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Purpose Lacosamide (LCM) is a third-generation anti-seizure medication (ASM) approved for focal onset epilepsy in patients aged ≥ 4.378 Previous studies have reported an efficacy of LCM as add-on treatment in brain tumor-related epilepsy (BTRE). To date, there are no studies in the literature focusing on lacosamide used in monotherapy to treat BTRE. In our retrospective study we investigated efficacy and tolerability of LCM in monotherapy in a multicenter national cohort of primary brain tumor patients. Methods We collected from 12 Italian Centers 132 patients with primary brain tumors who were treated with LCM in monotherapy. For each patient we evaluated seizure freedom at 3 and 6 months (primary endpoints), side effects and drop-out rate (secondary endpoints). Results Overall, LCM led to seizure freedom in 64.4% of patients at 3 months and 55% at 6 months. Patients who used two or more ASMs before LCM had a worse seizure control than patients in monotherapy with LCM as first choice. In 14 patients, we observed seizure control despite tumor progression on magnetic resonance (MRI). Multivariate analysis showed that gross-total resection at diagnosis was significantly associated with higher seizure freedom rate at 6 months. Side effects were mainly mild (grade 1–2 according to CTCAE classification) and drop-out rate was low (1.5%). Main side effects were dizziness and somnolence. Conclusions This is the first study showing a good efficacy and tolerability of LCM when used in monotherapy in BTRE. Further prospective studies are needed to confirm these preliminary data, investigating also quality of life and neurocognitive functions.

BackgroundOlfactory dysfunction has shown to accompany COVID-19. There are varying data regarding the exact frequency in the various study population. The outcome of the olfactory impairment is also not clearly defined.ObjectiveTo find the frequency of olfactory impairment and its outcome in hospitalized patients with positive swab test for COVID-19.MethodsThis is a prospective descriptive study of 100 hospitalized COVID-19 patients, randomly sampled, from February to March 2020. Demographics, comorbidities, and laboratory findings were analyzed according to the olfactory loss or sinonasal symptoms. The olfactory impairment and sinonasal symptoms were evaluated by 9 Likert scale questions asked from the patients.ResultsNinety-two patients completed the follow-up (means 20.1 (± 7.42) days). Twenty-two (23.91%) patients complained of olfactory loss and in 6 (6.52%) patients olfactory loss was the first symptom of the disease. The olfactory loss was reported to be completely resolved in all but one patient. Thirty-nine (42.39%) patients had notable sinonasal symptoms while rhinorrhea was the first symptom in 3 (3.26%). Fifteen patients (16.3%) had a taste impairment. Patients with sinonasal symptoms had a lower age (p = 0.01). There was no significant relation between olfactory loss and sinonasal symptoms (p = 0.07).ConclusionsSudden olfactory dysfunction and sinonasal symptoms have a considerable prevalence in patients with COVID-19. No significant association was noted between the sinonasal symptoms and the olfactory loss, which may suggest that other mechanisms beyond upper respiratory tract involvement are responsible for the olfactory loss.

Background Uruguay has a national electronic live birth certificate that includes variables of risk factors for infant mortality. Accurate risk stratification of newborns is needed to optimize the use of resources for homes visits. Artificial neural networks are computational tools that have been used successfully in many types of prediction problems. Objective To develop a neural network able to estimate the risk of infant mortality using information available in the electronic live birth and mortality certificate in Uruguay. Methods A historical cohort of records of newborns in Uruguay from 2014 to 2017 was used. The variables of the electronic live birth certificate were considered for the model. Infant mortality was obtained from the national mortality registry. A multilayer perceptron was trained with a random sample of 70% of the cohort; the remaining 30% was the validation set. The variables included were birth weight, Apgar score at 5 minutes, number of prenatal consultations, maternal educational level, multiple pregnancy and cohabiting father. ROC curve analysis was performed. Results The 2014-2017 birth cohort contains 187,388 records. 1,307 children under one year died (IMR 6.97 per 1,000 births). The area under the curve (AUC) was 88.7%, 95% CI [87.6% - 89.8%]. The optimal cut-off point of pseudoprobability of infant mortality was 0.008 (78.9% of sensibility and 82.4% of specificity). The IMR in high-risk newborns identified by the neural network was 32.8 per 1,000 births. Conclusions The neural network identifies high-risk newborns at the time of entering the data in the electronic live birth certificate as other models have done. This information could be used to plan and implement preventive actions. Key messages In Uruguay, high-risk newborns can be identified by applying artificial intelligence to data collected routinely. The procedure can be applied in other countries with electronic birth certificate.

Whey proteins (WP) gelation process with addition of Arabic gum (AG) was studied. Two different driving processes were employed to induce gelation: (1) heating of 12% whey protein isolate (WPI) solutions (w/w) or (2) acidification of previous thermal denatured WPI solutions (5% w/w) with glucono-δ-lactone (GDL). Protein concentrations were different because they were minimal to form gel in these two processes, but denaturation conditions were the same (90 °C/30 min). Water-holding capacity and mechanical properties of the gels were evaluated. The BST equation was used to evaluate the nonlinear part of the stress-strain data. Cold-set gels were weaker than heat-set gels at the pH range near the isoelectric point (pI) of the main whey proteins, but heated gels were more deformable (did not exhibit rupture point) and showed greater elasticity modulus. However, gels formed by heating far from the pI (pH 6.7 or 3.5) showed more fragile structure, indicating that, in these mixed gels, there are prevailing biopolymers interactions. Cold-set and heat-set gels at pH near or below the WP pI showed strain-weakening behavior, but heated gels at neutral pH showed strong strain-hardening behavior. Such results suggest that differences in stress-strain curve at the nonlinear part of the data could be correlated to structure particularities obtained from different gelation processes.

