Deep brain stimulation in Parkinson's disease: A scientometric and bibliometric analysis, trends, and research hotspots

Parkinson disease (PD), a prevalent neurodegenerative ailment in the elderly, relies mainly on pharmacotherapy, yet deep brain stimulation (DBS) emerges as a vital remedy for refractory cases. This study performs a bibliometric analysis on DBS in PD, delving into research trends and study impact to offer comprehensive insights for researchers, clinicians, and policymakers, illuminating the current state and evolutionary trajectory of research in this domain. A systematic search on March 13, 2023, in the Scopus database utilized keywords like "Parkinson disease," "PD," "Parkinsonism," "Deep brain stimulation," and "DBS." The top 1000 highly cited publications on DBS in PD underwent scientometric analysis via VOS Viewer and R Studio's Bibliometrix package, covering publication characteristics, co-authorship, keyword co-occurrence, thematic clustering, and trend topics. The bibliometric analysis spanned 1984 to 2021, involving 1000 cited articles from 202 sources. The average number of citations per document were 140.9, with 31,854 references. "Movement Disorders" led in publications (n = 98), followed by "Brain" (n = 78) and "Neurology" (n = 65). The University of Oxford featured prominently. Thematic keyword clustering identified 9 core research areas, such as neuropsychological function and motor circuit electrophysiology. The shift from historical neurosurgical procedures to contemporary focuses like "beta oscillations" and "neuroethics" was evident. The bibliometric analysis emphasizes UK and US dominance, outlining 9 key research areas pivotal for reshaping Parkinson treatment. A discernible shift from invasive neurosurgery to DBS is observed. The call for personalized DBS, integration with NIBS, and exploration of innovative avenues marks the trajectory for future research.

Zavegepant for Acute Treatment of Migraine: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Evaluate the safety and efficacy of zavegepant (BHV-3500), a recently approved nasal spray containing a third-generation calcitonin gene-related peptide receptor antagonist, for treating acute migraine attacks.

METHODS

A comprehensive search was conducted across various databases up to 06/26/2023 to identify relevant randomized clinical trials (RCTs) on zavegepant's efficacy and safety in treatment of acute migraine attacks. Primary outcome: freedom from pain at 2 hours postdose. Safety outcomes were evaluated based on adverse events (AEs), with zavegepant 10 mg and placebo groups compared for incidence of AEs.

RESULTS

Two RCTs, involving 2061 participants (1014 receiving zavegepant and 1047 receiving placebo), were quantitatively analyzed. An additional trial was included for qualitative synthesis. Zavegepant 10 mg exhibited a significantly higher likelihood of achieving freedom from pain at 2 hours postdose compared with the placebo group (risk ratio [RR] 1.54, 95% confidence interval [CI] 1.28 to 1.84). It also showed superior relief from the most bothersome symptoms at 2 hours postdose compared with placebo (RR 1.26, 95% CI 1.13 to 1.42). However, the zavegepant 10 mg group experienced a higher incidence of AEs compared with placebo (RR 1.78, 95% CI 1.5 to 2.12), with dysgeusia being the most reported AE (RR 4.18, 95% CI 3.05 to 5.72).

CONCLUSION

Zavegepant 10 mg is more effective than placebo in treating acute migraine attacks, providing compelling evidence of its efficacy in relieving migraine pain and most bothersome associated symptoms. Further trials are necessary to confirm its efficacy, tolerability, and safety in diverse clinic-based settings with varied patient populations.

The role of hydrogels in the management of brain tumours: a narrative review

Conventional therapeutic techniques for brain tumours have limitations and side effects, necessitating the need for alternative treatment options. MRI-monitored therapeutic hydrogel systems show potential as a non-surgical approach for brain tumour treatment. Hydrogels have unique physical and chemical properties that make them promising for brain tumour treatment, including the ability to encapsulate therapeutic agents, provide sustained and controlled drug release, and overcome the blood-brain barrier for better penetration. By combining hydrogel systems with MRI techniques, it is possible to develop therapeutic approaches that provide real-time monitoring and controlled release of therapeutic agents. Surgical resection remains important, but there is a growing need for alternative approaches that can complement or replace traditional methods. The objective of this comprehensive narrative review is to evaluate the potential of MRI-monitored therapeutic hydrogel systems in non-surgical brain tumour treatment.

Sushruta: The Father of Indian Surgical History

Sushruta, an ancient surgeon from 600 BCE in Kashi, India, is a pioneering figure in medical history. His innovations in surgical techniques, predating Hippocrates and Galen, have left an indelible mark in the field. This review article focuses on Sushruta's contributions to surgery, particularly his foundational work in plastic and reconstructive procedures. We delve into the Sushruta Samhita, the oldest surgical text, covering essential principles, pathology, anatomy, and surgical management. Sushruta's approach emphasized cleanliness, cadaver dissection, and innovative practices in anesthesia. Our article underscores the enduring impact of Sushruta's work on modern surgical science.

Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report

INTRODUCTION

This case study reports on a suicide attempt involving indoxacarb and vitamin C. Indoxacarb is a neurotoxic insecticide used in agriculture and as a flea controller in pets. Cotton, vegetables, and fruits are treated with indoxacarb, an insecticide that can be applied both indoors and outdoors. It causes skin allergies, methemoglobinemia, and hemolytic anemia. It is also attributed to allergic reactions through ingestion, inhalation, physical contact, and translaminar action. This case report highlights use of vitamin C in methemoglobinemia caused by indoxacarb poisoning. Indoxacarb poisoning has the potential to be extremely serious and even lethal. In this instance, the patient initially had no symptoms after ingesting a substance containing indoxacarb in an attempt at suicide. However, further tests revealed methemoglobinemia and low oxygen levels.

CASE PRESENTATION

A 28-year-old south-east Asian female patient ingested an insecticide containing 5.25% novaluron, 4.5% indoxacarb, and 25% thiamethoxam, and reported that she noticed muddy brown urine but presented with no active signs or symptoms of poisoning. Upon examination, the patient was fully conscious, alert, and hemodynamically stable, but had an oxygen saturation of 84%. Gastric lavage was performed, and blood investigations revealed a muddy-brown-colored blood sample and methemoglobin levels of 12%. The patient was treated with high-dose vitamin C and showed significant improvement, with a drop in methemoglobin levels to 1.2% and an increase in oxygen saturation to 97%.

DISCUSSION

Indoxacarb poisoning can cause severe methemoglobinemia. Vitamin C may be a useful treatment option for methemoglobinemia caused by indoxacarb, particularly in cases in which traditional treatment with methylene blue is contraindicated or not tolerated. Hence high doses of ascorbic acid, that is, vitamin C, were administered to the patient, which lowered their methemoglobin levels and improved oxygen levels without much safety concerns.

CONCLUSION

This example emphasizes the significance of early indoxacarb poisoning detection and treatment as well as the possible advantages of utilizing ascorbic acid in the management of methemoglobinemia, and highlights the use of vitamin C in the treatment of methemoglobinemia caused by indoxacarb poisoning. Therefore, it is important for healthcare professionals to be aware of the potential for indoxacarb to cause methemoglobinemia and to consider vitamin C as a treatment option.

Testicular mesothelioma disguised as hydrocele: a case report

BACKGROUND

Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis.

CASE PRESENTATION

We present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up.

CONCLUSION

Although hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.

Complex neuropsychiatric presentation of 17q12 duplication syndrome: A case report

The chromosomal band 17q12 is characterized by a high density of genes and is bordered by segmental duplications, the structural arrangement of which increases the susceptibility of the region to deletions and duplications. Duplication of 17q12 is a rare genetic condition associated with variable characteristics from clinically asymptomatic to intellectual disabilities, seizures, and behavioral problems. The variability in phenotype is primarily due to variable expressivity and incomplete penetrance. Diagnosis is mostly established by chromosomal microarray. Treatment involves a multidisciplinary approach. We present a case of a 43-year-old female who initially presented with hyperphagia and was eventually diagnosed with bulimia nervosa, anxiety, mood disorder, and personality disorder. Additional research is required to better understand the impact of 17q12 duplication syndrome on the development of bulimia nervosa since its pathogenesis has not been adequately described in the current literature.

Hyper-IgE syndrome: a case report

Introduction and importance

Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency disorder characterized by elevated serum IgE levels, recurrent infections, and various clinical features. Early diagnosis, prompt management of infections, and supportive care are essential in improving outcomes for individuals with HIES. Genetic testing, including STAT3 gene sequencing, plays a crucial role in confirming the diagnosis. Further research is needed to enhance our understanding of HIES and develop targeted therapies to improve the quality of life for affected individuals.

Case presentation

This case report presents the clinical features and management of a 37-year-old male with HIES, diagnosed at the age of 2 due to recurrent cold abscesses caused by Staphylococcal infections.

Clinical discussion

The patient exhibited typical symptoms of HIES, including recurrent eczema, frequent bacterial infections, mucocutaneous candidiasis, and various physical abnormalities. Diagnostic markers such as elevated IgE levels and eosinophilia supported the HIES diagnosis, which was further confirmed by the identification of a STAT3 gene mutation. Treatment primarily involved supportive measures and antibiotics for infections. The patient's blood test results and imaging findings revealed abnormalities such as low red blood cell count, elevated erythrocyte sedimentation rate, and pulmonary nodules.

Conclusion

This case report highlights the importance of early diagnosis, prompt management of infections, and the need for ongoing research to improve our understanding and treatment of HIES.

Impacts of the advancement in artificial intelligence on laboratory medicine in low- and middle-income countries: Challenges and recommendations-A literature review

Background and Aims

Artificial intelligence (AI) has emerged as a transformative force in laboratory medicine, promising significant advancements in healthcare delivery. This study explores the potential impact of AI on diagnostics and patient management within the context of laboratory medicine, with a particular focus on low- and middle-income countries (LMICs).

Methods

In writing this article, we conducted a thorough search of databases such as PubMed, ResearchGate, Web of Science, Scopus, and Google Scholar within 20 years. The study examines AI's capabilities, including learning, reasoning, and decision-making, mirroring human cognitive processes. It highlights AI's adeptness at processing vast data sets, identifying patterns, and expediting the extraction of actionable insights, particularly in medical imaging interpretation and laboratory test data analysis. The research emphasizes the potential benefits of AI in early disease detection, therapeutic interventions, and personalized treatment strategies.

