Unveiling biological activities of biosynthesized starch/silver-selenium nanocomposite using Cladosporium cladosporioides CBS 174.62.

BACKGROUND AND OBJECTIVES: Microbial cells capability to tolerate the effect of various antimicrobial classes represent a major worldwide health concern. The flexible and multi-components nanocomposites have enhanced physicochemical characters with several improved properties. Thus, different biological activities of biosynthesized starch/silver-selenium nanocomposite (St/Ag-Se NC) were assessed. METHODOLOGY: The St/Ag-Se NC was biosynthesized using Cladosporium cladosporioides CBS 174.62 (C. cladosporioides) strain. The shape and average particle size were investigated using scanning electron microscope (SEM) and high-resolution transmission electron microscope (HR-TEM), respectively. On the other hand, the St/Ag-Se NC effect on two cancer cell lines and red blood cells (RBCs) was evaluated and its hydrogen peroxide (H2O2) scavenging effect was assessed. Moreover, its effects on various microbial species in both planktonic and biofilm growth forms were examined. RESULTS: The St/Ag-Se NC was successfully biosynthesized with oval and spherical shape and a mean particle diameter of 67.87 nm as confirmed by the HR-TEM analysis. St/Ag-Se NC showed promising anticancer activity toward human colorectal carcinoma (HCT-116) and human breast cancer (MCF-7) cell lines where IC50 were 21.37 and 19.98 µg/ml, respectively. Similarly, little effect on RBCs was observed with low nanocomposite concentration. As well, the highest nanocomposite H2O2 scavenging activity (42.84%) was recorded at a concentration of 2 mg/ml. Additionally, Staphylococcus epidermidis (S. epidermidis) ATCC 12,228 and Candida albicans (C. albicans) ATCC 10,231 were the highly affected bacterial and fungal strains with minimum inhibitory concentrations (MICs) of 18.75 and 50 µg/ml, respectively. Moreover, the noticeable effect of St/Ag-Se NC on microbial biofilm was concentration dependent. A high biofilm suppression percentage, 87.5% and 68.05%, were recorded with S. epidermidis and Staphylococcus aureus (S. aureus) when exposed to 1 mg/ml and 0.5 mg/ml, respectively. CONCLUSION: The biosynthesized St/Ag-Se NC showed excellent antioxidant activity, haemocompatibility, and anti-proliferative effect at low concentrations. Also, it exhibited promising antimicrobial and antibiofilm activities.

Role of autoimmunity in Neuronal damage in children with Autism spectrum disorder.

"Autism spectrum disorder (ASD) is complex neurodevelopmental disorder characterized by impairments in three core behavioral: social deficits, impaired communication, and repetitive behaviors." There is developing indication and emerging data that irregular autoimmune responses to the central nervous system may play a pathogenic role in patients with autism spectrum disorder." The aim of this review was to discuss the updated research carried out at Autism research and treatment center, King Saud University, Riyadh, Kingdom of Saudi Arabia particularly on the role of autoimmunity in Autism spectrum disorder. This review also present state of information available about the role of autoimmunity biomarkers involved in the neuronal damage of central nervous system in autistic children. The systematic literature search was carried out using Google Scholar, Science direct and PubMed databases on the role of autoimmunity in autism and reviewed all relevant articles published in peer reviewed journals by Autism research and treatment center, King Saud University, Riyadh, Kingdom of Saudi Arabia till April, 2022. We searched relevant articles using key words Autism spectrum disorder, Autoimmunity, Neuroinflamation and Central nervous system. This review revealed that plasma levels of autoimmunity related factors/ markers were altered in patients with autism. Significant change in blood markers in subjects with ASD may resulted in several years of decreased neutrotrophic support along with increasing impairment in relationship with down-regulated inflammation that may play a role in the ASD. Overall, the role of autoimmunity in ASD subjects with excess of anti-brain antibodies suggest that in some patients, autoantibodies that target the CNS may be pathological factor in neuronal growth in autistic children. Large cohort studies with well-defined and specially pheno typed autistic groups and matched healthy controls are required to examine the role of autoantibodies in the pathology of subjects with ASD.

