Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) has become a suitable alternative to anticoagulation in patients with atrial fibrillation (AF). However, outcomes among patients age > 75 years undergoing LAAO are lacking. METHODS: We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020. Patient data including clinical, laboratory, procedural characteristics, medications and outcomes were collected. The primary composite outcome was major adverse cardiac events (MACE) including mortality, stroke, bleeding and readmissions at 60-days. RESULTS: Mean age was 75 ± 8 years and 434 (60%) were males. Median CHA₂DS₂-VASc score was 4 (IQR: 4, 5) points and median HASBLED score was 4 (IQR: 3, 4) points. Composite MACE outcome was significantly higher among patients age > 75 years in both unadjusted (17.1% vs. 11.5%, P = 0.03) and adjusted (Odds Ratio = 1.59, 95% CI: 1.02 - 2.46, P = 0.04) analysis. Composite MACE was primarily driven by higher all-cause mortality (1.3% vs. 0, P = 0.04) among patients age > 75 years. The secondary outcome of procedural success was also lower among patients age > 75 years (92.2% vs. 96.2%, P = 0.02). The occurrence of stroke (P = 0.38), major bleeding (P = 0.29) and readmissions (P = 0.15) did not differ between patients age > 75 years and less than 75 years. CONCLUSION Patients age >75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success. Future prospective studies evaluating these findings are warranted.

Background: Remimazolam is an ultra-short-acting benzodiazepine characterized by rapid onset and recovery with minimal accumulation after continuous infusion. This systematic review and meta-analysis aimed to evaluate whether remimazolam use results in better postoperative recovery as compared to inhalational anesthetics. Methods: Databases including MEDLINE, EMBASE, CENTRAL, Web of Science, Google Scholar, and Scopus were searched up to August 2024. Randomized controlled trials (RCTs) in adult patients comparing remimazolam with volatile agents were included. The primary outcome was incidence of postoperative nausea and vomiting (PONV) at 24 h. Secondary outcomes included use of rescue antiemetics and analgesics, pain scores, intraoperative hypotension, and other postoperative recovery parameters. Trial sequential analysis (TSA) was performed to validate the robustness of the primary outcome. Results: Twelve RCTs involving 853 patients were analyzed. Remimazolam significantly reduced the incidence of PONV (relative risk [RR] 0.51; 95% confidence interval [CI] 0.27–0.96; I² = 43%; P = 0.04) and need for rescue antiemetics (RR 0.30; 95% CI 0.10–0.89; I² = 0%; P = 0.03) compared to inhalational agents. No significant differences were found in postoperative pain scores (standardized mean difference –0.17; P = 0.11) or analgesic requirement (RR 0.95; P = 0.82). Remimazolam was associated with a significantly lower incidence of intraoperative hypotension (RR 0.58; P = 0.01). Time to extubation, sedation scores, and post-anesthesia care unit stay were comparable. TSA confirmed that the required information size for the primary outcome was reached, indicating statistical conclusiveness. Conclusions Remimazolam use is associated with significantly reduced PONV, rescue antiemetic use, and intraoperative hypotension compared to inhalational agents. TSA confirms the robustness of these findings.

We studied the publication trend in the field of orthopaedics and sports medicine over the last 25 years (1996 -2021), by various countries, and regions of the world. There was an increasing trend in publications, across the globe. Some of the Asian countries like China and India have shown a substantial growth in their research output. Europe continent has contributed the most publications in the last 25 years, whereas the United States as a country has been on the top of the list of contributors. Most research-publications came from high-income countries and disproportionately less from low- and middle-income countries.

