Primary Symptoms Research Articles

A dialectical behavior therapy skills training smartphone app for recurrent binge eating: a randomized clinical trial.

Dialectical behavior therapy (DBT) is a specialized treatment that has a growing evidence base for binge-spectrum eating disorders. However, cost and workforce capacity limit wide-scale uptake of DBT since it involves over 20 in-person sessions with a trained professional (and six sessions for guided self-help format). Interventions translated for delivery through modern technology offer a solution to increase the accessibility of evidence-based treatments. We developed the first DBT-specific skills training smartphone application (Resilience: eDBT) for binge-spectrum eating disorders and evaluated its efficacy in a randomized clinical trial. Participants reporting recurrent binge eating were randomized to Resilience (n = 287) or a waitlist (n = 289). Primary outcomes were objective binge eating episodes and global levels of eating disorder psychopathology. Secondary outcomes were behavioral and cognitive symptoms, psychological distress, and the hypothesized processes of change (mindfulness, emotion regulation, and distress tolerance). Intention-to-treat analyses showed that the intervention group reported greater reductions in objective binge eating episodes (incidence rate ratio = 0.69) and eating disorder psychopathology (d = -0.68) than the waitlist at 6 weeks. Significant group differences favoring the intervention group were also observed on secondary outcomes, except for subjective binge eating, psychological distress, and distress tolerance. Primary symptoms showed further improvements from 6 to 12 weeks. However, dropout rate was high (48%) among the intervention group, and engagement decreased over the study period. A novel, low-intensity DBT skills training app can effectively reduce symptoms of eating disorders. Scalable apps like these may increase the accessibility of evidence-based treatments.

A review article on the Ayurvedic aspects of Manyastambha

In today’s era, because of the stressful and fast lifestyle people are suffering from various degenerative diseases. Manyastambha is one of the lifestyle disorders which have a very high prevalence at present. Manyastambha is the clinical entity in which the back of the neck becomes stiff or rigid, painful, Stambh in the cervical region, and neck movement are hampered. Manyastambha has been enumerated in eighty Vataja Nanatmja Vyadhis as well as Urdhwajatrugata Vikaras. It can be clinically co-related with cervical Spondylosis in modern medicine. Cervical Spondylosis is a degenerative condition of the cervical spine. Ruk and Stambha are the primary symptoms. It may cause pressure on nerve roots with subsequent sensory or motor disturbances if severe. The prevalence of cervical spondylosis is rising due to the increase in a busy, professional, and social life, poor sitting posture in offices, continuous work, working long hours on computers, night jobs, watching hours of television, sleeping on abnormally soft mattresses and pillows, and placing the bare minimum importance on healthy physical, mental, and dietary habits.

The Potential Role of Dopamine Pathways in the Pathophysiology of Depression: Current Advances and Future Aspects.

Depression is a serious mental health disorder that impacts more than 350 million individuals globally. While the roles of serotonin and norepinephrine in depression have been extensively studied, the importance of dopaminergic pathways-essential for mood, cognition, motor control, and endocrine function-often gets overlooked. This review focuses on four major dopamine (DA) circuits: the mesolimbic (MLP), mesocortical (MCP), nigrostriatal (NSP), and thalamictuberoinfundibular pathways (TTFP), and their roles in depression. The MLP, which is key to reward processing, is linked to anhedonia, a primary depression symptom. The MCP, projecting to the prefrontal cortex, affects cognitive issues like impaired attention and decision-making. The NSP, mainly responsible for motor control, is related to psychomotor retardation in depression, while the TTFP manages neuroendocrine responses, which are often disrupted in stress-related depressive conditions. Current antidepressant treatments mainly target serotonin and norepinephrine systems but tend to be less effective for patients with DArgic dysfunction, leading to treatment resistance. This review underscores emerging evidence that suggests targeting DArgic pathways could improve treatment outcomes, especially for symptoms like anhedonia and cognitive deficits that conventional therapies often fail to address. Future research should aim to combine advancements in neuroimaging, optogenetics, and genetic studies to better map DArgic pathways and create personalized treatment plans. This review highlights the potential for new therapies that focus on DA systems, which could pave the way for more effective and tailored approaches to treating depression.