Instrumentation kinematics does not affect bacterial reduction, post-operative pain, and flare-ups: A randomized clinical trial.

AIM: This randomized clinical trial aimed to assess the effect of instrumentation kinematics (reciprocation or continuous rotation) on bacterial reduction, post-operative pain, and incidence of flare-ups after root canal treatment of single-rooted mandibular premolars with asymptomatic apical periodontitis. METHODOLOGY: Sixty-six patients were included in this prospective, parallel, randomized clinical trial. Patients were randomly allocated into two groups (N = 33) according to the kinematics of the shaping instrument: WaveOne Gold (WO) used in reciprocation or One Shape (OS) used in continuous rotation. Under complete asepsis, bacterial samples were taken before (S1) and after (S2) a standard cleaning and shaping protocol. Evaluation of bacterial reduction was done by both culture technique and quantitative real-time polymerase chain reaction (qPCR) analysis. Post-operative pain was evaluated using the visual analogue scale (VAS) after 24, 48, and 72 h following treatment, while flare-ups were recorded as a binary outcome (Yes/No). Independent and paired t-tests were used for inter- and intra-group comparisons for bacterial count data, respectively. For post-operative pain score, inter-group comparisons were analyzed using the Mann-Whitney U-test while intra-group comparisons were analyzed using Friedman test followed by pairwise comparisons utilizing the Wilcoxon signed rank test with Bonferroni correction. The significance level was set at p ≤ .05 within all tests. RESULTS: All the allocated participants received the intervention and were analysed. The comparison between culture and qPCR methods showed that qPCR analysis demonstrated significantly higher pre-instrumentation baseline bacterial count (p < .05). The percentage of bacterial reduction, detected by either method, significantly decreased after instrumentation using either rotation or reciprocation kinematics (p < .05). However, the difference between the WOG or OS files was statistically non-significant (p > .05). The intra-group comparisons showed a significant reduction in post-operative pain with time (p < .05) for both groups. However, the inter-group comparison demonstrated that the difference in post-operative pain after the use of either WOG or OS was statistically non-significant (p > .05). The incidence of flare-ups between both groups was also not-significant (p = 1). CONCLUSIONS: Shaping kinematics, either rotation or reciprocation motions, had no impact on bacterial reduction and the incidence of post-operative pain and flare-ups after root canal preparation of single-rooted premolars with asymptomatic apical periodontitis.

Impact of supervised exercise training on systemic sclerosis with multiple organ involvement: A case report.

Supervised training exercises are the mainstay of pulmonary rehabilitation (PR) in patients with chronic lung diseases like interstitial lung disease (ILD). A 40 years old female patient with systemic sclerosis clinically presenting with usual interstitial pneumonia (UIP) and pulmonary hypertension underwent an eight-week supervised exercise training programme. Forced Vital Capacity (FVC) showed improvement from 48.7% to 54% of predicted baseline, while the initial six-minute walk test (MWT) distance also showed a considerable increase of 15.4% from the baseline after completion of the exercise training. A remarkable improvement was noticed in muscle strength for both the upper and the lower limbs. There was an increase of 79.4% right side handgrip, 25% left side handgrip, and 30.9% increase in lower limbs than baseline strength. The findings show that an exercise training programme under the supervision of trained and competent staff can benefit the improvement of lung function and muscle strength in a patient suffering from chronic lung diseases.

Traceable Reference Full Metrology Chain for Innovative Aspheric and Freeform Optical Surfaces Accurate at the Nanometer Level.

