Category: 8. Health

  • Emotional Response to Music May Enhance Memory Specificity

    Emotional Response to Music May Enhance Memory Specificity

    Music that evokes an emotional response may influence the specificity of memory recall, new research suggests.

    Investigators found that participants who were shown a series of images of everyday items before listening to music were more likely to remember only general details of the photos if they experienced a more emotional response to the music, while those who had a moderate emotional response were more likely to recall specific details.

    Stephanie L. Leal, PhD

    “Most people think that emotional things are better remembered, but they actually aren’t. It’s just parts of the memory that are affected, not the whole memory,” co-investigator Stephanie L. Leal, PhD, assistant professor in the Department of Integrative Biology & Physiology at the University of California Los Angeles (UCLA), told Medscape Medical News. “One size doesn’t fit all when it comes to music and memory.”

    Interestingly, familiarity with a song was not associated with either general or detailed memory.

    “We played the same songs for everybody, but importantly, everyone responded differently. So I think personalization and taking individual preferences into account is going to be important for interventions,” said Leal, who is also director of the Neuroscience of Memory, Mood, and Aging Laboratory at UCLA.

    The findings were published online on July 23 in The Journal of Neuroscience.

    Memory Complexities

    As previously reported by Medscape Medical News, previous research has shown that both music appreciation and participations are tied to improvement in executive function and memory.

    For this study, researchers wanted to dive into the complexities of memory, including the possible connection between music and differing aspects of memory.

    “We tend to remember more of the gist of something emotional that happened and not as much of the details. So we wanted to see if music could boost certain parts of memory but not all of the parts,” she said.

    Many previous music studies have included older individuals, especially those with dementia. For this project, investigators chose instead to assess a younger population because they wanted to use their data as a “baseline” before moving on to further research in groups that are older and/or have impaired conditions such as depression or Alzheimer’s disease, Leal said.

    “We wanted to see what happens in healthy people first and then apply it to other populations,” she said.

    The study included 130 healthy undergraduate students between the ages of 18 and 35 years from Rice University, Houston.

    During the initial phase of memory formation — called the “encoding” phase — each participant was shown 128 images of common household objects and asked to choose whether the object should be considered as an indoor or outdoor item.

    Participants then donned headphones and listened to 10 minutes of classical music pieces, ambient soundscapes, or silence while they filled out questionnaires about their medical history.

    After the music ended, participants spent about 20 minutes filling out additional questionnaires, including a rating of the music or sounds they heard on the basis of emotional arousal, positive or negative reaction, or familiarity.

    They then viewed a set of 192 images that included some they hadn’t seen before (foils) and others that were identical (targets) or similar (lures) to the photos viewed earlier. Participants were asked to classify an image as old or new, allowing the researchers to measure target recognition — a measure of general memory — or lure discrimination — a measure of detailed memory.

    Big-Picture Recall

    General recall of the images was greater among those who experienced either low or high emotional response to music than among those who experienced moderate changes in emotional arousal (P for both < .001).

    More detailed memories were reported by those who reported only a moderate emotional response to music than those who reported a low or high emotional response (P for both < .001).

    There were no significant associations between memory of the images and song familiarity or whether a song was happy or sad.

    “Overall, music modulated both general and detailed memory, but individual differences in emotional response were crucial — participants listened to the same music yet responded differently,” the investigators wrote.

    “These findings suggest that music interventions may not uniformly enhance memory, emphasizing the need for personalized approaches in treating memory and mood impairments,” they added.

    The research suggests that a high emotional response may cloud details more than a moderate response.

    “Yes, the idea is that if something is very emotionally arousing, maybe we don’t want to remember the details associated with it. Maybe we just want to remember that general feeling or the bigger impact of that event, whether it’s positive or negative,” Leal said. “Maybe we just want to take the ‘big picture’ from that.”

    Early Days

    Commenting on the findings for Medscape Medical News, Daniel L. Bowling, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at the Stanford School of Medicine, Palo Alto, California, noted that the study “follows the general trend” of research that breaks down large concepts, such as memory, into specific features.

    photo of  Daniel Bowling
    Daniel L. Bowling, PhD

    Bowling, who is also director of the Music and Brain Health Lab at Stanford, was not involved with the current study.

