Introduction/Objective: Emotional, mental, or psychological distress, defined as increased symptoms of depression, anxiety, and/or stress, is common in patients with chronic diseases, such as cardiovascular (CV) disease (CVD). Methods: Literature was reviewed regarding data from studies and meta-analyses examining the impact of emotional stress on the occurrence and outcome of several CVDs (coronary disease, heart failure, hypertension, arrhythmias, stroke). These influences' pathophysiology and clinical spectrum are detailed, tabulated, and pictorially illustrated. Results: This type of stress is a newly recognized risk and prognosticator for CVD including coronary artery disease, heart failure, hypertension, cardiac arrhythmias, and stroke, independently of conventional risk factors. It can impact CV outcomes, and also affect health care utilization, with more patient visits to health care facilities. The biological systems activated by mental stress comprise the sympathetic nervous system (SNS), the renin-angiotensin system (RAS), and the hypothalamic- pituitary-adrenal (HPA) axis, while several other biological processes are disrupted, such as endothelial function, inflammatory responses, oxidative stress, mitochondrial function and the function of the amygdala which is the central nervous system processing center of emotions and emotional reactions. Conclusion: Emotional stress that aggravates symptoms of depression, anxiety, and/or perceived mental stress is common in patients with chronic diseases, such as CVD. It is a newly recognized risk and prognosticator for several CVDs. It can influence CV outcomes, and also affect health care utilization. The biological systems activated by mental stress comprise the SNS, the RAS, and the HPA axis, while several other biological processes are disrupted.

Introduction/Objective: Atrial fibrillation (AF) could present with slow ventricularresponse; bradycardia could facilitate the emergence of AF. The conviction that one “does not succumb” from bradycardia as an escape rhythm will emerge unless one sustains a fatal injury following syncope is in stark difference with ventricular tachyarrhythmia (VA), which may promptly cause cardiac arrest. However, this is not always the case, as a life-threatening situation may emerge during the bradycardic episode, i.e., the development of bradycardia-induced VAs, which could be fatal if there is no prompt intervention. Methods: An extensive review of the literature was undertaken with key words including but not limited to AF, bradycardia, bradyarrhythmia, AF and bradycardia, slow ventricular response, sinus node dysfunction, sick sinus syndrome, tachycardia-bradycardia syndrome. Results: AF is the commonest cardia arrhythmia worldwide and may be part of sick sinus syndrome, commonly presenting as bradycardia-tachycardia syndrome. Importantly, bradycardia-related cardiomyopathy and heart failure, as well as an adverse influence on brain function, may all be eluding consequences of this type of syndrome. Bradycardia could be the inciting mechanism for the occurrence of AF, and when the bradycardia is eliminated, AF may not recur. The bradycardia-related long-short-long sequence triggering VAs can be averted by pacing at rates ~80-110 bpm either via temporary or permanent pacing as needed. Conclusion: Balancing the benefits and risks of bradycardia together with other risks of antiarrhythmic drug and/or pacing management of AF versus those of catheter ablation is indeed a vexing problem; all these issues are herein discussed, tabulated, and pictorially illustrated.

