Addressing iatrophobia in transgender patients.

Transgender patients continue to receive suboptimal health care due to transphobia and inadequate trans-competency of health care professionals. Lack of adequate training and exposure may lead to improper bedside manners. This factor is among many other systemic and latent ones that inculcate a feeling of iatrophobia in transgender patients. This damages the patient-doctor relationship severely and ultimately results in suboptimal health care outcomes. This paper discusses the causes of iatrophobia in transgender patients and the steps that health care professionals can take to address this phenomenon. The authors believe that health care professionals that pay heed to this paper will greatly improve the competency of their care toward their transgender patients.

Colonic lipoma mimicking malignancy and presenting as an intussusception: A rare case report.

INTRODUCTION AND IMPORTANCE: Lipomas of the gastrointestinal tract are a rare entity compared to the more common tumors of the gut, such as adenomatous polyps and carcinomas. They were first described by Bauer in 1757. Gastrointestinal lipomas can grow in all segments of the gut, with the highest frequency in the colon. In this case report, we present a rare case of gastrointestinal lipoma mimicking colonic malignancy and causing intussusception, necessitating emergent surgery. This paper highlights the potential diagnostic challenges and therapeutic interventions associated with GI lipomas. CASE PRESENTATION: A 28-year-old female presented with symptoms of abdominal pain, weight loss, vomiting, and changes in bowel habits. Initially, she received a misdiagnosis of Irritable Bowel Syndrome. Subsequent investigations indicated the possibility of colonic malignancy. During the intra-operative biopsy, it was ultimately discovered that she had a colonic lipoma. CLINICAL DISCUSSION: CT revealed an abdominal mass and an intussusception, indicating the need for surgical intervention. A laparoscopic procedure was performed to remove the mass, which alleviated the symptoms. Subsequently, a histological examination confirmed the mass to be a lipoma. CONCLUSION: Differentiating a gastrointestinal lipoma from malignancy is crucial, and careful investigation is necessary to determine if a local excision can be performed instead of a wide excision.

Comparison of renal growth in breast fed and artificial fed infants: a cross-sectional study.

INTRODUCTION: Renal growth in infancy determines renal function in adulthood and can easily be assessed via infant renal volume. Renal growth is influenced by many endogenous and exogenous factors among which nutrition is of prime importance. Worldwide, infants get their nutrition either from breast milk or formula, both of which have controversial roles in kidney growth and development. METHODS: A cross-sectional study was done on healthy infants in the Pediatric Nephrology Department of Mayo Hospital, Lahore. These infants were either breastfed or artificially fed and their kidney volumes were noted to determine any significant difference in kidney size. Both informed and written consent was taken before data collection and the data was analyzed using SPSS version 26. RESULTS: Out of 80 infants included in our study, 55% were male and 45% were female. The mean age was 8.9 months and the mean weight was 7.6 kg. The mean total kidney volume was 45.38 cm3 and the mean relative kidney volume was 6.12 cm3/kg. No statistical difference in relative renal volume was found between breastfed and artificially fed infants. CONCLUSION: The present study aimed to compare the renal volume and thus renal growth in breastfed versus formula-fed infants. No statistical significance was found in relative renal volume between breastfed and artificially fed infants.

Primary mycetoma of the calcaneum: Case report on an unusual hazard of barefoot walking.

INTRODUCTION: Mycetoma is a rare tropical fungal infection characterized by a clinical triad of subcutaneous swelling, multiple discharging sinuses, and a purulent discharge containing granules. If left untreated, the disease can progress from cutaneous to intraosseous and can cause osteomyelitis. In very rare instances labeled "primary mycetoma", the fungus is insidiously inoculated directly into the bone and causes osteomyelitis without any preceding cutaneous involvement. This can make the diagnosis very difficult. PRESENTATION OF CASE: A twelve-year-old girl with a history of walking barefoot, presented with pain and inability to bear weight on her left foot. There was no overlying cutaneous involvement. X-ray showed an osteolytic lesion in the calcaneum. After the failure of antibiotic treatment, the diseased bone was excised. Black granules were discovered inside the lesion and their histopathology confirmed a diagnosis of primary eumycetoma. After some time, the disease relapsed, necessitating another debridement. This occurred many times with worsened severity in each successive episode. Because of worsening disease and failure of both antifungal and surgical treatment, foot amputation was done. DISCUSSION: Primary mycetoma is an insidious fungal infection that causes osteomyelitis without any cutaneous findings. Timely diagnosis and treatment provide the best chance of preventing an amputation. CONCLUSION: A high index of suspicion must be maintained for patients presenting with symptoms of osteomyelitis without any skin involvement so that timely diagnosis and treatment can prevent the progression of the disease and the need for amputation.

