Trends in authorship based on gender and nationality in published neuroscience literature.

OBJECTIVE: To evaluate the disparity in authorship based on gender and nationality of institutional affiliation among journals from developed and developing countries. MATERIALS AND METHODS: Original articles from two neuroscience journals, with a 5 year impact factor >15 (Neuron and Nature Neuroscience) and from two neurology journals from a developing country (Neurology India and Annals of Indian Academy of Neurology) were categorized by gender and institutional affiliation of first and senior authors. Articles were further divided by the type of research (basic/translational/clinical), study/target population (adult/pediatrics/both) and field of neurology. Data was collected for the years 2002 and 2012. RESULTS: There are large disparities in authorship by women and from developing countries in high impact factor neuroscience journals. However, there was a non-statistical rise in female first and senior authorship over a 10 year period. Additionally there was a significant increase in first authorship from institutions based in developing countries in the two neuroscience journals examined (P < 0.05). In the two neurology journals based in India there was a significant increase in the number of articles published by international investigators between 2002 and 2012 (P < 0.05). CONCLUSIONS: Over the last decade, there has been a non-statistical increase in proportion of female first and senior authors, and a significant increase in authors from developing countries in high impact factor neuroscience journals. However they continue to constitute a minority. The disparity in authorship based on gender also exists in neurology journals based in a developing country (India).

Factors contributing to delay in diagnosis of Guillain-Barré syndrome and impact on clinical outcome.

INTRODUCTION: Heterogeneity of presenting symptoms makes the initial clinical diagnosis of Guillain-Barré syndrome (GBS) challenging. METHODS: Observational retrospective study from 2 teaching hospitals (Parkland Memorial Hospital and University of Texas Southwestern University Hospital) between 2008 and 2013. RESULTS: Sixty-nine GBS patients were identified. GBS was suspected on initial emergency department visit in only 49%. During first hospital encounter, 58% were evaluated by a neurologist. Neuropathic pain and presence of intact deep tendon reflexes were associated with delayed GBS diagnosis (P < 0.05). There was significantly better clinical outcome among patients who were evaluated by a neurologist during the initial visit (P < 0.005). Among these patients there was also significant difference in discharge destination; 71.2% of patients evaluated by a neurologist were discharged home (P < 0.01). Patients in whom GBS was not suspected at the time of initial Neurology evaluation were more likely to require intubation and to have residual weakness at the time of discharge (P < 0.05). CONCLUSIONS: Atypical clinical signs and symptoms may lead to delayed diagnosis of GBS. Early neurological evaluation is associated with improved clinical diagnosis and discharge disposition.

The spectrum of autoimmune encephalopathies.

Despite being a potentially reversible neurological condition, no clear guidelines for diagnosis or management of autoimmune encephalitis exist. In this study we analyzed clinical presentation, laboratory and imaging characteristics, and outcome of autoimmune encephalitis from three teaching hospitals. Non-paraneoplastic autoimmune encephalitis associated with antibodies against membrane antigens was the most common syndrome, especially in the pediatric population. Clinical outcome was better for patients with shorter latency from symptom onset to diagnosis and initiation of immunomodulation. Patients with underlying malignancy were less likely to respond well to immunomodulatory therapy. The clinical spectrum of autoimmune encephalitis is fairly broad, but prompt recognition and treatment often leads to excellent outcome.

Smart phone applications as a source of information on stroke.