Results

In the realm of laboratory medicine, AI demonstrates remarkable precision in interpreting medical images such as radiography, computed tomography, and magnetic resonance imaging. Its predictive analytical capabilities extend to forecasting patient trajectories and informing personalized treatment strategies using comprehensive data sets comprising clinical outcomes, patient records, and laboratory results. The study underscores the significance of AI in addressing healthcare challenges, especially in resource-constrained LMICs.

Conclusion

While acknowledging the profound impact of AI on laboratory medicine in LMICs, the study recognizes challenges such as inadequate data availability, digital infrastructure deficiencies, and ethical considerations. Successful implementation necessitates substantial investments in digital infrastructure, the establishment of data-sharing networks, and the formulation of regulatory frameworks. The study concludes that collaborative efforts among stakeholders, including international organizations, governments, and nongovernmental entities, are crucial for overcoming obstacles and responsibly integrating AI into laboratory medicine in LMICs. A comprehensive, coordinated approach is essential for realizing AI's transformative potential and advancing health care in LMICs.

Unmasking diphtheria in Nigeria: A multifaceted approach to tackle outbreaks and improve immunization rates among the Nigerian population-An updated correspondence

Background and aims

The World Health Organization has recently declared the frequent outbreaks of diphtheria in Nigeria as a public health concern. Although vaccination efforts have been successful in Nigeria, unfortunately, the recent 2023 outbreak in Nigeria has been nothing short of distressing. Of course, cases of diphtheria incidence are under-reported in Nigeria. This present article aims to proffer a possible multifaceted approach to tackle outbreaks of diphtheria in Nigeria and improve immunization rates against the disease among the Nigerian population.

Methods

In writing this study, literature search was done about diphtheria in Nigeria using the following keywords: "diphtheria, prevalence, vaccination, efforts, challenges, and Nigeria" on PubMed, Web of Science, Google Scholar, and ResearchGate within 10 years.

Result

This study found that an estimated seven million people remain unvaccinated and are at risk for infection in the country, especially people living in the Northern part of the country. Between the June 30 and August 31, 2023, Nigeria recorded an unusual increase in the number of confirmed cases of diphtheria, where a total of 5898 suspected cases were reported from 59 local government areas in 11 states across Nigeria. The majority (99.4%) of suspected cases of the disease were reported from six states: Kano (1816), Katsina (234), Yobe (158), Bauchi (79), Kaduna (45), and Borno (33).

Conclusion

If Nigeria is to emerge beyond these frequent epidemics of diphtheria, the Nigerian government must work on tackling this issue on multiple fronts simultaneously, that is, at the national and international levels, as we believe that these levels would give a holistic way to unmask diphtheria in Nigeria.

One health approach to mitigate anthrax in Ghana

Anthrax outbreaks in Ghana have become a pressing public health concern, posing threats to human health, the agricultural sector, and social well-being. This letter to the editor highlights the gravity of the anthrax situation in Ghana and advocates for comprehensive interventions using a One Health approach. The epidemiology of anthrax, including its historical roots and modes of transmission, is discussed. The consequences of anthrax outbreaks, such as severe illness, economic losses, and social distress, are outlined. To combat this complex issue, the letter emphasizes the importance of enhanced awareness, prevention, accurate diagnosis, and timely treatment. Recommendations include vaccination of animals and humans, education campaigns, proper disposal of infected carcasses, strengthening healthcare systems, surveillance, and early detection. Collaboration and coordination among professionals in the human, animal, and environmental sectors are crucial. By adopting a One Health approach and implementing these measures, Ghana can effectively mitigate the impact of anthrax outbreaks and safeguard the health and well-being of its population and livestock.

Stabilizing the unstable: Tuberculosis of the odontoid process with atlanto-occipital instability-Case report and review of literature

Key Clinical Message

Tuberculosis (TB) of the odontoid process is a rare but potentially, a debilitating condition. Surgical intervention, in the form of stabilizing the spine and decompressing the spinal cord, offers a tailored approach to managing this condition effectively and improving prognosis.

Abstract

Odontoid process tuberculosis (TB) is a rare condition that can cause spinal instability and neurological complications. Diagnosis of odontoid process TB is difficult and requires a combination of clinical, radiographic, and histopathological examinations. This report describes the treatment of a 46-year-old female with quadriparesis and intermittent fever. Radiological findings showed TB of the odontoid process with atlanto-axial dislocation causing compressive myelopathy. She underwent C1-C3 decompressive laminectomy and stabilization from C1 to C5. GeneXpert for TB was positive and she was started on anti-tuberculous medications. She regained power gradually and at 1 year follow-up she was ambulant without any support. The C1-C5 lateral mass screw and C1-C3 decompressive laminectomy approach, as highlighted in this case, offers an effective solution, enhancing patient quality of life, and preventing disease progression.

Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series

INTRODUCTION AND IMPORTANCE

D-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development.

CASE PRESENTATION

Case 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness.

CLINICAL DISCUSSION

Magnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery.

CONCLUSION

This case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.

