Day3

  • University of Missouri, Columbia
  • Title:Enhanced Recovery: Post-Operative Delirium and Potential Interventions
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Abstract

Enhanced recovery programs have been developed to improve patient’s post-operative outcomes through pre-op education and preconditioning, modification of anesthetic techniques intraoperatively and multimodal pain management techniques post-operatively. The overall goal of these protocols is to decrease the use of medical interventions and time in the hospital. With a growing elderly population requiring surgical intervention, the impact of post-operative delirium and cognitive dysfunction is a growing problem and significantly increases the cost of care. The collaborative efforts of Neurology and Anesthesiology to identify patients who are at risk and modify anesthetic techniques are the next evolution for enhanced recovery protocols to improve patient outcomes and increase efficient delivery of care.

Biography

Dr. Quinn L. Johnson is the Chair of the Department of Anesthesiology at the University of Missouri-Columbia, and serves as the Russel B. and Mary D. Sheldon Professor in Anesthesiology. He also serves as adjunct faculty in the School of Business where he teaches management classes on healthcare as it relates to business. Clinically he has advanced training in acute pain management and ultrasound guided regional nerve block techniques. Clinically he works at the Missouri Orthopaedic Institute. He recently served as the president of the Missouri Society of Anesthesiology and is currently a member of the American Society of Anesthesiology’s committee on Academic Anesthesiology. He has received grants, published and presented in numerous journals and conferences, on a variety of topics including enhanced recovery and post-operative delirium in the elderly.

  • Brigham and Women's Hospital, USA
  • Title:How Self-Reported Hot Flashes May Relate to Affect, Cognitive Performance and Sleep
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Abstract

Purpose: To explain the controversy about whether midlife women who self-report hot flashes have relatively increased affective symptoms, poor cognitive performance or worse sleep. Methods: Retrospective data from 88 women seeking relief from bothersome day and night hot flashes were submitted to mixed linear regression modeling to find if estimated hot flashes, as measured by Women’s Health Questionnaire (WHQ) items or diary-documented hot flashes recorded daily were associated with each other or with affective, cognitive or sleep measures. Results: Subjects averaged 6.3 daytime diary-documented hot flashes and 2.4 nighttime diary-documented hot flashes per 24 h. Confounder-controlled, diary-documented hot flashes but not estimated hot flashes were associated with increased Leeds anxiety scores (F = 4.9; t = 2.8; p = 0.01) and Leeds depression scores (3.4; 2.5; 0.02), decreased Stroop Color–Word test performance (9.4; 3.5; 0.001), increased subjective sleep disturbance (effect size = 0.83) and increased objective sleep disturbance(effect size = 0.35). Hot flash effects were small to moderate in size. Univariate but not multivariate analyses revealed that all hot flash measures were associated with all affect measures. Different measures of hot flashes associated differently with affect, cognition and sleep. Only nighttime diary-documented hot flashes consistently correlated with any affect measures in multivariate analyses.
Conclusions: Reported inconsistencies in menopause study outcomes may be due to the use of differing measures for hot flashes, affect, cognition and sleep. This problem impedes forging a consensus on whether hot flashes correlate with neuropsychological symptoms.

Biography

Dr. Quentin Regestein is a clinician-researcher interested in menopause and transcranial brain stimulation. He currently develops applications to improve US health care delivery.

  • University of Sfax, Tunisia
  • Title:Effect of Nighttime Melatonin Ingestion on Dynamic Postural Balance and Muscle Strength in Persons with Multiple Sclerosis: A Controlled-Randomized Trial
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Abstract

Objective: To investigate the safety and the effect of nocturnal MEL ingestion on dynamic postural control the following morning in adults with MS.
Methods: Fourteen adults with mild relapsing-remitting (RR-MS) (28.36 ±6.81 years) were assessed before and after nocturnal ingestion of 6-mg MEL or placebo (PLA). A posturographic test in eyes opened condition (EO) was used to evaluate dynamic postural balance in in mediolateral and anteroposterior axis. Leg muscles strength, nociceptive and neuropathic pains, were evaluated by using the 5-sit to stand test (5-STST), the visual analogue scale (VAS) and the neuropathic pain 4 questions (DN4), respectively. Hooper index was used to evaluate sleep quality, fatigue, stress and muscle soreness.
Results: MEL decreased posturographic parameters [center of pressure (CoP) path length (CoPL), CoPL in anteroposterior axis (CoPLY), mean CoP velocity (CoPVm)], more than PLA by 7.56% (p=0.02), 19.27% (p=0.000001), 11.1%, (p=0.00003) respectively, in mediolateral axis, and by 9.1% (p=0.005), and 4.29% (p=0.025), respectively in anteroposterior axis. MEL reduced duration of 5-STST, VAS and DN4 scores more than PLA by 8.19% (p=0.008), 84.44% (p=0.04) and 37.69% (p=0.023), respectively. MEL enhanced fatigue and sleep quality more than PLA by 42.29% (p=0.044) and 30.2% (p=0.012). No significant difference was observed between MEL and PLA intake in stress and muscle soreness.
Conclusion: Acute MEL ingestion enhanced dynamic postural stability and lower-limb muscle strength via improving pains, fatigue and sleep quality in RR-MS adults. Since only the effect of single-dose of MEL was evaluated in this study, these results are recommended only for short-term use.

Biography

I am Sonda jallouli, 25 years old, a physiotherapist from the promotion of 2017. Currently, I am a PhD student in the biological sciences of physical and sports activities at the Higher Institute of Physical Education Sports in Sfax, Tunisia. My field of research is in neurological diseases (multiple sclerosis), physical disorders, gender differences, chronobiology, supplementation, sleep, cognitive functions, training, biochemistry, physiological adaptation, psycho-cognitive performance.

