-randi of an individual to pursue reasonable, purposeful goals; use his capacities and talents fruitfully.
84 Novel Brain Linear Measurements to Differentiate between Alzheimer Disease and Normal Pressure Hydrocephalus , Marcos Escosa Bage, Saleh S Baeesa, Mohammed Binmahfoodh and Youssef Al-Said.
Background:An Evans’ index (EI) greater than 0.3 has been associated with a diagnosis of idiopathic normal pressure hydrocepha-lus (iNPH). However, ventricular enlargement is also present in Alzheimer’s disease (AD) in the elderly. To assess the differences between ventricular enlargement in AD and iNPH, we developed a geometric model that incorporated different linear brain measure-ments and compared it with EI.Materials and Methods: Different ventricular linear measurements were obtained from 124 brain CT scans of normal participants, AD and iNPH patients. We developed a geometric model that yielded a linear measurement proportional to the skull shape.The maximum frontal horn distance was divided by this new tool and compared with EI to identify a cutoff point that can allow radiological differentiation between AD and iNPH
85 10,000-fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Parkinsonism Via Intrathecal Superfusion , Vinod Kumar Tewari, Neeraj Seth, Devesh Johari and Lori Tewari
Parkinsonism is a slow but nonfatal neurodegenerative disease characterized by hypokinesia, rigidity, postural instability and tremors, due to low quantity or deficient in dopamine neurotransmitter at Substantia Nigra, parkinsonism develops in, may be be-cause of toxins, head injury or infections or drugs. Dopamine release is also regulated by NO (Nitric Oxide) which is generated by nitric oxide synthase (NOS) and NO acts via 10000-fold effect to reverse the neuronal parkinsonism clinical features. We have used intracarotid and intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in Parkinsonism as a pilot study. The postural instability vanishes completely in 24 hours, loss of tremors was in just 48 hours, loss of rigidity around 5 days and hypokinesia improvement (to 75%) more than 30 days.
86 COVID-19 and Neurology. A Viewpoint , Gabriel Abudinén Adauy
During this last time we have had to learn and investigate this new strain of coronavirus, which not only affects the respiratory tract, but also produces a systemic affection of different organs through diffuse endothellopathy and a severe systemic inflammatory response. In relation to the affection of the central nervous system, there is a direct relationship or neurotropism, through the recep-tors of the type 2 angiotensin converting enzyme (ACE2). This review tries to explain the neurological relationship and SARS-COV 2
87 Publication Pattern of Clinical Parkinson’s Disease Research in Saudi Arabia , Naïf Alotibe, Eman Nasim, Talal Harbi, Raunaq Saba Ali, Muhammad Al Firdausi, Shafiq Ahmad and Shahid Bashir.
Objective: To assess the progress in the field clinical Parkinson’s disease (PD) in kingdom of Saudi Arabia (KSA), by analyzing in depth the research output productivity and publication pattern, and to identify the current situation of PD research and offer solutions.Method:Literature search strategy was designed to retrieve accessible articles that are related to PD utilizing PubMed, Google Schol-ar, and Embase. The retrieved articles were analyzed with several parameters including “journal name, impact factor, year of publica-tion, the affiliation of the first author, city, study design, population, citation numbers, study title and database”.
88 Glioblastoma Surgery: Technology for Gross Total Resection. A Review , Marcos Escosa Bagé
Current technologies used for glioblastoma resection seems to improve accuracy in achieving gross total resection but overall sur-vival has been similar in the last decades with only minimal improvement. Non-enhancing areas on contrast enhanced T1-weighted MRI images has the highest density of viable malignant cells and MRI sequences are not tumor specific, making complete resection of the tumor and obtaining better survival very difficult despite the current combination of treatments. In this article we review the latest technological advances that attempt to improve tumor resection to prolong survival time
89 Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial , Dimitriou Tatiana-Danai, Papatriantafyllou John, Konsta Anastasia, Kazis Dimitrios, Athanasiadis Loukas, Ioannidis Panagiotis, Koutsouraki Efrosini, Tegos Thomas and Tsolaki Magda
Background: Apathy is associated with greater caregiver burden and affects the cognitive abilities of the patient. Having a high prevalence of more than 71% in patients with dementia (PwD), it is a very common symptom in Alzheimer’s Disease (AD). In many cases it remains under-diagnosed or is misdiagnosed with depression. Methods:This study is a cross-over randomized controlled trial with 60 participants conducted in Greece. The participants were randomly assigned in 6 different groups of 10 participants each. The interventions that were evaluated are: a) Body Exercise (BE), b) Reminiscence therapy (RT) and c) Music therapy (MT). The interventions lasted for 5 days and there was two days off, as a wash-out period. There was no drop-out rate. The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaires.
90 A Seven Year Retrospective Review of Spinal Cord Injury Managed at a Physiotherapy Clinic in a South-western Tertiary Hospital in Nigeria , Olukoju Idowu, Opeyemi Oluwasanmi Adeloye, Olaniran Moses Ogunleye, Olubukola Arewa, Oyeneyin David Babatunde and Adegbembo Olusaanu
Introduction:The role of physiotherapy in the management and rehabilitation of spinal cord injury (SCI) patient is well documented. SCI is an enormous devastating condition which affect most commonly young and productive age group of predominantly male popu-lation with motor vehicle accidents accounting for the highest incidence.Method: This is a retrospective review of cases of spinal cord injured patient as seen in the Department of Physiotherapy University College Hospital Ibadan, Nigeria, over the 7 year period, January 1, 2006 to December 31, 2012. The case note accessed account for both out patients and in-patient seen at the hospital for the period under review. Information regarding Age, Gender, Marital Status, Occupation, Year of admission, Religion, Diagnosis/Frankel classifications, Neurological levels and Discharge pattern were retrieved using a spread sheet. Descriptive statistics of frequency, percentage, range, mean and standard deviation were used to summarize data.
91 Dental Health Issues in Persons with Epilepsy , Thania Elizabeth, Nandana J, Jithin George and Ashalatha Radhakrishnan
Epilepsy is a neurological disorder with significant disabilities. Persons with epilepsy (PWE) often need special care and atten-tion. A PWE can have multiple dental health issues in them. It can be due to poor oral hygiene, socioeconomic factors, neglect from the caregiver’s end, antiepileptic medications or due to the attitude by dentists towards them. Seizures by itself can lead on to bone fracture/tooth loss. Antiseizure medications can cause gingival hyperplasia, osteopenia, gum bleeding etc. While giving medications by dentists, undue care should be given to avoid prescribing drugs that lowers seizure threshold. Also in the dental care setting, education of dental hygiene is important. Also it is better to avoid removable dentures. While doing dental surgical procedures, the time duration should be made short as far as possible. Dentists should be made aware that they shouldn’t neglect the care they are supposed to give for PWE.
92 Cyberchondria in COVID19 Pandemic , Suprakash Chaudhury, Pooja V and Daniel Saldanha
As we are all aware of the impact of corona virus on not just the physical health, but mental as well, did we know in the latest news of published by Lancet Psychiatry journal about one in five Covid19 patients develop psychiatric illness in the first 90 days of turning positive? [1]. On comparing the previous large-scale epidemics, one issue of immediate relevance for mental health that is novel for the COVID-19 pandemic is a potentially increased problematic Internet use. The internet is too widespread and the lockdown has paved way for the access to the internet as an essential part of life.
93 The Role of Intracellular Bacteria in COVID-19 Pathogenesis , Abbas Alnaji
Much and a lot we heard about what Covid-19 had did in man/kind and his affairs over the last several months as an pandemic. Still a lot should be said in spite of the coordination of the globe efforts against the tiniest creature. A lot should be said not done! Why? Simply because as ones say our effeorts that basided on the current knowledge is as a humble wooden ship with torn sails thrown right and left by the angry sea waves on the earth of real-ity. For that, I will say my word as being invited by this respected journal in a time I kept standing a side after failed initial start up to present my work to overcome the need for ventilator machines shortage, this shortage both quantitative in numbers needed and qualitative when the lung destroyed and no more act as a vital ring in delivery of oxygen to the tissues.
94 Hemichorea as an Atypical Manifestation of Diabetes Mellitus , Bhavesh Trikamji
Non-ketotic hyperglycemic hemichorea (NHH), also known as chorea, hyperglycemia, basal ganglia syndrome or diabetic stria-topathy, is a rare neurological complication of non-ketotic hyperglycemia. We describe a case of 65 year old woman with previously undiagnosed diabetes who presented to the emergency room with continuous, involuntary, writhing movements on the left side of her body for one weeks duration. Exam revealed choreiform movements involving the left arm and leg. Laboratory testing revealed elevated blood glucose at 250 mg/dl and elevated HbA1C at 6.5%. MRI brain showed T1 hyper intensity in right basal ganglia without GRE correlate. Patient was diagnosed with non-ketotic hyperglycemic hemichorea and started on metformin. Follow-up MRI brain showed resolution of T1 hyper intensity with normalization of blood glucose.
95 Surgical Resection of Spinal Intradural Extramedullary Neoplasms: Policy According to the Lesion Location , Derya Burcu Hazer Rosberg, Selim Ayhan and Selçuk PalaoÄŸlu
Background: Intradural extramedullary (IDEM) tumors account for two thirds of all primary intraspinal neoplasms. They mostly include schwannomas, meningiomas and ependymomas which are located circumferentially anywhere by the spinal cord. Since the clinical symptoms and histology of these tumors are mostly benign in nature, the primary goal of the treatment should be gross total resection without any functional deterioration. Objective: In cases of intradural extramedullary tumors, surgery should be planned with respect to preservation of the stability and the anatomy of the spine without giving any harm to surrounding vital structures. Therefore, surgical policy should be planned thoroughly for the best outcome.
96 Role of 10000-fold Effect in Improving Leg Cramps in Myelopathic Spinal Cord Changes – A Case Study , Vinod Kumar Tewari, Neeraj Seth, Devesh Johari and Lori Tewari.
Leg muscle cramps in cervical myelopathic changes is inconsistent symptom and later on very disturbing to the patient specially in night time while taking rest. NO is generated by nitric oxide synthase (NOS) which acts via 10000-fold effect to reverse the neuronal damage.We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in muscle cramps in cervical myelopathy in a case.
97 Can Visual Complaints be Only Symptom in Slit Ventricle Syndrome? A Difficult Diagnosis to be Made , Sandeep Bhardwaj and Manish Chaurasiya
Background: Slit ventricle syndrome (SVS) is a rare symptomatic condition with radiological findings of small sized ventricles in a case of VP Shunt. Diagnosis may be difficult because radiological imaging of small ventricles can be misinterpreted as normal sized ventricles. SVS is a rare condition of reduced brain compliance with intermittent intracranial hypertension.Cases: Author reported two cases of ventriculoperitoneal (VP) shunted patients with only visual disturbances which on evaluation were found to be SVS
98 Ayushmaan Bharat: Boon for Medical Disorders and Bane for Mental Illness in India , Priya Ranjan Avinash and Rohit Gondwal
Ayushman Bharat a pan India health insurance scheme was launched in 2018. Since its inception, it has been lauded by all. How-ever it has a huge lacunae as far as Mental health care is concerned. The policy makers seem to have forgotten that a huge chunk of mental health care is provided by private health care facilities and ironically private healthcare machineries have been kept out of the purview of this scheme. mental healthcare burden is huge and often born exclusively by caregivers which lead to delayed and inadequate healthcare. We propose the inclusion of private healthcare in the Ayushman Bharat Scheme.
99 The Barking Girl: A Case Report , Malvik Pandey, Pradeep Yadav, Nitesh Kumar Singh and Mona Srivastava
Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience suggests that “habit cough” best describes this clinical entity and that various forms of suggestion therapy includ-ing hypnotic methods are the treatment of choice. Suggestion therapy is effective when it tells the patient that they have the capability to resist the urge to cough. Medicines are generally not successful in the absence of suggestion therapy. Relapses and remissions are common and continuation of the symptoms is also common.
100 Chemical Aspects of Emotive Memory , Gerard Marx and Chaim Gilon
“Chemistry is the only physical science which offers a pathway to understanding animate biology” Medawar [1] (1967).Chemistry has been used to clarify most aspects of biology including metabolism, structure and reproduction. However, current neuro-biological descriptions of animate life are incomplete, as they have not “grasped the nettle” of mentality. The outstanding issue: How do neural nets instigate experiential mental states, such as emotions and memory?Most chemical approaches to neural memory were skewed to pharmacology, which did not address how neurons and the neural net remember, but focused on physiologic effects of drugs.
101 External Shunt Complications in a Series of 100 Cases , Mohameth Faye, Mualaba Celebre, Yakhya Cissé, Alioune Badara Thiam, Momar Codé Ba and Seydou Boubacar Badiane
Introduction:The external ventricular shunt is an emergency procedure allowing the evacuation of cerebrospinal fluid to the out-side by placing a ventricular catheter connected to an external drainage bag. There are several factors which may be responsible for the occurrence of complications. The aim of our study was to collect all the external ventricular shunts performed in neurosurgery, to work on their different complications and to establish a comparison with the data in the literature.Materials andMethods:This was a descriptive study using a retrospective approach about a period of 8 years, from January 2010 to December 2018, on the files of patients who had received an EVS during their hospitalisation at the neurosurgery clinic of the Fann hospital in Dakar.
102 Cerebral-neurological Manifestations of the Acute Respiratory Distress Syndrome (ARDS) , Ahmed N Ghanem
Fluid therapy (FT) was introduced during WW2. Ever since its complications have been frequently reported but notably some se-rious complications have been overlooked. The role of VO in induc-ing VOS and causing ARDS has remained unrecognized until recent-ly, first by me and other authors are now catching up. The role of FT complications in inducing VOS and causing ARDS is hard to detect because VOS is a shock that complicates another existing shock being treated and it occurs seamlessly and un-noticed.
103 Cannabinoid Therapy for Glioblastoma Treatment: A Review , Marcos Escosa Bagé
In recent years, studies have brought to light preclinical evidence of the ability of cannabinoids to reduce tumor growth in animal models, and clinical trials have been designed to study this activity in patients with glioblastoma. The data in animal models show promising results. So far it has been seen that the administration of THC is safe, and can be carried out without psychoactive effects. These molecules act through receptors coupled to the G protein, which are part of the endocannabinoid system and which have been called CB1 and CB2. THC can attenuate tumor progression in some patients, and appears to have a positive effect on survival, similar to that generated by other chemotherapeutic agents. More trials are needed to validate this antitumor action, both in combination with other therapies, and independently. At this time there is not enough scientific evidence to be able to conclusively affirm that can-nabinoid treatment can contribute improve current therapies given to patients with brain tumors or other types of tumors.
104 Should We Embrace the Incorporation of Genetically Guided “Dopamine Homeostasis” in the Treatment of Reward Deficiency Syndrome (RSD) as a Frontline Therapeutic Modality? , Kenneth Blum, Ali Raza, Tiffany Schultz, Rehan Jalali, Richard Green, Raymond Brewer, Panyotis K Thanos, Thomas McLaughlin, David Baron, Abdalla Bowirrat, Igor Elman, B William Downs, Debasis Bagchi and Rajendra D Badgaiyan
In 2019, the US Center for Disease Control and Prevention provided vital statistics related to drug overdoses in the United State1. They concluded that in the USA the number of deaths at almost 72,000 was due to 66.6% of opioid overdoses. In fact, the rate is alarming and increasing yearly. To make 2021 even more scary is the daunting effect on increased drug usage due to COVID 19 as a pandemic, albeit the new vaccines. Specifically, in 2020, the death rate from opioid overdoses rose to 13% nationally and in some sates 30%. The common neuromodulating aspects of neurotransmission, and its disruption via chronic exposure of drugs and be-havioral addictions, requires further intense research focus on developing novel strategies to combat these unwanted genetic and epigenic infractions as accomplished with heroin addiction by our group.
105 Children ‘at Risk’ of Specific Learning Disorder: Individualized Diagnostic Profiles and Interventions , Victoria Zakopoulou, Maria Boukouvala, Nikos Tziakis, Panagiotis Vellis, Pavlos Christodoulides, George Dimakopoulos, Dimitrios Sarris, Maria Vergou, Pilios-Dimitris Stavrou, Vasiliki Koutsobina, Periklis Tagkas and Venetsanos Mavreas
Background:The development of individualized diagnostic profiles of children ‘at risk’ of Specific Learning Disorder (SLD) and the implementation of a well-suited to individual’s specific needs intervention program, could be of high significance for the early investigation of SLD. Materials and Methods: We assessed twenty children 5.4 to 6.0 years old aiming to the accomplishment of the following key-mile-stones: (a) implementation of an adequate cluster of diagnostic procedures, (b) formulation of individualized diagnostic profiles ‘at risk’ of SLD, and (c) implementation of intervention program, tailored to the individual’s profile. Results: According to the results, early extent of weaknesses was determined in the domains of working memory (p = .010), visuo-spatial abilities (p = .028), and phonological awareness (p < .001)
106 COVID 19: From the Perspectives of Children and Adolescents , Kamlesh Jha
COVID 19 has undoubtedly been one of the biggest health chal-lenges of present century for the whole mankind. Since almost an year whole world is desperately fighting the disease with all their available resources with limited success. Irrespective of the devel-opmental status of a country, class or religion, whole mankind suf-fered huge loss in terms of human life, money, jobs and businesses and academics
107 Neurodevelopmental Disorders: The Past, Present and the Future , Prajjita Bardoloi
Neurodevelopmental disorders are a group of complex multifactorial disorders with significant overlapping of symptoms that arise during the developmental period. This article looks into changing perspectives and evolving knowledge of these disorders as well as their future directions. These disorders can not only affect individuals but society as a whole. Accumulated knowledge of these disorders slowly began to change the perception of the disorders as well as how individuals experiencing these conditions are treated by society.
108 Brain Disorders at Admission, During and After SARS-CoV-2 Infection , Magda Tsolaki, Antonios Frontistis, Paschalis Devranis, Maria Zilakaki, Iordanis Saoulidis, Vasileios Siokas, Ioannis Papagiannis, Eleni Liouta, Evagelos Papatolis, Evripidis Pityrigkas, Vasiliki Poulidou, Evangelia Chartampila, Sofia Pettemeridou, Hadar Halivni, Cindy Cheng, Thomas Tegos
The potential involvement of SARS-CoV-2 in Central Nervous System (CNS) has attracted considerable attention because of the neurological and psychiatric manifestations presented throughout the disease process. There have been many reports of extra re-spiratory manifestations, such as neurological and psychiatric symptoms at the admission of the patients in the Hospitals, during and after SARS-CoV-2 infection. The seriousness of the virus in various parts of the body will determine what comes after the initial phase.
109 Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial , Dimitriou Tatiana-Danai, Papatriantafyllou John, Konsta Anastasia, Kazis Dimitrios, Athanasiadis Loukas, Ioannidis Panagiotis, Koutsouraki Efrosini, Tegos Thomas and Tsolaki Magda
Background: Apathy is associated with greater caregiver burden and affects the cognitive abilities of the patient. Having a high prevalence of more than 71% in patients with dementia (PwD), it is a very common symptom in Alzheimer’s Disease (AD). In many cases it remains under-diagnosed or is misdiagnosed with depression. Methods: This study is a cross-over randomized controlled trial with 60 participants conducted in Greece. The participants were randomly assigned in 6 different groups of 10 participants each. The interventions that were evaluated are: a) Body Exercise (BE), b) Reminiscence therapy (RT) and c) Music therapy (MT). The interventions lasted for 5 days and there was two days off, as a wash-out period. There was no drop-out rate. The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaires.
110 Sleep Disturbances and Association of Polymorphism rs2278749 Gene ARNTL in Male Population 25 - 44 Years in Russia/Siberia , Valery Gafarov, Elena Gromova, Dmitriy Panov, Igor Gagulin, Almira Gafarova and Eldar Krymov.
It was found that the most common genotype rs2278749 ARNTL gene was homozygous C/C genotype - 74,9%. Prevalence of C/T and T/T genotype was 22.3% and 2.8%, respectively. It was revealed that persons with the genotype C/T more likely to experience serious conflicts in the family, more experienced their frustration, they often have disturbing dreams, and they wake up tired and exhausted, in addition, they often met the high level of the life of exhaustion, and they soon became frustrated. Persons with genotype T/T often took the trouble “to heart” and were more punctual. On the other hand, persons with C/C genotype were more hostile, were inclined not to trust anyone, almost “never” accept negative situations “close to the heart” and much less experienced disturb-ing dreams
111 COVID 19 Vaccine Hesitancy , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha
COVID-19 is a contagious disease caused by the Severe Acute Respiratory Syndrome Corona Virus-2, a single-stranded RNA genome. After its initial occurrence in, in November, 2019, in Wuhan, China, it has resulted in a worldwide pandemic. In India since early 2020 over 1,05,42,000 have been infected and over 1,52,000 have succumbed to it. A year after the first recorded case in India, the immunisation exercise against the disease kicked off on 16th January, 2021, with two vaccines: Covishield and Covaxin. Serum Institute of India in Covidhield has grafted the COVID-19 antigen onto an adenovirus.
112 Diagnosis and Surgical Treatment of Epidural Varicose Veins of the Lumbar Spine , Kayode Agboola and Eugene Slynko
Introduction:Dilated lumbar epidural veins are vascular abnormalities causing compression, ischemic injury and excessive pres-sure on spinal nerve roots, theca sac or dorsal ganglia, giving rise to symptoms of lumbar radiculopathy of the involved neural struc-tures. Degenerative changes of the spine might also be observed. Importance:The importance of mentioned pathology is in the complexity of its diagnosis - missed diagnosis, relatively small number of observations, classification types, publications and estimates of the long-term outcomes of surgical treatment of this pathology on follow-ups. Misdiagnosis is often encountered due to low awareness even on MRI
113 Role of Non Invasive Ventilation in Neurology Clinical Practice , Arun R, J Nandana and Ashalatha Radhakrishnan
Non invasive ventilation (NIV) has become the standard practice for patients with neuromuscular respiratory failure. As me-chanical ventilator can increase the risk of developing pneumonia or may cause lung injury, non invasive ventilation may be a good alternative for the same in certain neurological disorders. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP). Long-term non-invasive ventilation was introduced in the 1980s, initially for patients with poliomyelitis, muscular dystrophy or chest wall deformities like scoliosis.
114 Different Disease-modifying Treatments do not Affect Quality of Life of Multiple Sclerosis Patients , Fawaz Al-Hussain
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that causes neuronal damage resulting in a variety of symptoms that include pain, fatigue, muscle weakness, impaired balance, and vision loss. In addition to these neurological symptoms patients also experience a decreased quality of life. Methods: In this study, a cross-sectional analysis was performed to compare the quality of life of MS patients on various treatments including β-interferon injections, fingolimod oral capsules, and natalizumab intravenous infusion. Quality of life was assessed using the patient-reported EQ-5D-5L assessment. A semi structured question guide was also used to include different research groups from various geographical areas to identify literature study about quality of life and reasons behind their preferences with regard to their treatment and care which was analyzed using content analysis and constructivist approach. Mobility, self-care, participation in usual activities, pain, discomfort, anxiety, and depression were evaluated as predictors of quality of life
115 Thoracic Intramedullary Sarcoidosis Masquerading as Thoracic Spondylotic Myelopathy: A Case Report and Review of the Literature , Saikiran G Murthy, Zheng Liu, Krupa Pandey and Adam C Lipson
We report a rare case of biopsy proven, thoracic intramedullary neurosarcoidosis in a 52- year-old male, who was thought to have progressive paraparesis as a result of degenerative spondylosis of the thoracic spine. Despite decompressive surgery, he would, over the course of 21 months, become irreversibly paraplegic and unresponsive to steroid treatment. To our knowledge, this is the only reported case of thoracic intramedullary neurosarcoidosis masked by severe thoracic stenosis and spondylotic changes.
116 COVID-19 Associated Neuroimaging Findings , Niharika Prasad
Neurological symptoms may be vague especially in the elderly with multiple comorbidities and in children. These include altered mental status, headache, anosmia, cerebellar ataxia, seizures, hemiparesis, and syncope. Encephalitis or a Guillain-Barré syn-drome like presentation may occur.
117 Super Refractory Status Epilepticus as the First Presentation of Cysticercal Encephalitis , Abhishek Juneja and Kuljeet Singh Anand
Neurocysticercosis (NCC) is the most common parasitic infection of nervous system. We report a case of 42 year old female patient with headache, multiple episodes of seizures and altered sensorium. Magnetic Resonance Imaging (MRI) of brain showed multiple cysticerci in different stages of development compatible with the diagnosis of Neurocysticercosis. Despite administration of multiple antiepileptic drugs and intravenous anaesthetic agent, patient continued to seize and later succumbed to super refractory status epilepticus. Super refractory status epilepticus (SRSE) is characterized by continuous or recurrent seizures without regaining con-sciousness, lasting for more than 24 hours despite administration of an intravenous (IV) anaesthetic.
118 The Causes of Sadness in the Elderly Resident in a Nursing Home from their Viewpoint. A Qualitative Study , Vahab Karamivand, Behnam Rashidi and Soroush Maazinezhad
Background and Aim:Mood swings such as sadness and depression are very common among the disabled elderly living in nursing homes. A systematic diagnosis of depression is very rare, and treatment is not always based on the best evidence. Distinguishing be-tween grief and non-pathological depression can be challenging, and we have little information about the elderly. The purpose of this qualitative study is to explain the causes of grief and grief from the respective of the elderly living in the nursing home.
119 Ozonetherapy as an Alternative to Pain Treatment in Temporomandibular Disorders , Jose Manuel Caldes Reyes and Maricel Galiano Del Castillo
Introduction:The temporomandibular disorders are very frequent; few studies exist that reflect the effectiveness of the ozone ap-plication intraarticular in the temporomandibular joint.Purpose: To evaluate the remission time of pain in the studied patients after the ozone therapy application. Material and Methods: An intervention study was realized in patients of the International Centre of Investigations of Ozone in La Havana, Cuba. Ozone (O3) was applied with the OZOMED Plus equipment. Ozone was applied intraarticular for ten sections 3 mg/L for a volume of 3 ml equivalent 0.03 mg in one bilateral section. Also combined with a rectal application at a dose of 30 to 40 mg / L for a volume of 200 ml per 20 continuous sections (daily).
120 The Role of Self-efficacy in Adapation Regarding Parental and Child Resilience - A Longitudinal Study on the Two Waves of Covid 19 , Andrea Kövesdi, Gábor Csikós, Krisztina TörÅ‘, Éva Hadházi, Szabolcs Takács, Sándor Rózsa and Rita F Földi
The COVID-19 epidemic also affects families in terms of material, work and relationships, and daily habits. The past 9 months are a lot of time during the extraordinary and stressful period, and its effects will be felt in the long run. Increased anxiety (e.g., double incidence in Canada, [15]) may change basic habits and long-term effects cannot be predicted. Presumably, individual- and family-level adaptation patterns, flexibility, or rigidity determine long-term changes. The study addresses the effects on family balance dur-ing COVID 19, such as perceived stress, health anxiety, and addresses psychological factors that support flexible adaptation during a pandemic period. For example, in the first wave, activity and movement showed a positive association with resilience [1,30] as an option for self-efficient behavior. Analysis of the first and second samples of our longitudinal study shows similar results where self-efficacy is a protective factor against the stress that occurs in a pandemic.
