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Introduction - Pure autonomic failure is a rare disorder characterized by orthostatic hypotension, absence of a compensatory rise in heart rate, and abnormal autonomic functions. In most cases, supine hypertension is seen coupled with orthostatic hypotension, making the management of these patients a big challenge. We present the case of a 74-year-old gentleman, who presented to the ED with altered mental status for a day; weakness, and falls for 3 weeks. The patient had a past medical history of Hypertension, alcoholism, and REM sleep disorder. He was being treated for erectile dysfunction for the last 10 years and had a family history of Parkinson's disease in his mother and sister. The patient was compliant with Lisinopril 40 mg, Amlodipine, and Rosuvastatin, Tamsulosin 0.4 mg. His blood pressure(BP) on presentation was ranging between 109/74-194/76 mm of Hg. Systolic BP dropped by 30mmHg after tilting the angle of the bed to 45 degrees for 1 minute with no change in HR and the patient became symptomatic in this position. Orthostatic vitals showed a dramatic drop in Systolic BP of >80mmHg with no change in heart rate. MRA and MRI showed chronic microvascular changes. The Echocardiogram, Cortisol, and TSH levels were all normal. All anti-hypertensives were discontinued and supportive treatment was started with Midodrine, Droxidopa, and Pyridostigmine, thigh-high TED hose and abdominal binders at bedtime, and Nitroglycerin patch at night for hypertension. The patient was started on fludrocortisone as he continued to drop his BP by 80 mmHg on standing. The use of TED stockings and bed tilting improved the issue of uncontrolled supine hypertension at night. Conclusion- Treatment of autonomic dysfunction continues to be challenging. There are no definitive guidelines and management is largely individualized. Both pharmacological and non-pharmacological measures are used.

Background: IDH-wild-type glioblastoma (GBM) is the most frequent brain-derived malignancy. Despite intense research efforts, it is still associated with a very poor prognosis. Several parameters were identified as prognostic, including general physical performance. In neuro-oncology (NO), special emphasis is put on focal deficits and cognitive (dys-)function. The Neurologic Assessment in Neuro-Oncology (NANO) scale was proposed in order to standardize the assessment of neurological performance in NO. This study evaluated whether NANO scale assessment provides prognostic information in a standardized collective of GBM patients. Methods: The records of all GBM patients treated between 2014 and 2019 at our facility were retrospectively screened. Inclusion criteria were age over 18 years, at least 3 months postoperative follow-up, and preoperative and postoperative cranial magnetic resonance imaging. The NANO scale was assessed pre- and postoperatively as well as at 3 months follow-up. Univariate and multivariate survival analyses were carried to investigate the prognostic value. Results: One hundred and thirty-one patients were included. In univariate analysis, poor postoperative neurological performance (HR 1.13, p = 0.004), poor neurological performance at 3 months postsurgery (HR 1.37, p < 0.001), and neurological deterioration during follow-up (HR 1.38, p < 0.001), all assessed via the NANO scale, were associated with shorter survival. In multivariate analysis including other prognostic factors such as the extent of resection, adjuvant treatment regimen, or age, NANO scale assessment at 3 months postoperative follow-up was independently associated with survival prediction (HR 1.36, p < 0.001). The optimal NANO scale cutoff for patient stratification was 3.5 points. Conclusion: Neurological performance assessment employing the NANO scale might provide prognostic information in patients suffering from GBM.

