Repercussions of Stress during Pregnancy and Beyond

Stress, anxiety and depression are the disorders of brain but these affect even unborn child (foetuses). Various phobias affect expecting mothers. All these happen due to stress hormone Cortisol which is secreted during stress. This along with cortisol and other stress hormones lead to endocrine disorders like Graves’ disease, gonadal dysfunction, psychosexual dwarfism and obesity. Stress can also alter the clinical status of many preexisting endocrine disorders such as precipitation of adrenal crisis and thyroid storm. Stress during pregnancy changes hormonal milieu which affect the fetal environment and results in inflammatory conditions that have implications for maternal and infant health.

Blunt Cerebrovascular Injury with Severe Head Injury

Blunt Cerebrovascular Injury (BCVI) are rare and comprises of less than 1% of total head injury in our tertiary neurocenter. This leads to significant morbidity and mortality of patient. This case report is to focus on the BCVI with head injury. Because of rarity of this disease, there’s no treatment guidelines. However whatever the treatment we have is based on the experience of the surgeons/physician our case came to our Emergency Room with alleged history of lying along the road side in pool of blood .He was evaluated in peripheral hospital and he was later transferred to our center. Patient on evaluation was found to have transaction of Right ICA just distal to right Common carotid artery bifurcation. There was associated fracture of spinous process C5, C6. Probable mechanism of injury was sudden hyperextension of neck. Patient presented with delayed stroke following BCVI. He was managed with Right Decompressive hemicraniectomy and anticoagulation therapy was started for Right ICA injury. Thus early diagnosis and treatment of Blunt Cerebrovascular injury is essential in traumatic brain injury patients with risk factors for BCVI for definitive treatment of vascular injury with either stenting or surgery and thereby limiting morbidity and mortality of the patient.

Psychological Services During the Pandemic and Isolation Period.

During a crisis such as the COVID-19 pandemic, it is common for everyone to experience increased levels of anxiety and worry, especially as a result of social isolation. Physicians and other front-line health care professionals are particularly vulnerable to the negative effects of mental health, as they try to balance the task of caring for patients with concerns for their own well-being and that of their family and friends, but by not leaving aside the rest of the population. Mental health care and psychosocial well-being are just as important as physical health management. The effects of pandemics such as COVID-19 have highlighted the need for governments to take measures to curb not only the physical health of individuals but also their mental and psychosocial well-being. In this paper, we review the provision of psychological mental health services in Kosovo during the pandemic and after.

Primary Carnitine Deficiency and Autism Spectrum Disorder is there a Relationship?

Carnitine plays essential role in energy metabolism .Systemic primary carnitine deficiency is a genetic disorder caused by decreased or absent organic cation transporter type 2 (OCTN2) carnitine transporter activity, resulting in low serum carnitine levels and decreased carnitine accumulation inside cells. The decrease carnitine results in impaired fatty acid oxidation. Primary carnitine deficiency presents a hypoketotic, hypoglycemia and hepatic encephalopathy. Recently, primary carnitine deficiency has been associated with neurodevelopmental disorders including autism spectrum disorders. A seven year-old schoolgirl with intellectual deficit, autistic features and primary carnitine deficiency has been reported. A significant decrease in carnitine levels has been shown in patients with autism and this has been related to the existence of a mitochondrial disease and more severe autism. The early identification of patients with low levels of carnitine or primary carnitine deficiency, with the different methods of measuring free carnitine, including tandem mass spectrometry could help to identify these patients early and achieve an early treatment and better neurological prognosis, because autism spectrum disorders may be preventable in this subgroup. We hope that this paper is useful to neurologists and pediatricians, and may give them more reason to suspect a diagnosis of PCD and autism.

A Review of the Co-Occurrence of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) often co-occur. This review describes the overlap between PTSD and TBI with special emphasis on mild TBI (mTBI) by defining these two conditions and their differential diagnosis. The impact of mTBI on PTSD is outlined and vice versa. The various psychotherapeutic and pharmacologic treatment interventions that could provide a symptomatic relief for both conditions are summarized with the hope that by implementing these interventions, individuals afflicted by these potentially very disabling conditions will experience improved functioning and quality of life.

Neonates with the KCNQ2 Y755C Variants: Not Associated with Neonatal Epileptic Encephalopathy

Background: Pediatric epilepsy caused by a KCNQ2 gene mutation usually manifests the phenotype of a neonatal seizure. KCNQ2 encephalopathy in newborns continues to be reported on. Objectives: The exact mechanism and phenotype of the KCNQ2 mutation still require investigation. Methods: One hundred twenty-one patients with childhood epilepsy without an identified cause underwent KCNQ2 sequencing. KCNQ2 mutation variants were transfected into human embryonic kidney 293 (HEK293) cells to investigate functional changes. Results: Two patients with the c.2264G>G/A (p.Y755C) variant had neonatal epileptic encephalopathy: one had electroencephalography (EEG) burst suppression and the other had multiple focal spikes. However, the mutation was not found in the 80 healthy adult claiming without ever seizures before. A functional study showed that p.Y755C currents were not different from those in the wild-type and from those in the benign (p.N780T) polymorphism in homomeric and heteromeric (wild-type KCNQ2: mutant = 1:1) transfected HEK293 cells. Electrical current differences between HEK293 cells with wildtype mutations and cells transfected with the wild-type KCNQ2, KCNQ3, and p.Y755C mutations in a 1:2:1 ratio were not significant. Their seizures remitted after they turned 1 year old. Conclusion: We suggest that patients with the KCNQ2 p.Y755C mutations are not associated with neonatal epileptic encephalopathy

