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A 56-year-old Japanese woman was admitted to our hospital because of rapidly progressive decline in her consciousness. The patient was in her usual state of health until 11 days before admission, when she developed headache. Eight days before admission, the patient had low-grade fever and her headache persisted despite treatment with analgesics. Five days before admission, memory loss and anomia developed; however, no psychobehavioral alterations were noted. Three days before this admission, the patient was admitted to another hospital for fever and memory loss. On examination, the patient was unable to state her date of birth or name. Brain magnetic resonance imaging (MRI) revealed bilateral hyperintensities on fluid-attenuated inversion recovery (FLAIR) in the medial temporal lobes. Cerebrospinal fluid (CSF) examination revealed 292 white blood cells (WBCs)/µL (mononuclear cell 83%) with normal protein and glucose levels. Herpes simplex encephalitis was suspected, and intravenous acyclovir was initiated. However, the patient’s mental state progressively deteriorated, resulting in an unresponsive state on day 3 of admission, ultimately leading to her transfer to our hospital for further evaluation and treatment. Her medical history was notable for chronic thyroiditis diagnosed 6 years earlier, for which she was not receiving treatment. Her family history was unremarkable. The patient did not smoke, drink alcohol, or use illicit drugs.

On examination, her temperature was 38.3°C, oxygen saturation was 98% on ambient air, and other vital signs were normal. The patient exhibited nuchal rigidity. The patient was mute and unresponsive to verbal stimuli, with eyes closed, no spontaneous or involuntary movements, and no withdrawal response to noxious stimuli; the Glasgow Coma Scale score was E1V1M1. Despite this, the patient exhibited resistance to passive eye-opening by closing the eyes tightly. Furthermore, the patient exhibited periodic contraction of the orbicularis oculi every 1 s. Muscle tone increased in the upper limbs with the elbows, wrists, and fingers held in a flexed posture, whereas tone was normal in the lower limbs with the knees extended. In the arm drop test, the patient exhibited avoidance of the face; when her hand was released above the face, it did not strike her face but instead slowly descended while maintaining the elbow extension posture. These findings were consistent with catatonic stupor and fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria for catatonia (positive for catalepsy, stupor, mutism, negativism, and grimacing). The resistance to passive movement distinguished her condition from akinetic mutism. The Bush Francis Catatonia Rating Scale (BFCRS) severity score was 18/69.

Laboratory investigations revealed elevated serum D-dimer levels (39.8 µg/mL) and positive test results for thyroglobulin antibodies (197 IU/mL, reference < 19.3 IU/mL) and thyroid peroxidase antibodies (6.3 IU/mL, reference < 3.3 IU/mL), with normal thyroid hormone levels. Autoantibodies against classical paraneoplastic (intracellular) antigens and glutamic acid decarboxylase 65 were examined in serum using a commercial immunoblotting assay, and the results were negative. CSF examination on admission (day 1) revealed 40 WBCs/µL (mononuclear cell 90%) with normal protein and glucose levels. The IgG index was elevated (0.83); however, no CSF-restricted oligoclonal bands were observed. Bacterial culture and real-time PCR for herpes simplex virus or varicella zoster virus were negative. DNA detection for cytomegalovirus, human herpesvirus-6, enterovirus, and human parechovirus was performed via multiplex PCR (FilmArray^®); however, the results were negative. Brain MRI obtained on day 3 revealed two slightly increased diffusion-weighted image/FLAIR signals in the right cerebellar hemisphere and left-sided predominant increased FLAIR signals in the medial temporal lobes with mild edema (Fig. 1A). Cerebral blood flow single-photon emission computed tomography (CT) using N-isopropyl-p-[123I]-iodoamphetamine as a flow tracer performed on day 8 revealed mild focal hypoperfusion in the right-sided predominant frontal lobes and right temporal lobe. Chest and abdominal contrast-enhanced CT revealed thrombi in the main trunk of the right pulmonary artery and deep veins in bilateral legs, without the findings of thymoma, ovarian teratoma, or malignancy. Additional laboratory tests confirmed negative results for anticardiolipin antibodies and lupus anticoagulant. Electroencephalogram (EEG) data recorded on day 2 revealed alternating patterns comprising either frontal predominant 1-Hz delta activity or frontocentral predominant 5-Hz theta activity without evolution or epileptiform discharges (Fig. 2A).

Autoantibodies against neuronal surface (NS) antigens were first examined at Kitasato University using a commercial kit (Euroimmun AG, product No: FA 111 m-3) following the instructions of the company with an indirect immunofluorescent assay. The patient’s CSF (diluted 1:2) exhibited intense reactivity with NS antigens (Fig. 3A). The rat brain immunostaining pattern—characterized by homogenous reactivity on the dentate gyrus and cerebellar molecular layers, dot-like reactivity on the cerebellar granular layer, and some reactivity with cytoplasmic antigens in the dentate granule and Purkinje cells—strongly suggested the presence of AMPAR antibodies [5]. Autoantibodies against the GluN1 subunits of NMDAR were not detected in the CSF using a commercial fixed cell-based assay (CBA) (Fig. 3B); however, antibodies against the GluA2 subunits of AMPAR were detected in both the CSF (diluted 1:2) and serum (diluted 1:10), confirming the diagnosis of anti-AMPAR encephalitis (Fig. 3C). The presence of AMPAR antibodies was subsequently confirmed at the laboratory of Josep Dalmau (Dalmau Lab, IDIBAPS Hospital Clinic, Barcelona) using an established in-house CBA; however, no other NS antibodies, including GluN1, GABAA and GABAB receptors, mGluR1, mGluR5, LGI1, Caspr2, DPPX, Neurexin-3, or Iglon5 antibodies, were detected.