Raising the alarm: Mental health status of the transgender community in Pakistan.

In Pakistan, the transgender community faces many challenges. Transgender identity is considered taboo and people tend to distance themselves from them without knowing their issues. They face difficulties seeking education, jobs, and even basic human rights. They also face violence and social exploitation. Due to the lack of support from their family members, they're more prone to develop psychological problems and suicidality. Trans rights are human rights - the purpose of our paper is to expose the dire state of mental health of the transgender community in Pakistan on an international platform. We aim to bring a global concern to this problem because we hope that it will spur the relevant authorities to take steps to mitigate the current situation. Special attention should be paid to the protection and education of transgender individuals. If they're suffering from any psychiatric disorder, healthcare professionals should be there to help them.

Maffucci syndrome: Case report and review of diagnostic signs of the rare disease.

Maffucci syndrome is a non-hereditary congenital condition that affects the skin and skeleton. Enchondromas (benign cartilage enlargements), bone abnormalities, and venous anomalies (hemangiomas) are all symptoms. Enchondromas occur as a result of mesodermal dysplasia and have the potential to become cancerous. They are most commonly found on the phalanges and long bones. Venous abnormalities commonly manifest themselves as soft lumps or tumors on the distal extremities. A 19-year-old boy presented with swellings on his fingers and left foot since the age of 5, along with a few bluish soft tissue swellings on his left heel. Multiple expansile lytic lesions and soft tissue swellings with phleboliths were seen on X-ray. Histology confirmed the diagnosis of hemangiomas and enchondromas. Soft tissue swellings were found to have hyper echoic areas, as well as modest marginal blood flow on Doppler, which could indicate hemangiomas. Maffucci syndrome was identified, and treatment with a multidisciplinary approach was initiated. Maffucci syndrome is a rare genetic illness reported in the literature less than 200 times. The enchondromas and hemangiomas have a strong link to malignant changes, with chondrosarcomas accounting for 30% of the associated malignancies. On X-ray, enchondromas are easily identified as osteolytic lesions with cortex thinning and endosteal scalloping while color Doppler ultrasound detects the presence of hemangiomas. Phleboliths are easily identified as small calcifications on X-rays. Radiographic examinations should be considered in patients presenting with bone or soft tissue swellings for an early diagnosis of Maffucci syndrome.

Lessons learned from five patients of persistent Mullerian duct syndrome: A case series.

INTRODUCTION: Persistent Mullerian duct syndrome (PMDS) is a genetic disorder characterized by the persistence of Mullerian structures of fallopian tubes, uterus, and upper two-thirds of the vagina in a normal XY male. It is a rare genetic disorder that has been reported less than two hundred times. More rarely it may be seen in association with transverse testicular ectopia (TTE). PRESENTATION OF CASES: Four patients presented with swelling in the inguinal region and undescended testes. Pre-op ultrasound was done on three of these patients and it showed a hernia with testes inside the hernial sac. Hernia surgery was planned for these patients. One patient presented with a complaint of bilateral cryptorchidism that prompted laparoscopic exploration. In all five patients, on surgical exploration, Mullerian derivatives i.e., fallopian tubes, uterus, and vagina were found in the abdomen. Hernia surgery was done and Mullerian structures were excised. For undescended testes, patients had orchiopexy or orchidectomy depending on their respective age group. DISCUSSION: PMDS is caused by failure of production of Mullerian inhibiting substance. Mullerian structures other than causing inguinal hernia are also at risk of malignant transformation, which is the most important significance of this condition. In light of the risk of malignant transformation, Mullerian structures must be excised. CONCLUSION: To prevent the risk of malignant transformation in PMDS, the Mullerian structures must be excised. If PMDS is associated with TTE, orchiopexy must be done for pediatric patients and orchidectomy for adult patients.

An acute viral hepatitis epidemic: does ultrasound help the pediatrician?

