Uncommon Location for a Common Disease, Simulating Cervical Cancer: A Rare Case Report.

BACKGROUND: Genital tuberculosis (GTB) is a common form of extra-pulmonary TB with cervical TB being a rare entity accounting for 0.1-0.65% of all TB cases globally. It is usually asymptomatic but may present with infertility, menstrual irregularities, dyspareunia, dysmenorrhoea, or vaginal discharge. CASE PRESENTATION: The present case report briefs about a 39 years old nulliparous infertile woman who presented with complaints of irregular menstrual cycles and amenorrhea with an erosive papillary growth over the cervix simulating invasive cervical carcinoma. Her Pap smear report revealed the presence of granulomas. On cervical punch biopsy also a large number of granulomas were seen and on Ziehl Nielsen staining the diagnosis of TB was further confirmed by the presence of acid-fast rodlike bacilli. The patient responded well to anti-tubercular drugs. DISCUSSION: GTB in most of the cases remains asymptomatic with infertility being the most common presenting complaint. Other symptoms include menstrual irregularities, amenorrhoea, dysmenorrhoea, dyspareunia, chronic pelvic pain, and occasionally abnormal vaginal discharge. Tuberculous cervicitis is difficult to diagnose clinically and many times mimics cervical malignancy. RESULT AND CONCLUSION: Hence, cervical tuberculosis should be kept in the differential diagnosis of cervical cancer especially in an infertile woman from a developing country.

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute.

Objectives: We undertook this study to find out the spectrum of the cervical smear pattern along with the clinical profiles of patients who underwent cervical Papanicolaou (Pap) smear evaluation in our newly started tertiary care center. We also tried to find the possible clinical cause for unsatisfactory smears and factors for epithelial cell abnormality. Material and Methods: The present study was a retrospective observational study. Pap smears cases with their clinical findings mentioned on the requisition form and cytopathology observations were retrieved from the archives of the department of pathology. Fisher's exact test was used for statistical analysis. Results: Five hundred and ninety-four cases were included in the study. The most common age group was 36- 40 years. White discharge per vaginum was the most common clinical presentation. The negative for squamous intraepithelial lesions or malignancy was the most common interpretation (86.87%). Cervical erosion had statistically significant associations with unsatisfactory smears, while bacterial vaginosis had with satisfactory smears. Epithelial cell abnormality was seen in 4.62% patients. We observed a statistically significant association of cervical mucoid discharge, and inflammation with "no epithelial cell abnormality" cases, while postmenopausal bleeding was associated with "epithelial cell abnormality" cases. Conclusion: In the presence of clinical factors like cervical erosion, which may affect the quality of Pap smear, proper sampling techniques are to be used by health-care providers. The careful evaluation of Pap smears, especially in cases of cervical mucoid discharge, postmenopausal bleeding, and inflammatory smears is required to ensure that epithelial cell abnormalities are not overlooked.

Efficacy of bioresorbable plating system in the treatment of pediatric maxillary fractures: A short clinical study.

Aim: The aim of this study was to evaluate the efficacy, stability, and clinical outcomes of a bioresorbable plating system in the treatment of pediatric maxillary fractures. Materials and Methods: Twenty pediatric patients with maxillary fractures (13 males and 7 females) were included in this study. The 1.5- and 2.0-mm resorbable plates were used and secured with monocortical resorbable screws 6 mm and 7 mm in length. All patients were followed up for 6 months. Clinical parameters, such as pain, swelling, soft-tissue infection, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Results: Fall from height (50%) was the most common cause of etiology, followed by road traffic accidents (35%). Maxillary alveolar # (40) was the most common fracture site, followed by nasal complex # (25%) and zygomatic complex # (25%). Appropriate fixation and adequate primary bone healing was achieved in 100% of the cases. Few minor complications were observed: (1) soft-tissue infection (5%) and (2) paresthesia (10%). There was a significant increase in bite force in the incisor and molar regions. Observation in clinical parameters shows that there was a significant reduction in postoperative pain and swelling at different follow-up periods. Conclusion: Bioresorbable plating system is used as a load-sharing plate in a semirigid fixation technique after anatomic fracture reduction. Although its high costs limit its feasibility for use low infection rates, minimized second surgery for implant removal attracts its use. 1.5- and 2-mm resorbable plating system along is a good treatment modality for moderately displaced maxillary fractures in pediatric patients. Larger sample size and longer follow-up studies are required for conclusive results.

An Unusual Case of Xanthoma of Bilateral Achilles Tendon with Gouty Infiltration: A Rare Case Report.

