The perinatal period represents a time of profound neurobiological, cognitive, and emotional change. While evidence points to the neuroplasticity of matrescence as adaptive in supporting the transition to motherhood, the perinatal period also entails subjective reports of cognitive difficulty known as “mommy brain” as well as a heightened vulnerability to mental health challenges. The role of cognition in the etiology of postpartum depression is a promising area of investigation into targets for maternal mental health intervention, considering evidence that important cognitive changes occur during the perinatal period, and given that cognitive alterations are key features of mood disorders. Here we review evidence for cognitive plasticity in matrescence, with a particular focus on executive function (EF) given its overlapping significance for adaptation to parenthood, central role in managing the mental load of motherhood, and implications in mood regulation and mood disorders. We also review evidence for EF changes in perinatal depression and major depressive disorder more broadly. Despite the strong association between EF impairments and major depressive disorder, research on EF changes in perinatal depression remains limited. Understanding normative EF changes during this period is essential for better understanding the relationship between EF, perinatal depression, and the mental load of motherhood. Consideration for these cognitive, neurobiological, and psychosocial factors of matrescence is critical for addressing maternal mental health and developing interventions that support parental well-being.
Nour al dain Marzouka, Halima Alnaqbi, Amira Al-Aamri
et al.
Abstract The Human leukocyte antigen (HLA) molecules are central to immune response and have associations with the phenotypes of various diseases and induced drug toxicity. Further, the role of HLA molecules in presenting antigens significantly affects the transplantation outcome. The objective of this study was to examine the extent of the diversity of HLA alleles in the population of the United Arab Emirates (UAE) using Next-Generation Sequencing methodologies and encompassing a larger cohort of individuals. A cohort of 570 unrelated healthy citizens of the UAE volunteered to provide samples for Whole Genome Sequencing and Whole Exome Sequencing. The definition of the HLA alleles was achieved through the application of the bioinformatics tools, HLA-LA and xHLA. Subsequently, the findings from this study were compared with other local and international datasets. A broad range of HLA alleles in the UAE population, of which some were previously unreported, was identified. A comparison with other populations confirmed the current population’s unique intertwined genetic heritage while highlighting similarities with populations from the Middle East region. Some disease-associated HLA alleles were detected at a frequency of > 5%, such as HLA-B*51:01, HLA-DRB1*03:01, HLA-DRB1*15:01, and HLA-DQB1*02:01. The increase in allele homozygosity, especially for HLA class I genes, was identified in samples with a higher level of genome-wide homozygosity. This highlights a possible effect of consanguinity on the HLA homozygosity. The HLA allele distribution in the UAE population showcases a unique profile, underscoring the need for tailored databases for traditional activities such as unrelated transplant matching and for newer initiatives in precision medicine based on specific populations. This research is part of a concerted effort to improve the knowledge base, particularly in the fields of transplant medicine and investigating disease associations as well as in understanding human migration patterns within the Arabian Peninsula and surrounding regions.
Yating Zhang,1 Hongyan Wang,1 Jie Yang,2 Sanchun Wang,1 Weifang Tong,1 Bo Teng1 1Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China; 2Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of ChinaCorrespondence: Bo Teng, Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, Jilin Province, 130000, People’s Republic of China, Email tengbo1975@163.comPurpose: This investigation sought to elucidate the genetic underpinnings that connect obesity indicators, circulating blood lipid levels, adipokines levels and obstructive sleep apnea syndrome (OSAS), employing a bidirectional two-sample Mendelian randomization (MR) analysis that utilizes data derived from extensive genome-wide association studies (GWAS).Methods: We harnessed genetic datasets of OSAS available from the FinnGen consortium and summary data of four obesity indices (including neck circumference), seven blood lipid (including triglycerides) and eleven adipokines (including leptin) from the IEU OpenGWAS database. We primarily utilized inverse variance weighted (IVW), weighted median, and MR-Egger methods, alongside MR-PRESSO and Cochran’s Q tests, to validate and assess the diversity and heterogeneity of our findings.Results: After applying the Bonferroni correction, we identified significant correlations between OSAS and increased neck circumference (Odds Ratio [OR]: 3.472, 95% Confidence Interval [CI]: 1.954– 6.169, P= 2.201E-05) and decreased high-density lipoprotein (HDL) cholesterol levels (OR: 0.904, 95% CI: 0.858– 0.952, P= 1.251E-04). Concurrently, OSAS was linked to lower leptin levels (OR: 1.355, 95% CI: 1.069– 1.718, P= 0.012) and leptin receptor levels (OR: 0.722, 95% CI: 0.530– 0.996, P= 0.047). Sensitivity analyses revealed heterogeneity in HDL cholesterol and leptin indicators, but further multiplicative random effects IVW method analysis confirmed these correlations as significant (P< 0.05) without notable heterogeneity or horizontal pleiotropy in other instrumental variables.Conclusion: This investigation compellingly supports the hypothesis that OSAS could be a genetic predisposition for elevated neck circumference, dyslipidemia, and adipokine imbalance. These findings unveil potential genetic interactions between OSAS and metabolic syndrome, providing new pathways for research in this domain. Future investigations should aim to delineate the specific biological pathways by which OSAS impacts metabolic syndrome. Understanding these mechanisms is critical for developing targeted prevention and therapeutic strategies.Keywords: sleep disorders, metabolic syndrome, causal inference, GWAS
La polineuropatia desmielinizante inflamatoria crónica (CIDP), por sus siglas en inglés, es una polineurorradicu-lopatía predominantemente motora de etiología autoinmune. Su comienzo es insidioso y el curso crónico, afecta tanto a hombres como a mujeres con un ligero predominio en los primeros. Puede aparecer en cualquier etapa de la vida, es más frecuente a partir de la segunda década. Es necesario diferenciarla de otras enfermedades, ya que es potencialmente tratable, con buena respuesta a los inmunosupresores.