  • Sacred Heart Psychiatric Institute, Ecuador
  • Title:Factors Associated with Psychiatric Adverse Effects in Healthcare Personnel during the COVID-19 Pandemic in Ecuador
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Abstract

Since the emergence of respiratory syndrome caused by the novel Coronavirus (COVID-19), the world has faced a pandemic with consequences at all levels. In many countries, the health systems collapsed, and the healthcare professionals had to be on the front line of this crisis. The adverse effects on the mental health of healthcare professionals have been widely reported. This research focuses on identifying the main factors associated with adverse psychological outcomes.
Method: Descriptive, cross-sectional study, based on surveys, applying the PHQ-9, GAD-7, ISI and EIE-R tests to healthcare professionals from Ecuador during the COVID-19 pandemic.
Results: 1028 participants, distributed in 557 physicians (54.18%), 349 nurses (33.94%), 29 laboratory workers (2.82%), 27 paramedics (2.62%), 52 psychologists (5.05%) and 14 respiratory therapists (1.36%). From 16 of the 24 provinces of Ecuador. 27.3% presented symptoms of depression; 39.2% anxiety symptoms; 16.3% insomnia and 43.8% symptoms of PTSD, the 4 types of symptoms in ranges from moderate to severe. The most relevant associated factors were: working in Guayas (the most affected province) (OR: 2.18 for depressive symptoms and 2.59 for PTSD symptoms); be a postgraduate doctor (1.52 for depressive symptoms and 1.57 for insomnia), perception of not having the proper protective equipment (OR: 1.71 for symptoms of depression and 1.57 for symptoms of anxiety) and female sex (OR: 1.39 for anxiety)
Discussion and Conclusions: Healthcare professionals have a significant impact on their mental health that may require psychiatric and psychological intervention. The main risk factors are mainly related to geographical distribution and job characteristics, such as being a resident physician and self-perception of safety. Further studies are required based on the evolution of the pandemic.

  • Iran University of Medical Sciences, Iran
  • Title:Protective Effect of N-Acetyl Cysteine on Mitochondrial Dynamic Imbalance In Temporal Lobe Epilepsy: Possible Role of Mtor
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Abstract

Epilepsy is a neurological disorder, and understanding the underlying molecular mechanisms is critical for the development of more effective therapies. It is believed that mTOR (Mechanistic Target of Rapamycin kinases) activity and the mitochondrial dynamic balance change during epilepsy. mTOR affects mitochondrial fission by stimulating the translation of mitochondrial fission process 1 (MTFP1). In this study, the protective role of N-acetylcysteine was studied in temporal lobe epilepsy (TLE) through the regulation of mTOR and mitochondrial dynamic proteins. Rats received N-acetylcysteine (oral administration) seven days before induction of epilepsy, followed by one day after epilepsy. TLE was induced by microinjection of kainite into left lateral ventricle. The total mTOR and Drp1 levels were detected in the hippocampus by western blotting. MFN1 was assessed using immunohistochemistry, and the expression of Fis.1 and MTFP1 (fission-related proteins) and OPA (fusion-related protein) was detected by real time PCR. The mitochondrial membrane potential was measured by Rhodamin 123. The results showed that 72 h after induction of epilepsy, the mTOR protein level increased, and the balance of the mitochondrial dynamic was disturbed; however, oral administration of NAC decreased the mTOR protein level and improved the mitochondrial dynamic. We concluded that NAC plays a neuroprotective role in temporal lobe epilepsy, probably through decreasing the mTOR protein level, which can improve the imbalance in the mitochondrial dynamic.

Biography

Farnaz Nikbakht, before obtaining her PhD degree in Human Physiology from Shiraz University in 2007, she received an award from the Iran Ministry of Health and Education; she spent six months at Flinders University, Adelaide, Australia for completing her research on degenerative diseases. Now, as the Professor of Department of Physiology, Iran University of Medical Sciences, she has managed several research programs and has conducted the thesis of several Masters and PhD students in her Lab. Since 2010 she has directed a research team on Epilepsy and Alzheimer’s diseases fields in her lab. Her research leads to publishing several articles.

  • Georgia State University, USA
  • Title:Classifying Handedness with MRI
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Abstract

When aggregating neuroimaging data across many subjects, an important consideration is establishing some group-level uniformity prior to further statistical analysis. Spatial normalization and motion correction are two important preprocessing steps that help achieve this goal. Researchers have also often excluded left-handed subjects due to presumptions about variable asymmetries relating to both brain structure and function, which may interfere with achieving a desired level of group homogeneity. It is well-known, however, that hand-preference is not a binary attribute and is not a perfect representation of structural asymmetry or hemispheric specialization. In an effort to demonstrate a more objective, data-driven approach for quantifying asymmetries across handedness, we tested the reliability of single-subject classification of handedness using data obtained from structural MRI in extant samples. We utilized data from deformation fields created during the spatial normalization process within a priori regions of interest (ROIs), including the motor and somatosensory cortex, and Broca’s and Wernicke’s areas. Using these deformation fields as features in machine learning classifiers, we achieved classification accuracies greater than 75% across two independent datasets (i.e., a sample of incarcerated adult offenders and a sample of community adults from the Netherlands). These results demonstrate reliability of morphological features attributable to handedness as represented in neuroimaging data and further suggest that application of data-driven techniques may be a principled approach for addressing asymmetries in group analysis.

Biography

Mr. Sandeep Panta is a Full Stack Engineer at TReNDS Center, Georgia State University. He has experience with creating easy-to-use tools for pre-processing neuroimaging data, data harmonization, big data visualization tools, machine learning, federated learning software to facilitate big data collaborative research that would not be possible otherwise. He has published two papers as first author: “A tool for interactive data visualization: application to over 10,000 brain imaging and phantom MRI data sets“ and “Classifying handedness with MRI“. His present work includes federated learning and differential privacy using COINSTAC software. He has co-authored 6 papers on the same. TReNDS Center is focused on developing, applying and sharing advanced analytic approaches and neuroinformatics tools that leverage advanced brain imaging and omics data, with a goal of translating these approaches into biomarkers that can help address relevant areas of brain health and disease. Large scale data sharing and multimodal data fusion techniques are the underpinnings of their approach.

  • Ibn Rochd University Hospital Center, Morocco
  • Title:An Atypical Protuberantial Lesion Revealing a MOG Antibody Disease
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Abstract

MOG antibody disease is a recently discovered demyelinating autoimmune disease of the central nervous system, involving anti-Myelin Oligodendrocyte Glycoprotein auto-antibodies (anti-MOG). There are different clinical and radiological aspects of this pathology. The most frequent and typical one is a retrobulbar optic neuritis, predominant on the anterior region of the optic nerve, without damage to the optic chiasma and optical strips. Brain damage is less common and the spinal cord involvement may be similar to that of Devic’s disease. Nevertheless, certain radiological manifestations may be atypical and therefore are not guiding the diagnosis. We encountered in our radiology department one of these atypical cases, a 42-year-old patient without any particular pathological history who consults for a symptomatology that has been evolving for 2 months, made up of pseudo-migraine headaches associated with pain when the eyeballs are mobilized, without loss of visual acuity. A cranio-orbital MRI was performed, objectifying the presence of retrobulbar optic neuritis and a single protuberantial lesion, median anterior, with no other cerebral or spinal anomaly. A demyelinating disease was suspected and the dosage of the various auto-antibodies, in particular the anti-MOGs, was positive for the latter.