Surgical and Oncologic Outcomes of Primary Tumor Resection in Patients with Small Intestinal Neuroendocrine Tumors: Results from a Single-Center Series Over a 15-Year Period.

The role of prophylactic primary tumor resection (PTR) in patients with small intestinal neuroendocrine tumors (SI-NETs) and unresectable liver metastases is a matter of debate. We aimed to evaluate outcomes in patients with SI-NETs who underwent PTR, according to the presence of metastasis and symptoms from primary. Data from patients who underwent PTR for SI-NETs from a single referral center (2007-2023) were prospectively collected. Patients were divided into three groups: non-metastatic (M0) and metastatic with primary tumor-related symptoms (MS) or metastatic asymptomatic (MA). Kaplan-Meier curves for overall survival (OS) and event-free survival (EFS) were generated and compared by group. Univariate and multivariable Cox regression analyses were performed to assess the significance of risk factors. Of 147 patients, 53 were M0, 23 were MS, and 71 were MA. Median follow-up was 26 months. The 5- and 10-year OS estimates were 100% and 100% in M0 patients, 82 and 21% in MS patients, and 89 and 80% in MA patients, respectively (p<0.001). Median EFS was 91 months overall and 43,126 months and not reached for the MS, MA, and M0 groups, respectively (p<0.001). In multivariable analysis, MS (hazard ratio [HR] 3.92, 95% confidence interval [CI] 1.71-9.52), functioning tumors (HR 1.98, 95% CI 1.03-3.81), and G2 grade (HR 3.20, 95% CI 1.64-6.85) were associated with a shorter EFS. In this large retrospective series, the MS group had a significantly worse OS and EFS compared with M0 and MA. This finding suggests that prophylactic PTR might benefit SI-NET patients with unresectable liver metastases, as symptom development could impair long-term prognosis after surgery.

What is schizophrenia - symptomatology.

Schizophrenia is a highly heterogenous disorder with substantial interindividual variation in how the illness is experienced and how it presents clinically. The disorder is composed of primary symptom clusters-positive symptoms, negative symptoms, disorganization, neurocognitive deficits, and social cognitive impairments. These, along with duration, severity, and excluding other possible etiologies, comprise the diagnostic criteria for the disorder outlined in the two commonly used diagnostic classification systems-the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and the International Classification of Diseases, 11th Revision. These primary symptoms as well as accessory symptoms (mood disturbances, anxiety, violence) and comorbidities (substance use, suicidality) bear upon each other to varying degrees and impact functional outcomes. The following review presents two patient cases illustrating the clinical heterogeneity of schizophrenia, the natural history of the illness and diagnosis, followed by the current understanding of the primary symptom clusters, accessory symptoms, and comorbidities. In addition to noting symptom prevalence, onset, and change over time, attention is paid to the impact of symptoms on functional outcome.

Exercise on Crepitus in Knee Osteoarthritis: A Systematic Review and Meta-Analysis

ABSTRACT Background Crepitus is one of the primary symptoms of knee osteoarthritis (OA). Exercise and education are key components of evidence-based recommendations for management of OA. However, evidence if these approaches alter knee crepitus is limited. We aimed to determine if knee crepitus improves with exercise either alone or combined with education in healthy adults or people with early or established OA. Methods Five electronic databases (Embase, CINAHL, PsycINFO, PubMed, and SportDISCUS) were searched from inception to July 1, 2022, for studies of adults with knee crepitus who undertook exercise compared to nonexercise control. Data were analyzed using a random-effects meta-analysis. Risk of bias was appraised using the Cochrane tool. Results Seven studies of adults with established knee OA were included. All studies measured crepitus with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale following varied exercise interventions, 3 of which included education. Compared with control, no effect of exercise on modifying knee crepitus was found (mean difference −0.01 (95% confidence interval = −0.23, 0.21) on the 0–4 KOOS subscale). Two studies were at low risk of bias. The others had some concern (n = 3) or high risk of bias (n = 2). Conclusion Based on studies with mixed risk of bias, knee crepitus is unlikely to change in individuals with established OA following exercise. Thus, exercise-based practitioners can provide reassurance to people who are concerned about crepitus that exercise should not exacerbate crepitus. Authors of future studies could explore the impact of crepitus on patient’s beliefs about and engagement with exercise.

