Neuroscience Institute Research Articles

Brain banking in India: Relevance in current day practice.

Biobanks are set to become the norm. The explosion of new and powerful technologies like genomics and other multiomics has catapulted research from individual laboratories to multi-institutional and international partners. Today, with increasing life span, and the rising incidence of brain diseases, Brain Banks have become an invaluable source for unravelling the pathogenesis of several brain disorders, and develop effective therapies. The article briefly reviews the evolution of brain banking, rise of global networks, with a brief overview of steps involved from donor recruitment, protocols of processing, storage, annotation, and tissue distribution. The ethics of biobanking is one of the most controversial issues in bioethics, the key issues being consent, confidentiality, and commercialisation. Regulatory authorities in different countries and in India, the Indian Council of Medical Research has taken a lead to formulate new ethical guidelines for research involving human participants protecting rights, and well-being of research participants. Although brain banks have been established in the 1960s, in India, the first Brain Bank was established in 1995 at the National Institute of Mental Health and Neurosciences, Bengaluru. Now a network with two more Brain banks is being established in the country. The challenges and benefits of establishing the first Brain Bank as a National Research Facility in India is shared. For optimising available resources and promote brain banking, it is essential for medical professionals, and the public to perceive the crucial advantage in conversion of biological waste into invaluable resources for neuroscience. This will be the greatest "gift of hope" that we can offer for the future generations to overcome hitherto untreatable disorders such as dementias.

Stay or Go? Neuronal Activity in Medial Frontal Cortex During a Voluntary Tactile Preference Task in Head-fixed Mice

The decision to move is influenced by sensory, attentional, and motivational cues. One such cue is the quality of the tactile input, with noxious or unpleasant sensations causing an animal to move away from the cue. Processing of painful and unpleasant sensation in the cortex involves multiple brain regions, although the specific role of the brain areas involved in voluntary, rather than reflexive movement away from unpleasant stimuli is not well understood. Here, we focused on the medial subdivision of secondary motor cortex, which is proposed to link sensory and contextual cues to motor action, and tested its role in controlling voluntary movement in the context of an aversive tactile cue. We designed a novel, 3D-printed tactile platform consisting of innocuous (grid) and mildly noxious (spiked) surfaces (50:50 % of total area), which enabled monitoring neuronal activity in the medial frontal cortex by two-photon imaging during a sensory preference task in head-fixed mice. We found that freely moving mice spent significantly less time on a spiked-surface, and that this preference was eliminated by administration of a local anesthetic. At the neuronal level, individual neurons were differentially modulated specific to the tactile surface encountered. At the population level, the neuronal activity was analyzed in relation to the events where mice chose to "stop-on" or "go-from" a specific tactile surface and when they "switched" surfaces without stopping. Notably, each of these three scenarios showed population activity that differed significantly between the grid and spiked tactile surfaces. Collectively, these data provide evidence that tactile quality is encoded within medial frontal cortex. The task pioneered in this study provides a valuable tool to better evaluate mouse models of nociception and pain, using a voluntary task that allows simultaneous recording of preference and choice. Grant support from NS109287 (G.A.), NS096246 (Y.U.), DK116624 (Y.U.) and NS113189 (Y.U.), the Iowa Neuroscience Institute, and the Williams- Cannon faculty fellowship (G.A). A.K. was supported by a predoctoral fellowship through NIH T32 Grant GM067795.

Anatomical Variations of the Superior Sagittal, Transverse and Sigmoid Dural Venous Sinuses in the Cerebral MRV Images of Adult Bangladeshis

