Collecting behavioral evidence from a highly mobile and seasonal population: A protocol for a survey on quad bike injuries

BACKGROUND

Quad bikes are popular recreational, four-wheeled bikes in the Middle East. Injury prevention programs targeting quad bike crashes in the United Arab Emirates (UAE) need evidence about the risk factors and behaviours associated with these crashes in the target population. This is a protocol for a study aiming to investigate quad bike rider behaviours and to assess the risk factors associated with related injuries in the UAE.

METHODS

This is a cross-sectional observational study aiming to describe a seasonal sport in a desert environment. With an estimated sample size of 451, the survey will follow a three-stage, location-based sampling strategy using the line-transect method. A sampling frame of desert locations with high injury incidences was developed, using Dubai ambulance injury records. Further expansion of the sampling frame was participatory, involving police, enthusiasts, emergency responders and gas station employees. The data collection will be limited to the winter months in fifteen high-injury desert locations across three major Emirates in the UAE. Trained researchers will observe the riders directly in the desert to note their riding habits, followed by a researcher-administered interview on riding and injury history. The interviews will be administered in Arabic and English using Qualtrics software on handheld tablets with offline and online entry mode. In addition, paper-based entry with the same format will be used as a contingency in busy quad bike locations.

CONCLUSION

The objective of this study protocol is to develop a comprehensive survey that will furnish substantial evidence for the formulation of effective injury prevention strategies. To enhance the credibility of the recorded riding behaviors, field observations will be employed. The uniqueness of this study lies in its innovative sampling strategy, custom-tailored to accommodate the highly mobile and transient population of desert bikers in the UAE.

Attribute-based choice model and willingness to pay for industrial services

Purpose

Pricing is widely acknowledged as a market entry challenge for servitising companies. The purpose of this research is to ascertain the attributes that contribute to willingness to pay (WTP) for industrial services and suggest incorporating those attributes to a pricing model.

Design/methodology/approach

Three attributes (Quality of Service, Nearness of Service Provider and Brand Equity of Service Provider) were analyzed at three respective levels to ascertain their importance on WTP. Conventional conjoint analysis (CCA), using an orthogonal design, was the method used. The 346 respondents were decision-makers and top management professionals from various industries.

Findings

Brand Equity emerged as the most significant attribute contributing to WTP, having more than 45% importance – followed by the Quality and Nearness.

Research limitations/implications

The scope of the study is limited to the industries and its Allies. However, the relative importance of the attributes may vary depending on the type of service.

Practical implications

The importance of attributes and their WTP preference helps future researchers create a pricing model involving these attributes. This helps service providers price their services rationally, thus succeeding in servitization.

Social implications

Product life is extended because the manufacturers themselves are servicing it and also help recycle the product with their expertise. Servitization is also helpful for the Indian economy, as it is turning into a manufacturing economy.

Originality/value

This research investigates three attributes that contribute to WTP, in accordance with their level of contribution. It also provides a direction to establish an adequate pricing model for industrial services.

Aggression As a Predictor of General Well-Being Among Public Health Workers

Social atrocities and discrimination make sanitary workers vulnerable to aggression which in turn disrupts their well-being. The issues concerning the psychological health of sanitary workers have been addressed less by researchers. The present study aimed to assess the level of aggression and general well-being among sanitary workers. An aggression questionnaire, consisting of four dimensions, namely physical aggression, verbal aggression, anger and hostility was used. The PGI general well-being measure and personal profile sheet consisting of socio-demographic details was given to 150 sanitary workers who were selected through purposive sampling method. The dimensions of aggression- anger and hostility were negatively correlated with the general well-being of the participants. Amongst the four dimensions of aggression, anger is found to be the predictor of general well-being.

Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves

INTRODUCTION

There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002-2020.

MATERIAL AND METHODS

Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed.

