Introduction The changes occurring due to growth modulation of the condylar cartilage act as an important mechanism for mandibular advancement using myofunctional appliance therapy. So this study aims to evaluate the condylar cartilage thickness by using MRI and USG in patients undergoing myofunctional appliance therapy for mandibular advancement with the null hypothesis being that there are no changes seen in the thickness of condylar cartilage in growing children. Materials and methods A prospective evaluation of samples having skeletal Class-II malocclusion ranging between cervical vertebral maturation index (CVMI) stage II and III, requiring twin block functional therapy was performed. Ten patients were selected randomly who underwent MRI and USG in the open and close positions for the evaluation of condylar cartilage thickness and the dimensional changes in the width of the right and left condyle in mm at T0 and T1. Result There was no statistically significant difference between the values interpreted by MRI or USG imaging when compared at T0 and T1 and in the open and closed mouth on the left and right sides. At T0, the mean thickness noted was 0.49 mm and 0.48 mm during opening and closing on the left side and 0.52 mm in both positions on the right side. At T1, the mean thickness noted was 0.8 and 0.79mm during opening and closing on the left side, whereas it was 0.81 mm in both positions on the right side. Conclusion The condylar cartilage thickness increases significantly after twin block therapy suggestive of mandibular growth in skeletal class II malocclusion. It can be inferred that both MRI and USG carry equal diagnostic interpretation, as there was no statistically significant difference between the two imaging modalities.The use of immune checkpoint inhibitors (iCPI) in the treatment of multiple cancers has gained prominence due to their high efficacy. However, neurological immune-related adverse events (irAEs) such as myasthenia gravis (MG) have been associated with iCPI therapy. Most of these neurological irAEs are rare, and in many cases, their diagnoses and management can be challenging. We present a case of a 70-year-old woman with stage IIIC melanoma who developed a new onset of gradually progressive dyspnea, diplopia, and bilateral ptosis following treatment with one cycle of nivolumab and ipilimumab (Nivo+Ipi). She was diagnosed with MG via positive serum acetylcholine receptor (AChR) antibodies. She had developed a severe dyspnea at rest, which was refractory to multiple immune-suppressive therapies including prednisone, pyridostigmine, and intravenous immunoglobulin (IVIG). Subsequently, she was treated with rituximab 375 mg/m2 monthly every four weeks with significant improvement of her symptoms within 48 hours each time. As the implementation of immunotherapy increases in medical practice, irAEs may become more apparent. When first-line therapies are not adequate, other alternative therapies should be explored. This case of MG as an irAE shows that rituximab can provide a potential benefit to treating patients with immunotherapy-induced MG who are refractory to other standard treatments. Prospective studies are needed to further evaluate the efficacy of rituximab in the management of irAEs.

Any abnormal space-occupying posterior fossa lesion may directly involve the vital structures like the brain stem, cranial nerves, cerebellum, vertebrobasilar artery, and venous sinuses, which makes the surgical approach and total excision very difficult. Hence for these reasons, precise evaluation of posterior fossa lesion with MRI is a must to visualize the vital structures, which helps in planning and safe surgery. Objective This study aimed to evaluate the added value of diffusion-weighted imaging and magnetic resonance spectroscopy in the localization, extension, characterization, differentiation of various posterior fossa space-occupying lesions, and correlating with the histopathological result.

This prospective study comprised of 40 patients who were suspected with posterior fossa space-occupying lesions on basis of clinical features or on CT scan. All patients were evaluated using conventional as well as newer MRI techniques using Siemens 1.5 Tesla MRI scanner (Siemens Medical System, Erlangen, Gd MR spectroscopy helps us to differentiate and diagnosevarious posterior fossa lesions even closer to the actual histopathological diagnosis.

