Pathophysiological mechanisms of neurological manifestations in COVID-19 are not fully known yet. In this case-control study, proteomic analysis was used to characterize cerebrospinal fluid (CSF) samples from COVID-19 patients with acute neurological manifestations primarily categorized as: isolated refractory headache (n = 12), encephalopathy (n = 24), and inflammatory neurological diseases (IND) (n = 13). Individuals with non-inflammatory, non-infectious neurological conditions (n = 8) were included as controls. Differentially expressed proteins (DEPs) in neuro-COVID-19 were associated with the complement system, function/activation of microglia/macrophages, inflammatory responses, and neuronal function/homeostasis. Functional enrichment analysis of DEPs and/or proteins specifically detected in neuro-COVID-19 groups indicated activation of complement and coagulation cascades, and synapse pruning in encephalopathy and IND. Upregulated complement activation was confirmed by increased CSF levels of C3a and soluble C5b-9. Biological processes of neuroinflammation, migration of immune cells into the central nervous system, activation of glia cells (microglia and astrocytes), and tissue remodeling were also present in IND. In turn, processes associated with disturbed organization/formation of neuron projections were related to encephalopathy and isolated headache. CSF from patients with isolated refractory headache was enriched for proteins related to neurons and to the cerebral cortex, cerebellum, and basal ganglia. Meanwhile, CSF from encephalopathy and IND patients was mostly enriched for proteins mapped to the cerebral cortex, choroid plexus, and thalamus. Moreover, CSF from IND patients had an increased proportion of microglia-related proteins. These findings support a model in which cases of IND and encephalopathy are associated with blood-brain barrier disruption potentially induced by complement activation and glia-promoted neuroinflammation, resulting in the involvement of distinct brain structures in COVID-19.

PurposePost-COVID syndrome (PCS) also known as long COVID affects up to 66.5% of children and young people (CYP) following SARS-CoV-2 infection. Common symptoms include fatigue, headaches, anxiety, brain fog, breathlessness, and post-exertional symptom exacerbation, resulting in reduced school attendance and recreational participation. This study aimed to co-design an online group intervention to support psychological wellbeing, breathing retraining, symptom management, and peer connection during PCS recovery.MethodA co-design approach refined a 'journey-of-life' online intervention for adolescents with PCS and incorporated respiratory physiotherapy activities.ResultsSeven CYP provided feedback on the intervention structure, pacing, accessibility, and content. Participants valued the breathing retraining with narrative-based psychological approaches and highlighted the importance of peer connection, regular breaks, and accessible online resources to accommodate fatigue and cognitive symptoms. Feedback informed refinement of the intervention structure, physiotherapy activities, and supporting digital materials.ConclusionCo-design with CYP with lived experience of PCS supported the development of a patient-centred online intervention integrating psychological and physiotherapy approaches. The findings highlight the value of involving CYP in the development of interventions for complex long-term conditions and demonstrate the potential of accessible telehealth approaches to support recovery and wellbeing. Further evaluation of feasibility, acceptability, and clinical impact is warranted.

BackgroundThe vestibular system contributes significantly to cognitive processes. Our study aims to detect the possible differences in cognitive function between patients with vestibular migraine (VM) and patients with migraine headaches only (MO).MethodsThis was a cross-sectional study. The participants took a number of tests during the same session: Mini Mental State Examination (MMSE), Stroop Test (ST), Digit Span Test (DST), Oktem Verbal Memory Process Test (OVMPT), Verbal and Nonverbal Cancellation Tests, Benton's Judgment Of Line Orientation Test (BJLOT), Rey-Osterrieth Complex Figure Test (ROCFT), Verbal Fluency Test (VFT), and Trail Making Test (TMT), in addition to Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI).ResultsThere were 97 participants (VM = 34, MO = 31, HC = 32), matched for age, sex, and education. Both patient groups had higher BAI scores than controls (p < 0.001). Both patients with VM and patients with MO performed worse than healthy controls on the Stroop tasks, DSFT, and DSBT (p < 0.05 for all tasks, except Stroop Task 3 in the MO group), but no significant differences were observed between the VM and MO groups (p > 0.05). In the multivariable analyses, Stroop performance remained significantly worse in patients with VM, while DSFT and DSBT performance remained significantly worse in patients with MO (p < 0.05). In addition, both patient groups showed significantly worse performance on the TMT-B compared with controls (p < 0.05).ConclusionIn conclusion, our study showed that attention, working memory, and spatial cognitive functions were affected in patients with VM. However, no overall cognitive differences were identified between patients with VM and patients with MO.

