Unlocking Therapeutic Potential: The Role of Theta Burst Stimulation in Multiple Sclerosis Management.

Objective: Current therapies for multiple sclerosis (MS) often have limited efficacy and side effects, necessitating alternative approaches. Noninvasive brain stimulation (NIBS), such as transcranial direct current stimulation and transcranial magnetic stimulation (TMS), offers potential solutions. Among NIBS techniques, theta burst stimulation (TBS) is notable for its ability to modulate cortical activity. The objective of this systematic review is to assess the impact of TBS on MS symptoms.Data Sources: The study conducted rigorous systematic searches in PubMed, Google Scholar, and Scopus databases up to June 2023, using specific Medical Subject Headings terms related to NIBS and MS, such as TMS and TBS, in conjunction with terms like MS or demyelinating disease. Additionally, the bibliographic references of included studies, book chapters, and original articles were manually reviewed.Study Selection: The study selection process involved a 2-tiered screening mechanism, beginning with an evaluation of titles and abstracts, followed by a full-text review of selected articles. Inclusion criteria incorporated randomized controlled trials (RCTs) focusing on TBS with MS patients. Exclusion criteria included non-qualitative, non-MS, and non-TBS studies. Risk of bias assessment was conducted using the 2008 Cochrane Risk of Bias 2 Scale for RCTs.Data Extraction: Data extraction was conducted by thoroughly reviewing each research article and systematically recording the relevant information using a standardized data extraction form, ensuring consistency and accuracy throughout the process.Results: In a systematic review encompassing 5 randomized controlled trials involving 117 individuals with relapsing-remitting or secondary progressive MS across Italy, France, and Russia, various forms of TBS were applied. These interventions ranged from intermittent TBS (iTBS) to continuous intermittent TBS (c-iTBS) that demonstrated favorable outcomes. Notably, TBS interventions led to significant reductions in spasticity, fatigue, and pain, with c-iTBS combined with vestibular rehabilitation showing additional improvements in vestibular-ocular reflexes, gait, and balance. While specific protocols varied among the studies, collectively, the results suggest promise for TBS approaches in alleviating MS-related symptoms.Conclusions: The findings of this review suggest that TBS may hold promise in addressing specific MS symptoms, notably fatigue and spasticity. Future research should include a more diverse participant pool to explore TBS effects across different MS subtypes and aim for larger sample sizes to enhance statistical power and result reliability.Prim Care Companion CNS Disord 2024;26(2):23r03645. Author affiliations are listed at the end of this article.

Modern Psychedelic Microdosing Research on Mental Health: A Systematic Review.

Objective: To investigate the relationship between psychedelic microdosing and its effects on mental health, aiming to understand if microdosing can improve mental well-being.Data Sources: PubMed and Scopus were searched on December 25, 2022, using search terms related to psychedelics, microdosing, and mental health. The inclusion criteria focused on studies published between January 1, 2012, and November 30, 2022. There were no language restrictions for the initial search; however, for the study selection, only articles in English were considered.Study Selection: A total of 45 articles were initially identified. After removing duplicates, 27 unique articles were screened based on their titles and abstracts, resulting in 19 articles included in the final review. The studies were selected based on their relevance to the relationship between mental health and psychedelic microdosing.Data Extraction: The extracted data from the selected studies included sample sizes, demographics, survey designs, and qualitative and quantitative analyses related to the outcomes of individuals with mental health issues who also engaged in psychedelic microdosing. The QualSyst Quality Assessment Checklist was used to assess the methodological rigor and quality of each study. The data extraction process involved systematically reviewing each article and summarizing key findings related to the impact of microdosing on mental health.Results: The review revealed that microdosing psychedelics, such as lysergic acid diethylamide and psilocybin, showed potential benefits on mental health. Users reported positive effects, including improved mood, increased focus, and better daily function. However, there were also challenges reported, such as physiologic discomfort and increased anxiety. Some studies observed that positive expectations about microdosing led to positive outcomes. The studies varied in design, with some being observational, others placebo-controlled, and some relying on self-reported data.Conclusions: There is a growing body of evidence suggesting a positive correlation between psychedelic microdosing and improved mental well-being. However, due to the limited number of controlled studies and the small sample sizes in some of the studies, the causal relationship between microdosing and mental health improvement remains uncertain. The review calls for further research with double-blind experiments, control groups, and larger sample sizes that represent the general population to better understand the potential benefits and risks of psychedelic microdosing on mental health.Prim Care Companion CNS Disord 2024;26(1):23r03581.Author affiliations are listed at the end of this article.