Achilles tendon xanthoma is a benign and rare disease with a high incidence in patients having familial hypercholesterolemia. Patients present with or without pain and thickened tendons. Gout is seen in patients with hyperuricemia. Coexistence of xanthoma and gout is extremely rare. We searched the PubMed literature with 'Xanthoma' and 'Gout' as keywords and could find only one case report. Imaging modalities such as radiography and ultrasonography, play a vital role in diagnosing this condition early, hence helping the patient to commence the use of potentially lifesaving lipid-lowering therapeutic agents. Magnetic resonance imaging is helpful in delineating the morphological changes, exact measurements, and eventually in treatment planning. It helps to rule out early involvement of other tendons by the same pathology. We present a case of a 25-year-old male patient who presented to our institute with bilateral large symmetrical swelling in the posterior aspects of ankles for 4 years, with normal serum and blood parameters. Bilaterality, enormous size and normal blood and serum parameters make this case unique.

Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Report III. Analysis of Earlier Failed Probing without Endoscopy Guidance.

AIM: The purpose of this study was to report the profile and outcomes of children with an earlier failed probing that was performed without endoscopy guidance. METHODS: Retrospective interventional case study was performed on all the patients who were referred with a diagnosis of a single or multiple failed probing from Jan 2016 to June 2019 to a tertiary care Dacryology center. All the patients had a blind probing without an endoscopy assistance before referral. The parameters evaluated were patient demographics, number of earlier probings, prior operative notes, clinical presentation, findings of endoscopy guidance during the repeat procedure, simple vs complex CNLDO, types of complex CNLDO, management, complications and outcomes. RESULTS: One hundred eyes of 82 children had a failed probing experience without endoscopic guidance elsewhere. The mean age of the children was 55.7 months (range: 9-168 months). Of these, 63 eyes underwent repeat probing under endoscopic guidance, 35 eyes being simple CNLDO (35/63, 55.5%), and 28 eyes (28/63, 44.5%) being complex CNLDO. Among the complex subset, balloon dacryoplasty was performed for five cases and monoka-Crawford stents for eight cases under direct endoscopy visualization. Buried probes were managed successfully by standard protocols of probe exteriorization. The two cases of misdirected probes were re-directed under endoscopy guidance for appropriate recanalization and the single case of granuloma at the NLD opening was excised followed by intubation without any recurrence. CONCLUSION: Endoscopy guidance plays a crucial role in the management of CNLDO with an earlier failed probing.

A rare case of pemetrexed-induced diffuse punctal and canalicular stenosis: management by coronary balloon puncto-canaliculoplasty.

Several chemotherapeutic agents are known to induce lacrimal drainage stenosis and obstruction, resulting in epiphora. Pemetrexed is one such drug and is used in the management of mesotheliomas and non-small cell lung carcinomas. Pemetrexed inhibits folate metabolism at multiple levels. The present case is the second report of pemetrexed induced punctal and canalicular stenosis, but the first to document dacryoendoscopy findings and report balloon puncto-canaliculoplasty as a minimally-invasive treatment option.

Clinical Profiles and Surgical Outcomes of Strabismus Following Orbital Wall Fractures: A Large Cohort From a Tertiary Eye Care Center.

PURPOSE: To evaluate the demographic details, clinical presentation, and surgical outcomes in patients presenting with strabismus following orbital wall fractures. METHODS: A retrospective review was conducted over a 6-year period on 347 consecutive patients with strabismus who presented after orbital wall fractures. The patients were evaluated for their demographic data, clinical presentation, and profiles, management, complications, and outcomes of strabismus. RESULTS: Strabismus following orbital wall fractures was noted in 347 patients: 87.03% were men (n = 302) and 12.97% were women (n = 45). Fracture of the orbital floor in isolation or in combination with other walls was more frequently noted in 72.3% of patients (n = 251). The resultant strabismus included paralytic, restrictive, or both etiologies. Exotropia was noted most frequently in 25.65% of patients (n = 89), followed by exotropia with hypotropia in 20.75% of patients (n = 72). Ten percent of patients with strabismus (n = 34), who were observed for at least 6 months after injury, underwent surgical correction for strabismus. Preoperative diplopia was observed in 79.41% of patients (n = 27) and persisted after strabismus surgery in 15% of patients (n = 6). A successful outcome regarding the postoperative angle of deviation of 10 prism diopters or less horizontal and/or 5 prism diopters or less of vertical deviation with elimination of diplopia was observed in 41.17% of patients. CONCLUSIONS: Strabismus following orbital wall fractures is complex and requires a tailored strategy. The current study found the orbital floor to be more frequently involved in orbital wall fractures. However, the resultant strabismus was a combination of paralytic and restrictive etiologies. [J Pediatr Ophthalmol Strabismus. 2022;59(3):172-179.].

Lacrimal drainage anomalies in Tessier cleft 3 with unilateral anophthalmos.

