Objective: Akathisia, a common side effect of psychotropic medications, poses a significant challenge in neuropsychiatry, affecting up to 30% of patients on antipsychotics. Despite its prevalence, akathisia remains poorly understood, with difficulties in diagnosis, patient reporting, and treatment efficacy. This research aimed to shed light on effective interventions to improve akathisia management.Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, encompassing controlled trials in English and Italian languages. Databases, such asPubMed, Scopus, and EMBASE, were searched until July 9, 2023. Treatment effectiveness was assessed using standardized mean differences (SMDs) in post-treatment akathisia scores.Results: Thirteen studies involving 446 individuals met the inclusion criteria. Benzodiazepines, beta-blockers, and NaSSA demonstrated significant efficacy as compared with placebo. Anticholinergic, anticonvulsant, triptan, and other treatments did not show significant differences. Benzodiazepines ranked highest in P-scores (0.8186), followed by beta-blockers and NaSSA.Conclusions: Effective management of akathisia is crucial, with benzodiazepines, beta-blockers, and NaSSA offering evidence-based options. Treatment rankings provide guidance for clinicians. Future research should prioritize larger, more robust studies to address limitations associated with small sample sizes and publication bias. This research enhances our understanding of interventions for akathisia, offering promising options to improve patient quality of life and prevent complications related to non-adherence and mismanagement.

Background: Increasing evidence supports the existence of a somatosensory subtype of tinnitus, in which craniocervical–craniomandibular structures can modulate tinnitus perception also through central auditory pathways. Despite growing mechanistic evidence, no targeted pharmacological intervention has been validated for this subtype. Objectives: This study aimed to synthesize the anatomical and neurophysiological rationale linking masseter hyperactivity to somatosensory tinnitus and to discuss BoNT/A as a hypothesis-generating therapeutic option requiring clinical validation. Methods: A PRISMA-ScR-guided scoping review was conducted in MEDLINE and EMBASE, using three complementary search lines (last search: 31 May 2026). Results: Of 284 records screened, four studies met eligibility criteria: three from the search strategy on BoNT/A and tinnitus and one from the search strategy on tinnitus and masticatory dysfunction. One additional record (Ranoux and Levine, 2024) was identified through manual search, describing tinnitus improvement following periauricular and splenius capitis BoNT/A injections, with masseter/temporalis injection proposed as an alternative site in the same protocol. Conclusions: Current anatomical and neurophysiological evidence supports a plausible link between masseter hyperactivity and somatosensory tinnitus in selected patients. BoNT/A is established for reducing masseter hyperactivity and may theoretically reduce abnormal somatosensory input; however, direct clinical evidence for tinnitus improvement remains insufficient. Its use should be considered experimental or hypothesis-based, within a multidisciplinary framework and with standardized outcome assessment. Prospective controlled trials are needed.

Diabetic kidney disease (DKD) is increasingly recognized as a heterogeneous condition encompassing distinct clinical and pathological phenotypes. Albuminuria and estimated glomerular filtration rate may follow divergent trajectories, with non-albuminuric kidney function decline representing a common and clinically relevant phenotype. Importantly, clinical features do not always reflect the underlying renal pathology, as patients with diabetes may present with diabetic kidney disease, non-diabetic kidney disease (NDKD), or mixed lesions. Conventional clinical markers, including diabetic retinopathy, hematuria, proteinuria, and eGFR decline, modify but do not reliably establish the underlying diagnosis. Kidney biopsy therefore retains a selective but important role in patients with atypical or rapidly evolving presentations, particularly when histological findings may alter treatment or prognosis. Beyond diagnostic classification, biopsy can provide prognostic information through assessment of glomerular, tubulointerstitial, and vascular injury. Future approaches should integrate longitudinal clinical trajectories with histopathology and molecular profiling, positioning kidney biopsy as a bridge toward mechanism-based classification and precision medicine in DKD.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis frequently associated with serum anti-neutrophil cytoplasmic antibodies (ANCAs), particularly anti-proteinase 3 (PR3). Multisystem involvement is typical, although disease onset with simultaneous manifestations affecting both the ocular and otorhinolaryngologic systems is rare and poorly reported in the literature. We describe a 65-year-old woman with renal impairment with microscopic hematuria and proteinuria and PR3-positive who developed bilateral otitis leading to sensorineural hearing loss and severe anterior scleritis, with a high suspicion of ANCA-associated vasculitis. Despite immunosuppression therapy, persistently elevated serum anti-PR3 levels in the absence of overt clinical activity prompted further diagnostic evaluation, which revealed previously unrecognized subglottic stenosis (SGS), confirmed by MRI, and fully resolved after anti-CD20 therapy. Concurrent involvement of the upper airways and ocular district as the initial presentation of GPA is unusual and may precede renal involvement by several months. Persistent elevation of PR3 levels in an apparent state of clinical remission may indicate ongoing active disease in other anatomical sites. The integration of laboratory tests, imaging studies, and multidisciplinary assessment is essential for early diagnosis and effective therapeutic management.