Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery: Two-center retrospective cohort study.

Background: Over the past two decades, endoscopic endonasal skull base surgery (EESBS) has revolutionized the treatment of skull base tumors by enabling minimal access to resect significant pathologies such as meningiomas, pituitary adenomas, and chordomas. Despite its efficacy, complications such as cerebrospinal fluid (CSF) leak pose significant challenges, with an average incidence of 8.9% following EESBS. Therefore, our study aims to investigate the risk factors associated with postoperative CSF leak after employing an endoscopic endonasal approach for skull base surgery, focusing on patients treated at King Abdul-Aziz Medical City in Jeddah and King Abdullah Medical City in Makkah, Saudi Arabia. Methods: A retrospective review of patients who underwent an endoscopic endonasal approach for the resection of intradural skull base pathology between January 2016 and December 2022 was performed with a total of 51 patients. Basic demographic data were collected, along with patient comorbidities, presenting symptoms, tumor pathology, tumor site, the extent of resection, and outcomes. Results: 51 participants were analyzed, with a mean age of 43.41. Male participants comprised (58.8%), while headaches were the most common symptom (74.5%), followed by visual disturbances (51.0%). Nonsecretory tumors predominated, primarily located in the sellar and suprasellar regions (58.8%). Gross total resection was performed in the majority (56.9%), with a 9.8% incidence of postoperative CSF leak. Notably, all four patients with CSF leak experienced preoperative headaches. Hypertension was prevalent in Cases 1 and 4, with Case 4 having a history of neurological disease and radiation therapy. Anterior skull base tumors were most frequent in Cases 3 and 4. Conclusion: The incidence of CSF leakage after surgery in this study was similar to that previously reported. It is worth noting that repeated surgeries may increase the risk of postoperative CSF leakage. Therefore, it is important to carefully evaluate the surgical approach for tumor removal and skull base reconstruction, considering the tumor characteristics and the patient's overall condition.

Intracranial Cysts: A Single-Institution Experience With 27 Surgically Managed Cases.

Introduction Intracranial cysts (ICs) are rare pathologies that are often found incidentally during radiological examinations. They may appear in various brain regions and are categorized as normal, congenital, traumatic, or tumor-associated variants. ICs can be asymptomatic or cause symptoms, such as headaches, visual impairments, or seizures, depending on their size and location. Severe complications include obstructive hydrocephalus, loss of consciousness, and intracranial bleeding. Surgical excision is the most accepted type of management in most ICs. Objectives This study aimed to evaluate 27 surgically managed ICs in a tertiary hospital focusing on their clinical, radiological, histopathological, surgical outcomes, and prognosis to enhance understanding and management of these rare, benign cysts. Methodology This retrospective cohort study included 27 surgically managed ICs with pathological confirmation in King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia, from May 2016 to May 2023. All extracranial and nonsurgically managed cysts have been excluded from this study. Data on demographics, clinical presentations, radiological features, surgical outcomes, and follow-up were retrospectively extracted and analyzed. MRI and CT scans were reviewed to determine cyst characteristics. Surgical outcomes and postoperative complications were recorded. Data were collected via Google Forms and analyzed using the JMP Pro software. Ethical approval was obtained from King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. Results The study included 27 ICs: 11 (40.74%) colloid cysts, six (22.22%) epidermoid cysts, five (18.51%) adamantinomatous craniopharyngiomas, two (7.40%) neuroepithelial cysts, and one each of Rathke's cleft cyst (3.70%), xanthogranuloma (3.70%), and dermoid cyst (3.70%). All 27 cases were surgically managed (100.00%), with gross total resection achieved in 14 (51.85%) cases. Only 12 cases (44.44%) did not develop any surgical complications. Twenty-two cases (81.48%) experienced an improvement in the preoperative presenting symptoms. During the follow-up, only three cases (11.11%) had evidence of recurrence. Conclusion This study analyzed 27 ICs of various histopathological types. Each type showed distinct clinical and radiological features. Surgical management generally improved preoperative symptoms with low mortality and recurrence rates, although complications were common. Identifying specific radiological features is crucial for an accurate preoperative diagnosis and optimal surgical outcomes.