BACKGROUND AND PURPOSE: Smartphone applications have been increasingly identified as a novel platform for dissemination of healthcare related information. However, there have been no studies done to evaluate the availability and content of stroke related apps. PURPOSE: This study aims to identify and analyze stroke-related applications available on the Apple iTunes and Android Google Play Store. METHODS: The Apple iTunes store and Android Google Play Store were searched for stroke-related applications on July 27, 2013 using keywords: stroke, brain attack, intracranial hemorrhage, subarachnoid hemorrhage, cerebral infarction. The content of the applications was analyzed by two independent investigators. RESULTS: A total of 93 relevant applications (46.2% android and 53.8% iPhone) were identified of which 47.3% were available free of cost. 92% of apps were identified as useful by users and over 60% had scientifically valid information. There is a significant participation of healthcare agencies in dissemination of stroke related information through apps with 47.3% apps being uploaded by them. Over half of all stroke related apps were aimed towards health care workers (51.6%), 75% of which could be utilized as bedside tools for patient care and remainder had information related to recent research advances. The difference in scientific validity between the apps aimed at general population versus healthcare professionals was statistically significant (P<0.01). There was no statistical association between cost of app and scientific validity or usefulness. CONCLUSIONS: Smartphone apps are a significant source of information related to stroke. An increasing participation of healthcare agencies should be encouraged to promote dissemination of scientifically valid information.

Para-dichlorobenzene toxicity - a review of potential neurotoxic manifestations.

BACKGROUND: Para-dichlorobenzene (PDCB) is an active ingredient of mothballs, deodorizers and fumigants. Due to the easy availability of this chemical, there is a considerable risk for accidental or intentional toxic exposure. Recently, multiple cases of PDCB toxicity due to mothball ingestion were reported. PDCB toxicity can affect multiple organ systems including liver, kidneys, skin, lung and the central nervous system (CNS). CNS toxicity often results in leukoencephalopathy and heterogeneous neurological manifestations. OBJECTIVES: The objective of this study was to illustrate the clinical presentation, imaging findings, diagnosis and management of PDCB toxicity. METHODS: We carried out a literature review of the pharmacological and toxicological properties of PDCB. CONCLUSIONS: PDCB and other aromatic hydrocarbons are capable of CNS tissue damage and in promoting functional neurological decline. While very little is currently known about prevalence of PDCB addiction, it cannot be ruled out that its illicit use among young people is under-recognized. The number of cases of PDCB toxicity might also rise due to the increasing industrial and domestic use of this chemical.

Analysis of YouTube as a source of information for West Nile Virus infection.

INTRODUCTION: A major outbreak of West Nile Virus was seen last year in different parts of the United States. Adequate dissemination of correct information about the disease would have helped decrease its spread and the associated panic in the general population. In this study, we looked into the use of YouTube as a resource for providing information about West Nile Virus infection. OBJECTIVE: This study aims to identify and evaluate YouTube as resource for providing information on West Nile Virus infection to the general public. METHODS: YouTube was searched on November 25, 2012, using the keywords West Nile Virus epidemic, West Nile Virus infection, and West Nile Virus prevention for videos uploaded in the past 6 months containing relevant information about the disease. The videos were classified as useful, misleading, or as news updates based on the type of information contained. Total viewership, number of days since upload, total duration of videos, and source of upload were noted. RESULTS: A total of 106 videos with information on West Nile Virus infection were included in the study, with 79.24% having useful information about the disease. Among the useful videos, 51/84 (60.71%) had information on disease prevention, and 29/84 (34.52%) contained information on news and research updates. The majority of these videos were uploaded by individuals (54.6%) or news agencies (41.8 %). Healthcare agencies contributed only 3.4 % of the total videos. Even though the useful videos represented 72% of all videos, there was significantly higher total viewership and viewership per day for the non-useful videos (P<0.05). CONCLUSIONS: YouTube may be a significant resource for dissemination of information on public health issues like West Nile virus infection and should be targeted by healthcare agencies for this use. The major drawback of this medium is lack of verification by authorized healthcare professionals before these videos are made available for viewing by the community. Hence, a strict caution should be exercised in obtaining the information from unauthorized videos posted on YouTube.

Paroxysmal paralytic attacks secondary to excessive cola consumption.