After admission, the patient was initially treated with corticosteroids alone due to concomitant pulmonary embolism: two cycles of intravenous high-dose methylprednisolone (1 g/day, 3 days) from day 1, followed by oral prednisolone (60 mg, daily) (Fig. 4). Additionally, the patient was treated with continuous heparin for venous thromboembolism, which was subsequently switched to edoxaban. D-dimer levels declined progressively, and intravenous immunoglobulin (0.4 g/kg/day, 5 days) was administered from day 16. Catatonic stupor ameliorated gradually over the following weeks, along with reductions in CSF, WBC count, and IgG index. One month after admission, the patient was able to speak, follow simple commands, and walk with assistance. EEG recorded on day 29 exhibited continuous but slightly arrhythmic 8–9-Hz alpha activity (Fig. 2B and C), and brain MRI obtained on day 49 revealed that all lesions had almost completely resolved (Fig. 1B). The patient was transferred to a rehabilitation hospital on day 59. At discharge, the BFCRS severity score had improved to 0/69, and the Mini-Mental State Examination (Japanese version) score to 30/30; however, the modified Rankin scale score was 2 due to residual short-term memory impairment.

Pharmacist-led interventions were promising in improving outcomes among patients with chronic obstructive pulmonary disease (COPD), according to a study published in Medical Principles and Practice.¹ Pharmacists’ capabilities in facilitating improved COPD outcomes highlight their increasing role in disease management.

“Managing COPD involves both pharmacological and non-pharmacological treatments, emphasizing the correct usage of medications and therapies,” wrote authors of the study. “A multidisciplinary approach, including doctors, pharmacists, physiotherapists, nurses, and even laypeople, is crucial for providing comprehensive, patient-centered care and improving life quality.”

COPD is a respiratory illness that causes damage in patients’ lungs and airways. This damage then leads to inflammation, making it difficult for patients to breathe. In the US, COPD affects over 14 million patients and it also goes significantly undiagnosed. Furthermore, there is no cure for the disease, making the providers who manage COPD medications and treatment regimens crucial to patient health.²

READ MORE: Pharmacists’ Role in Helping Patients Manage COPD | ASHP Midyear

Aside from specific therapeutic avenues like oxygen therapy and pulmonary rehabilitation, there are several different medications used to treat COPD symptoms. They include nebulizers, bronchodilators, inhaled or oral steroids, antibiotics, combination inhalers, and more. Finally, quitting smoking is almost always the first lifestyle change providers suggest patients with COPD make.³

While guidelines surrounding COPD medications and treatment may be well-established, the provider that will best facilitate COPD management and outcomes hasn’t necessarily been agreed upon.

“The term ‘pharmacist-led care’ or ‘pharmacist-led interventions’ refers to health care services where pharmacists play a leading or central role in patient care,” they continued.¹ “These concepts cover a wide range of activities involving pharmacists directly in clinical patient care across various settings.”

With pharmacist-led interventions and care increasingly on the rise, researchers explored them in the context of COPD management. The goal of the researchers’ study was to present the potential impact that pharmacist-led interventions and counseling can have for patients struggling with the condition. Furthermore, they conducted a systematic search to identify the nature and success of these interventions.

The researchers’ method for doing so consisted of the curation of key research questions: “What impact do pharmacist-led interventions have on health-related outcomes of patients with COPD?” and “Which interventions are particularly effective?” They then searched internet databases on November 19, 2023, to quantify the role of pharmacists’ interventions in COPD management.

“Included studies involved patients diagnosed with chronic obstructive pulmonary disease (COPD), regardless of gender, population group, or country. Interventions had to be pharmacist-led and could include any form of pharmaceutical care or counseling,” the authors wrote.¹ “Eligible outcomes included changes in health-related quality of life, medication adherence, hospitalization rates, inhalation techniques, or disease-related knowledge.”

Finally, pharmacist-led interventions were all conducted in community pharmacies, outpatient clinics, or hospital settings. The review’s final analysis included a total of 9 randomized control trials (RCTs) with 2094 patients that had COPD.

Whether they were a pharmaceutical care program with COPD education or simple counseling sessions, the 9 RCTs uncovered in the review mainly focused on medication adherence and health-related quality of life through a variety of pharmacist-led interventions. Education, awareness, and inhaler techniques were also areas of focus in these studies.

“Significant health improvements were noted in the intervention groups in 8 out of 9 studies compared to control groups, though concerns about high bias risk and lack of blinding were noted,” continued the authors. “The GRADE evaluation showed evidence quality ranged from ‘low’ to ‘very low.’”

