Coronavirus disease 2019 and stroke in Iran: a case series and effects on stroke admissions.

OBJECTIVE: The coronavirus disease 2019 pandemic has affected healthcare systems around the globe and massively impacted patients with various non-infectious, life-threatening conditions. Stroke is a major neurological disease contributing to death and disability worldwide, and is still an ongoing issue during the pandemic. Here we investigate the impact of the coronavirus disease 2019 outbreak on stroke manifestations, treatment courses, the outcome of stroke patients, and the hospitalization rate in a referral center for stroke management in Tehran, Iran. METHODS: We extracted data regarding 31 stroke patients (10 patients with laboratory-confirmed coronavirus disease 2019) and compared the demographic and pathological characteristics of the patients with or without coronavirus disease 2019 infection. The association of demographic/pathological characteristics of stroke patients during the coronavirus disease 2019 pandemic and a corresponding period during the previous year (49 patients) and an earlier period during the same year as the pandemic (50 patients) was also evaluated. RESULTS: The absolute number of admissions decreased about 40% during the coronavirus disease 2019 pandemic. Except for the stroke severity (P = 0.002), there were no significant changes in the demographic and pathological characteristics of the stroke patients during the three studied periods. A significantly higher mean of age (75.60 ± 9.54 versus 60.86 ± 18.45; P = 0.007), a significant difference in the type of stroke (P = 0.046), and significantly higher stroke severity (P = 0.024) were observed in stroke patients with coronavirus disease 2019 compared with those of stroke patients without coronavirus disease 2019. Treatment approaches, duration of hospitalization, and mortality rates did not differ significantly. CONCLUSIONS: This report shows that the pandemic caused the number of acute stroke admissions to plummet compared to other periods. Although the pandemic did not affect the treatment plans and care of the patients, stroke cases with coronavirus disease 2019 had higher age, more large vessel ischemic stroke, and more severe stroke. Further studies are urgently needed to realize the probable interaction of the coronavirus disease 2019 pandemic and the neurologic disease.

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry.

BACKGROUND AND METHODS: Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. RESULTS: Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0-2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. CONCLUSIONS: Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized.

Assessment of radiation protection of patients and staff in interventional procedures in four Algerian hospitals.

This study was aimed to assess patient dosimetry in interventional cardiology (IC) and radiology (IR) and radiation safety of the medical operating staff. For this purpose, four major Algerian hospitals were investigated. The data collected cover radiation protection tools assigned to the operating staff and measured radiation doses to some selected patient populations. The analysis revealed that lead aprons are systematically worn by the staff but not lead eye glasses, and only a single personal monitoring badge is assigned to the operating staff. Measured doses to patients exhibited large variations in the maximum skin dose (MSD) and in the dose area product (DAP). The mean MSD registered values are as follows: 0.20, 0.14 and 1.28 Gy in endoscopic retrograde cholangiopancreatography (ERCP), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures, respectively. In PTCA, doses to 3 out of 22 patients (13.6 %) had even reached the threshold value of 2 Gy. The mean DAP recorded values are as follows: 21.6, 60.1 and 126 Gy cm(2) in ERCP, CA and PTCA procedures, respectively. Mean fluoroscopic times are 2.5, 5 and 15 min in ERCP, CA and PTCA procedures, respectively. The correlation between DAP and MSD is fair in CA (r = 0.62) and poor in PTCA (r = 0.28). Fluoroscopic time was moderately correlated with DAP in CA (r = 0.55) and PTCA (r = 0.61) procedures. Local diagnostic reference levels (DRLs) in CA and PTCA procedures have been proposed. In conclusion, this study stresses the need for a continuous patient dose monitoring in interventional procedures with a special emphasis in IC procedures. Common strategies must be undertaken to substantially reduce radiation doses to both patients and medical staff.

Successful treatment of generalized granuloma annulare with adalimumab.

We report the case of a 64 year-old woman who demonstrated resolution of recalcitrant, generalized granuloma annulare (GA) following treatment with adalimumab. After showing little response to other treatment techniques, such as steroids and a triple antibiotic regimen, the patient was started on adalimumab. Within 3 months, she showed almost complete resolution of lesions. Within 6 months, she was completely lesion-free, and remained clear following 12 months of adalimumab therapy. This case provides further evidence that tumour necrosis factor-α inhibitors may be a treatment option for patients with recalcitrant, generalized GA.

Investigating the feasibility of EVestG assessment for screening concussion.