HbA1c and Blood Pressure Correlation in Patients with Uncontrolled Type 2 Diabetes Mellitus

The primary metabolic symptom of diabetes mellitus is hyperglycemia. Analysing HbA1c levels can help determine blood glucose management. Elevations in blood pressure can be caused by abnormalities in the metabolism of glucose. Patients with uncontrolled diabetes mellitus may experience elevated blood pressure. To ascertain whether blood pressure and HbA1c levels are correlated in patients with uncontrolled DM. There were 90 subjects aged between 31-65 years consisting of 48 men and 42 women. HbA1c levels were checked using the boronate affinity method and blood pressure was measured using a sphygmomanometer. Data analysis used the independent difference t-test and Mann-Whitney U test as well as the Spearman correlation test with a significance level of α=0.05. Research subjects had an average HbA1c level of 10 ± 2.08% (7.1-15). Mean systolic blood pressure was 132.75 ± 18.04 mmHg (90-180). The average diastolic blood pressure was 83.28 ± 10.38 mmHg (60-120). Subjects who experienced hypertension were 36.66%. There were no differences in blood pressure between men and women (systolic p=0.70 and diastolic p=0.58). There was no correlation between HbA1c levels and blood pressure (systolic: r=0.022, p=0.81 and diastolic: r=0.022, p=0.81). There was no correlation between duration of DM and blood pressure (systolic: r=.093 and p=0.38 and diastolic: r= -.032 and p=0.76). There was no correlation between HbA1c levels and blood pressure

Prevalence and associated risk factors of gout among patients at Khyber Teaching Hospital Peshawar: A cross-sectional study

Hyperuricemia and gout represent significant global public health challenges with varying prevalence rates across populations. This study aimed to investigate the prevalence and associated risk factors for gout among patients at the Khyber Teaching Hospital, Peshawar, Pakistan. This cross-sectional analytical study was conducted from January to March 2024 and involved 100 patients (57% female, 43% male) aged 18–65 years. Participants were recruited via systematic random sampling from the orthopedic department. Data collection included demographic information, anthropometric measurements, medical history, and serum uric acid levels, which were analyzed via the uricase enzymatic colorimetric method. 93% of the patients were between 21 and 60 years old, with 54% reporting a family history of gout. Notably, 95% of the participants presented elevated uric acid levels (&gt;6.8 mg/dL in men, &gt;6.0 mg/dL in women), with 40% falling within the 7.1–8.0 mg/dL range. The major comorbidities included hypertension (72%), thyroid problems (45%), and kidney disease (34%). Protein-rich diet consumption was reported by 84% of the participants, whereas alcohol consumption was reported by 17%. The general health assessment classified 65% of the participants as unhealthy. The findings indicate a greater prevalence of gout among females in this population, contradicting traditional patterns, along with significant associations with comorbidities and dietary factors. This study highlights the need for sex-specific screening protocols and comprehensive management approaches that address both primary gout symptoms and associated conditions. These results emphasize the importance of early intervention and lifestyle modification strategies in gout management within the South Asian.

