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In the process of urinary stone formation, several heavy metals and trace elements (HMTE) have been identified among the major constituents of the calculi. The micro-elements within the stones cannot be identified by ordinary laboratory analytical techniques, the latter can only detect the major crystalline component. The objective of the present study was to evaluate the different types of HMTE (no. 22) and their concentrations within the urinary stones. The stone samples were obtained from patients living in different geographical locations (10 countries: 5 Western and 5 non-Western). The number of retrieved stones after open or endoscopic procedures was 1177. The concentrations of the 22 HMTE in the stones were assessed by inductively coupled plasma optical emission spectrometry (ICP-OES). The statistical data were analyzed using Kruskal-Wallis, one-way ANOVA, and SPSS software (version 20). The biochemical stone analysis showed that calcium oxalate was present as a major component in 650 patients (55.2%), calcium phosphate in 317 (26.9%), and uric acid and cystine stones in 210 (17.8%). The analyzed stones showed the presence of HMTE in different concentrations. Significantly higher concentrations of 17 elements (Al, As, Ba, B, Ca, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, S, Se, Sr, and Zn) were noted in all stones. Seven elements (Al, As, Se, Sr, Fe, Zn, and Ni) were present in higher concentrations in calcium-based stones. In comparison, eight elements (Mg, B, Ba, Cd, Se, Pb, Sr, and Zn) in higher concentrations were associated with phosphate-based stones. Both uric acid and cystine stones had a higher concentration of sulfur. The concentrations of HMTE in calcium phosphate stones were higher than in calcium oxalate and uric acid stones. Calculi obtained from patients living in western countries contained higher levels of 13 HMTE (B, Ba, Ca, Cd, Co, Cu, Fe, K, Mg, Mo, P, Pb, and Se) than those in non-western countries. The age of calculi-forming patients from non-western countries was younger than those living in western countries. These results may indicate the role of many significant heavy metals and trace elements in the pathogenesis of urinary stone formation. The types and contents of HMTE within urinary stones differ from one country to another. The conventional stone analysis techniques cannot either identify the stone micro-elements or the concentrations of HMTE, so a specific and additional instrument such as the ICP-OES is necessary. Further research work on the urinary stone micro-elemental structure could lead to a new strategy for the prevention of stone formation and recurrence.

Background: This study aimed to calculate the frequency of elevated liver enzymes in hospitalized patients with coronavirus disease 2019 (COVID-19) infection and to test if liver enzyme biochemistry levels on admission could predict the computed tomography (CT) scan severity score of bilateral interstitial pneumonia. Methods: This single-center study comprised of 323 patients including their demographic data, laboratory analyses, and radiological findings. All the information was taken from electronic health records, followed by statistical analysis. Results: Out of 323 patients, 115 of them (35.60%) had aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) over 40 U/L on admission. AST was the best predictor of CT scan severity score of bilateral interstitial pneumonia (R2 = 0.313, Adjusted R2 = 0.299). CT scan severity score in the peak of the infection could be predicted with the value of AST, neutrophils, platelets, and monocytes count (R2 = 0.535, Adjusted R2 = 0.495). Conclusion: AST, neutrophils, platelets, and monocytes count on admission can account for almost half (49.5%) of the variability in CT scan severity score at peak of the disease, predicting the extensiveness of interstitial pneumonia related to COVID-19 infection. Liver enzymes should be closely monitored in order to stratify COVID-19 patients with a higher risk of developing severe forms of the disease and to plan the beforehand step-up treatment.

Microbial infections are a significant threat to public health, and resistance is on the rise, so new antibiotics with novel modes of action are urgently needed. The extracellular zinc metalloprotease collagenase H (ColH) from Clostridium histolyticum is a virulence factor that catalyses tissue damage, leading to improved host invasion and colonisation. Besides the major role of ColH in pathogenicity, its extracellular localisation makes it a highly attractive target for the development of new antivirulence agents. Previously, we had found that a highly selective and potent thiol prodrug (with a hydrolytically cleavable thiocarbamate unit) provided efficient ColH inhibition. We now report the synthesis and biological evaluation of a range of zinc‐binding group (ZBG) variants of this thiol‐derived inhibitor, with the mercapto unit being replaced by other zinc ligands. Among these, an analogue with a phosphonate motif as ZBG showed promising activity against ColH, an improved selectivity profile, and significantly higher stability than the thiol reference compound, thus making it an attractive candidate for future drug development., Stable “pathoblocker”: A series of compounds with non‐thiol (stable) zinc‐binding groups has been synthesised and tested for inhibition of the collagenase ColH, a key mediator of clostridial pathogenicity. The most promising compound, a phosphonate, was studied for selectivity over potential human off‐targets and its toxicity both in vitro and in vivo, and was shown to significantly reduce collagenase activity.