RESULTS

There were 27 patients [AUV (n = 11); AUD (n = 16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days-12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n = 3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig. 1B, C). Urethral hypoplasia distal to the valve (n = 4) urethral duplication (n = 1) were associated (Fig. 1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1 mg/dL (n = 5), trabeculated bladder (n = 12), and vesicoureteral reflux (VUR) (n = 12) was noted at presentation. Diverticulum/valve excision (n = 13, 48.2%), fulguration alone (n = 12, 44.4%) and primary urinary diversion (n = 2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n = 6), VUR (n = 4), impaired renal function on scans (n = 8), and lower urinary tract dysfunction (n = 7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1 mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60 ml/kg/min.

CONCLUSIONS

Co-existing PUV and AUD present earlier and have specific imaging findings. In proximal AUD, possibility of syringocele should be kept in mind, as they have similar presentation and imaging. Concomitant PUV did not alter prognosis. Secondary effects on bladder and renal function were more with AUD. Follow up eGFR less than 60 ml/kg/min was associated with pre-operative elevated serum creatinine, trabeculated bladder, non-dilated posterior urethra, and bilateral impaired renal function on scans.

Risk factors associated with quadbike crashes: a systematic review

Background

Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs.

Methods

The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed  protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM).

Results

Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries.

Conclusion

Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes.

PROSPERO registration number CRD42020170245

Systematic review of the effects of pandemic confinements on body weight and their determinants

Pandemics and subsequent lifestyle restrictions such as ‘lockdowns’ may have unintended consequences, including alterations in body weight. This systematic review assesses the impact of pandemic confinement on body weight and identifies contributory factors. A comprehensive literature search was performed in seven electronic databases and in grey sources from their inception until 1 July 2020 with an update in PubMed and Scopus on 1 February 2021. In total, 2361 unique records were retrieved, of which forty-one studies were identified eligible: one case–control study, fourteen cohort and twenty-six cross-sectional studies (469, 362 total participants). The participants ranged in age from 6 to 86 years. The proportion of female participants ranged from 37 % to 100 %. Pandemic confinements were associated with weight gain in 7·2–72·4 % of participants and weight loss in 11·1–32·0 % of participants. Weight gain ranged from 0·6 (sd 1·3) to 3·0 (sd 2·4) kg, and weight loss ranged from 2·0 (sd 1·4) to 2·9 (sd 1·5) kg. Weight gain occurred predominantly in participants who were already overweight or obese. Associated factors included increased consumption of unhealthy food with changes in physical activity and altered sleep patterns. Weight loss during the pandemic was observed in individuals with previous low weight, and those who ate less and were more physically active before lockdown. Maintaining a stable weight was more difficult in populations with reduced income, particularly in individuals with lower educational attainment. The findings of this systematic review highlight the short-term effects of pandemic confinements.

Vertebrobasilar Contribution to Cerebral Arterial System of Dromedary Camels (Camelus dromedarius)

It is hypothesized that in the “more highly evolved” mammals, including the domesticated mammals, that the brainstem and the cerebellum receive arterial blood through the vertebrobasilar system whilst the internal carotid arteries primarily supply the forebrain. In camels, the arterial blood supply to the brain differs from that of ruminants since the internal carotid artery and the rostral epidural rete mirabile (RERM) are both present and the basilar artery contributes a significant proportion of cerebral afferent blood. In this study, we described the anatomical distribution of the vertebrobasilar system arterial supply in the dromedary. Secondly, we determined the direction of blood flow within the vertebral and basilar arteries using transcranial color doppler ultrasonography. Thirdly, we quantified the percentage arterial contributions of the carotid and vertebrobasilar systems to the dromedary brain. Fifty-five heads of freshly slaughtered male Omani dromedaries aged 2–6 years were dissected to determine the distribution and topography of the arterial distribution to the brain. Their anatomical orientation was assessed by casting techniques using epoxy resin, polyurethane resin and latex neoprene. The epoxy resin and polyurethane resin casts of the head and neck arteries were used to measure the diameter of vertebrobasilar arterial system and carotid arterial system at pre-determined locations. These arterial diameters were used to calculate the percentage of blood supplied by each arterial system. The vertebrobasilar system in dromedary camels consists of paired vertebral arteries that contribute to the ventral spinal artery and basilar artery at multiple locations. In most specimens the vertebral artery was the primary contributor to the basilar artery compared to that of the ventral spinal artery. In four specimens the ventral spinal arteries appear to be the dominant contributor to the basilar artery. Transcranial color doppler ultrasonography confirmed that the direction of blood flow within the vertebral and basilar arteries was toward the brain in animals examined in ventral recumbency and when standing. The vertebrobasilar system contributes 34% of the blood supply to the brain. The vertebrobasilar system is the exclusive supply to the medulla oblongata, pons and cerebellum.

