Successful management of cervical tuberculosis and severe kyphosis using polyetheretherketone expandable cage and titanium plate: A case report.

Key Clinical Message: Successful management of cervical tuberculosis and severe kyphosis was achieved using a PEEK expandable cage and titanium plate, demonstrating favorable outcomes in restoring cervical alignment and stability. This approach represents a promising alternative for addressing complex cervical pathologies, highlighting the potential of PEEK-based interventions in surgical management. Abstract: Cervical tuberculosis can lead to severe vertebral destruction and kyphosis, posing challenges in surgical management. Recent advancements, including the use of polyetheretherketone (PEEK) expandable cages and titanium plates, show promise in addressing multilevel cervical pathologies. This report details the successful treatment of a 27-year-old male with cervical tuberculosis and severe kyphosis. Surgical intervention involved prevertebral abscess evacuation, C5-C7 corpectomy, and insertion of a PEEK expandable cage with an anterior titanium plate. Postoperative care included a Philadelphia collar, and follow-up demonstrated restored cervical alignment and stability. The use of PEEK-based surgical interventions, as demonstrated in this case, represents a significant evolution in managing complex cervical conditions. The successful outcome highlights the potential benefits of PEEK expandable cages in addressing cervical tuberculosis and kyphosis. Further research is needed to validate these findings and establish PEEK-based interventions as a viable alternative in such cases.

Subarachnoid Hemorrhage Caused by Supratentorial Cerebral Cavernous Malformation: A Case Report.

Cavernous malformations (CMs) are acquired vascular abnormalities of the central nervous system that are typically asymptomatic. Clinically symptomatic lesions may present with seizures, intracerebral hemorrhage, or focal neurological deficits. Very rarely, CMs have been described as the cause of subarachnoid hemorrhage. We report a case of a previously healthy 58-year-old man who presented with acute onset of severe headache associated with vomiting. Head computed tomography (CT) scan showed subarachnoid hemorrhage with intraventricular extension. Subsequent CT angiography (CTA) and digital subtraction angiography (DSA) studies showed no evidence of vascular abnormalities. The patient was initially managed conservatively but later required neurosurgical and radiological interventions due to a complicated hospital course and worsening clinical condition. During surgery, an incidental mass was found in the temporal lobe, and subsequent histopathological examination confirmed the diagnosis of cavernoma, which was likely the underlying cause of the subarachnoid hemorrhage. This report highlights the importance of considering CMs in the differential diagnoses of subarachnoid hemorrhage, especially in the absence of informative results from CTA and DSA studies. Timely detection and management of CMs may positively impact the clinical outcome, leading to reduced morbidity and mortality rates.

Upper Thoracic Spine (D2-D3) Fracture With Unilateral Lock Facets Without Associated Neurological Deficits: Case Report & Literature Review.

Introduction: Upper thoracic spine fractures are rare as compared to other spine segments due to anatomical landmarks. If they occur, they are usually associated with paraplegia or any other neurological dysfunction. We report upper thoracic fracture without neurological dysfunction which is a rare entity along with its radiological imaging, and management plan. Case Description: Forty-years old male presented after RTA. CT spine showed T2 vertebral body fracture with dislocation/locking of the right T2-T3 facet joint. The patient underwent surgical fixation and was neurologically intact. Conclusion: Upper thoracic spine fracture is a rare entity due to its anatomical location. And sometimes it is missed as well. Proper imaging should be considered if there is high suspicion and early surgery is warranted to prevent permanent damage.

Using Artificial Intelligence to Predict the Development of Kyphosis Disease: A Systematic Review.

The use of artificial intelligence in the field of medicine - including spine surgery - is now widespread and prominent. Kyphosis is a prevalent disease in spine surgery with abundant morbidity. Predicting the development of kyphosis disease has been somewhat difficult, and the use of AI to aid in the prediction of kyphosis disease may yield new opportunities for spine surgeons. The aim of this review is to recognize the contributions of AI in predicting the development of kyphosis. Five databases/registers were searched to identify suitable records for this review. Nine studies were included in this review. The studies demonstrated that AI could be utilized to predict the development of kyphosis disease after corrective surgery for a variety of spinal pathologies, including thoracolumbar burst fracture, cervical deformity, previous kyphosis disease, and adult degenerative scoliosis. The studies utilized a variety of AI modalities, including support vector machines, decision trees, random forests, and artificial neural networks. Two of the included studies also compared the use of different AI modalities in predicting the development of kyphosis disease. The literature has demonstrated that AI can be utilized effectively to predict the development of kyphosis disease. However, the current research is limited and only sparsely covers this broad field. Therefore, we suggest that further research is needed to explore the uncharted opportunities in predicting the development of kyphosis disease. Also, further research would confirm and consolidate the benefits demonstrated by the literature included in this review.

