Browsing by Author "Amit Agrawal"

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A scoping review to understand the indications, effectiveness, and limitations of cabergoline in radiological and biochemical remission of prolactinomas
(Wolters Kluwer Medknow Publications, 2021) Rakesh Mishra; Subhas K. Konar; Adesh Shrivastava; Pradeep Chouksey; Sumit Raj; Amit Agrawal
Cabergoline has long been used in the medical management of prolactin-secreting pituitary adenomas. However, there is contradicting and inadequate evidence on the efficacy of cabergoline in achieving radiological and biochemical remission in prolactinoma. This article presents scoping review of evidence in cabergoline achieving radiological and biochemical remission in cases of prolactinoma. We have used a recommended scoping review methodology to map and summarize existing research evidence and identify knowledge gaps. The review process was conducted according to the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews). The selection of studies was based on the criteria defined. Essential information such as reference details, study characteristics, topics of interest, main findings, and the study author's conclusion are presented in text and tables. With the study selection process, eight publications were finally included - one systematic review and meta-analysis, one RCT, and six primary studies. Cabergoline is effective in achieving biochemical and radiological remission in cases of prolactinoma. We identified several knowledge gaps with the scoping review and directions for future studies. Future studies, including randomized studies, will help address challenging questions associated with the management of prolactinoma. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Analysis of traumatic intracranial hemorrhage and delayed traumatic intracranial hemorrhage in patients with isolated head injury on anticoagulation and antiplatelet therapy
(Scientific Scholar LLC, 2023) Kevin Raymond; Alexander Sterling; Mary Roberts; Reuben W. Holland Iii; S. Galwankar; Rakesh Kumar Mishra; Amit Agrawal
Objectives: Anticoagulants and antiplatelet (ACAP) agents are increasingly and frequently used, especially in the elderly. The present study was carrieout to assess the prevalence of delayed traumatic intracranial hemorrhage (dtICH) after a normal result on an initial head computed tomography (CT) iadults who were taking ACAP medication. Materials and Methods: The present retrospective included all adult patients who arrived in the emergency department between January 2017 aJanuary 2021 with a history of fall from the patient’s own height, while being on ACAP medication with an isolated head injury. The Institutional ReviBoard approved the study with a waiver of consent. The primary outcome measures were prevalence of dtICH in patients who had initial normal CT scbrain and were on ACAP medication. Results: There were 2137 patients on ACAP medication, of which 1062 were male, and 1075 were of the female gender. The mean age of the patients was 82.1 years. About 8.2% had positive first CT scans (176/2137), while 0.023 (27/1149) had dtICH. The most common positive finding on the CT scan was subarachnoid hemorrhage followed by subdural hemorrhage. Male gender positively correlated with increased risk for first CT being positive (P = 0.033). Patient’s with comorbidity of cirrhosis and chemotherapy had higher risk of dtICH (P = 0.47, 0.011). Conclusion: There was a very low (0.023%) prevalence of dtICH. Dual therapy or Coumadin therapy made up the majority of tICH. Cirrhosis achemotherapy were associated with the risk of a repeat CT scan being positive with an initial CT scan negative. © 2023 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practic.
Artificial intelligence and machine learning in healthcare: Scope and opportunities to use ChatGPT
(Scientific Scholar LLC, 2023) Ajai Singh; Saikat Das; Rakesh Kumar Mishra; Amit Agrawal
[No abstract available]
Bowel and Bladder Dysfunction
(Nova Science Publishers, Inc., 2022) Rakesh Mishra; Bukkambudhi V. Murlimanju; Amit Agrawal
The function of bladder and bowel continence is the first priority in patients with fracture of dorsolumbar spine and subsequent spinal cord injury. Adequate management of bowel and bladder dysfunction in neurological diseases is often the primary goal of neurorehabilitation A knowledge of bowel and bladder dysfunction can be very useful while managing patients with neurodegenerative disorders and neurotrauma. Inadequate treatment of bowel and bladder dysfunction is detrimental to health and interferes with other rehabilitation measures. This chapter aims to sensitize neurologists, neurosurgeons, psychiatrists and other caregivers to patients suffering from neurological diseases and is not meant to deal with the subject exhaustively. © 2022 by Nova Science Publishers, Inc.
