Giant cell arteritis (GCA), a form of large vessel vasculitis, carries the risk of irreversible loss of vision due to involvement of arteries supplying optic nerve, retina and choroid. As such, timely diagnosis of GCA is crucial. The study examines the presenting symptoms among suspected GCA patients with both positive and negative biopsy results and the association of computed tomography angiography (CTA) findings of the suspected GCA patients with superficial temporal artery (STA) biopsy results.

A retrospective study involving 22 patients who underwent STA biopsy and CTA at Kingston Health Science Center. The CTA images of the patients were analyzed for the following imaging signs: blurred STA wall, perivascular enhancement, presence of stenosis or occlusion of STA and calcification. The association between imaging signs and STA biopsy results was assessed using odds ratios (ORs). Additionally, the final alternative diagnosis for the patients with negative biopsy results was also investigated.

There was a strong association between the presence of two CTA imaging findings : blurred STA wall and perivascular enhancement, and positive STA biopsy results (OR: 29, p: 0.001). Suspected GCA patients with negative STA biopsy results had no single unifying alternative diagnosis.

This study provides evidence for the potential role of CTA in the initial assessment of suspected GCA patients.

Prior research indicates that both structural and functional networks are compromised in older adults experiencing depressive symptoms. However, the potential impact of abnormal interactions between brain structure and function remains unclear. This study investigates alterations in structural–functional connectivity coupling (SFC) among older adults with depressive symptoms, and explores how these changes differ depending on the presence of physiological comorbidities.

We used multimodal neuroimaging data (dMRI/rs-fMRI) from 415 older adults with depressive symptoms and 415 age-matched normal controls. Subgroups were established within the depressive group based on the presence of hypertension, hyperlipidemia, diabetes, cerebrovascular disease, and sleep disorders. We examined group and subgroup differences in SFC and tracked its alterations in relation to symptom progression.

Older adults with depressive symptoms showed significantly increased SFC in the ventral attention network compared with normal controls. Moreover, changes in SFC within the subcortical network, especially in the left amygdala, were closely linked to symptom progression. Subgroup analyses further revealed heterogeneity in SFC changes, with certain physiological health factors, such as metabolic diseases and sleep disorders, contributing to distinct neural mechanisms underlying depressive symptoms in this population.

This study identifies alterations in SFC related to depressive symptoms in older adults, primarily within the ventral attention and subcortical networks. Subgroup analyses highlight the heterogeneous SFC changes associated with metabolic diseases and sleep disorders. These findings highlight SFC may serve as potential markers for more personalized interventions, ultimately improving the clinical management of depression in older adults.

Urgent care locations remain a target for antimicrobial stewardship initiatives due to high rates of inappropriate antibiotic prescribing, particularly for respiratory tract infections. This study evaluated the impact of an antimicrobial stewardship bundle at urgent care sites on appropriate antibiotic prescriptions.

Retrospective, observational, pre- and post-analysis.

Four advanced urgent care sites affiliated with an academic medical institution.

Urgent care patients evaluated for respiratory tract infections.

An antimicrobial stewardship bundle including clinician-signed stewardship posters, over-the-counter medication prescription pads, and an educational campaign was introduced to advanced urgent care sites from October to November 2024. Respiratory tract infections were tiered by antibiotic appropriateness (1 = always appropriate; 2 = sometimes appropriate; 3 = never appropriate). Adults with tier 2 or 3 diagnoses from December 2023 to January 2024 (pre-group) and December 2024 to January 2025 (post-group) were included. The primary outcome was proportion of appropriate antibiotic prescriptions.

Two hundred and seventy-five patients with tier 2 and tier 3 indications were screened; 200 patients were included. Following implementation of the antimicrobial stewardship bundle, there was no significant difference in rates of appropriate antibiotic prescriptions for tier 2 and tier 3 respiratory infections between the pre- and post-groups (76% vs 74%, respectively; P = 0.68). After implementation, more patients received appropriate antibiotics for tier 2 indications (77% vs 95%; p = 0.13). The most prescribed antibiotic agents amongst both groups were amoxicillin-based antibiotics (15%) and azithromycin (15%).

This study highlights challenges and opportunities for outpatient antimicrobial stewardship practices.

Childhood irritability and harsh parenting are associated with youth suicide attempts. Parents’ harsh reactions have been associated with children’s irritable behavior. While studies have shown individual associations of irritability and parenting behaviors with suicide risk, few have considered these factors jointly. We aimed to identify profiles of children based on irritability and parenting during childhood and examine their associations with youth suicide attempt.

Participants (N = 1626) were from the Québec Longitudinal Study of Child Development. Mothers reported on childhood irritability, harsh parenting, and positive parenting between ages 3.5 and 8; youth self-reported suicide attempt between ages 13 and 23.

We identified four profiles based on the joint development of irritability and parenting during childhood: (1) low irritability, low harsh parenting, and high positive parenting (30.3%); (2) moderate irritability, moderate harsh parenting, and high positive parenting (28.4%); (3) moderate irritability, moderate harsh parenting, and low positive parenting (26.6%); and (4) high irritability, high harsh parenting, and low positive parenting (14.8%). In logistic regression analyses, only children in the high irritability, high harsh parenting, and low positive parenting profile had higher odds of attempting suicide (OR = 2.51; 95% CI = 1.55–4.09) compared to those in the low irritability, low harsh parenting, and high positive parenting profile. This association remained significant (OR = 1.80; 95% CI = 1.03–3.15) in models adjusting for covariates.

