We report improvements in debilitating cervicogenic dizziness (CD), as well as neck pain and upper and lower back pain, using Chiropractic BioPhysics[®] (CBP[®]) orthopedic rehabilitation with a one-year follow-up. CD is extremely debilitating and strongly impacts health outcomes. Reports of successful conservative treatments for CD combined with neck and spine pain with improved outcomes and sustained long-term results are rare, and this study adds to the literature. A 29-year-old female suffered from sudden-onset dizziness and frequent syncope elicited by cranio-cervical extension motions. The patient concomitantly reported moderate neck pain, upper mid-back pain, and low back pain, self-reported significant disability, and objectively displayed poor posture and altered spine alignment on radiography. Due to the worsening of her condition, she sought treatment at a facility in Shoreline, WA, USA. Following examination and diagnostic evaluation, she undertook an in-office treatment regimen. The multi-modal orthopedic regimen included postural exercises, postural spinal manipulation, and specific spinal structural traction. This combination Mirror Image (MI®) protocol has been shown to reduce pain and disability in musculoskeletal conditions, with improvement in CD and cervical lordosis. Following 68 in-office treatments over 5.5 months, all initial outcome assessments and physical, orthopedic, and neurological examinations were repeated and recorded. At the post-treatment assessment, the patient reported improvements in CD symptoms and neck, upper back, and lower back pain. Cervical lordosis improved from C2 to C7, measuring +9.4° (kyphotic) to -16.4° (lordotic). At the one-year follow-up, all outcome measures were stable; syncope was fully resolved, and 90% of the previously reported CD symptoms were resolved. Cervical lordosis remained stable at -17.6° (lordotic). This case documents successful treatment in a single patient using conservative spine and posture treatment protocols. This case report followed reporting guidelines. This study may contribute to the evidence aiming to fill the gap in the understanding of CD and potential conservative therapeutic interventions that are directed toward improving spine alignment.

Paediatric dysautonomia has become increasingly recognised in children and adolescents, particularly in the post-COVID era. Affected patients commonly present with dizziness, palpitations, exercise intolerance, fatigue, and syncope, although reported prevalence varies widely because of evolving definitions and heterogeneous referral patterns. Contemporary evidence suggests that post-COVID dysautonomia arises from complex interactions among central autonomic network dysfunction, neurovascular dysregulation, impaired venous return, endothelial injury, hypovolemia, and altered cerebral perfusion, with tachycardia often representing a compensatory physiological response rather than a primary cardiac abnormality. Clinical phenotypes include postural orthostatic tachycardia syndrome, neurocardiogenic syncope, orthostatic hypotension, inappropriate sinus tachycardia, and undifferentiated orthostatic intolerance, frequently accompanied by fatigue, cognitive dysfunction, gastrointestinal symptoms, sleep disturbances, and post-exertional symptom exacerbation. Paediatric dysautonomia is best conceptualised as a distributed brain-heart-vascular network disorder that requires mechanistic understanding, standardised orthostatic assessment, and careful exclusion of structural heart disease and arrhythmia. The rapid expansion of specialised dysautonomia programmes and direct-to-consumer diagnostic pathways has also contributed to broader, and occasionally premature, application of autonomic diagnoses. Management should follow a stepwise, mechanism-guided approach emphasising patient education, trigger avoidance, hydration and salt optimisation, lower-body compression, individualised exercise rehabilitation, pacing strategies when post-exertional symptom exacerbation is present, school accommodations, and phenotype-directed pharmacotherapy for persistent functional impairment. Although post-COVID dysautonomia shares features with established paediatric autonomic disorders, important gaps remain in disease definitions, mechanistic understanding, and evidence-based treatment, underscoring the need for multidisciplinary care, standardised diagnostic frameworks, and prospective paediatric research.

