Modeling Amyotrophic Lateral Sclerosis Progression: Logic in the Logit.

Background Amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) has emerged as a clinical prognostic marker for clinical and research purposes in amyotrophic lateral sclerosis (ALS). However, tools for predicting disease progression are still underdeveloped. The aim of this study was to mathematically model ALS progression to provide a reliable and personalized approach to the prognosis for ALS patients. Also, it aimed to provide a reliable prediction tool for the current and newly diagnosed patients. Methods Twenty patients from the South-East England Amyotrophic Lateral Sclerosis register (SEALS) database were included in the analysis. A non-linear logistic regression model was used to describe disease progression from baseline health to the theoretical maximum disease. The reliability of predicted variables and correlation between model parameters were assessed separately for each subject. Results The logistic regression model best described the disease progression in patients with a high progression rate. Most notably, the model fitted better when a patient has progressed enough to approximately the midpoint of the functional rating scale. The model failed to characterize the disease course in patients defined as slow progressors. Furthermore, the linear relationship between the rate of progression and time since onset at ALFRS-R score of 24 was evident in 65% of patients. Conclusion These results indicate that the rate of disease progression and time when ALSFRS-R declines to half the maximum score are correlated with functional outcomes. Nonetheless, the logistic model failed to describe disease course in patients with slow progression rates. Different rates of progression can be attributed to the genetic heterogeneity of ALS. Thus, clinicians and patients can benefit from adding a gene factor to the equation. With the outlined limitations, the model can provide a good prognostic tool.

Bloody Ventriculography: Intracerebral Hemorrhage Artistically Casting the Ventricular System's Anatomy Into a Bird's Head.

Causes of intracerebral hemorrhage are mostly attributed to vascular anomalies or hypertension. It causes significant morbidity and mortality worldwide. This illustrative case report presents an interesting computed tomography image of hyperacute basal ganglia hemorrhage with intraventricular extension artistically casting the ventricular system. The intraventricular hemorrhage was moderate upon presentation; the blood had delineated the anatomic details of the ventricular system. It closely resembles a Crax rubra's head in the sagittal view. We believe that this radiographic finding is not seen frequently, especially early in the course of the condition. However, it could serve as an intriguing and reproducible sign of the radiographic anatomy of the ventricular system.

Epidural Abscess Following Epidural Evacuation in a Patient With Ventriculoperitoneal Shunt: A Case Report.

Epidural abscess is considered one of the most common intracranial infections. We report a pediatric patient with chronic hematopoiesis and thick double periosteal layers who developed an epidural pus collection after epidural hematoma evacuation. This article highlights the importance of detecting complications from epidural hematoma evacuation, including intracranial abscess and pus formation. Therefore, it is crucial to treat such cases meticulously.

Dangers of Using Bee Propolis and Foeniculum Vulgare Before Browplasty.

Several medicinal herbs have been associated with coagulopathy. They can be readily purchased at a local herb store without prescription or expert opinion based on scientific evidence. This is probably why patients do not disclose using these herbs to health care providers even on direct questioning. Here, we focus on two commonly used herbs in our community, bee propolis, and Foeniculum vulgare, also known as fennel seeds, as our patient ingested them before a scheduled browplasty. The significance of this anecdote is the concomitant ingestion of fennel seeds and bee propolis. Arguably, their consumption resulted in excessive intraoperative and postoperative bleeding in a previously healthy subject. This complication is undesirable in any aesthetic surgery, as it affects wound healing and the final cosmetic outcome. We hope that such bioactive herbs are warned against and that their risks are known to patients and physicians alike.