Spent coffee waste-derived biochar improves physical properties, water retention, and maize (Zea mays L.) growth in sandy soil.

Adding organic soil amendments can improve the physical and hydrological properties of soil, subsequently enhancing fertility for better crop production. In this study, spent Arabica and Columbian coffee wastes and their respective biochars were evaluated as soil amendments to improve the physical and hydrological properties of loamy sand soil and enhance maize (Zea mays L.) crop growth. Spent Arabica coffee (AC) and Columbian coffee (CC) wastes were collected and transformed into biochar through pyrolysis process at 550 °C with a residence time of 3 h and pyrolysis rate of 5 °C per minute. The AC and CC derived biochar were termed as ABC and CBC, respectively. The produced soil amendments were applied to soil at 0% (control), 1%, 3%, and 5% in a column setup. The moisture characteristics, including water infiltration, evaporation, and water retention, were investigated. Thereafter, the prepared amendments were applied to loamy sand soils at 0% (control), 1%, 3%, and 5% (w/w) application rates. Maize growth was then observed for a period of 30 days under greenhouse conditions. Results of the column trials showed that ABC and CBC applied at 5% reduced the cumulative water evaporation by 57%-66% and cumulative infiltration by 124%-181% compared to control. Likewise, 5% application of ABC and CBC resulted in 101 to 130% higher water retention in loamy sand soil. Results of the greenhouse experiment showed that 5% application of ABC and CBC amendments resulted in root biomass of 2.12 and 2.38 g, respectively, as compared to 0.51 g in control treatment. Similar treatments resulted in shoot biomass of 9.70 and 9.93 g respectively, as compared to 7.37 g in control. Likewise, 5% application of CBC and ABC increase plant height from 15.71 to 30.94 cm in ABC and 33.23 cm in CBC. Overall, 5% application of coffee waste-derived biochars significantly reduced water evaporation and infiltration, while increasing soil water retention and maize plant height, root biomass, and shoot biomass. Therefore, spent coffee waste-derived biochar could effectively be employed to improve physical and hydrological properties of loamy sand soils for better crop productivity.

Inappropriate Emergency Department Visits: Insights on Incidence, Associated, and Predictive Factors From 5,429 Visits.

INTRODUCTION: Inappropriate visits (IVs) and overcrowded emergency departments (EDs) can result in many complications for patients and medical staff. This study aimed to assess the incidence, associated factors, and predictive factors of IVs to ED. METHODS: This retrospective cohort single-center study was conducted in the ED of King Abdulaziz Medical City, Jeddah, Saudi Arabia. All ED visits in February 2023 were included. They were considered appropriate if the patient required investigation tests, underwent a procedure, was admitted to an inpatient ward, was admitted to the short-stay unit, was referred for follow-up at a specialist outpatient clinic after discharge from the ED, or was referred to the ED of another hospital. Failure to have at least one of these factors led to the visit being considered inappropriate. RESULTS: A total of 5,429 visits were included. The incidence rate of IVs was 1128 (20.7%). Of the visits, 1,028 (18.9%) were attended by patients aged <10 years, and 2,825 (52.0%) by female patients. The most reported complaints were pulmonological in 1,029 visits (18.9%). Patients with appropriate visits (AVs) had significantly higher median BMI scores than those with IVs (25.9 (20 - 3) vs. 23.7 (16.36 - 29), P = <0.0001). Visits with pulmonological (447 (39.6%) vs. 582 (13.5%)) and otorhinolaryngologic (54 (4.7%) vs. 94 (2.1%)) complaints were significantly more likely to be inappropriate (P = <0.0001). In multiple logistic regression, being a male (OR: 1.3, CI: 1.1 - 1.5, P = <0.0001), being non-Saudi (OR: 2.7, CI: 2.0 - 3.6, P = <0.0001), and visiting on the weekend (OR: 1.1, CI: 1.0 - 1.3, P = 0.0366) were significantly predictive of the visits being inappropriate. CONCLUSIONS: Our findings revealed a high incidence of IVs in the ED, with several factors predictive of IVs. Highlighting these factors can help minimize the incidence of IVs and, therefore, improve the quality of healthcare delivered to patients in need and their clinical outcomes.

