Solitary Skull Langerhans Cell Histiocytosis Presenting With a Pus Draining Fistula: An Unusual Presentation and Review of Literature.

Langerhans cell histiocytosis (LCH) is a rare condition in adults, especially when it is limited to a single area of the skull, known as solitary calvarial involvement. In this case report, we present a unique instance of LCH affecting the parietal bone with a pus-draining fistula. This is a rare and unusual presentation at this location, which has been scarcely reported in medical literature. A 30-year-old woman with no prior comorbidity presented with complaints of headache that persisted for a year. She also had swelling on her scalp and a yellowish discharge for 3 weeks, but no neurological problems were observed. Radiology revealed thinning of the calvaria, with ragged margins along the inner table, multiple focal erosions, and involvement of overlying soft tissue and bony sequestrum. The patient underwent biparietal craniotomy and excision of the lesion. The histopathology report showed LCH. After 8 months of follow-up, there was no recurrence. The management of solitary calvarial involvement by LCH with masquerading presentation as a scalp infection can be achieved through complete excision of the lesions, resulting in a favorable outcome.

Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h. METHODS: A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group. RESULTS: Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) = - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD = - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications. CONCLUSION: Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.

Intramedullary Subependymoma Of Lower Thoracic Cord.

Spinal subependymoma (SSE) is a rare intramedullary, benign tumour. Surgical excision isthe preferred approach. However, the interwoven pattern of neural tissue within the tumour dictates the extent of resection. Where gross total resection is linked with possible neurological deficits, subtotal resection or close observation may support better functional outcomes. The evidence for the management of SSE is based mostly on case reports. Herein, we review the existing literature regarding treatment options and clinical outcomes of spinal subependymoma.

Intracranial metastasis of testicular germ cell tumours.

Brain metastasis from testicular germ cell tumour (TGCT) is rare and represents only 2% of metastatic brain tumours. Although TGCTs have a good survival rate, the prognosis of brain metastasis is poor. Due to the rarity of the diagnosis, there are limited studies on the topic and a standardized treatment protocol does not exist. Surgical management has long been considered a positive prognostic factor; however, recent studies have investigated the impact of chemotherapy and radiotherapy in these patients. Current literature suggests multiplicity of brain lesions and treatment with chemotherapy or radiotherapy alone can have a poor impact on the prognosis of the disease. However, studies with larger cohorts are required to understand and develop the optimal treatment protocol for patients with brain metastasis from TGCT.

Awareness and safe practices of Hepatitis-B and C prevention and transmission among workers of women beauty salons.

Background & Objectives: Hepatitis-B and C is currently a major health problem all over the world including Pakistan. All beauty treatments including manicures are used by many people and can be a risk factor because of sharing of contaminated instruments. Proper sterilization needs to be achieved by an autoclave. Our study was conducted to know the awareness and safe practices of Hepatitis-B and C prevention and transmission by beauty salon workers in Karachi. Methods: This was a cross-sectional descriptive study performed from February 2021- July 2021 among workers of women's beauty salons across Karachi. Validated questioners were distributed and were filled in the presence of research worker. Data was compiled and analyzed using SPSS version 22. Workers who scored ≥ 70% were considered to have adequate knowledge. Results: Our results showed that out of 261 participants, 240 (92.3%) were females. 49(18.8%) had adequate knowledge about hepatitis-B, 63(24.1%) had adequate knowledge about hepatitis-C. 111(42.5%) had adequate practices. According to the independent T test, there was statistically significant relationship between family history of hepatitis-B and knowledge of Hepatitis-B (p=0.022), hepatitis-B vaccination and knowledge of Hepatitis-B (p=0.006). We also found significant relationship between family history of hepatitis-C and knowledge of hepatitis-C (p=0.019), also between previous blood test performed for hepatitis antibodies and knowledge about hepatitis-B and C. On Uni-Variate logistic regression we found that males participants are less likely to have adequate Hepatitis-C knowledge in comparison of female participants (OR=0.152). We also found that participants who have Hepatitis-B family history, have more likely to have adequate Hepatitis-C knowledge (OR=1.874) and males participants are less likely to have adequate Hepatitis-B knowledge in comparison of female participants (OR=0.212). Only 45(17.2%) workers were fully vaccinated with Hepatitis-B and 126(48.3%) had knowledge of adequate sterilization technique of equipment's. Conclusion: This study showed that overall awareness among workers of women beauty salon in Karachi about Hepatitis-B and C is inadequate with low vaccination rates. There is dire need to organize awareness programs with mass vaccination campaigns for safe practices and to curb viral transmission.