Targeting circulating tumor cells to prevent metastases

Circulating tumor cells (CTCs) are cancer cells that detach from the primary tumor, enter the bloodstream or body fluids, and spread to other body parts, leading to metastasis. Their presence and characteristics have been linked to cancer progression and poor prognosis in different types of cancer. Analyzing CTCs can offer valuable information about tumors' genetic and molecular diversity, which is crucial for personalized therapy. Epithelial-mesenchymal transition (EMT) and the reverse process, mesenchymal-epithelial transition (MET), play a significant role in generating and disseminating CTCs. Certain proteins, such as EpCAM, vimentin, CD44, and TGM2, are vital in regulating EMT and MET and could be potential targets for therapies to prevent metastasis and serve as detection markers. Several devices, methods, and protocols have been developed for detecting CTCs with various applications. CTCs interact with different components of the tumor microenvironment. The interactions between CTCs and tumor-associated macrophages promote local inflammation and allow the cancer cells to evade the immune system, facilitating their attachment and invasion of distant metastatic sites. Consequently, targeting and eliminating CTCs hold promise in preventing metastasis and improving patient outcomes. Various approaches are being explored to reduce the volume of CTCs. By investigating and discussing targeted therapies, new insights can be gained into their potential effectiveness in inhibiting the spread of CTCs and thereby reducing metastasis. The development of such treatments offers great potential for enhancing patient outcomes and halting disease progression.

Granular cell tumor of the brain: case report and review of literature

Granular cell tumors are rare tumors that develop from Schwann cells, which are glial cells surrounding neurons of the peripheral nervous system, which serve in the process of myelination. Granular cell tumors are rarely associated with the central nervous system in humans. In this report, we analyze a patient with granular cell tumor and review the current literature.

A rare case of tuberculous myocarditis: A diagnostic challenge in a tuberculosis-endemic country

Key Clinical Message

Tuberculous myocarditis is a rare presentation of tuberculosis, posing diagnostic challenges in endemic countries. Clinicians should consider this entity in patients with unexplained heart failure, conduction abnormalities, or sudden cardiac events in tuberculosis-endemic regions.

Abstract

Tuberculous myocarditis is an uncommon manifestation of tuberculosis, often presenting as a diagnostic challenge, particularly in tuberculosis-endemic regions. We report a case of a 58-year-old male with a history of chronic cough and fever, who presented with progressive dyspnea, generalized body swelling, and New York Heart Association (NYHA) Class IV heart failure. Clinical examination revealed signs of cardiac decompensation and congestive heart failure. Emergency echocardiography demonstrated biventricular dysfunction, and imaging showed clots in both atria and the left ventricle. The patient responded well to initial treatment with anticoagulants, antibiotics, diuretics, and inotropic support. Subsequent investigations, including computed tomography pulmonary angiogram (CTPA) and high-resolution computed tomography (HRCT), confirmed active pulmonary tuberculosis. Anti-tuberculous treatment (ATT) was initiated, and the patient showed remarkable improvement. The diagnosis of tuberculous myocarditis was based on clinical, radiological, and laboratory evidence, as cardiac biopsy was not performed due to resource limitations. Tuberculous myocarditis is an underreported condition, and clinicians should be vigilant about its occurrence, especially in tuberculosis-endemic regions. Early recognition and prompt initiation of ATT can lead to favorable outcomes. This case highlights the importance of considering tuberculous myocarditis in patients with unexplained heart failure or cardiac abnormalities in areas with a high burden of tuberculosis.

Non-osseous intradural tuberculoma of the thoracic spine with compressive myelopathy

Key Clinical Message

An uncommon form of CNS tuberculosis called non-osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment.

Abstract

Tuberculoma affecting the spinal cord is a rare condition in modern times. The occurrence of non-osseous intradural tuberculosis, specifically in the spine, is even more exceptional. In fact, it is uncommon to encounter an intradural extramedullary tuberculous granuloma that lacks radiological indications of vertebral involvement, especially within the thoracic region. We present a case of a patient with a neurological deficit caused by a non-osseous intradural tuberculoma in the thoracic region, without any associated bone involvement. The patient experienced a gradual deterioration of neurological function. An MRI of the thoracic spine revealed the presence of a tuberculoma located intradurally, extramedullary, and juxtamedullary of the T5 vertebra. The compression of the spinal cord resulted in paraparesis which was worsening to paraplegia. A D4-D6 laminectomy and microsurgical excision were performed under intraoperative neurophysiological monitoring (IONM), and the patient showed clinical recovery. Excellent clinical outcomes were achieved. However, it is crucial to consider the possibility of a non-osseous intradural tuberculoma as a rare condition when encountering a SOL, particularly in patients with a history of tuberculosis and spinal cord compression. In cases where a progressing neurological deficit is present, a combination of surgical intervention and anti-tuberculous treatment should be considered as the optimal approach.

Tuberculosis manifesting with significant peripheral eosinophilia: A case report and review of literature

Key Clinical Message

Peripheral eosinophilia is a rare but potential sign of TB infection. Physicians should assess patients for TB, especially if they display related symptoms or risk factors, and consider TB as a differential diagnosis, especially in idiopathic cases.