Objectives: The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Materials and Methods: Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. Results: DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Conclusions Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

Objective: Spinal cord injury (SCI), one of the major disabilities concerning central nervous system injury, results in permanent tissue loss and neurological impairment. The existing therapeutic options for SCI are limited and predominantly consist of chemical compounds. In this study, we delved into the neuroprotective effects of myricetin, a natural flavonoid compound, and the underlying mechanisms, specifically in the context of SCI, utilizing an in vivo model. Previously, our investigations revealed an elevation in the phosphorylated form of Lin-11, Isl-1, and Mec-3 kinase1 (LIMK1) at chronic time points postinjury, coinciding with neuronal loss and scar formation. Our primary objective here was to assess the potential neuroprotective properties of myricetin in SCI and to ascertain if these effects were linked to LIMK inhibition, a hitherto unexamined pathway to date. Methods: Computational docking and molecular dynamics simulation studies were performed to assess myricetin’s potential to bind with LIMK. Then, using a rat contusion model, SCI was induced and different molecular techniques (Western blot, Evans Blue assay, quantitative reverse transcription polymerase chain reaction and immunohistochemistry) were performed to determine the effects of myricetin. Results: Remarkably, computational docking models identified myricetin as having a better interaction profile with LIMK than standard. Subsequent to myricetin treatment, a significant downregulation in phosphorylated LIMK expression was observed at chronic time points. This reduction correlated with a notable decrease in glial and fibrotic scar formation, and enhanced neuroprotection indicating a positive outcome in vivo. Conclusion In summary, our findings underscore myricetin’s potential as a bioactive compound capable of attenuating SCI-induced injury cascades by targeting the LIMK pathway.

Purpose: Cervical cancer is a significant global health issue affecting approximately 600,000 women each year. This study aimed to address the knowledge gaps surrounding the influence of treatment time parameters, including the duration of external beam radiotherapy (EBRT) to brachytherapy and overall treatment duration, on early recurrences. Materials and Methods: Details on demographics, tumor characteristics, treatment details, and outcomes in patients undergoing chemoradiation and brachytherapy for cervical cancer were collected from the medical records. Early recurrence was defined as tumor reappearance within 6 months after treatment in patients with an initial complete response. Statistical analyses included descriptive statistics chi-square tests, independent t-tests, and logistic regression. Results: A total of 288 cervical cancer patients were included. Stage IIB was the most common stage and 93% of patients had a complete response, 4.5% partial response, and 3.1% had progressive disease at 3rd month. At 6 months, 8% experienced early. The average interval between EBRT and brachytherapy was 10.4 ± 4.2 days among the no recurrence group and 12.3 ± 4.5 days among early recurrence group. A total of 203 patients had a gap of 10 or fewer days and 123 patients had a gap of more than 10 days between EBRT and brachytherapy. Difference was observed in the overall treatment time between the two groups had significant differences (no recurrence group, 61.6 ± 11.5 days; early recurrence group, 73.8 ± 8.8 days; p < 0.001). Conclusion The study revealed that longer overall treatment durations were associated with a higher risk of early recurrences, highlighting the need for further investigation and optimized treatment strategies.

Objective: Spinal cord injury (SCI), one of the major disabilities concerning central nervous system injury, results in permanent tissue loss and neurological impairment. The existing therapeutic options for SCI are limited and predominantly consist of chemical compounds. In this study, we delved into the neuroprotective effects of myricetin, a natural flavonoid compound, and the underlying mechanisms, specifically in the context of SCI, utilizing an in vivo model. Previously, our investigations revealed an elevation in the phosphorylated form of Lin-11, Isl-1, and Mec-3 kinase1 (LIMK1) at chronic time points postinjury, coinciding with neuronal loss and scar formation. Our primary objective here was to assess the potential neuroprotective properties of myricetin in SCI and to ascertain if these effects were linked to LIMK inhibition, a hitherto unexamined pathway to date. Methods: Computational docking and molecular dynamics simulation studies were performed to assess myricetin’s potential to bind with LIMK. Then, using a rat contusion model, SCI was induced and different molecular techniques (Western blot, Evans Blue assay, quantitative reverse transcription polymerase chain reaction and immunohistochemistry) were performed to determine the effects of myricetin. Results: Remarkably, computational docking models identified myricetin as having a better interaction profile with LIMK than standard. Subsequent to myricetin treatment, a significant downregulation in phosphorylated LIMK expression was observed at chronic time points. This reduction correlated with a notable decrease in glial and fibrotic scar formation, and enhanced neuroprotection indicating a positive outcome in vivo. Conclusion In summary, our findings underscore myricetin’s potential as a bioactive compound capable of attenuating SCI-induced injury cascades by targeting the LIMK pathway.