Background Dapsone is used widely in dermatology as an anti-inflammatory agent for diseases including lichen planus, dermatitis herpetiformis, bullous pemphigoid, and sub-corneal pustular dermatosis (SCPD). Anemia and methemoglobinemia are known hematologic adverse effects of dapsone. These occur through distinct mechanisms and therefore develop independently of each other. Mild-to-moderate methemoglobinemia produces non-specific symptoms such as fatigue, exertional dyspnea, headache, and postural syncope that may affect daily functioning, impair treatment compliance, and lead to unnecessary evaluation when dapsone is not recognized as the cause. Biochemical confirmation requires arterial blood gas (ABG) measurement with co-oximetry, not routinely performed in dermatology outpatient settings. Objectives In this pilot retrospective cohort study, we aimed to estimate the prevalence and describe the clinical pattern of findings consistent with dapsone-induced methemoglobinemia in a dermatology outpatient clinic, evaluate the feasibility of a simple symptom- and pulse-oximetry-based screening strategy, and generate hypotheses for a prospective study with systematic methemoglobin (MetHb) measurement. Methods This study was conducted at a tertiary care dermatology outpatient clinic in central Kerala, India, over an 18-month period. Of a total of 41 patients prescribed dapsone during the study period, 28 had at least one follow-up visit while on dapsone and were included in the study. Clinical findings consistent with methemoglobinemia were defined as new-onset symptoms (fatigue, exertional dyspnea, headache, or postural syncope) or peripheral oxygen saturation (SpO2) at or below 94% on pulse oximetry, temporally correlated with dapsone initiation and not attributable to anemia or other comorbid illness. ABG MetHb levels were available in four patients only. Non-parametric tests were used for all comparisons due to the small sample size. All analyses were considered exploratory and hypothesis-generating given the pilot design. Results Of 28 patients followed up, 12 (43%) had clinical findings consistent with dapsone-induced methemoglobinemia, nine did not have any of the findings, and seven had insufficient data to be assessed against the clinical definition. Elevated MetHb levels were confirmed on ABG in four patients, all of whom had been classified as consistent with methemoglobinemia on clinical grounds, providing preliminary support for the feasibility of symptom and pulse-oximetry-based screening. No evaluated risk factor reached statistical significance. No patient required treatment beyond dapsone discontinuation. Conclusion This pilot study identifies a substantial burden of clinical findings consistent with dapsone-induced methemoglobinemia in a dermatology outpatient setting, comparable to rates in immunocompromised cohorts. Mild-to-moderate symptoms, easily misattributed to other causes, were the dominant presentation and carry real implications for symptom burden and treatment compliance. The four ABG-confirmed cases suggest, but do not confirm, the validity of clinical screening. Prospective studies are needed to evaluate the diagnostic performance and clinical utility of systematic screening strategies in dermatology outpatients receiving dapsone.

Postural orthostatic tachycardia syndrome (POTS) as conventionally defined is a chronic condition (typically > 3 months duration) incorporating reproducible symptoms of orthostatic intolerance (including dizziness/lightheadedness, and near-syncope) in the absence of orthostatic hypotension (ie, absence of a sustained systolic blood pressure drop > 20mmHg with upright posture). More recently, however, the :POTS: landscape as applied by many clinicians has broadened; the term :POTS: has become increasingly used to categorize a multisystem disorder the underlying etiologies of which remain unclear but may include autonomic dysfunction and/or autoimmune disorders; as such the clinical picture has evolved to encompass a wide range of non-cardiovascular symptoms such as persistent exertional intolerance, fatigue, "brain fog", thermo-regulatory disorders, and various gastrointestinal symptoms including gastroparesis and certain food intolerance reactions. Thus, while cardiovascular disorders may be the principal manifestation of presumed "POTS" in many patients, disturbances in a variety of body systems may dominate the clinical presentation in others. This communication, derived from a diverse group of practitioners who care for the wide range of patients often referred for :suspected POTS:, offer the view that optimizing diagnostic evaluation and subsequent care of these individuals necessitates a broad range of clinical skills; in essence involvement of a "village" of dedicated multi-talented care providers.

Pediatric postural orthostatic tachycardia syndrome is one of the main haemodynamic types of neurally mediated syncope and is commonly seen in school-aged children. Heart rate and blood pressure are important physiological indicators in the human cardiovascular system. They are easily accessible in clinical practice and have the advantages of being non-invasive, simple and safe. This article will review the predictive value of heart rate and blood pressure in the diagnosis and prognosis of pediatric postural orthostatic tachycardia syndrome.