Background: The understanding of the dural venous sinus anatomy and normal anatomical variations is fundamental for appropriate diagnosis of cerebral venous sinus pathology and also for surgical planning and treatment of neurological diseases. Cerebral MRV (Magnetic Resonance Venography) is an exclusive imaging technique for appropriate identification of the normal anatomical variations as well as pathology of the dural venous sinuses. Most of the variations have been detected in the superior sagittal, transverse and sigmoid venous sinuses. Objectives: To identify and determine the frequencies of some selected anatomical variations- symmetry, hypoplasia and aplasia (as applicable) of the superior sagittal, transverse and sigmoid dural venous sinuses in the cerebral MRV images of adult Bangladeshis. Methods: The research was observational in nature, carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the Department of Neuroradiology & Imaging, National Institute of Neuroscience and Hospital (NINS), Dhaka, from March 2020 to June 2021. A total of 70 adults (35 males and 35 females) Bangladeshi participants were included in this research. The MRV scans were produced by using 3 Tesla magnetic field strength following the routine standard protocols of the institution. By using the Radiant DICOM Viewer software, the MRV images were evaluated by the researcher and the co-investigator independently to identify the selected anatomical variations of the dural venous sinuses. Results: Bilateral symmetrical transverse and sigmoid sinus was found in 38% and 47% of total participants respectively. Among the variations of the transverse sinuses, the left sided hypoplastic transverse sinus was found in 17.1% participants whereas the right sided hypoplasia was found only in 2.9% participants. Regarding sigmoid sinus, hypoplasia and aplasia were found only on the left side respectively in 7.1% and 1.14% participants. ...

Inspired, but not mimicking: a conversation between artificial intelligence and human intelligence.

How intelligent is artificial intelligence (AI)? How intelligent will it become in the future? What is the relationship between AI and human intelligence (HI)? These questions have been a hot topic of discussion in recent years, but no consensus has yet been reached. To discuss these issues, we should first understand the concept of intelligence as well as the underlying mechanisms for both HI and AI. In this NSR Forum, experts from both disciplines gathered to discuss these issues; in particular, the similarities and differences between AI and HI, how these two disciplines could benefit from each other, and the emerging social and ethical challenges of AI. Xiaolan Fu Professor at the Institute of Psychology, Chinese Academy of Sciences (CAS) Yong Gu Professor at the Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, CAS Sheng He Professor at the Institute of Biophysics, CAS Zhuojun Liu Professor at the Academy of Mathematics and Systems Science, CAS Tieniu Tan Professor at the Institute of Automation, CAS Zhi-Hua Zhou Professor at National Key Laboratory for Novel Software Technology, Nanjing University Huimin Lin (Chair) Professor at the Institute of Software, CAS

Longitudinal Healthcare Utilization and Costs in Parkinson’s Disease: Pre-Diagnosis to 9 Years After

There is currently insufficient long-term data on costs of treatment in patients with Parkinson's disease (PD), which is chronic and progressive, and associated with substantial healthcare costs. Identifying patterns in healthcare utilization and cost may illuminate further discussion on early intervention. To characterize long-term healthcare utilization and costs of PD in newly diagnosed patients managed by movement disorder specialists. Using a longitudinal matched-cohort study of linked data from the National Neuroscience Institute Parkinson's disease and Movement Disorder and healthcare administrative databases in Singapore from 2008-2017, we compared healthcare utilization and costs between patients and controls matched on age, sex, race, and Charlson Comorbidity Index score. 1,162 patients met study inclusion criteria and 1,157 matched controls were identified. The total mean annual healthcare cost (at 2017 costs) was significantly increased in patients compared to controls from years 1-9 post-diagnosis. The increased cost was observed 2 years before diagnosis (USD2322 vs. 2052; p < 0.001). Mean annual cost attributable to PD increased from USD1854 at 1-year post-diagnosis to USD2652 at 9 years. Over 9 years, average costs were significantly higher across all domains of healthcare utilization except primary care-cost of intermediate and long-term care was increased by a factor of 2.5, specialist care by 2.3, emergency department visits by 1.6, and hospital admissions by 1.3. PD results in higher healthcare utilization and costs. Pre-diagnosis increase in healthcare utilization observed in patients supports the presence of prodromal PD symptoms and may present an opportunity for early diagnosis.

Advances in Stroke: Quality Improvement.