Respiratory syncytial virus (RSV) causes significant morbidity and mortality, especially in young children and the elderly. RSV vaccine development puzzled vaccinologists for years. Safety concerns of initial formulations, the lack of an absolute correlate of protection, and the need for selecting appropriate virus attenuation and antigen-adjuvant combinations contributed to delayed vaccine production. The recent stabilization of the RSV-F glycoprotein in the prefusion (preF) conformation that constitutes the primary target of RSV-neutralizing antibodies was key for efficient vaccine design. Two protein subunit vaccines (GSK's Arexvy and Pfizer's Abrysvo) and one mRNA RSV vaccine (Moderna's mRESVIA) are now available. This article aims to provide a comparative overview of the safety and efficacy of novel RSV vaccines that are approved for the prevention of RSV-lower respiratory tract disease (LRTD) in adults 60 years of age and older, with updated recommendations calling for the expansion of vaccination to all adults at increased risk for severe RSV disease. Abrysvo is the only vaccine indicated for use in pregnancy to prevent RSV-LRTD in infants from birth to 6 months of age. We provide a comparative assessment of the efficacy of approved RSV vaccines over a maximum of three seasons, summarizing currently available data. We conclude that despite the decreasing vaccine efficacy over time, which should be anticipated for a virus that is characterized by short-term immunity, efficacy was clinically meaningful over placebo. The increased risk of Guillain-Barré syndrome post vaccination with Abrysvo or Arexvy, which prompted the FDA to require the inclusion of such warnings in the prescribing information of these two RSV vaccines, should be prioritized and investigated thoroughly. Furthermore, ongoing vaccine surveillance and further evaluation, particularly among immunocompromised patients, frail elderly subjects, and young infants that were under- or not represented in pivotal clinical trials, are necessary. As in the success story of combined pediatric vaccines, combination vaccines, conferring protection against several respiratory illnesses in one dose, could help improve vaccine acceptance and coverage rates in older adults.

Background: Self-stigma significantly affects the outcome of mental illnesses as it affects the individual on a physical, functional, psychological, and emotional level. Attitudes towards mental illness are common indicators of social stigma. Aim: The main purpose of the present study was to investigate the relationship between self-stigma, functionality, and attitudes toward mental illness, among mentally ill persons. Material and methods: A quantitative cross-sectional study conducted, and questionnaires used to collect data. Specifically, the ISMI, ASMI and WHODAS scales used. The sample consisted of 130 participants with some mental illness, aged 18-65 years located in three Public Psychiatric Hospitals of Attica. Results: The 40% of participants were high school graduates, 69.2% were unemployed, while 62.3% lived with family or friends. living status (p 0.008), experience of discrimination (p 0.021) and resilience to stigma (p 0.002) were significantly associated with high rates of total disability. Accordingly, stereotype internalization (p 0.003) was significantly related to desire for social distance from temporary relationships. Female gender (p=0.044) was associated with optimism about the outcome of mental illnesses. Participants who lived alone (p=0.018) had less favorable coping with mental illness. Experiencing discrimination (p=0.031) was associated with understanding more negative perceptions of mental illness. Conclusion: Self-attribution and reproduction of stereotypical perceptions, as well as low functioning create greater rates of social stigma among people with mental illnesses. The findings above highlight the power of social stereotypes over scientific documentation and emphasize the necessity of awareness, information, and psychoeducation programs.

Sleep disturbance is considered a risk factor for cognitive decline in elderly individuals. Our aim in the current study was to investigate whether baseline sleep parameters can predict the conversion from normal cognition to mild cognitive impairment or dementia at follow-up. The Hellenic Longitudinal Investigation of Aging and Diet is a longitudinal population-based study designed to estimate the prevalence and incidence of cognitive decline and dementia in the older Greek population. A total of 955 cognitively normal older adults (aged ≥65y) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet study. A comprehensive neurological and neuropsychological assessment was conducted at baseline and a mean of 3.1 (SD = 0.85) years later, resulting in 160 individuals diagnosed with mild cognitive impairment and 34 with dementia at follow-up, whereas 761 remained cognitively normal. Using Cox regression analyses, no sleep parameters increased the risk of conversion status adjusting for demographics and clinical factors. Napping, however, decreased this risk by 19.3% (P < 0.001). As several previous studies have proposed, napping constitutes a protective factor against cognitive decline. Thus, clinicians should encourage their elderly patients to adopt this healthy habit.

