Classic central nervous system Hodgkin lymphoma masquerading as left sphenoid wing meningioma- A case report.

INTRODUCTION AND IMPORTANCE: Classic Hodgkin Lymphoma with an incidence of 2-3 cases per 100,000 population affects the Central Nervous System in 0.02 % of cases (Gerstner et al., 2008; Brice et al., 2021; Morawa et al., 2007). CNS lymphoma, contributing to 0.22 % of Central Nervous System tumors, is the uncommon extra-nodal manifestation of Hodgkin's Disease (Brice et al., 2021; Henkenberens et al., 2014). It affects the nervous system secondary to systemic lymphoma or the relapse of the disease (Gerstner et al., 2008). Only 17 cases of CNS lymphoma are reported which were limited to the CNS at the time of diagnosis (Paul et al., 2017). Only two cases of Dural-Based Hodgkin Lymphoma were reported in the literature (Paul et al., 2017). CASE PRESENTATION: We are reporting the third case of dural-attached extra-axial secondary CNS Hodgkin Lymphoma in a 33 years old female, which appeared and was operated as Left Sphenoid Wing Meningioma. CLINICAL DISCUSSION: Only 17 cases of CNS lymphoma are reported which were limited to the CNS at the time of diagnosis (Paul et al., 2017). Only two cases of Dural-Based Hodgkin Lymphoma were reported in the literature (Paul et al., 2017). Our case consists the third case of dural attached Classic CNS Hodgkin lymphoma and the first case of Classic CNS Hodgkin Lymphoma locating in the Sphenoid Wing. CONCLUSION: It is important to differentiate CNS Hodgkin Lymphoma from other types of brain tumors especially when it resides in an unusual location because the treatment of CNS Hodgkin Lymphoma is mainly combined chemo-radiotherapy than surgical intervention.

Cockroaches as carriers of human medically important parasites.

Cockroaches have been identified as mechanical carriers of pathogens capable of infesting humans. The primary objective of this research was to detect and separate medically significant parasites found within the collected cockroaches. A total of 185 cockroaches were captured. In the laboratory, cockroaches underwent a series of steps. Initially, they were washed in a saturated salt solution and rinsed with 70% alcohol, dried, and subsequently dissected to examine endoparasites. In this study, a transport rate of 29.729% was documented, and four types of helminths were identified, which included Ascaris lumbricoides (47.27%), Enterobius vermicularis (30.91%), Trichuris spp. (7.27%), and Hymenolepis nana (14.55%). The parasites were more frequently found on the external surface of cockroaches (38/69.09%), compared to the internal surface (17/30.91%). Cockroaches captured in toilets were found to carry a higher percentage of parasites (31/16.75%) compared to those from kitchens (11/5.94%) and houses (13/7.02%). These findings suggest that cockroaches can serve as carriers for intestinal parasites and potentially act as mechanical agents in the dissemination of these parasites.

Neurosurgical landscape in Pakistan: Past, present and future perspectives.

Intricate fields have always posed a challenge for the healthcare department all over the world, particularly in developing countries. This article elaborates on the history of neurosurgery in a developing country like Pakistan. In addition, it provides a summary of a roadmap that a young healthcare practitioner, who inspires to become a respectable neurosurgeon may need. After Pakistan gained its independence, Dr. Omer Wali Jooma became the first healthcare practitioner who planted the seed of an official department of Neurosurgery in Jinnah hospital, Karachi. Various challenges include the absence of a non-standardized curriculum, a non-updated syllabus, severe deficiency of neurosurgeons in a country facing massive growth spurt, lack of facilities for a young trainee etc. These factors contribute to the bleeding of the department from various sites and the wounds needs to be addressed and stitched as soon as possible to make the department successful.

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.

The assessment of knowledge and awareness about iron deficiency anemia among the population of Riyadh province.