The design of innovative reference aspheric and freeform optical elements was investigated with the aim of calibration and verification of ultra-high accurate measurement systems. The verification is dedicated to form error analysis of aspherical and freeform optical surfaces based on minimum zone fitting. Two thermo-invariant material measures were designed, manufactured using a magnetorheological finishing process and selected for the evaluation of a number of ultra-high-precision measurement machines. All collected data sets were analysed using the implemented robust reference minimum zone (Hybrid Trust Region) fitting algorithm to extract the values of form error. Agreement among the results of several partners was observed, which demonstrates the establishment of a traceable reference full metrology chain for aspherical and freeform optical surfaces with small amplitudes.

The possible link between Fetuin-A Protein and Neuro-inflammation in Children with Autism Spectrum Disorder.

OBJECTIVES: To investigate the blood plasma levels of Fetuin-A protein in children with Autism Spectrum Disorder (ASD) and healthy controls that could offer novel diagnostic biomarkers of disease development in ASD. Another objective was to investigate the severity of autistic children by Childhood Autism Rating Scale (CARS) and Short Sensory Profile (SSP). METHODS: This case control study was carried out at Autism Research and Treatment (ART) Center, King Saud University, Riyadh, Saudi Arabia, from October 2019 to February 2020. Plasma concentration of Fetuin-A was analyzed by enzyme-linked immunosorbent assay (ELISA) in ASD subjects (n=46) and normal controls (n=44). Correlation among Fetuin-A levels, CARS and SSP was established by Spearman's correlation coefficient (r). RESULTS: Overall, autistic children had significantly (p= 0.0.02) lower Fetuin-A concentration [50.76 (22.2-68.5) ng/ml] than those of healthy controls [53.7 (35.6-99.7) ng/ml] [median (interquartile range)]. Children with mild to moderate autism (n=24, 52%) also showed significantly lower Fetuin-A levels [50.0 (30.0-68.2) ng/ml], (p =0.02} than healthy controls [53.7 (35.6-99.7) ng/ml] [median (IQR)]. However, there was no significant change (p = 0.71) observed between the Fetuin-A levels of children with severe autism [51.8 (22.2-68.5)] ng/ml, mild to moderate autism [50 (30-68.2)] ng/ml [median (IQR)] and healthy controls (p=0.12). Also no significant correlations between Fetuin-A, CARS and SSP were observed (CARS, r= 0.024, p=0.88; SSP, r= -0.003, p=0.98). CONCLUSION: Overall the low Fetuin-A plasma values in ASD subjects, most likely show that Fetuin-A could be associated in the physiology of autism. Further studies with larger patient and control cohorts will be necessary to determine whether Fetuin-A can be used as a biomarker for ASD.

Impact of supervised exercise training on pulmonary function parameters, exercise capacity and Irisin Biomarker in Interstitial lung disease patients.

OBJECTIVES: To assess the impact of supervised exercise training (SET) on pulmonary function Parameters, exercise capacity and Irisin biomarker in Interstitial Lung Disease (ILD) patients. METHODS: Ten (10)patients with ILD and 18 healthy controls of age between 30-40+ years were selected for 8-week SET program. Before and after SET all subjects performed exercise capacity six minutes' walk test (6MWT), heart rate (HR) changes were recorded, shortness of Breath Respiratory Questionnaire (SOBQ) was obtained and Irisin levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA). This interventional study was carried out at Department of Physiology, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from October 2018 to February 2019. RESULTS: Mean six minutes' walk distance (6MWD) was 395 ± 68.4 m at 1st visit increased significantly (p=0.001) to 458.8± 87.1 mat 15 visit. However, 6MWD values found significantly higher in controls (517.4±84.1 m; 561.7±81.6 m; p=0.013) than ILD patients. Overall change (difference between post and pre exercise) in HRvalue was recorded lower in ILD patients (30-35 bpm) as compared to controls (40-45 bpm). Moreover, ILD patients had overall higher SOBQ score than controls. Pre SET Irisin levels of ILD patients (4.24 ±1.73 pg/ml) and controls (3.43 ±1.04pg/ml) were found unchanged dafter SET (4.48±2.02pg/ml, 3.39 ±1.41pg/ml, p=0.677, p=0.093)respectively. However, patients Irisin values were found higher as compared to controls before and after SET. CONCLUSION: Exercise capacity and Dyspneain patients with ILD were improved after 8-week of SET program. No major changes in Irisin levels among patients with ILD and controls were observed. Additional research requires to be carried out on large number of subjects to deter Minutese the advantages of exercise in ILD.

