Extracranial carotid artery aneurysms (ECAAs) are rare, and the optimal therapeutic modality for these lesions remains controversial. Surgical resection and covered stents may be limited to selected cases. While the concept of using flow diversion is appealing for large aneurysms, the application of flow diverters in extracranial carotid lesions may face restrictions due to off-label use, reimbursement challenges, and factors related to the devices themselves. We report our experience with multiple overlapping Low-profile Visualized Intraluminal Support (LVIS) stents as a reconstructive option for selected ECAAs. Five patients with large ECAAs were treated with multiple overlapping LVIS stents. The primary goal was parent-artery reconstruction and reduction of intra-aneurysmal flow reduction by increasing local metal coverage across the neck of the aneurysm. Double overlapping LVIS stents were used in 3 cases, whereas triple or more extensive overlapping constructs were used in 2 cases. During a mean radiologic follow-up of 24 months, complete occlusion in 2 cases, partial occlusion in 3 cases, and adjunctive procedures in 3 cases were required, and no major thromboembolic or hemorrhagic complications were documented. Adjunctive or staged treatment was required in 3 cases, including balloon angioplasty, additional LVIS stenting, flow-diverter placement, stent-graft placement, or coil embolization. Multiple overlapping LVIS stenting is a feasible and relatively safe reconstructive option for selected large or clinically significant ECAAs, particularly when primary flow-diverter treatment is constrained by off-label indication or reimbursement issues. However, they have limited standalone efficacy, particularly in large or complex aneurysms, often requiring adjunctive or staged treatment.

Objective: This study aims at spotlighting different lines of management of aggressive vertebral hemangioma (VH) through a retrospective analysis of single center experience. Methods: Patients diagnosed with aggressive VHs in a tertiary referral center were reviewed from 2014 through 2024. Data of patients who met the inclusion criteria were analyzed. Patients of all ages, both sexes, and all varieties of clinical presentation were included, only patients who underwent at least one intervention were included. Results: The study included nine patients, comprising six females and three males, with a mean age of 29.3 years (ranging from 14 to 46). Six patients underwent Trans-arterial embolization (TAE), of whom five underwent further surgical procedures, while one patient found TAE to be sufficient as a stand-alone management technique. Eight patients underwent surgical management, five of whom were pre-operatively embolized. Conclusions Aggressive VHs are rare, and their management is challenging. Most cases require a multi-modal management, especially when presented with neurological deficit. Pre-operative embolization and/or vertebroplasty are safe and useful tools to decrease intra-operative bleeding of such a vascular pathology in cases undergoing open surgical procedures.

Objective: This study aims at spotlighting different lines of management of aggressive vertebral hemangioma (VH) through a retrospective analysis of single center experience. Methods: Patients diagnosed with aggressive VHs in a tertiary referral center were reviewed from 2014 through 2024. Data of patients who met the inclusion criteria were analyzed. Patients of all ages, both sexes, and all varieties of clinical presentation were included, only patients who underwent at least one intervention were included. Results: The study included nine patients, comprising six females and three males, with a mean age of 29.3 years (ranging from 14 to 46). Six patients underwent Trans-arterial embolization (TAE), of whom five underwent further surgical procedures, while one patient found TAE to be sufficient as a stand-alone management technique. Eight patients underwent surgical management, five of whom were pre-operatively embolized. Conclusions Aggressive VHs are rare, and their management is challenging. Most cases require a multi-modal management, especially when presented with neurological deficit. Pre-operative embolization and/or vertebroplasty are safe and useful tools to decrease intra-operative bleeding of such a vascular pathology in cases undergoing open surgical procedures.

Objective: This study aims at spotlighting different lines of management of aggressive vertebral hemangioma (VH) through a retrospective analysis of single center experience. Methods: Patients diagnosed with aggressive VHs in a tertiary referral center were reviewed from 2014 through 2024. Data of patients who met the inclusion criteria were analyzed. Patients of all ages, both sexes, and all varieties of clinical presentation were included, only patients who underwent at least one intervention were included. Results: The study included nine patients, comprising six females and three males, with a mean age of 29.3 years (ranging from 14 to 46). Six patients underwent Trans-arterial embolization (TAE), of whom five underwent further surgical procedures, while one patient found TAE to be sufficient as a stand-alone management technique. Eight patients underwent surgical management, five of whom were pre-operatively embolized. Conclusions Aggressive VHs are rare, and their management is challenging. Most cases require a multi-modal management, especially when presented with neurological deficit. Pre-operative embolization and/or vertebroplasty are safe and useful tools to decrease intra-operative bleeding of such a vascular pathology in cases undergoing open surgical procedures.