Circadian Intervention Improves Parkinson’s Disease and May Slow Disease Progression: A Ten Year Retrospective Study

Background: The involvement of the circadian system in the etiology and treatment of Parkinson’s disease (PD) is becoming an increasingly important topic. The prodromal symptoms of PD include insomnia, fatigue, depression and sleep disturbance which herald the onset of the primary symptoms of bradykinesia, tremor and rigidity while robbing patients of their quality of life. Light treatment (LT) has been implemented for modifying circadian function in PD but few studies have examined its use in a protracted term that characterizes PD itself. Methods: The present exploratory study monitors the effect of LT over a 10 year course of PD in the context of ongoing circadian function. Results: Improvement in circadian based symptoms were seen soon after LT commenced and continued for the duration of the study. Improvement in motor function was more subtle and was not distinguishable until 1.2 years after commencing treatment. Improvement in most motor and prodromal symptoms remained in steady state for the duration of the study as long as patients were compliant with daily use. Conclusions: The sequence of improvement in prodromal symptoms and motor function seen here parallels the slow, incremental repair process mimicking the protracted degenerative sequelae of PD that extends over decades. This process also emulates the slow incremental improvement characterizing the reparative course seen with circadian symptoms in other disorders that improve with LT. Recent findings from epidemiological work suggest that early disruption of circadian rhythmicity is associated with increased risk of PD and the present findings are consistent with that hypothesis. It is concluded that intervening in circadian function with LT presents a minimally invasive method that is compatible with internal timing that slows the degenerative process of PD.

Unraveling the Bone-Brain Axis: A New Frontier in Parkinson's Disease Research.

Parkinson's disease (PD), as a widespread neurodegenerative disorder, significantly impacts patients' quality of life. Its primary symptoms include motor disturbances, tremor, muscle stiffness, and balance disorders. In recent years, with the advancement of research, the concept of the bone-brain axis has gradually become a focal point in the field of PD research. The bone-brain axis refers to the interactions and connections between the skeletal system and the central nervous system (CNS), playing a crucial role in the pathogenesis and pathological processes of PD. The purpose of this review is to comprehensively and deeply explore the bone-brain axis in PD, covering various aspects such as the complex relationship between bone metabolism and PD, the key roles of neurotransmitters and hormones in the bone-brain axis, the role of inflammation and immunity, microRNA (miRNA) functional regulation, and potential therapeutic strategies. Through a comprehensive analysis and in-depth discussion of numerous research findings, this review aims to provide a solid theoretical foundation for a deeper understanding of the pathogenesis of PD and to offer strong support for the development of new treatment methods.

Harnessing the impact of beneficial microorganisms to control Meloidogyne incognita in tomato cultivation across diverse environments

BackgroundTomato (Solanum lycopersicum L.) can overcome productivity challenges caused by plant-parasitic nematodes, especially Meloidogyne incognita. M. incognita is the most harmful polyphagous endoparasitic nematode of various cultivated crops globally and causes huge yield losses. The use of traditional chemical nematicides poses environmental and health risks, which is why safe alternatives are being explored. This study aimed to find alternatives to peat as a potting medium and evaluate their effectiveness in enhancing plant resilience against nematodes. Specifically, the study assessed the efficacy of four biocontrol agents (Trichoderma asperellum, Beauveria bassiana, Fusarium proliferatum and Bacillus mojavensis) in peat-based and compost-based potting media under open-field and greenhouse conditions.ResultThe research analyzes their impact on plant growth performance and their capacity to mitigate the severity of galling, the primary symptom caused by M. incognita in tomato cultivation. The results showed insignificant difference between peat and compost-based media in open-field (F(1,101) = 0.001, p = 0.97) and greenhouse (F(1,90) = 2.53, p = 0.12) experiments. However, biocontrol agents differed significantly in effectiveness (open field: F(4,101) = 5.85, p < 0.001; greenhouse: F(4,90) = 15.88, p < 0.001). B. mojavensis reduced the gall index by 81.24% in compost-based medium, and B. bassiana reduced it by 68.86% in peat-based medium.ConclusionThis study unequivocally demonstrated the remarkable efficacy of F. proliferatum and T. asperellum in promoting aboveground plant development. The application of biocontrol agents F. proliferatum, T. asperellum, B. bassiana and B. mojavensis resulted in a substantial 25–81% reduction in nematode galling index compared to the untreated control.

A Prospective Study on Gait Impairment in Patients With Symptomatic Lumbar Canal Stenosis and Impact of Surgical Intervention on Gait Function.