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Bakgrund: År 2020 efterlyste Statens beredning för medicinsk och social utvärdering, (SBU), en uppdaterad litteraturöversikt gällande effekten av kontrakturprofylax. Kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet utgör populationen där kontrakturprofylax är en del av den fysioterapeutiska interventionen och då oftast i form av passivt rörelseuttag.  Syftet: Denna systematiska översikt syftar till att undersöka effekten av kontrakturprofylax som förebyggande och behandlande åtgärd för vuxna individer med kroniska neurologiska tillstånd som föranlett nedsättning av aktiv rörlighet. Syftet utöver det var att sammanställa resultatets vetenskapliga kvalitet och tillförlitlighet. Metod: En systematisk översikt över RCT-studier producerade mellan 2013 och 2023, där interventionen syftar till att förebygga eller behandla kontrakturer. Artiklarnas kvalitet granskades med PEDro skalan och det sammanvägda resultatets tillförlitlighet granskades med den studentanpassade versionen av GRADE. Kvaliteten var genomgående hög medan det sammanvägda resultatet har en låg sammanvägd tillförlitlighet. Resultat: Sju artiklar med ett totalt deltagarantal på 367 granskades. Kvaliteten varierade bedömt utifrån PEDro mellan 7 och 10 poäng, samtliga studier inkluderades i den sammanvägda bedömningen av tillförlitlighet. Sammanvägt hade studierna låg tillförlitlighet, detta på grund av bristande samstämmighet och överförbarhet, precisionen ansågs acceptabel.  Slutsatser: Det går inte att dra slutsatser gällande enskild effekt av kontrakturprofylax i form av passiv rörelseträning. Samtidigt framkommer inte något underlag för att kontrakturprofylax skulle negativt påverka andra interventioner. Det behövs mer forskning inom området och mätning av ledrörlighet och definition av kontrakturprofylax bör även standardiseras för ett mer överförbart och samstämmigt resultat. Denna studie kan således inte konkludera om en fysioterapeut bör använda kontrakturprofylax, vare sig som förebyggande eller behandlande åtgärd. / Background: In 2020, the State's preparation for medical and social evaluation, (SBU), called for an updated literature review regarding the effect of contracture prophylaxis. Chronic neurological conditions that have caused a reduction in active mobility make up the population where contracture prophylaxis is part of the physiotherapeutic intervention and then usually in the form of passive range of motion. Aim: The aim of this systematic review was to investigate the effect of contracture prophylaxis as a preventive and treatment measure for adults with chronic neurological conditions that have caused impairment of active mobility. The purpose, in addition to that, was to compile the scientific quality and reliability of the results. Method: A systematic review of RCT-studies produced between 2013 and 2023, where the intervention aims to prevent or treat contractures. The quality of the articles was reviewed with the PEDro scale, and the reliability of the combined results was reviewed with the student-adapted version of GRADE. The quality was considered high, while the summarized result had a low reliability. Results: Seven articles with a total number of participants of 367 were reviewed. The quality varied as assessed based on PEDro between 7 and 10 points, all studies were included in the combined assessment of reliability. Summarized, the studies had low reliability, this due to a lack of consistency and transferability, the precision was considered acceptable. Conclusions: It is not possible to draw conclusions regarding the individual effect of contracture prophylaxis in the form of passive movement training. At the same time, there is no evidence that contracture prophylaxis would negatively affect other interventions. More research is needed in the field and measurement of joint mobility and definition of contracture prophylaxis should also be standardized for a more transferable and consistent result. This study cannot therefore conclude whether a physiotherapist should use contracture prophylaxis, either as preventive care or as treatment.

No / A neurological disorder is any disorder or abnormality in the nervous system. Among different neurological disorders, Alzheimer’s disease (AD) is recognized as the sixth leading cause of death globally. Considerable research has been conducted to find pioneer treatments for this devastating disorder among which cell therapy has attracted remarkable attentions over the last decade. Up to now, targeted differentiation into specific desirable cell types has remained a major obstacle to clinical application of cell therapy. Also, potential risks including uncontrolled growth of stem cells could be disastrous. In our novel protocol, we used basal forebrain cholinergic progenitor cells (BFCN) derived from human chorion-derived mesenchymal stem cells (hC-MSCs) which made it possible to obtain high-quality population of cholinergic neurons and in vivo in much shorter time period than previous established methods. Remarkably, the transplanted progenitors fully differentiated to cholinergic neurons which in turn integrated in higher cortical networks of host brains, resulting in significant improvement in cognitive assessments. This method may have profound implications in cell therapies for any other neurodegenerative disorders. / This work was carried outwithin the framework of a collaborative project (Project Grant No. 94-02-30-25922) by the School of Medicine, Iran University of Medical Sciences, (Project Grant No. REP209) council for stem cell sciences and technologies (Presidency of the Islamic Republic of Iran, vice-presidency for science and technology), and Iran National Science Foundation (INSF).