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Background: Cerebrospinal fluid (CSF) shunting refers to the surgical drainage of excess CSF, which arises due to outflow obstruction or a reduction in absorption. Although rare, the dissemination of neoplastic cells along ventriculoperitoneal shunts is well documented, a gap in knowledge exists regarding differences in the direction of neoplastic dissemination along CSF shunts. The aim of this systematic review was to comparatively assess the nature of antegrade and retrograde metastatic spread along CSF shunts. Methodology: A dual systematic review in six major databases was conducted for articles until June 15, 2023, without language restrictions following PRISMA 2020 guidelines and the Cochrane Handbook for Interventional Systematic Reviews. The study focused on the metastasis of both CNS malignancy to extra-neural sites and the retrograde metastasis of extra-neural tumours to the CNS along CSF shunts. Inclusion criteria were case reports with patient characteristics and clinical outcomes. Data were extracted using a standardised table and qualitatively analysed. The JBI case report critical appraisal tool assessed reporting quality. Grey literature was not included. Results: A total of 106 reports of antegrade metastasis were identified representing 121 cases. Patients were most commonly children, with the primary tumour and shunt type being germinomas. Six reports detailing retrograde metastasis met our inclusion criteria with an overall high quality of reporting. All primary tumours were in the abdomen or pelvic cavity with treatment from metastasis depending on patient characteristics. Generally, the prognosis was poor, with one patient succumbing to peritonitis, four cases showing residual disease, and one patient receiving palliative care. Discussion and Conclusion: This updated systematic review noted similar demographic trends regarding the metastasis of CNS malignancy to extra-neural sites through CSF shunts reported by Xu et al. (2018); yet, due to data inaccessibility, updated statistics could not be inferred. Germinomas remained the most common tumour pathology, warranting increased vigilance in patients with germinomas and a CSF shunt. Moreover, this review identified that extra-neural malignancy retrograde CSF shunt metastasis is extremely rare. This study proposes standardised nomenclature for classifying metastasis through CSF shunts for easier clinical identification. [ABSTRACT FROM AUTHOR]

This comprehensive review explores the intricate relationship between white matter (WM) asymmetry in the brain and handedness, shedding light on the intricate neural substrates that underlie manual dominance. The human brain's WM tracts, which facilitate rapid interregional communication, have been subjected to extensive investigation in the context of handedness. Diverse WM pathways, including commissural and association fibers, as well as global WM, have been implicated, although findings have often been contradictory. Studies utilizing diffusion tensor imaging (DTI) to assess WM asymmetry have revealed intriguing patterns by measuring anisotropy. Anisotropy is a measure of uniformity of axon directionality and diameter in WM tracts and is a useful measure of connectivity. Notably, right-handed individuals have demonstrated greater anisotropy, in both hemispheres, particularly in regions like the inferior frontal gyrus. Conversely, leftward fractional anisotropy (FA) asymmetry has been observed in left-handed individuals. Sex and age have also been identified as influential factors. Age, for instance, exhibits a positive association with FA in various WM tracts. Research on the corpus callosum has indicated differences between handedness groups, with left-handed twins displaying unique callosal patterns. Furthermore, studies have explored the corticospinal tract (CST) and its potential link to handedness. While some findings suggest CST structural asymmetry plays a role, others remain inconclusive. In conclusion, the interplay between WM asymmetry and handedness remains a complex and multifaceted phenomenon, influenced by various factors, including sex and age. Understanding these neural intricacies promises valuable insights into the nature of manual dominance and its broader implications for brain function. [ABSTRACT FROM AUTHOR]