121 Correlation of Clinical Signs and Symptoms in Ventriculoperitoneal Shunt Dysfunction in Children- A Cross Sectional Study , Logavengatesh KV, Santosh Mohan Rao Kanangi, Radhika R, Janani S and Chidambaram B
Aim:To study the usefulness of clinical symptoms and signs in predicting ventriculoperitoneal shunt malfunction in children. Materials and Methods:The study was a cross sectional study of all patients with suspected ventriculoperitoneal shunt dysfunction who presented to the ER. The study was done in a single centre metropolitan tertiary care paediatric hospital over a period of one year. Data from 38 patients were obtained and was analysed using SPSS 14 and Microsoft Excel software. Results: VP shunt block occur more commonly in males and more frequently between the ages of 1-5years. Congenital aqueduc-tal stenosis was the most common aetiology amongst those undergoing shunt revision. Most shunt revisions occurred within 3-12months of the previous shunt surgery. Vomiting, altered sensorium and seizures were the most common presenting symptoms. Bulging AF, CSF leak from operated site and the sunset sign were definitive signs of shunt dysfunction. 74% of cases had an identifi-able ventricular catheter displacement on CT scan. The most common cause was tube block by ependyma and infection as a cause for block was rare.
122 Bourneville Disease (Tuberous Sclerosis), Case Report , Randrianjafisamindrakotroka Ony, Rakotoarisoa Rivo Tahiry Rabetafika, Tongavelona Adrianna, Raobela Léa and Randrianjafisamindrakotroka Nantenaina Soa
Introduction: Bourneville disease or tuberous sclerosis complex (TSC) is an autosomal dominant disease with variable penetrance. It is classically described in the literature as a triad of seizures, intellectual disability and adenoma sebaceum. Rare disease, it con-cerns 1/10000 live births. Retinal phages are present in almost 50% of patients. These are glial hamartomas characteristic of the affection.Case Report: We report the case of a 9 years-old boy referred to the Ophthalmology Department This patient was followed in Rheu-mato-Dermatology clinic for tuberous sclerosis for about 4 years and there was an evolving of his cutaneous lesions. Dermatologists wanted to find out whether there was ocular manifestations. The interview revealed no history of epilepsy, nor intellectual retarda-tion no similar case in the family neither. The patient had angiofibromas on his face, the rest of the somatic examination was nor-mal. On ophthalmic examination his visual acuity was 10/10 P2 for both eyes.
123 Effect of COVID-19 Pandemic on Relationships , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha.
Coronaviruses comprise a large family of viruses, many of which cause illnesses in humans and animals. The coronavirus responsible for the current pandemic SARS coronavirus 2 (SARS-CoV-2) started in Wuhan, China, and then spread worldwide.In a few weeks, more than a hundred thousand cases and deaths were confirmed globally and these numbers kept increasing exponentially. The WHO on March 11, 2020 declared the COVID-19 outbreak a global pandemic. Worldwide, nations tried to halt the pandemic by testing, tracing contacts, limiting travel, quarantining, cancelling large meetings and events, and most importantly, imposing lockdowns.
124 A Case Report on COVID-19 Causing Retrobulbar Neuritis: Neither the Doctor nor the Patient Saw , Ayush Chandra, Avinash Chandra and Basant Pant
Vision problems with sudden in onset points towards the neurological deficit because of underlying acute attacks like stroke, or de-myelinating disease. While these problems are common, the viral infection particularly, novel corona virus, SARS-CoV-2 infection in current situation, should also be kept in physician’s mind and dealt accordingly.
125 Adult Right-sided Hemiatrophy: Dyke-Davidoff-Masson Syndrome in a 30 Years-old Patient , Tijana Vujanić Stankov, Aleksandar Ješić, Vojislava Bugarski Ignjatović, Željka Nikolašević and Marija Semnic
Background: Cerebral hemiatrophy or Dyke-Davidoff-Masson Syndrome is caused by developmental hypoplasia or acquired at-rophy of one cerebral hemisphere and leads to diverse clinical entities. In most cases, diagnose is made upon childbirth or during childhood period. Case: We present a case of 30 years old woman who was admitted to our Clinic of Neurology with left-sided hemiparesis and a his-tory of epileptic seizures during her childhood as well as perinatal hypoxia and reanimation after childbirth. Her magnetic resonance imaging exam showed right cerebral hemiatrophy. Further on, we discuss etiology, radiological morpho-functional findings and cog-nitive impairment in the patient with DDMS.
126 Culturally-biased Scientific Reporting , Uriel Halbreich.
The COVID-19 Pandemic and its consequences illuminates the globalization of the crisis but also differences and discrepancies in reporting the data as well as in their interpretations. From the outset the magnitude of the problem and its spread were assessed according to political interests. Public-Health responses were also implemented according to politics and compliance has been linked to communities` and individuals` preconceived social biases. It is apparent that “the numbers do not speak for themselves”-they are filtered, amplified or suppressed, through the megaphones of their reporters. Truth is in the eyes of the beholder.
127 Phenotypic Variability and Anticipation in a Family of D178N-Familial Creutzfeldt-Jakob Disease , Alfred Stenwin Sunny, Albert Stezin, Bala Balaji V, Nataraja P and Naveen Thota
Familial Creutzfeldt-Jakob disease (fCJD) is caused by mutation in PRNP gene. The D178N variant of CJD is known to have phe-notypic variability and can often mimic other neurological disorders. In this article, we report a family with D178N variant of PRNP mutation with phenotypic variability and anticipation phenomenon.
128 Functional Connectivity as a Tool to Ascertain Language Localization in a Group of Children with Intractable Epilepsy , Byron Bernal, Magno R Guillen, Nolan Altman and Michael Duchowny
Introduction: We investigated the relationship between lateralization indices based on the of Brodmann areas (BA) connectivity and language fMRI paradigms in a group of children with intractable epilepsy. Methodology: Intra-hemispheric ROI-to-ROI connectivity was assessed in 36 epileptic children (24 females) mean age 15.3 years, utilizing resting-state fMRI. Left vs right asymmetries were investigated between (1) BA pairs (pair-wise connectivity: PWC); (2) BA modules (global BA module connectivity: GBA); and (3) cerebral hemispheres (global hemispheric connectivity: GHC). Connectivity strength was graded in T scores (Z normalized values). Lateralization Index (LI) scores based on T values were obtained in all three assessments. Only LI with 2 SD above the mean were considered as significant lateralized pairs. Additionally, simple algebraic differ-ence between left and right T values were obtained (TDIF).
129 COVID-19 Pandemic: Mental Health of Doctors in Bangladesh , Roufun Naher, Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar and Nurul Islam Hasib
Background: The COVID-19 pandemic has affected everyone’s life in all aspects. It presents an unprecedented challenge to public health. Doctors and other healthcare providers are battling the virus on the frontline. Objective: This study is to see the mental health conditions of doctors in Bangladesh during the COVID-19 pandemic as well as to identify the percentage of doctors who are at high mental health risk and thus, need clinical intervention. Method: We have assessed the mental health of 358 Dhaka-based doctors applying ‘General Health Questionnaire-12’ in an online survey.
130 Neural Memory and Mentation , Gerard Marx and Chaim Gilon
From time immemorial, philosophers and theologians struggled to describe how mental states emerge from the operations of the brain.Our own efforts have been focused on memory and emotive states. We define the words: “Mentation”, “sensation” or “feelings”, “emotions”, “memory” and “mind”. In particular, we distinguish between computer memory and neural memory, the former being “demotive”, the latter imbued with emotive qualities. Feelings are sensations linked to psychic states; Emotions are the recall of fee-lings.
131 A Structured Approach to Care for Persons with Multiple Sclerosis: Need of the Hour , Vasundharaa S Nair, Priya Treesa Thomas, Netravathi M and Bhuvaneshwari
Introduction: Multiple sclerosis (MS) is an auto-immune disease which involves an abnormal response of the body’s immune system directed against the central nervous system (CNS) - brain, spinal cord and optic nerves being involved. Suicide is defined as the act of killing yourself, most often as a result of chronic conditions. Objective: The study aims to gain insight into the presence of suicidal ideations among Persons with Multiple Sclerosis and the effect of the same on their Quality of Life. Methodology: To achieve the purpose of the study, the patients presenting to the Multiple Sclerosis clinic of Department of Neurol-ogy were assessed using the Multiple Sclerosis Quality of Life Scale (MS-QOL), Expanded Disability Status Scale (EDSS) and the Scale for Suicide Ideation (SSI). Based on the assessment individualized interventions were carried out focusing on their perception, pre-cautions and the necessary preventive strategies to be taken.
132 Correlation Between COVID-19 Pandemic, Emotion Intelligence and Depression , Mosad Zineldin, Anotine Farhat and Melita Sogomonjan
The Covid-19 pandemic is causing serious fear of falling sick, dying, helplessness and stigma. Such diseases have had a negative considerable influence on every aspect of society of any given nation. Although depression is a commonly occurring global mental health disease, research concerning tools and strategies for early detection, prevention and treatment has not yes focused on the pos-sible utilisation of measures of Emotional Intelligence (EI) as a potential predictive factor impacting depression. The present study investigated the correlation between the construct of EI and the depression during Covid-19 pandemic. A population sample of 141 outpatients (57% female) have completed self-report instruments assessing EI and depression.
133 Beyond Placebo , Maja Roje-Novak
Placebo reaction is a relief of symptoms based on using medi-cally inactive substances or procedures. It seems that a human brain has innate capability of restituting wellbeing according to motivation to regain health and preserve one’s life. Brain- mind responds to informational context around the placebo treatment rather than the substance itself. Rituals around healing procedures stimulates human mind and this stimulation activates cascade of neurochemical processes which involve opioids and dopamine. Ac-tivated prefrontal cortex elicits reactions in neurovegetative sys-tem and hormonal axis which are both connected to immunity and other bodily functions.
134 Encapsulation of Probiotics: Need of the Hour , Amandeep Singh, Rohit Bhatia, Raj Kumar Narang and Uttam Kumar Mandal
Over the past decades, the administration of probiotics has gained much attention. As per the definition of probiotics by WHO, these are living microorganisms used for the management of vari-ous diseases [1]. In the market various strains of probiotics are available. Depends on the properties of these probiotics stains they are used in the management of various diseases. Probiotic plays an imperative role in the prevention of ulcerative colitis. Probiotics guard the intestinal mucosal layer against the attack of microbes. Additionally, it also serves as immunoglobulins. Probiotics also having anti-oxidant and inflammatory properties. But it is evident that in the case of ulcerative colitis, the concentration of probiotics is reduced at the colonic site therefore probiotic formulations are given to the patients to manage the disease [2]. But the problems with the conventional probiotic formulation are their viability. The health benefits of probiotics are purely dependent on the viability and enough number of probiotics in the target intestine.
135 Elastosis Perforans Serpiginosa - A Rare Side Effect of D-Penicillamine Therapy , Kuljeet Singh Anand and Abhishek Juneja
Penicillamine can cause various cutaneous adverse effects. Elastosis Perforans Serpiginosa (EPS) is a rare complication of long-term penicillamine therapy. We report a case of 21 year old male patient, diagnosed as a case of Wilson’s disease 10 years back, and taking D-penicillamine for last 10 years. Now, presented with non-itchy skin lesions over the neck region and bilateral axillae. Skin biopsy showed the presence of abnormal elastic fibers surrounded by acanthotic epidermis compatible with the diagnosis of elasto-sis perforans serpiginosa (EPS). EPS is a rare complication of long-term penicillamine therapy causing transepidermal elimination of abnormal elastic fibers.
136 Levetiracetam Versus Sodium Valproate in Refractory Convulsive Status Epilepticus in Children: An Open Randomized Trial , Rajniti Prasad, Astha Panghal, Ankur Singh, OP Mishra and TB Singh
Purpose: Levetiracetam (LEV) is a safe and effective drug to control status epilepticus (SE) or refractory status epilepticus (RSE) in adults. However, there is discernible lack of evidence of its use in children and adolescents. There is dearth of randomized trials comparing its efficacy with sodium valproate (VPA) in children. We performed an open randomized study to determine efficacy of LEV as an alternative to VPA in treatment of RSE.Methods: We randomized 80 children aged 1 to 16 years with SE not responding to any two of the first line drugs in adequate doses, into two drug groups LEV (n = 40) and VPA (n = 40). Primary end point was cessation of seizure activity within 30 minutes. Response of the two drug groups were compared at 30 minutes, 24 hrs, discharge and one month follow up
137 Combating COVID-19: Testing and/or Vaccinating? , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha
Coronavirus SARS-CoV-2 emerged in a wet market in Wuhan, China, and within a few weeks the morbidity and mortality exhib-ited by it led to the declaration by WHO of a worldwide pandemic of COVID-19 on the 11th of March, 2020 [1]. Plans to halt the pan-demic were devised - based on the proportion of the population at risk that needed to be protected in order for transmission to end significantly and quickly enough. The strategies revolved around the Basic Reproductive Number, R0 being reduced to less than 1. At this value the spread of infection shrinks and gradually shrivels up [2]. The R0 for India was calculated to be 1.2561 [3]. The highest R0for any country was that of the Syrian Arab Republic at 2.7936 and the lowest was for Nigeria at 1.0011. The mean R0 was estimated to be 2.2
138 Changers of Neurons of Central Nervous System and Immune Organs After Initiation of Demyelination and Remyelination with Interferon Beta-1a , Nataliia O Melnyk
After initiation of experimental model of demyelination and remyelination, was investigate morphological changers of neurons and myelinated nerve fibers in organs of central nervous system (CNS) and organ of immune system - thymus.In its experimental work was use model of demyelination - EAE (experimental allergic encephalomyelitis) in rats, and was study changers of neurons in cortex of cerebrum, cerebellum and spinal cord on 21 days and 39 days after initiation EAE. Histological sec-tions of the brain and spinal cord was stain by toluidine blue and cresyl violet, we observed the percentage of neurons with unmodi-fied, moderate and severe structural changes. In organs of CNS we studied of demyelination process in nervous fibers. In investiga-tions of nervous fibers was use methods of electron microscopy and morphometry. On early period EAE we observed demyelination process of nervous fibers, after influence of Rebif®(interferon beta-1a) by 2 weeks, we observed of remyelination.
139 Familial Presentation of Moyamoya Disease in India , Siddharth Maheshwari, Monali Chaturvedi, Suman Kushwaha and Aldrin Anthony
Moyamoya disease is a chronic progressive arteriopathy involving the cerebral vessels and is one of the rare causes of young stroke. Etiology can be idiopathic as well secondary to some other primary disease. It does affect the members of the same family but the definite pattern of inheritance has not been found out yet. There are few studies in the literature about the familial presentation of idiopathic Moyamoya disease, most of them from East Asian countries, which is why there are no common opinions and guidelines regarding the follow up and management of asymptomatic family members of such patients. We present and discuss the case reports of two family members with Moyamoya disease from India to further emphasise upon the need of research and long term follow up studies.
140 Levetiracetam Induced Acute Psychosis in a Patient with Juvenile Myoclonic Epilepsy , Abhishek Juneja and Kuljeet Singh Anand
We report a case of a 22 year old female patient who presented with altered behaviour in the form of anxiety, irritability and agitation for two days. Patient was a diagnosed case of juvenile myoclonic epilepsy for past 10 years on valproate therapy. Patient had been switched to Levetiracetam (1500 mg daily) two weeks back in view of valproate induced side effects. Formal psychiatric evaluation suggested acute psychosis possibly Levetiracetam induced. Levetiracetam was stopped and replaced with lamotrigine. Patient dramatically improved over next two days and became asymptomatic.
141 Spinal Modulation by Dexamethasone Sodium Phosphate, Cyclophosphamide and Miconazole Iontophoresis in asymptomatic SARS-COV2 patient with Extensive Myelitis , Wassim Mushtaq
A very rare neurological complication of SARS-CoV-2 infection includes transverse myelitis. I assume a post-infectious etiology in terms of secondary immunogenic overreaction. Iontophoresis is the process of the permeation of ionic (charged) drugs into the body under the influence of electrical current. Besides increasing therapeutic efficiency by, by passing first pass metabolism there are less risks of systemic absorption and undesirable side effects. The study was conducted in a SARS-CoV-2 patient with transverse myelitis, by transdermal application of dexamethasone sodium phosphate, cyclophosphamide and miconazole by iontophoresis at corresponding vertebral levels to look for the neurological outcome who had been unresponsive to intravenous methylprednisolone. With Dexamethasone sodium phosphate and cyclophosphamide iontophoresis there was modulation of the activity of posterior grey column, fasiculus gracilis and corticospinal tracts, and with miconazole iontophoresis I was able to ameliorate the dyesthesias, fasiculations and muscle atrophy probably due to neuromodulation at substantia gelatinosa and lamina IX and remyelination effect. There were no systemic or localized side effects and no adverse effects occurred during the treatment period.
142 Low Blood Pressure and Haquapathy (Haqua Revitalize Therapy-HART) , Faris AlHajri-PhD(AM)
Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body do not get enough blood. Normal blood pressure is mostly between 90/60 mmHg and 120/80 mmHg.Certain medicines and substances can lead to low blood pres-sure, including: alcohol, anti-anxiety, medicines, certain antide-pressants, diuretics, heart medicines, including those used to treat high blood pressure and coronary heart disease, medicines used for surgery, painkillers. Other causes of low blood pressure include: nerve damage from diabetes, changes in heart rhythm (ar-rhythmias), not drinking enough fluids (dehydration), and heart failure
143 A Rare Presentation of Liver Cirrhosis , Abhishek Juneja and Kuljeet Singh Anand
A 56 year old male patient presented with slowness of activities, gait disturbance and altered behaviour for four weeks. Patient had been diagnosed as a case of alcoholic liver disease for two years. Neurologically, he had rigidity, severe bradykinesia with short stepping gait while walking. Following investigations, patient was diagnosed as a case of alcoholic liver disease with hepatic encepha-lopathy. He was treated with appropriate diet, laxatives and low dose levodopa therapy. He improved over the next few days as his blood ammonia levels also fell. Parkinsonism is a rare presentation of liver cirrhosis with hepatic encephalopathy.
144 Experience of Holding Epilepsy Detection and Management Multidisciplinary Camp Organized in Alibaug, Maharashtra during the COVID 19 Pandemic: A Joint Project by Epilepsy Foundation and National Health Mission, Government of Maharashtra , Nirmal Surya, Hitav Someshwar, BN Sawant, Santosh Kondekar, Saurabh Kamath, Mehul Desai, Arti Sharma, Janvi Someshwar and Pooja Nagpure
There are approximately 13 million people suffering from Epi-lepsy in India and the treatment gap is 50 - 75% largely due to myths and taboo associated with Epilepsy [1]. About 70% patients are treatable with single medicine if the treatment is started in time. Epilepsy Foundation India, established in the year 2009, is a ‘Non Profit’ organization and registered under sections 12A and 80G of the Income Tax Act, 1961. It is dedicated to ‘Cure and Reha-bilitation of Patients suffering from Epilepsy’, spreading awareness and educating the people about Epilepsy
145 Epidemiological Patterns of Head Injury in Bauchi, North-Eastern Nigeria , Ogunleye Olabisi O, Shuaibu Ibrahim S and Obanife Henry O
Introduction:Head injury is the leading cause of death and disability among young adults. It constitutes close to 50% of all injuries. Data have shown that a significant proportion of the world’s population, over 57 million are living with neurological sequalae of head injury. The study aimed to describe the epidemiology of head injury in a center with no previous neurosurgical services in North Eastern Nigeria.Materials and Methodology:Aprospective study that involved all patients managed with head injury between September 2018 and August 2019. Demographic, clinical radiological details obtained and patients categorization made using Glasgow coma scale (GCS) and the treatment offered based it. The outcome was measured with Extended Glasgow Outcome Score (GOSE). Descriptive statistics were obtained Mean Standard deviation SD, Frequencies, Percentages.
146 The Association of Serum Total Cholesterol, Triglycerides Level and The Presence of Diabetic Neuropathy , Eriska Retno Indarti, Santoso Jaeri, Amallia Nuggetsiana Setyawati and Indranila Kustarini Samsuria
Background: Diabetic neuropathy (DN) is the most common complication of diabetes mellitus resulting in a decrease in quality of life. The association between lipid profiles and the presence of DN is controversial. We investigated the association of total choles-terol, triglycerides levels, and the presence of diabetic neuropathy. Methodology: A cross-sectional study among seventy diabetic types 2 patients with (n = 35) and without diabetic neuropathy (n = 35). The presence of diabetic neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI) and asked for fasting venous blood collection for the examination of total cholesterol using the CHOD-PAP method and triglycerides using GPO-PAP method. The association of serum total cholesterol and triglyceride level and the presence of DN were obtained from Chi-square test analysis.
147 Crisis Management Simulation: The Value of Interdisciplinary Debriefing , Devan Patel, Fakhry Dawoud, Brandon Lucke-Wold, Coulter Small, Michele Noles, Dawn Dillman, Mark Baskerville, Donn Spight and Jeremy Ciporen
Objective: Simulation offers an important avenue for surgical and anesthesia training. This is especially important for crisis man-agement scenarios where individuals need to act quickly and efficiently for optimal patient care. Practice based performance can be measured and real time feedback provided during debriefing scenarios. Methods: In this paper, we highlight a dual anesthesia and otolaryngology cavernous carotid injury scenario. The trials were run three different times with inter-trial debriefing.
148 Onabotulinum Toxin-A Injection into Salivary Glands for Parkinson’s Disease-related Drooling , Kuljeet Singh Anand, Himank Goyal, Abhishek Juneja and Rashmi Singh
Background: Excessive drooling is common and problematic issue faced by Parkinson’s disease (PD) patients and their caregivers. Drooling can cause both physical and psychosocial disability. Recent studies of Botulinum toxin type-A (BoNT-A) in PD-related drool-ing have shown favorable results with minimal side effects. Aim: To evaluate the safety and efficacy of botulinum toxin injections into salivary glands in decreasing PD-related drooling.
149 Mental Well-being and Loneliness Among Residents of Karachi During the Second Lockdown of COVID-19 , Hina Zahoor and Nasir Mustafa
Background: Covid-19 emerged as a global pandemic and its catastrophic effects have been felt throughout the world. The pandemic has caused a serious impact on mental health and loneliness of the people. The aim of the present research was to analyze the impact of the Covid-19 on the psychological health of residents of Karachi during the second lockdown. Method: It was a cross-sectional study conducted during the second wave of corona virus via an online survey, in which 380 persons participated. The survey consists of questions for the assessment of symptoms of depression, anxiety, stress by using DAAS-21 scale and for the questions related to loneliness, the UCLA-3 Item Loneliness Scale was used. Participants were selected by convenient and snow ball sampling method.
150 Air Pollution Increases the Risk of Transmission and Replication and Production of Mutant Forms of COVID-19 , Hamidreza Famitafreshi and Morteza Karimian
Air pollution is a dangerous condition to health that adversely affects human societies especially in industrialized countries [1]. However, there are some conditions that air pollution has an addic-tive effect on the pre-existing condition. Nowadays the COVID-19 pandemic has compressed human societies, it is necessary to mini-mize the addictive factors such as air pollution to decrease the risk of transmission, replication, and may be mutation since air pollu-tion is stressful to living creatures.
151 Chronic Cluster Headache from the Beginning Successfully Treated with Verapamil and Lithium: A Case Report , Arícia Miranda, Larisse Cruz, Cássy Moura, Wallyson Souza and Raimundo Silva-Néto
Cluster headache is a trigeminal-autonomic headache that predominantly affects young men. In its pathophysiology, it is believed that there is involvement of the ipsilateral trigeminal nociceptive pathways and activation of the cranial parasympathetic system. We report a case of a 23-year-old man presenting the chronic form of cluster headache from the beginning, according to ICHD-3 criteria. After effective prophylactic treatment, he evolved into an episodic form. To our knowledge, chronic form of cluster headache is un-common and when it is successfully treated it evolves into the episodic form.
152 Intrathecal Ziconotide - Time for Revival? , Georgios K Matis
Chronic pain is a multifaceted condition affecting not only the individuals, but the whole society as well [1]. It has been estimated that 20% of surveyed Europeans suffer from moderate to severe chronic pain which in turn impairs functioning, work and quality of life. Interestingly, direct and indirect health costs for chronic pain exceed those estimated for diabetes, heart disease and cancer.
153 Need for Profound Psychiatric Care Preparedness in India Post COVID-19 , Subhash Chandra
In recent days, India has set a world record for the highest number of new daily COVID-19 cases (India reported 346,786 new cases of Covid-19 on April 24th, 2021). Unlike the year 2020, the COVID-19 death toll of India has also hit a record high, with 2,624 reported deaths on April 24th, 2121. So, the question is: What changed from last year to now? Did they put their guards down too soon by lifting lockdowns and reopening prematurely? Was it a lack of safety measures, including poor mask practices or no re-gard for social distancing? Furthermore, the current death toll and infection rate can also be blamed upon the new variant strain of COVID-19.
154 Pharmacotherapeutic Effects of Hippophae rhamnoides in Rat Model of Post-traumatic Epilepsy in View of Oxidative Stress, Na+,K+ATPase Activity and Sodium Ion Channel Expression , Stanzin Ladol and Deepak Sharma
Background: Post-traumatic epilepsy (PTE) is a brain disorder characterized by an occurrence of spontaneous and recurrent sei-zures post brain insults. Initiation and progression of epilepsy is a complex process involving numerous cellular, molecular, and signalling mechanisms. Therefore, understanding the mechanism involved and finding safer treatments is of paramount importance.
155 Efficacy and Safety of Zonisamide as Initial Monotherapy in Indian Patients with Epilepsy: A Subgroup Analysis of Prospective, Multicentre, Post-marketing Surveillance Study , Sangeeta Ravat, Avathvadi Venkatesan Srinivasan, Ashutosh Shetty, Vivek Kumar, Renu Achtani, Vivek Narain Mathur, Boby Varkey Maramattom, Veeresh Bajpai, Nanjappa C Manjunath, Randhi Venkata Narayana, Balaji Patil1, Parvan Shetty1, Darshana Dighe and Amitabh Dash
Introduction:As very limited clinical data is available in Indian patients with Zonisamide initial monotherapy, a subgroup analysis of data from a prospective, post-marketing. A surveillance study was conducted to evaluate the efficacy and safety of Zonisamide as initial monotherapy in Indian adult patients.
156 Work Experiences as a Neurosurgeon in a Remote City , Manish Kumar Dhiraj
Create awareness in general population that Neurosurgery can be performed in remote areas and at low cost, (the aver-age cost of major brain surgeries in my hospital is about Rs. 1,20,000/-, i.e. approximately $ 1,700 including the cost of surgery, medicines and hospital stay), which is about 5 times less than the cost in big corporate Hospitals in India and much less compared to the cost incurred in the developed countries.
