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Background: Neuroleptic malignant syndrome (NMS) is a rare yet potentially fatal iatrogenic syndrome that can manifest with life-threatening symptoms. Theorized to be caused by the dopamine-blocking effects of certain medications, such as antipsychotics, or the withdrawal of dopaminergic agents, NMS is characterized by hyperthermia, autonomic instability, altered mental status, and muscular rigidity. Most treated cases resolve within weeks; however, in some cases, residual catatonic symptoms can persist for months after the resolution of acute hyperthermic and hypermetabolic symptoms. The utilization of dopaminergic agents, such as bromocriptine, to alleviate the catatonic symptoms of NMS has been described in the literature but has not been explored systematically., Objective: The objective of this study is to present a case where high-dose bromocriptine was used to successfully treat significant, residual catatonia following NMS and to further delineate the role of bromocriptine in the management of residual catatonia secondary to NMS through a systematic review., Methods and Results: This study presents an illustrative case report, and a systematic review of bromocriptine use in managing residual NMS catatonia. The databases of PubMed, Cochrane, PsycINFO, EBSCO, and OVID Medline were queried, identifying 338 studies. Utilizing COVIDENCE, 137 duplicate articles and 76 irrelevant studies were excluded. Ultimately, 125 studies were assessed for eligibility, yielding seven manuscripts and nine total cases of bromocriptine use in residual NMS catatonia. Including our case, bromocriptine use led to an improvement in catatonic symptoms in 80.0% of patients (8 out of 10) and resolved catatonic symptoms in 50.0% of patients (5 out of 10)., Conclusions: Based on this case and the accompanying systematic review, bromocriptine may serve as an effective treatment for residual catatonia following NMS, particularly when first-line strategies such as benzodiazepine and/or ECT treatment have failed or are infeasible. This highlighted efficacy of bromocriptine may be attributed to relieving persistent dopaminergic blockade in susceptible patients, necessitating further research into the etiological heterogeneity of catatonia., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To examine the intrarater and interrater reliability and construct validity of the Functional Symmetry Observation Scale, Version 2 (FSOS-V2) in infants with congenital muscular torticollis (CMT)., Methods: The FSOS-V2 is a video-based measure of postural and movement symmetry in infants with CMT. Four examiners scored 50 participants' videos twice. Scores obtained by the same rater and across 4 raters were compared to examine intrarater and interrater reliability, respectively. Participants' habitual head deviation from midline in supine photographs was measured using a protractor. Relationship between the head tilt angles and FSOS-V2 scores was examined to assess construct validity., Results: Fifty infants with CMT, age range 1 to 16 months, participated. Results indicated moderate to good intrarater and poor to moderate interrater reliability. The FSOS-V2 construct validity was supported., Conclusion: The FSOS-V2 can be used by the same therapist repeatedly to make clinical decisions. Further research will strengthen its psychometric properties., (Copyright © 2024 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Guillain-Barre syndrome (GBS) is an acute post-infectious polyradiculoneuropathy characterized by autoantibodies targeting host antigens, resulting in nerve fiber demyelination and axonal degeneration. While symmetric ascending weakness is typical, neuropathic pain is a common yet variable manifestation. We present a case of a 52-year-old man with progressive bilateral leg weakness and severe neuropathic pain following a flu-like illness. Despite conventional analgesics, his pain persisted, necessitating a unique pain management approach. The patient's examination revealed hyporeflexia and sensory deficits consistent with GBS. Diagnostic workup, including lumbar puncture, showed albuminocytologic dissociation. Plasma exchange therapy was initiated, but severe nocturnal neuropathic pain persisted, exacerbating during treatment. Conventional pain medications were ineffective, prompting a multimodal approach. Combining hydromorphone and lorazepam provided significant pain relief, enabling completion of plasmapheresis sessions. This regimen, supplemented with gabapentin, proved effective in managing both GBS-associated and treatment-induced pain. This case underscores the debilitating nature of GBS-related pain and the importance of tailored pain management strategies. While conventional agents may fail, a multimodal approach, including opioids and adjunctive medications, can offer relief, facilitating essential treatments like plasmapheresis. Careful monitoring is imperative to mitigate risks associated with potent analgesics. Our experience contributes to the armamentarium for managing GBS-related pain, emphasizing individualized care to improve patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Titus et al.)