Massive traumatic subarachnoid hemorrhage mimicking aneurysmal subarachnoid hemorrhage.

Introduction: Massive traumatic subarachnoid hemorrhage (tSAH) is a rare but potentially life-threatening condition that can mimic the clinical presentation of aneurysmal subarachnoid hemorrhage (aSAH). The accurate differentiation between these two entities is crucial, as their management and prognoses significantly differ. Case presentation: We present a case of a 64-year-old male patient who presented to our emergency department after being involved in a motor vehicle collision. His radiological findings on a computed tomography (CT) scan were suggestive of aSAH based on its location, which showed massive SAH in bilateral sylvian fissures and the basal cisterns. There was no evidence of vasospasm. The patient later developed a stroke despite the use of Nimodipine. Conclusion: While traumatic subarachnoid hemorrhage mimicking aneurysmal subarachnoid hemorrhage is a recognized phenomenon, it is relatively uncommon. We present a case of massive tSAH complicated by a stroke with no evidence of aneurysm on cerebral angiogram, shedding light on the diagnostic challenges in differentiating tSAH from aSAH and emphasizing the importance of accurate diagnosis for appropriate management, in addition, we aim to remind the readers that trauma may be a cause for massive SAH and should prompt a medical SAH management plan.

Primary Ewing Sarcoma of the Cervical Spine: A Case Report and Literature Review.

Ewing sarcoma is a rare neoplasm that mostly grows in bones or soft tissues around bones. Most cases of Ewing sarcoma occur in intra-skeletal locations (long bones, pelvis, or ribs) and rarely in extra-skeletal regions such as paravertebral or epidural space, whereas a primary intradural extramedullary Ewing sarcoma (IEES) is extremely rare. Fifty cases of primary IEES including our case were identified in the literature, so far, of which two-thirds are in the lumbosacral region, while only 12 reports described a cervical location of the tumor. Herein, we are presenting a case of C7-T1 primary IEES for a 24-year-old male, followed by a review of updated literature about the primary IEES in the cervical spine.

Hybrid FSK-FDM Scheme for Data Rate Enhancement in Dual-Function Radar and Communication.

In this paper, we present a hybrid frequency shift keying and frequency division multiplexing (i.e., FSK-FDM) approach for information embedding in dual-function radar and communication (DFRC) design to achieve an improved communication data rate. Since most of the existing works focus on merely two-bit transmission in each pulse repetition interval (PRI) using different amplitude modulation (AM)- and phased modulation (PM)-based techniques, this paper proposes a new technique that doubles the data rate by using a hybrid FSK-FDM technique. Note that the AM-based techniques are used when the communication receiver resides in the side lobe region of the radar. In contrast, the PM-based techniques perform better if the communication receiver is in the main lobe region. However, the proposed design facilitates the delivery of information bits to the communication receivers with an improved bit rate (BR) and bit error rate (BER) regardless of their locations in the radar's main lobe or side lobe regions. That is, the proposed scheme enables information encoding according to the transmitted waveforms and frequencies using FSK modulation. Next, the modulated symbols are added together to achieve a double data rate using the FDM technique. Finally, each transmitted composite symbol contains multiple FSK-modulated symbols, resulting in an increased data rate for the communication receiver. Numerous simulation results are presented to validate the effectiveness of the proposed technique.

The Elusive SLIPPERS Syndrome (Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids): A Case Report and Literature Review.

Background: In 2015, the term "SLIPPERS" was created to refer to a rare type of encephalomyelitis called CLIPPERS syndrome that affects the pons and sometimes other nearby structures, but in this case, it primarily affects the supratentorial region. This variation of the condition is responsive to treatment with steroids. Case Description: We report the case of a patient who presented with seizures and visual field deficit and had typical radiological and histopathological characteristics of SLIPPERS syndrome. Conclusion: Although the literature is inundated with CLIPPERS syndrome, its supratentorial variant is extremely rare. To our knowledge, this is fourth case of SLIPPERS syndrome to be reported in literature and serves to enhance clinicopathological understanding of this elusive entity.

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score.

Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

Risk Factors for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage: A Tertiary Care Center Experience.