HomeStrokeVol. 53, No. 5Advances in Stroke: Quality Improvement No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextAdvances in Stroke: Quality Improvement Dawn M. Bravata, MD, Tara Purvis, MSc and Monique F. Kilkenny, PhD Dawn M. BravataDawn M. Bravata Correspondence to: Dawn M. Bravata, MD, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 W 10th St, Indianapolis, IN 46202. Email E-mail Address: [email protected] https://orcid.org/0000-0002-3048-2536 Health Services Research and Development Center for Health Information and Communication, Department of Veterans Affairs and Medicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.). Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Health Services Research and Development, Department of Veterans Affairs (VA), Indianapolis, IN (D.M.B.). Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.). William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN (D.M.B.). Search for more papers by this author , Tara PurvisTara Purvis Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (T.P., M.F.K.). The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (T.P., M.F.K.). Search for more papers by this author and Monique F. KilkennyMonique F. Kilkenny https://orcid.org/0000-0002-3375-287X Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (T.P., M.F.K.). The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (T.P., M.F.K.). Search for more papers by this author Originally published4 Apr 2022https://doi.org/10.1161/STROKEAHA.122.037450Stroke. 2022;53:1767–1771FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1770.Correspondence to: Dawn M. Bravata, MD, Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H, 1481 W 10th St, Indianapolis, IN 46202. Email dawn.[email protected]gov

Morphometric Measurements of the Superior Sagittal, Transverse and Sigmoid Dural Venous Sinuses in Normal Cerebral MRV Images of Adult Bangladeshis

Background: The dural venous sinuses show different types of morphometric variations in their anatomy as well as involvement with various neurological conditions like cerebral venous sinus thrombosis, venous sinus stenosis, embolism, fistula etc. Cerebral MRV (Magnetic Resonance Venography) is a well-established radiological technique to visualize the dural venous system. By measuring the sinus dimensions in cerebral MRV images and calculating the indices, morphometric variations of the dural venous sinuses can be identified which is essential for diagnosing different pathologies of the dural venous system. Researcher have detected most of the variations in the superior sagittal, transverse and sigmoid venous sinuses. Objectives: To develop anatomical baseline data on morphometric measurements of the dural venous sinuses in normal cerebral MRV images of adult Bangladeshis. Methods: The research was cross-sectional and observational in nature. It was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the Department of Neuroradiology &amp; Imaging, National Institute of Neuroscience and Hospital (NINS), Dhaka, from March 2020 to June 2021. Adults (35 males and 35 females) aged 18 years or above who attended in the Department of Neuroradiology &amp; Imaging, NINS for cerebral MRV and diagnosed as having normal dural venous sinuses without any pathology by a registered Neuroradiologist were the participants of this research. The MRV scans were produced by using 3 Tesla magnetic field strength following the routine standard protocols of the institution. By using the Radiant DICOM Viewer software, a total of 9 linear and curvilinear dimensions were measured and 2 indices were calculated by the researcher and the co-investigator independently to reach consensus on each variable. Results: A numerical data set was generated on the morphometric measurements of the superior sagittal, transverse and sigmoid sinuses ......

Anterior Cervical Discectomy and Fusion Surgery: Results with Zero-Profile Spacer/Cage

Objective: Study provides proof to support the promised benefits of employing stand-alone zero-profile cages in multilevel ACDF procedures, as the stand-alone zero-profile device has proven safety and a reduction of the risk of dysphagia in single-level ACDF surgeries.&#x0D; Materials and Methods: This is a retrospective descriptive study, conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan. Data of 36 patients evaluated for post-operative dysphagia and fusion, who had multi-level ACDF surgery employing stand-alone zero-profile cages.&#x0D; Results: Total of 36 patients underwent ACDF surgeries. 86.1% (31/36) patients operated for 2 levels and 13.9% (5/36) patients operated for 3 levels. Dysphagia developed postoperatively in 2 (5.6%) patients in which zero-profile stand-alone cages were used. Fusion was achieved in 94.4% (34/36) patients.&#x0D; Conclusion: Stand-alone zero-profile cages in multi-level ACDF surgeries have a good outcome in terms of post-operative less dysphagia and higher fusion rates.&#x0D; Keywords: Anterior Cervical Discectomy (Decompression) And Fusion (ACDF), Zero-Profile Cages, Cervical Spondylotic Myelopathy.

Write With the Reviewers in Mind: Why You Got a Rejection and How to Avoid the Next.