OBJECTIVE: Acute viral hepatitis (AVH) caused by hepatitis virus A and hepatitis virus E is one of the many epidemics that plague third world countries like Pakistan. The serological tests required for the diagnosis of acute viral hepatitis may be unavailable or unaffordable to the denizens of a developing country like Pakistan. In such a scenario, the clinical manifestations and the ultrasonographic findings are the only diagnostic criteria usually present and these can be used to support a clinical diagnosis. This study aims to judge the utility of ultrasound in the diagnosis of AVH. RESULTS: Among the forty-seven subjects of this study, gall bladder wall thickening (GWT) was the most common radiological finding seen in 39 (82.9%) patients. Pericholecystic edema was the second most common finding, seen in 31 (65.9%) patients. Starry sky appearance of the liver was observed in 30 (63.8) patients. Hepatomegaly and ascites were seen in 28 (59.5%) and 25 (53.2%) of the patients, respectively. The ultrasonographic findings of GWT, pericholecystic edema, and starry sky appearance of the liver were the most common ultrasonographic findings associated with AVH.

Transverse testicular ectopia with persistent Mullerian duct syndrome: an operative eureka.

INTRODUCTION: Transverse Testicular Ectopia (TTE) is a rare entity in which both testes descend on the same side, and can be found in ectopic locations. When present with Persistent Mullerian Duct Syndrome (PMDS), a yet rarer entity, the persistence of Mullerian duct derivatives i.e. fallopian tubes, uterus, cervix and upper two-thirds of vagina occurs alongside testicular ectopia. There have only been about a hundred and fifty reported cases of TTE; a fifth of these accompanied by PMDS. PRESENTATION OF CASE: Two middle-aged male patients presented with two separate complaints of inguinoscrotal swellings. In both patients, ultrasonography showed a hernial defect protruding into the scrotum on one side and the testis absent on the contralateral side. During hernia surgery, Mullerian duct remnants were found. Diagnosis of TTE with PMDS was established. Bilateral orchidectomy was done and Mullerian derivatives were excised. DISCUSSION: There is controversy over the treatment of TTE with PMDS. Some authors,in addition to hernia repair, advocate the preservation of Mullerian structures because of risk to injury to vas deferens while others advocate resection of these structures due to risk of carcinoma. In pediatric patients, orchidopexy should be done to preserve fertility.However, in the older age group, orchidectomy should be done due to an increased risk of testicular carcinoma. CONCLUSION: TTE should be suspected in cases of unilateral inguinal hernia with contralateral undescended testes. Orchidectomy is recommended in patients older than 12 years old, otherwise, orchidopexy should be done. No Mullerian duct remnants should be left in situ.

Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns of High-resolution Computed Tomography.

Background and aim Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by bilateral involvement of mostly small joints of hands and feet. There can be various extra-articular manifestations of the disease including lung parenchymal disease. Pulmonary involvement in RA patients leads to increased morbidity and mortality. The overall burden of RA related pulmonary disease is underestimated due to the limitation of resources in underdeveloped countries. High-resolution computed tomography (HRCT) is an important tool used to diagnose different abnormalities in RA related interstitial lung disease (ILD). The objective of the study was to evaluate HRCT findings in patients of RA related ILD and categorize the radiological findings according to clinical findings. Method This descriptive prospective observational study was conducted at Mayo Hospital, Lahore from June 2014 to June 2015. Patients of RA suspected of lung disease after selection underwent HRCT chest on 128-slice Hitachi CT scanner (Hitachi Global, Tokyo, Japan) in the radiology department. Images were reconstructed and evaluated by experienced radiologists. Findings were recorded on a questionnaire. Data was analyzed on SPSS version 21 (IBM Corp, Armonk, US). Results Out of the 54 patients scanned, interlobular septal thickening was the most common finding found in 22 of the patients. Ground-glass opacification was recognized in 21 patients, honeycombing in nine and bronchiectasis in two patients. Regarding zonal predilection of disease pattern, lower zones of lungs were found involved in most of the cases. The disease was found to be bilateral in 15 patients. Based on these findings, usual interstitial pneumonitis (UIP) was diagnosed in six patients and non-specific interstitial pneumonitis (NSIP) in 14 others. Conclusion This study concluded that HRCT images are very useful in diagnosing interstitial lung disease related to rheumatoid arthritis.