Background: Iron deficiency anemia (IDA) is considered the most common micronutrient deficiency and the greatest health concern throughout the globe. The main causes of anemia are iron deficiency, parasitic infestations, viral infections (human immunodeficiency virus), hemorrhage, and renal and hepatic diseases. Therefore, it is mandatory to be equipped with the proper knowledge regarding the causes, signs, symptoms, and diets containing iron, which can be a good initiative for the proper treatment and management of the health hazards; also, it will help primary care physicians to differentiate the degree of the disease and further treatment, planning, and management. The recent study was performed to understand the level of knowledge and awareness about IDA and its causes, prevention, and treatment. Methods: The study was carried out through an online survey using Google forms, which were distributed to the population residing in Riyadh Province. Results and Discussion: The responses received about the knowledge regarding IDA and its symptoms indicated weakness [565 (52.9%)], cold hands and feet [593 (55.5%)], and hair loss [663 (62.1)], and the majority (84.3%) of the participants believed that the major cause for IDA is malnutrition. Conclusion and Recommendations: Conclusively, it was believed that the presented study will be helpful to primary care physicians, the patients suffering from IDA, and the general population with a better understanding of the causes, additional signs and symptoms, proper treatment, timely management, sources of iron, and how to avoid the worse outcomes and complications of the disease. It will also help the health agencies in the kingdom to set further planning for the treatment and management of the disease through awareness platforms.

Delayed cervical spine metastasis from intracranial solitary fibrous tumor.

Cervical spine metastasis from primary intracranial solitary fibrous tumors (SFTs) is an extremely rare clinical entity. This report focuses on its metastatic tendency, radiological imaging, management plan, and follow-up strategies in view of its long latency period for metastasis. A 35-year-old female presented with right-side cervical radiculopathy. Magnetic resonance imaging spine showed C7 vertebral body collapse with retropulsion and neural compression. Two years ago, the patient had surgical resection of intracranial SFT (World Health Organization grade 3) with no evidence of recurrence on follow-up imaging. Cervical C7 metastasis has been decompressed and fused by the anterior cervical approach. Histopathology confirmed SFT metastasis to the spine, and the patient received adjuvant radiotherapy. Cervical metastasis from well-controlled primary intracranial SFT poses a significant challenge for its diagnostic and management planning. Serial pre-emptive surveillance is warranted with regular imaging and appropriate patient counseling.

The CDX2 G allele and the FoKI F allele of the VDR gene are more prevalent and related to changes in vitamin D levels in patients with psoriasis vulgaris: A pilot study.

BACKGROUND AND AIMS: Psoriasis is a chronic, non-contagious autoimmune condition marked by dry, itchy,erythematous and scaly plaques. From modest, localized plaques to total body coverage, the severity of psoriasis varies. Plaque, guttate, inverted, pustular, and erythrodermic psoriasis are the five primary kinds. About 90% of cases are of plaque psoriasis, commonly known as psoriasis vulgaris. Study aims to determine the impact of an rs2228570 (FokI) variant and an rs11568820 (CDX2) variant on serum vitamin D levels (SVD) in patients with psoriasis, and the correlation between the two variants and disease severity. METHODS: A case-control study consisting of 95 psoriasis vulgaris patients and 84 healthy controls. The clinical investigation, molecular genetics analysis, and biochemical analysis were done for both groups. RESULTS: SVD levels were significantly decreased in psoriasis patients group. FokI genotypes analysis, we found no significant variance between groups. CDX2 G/G genotype is more prevalent in patients than controls. Moderate psoriasis vulgaris patients with CDX2 G/G genotypes have higher SVD levels than CDX2 G/A, and CDX2 A/A p = 0.003. CONCLUSION: The study found a difference in vitamin D levels between patients and healthy subjects, as well as a difference in vitamin D levels with different FoKI and CDX2 genotypes.

Pneumatic Retinopexy: An Experience of 12 Years at a Tertiary Care Hospital.

