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Purpose Subependymomas located within the 4th ventricle are rare, and the literature describing imaging characteristics is sparse. Here, we describe the clinical and radiological characteristics of 29 patients with 4th ventricle subependymoma. Methods This is a retrospective multi-center study performed after Institutional Review Board (IRB) approval. Patients diagnosed with suspected 4th ventricle subependymoma were identified. A review of clinical, radiology, and pathology reports along with magnetic resonance imaging (MRI) images was performed. Results Twenty-nine patients, including 6 females, were identified. Eighteen patients underwent surgery with histopathological confirmation of subependymoma. The median age at diagnosis was 52 years. Median tumor volume for the operative cohort was 9.87 cm3, while for the non-operative cohort, it was 0.96 cm3. Thirteen patients in the operative group exhibited symptoms at diagnosis. For the total cohort, the majority of subependymomas (n = 22) were isointense on T1, hyperintense (n = 22) on T2, and enhanced (n = 24). All tumors were located just below the body of the 4th ventricle, terminating near the level of the obex. Fourteen cases demonstrated extension of tumor into foramen of Magendie or Luschka. Conclusion To the best of our knowledge, this is the largest collection of 4th ventricular subependymomas with imaging findings reported to date. All patients in this cohort had tumors originating between the bottom of the body of the 4th ventricle and the obex. This uniform and specific site of origin aids with imaging diagnosis and may infer possible theories of origin.

To review the current literature on pineal region gliomas, summarizing the clinical characteristics and treatment outcomes.PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Comprehensive clinical characteristic review and survival analysis were conducted.Twelve studies describing 81 patients were included. The median age was 39 years (male=54.3%). Fifty patients (61.7%) had obstructive hydrocephalus requiring cerebrospinal fluid diversion with either ventriculoperitoneal shunt (VPS) (40.0%) or endoscopic third ventriculostomy (ETV) (24.0%). Patients who underwent VPS had significant survival benefits compared to ETV (p0.05). All patients in our review underwent surgery, and gross-total resection (≥98%) was achieved in 34.6%. The supracerebellar infratentorial approach was the most employed surgical approach (62.3%). Chemotherapy was administered in 32.1% of cases, and radiotherapy in 40.7%. The median overall survival (OS) was 12 months, and the overall one-year survival rate was 60%.This study could not establish a correlation between the extent of tumor resection and positive treatment outcomes. However, among cases with hydrocephalus, patients who underwent VPS placement had better survival as compared to ETV.

تعتبر دراسة التاريخ الاجتماعي من الموضوعات التاريخية الهامة لما تقدمة لنا من معلومات وصور عن طبيعة الحياة الاجتماعية التي كان يعيشها الناس ضمن الدولة العربية الإسلامية، كما وتلقي الضوء على اهم المظاهر الاجتماعية للمجتمعات الإسلامية، التي لم تسخر لها في الماضي جهود كافية للكشف عنها وجعلها ظاهرة للعيان. شهدت الدولة الفاطمية ازدهار في الحياة الاقتصادية في مصر ويتضح ذلك جليا في مظاهر البذخ والترف الذي عاشته الدولة وخاصة بعد قدوم الخليفة المعز لدين الله (341 -365هـ / 952 -975م) الفاطمي إلى مصر. وهذا بفضل ما حملة المعز لدين الله معه عند قدومه إلى مصر من أموال وجواهر، وهذا من شأنه ان ساعد على ازدهار الحياة الاقتصادية في مصر.

Herpes simplex (HSV) esophagitis is usually identified in patients with significant immunosuppressive conditions such as AIDS. Short course of immunosuppressive therapy is an uncommon risk factor for this condition. We present a case of acute gastrointestinal bleeding secondary to HSV type 1-induced esophageal ulcers. A 63-year-old woman developed acute hypoxic hypercapnic respiratory failure. Past medical history was significant for COPD for which the patient was taking short-acting bronchodilator inhalers. The patient was intubated and started on mechanical ventilation. Intravenous Solu-Medrol 40 mg Q6 was started. Hospital course was complicated by sepsis of unknown source. Empiric broad-spectrum antibiotic therapy was started. On the 11th hospital day, the patient experienced multiple episodes of coffee ground emesis. There was abdominal tenderness on physical examination. Significant laboratory results were lipase 1,911 U/L and lymphopenia (ALC = 300/mm3). Endoscopy revealed severe erosive esophagitis and multiple punched-out ulcerations of the esophagus. Empiric treatment with valacyclovir 500 mg OD was started. The patient required PEG tube insertion for dysphagia. Complete resolution of esophagitis was noted then. Immunohistochemical staining for HSV was strongly positive in the cells with inclusions. Short course of intravenous corticosteroids is an uncommon cause of HSV-1 esophagitis. Corticosteroid-induced lymphopenia impedes underlying cellular immunity, which might explain the reactivation of latent herpes and esophageal ulcer formation. Given the rarity of the disease, evidence of treatment is available from case reports only. We found complete resolution of esophageal ulcers after the patient received valacyclovir therapy for 10 days.