Abstract

Millions of new tuberculosis (TB) cases are reported annually. Peripheral eosinophilia is rare in tuberculosis. We describe a rare case of tuberculosis with a high peripheral eosinophil count. A 9-year-old male presented with fever, cough, and respiratory discomfort for a month. The patient's cough did not respond to treatment, along with weight loss and a loss of appetite. A physical examination revealed cervical lymphadenopathy and bilateral lung crepitations. A hematological investigation showed a high eosinophil count of 25,920 cells per cubic millimeter and medical imaging abnormalities consistent with TB. Some malignancies, allergies, and parasitic infections produce peripheral eosinophilia. However, medical literature rarely discusses TB-induced eosinophilia. Several studies attribute it to mycobacterium antigen hyperreactivity. Eosinophilic release of cytotoxic chemicals may cause tissue damage, and TB patients' eosinophil levels may fluctuate. This case report emphasizes the need to investigate TB in peripheral eosinophilia patients after ruling out other explanations. Our patient benefited from early detection and anti-TB medication. More studies are required to investigate the causes of TB eosinophilia and its consequences. A detailed medical history and physical examination are essential to diagnose and treat atypical presentations of TB.

Distal radius chondrosarcoma in a 35-year-old female patient: A case report

Key Clinical Message

Chondrosarcoma, although rare in the distal radius, poses significant challenges. Early diagnosis through incisional biopsy is essential. Surgical resection with margin control and fibular grafting can be effective, but vigilant surveillance is crucial due to its aggressive nature. Metastasis demands consideration of additional interventions or palliative care.

Abstract

Chondrosarcomas constitute a rarity in the upper limbs, and their occurrence in the distal radius is even rarer with only one case previously documented. We report a case of distal radius chondrosarcoma in a 35-year-old female patient who presented with pain and swelling in her left wrist. Following an initial examination, an incisional biopsy was performed, confirming the diagnosis of dedifferentiated chondrosarcoma. The patient underwent a marginal resection of the distal radius and first carpal with ipsilateral fibular and locking compression plate fixation. Unfortunately, despite the interventions, the patient experienced recurrent swelling and ultimately required below-elbow amputation, followed by above elbow amputation due to metastasis. Unfortunately, the patient passed away due to recurrence and metastasis.

Upper cervical intramedullary schwannoma of the spinal cord presenting with myelopathy: illustrative case

BACKGROUND

Intramedullary schwannomas account for 1.1% of all spinal schwannomas. Preoperative diagnosis is best accomplished by thoroughly evaluating clinical and radiological characteristics, accompanied by a high index of suspicion. The authors report a case of C2-3 intramedullary schwannoma in a young male who presented with neck pain and vertigo. The current literature is also reviewed.

OBSERVATIONS

The authors reviewed the data of a young male with a 2-month history of neck pain and vertigo. Magnetic resonance imaging of the brain and cervical spine showed an intramedullary mass at C2-3 with a syrinx extending into the cervicomedullary junction. Laminectomy, myelotomy, and microsurgical excision of the mass under intraoperative neurological monitoring (IONM) were done. Postoperative pathology reported the specimen as a schwannoma.

LESSONS

Gross-total resection of a schwannoma using IONM is the treatment of choice because of the lesion's benign nature, a better prognosis, and defined cleavage plane. Schwannomas should be included in the differential diagnosis of intramedullary spinal tumors. Because of its progressive nature, early surgery is recommended in symptomatic patients.

Noninvasive diagnosis of Ascaris lumbricoides in the common bile duct: A pediatric case report of acute pancreatitis

Key Clinical Message

This case report highlights the importance of considering parasitic infections, particularly Ascaris lumbricoides, as a possible cause of acute pancreatitis in children, especially in endemic regions. Noninvasive imaging techniques, such as ultrasonography, can play a crucial role in the early detection and diagnosis of this unusual presentation. Timely administration of anthelmintic therapy led to the resolution of symptoms and prevented the need for invasive procedures. Healthcare providers should be vigilant about the diverse clinical manifestations of ascariasis, and regular deworming programs and health education are essential in minimizing the burden of this neglected tropical disease among children.

Abstract

Ascariasis is a common public health problem globally but it is more prevalent in school-age children and it often goes undiagnosed, leading to severe complications. The purpose of this report is to spread awareness of its unusual presentation and how to judiciously use noninvasive approaches for its diagnosis. We present a case of a 10-year-old girl that was presented in pediatric emergency with gradually worsening epigastric pain. Initial lab work-up showed elevated pancreatic enzymes which lead to the diagnosis of acute pancreatitis. The patient was managed in the line of acute pancreatitis and with further evaluation by imaging techniques such as ultrasound and CT-scan abdomen, Ascaris lumbricoides (A. lumbricoides) was visualized. She was then treated with prophylactic antibiotics and antiparasitic medications, which resolved her symptoms and the child responded to the treatment. In children, parasites should be considered as a cause of acute pancreatitis by clinicians, especially in low-income countries, and before performing invasive procedures, noninvasive approaches should be considered as an initial option. This can save the patient from multiple invasive procedure and its severe complications.