    “This showed different levels of responses to music that were differentially related to varying types of memory that you might want to target,” Bowling said.

    For example, if a clinician’s purpose is cognitive training, with more of an emphasis on details, “you might want more moderate levels of [emotional] arousal. But if you want more big-picture stuff, which could be critical when asking people about their life, then higher levels of arousal may be better,” he added.

    He noted that because the researchers used almost a “pretreatment,” with music used before the recall task, it would be interesting to know if using such a pretreatment before taking a test could possibly improve performance.

    There are interventions, some of which Bowling is involved with, that are looking at supporting arousal and attention during studying. 

    A controlled study comparing these things and looking systematically into effects on different types of memory would be helpful, “but we’re really at the beginning of figuring all of this stuff out,” he said.

    Although the current study has some limitations and needs to be replicated, “any kind of talk toward systematic effects of different musical parameters or emotional modeling starts to help us bring this into the scientific-medical realm. And that’s a real strength here,” Bowling concluded.

    The investigators reported having no relevant financial relationships. Bowling reported consulting for and owning stock in Spiritune, an app that develops playlists for different purposes, including improved workflow.

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  • Pakistan records 14th polio case so far in 2025

    ISLAMABAD, July 2 (Xinhua) — As Pakistan continued to battle a crippling disease, the country recorded another polio case, increasing the overall tally to 14 so far in 2025, the Health Ministry said.

    The new case was reported from the northwest North Waziristan district of Khyber Pakhtunkhwa province as health officials confirmed the detection of type 1 wild poliovirus in a 19-month-old girl.

    So far, eight cases have been reported from the province, four from the southern Sindh province and one from the eastern Punjab province and the northern Gilgit-Baltistan region each.

    Special polio vaccination campaigns will soon kick off in 11 union councils of North Waziristan district, health officials said. Enditem

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  • Parasite-Specific Organelle Proteins as Antimalarial Targets

    Parasite-Specific Organelle Proteins as Antimalarial Targets


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    University of California, Riverside-led team has made an advance in the basic understanding of Plasmodium falciparum, the parasite responsible for the deadliest form of human malaria, that could make novel, highly targeted anti-malarial therapies possible.

    Led by Karine Le Roch, a professor of molecular, cell and systems biology, the team identified two key proteins inside the “apicoplast” — a unique, parasite-specific organelle found in P. falciparum — that control gene expression. These proteins belong to the RAP (RNA-binding domain Abundant in Apicomplexans) family of proteins. Far more numerous in parasites than in humans, RAP proteins play critical roles in regulating RNA molecules and translating them into proteins inside parasite organelles.

    Using advanced genetic tools, the team created knockdown strains of P. falciparum to selectively deactivate the two RAP proteins, PfRAP03 and PfRAP08. The team found the loss of either protein led to parasite death, confirming their essential roles.

    The researchers also discovered that PfRAP03 and PfRAP08 specifically bind to ribosomal RNA (rRNA) and transfer RNA (tRNA) molecules, respectively. These non-coding RNAs are fundamental to protein synthesis within the apicoplast.

    “This is the first time anyone has shown how RAP proteins in the apicoplast directly interact with rRNA and tRNA,” said Le Roch, who directs the UCR Center for Infectious Disease Vector Research. “We’ve now shown mechanistically how these proteins regulate translation in an organelle that’s completely foreign to the human body.”

    Le Roch explained that humans have six RAP proteins, but parasites like Plasmodium have more than 20.

    “This evolutionary expansion suggests that RAP proteins may perform parasite-specific functions, making them exciting drug targets,” she said.

    The study, published in Cell Reports, builds on the team’s previous research on RAP proteins in parasite mitochondria and represents the first detailed mechanistic analysis of their function in the apicoplast.

    Unlike any structure found in human cells, the apicoplast is unique to apicomplexan parasites — a large group of single-celled organisms that includes PlasmodiumToxoplasma gondii, and Babesia. This uniqueness makes it an ideal target for therapies that can eliminate the parasite without harming the human host.

    “While the focus of our paper is malaria, the implications extend to other apicomplexan diseases like toxoplasmosis — dangerous especially to pregnant women — and babesiosis, a growing tick-borne threat in the United States,” Le Roch said. “This work exposes vulnerabilities across an entire class of parasites, revealing the molecular machinery these parasites rely on. If we can take it apart, we can stop these diseases before they take hold.”