Biography

Dr Fadil Khaoula obtained her MD in the field of the Limbic system imaging in 2019 at Ibn Rochd university Hospital Center of Casablanca (Morocco) where she is currently a 4th year resident in radiology. During her formative years, she has been interested in neuro-radiology, mainly in demyelinating diseases and their atypical radiological manifestations. She is a member of the Moroccan and French society of radiology, with works (articles, posters) published and in the process of being published in the field of neuro-radiology.

  • Dalhousie University, Canada
  • Title:Do Symptoms of Depression and Anxiety Contribute to Heavy Episodic Drinking? A 3-Wave Longitudinal Study of Adult Community Members
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Abstract

Alcohol misuse, depression, and anxiety are major public health problems (Whiteford et al., 2013). One form of alcohol misuse is heavy episodic drinking (HED) – the consumption of five + drinks (four + for women) on a given occasion (Wechsler & Austin, 1998). HED has massive economic/health costs (e.g., $223.5 billion in costs; 80,000 deaths in the US in 2006; Bouchery, Harwood, Sacks, Simon, & Brewer, 2006; Gonzales et al., 2014).

Longitudinal associations between HED and internalizing symptoms are explained in several ways. The self-medication hypothesis posits individuals use alcohol to manage their internalizing symptoms (Khantzian, 1997; Stewart, Grant, Mackie, & Conrod, 2016). Alternatively, HED may present a risk for depression or anxiety through the effects of alcohol on the brain and/or negative social consequences. The issue of directionality/temporal precedence is far from settled.

Using a 3-wave, 3-variable cross-lagged panel model, we conducted a stringent test of either internalizing symptom’s effects on HED, and vice versa, after controlling the stability inherent in each construct over time. This model was tested in a community adult sample (N = 102) in a longitudinal study with measurements at baseline, 3 months, and 6 months.

The results suggest that depressive symptoms and anxiety symptoms significantly predict HED in opposite directions over time, and that HED does not significantly predict either type of internalizing symptom over time. Specifically, greater depressive symptoms were associated with greater HED over a 3-month period after adjusting for anxiety symptoms. Anxiety symptoms were negatively predictive of HED after accounting for depressive symptoms. We also found strong temporal stability in levels of HED, depressive symptoms, and anxiety symptoms over time.

Among community-recruited adults, increased depressive symptoms were related to more HED in a subsequent 3-month period after controlling anxiety symptoms, whereas increased anxiety symptoms were related to less HED over this timeframe after controlling depressive symptoms. Although this suggests support for the self-medication hypothesis, additional investigations are needed. Limitations of the study, future research, and clinical implications will be discussed.

Biography

Dr. Dayna Lee-Baggley is a Registered Clinical Psychologist in Nova Scotia, Canada. She is the director of Dr. Lee-Baggley and Associates, a virtual health psychology clinic specializing in clinical interventions, training for healthcare providers, and research in health-related issues (e.g., chronic pain, sleep, COVID burnout, PTSD for frontline workers). She worked for almost 15 years in multidisciplinary teams on medical, surgical and cancer care hospital units providing assessment, therapy and consultation for patients with chronic and life-threatening health conditions. She also conducts research as an Assistant Professor in the Department of Family Medicine, with a cross appointment in the Department of Psychology & Neuroscience at Dalhousie University and an Adjunct Professor appointment in the Department of Industrial and Organizational Psychology at Saint Mary’s University. She has an active research program on behavior change, obesity, chronic disease, professional resiliency, workplace mental health and Acceptance and Commitment Therapy. Dr. Lee-Baggley has close to 45 peer-reviewed publications and over 130 scholarly presentations. She is a senior consultant providing healthy workplace interventions for employees, teams, and leaders with Howatt HR Consulting and the Chief of Research for the Howatt HR Applied Workplace Research Institute. She is an internationally recognized trainer in Acceptance and Commitment Therapy and a certified therapist in Emotion Focused Therapy for Couples. She was the recipient of the 2017 Women of Excellence Award for her contributions to Health, Sport and Wellness (Canadian Progress Club Halifax Cornwallis). She is the author of the book “Healthy Habits Suck: How to get off the couch & live a healthy life…even if you don’t want to.”

  • King's College London, UK
  • Title:Choroid Plexus Enlargement is Associated with Neuroinflammation and Reduction of Blood Brain Barrier Permeability in Depression
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Abstract:

Background: Depression is often associated with elevations of peripheral inflammatory markers. The mechanisms linking peripheral inflammation and changes in the central nervous system in MDD are still under investigation. Recent studies have shown that choroid plexuses (CP) may be involved in the neuro-immune axes, playing a role in brain homeostasis and mediating the interaction between the central and peripheral inflammation. Here we aimed to investigate CP volume alterations in depression and their associations with central brain inflammation.

Methods: 51 depressed participants (HDRS score >13) and 25 age- and sex-matched healthy controls (HCs) from the Wellcome Trust NIMA consortium were re-analysed for the study. All the participants underwent full peripheral cytokine profiling and simultaneous [11C]PK11195 PET/structural MRI imaging for measuring neuroinflammation and CP volume respectively. We leveraged transcriptomic data from the Allen Human Brain Atlas (AHBA) to explore possible associations between the brain map depicting the correlations between CP volume and TSPO and functional brain pathways.

Results: We found a significantly greater CP volume in depressed subjects compared to HCs (t(76) =
+2.17, p=0.03) that was positively correlated with [11C]PK11195 binding in the anterior cingulate cortex (r=0.28, p=0.02), prefrontal cortex (r=0.24, p=0.04), and insular cortex (r=0.24, p=0.04). The CP volume exhibited a negative association with the blood-to-CSF radiotracer exchange parameters (r=- 0.28, p=0.02). Integration of transcriptomic data from the AHBA with the brain map, we found significant gene enrichment for several pathways involved in neuroinflammatory response.