Advancements in technology have ushered in a new era in spine surgery, offering innovative tools and techniques that improve surgical precision, efficiency, and safety. By exploring emerging technologies and techniques for minimally invasive spine surgery (MISS), providers may better address the challenges posed by spine pathology in an aging population and the imperative for refined surgical strategies to optimize outcomes of patient well-being. This narrative review analyzes studies exploring emerging technologies in MISS that contribute to better visualization and surgical accuracy, highlighting their respective surgical indications, objective reports of patient outcomes and user experiences, limitations in their use, and barriers to widespread implementation. This paper examines a spectrum of MISS technologies, including exoscope-assisted procedures, navigation-guided surgery, and robotic-assisted techniques for a range of spinal pathologies. The findings demonstrate enhanced preoperative knowledge and planning, as well as improved intraoperative precision and visualization, which may minimize tissue injury, surgical time, and postoperative complications. These technologies also enable more ergonomic surgical positioning for physicians and improved displays of the surgical site to the entire surgical team. Despite the potential benefits of these emerging technologies, the high costs of equipment and maintenance, as well as limited opportunities for sufficient training associated with their implementation, continue to pose limitations for supplementing or replacing existing surgical techniques.

THE EFFECT OF MARITAL STATUS AND CHILDREN ON PHYSICIAN’S ATTITUDE TOWARDS PSYCHOTROPIC MEDICATIONS Background: Psychiatric illnesses are a public health problem worldwide. An increasing number of Saudi citizens and residents utilize healthcare services for mental health concerns; hence, there is a need to assess these Physician’s attitudes towards psychotropic medications objectively. Aim: To examine of the effect of marital status on attitudes towards psychotropic medications among a sample of physicians in Saudi Arabia. Methods: A cross-sectional study was conducted over a period of three months. The study has been conducted on convenient Sample of physicians working in Saudi Arabia who accepted to share in research. Demographic data was gathered using an electronic self-administered questionnaire and Physician’s attitudes towards psychotropic medications have been evaluated by a previously validated questionnaire. Results: This study included 136 physicians, 67 (49.3%) physicians are married, with 48 (71.6%) of them having children and 19 (28.4%) not having children. Meanwhile, 69 (50.7%) are single, with 3 (4.3%) having children and 66 (95.7%) not having children. Physicians exhibit 83.3%-84.95% positive attitude, while 15.05%-16.7% display a negative attitude towards psychotropic medications. Conclusions: Physician’s attitudes may affect patients’ medication compliance, susceptibility to adverse drug reactions, and illness progression. Our study findings reveal similarities in attitudes towards psychotropic medications between the majority of married and single physicians in Saudi Arabia, regardless of whether they have children or not. Recommendations: Further larger studies are needed on large number of physicians in Saudi Arabia and other Arab countries to validate our study findings. Additionally, future research should explore the factors that influence Physician’s attitudes towards psychotropic medications, such as their personal experiences with mental illness or their training. Effective teaching and training programs are necessary to bring in Physician’s positive attitude towards psychotropic medications. ASEAN Journal of Psychiatry, Vol. 25 (1) January, 2024; 1-12.

Aims: This study was aimed to produce biodegradable cellulose acetate films impregnated with bacteriocin-like inhibitory substances to be used in food packaging. Methodology and results: Bacterial isolates were isolated from different sources and tested for their antimicrobial activity by agar well diffusion assay. The isolate that showed the highest antimicrobial activity against Staphylococcus aureus ATCC 29213, Escherichia coli ATCC 51659, Pseudomonas aeruginosa MG847103 and Streptococcus mutans ATCC 25175 was identified as Lactiplantibacillus plantarum strain N1 (OM019104) based on 16S rRNA based method of identification. The extracted bacteriocin-like inhibitory substances were partially purified with acetone precipitation and SP-Sephroase cation exchange chromatography. There was no change in the antimicrobial activity after treatment with the catalase enzyme, but there was a total loss in the activity after treatment with proteolytic enzymes. The obtained bacteriocin-like inhibitory substances showed pH stability over a wide range of pH values and thermal stability as it recovered 95% of its antimicrobial activity even after autoclaving for 15 min. Different concentrations of cellulose acetate (3 to 12%) were tested to develop the active antimicrobial films. The most flexible concentrations for food packaging were prepared and impregnated with partially purified bacteriocin-like inhibitory substances. The prepared films showed promising antimicrobial activity against S. aureus. Conclusion, significance and impact of study This study highlights the usage of active packaging in food preservation. Cellulose acetate films activated with the partially purified bacteriocin-like inhibitory substances have anti-staphylococcal activity, which can potentially be used in food packaging to prolong the shelf-life of perishable foo

