Letter to Editor

Review Article

Neurological Manifestation of COVID-19: A Literature Review

Arash Azhideh, Iman Menbari-Oskouie, Maryam Yousefi-Asl

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 164-170

In December 2019, the coronavirus ((COVID-19) outbreak related to severe acute respiratory syndrome (SARS-CoV2) originated in China and expanded exponentially as a public health pandemic to over 200 countries. Over 8 million validated cases and approximately 800 000 deaths. The main type is cardiac and respiratory but neurological symptoms are further mentioned as case series and case records in the research. The most frequent manifestations have been reported to include dizziness and headache followed by delirium and encephalopathy. Gillian barre syndrome, acute transversal myelitis, cerebrovascular accident, and encephalitis are among the complications noted. The most prominent occurrence at the periphery was hyposmia. This is also known that neurological demonstrations will also lead to regular features such as cough and fever, which evolve in these cases later on normal manifestations. For the timely diagnosis and separation of cases, therefore, a great suspicion guide is needed to arrest spread in neurology departments. This research provides a narrative study of COVID-19’s neurological symptoms and complexities. Our goal is to inform the neurologists and clinicians who work amidst potential COVID-19 patients regarding potential neurological symptoms, and likely neurological problems arising from the aforementioned new virus.

Schizophrenia; recent cognitive and treatment approaches using induced pluripotent stem cells

Nassim Rastgar

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 171-178

One of the most severe mental disorder which leads to a disturbance in the percipience of reality is named schizophrenia. Schizophrenia is a combination of hallucinations, delusions, and mental disorders, that the severity of them impairs normal thinking and behavior, and in general the inability to perform daily activities. Behavioral, intellectual, and emotional disorders indicate the widespread impact of Schizophrenia on various aspects of mental health. The signs and symptoms of schizophrenia are very varied, although delusions, hallucinations, or disorganized speech are included in common symptoms. Dopamine has been the main subject of much research on schizophrenia for decades. Molecular neuroimaging studies to explore the Dopamine System (DA system) in vivo have revealed that schizophrenia is first associated with a defect in the striatum and then with a defect in extrastriatal regions with centralizing on Cortex and midbrain. Also, the Gamma-Aminobutyric acid (GABA) mRNA dysregulation and Neuroinflammatory mechanisms can be effective in schizophrenia. Various medications such as antipsychotic drugs are used to the aim of treating this disease but they can just decline or improve the positive symptoms. Modeling of neurodevelopment and synaptic connection defects by induced human pluripotent stem cells have made appropriate circumstances to the elimination of schizophrenia treatment barriers. With the development of cell therapies and the usage of induced pluripotent stem cells, there is a hope that the negative symptoms can be improved by this approach.

Original / Research Article

Leaving Against Medical Advice Among Patients With Brain Tumours in the Middle East: Khoula Hospital Experience

Tariq Al-Saadi, Ali Al Sharqi, Jawaher ALSharqi, Khadija ALBlushi, Asma ALRasbi, Maather Al-Farsi, Shamsa Al-Ghafri, Said Al-Abri, Hatem Al-Saadi

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 179-184

Background: Leaving against medical advice (LAMA) can be defined broadly as a patient’s insistence upon leaving the hospital against the treating team has expressed advice, which is both a challenge and concern for physicians, as these patients lost to follow-up, and their outcomes remain unknown. There is no previous study conducted to find the prevalence and causes of LAMA in brain tumors patients in the Middle East to the best of our knowledge.
Methods: Patients studied in this research are those who were diagnosed with any type of brain tumors and were admitted to the Neurosurgical Department in Khoula Hospital (KH) but signed LAMA in the two years between January 2017 to December 2018 by going through the electronic medical records. Data obtained from the health information system includes socioeconomic characteristics, health status-related data, diagnosis-related data, and the reasons for LAMA.
Results: A total number of 302 patients with brain tumors included in this study. Twenty-eight patients (9.2%) signed LAMA with a majority of those who signed LAMA were in the young adult’s group (3-39 years) and represented 18 (64%). Eight patients (28.57%) among the LAMA group and 43 patients (15.69%) in the non-LAMA group have tumors in the frontal lobe, which has found to be the most familiar location (29%). There was a significant relationship between the reason for LAMA and gender (P = 0.020).
Conclusion: Younger patients, male, Omani, newly diagnosed tumors, and tumors in the frontal lobe were all risk factors for LAMA. Education and awareness about LAMA recommended in order to avoid readmission and loss of follow up.