Major depressive disorder (MDD) significantly contributes to the mental health burden in Africa, requiring insights into prevalence and risk factors to inform culturally responsive care. This study assessed current and lifetime MDD prevalence and associated factors among 7,073 adults from hospital settings in Uganda, Kenya, Ethiopia, and South Africa within the NeuroGAP-Psychosis study. Prevalence was 0.9% for current MDD and 5.1% for lifetime MDD, substantially lower than prior estimates from the region. Lower rates may be due to the population studied or cultural variations in expression of symptoms. Multilevel logistic regression identified significant associations between current MDD and negative life events, alcohol use, and Kessler psychological distress scores, while lifetime MDD was linked to age, female sex, chronic pain, frequent headaches, and positive psychosis screening. These findings underscore the need for targeted mental health interventions tailored to the identified factors to reduce the burden of MDD in diverse African contexts.

Portable functional near-infrared spectroscopy (fNIRS) may support brain-based monitoring around local anesthesia, but between-patient variability and patient-overlapping validation can limit generalization. We examined affected-tooth classification before versus after anesthesia, exploratory Pre-session affected-versus-healthy classification using both resting-state and held-out healthy-tooth reference schemes, and validation inflation. We analyzed fNIRS data from 25 patients during percussion before ("Pre") and after ("Post") anesthesia. The primary cohort comprised 13 patients with complete pain abolition; 156 affected-tooth epochs were classified using Pre-session healthy-tooth responses as patient-specific references. Leave-one-subject-out (LOSO) validation tested each patient using models trained on the others. A random forest using a fixed, data-informed three-feature oxyhemoglobin (HbO) panel achieved mean area under the receiver operating characteristic curve (AUC) = 0.752 (95% confidence interval [CI], 0.624-0.865; one-sided exact conditional p = 0.0057). Fold-nested selection yielded AUC = 0.740. Referencing improved estimates for two of four classifiers. In Pre-session analyses, resting-state and split-half referencing increased affected-versus-healthy AUC from matched raw values of 0.513 and 0.524 to 0.731 (12 patients) and 0.782 (21 patients); both gains survived eight-comparison adjustment. Because tooth blocks followed a fixed order, these pain-related estimates may include block-position effects. Across 32 feature-based configurations, pooled-epoch cross-validation exceeded LOSO by a mean of 0.159 AUC (95% CI 0.078-0.252); inflation was also positive in all three aligned waveform models. These results support proof-of-concept held-out-patient classification of pain-related affected-tooth responses before versus after anesthesia, exploratory referenced affected-versus-healthy classification before anesthesia, and patient-disjoint validation for estimating performance in new patients.

The purpose of this study was to describe real-world adjunctive use, tolerability, and hypothesis-generating seizure and multidomain outcomes of LALBAAY, an alpha-lactalbumin/sodium butyrate Food for Special Medical Purposes (FSMP), in patients with drug-resistant epilepsy (DRE). This retrospective national multicentre observational study (17 centres) analysed 60 patients with DRE treated with adjunctive LALBAAY. Seizure outcomes, individual treatment duration, clinician-documented gastrointestinal (GI) and behavioural changes, and tolerability were descriptively analysed. GI and behavioural domains were routinely monitored in clinical practice, but no standardised scales were used. Exploratory association analyses evaluated selected clinically plausible baseline variables potentially associated with ≥ 50% seizure reduction using Fisher exact tests and unadjusted odds ratios; all analyses were considered hypothesis-generating. The cohort included 30 patients (50.0%) with developmental and epileptic encephalopathy, 23 (38.3%) with focal epilepsy, and 7 (11.7%) with generalised epilepsy. Median age was 18.0 years (IQR 11.8-32.2). Any seizure reduction was documented in 35/60 patients (58.3%), ≥50% seizure reduction in 20/60 (33.3%; Wilson 95% CI 22.7-45.9%), and seizure freedom in 8/60 (13.3%). Two additional patients had resolution of clinician-designated major seizure events without complete seizure freedom. Favourable GI and behavioural changes were documented in 12/60 (20.0%) and 13/60 (21.7%) patients, respectively. Adverse events were documented in 4/60 patients (6.7%); 55/60 remained on treatment and 5/60 discontinued. Exploratory association analyses did not identify a statistically robust response-associated profile. In this retrospective real-world DRE cohort, adjunctive LALBAAY use was accompanied by descriptively favourable seizure findings and few documented adverse events. GI and behavioural observations were clinician-documented descriptive signals rather than standardised efficacy outcomes. Exploratory associations require confirmation in larger prospective studies.