Risk factors associated with quad bike crashes: a protocol for systematic review of observational studies

INTRODUCTION

Quad bikes are four-wheeled vehicles, driven off-road on uneven terrains by farmers for work or young adults for leisure. Quad bike accidental crashes result mostly due to the unique ecosystem of uneven terrain, where these unstable vehicles are commonly driven, in addition to numerous distinctive sociodemographic characteristics related to drivers. This is a protocol for a systematic review of observational studies from all geographical regions and demographic groups in the world to summarise the common risk factors relating to quad bike crashes.

METHODS AND ANALYSIS

A comprehensive search for the literature on quad bike crashes and related injuries will be conducted in six electronic databases: PubMed, Embase, Scopus, Web of Science, IEEE and PsycINFO. Proquest Dissertation and Thesis, OpenGrey and BASE will be searched for grey literature. Five researchers will be involved in the screening, and the review of full text articles, using the inclusion and exclusion criteria. Disagreements between reviewers will be resolved by discourse. Three researchers will help resolving conflicts that may arise during the screening process and will resolve eventual conflicts identified in the process with the help of the systematic review software 'Covidence' for automatic deduplication and blinded screening. Information on crashes leading to injuries and death, target population characteristics and risk factors involved will be extracted from eligible articles in addition to the assessment of the quality of the researched articles.

ETHICS AND DISSEMINATION

Since this is a systematic review of published literature, a formal ethical approval is not needed. Results of the review will be disseminated through peer-reviewed publications, conference presentations and reports to the concerned authorities.

PROSPERO REGISTRATION NUMBER

CRD42020170245.

1213 Sleepfect Tracker: A Crossplatform Mobile Researchkit App For Sleep Self-management

Introduction

We created Sleepfect Tracker, a researchkit-based cross platform app to explore the feasibility and acceptability of a sleep tracking app for sleep self-management.

Methods

We developed Sleepfect Tracker app on Appbakery, a DIY app making platform using ResearchKit for iOS and ResearchDroid for Android users. Sleepfect allows participants to track their sleep behavior (weekly via sleep diary) and environment (monthly), as well as their total sleep time and step counts data via Apple’s HealthKit, Android step count sensors, or Fitbit (wearable). Three hundred and ninety-five (395) individual from around the globe downloaded the app and 163 unique users answered surveys on their sleep behavior, environment, and architecture. In total we collected 6429 sleep and 2882 step data points and provided insights into user sleep behavior and sleep environment. We also analyzed whether sleep duration was associated with steps.

Results

Regarding immediate sleep environment and behavior, 11.1% worked or studied in bed, 27.0% reported having pets in bed, 39.7% red in bed prior to sleep, 40.3% watched TV in bed prior to sleep, 11.3% drank alcohol prior to bed, 9.8% smoked prior to bed or wake during night, 8.1% ate snack at bedtime, and 6.5% ate when they awake at night. 74.3% of the participants used electronic devices in their bedroom. Of the participants who used electronic devices in the bedroom, 52.1% had an average sleep duration of 6-8 hours and 29.8% reported sleeping 4-6 hours. Of the participants who did not use electronic devices in bedroom, 30.1% slept 4-6 hours, 31.8% slept 6-8 hours, and 32.45% slept 8-10 hours, on average. The relationship between steps count and sleep hours was trending, r=.16, p=.07.