Despite limitations in quality, bias, and blinding, almost all RCTs (88.9%) highlighted the pharmacist’s ability to improve COPD outcomes compared with control groups. While adherence and quality of life were the main areas of improvement in these trials, researchers uncovered overall positive effects on patients’ disease understanding as well as hospitalization rates.

Future research will focus deeper on the pharmacist’s role in COPD management, as well as other diseases. Researchers also suggest that future studies aim at strengthening the current evidence from reviews like the current one.

“Most included studies showed positive effects of pharmacist-led interventions on medication adherence, COPD knowledge, inhaler technique, and quality of life, though some had no significant impact,” they concluded.¹ “To draw firm conclusions, further high-quality studies with robust methodology are essential to strengthen the evidence base and close existing knowledge gaps.”

READ MORE: Respiratory Resource Center

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References

1. Hahn K, Flamm M, Wernly B. The impact of pharmacist-led interventions on the treatment of COPD patients. Med Princ Pract. 2025; https://doi.org/10.1159/000547390

2. What is COPD? National Heart, Lung, and Blood Institute. November 8, 2024. Accessed July 17, 2025. https://www.nhlbi.nih.gov/health/copd

3. Mayo Clinic Staff. COPD. Mayo Clinic. August 30, 2024. Accessed July 17, 2025. https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685

AI shows promise for improving consistency in the interpretation of biparametric MRI (bpMRI) exams for prostate cancer (PCa) imaging, researchers have reported.

The results contribute to a growing body of literature that supports the use of AI with imaging, wrote a group led by David Gelikman, MD, of the National Cancer Institute (NCI), National Institutes of Health (NIH) in Bethesda, MD. The study was published July 16 in the American Journal of Roentgenology.

“[Our] findings contribute to the ongoing evaluation of AI in clinical practice, supporting its role as a valuable tool for reducing variability among readers and improving reliability of PCa diagnosis on MRI,” the team noted.

Prostate cancer is the leading cause of cancer-related death around the world, the study authors explained, and although multiparametric MRI has proven useful for diagnosing the disease, interpretation of the images can be challenging.

Biparametric MRI is a “less resource-intensive modality and holds promise for wider clinical adoption,” they wrote, although it is also subject to interpretation variability. AI could help mitigate this variability and thus improve interpretation accuracy.

Gelikman and colleagues evaluated the impact of using a deep-learning AI model with bpMRI interpretations of prostate exams, tracking lesion- and patient-level clinically significant prostate cancer, cancer detection rates, and interreader agreement. Their study included six radiologist readers who interpreted bpMRI scans with and without AI assistance and 180 patients (120 in a case group, and 60 in a control group) who underwent bpMRI and prostate biopsy or radical prostatectomy between January 2013 and December 2022.

The researchers used pathology after radical prostatectomy as the reference standard for case group patients and negative 12-core systematic biopsies for control patients. They assessed the following measures: lesion-level sensitivity, positive predictive value (PPV), patient-level area under the receiver operating curve (AUC) for clinically significant prostate cancer and any prostate cancer detection, and interreader agreement for lesion-level PI-RADS scores and lesion size measurements.

Overall, the investigators found that the use of AI for bpMRI interpretations improved lesion-level PPV and interreader agreement but showed comparable AUC values and slightly lower lesion-level sensitivity compared to non-AI-assisted interpretations.

Assessment of use of AI with bpMRI exam interpretation
Measure	Interpretation without AI assistance	Interpretation with AI assistance
Clinically significant prostate cancer
Lesion-level PPV	67.2%	77.2%
Lesion-level sensitivity	48%	44.4%
Patient-level AUC	0.83	0.82
Any prostate cancer
Lesion-level PPV	69.4%	80.9%
Lesion-level sensitivity	44.9%	41.7%
Patient-level AUC	0.83	0.83
Interreader agreement
Lesion-level PI-RADS scores	κ = 0.336	κ = 0.748
Patient-level PI-RADS scores	κ = 0.507	κ = 0.704

Lesion Identification by AI and Histopathologic Annotation. 77-year-old man with serum PSA of 17.8 ng/mL. A) T2-weighted (T2W) MRI shows hypo-intensity in the left posterolateral peripheral zone. B) AI segmentation map overlaid on T2W image shows predicted prostate segmentation boundary in blue and PCa-suspicious lesion prediction segmentation in red. C) Ground truth histopathology slide registered to MR image shows annotated lesion segmented in red. D) Histopathologic annotation of whole mount prostate tissue after radical prostatectomy. This patient was found to have Gleason 4+3 disease in the region marked in blue. Yellow outlines represent cribriform architecture, red represents regions of Gleason 3, and light blue represents areas of lymphovascular invasion. Images and caption courtesy of the AJR.

In any case, more investigation into the use of AI with bpMRI for prostate imaging is needed, according to the team.

“Future research should focus on further optimizing AI algorithms to improve lesion-level sensitivity without compromising specificity, further integrating AI into clinical workflows to enhance patient outcomes,” Gelikman and colleagues concluded.

The complete study can be found here.