157 Towards Correct and Safe Diagnosis of Specific Learning Disorder in Preschool Age. The perspective of Early Multi-collector Diagnostic Approaches. A Pilot Study , Victoria Zakopoulou, Katerina D Tzimourta, Georgios Ntritsos, Alexandros T Tzallas, Markos G Tsipouras, Loukas G Astrakas, Pavlos Christodoulides, Ioannis Paliokas, Vassilis Zakopoulos and Nikolaos Giannakeas
Background:The wide range of terminology, multiple diagnostic criteria, and multifarious basis of Specific Learning Disorder (SLD) constitutes a new reality in the complex entity of SLD. In this manuscript, we address this issue and present the findings of a pilot study concerning the early diagnosis of SLD, while strongly emphasizing the necessity of integrating and testing a vast range of data from multiple domains and skills to achieve correct and safe early diagnosis of SLD
158 The Impact of Malingering on Inpatient Assault Rates , Julie S Costopoulos, Darby Proctor, Alyssa M Johnson and Skyler G Roberts
Assaults in forensic psychiatric hospitals are costly and damaging to the goals of treatment. This study examines the hypothesis that malingerers were responsible for a significantly higher rate of assaults. Individuals diagnosed as malingerers (n = 112) were matched with genuinely mentally ill individuals (n = 112) based on legal status, length of stay, closest age, and gender. Significantly more malingerers committed at least one assault, and committed a greater rate of assaults than patients with genuine clinical syndromes. Young age and personality disorders were also associated with higher frequency of assaults. Findings support the need to reform methods utilized to identify malingerers prior to commitment to an inpatient setting, to reduce the negative impact of assaults per-petrated by malingerers’ unnecessary hospital stays
159 The Importance of the Anatomical Variations in Practical Medicine , Valchkevich Dzmitry and Valchkevich Aksana
There are many variations of the structure of the human body that can significantly affect the outcome of medical procedures or they can cause pathological conditions in patients. Anatomical variants often met in anatomy and surgery. Knowledge of variant anatomy is extremely important in modern medical education, since the variations of structures can often change the symptoms and the course of diseases. According to the literature, about 10% of cases of intraoperative complications occur due to ignorance of ana-tomical variants. The anatomist teacher is obliged to analyze clinically significant variants of the structure of organs and structures with students during practical classes in anatomy.
160 Tumefactive Virchow Robin Spaces and its Mimics in Paediatric Patients: A Pictorial Review , Bhavini Gupta, Sumit Pruthi, Omprakash Tavri and Sarfaraz Shaikh
Virchow Robin spaces represent pial-lined perivascular spaces and correspond to extensions of subarachnoid space, found in cer-tain characteristic locations around the brain. These spaces are predominantly filled with interstitial fluid and follow CSF intensity on imaging. Enlarged Virchow-Robin spaces, also known as enlarged perivascular spaces (EPVS) are considered when their size increases beyond 2 mm.
161 Benign Sacrococcygeal Teratoma in Adults: A Systematic Review of the Literature , Anudeep Yekula, Sulekhya Inturu, Samiksha Jain, Anuroop Yekula, Abhinaya Kotha, Anurag Pasula and Kiran Kumar Yekula
Sacrococcygeal teratomas are tumors derived from embryonic germ cell layers predominantly occurring in pediatric cohorts. They are rare in adults and limited data exists on their clinicopathologic characteristics and their management. Methods:The aim of the study is to explore the demographic, clinical, radiographic, histopathologic, and the management of SCT in adults through a comprehensive systematic review of literature.
162 COVID-19: Psychosocial Impact on Medical Students. Comparison of Summer-Winter Results , Patricio García-Espinosa, Xóchitl Ortiz-Jiménez, Edgar Botello-Hernández, Rebeca Aguayo-Samaniego1, Jorge Leíja -Herrera, GECEN Investigators and Fernando Góngora-Rivera
The current SARS-CoV-2 pandemic has caused feelings of anxiety, confusion, and panic among the world's population. Because of these psychological changes resulting from the stress caused by the disease, we sought to investigate the psychological impact of the pandemic on the university student community
163 The Normative Value for Heart Rate Variability for the Assessment of Sympatho-vagal Balance in Healthy Adult Population of Bihar , Yogesh Kumar, Pramita Dubey, Kamlesh Jha, Tribhuwan Kumar and Ramji Singh
Recording of HRV will help us to identify cardiovascular autonomic derangement earlier. However, to be used clinically, normative data has to be established. In this study, HRV analysis of 111 young healthy subjects aged 18 to 30 yrs is done who are divided on the basis of gender. In time domain parameters, values are slightly higher for males for RR interval and slightly higher for females for RMSSD and PRR50%. In frequency domain parameters, higher values are found for VLF for males and LF and HF for females. Total power is higher for females and LF/HF ratio is higher for males. However, no comprehensive investigations of all HRV indices in large normal populations have yet been performed
164 Intramedullary Spinal Cord Metastasis from Urothelial Carcinoma , Michael Spinrad, Pouya Entezami, David Jones and John Dalfino
Intramedullary spinal cord metastases (ISCM) are rare neoplasms often associated with significant neurological deterioration. Spinal cord metastases secondary to bladder carcinoma are particularly rare. We report a 56-year-old male found to have an intra-dural intramedullary lesion at T12. A bladder mass was also discovered on ultrasound, as well as additional systemic metastases. A dorsal approach was undertaken for the spinal cord lesion. Bladder carcinoma was confirmed as the origin of this metastasis histo-pathologically. ISCM carries a poor prognosis and information is limited to case reports and series. Early recognition could improve patient therapy and quality of life
165 Herpes Simplex Virus Type 2 Encephalitis with Herpes Simplex Virus Type 1 MRI Findings in an Immunocompetent Adult , Lintu Ramachandran, Vibhav K Bansal, Muhammad Janjua, Taha Mohamed Djirdeh and Janine Borja
Infectious encephalitis is a common cause of acute altered mental status in adults. Most cases of viral encephalitis are often from Herpes Simplex Virus (HSV)-1 and are commonly associated with specific MRI findings that include temporal lobe changes. HSV-2 associated encephalitis is however remarkably rare.Even in HSV-2 encephalitis cases, MRI findings of temporal lobe changes are not typical. We present the case of a patient who presented with classic MRI findings, but was found to have PCR confirmed HSV-2 as-sociated encephalitis. We discuss and hypothesize mechanisms by which HSV gains access to CNS and the reason behind increasing cases of HSV-2 associated encephalitis.
166 The Biofeedback Therapy on Academic Stress among Graduate Students , K Jayasankara Reddy
The study aimed at understanding the effects of Biofeedback therapy, as an intervention strategy, on academic stress of undergradu-ate college students in Bangalore, India. Bangalore has been dealing with an increase in student suicide rates and academic stress has been touted to be one of the reasons for this increase. Moreover, academic stress is also linked with increased anxiety and depressive symptoms. Biofeedback therapy is a relatively new method of treatment, which utilizes modern technology to address various issues such as stress, by helping the individual self-regulate and monitor their own bodily processes thereby, reducing stress. Students with higher levels of academic stress were screened using the Academic stress scale
167 Pandemic Fatigue: An Overview of Systemic Processes , Primavera Fisogni
Pandemic fatigue is a recurrent topic in the narration of the mental effects due to pandemic. It is generally described in term of self-exhaustion or tiredeness, lack of attention, difficulty in carrying out the operations of everyday life, anxiety and loss of hope. It affects, in different ways, those who are particolarly exposed to the distress of COVID-19 (health systems operators) and ordinary people. Being a discomfort rooted in the existential frame, pandemic fatigue cannot be interpreted only as a sole cluster of psycholo-gical/psychiatric symptoms or syndromes.
168 Effect of Renal Complications on Brain - An Overview , Shalini K Mehta and Sivakumar JT Gowder
The association between chronic kidney disease (CKD) and cardiovascular disease has been extensively studied but, at the same time, little information has been available on the relationship between kidney and brain. In this manuscript, we have evaluated the recent updates on the relation between CKD and neurological disorders based on literature review and survey. A wide spectrum of neurological disturbances and behavioral changes such as fatigue, head ache, sensory clouding, vision impairment, seizures, delirium and coma can be observed in patients with renal complications [1-4]
169 Optic Neuritis and Hypophysitis: Partial Remission after Pulse Therapy , Isabela Morales Cozeto, Lívia Norcia Zenerato, Letícia Alarcão Max-ta, Ricardo Baer Filho, Érico Paulo Heilbrun, Márcio Luis Duarte and Lucas Ribeiro dos Santos
Lymphocytic or autoimmune hypophysitis (AH) is a rare disorder characterized by inflammation of the pituitary gland. There is no consensus on treatment, but may include corticosteroid therapy and decompression surgery. Optic neuritis (ON) is an inflammati-on of the optic nerve, both of unknown etiology and autoimmune hypothesis. The association of pathologies is rare, with few reports in the literature. The diagnosis of ON is clinical and treatment with high dose corticosteroids. A case initially diagnosed as ON with pituitary macroadenoma is described: 55-year-old woman with sudden bilateral visual loss associated with nausea, vomiting, diarr-hea and hypotension, MRI with pituitary expansive lesion with optic chiasm compression and laboratory tests showing thyrotrophic, corticotrophic and gonadotropic axes deficiencies, associated with mild hyperprolactinemia. Methylprednisolone pulse therapy was performed for ON treatment. Patient presented improvement of visual acuity, decreased pituitary volume and recovery of cortico-trophic axis, raising the hypothesis of AH. The case demonstrates the importance of careful neuro-ophthalmologic and radiographic evaluation of patients with pituitary adenoma and visual loss. NO and AH should be considered in the differential diagnosis as this may prevent unnecessary invasive procedures.
170 Impact of Psycho-Social Intervention in Patient with GBS in Neurological Rehabilitation Set Up: A Case Report , Arun M and BP Nirmala
The current case report describes the psycho-social assessment carried out with a person diagnosed with Guillain-Barre syndro-me. Psycho-social assessment sheet which is developed for assessing psycho-social factors of patients with neurological disorder and hospital anxiety and depression scale has been used in the case report. This report also focuses on the caregiver’s issues and the associated interventions. The common psycho-social intervention which was used in this case has alleviated patient’s emotional distress and helped her go through rehabilitation process effectively. Findings of this case study support the fact that medical mana-gement complimented with psychosocial intervention could help the patient and family members deal with social and psychological dysfunctions effectively.
171 The Psychology of Patients Infected with COVID 19 in Tunisia during the Treatment Period , Kahna Mohamed, Cherni Bochra and Baaouni Zaineb
The COVID-19 still causes anxiety and apprehension among many patients today, which can lead to a refusal of care or difficult working conditions. It, therefore, appears prerequisite to set up conditioning and relaxation methods for patients and caregivers to optimize care and working conditions. In this regard, we assess the psychological levels of patients in their forties to detect the fac-tors in order to facilitate the treatment.
172 Coronavirus - The New Generation Influenza Psychiovirus , Vahram R Sargsyan
The paper presents a new scientific approach for interpreting the mechanisms of functioning of the influenza virus in nature. New biological theories are discussed - viral theories, on the basis of which the coronavirus known to everyone since 2019 is considered as a psycho-influenza virus. More details are given - the viral theory of biocommunication and the viral theory of signal transduction. In conclusion, modern scientific methods of protection against infectious diseases are proposed.
173 Enhancement of Function of the Prefrontal Cortex to Improve Symptoms of Schizophrenia , Prajjita Sarma Bardoloi
Schizophrenia is a chronic psychotic illness with multifactorial etiology that manifests with a constellation of positive, negative, affective and cognitive symptoms [1]. As we are learning more about the neurobiology of schizophrenia, the role of the prefrontal cortex (PFC) in schizophrenia has become more evident. While various medications are available to treat psychotic symptoms in schizophrenia, treatment of cognitive functions, residual symptoms and comorbid disorders is still a substantial challenge. Here we present a case of a young male who suffers from schizophrenia, with a previous diagnosis of ADHD and substance abuse, who showed remarkable improvement following treatment with the alpha-2A adrenergic agonist guanfacine, likely related to enhanced PFC function
174 Mental Health of Healthcare Personnel during Quarantine for Infectious Epidemic--Real-time Data , Uriel Halbreich and Fanqiang Meng
Background: The 2020 Coronavirus (COVID-19) pandemic has been causing significant fear and anxiety among the general public and demonstrate insufficient preparedness of Healthcare systems. It shed light on front-line Healthcare-personnel who should func-tion and treat others while they share the same stressful situations.Objective: To provide actual real-time data on mood and mental symptoms of Healthcare personnel in quarantined wards during the Chinese-SARS epidemic, in order to support procedures for functioning of personnel during current and future epidemics.Setting, Participants and Measurements: Cross-sectional Study was conducted during the acute exacerbation of the SARS epide-mic at quarantined wards by nurses who were embedded and quarantined with the patients. Mood and perceptions of Healthca-re-personnel infected (n = 55) and not infected (n = 149) with SARS, as well as those during quarantine “rehabilitation” (n = 62) were compared to SARS patients (n = 96), healthy quarantined students (n = 55) and healthy non-quarantined controls (n = 52).Structured interviews were conducted with the Beck Depression Inventory (BDI), Spielberger’s State-Trait inventory, symptoms Checklist-90 (SCL-90) and a situation-specific questionnaire.Results: Healthcare-personnel -- infected and not-infected, suffered as much mood, anxiety and other stress-induced symptoms as their SARS patients. Strictly enforced quarantine amplified personnel’s frustration, mental symptoms and mistrust in authorities.Limitations: Data was collected when many patients were assisted by respirators, some could not be included.Conclusion: During acute epidemics front-line Healthcare-Personnel are exposed to same and even more extreme situations as their patients. Their emotional state under tumultuous situations should be of concern.Implications: Mental well-being procedures and enhancement of Mental resilience of Healthcare teams should be an integral com-ponent of their preparedness for future disasters
175 Takotsubo Cardiomyopathy Resulting from Transient Global Amnesia Following a Sexual Encounter , Kamalpreet Dhaliwal, Sonia Randhawa, Nabihah Kabir, Yadwinder Sidhu, Harsimran Singh, Shawn Banash, Muhammed Janjua and Vib-hav Bansal
Background: Transient global amnesia (TGA) is a neurological condition described as acute onset anterograde amnesia that resolves within 24 hours. TGA is often associated with migraine history, psycho-physical stress, and cardiovascular risk factors. Takotsubo Cardiomyopathy (TTC), also known as Broken Heart Syndrome, is a reversible, stress-induced weakening of the left ventricle (LV) resulting in cardiomyopathy. Concurrent occurrence of the two syndromes have rarely been reported. To date, there have been 10 documented concurrent TGA and TTC cases, all unrelated to sexual triggers. Here we report the first patient with simultaneous TGA and TTC following a sexual encounter.Insights and Aim: Summarize a case and its associated factors to establish awareness of a possible causal relationship between TGA and TTC following a sexual encounter as a precipitating factor. Case Report: A 66 year-old woman presented to the emergency department with sudden onset confusion and forgetfulness wit-nessed by the patient’s husband immediately after sexual intercourse.Neurologic exam on admission revealed short-term memory deficits, resulting in repeated questions of similar nature regarding the peri-ictal period. Lab results revealed an elevated High Sensitivity Troponin-T of 51 ng/L (normal, < 14 ng/L); all other pertinent labs were within normal limits. The patient’s neurological manifestations of amnesia resolved 14 hours after the time of presentation. Conclusion: Although TGA is considered a primary neurologic disorder, it is important to recognize a possible relationship between TGA and TTC in order to manage the cardiac complications that may arise from TTC
176 The Transcranial Direct Current Stimulation (tDCS) and Biofeedback (BFB) as a Mixed Methods in Reducing Symptoms of Migraine , Mohammadjavad Hoseinpourfard and Masoumeh Shajarian.
Migraines may be induced by triggers such as fatigue, certain foods, weather, and so on. Of-course some patients with migraine report other experiencing triggers include dietary and sleep disor-ders. Many of symptoms pertaining to the migraine may start, up to 24 hours after a trigger and continue for 72 hours. In addition, the psycho-physiological aspects could consider as other important triggers.
177 Class-I MHC-Restricted T-Cell Associated Molecule (CRTAM) Expression in Cerebellum. , Esther López-Bayghen, Karla Pérez-Toledo, Leticia Ramírez- Martínez, Jacqueline Robledo,Vianney Ortiz and Arturo Ortega.
The class-I MHC-restricted T-cell associated molecule (CRTAM), an activation molecule expressed in activated Natural Killer cells (NKT) and CD8+ T cells, is highly expressed in the cerebellar cortex, both in neurons and glial cells. During cerebellar development, granule cell migration over Bergmann glia cells depends on neuronal/glia glutamatergic signaling, suggesting a regulated cell-cell in-teraction process, opening the possibility of CTRAM and Nectin-like 2 involvement. Through the use of the well-established model of chicken cerebellar Bergmann glial cells and a wound/healing assay, we describe herein that glutamate represses CRTAM expression, enhancing migration. These results reveal an unexpected function of CTRAM in the cerebellum.
178 Corona Virus (COVID-19): A Brief Status in India about its Transmission and Precaution. , Abhishek Jha, Deepak kumar Mishra, Deepika Sharma  and Suvercha Arya.
Coronaviruses were first discovered in the 1930s when an acute respiratory infection of domesticated chickens was shown to be caused by infectious bronchitis virus (IBV). Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CO-V-2), was first reported in Wuhan, Hubei province, China has now rapidly spread over 200 countries. Rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic. Current Scenario of India is also not however very good and facing a high risk despite a continuous lockdown from 22nd March - 17th May 2020. However, the lockdown is again increased from 18th May - 31st May 2020.
179 External Ventricular Drains: An Overview of Indications, Technique, and Complications. , Anudeep Yekula,  Aditya Mittal, Varun Sagi  and Mihir Gupta.
External ventricular drains (EVDs or ventriculostomies) are frequently required for acute management of intracranial hyper-tension and monitoring intracranial pressure. Patients with ventriculostomies are frequently co-managed by multiple specialists including neurologists, neuro-intensivists, trauma specialists, emergency department physicians and neurosurgeons. We provide background on the indications, placement technique, troubleshooting and complications related to this procedure. We also discuss emerging best practices for preventing complications such as ventriculostomy-related infection. We conclude with considerations regarding ventriculostomy removal and areas of ongoing study. This review serves as a primer that may facilitate collaborative care between diverse allied providers.
180 Need for Antimicrobial Agents in Daily Applications in Hygiene and Disinfection: An Opinion. , Shimon Shatzmiller.
The hygienic situation in hospitals and other health facilities have become a source of sickness that is killing thousands all over the place, and in Israel as well. A similar situation is in agricultural land. Since the ban on the use of methyl-bromide for soil disinfec-tion, agricultural products can be infected with species of dead causing microbes, germs, and viruses. Imitation of natural materials isolated from amphibians and reptiles (crocodiles) can bring relief. These natural substances act on the bacteria in a way that does not cause the resistance of the microbes. Natural like synthetic imitators can be used, which can be produced in large quantities and low economic requirements and eradicate the pathogens in the soil and hospitals.  
181 Simple Strategies for Brain Health. , Seyedeh Nasim Habibzadeh.
The brain is a major organ in human body that is made up of a large nervous system of nerve tissues which process the sensory information and controls the thoughts, memory and speech. The brain also governs the movement of the limbs and the function of many other organs within the body. The brain is very highly sensitive organ which can harm easily. Any bad news, unexpected shocks and daily pressures can affect the brain functions. However, the servers kind of negative aforementioned stresses can cause the brain waves or vibrations and even any low level of stresses can induce the brain unwanted waves afterwards. In this regards, stress management would account for a good strategy to improve the brain health. Avoiding of being in stressful environments and performing some gentle exercise like walking and listening to the music can be very beneficial approaches to protect the brain and its functionality in time.
182 Love, Bonding Phenomenon, and the Healthy Narcissism. , Ronnie Solan  and Anat Ben-Artsy.
It is common psychoanalytic knowledge that the influence deriving from childhood experiences carries well on into adulthood. This article’s main objective is to disclose the survival motive behind the influence of childhood experiences throughout life. The survival motive seems to relate to the Healthy Narcissism Processing [1-3], a process metaphorically scrutinized to an Emotional immune system. Memory traces of childhood experiences, such as intimacy with the object or Separation Anxiety, etc., reverberate all along life through the processing of Healthy Narcissism. Accordingly, the sense of the Familiar Self may be preserved, immunized and assisted. Likewise, the “Me” and its belongings (like its objects and love relations) are recognized as familiar, stimulated to be restored, revived and recharged in present experiences according to past involvements. Re-finding the familiar senses in present events, according to the models of past experiences, facilitates adaptation to daily relationships and to almost familiar occurrences.
183 Critical Evaluation of Physical Exercise on Brain Structure and Function. , Mahsa R M Mansouri and Sivakumar J T Gowder.
Physical activity or physical exercise act against the sedentary lifestyle-induced health matters such as cognitive decline or neu-rodegenerative diseases. Physical exercise and physical activity is important for people of all age groups that not only could enhance mental capacity and social interactions development of pre-school aged children, but also could maintain and ameliorate muscle strengthening and health condition such as high blood pressure of old adults. Physical exercise also, acts as gene modulator which develops brain function due to structural and functional changes such as neurogenesis, glycogenesis, brain volumes, white matter integrity, neurotrophies levels and or cognitive performance.
184 Physical Therapy in Mental Health? , Stavros Stathopoulos
The core of physical therapy in mental health is to optimize wellbeing and empowering the individual by promoting functional movement, movement awareness and physical activity, exercise, bringing together physical and mental aspects. Physical therapists in mental health play a key part in the inte-grated multidisciplinary team/interprofessional care.
185 A Neuroscientific Study of the Brain Stimulator and Simulation Model to Predict Breakfast PPG Using GH-Method: Math-Physical Medicine , Gerald C Hsu
The author interprets the brain stimulator and its associated simulation model of predicted breakfast postprandial plasma glu-cose via a food or meal segmentation analysis and Sensor PPG waveform characteristics study. He has been using a continuous glucose monitoring device applied to his left upper arm and has collected 74 glucose data each day since 5/5/2018. However, by the mid-2019, he noticed that many of his post-breakfast glucose values escalated approximately one hour after the first bite of his breakfast, even when eating pure protein such as eggs without any carbs/sugar content. Therefore, during October of 2019, he modi-fied his computer software to sort out different food contents and processed their associated PPG waveforms. By using a pure protein egg breakfast case study, this research paper offers some explanations to his speculation and hypothesis on how when eating food, this would prompt the brain to send an order to the liver to start the glucose production. This paper further links the functions of our brain, liver, and pancreas working together.
186 Centralized Pain: Status Review and Medical Management , Ihsan F Shanti, Bilal F Shanti, Ali Otom,  Ali Al Rjoub  and Khalil Al-Abbadi
Centralized pain is non-fatal disorder linked to permanent changes and chaotic imprinting of pain inputs within the central ner-vous system. This occurs without obvious logical reasons that we know of. This persistent heightened alert of the nervous system is very exhausting to the patients and their families. The magnitude of other symptom comorbidities makes this pain entity even more challenging to diagnose and treat. Fortunately, recent research discoveries have introduced a few theories such the concept of glial activation and neuroinflammation as having some plausible role in this complex syndrome. This review manuscript will seek to explain and simplify some of the non-procedural clinical medical management options available to date, as tools for us, clinicians, to fight this painful entity
187 Thermotherapy and Vibroacoustic Therapy in Preventing and Possibly Reversing Dementia and Alzheimer’s , George Grant and Jay P Vanden Heuvel
The Objective of this Literature Review is to find any published scientific evidence to correlate the use of both Thermotherapy [Hyperthermia][Heat Therapy] and Vibroacoustic therapy [Vibration + Sound] to prevent and possibly reverse chronic neurological conditions like Dementia and Alzheimer’s Disease.
188 Defeating the Devil in the Waste: Remediation of Infectious Covid-19 Waste. , Sachin Kumar and Pinky Kain
The Covid-19 infectious-biomedical waste generated from the health care and research activities are posing a huge invisible threat. The waste containing many deadly microorganisms, their toxins and particularly Corona Virus are posing a risk of infection relapse and occurrence of future infection waves. Workers who are involved in taking care of this waste are at risk of getting exposed to Covid-19 and other dangerous biological agents by punctures/cuts (contaminated sharps), skin-mucous contact/projection of blood or biological fluids, ingestion or inhalation of contaminated particles.
189 COVID 19 Pandemic Anxiety and its Management , Suprakash Chaudhury, Pooja V, Mahesh Thakur and Daniel Saldanha
The COVID-19 Pandemic is likely to evoke questions within the minds of a vast number of individuals across the globe due to its high degree of communicability and an apparently greater fatality rate compared to many other flu-causing viruses. No specific medi-cations against COVID 19 are available presently. A vaccine against it has also not been developed thus far. The only known methods to prevent the disease are non-pharmacological measures like avoiding contact with infected person, social distancing, use of face masks, through hand-washing with soap and water or alcohol based sanitizers, etc.
190 Brain Imaging and Aging , Shimon Shatzmiller, Galina M Zats and Inbal Lapidot
Brain imaging is one of the main obstacles of modern disease diagnostics since it has to allow accurate and quantitative mea-surements on a living organ that is placed in adults (in neonatal humans skull penetration is somewhat easier) inside a bone cage. Inside is the brain, the main function controller of our body that has to be done in a non-invasive way on the living operation brain. Many spectroscopic methods are trying to overcome the difficult access to the brain: Photoacoustic microscopy, Confocal microsco-py, Two-photon microscopy, Optical coherence tomography, Scan-ning Laser Acoustic Microscopy, Acoustic microscopy, Ultrasonog-raphy, positron tomography, fluorescence methods, photo caustic microscopy and multy (two) photon imaging spectroscopy.
191 Distal Catheter Migration to Mediastina in Ventricular-peritoneal Shunt, a Case Report , Amir Kamalifar, Samar Kamalifar , Amir Rezakhah  and Firooz Salehpoor
Ventricular-peritoneal shunting (VPS) is common neurosurgical procedure in childhood and have many complication like mal-function infection and malposition, we present a case with a positioning of distal catheter in thoracic region.
192 Schizo-obsessive Disorder - Diagnostic and Therapeutic Difficulties - Case Report , Anna Urbańska, Aneta Perzyńska-Starkiewicz, Łukasz Proć, Agnieszka Lis, Aleksandra Kordyga-Proć and Marcin Olajossy
A case of patient with schizo-obsessive disorder is presented. Schizo-obsessive disorder causes many diagnostic difficulties. The patients may not respond to the basic treatment regimens for schizophrenia or schizo-affective disorder and they may need poly-pharmacotherapy more often than usual.
193 Concussion in Older Population , Oyeneyin Babatunde David, Opeyemi Oluwasanmi Adeloye  and Oyeneyin Oluwatosin
Concussion present with many symptoms but the most common is headache. Other symptoms include dizziness, nausea, imbalance or vertigo, fatigue or drowsiness, sensitivity to light and noise, amnesia (which is a typical feature), abnormal behavior and seizure. At old age, the human skull has an increased space as the brain begin to shrink just like the other body tissues which experience the same physical changes due to ageing. Subdural hematoma, easily occur in the aged brain vessels following an accident and could be worsened when patient is on anti-inflammatory drugs. In this study, we critically review the current knowledge of concussion in the older populations.
194 “Haquapathy” - The Most Natural Holistic Approach to Weight Loss , Faris Al Hajri
Haquapathy is one of the basic methods of revitalization in the system of natural medicine, which we also coined it as Haqua Re-vitalize® Therapy (HART), otherwise known as; Hot Aqua Therapy (HAT), Hot Water Therapy (HOWT), Hydrothermal Therapy (HTT), Aqua Calidum Therapy (ACT), Maysakhin Therapy (MST), and Majimoto Therapy (MMT), that we instigated, being the origina-tor and founder of this therapy since we discovered its significant health benefits to the human body in August 2007, until the pres-ent moment.
195 The Brain and Consciousness , Mette Mouritsen
A “knee experience” is a complicated process that requires coordination of the skin cell’s recording of touches and the mus-cle-tendon’s registration of position and more in order to bring a mental image to the brain. The brain cannot by itself generate the experience "knee," it requires a lived experience of the knee at the cellular level, which in all provides an awareness and remem-brance of “knee.” The experience of knee thus requires informa-tion from several different cells and direct contact. There must be something or someone that relate to the knee by touching it, before the knee can be experienced to its full, otherwise it will just be a mental image, which also is an experience of “knee,” however it is entirely a mental image.