Conclusion

Users can evaluate their sleep habits, monitor daily sleep-related behaviors through Sleepfect tracker. The app demonstrated initial usability and feasibility, but long-term usability and effectiveness must be evaluated. Further investigations on which functions will be more useful to help user to improve their sleep and engage users should be considered.

Support

K01HL135452, R01MD007716, R01HL142066, and K07AG052685

Impostor syndrome

Purpose

The purpose of this paper is to integrate impostor syndrome and leadership research to identify antecedents of impostor syndrome, their impact on sustainable leader behaviors. The paper also postulates the moderating effect of mindfulness and leader member exchange on impostor syndrome and sustainable leader behaviors, respectively.

Design/methodology/approach

The paper relies on an integrative approach of literature review on impostor syndrome and leadership. After identifying gaps in impostor syndrome research and its intersectionality with the constructs of contextual leadership theory, an integrative conceptual framework was formulated incorporating antecedents, consequences and moderators of impostor syndrome.

Findings

Three antecedents of impostor syndrome were identified from the literature, namely, gender, family/social role expectation and personality traits. Additionally, this paper also unearths contextual factors as yet another antecedent to impostor syndrome. Negative impact of impostor syndrome on leader behaviors such as managerial decision-making, innovative work behavior (IWB) and organizational citizenship behavior (OCB) were established by connecting those to the three primary characteristics of impostor syndrome, namely, low self-efficacy, fear of failure and perceived fraudulence, respectively. Finally, the paper also posits the moderating role of leader member exchange and mindfulness and proposes mindfulness training as an effective intervention for impostor syndrome.

Research limitations/implications

This being a conceptual paper will benefit from empirical studies that corroborate theoretical posits. The scope of studying the effect of impostor syndrome on sustainable leader behavior was limited to three major variables, namely, managerial decision-making, IWB and OCB. Thus, it calls for a more elaborate model of impostor syndrome including other relevant leader behaviors.

Practical implications

The model when applied in organizational context addresses the need for mindfulness training to reduce the effect of impostor syndrome among leaders. Leaders will exhibit sustainable behaviors when provided with the right kind of training.

Originality/value

The study attempts to integrate the two independent constructs, impostor syndrome and leadership to establish a novel and meaningful connection and throws light to the unaddressed antecedents, consequences and moderators of its impact on sustainable leader behaviors. From learning and development practitioners’ perspective, it also signifies the effectiveness of mindfulness training among employees’ personal and professional development.

Comparative efficacy of epidural clonidine versus epidural fentanyl for treating breakthrough pain during labor: a randomized double-blind clinical trial

BACKGROUND

Breakthrough pain during neuraxial labor analgesia is typically alleviated with additional administration of epidural local anesthetics, with or without adjuvants. Sometimes avoiding neuraxial opioids may be warranted and clonidine is an alternative. In a randomized double-blind trial we compared the efficacy of clonidine versus fentanyl, added to bupivacaine, for the management of breakthrough pain.

METHODS

Term parturients (n=98) receiving bupivacaine 0.0625% with fentanyl 2 μg/mL at 12 mL/h, a patient-administered bolus of 5 mL at lockout 6-10 min and a maximum of four boluses per hour, and experiencing breakthrough pain ≥5/10, were randomized to receive a 10 mL bolus containing 12.5 mg bupivacaine and either clonidine 100 μg or fentanyl 100 μg. The primary outcome was 'success' of study drug treatment, defined as a pain score reduction ≥4/10 within 15 min of administration. Maternal hemodynamics and fetal heart rate were documented for two hours after treatment.

RESULTS

There was no significant difference between groups in success rates (66.0% after clonidine (n=47) vs 74.5% after fentanyl (n=51), P=0.48) or in the incidence of hypotension (systolic blood pressure ≤80% of baseline or <90 mmHg) or sedation at 15 min, with 2/51 and 1/47 subjects in the fentanyl and clonidine groups, respectively, receiving phenylephrine.