    Though no drugs currently target RAP proteins, Le Roch’s lab is working toward solving the 3D structure of these RNA-protein complexes, a crucial step toward structure-guided drug design.

    “Our research is a step toward future therapeutic strategies,” Le Roch said. “By targeting essential, parasite-specific proteins that have no human counterparts, we can develop drugs that are both effective and have minimal side effects.”

    Reference: Hollin T, Chahine Z, Abel S, et al. RAP proteins regulate apicoplast noncoding RNA processing in Plasmodium falciparum. Cell Rep. 2025;44(7):115928. doi: 10.1016/j.celrep.2025.115928

    This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. Our press release publishing policy can be accessed here.

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  • WHO-backed integrated testing model strengthens response to mpox, HIV, and syphilis

    WHO-backed integrated testing model strengthens response to mpox, HIV, and syphilis

    As mpox cases rise again in parts of Central Africa, the Democratic Republic of the Congo is pioneering an integrated public health response for HIV and syphilis testing within national mpox management.

    This integrated approach, led by the Ministry of Health with technical support from WHO, aims to provide comprehensive care, reduce missed opportunities for diagnosis and treatment and support community protection. Clinicians working at mpox testing sites have welcomed the initiative.

    Growing evidence shows people with undiagnosed HIV and those living with HIV who are not virally suppressed are at increased risk of severe mpox illness and death. Co-infection with syphilis has also been documented among individuals affected by mpox, especially among key populations. Despite the availability of affordable and effective treatment, syphilis continues to be widely underdiagnosed and untreated, particularly in low-resource settings. It is now the second leading cause of stillbirth globally. Integrating syphilis screening into the mpox response not only addresses a major gap in maternal and newborn health but also reinforces broader efforts in surveillance, diagnosis and care of sexually transmitted infections (STIs).

    “We now know people with HIV, particularly those with a CD4 count under 200 cells/mm³, are at risk for severe disease and death from mpox,” said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “Ensuring early access to HIV and syphilis testing and treatment to all people with confirmed or suspected mpox, as well as timely access to mpox vaccines and antivirals, will save lives”.

    Implementation in Kinshasa

    In April 2025, the Democratic Republic of the Congo became the first country to implement WHO’s Standard Operating Procedure (SOP) for integrating HIV and syphilis testing services as part of the mpox response. With support from WHO, health workers were trained and began rolling out dual HIV/syphilis rapid diagnostic tests to improve detection among those with suspected mpox at designated treatment centres. 

    The approach was first launched in 5 mpox treatment centres and now covers 11 health zones. Between April 2025 and 7 June 2025:

    • 697 individuals with suspected mpox were tested for HIV and syphilis;
    • 36 (5%) tested positive for HIV, including 27 confirmed mpox co-infections;
    • 6 individuals (1%) tested positive for syphilis and were treated on-site; and
    • weekly testing volumes increased steadily, reaching over 120 tests per week.

    National coordination and scale-up

    This approach is now going national. On 3 June 2025, the National HIV/AIDS Control Programme, together with WHO, the Ministry of Health, the Centre d’opérations d’urgence de santé publique (COUSP), and the Divisions provinciales de la santé (DPS) reviewed progress and set priorities for expanding this integrated approach. Together, they have also: 

    • drafted a therapeutic protocol for managing HIV/mpox co-infection;
    • strengthened capacity at the Kinoise Mpox Treatment Centre;
    • integrated mpox services into 6 HIV care and treatment centres;
    • strengthened inter-programme coordination to address delays and optimize limited resources; and
    • prepared for geographic expansion to provinces with high mpox transmission and/or high HIV prevalence.

    Addressing real world challenges 

    Despite strong progress, the rollout has faced logistical and operational challenges, including stock-outs, expiration of HIV test kits and delays in mpox PCR test results, which affect timely treatment. There has also been limited capacity to manage severe mpox/HIV co-infection, with only one advanced care site (MSF Kabinda in Kinshasa) in operation.

    Looking ahead

    As the country continues to confront multiple health threats, including mpox, HIV, and syphilis, its integrated testing model offers a blueprint for action in resource-limited settings. Lessons learned can be applied in other neighbouring countries as part of emergency and outbreak response, as well as for future preparedness and planning. 