The Synergistic Effect of Co-delivery of Anticancer Drugs Into Astrocytes Isolated From Human Glioblastoma Multiforme

Mansoureh Hashemi, Alireza Zali

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 185-189

Background: Chemotherapy drugs are not effective in the treatment of primary brain tumors due to the low efficacy of these drugs and drug transfer from the blood-brain barrier (BBB) toward the tumor site. Our purpose in this study was to assess the co-delivery of anticancer drugs to increase drug permeability from BBB.
Methods: In this study, two chemotherapy drugs, namely methotrexate (MTX) and paclitaxel (PTX), were inserted into polyvinyl alcohol and poloxamer188-conjugated nanoparticles (NPs). Astrocytes were treated with different concentrations of 0-50 μg/ml from MTX, PTX, the MTX-PTX mixture, PTX-loaded NPs, MTX-loaded NPs, and PTX-MTX co-loaded NPs for 48 hours. The tumoricidal effect was assessed using the survival rate, Hoechst staining, and western blotting.
Results: The results indicated significant reduction of the survival rate in astrocytes treated with PTX-MTX co-loaded NPs. In addition, apoptosis hallmarks consisting of fragmented DNA, overexpression of Bax, and expression reduction of Bcl-2 were in the cultured astrocytes.
Conclusions: Our study proposes that the PTX-MTX co-delivery to NPs could be used as a possible approach for anti-cancer drug delivery to glioblastoma multiforme.

Neurotoxin Botulinum Inserts Apoptotic Effects on Certain Cancer Cell Lines Via Neural Niche of Tumors: A Molecular Study

Mona Farhadi, Melikasadat Jameie, Bahareh Derakhshanmehr, Moghadam Tahmasebi, Maryam Soleimani, Seyed Behnamedin Jameie

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 190-195

Background: Background: Botulinum toxin A (BtxA) is a powerful neurotoxin reported to be effective as a cancer adjuvant therapy with fewer side effects. Previously we showed the apoptotic effects of BtxA on the GBM cell line (U87-MG). In order to confirm the positive neurotoxicity of BtxA on other cancer cell lines, including SK-OV-3, CHO, MCF-7, and PC-3, the present research has designed.
Methods: The cell lines prepared, cultured, and exposed to different concentrations of BtxA for 24 and 48 hours. Using MTT, Annexin V/PI assays and western blotting, cell viability, and apoptosis studied.
Results: Our results showed that different BtxA Botox concentrations led to significant cell death in each cell line in a dose-dependent manner (P < 0.001) but did not for PC-3 cells. The results of the Annexin V/PI staining indicated that BtxA induced apoptosis after 24 hours. The 1.45U, 1.75U, and 1.65U of BtxA respectively induced more than 50% apoptosis in MCF 7, SK-OV-3, and CHO cell lines. The results of caspase 3 showed more protein expression in the treated group compares to the control group.
Conclusion: BtxA, as a neurotoxin, can insert therapeutic anti-cancer and apoptotic effects on various types of cancerous cells; further studies need to illuminate the possible mechanisms.

Drug Interactions in Iranian Veterans With Chronic Spinal Cord Injury - A Descriptive Study

Ashkan Divanbeigi , Amir Saied Seddighi , Sepideh Amiri , Shiva Jamshidi, Hesam Rahimi Baqdashti, Afsoun Seddighi

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 196-200

Background: Veterans with chronic spinal cord injury usually have various comorbidities. They are, therefore, visited by different doctors and use different medications. It is necessary to monitor the health of these veterans. One of the important issues in this regard is the attention to drug interactions. The purpose of this study was to investigate the drugs used and their interactions.
Methods: This descriptive study of the cross-sectional studies was carried out retrospectively in 2015 under the Shefa Neuroscience Research Center’s supervision, examining the medical records of veterans with spinal cord injury participating in the health screening program at Khatam Alanbiya hospital in Tehran. Demographic data, comorbidities, used drugs, and the level of involvement collected. According to the FDA, drug interactions among the drugs used for each patient has evaluated and classified into three severe, moderate, and weak groups. SPSS v. 21 analyzed data.
Results: The study population consisted of 404 men, ranging in age from 41 to 74, with a mean of 51.6 ± 6.4 years. One hundred forty-two of them (35.1%) had a complete injury, and 262 veterans (64.8%) had an incomplete injury. Only 17 veterans (4.2%) had no drug interactions. The number of drug interactions varied from 1 to 38, with an average of 5.9 ± 12.8 interactions per patient. The total number of interactions was 2856, of which 32.5% were weak, 55.3% moderate, and 12.2% severe, with a 95% confidence interval. Among the severe drug interactions in the study, the highest number belonged to the antidepressant drugs.
Conclusion: This study highlights the necessity of developing a strategy for investigating and preventing drug interactions in veterans with chronic spinal cord injury. It has recommended that physicians pay more attention to other medications used by the patient and prescribe as little as possible of the drug and the drug with the least number of interactions.