Effect of Bilateral Repetitive Protraction in Antispastic Position Of Suspended Upper Extremity on Motor Performance and Scapular Position in Stroke

Purpose: To find out the effect of bilateral repetitive protraction of suspended upper extremity in anti-spastic position with conventional therapy in patients with hemiplegia due to stroke. Methodology: A total of 36 subjects of hemiplegia due to stroke (post stroke duration more than 3 months) were recruited and distributed in two groups. Group 1 received bilateral repetitive scapular protraction in anti-spastic position of suspended upper extremity along with scapular mobilization in addition to conventional therapeutic exercises. Group 2 received Conventional therapeutic exercises consisted of task specific activity such as bilateral activity on pegboard, ball throwing activity and reaching activities, bilateral active range of motion exercises and weight bearing exercises for upper extremity. Outcome Measures: Universal Goniometer measurements and Fugl-Meyer upper extremity scale were taken prior to the beginning of treatment and after the completion of 4 weeks treatment protocol. Results: Overall results of the study showed significant improvement in active range of motion of the affected upper extremity for shoulder and elbow except wrist in experimental group only. Scapular spine distance improved in both the groups but more significantly in the experimental group. Fugl-Meyer assessment of upper extremity showed more significant improvement in experimental group post 4 week of intervention. Conclusion: Bilateral repetitive protraction in anti-spastic position of suspended upper extremity along with conventional therapeutic exercises for 4 weeks is more effective in improving scapular position and upper extremity motor performance as compared to conventional therapeutic exercise alone.

Effect of Goal Directed Physiotherapy vs a Goal Directed Home Program in AtRisk Infants: A Randomized Clinical Trial

Background: Goal directed physiotherapy is a task oriented therapy based on neurodevelopmental principles used in rehabilitation process. The aim of this study is to compare the neurodevelopmental effects of early goal directed physiotherapy with a detailed goal directed home program in infants with risk. Methods: Forty at-risk infants (18 male, 22 female, median age 5.69 mo) were assigned to early goal directed physiotherapy and detailed goal directed home program group randomely. Both early goal directed physiotherapy and detailed goal directed home program continued for 12 weeks. The outcome measures were Hammersmith Infant Neurological Examination, Alberta Infant Motor Scale and Goal Attainment Scale. Results: Significant difference was found in Hammersmith Infant Neurological Examination in early goal directed physiotherapy group (p<0.05) whereas no difference was found in Alberta Infant Motor Scale and Goal Attainment Scale between the groups (p>0.05). In all test results the effect size of early goal directed physiotherapy was more than detailed goal directed home program. Conclusions: According to our results, though Hammersmith Infant Neurological Examination results are better in the early goal directed physiotherapy group, it can be concluded that if parents had good, attainable and eligible guidelines received from the physiotherapist, detailed goal directed home program is also a useful approach in rehabilitation programs of infants with risk.

Vascular Epilepsy

Seizures can be a presenting feature of acute stroke. They may complicate its early clinical course or be a late complication or sequel. The incidence of combined “early” and “late” seizures after stroke has been reported to be approximately 10% and the prevalence is of 2-4%. Mechanisms leading to post stroke seizures and chronic epilepsy, in both ischemic and hemorrhagic strokes, are diverse. Focal slowing or diffuse slowing activities, rhythmic slow waves are associated with a low risk of early onset seizures whereas focal spikes, sharp waves, periodic lateralized, or periodic bilateral discharges are associated with a higher risk. There are no randomised controlled trials performed in stroke patients evaluating management strategies for poststroke seizures and epilepsy. Treatment options should be extrapolated from those of epilepsy in general, taking into consideration hepatic and renal function, tolerability, costs, interactions between antiepileptic drugs (AED), interactions with antithrombotic and other treatments. However, randomised controlled trials of AED prophylaxis for acute and remote seizures are essential to improve the evidence level of current guidelines and recommendations for the management of post-stroke seizures

Clinical Features of A Depressive Episode in People Who Had and Haven’t Had Covid-19

Objective: In publications, indicate increased anxiety, depression, and aggression of other mental disorders. The literature on psychiatric disorders associated with the depressive episode in people who had COVID-19. However, there are practically is not study clinical features of a depressive episode in people who had and haven’t had COVID-19. Materials and Methods: Eligible 100 participants all women to meeting the DSM-5 criteria, Hamilton Depression Rating Scale and PHQ-9 for depressive episode. Results: Patients who had a depressive episode after the COVID-19 disease were clinically different from those who had had major depressive episodes before COVID-19. On the one hand, this was expressed as a share in the fact that, in the clinical picture of a depressive episode manifested after the COVID-19 disease, visual hallucinations of various contents were encountered. On the other hand, patients who could not tolerate COVID-19, the presence of a pandemic exacerbated the onset of a depressive episode. Conclusion: Clinical features of a depressive episode in people who had and haven’t had COVID-19 dramatically differ from each other. Accordingly, therapy for these conditions is recommended.