In the absence of definitive treatment, vaccination against COVID-19 emerged as an effective solution to the spread of the pandemic. This study aimed to investigate the factors impacting the rates of COVID-19 vaccine acceptance in Jordan, in addition to examining the relationship between COVID-19 risk perception and vaccine acceptance among the Jordanian population.This cross-sectional study was conducted among a sample of adults (aged ≥18) residing in Jordan. Data were collected using an online questionnaire disseminated using social media platforms between December 2nd and December 29th, 2020.A total of 2,268 (72.3%) participants demonstrated willingness to receive the COVID-19 vaccine. The mean COVID-19 risk perception score among the participants was 4.65 out of 10 (median 5; IQR 3-6). Higher risk perception scores were significantly associated with being female (COVID-19 risk perception and certain sociodemographic characteristics (i.e., being male, being young, and having children aged under 18 years) were found to be significantly associated with vaccine acceptance. Policymakers are recommended to develop public educational campaigns to enhance people's trust in and willingness to take the COVID-19 vaccine.

Migraine is a primary headache disorder that causes debilitating throbbing pain. Several functional MRI (fMRI) and voxel-based morphometry (VBM) studies have been used to investigate the structural and functional alteration in migraine. Here, we aim to study the converged brain regions of functional and structural abnormalities in gray matter volume (GMV) associated with pain processing and management in migraineurs and healthy controls (HC).A systematic search through PubMed and Sleuth was carried out for peer-reviewed functional and structural neuroimaging studies on migraine patients and HC yielded a total of 1136 studies. We performed an activation likelihood estimation (ALE) meta-analysis on VBM and pain stimulation task-based fMRI studies to investigate the converged areas of GMV and functional abnormalities between migraineurs and HC. We performed two subgroup analyses between migraine with aura (MwA) and migraine without aura (MwoA) relative to HC, and between chronic migraine (CM) and episodic migraine (EM) compared to HC.The total sample included 16 fMRI and 22 VBM studies, consisting of 1295 migraine patients, compared to 995 HC. In fMRI analysis, ALE maps for pain stimulation tasks revealed hyperactivation in migraineurs in the substantia nigra compared to HC, whereas hypoactivation was seen in the cerebellum. For the VBM analysis, ALE clusters of increased GMV in migraineurs were observed in the parahippocampus and putamen nucleus. Whereas clusters of reduced GMV in migraineurs were seen in the frontal gyri. Compared to HC, MwoA patients showed a GMV reduction in the insula, and anterior cingulate, whereas MwA patients showed GMV reduction in the cerebellum, cingulate gyrus, and insula. CM patients showed decreased GMV in the precentral gyrus, whereas EM patients showed decreased GMV in the parahippocampus, and inferior frontal gyrus when compared to HC.Our findings represent a potential biomarker for the diagnosis and management of migraine, by showing clustered brain regions of abnormal patterns of activation and GMV changes between migraineurs and HC which might be associated with hyposensitivity to pain in migraineurs. Further studies are required to determine disease progression or therapeutic interventions' effect on migraine.

Introduction. Health care providers are at high risk of becoming infected when taking care of patients who have COVID-19, especially while attending aerosol generating procedures. Protective personal equipment must be used in the correct manner to prevent transmission of the disease. Published protocols on protective personal equipment (PPE) donning and doffing have been issued by disease control agencies. Methods. A questionnaire-based cross-sectional study was designed. An online anonymous questionnaire, which was validated and tested for reliability, focused on PPE related knowledge, donning and doffing practices of healthcare providers across the eastern region of Saudi Arabia. Results. A total of 312 healthcare providers across the eastern region of Saudi Arabia participated in the study, 208 physicians (66.7%) and 104 non-physicians (33.3%). Results indicate poor practice regarding PPE donning (13.8% reported the correct sequence) and PPE doffing (3.5% reported the correct sequence) among participants. In addition, practice and confidence scores regarding other issues with PPE were analyzed. Based on questionnaire responses, being male (T=2.825; p=0.008), being a non-physician (T=-2.120; p=0.014) and being an allied medical professional (F=5.379; p=0.003) were significantly associated with higher confidence levels. Also, being a consultant was significantly associated with higher practice scores (F=4.774; p=0.008). Conclusion. The study demonstrates deficiencies among healthcare providers in following the recommended practices for correctly using PPE during the pandemic. Poor practice in PPE donning and doffing necessitates additional educational and training programs focused on infection control practices., Journal of Preventive Medicine and Hygiene, Vol. 62 No. 4 (2021): 2021624