Comparison of the Effectiveness of Two Types of Single Port Minimal Invasive Neurosurgical Robots to Ablation and Resection of Brain Tumor

Sahar Delasaei Marvi , Arash Sherafati, Majid Mohammad Tahery , Samir Zein

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 201-207

Background: Using minimally invasive neurosurgical robots is one of the most desirable ablation methods and resection of brain tumors. In this study, forward kinematics and Jacobian matrix calculated for two single-port robots for comparing the effectiveness of two types of single port minimal invasive surgical robots to ablation and resection of brain tumor
Methods: The motion analysis of robots type 1 and 2 has compared to each other. Ablation manipulator in robot type 1 has five degrees of freedom, but in robot type 2, three revolute degrees of freedom of this manipulator has replaced with a revolute joint perpendicular to the previous three revolute joints.
Results: Results showed that for resection surgery, in the same conditions, robot type 2 damaged 58.9 mm3 more of cerebral cortex tissue than robot type 1 to resect the brain tumors. To establish a static balance, robot type 2 needs to tolerate at least 41% more internal loading than robot type 1. The maximum velocity for robot type 1 in the contact location between the end-effector and the tumor is 1.7 times more than robot type 2. The maximum end-effector force of robot type 1 to apply the tumor for ablation surgery is more than 1.8 times in robot type 2, but the maximum moment and power for ablation surgery and resection of these two robots were the same less than 1% difference.
Conclusion: Despite the more straightforward mechanism, a minimum number of joints, and better kinematics range of robot type 2, robot types 1 has the possibility for transformation, establishes the static balancing, and does a better ablation surgery with less damage to the brain.

A Comprehensive Investigation to Identify Working Memory Components Utilizing Thematic Analysis Technique: A Qualitative Research

Nafiseh Tabatabaei, Mohammad ali Nadi, Ilnaz Sajjadian

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 208-215

Background: Working memory (WM) is commonly known as a mediator between short-term and long-term memory. However, WM as well is a data processor and manipulator in charge of a considerable portion of our cognitive abilities. Due to the recently grasped significance of further investigations of WM, this study was conducted aiming to identify the entire WM components present in the current literature utilizing qualitative thematic analysis.
Methods: Stirling’s novel method of qualitative inductive thematic analysis was applied to extract the entire components of WM from the current literature up to 2018.
Results: Our results yielded 57 basic concepts (themes) related to WM out of 1099 concepts, which was integrated into 18 organizing concepts that altogether comprise the global notion of WM. Statistical validation was conducted through expert confirmation and content validity index (CVI) calculation (0.88). Moreover, the Holsti coefficient was 0.60 that indicates relatively appropriate reliability.
Conclusion: Considering the growing interest in studying WM components, conducting an integrative research aiming to thoroughly clarify these components was required. Herein, through applying the novel technique of thematic analysis, we have developed a comprehensive theme network designed to facilitate future studies on WM.

Case Report

Anesthetic Management “Arnold Chiari Malformation” in the well-known Case of Cystic Fibrosis

Gholamreza Mohseni, Faranak Behnaz, Houman Teymourian, Saeed Oraee- Yazdani

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 216-218

Cystic fibrosis (CF) is a genetic disease resulting from a chlorine channel defect with autosomal recessive show, a physical and functional disorder in the transport of chlorine (Cl) through the plasma membrane in epithelial cells in organs such as the lungs, pancreas, liver, intestines, sweat glands, and epididymis. These cases are important for their perioperative respiratory complications. We present an anesthesia method conducted on a 24-year-old men CF case receiving general anesthesia for Arnold Chiari malformation surgery.

Novel Approach of Linear Accelerator-Based Stereotactic Radiosurgery in an Adult Patient With Brain Arteriovenous Malformation: A Case Report and Clinical Outcome

Santosh Devarakonda, Vijay Kumar Kontham

International Clinical Neuroscience Journal, Vol. 7 No. 4 (2020), 28 September 2020, Page 219-221

Stereotactic radiosurgery (SRS) is a proven strategy for treating the central nervous system arteriovenous malformation (AVM). We intend to present a case of cerebral AVM in an adult patient, successfully treated with a linear accelerator (LINAC) based SRS using simplified setup techniques and an advanced planning system. In the current scenario, frame-based SRS is the standard of care with LINAC. Recently, it has proven that even frameless SRS has similar results. In our case, we used a frameless SRS technique with similar results. While calculating the dose in radiotherapy planning, we used the Acuros™ algorithm, which has proven dosimetric advantages compared to the traditional AAA™ algorithm.