Phoenix dactylifera, commonly known as palm dates, is an inexpensive dietary staple in many countries. It is rich in many nutrients and bioactive chemicals, which are responsible for its health benefits. Folk medicine has suggested that P.dactylifera has potent anti-constipation effects. Although many studies have investigated its physiological mechanisms and phytochemistry against diseases like colon cancer, hypertension and diabetes mellitus, research unraveling this fruit's laxative properties is limited. Studies characterizing the phytochemical, micromolecular and macromolecular composition of Phoenix dactylifera revealed numerous compounds with anti-constipation properties. The flavonoid, phenol, dietary fiber and mineral content were identified as the likely protagonists collectively contributing to Phoenix dactylifera's laxative properties. [ABSTRACT FROM AUTHOR]

Background: All events in Europe, including EURO2020 football championship, were postponed due to Covid‐19 in 2020. Instead, Euro2020 took place in 2021, as mitigation measures were relaxed, cross‐country mobility increased and the Delta variant was spreading across Europe. This study explored the possibility of an increased Covid‐19 spread across Europe following EURO2020 matches. Methods: Covid‐19 data on cases, vaccination and delta variant for participating countries, host cities/regions and neighbouring countries, for May till July 2021, were obtained from European Centre for Disease Prevention and Control, Our World in Data, Johns Hopkins COVID‐19 Dashboard and the UK Government website. EURO2020 data were obtained from the Union of European Football Associations official website. Results: A general increase in Covid‐19 positivity trend in Europe was observed following a week of EURO2020 matches across most countries and host cities. A similar trend was observed for the Delta variant sample positivity rate. The increased incidence was mostly among the young generation (<49 years). A decline in positive cases was observed on a national level for most countries following the Finals match. Conclusion: The EURO2020 was an anticipated mass sports event, and it was the first‐time spectators were allowed to enter stadiums in Europe. Stadiums instituted several mitigations to safeguard the spectators although reports of transmission were still present. The major challenges were the gatherings outside the stadiums that might have contributed to these observations. Targeted restrictions might be required during mass sport events especially in the presence of highly transmissible variant(s) and low vaccination rates among the young generation. [ABSTRACT FROM AUTHOR]

Introduction and aim. Literature documenting the occurrence and management of Gullain-Barre' syndrome GBS in glioblastoma multiforme patients following craniotomy is scarce. This study aims to systematically review relevant literature while outlining demographic factors, onset, and management of GBS following craniotomy for Glioblastoma multiforme (GBM). Material and methods. A systematic literature review was conducted in four major databases, following the PRISMA 2020 guidelines. Two cases of GBS following GBM resection were identified. An additional study discussing GBM leptomeningeal dissemination presenting as GBS was also included. Analysis of literature. Patients presented with symptoms unrelated to their tumour location consisting of proximal weakness in the lower extremities, distal paraesthesia and symmetrical areflexic paraparesis without loss of sensitivity. Lumbar puncture demonstrated albuminocytological dissociation, elevated CSF proteins. Cytopathology was unremarkable and gram stains and cultures were negative. Routine blood chemistry was also unremarkable. Decreased motor conduction velocities with prolongation and distal latency coupled with decreased motor recruitment without denervation in limb muscles was noted. Cerebrospinal MRI did not evidence tumour mass or leptomeningeal abnormalities. Plasmapheresis treatments significantly improved motor function and parasthesia, while a regiment of immunoglobulins resulted in a full recovery within two weeks. It is worth noting that leptomeningeal dissemination may present as GBS, as documented by Cooke et al. who started their patient empirically on intravenous immunoglobulin for suspected GBS, despite subsequent tests evidencing a diagnosis of fulminating leptomeningeal dissemination, since early treatment is crucial for full resolution of GBS. Conclusion. Despite being a rare occurrence, GBS should be considered in the differential for GBM who develop generalized acute-subacute progressive weakness which is inconsistent with their tumour location, particularly patients on immunosuppressive regiments. CSF cytological studies by lumbar puncture and cerebrospinal MRI with contrast are key in differentiating GBS from leptomeningeal dissemination in post-resection GBM patients. If CSF cytology and imaging investigations remain inconclusive, electrophysiological studies are not only warranted but necessary. Moreover, if GBS is suspected, the administration of appropriate treatments should be considered prior to establishing a firm diagnosis, as early intervention increases the chances of complete resolution. [ABSTRACT FROM AUTHOR]