Focal signs are a big deal in neurology and are among the most important clues leading to diagnosis and localization. Wernekink commissure syndrome is due to lesions in the caudal paramedian midbrain involving the entire decussation of the superior cerebellar peduncles, resulting in the clinical hallmark of a bilateral cerebellar syndrome.A 79-year-old man presented with sudden, severe unsteadiness associated with slurring of speech, binocular double vision, and bilateral hand tremor. Examination showed right INO, moderately severe dysarthria, bilateral dysmetria and dysdiadochokinesia, with severe truncal ataxia and bilateral upper and lower limb ataxia. Also, bilateral coarse tremor was noted in both hands which was present at rest, action and on reaching for objects. Brain MRI revealed an acute infarction involving the Wernekinck decussation in the right caudal midbrain and mesencephalo-pontine junction.The differential of Wernekink Commissure Syndrome is complex, and localization and lateralization are extremely difficult owing to prominent bilateral cerebellar symptoms. The finding of an associated unilateral INO in some cases makes it possible to confidently narrow the list of differentials and localize the lesion to the paramedian tegmentum ipsilateral to the non-adducting eye.

As previously reported, intention-to-treat findings from our phase III randomized clinical trial found that a supplement of 600 mg docosahexaenoic acid (DHA)/day during the last half of pregnancy reduced the incidence of early preterm birth (ePTB

Background:The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity.Methods:Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia.Results:Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia.Conclusions:QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.

From 1983 to 1990, 234 patients with one or several cerebral arterial aneurysms were surgically treated in our department. Since 1983, we have been performing surgery as early as possible. As soon as the subarachnoid hemorrhage diagnosis is confirmed by computed tomography (or if unconfirmed, by lumbar puncture), we assume that each patient may have an aneurysm. Between 1987 and 1990, 111 patients were treated by vascular volume expansion (maintenance of central venous pressure above 5 cm H2O with 4% albumin or Ringer-lactate or, if necessary, with 20% albumin), which we supplemented with calcium antagonists (nimodipine in 60 patients and nicardipine in 51 patients). Two months after being discharged, each patient is examined by a neurosurgeon and, on the same day, is subjected to a neuropsychological evaluation and a computed tomographic scan of the brain. A few months after this consultation, a working-position/family-activities questionnaire is issued to the patient. All of the results studied on the basis of postoperative mortality, second-month computed tomographic scan ischemia, neuropsychological evaluation, and return to work show no significant difference between the groups with or without calcium antagonists or between the nimodipine and nicardipine subgroups.

As life expectancy increases and spinal imaging techniques improve, surgery is being increasingly viewed as a therapeutic alternative for symptomatic lumbar spinal stenosis in patients older than 80 years. Thirty-four patients (21 men and 13 women) who had surgery for lumbar spinal stenosis in our department between 1979 and 1994 were studied retrospectively. The most common initial symptoms were walking-related disorders (n = 29) and sciatica or femoral neuralgia (n = 34). All 34 patients underwent laminectomy at one or more levels. Ten patients also had a herniated disk. There were no deaths and only two patients had serious complications (persistent foot drop in one and left-sided hemiplegia in the other). Results were evaluated immediately after surgery and after three and 12 months. The overall result on pain and walking-related disorders was good in 53% of cases, acceptable in 32%, and poor in 15%. Our data suggest that surgery is a reasonable alternative in symptomatic elderly patients who are in good general health. Satisfactory results can be obtained although disabling complications can occur.

