Post-COVID-19 Encephalitis With Claustrum Sign Responsive to Immunomodulation.

We describe a case of encephalitis following coronavirus disease 2019 (COVID-19) in a six-and-a-half-year-old girl who presented with acute onset confusion and jerky movements of the limbs. The patient was unvaccinated for COVID-19. Subsequent magnetic resonance imaging revealed a bilateral "claustrum sign" on T2 and fluid-attenuated inversion recovery (FLAIR) images and electroencephalogram reported moderate diffuse encephalopathy. The patient tested negative for COVID-19 by polymerase chain reaction, had positive serology for COVID-19 indicating past infection, and had a negative autoimmune panel and infectious workup. She was treated on the lines of post-infectious encephalitis with immunomodulatory therapies such as high-dose intravenous steroids and intravenous immunoglobulins. She responded significantly and had complete resolution of her symptoms; therefore, further supporting the suspicion of an immune-mediated etiology. Cases of post-COVID-19 encephalitis have been reported all over the world; however, most cases are based on speculation and temporal associations and therefore more research is required to optimize treatment guidelines.

Pain reduction in fibromyalgia syndrome through pairing transcranial direct current stimulation and mindfulness meditation: A randomized, double-blinded, sham-controlled pilot clinical trial.

Background: This double-blinded, randomized and sham-controlled pilot clinical trial aimed to investigate the preliminary clinical efficacy and feasibility of combining mindfulness meditation (MM) and transcranial direct current stimulation (tDCS) for pain and associated symptoms in patients with fibromyalgia syndrome (FMS). Methods: Included FMS patients (age: 33 to 70) were randomized to three different groups to receive either ten daily sessions of anodal tDCS over the left primary motor cortex paired with MM for 20 min (active + MM, n = 10), sham tDCS combined with MM (sham + MM, n = 10) or no intervention (NoT, n = 10). Patients in the bimodal therapy groups received a week of training in MM prior to the stimulation. Participants reported pain intensity, the primary outcome, by filling in a pain diary daily throughout the whole study. They were also evaluated for quality of life, pressure pain sensitivity, psychological wellbeing, sleep quality and sleep quantity. Assessments were performed at three time points (baseline, immediately after treatment and one-month follow-up). Results: Participants in the active + MM group did not exhibit reduced pain intensity following the bimodal therapy compared to controls. Patients in active group demonstrated clinically meaningful and significantly higher quality of life following the therapeutic intervention than other groups. There was no significant difference among groups regarding pressure pain sensitivity, sleep parameters and psychological scales. The combined treatment was well tolerated among participants, with no serious adverse effects. Conclusion: This study was the first to pair these two effective non-pharmacological therapies for pain management in FMS. In the light of an underpowered sample size, repetitive anodal tDCS combined with MM did not improve pain or FMS-associated symptoms. However, patients in the active + MM group reported higher quality of life than the control groups. Studies with more participants and longer follow-ups are required to confirm our findings. Clinical trial registration: [www.drks.de], identifier [DRKS00023490].

Polygenic risk score prediction of antipsychotic dosage in schizophrenia.

OBJECTIVE: Genetic variants have yet to be identified as reliable predictors of antipsychotic dosage. The purpose of this study is to quantify significant genetic risk variants prioritized from the Psychiatric GWAS Consortium (PGC2) study for schizophrenia as a polygenic score to test our hypothesis that it may represent symptom severity in patients and therefore predict antipsychotic dosage. METHODS: Antipsychotic medication and dosage were collected in our sample of 83 patients with schizophrenia spectrum disorders of a homogeneous European background. Antipsychotic dosage was standardized according to the Product Monograph (PM%), chlorpromazine equivalents (CPZe), and Defined Daily Dose (DDD). We calculated polygenic risk scores (PRS) for the significant risk loci identified from the PGC2 GWAS to predict dosage using a linear regression model. RESULTS: In our analysis, the PRS showed no significant association with PM%, CPZe, and DDD dosage. Considering symptom severity and overall functioning, our PRS was similarly not significantly associated with Global Assessment of Functioning (GAF) scores. DISCUSSION: Our results do not provide evidence for a polygenic inheritance of schizophrenia that influences levels of antipsychotic dosage. To the best of our knowledge, this is one of the first studies of its kind to use the PRS from the PGC2 significant risk variants to predict a clinically relevant phenotype. The PRS offers a novel approach to analyzing the genetic liability for many clinically relevant phenotypes in schizophrenia.

Prognosis of stroke in children after three months of regular physical therapy in Lahore.

OBJECTIVE: To evaluate the effects and significance of Proprioceptive Neuromuscular Facilitation exercises on stroke patients. METHODS: The prospective follow-up study was conducted from January, 2012, to June, 2012, and comprised randomly-selected patients at the Department of Neurology, Children Hospital and Institute of Child Health, Lahore, Using systematic sampling the patients were divided into two groups. Patients in group I were subjected to Proprioceptive Neuromuscular Facilitation therapy, while those in group II were treated by passive range of motion exercises only. All patients were followed up at months 1, 2 and 3. Data was collected through a questionnaire, while muscle strength was evaluated through Medical Research Council scale. All date was analysed using SPSS 20. RESULTS: There were 50 patients in the study who were all below 15 years of age. Muscle strength of affected side at baseline in the experimental group I was 2.36±0.49 and in the control group II it was 2.60±0.50. At the end of the three-month follow-up, it had considerably increased to 4.76±0.43 in group I while it was 3.80±0.50 in grgup II (p<0.0001) CONCLUSION: Proprioceptive Neuromuscular Facilitation technique was an effective method in terms of pain relief, stiffness reduction and functional improvement.

Evidence for a tumor promoting effect of high-fat diet independent of insulin resistance in HER2/Neu mammary carcinogenesis.

The mechanism of the association between breast cancer and obesity remains unknown. To investigate this mice over-expressing HER2/Neu in the mammary gland (MMTV-HER2/Neu) were fed either a high-fat diet (45% of calories) (HFD) or low-fat diet (10%) (LFD) from 4 weeks of age and followed for up to 1 year, or sacrificed when a mammary tumor reached 1.5 cm. There was a small but significant increase in body weight on HFD (P < 0.05) and the HFD mice displayed a greater fat mass determined by MRI (P < 0.01). Mild glucose intolerance was observed from 3 months of age on HFD, but insulin levels were not elevated. While the time of onset of a first tumor and tumor growth rates were not altered, mice on HFD had an earlier onset of a second tumor and a twofold greater incidence (LFD 25%, HFD 54%) and a greater absolute number of multiple tumors (tumors/mouse, LFD 1.5 +/- 0.25 vs. HFD 2.7 +/- 0.23, P < 0.01). Consistent with a lack of hyperinsulinemia, immunoblotting of skeletal muscle lysates from mice injected with insulin showed no insulin resistance determined by the phosphorylation of Akt/PKB. Similarly, there was no difference in basal or maximum insulin-stimulated phosphorylation of IRS-1/2, Akt/PKB, or p70 S6K in tumor cell lysates from HFD and LFD groups. Immunohistochemistry revealed no difference in tumor tissue staining for the proliferative marker, Ki67, between diets. These data indicate that HFD, in the absence of significant insulin resistance, mediates a tumor promoting, but not a tumor growth effect in this model of mammary carcinogenesis.