Climate change and obesity were considered threats to our planet long before the onset of COVID-19. The recent pandemic has enhanced the global burden of both pre-existing crises. The aim of this narrative review is to explore the interaction between the three concurrent crises and the future of our planet should they not be dealt with accordingly. A PubMed and Google Scholar literature search was performed using different combinations of search strategies and using the keywords "obesity", "climate/temperature change", "cold/hot temperatures", and "COVID-19". High global greenhouse gas (GHG) emissions link obesity and climate change as a result of the interplay between biological and behavioural factors. COVID-19 mitigation measures have indirectly impacted obesity and GHG emissions through the shift in dietary habits, restricted mobility, the impact on healthcare services, and enhanced psychological stress. Furthermore, COVID-19 has a more detrimental effect if acquired by an obese individual, with a higher chance of hospitalization and mechanical ventilation. This leads to higher GHG emissions and negative repercussions on the climate. A tri-directional relationship exists between obesity, climate change, and COVID-19. Various factors contribute to this relationship, but unless urgent global integrated action plans are implemented that target all three calamities, and not just COVID-19, a devastating and unsustainable future may ensue. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic spread across the globe, including across the Mediterranean basin. This region presents diversity in economy, culture, and societal affairs. We attempted to evaluate the impact of COVID-19 on the population and on the Sustainable Development Goals (SDGs), our aim being to aid in the development of COVID-19 national plans., Methods: Epidemiological data was obtained from 'Our World in Data' databases (January 2020 - July 2021). Case, mortality, and vaccination incidence comparisons were made across neighbouring countries. The SDG index, universal health coverage (UHC) and health workforce targets were collected for each country. Correlations between SDG targets and COVID-19 outcomes were analysed., Results: Similarities in morbidity and mortality outcomes were present across neighbouring countries, with a bidirectional relationship between cumulative fully vaccinated population and infectivity fatality rates. Positive relationships were present between SDG indexes, UHC and health workforces and COVID-19 cases, deaths, and vaccinations., Conclusion: At prima face, high-income countries seem to have sustained worse morbidity and mortality outcomes, despite having had better UHC and a greater health workforce in the pre-COVID-19 era however, one must also consider that factors such as health-seeking behaviour and underdiagnosis may have influenced this. Cross-border infectivity was, however, evident. Pan-Mediterranean action must therefore be taken to ensure COVID-19 transmissibility and mortality are reduced across borders, while ensuring an equitable health outcome across populations., (© 2022 Cuschieri S et al.)

Objective: Coronavirus disease 2019 (COVID-19) spread globally, including across Europe, resulting in different morbidity and mortality outcomes. The aim of this study was to explore the progression of the COVID-19 pandemic over 18 mo in relation to the effect of COVID-19 vaccination at a population level across 35 nations in Europe, while evaluating the data for cross-border epidemiological trends to identify any pertinent lessons that can be implemented in the future., Methods: Epidemiological data were obtained from European Centre for Disease Prevention and Control and Our World in Data databases while Ministry of Health websites of each respective country and local newspapers were used for COVID-19-related vaccination strategies. Case, mortality, and vaccination incidence comparative analyses were made across neighboring countries., Results: Similar morbidity and mortality outcomes were evident across neighboring countries over 18 mo, with a bidirectional relationship evident between cumulative fully vaccinated population and case fatality rates., Conclusion: Countries' COVID-19 outcome is related on national mitigative measures, vaccination rollouts, and neighboring countries' actions and COVID-19 situations. Mass population vaccination appeared to be effective in reducing COVID-19 case severity and mortality rates. Vaccination equity and pan-European commitment for cross-border governance appear to be the way forward to ensure populations' return to "normality."