Adult chordoid meningioma: a case report

Chordoid meningioma is a rare tumour accounting for less than 0.5% of all meningiomas. It is a WHO grade II tumour with an aggressive behavior. It is a rare variant characterized by cords or trabeculae of eosinophilic or vacuolated cells set in an abundant mucoid matrix. It can be associated with systemic or hematologic manifestations like Castleman disease. The tumor has a propensity for aggressive behavior and increased likelihood of recurrence We report a case of an adult patient with chordoid meningioma who presented with headache and seizures and did not have any hematological/ systemic manifestations. She underwent total excision of the lesion and is doing well

Protective effect of Acampe praemorsa (Roxb.) Blatt. & McCann against oxidative stress

The current study was carried to make available phytochemical information and evaluation of antioxidant activity of Acampe praemorsa (Roxb.) Blatt. & McCann. The phytochemical analysis was carried out using procedures and quantified phenolic and alkaloid contents. The antioxidant activity was evaluated by in-vitro and in-vivo studies. The In-vitro antioxidant activity was carried on free radicals such as superoxide, hydroxyl DPPH, hydrogen peroxide, evaluation of reducing power. In-vivo study was carried on albino Wistar rats with different doses of extracts. The results provide that, A. praemorsa extracts have diversified phytochemicals in extracts like steroids, alkaloids, phenolics, glycosides, oils, quinones, tannins etc. The hydroalcoholic extract has more phenolic (26.80±0.51) and alkaloid (20.59±0.22) contents. The antioxidant activity results provide information that the extracts possess concentration dependent activity on tested free radicals. The hydroalcoholic extract has more protective nature against superoxide, DPPH, H2O2 free radicals and reducing power but ethyl acetate extract has more potential against hydroxyl free radical than hydroalcoholic extract. The extracts were found to be safe on toxic studies and In-vivo study results and they play significant role in controlling the oxidative enzymes such as catalase, superoxide dismutase, lipid peroxidation (malonaldehyde) in the body. Thus, it was determined that A. praemorsa have potential bioactive compounds and antioxidant activity

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

A patient with reversible pupil-sparing Weber's syndrome

This is a case report of a lady who presented with pupil-sparing Weber's syndrome. She had left oculomotor nerve palsy with normal pupil and right hemiparesis. The patient subsequently made a good recovery. An ischemic lesion of the lower mid-brain was demonstrated on the MRI scan of the brain, which corresponds to the motor nucleus of the oculomotor nerve. The article also describes the neuroanatomy of the oculomotor nerve and how its partial lesions lead to sparing of the pupil. In addition, this case report documents that a pupil-sparing Weber's syndrome could be reversible

Unravelling the ecological ramifications of biodegradable microplastics in soil environment: A systematic review

Plastic pollution, especially microplastics (MPs), poses significant environmental challenges, with biodegradable plastics (BPs) often presented as sustainable alternatives. However, incomplete degradation of BPs in soil environment leads to the creation of biodegradable microplastics (BMPs), whose impacts remain inadequately understood. This systematic review synthesizes findings from 85 publications to assess the effects of BMPs on soil ecosystems, encompassing physical, chemical, and biological properties. BMPs influence soil texture, porosity, nutrient cycling, microbial diversity, and plant growth, with varying impacts depending on polymer type, concentration, and soil conditions. While BMPs can enhance soil organic matter and microbial activity at low concentrations, higher concentrations often alter nutrient availability and soil stability. Soil biota shows differential responses to BMPs, with potential implications for nutrient cycling and soil ecosystem functioning. Contradictory research findings underscore the need for long-term, field-based studies under varied environmental conditions. The insights from this review contribute to a deeper understanding of the ecological ramifications of BMPs in soil ecosystems, highlighting critical research gaps, advocating for multidisciplinary approaches to comprehensively evaluate impacts of BMPs