Glioblastoma multiforme (GBM) is the most aggressive astrocytic primary brain tumor, and concurrent temozolomide (TMZ) and radiotherapy (RT) followed by maintenance of adjuvant TMZ is the current standard of care. Despite advances in imaging techniques and multi-modal treatment options, the median overall survival (OS) remains poor. As an alternative to surgery, re-irradiation (re-RT) can be a therapeutic option in recurrent GBM. Re-irradiation for brain tumors is increasingly used today, and several studies have demonstrated its feasibility. Besides differing techniques, the published data include a wide range of doses, emphasizing that no standard approach exists. The current study aimed to investigate the safety of moderate–high-voxel-based dose escalation in recurrent GBM. From 2016 to 2019, 12 patients met the inclusion criteria and were enrolled in this prospective single-center study. Retreatment consisted of re-irradiation with a total dose of 30 Gy (up to 50 Gy) over 5 days using the IMRT (arc VMAT) technique. A dose painting by numbers (DPBN)/dose escalation plan were performed, and a continuous relation between the voxel intensity of the functional image set and the risk of recurrence in that voxel were used to define target and dose distribution. Re-irradiation was well tolerated in all treated patients. No toxicities greater than G3 were recorded; only one patient had severe G3 acute toxicity, characterized by muscle weakness and fatigue. Median overall survival (OS2) and progression-free survival (PFS2) from the time of re-irradiation were 10.4 months and 5.7 months, respectively; 3-, 6-, and 12-month OS2 were 92%, 75%, and 42%, respectively; and 3-, 6-, and 12-month PFS2 were 83%, 42%, and 8%, respectively. Our work demonstrated a tolerable tolerance profile of this approach, and the future prospective phase II study will analyze the efficacy in terms of PFS and OS.

To determine whether intensity, duration, age at initiation, and cessation of cigarette smoking act differently in the development of various histologic types of lung cancer. Design: A case-control study among deceased men who underwent autopsy, a procedure that involves approximately 73% of all local deaths. The Province of Trieste in northeastern Italy Seven hundred fifty-five patients with lung cancer, including 267 with squamous cell carcinoma, 218 with small cell carcinoma, 90 with large cell carcinoma, 158 with adenocarcinoma, and 22 with other histologic types, and 755 control subjects who had died of causes other than chronic lung diseases and certain tumors. Information on smoking habits, residential history, and occupational exposure was obtained from each subject's next of kin. Compared with nonsmokers, the odds ratio (OR) for current smokers was 13.4 for all types combined, 18.8 for squamous cell carcinoma, 14.3 for small cell carcinoma, 34.3 for large cell carcinoma, and 7.9 for adenocarcinoma. Intensity of smoking, duration, age at starting, and dose were all directly associated with all histologic types of lung cancer, although the OR was lower for adenocarcinoma than for other cell types. When results were restricted to ever smokers, exposure-response curves were similar across histologic types. The risk of lung cancer attributable to smoking was 88% for all types combined, 91% for squamous cell carcinoma, 89% for small cell carcinoma, 95% for large cell carcinoma, and 82% for adenocarcinoma. This study confirms that cigarette smoking causes all types of lung cancer, but the proportion of cases attributable to smoking is lower for adenocarcinoma than for other types, due to a higher proportion of nonsmokers.

Toxoplasma gondii and Neospora caninum infect a wide range of domestic and wild animals, including humans, in the case of T. gondii , and cause economic losses in livestock due to abortion and neonatal mortality. In Somalia, zoonotic diseases are concerning due to cultural practices and livestock’s economic importance, but surveillance is limited. This study aimed to determine the seroprevalence and molecular prevalence of T. gondii and N. caninum in Somali sheep, goats, and cattle. A cross-sectional study was conducted between December 2018 and January 2020 in Benadir and Lower Shabelle regions of Somalia. Blood samples were collected from 128 cattle, 184 goats, and 46 sheep. Serum samples were tested for anti- T. gondii and anti- N. caninum antibodies using IFAT, and PCR was performed on extracted DNA to detect T. gondii and N. caninum DNA. Overall, 106/358 (29.6%) animals tested positive for anti- T. gondii antibodies, with the highest prevalence in sheep (62.5%), followed by goats (30.4%) and cattle (15.6%) ( P  < 0.001). For anti- N. caninum antibodies, 13/358 (3.6%) animals tested positive, with cattle showing the highest prevalence (6.2%), followed by goats and sheep (both 2.2%). Co-seropositivity for both antibodies was found in cattle and sheep. Molecular detection of T. gondii DNA revealed a prevalence of 9/358 (2.5%), primarily in sheep (15.2%) and cattle at 1.6% while all goat samples tested negative. No samples were positive for the N. caninum Nc5 gene. This study reveals T. gondii and N. caninum prevalence in Somali ruminants, highlighting the need for better surveillance and control.

To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports. Delphi. LimeSurvey platform. Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries. Factors related to sports IPP planning, organization and implementation. We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement). Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist. •IPP structuring involve injury rates, history and screening outcome as main factors.•IPP organization involve injury risk profile, low-cost material and financial resources.•IPP implementation is delivered mainly by warm-up or physical therapy sessions.•Coach's support, athlete's routine and the work environment are considered for implementation.

Background and Purpose The COVID‐19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. Methods An online 18‐item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID‐19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. Results We collected 430 responses from 79 countries. Most health care professionals were aged 35–44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID‐19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in‐ and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. Conclusions Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID‐19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.