Pediatric primary intraventricular hemorrhage: A case report of isolated fourth ventricle hemorrhage in a 10-year-old boy

Key Clinical Message

Primary intraventricular hemorrhage (PIVH) is a rare condition in pediatric patients, presenting with headache, vomiting, and altered mental status. Surgical interventions, such as external ventricular drain placement, followed by ventriculoperitoneal shunting, show promising outcomes. Further research is needed to enhance understanding and optimize management strategies for pediatric PIVH.

Abstract

This case report describes a 10-year-old boy with isolated primary intraventricular hemorrhage (PIVH) in the fourth ventricle, shedding light on its clinical presentation and management challenges. The patient presented with headache, vomiting, and altered sensorium, and was subsequently diagnosed with obstructive hydrocephalus due to intraventricular bleeding. Emergency external ventricular drain (EVD) insertion was performed, followed by ventriculoperitoneal shunt placement, resulting in a favorable outcome. The etiology of PIVH in children differs from that in adults, with arteriovenous malformations, Moyamoya disease, and aneurysms being commonly implicated causes. Management strategies for pediatric PIVH are challenging due to limited research, but EVD placement and surgical interventions have shown promise.

Celebrating breakthrough in dental diagnostics: FDA approval of an AI model for diagnosis of periodontal diseases: A correspondence

Periodontal diseases are prevalent and have significant implications for oral health and overall well-being. Current diagnostic methods have limitations in accuracy and standardization. The recent Food and Drug Administration approval of Videa Perio Assist (VPA), an AI model for diagnosing periodontal diseases, presents a breakthrough in dental diagnostics. VPA is a cloud-based, AI-powered software that automatically measures and visualizes bone levels associated with each tooth from radiographic images. Clinical testing has demonstrated VPA's efficacy in accurately diagnosing periodontal diseases with high sensitivity and specificity. The integration of AI in dentistry has the potential to revolutionize periodontal disease diagnosis, improve patient care, and enhance decision-making. However, further research, education, cost-effectiveness, and collaboration are essential for maximizing the benefits of AI in dental settings. The approval and implementation of VPA mark a significant advancement in dental diagnostics, paving the way for more effective solutions and a healthier global population.

National hepatitis registry in Pakistan: a dire need for hepatitis surveillance and control

Hepatitis is a major public health issue in Pakistan, with an estimated 11.55% prevalence of HCV infection in the adult population. The country ranks second globally in terms of hepatitis C virus (HCV) infections, with approximately one in every 20 Pakistanis already infected. The mortality rates due to HBV and HCV stand at 563,000 and 366,000 annually, respectively. However, the absence of a national registry or database system and the lack of coordination among provinces pose significant obstacles in combating this disease effectively. To address this issue, the establishment of a centralized national database registry is crucial, allowing comprehensive analysis, tracking of hepatitis prevalence, and identification of high-risk areas for targeted interventions. By fostering collaboration among provinces, the government, and non-governmental organizations, the registry would facilitate joint decision-making, minimize duplication of efforts, and address inconsistencies in diagnosis and treatment. Collaborating with student-run organizations and leveraging enhanced laboratory capacities post-COVID era can strengthen the hepatitis control program. The centralized approach and unified efforts are necessary to achieve the goal of a hepatitis-free Pakistan, where a healthier future can be realized.

Diphtheria in Pakistan post-COVID-19, a potential public health threat: an update

Diphtheria, a vaccine-preventable disease, remains a concern in Pakistan as cases have risen post-COVID-19 pandemic causing more than 45 deaths in Pakistan in the year 2022. The respiratory variant of the disease is more common and can lead to serious complications, such as myocarditis and respiratory insufficiency. Diphtheria has caused havoc in the past killing millions of people worldwide before the development of its vaccine. Although the diphtheria toxoid vaccine is effective against toxigenic strains, there have been cases of treatment-resistant strains, particularly the non-toxigenic strains of C. diphtheriae. Pakistan's economic and health systems have suffered setbacks, which have been exacerbated by the COVID-19 pandemic. The pandemic has disrupted routine vaccination programs, and recent floods have contributed to an increase in diphtheria cases and rendered millions homeless. Poor immunization services, inadequate training of vaccination teams, and wealth inequality have all contributed to unequal vaccination coverage in Pakistan. The rising cases of diphtheria call for prompt action, including booster shots, updating vaccination records and administering immediate doses of the toxoid to close contacts.

ChatGPT in medicine: an overview of its applications, advantages, limitations, future prospects, and ethical considerations

This paper presents an analysis of the advantages, limitations, ethical considerations, future prospects, and practical applications of ChatGPT and artificial intelligence (AI) in the healthcare and medical domains. ChatGPT is an advanced language model that uses deep learning techniques to produce human-like responses to natural language inputs. It is part of the family of generative pre-training transformer (GPT) models developed by OpenAI and is currently one of the largest publicly available language models. ChatGPT is capable of capturing the nuances and intricacies of human language, allowing it to generate appropriate and contextually relevant responses across a broad spectrum of prompts. The potential applications of ChatGPT in the medical field range from identifying potential research topics to assisting professionals in clinical and laboratory diagnosis. Additionally, it can be used to help medical students, doctors, nurses, and all members of the healthcare fraternity to know about updates and new developments in their respective fields. The development of virtual assistants to aid patients in managing their health is another important application of ChatGPT in medicine. Despite its potential applications, the use of ChatGPT and other AI tools in medical writing also poses ethical and legal concerns. These include possible infringement of copyright laws, medico-legal complications, and the need for transparency in AI-generated content. In conclusion, ChatGPT has several potential applications in the medical and healthcare fields. However, these applications come with several limitations and ethical considerations which are presented in detail along with future prospects in medicine and healthcare.