While reviewing a series of 138 cerebellar tumors operated upon between 1978 and 1991, the authors could only find 2 glioblastomas and 8 anaplastic astrocytomas, occurring in 4 children (3 to 14 years old) and 6 adults (23 to 48 years old). These 10 cases represent 2% of the all malignant gliomas population observed during the same period of time. Clinically speaking, nothing makes these tumors different from other cerebellar ones. However, with an heterogenous image and an irregular contrast enhancement, the CT (scan) appearance can lead to the diagnosis. 7 lesions develop within the cerebellar vermis (vermis cerebelli) and 3 develop within the cerebellar hemisphere. Total surgical resection is performed in 9 cases and subtotal resection in 1 case (because of the extension to the floor of the fourth ventricle). Adjunctive radiotherapy on their posterior cranial fossa is achieved in 8 cases. The 2 patients with a glioblastoma present with a recurrence of their tumor at 15 months and 6 years respectively, and eventually died. Out of the patients with an anaplastic astrocytoma, 4 are still alive without recurrence and with a median follow-up of 7 years. The pathogenesis of such lesions is discussed. An aggressive therapeutic management is suggested because of the possible prolonged survival rate.

Two new cases of cauda equina metastases from visceral cancers are reported. This diagnosis is only infrequently considered in patients with intra-dural lesions visualized by magnetic resonance imaging or saccoradiculography. The diagnosis is especially difficult in patients with no known primary cancer. Diagnosis rests on surgery during which only a biopsy is performed. Treatment is symptomatic and focuses on relieving pain. Prognosis is bleak.

Two retrospective series of early operated cerebral arterial aneurysms are compared. One series involves 74 patients treated from 1983 to 1987 by vascular volume expansion only. The other series involves 75 patients treated from 1987 to 1990 by vascular volume expansion associated by calcium antagonists (nimodipine or nicardipine). The conclusion is that in our experience, calcium antagonists do not improve the outcome (mortality, cognition findings and return to work) obtained by vascular volume expansion alone. Moreover they put forward that there is no difference between the patients treated by nimodipine and those treated by nicardipine.

Early examination (3 months) of 81 patients, operated on for ruptured cerebral aneurysms, by neurosurgeons and neuropsychologists show significant differences between them both; the neuropsychological evaluation has the best predictive value as far as the outcome is concerned especially regarding the return to their initial job (69% after a year in this series). The outcome also depends on the age, the preoperative grade, and the professional qualification. The aneurysm location and the date of the operation are not so important. Early neuropsychological evaluation enable us to start a rehabilitation program for socio professional reinsertion and to improve the quality of life.

A case of cerebral oedema developed during an apparently common attempted suicide with valpromide is reported. The most conspicuous biochemical abnormality was hyperammonaemia. The oedema proved refractory to the standard medical treatment of intracranial hypertension, and decompressive craniectomy was performed with only minor sequelae. The cerebral oedema cum hyperammonaemia syndrome led to the discovery, in this hitherto asymptomatic adult subject, of a 50 per cent deficiency in type a carbamyl phosphate synthetase liver activity. By completing such a deficiency, valproate may produce an extremely serious syndrome resembling the neonatal encephalopathy due to complete enzyme deficiencies in the urea cycle. All valpromide or valproate intoxications probably are cerebral oedemas with hyperammonaemia akin ti Reye's syndrome. All accidents of this type occurring during treatment or poisoning with valproate should be investigated for urea cycle enzyme abnormalities.

Recently, it has been demonstrated that symptomatic epidural calcifications represent a complication of intradiscal injection of triamcinolone hexacetonide (Hexatrione). Out of our three cases, pathological examination showed lesions of necrosis with granulomatous inflammatory reaction and bone metaplasia. Necrosis seems to be the primary cause of calcifications so we propose to call the lesion inflammatory and necrotic granuloma. The incidence of these granulomas is unknown. They are unpredictable and appear with a mean range of a year following the intradiscal injection. The treatment is surgery if they become symptomatic.

The authors report a case of sacral osteosarcoma, which is a rare and dreaded tumor. Sciatica was the first manifestation. Patients with refractory sciatica and normal plain films and computed tomography studies of the lumbar spine should undergo magnetic resonance imaging to look for a sacral lesion.

Radical excision of skull base tumors is a real challenge for neurosurgeons. The need to preserve the nerves and the vessels in the area lead us to use lateral approaches, if the lesion lies lateral to the cavernous portion of the carotid artery and behind the petrous apex. Lateral approaches are classified into two groups: ventrolateral approaches (in front of the cochlea) and dorsolateral approaches (with or without resection of the bony labyrinth). The three surgical approaches studied were the subtemporal preauricular infratemporal, the subtemporal anterior transpetrosal, and the combined supra and infratentorial presigmoid approach. The approaches were performed on adult cadaver heads fixed in formolin. The technique, the exposure, the modifications and extensions, as well as the problems of reconstruction are discussed.