The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report.

Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-products of lysing clots in ICH might contribute to this secondary injury by triggering perihematomal edema. We present a clinical situation of an ICH case where iron-chelating therapy might be beneficial, as supported by scientific evidence. We looked through four databases (Pubmed, Cochrane, Embase, and Google Scholar) to find studies assessing the efficacy of iron-chelating therapy in ICH patients. Validity, importance, and applicability (VIA) of the included articles were appraised using worksheets from the Oxford Centre for Evidence-Based Medicine. Two out of five eligible studies were valid, important, and applicable to our patient. Both studies showed the positive effects of iron-chelating therapy on neurological outcome, as measured by National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS). The beneficial effects of deferoxamine were demonstrated within the moderate volume (10-30 mL) subgroup, with a positive relative risk reduction (RRR) and low number needed to treat (six persons). Based on our appraisal, we considered iron-chelating therapy as an additional therapy for ICH patients, given its benefits and adverse effects. More specific studies using a larger sample size, focusing on moderate-volume ICH, and using standardized neurological outcomes are encouraged.

hUMSC vs. hUMSC-Exosome: Which One Is Better for Epilepsy?

Epilepsy is a disorder characterized by abnormal brain cell activity that results in seizures. It causes progressive damage to neurons. Epilepsy treatment currently focuses mostly on symptoms, which also have risks of unwanted side effects. There is currently no effective treatment to prevent epileptogenesis and the resulting neural damage. Human Umbilical Cord Mesenchymal Stem Cell (hUMSC) and exosome therapy are examples of cellular therapies that may be used to treat degenerative diseases, such as epilepsy, or cell damage. However, there is still little research on the use of hUMSCs or hUMSC-exosomes for treating epilepsy. Hence, the purpose of this paper is to compare the potential and risk of hUMSCs and hUMSC-exosomes as therapies for epilepsy. This article provides a brief summary of hUMSCs and hUMSC-exosomes in multiple aspects, such as the isolation and purification method, the mechanism of action, immunological compatibility, tumorigenicity, the risk of transmitting disease, stability upon storage, the potential of new composition with other substances, and also ethical and political issues. We conclude that hUMSCs and hUMSC-exosomes have therapeutic potential for epilepsy, with hUMSC-exosomes being safer due to their reduced immunogenicity.

Risk of developing cognitive impairment on patients with chronic obstructive pulmonary disease: A systematic review.

BACKGROUND: The increasing number of chronic obstructive pulmonary disease (COPD) incidence has led to a great negative impact on older people's lives. This chronic disease was a critical and independent risk factor for cognitive function impairment in the elderly with mild cognitive impairment as a frequent feature. This systematic review aimed to examine the risk of developing cognitive impairment in COPD. METHODS: A structured search of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guideline, with a pre-determined search strategy starting from study identification, title and abstract screening, eligibility assessment, and inclusion of relevant study. The search was conducted in PubMed and MEDLINE via EBSCOhost, with restriction to human studies. The studies from inception until January 12, 2021. RESULTS: Five original articles were included. Most studies found that patients with COPD had a higher chance of developing cognitive impairment, especially when patients were followed up for more than 5 years. We discovered that the risk of cognitive impairment seemed to be correlated with the length of time spent following the participants, with the highest risk of cognitive impairment being identified in those who had the longest observation period. It is critical to conduct cognitive screening from the time a diagnosis of COPD is obtained and on a continuing basis in order to recognize and treat these individuals appropriately. CONCLUSION: There is a potential association between COPD and mild cognitive impairment. We encourage more studies to be done with higher sensitivity and specificity cognitive screening tools in the future to build better evidence and qualify to be analyzed quantitatively with meta-analysis.

Increasing Traumatic Brain Injury Incidence during COVID-19 Pandemic in the Emergency Department of Cipto Mangunkusumo National General Hospital-A National Referral Hospital in Indonesia.