Clinical outcomes among hospital patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

BACKGROUND: Mortality is high among patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection. We aimed to determine hospital mortality and the factors associated with it in a cohort of MERS-CoV patients. METHODS: We reviewed hospital records of confirmed cases (detection of virus by polymerase chain reaction from respiratory tract samples) of MERS-CoV patients (n = 63) admitted to Buraidah Central Hospital in Al-Qassim, Saudi Arabia between 2014 and 2017. We abstracted data on demography, vital signs, associated conditions presented on admission, pre-existing chronic diseases, treatment, and vital status. Bi-variate comparisons and multiple logistic regressions were the choice of data analyses. RESULTS: The mean age was 60 years (SD = 18.2); most patients were male (74.6%) and Saudi citizens (81%). All but two patients were treated with Ribavirin plus Interferon. Hospital mortality was 25.4%. Patients who were admitted with septic shock and/or organ failure were significantly more likely to die than patients who were admitted with pneumonia and/or acute respiratory distress syndrome (OR = 47.9, 95% CI = 3.9, 585.5, p-value 0.002). Age, sex, and presence of chronic conditions were not significantly associated with mortality. CONCLUSION: Hospital mortality was 25%; septic shock/organ failure at admittance was a significant predictor of mortality.

Implementing a connected health intervention for remote patient monitoring in Saudi Arabia and Pakistan: explaining 'the what' and 'the how'.

BACKGROUND: Recent developments in connected health technology provide an opportunity to remotely monitor and provide health care to the patient needing long-term medical care. However, information about how any connected health interventions should be implemented for remote patient monitoring, and how patients should be educated and enabled for active participation in treatment is still not available to a sufficient degree. DISCUSSION: In this paper, we discussed what the components of a connected health intervention, entitled Remotely Accessible Health Care at Home (RAHAH), are, and how this intervention has been implemented in Saudi Arabia and Pakistan. The aim of this intervention is to remotely monitor, treat and educate patients needing long-term medical care. The description of the intervention is presented based on the Template for Intervention Description and Replication (TIDieR) checklist for the transparent, comprehensive and explicit reporting. CONCLUSION: We believe, successful implementation of RAHAH would be crucial to monitor and manage growing chronic care populations more effectively and efficiently in Saudi Arabia and Pakistan.

Impact of environmental pollution, dietary factors and diabetes mellitus on Autism Spectrum Disorder (ASD).

Autism spectrum disorder (ASD) is complex neurodevelopmental condition described by impairments in three main behavioral areas: social deficits, impaired communication, and repetitive behaviors. Despite many years of vast study, the causes of ASD are still unknown. Various risk factors including genetic, infectious, metabolic and immunological have been investigated however, environmental, nutritional and diabetes related risk factors have not received sufficient attention. This study has provided an insight into the comprehensive interaction between environmental pollution, dietary factors and diabetes mellitus that could lead to the advancement of this debilitating neurodevelopment disorder. The literature search was done using PubMed and Google Scholar databases up to October 2018. Key words "Environmental Pollution", "Nutritional Factors", "Diabetes Mellitus", "Autism Spectrum Disorder" were selected.

Impact of Auditory Integrative Training on Transforming Growth Factor-ß1 and Its Effect on Behavioral and Social Emotions in Children with Autism Spectrum Disorder.