Objectives Cerebral vasospasm in subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. There is a lack of consensus on the risk factors leading to cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this retrospective study, our objective was to determine the association of risk factors for cerebral vasospasm aSAH. Methods A total of 259 charts of aSAH patients consecutively admitted to the surgical intensive care unit of Hamad General Hospital from January 2007 to December 2016 were reviewed and included. The patient's demographic data, including comorbidities like hypertension (HTN), was recorded. Variables of interest included measurements of the neurological deficit on admission, the severity of SAH, treatment modality, and the initial computerized tomography scan of the head for intraventricular hemorrhage, intracerebral hemorrhage, or hydrocephalus. Multivariate analysis and multiple logistic regression analyzed the relationship to identify the association of independent variables. Results Out of the 259 patients, 34% ( n = 87) suffered from cerebral vasospasm. The severity of SAH was associated with the development of cerebral vasospasm ( p < 0.05). The presence of HTN and neurological deficits on admission were associated with an increased risk of cerebral vasospasm ( p < 0.05, p < 0.01, respectively). Hydrocephalus requiring treatment using external ventricular drains decreased the risk of cerebral vasospasm ( p < 0.05). Intraventricular and intracerebral hemorrhage were not associated with cerebral vasospasm ( p = 0.25, p = 0.16). The endovascular treatment of cerebral aneurysms was associated with an increased risk of cerebral vasospasm ( p < 0.05). Conclusion Cerebral vasospasm is common among patients admitted with aSAH. It is significantly associated with the history of HTN, the neurological deficit on admission that corelates more strongly to the motor deficit on admission, the severity of hemorrhage (modified Fischer score), and endovascular treatment. External ventricular drainage was associated with a decrease in cerebral vasospasm. The present study's findings shed light on cerebral vasospasm's risk factors in the country and the region.

Development of a Novel Methodology for Remaining Useful Life Prediction of Industrial Slurry Pumps in the Absence of Run to Failure Data.

Smart remaining useful life (RUL) prognosis methods for condition-based maintenance (CBM) of engineering equipment are getting high popularity nowadays. Current RUL prediction models in the literature are developed with an ideal database, i.e., a combination of a huge "run to failure" and "run to prior failure" data. However, in real-world, run to failure data for rotary machines is difficult to exist since periodic maintenance is continuously practiced to the running machines in industry, to save any production downtime. In such a situation, the maintenance staff only have run to prior failure data of an in operation machine for implementing CBM. In this study, a unique strategy for the RUL prediction of two identical and in-process slurry pumps, having only real-time run to prior failure data, is proposed. The obtained vibration signals from slurry pumps were utilized for generating degradation trends while a hybrid nonlinear autoregressive (NAR)-LSTM-BiLSTM model was developed for RUL prediction. The core of the developed strategy was the usage of the NAR prediction results as the "path to be followed" for the designed LSTM-BiLSTM model. The proposed methodology was also applied on publically available NASA's C-MAPSS dataset for validating its applicability, and in return, satisfactory results were achieved.

A 24-generation-old founder mutation impairs splicing of RBBP8 in Pakistani families affected with Jawad syndrome.

Jawad syndrome is a multiple congenital anomaly and intellectual disability syndrome with mutation in RBBP8 reported only in two families. Here, we report on two new families from Pakistan and identified a previously reported variant in RBBP8, NM_002894.3:c.1808-1809delTA. We could show that this mutation impairs splicing resulting in two different abnormal transcripts. Finally, we could verify a shared haplotype among all four families and estimate the founder event to have occurred some 24 generations ago.

Cervical Epidural Abscess due to Brucella Treated with Decompression and Instrumentation: A Case Report and Review of Literature.

Brucella is caused by a Gram-negative bacillus and is a common disease in endemic areas where people are in close contact with animals and dairy products, but brucellar cervical epidural abscess is rare. We describe a rare case of a C5-6 brucellar epidural abscess in a veterinary doctor who was treated with decompression and instrumentation. We also review the cases of cervical brucellar epidural abscess treated with instrumentation in the literature.

Case Report: COVID-19-Associated Bilateral Spontaneous Pneumothorax-A Literature Review.

COVID-19 is a pandemic caused by SARS-CoV-2, primarily affecting the respiratory tract. Pulmonary complications of COVID-19 may include acute respiratory distress syndrome and pulmonary embolism. Pneumothorax has been recently reported in association with COVID-19. We report a case of COVID-19 pneumonia with bilateral spontaneous pneumothorax with no known underlying lung disease or risk factors.

Rapidly fatal pneumococcal meningitis following non-penetrating traumatic brain injury.

A previously healthy young man presented to hospital with severe traumatic brain injury following a motor vehicle collision. Within 24 hours of admission, and despite antibiotic coverage, he developed a fever. On the second day, the source of infection was discovered to be purulent pneumococcal meningitis. At 48 hours post-accident, he developed brain-stem death without evidence of raised intracranial pressure or trans-tentorial herniation. Initial CT scans of the head were essentially normal, but early repeat scans revealed evidence of pneumocephalus and possible frontal bone fracture. Current recommendations do not make room for targeted antibiotic prophylaxis in traumatic brain injury patients with traumatic skull fracture. We argue that our case demonstrates the need for aggressive targeted antibiotic prophylaxis in the presence of certain features such as frontal or sphenoid bone fracture and pneumocephalus.