196 Death and Consciousness , Mette Mouritsen
When observing a dead body, it is obvious that something is missing. The glow, warmth and movement that characterizes a liv-ing human being are obviously lacking. “The thing”, which is lack-ing is the formless energy that makes a person alive. The entire physical body including the brain and the heart and the genes are left back, they are no longer self-propelled as they seemed to be when the body was fully alive. In a metaphor the notes and the instruments that contributed to the orchestra of the body are still there, but the conductor and the sound has left the orchestra. It all happens in a breath, one moment alive the next moment dead.
197 “KD Ear Blow Sign” in Rabies , Vinod Kumar Tewari, Abhishek Gupta, Devesh Johari and Lori Tewari
In rabies patient on blowing on any ear, the respiratory muscle spasms is increased. This “KD EAR BLOW SIGN IN RABIES” is due to increase in humidity (examiners moist air blow) in the auditory canal which in turn sends impulses via those auditory nerves to temporal lobe thus stimulating reflex.
198 COVID-19 and Nervous Relation , Vijay Kumar
The COVID-19 predominantly affects the respiratory system, causes alveolar damage, edema, and inflammation [1]. However, many experimental studies and case reports on coronaviruses (CoVs) highlighted their potential neurotropism. The neuro-inva-sive propensity has been illustrated as a common feature of CoVs. The SARS-CoV and SARS-CoV-2 showed the greater similarity, it is quite possible that they also possess similar potential. The neuro-trophic viruses may enter the brain by direct infection injury, hy-poxic injury, blood circulation pathway, immune-mediated injury, neuronal pathway, and include other mechanisms [2]. After the invasion, the impact of SARS-CoV-2 on neurological manifestation and complications can be seen in central and peripheral nervous system.
199 Preterm Births and Cognitive Development , Frolli A, Ricci MC, Valenzano L, Cavallaro A, Pastorino GMG and Operto FF.
The birth of a premature baby is a decisive factor in determining long-term consequences on cognitive development. Considering the Wechsler Intelligence Scale for Children (WISC) as a reference, there are several evidences resulting from numerous studies that show a variation in the cognitive profile: preterm-born children have been shown to have an increased risk of cognitive impairment and have consistently shown lower results than control groups on standardized tests of general intellectual functioning. In our study we expand the sample age and evaluate the cognitive profile of adolescents and understand if cognitive abilities had specific effects, comparing a group of adolescents born preterm (group 1) with a group of adolescents born on term (group 2). Broadening the study population age, we may conclude that the impairment of WM’s abilities persists during the course of development, and therefore subjects with a preterm birth history continue to present difficulties in global cognitive functioning, also impacting lifestyle.
200 Rare Case of Inflammatory Pseudotumour of Central Nervous System - A Case Report , Siddharth Gautam
Inflammatory Pseudotumours (IPT) are mostly benign lesions, mimicking malignant lesions and affecting almost all organ systems and are characterised by fibrotic ground tissue and polyclonal mononuclear infiltrate on histopathology. It is a disease of unknown pathogenesis and the brain is a rare site of occurrence. Here we present one such case we operated recently in our department.
201 Epilepsy and its Management in Unani Medicine , Azma Waseem, Anwar Jamal, Usama Akram and M Fazil.
Epilepsy is one of the oldest ailments that have been affecting the human beings. As per World Health Organization (WHO), epi-lepsy is a chronic non communicable brain disease that may affects people of all ages. It is characterized by two or more provoked seizures, which are brief episodes of involuntary movement that may involve the whole body or a part of the body. Near about 50 mil-lion people is suffering from epilepsy worldwide, and approximately 5 million people are diagnosed with epilepsy each year making it the most common neurological disease globally. Discrimination and social stigma is still associated with epilepsy in the world and it impact on the patient’s quality of life and their families as well. Most of epilepsy patients live in developing countries and unable to get the proper treatment for the disease. In Unani system of medicine, epilepsy is described as Sar‘. Classification of epilepsy in this ancient system of medicine has been done on the basis of temperament, predominance of humor involved, internal and external factors etc. In this paper an attempt has been made to explore the concept of epilepsy in Unani medicine, its type, etiology and management through various modes of Unani treatment. This article will help in reducing the burden of this common neurological problem and development of new intervention for the disease
202 Complications of the Anterior Cervical Discectomy and Fusion , Muthana Ibrahim Jameel, Liwa Abdullah Ali, Ihssan S Nema and Zahraa F Al-Sharshahi
Background: Anterior cervical discectomy and fusion (ACDF) means removing the symptomatic disc by an anterior approach with placement of a bone graft or a synthetic cage. Many studies have shown the procedure to be effective, but associated with complica-tions.Objective: To document and record the type and incidence of complications associated with ACDF, and to find any predisposing fac-tors or associated medical illnesses and other demographic factors or conditions that increase the complications.Patients and Methods: A prospective review of 48 patients who underwent an anterior cervical discectomy and fusion between (May\2012 - July\2014) in two hospitals with an average 6 months follow up.Results: The sample of patients was classified according to age, gender, diagnosis, complications, associated medical illnesses, level of the operation. Then the complications were analyzed according to these parameters trying to find any predisposing factors or as-sociations. Hoarseness of voice was 79%, Dysphagia 54%, Neurapraxia 14.6%, Other medical illnesses 12%, Infection 4%, Reopening 4%, wrong diagnosis 4%, worsening 4% and Death 2%.Conclusion: The complication rate for ACDF is low in experienced hands. Hoarseness is the most common reported complication. Dysphasia, laryngeal edema or a sensation of a lump in the throat are also reported. Associated medical illnesses especially asth-matics and smokers and any patient with chronic cough or respiratory problems are the major cause of complication. Also there is marked association of complications in patients with multisystemic chronic diseases.
203 Use of Dopamine Agonist in Tetanus Spasms - A Novel Approach to Revert the Respiratory Spasm - The Cause of Mortality , Vinod Kumar Tewari, Abhishek Gupta, Devesh Johari and Lori Tewari.
In tetanus patients Levodopa and Carbidopa combination (which is usually used to relieve the signs of extrapyramidal) causes respiratory muscles spasm relief thereby the need for sedatives is decreased and patient saved later on via central nervous system mechanism, by providing the inhibitory neurotransmitters at Anterior Horn cells.
204 Post-intensive Care Syndrome in COVID 19: Monitoring from the Physical Medicine and Rehabilitation and Clinical Psychology , Espinosa-Gil Rosa María and Monteagudo-Santamaría María
The Covid-19 has been a great challenge. At this time, it is interesting to approach patients with severe COVID who have required prolonged admission to the Critical Care Unit (ICU), intubation with connections to mechanical respiration, even connection to the extracorporeal oxygenation membrane (ECMO), because our hospital (Virgen de la Arrixaca, University Hospital, in Murcia), is reference for connection to ECMO.We have elaborated a process/protocol for offering physical and psychological care (assessment, diagnosis and treatment) from the hospital environment and specifically from Rehabilitation Service. This constitutes a challenge and we consider that it will have a significant improvement in both physical and psychological symptoms. We are working in the context to Post ICU Syndrome.The sample is reduced by the severity of the patients.We cannot offer results due to the recent pandemic and because in our region it occurred one month later than in the rest of the most affected regions in Spain (Madrid, Barcelona, Bilbao). We are in the first medical and psychological evaluations and treatment in the actuality.
205 The Bitter Truth: Lessons from Pandemic Covid-19 , Pinky Kain
The pandemic is treating everybody equal. Current rise in Co-vid-19 cases in USA has taught that no country is a super power or leading now. Nobody is as educated as we think. We all are proving failures. Even the wealthiest are hiding and isolating. Riches having less immunity is a weaker and most vulnerable class. Lack of tis-sues rolls, grocery, medical supply, health insurance and food has driven the upper class crazy. The poor class is actually more on the safer side where having no money is a blessing in disguise. Their strong will powers and immunity is shielding them.
206 COVID-19 and the Brain , Maria Elena López and Sofia Isea
During the present pandemic of COVID-19 disease, interest has shifted from the respiratory system affectation to involvement of other organs and systems. Recently pre-eminence of neurological symptoms and signs has emerged. We have done a comprehen-sive review of the literature published as open access in various databases with the purpose of increasing our understanding of the disease and aid in the identification of patients with these neurological conditions. We have reviewed articles reporting neurologic manifestations in young individuals and children. Although there is nor enough data to establish prevalence of the conditions affect-ing pediatric population, as the number of worldwide cases increases we expect to find an increase in these reports. it is considered of utmost importance to urge clinicians to document symptoms and neurological signs in the context of the disease in order to contribute to a better understanding of Neurocovid and to generate a body of knowledge that influences the optimization of the diagnosis and approach of this entity, taking as a premise that the early installation of individualized and reasoned treatments will translate in a better survival rate of those affected and lower the occurrence of eventual ongoing deficits.
207 Coronation's Disturbing Effect: Even After they Recuperate - The Sense of taste and Smell did not Return to Some of the Adhesives , Shimon Shatzmiller
A Wall Street Journal study claims that a high percentage of re-covering Corona researchers already claimed that the loss of taste and smell is one of the symptoms of those infected with the virus. Some patients experience this sensory loss along with other symp-toms, such as high fever, cough, or shortness of breath. According to a study published in the Wall Street Journal, some patients have recovered from Coronavirus SARS-COV-2 and most of its many effects on the human body. But have reported that their sense of taste and smell has not returned to this day.
208 Impact of the COVID 19: Losses and Mourning , Eva María Esparza Meza
At birth we humans are in a situation of absolute deviation, to survive we depend on the physical and psychic care that is provid-ed to us. The state of helplessness resulting from the immaturity with which we are born, is compensated by the devoted care of the mother, who, with the support of her partner, family and society in general, lends the baby a kind of external nesting that subjudges this first catastrophe called birth
209 Mental Health through Unani Medicine , Usama Akram, Neelam Quddusi, Azma Kausar, Mohammed Fazil and A A Khan.
Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. In 2017, there were an estimated 46.6 million adults aged 18 or older in the United States with mental disorder. Young adults aged 18-25 years had the highest prevalence of mental disorder (25.8%) compared to adults aged 26-49 years (22.2%) and aged 50 and older (13.8%). In low and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder.Unani system of medicine is the only system which intervenes with six essential factors (Asbab-e-Sitta Zarooriya) especially by Bodily AND Psychic movement (Harkat wa Sukoon Nafsani) and sleep AND wakefulness (Naum wa yaqza). In this regard, Tadeel-e-Ruh is the basic concept to keep away mental disorders. Equilibrium between these two causes of health (Asbab-e-Sehat) is enough to keep away mental problems. In spite of that there are a number of Unani single (Mufradat) and compound (Murakkabat) drugs for examples Sedative (Musakkinat), exhilarants (Mufarrihat), Mubrridat (cold inducers) and brain strengthener (Muqwaiy-e-Demagh) keep away mental disorder such as Dementia, Insomnia, Headache, Depression and other mental disorders.
210 Proper Names and Repression. A Freudian Finding , Araceli Colín
I intend to locate Freud's contributions in relation to personal names and repression. His most spreaded idea of the unconscious is a consequence of repression. Repression operates in three stages described in his metapsychology. In order to articulate his findings, it is necessary to highlight the way in which the personal name is tied to a lack. Without lack the reality-test could not be installed and the separation between conscious and unconscious could not be established. For Freud, the core of the unconscious is made up of agents of the representation (Vorstellungrepräsentanz). They are of the order of nonsense. In my opinion those representatives are letters. Letters of personal names are one of the first fixation materials (Fixierung). Fixation constitutes the first time of repres-sion: It is a necessary but not sufficient condition for the psychic apparatus to be founded. I also analyze another Freudian idea of the unconscious: the inherited unconscious. Freud deployed this idea in his last work.
211 Evidence of a Neuroprotective Function for Niclosamide in Human SH-SY5Y Neuroblastoma and Rat PC12 Neural Cells , Kevin C Bermea, Edgar A Casillas, Liza D Morales, Laura L Valdez, Brenda Bin Su, Andrew Tsin and Benxu Cheng
Neurodegenerative disease is a debilitating and incurable condition that affects millions. It results in the loss of function and eventual death of neural cells. It has been established that exposure of model neuronal-derived cell lines to the proteasome inhibitor MG132 emulates in vitro neurodegeneration as evidenced by a marked decrease in protein degradation concomitant with an increase in aggregate intracellular ubiquitinated proteins and endoplasmic reticulum (ER) stress (via upregulation of CHOP/GADD153). Consequently, apoptosis ensues corresponding to the upregulation of p53, activation of caspase-3, cleavage of poly (ADP-ribose) polymerase (PARP), and DNA condensation/fragmentation. In this study, we investigated the potential neuroprotective function of niclosamide and its associated signaling mechanisms in SH-SY5Y and PC12 neural cells exposed to MG132. All markers of MG132-induced neurodegeneration, including the accumulation of ubiquitinated proteins, were prevented by exposure to niclosamide. In addition, niclosamide was shown to induce autophagy independently and to enhance autophagy induced by MG132. These results show that niclosamide may serve as a potential neuroprotective agent through its ability to inhibit proteasome dysfunction-induced protein ubiquitination.
212 10,000-fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Duchenne Muscular Dystrophy (DMD) Via Intrathecal Superfusion and Oral Tadalafil - A Case Report , Vinod Kumar Tewari, Neeraj, Devesh Johari and Lori Tewari
Duchenne Muscular Dystrophy (DMD) is a slow, progressive and fatal X-linked neuromuscular disorder due to loss of dystrophin that links the contractile apparatus to the sarcolemma via the dystrophin-associated protein complex (DPC). The NOD (Nitric Oxide Donor) causes release of Nitric Oxide (NO) by nitric oxide synthase (NOS) and then via 10,000-fold effect NOR (Nitric Oxide Receptor) it acts to release cGMP thus modulates DPC and improves the skeleton muscle functionality. We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in DMD (diagnosed by muscle biopsy) and oral Tadalafil as NODs and well checked by AL-TENS (acupuncture like transepidermal neu-ral stimulation) in pre ITSNP and post ITSNP phase
213 Peduncular Hallucination Status Secondary to Thalamic Stroke: Brief Case Report and Review of the Literature , Carmen Maura Carrillo de Albornoz Calahorro, Margarita Guerrero-Jiménez and Luis Gutiérrez-Rojas.
Background: The role of thalamus in the pathogenesis of visual and auditory hallucinations has been described as “Peduncular Hal-lucinosis”. This kind of hallucinations has been reported to be associated with thalamic injury joined to midbrain structures damage. Hallucinations are filled with vivid images of animals and colorful characters in motion and in many cases are associated with sleep disorders. Despite these characteristics, patients generally distinguish them as not real. Case Report: The present case has the distinction of having characteristics somewhat different from those described in published cases. In the first place, it is the case of the longest duration published up to date, 5 years, secondly, contrary to what usually happens, the patient does not criticize the objects and understands them as realConclusions: We present an updated review about literature published and redefinition of the concept the particular characteristics of this rare syndrome. When facing hallucinatory cases of an organic type, especially in patients with cardiovascular risk factors, it is important to rule out rare syndromes such as Charles Bonnet or hallucinations of thalamic origin.
214 Estrogen Detoxification and Neuroendocrinological Activation and Balancing Via Hormonal Yoga , Vidhu Gill, Kritanjali Singh and Ashok Kumar.
Estrogen is the major sex hormone formed in both males and females and is responsible for development of reproductive organs as well as secondary sexual characters. In females, its major function is to maturation and regulation of ovaries and uterus. Its major forms are Estrone (E1), Estradiol (E2), and Estriol (E3), but E2 is the most effective form of estrogen and is formed from cholesterol (steroid) ring. Most of the estrogen formed along with other hormones like progesterone is utilized in maintenance of menstrual cycle, uterine health and pregnancy by number of feedback mechanisms. Major detoxification of this chemical messenger occurs in liver by two phase mechanism: hydroxylation and methylation and usually take 2-OH pathway of detoxification which is the safest and the most efficient at molecular levels. This pathway also reduces the chances of formation of estrogen adducts which leads to abrupt DNA processing, mutation, and base exclusion. 4-OH and 16-OH pathways of detoxification is usually neglected but if there is disturbances in feedback mechanisms and estrogen load increases it might leads to blockage of energy channels by overlapping them with steroid hormone. These blocked energy channels can be healed and reopened by yoga and naturopathic interventions along with dietary and lifestyle modifications. Yoga kriyas, asanas, bandhas, mudras and relaxation reactivates and balances hormones by suppressing over-processing or rejuvenating endocrine glands to form more of these chemical messengers, without any synthetic chemicals or invasive interventions
215 Sacral Nerve Stimulation for Neurogenic Bladder: Our Experience , R Ramnarayan and H Krishna Moorthy.
Introduction: Neurogenic bladder is a condition causing significant effect on the quality of life of the patient. Sacral nerve stimula-tion (SNM) has a good role in these patients. We report our experience with sacral neuromodulation. Methods: 15 patients with refractory urinary bladder were included in this study. The aetiology of the neurogenic bladder included 7 spinal cord injury, 3 meningomyelocele, 2 failed back surgery syndromes, two multiple sclerosis and one mixed bowel/bladder (aetiology unknown). All 15 underwent test stimulation.Results: Only 10 out the 15 had a positive trial and proceeded to the next stage of implantation. The 3 patients with failed trial were all patients with complete cord injury or injuries below T12 (vertebral level) and more than 8 years duration. Of the other two one was a meningomyelocele and other was a case of advanced multiple sclerosis. Follow up period was upto four years; all 10 patients doing well. One of early cases had lead migration and had to be repositioned. One patient used to develop shock like sensation in perineum; the stimulation was stopped for six weeks and restarted at lower frequency. Conclusion: SNM is a very effective therapy for neurologic bladder in selected patients. Detailed preoperative assessments and trial are very important in this selection.
216 Concomitant Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Myasthenia Gravis-A Two-Case Report , Nan Jiang and Mohamed Kazamel
Few cases of co-existing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and seropositive myasthenia gravis (MG) were reported. However, there is no reports on co-existence of CIDP with seronegative MG or on the responses to treatment of both diseases. We report two cases with diagnosis of CIDP and MG. The first case is 38-year-old African American female with initial diagnosis of CIDP and later onset bulbar symptoms. She was diagnosed with seronegative MG by clinical suspicion and single fiber electromyography (SFEMG). The other case is a 65-year-old British male who initially diagnosed as seropositive MG then he devel-oped paresthesia and difficult walking a few months later. CIDP was confirmed by electrodiagnostic study and albuminocytologic dissociation in cerebrospinal fluid analysis. The first case underscores the importance of performing SFEMG on cranial muscles in cases of CIDP with cranial nerve involvement even if serological testing for MG is negative. In both cases, bulbar symptoms were more responsive to immunomodulatory treatment than limb symptoms.
217 Unusual Occurrence of Spinal Chondromyxoid Fibroma of the C2 Odontoid: A Case Report of a Rare Tumor at an Extremely Uncommon Site , Jean Marie Vianney Hope, Jean Paul Bitega, Edmond Mukimbili, Francis Mugabo and Albert Ndata.
Chondromyxoid fibroma is a rare benign cartilaginous bone tumor that is uncommonly found in the spine. To date, among 13 cas-es reported in the cervical spine, only two cases involve the C2 vertebra and all arise from the body. We report the first case occurring in the odontoid process of a 26-year-old woman. Firstly, because of the craniocervical instability, fusion from the occipital condyles to the posterior elements of C1 through C3 was performed. Secondarily, an expansile tumor of the C2 odontoid process was resected along with phenolization and synthetic processed bone grafting via a transoral approach. The postoperative course was uneventful without recurrence at 3-year-follow up. Then, she has returned to full-time employment
218 Typical and Atypical NMOSD - Its Implications , Venkata Krishna Chaitanya Koduri, Venkata Sundarachary Nagarjunakonda, Veeramma Uppala and Ramakrishna Gajula.
Background:Neuromyelitis optica (NMO) has evolved from Devic’s classical description to a broader disease spectrum of NMO Spectrum Disorder (NMOSD), from monophasic illness to a polyphasic illness with multiple recurrences, disease confined to optic nerve and spinal cord to now brain stem, cerebrum and even with endocrinopathy due to hypothalamic involvement [1], coexisting infections [2] and a variety of autoimmune diseases, including non-organ specific autoimmune diseases and co-existent autoanti-bodies without diseases [3].Objectives:To report, the epidemiological characteristics, clinical presentations, recurrence rate, treatment and response to therapy in 23 patients with NMO spectrum disorder among the Indian population.Materials and Methods:An observational, retrospective analysis of our prospectively maintained data base of patients during the period of May 2018 - June 2018 who satisfied International Panel for NMO Diagnosis (IPND) revised criteria [4] of NMOSD was done.Results:1. 23 case records of NMOSD were retrieved. 14 cases were aquaporin4 positive and 9 were aquaporin4 negative.2. Mean age is 39.6 years. Median age is 42 years (Range 17 - 64). Female to male ratio is 1:2.8.3. Clinical presentations included longitudinally extensive transverse myelitis being the most common followed by optic neuri-tis, area postrema syndrome, seizures and brainstem encephalitis.4. Two had associated herpes simples virus encephalitis, one CSF VDRL positivity. Two had associated retro viral disease. 5. Two had ANA, Anti ds DNA antibody positive vasculitis.6. One had CSF oligoclonal bands in CSF and an open ring enhancement on MRI suggestive of tumefactive demyelination.Discussion and Conclusion:• Contrary to current literature an unusual there is male preponderance in our study population [1,5,6].• Atypical lesions or course(Red flags)should suggest additional work up for associated diseases and prompt treatment of which can lead to significant recovery.• Aquaporin 4 antibody positivity, severity at presentation, associated diseases and relapse rate determine the prognosis.
219 PLEDs and NCSE: To Split or Lump them Together? , Keni Ravish Rajiv, Deepak Menon and Ashalatha Radhakrishnan.
Periodic lateralised epileptiform discharges are electrophysiological biomarkers of acute and sometimes chronic brain injury. A major controversy through the years has been whether PLEDs are truly ictal or just interictal or post-ictal epiphenomenon, and whether these discharges warrant any treatment. In this review, we aimed to critically analyze this issue of whether to actively treat or wait and watch PLEDs in various situations. We conclude that the etiology of PLEDs, depth of encephalopathy and presence of clinical seizures is associated with poor outcome rather than presence of PLEDs per se. Continuous EEG monitoring is warranted to recognise ictal or high risk interictal EEG patterns akin to NCSE before treating aggressively with antiepileptic drugs.
220 Therapeutic Applications of Repetitive Transcranial Magnetic Stimulation in Neurology , Suprakash Chaudhury and Daniel Saldanha
Some neurological and psychiatric disorders present with dis-abling symptoms for which presently effective, mechanism-based treatments are lacking. As a result, researchers all over the world are searching and evaluating newer drugs and also more advanced non-invasive therapeutic methods. One of these methods that modulate brain activity and may be useful in clinical practice is repetitive transcranial magnetic stimulation (rTMS). In this non-invasive procedure stimulation of electrical activity in the brain takes place through a pulsed magnetic field. rTMS is being evalu-ated for number of disorders all over the world.
221 Transient Blindness due to Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient of Beta-thalassemia Major , Muhtamim Chowdhury, Purushuttom Baniya, Vijay Kumar Raut, Fahtiha Nasreen, Tonazzina Hossain Sauda, Zakia Jabin Loskor, Md Moshiur Rahman and Asifur Rahman.
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical but mostly radiological diagnosis with a wide variety of eti-ologies that is commonly underdiagnosed and missed due to the complete reversibility of its course. The pathophysiology lies in the raised blood pressure that disrupts the internal autoregulation within brain. Ours is a patient who presented as such, is a diagnosed case of B-thalassemia major. One previous author reported of PRES in gravid women with abnormal blood picture which being a rarity interested us in reporting this case [1]. Diagnosis now is more MR based but treatment yet remains elusive and mostly symptomatic.
222 Trigeminal Nerve Atrophy due to Vertebrobasilar Dolichoectasia: A Rare Entity. , Ahmad Al Ali, Ihsan F Shanti, Zaynab I Shanti, Bilal F Shanti and Hani Al-Ali.
The term dolichoectasia implies abnormal dilatation and elongation of an artery or vein. In the brain, this condition most com-monly affects the vertebrobasilar system. The exact etiologic mechanism of the disease is unknown. However, many theories are sug-gested such as hypertension, atherosclerosis, and congenital factors (Marfan’s disease, Ehlers Danlos disease, autosomal recessive polycystic kidney disease, Fabry disease and sickle cell anemia).
223 Brain Organoids and the New Context of Bioethical Redefinition. , Antonio Bartolomeu Jácomo Ferreira
The development of the use of organoids, as well as adult stem cells, is the expression that the origin of the relationship between science ethics is complementarity.The ethical challenge of organoids lies in the fact that their cells in their development differ and form structures related to those seen in embryonic tissues.One of the challenges that bioethics faces in the area of organoids is the fact that today we are able to use cells in ways that we might not have imagined until a few years ago.The consequences of using this technique in the animal model is the need to change the degree of ethical commitment in using the animal model. The enhancement of animal faculties.
224 Patient Management Strategy and Resilience in COVID-19 Era. , Mohammad Noor A Alam, Ruma Parvin, Jalal Mohsin Uddin, AQM Omar Sharif, Umme Kulsum Sharmin Zaman, Md Moshiur Rahman and Mohammad Shahidullah.
The COVID-19 worldwide pandemic has profoundly affected our everyday lifestyle, yet in addition to human services conveyance and wellbeing frameworks around the world. Each pandemic begins suddenly, unusually and it surpasses the limit of medical frameworks [1]. Throughout this current year, wellbeing frameworks reacted to the pandemic danger with a lifestyle of general wellbeing estimates intended to both treat and sort the disease, yet additionally to forestall contaminations and critically, to set up the wellbeing framework itself for a surge of contaminated patients. One of the most well-known components to build a wellbeing framework and medical clinic limit has been the wiping out or postponement of planned and elective medical procedures.
225 Surgical Management of Metastatic Spinal Lesions in National Cancer Center of Belarus. , Ivan Papkou and Siarhei Zaretski.
According to different publications, nearly 96% of all spinal neoplasms are metastatic tumors. It is observed that majority (nearly 80%) of patients with disseminated malignant tumors develop spinal metastases.
226 10,000-Fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Motor Neuron Disease Via Intrathecal Superfusion. , Vinod Kumar Tewari, Neeraj, Devesh Johari and Lori Tewari.
Motor Neuron Disease (MND) or Amyotrophic lateral sclerosis (ALS) is a slow fatal neurodegenerative disease characterized by selective and gradual motor neuronal death with unknown aetiology. The insufficient clearance of glutamate through the glutamate transporter and the specific distribution of Ca2+-permeable AMPA receptors in spinal motor neurons, indicates that glutamate-in-duced neurotoxicity is involved in its pathogenesis. NO is generated by nitric oxide synthase (NOS) which acts via 10000-fold effect to reverse the neuronal death. NO is destructive within 5 to 7 days as noted in earlier study by various authors. We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in MND.
227 The Tipping Point: How Little Things Can Make a Big Difference , Chaturvedi Surbhi, Kalia Anchin, Capoor Shekhar and Tank ML.
Stroke is a common neurological complication of cardiac arrhythmias and is associated with increased morbidity and mortality unless diagnosed and treated. Sometimes it becomes difficult to discover cardiac arrhythmias in absence of ECG and 2-D echo findings. Here, we are reporting a similar unique case of recurrent stroke who initially was labelled as a case of cryptogenic stroke later found out to have cardioembolic stroke.
228 Deregulated Homocysteine Metabolism in Friedreich’s Ataxia Patients: A Risk Factor? , Deepti Pathak, Achal K Srivastava, Sheffali Gulati and Moganty R Rajeswari.