Conclusion: This result supports the hypothesis that changes in brain barriers may cause reduction in solute exchanges between blood and CSF, disturbing the brain homeostasis and ultimately contributing to inflammation in depression. Given that CP anomalies have been recently detected in other brain disorders, these results may not be specific to depression and might extend to other conditions with a peripheral inflammatory component.

Acknowledgements
The BIODEP study was sponsored by the Cambridgeshire and Peterborough NHS Foundation Trust and the University of Cambridge and funded by a strategic award from the Wellcome Trust. Recruitment of participants was supported by the National Institute of Health Research (NIHR) Clinical Research Network. We gratefully acknowledge all study participants and the King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, and the Saudi Arabia Cultural Bureau (SACB).

Biography:

Dr. Noha Althubaity is a PhD candidate in neuroimaging research at King’s College London. A teaching assistant at Radiology department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. She earned her bachelor’s degree in Radiological Sciences at King Saud University (Riyadh, Saudi Arabia) and the master’s degree in Radiologic and Imaging Sciences at Thomas Jefferson University (Philadelphia, USA). She is registered as a Radiologic Technologist Saudi Commission for Health Specialties and as Magnetic Resonance Imaging Technologist from The American College of Radiology and The American Society of Radiologic Technologist, ST. Paul, Minnesota (ARRT). Area of interest is the glymphatic system and depression.

Her Publications are:
• Increased serum peripheral C-reactive protein is associated with reduced brain barriers permeability of TSPO radioligands in healthy volunteers and depressed patients: implications for inflammation and depression
• Choroid plexus enlargement is associated with neuroinflammation and reduction of blood brain barrier permeability in depression

  • SVIMS, INDIA
  • Title:Cisternostomy vs Decompressive Craniectomy for The Management of Traumatic Brain Injury: A Randomized Controlled Trial
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ABSTRACT:
Background: Goal of treatment in the management of traumatic brain injury (TBI) is to
avoid the secondary brain injury. Though decompressive craniectomy has shown to reduce
ICP but in reality, it provides an outlet for brain tissue to expand only without reducing the
oedema. Basal Cisternostomy (BC) is an emerging microsurgical technique in the
management of cerebral oedema in TBI. By this technique, CSF is let out from basal cisterns
which reduces cerebral oedema. In this study we compared the outcomes of Cisternostomy
with decompressive craniectomy and studied the effectiveness of Cisternostomy in
decreasing cerebral oedema. This is the first Randomized controlled trial on comparing the
Cisternostomy with decompressive craniectomy
Methods: All the enrolled patients were randomised into 2 groups. They were assessed
clinically and radiologically. Categorised into mild, moderate and severe head injury groups
and Marshall CT score was given. Intraoperative ICP was measured in both the groups.
Outcomes were assessed with the factors like post-operative ICU care, days on ventilator
support and GOS score.
Results: 50 patients were randomized into 2 groups with 25 patients each. Mortality rate in
this study was 32% (8) in Cisternostomy group whereas it was 44% (11) in decompressive
craniectomy group. There was decreased mean days of ventilator support and ICU care
requirement in Cisternostomy group. Cisternostomy causes significant decreases in ICP after
craniotomy. Age, time interval from trauma to surgery and Marshall CT score showed
prognostic importance on outcomes.
Conclusion: Cisternostomy was effective in reducing the ICP in the traumatic brain injury
patients. With Cisternostomy there is good GOS and low rate of complications in the postoperativeperiod. Age, presenting GCS, Marshall CT score, association with other major
injuries and time interval from trauma to surgery had a significant prognostic impact on the
outcome in the management of traumatic brain injury.

Biography :
Dr. Hanuma Naik Banavath is an Assistant Proffessor, MS, Mch – NEUROSURGERY
SVIMS, TIRUPATHI, ANDHRA PRADESH, INDIA
EDUCATION:
He gained his Mch – Neurosurgery from SVIMS, Tirupati, A.P, He also obtained his MS – General surgery from PGIMER, Chandigarh. He completed his MBBS from NRI medical college, Chinakakani, Guntur dist., A.P

WORK EXPERIENCE:
He is an Assistant professor – Neurosurgery from September 2021 – present
SVIMS, Tirupati. He also served as a Senior resident in Neurosurgery (non-academic, after MS) from Sep 2017 – Aug 2018, GMCH-32, Chandigarh.

PUBLICATIONS:
His Publications are:
1. Cisternostomy vs Decompressive Craniectomy for The Management of Traumatic Brain Injury: A Randomized Controlled Trial – World Neurosurgery published as corresponding author
2. Outcomes and predictors of outcome with cisternostomy in the management of traumatic brain injury – a prospective observational study at tertiary centre – Indian journal of neurotrauma (original article)
2. Spontaneous rapid resolution of acute subdural hematoma: revelation in the era of modern science – Indian journal of neurotrauma (case report)

Under review as corresponding author
1. Percutaneous surgical approach for vertebral compression fractures – Predictors of Outcome: 5 Years of Experience at A Tertiary Care Center – Indian journal of neurotrauma

  • B. P. Koirala Institute of Health Sciences, Nepal
  • Title:A Rare Case of Creutzfeldt-Jakob Disease Reported from Nepal
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Abstract:
Creutzfeldt‐Jakob disease (CJD) is a rare disorder of the central nervous system. It is rapidly progressive and always fatal. Even in absence of typical imaging pattern, good clinical judgement along with supporting investigations can aid to the diagnosis of CJD in a setting where resources are limited.
We report a rare case of probable Creutzfeldt‐Jakob disease (CJD) in a 65‐year‐old man, probably the second case in Nepal, who initially presented with progressively increasing low mood with catatonia along with rapidly progressive dementia and features of upper motor neuron lesions. The first case of CJD from Nepal being reported by Kharel et al in 2019. Magnetic resonance imaging of brain revealed confluent areas of T2 and fluid‐attenuated inversion recovery (FLAIR) high signal intensity in bilateral fronto‐parietal deep white matter. The electroencephalogram showed bilaterally synchronous periodic pattern of bi‐ or triphasic sharp waves of 1 Hz. The patient expired at 1.5 months of diagnosis.
Creutzfeldt‐Jakob disease is a progressive, fatal neurodegenerative disease and is caused by misfolded, transmissible proteinaceous infections particles, or prions. Although the concentration of CJD prions varies throughout the body of an infected individual, it is highest in the brain and the posterior eye (retina and optic nerve), resulting in neurological symptoms, including rapidly progressing dementia, cerebellar and extrapyramidal signs, and myoclonus and visual symptoms. The life expectancy of most people clinically diagnosed with CJD is 1 year from the onset of symptom. Among the three major groups of human prion disease: sporadic, genetic, and acquired; sporadic CJD (sCJD) is most common, accounting for about 85% of CJD cases. With the occurrence generally in late middle age at a mean age of 67 years, they have a short survival post‐diagnosis of about 4 months. However, at least six different clinic‐pathological CJD subtypes with variable presentations are known. Even with the evidence of a genetic predisposition to sCJD, the precise cause of the disorder is unknown. The global incidence of CJD is typically reported to be around 1–2 cases per million per year.
We present a case report that includes the clinical and radiological features of the probably second case of CJD in Nepal, and also illustrates the complexity of diagnosing this disease in a resource‐limited setting.