OBJECTIVE: To explore the impact of auditory integrative training (AIT) on the inflammatory biomarker transforming growth factor (TGF)-ß1 and to assess its effect on social behavior in children with autism spectrum disorder (ASD). SUBJECTS AND METHODS: In this cross-sectional study, 15 patients (14 males and 1 female) with ASD aged 3-12 years were recruited. All were screened for autism using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Plasma levels of TGF-ß1 were measured in all patients using a sandwich enzyme-linked immunoassay (ELISA) immediately and 1 and 3 months after the AIT sessions. Pre- and post-AIT behavioral scores were also calculated for each child using the Childhood Autism Rating Scale (CARS), the Social Responsiveness Scale (SRS), and the Short Sensory Profile (SSP). Data were analyzed using the Statistical Package for the Social Sciences (SPSS 21.0 for Windows). RESULTS: Plasma levels of TGF-ß1 significantly increased to 85% immediately after AIT (20.13 ± 12 ng/mL, p < 0.05), to 95% 1 month after AIT (21.2 ± 11 ng/mL, p < 0.01), and to 105% 3 months after AIT (22.25 ± 16 ng/mL, p < 0.01) compared to before AIT (10.85 ± 8 ng/mL). Results also revealed that behavioral rating scales (CARS, SRS, and SSP) improved in terms of disease severity after AIT. CONCLUSION: Increased plasma levels of TGF-ß1 support the therapeutic effect of AIT on TGF-ß1 followed by improvement in social awareness, social cognition, and social communication in children with ASD. Furthermore, TGF-ß1 was associated with severity in all scores tested (CARS, SRS, and SSP); if confirmed in studies with larger sample sizes, TGF-ß1 may be considered as a marker of ASD severity and to assess the efficacy of therapeutic interventions.

Obesity and associated risk factors among students of health colleges of King Saud University, Saudi Arabia: A cross-sectional study.

OBJECTIVE: To determine the prevalence of obesity and associated risk factors among medical students in Saudi Arabia. METHODS: The cross-sectional study was conducted from December 2012 to March 2013 at King Saud University, Riyadh, Saudi Arabia. Using stratified sampling technique, undergraduate students of either gender from the health colleges were included. Information was collected through a pretested questionnaire. Measurements of the height and weight were noted and body mass index for all the subjects was calculated. RESULTS: Of the 292 students, 146(50%) were males and 146(50%) were females. Obesity was found in 40(13.7%)students. It was more prevalent among males than females (p<0.05) and among those who had chronic diseases (p<0.001). Family history of obesity was significantly associated with obesity (p=0.016). No significant association was found between physical activity and obesity (p=0.863). CONCLUSIONS: There was considerable prevalence of obesity among the medical students. Being male, having family history of obesity, and having chronic diseases were important risk factors.

Activity-Regulated Cytoskeleton-Associated Protein Dysfunction May Contribute to Memory Disorder and Earlier Detection of Autism Spectrum Disorders.

OBJECTIVE: To explore a possible role for activity-regulated cytoskeleton-associated (Arc/Arg3.1) protein in the clinical identification of children with autism. SUBJECTS AND METHODS: The plasma levels of Arc/Arg3.1 in 62 boys with autism and 32 healthy boys were measured using an enzyme-linked immunosorbent assay (ELISA). The Childhood Autism Rating Scale (CARS) was used to assess the severity of autism as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The Mann-Whitney U test was used for comparisons between children with autism and healthy children. The Spearman r correlation coefficient (r) was used to determine the relationship between the CARS scores among patients with autism and different variables. RESULTS: The mean plasma level of Arc/Arg3.1 protein in autism was 1.689 ± 0.917 pg/ml, significantly higher than that of healthy controls, i.e. 0.792 ± 1.056 pg/ml (p < 0.001). No significant relationship was found between plasma levels of Arc/Arg3.1 protein and CARS scores (r = -0.06; p > 0.05) or age (r = -0.27; p > 0.05). CONCLUSIONS: The mean plasma level of Arc/Arg3.1 protein was higher in children with autism than in controls, suggesting that Arc/Arg3.1 could be a potential early blood biomarker for diagnosis of autism.

Heart Rate Beat-to-Beat Slope Change during Six-Minute Walk Test: a Useful Clinical Tool for Estimating Fitness level.