Friedreich’s ataxia (FRDA) is a progressive neurodegenerative disorder primarily caused by sub-optimal levels of mitochondrial protein, frataxin, and is characterized by hypersensitivity to oxidative stress. Homocysteine (Hcy) is well acknowledged to mediate oxidative stress-induced toxicity and mitochondrial dysfunction in pathogenesis of several cardiovascular and neurological diseases.Here, we tried to explore the correlation between plasma Hcy levels with various biochemical, genetic and clinical parameters in FRDA. Assessment of Hcy levels in blood plasma of FRDA patients (N = 25) and healthy controls (N = 25) showed that mean levels of Hcy were significantly elevated (9.78 ± 2.7 μmol/l) in FRDA as compared to those of controls (7.0 ± 2.05 μmol/l). The clinical severity of FRDA, as reflected by the (GAA) expansion number in DNA (extent of genetic error), the decreased levels of frataxin protein (pri-mary pathogenic marker), longer disease duration and the high score of Friedreich’s Ataxia Rating Scale (measure of neuromuscular activity) revealed positive correlation with plasma Hcy levels in FRDA patients.
229 An Overview of Conversion Disorder: Prevalence, Causes, and Treatment , Dhruv Beri  and K Jayasankara Reddy.
This paper reviews an overall picture of conversion disorder to develop a clear and systematic understanding of its etiology, causes, and treatment.
230 The Role of Cytokins in Some Viral Infectious Diseases , Shimon Shatzmiller, Galina Zats, Inbal Lapidot and Rami Krieger
Cytokines are small glycoproteins produced by several cell types, mainly leukocytes, which regulate immunity, inflamma-tion and hematopoiesis. They control several physiological and pathological roles, including innate immunity, acquired protec-tion, and an abundance of inflammatory responses. The research of cytokines starts in the 1950s. However, the exact identification of the structure and its function took many years to explore. The original findings were those of IL-I, IFN, and neurodevelopment factors (NGFs); However, these cytokines were purified and trans-ferred in their name years later.
231 Role of Artificial Intelligence in Management of Covid19 Patients: An Editorial Note , Piush Choudhry
Artificial intelligence has now become an integral part of our healthcare infrastructure such as precision medicine in cancer diagnosis, radiological analysis, digital pathology reporting, surgi-cal robots to name a few besides finding brain activity in clinically unresponsive patients. Neural networks are now trained to detect changes in chest x-rays that can predict mortality upto twelve years in advance using parameters such as aortic calcification and heart size. Covid19 is a global pandemic and a life threatening condition that would largely benefit by a software that can cope with unpredictable mutations in viruses which are often beyond routine human observation.
232 COVID-19 in Real Time in a Population of Alamar , Clara Perez Cardenas
Introduction: COVID 19 is a pandemic that currently affects 183 countries. So far it has caused threats to people’s physical health and lives. Has triggered a variety of psychological problems and the field of assistance and research for psychology professionals.Objectives: To specify population information on COVID 19, sources of information used and their evaluation; identify emotional reactions as a result of living in real time this pandemic and point out behaviors assumed food achieve the time of oscillation in the house.Materials and Methods:Qualitative research, developed inthehealth area of the Teaching Polyclinic Dr. Mario Escalona Reguera, in Alamar, Municipality Habana del Este,during the month of April 2020.The interview (telephone) is usedas an information collectiontool, doing content analysis of the responses.
233 A Clinicopathological Correlation of Pineal Region Tumours , Prabal Deb and Gurpreet Kaur
A variety of lesions involve the pineal region these include both neoplastic processes and congenital lesions. Tumors of the pineal region are classified into those arising from the pineal parenchyma, germ cell neoplasms, metastasis, and lesions arising from adja-cent structures. They make up less than 1% of intracranial tumors in adults and are commoner in children.Knowledge of the variety of lesions that occur in the pineal region, their imaging appearances, and their clinical features assists in narrowing the differential diagnosis and optimizing patient treatment of these rare tumors. Pineal gland lesions as it is are rare, with only a few cytologic de-scriptions occurring in the literature. We hereby present 04 cases of pineal region tumours with a radiology cytology and histopatho-logical correlation.
234 Role of 10000-Fold Effect in Improving Urodynamic Parameters with Supra Spinal Cord Injury , Vinod Kumar Tewari, Devesh Johari, Lori Tewari and Neeraj
Background: Spinal cord injury (SCI), whether complete or incomplete of supra-above D6 (SSCI as the autonomic supply of spinal cord is usually controlled and is situated here at D6 level) usually also presents with urinary problems of UMN type. Nitric oxide by virtue of its 10000-fold effect at synapse and neuromuscular junction has been shown excellent results in ASIA grading and also its predictability of improvements has been well demonstrated with the use of ALTENS (Acupressure Like Transcutaneous Epidermal Stimulation). Objectives: To access the urodynamic urinary bladder parameter improvements via 10000-fold effect by Intrathecal Sodium Nitro-prusside (ITSNP) superfusion, on patients with supra spinal cord injury cases.
235 Does Estrogen Therapy Prevent Late Onset Alzheimer's Disease? , Thekkuttuparambil Ananthanarayanan Ajith
Neurodegenerative diseases such as Alzheimer’s disease, Par-kinson’s disease, Amyotrophic lateral sclerosis and Huntington’s disease remain a major challenge to human. Among the neuro-degenerative diseases, Alzheimer's disease (AD) and Parkinson’s disease are two major forms. According to the recent survey in US, more than 5.5 million (age 65 or older) people have dementia caused by Alzheimer’s and remain the 5th leading cause of death among the elders. World Health Organization (WHO) expected ~ 16.2% prevalence of AD among people over 65 years worldwide by 2050. The median survival of AD patients who diagnosed at age 65 years is estimated to be 9 years.
236 Possible Applications of Noisy Synthetic Systems in Covid-19 , Sisir Roy and Sarangam Majumdar
Noise is usually thought as an unwanted signal in the study of science and technology. The introduction of stochastic resonance in nonlinear dynamical systems change our view of the role of noise (in living systems) from the destructive nature to constructive one. We highlight some recent time observations on the role of noise in synthetic systems. Finally, we address the possible application of synthetic systems in a Covid-19 situation along with the role of noise in the systems.
237 Executive Functions and Cannabis Use in Adolescents , Frolli A, Ricci M C, Cavallaro A, Lombardi A, Bosco A, Operto FF and Franzese L
Adolescence is a development stage characterized by multiple neuro-cognitive and psychosocial changes and therefore consid-ered a critical phase of human development. At this stage, is when young adults start consuming substances, consequently the ad-diction process begins. Several studies show that chronic cannabis abuse can cause neurofunctional and neuro-cognitive changes. Particularly it would negatively impact on divided attention, short-term verbal memory and working memory performance. In this study we investigate how abuse of cannabis can affect global cognitive functioning, also through the evaluation of executive functions. Sample population that took part in this study was grouped by the frequency of use of cannabinoid substances (chronic, occasional, and absent consumption). Statistical analysis showed a significant decrease in performance in working memory tasks by subjects who used chronic cannabis (group 1) compared to subjects who did not use it at all (group 3). Future studies could verify the extent of the neuro cognitive alterations through re-evaluations with controlled follow-ups.
238 Knowledge, Attitude, and Practices Towards Covid-19 in Nepal: A Cross-sectional Study , Pooja Prakash, Ayush Chandra, Nabina Shanrma and Avinash Chandra.
Background:The recently surfaced infectious disease SARS-CoV-2 caused by novel corona virus was first reported in Wuhan, China in December 2019. Despite the entire endeavor, it has rapidly infected nearly 200 countries and millions of deaths while many more is counting.In Nepal, the first case had appeared in late January 2020. Till now the lack of knowledge and lack of safe practices are main reason of the spread the pandemic world-wide. Our study aims to assess the Nepalese’s knowledge, attitude regarding COVID-19 and its preventive practices. Methods:A cross-sectional survey was conducted from March 28th to April 8th, 2020. A total of 114 Nepalese residents were selected using convenience sampling method. An anonymous, self-administered questionnaires (SAQ) containing 16 knowledge questions and 3-point Likert scale to acknowledge attitude and practices regarding COVID-19 was used for data collection. Chi-square test as Bivariate analysis and Linear regression models as multivariate analysis were used to assess association between KAP
239 Nutritional Epigenetic Support for Fighting Viral and Toxin Exposure , Jennifer Gantzer
Extrinsic epigenetic influences alter the physiological function and body habitus response to transient as well as long-term expo-sures and more importantly, the outcome of the response. We must prepare nutritionally and epigenetically to sustain and support optimal function which then allows the body’s intrinsic mechanisms to do their job, including fighting foreign invaders (i.e. bacte-ria, virus, parasite, fungus) and eliminating toxins (i.e. chemicals, pollutants, xenobiotic medications and OTC drugs, heavy metals, volatile gases) each requiring bioavailable essential nutrients that power and support enzymatic reactions that are the physiological machinery behind these immune and toxic battles.
240 Young People in the Face of Remote Schooling Imposed by the Pandemic , Eva María Esparza Meza
A fundamental task of young people is to achieve sufficient au-tonomy and maturity to actively insert the social community; for this purpose, the school represents a device of both learning and socialization, which allows the young person to gradually detach himself from family dependence and form a new system of ideas about the world. Data from recent research [1-3] report that both education and socialization have been adversely affected by the pandemic, since due to the globally recommended confinement to prevent the spread of the COVID-19 virus, students moved away from classrooms untimely to continue their education at home through classes taught online.
241 The Protective Role of Self-Efficacy for Resilience in the COVID-19 Period , Andrea Kovesdi, Krisztina Toro, Éva Hadhazi, Szabolcs Takacs, Sandor Rozsa, Gabor Csikos and Rita F Foldi
The aim of our research group is to examine the protection of mental health during a pandemic. In our April 2020 study, we ana-lyzed the association between stress, health anxiety and self-efficacy in terms of resilience. The study included 684 persons, arranged by parents and their children. Women are overrepresented in the sample. Based on the results, we can say that parental health anxi-ety and perceived stress reduce resilience. And self-efficacy is a protective factor for both parental and child resilience
242 A New Definition of Body Schema with Respect to Body-Centered Vs External Frames of Reference , Rodrigues MRM PT MSc
Moving is a way of experiencing the world and the way we move, as well as the way we perceive the environment around us, is rel-evant to this experience. The world we live in, however, is more than an ensemble of coordinates and the body is more than a passive machine ruled by laws of mechanics. A pragmatic view arised in 1920, when Held implied that body schema plays an important role in the control of action, involving aspects of both central and peripheral nervous systems. This is typically a non-conscious process and is used primarily for spatial organization of action.
243 A Brief Review between the Relationship of Chronic Pain with Brain , Abhishek Jha and Suvercha Arya
Pain comprises a multidimensional encounter that incorporates intellectual, full of feeling and tangible qualities in light of noxious stimuli. Numerous frameworks for ordering pain exist. These incorporate multidimensional arrangement frameworks, for example, the International Association for the Study of Pain (IASP) Classification of Chronic Pain, and frameworks dependent on a solitary ele-ment of the pain insight. Of the last frameworks, those dependent on basic pathophysiology and agony term (i.e. intense versus ongo-ing pain) are most ordinarily utilized and structure the premise of this review. Constant agony is a condition where pain advances from an intense to persistent state and continues past the healing process. Ongoing agony disables capacity and diminishes patients’ personal satisfaction. Lately, endeavors have been made to extend our comprehension of persistent agony and to grow better thera-pies to ease constant torment. In this survey, we sum up the aftereffects of past investigations, zeroing in on the systems hidden ongo-ing torment improvement and the distinguishing proof of neural areas related to chronic pain.
244 Burnout among Doctors during the COVID-19 Pandemic , Suprakash Chaudhury, Pushpa V and Daniel Saldanha
There are situations when a doctor is overwhelmed by the sheer number of patients he has to deal with viz. following natu-ral or man-made disasters, accidents or war. Fortunately, most of these occur at one time or over a short period. Though wars may last longer, their intensity and the consequent casualties usually wax and wane. Pandemics however are different; there is a spate of patients who are critically ill and this continues for months on end without let up. Doing duties under severe stress for prolonged periods is going to take its toll on the mental health of doctors, Manifesting with depletion of affective reserves, a sense of unreal-ity along with a negative evaluation of one’s expertise as a spe-cialist. This abnormal mental state was described as “Burnout” by Freudenberger and subsequently by Maslach [1,2]. In addition, during the COVID-19 pandemic, doctors are finding themselves in combat with a new virus about which very little is known and the management of the disorder is being learnt on the job. Almost ev-ery day contradictory evaluations of various treatment regimens are published, which adds to the stress.
245 Impact of COVID-19 Pandemic on Academia , Uriel Halbreich
The COVID-19 Pandemic has been impacting all aspects of life. Scientific publications related to the Pandemic flooded the profes-sional literature. They reflect current focus of public interest as well as academic endeavors and funding. It is of interest when the acute short-term academic interest would give way to long-term pursuits.
246 Realigning Minds and Mental Health Resilience during Covid-19 , Pinky Kain
The ongoing pandemic Covid-19 is impacting lives of millions of people daily by mental health conditions. The current unprec-edented situation demands to highlight mental issues more often and find solutions to deal with stress, anger, setting boundaries in and out of the workplace. A mandatory exhaustive list should pro-vide solutions of how and where one can get mental health coun-seling probably through free E- mental health counselling, health insurances or personal at home and workplaces. A commitment towards building our understanding of mental illness, increasing access to treatment and ensuring support to those who are strug-gling to know they are not alone is required
247 10,000-Fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Essential Tremor Via Intrathecal Superfusion , Vinod Kumar Tewari, Devesh Johari, Lori Tewari, Neeraj, Rajeev Gupta and SD Mishra
Essential tremor (ET) is involuntary tremors at upper part of body specially. The pathological neural circuits of GABAergic neuron of cerebellar dentate nucleus, brain stem (locus ceruleans and inferior olives) and thalamus is involved causes tremulous activity within the cerebellothalamocortical circuits. Nitric oxide donors, like Sodium nitroprusside, modulates the antegrade neurotransmis-sion via retrograde neuroregulation by 10000-fold effect. The GABAergic neurons are in turn controlled by the very sensitive 10,000-fold effect circuits via Nitric Oxide. We have utilised intrathecal sodium nitroprusside superfusion (ITSNP) to induce 10000-fold effect after 2 years of failed routine conservative treatment by oral drugs like gabapentin, topiramate, trihexiphenedyl, or other drugs recommended in one ET cases. We have utilised various clinical parameters like spiral drawing (T-CALM TEST) and video recordings of routine daily activities in pre ITSNP and post ITSNP phase
248 The Effect on Histo-morphology of Lungs in Fluconazole and Vitamin E Treated Sprague Dawley Albino Rats with Septic Shock , Nasir Mustafa, Hina Zahoor and Kanza Shamim
Fluconazole is a subclass of triazole antifungal agents, is available as oral tablets, powder or for oral suspension, and as a sterile solution for intravenous administration. Fluconazole is designated chemically as 2,4-difluoro-α,α1-bis benzyl alcohol in the form of white crystalline solid which is slightly soluble in water and saline. Fluconazole oral suspension contains 350 mg or 1400 mg contains sucrose, citric acid anhydrous, sodium benzoate, sodium citrate, colloidal, silicon dioxide, titanium dioxide, xanthan gum, and natural orange flavor. After reconstitution with 24 ml of distilled water or purified water each ml of reconstituted suspension contains 10 mg or 40 mg of fluconazole. Animals are divided into 4 groups. The rats of group A were taken as control group. In group B rats are kept nil per orally at 12 hours prior to induction of septic shock produce by Candida albicans s. Group C animals are administrated with fluconazole at doses of 3mg/kg, 10mg/kg and 30mg/kg after the septic shock produce by Candida albicans s. Since fluconazole at a higher dose had clearly shown to decrease tissue injury. We decided to keep fluconazole dose as constant and vitamin E would be administered in dose of 10mg/100gm of body weight in group D
249 Preventing and Possibly Reversing Dementia and Alzheimer’s Using Thermotherapy and Vibroacoustic Therapy in 12 Subjects Over 3 Months , George Grant and Jay Vanden Heuvel
The Objective of this study is to find the possibility of the use of both Thermotherapy [Hyperthermia][Heat Therapy] and Vibro-acoustic therapy [Vibration + Sound] to prevent and possibly reverse chronic neurological conditions like Dementia and Alzheimer’s Disease in 12 subjects over 3 months using Pre/Post Biofeedback Testing, Oximeter, Wellness IQ Questionnaire [www.academyof-wellness.com] and CBC blood test results including HBA1C. Overall Results were positive suggesting possible prevention and reversal of Dementia and Alzheimer’s using Thermotherapy and Vibroacoustic Therapy.
250 COVID-19 on Mental Health Crisis in Developing Countries. An Overview , Solomon I Damilare and Sivakumar J T Gowder.
Mental Health has been considered as an important dimen-sion of human health since the origin of Homo sapiens. Other di-mensions such as physical, social and economic factors have also an influence on human health [1]. Mental health refers to fluid contributions of culture, religion, and socio-economic concerns; a psychological conceptualization will still recognize some basic ingredients of mental health such as presence of mental fitness, availability (both real and perceived) of certain qualities, com-petencies, resources, that are potentially available to mobilize as their need arises “and not merely the absence of abnormal behav-ior”. According to Henderson [2], mental health signifies the ope-randi of an individual to pursue reasonable, purposeful goals; use his capacities and talents fruitfully.
251 Novel Brain Linear Measurements to Differentiate between Alzheimer Disease and Normal Pressure Hydrocephalus , Marcos Escosa Bage, Saleh S Baeesa, Mohammed Binmahfoodh and Youssef Al-Said.
Background:An Evans’ index (EI) greater than 0.3 has been associated with a diagnosis of idiopathic normal pressure hydrocepha-lus (iNPH). However, ventricular enlargement is also present in Alzheimer’s disease (AD) in the elderly. To assess the differences between ventricular enlargement in AD and iNPH, we developed a geometric model that incorporated different linear brain measure-ments and compared it with EI.Materials and Methods: Different ventricular linear measurements were obtained from 124 brain CT scans of normal participants, AD and iNPH patients. We developed a geometric model that yielded a linear measurement proportional to the skull shape.The maximum frontal horn distance was divided by this new tool and compared with EI to identify a cutoff point that can allow radiological differentiation between AD and iNPH
252 10,000-fold Effect by a Nitric Oxide Donor (Sodium Nitroprusside) in Parkinsonism Via Intrathecal Superfusion , Vinod Kumar Tewari, Neeraj Seth, Devesh Johari and Lori Tewari
Parkinsonism is a slow but nonfatal neurodegenerative disease characterized by hypokinesia, rigidity, postural instability and tremors, due to low quantity or deficient in dopamine neurotransmitter at Substantia Nigra, parkinsonism develops in, may be be-cause of toxins, head injury or infections or drugs. Dopamine release is also regulated by NO (Nitric Oxide) which is generated by nitric oxide synthase (NOS) and NO acts via 10000-fold effect to reverse the neuronal parkinsonism clinical features. We have used intracarotid and intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in Parkinsonism as a pilot study. The postural instability vanishes completely in 24 hours, loss of tremors was in just 48 hours, loss of rigidity around 5 days and hypokinesia improvement (to 75%) more than 30 days.
253 COVID-19 and Neurology. A Viewpoint , Gabriel Abudinén Adauy
During this last time we have had to learn and investigate this new strain of coronavirus, which not only affects the respiratory tract, but also produces a systemic affection of different organs through diffuse endothellopathy and a severe systemic inflammatory response. In relation to the affection of the central nervous system, there is a direct relationship or neurotropism, through the recep-tors of the type 2 angiotensin converting enzyme (ACE2). This review tries to explain the neurological relationship and SARS-COV 2
254 Publication Pattern of Clinical Parkinson’s Disease Research in Saudi Arabia , Naïf Alotibe, Eman Nasim, Talal Harbi, Raunaq Saba Ali, Muhammad Al Firdausi, Shafiq Ahmad and Shahid Bashir.
Objective: To assess the progress in the field clinical Parkinson’s disease (PD) in kingdom of Saudi Arabia (KSA), by analyzing in depth the research output productivity and publication pattern, and to identify the current situation of PD research and offer solutions.Method:Literature search strategy was designed to retrieve accessible articles that are related to PD utilizing PubMed, Google Schol-ar, and Embase. The retrieved articles were analyzed with several parameters including “journal name, impact factor, year of publica-tion, the affiliation of the first author, city, study design, population, citation numbers, study title and database”.
255 Glioblastoma Surgery: Technology for Gross Total Resection. A Review , Marcos Escosa Bagé
Current technologies used for glioblastoma resection seems to improve accuracy in achieving gross total resection but overall sur-vival has been similar in the last decades with only minimal improvement. Non-enhancing areas on contrast enhanced T1-weighted MRI images has the highest density of viable malignant cells and MRI sequences are not tumor specific, making complete resection of the tumor and obtaining better survival very difficult despite the current combination of treatments. In this article we review the latest technological advances that attempt to improve tumor resection to prolong survival time
256 Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial , Dimitriou Tatiana-Danai, Papatriantafyllou John, Konsta Anastasia, Kazis Dimitrios, Athanasiadis Loukas, Ioannidis Panagiotis, Koutsouraki Efrosini, Tegos Thomas and Tsolaki Magda
Background: Apathy is associated with greater caregiver burden and affects the cognitive abilities of the patient. Having a high prevalence of more than 71% in patients with dementia (PwD), it is a very common symptom in Alzheimer’s Disease (AD). In many cases it remains under-diagnosed or is misdiagnosed with depression. Methods:This study is a cross-over randomized controlled trial with 60 participants conducted in Greece. The participants were randomly assigned in 6 different groups of 10 participants each. The interventions that were evaluated are: a) Body Exercise (BE), b) Reminiscence therapy (RT) and c) Music therapy (MT). The interventions lasted for 5 days and there was two days off, as a wash-out period. There was no drop-out rate. The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaires.
257 A Seven Year Retrospective Review of Spinal Cord Injury Managed at a Physiotherapy Clinic in a South-western Tertiary Hospital in Nigeria , Olukoju Idowu, Opeyemi Oluwasanmi Adeloye, Olaniran Moses Ogunleye, Olubukola Arewa, Oyeneyin David Babatunde and Adegbembo Olusaanu
Introduction:The role of physiotherapy in the management and rehabilitation of spinal cord injury (SCI) patient is well documented. SCI is an enormous devastating condition which affect most commonly young and productive age group of predominantly male popu-lation with motor vehicle accidents accounting for the highest incidence.Method: This is a retrospective review of cases of spinal cord injured patient as seen in the Department of Physiotherapy University College Hospital Ibadan, Nigeria, over the 7 year period, January 1, 2006 to December 31, 2012. The case note accessed account for both out patients and in-patient seen at the hospital for the period under review. Information regarding Age, Gender, Marital Status, Occupation, Year of admission, Religion, Diagnosis/Frankel classifications, Neurological levels and Discharge pattern were retrieved using a spread sheet. Descriptive statistics of frequency, percentage, range, mean and standard deviation were used to summarize data.
258 Dental Health Issues in Persons with Epilepsy , Thania Elizabeth, Nandana J, Jithin George and Ashalatha Radhakrishnan
Epilepsy is a neurological disorder with significant disabilities. Persons with epilepsy (PWE) often need special care and atten-tion. A PWE can have multiple dental health issues in them. It can be due to poor oral hygiene, socioeconomic factors, neglect from the caregiver’s end, antiepileptic medications or due to the attitude by dentists towards them. Seizures by itself can lead on to bone fracture/tooth loss. Antiseizure medications can cause gingival hyperplasia, osteopenia, gum bleeding etc. While giving medications by dentists, undue care should be given to avoid prescribing drugs that lowers seizure threshold. Also in the dental care setting, education of dental hygiene is important. Also it is better to avoid removable dentures. While doing dental surgical procedures, the time duration should be made short as far as possible. Dentists should be made aware that they shouldn’t neglect the care they are supposed to give for PWE.
259 Cyberchondria in COVID19 Pandemic , Suprakash Chaudhury, Pooja V and Daniel Saldanha
As we are all aware of the impact of corona virus on not just the physical health, but mental as well, did we know in the latest news of published by Lancet Psychiatry journal about one in five Covid19 patients develop psychiatric illness in the first 90 days of turning positive? [1]. On comparing the previous large-scale epidemics, one issue of immediate relevance for mental health that is novel for the COVID-19 pandemic is a potentially increased problematic Internet use. The internet is too widespread and the lockdown has paved way for the access to the internet as an essential part of life.
260 The Role of Intracellular Bacteria in COVID-19 Pathogenesis , Abbas Alnaji
Much and a lot we heard about what Covid-19 had did in man/kind and his affairs over the last several months as an pandemic. Still a lot should be said in spite of the coordination of the globe efforts against the tiniest creature. A lot should be said not done! Why? Simply because as ones say our effeorts that basided on the current knowledge is as a humble wooden ship with torn sails thrown right and left by the angry sea waves on the earth of real-ity. For that, I will say my word as being invited by this respected journal in a time I kept standing a side after failed initial start up to present my work to overcome the need for ventilator machines shortage, this shortage both quantitative in numbers needed and qualitative when the lung destroyed and no more act as a vital ring in delivery of oxygen to the tissues.
261 Hemichorea as an Atypical Manifestation of Diabetes Mellitus , Bhavesh Trikamji
Non-ketotic hyperglycemic hemichorea (NHH), also known as chorea, hyperglycemia, basal ganglia syndrome or diabetic stria-topathy, is a rare neurological complication of non-ketotic hyperglycemia. We describe a case of 65 year old woman with previously undiagnosed diabetes who presented to the emergency room with continuous, involuntary, writhing movements on the left side of her body for one weeks duration. Exam revealed choreiform movements involving the left arm and leg. Laboratory testing revealed elevated blood glucose at 250 mg/dl and elevated HbA1C at 6.5%. MRI brain showed T1 hyper intensity in right basal ganglia without GRE correlate. Patient was diagnosed with non-ketotic hyperglycemic hemichorea and started on metformin. Follow-up MRI brain showed resolution of T1 hyper intensity with normalization of blood glucose.
262 Surgical Resection of Spinal Intradural Extramedullary Neoplasms: Policy According to the Lesion Location , Derya Burcu Hazer Rosberg, Selim Ayhan and Selçuk PalaoÄŸlu
Background: Intradural extramedullary (IDEM) tumors account for two thirds of all primary intraspinal neoplasms. They mostly include schwannomas, meningiomas and ependymomas which are located circumferentially anywhere by the spinal cord. Since the clinical symptoms and histology of these tumors are mostly benign in nature, the primary goal of the treatment should be gross total resection without any functional deterioration. Objective: In cases of intradural extramedullary tumors, surgery should be planned with respect to preservation of the stability and the anatomy of the spine without giving any harm to surrounding vital structures. Therefore, surgical policy should be planned thoroughly for the best outcome.
263 Role of 10000-fold Effect in Improving Leg Cramps in Myelopathic Spinal Cord Changes – A Case Study , Vinod Kumar Tewari, Neeraj Seth, Devesh Johari and Lori Tewari.
Leg muscle cramps in cervical myelopathic changes is inconsistent symptom and later on very disturbing to the patient specially in night time while taking rest. NO is generated by nitric oxide synthase (NOS) which acts via 10000-fold effect to reverse the neuronal damage.We have used intrathecal sodium nitroprusside to activate the 10000-fold effect to modulate the retrograde neuroregulation in muscle cramps in cervical myelopathy in a case.