    WHO and the Democratic Republic of the Congo are now planning to continue to provide joint supervision and mentoring visits, in order to strengthen data reporting and monitoring and improving stock management so as to avoid future commodity shortages. Both remain committed to protecting and saving lives by linking outbreak response with essential HIV and STI services, ensuring that no one is left behind.

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  • As mosquito season peaks, officials brace for new normal of dengue cases

    As mosquito season peaks, officials brace for new normal of dengue cases

    As summer ushers in peak mosquito season, health and vector control officials are bracing for the possibility of another year of historic rates of dengue. And with climate change, the lack of an effective vaccine, and federal research cuts, they worry the disease will become endemic to a larger swath of North America.

    About 3,700 new dengue infections were reported last year in the contiguous United States, up from about 2,050 in 2023, according to the Centers for Disease Control and Prevention. All of last year’s cases were acquired abroad, except for 105 cases contracted in California, Florida, or Texas. The CDC issued a health alert in March warning of the ongoing risk of dengue infection.

    “I think dengue is here with us to stay,” said infectious disease specialist Michael Ben-Aderet, associate medical director of hospital epidemiology at Cedars-Sinai in Los Angeles, about dengue becoming a new normal in the U.S. “These mosquitoes aren’t going anywhere.”

    Dengue is endemic — a label health officials assign when diseases appear consistently in a region — in many warmer parts of the world, including Latin America, India, and Southeast Asia. Dengue cases increased markedly last year in many of those places, especially in Central and South America.

    The disease, which can spread when people are bitten by infected Aedes mosquitoes, was not common in the contiguous United States for much of the last century. Today, most locally acquired (meaning unrelated to travel) dengue cases in the U.S. happen in Puerto Rico, which saw a sharp increase in 2024, triggering a local public health emergency.

    Most people who contract dengue don’t get sick. But in some people symptoms are severe: bleeding from the nose or mouth, intense stomach pain, vomiting, and swelling. Occasionally, dengue causes death.

    California offers a case study in how dengue is spreading in the U.S. The Aedes aegypti and Aedes albopictus mosquitoes that transmit dengue weren’t known to be in the state 25 years ago. They are now found in 25 counties and more than 400 cities and unincorporated communities, mostly in Southern California and the Central Valley.

    The spread of the mosquitoes is concerning because their presence increases the likelihood of disease transmission, said Steve Abshier, president of the Mosquito and Vector Control Association of California.

    From 2016 through 2022, there were an average of 136 new dengue cases a year in California, each case most likely brought to the state by someone who had traveled and been infected elsewhere. In 2023, there were about 250 new cases, including two acquired locally.

    In 2024, California saw 725 new dengue cases, including 18 acquired locally, state data shows.

    Climate change could contribute to growth in the Aedes mosquitoes’ population, Ben-Aderet said. These mosquitoes survive best in warm urban areas, often biting during the daytime. Locally acquired infections often occur when someone catches dengue during travel, then comes home and is bitten by an Aedes mosquito that bites and infects another person.

    “They’ve just been spreading like wildfire throughout California,” Ben-Aderet said.

    Dengue presents a challenge to the many primary care doctors who have never seen it. Ben-Aderet said doctors who suspect dengue should obtain a detailed travel history from their patients, but confirming the diagnosis is not always quick.

    “There’s no easy test for it,” he said. “The only test that we have for dengue is antibody tests.” He added that “most labs probably aren’t doing it commercially, so it’s usually like a send-out test from most labs. So you really have to suspect someone has dengue.”

    Best practices for avoiding dengue include eliminating any standing pools of water on a property — even small pools — and using mosquito repellent, Abshier said. Limiting activity at dusk and dawn, when mosquitoes bite most often, can also help.

    Efforts to combat dengue in California became even more complicated this year after wildfires ripped through Los Angeles. The fires occurred in a hot spot for mosquito-borne illnesses. San Gabriel Valley Mosquito and Vector Control District officials have worked for months to treat more than 1,400 unmaintained swimming pools left in the wake of fire, removing potential breeding grounds for mosquitoes.

