Real-world infection risk in multiple sclerosis patients on long-term immunomodulatory treatments.

Introduction: Numerous immunomodulatory treatments exist for multiple sclerosis (MS), including those that deplete immune cells (e.g. anti-CD20 medications), relocate immune cells (e.

Enhancing stroke knowledge among youth: Insights from Stroke Busters.

Introduction: Community stroke education has shown promising results with sustained stroke knowledge and behavioral changes; however less is known about the effects of targeted education towards youth. We developed an interactive educational program for high school students, Stroke Busters, that focuses on stroke prevention, recognizing warning signs, and the importance of seeking prompt care.

Methods: This is a prospective cohort study where students are offered a stroke education program, 'Stroke Busters', through the Yale Pathways to Science Program, a Science, Technology, Engineering and Math (STEM) pipeline program for high school students living near New Haven, Connecticut.

Defining the Age of Young Ischemic Stroke Using Data-Driven Approaches.

: The cut-point for defining the age of young ischemic stroke (IS) is clinically and epidemiologically important, yet it is arbitrary and differs across studies. In this study, we leveraged electronic health records (EHRs) and data science techniques to estimate an optimal cut-point for defining the age of young IS. Patient-level EHRs were extracted from 13 hospitals in Pennsylvania, and used in two parallel approaches.

"Lessons Learned" Preventing Recurrent Ischemic Strokes through Secondary Prevention Programs: A Systematic Review.

Recurrent ischemic strokes are a cause of significant healthcare burdens globally. Patients with uncontrolled vascular risk factors are more likely to develop recurrent ischemic strokes. This study aims to compile information gained from current secondary prevention programs.

Second-Generation Antipsychotic Use in Pediatric Emergency Medicine.

In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.

Trends in ischemic stroke outcomes in a rural population in the United States.

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018.

Methods: This was a retrospective cohort study based on electronic health records (EHR) data.

Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States.

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States.

Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019.

Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors.

Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review.

Pain management for children needing laceration repair.

An 8-year-old child who lives in a small town has presented to my practice with a 3-inch laceration on the calf that has been assessed and needs repair with sutures. The family lives 4 hours from the nearest emergency department and I was planning to repair the wound in the office. What is the best way to manage pain in young patients needing sutures for laceration repair? Children are particularly susceptible to experiencing high levels of pain and anxiety during routine emergency procedures such as laceration repair.

Second-generation antipsychotics in children: Risks and monitoring needs.

A 10-year-old male patient presented to my clinic with irritability associated with autism spectrum disorder, and previous therapeutic efforts had not been successful. Treatment with quetiapine has considerably reduced irritability and improved his quality of life; however, the patient's mother has stated that her child's clothes are no longer fitting because his waist size has increased substantially, and that he has gained 5 kg since treatment initiation 8 weeks ago. Should second-generation antipsychotic (SGA) treatment be stopped or continued, and how can these side effects be best mitigated in a family practice setting? Use of SGAs in pediatric patients has increased in recent years, which has brought to light a number of worrisome metabolic side effects that occur in children.

Anhedonia in depression and schizophrenia: A transdiagnostic challenge.

Background: Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ).

Aims: To elucidate the clinical and neurobiological differences between schizophrenia (SZ) and depression (MDD) in regard to anhedonia, while reconciling the challenges and benefits of assessing anhedonia as a transdiagnostic feature under the Research Domain Criteria (RDoC) framework.

Methods: In this review, we summarize data from publications examining anhedonia or its underlying reward deficits in SZ and MDD.

Presentation and Neurobiology of Anhedonia in Mood Disorders: Commonalities and Distinctions.

Purpose Of Review: To focus on the clinical and behavioral presentation of anhedonia in mood disorders, as well as the differences and commonalities in the underlying neurocircuitry.

Recent Findings: Evidence suggests that depression is characterized by hypofunction of the reward system, while bipolar disorder manifests dysregulation of the behavioral activation system that increases goal-directed reward behavior. Importantly, strong evidence does not exist to suggest significant differences in anhedonia severity between depressed unipolar and bipolar patients, suggesting that there are more nuanced fluctuations in reward processing deficits in bipolar patients depending on their state.