The COVID-19 pandemic has halted many large gatherings, and research conferences are no exception. Large conferences, once attended in-person, have primarily switched to a virtual format, utilizing online platforms. Every January, Medical Students Providing Across Continents (MedPACt), the University of Central Florida College of Medicine's global health interest group, hosts a student-run Global Health Conference that features a keynote speaker, discussion panel, and research presentations, and workshops for participants to engage in. Though planning this event is always challenging, organizing the 2021 conference was particularly strenuous as accommodations had to be made to optimize the conference to fit a never-attempted virtual format.  This drastic shift warrants further investigation into the efficacy and audience engagement of the virtual format. Using a post-conference survey with specific questions geared towards each component of the conference along with registration data, the virtual conference in 2021 was compared to the in-person conference in 2020. This study found that the virtual format was comparably efficacious in creating relevant and global health-oriented programming for the 2020 in-person conference. Additionally, the 2021 virtual conference received more registrants and cost less to plan, meaning the virtual model is a cost-effective way to deliver quality conference content., Competing Interests: The authors were members of Medical Students Providing Across Continents (MedPACt) throughout the duration of the project and helped to organize the Global Health Conference in either 2020, 2021, or both years., (Copyright © 2022, Kubiszewski et al.)

Purpose: To describe the development of the Functional Symmetry Observation Scale (FSOS) Version 2 and its content validation., Methods: The FSOS Version 2 is an observational assessment that quantifies symmetry in spontaneous movement and posture in infants with congenital muscular torticollis, age birth to 18 months. Twenty expert pediatric physical therapists were identified through purposive sampling and invited to participate in a modified Delphi study. Survey data were collected on Qualtrics. Consensus was evaluated using median ratings and percent agreement on Likert Scale items. Thematic analysis was performed for open-ended question responses., Results: Thirteen experts completed Round 1 and 2 surveys. In Round 1, consensus was achieved on all but 1 item. The scale was modified based on received feedback. In Round 2, consensus was achieved on all items (median rating of 4, agreement at 85%-100%)., Conclusions: This study established the content validity of the FSOS Version 2., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Introduction: We compared the motor learning, self-confidence whilst performing an anaesthesia technique and the perception of confidence between a group of students trained (G1) with two distinct dental anaesthesia simulation models (DASM) and a group of students (G2) not trained with DASM., Materials and Methods: The G1 students (n = 22) were trained with a learning protocol including a DASM for simulating a puncture and a DASM for simulating an injection of dental anaesthesia. The G2 students (n = 22) received no such training. Both groups performed the mental nerve block (MNB) in a clinical setting, after which the average working time (motor learning), number of times help was requested for performing the MNB (self-confidence) and the scores of a Likert Scale questionnaire (perception of confidence) between the groups were compared with a t test., Results: Compared with G2, the G1 students showed a shorter average working time (G1, 7:30 ± 0:54 min; G2, 9:06 ± 2:27 min; P = .017). Hence, G1 students had better motor skills. They also requested help when performing the MNB fewer times than the G2 students (G1, 2.2 ± 0.5 times; G2, 4.6 ± 1.95 times; P < .001). On the other hand, the G1 students demonstrated better perception of confidence (Likert Scale questionnaire) when performing the MNB compared with the G2 students (P = .007)., Conclusion: The learning protocol with two different DASMs had a positive effect on the motor skills and the confidence of dental students performing the mental nerve block., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Competing Interests: Competing interests: None declared.

Purpose: To establish intrarater and interrater reliability of still photography for measuring habitual head deviation from midline in infants with congenital muscular torticollis (CMT)., Methods: Two investigators took still photographs of 30 infants with CMT in a supine position and measured head deviation angles with a protractor. Data analysis included paired t tests, Pearson r, and intraclass correlation coefficients (ICC) with 95% confidence intervals., Results: Pearson r varied from 0.80 to 0.85 for the same rater and from 0.72 to 0.99 for 2 different raters. The ICC (3,1) varied from 0.79 to 0.84, and ICC (2,1) varied from 0.72 to 0.99. Participants with smaller head-tilt angles showed greater variability in head position., Conclusions: Still photography is a reliable method for measuring habitual head deviation from midline in infants with CMT. Several modifications to the measurement procedure have been suggested.

Dielectric Barrier Discharges (DBD) operated at atmospheric pressure and working at reduced temperatures (T < 115 degrees C) and a copper-manganese oxide catalyst are combined for the direct decomposition and the steam reforming of methanol (SRM) for hydrogen production and for the preferential oxidation of CO (CO-PROX).