Prospective observational cohort study. To analyze the effect of decompression surgery on gait characteristics in patients with stenosis. Also, to test the hypothesis that patient-reported functional outcomes and gait parameters (spatiotemporal, kinetic, and kinematic measures) will improve postoperatively and achieve normal values when compared with matched healthy controls. Lumbar spinal stenosis is one of the leading causes of disability among elderly population. Gait impairment is one of the primary symptoms of degenerative conditions involving lumbar spine. Research suggests that decompressive surgery can positively influence gait parameters in patients with spinal stenosis. Studies have shown improvements in walking speed, stride length, and balance post-surgery. Thirty-two patients with single-level lumbar stenosis and 32 healthy volunteers were prospectively recruited. All patients underwent gait analysis preoperatively and 6 months postoperatively as per standard protocol. Spatiotemporal, kinematic, and kinetic parameters were analyzed. Stepwise linear regression models were used to detect significant relationships between changes in functional score (Visual Analogue Scale/Oswestry Disability Index) and gait parameters. Significant improvement was noted in functional scores(P<0.05) 6 months post-surgery. Spatiotemporal (swing phase, mean velocity, cadence, stride length, step length, and step width) and kinetic parameters (hip, knee, and ankle power) were significantly better after surgery, reaching normal levels. Kinematic parameters significantly improved after surgery but did not reach normal levels when compared with controls. A significant correlation was found between changes in functional scores with changes in certain kinematic parameters (knee-power, ankle plantarflexion, swing time, peak ankle dorsiflexion in swing, peak-hip, and knee flexor moment). Decompression surgery in lumbar stenosis produces improvement in gait parameters, pain scores, and functional outcomes that significantly improve gait posture and speed.

A Case Report of Disseminated Nocardiosis

Objective: To summarize the clinical characteristics and treatment plan for a case of disseminated nocardiosis. Methods: The study summarized the clinical characteristics and treatment plan for a case of disseminated nocardiosis. Results: The primary symptoms of the patient included high fever and multiple enlarged lymph nodes. Chest computed tomography revealed a shadow of nodules in the upper lobe of the left lung, multiple nodules, and pleural effusion in both lungs. Additionally, bilateral blood cultures indicated the presence of Nocardia terpenica. The final diagnosis was disseminated Nocardia sp. infection. Upon admission, anti-infective treatment was initiated with sulfamethoxazole and linezolid. Conclusion: In patients with normal immune function, disseminated nocardiosis may present as high fever with lymph node enlargement, necessitating differentiation from lymphoma. This study reports on the diagnosis and treatment plan of a case of disseminated nocardiosis to enhance understanding and clinical management of this disease.

Clinical Perspectives on Tandem Spinal Stenosis: Addressing the Controversies in Surgical Management

Introduction: Tandem spinal stenosis, characterized by narrowing at multiple spinal levels, often affects the cervical and lumbar regions and is linked to neurological deficits. Commonly stemming from degenerative or congenital changes, its prevalence increases with aging, especially for cervical myelopathy associated with lumbar stenosis. Diagnosis relies on imaging, with MRI offering precise evaluation of spinal compression and neural impact. Review: This review examines tandem spinal stenosis management, noting ongoing debate on treatment approaches. While simultaneous decompression minimizes hospital time, staged surgery may reduce complications and tailor treatment to predominant symptoms. For patients with primary lumbar symptoms, cervical decompression has shown to alleviate lumbar issues due to motor pathway organization. Conclusions: Tandem spinal stenosis requires early diagnosis and individualized treatment, especially as prevalence rises with an aging population. A tailored approach enhances therapeutic outcomes and supports better quality of life for affected patients.