We report a rare case of cola-induced hypokalemia presenting as recurrent attacks of lower extremity weakness and falls. Excessive consumption of cola-based drinks has been associated with dental enamel erosion, obesity, and diabetes. There are very few published cases depicting the correlation between cola drinks and hypokalemic manifestations. In our patient an extensive workup was performed, and common causes were ruled out before making the diagnosis of cola-induced hypokalemia. Improvement in the patient's symptoms and electrolyte levels after reducing the consumption of cola-based drinks further confirmed our diagnosis. This case also emphasizes the importance of obtaining a detailed history and consideration of broad differential diagnoses in identifying uncommon but reversible etiologies.

Combination therapy of intravenous glycoprotein IIB/IIIA inhibitors and tissue plasminogen activator for acute ischemic stroke.

OBJECTIVES: Retrospective pooled analysis of data from published prospective studies and randomized phase 1 and 2 trials was done to assess efficacy and safety profile of intravenous combination therapy [glycoprotein IIb/IIIa inhibitors and IV tissue plasminogen activator (tPA)] in management of acute ischemic stroke. MATERIALS AND METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and EMBASE databases; two reviewers independently selected studies reporting safety endpoints and outcome measures in acute ischemic stroke patients treated with combination therapy. tPA arm of the National Institute of Neurological Disorders and Stroke (NINDS) tPA trial was included in tPA-only group. Weighted means and proportions were calculated for numeric and categorical variables respectively. Bivariate analysis using Fisher's exact test was done to compare baseline descriptors, safety endpoints, and outcome measures. RESULTS: Combination therapy arm included 188 patients and IV tPA arm had 218 patients. Mean National Institutes of Health Stroke Scale (NIHSS) in two groups were 12.8 and 14.6, respectively. Mean time-to-treatment was 2.3 hours in combination therapy arm and 2.55 hours in tPA arm. Treatment with combination therapy was associated with significant reduction in rate of symptomatic intracranial hemorrhage (sICH) [odds ratio (OR) 0.26, 95% cumulative incidence (CI) 0.07 0.83, P value 0.01). Difference in better functional outcome at 90 days (OR 0.87, 95% CI 0.59-1.30, P value 0.54) and death at 90 days (OR 1.16, 95% CI 0.69-1.93, P value 0.60) were not significantly different in two groups. CONCLUSION: Combination of low dose IV TPA with glycoprotein IIb/IIIa inhibitors is associated with reduction in sICH rates in patients with acute ischemic stroke as compared to standard dose of IV tPA.

Klebsiella pneumoniae Renal Abscess Syndrome: A Rare Case with Metastatic Involvement of Lungs, Eye, and Brain.

We describe a rare case of Klebsiella pneumoniae renal abscess with metastatic spread leading to endopthalmitis, pulmonary cavitary lesions, and cerebral emboli in a 41-year-old Hispanic female with diabetes mellitus who presented with a four-to-five-day history of fevers, headache, eye pain, and vomiting. She was treated with IV antibiotics and made a gradual but full recovery.

GAD65 Positive Autoimmune Limbic Encephalitis: A Case Report and Review of Literature.

Limbic encephalitis is a rare disorder affecting the medial temporal lobe of the brain, sometimes also involving hippocampus atrophy. It was initially considered to be only of paraneoplastic origin but now auto-immune (non-paraneoplastic) cases have also been reported. Most common non paraneoplastic antibodies associated with limbic encephalitis are Voltage gated potassium channel antibodies, NMDA receptor antibodies and GAD receptor antibodies. We present a case of limbic encephalitis which presented with sudden onset seizures which was preceded by confusion, disorientation and other psychiatric symptoms for a period of 5 weeks. No tumor was found on imaging and the classic paraneoplastic panel was negative. CSF and serum examination showed high titers GAD65 antibody guiding towards a diagnosis of non paraneoplastic limbic encephalitis. Her symptoms and GAD 65 antibody titers showed significant improvement following immunomodulatory therapy. The case presented here is unique and scientifically relevant, as it intends to raise awareness of Auto-immune Limbic Encephalitis, a potentially reversible cause of a medical emergency.