INTRODUCTION Extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) are common and can involve nearly any organ. EIM can cause a significant impact on morbidity and quality of life and can be a challenge to physicians to manage IBD patients. Arthropathies occur in 6–53% of IBD patients and is considered the most common EIM. This study compares IBD- Rheumatological overlap in our university clinic with inpatients identified via the NIS database. We also evaluated the overlap in our clinic population concerning patient care. The objective of the study was to further characterize IBD-Rheumatological overlap by comparing our institution’s clinic population to patients identified via the NIS database. METHODS We used ICD-10 codes to identify IBD patients and further used a broad range of ICD-10 codes for rheumatological manifestation to identify overlapping patients in 2018 in our clinic population, the inpatient database population and NIS database. Incidence of coordinated care was determined in the clinic population. RESULTS In the clinic population there were 228 IBD patients and 2240 rheumatologic patients. Dual ICD-10 codes were found for 46 patients and further analysis resulted in 21 clinic patients with true overlap and recent visits (21/228 = 9.2%). For the inpatient analysis, there were 65,379 IBD patients with 3741 having a diagnosis for a rheumatologic disease (3741/65,379= 6%). In the clinic population, the majority of patients had diagnosed Crohn’s Disease (95.2%), were female (60%) and were African American (77%). The most common rheumatological manifestation was AS. While the inpatient data analysis also suggests that AS is more likely to be associated with Crohn’s Disease (0.64 % vs 0.43%), the most frequent manifestation was the general category of RA (3.54% vs 3.03%) In the National inpatient database, 22,552 patients had a diagnosis of UC out of which 81% were Caucasian, 10% African American, and 9% Hispanic. There were 38,962 patients with Crohn’s disease out of which 82% were Caucasian, 15.2% African American and 7% were Hispanic. The most common rheumatological manifestation was RA. DISCUSSION In the clinic population study where rheumatological disease was well characterized by experienced rheumatologists, the most frequent disease was AS and the primary IBD manifestation was Crohn’s disease. In the inpatient population, rheumatological disease in general was present in 6% of patients but it is unknown if more specific rheumatological evaluation was performed on the patients. The fact that the majority of clinic patients were seen by both GI and Rheumatology and were on effective therapies for their IBD and Rheumatological manifestations is encouraging. Both gastroenterologists and rheumatologists should be vigilant to identify the co-existence of these conditions and follow-up these patients for better outcomes.

PURPOSE: We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO). METHODS: PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted. RESULTS: Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05). CONCLUSION: SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Complete surgical resection showed better survival rates compared to partial resection. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart.

Objective: To determine the frequency of electrolyte disorders, i.e., serum sodium and potassium and to evaluate its effect on mortality rate among children admitted at the pediatric intensive care unit. Study Design and Setting: This was a descriptive cross sectional study conducted at Pediatric Intensive care unit of Civil Hospital Karachi from April to December 2017 Methodology: Informed consent was obtained from 150 parents of the children who fulfill the inclusion criteria. Laboratory data (serum sodium and serum potassium) were recorded during the stay in the pediatric intensive care unit. Data was analyzed using SPSS version 20. Mean ± S.D was calculated for quantitative variables. Frequency and percentage were calculated for gender, electrolyte disorders and mortality. Effect modifiers were controlled by stratification of age, gender and electrolyte disorders (Hypernatremia, Hyponatremia, Hyperkalemia, and Hypokalemia). Post-stratification, Chi-squared test was applied. P-value = 0.05 was taken as significant. Results: Out of 150 patients, electrolyte disorders in terms of serum sodium and potassium, were found in 86(57.3%) children. Mortality in children with electrolyte disorders was found to be 46(53.5%) which was significantly higher (P