Cisternal irrigation and clot removal to prevent vasospasm and poor outcome in aneurysmal subarachnoid hemorrhage: Systematic review and meta-analysis
(Elsevier Ltd, 2022) William Florez-Perdomo; Rakesh Mishra; Ezequiel García-Ballestas; Ivan David Lozada-Martínez; Gabriel Alexander Quiñones-Ossa; Andrei Joaquim; Amit Agrawal; Tariq Janjua; Sabrina Rahman; Amileth Suarez-Causado; Luis Rafael Moscote-Salazar
Introduction: Cerebral vasospasm is the most common factor contributing to morbidity and poor outcome in patients with aneurysmal subarachnoid hemorrhage, second only to rebleeding. Most of current evidence assessed the role of vasodilator effect of the irrigating fluid, and the evidence on effects of cisternal irrigation and clots is currently scarce. Method: According to PRISMA guidelines, determined databases were searched for studies and a meta-analysis was performed. Studies included had to meet the established criteria. The statistical analysis was carried out to obtain relative risk with the Mantel-Haenszel methodology for dichotomous variables. Results: After screening and thorough review, five articles were included for qualitative and quantitative synthesis. (n = 621) participants included in this study with n = 472 for the irrigation group and n = 149 for the non-irrigation group. The mean age of the patients was 59.5 years (age range 27–91 years), with 33.5% male and 66.5% female patients. Cisternal irrigation and clot removal reduce vasospasm (OR 0.46; 95% CI 0.22–0.95) and poor outcome (OR 0.41; 95% CI 0.25–0.65). Conclusions: Irrigation of cisterns and aggressive clot removal is a safe and effective procedure in preventing vasospasm and poor outcome in aSAH patients. No significant differences in hemorrhagic, ischemic, and infectious complications with cisternal irrigation and clot removal were reported. Removal of blood clots increases clot clearance and reduces the risk of the development of post-aneurysmal hydrocephalus. © 2022 The Authors
Clinical and Radiological Characteristics for Recurrence of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis
(MDPI, 2022) Rakesh Mishra; Harsh Deora; William Andres Florez-Perdomo; Luis Rafael Moscote-Salazar; Ezequiel Garcia-Ballestas; Md Moshiur Rahman; Adesh Shrivastava; Sumit Raj; Vishal Chavda; Nicola Montemurro; Amit Agrawal
Chronic subdural hematoma (cSDH) is one of the most studied clinical entities in the neurosurgical literature. Management of cSDH is complicated by its propensity to recurrence. Various factors for the development of recurrence of cSDH have been described in various clinical, epidemiological, and observational studies, yet the evidence available is limited. A systematic review and meta-analysis as per PRISMA guidelines to identify clinical and radiological factors which can predict the development of recurrence in cSDH. A total of 14 studies were included for the systematic review and meta-analysis after a comprehensive search of the online databases. Eight studies were of high methodological quality. Age, use of anticoagulants, obesity, seizure, and liver disease were found to be statistically significant clinical risk factors for the development of recurrence in cSDH. Among the radiological parameters, the internal structure of the hematoma and the width of the hematoma was found to be significant risk factor predicting the development of recurrence. Age >75 years, use of anticoagulation therapy, liver disease, and obesity were significant risk factors for cSDH recurrence. Pneumocephalus, internal architecture of hematoma, bilateral cSDH, the width of hematoma, and the presence of bilateral cSDH are important radiological parameters of the development of recurrent cSDH © 2022 by the authors.
