Rare Aneurysmal Bone Cyst Presentation in the Orbit: A Systematic Review of the Literature with an Illustrative Case Report.

OBJECTIVE: Aneurysmal bone cysts (ABCs) are benign but aggressive vascular lesions within bone. Orbital ABCs, though rare, are clinically significant due to the risk of debilitating symptoms such as vision loss. METHODS: Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Google Scholar, Embase, and SCOPUS databases to identify and assess primary articles exploring orbital ABC cases. Additionally, we present an illustrative case report. RESULTS: Among the 54 cases from the 51 studies included, the mean age was 16.87 years, with 23 males, 29 females, and 2 unspecified. The most prevalent symptoms were exophthalmos (N = 36) and diplopia (N = 21). Regarding laterality, the right orbit was most commonly affected (N = 27), followed by the left orbit (N = 21), with 4 cases of bilateral involvement. Within the orbit, the medial wall most frequently impacted location (N = 14), followed by the orbital roof (N = 13), posterior wall (N = 7), lateral wall (N = 3), and orbital floor (N = 2), with 15 cases involving multiple locations. Surgical resection was the primary treatment, resulting in complete resolution in 44 cases. In our case, a 30-year-old male with an orbital ABC was managed surgically through bifrontal craniotomy with superior orbitotomy for lesion excision and orbital roof reconstruction. CONCLUSIONS: ABCs in the orbit can be challenging, and complete removal of the lesion is essential for achieving optimal patient outcomes.

Behind the Mask of Parkinsonism: A Case Report and Literature Review on Progressive Supranuclear Palsy.

Progressive supranuclear palsy (PSP) is a neurodegenerative condition that typically emerges in adulthood and does not exhibit any familial inheritance pattern. PSP is characterized by gradual stiffness in the central body, an inability to move the gaze upward voluntarily, postural instability, and a decline in cognitive function linked to frontal lobe dysfunction. Clinical assessment reveals a variety of findings, and cases of PSP frequently go unnoticed or are incorrectly diagnosed as other conditions. Notably, prominent neurotransmitter-related changes in PSP involve damage to the dopaminergic nigrostriatal pathway and cholinergic impairment in multiple regions. We hereby present a case of a 71-year-old female patient whose medical journey unfolds as a perplexing riddle. Despite the collective expertise of several physicians, she found herself bearing the weight of a misdiagnosis ascribed to Parkinson's Disease (PD) erroneously. She initially presented with recurring falls due to postural instability and bradykinesia, which progressed such that she became dependent on a walking aid. A comprehensive physical examination revealed indicators consistent with PSP.

A Case Report and Literature Review on Positivity for Multiple Antibodies: Autoimmune Encephalitis in Focus.

Autoimmune encephalitis (AE) is a group of neuropsychiatric disorders caused by antibodies that target the neuronal surface, synaptic, or intracellular antigens, impairing brain function. Although AE can affect people of different age groups, the occurrence of AE within specific age brackets depends on the specific type of AE and the antibodies produced. While AE is frequently considered a paraneoplastic syndrome linked to cancer, it is essential to acknowledge that the intensity of this association can vary depending on the specific antibody, leading to diverse relationships with paraneoplastic syndromes. Numerous cases have been recorded where AE manifests without an underlying malignancy. The diagnostic criteria for AE are characterized by a subacute deterioration of cognition, altered mental status, or psychiatric symptoms. Immunotherapy is recommended as a treatment for the condition, and the prognosis varies depending on the subtype. In this case, we present the case of an elderly woman who showed acute mental status changes, psychiatric symptoms, EEG alterations, and positive antibody results in both serum and CSF. Our case breaks new ground as the first documented instance of a female with positive serum anti-LGI 1, anti-AMPAR2, anti-Ri, and anti-CENP-A/B antibodies.

The role of an antibiotic envelope in the prevention of major cardiac implantable electronic device infections: A systematic review and meta-analysis.

BACKGROUND: Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems. METHODS: To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A random-effects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI). RESULTS: We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72). CONCLUSION: The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection.

Comparison of radiation doses between diagnostic full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT): a clinical study.

INTRODUCTION: There are increasing concerns about radiation exposure among women who undergo full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT). The main aim of this study was to compare the entrance surface dose (ESD) and average glandular dose (AGD) from FFDM and DBT for different breast thicknesses. METHODS: The ESD and AGD for FFDM in craniocaudal, mediolateral oblique and DBT in craniocaudal projection were recorded from a GE Senographe Essential FFDM unit. The accuracy of the ESD and AGD from the FFDM unit was verified during regular quality assurance programme. Patients were categorised according to their compressed breast thicknesses. X-ray tube potential and target filter combinations were varied with ESD and AGD recorded directly from the FFDM unit. The non-parametric Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were performed. RESULTS: The median and interquartile range (IQR) age of the patients were 48 and 11 years, respectively. The highest median for ESD and median total AGD for different breast thicknesses were ranged from 3.3 to 9.1 mGy and 3.3 to 6.0 mGy, respectively, for two-view FFDM. However, it ranged from 3.1 to 8.9 mGy and 1.8 to 4.0 mGy, respectively, for single-view DBT. Both ESD and AGD were significantly lower for DBT (P < 0.001) compared with FFDM. There was a significant difference (P = 0.001) in the ESD and AGD values for different breast thicknesses in FFDM and DBT techniques. CONCLUSIONS: The AGD for a single-view DBT was lower than the two-view FFDM technique.