Neurology

• Having social connections improves peoples’ odds of survival by 50% on average.
• Living alone increased the likelihood of mortality the most, 32%, while social isolation raised the risk by 29% and loneliness by 26%.
• Simply living with someone else increased survival by nearly 20%.
• Extensive social integration nearly doubled the odds of survival.

• People who exercised showed cognitive improvement compared with those who didn't exercise.
• Researchers found a time threshold for exercise efficacy in cognitive improvement.
• All study patients showed mental decline caused by mild subcortical ischemic vascular cognitive impairment.

An initial blood test reveals renal impairment and a serum calcium level of 13 mg/dL. An X-ray of her skull demonstrates numerous lytic lesions and a bone marrow biopsy is performed. What findings would you expect to see in this patient’s bone marrow aspirate?
(Image credit: @Lucy_A.)

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• Stroke kills almost 130,000 Americans each year, according to the Centers for Disease Control and Prevention (CDC).
• Intracranial hemorrhage (ICH) comprises 10% to 15% of all strokes.
• Approximately 37,000 to 53,000 people suffer an ICH annually.
• Incidence of ICH is down but related mortality remains high.
• Ambient temperature did not correlate with risk for stroke or subarachnoid hemorrhage.
• Change in temperature over the previous 24 hours appeared to be more important than absolute temperature with regard to risk of stroke or ICH.
• Lancet study finds that 90% of strokes are preventable.

• Plasma donepezil concentration increased proportionally with dose (5–10 mg/day).
• Plasma donepezil concentration was affected mainly by dose and partially by age.
• Change in cognitive function correlated positively with plasma concentration.
• Safety parameters were not significantly related to plasma concentration.
• Increasing plasma donepezil concentration further improves cognitive function.

• People diagnosed with an autistic spectrum disorder (ASD) die an average of 18 years prematurely.
• Autistic patients are at significantly increased risk of suicide.
• Accidents such as drowning are frequently fatal to patients with autism.
• People with both ASD and an intellectual disability die even younger, on average 30 years earlier than those without the conditions.

• Low to moderate intensity physical exercise improved cognitive and physical health in both middle-aged and older adults.
• Studies evaluated executive function, memory, processing speed, depressive symptoms, flexibility, balance, and lower limb strength.
• Two meta-analyses include 38 studies in all.

• New technique uses ultrasound and microscopic bubbles to temporarily open the blood-brain barrier, for the first time in history.
• Could allow for deposition of chemotherapeutic agents directly into tumor.
• Creates entirely new mode of drug delivery.

• About 25% to 30% of ischemic strokes occur during sleep.
• Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
• Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
• Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the emergency department.

• About 25% to 30% of ischemic strokes occur during sleep.
• Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
• Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
• Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the ED.

• Is general anesthesia to be avoided in children?
• Regional anesthesia offers a viable alternative in most surgical cases.
• It is appropriate to examine the clinical wisdom of administering central anesthesia in a child when regional is equally or more effective.
• Regional anesthesia offers profound analgesia in addition to anesthesia, reducing the need for strong oral analgesics.