Determining Information Requirements for a Mobile Self-Care App for Chronic Kidney Disease Patients

Introduction: Chronic kidney disease is a common condition that affects a person's entire life after diagnosis. Self-care using a mobile phone helps to improve the management and ease the disease. This study aims to identify the educational content needed to design a self-care mobile application for chronic kidney disease patients. Methods: This applied study was conducted using a descriptive method. The tool used was a researcher-made questionnaire, which was validated for reliability and validity. The study population consisted of nephrologists and general surgeons, from which 25 participants were randomly and purposefully selected from the nephrology clinics of Tehran and Kurdistan University of Medical Sciences. Data analysis was performed using descriptive statistics with SPSS software version 19. Results: The educational content of the application was organized into three main axes, comprising 28 educational needs: Disease information, including understanding kidney function, stages of disease progression, and early and primary signs and symptoms; medications, encompassing familiarity with prescribed medications, drug interactions, and the importance of accurate and timely medication intake; and lifestyle and personal habits, covering healthy nutrition, weight management, and work-related issues. However, topics such as diagnostic methods, various tests, drug side effects, dietary regimens, nutritional energy tables, and opioid use were not deemed essential. Conclusion: The educational needs serve as the first step in designing a self-care application for chronic kidney disease education. By defining the technical capabilities and various features of the application, patient awareness and adherence to desirable self-care behaviors will improve.

A potential candidate for prevention of PTSD: Prazosin prevents learned helplessness behavior in adult male rats

Post-Traumatic Stress Disorder (PTSD) is a debilitating psychiatric disorder that arises following exposure to an extreme stress. PTSD is characterized by five primary trauma-related symptom clusters, including symptoms of negative mood and hyperresponsivity to the traumatic event. Regrettably, the current therapy options are not highly effective. Therefore, prevention of PTSD is crucial and potentially applicable. Prazosin is an anti-adrenergic medication that is used to reduce nightmares in patient with PTSD, and can also mitigate the noradrenergic dysfunction caused by trauma. Here we show that administration of prazosin prior to the trauma prevented learned helplessness behavior in adult male rats. We show that the animals that were exposed to three days of inescapable foot shocks preceded by prazosin injections have fewer prazosin-treated animals showing learned helplessness compared to saline-treated animals. Nevertheless, there was no significant difference in anxiety-related behavior as measured in the elevated plus maze. Furthermore, the results of in vivo electrophysiological recordings of the ventral tegmental area shows that the prazosin group has a trend of increased number of active dopaminergic cells per track; this is significant when limited to central region of the ventral tegmental area. Our results demonstrate that prazosin has a potential for prevention of PTSD.

Comparative Analysis of Medical Interventions to Alleviate Endometriosis-Related Pain: A Systematic Review and Network Meta-Analysis.

Background/Objectives: Endometriosis is a chronic condition that affects 6-10% of women of reproductive age, with pain and infertility being its primary symptoms. The most common aspects of pain are overall pelvic pain, dysmenorrhea, and dyspareunia. Our aim was to compare the available medical treatments for endometriosis-related pain. Methods: A systematic search was conducted in three medical databases to assess available drug options for pain management. Randomized controlled trials (RCTs) investigating various medical treatments for endometriosis-related pain on different pain scales were included. Results were presented as p-scores and, in cases of placebo controls, as mean differences (MD) with 95% confidence intervals (CI). From the available data, a network meta-analysis was carried out. Results: The search yielded 1314 records, of which 45 were eligible for data extraction. Eight networks were created, and a total of 16 treatments were analyzed. The highest p-score, meaning greatest pain relief (p-score: 0.618), for the treatment of dysmenorrhea was achieved using gonadotropin-releasing hormone (GnRH) agonists for 3 months on a scale of 0-100. Additionally, a p-score of 0.649 was attained following a 6-month treatment with GnRH agonists combined with hormonal contraceptives (CHCs). In the case of dyspareunia on a scale of 0-100 following 3 months of treatment, CHCs (p-score: 0.805) were the most effective, and CHCs combined with aromatase inhibitors (p-score: 0.677) were the best treatment option following 6 months of treatment. In the case of overall pelvic pain, CHCs (p-score: 0.751) yielded the highest p-score on a scale of 0-100 following 3 months of treatment, and progestins combined with aromatase inhibitors (p-score: 0.873) following 6 months of treatment. Progestins (p-score: 0.901) were most effective in cases of overall pelvic pain on a scale of 0-3 following 3 months of treatment. Conclusions: Our network meta-analysis showed that in cases of dysmenorrhea, GnRH agonists supplemented with CHCs reduced pain the most following 3 months of treatment. Regarding dyspareunia CHCs were most effective, and in the case of overall pelvic pain, CHCs or progestins combined with aromatase inhibitors yielded the most desirable results.