Purpose The purpose of this study is to retrospectively analyze single-operation success (SOS) rates of pneumatic retinopexy (PR) for the treatment of rhegmatogenous retinal detachment (RRD) and to identify the predictors of treatment outcomes. Methods Sixty-one eyes of 61 patients who underwent PR for RRD during a period of 12 years were included in this study. Patient demographics along with pre-treatment clinical characteristics were recorded. Treatment outcomes in terms of best-corrected visual acuity (BCVA) and anatomical characteristics were reported including any post-operative complications. Visual outcomes were compared according to pre-treatment characteristics and between groups of the eyes achieving SOS and those requiring additional surgery. Results SOS was achieved in 37 (61%) eyes. Twenty-four (39%) eyes required one (36%) or two (3%) additional procedures. There was no significant association between pre-treatment characteristics and treatment failure. SOS eyes had significantly better visual outcomes (P=0.002), and so did those with macula-on status (P=0.003). New/missed breaks (9.8%) and proliferative vitreoretinopathy (PVR) (4.9%) were the most common causes of failure. Conclusions We found PR to be a beneficial technique for the treatment of RRD in this cohort. PR remains the least invasive treatment modality, and as a cost-effective technique, it is especially useful in low/middle-income countries such as Pakistan.

Waldenström macroglobulinemia: a review of pathogenesis, current treatment, and future prospects.

Waldenström macroglobulinemia (WM) is a chronic B-cell lymphoproliferative disorder characterized by lymphoplasmacytic cell overgrowth in the bone marrow and increased secretion of IgM immunoglobulins into the serum. Patients with WM have a variety of clinical outcomes, including long-term survival but inevitable recurrence. Recent advances in disease knowledge, including molecular and genetic principles with the discovery of MYD88 and CXCR4 mutations, have rapidly increased patient-tolerable treatment options. WM patients may benefit from chemotherapy regimens that include rituximab-based regimens, alkylating drugs, proteasome inhibitors, monoclonal antibodies, and drugs targeting Bruton tyrosine kinase inhibitors. In light of these advancements, patients can now receive treatment customized to their specific clinical characteristics, focusing on enhancing the depth and durability of their response while limiting the adverse effects. Despite the rapidly developing therapeutic armament against WM, a lack of high-quality evidence from extensive phase 3 trials remains a significant challenge in the research. We believe clinical outcomes will keep improving when new medicines are introduced while preserving efficacy and minimizing toxicity.

Physical properties and photocatalytic activity of Cr-doped TiO2 nanoparticles.

Nanocrystalline Ti1- x Crx O2 (0 ≤ x ≤ 0.20) samples were synthesised via acid-modified sol-gel process and characterised with various techniques, such as HRTEM, FESEM, Raman, XPS, DTA and VSM. The TEM image of TiO2 exhibits elongated nanoparticles with an average size of 10 nm. The HRTEM in combination with selected area electron diffraction (SAED) reveals the interplanar spacing and polycrystalline nature of the samples, respectively. FESEM micrographs divulge nonuniform morphologies and less aggregation of the particles in the doped sample. Raman spectra ensure the phase purity of the samples and a blue shift on Cr doping. X-ray photoelectron spectra (XPS) predict the chemical state of the elements and oxygen vacancies in the prepared samples. Room temperature magnetic measurements exhibit a significant variation in the magnetic parameters on Cr doping in TiO2 . The differential thermal analysis (DTA) shows the structural phase transition at ∼630°C. The photocatalytic performance is studied for the degradation of methylene blue (MB) dye under visible light irradiation. A higher photocatalytic efficiency is found for the 20% of Cr-doped TiO2 . These studies propose that the appropriate incorporation of Cr ions makes TiO2 very efficient for visible light-driven photocatalysts required for applications in wastewater treatment. LAY DESCRIPTION: In the present study, nanoparticles of TiO2 and Cr-doped TiO2 have been synthesised by a cost-effective acid-modified sol-gel process. The effect of Cr doping on the microstructure, thermal, magnetic and photocatalytic properties of TiO2 were explored in detail. The transmission electron microscopy (TEM) images exhibit the presence of elongated nanoparticles with an average size of 10 nm. Field emission scanning electron microscopy (FESEM) was used to study the surface morphology of the synthesised materials, which revealed nonuniform morphologies and less aggregation of the particles in the Cr-doped sample. Energy dispersive x-ray spectroscopy (EDS) confirms the elemental compositions with the appropriate stoichiometry of the elements. Raman spectra ensure the phase purity of the materials and also a blue shift with the incorporation of Cr ions in TiO2 . X-ray photoelectron spectra (XPS) predict the chemical state of the elements and oxygen vacancies in the prepared samples. The magnetic nature of all the synthesised samples was examined through the vibrating sample magnetometer (VSM) and revealed weak ferromagnetic behaviour of the samples. These results signify that the oxygen vacancies and defects play a crucial role in developing the ferromagnetic nature of oxide semiconductors. The differential thermal analysis (DTA) shows the structural phase transition at ∼630°C. The photocatalytic performance of the prepared samples was studied for the degradation of methylene blue (MB) dye under irradiation of visible light. A higher photocatalytic efficiency was found for the 20% of Cr-doped TiO2 . These studies propose that the appropriate incorporation of Cr ions makes TiO2 very efficient for visible light-driven photocatalysts required for applications in wastewater treatment.