HomeStrokeVol. 53, No. 7Write With the Reviewers in Mind: Why You Got a Rejection and How to Avoid the Next No AccessResearch ArticleRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessResearch ArticleRequest AccessFull TextWrite With the Reviewers in Mind: Why You Got a Rejection and How to Avoid the Next Joseph Kamtchum-Tatuene, MD, Larissa Ange Tchuisseu-Kwangoua, MD, Noëlle Audrey Moko-Tatuene, MSc, Jean Joel Bigna, MD and Jean Jacques Noubiap, MD Joseph Kamtchum-TatueneJoseph Kamtchum-Tatuene Correspondence to: Joseph Kamtchum-Tatuene, MD, Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-065 Katz Building, 114 Street and 87 Avenue, Northwest, Edmonton, T6G 2E1 Alberta, Canada. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1041-4202 Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (J.K.-T.). Search for more papers by this author , Larissa Ange Tchuisseu-KwangouaLarissa Ange Tchuisseu-Kwangoua https://orcid.org/0000-0002-9591-6139 Faculty of Medicine, University of Southampton, United Kingdom (L.A.T.-K.). Search for more papers by this author , Noëlle Audrey Moko-TatueneNoëlle Audrey Moko-Tatuene https://orcid.org/0000-0001-7542-0948 Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada (N.A.M.-T.). Search for more papers by this author , Jean Joel BignaJean Joel Bigna https://orcid.org/0000-0001-8018-6279 Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon (J.J.B.). Search for more papers by this author and Jean Jacques NoubiapJean Jacques Noubiap https://orcid.org/0000-0002-7722-9757 Centre for Heart Rhythm Disorders, The University of Adelaide, Australia (J.J.N.). Search for more papers by this author Originally published28 Mar 2022https://doi.org/10.1161/STROKEAHA.122.036142Stroke. 2022;53:e273–e275FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.036142.For Sources of Funding and Disclosures, see page e275.Correspondence to: Joseph Kamtchum-Tatuene, MD, Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-065 Katz Building, 114 Street and 87 Avenue, Northwest, Edmonton, T6G 2E1 Alberta, Canada. Email [email protected]ca

Seeing Makes the Difference: Augmented Reality in the OR.

Although many surgeries, including spinal procedures, have been much improved with robotics in recent years, the additional technology has created associated issues with its use in the space constraints of the operating room (OR). This is especially true with monitors and their small screen sizes, which make it difficult for surgeons to see details during procedures. Solving such problems and finding the optimal position for viewing as well as ensuring integration with current technology were primary objectives in the development of iSight, a wireless augmented reality (AR) system designed by Dr. Chetan K. Patel, MD, in collaboration with startup Altair Innovations [1]. Patel is an orthopedic spine surgeon and executive medical director for spine surgery at AdventHealth Neuroscience Institute (Figure 1).

Impact of introducing a minimum alcohol tax share in retail prices on alcohol-attributable mortality in the WHO European Region: A modelling study.

SummaryBackgroundAlcohol use and its burden constitute one of the largest public health challenges in the WHO European Region. Raising alcohol taxes is a cost-effective “best buy” measure to reduce alcohol consumption, but its implementation remains uneven. This paper provides an overview of existing tax structures in 50 countries and subregions of the Region, estimates their proportions of tax on retail prices of beer, wine, and spirits, and quantifies the number of deaths that could be averted annually if these tax shares were raised to a minimum level.MethodsReview of databases and statistical reports on taxes and mean retail prices of alcohol beverages in the Region. Affordability was calculated based on alcohol prices, adjusted for differences in purchasing power. Consumption changes and averted mortality were modelled assuming two scenarios. In Scenario 1, a minimum excise tax share level of 25% of the beverage-specific retail price was assumed for all countries. In Scenario 2, in addition to a minimum excise tax share level of 15% it was assumed that per unit of ethanol minimal retail prices were the same irrespective of alcoholic beverages (equalisation). Sensitivity analyses were conducted for different price elasticities.FindingsAlcohol is very affordable in the Region and alcohol taxes have clearly been under-utilized as a public health measure, constituting on average only 5·7%, 14·0% and 31·3% of the retail prices of wine, beer, and spirits, respectively. Tax shares were higher in the eastern part of the Region compared to the EU, where various countries did not have excise taxes on wine. Annually, the introduction of a minimum tax share of 25% (Scenario 1) could avert 40,033 (95% CI: 38,054-46,097) deaths in the WHO European Region (with 753,454,300 inhabitants older than 15 years of age). If a 15% tax share with equalisation were implemented (Scenario 2), 132,906 (95% CI: (124,691-151,674) deaths could be averted. All sensitivity analyses with different elasticities yielded outcomes close to those of the main analyses.InterpretationSimilar to tobacco taxes, increasing alcohol taxes should be considered to be a health-based measure aimed at saving lives. Many countries have hesitated to apply higher taxes to alcohol, but the present results show a clear health benefit as a result of implementing a minimum tax share.FundingThis work was supported by the National Institute on Alcohol Abuse and Alcoholism (1R01AA028224) and the Canadian Institutes of Health Research, Institute of Neurosciences, and Mental Health and Addiction (SMN-13950).