Su diagnóstico se sustenta en cuatro pilares: la clínica, los estudios neurofisiológicos, el estudio del líquido cefalorraquideo y los análisis anatomopatológicos. Desde su descripción inicial se han planteado numerosos criterios diagnósticos, aspecto polémico y controversial, ya que en la práctica clínica existen numerosos pacientes que no cumplen estrictamente con estos criterios pues presentan casos atípicos.
Por la dificultad en el diagnóstico de esta patología se realizó una revisión del tema, exponiendo los principales aspectos clínicos, electrofisiológicos, fisiopatológicos y anatomopatológicos, junto con una breve exposición de lo hallado en doce años de experiencia con esta patología en la Habana, Cuba.
Introduction
Appropriate and adequate treatment of psychiatric conditions in the community or at first presentation to the hospital may prevent rehospitalization. Information about hospital readmission factors may help to reduce readmission rates.
Objectives
The scoping review sought to examine the readmission of patients to acute psychiatric hospitals to determine predictors and interventions to reduce psychiatric readmission rates.
Methods
A scoping review was conducted in eleven bibliographic databases to identify the relevant peer‐reviewed studies. Two reviewers independently assessed full‐text articles, and a screening process was undertaken to identify studies for inclusion in the review. PRISMA checklist was adopted, and with the Covidence software, 75 articles were eligible for review. Data extraction was conducted, collated, summarized, and findings were reported.
Results
The outcome of the review shows that learning disabilities, developmental delays, and alcohol, drug, and substance abuse, were crucial factors that increased the risk of readmission. It was also established through the review that greater access to mental health services in residential treatment and improved crisis intervention in congregate care settings were indicated as factors that reduce the risk of readmission.
Conclusions
High rates of readmission may adversely impact healthcare spending. This study suggests a need for focused health policies to address readmission factors and improve community‐based care.
Disclosure of Interest
None Declared
Steve Chung, Jurriaan M. Peters, Kamil Detyniecki
et al.
Nasal administration of treatments for neurologic conditions, including rescue therapies to treat seizure clusters among people with epilepsy, represents a meaningful advance in patient care. Nasal anatomy and physiology underpin the multiple advantages of nasal administration but also present challenges that must be addressed in any successful nasal formulation. Nasal cavity anatomy is complex, with a modest surface area for absorption that limits the dose volume of an intranasal formulation. The mucociliary clearance mechanism and natural barriers of the nasal epithelia must be overcome for adequate absorption. An extensive vasculature and the presence of olfactory nerves in the nasal cavity enable both systemic and direct-to-brain delivery of drugs targeting the central nervous system. Two intranasal benzodiazepine rescue therapies have been approved by the US Food and Drug Administration for seizure-cluster treatment, in addition to the traditional rectal formulation. Nasal sprays are easy to use and offer the potential for quick and consistent bioavailability. This review aims to increase the clinician’s understanding of nasal anatomy and physiology and of the formulation of intranasal rescue therapies and to facilitate patient education and incorporate intranasal rescue therapies for seizure clusters (also known as acute repetitive seizures) into their seizure action plans.
Neurology. Diseases of the nervous system, Neurophysiology and neuropsychology
Yasemin Dinç, Aylin Bican Demir, Güven Özkaya
et al.
Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECT score have not been studied in acute ischemic stroke patients that received IV rt-PA treatment.
Natália de Oliveira Ferrarini , Izabely Lima Assunção, Márcia Andréa Silva Carvalho Sombra
et al.