    San Gabriel vector control officials have used local and state resources to treat the pools, said district spokesperson Anais Medina Diaz. They have applied for reimbursement from the Federal Emergency Management Agency, which has not historically paid for vector control efforts following wildfires.

    In California, vector control agencies are often primarily funded by local taxes and fees on property owners.

    Some officials are pursuing the novel method of releasing sterilized Aedes mosquitoes to reduce the problem. That may prove effective, but deploying the method in a large number of areas would be costly and would require a massive effort at the state level, Abshier said. Meanwhile, the federal government is pulling back on interventions: Several outlets have reported that the National Institutes of Health will stop funding new climate change-related research, which could include work on dengue.

    This year, reported rates of dengue in much of the Americas have declined significantly from 2024. But the trend in the United States likely won’t be clear until later in the year, after the summer mosquito season ends.

    Health and vector control researchers aren’t sure how bad it will get in California. Some say there may be limited outbreaks, while others predict dengue could get much worse. Sujan Shresta, a professor and infectious disease researcher at the La Jolla Institute for Immunology, said other places, like Nepal, experienced relatively few cases of dengue in the recent past but now regularly see large outbreaks.

    There is a vaccine for children, but it faces discontinuation from a lack of global demand. Two other dengue vaccines are unavailable in the United States. Shresta’s lab is hard at work on an effective, safe vaccine for dengue. She hopes to release results from animal testing in a year or so; if the results are positive, human trials could be possible in about two years.

    “If there’s no good vaccine, no good antivirals, this will be a dengue-endemic country,” she said.

    Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 




    This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Erenumab Not Effective for Chronic Cluster Headache

    Erenumab Not Effective for Chronic Cluster Headache

    TOPLINE:

    Preventive treatment with the calcitonin gene-related peptide (CGRP) receptor monoclonal antibody erenumab for 6 weeks was not associated with significant reductions in weekly headache attacks, pain severity, or attack duration in adults with chronic cluster headache (CCH), a new phase 2 placebo-controlled trial showed.

    METHODOLOGY:

    • The CHERUB01 phase 2 12-week, double-blind, placebo-controlled randomized clinical trial was conducted at 11 sites in Germany between 2021 and 2023.
    • About 81 adults with CCH (mean age, 49 years; 74% men) who failed to respond to standard prophylactic therapies were randomly assigned to receive either subcutaneous erenumab (280 mg at baseline, followed by 140 mg at week 4) or a matching placebo.
    • The primary endpoint was change in the mean number of weekly CH attacks from baseline to weeks 5 and 6.
    • Secondary endpoints included the proportion of patients achieving a ≥ 50% reduction in attacks and the number of participants with Patient Global Impression of Improvement (PGI-I) scores of 1 or 2 at week 6. Exploratory endpoints included reduction in CH attack duration and change in mean pain severity on the numeric pain rating scale.

    TAKEAWAY:

    • The primary endpoint was not met. Although there was a greater reduction in the mean number of weekly attacks for the erenumab group compared to the placebo group, the difference was not statistically significant (-7.3 vs -5.9 attacks per week; 95% credible interval, -5.7 to 2.8).
    • There was no significant difference between groups in the proportion of participants achieving a ≥ 50% reduction in weekly attacks, the number of patients with improved PGI-I scores, changes in attack duration, or change in pain severity.
    • Adverse events were more common in the erenumab group compared to the placebo group (66% vs 43%), with most considered to be mild or moderate.

    IN PRACTICE:

    “Erenumab failed to show a benefit over placebo in patients with CCH, indicating that blockade of peripheral CGRP receptors has no beneficial role in the prophylaxis of CCH,” the investigators wrote.

    “To date, all double-blind controlled trials in CCH using an mAb affecting the CGRP pathway were negative, leading to the conclusion that future research should revisit the role of CGRP in CCH,” they added.

    SOURCE:

    This study was led by Jasper Mecklenburg, MD, Charité – UniversitätsmedizinBerlin, Berlin, Germany. It was published online on June 17 in JAMA Network Open.

    LIMITATIONS:

    Data on patients who progressed from episodic headache to CCH were missing. Additionally, the onset timing of current CCH episodes was unclear, with no detailed records of past steroid responses or reasons for prior treatment failures with verapamil or lithium, which relied on patient recall.