Background/Aim: To systematically review the patient characteristics and management approaches of adenoid cystic carcinoma (ACC) infiltrating the skull base. Materials and Methods: According to PRISMA guidelines, PubMed, Scopus, and Cochrane were searched to retrieve studies reporting management protocols and survival outcomes of patients with skull base ACCs. Patient characteristics, management strategies, and outcomes were investigated. Results: The review encompassed 17 studies involving 171 patients, with a female predominance (57.9%) and a mean age of 49±7.12 years. ACCs mostly infiltrated the paranasal sinus (22.2%), cavernous sinus (8.8%), and nasopharynx (7.1%). Perineural invasion was reported in 6.4% of cases. Facial pain, nasal obstruction, and facial paresthesia were the most common symptoms. Surgical resection (45.6%) was favored over biopsy (12.2%). Employing the free flap technique (4.7%), surgical reconstruction of the bony defect after resection was performed using abdominal and anterior thigh muscle grafts in 1.8% of patients each. As adjuvant management, 22.8% of cases had radiotherapy and 14.6% received chemotherapy. Recurrence of skull base ACCs occurred in 26.9% of cases during a mean follow up-time of 30.8±1.8 months. Conclusion: Skull base ACCs pose a surgical challenge mainly due to their proximity to critical neurovascular structures and aggressive behavior. Surgical resection and radiotherapy are shown to be safe and effective treatment modalities. The dismal prognosis and limited data on non-surgical strategies highlight the need for further evaluation of the current management paradigm and upraising innovative therapies to improve patient mortality and quality of life.

To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications.PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI).We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; ISurgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

Sarcoidosis is described as a state of immune-mediated chronic systemic inflammatory disease that is typically characterized by non-caseating granulomas. It involves multiple organs like the lungs, lymph nodes, eyes, skin, and liver. Besides the solid organ involvement, it is also known to be associated with various pro-thrombotic states leading to pulmonary embolism and deep vein thrombosis. Mechanical factors causing the venous stasis were considered the major contributing factors. However, based on recent studies, chronic inflammation from macrophages and activated leukocytes are also hypothesized to further activate thrombin and fibrin formation. Regardless of the etiology, the management focuses on life-long anticoagulation to prevent further episodes of thrombosis. Herein we present a case of a 38-year-old male with a history of sarcoidosis who was admitted after having recurrent deep vein thromboses. Further investigations revealed a negative hypercoagulable workup or other auto-immune processes and the absence of any granulomas causing mechanical compression on large vessel venous vasculature. He was adequately managed with anticoagulation therapy and followed up outpatient with no further similar episodes. This case adds to the growing understanding that the mechanisms by which sarcoidosis induces thromboembolism is primarily pro-inflammatory rather than mechanical in nature.

INTRODUCTION: Acute ischemic stroke (AIS) complicating cardiac interventions (CI) is well described. The use of mechanical thrombectomy (MT) for treatment of emergent large vessel occlusion (ELVO) in this setting, however, is not widely reported. METHODS: Cases of patients undergoing MT for AIS with ELVO at a single institution were reviewed. Cases preceded by recent CI were investigated retrospectively. Data was collected for patient demographics, type of cardiac intervention, stroke characteristics, neurovascular intervention, and patient outcomes. RESULTS: Between 2008 and 2017, registry analysis identified nine patients treated with MT for AIS complicating recent CI. Patients were more commonly male with a mean age of 67 years. A large majority had a known cardiac arrhythmia. Coronary artery bypass graft surgery (CABG) was the most identified CI, followed by valve repair, and cardiac ablations. Mean presenting NIHSS was 18. Most presented with hemiplegia. Seven cases were found to have MCA occlusions. Stent-retrievers were used in 6 cases with excellent recanalization in five MCA cases (TICI 2c or 3) and in two basilar cases. Despite immediate improvements in NIHSS scores in most cases, functional outcomes were poor in 7 cases (mRS of 4-6). Three cases were complicated by hemorrhage and three cases ended in mortality. CONCLUSION: AIS with ELVO following recent CI is associated with high rates of mortality and poor functional outcomes despite MT. Further work is needed to understand the key drivers to poor outcomes in this ELVO subgroup.

Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0-10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24-40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.