Biography:
Dr. Durga Neupane, had completed Bachelor of Medicine and Bachelor of Surgery(MBBS) from B.P. Koirala Institute of Health Sciences, Dharan, Nepal. He has been currently enrolled in Bachelor of Science in Neurosurgery in Abdulrauf University of Neurosurgery, USA, a first online university of Neurosurgery. He has been accepted by Harvard Medical School, Boston, USA for Foundations of Clinical Research, Class of 2022 with a scholarship. He has been appointed as an official peer reviewer and editorial board member of few international medical journals. He has core interest in Neurosurgery and has published about 20 research articles in Neuroscience. He attended World Congress of Neurosurgery in 2021. He is fluent in Nepali, English and Hindi languages. He enjoys literature and football. He has attended a national level conference on mental health which was organized jointly by WHO and Ministry of Health and Population of Nepal. He is an active member of Walter E Dandy Neuro Club of Nepal. He has been serving as a primary care physician in a rural municipality of Eastern Nepal. Recently, he conducted a free mega health camp at a countryside, the report of which is published in international journal.

  • Santa Casa Hospital of Porto Alegre, Brazil
  • Title:Single Burr-Hole Extended Transforaminal Approach for Concurrent Endoscopic Surgery in the Third Ventricle Posterior to the Foramen of Monro and Ventriculostomy: Clinical Series and Planning Steps
  • Time :

Abstract

Objective. For endoscopic surgery of lesions in the middle to posterior third ventricle that frequently require a third ventriculostomy during the same procedure, an extended transforaminal approach (ETFA) via a single burr hole is presented. Aims of the study were to define a safe transchoroidal entry zone, to
calculate the optimal position of the burr hole, and to report the clinical results from a patient series.
Patients and Methods. Preclinical part with cadaver study (n=6 hemispheres) and retrospective MRI assessment of cases with occlusive hydrocephalus (n=30 sides). Retrospective review of clinical series of concurrent third ventricle surgery (14 cystic lesions and 11 tumor cases) and third ventriculostomy for feasibility of the endoscopic ETFA procedures and clinical outcome.
Results. The anatomical study revealed a foramen of Monro diameter of 5mm (4-7mm) and a safe entry zone of additional 5mm (3-6mm). On MRI of patients with enlarged third ventricle, the foramen of Monro diameter was 7mm (3-11mm) and the safe entry zone 6mm (3-12 mm) for the ETFA. The optimal burr hole
position was 22mm (10-30mm) lateral to the midline and 8mm (27 to -23mm) precoronal. Clinically, the ETFA was feasible in 24/25 cases. The safe entry zone was sufficient in 16 cases; the anterior septal vein was transectioned in 9 cases without clinical consequences.
Conclusion. According to our data, concurrent endoscopic surgery in the middle to posterior third ventricle and ventriculostomy are feasible via a single burr hole and a transchoroid extension of the transforaminal approach. Precise preoperative planning is recommended for assessing the individual nuances of this approach.
Keywords: ventricular endoscopy, transchoroidal approach, minimally invasive, tumors

Biography

Dr. Carlos V Brusius is a Physician specialized in Neurosurgery, he has done his MHSc in Neurosurgery at Federal University of São Paulo (UNIFESP), he obtained the PhD in Medical Sciences at Federal University of Rio Grande do Sul (UFRGS), acting on the topics of Neurosciences, Artificial Intelligence, and Oncology.

  • University Hospital Nuestra Señora de Candelaria, Spain
  • Title:Rhombencephalitis Associated with Anti-NMDA Receptor Antibodies: An Unusual Presentation.
  • Time :

Abstract

Introduction:
Anti-NMDA receptor encephalitis mainly affects young people, often requiring a high clinical suspicion for diagnosis. The typical clinical presentation includes psychiatric symptoms, movement
disorders, seizures and dysautonomia. We present a highly unusual case where the rhombencephalon was exclusively affected, leading to a clinical expression of a pancerebellar syndrome.
Case report:
A 21 year-old male individual lacking any previous relevant medical history, was hospitalised as a result of a progressive clinical picture of dizziness, cephalalgy and binocular diplopia. Physical examination showed lethargy, limited right-eye abduction, bilateral appendicular ataxia and general hyporeflexia. Complementary tests showed there was a mononuclear pleocytosis, high protein levels in the cerebrospinal fluid, and MRI revealed abnormal T2/FLAIR hyperintensity localised in pons and cerebellar hemispheres. Despite having received a treatment of intravenous immunoglobulins, the patient presented seizures and a paracerebellar syndrome. Thus, another cycle of high concentration of both immunoglobulins and intravenous steroids was required for eight days to observe a decrease of symptoms.
Further analyses conducted by an external laboratory showed the presence of anti-NMDA receptor antibodies in the cerebrospinal fluid, as well as a secondary surface antibody that still remains unknown.
Conclusion:
This case increases the clinical spectrum of anti-NMDA receptor encephalitis. Other studies have described several cases where anti-NMDAr antibodies have caused syndromes affecting the brain stem or the cerebellum. However, solely presenting a rhombencephalitis as an initial symptom has barely been documented so far. Additionally, the impact that the secondary surface antibody that was detected in the cerebrospinal liquid might have on the patient’s pathology remains unknown. Nonetheless, several studies suggest that 4-7.5% of anti-NMDAr encephalitis could present coexistent antibodies, as this area of study continues to expand.