Association of Body Dysmorphic-Induced Anabolic-Androgenic Steroid Use With Mental Health Outcomes: A Systematic Review.

Objective: To explore the relationship between body dysmorphic disorder (BDD), anabolic-androgenic steroid use (AAS) use, and mental health outcomes and to identify potential interventions and treatments that may help mitigate these detrimental effects.Data Sources: PubMed, Scopus, CINAHL, Embase, and PsycINFO were searched from 1992 to 2022 with no language limits. Search terms included "AAS" AND "mental health outcomes" AND "body dysmorphia" and were expanded in PubMed to include "anabolic steroids induced depression," "anabolic steroids induced depression in athletes," "steroids," "mental health," and "performance-enhancing drugs."Study Selection: Forty-one articles were identified, and 37 remained after duplicates were removed. After full-text appraisal, 33 articles were included in the final review.Data Extraction: Two reviewers independently screened studies for inclusion criteria, extracted pertinent data, and assessed the quality of evidence.Results: Bodybuilders and fitness athletes may be more susceptible to developing muscle dysmorphia, having disordered eating habits, and using performance-enhancing drugs like AAS. The COVID-19 pandemic increased reliance on social media and online interactions, which was previously associated with disordered eating patterns and negative body image. Being a member of a sexual minority may increase one's risk of developing muscle dysmorphia and other types of BDD, as these individuals may experience additional stressors and difficulties due to stigma and discrimination, which may worsen one's sense of self and body image.Conclusion: The development and evaluation of interventions such as cognitive-behavioral therapy, mindfulness-based interventions, and peer support programs, should be prioritized to deter AAS use in people at risk.Prim Care Companion CNS Disord 2023;25(5):23r03532. Author affiliations are listed at the end of this article.

Lactate concentration gradient from right atrium to pulmonary artery.

INTRODUCTION: We compared simultaneous measurements of blood lactate concentration ([Lac]) in the right atrium (RA) and in the pulmonary artery (PA). Our aim was to determine if the mixing of right atrial with coronary venous blood, having substantially lower [Lac], results in detectable decreases in [Lac] from the RA to the PA. METHODS: A prospective, sequential, observational study was conducted in a medical-surgical intensive care unit. We enrolled 45 critically ill adult individuals of either sex requiring pulmonary artery catheters (PACs) to guide fluid therapy. Immediately following the insertion of the PAC, one paired set of blood samples per patient was drawn in random order from the PAC's proximal and distal ports for measurement of hemoglobin concentration, O2 saturation (SO2) and [Lac]. We defined Delta[Lac] as ([Lac]ra - [Lac]pa), DeltaSO2 as (SraO2 - SpaO2) and the change in O2 consumption (DeltaVO2) as the difference in systemic VO2 calculated using Fick's equation with either SraO2 or SpaO2 in place of mixed venous SO2. Data were compared by paired Student's t-test, Spearman's correlation analysis and by the method of Bland and Altman. RESULTS: We found SraO2 > SpaO2 (74.2 +/- 9.1 versus 69.0 +/- 10.4%; p < 0.001) and [Lac]ra > [Lac]pa (3.9 +/- 3.0 versus 3.7 +/- 3.0 mmol x l-1; p < 0.001). Delta[Lac] correlated with DeltaVO2 (r2 = 0.34; p < 0.001). CONCLUSION: We found decreases in [Lac] from the RA to PA in this sample of critically ill individuals. We conclude that parallel decreases in SO2 and [Lac] from the RA to PA support the hypothesis that these gradients are produced by mixing RA with coronary venous blood of lower SO2 and [Lac]. The present study is a preliminary observation of this phenomenon and further work is needed to define the physiological and clinical significance of Delta[Lac].