264 Can Visual Complaints be Only Symptom in Slit Ventricle Syndrome? A Difficult Diagnosis to be Made , Sandeep Bhardwaj and Manish Chaurasiya
Background: Slit ventricle syndrome (SVS) is a rare symptomatic condition with radiological findings of small sized ventricles in a case of VP Shunt. Diagnosis may be difficult because radiological imaging of small ventricles can be misinterpreted as normal sized ventricles. SVS is a rare condition of reduced brain compliance with intermittent intracranial hypertension.Cases: Author reported two cases of ventriculoperitoneal (VP) shunted patients with only visual disturbances which on evaluation were found to be SVS
265 Ayushmaan Bharat: Boon for Medical Disorders and Bane for Mental Illness in India , Priya Ranjan Avinash and Rohit Gondwal
Ayushman Bharat a pan India health insurance scheme was launched in 2018. Since its inception, it has been lauded by all. How-ever it has a huge lacunae as far as Mental health care is concerned. The policy makers seem to have forgotten that a huge chunk of mental health care is provided by private health care facilities and ironically private healthcare machineries have been kept out of the purview of this scheme. mental healthcare burden is huge and often born exclusively by caregivers which lead to delayed and inadequate healthcare. We propose the inclusion of private healthcare in the Ayushman Bharat Scheme.
266 The Barking Girl: A Case Report , Malvik Pandey, Pradeep Yadav, Nitesh Kumar Singh and Mona Srivastava
Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience suggests that “habit cough” best describes this clinical entity and that various forms of suggestion therapy includ-ing hypnotic methods are the treatment of choice. Suggestion therapy is effective when it tells the patient that they have the capability to resist the urge to cough. Medicines are generally not successful in the absence of suggestion therapy. Relapses and remissions are common and continuation of the symptoms is also common.
267 Chemical Aspects of Emotive Memory , Gerard Marx and Chaim Gilon
“Chemistry is the only physical science which offers a pathway to understanding animate biology” Medawar [1] (1967).Chemistry has been used to clarify most aspects of biology including metabolism, structure and reproduction. However, current neuro-biological descriptions of animate life are incomplete, as they have not “grasped the nettle” of mentality. The outstanding issue: How do neural nets instigate experiential mental states, such as emotions and memory?Most chemical approaches to neural memory were skewed to pharmacology, which did not address how neurons and the neural net remember, but focused on physiologic effects of drugs.
268 External Shunt Complications in a Series of 100 Cases , Mohameth Faye, Mualaba Celebre, Yakhya Cissé, Alioune Badara Thiam, Momar Codé Ba and Seydou Boubacar Badiane
Introduction:The external ventricular shunt is an emergency procedure allowing the evacuation of cerebrospinal fluid to the out-side by placing a ventricular catheter connected to an external drainage bag. There are several factors which may be responsible for the occurrence of complications. The aim of our study was to collect all the external ventricular shunts performed in neurosurgery, to work on their different complications and to establish a comparison with the data in the literature.Materials andMethods:This was a descriptive study using a retrospective approach about a period of 8 years, from January 2010 to December 2018, on the files of patients who had received an EVS during their hospitalisation at the neurosurgery clinic of the Fann hospital in Dakar.
269 Cerebral-neurological Manifestations of the Acute Respiratory Distress Syndrome (ARDS) , Ahmed N Ghanem
Fluid therapy (FT) was introduced during WW2. Ever since its complications have been frequently reported but notably some se-rious complications have been overlooked. The role of VO in induc-ing VOS and causing ARDS has remained unrecognized until recent-ly, first by me and other authors are now catching up. The role of FT complications in inducing VOS and causing ARDS is hard to detect because VOS is a shock that complicates another existing shock being treated and it occurs seamlessly and un-noticed.
270 Cannabinoid Therapy for Glioblastoma Treatment: A Review , Marcos Escosa Bagé
In recent years, studies have brought to light preclinical evidence of the ability of cannabinoids to reduce tumor growth in animal models, and clinical trials have been designed to study this activity in patients with glioblastoma. The data in animal models show promising results. So far it has been seen that the administration of THC is safe, and can be carried out without psychoactive effects. These molecules act through receptors coupled to the G protein, which are part of the endocannabinoid system and which have been called CB1 and CB2. THC can attenuate tumor progression in some patients, and appears to have a positive effect on survival, similar to that generated by other chemotherapeutic agents. More trials are needed to validate this antitumor action, both in combination with other therapies, and independently. At this time there is not enough scientific evidence to be able to conclusively affirm that can-nabinoid treatment can contribute improve current therapies given to patients with brain tumors or other types of tumors.
271 Should We Embrace the Incorporation of Genetically Guided “Dopamine Homeostasis” in the Treatment of Reward Deficiency Syndrome (RSD) as a Frontline Therapeutic Modality? , Kenneth Blum, Ali Raza, Tiffany Schultz, Rehan Jalali, Richard Green, Raymond Brewer, Panyotis K Thanos, Thomas McLaughlin, David Baron, Abdalla Bowirrat, Igor Elman, B William Downs, Debasis Bagchi and Rajendra D Badgaiyan
In 2019, the US Center for Disease Control and Prevention provided vital statistics related to drug overdoses in the United State1. They concluded that in the USA the number of deaths at almost 72,000 was due to 66.6% of opioid overdoses. In fact, the rate is alarming and increasing yearly. To make 2021 even more scary is the daunting effect on increased drug usage due to COVID 19 as a pandemic, albeit the new vaccines. Specifically, in 2020, the death rate from opioid overdoses rose to 13% nationally and in some sates 30%. The common neuromodulating aspects of neurotransmission, and its disruption via chronic exposure of drugs and be-havioral addictions, requires further intense research focus on developing novel strategies to combat these unwanted genetic and epigenic infractions as accomplished with heroin addiction by our group.
272 Children ‘at Risk’ of Specific Learning Disorder: Individualized Diagnostic Profiles and Interventions , Victoria Zakopoulou, Maria Boukouvala, Nikos Tziakis, Panagiotis Vellis, Pavlos Christodoulides, George Dimakopoulos, Dimitrios Sarris, Maria Vergou, Pilios-Dimitris Stavrou, Vasiliki Koutsobina, Periklis Tagkas and Venetsanos Mavreas
Background:The development of individualized diagnostic profiles of children ‘at risk’ of Specific Learning Disorder (SLD) and the implementation of a well-suited to individual’s specific needs intervention program, could be of high significance for the early investigation of SLD. Materials and Methods: We assessed twenty children 5.4 to 6.0 years old aiming to the accomplishment of the following key-mile-stones: (a) implementation of an adequate cluster of diagnostic procedures, (b) formulation of individualized diagnostic profiles ‘at risk’ of SLD, and (c) implementation of intervention program, tailored to the individual’s profile. Results: According to the results, early extent of weaknesses was determined in the domains of working memory (p = .010), visuo-spatial abilities (p = .028), and phonological awareness (p < .001)
273 COVID 19: From the Perspectives of Children and Adolescents , Kamlesh Jha
COVID 19 has undoubtedly been one of the biggest health chal-lenges of present century for the whole mankind. Since almost an year whole world is desperately fighting the disease with all their available resources with limited success. Irrespective of the devel-opmental status of a country, class or religion, whole mankind suf-fered huge loss in terms of human life, money, jobs and businesses and academics
274 Neurodevelopmental Disorders: The Past, Present and the Future , Prajjita Bardoloi
Neurodevelopmental disorders are a group of complex multifactorial disorders with significant overlapping of symptoms that arise during the developmental period. This article looks into changing perspectives and evolving knowledge of these disorders as well as their future directions. These disorders can not only affect individuals but society as a whole. Accumulated knowledge of these disorders slowly began to change the perception of the disorders as well as how individuals experiencing these conditions are treated by society.
275 Brain Disorders at Admission, During and After SARS-CoV-2 Infection , Magda Tsolaki, Antonios Frontistis, Paschalis Devranis, Maria Zilakaki, Iordanis Saoulidis, Vasileios Siokas, Ioannis Papagiannis, Eleni Liouta, Evagelos Papatolis, Evripidis Pityrigkas, Vasiliki Poulidou, Evangelia Chartampila, Sofia Pettemeridou, Hadar Halivni, Cindy Cheng, Thomas Tegos
The potential involvement of SARS-CoV-2 in Central Nervous System (CNS) has attracted considerable attention because of the neurological and psychiatric manifestations presented throughout the disease process. There have been many reports of extra re-spiratory manifestations, such as neurological and psychiatric symptoms at the admission of the patients in the Hospitals, during and after SARS-CoV-2 infection. The seriousness of the virus in various parts of the body will determine what comes after the initial phase.
276 Non-pharmacological Interventions for the Apathy in Patients with Dementia. A Cross-over Randomized Controlled Trial , Dimitriou Tatiana-Danai, Papatriantafyllou John, Konsta Anastasia, Kazis Dimitrios, Athanasiadis Loukas, Ioannidis Panagiotis, Koutsouraki Efrosini, Tegos Thomas and Tsolaki Magda
Background: Apathy is associated with greater caregiver burden and affects the cognitive abilities of the patient. Having a high prevalence of more than 71% in patients with dementia (PwD), it is a very common symptom in Alzheimer’s Disease (AD). In many cases it remains under-diagnosed or is misdiagnosed with depression. Methods: This study is a cross-over randomized controlled trial with 60 participants conducted in Greece. The participants were randomly assigned in 6 different groups of 10 participants each. The interventions that were evaluated are: a) Body Exercise (BE), b) Reminiscence therapy (RT) and c) Music therapy (MT). The interventions lasted for 5 days and there was two days off, as a wash-out period. There was no drop-out rate. The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaires.
277 Sleep Disturbances and Association of Polymorphism rs2278749 Gene ARNTL in Male Population 25 - 44 Years in Russia/Siberia , Valery Gafarov, Elena Gromova, Dmitriy Panov, Igor Gagulin, Almira Gafarova and Eldar Krymov.
It was found that the most common genotype rs2278749 ARNTL gene was homozygous C/C genotype - 74,9%. Prevalence of C/T and T/T genotype was 22.3% and 2.8%, respectively. It was revealed that persons with the genotype C/T more likely to experience serious conflicts in the family, more experienced their frustration, they often have disturbing dreams, and they wake up tired and exhausted, in addition, they often met the high level of the life of exhaustion, and they soon became frustrated. Persons with genotype T/T often took the trouble “to heart” and were more punctual. On the other hand, persons with C/C genotype were more hostile, were inclined not to trust anyone, almost “never” accept negative situations “close to the heart” and much less experienced disturb-ing dreams
278 COVID 19 Vaccine Hesitancy , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha
COVID-19 is a contagious disease caused by the Severe Acute Respiratory Syndrome Corona Virus-2, a single-stranded RNA genome. After its initial occurrence in, in November, 2019, in Wuhan, China, it has resulted in a worldwide pandemic. In India since early 2020 over 1,05,42,000 have been infected and over 1,52,000 have succumbed to it. A year after the first recorded case in India, the immunisation exercise against the disease kicked off on 16th January, 2021, with two vaccines: Covishield and Covaxin. Serum Institute of India in Covidhield has grafted the COVID-19 antigen onto an adenovirus.
279 Diagnosis and Surgical Treatment of Epidural Varicose Veins of the Lumbar Spine , Kayode Agboola and Eugene Slynko
Introduction:Dilated lumbar epidural veins are vascular abnormalities causing compression, ischemic injury and excessive pres-sure on spinal nerve roots, theca sac or dorsal ganglia, giving rise to symptoms of lumbar radiculopathy of the involved neural struc-tures. Degenerative changes of the spine might also be observed. Importance:The importance of mentioned pathology is in the complexity of its diagnosis - missed diagnosis, relatively small number of observations, classification types, publications and estimates of the long-term outcomes of surgical treatment of this pathology on follow-ups. Misdiagnosis is often encountered due to low awareness even on MRI
280 Role of Non Invasive Ventilation in Neurology Clinical Practice , Arun R, J Nandana and Ashalatha Radhakrishnan
Non invasive ventilation (NIV) has become the standard practice for patients with neuromuscular respiratory failure. As me-chanical ventilator can increase the risk of developing pneumonia or may cause lung injury, non invasive ventilation may be a good alternative for the same in certain neurological disorders. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP). Long-term non-invasive ventilation was introduced in the 1980s, initially for patients with poliomyelitis, muscular dystrophy or chest wall deformities like scoliosis.
281 Different Disease-modifying Treatments do not Affect Quality of Life of Multiple Sclerosis Patients , Fawaz Al-Hussain
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system that causes neuronal damage resulting in a variety of symptoms that include pain, fatigue, muscle weakness, impaired balance, and vision loss. In addition to these neurological symptoms patients also experience a decreased quality of life. Methods: In this study, a cross-sectional analysis was performed to compare the quality of life of MS patients on various treatments including β-interferon injections, fingolimod oral capsules, and natalizumab intravenous infusion. Quality of life was assessed using the patient-reported EQ-5D-5L assessment. A semi structured question guide was also used to include different research groups from various geographical areas to identify literature study about quality of life and reasons behind their preferences with regard to their treatment and care which was analyzed using content analysis and constructivist approach. Mobility, self-care, participation in usual activities, pain, discomfort, anxiety, and depression were evaluated as predictors of quality of life
282 Thoracic Intramedullary Sarcoidosis Masquerading as Thoracic Spondylotic Myelopathy: A Case Report and Review of the Literature , Saikiran G Murthy, Zheng Liu, Krupa Pandey and Adam C Lipson
We report a rare case of biopsy proven, thoracic intramedullary neurosarcoidosis in a 52- year-old male, who was thought to have progressive paraparesis as a result of degenerative spondylosis of the thoracic spine. Despite decompressive surgery, he would, over the course of 21 months, become irreversibly paraplegic and unresponsive to steroid treatment. To our knowledge, this is the only reported case of thoracic intramedullary neurosarcoidosis masked by severe thoracic stenosis and spondylotic changes.
283 COVID-19 Associated Neuroimaging Findings , Niharika Prasad
Neurological symptoms may be vague especially in the elderly with multiple comorbidities and in children. These include altered mental status, headache, anosmia, cerebellar ataxia, seizures, hemiparesis, and syncope. Encephalitis or a Guillain-Barré syn-drome like presentation may occur.
284 Super Refractory Status Epilepticus as the First Presentation of Cysticercal Encephalitis , Abhishek Juneja and Kuljeet Singh Anand
Neurocysticercosis (NCC) is the most common parasitic infection of nervous system. We report a case of 42 year old female patient with headache, multiple episodes of seizures and altered sensorium. Magnetic Resonance Imaging (MRI) of brain showed multiple cysticerci in different stages of development compatible with the diagnosis of Neurocysticercosis. Despite administration of multiple antiepileptic drugs and intravenous anaesthetic agent, patient continued to seize and later succumbed to super refractory status epilepticus. Super refractory status epilepticus (SRSE) is characterized by continuous or recurrent seizures without regaining con-sciousness, lasting for more than 24 hours despite administration of an intravenous (IV) anaesthetic.
285 The Causes of Sadness in the Elderly Resident in a Nursing Home from their Viewpoint. A Qualitative Study , Vahab Karamivand, Behnam Rashidi and Soroush Maazinezhad
Background and Aim:Mood swings such as sadness and depression are very common among the disabled elderly living in nursing homes. A systematic diagnosis of depression is very rare, and treatment is not always based on the best evidence. Distinguishing be-tween grief and non-pathological depression can be challenging, and we have little information about the elderly. The purpose of this qualitative study is to explain the causes of grief and grief from the respective of the elderly living in the nursing home.
286 Ozonetherapy as an Alternative to Pain Treatment in Temporomandibular Disorders , Jose Manuel Caldes Reyes and Maricel Galiano Del Castillo
Introduction:The temporomandibular disorders are very frequent; few studies exist that reflect the effectiveness of the ozone ap-plication intraarticular in the temporomandibular joint.Purpose: To evaluate the remission time of pain in the studied patients after the ozone therapy application. Material and Methods: An intervention study was realized in patients of the International Centre of Investigations of Ozone in La Havana, Cuba. Ozone (O3) was applied with the OZOMED Plus equipment. Ozone was applied intraarticular for ten sections 3 mg/L for a volume of 3 ml equivalent 0.03 mg in one bilateral section. Also combined with a rectal application at a dose of 30 to 40 mg / L for a volume of 200 ml per 20 continuous sections (daily).
287 The Role of Self-efficacy in Adapation Regarding Parental and Child Resilience - A Longitudinal Study on the Two Waves of Covid 19 , Andrea Kövesdi, Gábor Csikós, Krisztina TörÅ‘, Éva Hadházi, Szabolcs Takács, Sándor Rózsa and Rita F Földi
The COVID-19 epidemic also affects families in terms of material, work and relationships, and daily habits. The past 9 months are a lot of time during the extraordinary and stressful period, and its effects will be felt in the long run. Increased anxiety (e.g., double incidence in Canada, [15]) may change basic habits and long-term effects cannot be predicted. Presumably, individual- and family-level adaptation patterns, flexibility, or rigidity determine long-term changes. The study addresses the effects on family balance dur-ing COVID 19, such as perceived stress, health anxiety, and addresses psychological factors that support flexible adaptation during a pandemic period. For example, in the first wave, activity and movement showed a positive association with resilience [1,30] as an option for self-efficient behavior. Analysis of the first and second samples of our longitudinal study shows similar results where self-efficacy is a protective factor against the stress that occurs in a pandemic.
288 Correlation of Clinical Signs and Symptoms in Ventriculoperitoneal Shunt Dysfunction in Children- A Cross Sectional Study , Logavengatesh KV, Santosh Mohan Rao Kanangi, Radhika R, Janani S and Chidambaram B
Aim:To study the usefulness of clinical symptoms and signs in predicting ventriculoperitoneal shunt malfunction in children. Materials and Methods:The study was a cross sectional study of all patients with suspected ventriculoperitoneal shunt dysfunction who presented to the ER. The study was done in a single centre metropolitan tertiary care paediatric hospital over a period of one year. Data from 38 patients were obtained and was analysed using SPSS 14 and Microsoft Excel software. Results: VP shunt block occur more commonly in males and more frequently between the ages of 1-5years. Congenital aqueduc-tal stenosis was the most common aetiology amongst those undergoing shunt revision. Most shunt revisions occurred within 3-12months of the previous shunt surgery. Vomiting, altered sensorium and seizures were the most common presenting symptoms. Bulging AF, CSF leak from operated site and the sunset sign were definitive signs of shunt dysfunction. 74% of cases had an identifi-able ventricular catheter displacement on CT scan. The most common cause was tube block by ependyma and infection as a cause for block was rare.
289 Bourneville Disease (Tuberous Sclerosis), Case Report , Randrianjafisamindrakotroka Ony, Rakotoarisoa Rivo Tahiry Rabetafika, Tongavelona Adrianna, Raobela Léa and Randrianjafisamindrakotroka Nantenaina Soa
Introduction: Bourneville disease or tuberous sclerosis complex (TSC) is an autosomal dominant disease with variable penetrance. It is classically described in the literature as a triad of seizures, intellectual disability and adenoma sebaceum. Rare disease, it con-cerns 1/10000 live births. Retinal phages are present in almost 50% of patients. These are glial hamartomas characteristic of the affection.Case Report: We report the case of a 9 years-old boy referred to the Ophthalmology Department This patient was followed in Rheu-mato-Dermatology clinic for tuberous sclerosis for about 4 years and there was an evolving of his cutaneous lesions. Dermatologists wanted to find out whether there was ocular manifestations. The interview revealed no history of epilepsy, nor intellectual retarda-tion no similar case in the family neither. The patient had angiofibromas on his face, the rest of the somatic examination was nor-mal. On ophthalmic examination his visual acuity was 10/10 P2 for both eyes.
290 Effect of COVID-19 Pandemic on Relationships , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha.
Coronaviruses comprise a large family of viruses, many of which cause illnesses in humans and animals. The coronavirus responsible for the current pandemic SARS coronavirus 2 (SARS-CoV-2) started in Wuhan, China, and then spread worldwide.In a few weeks, more than a hundred thousand cases and deaths were confirmed globally and these numbers kept increasing exponentially. The WHO on March 11, 2020 declared the COVID-19 outbreak a global pandemic. Worldwide, nations tried to halt the pandemic by testing, tracing contacts, limiting travel, quarantining, cancelling large meetings and events, and most importantly, imposing lockdowns.
291 A Case Report on COVID-19 Causing Retrobulbar Neuritis: Neither the Doctor nor the Patient Saw , Ayush Chandra, Avinash Chandra and Basant Pant
Vision problems with sudden in onset points towards the neurological deficit because of underlying acute attacks like stroke, or de-myelinating disease. While these problems are common, the viral infection particularly, novel corona virus, SARS-CoV-2 infection in current situation, should also be kept in physician’s mind and dealt accordingly.
292 Adult Right-sided Hemiatrophy: Dyke-Davidoff-Masson Syndrome in a 30 Years-old Patient , Tijana Vujanić Stankov, Aleksandar Ješić, Vojislava Bugarski Ignjatović, Željka Nikolašević and Marija Semnic
Background: Cerebral hemiatrophy or Dyke-Davidoff-Masson Syndrome is caused by developmental hypoplasia or acquired at-rophy of one cerebral hemisphere and leads to diverse clinical entities. In most cases, diagnose is made upon childbirth or during childhood period. Case: We present a case of 30 years old woman who was admitted to our Clinic of Neurology with left-sided hemiparesis and a his-tory of epileptic seizures during her childhood as well as perinatal hypoxia and reanimation after childbirth. Her magnetic resonance imaging exam showed right cerebral hemiatrophy. Further on, we discuss etiology, radiological morpho-functional findings and cog-nitive impairment in the patient with DDMS.
293 Culturally-biased Scientific Reporting , Uriel Halbreich.
The COVID-19 Pandemic and its consequences illuminates the globalization of the crisis but also differences and discrepancies in reporting the data as well as in their interpretations. From the outset the magnitude of the problem and its spread were assessed according to political interests. Public-Health responses were also implemented according to politics and compliance has been linked to communities` and individuals` preconceived social biases. It is apparent that “the numbers do not speak for themselves”-they are filtered, amplified or suppressed, through the megaphones of their reporters. Truth is in the eyes of the beholder.
294 Phenotypic Variability and Anticipation in a Family of D178N-Familial Creutzfeldt-Jakob Disease , Alfred Stenwin Sunny, Albert Stezin, Bala Balaji V, Nataraja P and Naveen Thota
Familial Creutzfeldt-Jakob disease (fCJD) is caused by mutation in PRNP gene. The D178N variant of CJD is known to have phe-notypic variability and can often mimic other neurological disorders. In this article, we report a family with D178N variant of PRNP mutation with phenotypic variability and anticipation phenomenon.
295 Functional Connectivity as a Tool to Ascertain Language Localization in a Group of Children with Intractable Epilepsy , Byron Bernal, Magno R Guillen, Nolan Altman and Michael Duchowny
Introduction: We investigated the relationship between lateralization indices based on the of Brodmann areas (BA) connectivity and language fMRI paradigms in a group of children with intractable epilepsy. Methodology: Intra-hemispheric ROI-to-ROI connectivity was assessed in 36 epileptic children (24 females) mean age 15.3 years, utilizing resting-state fMRI. Left vs right asymmetries were investigated between (1) BA pairs (pair-wise connectivity: PWC); (2) BA modules (global BA module connectivity: GBA); and (3) cerebral hemispheres (global hemispheric connectivity: GHC). Connectivity strength was graded in T scores (Z normalized values). Lateralization Index (LI) scores based on T values were obtained in all three assessments. Only LI with 2 SD above the mean were considered as significant lateralized pairs. Additionally, simple algebraic differ-ence between left and right T values were obtained (TDIF).
296 COVID-19 Pandemic: Mental Health of Doctors in Bangladesh , Roufun Naher, Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar and Nurul Islam Hasib
Background: The COVID-19 pandemic has affected everyone’s life in all aspects. It presents an unprecedented challenge to public health. Doctors and other healthcare providers are battling the virus on the frontline. Objective: This study is to see the mental health conditions of doctors in Bangladesh during the COVID-19 pandemic as well as to identify the percentage of doctors who are at high mental health risk and thus, need clinical intervention. Method: We have assessed the mental health of 358 Dhaka-based doctors applying ‘General Health Questionnaire-12’ in an online survey.
297 Neural Memory and Mentation , Gerard Marx and Chaim Gilon
From time immemorial, philosophers and theologians struggled to describe how mental states emerge from the operations of the brain.Our own efforts have been focused on memory and emotive states. We define the words: “Mentation”, “sensation” or “feelings”, “emotions”, “memory” and “mind”. In particular, we distinguish between computer memory and neural memory, the former being “demotive”, the latter imbued with emotive qualities. Feelings are sensations linked to psychic states; Emotions are the recall of fee-lings.
298 A Structured Approach to Care for Persons with Multiple Sclerosis: Need of the Hour , Vasundharaa S Nair, Priya Treesa Thomas, Netravathi M and Bhuvaneshwari
Introduction: Multiple sclerosis (MS) is an auto-immune disease which involves an abnormal response of the body’s immune system directed against the central nervous system (CNS) - brain, spinal cord and optic nerves being involved. Suicide is defined as the act of killing yourself, most often as a result of chronic conditions. Objective: The study aims to gain insight into the presence of suicidal ideations among Persons with Multiple Sclerosis and the effect of the same on their Quality of Life. Methodology: To achieve the purpose of the study, the patients presenting to the Multiple Sclerosis clinic of Department of Neurol-ogy were assessed using the Multiple Sclerosis Quality of Life Scale (MS-QOL), Expanded Disability Status Scale (EDSS) and the Scale for Suicide Ideation (SSI). Based on the assessment individualized interventions were carried out focusing on their perception, pre-cautions and the necessary preventive strategies to be taken.
299 Correlation Between COVID-19 Pandemic, Emotion Intelligence and Depression , Mosad Zineldin, Anotine Farhat and Melita Sogomonjan
The Covid-19 pandemic is causing serious fear of falling sick, dying, helplessness and stigma. Such diseases have had a negative considerable influence on every aspect of society of any given nation. Although depression is a commonly occurring global mental health disease, research concerning tools and strategies for early detection, prevention and treatment has not yes focused on the pos-sible utilisation of measures of Emotional Intelligence (EI) as a potential predictive factor impacting depression. The present study investigated the correlation between the construct of EI and the depression during Covid-19 pandemic. A population sample of 141 outpatients (57% female) have completed self-report instruments assessing EI and depression.
300 Beyond Placebo , Maja Roje-Novak
Placebo reaction is a relief of symptoms based on using medi-cally inactive substances or procedures. It seems that a human brain has innate capability of restituting wellbeing according to motivation to regain health and preserve one’s life. Brain- mind responds to informational context around the placebo treatment rather than the substance itself. Rituals around healing procedures stimulates human mind and this stimulation activates cascade of neurochemical processes which involve opioids and dopamine. Ac-tivated prefrontal cortex elicits reactions in neurovegetative sys-tem and hormonal axis which are both connected to immunity and other bodily functions.
301 Encapsulation of Probiotics: Need of the Hour , Amandeep Singh, Rohit Bhatia, Raj Kumar Narang and Uttam Kumar Mandal
Over the past decades, the administration of probiotics has gained much attention. As per the definition of probiotics by WHO, these are living microorganisms used for the management of vari-ous diseases [1]. In the market various strains of probiotics are available. Depends on the properties of these probiotics stains they are used in the management of various diseases. Probiotic plays an imperative role in the prevention of ulcerative colitis. Probiotics guard the intestinal mucosal layer against the attack of microbes. Additionally, it also serves as immunoglobulins. Probiotics also having anti-oxidant and inflammatory properties. But it is evident that in the case of ulcerative colitis, the concentration of probiotics is reduced at the colonic site therefore probiotic formulations are given to the patients to manage the disease [2]. But the problems with the conventional probiotic formulation are their viability. The health benefits of probiotics are purely dependent on the viability and enough number of probiotics in the target intestine.
