Outcomes and Factors Affecting Transcranial Direct Current Stimulation in Alzheimer's Disease Patients: A Systematic Review.

INTRODUCTION: Alzheimer's disease (AD) is the most common form of dementia. There have been various proposed pharmacologic and non-pharmacologic treatments proposed for preventing cognitive decline in AD patients. Transcranial Direct Current Stimulation (tDCS) is a neuromodulation technique used to enhance cognitive functions and motor skills of the brain. Our study aimed to assess the effects of tDCS in AD patients, including effects on general cognitive status, memory, attention, executive functions, language, IQ, and neuropsychological effects, along with the factors influencing the outcomes. METHODS: Systematic searches were conducted for relevant evidence using PubMed, ScienceDirect, and Cochrane Library databases for (Transcranial Direct Current Stimulation) and (Alzheimer's). Duplicates were removed, and the remaining articles were screened for double-blind, placebo-controlled, randomized clinical trials (Phase III), case studies, and case series on patients diagnosed with AD using tDCS. The articles were assessed for full text, and studies were selected and analyzed to include in the review. RESULTS: Overall, 20 studies were reviewed. Cognitive status, executive function and working memory, recognition memory, and language function may improve following AtDCS depending on the stimulation polarity and area stimulated. No significant effects of tDCS were seen on attention, associative memory, recall memory, visuospatial ability, and neuropsychiatric symptoms. DISCUSSION: Therapy outcomes and the factors that could affect them were analyzed, which included the number of sessions taken, current density, stimulation polarity (cathodal/anodal/dual), area stimulated, training(s) given, and study timeline. CONCLUSION: tDCS is a well-tolerated therapy that can be used for improving several cognitive domains in patients having Alzheimer's disease. Its treatment outcomes are affected by polarity (cathodal/ anodal), site of stimulation, number of sessions taken, and any training(s) given during the study.

Rituximab in the Management of Refractory Myasthenia Gravis and Variability of Its Efficacy in Anti-MuSK Positive and Anti-AChR Positive Myasthenia Gravis.

Myasthenia gravis affects the neuromuscular junction of the skeletal muscles. It results in muscle weakness involving skeletal muscles (diaphragm, extraocular muscles) and myasthenic crisis. Treatment options for myasthenia gravis management have expanded, including azathioprine, corticosteroids, plasma exchange, and tacrolimus. Unfortunately, a few cases of myasthenia gravis don't respond to conventional treatment modalities. Monoclonal antibodies, rituximab (RTX), are novel treatments that have garnered interest as of late due to their efficacy within the patient population presented with refractory form myasthenia gravis. This review aims to showcase how RTX is an effective treatment within different forms of myasthenia gravis. A limited review was performed using databases that include PubMed and Google Scholar. The following keywords were used: "myasthenia gravis," "rituximab," "monoclonal antibody," "anti-AChR antibody," and "refractory myasthenia." The review focused on case reports, human studies, or research surveys based on the inclusion criteria of human studies involving participants more than 18 years of age and published in English literature. Out of 69 articles, 14 were duplicates, and 29 were relevant and met the inclusion criteria. The findings from the study demonstrate that patients with refractory myasthenia gravis responded well to RTX treatment. Furthermore, RTX has been shown to decrease corticosteroid dependence, induce sustained remission, and have a favorable response to anti-MuSK antibody positive myasthenia gravis compared to anti-AChR antibody positive myasthenia gravis. This literature review suggests that patients with refractory myasthenia gravis can benefit from rituximab; however, it has a variable response in different forms of myasthenia gravis.

Fetal Complications in COVID-19 Infected Pregnant Woman: A Systematic Review and Meta-Analysis.

Background Pregnancy is an immunocompromised state and, for this reason, a pregnant woman is at a higher risk of getting infected as compared with a healthy individual. There is limited data available regarding the impact of COVD-19 on pregnancy; however, the case of miscarriage due to placental infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in second trimester has already been reported. Methods We searched for all published articles in PubMed, Science Direct, Cochrane, Scopus, and Embase. The literature search produced 167 relevant publications; 67 manuscripts were further excluded because they did not satisfy our inclusion criteria. Out of the remaining 100 articles, 78 were excluded after full text screening. Therefore, a total of 22 articles were eligible for review in our study. Results Overall, these 22 studies included a total of 7,034 participants: 2,689 (38.23%) SARS-CoV-2 positive pregnant women, of which 2,578 (95.87%) were laboratory confirmed and 111 (4.13%) were clinically diagnosed. Among the positive patients, there were 174 (6.47%) cases of abortion, of them 168 (96.55%) were spontaneous abortions and 6 (3.45%) were missed. Most patients either reported mild symptoms of fever, cough, fatigue, and anosmia or they presented asymptomatic. Conclusion Additional investigation and rigorous research are warranted to confirm placental pathology mechanisms concerning COVID-19 to protect maternal and fetal health.