Microsurgical Management of Symptomatic Intracranial Arachnoid Cyst: Experience of 15 Cases

Background: Arachnoid cysts are fluid-filled sacs that occur on the arachnoid membrane that covers the brain. In most of the cases these cysts are asymptomatic and do not require any treatment. Only symptomatic arachnoid cysts require treatment. Objectives: The objective of this study was to see the results of microsurgical treatment of intracranial arachnoid cyst. Methods: This retrospective cross sectional study was carried out in the Department of Neurosurgery, National Institute of Neurosciences &amp; Hospital, Dhaka, Bangladesh. Total 15 cases were included in this study for a period of 3 years. Data were collected including their operation procedures and follow up by questionnaires and finally observed the results. Results: Among the 15 patients about one third were presented in the second decades of life with male predominant. Significant clinical improvement was observed among most of the patients. The radiological decrease of the size of the cysts was also found. The results of microsurgical excision were better than other procedures. Conclusions:Surgical treatments are needed only in symptomatic cases. Clinical and radiological outcome of the surgical treatment is satisfactory. Bang. J Neurosurgery 2021; 11(1): 13-17

Response and Outcome of Moderate Dose Adrenocorticotropic Hormone in the Treatment of West Syndrome

Background: West Syndrome (WS) consist of a triad of epileptic spasms, hypsarrhythmia on EEG and arrest or regression of psychomotor development. Although ACTH has been found to be effective in the treatment of WS, questions remain regarding the optimum dosage, type of ACTH, duration of therapy, and its comparative efficacy with other treatment options.&#x0D; Objective: To assess the response and outcome of treatment with moderate dose (100 IU/m2) ACTH in children of west syndrome.&#x0D; Methodology: This was a prospective observational study and done over 1-year period (July 2017 to June 2018) in Pediatric Neurology OPD, National Institute of Neuroscience and Hospital (NINS&amp;H), Dhaka among the patients with West syndrome. All study participants were treated with moderate dose ACTH (100 unit/m2) (I/M) and treatment completed within 12 weeks. Patients were followed up at 2, 4, 6 and 12 WKs of treatment.&#x0D; Results: Total 52 cases were for enrolled. In this study it was found that complete cessation of spasm 21/50 (42%), ≥50% reduction of spasm 12/50 (24%), &lt;50% reduction of spasm 8/50 (16%) and non-responder 9/50 (18%). At the end point of 12 weeks observation resolution of hypsarrhythmia occurred in 19/50 (38%) cases. About 78.0% patients developed any kind of the adverse effect.&#x0D; Conclusion: Moderate dose ACTH is effective in cessation of spasm and resolution of hypsarrhythmia in the studied children.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 108-112

Efficacy of Low Intensity Laser Therapy for Carpal Tunnel Syndrome: Experience of 54 Cases in Bangladesh

