As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation (rTMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rTMS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rTMS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rTMS in the elderly. These factors include but not limited to: (1) brain atrophy; (2) intensity and number of pulses (dose-response relationship); and (3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.

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Purpose We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radio-therapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm3 were 18.02 times more likely to progress than those with tumor volumes of 1 cm3 or greater (odds ratio, 18.02; 95% confidence interval, 4.25–76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the “no salvage surgery needed” and “no additional treatment needed” criteria for treatment success need to be complemented by the radiologic data.

Objective: Our objective was to evaluate the efficacy and safety of sunitinib following at least one course of radioactive iodine treatment in patients with advanced differentiated thyroid cancer (DTC). The study endpoints included best response rate (including best objective response rate) and progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, measurement of serum thyroglobulin (Tg), and toxicity evaluation. Design and methods: This was a single center, nonrandomized, open-label, phase 2 clinical trial. In total, 23 patients were enrolled and were treated with a starting daily, oral dose of 37.5 mg sunitinib. Patients were evaluated with imaging, laboratory tests, and physical examination periodically per protocol. Results: The mean best response was a decrease of 17.2% (S.D. 22.8) in tumor sum from baseline. Six (26%) patients achieved a partial response (PR), and 13 (57%) had stable disease (SD) for a clinical benefit rate (PRCSD) of 83%. The overall median PFS was 241 days (interquartile limits, 114-518). No statistically significant difference was observed between the medians of the baseline and post-treatment Tg values (PZ0.24). The most common adverse events included grades 1 and 2 decreases in blood cell counts (especially leukocytes), diarrhea, fatigue, hand-foot skin reaction, nausea, musculoskeletal pain, and hypertension.Conclusions: These data demonstrate that sunitinib exhibits significant anti-tumor activity in patients with advanced DTC. Since sunitinib was relatively well-tolerated, there is the potential for clinical benefit in these patients, and further investigation of this agent is warranted.

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The intensification of human immunodeficiency virus (HIV) and rising frequency of immunocompromised individuals have resulted in a resurgence of opportunistic infections. The most common opportunistic oral fungal infection in HIV-positive individuals is oral candidiasis. The classical presentation is as white scrapable form called as thrush, which is easily diagnosed and treated. The clinician is presented with a diagnostic and management dilemma when these lesions appear in new facades such as erythematous candidiasis, the latter's prevalence with HIV and AIDS being well established. In this case report, we present a case of Erythematous Candidiasis, which was associated with type 1 HIV co-infected with syphilis. We highlight the diagnostic importance of a naive looking manifestation of the tongue which was followed by a series of challenging presentations of secondary syphilis. Since the patient had a negative Veneral Disease Research Laboratory and left us with a management dilemma, the article also features the importance of prozone phenomenon (seen in 2% cases of secondary syphilis), and it's higher association with HIV co-infected individuals. With confusing clinical oral manifestations associated with these diseases, the dentist might be the first person to encounter such lesions, who should be able to recognize erythematous candidiasis and correlate them with the underlying pathology.

Orbital cellulitis along with panophthalmitis is a rare occurrence, most commonly being trauma-related or endogenous (1). Panophthalmitis is a purulent inflammation of all the coats of the eyes and the intraocular contents, resulting from either an endogenous or exogenous source of infection. In this communication, we describe a case in a 25-year-old female, in the second trimester of her pregnancy, who developed orbital cellulitis and panophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA), with the primary source of infection being cellulitis on her forearm following an intravenous injection. During pregnancy, generalized sepsis (in general) and orbital infections (in specific) are uncommon and must be treated promptly and adequately; at the same time, caution must be exercised due to the potentially adverse effects of therapeutic interventions on the unborn child. Institutional Review Board approval and written, informed consent from the patient for photography and publication were obtained prior to preparation of this manuscript.A 25-year-old female patient, in her second trimester of pregnancy, presented with complaints of sudden on-