Neuroendocrine hyperplasia of infancy; a rare form of childhood interstitial lung disease: a case report.

Interstitial lung disease in infancy is rare. In this case report, we discuss the case of a six-week-old male infant who presented with persistent tachypnoea, retraction and mild hypoxaemia corrected by low-dose supplemental oxygen since the age of 2 weeks. Birth history was unremarkable. Routine workup was done which turned out to be non-contributory. The child received multiple rounds of antibiotics along with bronchodilators and corticosteroids. There was no evidence of severe gastroesophageal reflux. Computed tomography of chest showed ground glass appearance, which was especially prominent in the right middle lobe and lingula ,and accompanied with air trapping. He was managed with mild respiratory supportive care, without positive pressure ventilation and nutritional management. He was discharged home, with instructions for in clinic follow up. A distinctive topographical picture and typical clinical symptoms were consistent with neuroendocrine hyperplasia of infancy (NEHI), which has a favourable prognosis. A high index of suspicion may enable a timely diagnosis. Adequate long-term respiratory and nutritional management without lung biopsy improves the outcome.

Nanozymes and nanoflower: Physiochemical properties, mechanism and biomedical applications.

Natural enzymes possess several drawbacks which limits their application in industries, wastewater remediation and biomedical field. Therefore, in recent years researchers have developed enzyme mimicking nanomaterials and enzymatic hybrid nanoflower which are alternatives of enzyme. Nanozymes and organic inorganic hybrid nanoflower have been developed which mimics natural enzymes functionalities such as diverse enzyme mimicking activities, enhanced catalytic activities, low cost, ease of preparation, stability and biocompatibility. Nanozymes include metal and metal oxide nanoparticles mimicking oxidases, peroxidases, superoxide dismutase and catalases while enzymatic and non-enzymatic biomolecules were used for preparing hybrid nanoflower. In this review nanozymes and hybrid nanoflower have been compared in terms of physiochemical properties, common synthetic routes, mechanism of action, modification, green synthesis and application in the field of disease diagnosis, imaging, environmental remediation and disease treatment. We also address the current challenges facing nanozyme and hybrid nanoflower research and the possible way to fulfil their potential in future.

Non-traumatic Spontaneous Paraplegia Secondary to Thoracic Disc Herniations in the Setting of Tobacco Abuse and COVID-19: A Case Report and Literature Review.

Thoracic disc herniations (TDHs) are very rare. While most common in the setting of trauma, other etiologies have been documented. Here, we present a case of spontaneous TDHs in the setting of tobacco abuse and coronavirus disease 2019 (COVID-19) causing acute paraplegia. We review spontaneous TDHs, associated risk factors, and the possible role of COVID-19 in the pathophysiology.

The Association Between Antidiabetic Agents and Clinical Outcomes of COVID-19 Patients With Diabetes: A Bayesian Network Meta-Analysis.

