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Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging findings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns phar macological interventions. This systematic review aimed to evaluate the role of nonpharmacological interven tions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane databases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postin jury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exer cise, collaborative care intervention, cervical spine reha bilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular reha bilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. However, this systematic review shows a lack of high-quality literature supporting nonpharmacological pedi atric concussion treatments. [ABSTRACT FROM AUTHOR]

Background/Objectives: Spinal tuberculosis (STB) is frequently misdiagnosed due to the multitude of symptoms it presents with. This review aimed to investigate the biomarkers that have the potential to accurately diagnose spinal TB in its early stages. Methods: A systematic search was conducted across multiple databases, yielding a diverse range of biomarkers categorized into complete blood count parameters, host inflammatory responses, bacterial antigens, and RNA-based markers. This review included studies on spinal tuberculosis patients, including blood serum biomarkers, while exclusion criteria included pediatric cases, cerebrospinal fluid or imaging biomarkers, co-infection with other bacteria, viruses, comorbidities, tumors, immune diseases, HIV infection, metabolic disorders, animal studies, opinion papers, and biomarkers relevant to health problems outside the disease. QUADAS-2 was used as a quality assessment tool for this review. This review identifies several promising biomarkers with significant diagnostic potential. Results: The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), IFN-γ, CXCR3, CXCL9, CXCL10, PSMB9, STAT1, TAP1, and specific miRNA combinations demonstrated noteworthy diagnostic accuracy in distinguishing STB from other spinal pathologies. Additionally, these biomarkers offer insights into disease severity and progression. The review also highlighted the importance of combining multiple biomarkers to enhance diagnostic precision. This comprehensive systematic review underscores the potential of biomarkers to revolutionize the diagnosis of spinal tuberculosis. By integrating these markers into clinical practice, healthcare providers can achieve earlier and more accurate diagnosis, leading to improved patient care and outcomes. Conclusions: The combination of multiple biomarkers, including NLR, PSMB9, STAT1, and specific miRNAs, demonstrates promising diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Stroke is the world's second-leading cause of death. Current treatments for cerebral edema following intracerebral hemorrhage (ICH) mainly involve hyperosmolar fluids, but this approach is often inadequate. Propolis, known for its various beneficial properties, especially antioxidant and anti-inflammatory properties, could potentially act as an adjunctive therapy and help alleviate stroke-associated injuries. The chemical composition of Geniotrigona thoracica propolis extract was analyzed by GC-MS after derivatization for its total phenolic and total flavonoid content. The total phenolic content and total flavonoid content of the propolis extract were 1037.31 ± 24.10 μg GAE/mL and 374.02 ± 3.36 μg QE/mL, respectively. By GC-MS analysis, its major constituents were found to be triterpenoids (22.4% of TIC). Minor compounds, such as phenolic lipids (6.7% of TIC, GC-MS) and diterpenic acids (2.3% of TIC, GC-MS), were also found. Ninety-six Sprague Dawley rats were divided into six groups; namely, the control group, the ICH group, and four ICH groups that received the following therapies: mannitol, propolis extract (daily oral propolis administration after the ICH induction), propolis-M (propolis and mannitol), and propolis-B+A (daily oral propolis administration 7 days prior to and 72 h after the ICH induction). Neurocognitive functions of the rats were analyzed using the rotarod challenge and Morris water maze. In addition, the expression of NF-κB, SUR1-TRPM4, MMP-9, and Aquaporin-4 was analyzed using immunohistochemical methods. A TUNEL assay was used to assess the percentage of apoptotic cells. Mannitol significantly improved cognitive–motor functions in the ICH group, evidenced by improved rotarod and Morris water maze completion times, and lowered SUR-1 and Aquaporin-4 levels. It also significantly decreased cerebral edema by day 3. Similarly, propolis treatments (propolis-A and propolis-B+A) showed comparable improvements in these tests and reduced edema. Moreover, combining propolis with mannitol (propolis-M) further enhanced these effects, particularly in reducing edema and the Virchow-Robin space. These findings highlight the potential of propolis from the Indonesian stingless bee, Geniotrigona thoracica, from the Central Tapanuli region as a neuroprotective, adjunctive therapy. [ABSTRACT FROM AUTHOR]