Rift Valley fever virus outbreak in Mauritania yet again in 2022: No room for complacency

Rift Valley fever is an important yet ignored viral hemorrhagic fever claiming many lives of African and Arabian countries over the past decade. Unfortunately, a recent outbreak of Rift Valley fever is currently ravaging in Mauritania. Death toll is rising continuously with 23 deaths reported in the month of October, 2022. Our article aims to shed light on the ongoing Rift Valley fever outbreak and recommendations to eradicate this potential threat to public health. Online databases including PubMed, the Lancet, and Science Direct as well as conferences, news, and press releases were used to for data collection. All the available medical literature related to Rift Valley fever in Mauritania were taken into consideration while writing the manuscript. As of October 17, 2022, 47 cases have been documented out of which 23 are dead. Case fatality rate has been reached to 49% which has given a wakeup call to the authorities. Efforts are being made by the concerned authorities and World Health Organization to halt the progression of this outbreak. Further investigations are required to completely eradicate the recurrent outbreaks in Mauritania especially in the area of vaccine development. Active involvement of public with the government authorities is of extreme significance in combating this disease.

Exploring the Boundaries of Reality: Investigating the Phenomenon of Artificial Intelligence Hallucination in Scientific Writing Through ChatGPT References

Background Chatbots are computer programs that use artificial intelligence (AI) and natural language processing (NLP) to simulate conversations with humans. One such chatbot is ChatGPT, which uses the third-generation generative pre-trained transformer (GPT-3) developed by OpenAI. ChatGPT has been praised for its ability to generate text, but concerns have been raised about its accuracy and precision in generating data, as well as legal issues related to references. This study aims to investigate the frequency of AI hallucination in research proposals entirely drafted by ChatGPT. Methodology An analytical design was employed to investigate AI hallucination by ChatGPT. A total of 178 references listed by ChatGPT were verified for inclusion in the study. Statistical analysis was performed by five researchers who entered their data into a Google Form, and the final results were represented using pie charts and tables. Results Out of the 178 references analyzed, 69 references did not have a Digital Object Identifier (DOI), and 28 references neither turned up on Google search nor had an existing DOI. Three references were listed from books and not research articles. These observations suggest that ChatGPT's ability to generate reliable references for research topics may be limited by the availability of DOI and the accessibility of online articles. Conclusions The study highlights the potential limitations of ChatGPT's ability to generate reliable references for research proposals. AI hallucination is a problem that may negatively impact decision-making and may give rise to ethical and legal problems. Improving the training inputs by including diverse, accurate, and contextually relevant data sets along with frequent updates to the training models could potentially help address these issues. However, until these issues are addressed, researchers using ChatGPT should exercise caution in relying solely on the references generated by the AI chatbot.

Novel Oral CGRP Receptor Antagonist Atogepant in the Prevention of Migraine

Advancements in molecular biology and neuroscience have uncovered calcitonin gene-related peptide (CGRP), a neuropeptide consisting of thirty-seven amino acids that plays a crucial role in migraine pathogenesis. CGRP receptor antagonist or gepant is an oral medication that can impede the nociceptive signaling pathway related to CGRP. Atogepant, the latest CGRP antagonist approved by the Food and Drug Administration (FDA) for prophylaxis of episodic migraine, works by non-competitively blocking CGRP receptors, thereby curtailing neurogenic inflammation and pain sensitization. Numerous trials have demonstrated that atogepant is an effective therapy for migraine prevention, with its extended half-life and minimal risks of cardiovascular or liver toxicity making it the first drug in its class primarily authorized for that purpose. In terms of monthly migraine days, monthly headache days, and acute medication usage days, atogepant demonstrated a statistically significant difference from baseline.  It was well-tolerated with low adverse event rates. The most commonly reported adverse events were constipation and nausea. Atogepant appears to be beneficial for migraine prevention, and it may be more useful in those who do not want to take the medication as an injection or who do not require a lengthy duration of pharmacological impact. In this article, we provide a systematic review of the literature on atogepant and migraine, emphasizing current achievements in this field of study.

Evaluation of the EyeSys model II computerized videokeratoscope. Part II: The repeatability and accuracy in measuring convex aspheric surfaces

PURPOSE

To evaluate the precision and repeatability of a Placido disc-based computerized videokeratoscope, using convex surfaces of varying eccentricities and apical radii designed to simulate the range of topographical variations of the human cornea, rather than the purely spherical surfaces used in most previous studies.

METHODS

Form Talysurf analysis was used to verify the exact form of 12 Perspex convex surfaces. The EyeSys model II videokeratoscope was used to measure the sagittal radii of curvature twice at known points on each surface. The raw data tables were analyzed to assess the repeatability and accuracy for both central and peripheral points on each surface. The relationship between these factors and the eccentricity was investigated.