Electrovestibulography (EVestG™) is a new technology that objectively measures the vestibular response. It has the potential to objectively, quickly and cost-effectively screen concussion. EVestG signals are recorded painlessly and non-invasively from the external ear in response to vestibular stimuli, and consist of brainstem and peripheral sensory oto-acoustic signals modulated by the cortical responses. In this study, we investigated the relationship between characteristic features of the extracted field potentials (FPs) of EVestG signals in people with side-impact concussion in comparison with those of control participants. 10 side-impact concussed individuals (4 Right and 6 left side-impact) and 10 age-and-gender-matched controls were tested by EVestG. The participants also completed comprehensive neuropsychological assessments. Characteristic features were extracted from the FPs during side tilt, and linear discriminant analysis (LDA) classification was applied to the extracted features using a leave-one-out routine. The results show the difference between the left and right FP area was significantly (P<0.05) different. The LDA classification resulted a sensitivity of 85% and specificity of 69% for separating concussed individuals from controls. EVestG appears to have diagnostic potential in diagnosing side impact concussion.

Treatment of two patients with generalized pustular psoriasis with the interleukin-1ß inhibitor gevokizumab.

Generalized pustular psoriasis (GPP) is a severe, potentially life-threatening inflammatory dermatosis, which is traditionally difficult to manage. Recent evidence suggests that interleukin (IL)-1 plays a central role in the disease pathogenesis, and thus makes the use of IL-1 inhibitors potentially effective. Two patients with severe, recalcitrant GPP were enrolled in an open-label, expanded access study to receive a new IL-1ß inhibitor, gevokizumab. The two patients had a respective 79% and 65% reduction in GPP area and severity index scores at weeks 4 and 12, with some improvements in quality-of-life instruments. There were no significant adverse events related to the study medication, although one patient developed an abscess in a haematoma secondary to an injury. Both patients showed substantial initial clinical response to gevokizumab, with no significant laboratory abnormalities noted. These cases illustrate the growing need for targeted, efficacious therapies for this severe, debilitating disease. Prospective randomized control studies are required to further assess the safety and efficacy of IL-1ß inhibitors for the treatment of GPP.

[Birth-related retinal hemorrhages in the newborn: incidence and relationship with maternal, obstetric and neonatal factors. Prospective study of 2,031 cases]. / Hémorragies rétiniennes liées à l'accouchement chez le nouveau-né : fréquence et relation avec les facteurs maternels, néonataux et obstétricaux. Étude prospective de 2031 cas.

PURPOSE: To assess the prevalence, morphology and distribution of retinal hemorrhages in healthy newborns and their relationship to neonatal, maternal and obstetrical factors, and to determine their natural history. PATIENTS AND METHODS: The present study prospectively included 2,031 consecutive healthy newborns. Indirect ophthalmoscopy was performed within 24 hours after birth in all newborns. Infants with retinal hemorrhages were reexamined weekly until the hemorrhage resolved. Annual ophthalmologic follow-up was also scheduled in these children. Neonatal, maternal and obstetric parameters were analyzed in all newborns and compared between newborns with retinal hemorrhages and those without retinal hemorrhages. RESULTS: 31.8 % of newborns exhibited retinal hemorrhages. 72.6 % of hemorrhages were bilateral. They tended to be localized around the optic discs and in the posterior pole, but their distribution was variable. Retinal hemorrhages were of variable shapes. The prevalence of retinal hemorrhages was higher in newborns delivered with vacuum-assisted extraction (38 %, P<0.001), intermediate during normal vaginal delivery (32.6 %, P<0.001) and lower with cesarean section (20.8 %). Comparative analysis between elective cesarean section and emergency cesarean showed a higher incidence of retinal hemorrhages in the emergency cesarean group (P=0.006). On multivariate analysis, vacuum-assisted delivery was the only factor associated with a higher prevalence of retinal hemorrhages in newborns (P=0.045). Two thirds of hemorrhages had disappeared by one week after birth. Retinal hemorrhages had resolved in all newborns within four weeks. CONCLUSION: Birth-related retinal hemorrhages are common (1/3 of our newborns). Vacuum-assisted delivery is the main risk factor in this study. All hemorrhages resolved by one month of age. These findings may help in differential diagnosis with shaken baby syndrome.

Binocular training reduces amblyopic visual acuity impairment.