Concussion is a common complaint among adult and adolescent athletes around the world and poses a safety risk in competitive, recreational, and noncontact sports. It is estimated that concussions occur at a rate of 0.5 per 1000 playing hours; however, the precision of this estimate is uncertain due to variations in the interpretation and reporting of concussions. Athletes with a history of concussions are more likely to sustain additional concussions, which can result in cognitive decline, depression, and early degenerative change. In order to lessen the likelihood of future difficulties, this study compiles the research on preventing sports-related concussion in soccer and presents a summary of the findings., Material and Methods: We performed a literature search on PubMed, EBSCO (Elton B. Stephens Company), DOAJ (Directory of Open Access Journals), and Cochrane for the past 20 years. The search strategy was using Boolean terms based on any of the search terms of sports-related-concussion, soccer, and prevention. The studies were included based on inclusion and exclusion criteria., Results: This research identified three systematic reviews, seven literature reviews, five cross-sectional studies, one randomized controlled trial, three prospective studies, and one retrospective study. As concussion prevention measures in soccer, several strategies can be implemented, including concussion education, rule/regulation changes, proper heading technique, behavioral skills training, vision training to improve sensory and anticipation, the use of supplements to prevent severe concussion and accelerate recovery, as well as prevention in youth sports and head impact detection., Conclusion: Good education, good technique, good training, and a good strengthening program can be implemented to prevent concussions in soccer. To determine the relationship between prevention and concussion, however, additional research is required., Competing Interests: There are no conflicts of interest in this paper., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Implantation metastasis following stereotactic biopsy in the brain had been reported as a rare complication. A 36-years-old female patient was treated with ventriculoperitoneal (VP) shunt and stereotactic biopsy of a pineal parenchymal tumor of intermediate differentiation (PPTID) with hydrocephalus. The patient underwent five cycles of radiotherapy on the pineal area. Seven years after the procedure, the patient developed left hemiparesis with the brain MRI findings showing an enhanced mass along the biopsy tract. Craniotomy tumor removal was carried out and the pathological assessment was consistent with those of the PPTID. Radiation on metastase area and craniospinal was subsequently performed. The patient was disease-free during the 2-year follow-up assessments. The potential occurrence of implantation metastasis following the stereotactic biopsy of PPTID should be considered in the treatment plan and follow-up assessments and evaluations. Expanding the radiation area to cover the entire biopsy tract may be favorable to lower the risk of implantation metastasis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tandean, Siahaan, Loe, Indharty, Julijamnasi, Sitorus, Japardi and July.)

Background: Traumatic brain injury (TBI) is one of the major causes of death and disability. Apoptosis after TBI contributes significantly to the final extent of tissue damage. The Bcl-2 family proteins are important apoptosis modulators which increased in injured neurons. Bcl-2 has shown an antiapoptotic effect in rats and mice. ACTH4-10Pro(8)-Gly(9)-Pro(10) is a synthetic short fragment of ACTH devoid of hormonal effects and has neuromodulatory properties. ACTH4-10Pro8-Gly9-Pro10 has been shown to increase levels of Bcl-2 and BDNF in vitro as well as in vivo. It has been postulated that ACTH4-10Pro(8)-Gly(9)-Pro(10) will result in improved clinical outcome and reduce hospital length of stay. The goal of this study is to compare the effect of standard therapy only with standard therapy and ACTH4-10Pro(8)-Gly(9)-Pro(10), the increase of Bcl-2, and clinical outcome with reduction of hospital stay., Materials and Methods: Subjects of moderate head injury (MHI) with no indication of surgery were taken consecutively (n = 40) and separated into two groups: standard treatment only and standard treatment combined with ACTH4-10Pro(8)-Gly(9)-Pro(10). Blood samples were taken on day 1 and day 5 from each subject for measurements of Bcl-2 concentration. Barthel Index and MMSE were measured, at discharge and hospital length of stay was noted., Results: Forty subjects have been involved in this study, three subjects died in the standard therapy group, and one subject in ACTH4-10Pro(8)-Gly(9)-Pro(10) group. Bcl-2 serum level in standard therapy was 1.39 ± 0.75 ng/mL on day 1 and 1.48 ± 0.77 ng/mL on day 5. After treatment with ACTH4-10Pro(8)-Gly(9)-Pro(10), Bcl-2 level was 1.39 ± 0.70 ng/mL on day 1 and 3.70 ± 1.02 ng/mL on day 5. The serum Bcl-2 concentration was significantly increased with ACTH4-10Pro(8)-Gly(9)-Pro(10) therapy with shorter hospital length of stay (P < 0.05)., Conclusion: ACTH4-10Pro(8)-Gly(9)-Pro(10) increased serum Bcl-2 levels and reduced hospital length of stay significantly compared with standard therapy alone.