Sarcoidosis is a non-necrotizing granulomatous disease of unknown etiology presenting with variable systemic manifestations. Lung involvement is the most common initial presentation of sarcoidosis. Rarely, patients can present with initial non-pulmonary symptoms. Asymptomatic gastric sarcoidosis is a difficult diagnosis as it is not only rare but also under-recognized in the majority of cases. Its treatment is exclusively recommended for symptomatic cases only. However, it is of extreme significance to have the asymptomatic patients follow up outpatient regularly to prevent any major complications. Here, we present an interesting case of a 54-year-old African American female patient with only abdominal pain symptoms attributed to a hepatic abscess. A diagnosis of gastric sarcoidosis was solely based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). Incidentally, she was also found to have pulmonary sarcoidosis based on imaging. Her abdominal symptoms improved with abscess drainage and so, she was never started on steroids. She was followed up outpatient for pulmonary function tests. The patient continues to do well without any specific treatment for sarcoidosis. This case demonstrates the variability of sarcoidosis and the significance of biopsy in gastric sarcoidosis.

PURPOSE To study the multidisciplinary management and survival outcomes of orbital metastasis (OM). METHODS All patients with a diagnosis of OM treated during 1999-2019 were included. Clinical data were retrospectively collected and analyzed. RESULTS The study included 118 patients, 71 females and 47 males, with a median age of 61 years. The most common primary tumor types were breast carcinoma (43 patients), melanoma (17), and lung (13), thyroid (7), renal cell (6), and neuroendocrine carcinoma (6). Ninety-six patients had a known history of cancer at OM diagnosis. The median time from diagnosis of primary cancer to OM was 31 months (range, 0-304). In 22 patients, OM was the first sign of cancer. In 47 patients, the orbit was the only site of metastasis. The most common presenting features were restricted by extraocular motility (77 patients) and proptosis (61). Eight patients had enophthalmos. OM was diagnosed based on clinical history and imaging studies in 81 patients and orbital biopsy in 37. One hundred nine patients were treated with chemotherapy and immunotherapy, 75 with radiation, and 21 with palliative surgical resection. Eighty-two patients died during follow up. The median overall survival (OS) time after diagnosis of OM was 17 months (95% CI: 12-28). OM from renal cell carcinoma was associated with the best and OM from thyroid cancer with the worst OS. Patients with breast cancer had longer median survival (28 months; 95% CI: 15-60) than patients with lung, melanoma, neuroendocrine, or thyroid cancer. CONCLUSION In this large series, breast cancer and melanoma were the most common causes of OM. Most patients had a known history of cancer at OM diagnosis and did not require orbital biopsy to confirm the diagnosis. Patients with renal cell carcinoma and breast carcinoma had the best prognosis after diagnosis of OM.

Introduction Traumatic lumbar puncture (TLP+) can lead to the iatrogenic infiltration of the central nervous system (CNS) by circulating leukemic blast cells in childhood acute lymphoblastic leukemia (ALL). The risk of TLP+ is increased by a number of factors at the time of presentation of the disease, such as a high white cell count (WCC), T-ALL phenotype, and unstable clinical condition of the patient. For this reason, the first lumbar puncture (LP) was deferred until Day Eight of prednisolone prophase during remission induction therapy in one set of patients. The objective was to compare the historical cohort of Day-One LP with Day-Eight LP with respect to the incidence of TLP+ and de novo CNS leukemia. Methods A retrospective comparative data analysis of 1,185 childhood ALL patients aged 1-16 years was conducted based on the electronic medical records of the pediatric hematology-oncology department of The Indus Hospital (TIH), Karachi, from January 2010 to August 2018. A total of 600 patients whose LP was done on Day One (January 2010-May 2015) were placed in cohort A, whereas 585 patients whose LP was performed on Day Eight (June 2015-August 2018) were placed in cohort B. After the examination of the cerebrospinal fluid (CSF), the status of CNS infiltration was classified as CNS-1, CNS-2, CNS-3, and TLP+. Results A total of 1,185 patients were included in the study, of whom 600 patients were in cohort A and 585 patients in cohort B. The incidence of TLP+ was found to be lower in cohort B (1.7%) as compared with the incidence in cohort A (4.3%) (p-value=0.009). However, there was an increase in the incidence of CNS-3 cases in cohort B (8%) as compared to cohort A (3%) (p-value

Background Surgical site infection (SSI) after cardiac surgery is a major concern. A limited number of studies have addressed the relationship of preoperative glycemic control on the risk of developing SSI after cardiac surgery. We aim to determine the incidence, microbiological pattern, and impact of preoperative hemoglobin A1C (Hgb A1C) on the development of SSI after cardiac surgery. Methods This is a single-center retrospective chart review that was performed on adult patients undergoing cardiac surgery from January 2017 to December 2018. Results Two hundred and twenty-nine patients underwent 233 procedures. The median age was 60 years; 71% males, 64% were diabetic, and 67% had a Hb A1C above 7% preoperatively. Around 7% of patients developed deep SSI. For patients that developed SSI, 63% had gram-negative bacteria. Hb A1C >7% was not found to be associated with an increased incidence of SSI. Conclusion Our results show that there is no apparent relationship between pre-operative Hgb A1C levels and SSI after cardiac surgery. Although we follow a comprehensive SSI perioperative bundle based on international guidelines that advocates using antibiotics to cover gram-positive organisms, it is interesting that the rate of gram-negative organisms in our patients' cohort is unexpectedly high. We believe that adjusting the perioperative antibiotic regimen based on local microbiological patterns seems to be a reasonable and easily achievable target to decrease the incidence of SSI.