Intraosseous mandibular schwannoma managed via submandibular approach: a case report with a review of previously published cases.

A 40-year-old female presented with right mandibular swelling. A panoramic radiograph showed a unilocular radiolucency from the mandibular angle to tooth #46. Biopsy confirmed a schwannoma. Surgical resection was performed via a submandibular approach with a reconstruction plate. Teeth 46 and 47 were extracted. Surgery was complication-free, and histopathology confirmed the tumor's benign nature. The patient was discharged on the second postoperative day. At the 1-year follow-up, she had no paresthesia, normal mouth opening, and full mandibular motion. The reconstruction plate was intact. This case adds to the limited literature on intraosseous schwannomas, emphasizing early detection, thorough radiological assessment, and meticulous surgical planning.

Frequency and Determinants of Depression in Hypothyroidism Patients at a Tertiary Care Hospital in the Western Region of Saudi Arabia.

Background: Several studies have reported a strong association between depression and hypothyroidism, including from several regions of Saudi Arabia. However, studies on the frequency of depression among patients with hypothyroidism from the Western region of Saudi Arabia is limited. Objectives: To determine the frequency and risk factors of depression among patients with hypothyroidism in the Western Region of Saudi Arabia. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in Jeddah, Saudi Arabia, and included adult patients diagnosed with hypothyroidism. After contacting the patients through phone calls and obtaining their consent, a questionnaire weblink was sent. The first part of the questionnaire elicited details regarding demographics and history of hypothyroidism, while the second part comprised the Arabic version of the Patient Health Questionnaire-9 to evaluate depression. Results: A total of 100 patients completed the survey, of which 80% were found to have depression (mild: 35%, moderate: 26%, moderate to severe: 12, severe: 7%). There was no significant association between depression and gender, age group, employment status, and marital status. In the bivariate analysis, a significant association was found between depression and reporting fatigue (P < 0.001), constipation (P < 0.001), hair loss (P = 0.002), cold intolerance (P = 0.014), dry skin (P = 0.028), memory problems (P = 0.029), and menorrhagia (P = 0.037). However, in the multivariate analysis, only reporting fatigue was found to be significantly associated with depression (P = 0.040; OR = 15.215). Conclusion: This study found that the prevalence of depression was very high among patients with hypothyroidism in the Western region of Saudi Arabia, and that fatigue is an independent risk factor of depression.

Retained wood penetrating the inferior orbital fissure removed after several months from injury: A case report and a comprehensive literature review.

Background: Intraorbital wooden foreign bodies (IOWFBs) constitute a relatively rare ocular trauma. Clinically, it can be difficult to diagnose them due to their wide variety of clinical manifestations. In addition, radiologic diagnosis of IOWFBs is always uncertain and challenging since their low density and low intensity on initial images are identical to air and fat. Therefore, IOWFBs are commonly missed and may not be confirmed for days or months after the initial injury. This article endeavors to contribute to the existing literature on IOWFBs by adding a case of an unusual occurrence of retained wood penetrating the inferior orbital fissure (IOF). To date, there have been no documented instances of a similar occurrence in this particular anatomical location. Case Description: A 58-year-old female with a history of trauma sustained by a slipping accident 10 months before her referral to our hospital. She underwent multiple surgeries and was referred to us due to persistent right eye pain, periorbital swelling, recurrent eye discharge, and inferior orbital paresthesia. The imaging revealed a retained foreign body located in the right orbital floor inferior to the inferior rectus muscle extending to the sub-temporal fossa through the IOF. The residue was successfully removed without complications. Conclusion: A history of trauma followed by persistent symptoms should raise the suspicion of a retained foreign body, regardless of the severity of trauma or the time between trauma and clinical presentation. Appropriate and timely imaging, followed by surgical removal, remains the cornerstone of treatment with a favorable prognosis.