    DISCLOSURES:

    This trial was funded by a grant from Novartis Pharma GmbH to Charité – UniversitätsmedizininBerlin. Several investigators reported having financial ties with various sources including the funding company. Full details are listed in the original article.

    This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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  • Near Miss Ruptured Ectopic Pregnancies: A Case Series of Diagnosis With Point-of-Care Ultrasound and an Independent Review of Radiology Images

    Near Miss Ruptured Ectopic Pregnancies: A Case Series of Diagnosis With Point-of-Care Ultrasound and an Independent Review of Radiology Images


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  • Cheryl Kyinn, PA-C, on Personalizing On-Demand Therapies for OFF Episodes in Parkinson Disease

    Cheryl Kyinn, PA-C, on Personalizing On-Demand Therapies for OFF Episodes in Parkinson Disease

    Cheryl Kyinn, PA-C

    (Credit: OCParkinsons.com)

    Although levodopa is considered the cornerstone treatment in Parkinson disease (PD), its long-term use may be limited by motor complications and the inability to slow neurodegeneration. Early in treatment, motor control is strong, but over time, striatal changes can cause dopamine levels to rely entirely on external sources, leading to OFF episodes. Current strategies aim to optimize dopaminergic stimulation to better mimic natural, tonic dopamine activity through pharmacologic, nonpharmacologic, adjunctive, rescue, and device-aided approaches.1

    At the recently concluded 4th Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 27-30, 2025, movement disorder expert Cheryl Kyinn, PA-C, gave a talk about on-demand therapies that can help offer relief for OFF episodes in patients with PD and how to go about using them. In this session, Krinn, a physician assistant specializing in PD in Orange County, California, placed an emphasis on recent findings from clinical trials that documented the timing and optimal use of these medications.

    In a new iteration of NeuroVoices, Kyinn discussed her clinical approach to selecting on-demand therapies for patients with PD experiencing OFF episodes. She highlighted the importance of considering comorbidities, patient preferences, and proper administration education to ensure treatment efficacy. Kyinn also underscored the advantages of therapies that bypass the gastrointestinal tract and the value of open-label data supporting options like inhaled levodopa. Additionally, she advocated for early adoption of extended-release levodopa to help reduce motor fluctuations and stressed shared decision-making to optimize patient quality of life.

    NeurologyLive: How should clinicians approach determining which on-demand therapy may be best suited for a patient experiencing OFF episodes?

    Cheryl Kyinn, PA-C: It’s very similar to how you would make any medication choice for a patient. The first thing is the baseline characteristics of a patient. Do they have other comorbidities? Because, let’s say, the 2 options are quite different and have different adverse effect profiles, so you want to first look at that.

    For instance, if you’re doing an apomorphine subcutaneous injection, that might have a little bit more susceptibility to hypotension and nausea. If someone’s already hypotensive, like many of our patients with PD, you probably wouldn’t go for that one. But let’s say a patient has a comorbidity of COPD, you’re probably not going to go with inhaled levodopa powder, because they probably can’t inhale it. That’s 1 key factor.

    Of course, you also have patient preference. Maybe patients are needle-phobic, or maybe patients honestly, they can’t get over the administration adverse effects. I think the number one thing is patient choice. First of all, I get a lot of needle-phobic patients, so that’s easy off the bat. And then again, their comorbidities as well.

    What findings have maybe most influenced decision-making when it comes to on-demand treatment for PD-related off periods?

    The key thing is that we know all of our oral medications run into the gastrointestinal dysfunction issues. Of course, seeing how these are delivered and that they bypass the GI tract that’s a huge thing.

    I think one of the most interesting studies was the open-label study for morning akinesia. I mean, that’s huge. We don’t have a lot of stuff—actually hardly anything—that helps with that, right? I actually tell my patients, just put your first pill on your bedside, and as soon as you get up, just reach over and swallow it. But again, you have the gastrointestinal dysfunction. The study with morning akinesia was very helpful and great for us clinicians to know that there is an option for this very tough symptom that patients experience.

    For the inhaled levodopa powder, I think it’s a little bit easier to use because you don’t have to do a needle. I did make a joke that it’s kind of similar to smoking but it kind of is. When I’ve seen patients do it, I’m like, it kind of looks like that. But I think the ease of use is helpful, and you see the improvement in the UPDRS score quickly, within 10 minutes. But I guess that’s the other point:, both of them show that T-max concentration within 10 to 20 minutes, and that’s a big factor in wanting to use these on-demand therapies for OFF times.