OBJECTIVE: Evaluating the TBI incidence during the COVID-19 pandemic era compared with similar period in previous year. BACKGROUND: The emergence of SARS-CoV2 influenced the evolution of governmental and hospital policy worldwide, which might eventually impact many aspects. The incidence of many diseases in the Emergency Department (ED), especially traumatic brain injury (TBI), has been an area of interest. DESIGN/METHODS: Retrospective study comparing TBI incidence before and during COVID-19 pandemic era starting from the declaration of national pandemic date (March 16, 2020) until June 14, 2020 with the comparison of the same period in the previous year. RESULTS: There was an increase in admission rate due to TBI during COVID-19 pandemic compared with the previous year (157/752 (20.9%) vs 106/766 (13.8%), p < 0.001, respectively). While the range of age was similar between COVID-19 and non-COVID-19 era (37.9 ± 14.8 vs 38.6 ± 15.4 years, p = 0.712), male was higher in percentage to experience the injury (131/157 (83.4%) vs 67/106 (63.2%), p < 0.001). During the pandemic era, road traffic injury (97/157 (61.8%) vs 56/106 (52.8%), p = 0.149) as well as moderate-to-severe brain injury tended to increase (30/157 (19.1%) vs 17/106 (16.0%) p = 0.524) albeit statistically insignificant. Although the mortality rate was similar (12/157 (7.6%) vs 9/106 (8.5%), p = 0.804), higher hospitalization rate was observed in the pandemic era (81/157 (51.2%) vs 37/106 (34.9%) p = 0.008). CONCLUSIONS: TBI incidence remained increasing despite entering the COVID-19 era. These phenomena required further investigation and analysis that may possibly be unrelated with the COVID-19, but due to the change of the government policy and its impact, such as the more quiet road after national social distancing.

Proceedings of the Inaugural Strategy Meeting for the Establishment of a Southeast Asia Regional Therapeutic Plasma Exchange Consortium for Neurological Disorders.

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre-meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs.

Middle Cerebral Artery Pulsatility Index as Predictor of Cognitive Impairment in Hypertensive Patients.

Background: Cognitive impairment is a manifestation of cerebrovascular disease regarding hypertension and other degenerative diseases which has become a global health issue due to increased life expectancy. Recently, the gold standard used for diagnosing vascular cognitive impairment (VCI) has required a combination of the neurophysiological approach and magnetic resonance imaging (MRI). The Neurosonological approach, involving measuring the pulsatility index (PI) of the middle cerebral artery (MCA) using Trans Cranial Doppler (TCD), can hopefully be used as an affordable alternative predictor of VCI in patients with hypertension. Methods: A cross-sectional study was conducted at the Outpatient Clinic of the Department of Neurology in Ciptomangunkusumo Hospital, Jakarta. Sixty-six hypertensive subjects with no macrovascular complication were selected and screened using the Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Subjects were categorized into two groups; subjects with scores ≥26 were classified as the normal cognitive group, while subjects with scores <26 were classified as the cognitive impairment group. Both groups then underwent TCD examination to determine bilateral MCA PI. Results: There was a significant difference between MCA PI in both groups; it was higher in the cognitive impairment group than normal group (p < 0.001). Subjects with an increased left MCA PI were more likely to suffer cognitive impairment than those with an increased right MCA PI. Conclusion: MCA PI can be used as a predictor for cognitive impairment in hypertensive subjects.

Intra-arterial Transplantation of Human Umbilical Cord Blood Mononuclear Cells in Sub-acute Ischemic Stroke Increases VEGF Expression in Rats.

Thrombolysis (rt-PA) is the only United States Food and Drug Administration (FDA) approved drug currently available. Unfortunately, its effect has been limited by the narrow therapeutic time window. Human cord blood mononuclear cells (cbMNC) is a promising treatment for ischemic stroke by forming collateral and neo-vascularization where it is one of the important factors that contribute to cell repair. Therefore, evaluation of neo-vascularization in sub-acute stroke may be beneficial for recovery. One group for healthy rat and three groups (n=6 per group) of male wistar rats have undergone permanent middle cerebral artery occlusion (MCAO). Transplantation 1x106 cells/kg of human cbMNC intra-arterially (IA) and intra-venously (IV) were administered after 7 days. Behavioural tests were performed before MCAO, 1 week after MCAO and at 3,9 and 14 days after cbMNC transplantation. Beta III tubulin protein (TUJ1), glial fibrillary acidic protein (GFAP) and vascular endothelial growth factor (VEGF) antibody marker were evaluated. Spontaneous activity of transplanted rats by cbMNC have significantly improved compared to placebo group (p<0.05). Angiogenesis in IA group showed significant difference (P<0.001) when compared to IV and placebo respectively. The existence of neovascularization in the transplanted rats of cbMNC provide hope in accelerating repairment of the neuronal cells and functional outcome.