Background: Management of the carpal tunnel syndrome (CTS) is very crucial for the clinical outcomes of the patients.&#x0D; Objective: The purpose of the present study was to assess the effectiveness of low intensity laser therapy (LILT) for the management of carpal tunnel syndrome patients.&#x0D; Methodology: This single centered, parallel, single blinded randomized control trial was conducted in the Department of Physical Medicine and Rehabilitation at National Institute of Neurosciences &amp; Hospital, Dhaka, Bangladesh from January 2019 to June 2019 for a period of six months. All the Nerve Conduction Study (NCS) test confirmed cases of CTS patients with the age group of more than 18 years in both male and female were selected as study population. Patients who received regular nonsteroidal anti-inflammatory drugs or corticosteroids, patients treated with therapeutic modalities before, acute wrist trauma and surgery, cervical radiculopathy, thoracic outlet syndrome, tumor or infectious diseases, pregnancy, and any serious heart, liver or kidney diseases were excluded from this study. Patients were randomly assigned into two groups designed as group A and group B. The assignment was done with single blind method. Group A underwent laser therapy (3 Joules/cm2, 50 Hz, 2 min) over the carpal tunnel area. Group B were treated with conventional method. All patients received therapy for a total of 14 sessions, first 7 sessions on consecutive 7 days, and last 7 sessions on alternate days. Patients also used a wrist splint each night, practiced therapeutic exercises for CTS, and followed ADL advices. Patients were assessed according to BCTQ, Boston Carpal Tunnel Questionnaire.&#x0D; Result: Male-Female distribution was 9% &amp; 91% respectively. Total score of SSS was 26.35±5.94 and 13.70±1.78 in baseline and after 6 weeks follow up respectively (p &lt; 0.001) in group A. In group B, total score of SSS was 28.19 ±7.35 and 18.22 ± 5.63 in baseline and after 6 weeks follow up respectively (p &lt; 0.001). In group A, FSS was initially 18.1, which was improved to 9.15 in 6 weeks; whereas in group B, FSS was improved from 18.86 to 11.25. The pain, numbness and paresthesia also significantly changed after 6 weeks follow up in laser therapy group.&#x0D; Conclusion: Low intensity laser therapy has superior clinical effectiveness at 6 weeks compared with night-resting splints in mild or moderate CTS.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 103-107

Glycemic Status and Outcome of Neurological Patients with COVID-19 Admitted at Referral Neuroscience Institute of Bangladesh

Background: The presentation of corona virus disease 2019 (COVID-19) may include neurological features and patients with neurological disorders may develop concomitant COVID-19 during pandemic. Hyperglycemia leads to higher propensity to COVID-19 infection with higher disease severity.&#x0D; Objective: To assess the neurological diagnoses, glycemic status and outcome in patients hospitalized primarily for neurological problems and subsequently diagnosed as COVID-19.&#x0D; Methods: This retrospective cohort study was conducted in National Institute of Neurosciences (NINS) &amp; Hospital, Dhaka, Bangladesh. Patients admitted to adult Neurology ward during April to November 2020 primarily for neurological problems and diagnosed as confirmed COVID-19 (with positive RT-PCR test for COVID-19) were included. The hospital records were reviewed and recorded in a checklist. Outcome of patients referred to COVID-19 dedicated hospitals was obtained over telephone.&#x0D; Results: The study included 85 patients with COVID-19 [median age 60 years (IQR: 45-65); 63.5% male]. Acute ischemic stroke was the most common neurological diagnosis (32.9%), followed by acute hemorrhagic stroke and subarachnoid hemorrhage (22.4% and 15.3% respectively). Other neurological diagnoses were meningoencephalitis (7.1%), Guillain Barre Syndrome (4.7%), Myasthania Gravis (1.2%), brain abscess (1.2%) and intracranial space occupying lesion (1.2%). Fourteen percent patients had no definite neurological diagnosis, they were admitted for delirium. History of diabetes was present in 18% patients. The mortality was 27% and the proportion of mortality was significantly higher in patients known to have DM in comparison to those who were not (p=0.012). The mean age and proportion of male sex was significantly higher among those who expired.&#x0D; Conclusion: There is high rate of mortality in neurological patients with COVID-19 who have variable neurological diagnosis including stroke, autoimmune disease and cerebral infections. Co-existent diabetes further increases the rate of mortality.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 97-102