Aims: This study aimed to assess the impact of different antidiabetic agents on individuals with diabetes and COVID-19. Methods: We searched PubMed, Web of Science, Embase, and Cochrane Library databases from inception to October 31, 2021 and included seven antidiabetic agents. The data were pooled via traditional pairwise meta-analysis and Bayesian network meta-analysis. Results: The pairwise meta-analysis included 35 studies. Metformin (odds ratio (OR), 0.74; P=0.001), dipeptidyl peptidase-4 inhibitors (DPP4i) (OR, 0.88; P=0.04), sodium-glucose cotransporter-2 inhibitors (SGLT2i) (OR, 0.82; P=0.001), and glucagon-like peptide-1 receptor agonists (GLP1RA) (OR, 0.91; P=0.02) treatment were associated with lower COVID-19 mortality in individuals with diabetes compared to respective non-users. However, insulin treatment resulted in higher mortality (OR, 1.8; P=0.001). Mortality did not significantly differ in sulfonylurea (OR, 0.97; P=0.56) and thiazolidinediones (TZDs) (OR, 1.00; P=0.96) users. Furthermore, due to limited data, we analyzed five antidiabetic agents (metformin, DPP4i, sulfonylurea, insulin, and SGLT2i) and found no association between them and severe disease risk (all P>0.05). The Bayesian network meta-analysis included 18 studies. GLP1RA and SGLT2i had the highest first and second rank probability (67.3% and 62.5%, respectively). Insulin showed the maximum probability of ranking seventh (97.0%). Metformin had the third and fourth highest rank probability of 44.8% and 38.9%, respectively. Meanwhile, DPP4i had the fifth-highest rank probability of 42.4%, followed by sulfonylurea at 45.1%. Conclusion: Metformin, DPP4i, SGLT2i, and GLP1RA treatments were highly possible to reduced COVID-19 mortality risk in individuals with diabetes, while insulin might be related to increased mortality risk. Sulfonylurea and TZDs treatments were not associated with mortality. None of the antidiabetic agents studied were associated with the risk of severe disease. Additionally, GLP1RA probably had the most significant protective effect against death, followed by SGLT2i and metformin. Systematic Review Registration: PROSPERO (CRD42021288200).

Optic Disc Edema and Elevated Intracranial Pressure (ICP): A Comprehensive Review of Papilledema.

Papilledema is a swelling of the optic disc secondary to elevated intracranial pressure (ICP). We analyzed 79 peer-review journal articles and provided a concise summary of the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, natural history, differential diagnosis, treatment, and prognosis of papilledema. Only studies written in English with the full text available were included. Although many etiologies of papilledema exist, idiopathic intracranial hypertension is the most common and, thus, a large focus of this review.

Report of cerebral vasospasm as a complication of intracranial subarachnoid hemorrhage following traumatic lumbar puncture.

Background: This case report is the first documented and illustrated case of the identification and treatment of intracranial vasospasm as a sequalae of traumatic lumbar puncture (LP). LP is a routine procedure performed for both diagnostic and therapeutic purposes. Although rare, this procedure has risks and complications that should be considered before performing. Case Description: A 58-year-old male was found to have intracranial subarachnoid hemorrhage (SAH) 2 days after a traumatic LP which occurred in the setting of subtherapeutic international normalized ratio. During his hospitalization, the patient developed both clinical and radiographic signs of vasospasm. He was taken for angiography, which demonstrated significant vasospasm of bilateral middle cerebral arteries and bilateral anterior cerebral arteries. All vasospasms resolved and the patient improved clinically after intra-arterial spasmolytic therapy. Conclusion: LP is a routine procedure with complications that are often overlooked. The authors describe intracranial vasospasm from traumatic LP before correction of patient's coagulopathy. Cases with similar hemorrhage occurring in the spine resulting in non-aneurysmal SAH and vasospasm were reviewed.

Rhodium-Catalyzed Enal Transfer with N-Methoxypyridazinium Salts.

Herein, we report a simple method for functionalized enals involving enal-transfer reaction of water-soluble N-methoxypyridazinium salts. This open-flask reaction proceeds under mild aqueous basic conditions through [2,3]-sigmatropic rearrangement of propargyl/allyl sulfur-ylides derived from in situ-generated Rh-(E)-enalcarbene. Various synthetically challenging allene- and allyl-functionalized (E)-enals with a γ-C(sp3) quaternary center were obtained in good to high yields. InCl3-catalyzed cascade cyclization of allenyl-enal and aniline gave a valuable pyrrolo[1,2-a]quinoline motif.