Bilateral Tessier cleft types 3 and 4 are rare and commonly involve the lacrimal drainage system owing to their anatomical location. Such clefts commonly present with associated ocular anomalies and include colobomatous eyelids, hypertelorism, microphthalmia, punctal or canalicular agenesis, and nasolacrimal duct obstruction or exstrophy. The current report presents an 18-month-old baby with bilateral Tessier cleft 3 with a unilateral anophthalmos, symmetrical eyelid colobomas, and lacrimal drainage anomalies. The lacrimal anomalies noted include small lacrimal sac with inferior canaliculus on the right side and upper and lower punctal and canalicular agenesis on the left side. Computed tomographic dacryocystography demonstrated unilateral lacrimal sac and bilateral maldevelopment of the bony nasolacrimal duct.

Interferon Alfa-2b for Pigmented Ocular Surface Squamous Neoplasia: A Report of 8 Lesions.

PURPOSE: To study the efficacy of interferon alfa-2b (IFN-a2b) on pigmented ocular surface squamous neoplasia (p-OSSN) and assess the resolution of the pigment to the treatment. METHODS: A retrospective case series of 8 tumors in 7 patients. RESULTS: The mean age at diagnosis of p-OSSN was 65 years (median, 61 years; range, 51-84 years), and all patients were men. The mean duration of symptoms was 2 months (median, 1 month; range, 1-4 months). One patient had 2 distinct lesions in the same eye. Tumor epicenter was located at the limbus (n = 5) or bulbar conjunctiva (n = 2). Complexion-associated melanosis was noted in all eyes. The mean basal dimension of the tumor was 8 mm (median, 7 mm; range, 5-12 mm). The mean % of tumor pigmentation was 47% (median, 30%; range, 10%-100%). The treatment details included topical IFN-a2b (n = 1) or a combination of topical and subconjunctival injection of IFN-a2b (n = 7). All patients with p-OSSN showed excellent response to IFN-a2b with complete tumor regression and resolution of tumor-associated pigment with a mean number of 2 subconjunctival IFN-a2b injections (median, 2; range, 0-3) and topical IFN-a2b for an average of 2 months (median, 2 months; range, 1-3 months). There was no change in the complexion-associated melanosis with IFN-a2b. CONCLUSIONS: IFN-a2b is very effective in the management of p-OSSN. There is a complete resolution of the pigment along with the tumor.

Rhabdoid melanoma: A diagnostic ordeal.

A 64-year-old man presented with multiple, bilateral pulmonary nodules, considered clinically to be intrapulmonary metastasis from lung carcinoma. On histopathologic examination, a tumor with a solid growth pattern and rhabdoid neoplastic morphology was seen. Initially, a diagnosis of nonsmall cell carcinoma of lung was considered but the immunophenotype was not supportive. Further, extensive immunohistochemistry revealed SOX10, Melan-A, and HMB45 expression in the absence of S-100. Strong globular cytoplasmic staining for vimentin, SMA, Desmin, and WT1 were observed. A final diagnosis of rhabdoid melanoma was made. The immunoprofile of our case was unique from previously described rhabdoid melanoma in English literature. The globular staining for intermediate filaments such as desmin and SMA is a novel finding. The strong WT1 intracytoplasmic staining reported previously was also observed in this case, with intense globular characteristics.

Risks and complications associated with dental implant failure: Critical update.

Risks and complications have been identified with dental implant failure though there is continuous innovation in implant systems and various interceptive treatment modalities. The success rate of dental implants has increased over a period of years as a treatment option for the rehabilitation of missing teeth. The dental implants are designed that best suits the various types of bone. Endosseous implants fail due to many reasons. Different reasons for the implant failure and their contributing factors have been discussed in this review article. A better understanding of the factors responsible for the implant failure will provide clinical decision-making and may enhance the field of implant dentistry. This article summarizes the factors causing implant failure. This paper presents the results of a survey of dentists practicing implant dentistry and updates regarding their knowledge of risk factors that they consider to be important for predicting dental implant failure.

Optic nerve invasion of non-juxtapapillary uveal melanoma: a rare occurrence.

A 44-year-old man presented with complaints of pain and discomfort in his left eye (OS). On examination, he had bare perception of light in OS and had a diffuse pigmented mass lesion in the nasal quadrant of the bulbar conjunctiva, associated with neovascularisation of the iris and iridocyclitis, with no fundus view. Intraocular pressure OS was 40 mm Hg. B-scan ultrasonography OS revealed an intraocular mass with thickened sclerochoroidal complex. A clinical diagnosis of OS ciliochoroidal melanoma with extraocular extension was made. He underwent OS extended enucleation with implant. Histopathological examination confirmed the diagnosis of ciliochoroidal melanoma with tumour extension into the optic nerve posteriorly and the extrascleral tissues anteriorly. There was no evidence of systemic metastasis. Even in a case of non-juxtapapillary uveal melanoma, poor vision and high intraocular pressure are clinical indicators of optic nerve tumour invasion.