Biography

Dr. Miguel Solé-Sabater graduated in Medicine from the University of La Laguna in 2018. He now works as a resident of Neurology in Hospital Universitario Nuestra Señora de Candelaria, Tenerife.
He is also doing a PhD in the University of La Laguna, where he focuses on neurophysiology, by studying brain biorhythms and transcranial magnetic stimulation.

  • University of Concepción, Chile
  • Title:Covered-Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a 3 Years-Old Child with 12-Years Follow-Up. Case Report.
  • Time :

Abstract

Introduction: Extracranial internal carotid artery (ICA) pseudoaneurysms in children, although uncommon, are life-threatening. Covered stents are a good alternative treatment, as they avoid the risk of open surgery and preserve the internal carotid artery. Long- term outcomes were unknown until recently. Report: In August 2008, a 3-years-old child was treated with a covered stent for a pseudoaneurysm in the extracranial ICA. A long-term follow up is presented. Results: The child was discharged with full recovery and without neurological sequelae. He has been followed-up and has remained asymptomatic for 12 years, with CTA- confirmed internal carotid artery patency, without deformation or evidence of significant re- stenosis. Conclusion: This the first report of the long-term outcome of a covered stent in a child treated at 3 years of age, with a 12-year follow-up. The good performance of the covered stent in this case reinforces its adoption as a first-line option in the treatment of extracranial ICA pseudoaneurysms in children.

Biography
Dr. Roberto Sánchez, is a Professor of Surgery
Faculty of Medicine- University of Concepción- CHILE Fellow of the American College of Surgeons.
He is a Former Foreign Resident of Paris Hospitals,He is also a Foreign Associate Member Society of Vascular and Endovascular Surgery of French Language (SCVE), Non-European Membership European Society of Vascular and Endovascular Surgery (ESVS)

  • University of Iceland, Iceland
  • Title:Sudden Unique Self-Similarity Between Human and Pre-Neuronal Intracellular Mass-Societies: Giant Extra-Individual T-Strings and the Forming of Citizens
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Abstract

This presentation is mainly based on long standing biomathematical behavioral research recently described in “T-patterns, external memory and mass-societies in proteins and humans: In an eye-blink the naked ape became a string-controlled citizen” https://doi.org/10.1016/j.physbeh.2020.113146 (free open access).
Since the early 1970’s, this project was much inspired by N. Tinbergen, K. Lorenz, and K. von Frisch’s research on animal and human social behavior winning them the Nobel Prize in Physiology or Medicine in 1973, the first in Ethology, the biology of behavior. Insects were still the smallest animals studied so none were components of any others and there was no mention of nanoscale actors nor self-similarity.
The focus here has been on defining mathematical pattern types for behavior analysis, mainly the T-pattern, a hierarchical and self-similar pattern recurring with significant translation symmetry in time and on strings (T-strings) and developing (since the late 70’s) adequate computational algorithms and software (THEMETM, patternvision.com) used for their detection in humans, animals, neurons, and proteins. This has finally drawn attention to unique structural similarities between intracellular protein mass-societies and those extremely recent of humans; a self-similar hierarchy of T-pattern based mass-societies.
Nanoscale phenomena have recently become visible to humanity uncovering a highly patterned pre-neural world where billions of years ago an RNA world invented extra-individual purely informational T-strings, i.e., DNA, and soon there was only the world of DNA-based world of walking and working protein mass-societies (“Cell Cities”). Billions of years later, human mass-societies are the first and only animal societies to reach self-similarity with these DNA/protein mass-societies of every cell in their bodies, by also inventing extra-individual purely informational T-strings, i.e., TEXT and bit T-strings, and now nearly all human life is TEXT-based and mass-social with external-memory (first using clay, now mostly silicon) allowing explosive growth of human knowledge, science, and technology separating human life dramatically from any other known forms of life.

Biography

Dr. Magnus S. Magnusson, Emeritus Research Professor, he is a founder and director of the Human Behavior Laboratory, School of Health Sciences, University of Iceland. Author of the T-system and THEMETM (PatternVision). Co-directed project “DNA analysis with Theme”. Keynotes in biology, neuroscience, mathematics, science of religion, proteomics, A.I., and nanoscience. Deputy Director 1983-1988 in the Museum of Mankind of the National Museum of Natural History, Paris. Repeatedly, invited Professor at the University of Paris V, VIII & XIII. Since 1995 in formal collaboration between 32 European and American universities initiated at the University of Paris V, Sorbonne, based on “Magnusson’s analytical model”. His Main interest: mass-societies and bio-mathematical self-similarity between nano and human scales.

  • University hospital of Coventry and Warwickshire, U.K
  • Title:Spinal Cord Tumor Presenting as Idiopathic Intracranial Hypertension-a Misdiagnosis: Case Report
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Abstract

Background: Idiopathic Intracranial hypertension (IIH), is a relatively uncommon disorder characterised by raised intracranial pressure without any established pathogenesis. The symptoms are essentially of headache, nausea, vomiting, visual loss and findings of papilledema. Very rarely a spinal tumor is seen as the cause of the symptoms.
Case description: We present a 26 year old male, with BMI of 24.6, who is otherwise fit and well, that was admitted from the Emergency department with 6 days history of headache, one episode of vomiting, photophobia, neck pain, low grade fever, confusion and blurring of vision. He was initially treated by Neurologist with broad spectrum antibiotics and antiviral for suspicion of meningio – encephalitis. Later lumbar puncture with cerebro spinal fluid (CSF) analysis and MRI brain demonstrated no infective pathology. Patient had persistent headache and blurry vision and input from Ophthalmology revealed Left VI nerve palsy and bilateral papilledema. Neurologist made a differential diagnosis of IIH and venous sinus thrombosis and started him on Acetazolamide.
He did not have any significant past medical history and his BMI was not typical for IIH. The CT venogram showed no obstructive pathology or any stenosis. The lumbar puncture revealed opening pressure of 34cm H20. Reconfirmation of CSF results showed no infective aetiology and the antibiotics and antivirals were stopped. IIH was provisionally diagnosed and he was referred to Neurosurgeons for CSF diversion.
Investigation: Due to unusual presentation, we advised a full cranio-spinal MRI and it revealed a spinal cord lesion attached to the filum terminale at L1/2 level with significant compression to the thecal sac, conus and cauda equina with spinal CSF flow impairment at that level
Treatment: He underwent a Posterior T12 to L2 laminectomy and complete excision of the tumor under Neurophysiological monitoring. He improved significantly within one week of his operation with headaches and vision getting better and objectively the papilledema was also better as confirmed by the Ophthalmologist. He was discharged home and till his first follow up after 6 weeks is neurologically much better with headaches completely resolved and vision almost back to normal. The histopathology came as Ependymoma WHO grade 2.
Conclusion: For someone presenting with IIH, a spinal tumor should be considered in the differential diagnosis, especially when there is no dural venous sinus anomaly and patient refractory to medical treatment.
Keywords: Idiopathic Intracranial hypertension (IIH), Cerebro spinal fluid (CSF), Papilledema, Intradural Extramedullary