Endoscopy-Assisted Microneurosurgery for Sella and Optic Foramen Invading Anterior Cranial Fossa Base Meningiomas
(Elsevier Inc., 2023) Adesh Shrivastava; Rakesh Mishra; Manjul Tripathi; Pradeep Chouksey; Sumit Raj; Amit Agrawal; Suresh Nair
Background: Anterior skull base meningioma produces symptoms as a result of mass effect and neurovascular compression. The bony anatomy of the anterior skull base is complex and houses the critical cranial nerves and vessels. Traditional microscopic approaches remove these tumors effectively but require extensive brain retraction and bone drilling. Endoscope assistance offers the advantages of a smaller incision, less brain retraction, and bone drilling. The most significant advantage of endoscope-assisted microneurosurgery for lesions invading the sella and optic foramen is the complete resection of the sellar and foraminal components frequently responsible for recurrence. Objective: In this report, we describe the technique of endoscope-assisted microneurosurgical resection of anterior skull base meningiomas invading the sella and foramen. Methods: We present 10 cases and 3 case examples of endoscope-assisted microneurosurgery for meningiomas invading the sella and optic foramen. This report presents the operating room setup and surgical details to resect sellar and foraminal tumors. The surgical procedure is presented as a video. Results: Endoscope-assisted microneurosurgery yielded excellent clinical and radiologic results and no recurrence at the last follow-up of meningiomas invading the sella and optic foramen. The present article discusses the challenges faced with endoscope-assisted microneurosurgery, techniques, and challenges in the procedure. Conclusions: Endoscope assistance enables complete tumor excision under vision with less retraction and bone drilling in anterior cranial fossa meningioma, invading the chiasmatic sulcus, optic foramen, and sella. The mixed use of microscope and endoscope makes it safer and saves time and is like bringing out the best of both worlds. © 2023 Elsevier Inc.
Intrahospital transport and SAH: possible impact on low- and middle-income countries
(American Association of Neurological Surgeons, 2021) Ivan David Lozada-Martínez; William Camargo-Martínez; Amit Agrawal; Rakesh Mishra; Bukkambudhi V. Murlimanju; Adesh Shrivastava; Luis Rafael Moscote-Salazar
[No abstract available]
Letter to the Editor Regarding “Females in Neurosurgery: from a Matter of Fortuitous Occasions Towards a Conscious Choice”
(Elsevier Inc., 2021) Rakesh Mishra; Ivan David Lozada Martínez; Rafael Cincu; Bukkambudhi V. Murlimanju; Amit Agrawal
[No abstract available]
Letter to the Editor Regarding: “Functional Motor Skills in Children that Underwent Fetal Myelomeningocele Repair: Does Anatomic Level Matter?”
(Elsevier Inc., 2021) Bukkambudhi V. Murlimanju; Rakesh Mishra; Rafael Cincu; Amit Agrawal
[No abstract available]
Letter to the Editor Regarding: Decompressive Craniectomy After Traumatic Brain Injury: Incorporating Patient Preferences into Decision Making
(Elsevier Inc., 2022) Bukkambudhi V. Murlimanju; Rakesh Mishra; Latha V. Prabhu; Amit Agrawal
[No abstract available]
Letter: Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study
(Oxford University Press, 2021) Sandra Marcela Mass-Ramirez; Ivan David Lozada-Martínez; Amit Agrawal; Luis Rafael Moscote-Salazar; Yelson Alejandro Picón-Jaimes; William Florez-Perdomo; Rakesh Mishra
[No abstract available]
Motor System, Gait and Balance
(Nova Science Publishers, Inc., 2022) Rakesh Mishra; Bukkambudhi V. Murlimanju; Amit Agrawal
The motor system is crucial for independence and a person quality of life. When an individual loses his ability to use his limbs, it has dramatic consequences. Motor function implies a wide range of functions subserved by the motor system in humans. It includes locomotor, gait, and balance. In the event of motor dysfunction, there is an abnormality in gait that makes a person walk less and sets in the vicious cycle with an impact on other organ systems like the cardiovascular system. The main principle behind motor learning is neuroplasticity. It is based on the findings that repetitive movements induce plasticity in functionally preserved brain areas and neural networks take over repetitive movements. The objective of the present chapter is to present an outline principles of motor learning, neurobiological control of motor rehabilitation and to sensitize physicians and surgeons on the neurorehabilitation aspects of motor gait and balance disorder. © 2022 by Nova Science Publishers, Inc.