Rate and Causes of Unplanned Hospital Returns within 60 Days following Head and Neck Surgery.

Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score ( p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.

The Prevalence of Depression and Acceptance Rate of Referral to Psychiatrist Among Psoriatic Patients in Saudi Arabia.

Background Psoriasis is a chronic inflammatory disease that primarily affects the skin and can significantly impact the quality of life. Previous studies have shown that psoriasis increases the risk of depression; however, there is a lack of information about the prevalence of depression and psoriatic patients' acceptance of referral to a psychiatric clinic in Saudi Arabia. This study aims to estimate the prevalence of depression among psoriatic patients in Saudi Arabia, determine their referral acceptance rate to psychiatric clinics, and assess their knowledge regarding the impact of depressive symptoms on psoriasis. Methods This questionnaire-based cross-sectional study included patients with psoriasis who presented to dermatology clinics in Saudi Arabia. All patients were instructed to complete three sets of questionnaires encompassing sociodemographic information, the clinical characteristics of their illness, and the Beck Depression Inventory. Results Of 406 patients, 54.9% had symptoms of depression, and 46.3% were willing to go to a psychiatrist when symptoms of depression were present. Most of the patients (70%) thought that depression affects psoriasis. Conclusions More than half of the psoriatic patients in this study were depressed. The patients understood that depression can lead to a worsening of their symptoms, but the majority refused to see a psychiatrist. To remove barriers to seeing a psychiatrist, psoriasis patients should be provided with mental health assistance, taught to identify psychological stressors and effective strategies to cope with these stressors, and educated about available services, including telemedicine.

Knowledge about HIV and Stigmatizing Attitudes of Medical Students in Saudi Arabia Towards Patients with HIV/AIDS: A Cross-Sectional Nationwide Study.

BACKGROUND: The Human Immunodeficiency Virus (HIV) and the social stigma directed toward patients with HIV are serious public health issues. We aimed to evaluate the HIV knowledge base and stigmatizing attitudes toward patients with HIV among students enrolled in medical schools in Saudi Arabia. METHODS: This cross-sectional study included students at medical colleges in Saudi Arabia and was conducted between February and March 2023. We used non-random convenience sampling with an online chain referral via a validated Arabic questionnaire composed of 35 questions. Data were analyzed using descriptive and comparative statistics. RESULTS: A total of 1,213 medical students (women: 56.6%) participated in the study. Students in clinical years had a higher level of HIV knowledge than their pre-clinical colleagues. Logistic regression analysis revealed that participants who gave incorrect answers to questions related to mother-to-child and casual contact HIV transmission had a higher likelihood of harboring a negative attitude towards patients with HIV. Conversely, those who correctly answered queries on prevention and treatment were less likely to have stigmatizing attitudes. A significant proportion of this cohort harbored negative attitudes toward patients with HIV, with the sex and geographic location of participants being significant predictors of negative attitudes. CONCLUSION: Our data have revealed a significant percentage of medical students in Saudi Arabia to have misconceptions about HIV transmission and prevention, and stigmatizing attitudes toward patients with HIV, indicating a need for targeted interventions to enhance the HIV knowledge base in this population of future caregivers.

Enhancement in Tomato Yield and Quality Using Biochar Amendments in Greenhouse under Salinity and Drought Stress.

