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In children with drug-resistant epilepsy, the rate of freedom from seizures at 1 year was higher with epilepsy surgery than with medical therapy alone. Most measures of cognitive development were better in the surgery group than in the medical-therapy group.

The eye is said to be the window into the brain. Alzheimer’s disease (AD) and glaucoma both being diseases of the elderly, have several epidemiological and histological overlaps in pathogenesis. Both these diseases are neurodegenerative conditions. Over the years, a consensus has developed that both may be two ends of a singular spectrum of diseases. Epidemiological studies have shown that more Alzheimer’s patients may be suffering from glaucoma than general healthy population. Retinal ganglion cell damage is a characteristic of both diseases, along with discovery of amyloid-β and tau protein deposition in the retina and aqueous humor of eye. The latter two proteins are known to be pathognomonic of AD. Other pathways such as the insulin receptor pathway also seem to be affected in both diseases similarly. In spite of these overlaps, there are few missing links which still need more evidence, namely, intraocular pressure mechanisms, cerebrospinal fluid pressure and trans-lamina cribrosa pressure gradients, vascular autoregulation factors, etc. Several factors point towards a common pathogenesis at some level for both diseases and prospective studies are necessary to study the natural course of both diseases.

Background: COVID-19 pandemic has affected the world globally causing widespread repercussions on individuals' physical, mental and emotional well-being. In such times, sleep is likely to be affected. Objective: The aim of this study was to present the available literature on sleep and also the foresight as to the future national strategy to mitigate the effects of this pandemic. Materials and Methods: An extensive literature search on PubMed, Google Scholar, Epistemonikos database (https://www.epistemonikos.org), PsycINFO for available literature on the prevalence of sleep problem on COVID-19 was done. Cross-citation search was also conducted to increase relevance of the review. The key words used were- (((insomnia)) OR (sleep)) OR (sleepiness)) OR (\"sleep quality\")) OR (OSA)) OR (\"obstructive sleep apnoea\")) OR (\"obstructive sleep apnea\")) OR ((\"sleep problem\")) AND \"covid-19\" OR covid19* OR \"COVID-19\" OR \"2019-nCoV\" OR cv19* OR \"cv-19\" OR \"cv 19\" OR \"n-cov\" OR ncov* OR \"sars-cov-2\" OR \"sars-cov2\" OR \"2019-ncov\" OR \"SARS-Coronavirus-2\" OR \"SARS-Coronavirus2\" OR (wuhan* AND (virus OR viruses OR viral)) OR (covid* AND (virus OR viruses OR viral)) OR \"covid-19-related\" OR \"SARS-CoV-2-related\" OR \"SARS-CoV2-related\" OR \"2019-nCoV-related\" OR \"cv-19-related\" OR \"n-cov-related\"). Inclusion criteria consisted of articles in English, published from Jan 2020 till 19 Apr 2020. Two reviewers independently screened each research study for inclusion and eligibility. Results and Conclusion: Sleep is affected during COVID-19 pandemic in patients, their families, health-care workers and their families, population in isolation, and quarantine and as such in public. Limited literature exists with subjective data and no objective criteria were found to study sleep in COVID-19 pandemic. OSA was found to be a frequent baseline characteristic of COVID-19 patients. A need to follow guidelines is of paramount importance and strategies to better sleep in the population needs to be addressed.

In a randomized trial, over 2700 patients with obstructive sleep apnea and cardiovascular disease were assigned to CPAP plus usual care or to usual care alone. At a mean of 3.7 years, the rate of adverse cardiovascular events did not differ significantly between the groups. Obstructive sleep apnea causes episodic hypoxemia and nocturnal sympathetic nervous system activation 1 and elevates blood pressure 2 and markers of oxidative stress, inflammation, and hypercoagulation. 3 , 4 Large negative intrathoracic pressure swings also impose mechanical stress on the heart and great vessels. 5 – 7 Population-based and sleep-clinic–based cohort studies have shown an association between obstructive sleep apnea and cardiovascular events, 8 – 16 particularly stroke. 17 Randomized, controlled trials have shown that treatment with continuous positive airway pressure (CPAP) lowers systolic blood pressure by 2 to 3 mm Hg in patients with normotensive obstructive sleep apnea 18 and by 6 to 7 mm Hg in patients with . . .

Neural oscillations were established with their association with neurophysiological activities and the altered rhythmic patterns are believed to be linked directly to the progression of cognitive decline. Magnetoencephalography (MEG) is a non-invasive technique to record such neuronal activity due to excellent temporal and fair amount of spatial resolution. Single channel, connectivity as well as brain network analysis using MEG data in resting state and task-based experiments were analyzed from existing literature. Single channel analysis studies reported a less complex, more regular and predictable oscillations in Alzheimer's disease (AD) primarily in the left parietal, temporal and occipital regions. Investigations on both functional connectivity (FC) and effective (EC) connectivity analysis demonstrated a loss of connectivity in AD compared to healthy control (HC) subjects found in higher frequency bands. It has been reported from multiplex network of MEG study in AD in the affected regions of hippocampus, posterior default mode network (DMN) and occipital areas, however, conclusions cannot be drawn due to limited availability of clinical literature. Potential utilization of high spatial resolution in MEG likely to provide information related to in-depth brain functioning and underlying factors responsible for changes in neuronal waves in AD. This review is a comprehensive report to investigate diagnostic biomarkers for AD may be identified by from MEG data. It is also important to note that MEG data can also be utilized for the same pursuit in combination with other imaging modalities.