Neurosurgery Research: An Update
(Nova Science Publishers, Inc., 2022) Amit Agrawal; Pradeep Chouksey; Adesh Shrivastava; Sumit Raj; Rakesh Mishra
In this book, chapters covering the broad areas in spinal neurosurgery, pediatric neurosurgery, and peripheral nerve surgery are included. Chapters presented have been of active interest in academia for the last couple of decades. Care has been taken to avoid duplication of other neurological texts. These chapters will provide a framework of current understanding and available evidence, which will help interested readers understand the area in more depth. © 2022 by Nova Science Publishers, Inc.
Neutrophil-lymphocyte ratio as a predictor of outcome following traumatic brain injury: Systematic review and meta-analysis
(Scientific Scholar LLC, 2022) Rakesh Kumar Mishra; Sagar Galwankar; Joel Gerber; Anuj Jain; Md. Yunus; Rafael Cincu; Luis Rafael Moscote-Salazar; Gabriel Alexander Quiñones-Ossa; Amit Agrawal
Objectives: The neutrophil-to-lymphocyte ratio (NLR) is a simple and routinely performed hematological parameter; however, studies on NLR as a prognostic tool in traumatic brain injury (TBI) have yielded contradictory results. Materials and Methods: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-Analysis guidelines 2020. Electronic databases of PubMed, Cochrane Library, Web of Science, and Scopus were searched. The population consisted of TBI patients in the absence of moderate and severe extracranial injury. Day 1 NLR was taken for the analysis. The outcomes evaluated were mortality and the Glasgow Outcome Scale (GOS). No restrictions were placed on the language, year and country of publication, and duration of follow-up. Animal studies were excluded from the study. Studies, where inadequate data were reported for the outcomes, were included in the qualitative synthesis but excluded from the quantitative synthesis. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). The risk of bias was estimated using the Cochrane RoBANS risk of bias tool. Results: We retrieved 7213 citations using the search strategy and 2097 citations were excluded based on the screening of the title and abstract. Full text was retrieved for 40 articles and subjected to the eligibility criteria, of which 28 were excluded from the study. Twelve studies were eligible for the synthesis of the systematic review while seven studies qualified for the meta-analysis. The median score of the articles was 8/9 as per NOS. The risk of selection bias was low in all the studies while the risk of detection bias was high in all except one study. Ten studies were conducted on adult patients, while two studies reported pediatric TBI. A meta-analysis for GOS showed that high NLR predicted unfavorable outcomes at ≥6 months with a mean difference of −5.18 (95% confidence interval: −10.04, −0.32); P = 0.04; heterogeneity (I2), being 98%. The effect estimates for NLR and mortality were a mean difference of −3.22 (95% confidence interval: −7.12, 0.68), P = 0.11, and an I2 of 85%. Meta-analysis for Area under the curve (AUC) receiver operating characteristic of the included studies showed good predictive power of NLR in predicting outcomes following TBI with AUC 0.706 (95% CI: 0.582–0.829). Conclusion: A higher admission NLR predicts an increased mortality risk and unfavorable outcomes following TBI. However, future research will likely address the existing gaps. © 2022, Scientific Scholar LLC. All rights reserved.
Prognostic factors affecting outcome of multifocal or multicentric glioblastoma: A scoping review
(Scientific Scholar LLC, 2023) Saikat Das; Rakesh Kumar Mishra; Amit Agrawal
It has been reported that patients with multiple lesions have shorter overall survival compared to single lesion in glioblastoma (GBM). Number of lesions can profoundly impact the prognosis and treatment outcome in GBM. In view of the advancement of imaging, multiple GBM (mGBM) lesions are increasingly recognized and reported. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for systematic review. Database was searched to collect relevant articles based on predefined eligibility criteria. Our observations suggest that multifocal/multicentric GBM has poorer outcome compared to GBM with singular lesion (sGBM). As the factors influencing the prognosis and outcome is poorly understood and there is no consensus in the existing literature, this review is clinically relevant. As patients with single lesion are more likely to undergo gross total excision, it is likely that further adjuvant treatment may be decided by extent of resection. This review will be helpful for design of further prospective randomized studies for optimal management of mGBM. © 2023 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practic.