A patient with reversible pupil-sparing Weber's syndrome

This is a case report of a lady who presented with pupil-sparing Weber's syndrome. She had left oculomotor nerve palsy with normal pupil and right hemiparesis. The patient subsequently made a good recovery. An ischemic lesion of the lower mid-brain was demonstrated on the MRI scan of the brain, which corresponds to the motor nucleus of the oculomotor nerve. The article also describes the neuroanatomy of the oculomotor nerve and how its partial lesions lead to sparing of the pupil. In addition, this case report documents that a pupil-sparing Weber's syndrome could be reversible

671 DEMOGRAPHIC VARIABILITY IN MORTALITY FROM COVID DURING THE TWO SURGES

Abstract Introduction COVID-19 resulted in significant mortality over the last several months. This survey aims to evaluate demographic differences between those hospitalised patients who died of COVID during the first surge [until 31/08/2020] and those who died during the second [01/09/2020–15/03/2021]. Methods Data was obtained for all patients admitted with COVID during the two pandemic surges at two multi-ethnic,inner-city district general hospitals. Univariate and multivariable analyses [stepwise backward logistic regression] were conducted to evaluate mortality as per patient demographics, length of stay, and whether patients had been managed in critical care. Results 1013 [21.5%] of 4,707 patients died during this period. Mortality was significantly lower during the second wave,compared to first i.e. 18.5% [632/2784]vs29.5% [381/901];39% reduction [P &amp;lt; 0.001]. This reduction was observed across all ages, gender, ethnic subgroups, and both sites. Advancing age was associated with significant mortality at all times with no differences between the two waves. 77% of all deaths occurred in patient&amp;gt;70. There were fewer deaths among those&amp;lt;50 during the second wave compared to first [7vs12]. Reduction in mortality during second wave was noted across all ethnic sub-groups. However,significantly greater reduction was observed in Black African [54.6%],South-Asian [47.3%],Black Caribbean [44.4%],and East-Asian [44.2%] groups, compared to white subgroup [34.2%]. Majority of patients who died were managed on general medical wards during both waves [n = 824,81.3%]. For patients who spent time in critical care, there were no significant differences in mortality [30.6vs33.7%,p = ns]. There were no differences in terms of length of hospital stay between the two waves. Multivariable analyses showed that Black African [OR 0.47,95%CI 0.27–0.82] was independently associated with lesser mortality during second wave. Discussion This large survey has described demographic differences in mortality between the two surges. Lower mortality rates during second wave may be due to better treatment modalities, greater awareness of infection prevention and control,and possibly vaccination. This survey indicates greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths. </jats:sec

90 Socio-Demographic and Medical Factors in A Multi-Ethnic Cohort of COVID Deaths

Abstract Introduction Whilst most patients during the COVID pandemic made an uneventful recovery,there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to examine and evaluate risk factors for those patients who died of COVID and to identify any markers for improvement in the management of such patients during future COVID surges. Methods Medical records of all patients who died within a multi-ethnic, inner city acute district general hospital over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for these patients. Results Of 275 deaths,204 were related to COVID. Compared to non-COVID deaths(n = 71), there were no age differences. There were significantly more deaths in males (58%vs39%,P &amp;lt; 0.001)) and in Black African and South Asian groups. 18% of COVID deaths were those who were not frail (Frailty Rockwood Scale 1–3) whereas there were no non-COVID deaths in this group(P &amp;lt; 0.001). 69% of COVID deaths occurred in general medical wards whereas 19% in critical care units (90% and 7% for non-COVID deaths,p &amp;lt; 0.001). COVID patients died more quickly compared to non-COVID patients (length of stay mean, 11vs21,p &amp;lt; 0.001). Medical factors prevalent in &amp;gt;20% of COVID deaths included Diabetes, Hypertension, Chronic Heart Disease, Chronic Kidney Disease,and Dementia. Multivariable analyses showed males (OR 1.9), age &amp;gt; 70(OR 2.0), frailty (OR 2.3) were independent risk factors for COVID deaths. Discussion Compared to non-COVID deaths,COVID deaths were more common in previously well individuals,males,Black African and South Asian ethnicity, but multivariable analyses showed males, age &amp;gt; 70 and frailty were independent risk factors for COVID deaths. This survey indicates that greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths. </jats:sec