Enhancing saline water productivity in arid regions is essential for sustainable agriculture. Adding biochar can improve the quantity and quality of tomato yield under higher levels of salinity and lower levels of irrigation. The experiment aimed to evaluate the effects of biochar on enhancing tomato fruit quality and yield under salinity and drought stress. The experiment combines two treatments for irrigation water quality (0.9 and 2.3 dS m-1), four irrigation levels (40, 60, 80, and 100%) of crop evapotranspiration (ETc), and the addition of 5% of biochar to treated soil (BC5%) and untreated soil (BC0%). The results showed that the decrease in the water quality and irrigation levels negatively impacted the yield and properties of tomato fruit, while 5% of biochar application positively improved the yield. Adding biochar decreased the tomato yield by 29.33% and 42.51% under lower-saline-irrigation water than the control, negatively affecting the fruit's physical parameters and mineral content. In contrast, adding biochar and irrigating with saline water at 60% of ETc improved the firmness and quality characteristics of the fruit by 56.60%, 67.19, 99.75, and 73.57% for vitamin C (VC), total titratable acidity (TA), total soluble solids (TSS), and total sugars (TS), respectively, compared to the control, and also reduced the sodium content of the fruits under all irrigation levels compared to untreated plants by biochar. Generally, biochar with saline water under deficit irrigation with 80 and 60% of ETc could be an excellent strategy to enhance the qualitative characteristics of tomato fruits and save approximately 20-40% of the applied water.

Effect of Stabilized nZVI Nanoparticles on the Reduction and Immobilization of Cr in Contaminated Soil: Column Experiment and Transport Modeling.

Batch and transport experiments were used to investigate the remediation of loamy sand soil contaminated with Cr(VI) using zero-valent iron nanoparticles (nZVI) stabilized by carboxymethylcellulose (CMC-nZVI). The effect of pH, ionic strength (IS), and flow rate on the removal efficiency of Cr(VI) were investigated under equilibrium (uniform transport) and non-equilibrium (two-site sorption) transport using the Hydrus-1D model. The overall removal efficiency ranged from 70 to over 90% based on the chemical characteristics of the CMC-nZVI suspension and the transport conditions. The concentration and pH of the CMC-nZVI suspension had the most significant effect on the removal efficiency and transport of Cr(VI) in the soil. The average removal efficiency of Cr(VI) was increased from 24.1 to 75.5% when the concentration of CMC-nZVI nanoparticles was increased from 10 to 250 mg L-1, mainly because of the increased total surface area at a larger particle concentration. Batch experiments showed that the removal efficiency of Cr(VI) was much larger under acidic conditions. The average removal efficiency of Cr(VI) reached 90.1 and 60.5% at pH 5 and 7, respectively. The two-site sorption model described (r2 = 0.96-0.98) the transport of Cr(VI) in soil quite well as compared to the uniform transport model (r2 = 0.81-0.98). The average retardation of Cr(VI) was 3.51 and 1.61 at pH 5 and 7, respectively, indicating earlier arrival for the breakthrough curves and a shorter time to reach maximum relative concentration at lower pH. The methodology presented in this study, combining column experiment and modeling transport using the Hydrus-1D model, successfully assessed the removal of Cr(VI) from polluted soils, offering innovative, cost-effective, and environmentally friendly remediation methodologies.

Prevalence of Acute Tonsillitis and Its Association With Oral Hygiene Among the Population of Taif City, Saudi Arabia.