Evidências crescentes sugerem que a farmacoterapia pode ser benéfica para alguns pacientes com transtorno da compulsão alimentar, um transtorno alimentar caracterizado por episódios repetitivos de consumo incontrolável de quantidades anormalmente grandes de alimentos sem comportamentos inadequados de perda de peso. Diante disso, este estudo teve como objetivo avaliar a eficácia de alternativas terapêuticas farmacológicas no tratamento do transtorno da compulsão alimentar. Assim, realizou-se uma revisão sistemática a partir da seleção de estudos científicos publicados nos anos de 2017 a 2022. Com base na análise e interpretação dos dados, concluiu-se que alternativas terapêuticas farmacológicas são recursos complementares tanto no tratamento do transtorno da compulsão alimentar como de sintomas de desordem alimentar e não substitutas. Nesse sentido, o uso de medicamentos tais como fluoxetina, lisdexamfetamina e simplicifolia, aliado a outros tratamentos, como a psicoterapia, podem ser eficazes para pacientes e suas necessidades específicas.
Blanca Rodríguez-Fernández, Natalia Vilor-Tejedor, Eider M. Arenaza-Urquijo
et al.
Abstract Telomere length (TL) is associated with biological aging, consequently influencing the risk of age-related diseases such as Alzheimer’s disease (AD). We aimed to evaluate the potential causal role of TL in AD endophenotypes (i.e., cognitive performance, N = 2233; brain age and AD-related signatures, N = 1134; and cerebrospinal fluid biomarkers (CSF) of AD and neurodegeneration, N = 304) through a Mendelian randomization (MR) analysis. Our analysis was conducted in the context of the ALFA (ALzheimer and FAmilies) study, a population of cognitively healthy individuals at risk of AD. A total of 20 single nucleotide polymorphisms associated with TL were used to determine the effect of TL on AD endophenotypes. Analyses were adjusted by age, sex, and years of education. Stratified analyses by APOE-ɛ4 status and polygenic risk score of AD were conducted. MR analysis revealed significant associations between genetically predicted longer TL and lower levels of CSF Aβ and higher levels of CSF NfL only in APOE-ɛ4 non-carriers. Moreover, inheriting longer TL was associated with greater cortical thickness in age and AD-related brain signatures and lower levels of CSF p-tau among individuals at a high genetic predisposition to AD. Further observational analyses are warranted to better understand these associations. Graphical Abstract
Neurosciences. Biological psychiatry. Neuropsychiatry, Neurology. Diseases of the nervous system
Vafi Salmasi, Theresa R. Lii, Keith Humphreys
et al.
Abstract. The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: ((“eligibility criteria” AND generalizability) OR (“exclusion criteria” AND generalizability) OR “exclusion criteria”[ti] OR “eligibility criteria”[ti]) AND pain. We only considered studies relevant if they analyzed data on (1) the prevalence and nature of exclusion criteria or (2) the impact of exclusion criteria on sample representativeness or study results. The 4 articles that were identified reported differences in patients who were included and excluded in different clinical trials: excluded patients were older, less likely to have a paid job, had more functional limitations at baseline, and used strong opioids more often. The clinical significance of these differences remains unclear. The pain medicine literature has very few published studies on the prevalence and impact of exclusion criteria, and the outcomes of excluded patients are rarely tracked. The frequent use of psychosocial exclusions is especially compromising to generalizability because chronic pain commonly co-occurs with psychiatric comorbidities. Inclusion of more representative patients in research samples can reduce recruitment barriers and broaden the generalizability of findings in patients with chronic pain. We also call for more studies that examine the use of exclusion criteria in chronic pain trials to better understand their implications.
Vinicius Lima, MD, Noel Schechtman, MD, David Araujo Junior, MD
et al.
Chronic subdural hematoma (cSDH) is classically defined as a collection of blood in the space between the dura mater and arachnoid meninges. Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the middle meningeal artery (MMA) the most used technique, though the best embolization material is still subject to studies. Methods: we present the detailed description of the technique for MMA embolization with a 20% solution of NBCA for the treatment of chronic subdural hematoma. Discussion: Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the MMA the most used technique, though the best embolization material is still subject to studies. NBCA is a low-cost embolic agent that has been used for a long time in endovascular treatments. Conclusion: There is great potential for MMA embolization in the management of chronic subdural hematomas, either as a single or adjuvant treatment. NBCA represents an effective and low-cost material.
Surgery, Neurology. Diseases of the nervous system
J. C. M. Prick, S. M. van Schaik, I. A. Deijle
et al.
Abstract Background Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke. Methods A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria. Results In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of: 1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient; 2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated “patients-like-me” model with outcome information about discharge destinations; 3) a summary sheet to support actual decision-making during consultation, containing the patient’s values and preferences concerning discharge planning. In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information. Conclusions The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness.