302 Elastosis Perforans Serpiginosa - A Rare Side Effect of D-Penicillamine Therapy , Kuljeet Singh Anand and Abhishek Juneja
Penicillamine can cause various cutaneous adverse effects. Elastosis Perforans Serpiginosa (EPS) is a rare complication of long-term penicillamine therapy. We report a case of 21 year old male patient, diagnosed as a case of Wilson’s disease 10 years back, and taking D-penicillamine for last 10 years. Now, presented with non-itchy skin lesions over the neck region and bilateral axillae. Skin biopsy showed the presence of abnormal elastic fibers surrounded by acanthotic epidermis compatible with the diagnosis of elasto-sis perforans serpiginosa (EPS). EPS is a rare complication of long-term penicillamine therapy causing transepidermal elimination of abnormal elastic fibers.
303 Levetiracetam Versus Sodium Valproate in Refractory Convulsive Status Epilepticus in Children: An Open Randomized Trial , Rajniti Prasad, Astha Panghal, Ankur Singh, OP Mishra and TB Singh
Purpose: Levetiracetam (LEV) is a safe and effective drug to control status epilepticus (SE) or refractory status epilepticus (RSE) in adults. However, there is discernible lack of evidence of its use in children and adolescents. There is dearth of randomized trials comparing its efficacy with sodium valproate (VPA) in children. We performed an open randomized study to determine efficacy of LEV as an alternative to VPA in treatment of RSE.Methods: We randomized 80 children aged 1 to 16 years with SE not responding to any two of the first line drugs in adequate doses, into two drug groups LEV (n = 40) and VPA (n = 40). Primary end point was cessation of seizure activity within 30 minutes. Response of the two drug groups were compared at 30 minutes, 24 hrs, discharge and one month follow up
304 Combating COVID-19: Testing and/or Vaccinating? , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha
Coronavirus SARS-CoV-2 emerged in a wet market in Wuhan, China, and within a few weeks the morbidity and mortality exhib-ited by it led to the declaration by WHO of a worldwide pandemic of COVID-19 on the 11th of March, 2020 [1]. Plans to halt the pan-demic were devised - based on the proportion of the population at risk that needed to be protected in order for transmission to end significantly and quickly enough. The strategies revolved around the Basic Reproductive Number, R0 being reduced to less than 1. At this value the spread of infection shrinks and gradually shrivels up [2]. The R0 for India was calculated to be 1.2561 [3]. The highest R0for any country was that of the Syrian Arab Republic at 2.7936 and the lowest was for Nigeria at 1.0011. The mean R0 was estimated to be 2.2
305 Changers of Neurons of Central Nervous System and Immune Organs After Initiation of Demyelination and Remyelination with Interferon Beta-1a , Nataliia O Melnyk
After initiation of experimental model of demyelination and remyelination, was investigate morphological changers of neurons and myelinated nerve fibers in organs of central nervous system (CNS) and organ of immune system - thymus.In its experimental work was use model of demyelination - EAE (experimental allergic encephalomyelitis) in rats, and was study changers of neurons in cortex of cerebrum, cerebellum and spinal cord on 21 days and 39 days after initiation EAE. Histological sec-tions of the brain and spinal cord was stain by toluidine blue and cresyl violet, we observed the percentage of neurons with unmodi-fied, moderate and severe structural changes. In organs of CNS we studied of demyelination process in nervous fibers. In investiga-tions of nervous fibers was use methods of electron microscopy and morphometry. On early period EAE we observed demyelination process of nervous fibers, after influence of Rebif®(interferon beta-1a) by 2 weeks, we observed of remyelination.
306 Familial Presentation of Moyamoya Disease in India , Siddharth Maheshwari, Monali Chaturvedi, Suman Kushwaha and Aldrin Anthony
Moyamoya disease is a chronic progressive arteriopathy involving the cerebral vessels and is one of the rare causes of young stroke. Etiology can be idiopathic as well secondary to some other primary disease. It does affect the members of the same family but the definite pattern of inheritance has not been found out yet. There are few studies in the literature about the familial presentation of idiopathic Moyamoya disease, most of them from East Asian countries, which is why there are no common opinions and guidelines regarding the follow up and management of asymptomatic family members of such patients. We present and discuss the case reports of two family members with Moyamoya disease from India to further emphasise upon the need of research and long term follow up studies.
307 Levetiracetam Induced Acute Psychosis in a Patient with Juvenile Myoclonic Epilepsy , Abhishek Juneja and Kuljeet Singh Anand
We report a case of a 22 year old female patient who presented with altered behaviour in the form of anxiety, irritability and agitation for two days. Patient was a diagnosed case of juvenile myoclonic epilepsy for past 10 years on valproate therapy. Patient had been switched to Levetiracetam (1500 mg daily) two weeks back in view of valproate induced side effects. Formal psychiatric evaluation suggested acute psychosis possibly Levetiracetam induced. Levetiracetam was stopped and replaced with lamotrigine. Patient dramatically improved over next two days and became asymptomatic.
308 Spinal Modulation by Dexamethasone Sodium Phosphate, Cyclophosphamide and Miconazole Iontophoresis in asymptomatic SARS-COV2 patient with Extensive Myelitis , Wassim Mushtaq
A very rare neurological complication of SARS-CoV-2 infection includes transverse myelitis. I assume a post-infectious etiology in terms of secondary immunogenic overreaction. Iontophoresis is the process of the permeation of ionic (charged) drugs into the body under the influence of electrical current. Besides increasing therapeutic efficiency by, by passing first pass metabolism there are less risks of systemic absorption and undesirable side effects. The study was conducted in a SARS-CoV-2 patient with transverse myelitis, by transdermal application of dexamethasone sodium phosphate, cyclophosphamide and miconazole by iontophoresis at corresponding vertebral levels to look for the neurological outcome who had been unresponsive to intravenous methylprednisolone. With Dexamethasone sodium phosphate and cyclophosphamide iontophoresis there was modulation of the activity of posterior grey column, fasiculus gracilis and corticospinal tracts, and with miconazole iontophoresis I was able to ameliorate the dyesthesias, fasiculations and muscle atrophy probably due to neuromodulation at substantia gelatinosa and lamina IX and remyelination effect. There were no systemic or localized side effects and no adverse effects occurred during the treatment period.
309 Low Blood Pressure and Haquapathy (Haqua Revitalize Therapy-HART) , Faris AlHajri-PhD(AM)
Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body do not get enough blood. Normal blood pressure is mostly between 90/60 mmHg and 120/80 mmHg.Certain medicines and substances can lead to low blood pres-sure, including: alcohol, anti-anxiety, medicines, certain antide-pressants, diuretics, heart medicines, including those used to treat high blood pressure and coronary heart disease, medicines used for surgery, painkillers. Other causes of low blood pressure include: nerve damage from diabetes, changes in heart rhythm (ar-rhythmias), not drinking enough fluids (dehydration), and heart failure
310 A Rare Presentation of Liver Cirrhosis , Abhishek Juneja and Kuljeet Singh Anand
A 56 year old male patient presented with slowness of activities, gait disturbance and altered behaviour for four weeks. Patient had been diagnosed as a case of alcoholic liver disease for two years. Neurologically, he had rigidity, severe bradykinesia with short stepping gait while walking. Following investigations, patient was diagnosed as a case of alcoholic liver disease with hepatic encepha-lopathy. He was treated with appropriate diet, laxatives and low dose levodopa therapy. He improved over the next few days as his blood ammonia levels also fell. Parkinsonism is a rare presentation of liver cirrhosis with hepatic encephalopathy.
311 Experience of Holding Epilepsy Detection and Management Multidisciplinary Camp Organized in Alibaug, Maharashtra during the COVID 19 Pandemic: A Joint Project by Epilepsy Foundation and National Health Mission, Government of Maharashtra , Nirmal Surya, Hitav Someshwar, BN Sawant, Santosh Kondekar, Saurabh Kamath, Mehul Desai, Arti Sharma, Janvi Someshwar and Pooja Nagpure
There are approximately 13 million people suffering from Epi-lepsy in India and the treatment gap is 50 - 75% largely due to myths and taboo associated with Epilepsy [1]. About 70% patients are treatable with single medicine if the treatment is started in time. Epilepsy Foundation India, established in the year 2009, is a ‘Non Profit’ organization and registered under sections 12A and 80G of the Income Tax Act, 1961. It is dedicated to ‘Cure and Reha-bilitation of Patients suffering from Epilepsy’, spreading awareness and educating the people about Epilepsy
312 Epidemiological Patterns of Head Injury in Bauchi, North-Eastern Nigeria , Ogunleye Olabisi O, Shuaibu Ibrahim S and Obanife Henry O
Introduction:Head injury is the leading cause of death and disability among young adults. It constitutes close to 50% of all injuries. Data have shown that a significant proportion of the world’s population, over 57 million are living with neurological sequalae of head injury. The study aimed to describe the epidemiology of head injury in a center with no previous neurosurgical services in North Eastern Nigeria.Materials and Methodology:Aprospective study that involved all patients managed with head injury between September 2018 and August 2019. Demographic, clinical radiological details obtained and patients categorization made using Glasgow coma scale (GCS) and the treatment offered based it. The outcome was measured with Extended Glasgow Outcome Score (GOSE). Descriptive statistics were obtained Mean Standard deviation SD, Frequencies, Percentages.
313 The Association of Serum Total Cholesterol, Triglycerides Level and The Presence of Diabetic Neuropathy , Eriska Retno Indarti, Santoso Jaeri, Amallia Nuggetsiana Setyawati and Indranila Kustarini Samsuria
Background: Diabetic neuropathy (DN) is the most common complication of diabetes mellitus resulting in a decrease in quality of life. The association between lipid profiles and the presence of DN is controversial. We investigated the association of total choles-terol, triglycerides levels, and the presence of diabetic neuropathy. Methodology: A cross-sectional study among seventy diabetic types 2 patients with (n = 35) and without diabetic neuropathy (n = 35). The presence of diabetic neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI) and asked for fasting venous blood collection for the examination of total cholesterol using the CHOD-PAP method and triglycerides using GPO-PAP method. The association of serum total cholesterol and triglyceride level and the presence of DN were obtained from Chi-square test analysis.
314 Crisis Management Simulation: The Value of Interdisciplinary Debriefing , Devan Patel, Fakhry Dawoud, Brandon Lucke-Wold, Coulter Small, Michele Noles, Dawn Dillman, Mark Baskerville, Donn Spight and Jeremy Ciporen
Objective: Simulation offers an important avenue for surgical and anesthesia training. This is especially important for crisis man-agement scenarios where individuals need to act quickly and efficiently for optimal patient care. Practice based performance can be measured and real time feedback provided during debriefing scenarios. Methods: In this paper, we highlight a dual anesthesia and otolaryngology cavernous carotid injury scenario. The trials were run three different times with inter-trial debriefing.
315 Onabotulinum Toxin-A Injection into Salivary Glands for Parkinson’s Disease-related Drooling , Kuljeet Singh Anand, Himank Goyal, Abhishek Juneja and Rashmi Singh
Background: Excessive drooling is common and problematic issue faced by Parkinson’s disease (PD) patients and their caregivers. Drooling can cause both physical and psychosocial disability. Recent studies of Botulinum toxin type-A (BoNT-A) in PD-related drool-ing have shown favorable results with minimal side effects. Aim: To evaluate the safety and efficacy of botulinum toxin injections into salivary glands in decreasing PD-related drooling.
316 Mental Well-being and Loneliness Among Residents of Karachi During the Second Lockdown of COVID-19 , Hina Zahoor and Nasir Mustafa
Background: Covid-19 emerged as a global pandemic and its catastrophic effects have been felt throughout the world. The pandemic has caused a serious impact on mental health and loneliness of the people. The aim of the present research was to analyze the impact of the Covid-19 on the psychological health of residents of Karachi during the second lockdown. Method: It was a cross-sectional study conducted during the second wave of corona virus via an online survey, in which 380 persons participated. The survey consists of questions for the assessment of symptoms of depression, anxiety, stress by using DAAS-21 scale and for the questions related to loneliness, the UCLA-3 Item Loneliness Scale was used. Participants were selected by convenient and snow ball sampling method.
317 Air Pollution Increases the Risk of Transmission and Replication and Production of Mutant Forms of COVID-19 , Hamidreza Famitafreshi and Morteza Karimian
Air pollution is a dangerous condition to health that adversely affects human societies especially in industrialized countries [1]. However, there are some conditions that air pollution has an addic-tive effect on the pre-existing condition. Nowadays the COVID-19 pandemic has compressed human societies, it is necessary to mini-mize the addictive factors such as air pollution to decrease the risk of transmission, replication, and may be mutation since air pollu-tion is stressful to living creatures.
318 Chronic Cluster Headache from the Beginning Successfully Treated with Verapamil and Lithium: A Case Report , Arícia Miranda, Larisse Cruz, Cássy Moura, Wallyson Souza and Raimundo Silva-Néto
Cluster headache is a trigeminal-autonomic headache that predominantly affects young men. In its pathophysiology, it is believed that there is involvement of the ipsilateral trigeminal nociceptive pathways and activation of the cranial parasympathetic system. We report a case of a 23-year-old man presenting the chronic form of cluster headache from the beginning, according to ICHD-3 criteria. After effective prophylactic treatment, he evolved into an episodic form. To our knowledge, chronic form of cluster headache is un-common and when it is successfully treated it evolves into the episodic form.
319 Intrathecal Ziconotide - Time for Revival? , Georgios K Matis
Chronic pain is a multifaceted condition affecting not only the individuals, but the whole society as well [1]. It has been estimated that 20% of surveyed Europeans suffer from moderate to severe chronic pain which in turn impairs functioning, work and quality of life. Interestingly, direct and indirect health costs for chronic pain exceed those estimated for diabetes, heart disease and cancer.
320 Need for Profound Psychiatric Care Preparedness in India Post COVID-19 , Subhash Chandra
In recent days, India has set a world record for the highest number of new daily COVID-19 cases (India reported 346,786 new cases of Covid-19 on April 24th, 2021). Unlike the year 2020, the COVID-19 death toll of India has also hit a record high, with 2,624 reported deaths on April 24th, 2121. So, the question is: What changed from last year to now? Did they put their guards down too soon by lifting lockdowns and reopening prematurely? Was it a lack of safety measures, including poor mask practices or no re-gard for social distancing? Furthermore, the current death toll and infection rate can also be blamed upon the new variant strain of COVID-19.
321 Pharmacotherapeutic Effects of Hippophae rhamnoides in Rat Model of Post-traumatic Epilepsy in View of Oxidative Stress, Na+,K+ATPase Activity and Sodium Ion Channel Expression , Stanzin Ladol and Deepak Sharma
Background: Post-traumatic epilepsy (PTE) is a brain disorder characterized by an occurrence of spontaneous and recurrent sei-zures post brain insults. Initiation and progression of epilepsy is a complex process involving numerous cellular, molecular, and signalling mechanisms. Therefore, understanding the mechanism involved and finding safer treatments is of paramount importance.
322 Efficacy and Safety of Zonisamide as Initial Monotherapy in Indian Patients with Epilepsy: A Subgroup Analysis of Prospective, Multicentre, Post-marketing Surveillance Study , Sangeeta Ravat, Avathvadi Venkatesan Srinivasan, Ashutosh Shetty, Vivek Kumar, Renu Achtani, Vivek Narain Mathur, Boby Varkey Maramattom, Veeresh Bajpai, Nanjappa C Manjunath, Randhi Venkata Narayana, Balaji Patil1, Parvan Shetty1, Darshana Dighe and Amitabh Dash
Introduction:As very limited clinical data is available in Indian patients with Zonisamide initial monotherapy, a subgroup analysis of data from a prospective, post-marketing. A surveillance study was conducted to evaluate the efficacy and safety of Zonisamide as initial monotherapy in Indian adult patients.
323 Work Experiences as a Neurosurgeon in a Remote City , Manish Kumar Dhiraj
Create awareness in general population that Neurosurgery can be performed in remote areas and at low cost, (the aver-age cost of major brain surgeries in my hospital is about Rs. 1,20,000/-, i.e. approximately $ 1,700 including the cost of surgery, medicines and hospital stay), which is about 5 times less than the cost in big corporate Hospitals in India and much less compared to the cost incurred in the developed countries.
324 Towards Correct and Safe Diagnosis of Specific Learning Disorder in Preschool Age. The perspective of Early Multi-collector Diagnostic Approaches. A Pilot Study , Victoria Zakopoulou, Katerina D Tzimourta, Georgios Ntritsos, Alexandros T Tzallas, Markos G Tsipouras, Loukas G Astrakas, Pavlos Christodoulides, Ioannis Paliokas, Vassilis Zakopoulos and Nikolaos Giannakeas
Background:The wide range of terminology, multiple diagnostic criteria, and multifarious basis of Specific Learning Disorder (SLD) constitutes a new reality in the complex entity of SLD. In this manuscript, we address this issue and present the findings of a pilot study concerning the early diagnosis of SLD, while strongly emphasizing the necessity of integrating and testing a vast range of data from multiple domains and skills to achieve correct and safe early diagnosis of SLD
325 The Impact of Malingering on Inpatient Assault Rates , Julie S Costopoulos, Darby Proctor, Alyssa M Johnson and Skyler G Roberts
Assaults in forensic psychiatric hospitals are costly and damaging to the goals of treatment. This study examines the hypothesis that malingerers were responsible for a significantly higher rate of assaults. Individuals diagnosed as malingerers (n = 112) were matched with genuinely mentally ill individuals (n = 112) based on legal status, length of stay, closest age, and gender. Significantly more malingerers committed at least one assault, and committed a greater rate of assaults than patients with genuine clinical syndromes. Young age and personality disorders were also associated with higher frequency of assaults. Findings support the need to reform methods utilized to identify malingerers prior to commitment to an inpatient setting, to reduce the negative impact of assaults per-petrated by malingerers’ unnecessary hospital stays
326 The Importance of the Anatomical Variations in Practical Medicine , Valchkevich Dzmitry and Valchkevich Aksana
There are many variations of the structure of the human body that can significantly affect the outcome of medical procedures or they can cause pathological conditions in patients. Anatomical variants often met in anatomy and surgery. Knowledge of variant anatomy is extremely important in modern medical education, since the variations of structures can often change the symptoms and the course of diseases. According to the literature, about 10% of cases of intraoperative complications occur due to ignorance of ana-tomical variants. The anatomist teacher is obliged to analyze clinically significant variants of the structure of organs and structures with students during practical classes in anatomy.
327 Tumefactive Virchow Robin Spaces and its Mimics in Paediatric Patients: A Pictorial Review , Bhavini Gupta, Sumit Pruthi, Omprakash Tavri and Sarfaraz Shaikh
Virchow Robin spaces represent pial-lined perivascular spaces and correspond to extensions of subarachnoid space, found in cer-tain characteristic locations around the brain. These spaces are predominantly filled with interstitial fluid and follow CSF intensity on imaging. Enlarged Virchow-Robin spaces, also known as enlarged perivascular spaces (EPVS) are considered when their size increases beyond 2 mm.
328 Benign Sacrococcygeal Teratoma in Adults: A Systematic Review of the Literature , Anudeep Yekula, Sulekhya Inturu, Samiksha Jain, Anuroop Yekula, Abhinaya Kotha, Anurag Pasula and Kiran Kumar Yekula
Sacrococcygeal teratomas are tumors derived from embryonic germ cell layers predominantly occurring in pediatric cohorts. They are rare in adults and limited data exists on their clinicopathologic characteristics and their management. Methods:The aim of the study is to explore the demographic, clinical, radiographic, histopathologic, and the management of SCT in adults through a comprehensive systematic review of literature.
329 COVID-19: Psychosocial Impact on Medical Students. Comparison of Summer-Winter Results , Patricio García-Espinosa, Xóchitl Ortiz-Jiménez, Edgar Botello-Hernández, Rebeca Aguayo-Samaniego1, Jorge Leíja -Herrera, GECEN Investigators and Fernando Góngora-Rivera
The current SARS-CoV-2 pandemic has caused feelings of anxiety, confusion, and panic among the world's population. Because of these psychological changes resulting from the stress caused by the disease, we sought to investigate the psychological impact of the pandemic on the university student community
330 The Normative Value for Heart Rate Variability for the Assessment of Sympatho-vagal Balance in Healthy Adult Population of Bihar , Yogesh Kumar, Pramita Dubey, Kamlesh Jha, Tribhuwan Kumar and Ramji Singh
Recording of HRV will help us to identify cardiovascular autonomic derangement earlier. However, to be used clinically, normative data has to be established. In this study, HRV analysis of 111 young healthy subjects aged 18 to 30 yrs is done who are divided on the basis of gender. In time domain parameters, values are slightly higher for males for RR interval and slightly higher for females for RMSSD and PRR50%. In frequency domain parameters, higher values are found for VLF for males and LF and HF for females. Total power is higher for females and LF/HF ratio is higher for males. However, no comprehensive investigations of all HRV indices in large normal populations have yet been performed
331 Intramedullary Spinal Cord Metastasis from Urothelial Carcinoma , Michael Spinrad, Pouya Entezami, David Jones and John Dalfino
Intramedullary spinal cord metastases (ISCM) are rare neoplasms often associated with significant neurological deterioration. Spinal cord metastases secondary to bladder carcinoma are particularly rare. We report a 56-year-old male found to have an intra-dural intramedullary lesion at T12. A bladder mass was also discovered on ultrasound, as well as additional systemic metastases. A dorsal approach was undertaken for the spinal cord lesion. Bladder carcinoma was confirmed as the origin of this metastasis histo-pathologically. ISCM carries a poor prognosis and information is limited to case reports and series. Early recognition could improve patient therapy and quality of life
332 Herpes Simplex Virus Type 2 Encephalitis with Herpes Simplex Virus Type 1 MRI Findings in an Immunocompetent Adult , Lintu Ramachandran, Vibhav K Bansal, Muhammad Janjua, Taha Mohamed Djirdeh and Janine Borja
Infectious encephalitis is a common cause of acute altered mental status in adults. Most cases of viral encephalitis are often from Herpes Simplex Virus (HSV)-1 and are commonly associated with specific MRI findings that include temporal lobe changes. HSV-2 associated encephalitis is however remarkably rare.Even in HSV-2 encephalitis cases, MRI findings of temporal lobe changes are not typical. We present the case of a patient who presented with classic MRI findings, but was found to have PCR confirmed HSV-2 as-sociated encephalitis. We discuss and hypothesize mechanisms by which HSV gains access to CNS and the reason behind increasing cases of HSV-2 associated encephalitis.
333 The Biofeedback Therapy on Academic Stress among Graduate Students , K Jayasankara Reddy
The study aimed at understanding the effects of Biofeedback therapy, as an intervention strategy, on academic stress of undergradu-ate college students in Bangalore, India. Bangalore has been dealing with an increase in student suicide rates and academic stress has been touted to be one of the reasons for this increase. Moreover, academic stress is also linked with increased anxiety and depressive symptoms. Biofeedback therapy is a relatively new method of treatment, which utilizes modern technology to address various issues such as stress, by helping the individual self-regulate and monitor their own bodily processes thereby, reducing stress. Students with higher levels of academic stress were screened using the Academic stress scale
334 Pandemic Fatigue: An Overview of Systemic Processes , Primavera Fisogni
Pandemic fatigue is a recurrent topic in the narration of the mental effects due to pandemic. It is generally described in term of self-exhaustion or tiredeness, lack of attention, difficulty in carrying out the operations of everyday life, anxiety and loss of hope. It affects, in different ways, those who are particolarly exposed to the distress of COVID-19 (health systems operators) and ordinary people. Being a discomfort rooted in the existential frame, pandemic fatigue cannot be interpreted only as a sole cluster of psycholo-gical/psychiatric symptoms or syndromes.
335 Neurological Manifestations of COVID-19 , Suprakash Chaudhury, Tahoora Ali and Daniel Saldanha
Although, the most common and important clinical presentation of COVID-19 is respiratory illness, reports of neurological symptoms are increasing. The neurological features can be as a result of a combination of non-specific complications of systemic disease, the effects of a direct viral infection and inflammation of the nervous system and its vasculature [1]. The neurotropic and neuro-invasive properties of the coronaviruses enable them to easily enter the CNS through the olfactory bulbs, most commonly; causing inflammation and demyelination in cases implicating neurological involvement.
336 The Association Between Serum Biomarker Levels and Clinical Outcomes among Acute Ischemic Stroke Patients , Retnaningsih, Ben Asiel Padang, Windri Kartikasari, Christina Roseville Lasma Aritonang, Amin Husni and Santoso Jaeri
Background:Ischemic brain damage results in the release of some of the neurons or glia-specific biomarkers including S100 calci-um-binding protein B (S100B), glial fibrillary acidic protein (GFAP), and neuron-specific enolase protein (NSE). These biomarkers are currently being used in neuroimaging studies in the management of stroke patients. Unfortunately, the association of these biomarkers and clinical outcome among acute ischemic stroke patients are still in debate. This study determines the association of serum S100B, NSE, and GFAP levels at 72 hours onset with the changes of the NIHSS score between the onset of day 3 and day 7 in acute ischemic stroke patients.
337 Focal Electrical Status in a Rare Case of Unilateral Perisylvian Polymicrogyria , Ravish R Keni, Sreekanta Swamy, K Achint, M Sowmya, Ravindra B Kamble, KN Harsha, Kalale Nikhil Nagaraj and P Usha
Centroparietotemporal (CPT) spikes in EEG are commonly associated with childhood epilepsies such as Benign Epilepsy with Cen-trotemporal spikes (BECTS). This EEG finding can rarely be associated with symptomatic peri-rolandic epilepsies due to pathologies such as perisylvian polymicrogyria (PMG). We report a rare case of left perisylvian polymicrogyria presenting with refractory sei-zures and focal electrical status in EEG. We highlight the electroclinical features that warrant an MRI brain to rule out a possibility of perisylvian PMG in children presenting with seizures and CPT spikes in EEG.
338 Covid 19 and its Psychological Resilience among Different Population - A Short Review , Prabhu MR, Dwajani S and Sahajanand H
The COVID-19 pandemic has rapidly spread across the globe causing massive disruptions to everyday life with its impact of health, economics, human behaviors and mental illness. A wide range of mental illness and psychological effects have been observed during COVID-19 pandemic outbreak in all over the global level. The excessive level of stress during COVID-19 pandemic affects healthcare workers and their family members for financial losses contributing to wide spread emotional distress and increase for psychological stress and other mental symptoms. These impacts on healthcare workers may increase their stress and this could be associated with other variables like anxiety and depression.
339 Recurrent Cerebellar Hemangioblastoma with Thoracic Intramedullary Spinal Tumor in a Young Patient with Von Hippel Lindau Disease: A Case Report , K Raja Shekar and BT Badadal
Introduction: Hemangioblastomas are most common intraaxial tumors in patients with VHL syndrome.They are commonly seen in cerebellum and spinal cord. These are associated with retinal angiomas, cystic lesions in pancreas, kidney and epididymis.Case Presentation: A 22 year old man who underwent surgery for cerebellar hemangioblastoma 4 years ago has now presented with complaints of headache, visual blurring, difficulty in walking since 2 months. He also had decreased speech output.His family history was significant as his mother died of cerebellar hemangioblastoma.