Introduction  Dental surfaces have dense bacterial deposits, and poor oral hygiene can exacerbate bacterial infections, causing acute tonsillitis. The study aims to quantify acute tonsillitis prevalence and assess its association with oral hygiene practices. Methods  A descriptive cross-sectional study aimed to assess the prevalence of acute tonsillitis and its association with oral hygiene was conducted among adults aged 20 and above in Taif City, Saudi Arabia. Illiterates and those unwilling to participate were excluded. We employed an Arabic online self-administered questionnaire that was disseminated conveniently via Google Forms to social media assessing oral hygiene such as last dental visit, age at starting dental care, number of toothbrushes per day, frequency of toothbrush change, and duration of brushing teeth, and acute tonsillitis characteristics of the participants. Results About 393 participated in the study. Of them, 54% were aged 20-30, 53% were males, and 70% had a university education. The prevalence of acute tonsillitis was 64%. Approximately 28% reported dental clinic visits within three months, and 21% initiated oral hygiene practices at age 20. Among participants, 43% brushed twice daily, with 33% spending one minute and 43% two minutes. About 31% replaced toothbrushes every three months, while 23% acknowledged having bad breath. Experiencing bad breath, changing toothbrushes every three months, and having dental visits within less than three months were associated with having acute tonsillitis (p<0.05). However, regression analysis revealed that experiencing bad breath (OR: 2.11, 95% CI: 1.23, 3.70) was associated with a higher risk of acute tonsillitis, while less frequent toothbrush changes correlated with a lower risk (OR: 0.54, 95% CI: 0.30, 0.94). Conclusion  This study revealed a substantial prevalence of acute tonsillitis among adults in Taif City. Oral care practices need improvement. There are significant associations between oral hygiene practices, bad breath, and the occurrence of acute tonsillitis. Addressing oral hygiene practices could be a key focus for preventative measures.

Significance of pyrolytic temperature, application rate and incubation period of biochar in improving hydro-physical properties of calcareous sandy loam soil.

Biochar is increasingly recognized for its ability to enhance hydro-physical properties of soil, offering promising solutions for improving soil structure, water retention, and overall agricultural productivity. In this study, sandy loam soil was amended at different rates (0, 15, 30, and 60 t ha-1) of biochar produced from olive pomace (Jift) at different pyrolysis temperatures (300, 400, 500, and 600 °C), and incubated for 30, 60, and 90 days. The biochar-amended soils were collected for analysis after each incubation period for infiltration rate, aggregate stability, soil water retention, water repellency, and penetration resistance. At 300 °C, aggregate stability increased with biochar amendments; the highest value (65%) was after 60 days of incubation. At other pyrolysis temperatures, aggregate stability decreased, or no effect of temperature was observed. Also, at 300 °C, the infiltration rate was decreased with biochar application and the lowest value of (0.14 ml/min) was at 90 days of incubation. At other pyrolysis temperatures, the infiltration rate was increased with increased biochar application rate. Water retention was increased with biochar application at 300 °C; however, biochar application did not affect water retention at other pyrolysis temperatures. These results strongly suggest the improvement of soil physical and hydraulic properties following the addition of biochar amendment. Overall, biochar had positive effects on hydro-physical properties. The biochar produced at 300 °C pyrolysis temperature was the most beneficial to agriculturally relevant hydraulic conditions. However, field assessments are necessary to evaluate the long-term effects of biochar on hydro-physical properties.

Combined Preoperative Endovascular Embolization and Surgical Excision for Scalp Arteriovenous Malformations: A Systematic Review and Case Illustration.

OBJECTIVE: To evaluate the efficacy of the combined approach of preoperative endovascular embolization (EE) and surgical excision (SE) for scalp arteriovenous malformation (AVM) and present an illustrative case report. METHODS: A systematic review was conducted using online databases (PubMed/Medline, Cochrane, and Embase) on February 15, 2023. The inclusion criteria were any type of study of patients with scalp AVMs who were diagnosed and confirmed through angiography and treated with combined preoperative EE and SE. All the articles that met the inclusion criteria were included in this study. RESULTS: A total of 49 articles (91 patients) were included. The patients' age ranged from 10 days to 70 years at the time of presentation. The most common symptoms were a pulsatile mass in 51 patients (56.04%), progressively growing mass in 31 patients (34.06%), and bruits and/or thrills in 22 patients (24.17%). Complications of preoperative EE and SE were observed in only 5 patients; 3 patients (3.29%) had harvested skin graft marginal necrosis, 1 patient (1.09%) had skin necrosis, and 1 patient (1.09%) had a wound infection. Only 2 patients (2.19%) reported a recurrent or residual mass during a median follow-up period of 12 months. CONCLUSIONS: The management of scalp AVMs can be challenging; therefore, focused, and accurate identification of the complexity of the vascular anatomy is required. The combined method of preoperative EE and SE showed satisfactory outcomes with low rates of complications and recurrence; thus, we recommend this approach for the management of scalp AVMs.