Abstract 48: Hospital Door To Rapid Follow Up, A Nurse Practitioner Led Model

Introduction: The Neuroscience Institute is comprised of a Comprehensive Stroke Center and three Primary Centers. The healthcare team manages 1,800 hospital admissions yearly with expertise in acute treatment. However, door to rapid follow-up was not well defined. Literature review indicates expeditious post-stroke visits, a structured path to clinic, standardized ambulatory management and clear communication across the continuum ensures best practice. Hypothesis: A defined post-acute stroke management model could be implemented with Nurse Practitioners (NPs). A principal objective was to facilitate a rapid ambulatory visit less than two weeks post-hospitalization. Methodology: NPs were hired in 2019, then trained in acute and outpatient clinical rotations with Vascular Neurologists and inpatient Neurology NPs. Ambulatory NPs created a comprehensive guideline for sub acute visits. Content included: review of hospitalization, appropriate referrals, secondary prevention, functional assessments, medication adherence and stroke health literacy. Formal visit templates were imbedded in the electronic medical record, affording a consistent approach by NPs. Education templates were developed, with content personalized and provided to patients. Interval summary are completed by inpatient NPs; this includes a synopsis of stroke mechanism and acute intervention, neurological deficits, comorbid diagnosis and management plan at discharge. The summary incorporates a thorough review of core measures. A consistent process for scheduling rapid appointments was defined. Results: Data January to June 2021 demonstrated &gt; 50% of patients completed rapid clinic appointments. Communication across the continuum was improved by electronic documentation and enhanced collaboration. There is a standardized approach to ambulatory management with individuation to patients. Expeditious outpatient visits are consistently occurring with an optimized process. Conclusion: NPs are essential stroke providers, closing gaps in the system of care in the acute and post-acute settings. A future goal is to increase the percentage of patients managed expeditiously, reducing incidence of cerebrovascular events thru a comprehensive ambulatory care model.

Our Experience of Posterior Fossa Tumors Surgeries

Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes.&#x0D; Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically.&#x0D; Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery.&#x0D; Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.

Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan

Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS).&#x0D; Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years.&#x0D; Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy. &#x0D; Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.

Viewing interprofessional collaboration through the lens of networked ecological systems theory

ABSTRACT Interprofessional collaboration (IPC) is key to ensuring safe quality care for patients. However, IPC intervention outcomes are variable, leading to calls for systems theories to understand complex interactions in healthcare. Using networked ecological systems theory (NEST), we aimed to uncover facilitators and barriers impacting the interactions between nurses and physicians in a specialty healthcare center. A qualitative study involving 55 non-participant observations and 17 individual semi-structured interviews was conducted at the National Neuroscience Institute of Singapore from April 2019 to March 2021. Template analysis was used to analyze the data. The most important IPC facilitators were exosystemic institutional support and physicians’ willingness to engage in IPC in the microsystems that together enabled the establishment of disease-based outpatient programs fostering patient-centered interactions among different healthcare professionals (HCP). We also found that patient-, disease-, and systems-related knowledge played an important role in facilitating IPC. Macrosystemic entrenchments such as intraprofessional composition of ward rounds emerged as a significant barrier. However, microsystemic efforts such as chat groups connecting all HCP involved in the care of the patients in the wards have fostered IPC. Although still preliminary, these findings suggest NEST can be useful to inform systematic interventions to improve IPC.

‘Do You Hear Voices, or Do You Think You Hear Voices?’: Malevolence and Modernity in the Psychiatric Clinic

Based upon fieldwork at India’s National Institute of Mental Health and Neurosciences (NIMHANS), I trace the contours of hysteria as an enduring, albeit informal, analytic that continues to disturb neuropsychiatric reductionism within psychiatry. I argue that at this historical moment, the political and economic demand for singular identities out of more porous cultural life-worlds (e.g. ethnic, religious, linguistic, occupational) produces clinical subjects incapable of nuance and flexibility, hastening a host of possessive, literalist, legalist and ‘hysteric’ symptoms that overtake India’s most vulnerable modern subjects, fuelling the sense of a crisis in search of a pharmaceutical solution to a psychopathological diagnosis.