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage.

No guidelines currently exist for surgeons to follow regarding drain use after spine surgery for degenerative disc disease. Therefore, we conducted a literature review to determine what situations warrant drain placement versus those which do not. When placed, we further investigate optimal drain duration. The goal of this article is to provide spine surgeons insight into the current literature and guidance when deciding if a drain should be used or discontinued. We performed a PubMed search and analyzed 44peer-reviewed journal articles. Only studies that had the full article available were included. The highest-quality studies that were reviewed, demonstrated that in most situations using a drain is not associated with superior outcomes. It revealed that when drains are retained for a longer duration they run a greater risk of surgical site infection (SSI). Additionally, drains are associated with increased blood loss, a greater chance of requiring blood transfusions, and longer hospital stays. We conclude that drains are currently being overused in spine surgery for cases of degenerative disc disease, which exposes patients to unnecessary complications while providing minimal benefit.

Intraoperative localization and "snowman" muscle pledget repair for ventral dural defect in a case of spontaneous intracranial hypotension.

BACKGROUND: This image report with technical notes is the first to illustrate and describe the technique used to treat spinal cerebrospinal fluid (CSF) leaks with the "snowman" muscle pledget. A 49-year-old male presented with orthostatic headaches as well as the left abducens nerve palsy. Patient's workup including findings of diffuse meningeal enhancement on magnetic resonance imaging, lumbar puncture opening pressure of 4 cm H2O, and CT myelogram demonstrating evidence of ventral spinal thoracic CSF leak. CASE DESCRIPTION: Procedure took place in a hybrid biplane operating room so that simultaneous digital subtraction myelogram may also be performed for intraoperative localization. Dural defect was identified intraoperatively and repaired with thoracic laminectomy and "snowman" muscle pledget technique. Postoperatively, the patient did well with resolution of his symptoms. CONCLUSION: The authors have proposed a grading scale to aid in the work up and management of intracranial hypotension. The use of a hybrid biplane operating room and "snowman" muscle pledget technique is a safe and effective technique to treat spontaneous spinal CSF leaks resulting from dural defects.

Quantifying burden of intravitreal injections: questionnaire assessment of life impact of treatment by intravitreal injections (QUALITII).

AIM: To quantify the areas of burden experienced by patients requiring repeated intravitreal injections (IVI) in the management of exudative retinal diseases. METHODS: The validated Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections survey was administered to patients at four retina clinical practices across four US states. The primary outcome measure was Treatment Burden Score (TBS), a single score assessing overall burden. RESULTS: Of 1416 (n=657 age-related macular degeneration; n=360 diabetic macular oedema/diabetic retinopathy; n=221 retinal vein occlusion; n=178 other/uncertain) patients, 55% were women with an average age of 70 years. Patients most frequently reported receiving IVI every 4-5 weeks (40%). The mean TBS was 16.1±9.2 (range 1-48; scale of 1-54), and the TBS was higher in patients with diabetic macular oedema and/or diabetic retinopathy (DMO/DR) (17.1) compared with those with age-related macular degeneration (15.5) or retinal venous occlusive (15.3) (p=0.028). Though the mean level of discomfort was quite low (1.86) (scale 0-6), 50% of patients reported experiencing side effects more than half of the visits. Patients having received fewer than 5 IVI reported higher mean anxiety levels before (p=0.026), during (p=0.050) and after (p=0.016) treatment compared with patients having received more than 50 IVI. After the procedure, 42% of patients reported restrictions from usual activities due to discomfort. Patients reported a high mean satisfaction rating of 5.46 (scale 0-6) with the care of their diseases. CONCLUSIONS: The mean TBS was moderate and highest among patients with DMO/DR. Patients with more total injections reported lower levels of discomfort and anxiety but higher disruption to daily life. Despite the challenges related to IVI, the overall satisfaction with treatment remained high.