José Fidel Baizabal-Carvallo, Marlene Alonso-Juarez, Robert Fekete
Background: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor impairment. Freezing of gait, impaired mobility and falls are common problems in these patients. We aimed to evaluate the effect of a novel therapy for these patients. Methods: We studied patients with moderate to severe freezing of gait who underwent antigravity treadmill training twice a week for 4 consecutive weeks with 50% reduction of body weight. Results: We enrolled 26 consecutive patients with PD, 19 completed the study. There were 10 males; mean age at evaluation was 72.7 ± 10.1 years. Compared to baseline, patients showed improvement in the Freezing of Gait Questionnaire (<i>p</i> = 0.001); and a mean reduction of 7 s in the Timed Up & Go (TUG) test (<i>p</i> = 0.004). Moderate or significant improvement in gait was reported by 84% of patients. Conclusions: Antigravity treadmill training improved freezing of gait and mobility in patients with PD.
<p><strong>Background</strong></p><p>Dementia is a common, disabling disorder of the elderly. With the steady growth in the older population, the rate of dementia is expected to increase two fold by 2030 and three fold by 2050. Dementia of Alzheimer Type (DAT) and vascular dementia (VD) are among the most common types of dementia. Behavioral and psychological symptoms of dementia (BPSD) are associated with increased patient morbidity and carer burden.</p><p><strong>Aims</strong></p><p>The objective of this study was to compare symptoms of BPSD in patients with DAT and VD and to explore the correlates of BPSD in patients with DAT and VD.</p><p><strong>Methods</strong></p><p>Persons aged over 60 years, attending an outpatient clinic tertiary care centre in Northern India, who met diagnostic criteria for either DAT or VD, were included in the study. Outcomes of interest include socio-demographic details, level of cognitive functioning and the nature and severity of BPSD.</p><p><strong> </strong><strong>Results</strong></p><p>A total of 64 patients were included in the study, of whom 43 had DAT and 21 suffered from VD. Disturbance of activity levels was the most commonly seen feature of BPSD in both patients with DAT and VAD. There was no significant difference in the levels BPSD or of cognitive functioning between the two groups.</p><p><strong> </strong><strong>Conclusions</strong></p>BPSD is a common feature in patients with dementia. Increased clinician awareness and management of this problem is required to improve patient care and reduce carer burden.
Pharmacological Magnetic Resonance Imaging (phMRI) is a variant of conventional MRI that adds pharmacological manipulations in order to study the effects of drugs, or uses pharmacological probes to investigate basic or applied (e.g. clinical) neuroscience questions. Issues that may confound the interpretation of results from various types of phMRI studies are briefly discussed, and a set of methodological strategies that can mitigate these problems are described. These include strategies that can be employed at every stage of investigation, from study design to interpretation of resulting data, and additional techniques suited for use with clinical populations are also featured. Pharmacological MRI is a challenging area of research that has both significant advantages and formidable difficulties, however with due consideration and use of these strategies many of the key obstacles can be overcome.
Oculomotor events such as blinks and saccades transiently interrupt the visual input and, even though this mostly goes undetected, these brief interruptions could still influence the percept. In particular, both blinking and saccades facilitate switching in ambiguous figures such as the Necker cube. To investigate the neural state antecedent to these oculomotor events during the perception of an ambiguous figure, we measured the human scalp electroencephalogram (EEG). When blinking led to perceptual switching, antecedent occipital alpha band activity exhibited a transient increase in amplitude. When a saccade led to switching, a series of transient increases and decreases in amplitude was observed in the antecedent occipital alpha band activity. Our results suggest that the state of occipital alpha band activity predicts the impact of oculomotor events on the percept.
OBJECTIVE The number of U.S. medical graduates choosing careers in psychiatry is in decline. In order to determine whether this disinclination toward psychiatry occurs before versus during medical school, this study surveyed medical students at the start of their freshman year. METHOD Within the first 2 weeks of medical training, 223 freshman medical students from three Southwestern medical schools were surveyed with a questionnaire designed to assess their perceptions of careers in various specialties. RESULTS Responses suggest that new medical students most strongly value aspects of doctoring that seem to comport well with the actual practice of psychiatry: desire for interpersonal contact, helping patients, attractive lifestyle, and challenging work. However, these students begin their medical training viewing a career in psychiatry as distinctly and consistently less attractive than other specialties surveyed. More than one-quarter of the new medical students had already definitively ruled out a career in psychiatry. New medical students rated psychiatry significantly lower than each of the other specialties in regard to the degree to which it was a satisfying job, financially rewarding, enjoyable work, prestigious, helpful to patients, dealing with an interesting subject matter, intellectually challenging, drawing on all aspects of medical training, based on a reliable scientific foundation, expected to have a bright and interesting future, and a rapidly advancing field of understanding and treatment. CONCLUSIONS Contrasting these results with previous studies suggests that an erosion has occurred over the past two decades in the attitudes that new medical students hold toward psychiatry. The authors suggest that some of the negative attitudes are based on objectifiably false beliefs that should be actively targeted for remediation within the medical school curriculum.