Background Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. Methods We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. Results Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4–50.2), taste disturbances (38.5%; 95%CI 24.0–53.0), myalgia (19.3%; 95% CI 15.1–23.6), headache (14.7%; 95% CI 10.4–18.9), dizziness (6.1%; 95% CI 3.1–9.2), and syncope (1.8%; 95% CI 0.9–4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0–3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9–3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2–0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1–0.6). Conclusions Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.

In stage II adenocarcinoma of the pancreatic head and uncinate process, serum bilirubin, histological differentiation and adjuvant chemotherapy were independent prognostic factors, and en-bloc vascular resection is a feasible option in carefully selected patients.

Statin plays a major role in the primary and secondary prevention of cardiovascular disease (CVD). Inconsistent findings in the studies have been observed toward the risk of intracerebral hemorrhage (ICH) using higher dose of statin. To examine this issue, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the association between higher dose of various statins and risk of ICH among patients with CVD. Literature was searched for studies published before June 10, 2015, using electronic database 'PubMed', 'EMBASE', and 'Google Scholar' as well as from many trial databases. The following search terms were used: 'Statin therapy' AND 'Cardiovascular Disease', AND 'Dose' AND 'Intracerebral hemorrhage', AND 'Randomized Controlled Trials' AND 'High Dose Statin'. High dose of statins was defined as atorvastatin 80 mg, simvastatin 80 mg, pravastatin 40 mg, rosuvastatin 20 mg per day. Fixed-effect model was used to estimate the risk ratio (RR) and 95% confidence interval (CI) if heterogeneity was <50%; otherwise, random-effect model was used. Begg's funnel plot was used to assess the publication bias. Seven RCTs involving 31,099 subjects receiving high-dose statin and 31,105 subjects receiving placebo were analyzed in our meta-analysis. A significant risk of ICH was observed in subjects with higher dose of statin (RR = 1.53; 95% CI: 1.16-2.01; P = 0.002). There was no difference in all-cause mortality between the two groups (RR = 0.95; 95% CI: 0.86-1.06; P = 0.36). No publication bias was observed through Begg's funnel plot. Higher dose of statins was found to be associated with the risk of ICH. Future studies are needed to confirm these findings.

BackgroundIn this mini review, we discuss some of the atypical neurological manifestations of dengue virus and attempt to bring them to attention to highlight the neurotropic property of the dengue virus.MethodsCases were chosen from retrospective hospital and outpatient records of all patients seropositive for dengue who attended the neurology referral. Seven patients have been chosen as illustrative examples of dengue-associated neurological involvement. We discuss the various central and peripheral nervous system involvement of patients and discuss the relevant findings in them.ConclusionThrough this case series, we wish to highlight that the dengue virus can affect the nervous system at various targets, using multiple mechanisms of pathogenesis to generate a plethora of presentations. Hence, it is vital to be aware of its presentations to be able to diagnose dengue and treat it accordingly.

Background: Previous studies examining the association of apolipoprotein E (APOE) gene polymorphism with the risk of ischemic stroke (IS) have yielded conflicting results. Therefore, we performed a meta-analysis to investigate the association between APOE ε4 gene polymorphism and risk of IS. Summary: A literature search for genetic association studies published before May 30, 2015, was conducted in the PubMed, EMBASE and Google Scholar databases. The following search terms were used: (apolipoprotein E) or (APOE) and (ε4) and (polymorphism) or (polymorphisms) and (‘ischemic stroke' or ‘IS') and (‘cerebral infarction' or ‘CI') and (‘genetic polymorphism' or ‘single nucleotide polymorphisms' or ‘SNP'). ORs and 95% CIs were used to calculate the strength of association. Begg's funnel plot was used to assess the potential for publication bias. In our meta-analysis, 26 case-control studies involving 6,397 IS cases and 19,053 controls were included. Overall significant association between carrier of ε4 allele and risk of IS was observed (OR 1.43, 95% CI 1.10-1.85, p = 0.007). In the subgroup analysis based on ethnicity, a significant association between Apo ε4 carrier and risk of IS was observed in Asian studies (OR 1.53, 95% CI 1.04-2.25, p = 0.031) whereas borderline significant association between APO ε4 carrier and risk of IS was observed in Caucasian studies (OR 1.36, 95% CI 0.95-1.93, p = 0.093). Key Messages: Our meta-analysis suggests that APOE ε4 allele is associated with higher risk of IS in Asian population as compared to Caucasian population.