Laparoscopic splenectomy for isolated sarcoidosis of the spleen.

Sarcoidosis is a granulomatous disease of unknown etiology. Over 90% of patients with sarcoidosis present with pulmonary findings at the time of diagnosis. Extrapulmonary involvement is common, including the liver, eyes, central nervous system, lymph nodes, and joints. However, isolated granulomatous disease confined to the spleen is rare. This report documents a rare case of isolated granulomatous disease of the spleen diagnosed and treated laparoscopically. A 47-year-old female presented to her internist with nausea and mild epigastric abdominal pain. Laboratory evaluation revealed slightly elevated bilirubin and liver function tests as well as neutropenia. An abdominal ultrasound revealed normal biliary and pancreatic anatomy and multiple splenic lesions. Computed tomography of the abdomen confirmed the multiple hypodense lesions within the spleen. The differential diagnosis at this time included neoplasm, infection, and autoimmune etiologies. Subsequently, the patient underwent a diagnostic laparoscopy with splenectomy. No other intra-abdominal pathology was found. Pathology revealed multiple noncaseating, splenic granulomas. Isolated extrapulmonary manifestations of sarcoidosis occur in only 10% of these patients. Moreover, isolated splenic sarcoidosis is rare. Currently, the literature documents only two prior cases of sarcoidosis presenting with isolated splenic lesions. Primary management consists of medical therapy with prednisone, methotrexate, and/or antimalarial drugs. Indications for surgery include symptomatic splenomegaly, severe hypersplenism, prophylaxis for splenic rupture, and neoplastic exclusion. Our patient required a laparoscopic splenectomy for diagnostic purposes and neoplastic exclusion. Once diagnosed, patients require continual follow-up for systemic manifestations and associated complications of sarcoidosis.

Lack of equivalence between central and mixed venous oxygen saturation.

STUDY OBJECTIVE: We compared paired samples of central venous O(2) saturation (Scvo(2)) and mixed venous O(2) saturation (Svo(2)) to test the hypothesis that Scvo(2) is equivalent to Svo(2). We also compared O(2) consumption (Vo(2)) computed with Scvo(2) (Vo(2)cv) to that computed with Svo(2) (Vo(2)v). DESIGN: Prospective, sequential, observational study. SETTING: Combined medical-surgical ICU. PATIENTS: Fifty-three individuals > 18 years of age of either sex who required a pulmonary artery catheter (PAC) to guide fluid therapy. Subjects were identified as postsurgical (32 patients) or medical (21 patients) according to their ICU admission diagnosis. INTERVENTIONS: A PAC was inserted through the internal jugular or subclavian veins. Care was taken to place the PAC proximal port approximately 3 cm above the tricuspid valve. Blood samples were drawn from the proximal and distal ports in random order. An arterial blood sample also was drawn. MEASUREMENTS: Cardiac output in triplicate, systemic pressure, and central pressure. We analyzed blood samples for hemoglobin concentration and O(2) saturation (So(2)). Data were compared by correlation analysis and by the method of Bland and Altman. RESULTS: Svo(2) was consistently lower than Scvo(2) (p < 0.0001), with a mean (+/-SD) bias of -5.2 +/- 5.1%. Similar differences in Scvo(2) and Svo(2) were present within each subgroup (p < 0.001). A lower Svo(2) resulted in Vo(2)v values that were higher than the Vo(2)cv values for all patients in the study (mean Vo(2)v, 236.7 +/- 103.4 mL/min; mean Vo(2)cv, 191.1 +/- 84.0 mL/min; p < 0.001) as well as for patients within each subgroup (p < 0.001). CONCLUSIONS: Measurements of Scvo(2) and Svo(2) were not equivalent in this sample of critically ill patients. Moreover, substituting Scvo(2) for Svo(2) in the calculation of Vo(2) produced unacceptably large errors. The decrease in So(2) between Scvo(2) to Svo(2) may result from the mixing of atrial and coronary sinus blood. As such, this difference may be a marker of myocardial O(2) consumption.