Modulating the cholinergic system—Novel targets for deep brain stimulation in Parkinson's disease

AbstractParkinson's disease (PD) is the second‐fastest growing neurodegenerative disease in the world. The major clinical symptoms rigor, tremor, and bradykinesia derive from the degeneration of the nigrostriatal pathway. However, PD is a multi‐system disease, and neurodegeneration extends beyond the degradation of the dopaminergic pathway. Symptoms such as postural instability, freezing of gait, falls, and cognitive decline are predominantly caused by alterations of transmitter systems outside the classical dopaminergic axis. While levodopa and deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus effectively address PD primary motor symptoms, they often fall short in mitigating axial symptoms and cognitive impairment. Along these lines, the cholinergic system is increasingly recognized to play a crucial role in governing locomotion, postural stability, and cognitive function. Thus, there is a growing interest in bolstering the cholinergic tone by DBS of cholinergic targets such as the pedunculopontine nucleus (PPN) and nucleus basalis of Meynert (NBM), aiming to alleviate these debilitating symptoms resistant to traditional treatment strategies targeting the dopaminergic network. This review offers a comprehensive overview of the role of cholinergic dysfunction in PD. We discuss the impact of PPN and NBM DBS on the management of symptoms not readily accessible to established DBS targets and pharmacotherapy in PD and seek to provide guidance on patient selection, surgical approach, and stimulation paradigms.image

17α-hydroxylase/17,20-lyase Deficiency Diagnosed at 45 Years of Age with Hyperaldosteronism.

17α-hydroxylase deficiency is a type of congenital adrenocortical hyperplasia that is typically diagnosed in childhood or adolescence. It manifests as hypertension with gonadal dysfunction as the primary symptom. We herein report 17α-hydroxylase/17,20-lyase deficiency (17OHD) diagnosed at the age of 45 years. The patient presented with hypertension, irregular menstruation, and hyperaldosteronism. The clinical manifestations of 17OHD vary based on the specific variant pattern of CYP17A1. In this case, the variant was c.157_159 TCC del p. Phe53del, which has been frequently reported in Japan. The enzymatic deficiency due to this variant is partial, leading to a delay in making a correct diagnosis.

DECISION MAKING IN EPILEPTIC AVMS

While there is no doubt about the need for surgical treatment of a ruptured arteriovenous malformation (AVM), the decision to surgically treat a patient presenting solely with seizures is more controversial. Arteriovenous malformations (AVMs) arise from an abnormal connection between high-flow arterial vessels and low-flow venous vessels, resulting in a dysplastic vascular nidus within the brain tissue. The inherent flow irregularities within AVMs make them prone to rupture, which occurs in approximately half of patients. Additionally, seizures represent the second most common clinical manifestation of AVMs, presenting in 20%–45% of individuals with these lesions. This paper investigates the angiographic and MRI features of arteriovenous malformations that present with epilepsy, and discusses the surgical considerations in managing these patients and integration of multimodal approach focusing on the standard microsurgical techniques utilized. Patients presenting with seizures as the primary symptom of an arteriovenous malformation carry a higher surgical risk compared to those presenting with haemorrhage. Several factors have been associated with an increased risk of seizures in patients with arteriovenous malformations (AVMs). These include male gender, younger patient age, AVMs located in the frontal or temporal lobes, AVMs situated in the brain cortex, superficial venous drainage, a superficial temporal lobe AVM nidus, fistulous AVMs, and AVMs with venous stenosis. Surgical treatment is the recommended approach for patients with Spetzler-Martin grade I–III arteriovenous malformations. Resecting an unruptured brain arteriovenous malformation in a patient presenting only with epilepsy is a complex decision that requires a thorough understanding of the lesion’s anatomy, the patient’s history, and the neurosurgeon’s skills.