    In your experience, what key factors could help with ensuring effective and consistent use of these on-demand therapies for patients?

    I think education, education, education, and setting expectations. For instance, if you don’t tell a patient that they might have the cough issue with the inhaled levodopa powder, they will—when they first encounter that cough. First, they’re going to do it wrong, and they’re going to assume it’s like any other inhaler that they’ve seen like an asthma inhaler where you take a big puff and they’ll cough it all out. Not only, 1, do they have the adverse effect, 2, they’re going to cough it all out and not even get the therapeutic effect of the medication.

    Same thing with apomorphine. I think if you set the precedent that, yes, there’s a possibility you can have hypotension and nausea, especially because there’s no current antiemetic therapy that we can give to counter that, at least if they know about it and it happens. They’re not going to be completely caught off guard and then just choose to discontinue either of the medications.

    Setting good expectations, educating the patient on what could happen, and letting them know that if it happens, it’s okay it’s not going to be permanent. It’s going to be very short and brief and mild to moderate, I guess, based off of clinical trials. You’ll get over it, and if you don’t like it, then you don’t have to do it again. That’s the first part of it. And luckily, the companies also I think send nurses to the patient’s home to educate them about that as well, and to help them administer their first couple of doses. So hopefully there’s that continuity of care.

    What clinical signs would prompt you to consider switching a patient with PD to a different levodopa formulation?

    Honestly, I think from the get-go, based off all the clinical data that we have now, the preference is showing that ER formulations are much preferred. All the data suggests that, unfortunately, even though IR levodopa is great and cheap and effective, long-term use of this volatile pulsing of the medication is going to cause issues over time.

    We definitely see that with our patients who’ve had long-standing PD where we feed into the motor fluctuations. I think presenting patients with that data, if we can, we should start them on an ER formulation. But let’s say they are on an IR formulation then, when they start experiencing these motor fluctuations because we know it’s a question of when, not a question of if that, for sure, is a reason. If accessibility wasn’t an issue and cost wasn’t an issue, for sure, as soon as they start experiencing motor fluctuations, we should switch to an ER formulation if possible.

    How do you go about the decision-making process with the patient for treatment?

    I always try to tell my patients when we’re together, I’m here to provide you with the information, and I will guide you on what I think might work best for you but ultimately, they’re in the driver’s seat. It’s a full-on conversation that we’re having. It’s not a one-sided, “I tell you what to do” situation. I’ll even tell patients, “I’m not your mom—I can’t make you do anything,” It’s all up to you. This is your life, the life that you’re living. But it is an open discussion between clinical provider and patient. And I tell them, we’re trying to optimize your quality of life. And the decision-making process is 2-fold. I provide information, and then we, together, pick what’s best for your life, what fits into your lifestyle, with the ultimate goal of improving quality of life.

    Transcript edited for clarity. Click here for more coverage of ATMRD 2025.

    REFERENCES
    1. Masood N, Jimenez-Shahed J. Effective Management of “OFF” Episodes in Parkinson’s Disease: Emerging Treatment Strategies and Unmet Clinical Needs. Neuropsychiatr Dis Treat. 2023;19:247-266. Published 2023 Jan 25. doi:10.2147/NDT.S273121
    2. Kyinn, C. Conquering Off Episodes With On-Demand Therapies. Presented at: ATMRD; June 27-30, 2025; Washington, DC.

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  • Diagnostic dilemma: Shingles popped a hole in a man’s bladder

    Diagnostic dilemma: Shingles popped a hole in a man’s bladder

    The patient: A 77-year-old man in China

    The symptoms: Seven hours before being admitted to a hospital, the patient developed shortness of breath, abdominal pain and “obvious” abdominal distension, meaning his belly appeared very bloated and stretched out, doctors wrote in a report of the case. He’d had trouble urinating and defecating for about four days, and one week prior to admission, he’d been given antiviral and pain-relieving medicines for a case of shingles that was affecting his lower back, around the sacrum, or the base of the spine.

