Cholinergic Neurons in Nucleus Subputaminalis in Primary Progressive Aphasia.

BACKGROUND: Primary Progressive Aphasia (PPA) is a syndrome characterized by an isolated impairment of language function at disease onset. The cholinergic system is implicated in language function and cholinergic deficits are seen in the brains of individuals with PPA. One major source of cholinergic innervation of the cerebral cortex is the nucleus basalis of Meynert (NBM) within which lies the nucleus subputaminalis (NSP). This nucleus is postulated to be involved in language function. We compared the abundance of cholinergic neurons in the NBM and NSP of controls and individuals with PPA. Also explored was whether the individuals presenting with PPA, who subsequently developed different clinical and neuropathological profiles, showed similar cholinergic deficits in the NSP. METHODS: Cytoarchitecture of the basal forebrain was studied using Nissl staining in control (n = 5) and PPA (n = 5) brains. Choline acetyltransferase (ChAT) immunohistochemical staining labeled cholinergic neurons were quantified using Neurolucida software. RESULTS: In comparison to matched controls, PPA showed reduction of cholinergic neurons in the NBM (t(8) = 4.04, p = 0.0037; Cohen's effect size value d = 2.62) and the NSP (t(6) = 4.62, p = 0.0042; Cohen's d effect size d = 2.92). The average percent of cholinergic neuronal loss was relatively higher in the NSP (64.7%) compared to the NBM (47.7%). CONCLUSION: Regardless of underlying pathology, all cases presenting with PPA showed a marked loss of cholinergic neurons in the NSP, providing further evidence for the importance of this nucleus in language function.

Primary Care Physicians' Knowledge, Perceptions, and Comfort Level in Managing Patients Fasting in Ramadan.

Background: Once a year, Muslims fast from dawn to sunset during the month of Ramadan. While fasting has many positive health implications, it may pose risks to individuals with underlying health issues. Despite the exemption from fasting for those who are ill, many Muslims with chronic conditions choose to fast. It is unclear how many Muslim patients receive counseling on fasting. As such, the purpose of this pilot project was to assess the knowledge, perception, and comfort level of primary care physicians (PCPs) at Dalhousie University's Department of Family Medicine in managing patients choosing to fast during Ramadan. Methods: A 16-item anonymous, self-administered, structured online survey was distributed to PCPs with an academic affiliation with the Department of Family Medicine at Dalhousie University. Participants rated their level of comfort, objective knowledge, and perceptions of managing patients fasting in Ramadan. Results: Many PCPs perceived the importance of understanding Ramadan fasting and its relevance to their patients' health, however, they did not have adequate knowledge about the matter. The majority of PCPs felt they received inadequate training in this area and did not feel comfortable counseling and managing the health of these patients. Conclusions: The findings of this study have outlined a knowledge gap that exists within our PCP community and will help inform and prioritize educational needs and direct efforts to ensure safe patient management during Ramadan.

Neurosarcoidosis resulting in thoracic radiculopathy: a case report.

BACKGROUND: Thoracic radiculopathy is a rare etiology of vague abdominal pain. There are few reports of neurosarcoidosis manifesting as a thoracic radiculopathy, which highlights the diagnostic challenge. CASE PRESENTATION: A 54-year-old Caucasian man was being investigated for right upper quadrant abdominal pain and was found to have diffuse lymphadenopathy on imaging. He was eventually diagnosed with sarcoidosis. Over time, his abdominal pain progressed to neuropathic pain along his T7-T11 dermatome. Magnetic resonance imaging revealed findings consistent with a thoracic radiculopathy due to neurosarcoidosis. The patient received corticosteroids for treatment of neurosarcoidosis and immunosuppressant therapy to manage neuropathic pain. CONCLUSIONS: This case report highlights the importance of considering thoracic radiculopathies in the differential diagnosis of vague abdominal pain and explores guidelines in diagnosing neurosarcoidosis in the absence of neural tissue biopsy.