CONCLUSION

Epidural clonidine 100 μg was not superior to fentanyl 100 μg for decreasing pain scores within 15 min of co-administration with bupivacaine 0.125% for intrapartum breakthrough pain. The analgesic efficacy and hemodynamic side effects did not significantly differ.

Descriptive Analysis of Cerebral Arterial Vascular Architecture in Dromedary Camel (Camelus dromedarius)

The artiodactyl brain has multiple levels of vascular pooling and the rostral epidural rete mirabile (RERM) at its base. The current study is the first of its kind to precisely demonstrate the arterial vasculature of the dromedary brain, utilizing a new casting method with colored latex and epoxy paint. In total, 35 freshly slaughtered dromedary heads were injected with colored latex or colored epoxy paint prior to dissection in order to reveal cerebral vasculature; Ten processed heads were chemically digested with 5% potassium hydroxide to obtain hard casts of cerebral arteries and anastomosing structures. The outcomes of this study ascertain the distinct vascular features of dromedaries that set them apart from other artiodactyls. In addition to the RERM, the dromedary possesses a well-developed ophthalmic and chiasmatic rete. The dromedary is similar to giraffe, goat, cat and pig in the contribution of middle meningeal artery to the rete mirabile; however, dromedaries have several arteries emerging directly from the cerebral arterial circle that supply the choroid plexus and pineal gland. Additionally, dromedaries exhibit a dominant basilar system that dominates the blood supply to the medulla oblongata, pons, and cerebellum. In our study, we were able to graphically prove the lack of connection between the areas supplied by vertebrobasilar system and carotid system in the dromedary. Furthermore, the vertebral artery does not branch into the basilar artery; instead, it acts as a contributing vessel to the ventral spinal artery that later fuse to form the basilar artery. This study employed the new casting method to illustrate a new arterial source to RERM and the various anastomoses among arterial sources supplying the brain in the dromedary. These anastomoses play an important role in maintaining an uninterrupted cerebral blood supply, decreasing the vulnerability of the fragile brain against ischemia and stroke, as well as, play an important role in maintaining blood pressure and flow in long-necked dromedaries when they raise or lower their heads.

'Khatatonia' - cathinone-induced hypertensive encephalopathy

Khat consumption is an under-recognised cause of hypertensive encephalopathy and intraparenchymal brain haemorrhage. We report the radiological findings of extensive periventricular, subcortical and brain stem white matter pathology of a patient who had consumed excessive amounts of Khat. The Khat plant contains cathinone, an amphetamine-like alkaloid which has been associated with chronic hypertensive end-organ damage, but is seldom considered a cause of cerebrovascular events in northern Europe.

A Comparative Study of the Retentive Strengths of Commercial and Indigenously Developed Luting Cements using Both Lathe-cut and Clinically Simulated Specimens

INTRODUCTION

Superior adhesive strength in luting agents is of paramount significance in fixed partial denture success. In this in vitro study five cements were tested for retentive qualities, using both lathe-cut and hand-prepared specimens.

MATERIALS AND METHODS

A total of 104 freshly extracted tooth specimens were prepared. Seventy of them were lathe-cut and 30 specimens were hand-prepared to simulate clinical conditions. Five different cements were tested, which included a compomer, a composite, a zinc phosphate, and 2 glass-ionomer luting cements. Of the 5, 2 trial cements were indigenously developed by Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India - a glass-ionomer cement (Chitra GIC) and a chemical-cure composite (Chitra CCC). All cements were compared within each group and between groups (lathe-prepared and hand-prepared).

RESULTS

GC Fuji 1 (GC America) exhibited superior retentive strengths in both lathe-cut and hand-prepared specimens, whereas the compomer cement displayed the lowest values when tested. In lathe-cut specimens, statistical analysis showed no significant difference between GC Fuji 1 and indigenously developed Chitra CCC.

CONCLUSION

Both Chitra CCC and GC Fuji 1 have comparable strengths in lathe-cut samples, making Chitra CCC a potential luting agent. Statistical analysis reveals that all cements, except GC Fuji 1, exhibited a significant decrease in strength due to the change in design uniformity. The chemical bonding of GC Fuji 1 proves to be quite strong irrespective of shape and precision of the tooth crown.