Membrane constriction and thinning by sequential ESCRT-III polymerization.

The endosomal sorting complexes required for transport (ESCRTs) mediate diverse membrane remodeling events. These typically require ESCRT-III proteins to stabilize negatively curved membranes; however, recent work has indicated that certain ESCRT-IIIs also participate in positive-curvature membrane-shaping reactions. ESCRT-IIIs polymerize into membrane-binding filaments, but the structural basis for negative versus positive membrane remodeling by these proteins remains poorly understood. To learn how certain ESCRT-IIIs shape positively curved membranes, we determined structures of human membrane-bound CHMP1B-only, membrane-bound CHMP1B + IST1, and IST1-only filaments by cryo-EM. Our structures show how CHMP1B first polymerizes into a single-stranded helical filament, shaping membranes into moderate-curvature tubules. Subsequently, IST1 assembles a second strand on CHMP1B, further constricting the membrane tube and reducing its diameter nearly to the fission point. Each step of constriction thins the underlying bilayer, lowering the barrier to membrane fission. Our structures reveal how a two-component, sequential polymerization mechanism drives membrane tubulation, constriction and bilayer thinning.

Punctal dilatation and non-incisional canalicular curettage in the management of infectious canaliculitis.

OBJECTIVE: To describe the outcomes of punctal dilatation and non-incisional canalicular curettage in patients with infectious canaliculitis. METHODS: A retrospective analysis of 53 canaliculi of 47 eyes of 46 consecutive patients diagnosed with canaliculitis was performed from November 2015 to December 2018. All patients were treated with punctal dilatation and a non-incisional canalicular curettage. Parameters studied include demographics, clinical presentation, microbiological analysis, management and treatment outcomes. The outcome measures were clinical resolution of canaliculitis and resolution of epiphora. RESULTS: The mean age at presentation was 59.34 years with female preponderance (M:F = 19:28). Left eye was more affected (64%, n = 30) as compared to the right (36%, n = 17). Only one patient presented bilaterally. Lower canaliculus was most commonly involved (68%, n = 32). Six eyes showed involvement of both upper and lower canaliculus. Presenting symptoms include discharge (81%), swelling of the eyelids (64%), watering (55%), redness (51%) and pain (39%). Punctal dilatation and non-incisional canalicular curettage were performed using punctum dilator and a small chalazion scoop (1 mm Meyhoefer chalazion curette). Of the 53 involved canaliculi, 14 canaliculi of 14 eyes underwent a repeat curettage for complete resolution and 1 canaliculus underwent the same procedure thrice. The most common micro-organisms isolated were Streptococci species (28% cases). At a mean follow-up of 6.8 months, resolution of canaliculitis was achieved in all patients; however, epiphora persisted in two eyes (4%). CONCLUSION: Non-incisional canalicular curettage is a minimally invasive technique with good preservation of the punctal and canalicular anatomy. It also facilitates good anatomical and functional outcomes in infectious canaliculitis.

Prevalence, knowledge, attitude and nicotine dependence among ESI-insured populations of Delhi NCR region: Institutional study.

AIM: To assess the prevalence of tobacco consumption among the ESI-insured patients. The study also assessed the knowledge, practice, and attitude among industrial workers as well as nicotine dependence with different forms of tobacco products consumed. MATERIALS AND METHODS: A cross-sectional study was conducted among industrial workers from various industries (small and large scale) insured under the employee state insurance corporation scheme. The study was conducted for 3 months included 500 workers of which 470 were males and 30 were females. A predesigned, pretested, and structured interviewed administered questionnaire was used to collect the data on sociodemographic factors, reasons for tobacco consumed, and level of dependencies among industrial workers. Questionnaire also included questions related to awareness regarding health hazards and lesion present in the oral cavity as a result of tobacco consumption. Fegarstrom scale was used to access nicotine dependency level. A Hindi translated version of Fegarstrom test for Nicotine dependence in the questionnaire was used which included six standard questions for both smokeless and smoked form. RESULT: Majority of both males and females consumed tobacco in smokeless (58.8%) form. Out of which 92.85% in males and 7.15% in females followed by the smoke (28.8%) form. 93.04% in males and (7%) in females (79.86%) of the tobacco users in our study were aware that consuming tobacco causes health related problems. 38.6% of the users have moderate dependency in both smoke and smokeless form. Seventy six percent of the consumers feel that they didn't have any changes in the mouth by consuming tobacco and thus never thought of quitting tobacco. CONCLUSION: Tobacco consumption among the ESI-insured patients is high. Execution of tobacco cessation programs are required to curb this trend.