BACKGROUND: The six-minute walk test (6MWT) is one of the most common exercise tests and is used to estimate the level of physical fitness. This study aimed to evaluate the feasibility of the beat-to-beat heart rate 6MWT slope (6MWTS) and recovery slope for predicting and estimating the level of physical fitness during 6MWT, instead of depending on the distance covered during the test. METHODS: Seventy healthy adult male subjects aged 18 to 27 years were recruited randomly from the general Saudi population in Riyadh. Using a 50-m corridor, 6MWT was performed according to standardised American Thoracic Society guidelines. RESULTS: The mean distance walked in 6 minutes (470.5±64.6 m) and beat-to-beat heart rate (HR) were calculated using a HR monitor. In addition, the body mass index, body surface area, Borg Rating of Perceived Exertion, and maximum predicted HR percentage were also calculated. A stepwise regression equation was used to predict the 6MWT distance (6MWTD), 6MWTS, and recovery slope. There was a significant correlation between 6MWTS and the recovery slope (r= -0.575, p<0.001), between 6MWTS and 6MWTD (r= 0.414, p<0.001), and between recovery slope and 6MWTD (r= -0.454, p<0.001). CONCLUSION: Our findings suggest that both 6MWTS and recovery slope can predict 6MWTD.

Effect of Viscum schimperi on advanced glycation endproducts formation.

Diabetes is a disease characterized by elevated uncontrolled glucose level. Hyperglycemia results in diabetic complication due to a reaction between sugar and amino acid of proteins to form advanced glycation endproducts (AGEs) in different tissues. Medicinal plants are considered as a great source of bioactive compounds that affect many ailments. In this regard; AGEs formation could be inhibited by many bioactive compounds isolated from medicinal plants. Viscum schimperi Engl. is a plant belongs to Loranthaceae and known for its antidiabetic activity. In this study; total methanol extract of V. schimperi (VT) was prepared, suspended in water and subjected to fractionation with chloroform followed by n-butanol to give (VC) and (VB) fractions respectively. The aqueous mother liquor was evaporated to form (VA) fraction. The inhibitory effect of all prepared fraction on the formation of advanced glycation endproducts (AGEs) was studied. The results revealed that V. schimperi extract and its different fractions inhibited protein glycation and oxidation of BSA induced by ribose together with decrease of protein aggregation. In conclusion; V. schimperi will be useful in management of diabetic complications based on its inhibition of advanced glycation endproduct formation.

Fat embolism: the hidden murder for trauma patients!

INTRODUCTION: fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS: we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS: the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION: to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.

Surgical management of a thoraco-lumbar extradural cyst in a pediatric patient with Klippel-Trenaunay syndrome: a case report.

Introduction and importance: Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by the abnormal development of blood vessels, soft tissues, bones, and the lymphatic system. The syndrome is rare, with few cases reported worldwide, especially those describing an association between KTS and spinal extradural meningeal cysts (SEMC). This report highlights a rare case of a pediatric patient with KTS who underwent successful surgical decompression of a thoraco-lumbar extradural cyst, highlighting the importance of reevaluating surgical interventions in KTS patients. Case presentation: A 15-year-old girl diagnosed with KTS 4 days postnatally, was referred to our clinic due to chronic back pain and spastic paraparesis. These symptoms were attributed to a compressive extradural thoraco-lumbar cyst. Diagnostic evaluations confirmed the presence of the cyst, leading to the decision to proceed with surgical intervention. Clinical discussion: The surgical approach involved a laminoplasty at T11-T12-L1, resulting in the total removal of the cystic lesion. The patient exhibited a complete resolution of symptoms postoperatively, with no significant complications reported during the surgery. Conclusion: With this case, the authors question the fear of surgical intervention in KTS patients, which is often avoided due to concerns of high-risk complications like excessive bleeding or poor wound healing, and hint at a possible association between KTS and extradural meningeal cysts.

Spinal intradural extramedullary cavernoma: A case report.