Social media is a mode of communication, influencing nearly every field of life. Researchers have found that the use of social media can be addictive, which may cause significant impairment in various aspects of an individual’s life. This study has been designed to investigate the impact of Social Networking on students’ academic performance in Islamabad and Rawalpindi (Pakistan). This Cross-sectional study was conducted from April 2019 to February 2020. 385 students of age 15 to 25 years, enrolled in different educational institutes of twin cities were included in the study. Data was collected using self-designed Questionnaire. Analysis of data was performed using SPSS V.21. Total of 348 participants were included from different educational institutes of Rawalpindi and Islamabad city. Studies show that among youth, teen age group was more addicted to social networking and maximum participants were using social media for more than 3 years for just recreation or relaxation purpose. Though the results do not show statistical significance (Social Network Usage per 24 hours* Negative Effect of social networking on study timings p-value 0.061) but being close to the statistically significant figure, shows that somehow the fact that spending more time on social network has overall negative effect on academic’s outcome. We cross tabulated, duration since using social network with social network usage/24 hours and found statistically significant association between it (i.e. p- value= 0.000) which shows that those who were using social media for longer duration are actually using it for no specific reason or fruitful purpose. Most of the subjects under study were females in both age groups. More time spent on social media in 24 hours affects the study timings negatively thus affecting the study outcome and academic results.

Background Microwave ablation (MWA) is a novel technique that offers several potential advantages over existing ablation systems, which include production of larger ablation zones, shorter procedural times, and more effective heating through high impedance tissues such as bone. Methods A systematic review was performed using inclusion criteria defined as follows: 1) metastatic spinal tumors treated with open or percutaneous MWA alone or in combination with other treatments, 2) available data on pain palliation and/or local tumor control, and 3) retrospective or prospective studies with at least 1 patient. Results A total of 156 patients harboring 196 spinal lesions underwent MWA in the 8 included studies. Most studies employed the use of additional interventions, which included minimally invasive open surgery with pedicle screw fixation, traditional open surgical intervention, and cement augmentation. Despite the variability in time intervals for pain assessment, postoperative pain scores decreased considerably in both percutaneous and open MWA studies. No evidence of tumor progression was additionally seen in >80% of patients at the last follow-up across 5 studies. Complications were reported in 6.5% of all patients who underwent percutaneous MWA and in 12.2% of patients who underwent open MWA. Conclusions This review showed that MWA can be effective in achieving analgesia for up to 6 months in select cases, although most procedures were performed in combination with augmentation and/or open surgery. Local tumor control was additionally successful in most patients, suggestive of a potential curative role for MWA.

Rhesus (Rh) isoimmunization commonly presents with anemia and jaundice of varying intensity in the early postnatal period and is usually treated with phototherapy and exchange transfusion. Rarely, babies with mild or no symptoms at birth may present later with severe hemolytic anemia. This report describes a newborn infant with no postnatal jaundice who presented during the second week of life with severe anemia. These findings indicate the importance of regular follow-up and close monitoring of Rh-isoimmunized infants during the first two months of life for delayed onset anemia.

Aim To evaluate the analgesic efficacy, safety, and local tumor control of iodine-125 (125I) seed brachytherapy (BT) for the management of spine and bone metastases. Methods A systematic literature search was conducted using PubMed, the Cochrane Library, and Scopus databases. Data regarding patient demographics, tumor characteristics, procedural parameters, and clinical outcomes were extracted and analyzed. Results Fourteen studies (7 prospective, 7 retrospective) were included, accounting for 689 patients, in our review. Analgesic efficacy was assessed at baseline and various postoperative time points. Significant improvement in pain was noted at 4- and 24-week follow-ups (p Conclusion 125I seed BT, alone or in conjunction with cement augmentation, may be a viable salvage therapy in appropriately selected patients. However, further studies are needed to analyze the long-term efficacy of this intervention as a palliative and curative modality.