Children with chronically high irritability were also those experiencing the harshest parenting and the least positive parenting, as well as those most at risk of suicide attempt. Targeting both child and parental behavior may maximize suicide prevention efforts among children with high irritability.

To determine the prevalence and severity of anxiety and depression among health care professionals in Khyber Pakhtunkhwa and the impact of gender and professional roles on mental health outcomes.

A cross-sectional study was conducted between March and November 2023 using stratified random sampling among health care professionals, including doctors, nurses, paramedics, and emergency staff, across multiple hospitals. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and depression. Data were analyzed using R/RStudio, employing descriptive statistics, chi-square tests, independent t-tests, Mann-Whitney U tests, and Pearson’s correlation coefficient.

Among 651 participants, 65% were male. Anxiety prevalence was significant, with 42% experiencing minimal anxiety, 35% mild, 16% moderate, and 7.7% severe. Depression prevalence included 10% with no depression with 7.8% moderately severe and 5.9% severe depression. Nurses (40%) and doctors (34%) had the highest depression rates. Females exhibited significantly higher anxiety and depression scores. Anxiety prevalence varied across hospitals (P = 0.024). A strong positive correlation was observed between GAD-7 and PHQ-9 scores.

Mental health challenges among frontline health care workers in Khyber Pakhtunkhwa are substantial, with anxiety and depression particularly prevalent among nurses and doctors. Female workers experience greater psychological distress. We recommend implementation of hospital-based mental health support systems, prioritizing interventions for female staff and high-burden departments. Policies ensuring regular psychological screening and peer support mechanisms are urgently needed.

This study aimed to report the outcomes of patient-specific quality assurance (QA) in spot-scanning proton therapy using a two-dimensional ionisation chamber array and investigate the relationship between gamma passing rate and plan parameters.

Patient-specific QA was performed and evaluated by gamma analysis using a 3% dose difference and 2-mm distance-to-agreement with 172 treatment plans in the head and neck, breast, chest, abdominal and pelvic regions. The outcomes of patient-specific quality assurance regarding the gamma passing rate of the treatment sites, monitor unit (MU) per spot, measurement depth, range shifter, number of spots, energy layer and target volume were analysed.

No significant difference (p = 0·10) in the gamma passing rates between the treatment sites. The gamma passing rate was >98% in all the regions. The overall result of patient-specific QA with the gamma evaluation was 99·1 ± 1·6%. For the MU per spot, range shifter and measurement depth, the gamma passing rate was >98%. The gamma passing rate of the number of spots, energy layer and target volume was >97%.

Patient-specific QA measurements showed that the gamma passing rate was >98% and was independent of the treatment site, MU per spot, range shifter, number of spots, energy layer and target volume but depend on measurement depth (p < 0·05). A gamma index of 3%, 2 mm forms reasonable criteria for patient-specific QA in spot-scanning proton therapy.

Reward can influence cognitive control; however, dysfunctional interactions between reward and cognitive control in adolescents with major depressive disorder (MDD) remain unclear.

We recruited 35 adolescents with MDD and 29 healthy controls (HC) who completed the AX version of the Continuous Performance Test (AX-CPT) under reward and non-reward conditions, while undergoing functional Near-Infrared Spectroscopy (fNIRS).

Adolescents with MDD exhibited slower response times and higher error rates compared to healthy controls. Under reward conditions, they responded more quickly but made more errors. Hierarchical Drift Diffusion Modeling (HDDM) revealed that adolescents with MDD showed a reduced starting bias toward more rewarding responses and a broader decision threshold in reward contexts. Neuroimaging results indicated that the MDD group showed diminished activation differences in the left dorsolateral prefrontal cortex (DLPFC), left ventrolateral prefrontal cortex (VLPFC), and right VLPFC in response to cues requiring high versus low cognitive control. Additionally, they exhibited weaker functional connectivity between these regions during reward-related cognitive control. Correlation analyses further showed that greater anhedonia severity was associated with poorer behavioral performance and less flexible activation in the prefrontal cortex.

Cognitive control impairments in depressed adolescents may be related to dysfunction in the motivational system. Our findings provide behavioral, computational, and neural evidence for the Expected Value of Control (EVC) theory. Diminished reward sensitivity and inflexible cognitive control may jointly contribute to these deficits, highlighting the importance of considering motivational factors in the diagnosis and intervention of cognitive control impairments in adolescents with depression.

Radiofrequency catheter ablation of ventricular arrhythmias, originating from the left ventricular summit, is challenging due to epicardial localisation of the substrate, surrounded by coronary arteries. This paper highlights the successful elimination of LVOT summit ventricular arrhythmia which was ablated from the aortic cusp and aortic mitral continuity in two paediatric patients.

Ventricular tachycardia arising from the basal region of the left ventricular summit was identified in two male patients aged 9 and 13 years. Electroanatomic mapping of ventricular arrhythmia revealed the earliest ventricular signal within the left coronary artery which was successfully ablated from the left coronary cusp. The second patient with exactly similar ECG of ventricular arrhythmia was treated by delivering energy to the aorta-mitral continuity beneath the aortic valve. No recurrences were observed during the follow-up period of 20 months.

Ventricular tachycardia arising from the basal region of the left ventricular summit is very rarely observed in paediatric patients. Utilising radiofrequency catheter ablation in proximity to the source can effectively and safely eliminate tachycardia.