INTRODUCTION: Cavernomas are rare vascular lesions that can occur anywhere along the neuraxis. However, they are most commonly found in the cerebral hemispheres. Spinal cavernomas are more uncommon and intradural extramedullary cavernomas are the most uncommon as they constitute only 3 % of spinal cavernomas. PRESENTATION: A 36-year-old female presented to our neurosurgical clinic with a history of back pain radiating to the left side of the chest with left lower extremity paresthesia and ataxia without urinary disturbance. Neurological exam showed left-sided hypoesthesia below the T9 dermatome in addition to increased patellar and Achilles reflexes on the left side. MRI showed a homogeneous intradural extramedullary mass which was hyperintense on T1 and hypointense on T2 and it was surgically resected. Pathological examination confirmed the diagnosis of intradural extramedullary cavernoma. DISCUSSION: Intradural extramedullary cavernomas are extremely rare lesions that arise within the area located between the inner surface of the dura and the pial surface of the spinal cord. Up until 2022 only 40 cases of intradural extramedullary cavernomas were reported in the literature. MRI is the preferred imaging modality and pathology is the golden standard for diagnosis. Surgical resection showed very promising results and it is considered the golden standard for treating this condition. However, surgery should be performed urgently to give an optimal outcome. CONCLUSION: Clinicians should consider this condition in their differential diagnoses when faced with progressive spinal root compression symptoms, sudden onset myelopathy, or progressive subarachnoid hemorrhage.

Atypical teratoid/rhabdoid tumor of the central nervous system: Clinicopathological features of two challenging cases.

INTRODUCTION: Atypical Teratoid/Rhabdoid Tumor (AT/RT) is a rare aggressive neoplasm that mainly affects the pediatric population with a peak incidence in the first two years of life and a slight male predominance, whereas presentation of this neoplasm in older ages is extremely rare. CASE PRESENTATION: Herein, we present two cases of AT/RT. In the first case, a 9-year-old female presented with diplopia, dizziness, headache, and morning vomiting. CT Scan of the head demonstrated a heterogeneous mass in the left frontal-parietal region with vasogenic edema and midline deviation. In the second case, a 57-year-old female presented with severe generalized headache, numbness, and tingling in the right hand. MRI revealed a lobulated cystic mass in the right occipitotemporal region, with surrounding edema compressing the left lateral ventricle and causing a midline shift to the left, and enlargement of the right lateral ventricle. In both case, histopathological and immunohistochemical examinations revealed the diagnosis of Atypical teratoid/Rhabdoid tumors. CLINICAL DISCUSSION: Microscopic examination demonstrated the proliferation of medium-sized to large cells with abundant eosinophilic cytoplasm, large vesicular eccentric nuclei, and conspicuous nucleoli with areas of necrosis and hemorrhage, thus confirming the diagnosis with adequate immunohistochemical staining. The first patient developed signs of recurrence and passed away six months later, whereas in the second case, the 57-year-old female received radiotherapy for 6 weeks before being put on chemotherapy. CONCLUSION: Despite the challenges facing the diagnosis of this aggressive neoplasm, we managed to present our cases with detailed histopathological and immunohistochemical examinations.

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma.

Primary biliary tract tumors are malignancies that originate in the liver, bile ducts, or gallbladder. These tumors often present with jaundice of unknown etiology, leading to delayed diagnosis and advanced disease. Currently, several palliative treatment options are available for primary biliary tract tumors. They include percutaneous transhepatic biliary drainage (PTBD), biliary stenting, and surgical interventions such as biliary diversion. Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors. It involves the administration of chemotherapy drugs, such as gemcitabine and cisplatin, which have shown promising results in improving overall survival in patients with advanced biliary tract tumors. PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction. Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction. Surgical interventions, such as biliary diversion, have traditionally been used as palliative options for primary biliary tract tumors. However, biliary diversion only provides temporary relief and does not remove the tumor. Primary biliary tract tumors often present in advanced stages, making palliative treatment the primary option for improving the quality of life of patients.