Comparative efficacy of akathisia treatments: A network meta-analysis.

OBJECTIVE: Akathisia, a common side effect of psychotropic medications, poses a significant challenge in neuropsychiatry, affecting up to 30% of patients on antipsychotics. Despite its prevalence, akathisia remains poorly understood, with difficulties in diagnosis, patient reporting, and treatment efficacy. This research aimed to shed light on effective interventions to improve akathisia management. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, encompassing controlled trials in English and Italian languages. Databases, such asPubMed, Scopus, and EMBASE, were searched until July 9, 2023. Treatment effectiveness was assessed using standardized mean differences (SMDs) in post-treatment akathisia scores. RESULTS: Thirteen studies involving 446 individuals met the inclusion criteria. Benzodiazepines, beta-blockers, and NaSSA demonstrated significant efficacy as compared with placebo. Anticholinergic, anticonvulsant, triptan, and other treatments did not show significant differences. Benzodiazepines ranked highest in P-scores (0.8186), followed by beta-blockers and NaSSA. CONCLUSIONS: Effective management of akathisia is crucial, with benzodiazepines, beta-blockers, and NaSSA offering evidence-based options. Treatment rankings provide guidance for clinicians. Future research should prioritize larger, more robust studies to address limitations associated with small sample sizes and publication bias. This research enhances our understanding of interventions for akathisia, offering promising options to improve patient quality of life and prevent complications related to non-adherence and mismanagement.

Is Mental Health Worse in Medical Students than in the General Population? A Cross-Sectional Study.

Background and Objectives: In recent years, there has been a notable increase in university students experiencing severe mental illness. The transition to university life can be demanding, leading to mental health disorders. Persistent stress and anxiety can cause demotivation, difficulties with concentration, cognitive impairment, and reduced academic performance. Mental health issues can also impact social relationships and overall well-being. This cross-sectional study aims to investigate the mental health of medical students and compare it with the mental health of the non-student population. Materials and Methods: The survey collected demographic information such as age and gender. Participants were questioned about their self-perceived mental distress, diagnosed mental disorders, and history of therapy for mental distress. Various validated assessment tools were utilized to assess mental health and quality of life. Results: Medical students exhibit a higher self-perception of mental symptoms that does not translate into a significantly higher prevalence of diagnosed mental disorders. Medical students experience higher levels of anxiety and subclinical depressive symptoms and lower quality of life. Female participants reported lower QoL scores and higher levels of anxiety symptoms compared with male participants. While the prevalence of mental disorders did not differ significantly between genders (except for clinical anxiety), females tended to perceive a higher burden of mental health challenges. Conclusions: By addressing mental health issues among medical students, especially females, institutions can create a more supportive and conducive learning environment. Encouraging open conversations about mental health and providing accessible mental health services can help in destigmatizing mental health challenges and promoting early intervention when needed.

High-Energy Cosmic Ray Self-Confinement Close to Extra-Galactic Sources.

The ultrahigh-energy cosmic rays observed on the Earth are most likely accelerated in extra-Galactic sources. For the typical luminosities invoked for such sources, the electric current associated to the flux of cosmic rays that leave them is large. The associated plasma instabilities create magnetic fluctuations that can efficiently scatter particles. We argue that this phenomenon forces cosmic rays to be self-confined in the source proximity for energies E

[The Treatment of Acute Antibody-Mediated Rejection: Current State and Future Perspectives].

Despite the advances in the immunosuppressive therapies and improvements in short term allograft survival, Antibody-mediated rejection (AMR) still represents the leading cause of late allograft failure in kidney transplant recipients. We present an insidious case of late active AMR that evolved into a severe chronic active antibody-mediated rejection, that we treated with a multidrug approach. Then, we review the current literature on the pathogenesis, diagnosis and treatment of AMR. Antibody-mediated rejection (AMR) typically occurs when anti-HLA donor-specific antibodies (DSA) bind to vascular endothelial cells of the kidney graft. DSAs may preexist to transplantation (preformed DSA) or develop after transplantation (de novo DSA). Pathogenetic mechanisms of AMR involve complement-dependent, and -independent inflammatory pathways that are variably activated depending on antigen and antibody characteristics, or on whether rejection develops early (0-6 months) or late (beyond 6 months) post-transplantation. The Banff classification system categorizes AMR rejection into active antibody-mediated rejection, chronic active antibody-mediated rejection, and chronic (inactive) antibody-mediated rejection. Currently, there are no approved therapies, treatment guidelines being based on low-quality evidence. Therefore, standard of care therapy is consensus-based. In early rejection, it is usually based on plasma exchange, intravenous immune globulin, anti-CD20 antibodies, while complement-inhibitor eculizumab is used in severe and/or refractory cases, treatments with. Recent evidence suggests that late AMR may be effectively treated with anti-CD38 therapy, which targets long lived plasma cells and NK cells.

Borderline rejection: To treat or not to treat?

INTRODUCTION: It is unclear whether kidney transplant recipients with a biopsy diagnosis as a "borderline" acute T-cell mediated rejection (TCMR) requires the treatment with intravenous (iv) steroids pulse plus/minus intensification of the maintenance therapy (TRT) in comparison with the simple clinical follow-up (F-UP). METHODS: We retrospectively followed a consecutive series of kidney transplant recipients diagnosed with a borderline acute TCMR at biopsy by surveillance or clinical indication for 12 months and compared TRT and F-UP groups. We evaluated trends in renal function by measuring estimated glomerular filtration rate (eGFR) using multiple regression models. Repeated eGFR measures (REML) were adjusted for potential confounding factors for 12 months. The difference in 12-month eGFR values were observed in the TRT vs F-UP groups, type of biopsy, as well as the surveillance vs. clinical outcomes. RESULTS: Out of 59 included patients, 37% of them were in the TRT group and remaining 63% in the F-UP group. As expected, the TRT group had, at the time of biopsy, lower eGFR value of 39.0 ml/min/m2 [16.5] in comparison to 49.6 [19.6] ml/min/m2 in the F-UP group (P = 0.043), Similarly, the TRT group required more frequent clinical biopsies vs. F-UP group (68% vs. 32%; P = 0.014). However, the TRT group recovered kidney function reaching the eGFR values of the F-UP group at 12 months; the increase being significant only in patients who received indication biopsies (P < 0.001). The estimated adjusted TRT effect on 12-month eGFR change after indication biopsy was improved by +15.8 ml/min/1.73m2 (95%CI: +0.1 to +31.4 ml/min/1.73 m2; P = 0.048 by three-way interaction term) compared to the F-UP group. CONCLUSION: Our preliminary study supports the indication for the treatment of acute borderline TCMR only in cases with biopsies performed by clinical indication.