Biography
Dr. Debasish Hajra, is a Medical graduate from India and have been working in the Neurosurgery speciality in the UK for over 17 years. After completing his Membership Royal College of Surgeons (MRCS), he has worked as a registrar and subsequently got promotion as a senior registrar in Neurosurgery. He currently works in University Hospitals Coventry and Warwickshire, U.K. He had also passed his EANS (European Association of Neurosurgery Societies) exam and cleared his Fellowship Royal College of Surgeons (FRCS) part I exam. He had a special interest in Spine and Skull base.

  • Queensland University of Technology, Australia
  • Title:Gene Profiling in Different Stages Of Alzheimer’s Disease: A Genome-Wide Study
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Abstract

Alzheimer’s Disease (AD), the most common form of age-related dementia, is a progressive, neurodegenerative disease characterized clinically by a gradual cognitive decline including loss of memory, orientation and reasoning and pathologically characterized by neurofibrillary tangles and amyloid plaques in the brain. There is currently no simple definite test to diagnose AD. Hence, there is a considerable interest in reliable early detection. Despite recent progress in genetic research, gene testing is currently not sufficiently reliable for most individuals and has limited utility for predictive purposes. We here examined gene expression profiles and microRNA patterns using the Affymetrix Human Transcriptome array 2.0 in saliva in patients across several stages of AD (mild, moderate and severe) compared to a healthy control group matched for gender and age. AD patients (with diagnosis established according to NINCDS-ADRDA criteria) were classified into mild (n=8), moderate (n=7) and severe (n=7) stages of AD dependent on their clinical profiles and cognitive performance. The control group (n=19) consisted of individuals with no family history of AD. Analysis of the array data was performed in R using oligo and limma. The ratio of expression of genes between groups was reported as fold change, and a globally adjusted Benjamini Hochberg FDR of 0.1 was utilised to maximise the discovery of differentially expressed genes and pathways.
Pathway and gene-set enrichment analysis (GSEA) was performed using clusterProfiler. Results showed increased levels of differential expression between AD patients and control groups in saliva, with differentially expressed genes becoming more substantial with disease progression. Specifically, in early stage of AD, chromosome and chromatin organisation pathways were some of the most enriched in Gene Ontology GSEA when compared to controls (FDR<0.001), while immune response and cytokine pathways were most enriched when comparing both AD patients in late-stage to early-stage, and late-stage to controls (FDR<0.001). This study presents a new avenue of investigation into molecular processes occurring at the early stage of disease. The result of this research will help to gain a better understanding of the pathways implicated in AD pathophysiology at early stage of the disease and may offer a new avenue for diagnostic and/or the therapeutic development for AD. Biography

Dr Francesca Fernandez is an innovative researcher, with education and research training in both Neurosciences and Human Genetics. Her research expertise spans both mental health and neurobiological disorders, utilising a variety of approaches and contributing to knowledge of cellular, individual and population aspects of these disorders. For over 15 years, her research uses various models (DNA case-control populations, postmortem human brain tissue, cognitive testing in animal and/or human) to uncover mechanisms underlying the molecular basis of learning and memory processes in the context of healthy ageing and/or pathological disorders (dementia) and mental health (depression, schizophrenia, cannabis use). Dr Fernandez’s national and international reputation are illustrated from her numerous research collaborations, invitations to contribute to publications from diverse disciplines and her successful research funding totaling around $3 million. Her multidisciplinary approach uniquely places Dr Fernandez’s at the cutting edge of research examining the molecular basis in brain in healthy and pathological contexts.

  • Faculty of Health Sciences of the Federal University of Grande Dourados Foundation, Brazil
  • Title:Profile of the Indigenous Epileptic Patient in a Brazilian Village
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Abstract

This study aimed to characterize the nature of epileptic seizures in the indigenous population of the Jaguapirú village in the municipality of Dourados (MS), Brazil. In addition to the prevalence, we aimed to determine the nature of paroxysmal events of non-epileptic origin in this population. We believe that our study means a significant contribution to the literature because it shows that an excellent therapeutic response is achieved with first-generation antiepileptic drug monotherapy in most cases (87.7%). EEG contributed to the definition of focal epilepsies and helped in the diagnosis of patients with seizures of non-epileptic origin, among which psychogenic seizure were most frequent, followed by syncope. Vertigo predominated in the elderly aged over 60 years, while psychogenic seizures prevailed in younger patients. Epilepsy was more prevalent in the Guarani ethnic group, even though they represented less than 30% of the patients in the study, which may be related to the lower socioeconomic status of this ethnic group in relation to the others. Another expected association was home birth and epilepsy, which was not statistically confirmed. Investigating the epidemiological determinants of epilepsy in traditional communities is essential for the establishment of public policies in countries such as Brazil.

Biography

Commission on Classification and Terminology of the International League Against Epilepsy Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the. Epilepsia 1981; 22: 489–501.
Engel J Jr, International League Against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia 2001; 42: 796–803.
Fisher RS, Cross JH, D’Souza C, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 2017; 58: 531–42.
Scheffer L, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies. Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58: 512–21.
Placencia M, Sander JW, Roman M, Madera A, Crespo F, Cascante S, Shorvon SD. The characteristics of epilepsy in a largely untreated population in rural Ecuador. Jr. Neurol Neurosurg and Psychiatr 1994; 57:320-25.
Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016; 16: 48–61.