Conventional MRI sequences able to diagnose most of the benign-appearing lesions of posterior fossa, however, adding advanced MRI sequences like diffusion-weighted imaging and MR spectroscopy helps us to differentiate and diagnose various posterior fossa lesions even closer to the actual histopathological diagnosis.Research on the brain regions involved in suicidal behavior has led to the identification of a number of regions as being implicated in the neurobiology of suicide. Some of the brain regions identified have a clear correlation between the levels of activity and suicidal behavior. For some regions, such as the insular cortex and anterior cingulate cortex (ACC), both hyperactivity and hypoactivity have been correlated with suicidal behavior. More studies are needed to characterize more clearly the activity of the insular cortex and ACC when it comes to suicidal behavior. The case report presented adds to the literature seeking to clarify the correlation between ACC and insular activities and suicidal behavior. Structural damage of the insular region and ACC, thus leading to a decline in their activity level, was found in a patient who had resolution of suicidal intent after hypoxic brain injury. We discuss the significance of our findings for the neurobiology of suicide.Dabbing has been gaining popularity among young people in recent years due to its ability to deliver a high concentration of tetrahydrocannabinol. When produced illegally, it is usually contaminated by toxic substances and associated with multiple health hazards. We present the case of a 66-year-old woman who developed hypersensitivity pneumonitis after dabbing butane hash oil for the first time and was successfully treated with corticosteroids with complete resolution of her symptoms. This case report emphasizes the respiratory complications associated with using a noxious substance like butane hash oil and gives physicians an insight into the diagnosis and management of dabbing-induced hypersensitivity pneumonitis.Background and objective The recent emergence of new molecules like angiotensin receptor-neprilysin inhibitor (ARNI) has highlighted the need for an update in heart failure (HF) management, as they have proven to yield better patient outcomes compared to the traditional angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use. This study aimed to compare HF-related hospitalization and death in patients on either ACEI/ARBs or ARNI in a local setting. Methods This two-arm interventional study was conducted in the cardiology and internal medicine units of a tertiary care hospital in Pakistan from July 2018 to December 2020. After enrollment, participants were randomized into two groups as per 11 ratio using an online research randomizer software (https//www.randomizer.org). Group A received 24/26 or 49/51 mg sacubitril/valsartan twice daily for HF. Group B received 2.5 or 5 mg enalapril twice daily. Patients were followed up for 12 months or till the development of an event. Results The sacubitril/valsartan group had significantly fewer HF-related hospitalizations compared to the enalapril group (13.8% vs. 22.4%; p-value 0.03), with a relative risk reduction (RRR) of 38.3%. The sacubitril/valsartan group had 52% RRR for HF-related deaths compared to the enalapril group. Conclusion Based on our findings, treatment with sacubitril/valsartan was superior to enalapril in reducing the risk of hospitalization and death related to HF. The magnitude of the beneficial effects of sacubitril/valsartan as compared to enalapril on cardiovascular mortality was at least as high as that of long-term treatment with enalapril.Carotid web (CW) is an atypical form of intimal fibromuscular dysplasia that occurs at the level of the carotid bulb. It is associated with ischemic strokes. The first report of this association was in 1967 and it is currently known to represent a significant percentage of cryptogenic stroke. We report the case of a young female patient with a history of transient ischemic attack who presented a cerebral infarction of the territory of the left middle cerebral artery. The diagnosis of CW was suggested by the findings of the ultrasound carotid duplex and was confirmed by digital subtraction angiography. Likewise, brain magnetic resonance angiography showed an incipient alteration in the morphology of the wall of the left internal carotid artery in its intracranial segment. Aspirin treatment was started and there was no recurrence up to two years of follow-up. CW represents a diagnostic challenge; it should be suspected in young adults with ischemic stroke. In them, studies of the supra-aortic vessels should be performed. Ultrasound carotid duplex can be a useful diagnostic tool.Beaver tail liver, or else known as the sliver of liver, is a rare anatomic variation of the liver where the left lobe of the liver extends laterally to contact and enwrap the spleen. A case is presented here where a middle-aged male presented with complaints of abdominal pain, hematuria, and fever. After the routine blood and urine examinations revealed urinary tract infection, CT abdomen was done to find out the etiology, and beaver tail liver was found incidentally with the left lobe of liver encircling the spleen. Sometimes it may be difficult to differentiate liver and spleen from each other when echogenicity or density on USG and CT are equivalent. More common in females, it may imitate a splenic trauma or a subcapsular hematoma, or a perisplenic hemorrhage within the splenic parenchyma.Hereditary multiple exostoses (HME) are an autosomal dominant skeletal disorder characterized by the development of multiple benign osteochondromas (exostoses) that frequently involve long bones of the body. Less commonly, the ribs are a site of involvement, and long-term friction between an exostosis and pleura can produce a hemothorax or pneumothorax. The purpose of this study is to provide a comprehensive review of existing literature on pneumothorax or hemothorax secondary to costal exostosis in HME patients. We reviewed the databases of PubMed and Embase and included data as current as of February 15, 2021. All case reports included cases of hemothorax or pneumothorax in patients with a known personal or family history of HME. After evaluation for inclusion based on eligibility criteria, 18 cases were included. The average age at presentation was 11.7 years (range 3-32), and most patients were male (83%). Hemothoraces occurred in 15 cases, while pneumothoraces occurred in three cases. All cases were evaluated using chest X-ray and CT scan, and the majority of the cases were treated with surgical resection of the exostosis, either with video-assisted thoracoscopic surgery (VATS; 61%) or thoracotomy (22%). Outcomes were successful with no cases of recurrence after surgical intervention. Although rare, costal exostosis should be considered as a differential in patients presenting with pneumothorax or hemothorax and past medical history or physical exam findings suggestive of HME. Immediate evaluation and surgical intervention to resect costal exostosis are essential to reduce the risk of recurrent life-threatening injury.