Seizures are the most common brain dysfunction. EEG is required for their detection and treatment initially. Studies proved that if seizures are detected at their early stage, proper and effective treatment can be given to patients. Automatic detection of seizures using the EEG signal was a very powerful area of research during the last decade. Various techniques have been proposed in the literature for feature extraction and classification of recorded EEG signals for seizure detection. However, to achieve reliable performance, some challenges in this area need to be addressed. In this work, an algorithm for seizure detection has been proposed, which is a combination of frequency-domain features and neutrosophic logic-based k-means nearest neighbor (NL-k-NN) classifier. An EEG database, collected at All India Institutes of Medical Sciences (AIIMS), New Delhi, has been used to test the performance of the proposed algorithm. The consistency in the performance of the proposed algorithm has been checked by applying it to the well-known Bonn University and CHB-MIT scalp EEG datasets. The classification accuracies of 98.16%, 100%, and 89.06% were achieved when the proposed algorithm was tested with AIIMS, Bonn University, and CHB-MIT datasets, respectively. The main contribution of this study is that a novel neutrosophic classifier is proposed in the field of seizure detection, for improvement in reliability and precision. The accuracy of the NL-k-NN classifier has further been established by comparing it with the reported results of linear discriminant analysis (LDA), support vector machine (SVM), and traditional k-NN classifiers.

There is a pressing clinical need for thrombolytic agents that can effectively disaggregate arterial thrombi in acute ischemic stroke without significantly increasing the risk of bleeding. This pilot study aimed to investigate the safety and efficacy of N -acetylcysteine (NAC) as an adjunctive therapy to intravenous recombinant tissue plasminogen activator (rtPA or alteplase). A randomized, open-label, blinded assessor pilot study was conducted. Patients presenting with an acute ischemic stroke within 4.5 h from onset were randomized into two groups: intravenous NAC and rtPA or rtPA alone. Primary outcomes included intracerebral hemorrhage, symptomatic intracerebral hemorrhage, extracranial bleeding, and adverse reactions. Secondary outcomes comprised major neurological improvement assessed by (National Institute of Health Stroke Scale) NIHSS at 24 h, recanalization on first run of angiography in patients who underwent thrombectomy or on repeat vascular imaging at 24 h, modified Rankin scale, and three-month mortality. Forty patients were enrolled, with 21 receiving only rtPA and 19 receiving NAC with rtPA. Baseline characteristics were comparable among groups. No significant differences were observed in adverse events ( p  = 0.99), intracranial hemorrhage ( p  = 0.21), symptomatic intracerebral hemorrhage ( p  = 0.47), or extracranial bleeding ( p  = 0.21). Median NIHSS at 24 h was significantly lower in the intervention group ( p  = 0.03). Functional outcomes and three-month mortality were similar between groups ( p  = 0.85 and p  = 0.99 respectively). The co-administration of N -acetylcysteine with alteplase did not significantly alter safety profiles, morbidity, or mortality at 3 months. While no substantial differences were noted, a slightly improved early neurological outcome was observed in the intervention arm. The study's findings were constrained by a small sample size, emphasizing the necessity for future large-scale trials to comprehensively evaluate the safety and efficacy of N -acetylcysteine as a thrombolytic agent in acute ischemic stroke. Trial Registration Clinical Trials Registry India—CTRI/2019/05/019305.

Sirtuin (SIRT) pathway has a crucial role in Alzheimer's disease (AD). The present study evaluated the alterations in serum sirtuin1 (SIRT1) concentration in healthy individuals (young and old) and patients with AD and mild cognitive impairment (MCI). Blood samples were collected from 40 AD and 9 MCI patients as cases and 22 young healthy adults and 22 healthy elderly individuals as controls. Serum SIRT1 was estimated by Surface Plasmon Resonance (SPR), Western Blot and Enzyme Linked Immunosorbent Assay (ELISA). A significant (p<0.0001) decline in SIRT1 concentration was observed in patients with AD (2.27 ± 0.46 ng/µl) and MCI (3.64 ± 0.15 ng/µl) compared to healthy elderly individuals (4.82 ± 0.4 ng/µl). The serum SIRT1 concentration in healthy elderly was also significantly lower (p<0.0001) compared to young healthy controls (8.16 ± 0.87 ng/µl). This study, first of its kind, has demonstrated, decline in serum concentration of SIRT1 in healthy individuals as they age. In patients with AD and MCI the decline was even more pronounced, which provides an opportunity to develop this protein as a predictive marker of AD in early stages with suitable cut off values.