Amblyopia is the most common cause of monocular visual impairment. Patching, which is modestly effective, is the current treatment of amblyopia in children. There is no clinically approved treatment for adults. The present study is a clinical trial (non-sham controlled and non-randomized) that assessed the efficacy of binocular training for improvement of the visual acuity in children and adults with amblyopia. Twenty-two amblyopic subjects ranging in age from 5 to 73 (mean: 36.2) years for whom patching and/or surgical treatments did not correct their visual impairment completed an average of 14.5 sessions of binocular training over a period of 4 to 6 weeks. Random dot kinematograms were presented dichoptically to the two eyes and the participants' task was to identify the direction of motion of the targets. Mean visual acuity improvement was 0.34 LogMAR (range: 0.1-0.58 LogMAR) and was shown to persist 6 months following the cessation of binocular training. Our study provides results in a large number of patients that confirm the clinical effectiveness of binocular training as a treatment for amblyopia in improving visual acuity in both children and adults. Moreover, this study is the first to demonstrate that the improvements in visual function were maintained for 6 months in the absence of any additional treatment.

Restoration of binocular vision in amblyopia.

PURPOSE: To develop a treatment for amblyopia based on re-establishing binocular vision. METHODS: A novel procedure is outlined for measuring and reducing the extent to which the fixing eye suppresses the fellow amblyopic eye in adults with amblyopia. We hypothesize that suppression renders a structurally binocular system, functionally monocular. RESULTS: We demonstrate that strabismic amblyopes can combine information normally between their eyes under viewing conditions where suppression is reduced by presenting stimuli of different contrast to each eye. Furthermore we show that prolonged periods of binocular combination leads to a strengthening of binocular vision in strabismic amblyopes and eventual combination of binocular information under natural viewing conditions (stimuli of the same contrast in each eye). Concomitant improvement in monocular acuity of the amblyopic eye occurs with this reduction in suppression and strengthening of binocular fusion. Additionally, stereoscopic function was established in the majority of patients tested. We have implemented this approach on a headmounted device as well as on a handheld iPod. CONCLUSION: This provides the basis for a new treatment of amblyopia, one that is purely binocular and aimed at reducing suppression as a first step.

A new binocular approach to the treatment of amblyopia in adults well beyond the critical period of visual development.

PURPOSE: The present treatments for amblyopia are predominantly monocular aiming to improve the vision in the amblyopic eye through either patching of the fellow fixing eye or visual training of the amblyopic eye. This approach is problematic, not least of which because it rarely results in establishment of binocular function. Recently it has shown that amblyopes possess binocular cortical mechanisms for both threshold and suprathreshold stimuli. METHODS: We outline a novel procedure for measuring the extent to which the fixing eye suppresses the fellow amblyopic eye, rendering what is a structurally binocular system, functionally monocular. RESULTS: Here we show that prolonged periods of viewing (under the artificial conditions of stimuli of different contrast in each eye) during which information from the two eyes is combined leads to a strengthening of binocular vision in strabismic amblyopes and eventual combination of binocular information under natural viewing conditions (stimuli of the same contrast in each eye). Concomitant improvement in monocular acuity of the amblyopic eye occurs with this reduction in suppression and strengthening of binocular fusion. Furthermore, in a majority of patients tested, stereoscopic function is established. CONCLUSIONS: This provides the basis for a new treatment of amblyopia, one that is purely binocular and aimed at reducing suppression as a first step.

[Hypoplasia of the hepatic segment of the inferior vena cava]. / Hypoplasie de la veine cave inférieure rétrohépatique.

Congenital anomalies of the inferior vena cava are not uncommon. In the past, the diagnosis was made by angiography and retrograde right heart studies which were being commonly performed for the assessment of congenital malformation of the heart. The advent of ultrasound and three-dimensional imaging such as computed tomography and magnetic resonance made it easier to obtain the diagnosis. We report here a case of inferior vena cava hypoplasia in a 19-year-old male, who presented with progressive ascitis and edema.

Measurement of suprathreshold binocular interactions in amblyopia.

It has been established that in amblyopia, information from the amblyopic eye (AME) is not combined with that from the fellow fixing eye (FFE) under conditions of binocular viewing. However, recent evidence suggests that mechanisms that combine information between the eyes are intact in amblyopia. The lack of binocular function is most likely due to the imbalanced inputs from the two eyes under binocular conditions [Baker, D. H., Meese, T. S., Mansouri, B., & Hess, R. F. (2007b). Binocular summation of contrast remains intact in strabismic amblyopia. Investigative Ophthalmology & Visual Science, 48(11), 5332-5338]. We have measured the extent to which the information presented to each eye needs to differ for binocular combination to occur and in doing so we quantify the influence of interocular suppression. We quantify these suppressive effects for suprathreshold processing of global stimuli for both motion and spatial tasks. The results confirm the general importance of these suppressive effects in rendering the structurally binocular visual system of a strabismic amblyope, functionally monocular.

