Objectives This study describes the prevalence of mild cognitive impairment (MCI) across different aspects of social isolation among adults 65 years or older. Methods In this cross-sectional study, we utilized the Wave 3 data from the National Social Life, Health, and Aging Project (NSHAP). MCI was defined as a Montreal Cognitive Assessment (MoCA) score less than 23. Prevalence of MCI was calculated for above and below average social disconnectedness (SD), perceived isolation (PI), and demographic variables age, gender, race/ethnicity, education, and household income. Results The overall prevalence [and 95% confidence interval] of MCI was 27.5% [25.5–29.6]. The high prevalence of MCI was found in those who had above average SD (32.0% [29.1–34.9]), above average PI (33.3% [29.7–36.8]), were older in age (43.1% [38.9–47.3]), male (28.7% [25.9–31.5]), Black (61.1% [52.5–69.6]), had less than a high school education (66.3% [58.9–73.8]), or were in the lowest income group (46.2% [39.7–52.7]). Those with above average SD or PI had a higher prevalence of MCI in almost all demographics, compared to those with below average SD or PI. Those who were Black or African American or had less than a high school education did not have a greater prevalence of MCI when SD was above average. Discussion This current study adds to the body of literature that links SD and PI to MCI and sheds light on the possible existing socio-demographic disparities. Groups with greater than average SD or PI tend to have a higher prevalence of MCI. Further studies are needed to establish a causal association of SD and PI with MCI.

Chimeric antigen-receptor (CAR)-associated hemophagocytic lymphohistiocytosis (HLH)-like toxicities involving hyperferritinemia, multi-organ dysfunction, coagulopathy, and/or hemophagocytosis are described as occurring in a subset of patients with cytokine release syndrome (CRS). Case series report poor outcomes for those with B-acute lymphoblastic leukemia (B-ALL) who develop HLH-like toxicities, although larger outcomes analyses of children and young adults (CAYA) with B-ALL who develop these toxicities following commercial tisagenlecleucel are not described. Using a multi-institutional database of 185 CAYA with B-ALL, we conducted a retrospective cohort study including groups that developed HLH-like toxicities, high grade CRS without HLH-like toxicities, or no to low grade CRS without HLH-like toxicities. Primary objectives included characterizing the incidence, outcomes, and pre-infusion factors associated with HLH-like toxicities. Among 185 CAYA infused with tisagenlecleucel, 26 (14.1%) met criteria for HLH-like toxicities. One-year overall survival and relapse-free survival were 25.7% and 4.7% in those with HLH-like toxicities, compared with 80.1% and 57.6% in those without. In multivariable analysis for death, meeting criteria for HLH-like toxicities carried a hazard ratio of 4.61 (95% confidence interval: 2.41-8.83), controlling for disease burden, age, and sex. Patients who developed HLH-like toxicities had higher pre-tisagenlecleucel disease burden, ferritin, C-reactive protein levels, and lower platelet and absolute neutrophil counts than patients with high grade or no/low grade CRS without HLH-like toxicities. Overall, CAYA with B-ALL who developed HLH-like toxicities following tisagenlecleucel experienced high rates of relapse and non-relapse mortality, indicating the urgent need for further investigations into prevention and optimal management of patients who develop HLH-like toxicities following tisagenlecleucel.

The most striking observation was marked atrophy with neural loss and gliosis in the caudate nucleus and putamen and, to a lesser extent, in the nucleus accumbens and globus pallidus (GP; patchy distribution, no clear rostrocaudal gradient). The neuropil showed rarefaction, vacuolation, scattered brown pigment, and marked reactive astrocytosis. Dopaminergic fibers in the striatum were well preserved as found using tyrosine hydroxylase immunohistochemistry. Tau immunohistochemistry showed thorn-shaped astrocytes in subpial and perivascular spaces at the base of the brain, consistent with aging-related tau astrogliopathy (ARTAG) 4 and sparse mediobasal NFTs. Hypothalamic perivascular taupositive neuritic dystrophy was consistent with sex-related tauopathy. ARTAG and sex-related tauopathy have no known clinical correlates.Autopsy findings were compatible with MLS. Mild Alzheimer's-type changes (Braak NFT III, Thal amyloid I), mild ARTAG, and hypothalamic perivascular dystrophy were considered coincidental.Only three other autopsies are reported with MLS. [5][6][7] Selective striatal atrophy, a mainly unaffected SN, an unaffected thalamus, and absence of Lewy bodies were described. Our results are similar. However, we performed more extensive immunohistochemistry to investigate the presence of other proteinopathies.Neuropathological hallmarks of MLS are atrophy of the caudate nucleus and putamen and, to a lesser extent, of the GP with dilated lateral ventricles, normal SN, normal dopaminergic neurons, and no distinctive neuronal or glial inclusions (α-synuclein, TDP-43, p62; tau: only age-related changes).

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The widespread use of WhatsApp as a communication tool makes it a candidate platform to facilitate the delivery of educational materials to radiology trainees in Eastern Africa. The aim of this pilot program is to assess the novel approach of using WhatsApp as a learning tool in pediatric radiology for residents in Kenya, Rwanda, Tanzania and Uganda. We recruited radiology residents to participate in a 3-month case-based pediatric radiology learning module that was delivered through WhatsApp to personal cell phones. Residents were presented with a multiple choice question once a week. Once they submitted their answer, the correct answer and explanations for each choice were provided. Questionnaires investigated comfort with reading pediatric radiology imaging, perception of the module content and convenience of the approach. Of the 72  participants, 40 (56%) responded to all 12 questions and both questionnaires, of whom 22 (55%) reported little to no comfort before the module and feeling very comfortable after. Confidence decreased with the number of incorrect answers. There was no correlation between the number of correct answers and the year level of the resident. Participants reported that the module was useful for learning pediatric radiology, found the material moderately difficult and found the application convenient for learning. Pediatric radiology educational content delivered over WhatsApp to residents in Eastern Africa is perceived as beneficial and convenient. This interactive learning platform provides opportunities for mentorship and enhanced learning of pediatric radiology. Supplementary Information The online version contains supplementary material available at 10.1007/s00247-023-05658-x.