To examine the natural adaptive course of ocular motor system in unilateral abducens nerve palsy while addressing the scarce literature on saccade dynamics and natural adaptation. Binocular horizontal eye movements were recorded from 18 healthy adults and 21 adults with unilateral abducens nerve palsy during the acute and chronic phases. Dynamics of the paretic and non-paretic eyes were compared, and the non-paretic eye dynamics were correlated with the respective prism diopters. Non-parametric tests were used for statistical comparisons. The paretic eye, compared to the non-paretic eye, presented a slightly lower saccadic gain and velocity/amplitude ratio and a higher duration/amplitude ratio. The non-paretic eye, compared to healthy controls, showed consistent amplitude gain ( 1) and a tendency for a higher duration/amplitude ratio. In the acute phase, when the non-paretic eye was covered, the paretic eye's amplitude ratio was lower and the duration/amplitude ratio decreased significantly. In the acute phase, a greater degree of esotropia in the paretic eye was associated with a lower amplitude gain and duration/amplitude ratio in the non-paretic eye. During adaptation in abducens nerve palsy, the saccade duration of the paretic eye increased, and a similar tendency was observed in the non-paretic eye. This finding likely reflects a change in the "pulse-step" pattern and may be related to plastic changes in central structures, such as the cerebellum, that support learning processes.

Parkinson's disease (PD) is considered to be the second most prominent neurodegenerative disease and has a global prevalence. Glucocerebrosidase (GBA1) gene mutations represent a significant hereditary risk factor for the development of PD and have a profound impact on the motor and cognitive progression of the disease. The aim of this review is to summarize the literature data on the prevalence, type, and peculiarities of GBA1 mutations in populations of different ethnic backgrounds. We reviewed articles spanning the 2000-2024 period. GBA1-related PD has a worldwide distribution. It has long been recognized that pathogenic GBA1 mutations are particularly common in certain ethnic populations, including PD patients of Ashkenazi Jewish ancestry. Moreover, a considerable number of studies focused on European ancestry patients from Europe and North America have revealed a high proportion (up to 15%) of carriers among the PD population. GBA1 mutations also appear to play an important role in patient groups with an East Asian background, although the frequency of specific variants may differ as compared to those of European ancestry. Notably, the assessment of underrepresented populations in other parts of Asia (including India) and Latin America is in the spotlight of current research, while a variant with a newly described pathogenic mechanism has been reported in Sub-Saharan Africans. Given the importance of GBA1 mutations for PD genetics and clinical phenotype, a focused assessment of the prevalence and type of GBA1 variants in distinct ethnic populations will possibly inform ongoing PD-related clinical studies and facilitate upcoming therapeutic trials.

Oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) are utilized for diagnosing multiple sclerosis (MS), as they are found in 95% of patients. Additionally, OCBs are linked to disease prognosis. The primary contributors to OCB production are long-lived plasma cells. This study aims to quantify the impact of natalizumab (NTZ) on OCB levels in the CSF of MS patients. A systematic search on MEDLINE, SCOPUS and Web of Science for English-written and peer-reviewed longitudinal studies on adults was performed. Methodological quality was assessed with the Newcastle-Ottawa Scale. Proportional meta-analysis was performed in R using a generalized linear mixed-effects model. We investigated heterogeneity with influence diagnostics, sensitivity analysis and meta-regression. Eight eligible studies of adequate quality with a total sample of 326 relapsing-remitting MS patients were included. A summary rate of 14.07% [95% CI, 4.48%-36.36%] for complete loss of OCBs and 42.02% [95% CI, 15.23%-74.51%] for reduction in OCB number or intensity was observed, both with considerable heterogeneity. Pooled estimates dropped (11% [95% CI, 0.04%-0.29%] and 34% [95% CI, 0.11%-0.68%] respectively) after the identification of an influential study. Multivariable meta-regression identified IgG index as a factor contributing to heterogeneity (adj. p = 0.0279), regarding reduction of OCB number or intensity. In conclusion, our systematic review and meta-analysis showed that NTZ can lead to reduction of intrathecal OCBs in MS patients, indicating a possible effect of NTZ on memory plasma cells, which are the main source of OCBs in MS.