Solitary plasmacytoma of the calvarium: A successful management of a long-standing large lesion with a long-term follow-up.

Background: Solitary plasmacytoma of the calvarium (SPC), without evidence of multiple myeloma (MM), is extremely rare. We report a case of a long-standing large SPC that was treated successfully by surgical excision and adjuvant radiotherapy with a long follow-up period. Case Description: A 58-year-old male patient presented with a 5-year history of painless skull swelling. On the physical examination, the mass was 6 × 6 cm in size, oval, not tender, and firm in consistency with normal skin color. A brain computed tomography scan showed a destructive skull lesion. A brain magnetic reasoning imaging (MRI) showed a large expansile lytic mass lesion arising from the skull vault in the frontal-parietal region with multiple internal septa. The patient underwent a craniectomy and excision of the lesion, followed by cranioplasty using methyl methacrylate. The final diagnosis was consistent with plasmacytoma based on the histopathological features. One month follow-up brain MRI showed no evidence of residual tumor. The skeletal survey and bone marrow biopsy did not reveal any evidence of MM. The patient was referred to medical oncology for further treatment and received radiation therapy. During nine years of clinical and radiological follow-up, there was no evidence of any metastasis or recurrence. Conclusion: SPC is a rare disease with high rates of misdiagnosis. Careful evaluations are crucial to exclude systemic involvement. Surgical resection followed by radiotherapy may be adequate for the disease control. Close follow-up with regular lifelong examinations is important to avoid a generalized incurable disease.

Retraction: Amyand Hernia With Acute Appendicitis: A Rare Type of Hernia.

[This retracts the article DOI: 10.7759/cureus.18720.].

Retraction: Extensive Pulmonary Embolism Following Mild COVID-19 Pneumonia.

[This retracts the article DOI: 10.7759/cureus.21436.].

Bi-allelic variants in HCRT cause autosomal recessive narcolepsy.

Narcolepsy with cataplexy is a complex disease with both genetic and environmental risk factors. To gain further insight into the homozygous HCRT-related narcolepsy, we present a case series of five patients from two consanguineous families, each harboring a novel homozygous variant of HCRT c.17_18del. All affected individuals exhibited severe cataplexy accompanied by narcolepsy symptoms during infancy. Additionally, cataplexy symptoms improved or disappeared in the majority of patients over time. Pathogenic variants in HCRT cause autosomal recessive narcolepsy with cataplexy. Genetic testing of the HCRT gene should be conducted in specific subgroups of narcolepsy, particularly those with early onset, familial cases, and a predominantly cataplexy phenotype.

Herpes simplex encephalitis with normal brain magnetic resonance imaging and normocellular initial cerebrospinal fluid.

Introduction: Herpes simplex virus (HSV) is associated with one of the lethal diseases, Herpes simplex encephalitis (HSE). Diagnosis is confirmed using MRI and CT scan imaging techniques and more sensitive DNA PCR from cerebrospinal fluid analysis and brain biopsy.Case presentation: However, after four days, the patient's HSE diagnosis was confirmed by the detection of herpes simplex virus type 1 (HSV1) via polymerase chain reaction (PCR) testing. This case highlights the importance of utilizing multiple diagnostic aids and not solely relying on initial test results, as infections may not appear in CSF analysis or MRI scans initially. Furthermore, this case also emphasizes the necessity of initiating empirical treatment based on clinical signs and symptoms, even in cases where diagnostic tests initially appear negative. Prompt and efficient diagnosis and treatment are crucial in managing HSE and preventing long-term neurological damage.Conclusion: This case of HSE underscores the significance of a multifaceted diagnostic approach and timely intervention in managing this potentially severe and life-threatening condition. As mentioned, sometimes the infection does not appear in CSF analysis initially, nor does its effects appear in MRI. HSV PCR remains the golden test to confirm the diagnosis of HSE.