[Seroprevalence of toxoplasmosis in pregnant women in Rabat, Morocco]. / Séroprévalence de la toxoplasmose chez la femme enceinte dans la ville de Rabat au Maroc.

In Morocco, the seroprevalence of toxoplasmosis in pregnant women living in Rabat, was estimated by analyzing antibodies (IgG, IgM) levels using an ELISA test. The analysis of 2456 serums at the Institut National d'Hygiène showed that the seroprevalence of toxoplasmosis is about 50.6%. According to the questionnaire, the lack of knowledge about this disease and soil contact could be the main causes of toxoplasmosis infection. The use of IgG avidity test has excluded a recent infection in 93.5% of pregnant women with IgM positive sera.

Binocular influences on global motion processing in the human visual system.

This study investigates four key issues concerning the binocular properties of the mechanisms that encode global motion in human vision: (1) the extent of any binocular advantage; (2) the possible site of this binocular summation; (3) whether or not purely monocular inputs exist for global motion perception; (4) the extent of any dichoptic interaction. Global motion coherence thresholds were measured using random-dot-kinematograms as a function of the dot modulation depth (contrast) for translational, radial and circular flow fields. We found a marked binocular advantage of approximately 1.7, comparable for all three types of motion and the performance benefit was due to a contrast rather than a global motion enhancement. In addition, we found no evidence for any purely monocular influences on global motion detection. The results suggest that the site of binocular combination for global motion perception occurs prior to the extra-striate cortex where motion integration occurs. All cells involved are binocular and exhibit dichoptic interactions, suggesting the existence of a neural mechanism that involves more than just simple summation of the two monocular inputs.

The extent of the dorsal extra-striate deficit in amblyopia.

Previously, we have shown that humans with amblyopia exhibit deficits for global motion discrimination that cannot be simply ascribed to a reduction in visibility or contrast sensitivity. Deficits exist in the processing of global motion in the fronto-parallel plane that suggest reduced extra-striate function (i.e., MT) in amblyopia. Here, we ask whether such a deficit also exists for rotation and radial components of optic flow that are first processed at higher sites along the dorsal pathway (i.e., MSTd). We show that similar motion processing deficits occur in our amblyopic group as a whole for translation, rotation, and radial components of optic flow and that none of these can be solely accounted for by the reduced visibility of the stimuli. Furthermore, on a subject-by-subject basis there is no significant correlation between the motion deficits for radial and rotational motion and those for translation, consistent with independent deficits in dorsal pathway function up to and including MSTd.

The changes in the transmission functioning of the ulnar nerve in a high power magnetic field.

INTRODUCTION: The present study aims at exploring the changes in the functioning of the ulnar nerve in a high power magnetic field. METHODS: 12 volunteers with a healthy peripheral nervous system participated in the study. The ulnar nerve was selected from the upper organs as the site for study. The functioning of both the sensory and motor parts of the ulnar nerve in normal conditions was electromyographically tested. Then, using the same setting, the functioning of the nerve was electromyographically tested within a high power magnetic field (0.2 Tesla). With regard to the sensory function, the distal latency and the amplitude were examined. With regard to the motor section, the duration, amplitude of the evoked potentials, and latency from two sites--distal and proximal--were examined. These results of the two readings, taken in normal condition and in a high power magnetic field, as well as the motor neural conduction velocity, were compared. RESULTS: The statistical analyses indicated that the changes in both the distal latency and amplitude of the sensory part of the ulnar nerve were significant. However, the changes in the motor function of the nerve were not significant.

Uremic neuropathy and the analysis of electrophysiological changes.

Fourteen patients with chronic renal failure were clinically examined and electrodiagnostically tested before and after a single session of hemodialysis. The electrodiagnostic test conducted on the ulnar sensory and the tibial motor parts indicates that the sensory and motor evoked wave amplitudes increase after dialysis (p value < 5%) but there is little change in the nerve conduction velocity. Wave amplitude is related to number of actively participating axons in neural message transference, so a decrease in amplitude means a decrease in the number of active axons involved in the neural message transfer. The present findings indicate that in the process of dialysis some of the previously inactive axons become activated. The reason for the inactivation of the axons may be due to the accumulation of toxic substances in the body as a result of renal failure. After hemodialysis, most the toxic substances are removed from the body and this leads to an increase in the number of active axons.