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Limbic encephalitis (LE) diagnosis can be challenging due to its broad spectrum of clinical presentation and variety of causes. The most commonly known causes include paraneoplastic and autoimmune, but they can also occur post-vaccine. Since 2020, many people worldwide have received the coronavirus disease 2019 (COVID-19) vaccine after FDA approval. Mild self-limited neurological adverse reactions, including headache and dizziness, were reported post-vaccine. However, emerging few neurological severe events, including encephalitis, have also been reported. Herein, we present a case of a middle-aged female who presented with seizures after two days of receiving the second dose of the Moderna COVID-19 vaccine. A diagnosis of limbic encephalitis was made based on head MRI findings. It was treated with immunosuppressive agents and responded well with no additional neurological sequelae. This case is unique as it highlights a possible association between limbic encephalitis and the COVID-19 vaccine.

To assess onset of effect in three placebo- or nonsteroidal anti-inflammatory drug (NSAID)-controlled trials of tanezumab in patients with moderate-to-severe osteoarthritis.

A 51-year-old male presented with intermittent chest pain for one month and productive cough with yellow sputum for seven days. He had a history of chronic kidney disease stage G3, depression, and polysubstance abuse. His chest X-ray revealed mild hazy opacity in the right lower lobe, followed by a chest computed tomography without contrast that indicated multiple nodular opacities in the left mainstem bronchus with clear lungs. The patient underwent flexible bronchoscopy where the left mainstem bronchus was found to be completely occluded by three clear plastic bags, about 1 x 0.5 cm in size containing whitish content consistent with the appearance of crack cocaine. A high index of suspicion is crucial in patients with suspected foreign body aspiration as prompt extraction of foreign bodies may prevent complications.

Introduction Gamification is a novel interventional approach to functional recovery and rehabilitation. A significant impact has been observed with the application of gamification on non-traumatic conditions and chronic neurological and musculoskeletal illnesses; however, the implication of gamification on the functional recovery of patients with distal radius fractures (DRF) is yet to be explored.  Methodology This pilot study included 20 post-DRF patients aged 18-65 years with unilateral DRF, managed with closed reduction and K-wire internal fixation. The patients were assigned to group A (gamification) and group B (conventional rehabilitation) in a 1:1 ratio. Group A patients played Racket: NX game, Until you fall game, and Holofit game on Oculus Quest head-mounted display (HMD) (Oculus, USA), while group B patients received a conventional rehabilitation program. Both groups underwent a rehabilitation program for 60 min/day, five days a week, for four weeks. The visual analogue scale (VAS), universal goniometer, Jamar dynamometer, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were used as outcome measures at baseline, at the end of the second week, and at the end of treatment. Results There were significant improvements in pain, range of motion (ROM), grip strength, and functional independence in both groups. However, improvements in hand function and functional independence were significantly greater in the gamification group than in the conventional physiotherapy rehabilitation group. Conclusion The study concluded that gamification appears to have a significant impact on post-DRF rehabilitation in terms of pain, ROM, grip strength, and functional independence. Further research with larger sample sizes is required to confirm the preliminary findings.

Background In this study, we aimed to describe eight cases of dengue encephalitis along with their magnetic resonance imaging (MRI) findings. Dengue encephalitis is caused by an arbovirus that has four strains DENV1-DENV4. The dengue virus is usually non-neurotropic but DENV2 & DENV3 are neurotropic. Dengue encephalitis is characterized by headaches, seizures, and altered consciousness. Methodology At our facility, we performed 3T MRI on eight suspected cases of dengue encephalitis using the criteria established by Varatharaj et al. We were able to diagnose dengue encephalitis based on the proposed criteria which included symptoms, serology, cerebrospinal fluid (CSF) analysis results, MRI findings, and routine blood laboratory workup in dengue encephalitis. Because numerous brain regions are potentially impacted in severe cases of dengue encephalitis, an MRI of the brain can reveal the severity of the condition. In deteriorating situations, it may detect whether or not further regions are being impacted. Hence, MRI should be done in all suspected cases of dengue encephalitis. Results The changes observed on MRI of the eight cases were in the supra-tentorium (deep periventricular white matter, subcortical white matter, and deep gray matter of the brain, which includes basal ganglia and thalami), infra-tentorium (cerebellar white matter and brainstem, which includes pons), and occasionally in cortical gray matter. The MRI showed mild-to-moderate hyperintensities on T2-weighted images and fluid-attenuated inversion recovery sequence (FLAIR); diffusion restriction is seen on diffusion-weighted images. The neurological clinical features included non-localizing signs and symptoms such as altered mental status, headache with vomiting, and fever. Conclusions The commonly affected areas of the brain in dengue encephalitis are the basal ganglia, thalamus, brainstem, cerebellum, cortical white matter, periventricular white matter, and cortical gray matter, which are all hyperintense on T2-weighted images and FLAIR. The lesions are iso or hypointense on T1-weighted images and micro-hemorrhages appear as blooming on susceptibility-weighted MRI. MRI is a crucial initial investigation in suspected cases of dengue encephalitis and known cases of dengue fever experiencing worsening neurological conditions.

Remote knee osteoarthritis (OA) management programs are becoming more popular. This systematic review examined the efficacy of remote exercise programs for relieving pain in persons with knee OA.

Methadone is a long-acting opioid medication that is used as maintenance therapy for heroin addiction. We present a case of a patient on methadone maintenance therapy for chronic back pain who developed neurological complications. The patient presented with mental status changes and choreiform movements. Workup revealed lesions involving the subcortical white matter and basal ganglia. Choreiform movements improved after the initiation of treatment with topiramate, clonazepam, and risperidone. This combination was chosen as several prior case reports published significant benefit and improvement in choreiform movements with the mentioned regimen.

Several government-sponsored reporting systems have stated mild to moderate side effects of COVID-19 vaccines. However, patient-reported data on COVID-19 vaccine-associated adverse effects in adolescents are lacking. Our objective was to assess the short-term side effects of Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccinations among teenagers in Saudi Arabia.