  • Queensland University of Technology, Australia
  • Title:Antroquinonol Administration in Preclinical Studies for Alzheimer's Disease: A New Avenue for Modifying Progression of AD Pathophysiology
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Abstract

Despite the rise of Alzheimer’s disease (AD) in an ageing population, no cure is currently available
for this disorder. This study assessed the role of a natural compound, Antroquinonol extracted from a
Taiwanese mushroom, in modifying the progression of AD when administered at the start and/or before
appearance of symptoms and when the disease was well established, in a transgenic animal model. Male
transgenic mice (3 times Transgenic mice PS1M146V, APPSwe, and tauP301L, 3 Tg XAD) were chosen for this
study due to amyloid beta and tau pathways involved in AD pathophysiology.
Different doses of antroquinonol (7, 34 and 75 mg/kg) were administered daily by oral gavage for
8 weeks, in 11 week- (early stage) and 9 month- (late stage) old male transgenic mice (3 times Transgenic
mice PS1M146V, APPSwe, and tauP301L, 3 Tg XAD) and their respective aged controls. Behavioural testing
(including Elevated Plus Maze Watermaze, Recognition object testing and Y maze) was performed at the
end of the drug administration. Alzheimer’s disease’ biomarkers (amyloid beta 42 (Aβ42), tau and phosphotau levels), oxidative stress and inflammatory markers, were assessed in mouse brains at the end of the
treatment.
When administered 11 weeks before the start of AD related symptoms at, antroquinonol treatment
at 34 mg/kg (D2) and more consistently at 75 mg/kg (D3), had a significant effect on reducing systemic
inflammatory markers (Interleukin 1, IL-1β and TNF-α) and AD biomarker (Amyloid Beta 42, Aβ42 and
tau) levels in the brain. The reduction of behavioural impairment reported for 3TgXAD mice was observed
significantly for the D3 drug dose and for all behavioural tests, when administered at 11 weeks. Similarly,
beneficial effects of antroquinonol (at higher dose D3) were noted in the transgenic mice in terms of AD
biomarkers (tau and phosphorylated-tau), systemic inflammatory (IL-1β), brain anti-inflammatory (Nrf2)
and oxidative (3-Nitrotyrosine, 3NT) markers. Improvement of memory impairment was also significantly
identified when antroquinonol (D3) was administered at late stage (9 months).
Considering both the high social and economic costs of AD in our growing elderly society, there is
an urgency to find new strategies for the prevention and treatment of this pathology. Since antroquinonol
has been utilized without adverse effects in previous successful clinical trials and is currently used for other
pathologies, its consideration as a preventive and/or therapeutic AD agent at early and/or later stage of AD
pathophysiology now appears timely and topical.

Biography

Distinguished Professor Lyn Griffiths is a molecular geneticist with more than 30 years’ research experience.
DProf Griffiths established and heads the Genomics Research Centre at QUT undertaking research focused
on identifying genes involved in common traits and disorders including migraine, cardiovascular disease,
memory, dementia and concussion. For this research she has established a significant bank of population
genomics resources including case-control, multigenerational pedigree and genetic isolate (from Norfolk
Island) cohorts. She is also Director of the Centre for Genomics and Personalised Health which aims to
discover better methods of diagnosing disease, develop targeted treatments based on genetic information,
and training the next generation of translational genomics scientists. In addition, DProf Griffiths is a
passionate advocate of the translation of medical research through commercialisation and is the Director of
the MTP Connect and industry led Bridge and BridgeTech programs, undertaking commercialisation
training for the pharmaceutical and medical devices-technology fields across Australia, respectively. Prof
Griffiths’ own genetics research at the Genomics Research Centre has led to diagnostic breakthroughs for
several neurogenetic disorders, including familial migraine, ataxia, epilepsy and hereditary stroke. Her
research has appeared in more than 400 peer-reviewed international journals and she has obtained significant
competitive and industry research funds to support her research team.

  • Ozel Bağlar Hospital, Turkey
  • Title:COVID-19: Endogenous Retinoic Acid Theory and Retinoic Acid Depletion Syndrome
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Abstract

This study presents two new concepts and definitions to the medical literature. One of those is “endogenous retinoic acid theory” and the other “retinoic acid depletion syndrome”. A new classification will be provided for the immune system. “retinoic acid-dependent component” and “retinoic acid non-dependent component”. If this theory is verified, all the diseases where the retinoic acid metabolism is defective and retinoic acid levels are low will be identified and new approaches will be developed fortreating such diseases. When the need for retinoic acids increases, such as acute infection, high fever, severe catabolic process, or chronic antigenic stimulation, cytochrome P450 monooxidase enzymes are inhibited by drugs or internal mechanisms. Metabolism and excretion of retinoic acids stored in the liver are prevented. In this way, retinoic acid levels in the blood are raised to therapeutic levels. This is called “Endogenous Retinoic Acid Theory”. Retinoic acids also manage their metabolism through feedback mechanisms. Despite compensatory mechanisms, causes such as high fever, serious catabolic process and excessively large viral genome (SARS-CoV-2), excessive use of RIG-I and Type- I interferon synthesis pathway using retinoic acid causes emptying of retinoic acid stores. As a result, the RIG-I pathway becomes ineffective, Type-I IFN synthesis stops, and the congenital immune system collapses. Simultaneously, the immune mechanism crosses the TLR3, TLR7, TLR8, TLR9, MDA5 and UPS pathways in monocyte, macrophage, neutrophil and dendritic cells of the adaptive immune defense system that do not require retinoic acid. This leads to excessive TNFα and cytokine discharge from the pathway. With the depletion of retinoic acid stores as a result of this overuse, the immune defense mechanism switches from the congenital immune system to the adaptive immune system, where retinoic acids cannot be used. As a result of this depletion of retinoic acids, the shift of the immune system to the NFκB arm, which causes excessive cytokine release, is called “retinoic acid depletion syndrome”. COVID-19 and previously defined sepsis, SIRS and ARDS are each retinoic acid depletion syndrome. We claim that retinoic acid metabolism is impaired in autoimmune and other chronic inflammatory diseases, and therefore the RIG-I pathway and UPS degradation system are not working properly. Endogenous retinoic acid metabolism is defective in COVID-19 (cytokine storm), sepsis, SIRS, ARDS, severe viral and bacterial infectious diseases, chronic autoimmune diseases and degenerative neurological diseases. This pathogenesis explanation brings a new perspective and treatment approach to this type of disease.

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