The link between sleep and depression in older adults is complex and not fully understood. Reports of sleep problems in individuals with a history of depression, but who are no longer symptomatic, are inconsistent. This study aimed to characterize the sleep of 43 older adults (50+ years) with and without a history of clinical depression using questionnaires, actigraphy, and polysomnography. Participants were divided into three groups: current Major Depressive Disorder (MDD; ‘Current’, n = 10), a history of clinical depression (‘Past’, n = 14), and no history of depression (‘Never’, n = 19). Morning salivary cortisol measures confirmed elevated waking cortisol levels in current depression. Examination of sleep measures revealed significantly less Slow Wave Sleep (%SWS) and greater self-reported sleep problems in the current depression group compared to the remaining groups. A past history of depression was not linked to poor sleep relative to those with no history of depression. Across the whole sample, more severe depression was associated with more %REM, less %NREM and %SWS, poorer self-reported sleep, but less time spent Awake After Sleep Onset (WASO). Increased cortisol was linked to more %REM and less %NREM sleep, and shorter actigraphic total sleep time and poorer actigraphic sleep efficiency. Overall, sleep abnormalities were a feature of current MDD, and increased across the sample in a dose-dependent fashion with increasing depression severity and cortisol levels. Results suggest that current depressive symptoms, and cortisol levels, are more important determinants of sleep problems than a past history of depression.

Objectives: This study aims to investigate the relationship between cortical thickness and manual motor performance in a sample of healthy elders from a large urban cohort.

Experimental design: we examined the correlation between cortical thickness, dexterity and handgrip considering age, sex, and education in a population-based sample of 303 right-handed older adults. Cortical thickness was measured using surface-based morphometry implemented in Free surfer software.

Main points: Significant positive FDR-corrected correlations (p<0.05) were observed between right hand dexterity and left cortical thickness in the insula, postcentral, superior parietal and superior frontal gyrus. Moreover, significant positive correlations were observed between right hand dexterity and right cortical thickness in the inferior parietal gyrus, precuneus, superior frontal, precentral, superior temporal and insula. The dexterity of the left hand showed no significant association with cortical thickness, and no significant association was observed between the right or left handgrip and right or left cortical thickness. No significant effects of sex or education were observed.

Conclusion: Differences in hand dexterity contribute to differences in brain thickness even at the later stages of life, suggesting that motor skill could be a protecting factor for cortical thinning during the aging process.

Short summary: We report an incidence of bacterial meningoencephalitis with an otherwise low-virulent infectious agent, following monotherapy with dimethylfumarate (DMF) in an elderly woman with Relapsing Remitting Multiple Sclerosis (RRMS). DMF was first lowered to half the dose and eventually discontinued due to persistent lymphopenia.

A well known side effect of DMF is lymphopenia. In elderly patients DMF induced lymphopenia may provoke severe infection with otherwise ubiquitous low-virulent agents. We recommend caution when prescribing DMF to elderly RRMS patients in case of lymphopenia and discontinuation may need to be considered even at mildmoderate lymphopenia in elderly RRMS patients.

Adult-onset adult Rasmussen´s syndrome is a rare, chronic and progressive disease of the central nervous system characterized by unilateral cerebral cortex atrophy due to immune-mediated inflammatory response. The disease is characterized by focal drug-resistant epilepsy, contralateral progressive hemiparesis, and cognitive impairment. Despite the higher prevalence and earlier precocity in children, cases of adult-onset are reported and may present atypical clinical course.

Mucormycosis is a serious and deadly fungal infection caused by filamentous fungi of mucoraceae family usually by Mucor or Rhizopus species occurs in patients with weakened immune system and uncontrolled diabetes mellitus. Rhino-orbito cerebral form presents with a fever, headache, rhinnorhea, formation of black necrotic intranasal or intra oral masses progress to orbital cellulitis. Filamentous mucorales prefer low oxygen, high glucose, acidic medium and increased iron levels. Poor glycemic control decrease the ability of neutrophils to phagocytize and also modify the ability of macrophages, hence poorly controlled diabetes mellitus is a risk factor for invasive mucormycosis. Early histopathological examination of the affected tissue with fungal culture confirms the diagnosis. Aggressive treatment for achieving euglycemia and correcting acid status is the cornerstone of therapy. Treatment of rhinocerebral mucormycosis involves surgical debridement with prolonged systemic antifungal therapy and control of glycemic status.

Avascular Necrosis (AVN) of a vertebral body or osteonecrosis is an uncommon entity. AVN has been described in the context of several underlying lesions; one of them is Sickle Cell Disease (SCD). This is a case report of Avascular Necrosis (AVN) of a vertebral body in a young patient diagnosed with Sickle Cell Disease (SCD).

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Background: Tolosa-Hunt syndrome (THS) is an uncommon disease caused by non-specific inflammation of the cavernous sinus, superior orbital fissure and the apex of the orbit. The disease is characterized by periorbital pain, paresis of the bulbomotor and quick response to steroid treatment.

Case Reports: We presented 38-year old male patient, with THS. The patient had severe frontal headache and left-sided periorbital pain. Examination showed upper left-sided eyelid ptosis, left-sided oculomotor cranial nerve palsy and partial left sided abducens nerve palsy. MRI of the head showed asymmetric enhancement of the cavernous sinus. The clinical diagnosis satisfies the criteria for THS. After steroid therapy her symptoms and clinical signs dramatically reverses.

Conclusion: THS is an entity that occurs rarely, its etiopathogenesis is unknown, and it is manifested clinically by unilateral orbital pain associated with simple or multiple oculomotor paralyses, which resolves spontaneously but may recur. MRI orbital phlebography and biopsy are the recommended methods for making diagnosis. In our patient clinical presentation MRI findings and positive response to the corticosteroid treatment were relevant for making the diagnosis.