Cluster headache (CH) is a devastating primary headache disorder and is widely recognized as one of the most severe pain conditions encountered in clinical practice. The goal of this narrative review is to examine the challenges contributing to the delayed recognition and diagnosis of CH. We divided the cost of CH into direct and indirect costs. We found that direct costs include healthcare services, such as emergency department, primary care, and specialist visits, diagnostic tests, pharmacy services, oxygen therapy, and neuromodulation devices, and increased healthcare utilization, including more frequent emergency department visits. Indirect costs include such invisible burdens of the disease as pain, demoralization, and suicide risk. Despite the cyclic nature of the disease, CH is a chronically disabling disease that impacts patients even during periods of remission. Misdiagnosis is common, particularly among female patients. Diagnostic delays often impede initiation of optimal treatment. Reducing diagnostic delays will require educating clinicians who may encounter patients suffering from CH, including those in primary care, emergency medicine, pain management, neurology, otolaryngology, and dentistry. To address misdiagnosis, it is recommended to incorporate the Erwin Test for Cluster Headache (ETCH) into clinical practice and healthcare professional education to support earlier recognition and improve diagnostic accuracy. Collaboration among healthcare professionals, patient advocacy organizations, and patients themselves, together with improved diagnostic tools and expanded access to care, may increase awareness, reduce diagnostic delays, and improve patient outcomes.

We describe the clinical and radiographic outcomes of a patient presenting with post‑traumatic loss of cervical lordosis following a motor vehicle collision (MVC). A 27‑year‑old man reported to a spine rehabilitation clinic complaining of neck pain, low back pain, and headaches following an MVC one month prior. The patient scored moderate disability: 36% and 34% on the neck and headache indices, respectively. Radiograph screening of the cervical spine demonstrated severe anterior head translation (AHT) of 59.9 mm (ideal = 0 mm), complete loss of the cervical lordosis (C2-C7 absolute rotation angle = -1.6°; ideal = -42°), and a sharp reversal of the C5-C6 intersegmental angle of +5.9° (ideal = -8.0°). Chiropractic BioPhysics® (CBP®) (Chiropractic BioPhysics Seminars, Eagle, ID, USA) treatment aimed at restoring cervical lordosis and sagittal balance was performed over 6.5 months with a 17-month follow-up. Symptomatic improvement progressed to being negligible over the 6.5-month treatment duration. At the final follow-up, radiographic parameters improved by 38 mm in AHT, 17° in lordosis, and 10.5° in the C5-C6 segmental kyphosis. This case illustrates that meaningful structural correction is achievable and may coincide with profound and sustained clinical recovery, supporting further investigation into sagittal alignment restoration as a central therapeutic objective in patients suffering from cranio-cervical symptoms following an MVC.

Background Lower urinary tract symptoms (LUTS), highly prevalent among aging men, adversely affect the quality of life. Pharmacological management has evolved with multiple drug classes, but real-world prescribing patterns in India have not been adequately studied. Thus, we evaluated prescription trends among Indian urologists for the management of male LUTS, assessed symptom patterns, evaluated factors influencing choice of fixed-dose combination (FDC), with special focus on silodosin-mirabegron FDC, and identified adverse events (AEs) and adherence. Methods This cross-sectional, questionnaire-based survey was performed over three months (January 2, 2026, to April 5, 2026) and included 110 Indian urologists actively managing male patients with LUTS. A 27-item structured questionnaire captured demographic characteristics, clinical practice patterns, and prescribing preferences for LUTS pharmacotherapy, including monotherapies, combination therapies, and FDCs, along with AEs and adherence. Results Of 135 urologists invited, 110 (81.48%) completed the survey. LUTS mainly involved a combination of storage, voiding, and post-micturition symptoms (n = 59, 53.6%). As a class, α1-blockers were the most frequently prescribed monotherapy (n = 109, 99.1% frequent/very frequent use), with silodosin (n = 98, 89.1%) and tamsulosin (n = 84, 76.4%) being most preferred. Use of dutasteride (n = 108, 98.2%) exceeded finasteride (n = 13, 11.8%). In patients with benign prostatic hyperplasia (BPH) with overactive bladder, silodosin-mirabegron was the most favored FDC (n = 97, 88.2%). FDCs of α1-blockers with muscarinic receptor antagonists and β-3 adrenergic agonists were preferred due to their proven efficacies (n = 83, 75.5% and n = 87, 79.1%, respectively) and lower incidences of AEs (n = 69, 62.7% and n = 80, 72.7%). Common AEs included dry mouth (n = 73, 66.4%), anejaculation (n = 69, 62.7%), and headache (n = 67, 60.9%). Moderate adherence (25%-75%) was reported by 95 (86.4%) urologists. Conclusion Adherence to pharmacotherapy, as assessed by participating urologists, was moderate, with urologists preferring silodosin as first-line therapy and silodosin-mirabegron FDC for mixed LUTS.

Kyasanur forest disease (KFD) is a tick-borne viral haemorrhagic fever that has recently expanded beyond its historically endemic focus in Shimoga district, Karnataka, India. Robust estimates of disease burden, distribution and clinical manifestations remain limited. This systematic review and meta-analysis aimed to estimate pooled KFD positivity, case-fatality rates and to characterise the distribution and clinical features of KFD across India.