340 A Comprehensive Study for the Pharmacological Activities of Mercurius Solubilis , Simranjeet Kaur
At room temperature, mercury is a silver- colored metallic element in fluid form. Organic and inorganic mercury salts are used as antiseptic, preservative, vaccine, etc. exposure of various mammalian species to mercurial compounds can give rise to immunosup-pression and auto- immunity. Merc solubilis is of mineral origin. Mercurius solubilis, is prepared from mercury nitrate, Hg (NO3)2. This medicine is used clinically in homeopathy for the treatment of infectious and suppurative processes. Mercurius solubilis is also used for treatment of various acute and chronic inflammatory conditions by homeopathic physicians. It is also called as Quicksilver. Mercurius solubilis is considered as a best alternative drug for acute inflammatory conditions treatment
341 Sarcopenia: A Clinical Review in Spinal Cord Injury Patients , Ali Otom, Bilal F Shanti, Ihsan F Shanti and Maram Bani Mustafa
Sarcopenia is a progressive decrease of muscle function, bulk, and strength that occurs gradually as we age and become frail. This results in a decline in physical stamina that affects normal individuals and those with disabilities. Sarcopenia interferes with func-tionality, productivity, activities of daily living, and poses risks related to deconditioning and predisposition to physical and psycho-logical consequences. The affected individuals become at increased risk for falls, lack of independence, increased fatty tissue, social isolation, and eventual possible depression. Sarcopenia was considered a natural course of the aging process and was not considered a disease. But, recently, with revised consensus on definition, it is now considered a muscle disease that can be acute or chronic. Em-phasis here is made at the difference between aging that is a natural process and frailty that is partially reversible.
342 Effects of a Whole-body Vibration on Fatigue-pain and Mobility Among Adults and Middle-aged People , Fayz S Alshahry, Alya A Alalwan, Latifah M Alruwaitea, Latifa M Alshawi and Lamia A Alhussain
Introduction: Whole body vibration (WBV) is a device that conducts oscillatory motion. WBV stimulates muscle spindles' primary motor endings in muscles which rises primary afferent neurons sensory input led to produce powerful alpha motor neuron output, result in increased recruitment rate of motor units that improve muscles activity. WBV does not cause any harmful side effect unless exposed to it with high frequency for a long period of time.
343 Effectiveness of a Brief Cognitive Behavioral Intervention in Insomnia: Case Report , Horacio Balam Alvarez-Garcia
The clinical case of a 38-year-old man with chronic insomnia lasting two years is presented. The problem has begun to affect their work, social and sexual performance. The patient reports that the problem has been present since his adolescence, but worsened when he began to work independently. Due to excessive daytime sleepiness and poor sleep quality, she decided to take care of her problem. After an assessment, it was decided to implement Brief Cognitive Behavioral Therapy for Insomnia. The intervention com-ponents were: sleep restriction, stimulus control therapy, sleep hygiene, muscle relaxation, and cognitive restructuring. The inter-vention lasted six sessions divided into: one for evaluation, and five for treatment. Pre-treatment and post-treatment measurements were made with psychometric instruments and sleep diaries. Finally, it is observed that the symptoms of insomnia decreased and the quality of sleep increased, however, the limitations of the clinical case study are shown
344 Modulation of Aromatase (CYP19A1) Gene in the Testis of Mice Under the Exposure of 4-Nonylphenol , Kusum Kusum, Ashish Ashish, Sangeeta Rai, Royana Singh and Radha Chaube
Background: 4-Nonylphenol (4-NP) is an Endocrine Disrupting Chemical (EDC), which interferes with endocrine (hormonal) system at certain doses. It is the primary final degradation product of Alkylphenolethoxylates (APE) which is a non-ionic surfactant, widely used in industries, agriculture and domestic purposes. 4-NP is a persistent and ubiquitous Xenoestrogen with endocrine disrupt-ing activities. It is highly prevalent in aquatic environments and is moderately bio-accumulative due to its lipophilic nature. Several studies have reported adverse effects of 4-NP on male reproductive system, including testicular abnormalities with gene expression profiling.
345 Use of Artificial Intelligence in Healthcare Applications , Piush Choudhry
In this era of modern times innovative technology and unpre-dictability of diseases we need to prepare ourselves to fight the un-known. There are limitations to exercise the human brain through the vast boundaries, that encompass spectrum of human diseases and behavior. Therefore, supplementing our own cognitive abili-ties with computing would definitely be beneficial in terms of management and treatment of the human body.
346 Covid19-9 Infection Induced Hydrocephaly: A Case Report and Review the Article , Amir Kamalifar, Firooz Salehpour, Farhad Mirzaii, Samar Kamalifar and Ebrahim Rafeei
Covid19-9 can be presented with various neurological problem like headache, dizziness, anosmia...and sometimes was make disaster situation like intracranial hemorrhage. We report 32 years old woman with post covid19-9 infected late onset hydrocephaly
347 Virtual Adaptation in Corona Pandemic in Neurosurgical Practice , Md Moshiur Rahman and Sabrina Rahman
The coronavirus disease 2019 (COVID-19) pandemic, which was caused by a novel coronavirus (severe acute respiratory syn-drome coronavirus 2), has threatened human civilization. This pandemic has imposed a significant impact on the field of neuro-surgery.
348 Cerebral Venous Thrombosis: An Important Cause of Bilateral Thalamic Involvement , Aravind G, Monali Chaturvedi, Suman Kushwaha, Aldrin Anthony and Siddharth Maheshwari
Cerebral venous thrombosis (CVT) has protean manifestations, radiological features and treatment outcomes. The first case that was described in literature was a 45year old man with headache, seizures and delirium. In India the first case series was reported in 1957. At that time it was a lethal disease with no antemortem diagnostic modalities. With current advances in imaging, it has now become easier to diagnose and treat. We present an interesting case of a 43 year-old male with hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami.
349 Microsurgical Clipping of Paraclinoid Aneurysm , Ivan David Lozada-Martinez, Mohammed Maan Al-Salihi, Abdur Rahman, AHM Ataullah, Sabrina Rahman, Md Nazmul Huda Ridoy, Karen Muñoz-Báez and Md Moshiur Rahman
Through pterional approach and trans-sylvian dissection op-tico-carotid cistern was exposed and anterior clinoid was drilled intradurally, proximal dural ring was sharply cut and paraclinoid aneurysm was clipped by a fenestrated clip parallel to carotid.
350 What We Need to Know When the Patient has a Stroke with or without COVID-19? , Huang Wei Ling
The study carried out by the author, studying the chakras’ en- ergy centers of a thousand patients in her clinic in Brazil, she found that more than 90% of patients she is attending have no energy in the chakras’. The study was published in an article written by Huang (2021) entitled Chakras’ Energy Deficiencies as the Cause of Fatigue Post SARS-CoV-2 Infection Patients Treatment
351 Conditioned Medium from the Stem Cells of Human Exfoliated Deciduous Teeth Rescues White Matter Injury in Neonatal Rats , Lingyi Huang, Zizhuo Zheng, Hui Li, Yi Qu and Fengyan Zhao
White matter injury (WMI) is the most common type of brain injury in premature infants. Hypoxic ischemia (HI) is the major cause of neonatal WMI and in that case oligodendrocytes (OLs) are the main involved cells. Stem cell transplanta-tion which can differentiate into OLs or promote endogenous OLs survival or differentiation is considered to be the optimal strategy for the treatment of WMI. Specifically, the neural crest-derived origin of stem cells from human exfoliated deciduous teeth (SHEDs) predisposes the cells to be optional candidates for the treatment of nervous system diseases. Recently, the conditioned medium from SHEDs (SHED-CM) has also garnered more and more attention as it can replace most of the paracrine roles of SHEDs. In the present study, we aim to explore the effects and related mechanisms of SHED-CM on the treatment of neonatal WMI.
352 Post-Operative Complications of Ventriculoperitoneal Shunts in Children at the Children’s Hospital $ The Institute of Child Health Lahore , Mian Awais, Akhtar Munir, Lubna Ijaz, Muhammad Akmal Hussain, Ihsan Ullah, Muhammad Jahanzeb Aslam and Rimla Ayesha
Objective: Hydrocephalus is the most encountered pediatric neurosurgical abnormality, with a high prevalence in developing coun- tries. Untreated, hydrocephalus leads to permanent disability or death. The epidemiology and outcomes of hydrocephalus treated by ventriculoperitoneal (VP) shunts in Pakistan still are not well defined and vary by region and class. The aim of this study was to determine the post operative complications of VP shunt in children presented to Department of Pediatric Neurosurgery in The Chil- drens Hospital $ The Institute of Child Health Lahore.
353 Manual Therapy for Cervicogenic Headache , Umasankar Mohanty
Headaches are often caused by disorders of the neck or physical and emotional tension. Skilled manipulative physiotherapists can successfully treat headaches originating from the neck or soft tissues and facilitate to prevent the pain arising from cervicogenic headache.
354 Evidence-based Psychological Intervention in the Treatment of a Pre-adolescent with Attention Deficit/Hyperactivity Disorder: The Circumplex Approach , Suela Ndoja and Kledi Bala/Lame
The manifestation of significant behavioral problems, inadequate social and adaptive abilities, and high levels of depressive symptomology have consistently been observed in children and adolescents with multiple disabilities including those with attention and hyperactivity disorder. Understanding, evaluating, and addressing this magnitude of emotional, behavioral, and cogni- tive problems requires a systematic, integrative approach to psychological intervention that functions as a cascade network.
355 Cranioplasty, Head Trauma and Neuropsychological Rehabilitation , Espinosa-Gil Rosa María, Raya-Güimil David and Monteagudo Santamaría María
Decompressive craniectomy in people suffering from head injuries have been performed since the early twentieth century. At first they were performed in both hemispheres and today it is usually performed in the affected hemisphere. Although it is usually the last measure to be taken by neurosurgeons due to the strong risk it entails at the functional level, its practice is still necessary for some patients.
356 Sensory Motor Polyneuropathy in a COVID 19 Patient: An Interesting Case Report , Pushpanjali R Ojha, Mohd Saif Khan, Pradip Kumar Bhattacharya, Aneesha Thomas and Kritika Raj
The neurotropic effect of SARS - CoV2 virus manifests as inflammatory and demyelinating changes. The major entities reported were stroke, GBS, ADEM and encephalitis. A rare case of sensory motor polyneuropathy (SMPN) in COVID 19 was reported in our institute.
357 Bilateral Thalamic Tumour in Children: Therapeutic Problems in Our Setting - A Case Report and Review of the Literature , Mhacks Malangu, Elisée job Befio, Jean Michel Nzisabira, Célèbre Mualaba, Daddy Singoto and Momar Codé Ba
Thalamic tumours in children are rare, although their incidence has not yet been established. We report a case found in our milieu in order to share experience and awake practitioner about the existence of this lesion in children.
358 Bilateral Thalamic Tumour in Children: Therapeutic Problems in Our Setting - A Case Report and Review of the Literature , Mhacks Malangu, Elisée job Befio, Jean Michel Nzisabira, Célèbre Mualaba, Daddy Singoto and Momar Codé Ba
Thalamic tumours in children are rare, although their incidence has not yet been established. We report a case found in our milieu in order to share experience and awake practitioner about the existence of this lesion in children.
359 Fear of COVID-19 Reinfection , Suprakash Chaudhury and Tahoora Ali
How long does the immunity inferred from COVID-19 infection last? What are the chances of contracting the virus again? How likely is reinfection with a new strain? What will be the severity of a probable reinfection? When will herd immunity against COVID-19 set in? Queries of such nature are puzzling not just the general population, but are also posing a formidable challenge to scientists and epidemiologists.
360 td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;} Effects of Testosterone Replacement Patients with Moderate to Severe Head Injury and Persistent Hypogonadotropic Hypogonadism: An Open-label Randomized Controlled Trial , Chandan H Anandegowda, Srivatsan Thirumalai Vasu, Kanishk Parmar, Vishnu PS, Lakshay Raheja, Haroon Manadath Pillay, Venkidesh Krishnamoorthy and Rahul Srinivasan
Traumatic brain injury (TBI) pertains to the significant potential for brain parenchymal lesions after suffering cranial trauma. Individuals with TBI are at high risk for developing neuroendocrine dysfunction, especially moderate and severe types. This study was conducted to understand relationships between hypogonadism and outcomes at 6 months post-TBI and to study the effect of testosterone supplementation in patients with persistent hypogonadism on the outcome of moderate to severe TBI
361 Comorbid Multiple Sclerosis and Huntington’s Disease , Sandro Marini, Michelle Kaku, Stephanie L Bissonnette and Ornella Dubaz
Huntington’s disease (HD) and multiple sclerosis (MS) are two neurodegenerative diseases for which different pathologies and limited commonalities have been described. Here, we report the second case in the literature of comorbid MS and HD. When comor- bidity occurs between rare diseases, shared pathological pathways may be suspected and common genetic or environmental triggers can be hypothesized to ultimately advance the understanding of the two diseases.
362 Postoperative Intracranial Remote Haemorrhages: An Experience from 2 Tertiary Care Hospitals , Kartik Manoj Multani, Rahul Srinivasan, Haroon Pillay, Boyina Jagadeshwar Rajesh and Kotakadira Srinivas
Postoperative haemorrhages (POH) after any neurosurgical procedure can be seen at surgical site or at virgin sites away from operative field, more commonly known as remote haemorrhages. Cerebellum is the most common site of remote POH while supratento- rial remote POH are very sparsely described in literature. usually benign in their clinical course but sometime can condemn patients to devastating morbidity and mortality. Due to the rare reporting, natural history of remote POH and its exact pathophysiology is not very well known that can put clinicians in a jumbled position. Multiple theories have tried to explain its genesis, of which most widely accepted are “Cerebellar sag theory” and “Drain theory”. Other theories that lack good supportive evidence blames surgical position, sudden decompression of intraaxial lesion, preoperative coagulation defects and cryptic vascular malformations as plau- sible culprits for remote POH. Their treatment is usually based on severity of clinical presentation and can range from observation to need of surgical evacuations.
363 Hypothalamus and Hypothalamic Dysfunction in COVID-19 , Luis Rafael Moscote-Salazar, Md Moshiur Rahman, Sabrina Rahman, Ivan David Lozada-Martinez and Mohammed Maan Al-Salihi
The recent pandemic associated with the new coronavirus has represented a new paradigm in different aspects of medicine. The neuroinvasive properties verified regarding SARS-Cov2 have allowed us to know how this virus affects multiple organs and systems in the human body. One of the affected structures is the hypothalamus, an anatomical region located in the diencephalon with different vital functions for the body's normal functioning  
364 Neurobiology and Spirituality in Addiction Recovery , A Kenison Roy lll, Abdalla Bowirrat, David E Smith, Eric R Braverman, Rehan Jalali, Rajendra D Badgaiyan, David Baron, Luis Llanos -Gomez, Debmalya Barh and Kenneth Blum
This commentary explores the neurobiology of spirituality and asks whether it is possible or desirable to apply genetic engineering to increase human spiritual and religious experience - (gene-spirituality) to deal better with the ever-increasing catastrophes that face humanity? Neurological connections between spirituality and reward genes, reward deficiencies (RDS) (hypodopaminergia), the mirror neuron system, and the default mode network are examined. Some interventions from addiction medicine that may be useful to enhance the neuro-spirituality connectome identified as a cornerstone of the Purpose and Meaning of Life as Reward (PMLR) are identified as reasonable targets for interventions to treat RDS and balance DMN activity.
365 Fraudulent Science and Starling’s Law for the Capillary-interstitial Fluid Transfer , Ahmed N M Ghanem
Substantial evidence currently exists to demonstrate that Starling’s law is wrong , the revised Starling Principle is a misnomer and all the formulae that goes with it are also wrong. Persistent to  defend  such  erroneous  concepts  is  a  futile  attempt  to  defend  fraudulent science. It is well known that Starling’s law dictates the rules on fluid therapy for the management of shock which misleads physicians, and particularly anaesthetists and surgeons, into giving to much fluid during shock resuscitation, induction of anaesthesia and prolonged major surgery [3]. This practice induces the newly recognized volumetric overload shocks (VOS) that cause ARDS and hundreds of thousands of patients death per year  though remain unrecognized and underestimated
366 Study of the Clinical Profile, Management and Follow Up of Patients with Longitudinally Extensive Transverse Myelitis in a Tertiary Care Centre in India , Kumar Abhinav, Aldrin Anthony Dung Dung, Suman Kushwaha and Monali Chaturvedi
Longitudinally extensive transverse myelitis (LETM) is characterized by contiguous inflammatory lesion of spinal cord extending to three or more vertebral segments. NMO is invariably the most common cause of LETM. Other causes of LETM are infective,neoplastic, autoimmune and connective tissue disorders. All other causes should be ruled out before diagnosis of NMO with appropriate investigations, as early diagnosis and management is essential for optimal outcome [1]. The syndrome can be roughly divided into two groups based on whether the syndrome is complete or partial. However, the clinical and radiologic findings do not always co-associate
367 Lateral Medullary Infarction (Wallenberg syndrome): A Case Report , Lenis Adriana Zempoaltecatl Cruz, Liceth Meliza Arrieta Mariotis and María Guadalupe Campos Escoto
Wallenberg syndrome is a clinical entity characterized by neurological symptoms conditioned by the total or partial occlusion of the basilar artery or one of it’s branches, mainly the posterior-inferior cerebellar artery which supplies the lower face of the vermis, central nuclei of the cerebellum, medulla oblongata and choroid plexus of the fourth ventricle, so the symptomatology is closely related to the areas compromised by ischemia, the most frequent symptoms being: ataxia and/or dysmetria - diadochokinesis, nausea, vomiting, vertigo, dysphagia, dysarthria and in extensive cases ipsilateral facial hemihypoesthesia and contralateral hemianesthesia. We present the case of a 67 years old male patient who clinically debut with some of these neurological symptoms, so the diagnostic approach was by means of MRI of the skull.
368 Neural Tube Malformations: Monocentric Results of Operated Cases , Rasolonjatovo EC, Rakotovao TK, Tsiaremby MG, Ramarokoto M, Ratovondrainy W, Rabarijaona M and Adriamamaomonjy C
NTDs are malformations of the central nervous system. It’s therapeutic complexities and the functional future of the child are the challenges in their management. The main objective of this study is to identify the epidemiological profile and short-term prognosis of these abnormalities.
369 Hypokalemic Quadriparesis in a case of Plasmodium vivax and Scrub Typhus Co-Infection - A Case Report From Eastern India , Somnath Maji, Boudhayan Bhattacharjee, Avisek Gon, Olivia Bhattacharya, Koushik Mukherjee, Arunansu Talukdar and Udas Chndra Ghosh
Both Plasmodium vivax malaria and Scrub Typhus has numerous reported neurological complications. In our case a middle-aged man presented with quadriparesis with history of high-grade fever with chills and rigor. On investigation, serum potassium found to be low and Plasmodium vivax ring form was found in blood smear. Patient started intravenous Potassium supplementation along with Anti-malarial therapy. Weakness improved within 48 hours of potassium supplementation, but fever persists after three days of antimalarials. On through examination we found an eschar in the back region and subsequently Scrub Typhus serology (IgM) came Positive, fever subsided after starting Doxycycline. Hypokalemia often seen in children with Plasmodium falciparum malaria infection. But co-infection of Plasmodium vivax malaria with Scrub typhus can also cause severe form of hypokalemia which may lead to even hypokalemic quadriparesis. This is very much atypical presentation in a rickettsia and parasitic co-infection which has not been previously reported.
370 Clapping on the Back and Chest 30 Minutes a Time Can Treat Cough, Chronic Cough, Cough with Phlegm and Difficult Breathing and Reduce the Fever Which is the Symptoms of Covid-19 , Van Duy Dao
The trigger points can prevent the blood circulation in the organs and between organs, over time it can make the body have the illness, especially the Covid-19 patients. During practicing, Clapping on the back and chest, I have treated many problems of the lungs like coughing, chest pain, difficulty breathing and I think that we can apply on treatment. Best of all, Clapping can be applied by the patients and caregivers, which can help quick recover and prevent the severe complications
371 Cannabinoid Efficacy in Vanishing White Matter Disease: A Case Report , Giulia Galli, Virgilio E, Naldi P, Fornara R, Baricich A, Vecchio D and Cantello R
We present a 30-year-old man who was diagnosed with Vanishing White Matter disease at the age of 9. VWMS is a rare autosomal recessive syndrome characterized by progressive white matter deterioration, due to mutations in either one of the five subunits of eukaryotic translation initiation factor eIF2B. The classic phenotype includes ataxia, spasticity, cognitive decline and seizures from early childhood. As young adult, our patient showed severe spastic tetraparesis with spasms and neck muscle stiffness with right laterocollis. Clonazepam, baclofen and botulinum injections were tried with poor results. THC-CBD spray at the dose of 4 sprays per day improved muscular pain, spasms and night sleep, reduced modestly spasticity and caused only mild drowsiness. To maximize the spasticity treatment, a baclofen intrathecal infusion pump was positioned, but Sativex® was continued after surgery for its positive effect on patient’s quality of life.
372 Contribution of the Electroencephalogram in Precose Neonatal Epilepsies , Halladain Mpung Mansoj, Mualaba Celebre and Adaratou Dieynabou Sow
Epilepsy, a chronic neurological disease, is a public health problem because it is frequent, potentially serious, cosmo-politan without distinction of age, sex or race [1]. Objective: To study the contribution of electroencephalography in the diagnosis and management of epilepsy in newborns: aged between 2 and 3 months. Material and Methods: Descriptive and analytical retrospective analysis carried out during the period 2017 - 2020, i.e. 36 months. Results: The age group concerned were predominantly month-old infants with 50% of cases, followed by newborns under one month with 28.6% and 21.4% of cases, respectively. The male sexes were mainly concerned, in 92% of cases and a sex ratio of 13. The main indications of the electroencephalogram were represented by chronic tonic convulsive seizures (92%), followed by non-febrile neonatal convulsions and focal seizures in respectively 21.4% of cases.
373 Non-pharmacological Treatment of Bruxism in the Elderly , Reza Bidaki and Sahar Bijari
Treatments for bruxism in the elderly is one of the major thera-peutic challenges and is significant. Also, there is no definitive treatment, unit and specific instructions for treatment. The first line of treatment for bruxism is always non-drug treatment in the form of behavior therapy. In this article, we tried to have a brief discussion of non-drug treatments. Bruxism is defined as a daily or nocturnal functional activity, including squeezing, restraining, grinding teeth, severe contraction of facial muscles, annoying noises of grinding teeth at night, and tooth wear, which include sleep- ing and waking teeth
374 Non-pharmacological Treatment of Bruxism in the Elderly , Reza Bidaki and Sahar Bijari
Treatments for bruxism in the elderly is one of the major therapeutic challenges and is significant. Also, there is no definitive treatment, unit and specific instructions for treatment. The first line of treatment for bruxism is always non-drug treatment in the form of behavior therapy. In this article, we tried to have a brief discussion of non-drug treatments. Bruxism is defined as a daily or nocturnal functional activity, including squeezing, restraining, grinding teeth, severe contraction of facial muscles, annoying nois-es of grinding teeth at night, and tooth wear, which include sleeping and waking teeth
375 Headache and MTHFRT677T Genotype in a Young Woman - Clinical Case , Damelan Kombate, Sirui Zhou, Seylom Kossi Biosse, Agbémélé K M Soedje, Kossivi Apetse, Komi Assogba, Koffi AA Balogou and Guy A Rouleau
The MTHFRC677T polymorphism is involved in several pathologies. Objectives: We report one case of headache associated with the MTHFR T677T genotype in woman. Observation: A 39-year-old woman was admitted in neurology department on March 12, 2012 for headaches with feet and hands parathesia for several months. The physical examination had noted a decrease in osteotendinous reflexes and an abolition of the plantar cutaneous reflex. Hamilton’s 17-item depression score was 7. In the etiological investigation of probable polyneuropathy, homocysteine was 88.39 μmol/l (standard < 15 μmol/l), folates 2.34 nmol/l (standard ≥ 11 nmol/l) and vitamin B12 132 pmol/l (standard ≥ 147 pmol/l). The aetiological investigation of this hyperhomocysteinemia revealed an MTHFRT677T genotype.
376 Can Non-neurological Intrinsic Factors Affect Outcome of TURP in Patients with BPH? , Ganesh Sonawane, Biju S Pillai and H Krishna Moorthy
Transurethral resection of prostate (TURP) is the mainstay of surgery for Benign Prostatic Hyperplasia (BPH). Howev-er it is estimated that upto 20% of patients have unfavourable results after TURP, suggesting certain other factors affecting outcome of TURP. Neurological changes occurring in the urinary bladder in patients with long standing BPH have been widely postulated as the reason for this poor outcome in some patients. This study was undertaken to assess the role of various intrinsic factors other than neurological causes, influencing outcome of TURP for BPH.
377 Co-ultraPEALut Effect on Mild Cognitive Impairment: A Retrospective Observational Study , Barbara Manni, Lucia Federzoni, Patrizia Zucchi and Andrea Fabbo
Mild cognitive disorder (MCI) may precede the onset of cognitive decline. Neuroinflammation may have a leading role in early phase of many neurocognitive diseases and may represent a useful target to limit MCI progression. Palmitoylethanolamide is endowed with anti-inflammatory and neuroprotective activities. Its formulation containing luteolin (PEALut) has been found to improve memory impairments in experimental models and in cognitively impaired patients suggesting its potential use for delaying the dementia onset. This retrospective study provides a preliminary evaluation of PEALut effect on clinical aspects in MCI subjects. Data related to three MCI subject groups, matched case control for age, sex and comorbidity, were obtained via retrospective chart review. Groups received PEALut, dietary food and no treatment, respectively. Mini-Mental State Examination (MMSE) questionnaire was used to evaluate cognitive symptoms; Activity Daily Living and Instrumental Activity functional Daily Living were used for measuring activity daily living and functional status; UCLA-Neuropsychiatric Inventory was used for behavioral symptoms.
378 Non-pharmacological Treatment of Bruxism in the Elderly , Reza Bidaki and Sahar Bijari
Treatments for bruxism in the elderly is one of the major therapeutic challenges and is significant. Also, there is no definitive treatment, unit and specific instructions for treatment. The first line of treatment for bruxism is always non-drug treatment in the form of behavior therapy. In this article, we tried to have a brief discussion of non-drug treatments. Bruxism is defined as a daily or nocturnal functional activity,
379 Headache and MTHFRT677T Genotype in a Young Woman - Clinical Case , Damelan Kombate, Sirui Zhou, Seylom Kossi Biosse, Agbémélé K M Soedje, Kossivi Apetse, Komi Assogba, Koffi AA Balogou and Guy A Rouleau
The MTHFRC677T polymorphism is involved in several pathologies. Objectives: We report one case of headache associated with the MTHFR T677T genotype in a woman. Observation: A 39-year-old woman was admitted in neurology department on March 12, 2012 for headaches with feet and hands parathesia for several months. The physical examination had noted a decrease in osteotendinous reflexes and an abolition of the plantar cutaneous reflex. Hamilton’s 17-item depression score was 7. In the etiological investigation of probable polyneuropathy, homocysteine was 88.39 μmol/l (standard < 15 μmol/l), folates 2.34 nmol/l (standard ≥ 11 nmol/l) and vitamin B12 132 pmol/l (standard ≥ 147 pmol/l). The aetiological investigation of this hyperhomocysteinemia revealed an MTHFRT677T genotype. Conclusion: The MTHFRT677T genotype is associated with a variety of manifestations ranging from metabolic (B12 deficiency), headache and polyneuropathies.