Purpose: This study aimed to identify the factors influencing the surgical outcome in patients with T3 gallbladder adenocarcinoma (GBA). Methods: Between 1996 and 2006, 100 GBA patients who underwent surgical treatment in Chang Gung Memorial Hospital, Taiwan, were retrospectively reviewed. Among them, 39 patients with pathological stage T3 GBA were analyzed statistically in terms of demographic data and clinicopathological features. Results: The 1-, 3- and 5-year survival rates for patients with T3 GBA undergoing surgical treatment were 53.5, 37.0 and 32.9%, respectively. Univariate survival analysis revealed male gender, low serum carcinoembryonic antigen (CEA) level, and curative resection as factors which predicted favorable overall survival for T3 GBA patients. Multivariate survival analysis revealed low preoperative CEA levels and curative resections independently predicted favorable outcomes. Conclusions: Negative resection margin and serum CEA levels were found to be the independent prognostic factors in predicting long-term survival in patients with T3 GBA, and the serum CEA level was also found to be an independent prognostic factor in predicting the long-term prognosis of T0–T4 GBA; however, the result is preliminary due to the limited number of patients. Further studies with a large number of patients are necessary to confirm our result.

BackgroundSequence variations in genes involved in inflammatory system are known to contribute to the risk of cerebrovascular diseases (CVD) including stroke. Very few number of studies have been published in the context of the association between Interleukin-1α(IL-1α), CD14 cell surface glycoprotein (CD14), Galectin-2-encoding gene (LGALS2)and proteasome subunit type 6 (PSMA6) gene polymorphisms with susceptibility to ischemic stroke (IS).ObjectiveThe present meta-analysis aimed to provide a comprehensive account of the association between IL-1α (-C889T and -C511T), CD14 (-C159T), LGALS2 (-C3279T) and PSMA6 (-C8G) gene polymorphisms and susceptibility to IS.MethodsA literature search for eligible genetic studies published before August 31, 2015 was conducted in the PubMed, Medline, EMBASE, OVID, and Google Scholar databases. Fixed or random effects models were used to estimate the Pooled Odds ratio (OR) and 95% confidence interval (CI) using RevMan 5.3 software.ResultsTotal 21 studies were included in our meta-analysis. No significant association was observed between IL-1α (-C889T) [OR = 1.18, 95% CI: 0.67–2.08, P = 0.58], IL-1α (-C511T) [OR = 0.95, 95% CI: 0.66–1.37, P = 0.77], LGALS2(-C2379T) [OR = 0.29, 95% CI: 0.02–4.26, P = 0.37] and CD14 (-C260T) [OR = 0.93, 95% CI: 0.77–1.11, P = 0. 42] gene polymorphisms and risk of IS. However, protective level of association was observed between PSMA6 (-C8G) gene polymorphism and susceptibility to IS under the recessive model [OR = 0.25, 95% CI: 0.08–0.72, P = 0.01].ConclusionOur meta-analysis shows that IL-1α (-C889T and -C511T), CD14 (-C159T), LGALS2 (-C3279T) and gene polymorphisms are not significantly associated with the risk of IS while PSMA6 (-C8G) gene polymorphism may play a protective role with the susceptibility of IS. Further prospective large epidemiological studies are needed to confirm these findings in different populations.

Tumor necrosis factor-α (TNF-α) is a proinflammatory pleiotropic cytokine which may contribute to the initiation and progression of ischemic stroke (IS). Thus far, numerous studies have been performed to examine the association between -238G/A (rs361525) and -308G/A (rs1800629) polymorphisms in the promoter regions of the TNF-α gene and susceptibility to IS, but results are still conflicting. The aim of this meta-analysis is to provide a relatively comprehensive account of the association between TNF-α -238G/A and -308G/A gene polymorphisms and susceptibility to IS. A literature search for eligible candidate gene studies published before April 20, 2015, was conducted in the PubMed, Medline, EMBASE and Google Scholar databases. The following combinations of main keywords were used: (‘Tumor Necrosis Factor-Alpha' or ‘TNF-α') and (‘ischemic stroke' or ‘cerebral infarction' or ‘IS') and (‘genetic polymorphism' or ‘single nucleotide polymorphisms' or ‘SNP'). Fixed- or random-effect models were used to estimate the pooled odds ratio (OR) and 95% confidence interval (CI). Meta-analysis was carried out by using RevMan 5.3 software. For TNF-α -238G/A gene polymorphism, 7 case-control studies with a total of 1,846 IS patients and 1,905 controls showed a significant association with susceptibility to IS under a dominant model (AA + GA vs. GG; OR, 1.40; 95% CI, 1.11-1.76; p value 0.004). For TNF-α -308G/A gene polymorphism, 16 case-control studies with a total of 5,651 IS patients and 5,792 controls showed a significant protective association with susceptibility to IS under a dominant model (AA + GA vs. GG; OR, 0.78, 95% CI, 0.63-0.97; p value 0.03). Our meta-analysis shows that TNF-α -238G/A gene polymorphism is more likely to be associated with the risk of IS in Caucasian populations as compared to Asian populations. However, TNF-α -308G/A gene polymorphism is more likely to be protective against IS in Asian populations as compared to Caucasian populations. Further large, well-designed prospective epidemiological studies are needed to confirm these findings.