Objective: To evaluate the combination therapy of pyronaridine tetraphosphate and diminazene aceturate against Babesia in vitro and in vivo. Methods: Bioinformatic analysis was performed using atom pair fingerprints. An in vitro combination test was performed against Babesia bovis and Theileria equi. Moreover, the in vivo chemotherapeutic efficacy of pyronaridine tetraphosphate in combination with diminazene aceturate was investigated against the growth of Babesia microti in mice using a fluorescence inhibitory assay. Results: Pyronaridine tetraphosphate and diminazene aceturate exhibited nearly similar molecular weights. The in vitro combination of pyronaridine tetraphosphate and diminazene aceturate was synergistic on Babesia bovis and additive on Theileria equi. In addition, 5 mg/kg pyronaridine tetraphosphate combined with 10 mg/kg diminazene aceturate inhibited Babesia microti growth significantly compared with those observed after treatment with 25 mg/kg diminazene aceturate alone from day 6 post treatment to day 12 post treatment. The combination therapy also normalized the hematological parameters of infected mice. Conclusions: An oral dose of pyronaridine tetraphosphate combined with a subcutaneous dose of diminazene aceturate inhibits Babesia in vitro and in mice, suggesting it might be a new paradigm for the treatment of babesiosis.

Background: The pathophysiology and susceptibility of children to primary immune thrombocytopenia (ITP) are linked to polymorphisms of the interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonist genes.Purpose: To investigate the association between the susceptibility and severity of primary ITP in children and the IL-1B and IL-1R antagonist gene polymorphisms. Methods: This comparative case-control studywas conducted at the Menoufia University Hospital Hematology and Oncology Unit, Pediatric Department, between August 2022 and September 2023. The children were divided into patients (28 boys, 22 girls) who received hospital and outpatient clinic care and controls (50 healthy age- and sex-matched children). Results: The mutant homozygous GG genotype and mutant G allele of rs16944 of the IL1B gene were considerably greater in patients than in controls (P<0.001). Furthermore, the mutant homozygous II/II genotype and heterozygous I/II genotype of the IL-1R antagonist gene were considerably greater in the case versus control group. The mutant II allele was significantly more prevalent in patients versus controls (P<0.001). Conclusion IL-1B and IL-1R antagonists may have a major impact on the development of immune thrombocytopenia. Furthermore, we found a relationship between IL-1B and IL-1R antagonist gene polymorphisms and the etiology of and children's susceptibility to primary immune thrombocytopenia.

Background: The pathophysiology and susceptibility of children to primary immune thrombocytopenia (ITP) are linked to polymorphisms of the interleukin (IL)-1B and IL-1 receptor (IL-1R) antagonist genes.Purpose: To investigate the association between the susceptibility and severity of primary ITP in children and the IL-1B and IL-1R antagonist gene polymorphisms. Methods: This comparative case-control studywas conducted at the Menoufia University Hospital Hematology and Oncology Unit, Pediatric Department, between August 2022 and September 2023. The children were divided into patients (28 boys, 22 girls) who received hospital and outpatient clinic care and controls (50 healthy age- and sex-matched children). Results: The mutant homozygous GG genotype and mutant G allele of rs16944 of the IL1B gene were considerably greater in patients than in controls (P<0.001). Furthermore, the mutant homozygous II/II genotype and heterozygous I/II genotype of the IL-1R antagonist gene were considerably greater in the case versus control group. The mutant II allele was significantly more prevalent in patients versus controls (P<0.001). Conclusion IL-1B and IL-1R antagonists may have a major impact on the development of immune thrombocytopenia. Furthermore, we found a relationship between IL-1B and IL-1R antagonist gene polymorphisms and the etiology of and children's susceptibility to primary immune thrombocytopenia.