RESULTS

For central radii the instrument showed high correlation (r = 0.996) between actual and measured values. There was a small instrumental bias of +0.042 mm and the 95% limits of agreement were narrow (+0.121 to -0.037 mm), indicating clinically acceptable accuracy. The accuracy decreased slightly as the p-value decreased (greater peripheral flattening). For peripheral radii, the overall accuracy compared well to central radii, with an average bias of +0.022 mm and maximum error in 95% of cases 0.083 mm (bias +1.96 x SD). However, for surfaces where p = 0.50, the bias was +0.049 and maximum error in 95% of cases 0.110 mm. Repeatability for the aspheric surfaces was shown to be high (SD +/- 0.01 mm in all quadrants).

CONCLUSIONS

The accuracy of the EyeSys corneal analysis system (CAS) in measuring central and peripheral radius of curvature was shown to be dependent on the shape of the surface to be measured. For more rapidly flattening surfaces, a decrease in accuracy was found for both central and peripheral radius of curvature, which in clinical terms is thought acceptable.

Evaluation of the EyeSys model II computerized videokeratoscope. Part I: Clinical assessment

PURPOSE

To compare the agreement and repeatability of keratometry measurements with simulated keratometry measurements from the EyeSys (model II) corneal analysis system (CAS). Furthermore, to establish any relationship between the repeatability of peripheral corneal measurements and the spatial location at the cornea.

METHODS

Measurements using a Bausch & Lomb keratometer in 19 eyes (19 subjects) were compared with the simulated keratometry values using the EyeSys CAS. Repeatability of the keratometer (14 eyes, 14 subjects) and the EyeSys simulated keratometry values (10 eyes, 10 subjects) was assessed by comparing the difference of two measurements. Peripheral repeatability of the EyeSys CAS was compared in a similar manner in a sample of 10 eyes (10 subjects).

RESULTS

The 95% confidence limits (-0.529 to +0.149 D) showed a lack of agreement between both instruments. With respect to the repeatability, both the keratometer (SD = +/- 0.103 D) and the EyeSys (SD = +/- 0.072 D) were found to exhibit approximately similar degrees of repeatability. The repeatability of peripheral corneal measurements using the EyeSys CAS showed changes in repeatability dependent on the corneal meridian and the distance from the point of alignment. Measurements along the superior and nasal meridians showed poorest repeatability. Repeatability was also found to deteriorate away from the point of alignment.

CONCLUSIONS

EyeSys simulated keratometry values were not interchangeable with the keratometer. This could be due to differences in the method of alignment or measurements from different areas on the corneal surface. Repeatability of both the Bausch & Lomb keratometer and the EyeSys CAS was found to be similar. The spatial dependency of peripheral corneal radius repeatability measurements could be attributed to interference of the ocular adnexa in those areas of measurement.

Current trends in modern orthokeratology

The present article describes the basic concepts and principles of modern orthokeratology. Early investigators postulated a variety of theories. However, controlled clinical studies have shown these methods to be both unpredictable and also modest in their ability to correct myopia. These traditional techniques involved fitting lenses according to a 'rule-of-thumb' and clinicians had no means of accurately evaluating corneal topography. More recently, with the significant advances in corneal topography systems and the application of reverse geometry lenses (lenses where the secondary curve steepens) certain investigators have concluded that the technique can rapidly reduce greater levels of myopia with greater predictability. The procedure involves a more scientific sagitta based fitting philosophy and predictability is defined according to corneal asphericity.

Current developments in measurement of corneal topography

Significant developments in the measurement of corneal topography have taken place since the early Placido devices. These developments have arisen as a result of two key factors: increased computer processing power and also improved algorithms that are capable of deriving corneal shape without making any fundamental assumptions. These developments are reviewed and attention is drawn to some of the key areas where current topographical devices are somewhat limited.

Myocardial and endocardial involvement in tuberculous constrictive pericarditis: difficulty in biopsy distinction from endomyocardial fibrosis as a cause of restrictive heart disease

Differentiation of constrictive pericarditis and endomyocardial fibrosis by the available diagnostic methods is difficult at present. With this in mind, we compared autopsy data in heart specimens from 8 patients of constrictive pericarditis of tuberculous origin and 6 patients with tropical endomyocardial fibrosis. Post-mortem endomyocardial biopsies were also performed from both the ventricles. Pericardial thickening and adhesions were present in all cases of constrictive pericarditis and in none of those with endomyocardial fibrosis. Interestingly, significant endocardial thickening was seen in four, and myonecrosis, lymphohistiocytic cellular infiltration and myofibrosis were observed in seven of the eight cases of constrictive pericarditis. This suggests that the tubercular insult to heart may result in involvement of all three layers with varying severity. The endomyocardial biopsy specimens from the affected areas revealed similar histopathological changes of endocardial thickening and focal myofibrosis with cellular infiltrates in patients with both constrictive pericarditis and endomyocardial fibrosis, making distinction of the two difficult. The hallmark of differentiation between these two clinical entities appears to be a diligent attempt at identification of the thickened pericardium.