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  • Orthopedic surgeon says ‘even modest weight loss’ can reduce osteoarthritis risk: Here’s everything women should know | Health

    Orthopedic surgeon says ‘even modest weight loss’ can reduce osteoarthritis risk: Here’s everything women should know | Health

    According to the World Health Organisation (WHO), more than 60 percent of the 528 million people with osteoarthritis (OA) globally are women, and 73 percent of those affected are over the age of 55. The WHO reports that the knee is the most commonly affected joint, followed by the hip and hand. Also read | Nearly one billion people globally will have osteoarthritis by 2050: Lancet study

    Osteoarthritis (OA) is a common joint disorder that affects many women. (Freepik)

    In an interview with HT Lifestyle, Dr Sharmila Tulpule, orthopaedic surgeon, regenerative medicine specialist, and founder and director of Orthobiologix Biotech Pvt Ltd, said that osteoarthritis, long thought of as a ‘wear-and-tear’ disease, has become incredibly complex, especially for women.

    The prevalence of osteoarthritis, a type of joint disorder that occurs due to cartilage breakdown in the joints, is expected to increase with ageing populations and rising rates of obesity and injuries. By understanding the causes, symptoms, and treatment options for OA, you can take steps to manage the condition and improve your quality of life. 

    According to Dr Tulpule, below are the factors concerning osteoarthritis in women:

    Hormonal changes and menopause

    ● Estrogen decline during menopause accelerates cartilage degradation, increasing OA risk.

    ● Hormone replacement therapy (HRT) may offer some benefits but requires careful consideration due to potential risks.

    Obesity and metabolic factors

    ● Obesity is a significant risk factor for OA, particularly in weight-bearing joints like the knees.

    ● Excess weight increases joint stress and systemic inflammation, exacerbating OA symptoms.

    ● Even modest weight loss can reduce OA risk and improve joint function.

    Physical activity and joint health

    ● Regular, moderate physical activity strengthens muscles around joints, enhancing mobility and reducing pain.

    ● Conversely, sedentary lifestyles contribute to joint stiffness and muscle weakness.

    Mental health and quality of life

    ● OA can lead to depression and anxiety, particularly in women, affecting overall well-being.

    ● Addressing mental health is crucial for effective OA management and improving quality of life.

    By understanding the risk factors, symptoms, and treatment options for OA, women can take steps to manage the condition and improve their quality of life. (Freepik)
    By understanding the risk factors, symptoms, and treatment options for OA, women can take steps to manage the condition and improve their quality of life. (Freepik)

    What to know about regenerative therapies

    Dr Tulpule said, “Regenerative therapies offer a more holistic approach by addressing the underlying causes of OA rather than merely alleviating symptoms. They are particularly beneficial for women seeking alternatives to invasive surgeries and medications.”

    According to Dr Tulpule, stem cell therapy holds promise as a regenerative treatment for knee osteoarthritis, offering potential benefits in pain reduction and functional improvement. 

    Explaining platelet-rich plasma (PRP) therapy, Dr Tulpule said it utilises growth factors from the patient’s own blood to stimulate tissue repair and reduce inflammation. “Studies indicate that PRP can provide longer-term pain relief and functional improvement compared to traditional treatments like hyaluronic acid (HA) injections,” she said.

    Dr Tulpule added that gold-induced cytokine therapy is a novel regenerative treatment that involves incubating the patient’s own blood with gold particles, enhancing the anti-inflammatory and reparative properties of platelets. Studies have shown that it can lead to significant improvements in pain and function in patients with knee OA, with minimal adverse effects, she said.

    Management and prevention

    “For women, osteoarthritis is not just a joint issue — it intertwines with hormonal health, body weight, lifestyle, mental wellness, and occupational context,” Dr Tulpule said. 

    According to her, a nuanced approach means:

    1. Advocating early detection especially during menopause.

    2. Promoting preventive strategies combining diet, weight management, and exercise.

    3. Considering hormone-based therapies for symptomatic relief when appropriate.

    4. Supporting women’s mental health alongside physical care.

    5. Raising community awareness on how everyday activities shape OA risk.

    Dr Tulpule concluded, “By addressing the unique facets of OA in women, clinicians can shift from reactive interventions to proactive, personalised care. This not only delays disease progression, but preserves mobility, dignity, and quality of life for millions of women worldwide.”

    Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

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