The choline analogue, ethylcholine mustard azirinium ion (AF64A), has been proposed as a selective neurotoxin that produces degeneration of central cholinergic neurons. However, the mechanisms of action and the specificity or non-specificity of this toxin are still undefined. In this study, we have investigated the effects of AF64A, in comparison with kainic acid, on cholinergic neurons of the mesopontine formation (pedunculopontine and laterodorsal tegmental nuclei), a neuronal population also expressing nitric oxide synthase, the enzyme responsible for the synthesis of nitric oxide. We used choline acetyltransferase immunohistochemistry as a marker of acetylcholine activity, and nitric oxide synthase immunohistochemistry and NADPH-diaphorase histochemistry as markers of nitric oxide synthase activity. Our results show that the injection of low doses of AF64A produces: (1) an area of cavitation in the injection site of pedunculopontine tegmental nucleus (local non-specific effect), and (2) a transient decrease in choline acetyltransferase immunoreactivity in choline acetyltransferase-nitric oxide synthase neurons in both the ipsilateral laterodorsal tegmental nucleus and the perilesional area of the pedunculopontine tegmental nucleus, while their morphology and nitric oxide synthase immunoreactivity remain unaltered (post-diffusion specific effect). These findings indicate that the loss of choline-related enzymatic activity is not necessarily associated with degeneration of cholinergic neurons, and that the recovery of choline acetyltransferase immunoreactivity may arise from neurons whose activity is diminished during the first postinjection weeks. Taking into account that AF64A is a suitable tool to develop a reversible model of neurological disorders related to cholinergic deficit, further efforts should be directed toward elimination of its local non-specific effect.

We have studied the GABAergic projections to the inferior colliculus (IC) of the rat by combining the retrograde transport of horseradish peroxidase (HRP) and immunohistochemistry for gamma-amino butyric acid (GABA). Medium-sized (0.06-0.14 microliter) HRP injections were made in the ventral part of the central nucleus (CNIC), in the dorsal part of the CNIC, in the dorsal cortex (DCIC), and in the external cortex (ECIC) of the IC. Single HRP-labeled and double (HRP-GABA)-labeled neurons were systematically counted in all brainstem auditory nuclei. Our results revealed that the IC receives GABAergic afferent connections from ipsi- and contralateral brainstem auditory nuclei. Most of the contralateral GABAergic input originates in the IC and the dorsal nucleus of the lateral lemniscus (DNLL). The dorsal region of the IC (DCIC and dorsal part of the CNIC) receives connections mostly from its homonimous contralateral region, and the ventral region from the contralateral DNLL. The commissural GABAergic projections originate in a morphologically heterogeneous neuronal population that includes small to medium-sized round and fusiform neurons as well as large and giant neurons. Quantitatively, the ipsilateral ventral nucleus of the lateral lemniscus is the most important source of GABAergic input to the CNIC. In the superior olivary complex, a smaller number of neurons, which lie mainly in the periolivary nuclei, display double labeling. In the contralateral cochlear nuclei, only a few of the retrogradely labeled neurons were GABA immunoreactive. These findings give us more information about the role of GABA in the auditory system, indicating that inhibitory inputs from different ipsi- and contralateral, mono- and binaural auditory brainstem centers converge in the IC.

A case of aggressive cytomegalovirus retinitis is reported in an infant with acquired immunodeficiency syndrome. Intravenous treatment with ganciclovir did not control the infection. The combination of ganciclovir and foscarnet was needed to obtain a complete response.

NADPH-d activity is a marker for neurones which synthesize nitric oxide (NO). In the present paper we study the NADPH-d activity in the human brain stem between 16 and 24 gestational weeks (GW). The adult distribution of NADPH-d containing neurones is established at 24 GW. Between 19 and 21 GW, neurones of the facial, hypoglossal and ambiguus nuclei show transient NADPH-d positivity. Therefore, in the human brain stem there are two chronological patterns of neuronal nitric oxide synthase (NOS) expression, one that appears during prenatal development and persists during the whole life, and another one, present only at a precise foetal moment. The transient NADPH-d activity in motor nuclei suggests that NO is involved in early regulatory processes of the human brain development.

We have studied the postnatal development of dihydronicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) activity in the superior colliculus (SC) and the ventral lateral geniculate nucleus (LGv) of the rat. We describe two different developmental patterns of NADPH-diaphorase activity. The first pattern, observed in the deep layers of the SC, shows a transient activity during the first week which progressively decreases during the following two weeks. The second pattern is observed in the superficial layers of the SC and in the LGv. They become positive during the first week, their NADPH-d activity increases progressively during the second and third weeks, reaching the adult pattern at the fourth week. On the whole, the developmental chronology of the laminar distribution of NADPH-d in the SC displays an inside-out pattern. Our results suggest that NADPH-d activity may play different roles at different stages of the developing nervous system.