CLINICAL SIGNIFICANCE

The indigenously developed Chitra GIC and Chitra CCC showed promising results to be used as a potential luting agent.

Clinical risk factors for ovarian torsion

Ovarian torsion is a relatively common gynaecological emergency, usually presenting as acute lower abdominal pain. The underlying pathophysiology involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal oedema, internal haemorrhage and infarction with the subsequent sequelae. It is not clear from looking at the literature which factors are responsible for the development of ovarian torsion and what are the odds of a particular clinical feature in determining the likelihood of developing ovarian torsion. In order to assess the likelihood of a particular clinical feature to be a risk factor for ovarian torsion, we studied the prevalence of each presenting clinical feature in the background population of women, for instance, looking at ovarian cysts and compared this with the odds of the feature occurring in the affected population of torsion patients. Thus we compared the odds of various clinical variables in ovarian torsion patients against the odds of the same feature occurring in the background population of women. Ovarian cysts are three times more common in ovarian torsion cohorts than in the general population. Evidence suggests that ovarian cysts are very common in the asymptomatic pregnant cohorts; however, they spontaneously resolve as the pregnancy progresses. Pregnancy is a risk factor for torsion (odds ratio: 18:1); however, it remains an uncommon event (0.167%). Tubal sterilisation practices vary according to geographical location and over chronology of the published literature. After considering the extremes of variation in tubal sterilisation practices, the risk of torsion increases by at least 8-fold following surgery. Hysterectomy with ovarian conservation is not a risk factor of torsion.

Cortical excitability changes distinguish the motor neuron disease phenotypes from hereditary spastic paraplegia

BACKGROUND AND PURPOSE

Cortical hyperexcitability has been identified as an important pathogenic mechanism in motor neuron disease (MND). The issue as to whether cortical hyperexcitability is a common process across the MND phenotypes, including amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS), remains unresolved. Separately, the clinical distinction between PLS and 'mimic disorders' such as hereditary spastic paraparesis (HSP) may be difficult, potentially delaying diagnosis. Consequently, the aim of the present study was to determine the nature and spectrum of cortical excitability changes across the MND phenotypes, and to determine whether the presence of cortical dysfunction distinguishes PLS from HSP.

METHODS

Cortical excitability studies were undertaken on a cohort of 14 PLS, 82 ALS and 13 HSP patients with mutations in the spastin gene.

RESULTS

Cortical hyperexcitability, as heralded by reduction of short interval intracortical inhibition (PLS 0.26%, -3.8% to 1.4%; ALS -0.15%, -3.6% to 7.0%; P < 0.01) and cortical silent period duration (CSPPLS 172.2 ± 5.4 ms; CSPALS 178.1 ± 5.1 ms; P < 0.001), along with an increase in intracortical facilitation was evident in ALS and PLS phenotypes, although appeared more frequently in ALS. Inexcitability of the motor cortex was more frequent in PLS (PLS 71%, ALS 24%, P < 0.0001). Cortical excitability was preserved in HSP.

CONCLUSIONS

Cortical dysfunction appears to be an intrinsic process across the MND phenotypes, with cortical inexcitability predominating in PLS and cortical hyperexcitability predominating in ALS. Importantly, cortical excitability was preserved in HSP, thereby suggesting that the presence of cortical dysfunction could help differentiate PLS from HSP in a clinical setting.

Gastric lipoma

We report a 12-year-old-boy with gastric lipoma. Upper gastrointestinal (GI) endoscopy with biopsy and abdominal computed tomogram (CT) scan revealed the diagnosis. Open surgical excision of the mass with stomach preservation was done. The clinical presentation and management are discussed and the literature reviewed here. This is the sixth pediatric case reported in the English literature.

Unusual association of polysplenia syndrome with abdominal teratoma

Report of a hitherto unreported association of polysplenia, teratoma and eventration of diaphragm.