Recent Advances in the Anatomical Sciences Education
(Brazilian Society of Anatomy, 2022) B.V. Murlimanju; Ebtesam Abdulla; Rakesh Mishra; Amit Agrawal
[No abstract available]
Sexual and Reproductive Dysfunction
(Nova Science Publishers, Inc., 2022) Rakesh Mishra; Bukkambudhi V. Murlimanju; Amit Agrawal
Sexual dysfunction is often ignored in the clinical setting of neurology, neurosurgery, and psychiatry. The caregivers and the patients are not very comfortable discussing sexual problems. Human sexual activity is a complex mechanism that requires interaction with or endocrine and nervous system. Plexus of nerves somatic and autonomic innervate the genitalia. Unlike other mammals, the psychogenic component plays a significant role in human sexual activity. Persons suffering from brain disorders often have sexual dysfunction. Particularly for young men, it can be devastating. With an increase in the incidence of neurotrauma, the prevalence of sexual dysfunction has also increased. There is a requirement of enhanced awareness on options of management available for sexual dysfunction. Such awareness among treating physicians, surgeons, and patients will significantly reduce the emotional burden and stress of sexual dysfunction. As other symptoms of neurological disorders like mood changes, anxiety, and memory issues can impact sexual activity, there are no uniform guidelines for assessing and managing sexual dysfunction. In this chapter, we present an outline of sexual dysfunction in neurological disorders, physiology, pathogenesis, and management options. We summarize the neurorehabilitation aspects and diagnosis of sexual dysfunction in brain disorders. By no means is the intention to provide an exhaustive list of references to the readers, and for further details, they are suggested for articles on individual neurological disorders. © 2022 by Nova Science Publishers, Inc.
Systematic review and meta-analysis of studies comparing baseline d-dimer level in stroke patients with or without cancer: Strength of current evidence
(Scientific Scholar LLC, 2024) Rakesh Kumar Mishra; Vishal K. Chavda; Luis Rafael Moscote-Salazar; Oday Atallah; Saikat Das; Tariq Janjua; Ved Prakash Maurya; Amit Agrawal
Objectives: D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. Materials and Methods: We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. Results: The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001. Conclusion: D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients. © 2024 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practice.
Systematic scoping review of papilledema in vestibular schwannoma without hydrocephalus
(Taylor and Francis Ltd., 2023) Rakesh Mishra; Subhas Kanti Konar; Adesh Shrivastava; Amit Agrawal; Suresh Nair
Background: Vestibular schwannoma is a common pathology encountered by neurosurgeons worldwide. Often vestibular schwannoma presents with obstructive hydrocephalus. Papilledema is present in 8% of the patients with vestibular schwannoma, primarily due to obstructive hydrocephalus. Hyperproteinorrhachia is believed to be responsible for papilledema in the absence of hydrocephalus in vestibular schwannoma. However, there is a paucity of literature on the mechanism of papilledema in vestibular schwannoma patients with hydrocephalus. Objective: The aim of this study was to conduct a scoping review of scientific literature on papilledema in vestibular schwannoma patients without hydrocephalus. Methods: Design: This was a systematic scoping review and critical appraisal. Literature Search from PubMed was done following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Joanna Briggs Institute guidelines for conducting and reporting scoping reviews. Results: A total of seven studies, including eight patients, were identified for inclusion in the review. The studies were heterogeneous in terms of reporting for various variables. All the included studies were case reports, with the earliest publication in 1954 and the latest publication in 2020. The mean age of the patients in the included studies was 35 years, with a minimum age of 20 years and maximum age of 64 years. Approximately 62.5% were females, and 37.5% were males in the included study. Only three studies have studied cerebrospinal fluid (CSF) proteins levels in these patients. Conclusions: There is paucity in literature and a lack of evidence to conclusively state hyperproteinorrhachia as an antecedent to the development of papilledema in vestibular schwannoma patients without hydrocephalus. Younger age and female gender are risk factors for developing papilledema in the absence of hydrocephalus in vestibular schwannoma patients. Brainstem compression due to the large size of vestibular schwannoma can still have a patent aqueduct of Sylvius and no obstruction to CSF flow. The development of papilledema in vestibular schwannoma is a complex interplay of multiple factors that must be studied comprehensively for complete understanding. © 2022 The Neurosurgical Foundation.