Hyperreactio Luteinalis: A Rare Phenomenon Complicating Gestational Trophoblastic Disease Presenting as Acute Abdomen in the Convalescence Period.

The hydatidiform mole is a rare gynaecological condition originating from trophoblastic cells, with an incidence of 1-3 per 1000 pregnancies. Theca lutein cysts (TLCs) and an invasive mole are rarely observed in association with a partial mole. This case describes an unusual case involving a 17-year-old primigravida at 11 weeks of gestation. She presented with abdominal pain and was diagnosed with a molar pregnancy with post-evacuation rupture of TLC, presenting as an acute abdomen, subsequently undergoing laparoscopy. Post-molar pregnancies exhibit a highly variable course, ranging from recurrent pregnancy loss and stillbirths to preterm deliveries and recurrent molar pregnancies. Few studies are available on obstetric outcomes after a molar pregnancy; most available data originate from national databases and monocentric research.

Immunosenescence and Inflamm-Aging: Clinical Interventions and the Potential for Reversal of Aging.

Inflammation is often associated with the impairment of the ability to sustain the consequences of the physical, chemical, nutritional, and antigenic triggers of inflammation. The process of immunosenescence may only partially be explained by the senescence of cells, tissues, or the organism, and, hence, the hallmarks of immunosenescence may be markedly and differentially affected by the history of an individual's pathogenic encounter. Inflammation is a key component of immunosenescence, which itself is a direct consequence of aging. This review article highlights the therapeutic interventions for slowing the processes of inflamm-aging and immunosenescence and the possible reversal of aging and includes domains of immunomodulatory interventions, vaccination strategies, nutritional interventions, stem cell therapies, personalized medicine, microbiome interventions, and the positive effects of physical activity and exercise.

Small Cell Non-keratinizing Neuroendocrine Carcinoma Involving the Larynx and the Base of the Tongue: A Rare Case With a Locally Aggressive Spread.

Squamous cell carcinoma is the most predominant type of malignancy in the head and neck region with neuroendocrine carcinomas (NECs) being a rare occurrence. Here we report a rare case of small cell non-keratinizing NEC (WHO grade 3), TNM (tumor, node, and metastasis) stage T3N1M0, involving the larynx and the base of the tongue, in a 54-year-old male patient, demonstrating its rarity in an uncommon anatomical site and an aggressive and relatively uncommon pattern of spread for this tumor, over a period of two months. NECs in the head and neck region, especially those affecting the larynx and the posterior third of the tongue, remain exceedingly rare, comprising only a small fraction of malignancies in this region. The aggressive nature and distinct pattern of spread observed in this case underscore the importance of recognizing such unusual presentations for appropriate diagnosis and management. Given the rarity of this tumor type, a comprehensive understanding of its clinicopathological features is essential for guiding effective treatment strategies. We also discuss the treatment.

Unveiling the Enigma: A Rare Case of a Massive Gartner's Cyst Inducing Acute Urinary Retention.

Vaginal cysts can occur due to embryonic remnants, misplaced tissue, or an abnormality in the urinary system. They are a common occurrence and usually indicate non-cancerous conditions. A case is presented here of a 35-year-old female para three living three who reported to the emergency room with complaints of acute retention of urine with something coming out of her vagina over the last two years. She was managed operatively by vaginal cystectomy, which led to the resolution of the symptoms.

Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis.

Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.

Chemical characterization of the crude extract of Sauromatum venosum (voodoo lily) and docking study with 12-O-acetylingol 8-tiglate for cytotoxicity testing in SaOS2 (osteoblastic osteosarcoma cells).

The current study was carried out to investigate the anticancer potential of Sauromatum venosum (SV) tuber by gas chromatography with high-resolution mass spectrometry (GC-HRMS) analysis of ethanolic (eSV), hydroalcoholic (hSV), and aqueous extracts (wSV), and in silico study were performed to investigate the main targets of 12-O-acetylingol 8-tiglate by computational docking. The GC-HRMS analysis of three plant samples was carried out on a system equipped with a high-resolution mass spectrometer. The major compounds were identified in all crude extracts. Computation docking analysis was performed for the prediction of the main target of the cancer proliferation of active compound of the Sauromatum venosum tuber extract in cancer therapy. A total of 45 phytocompounds were detected including diterpenoids, esters of fatty acid, hydrocarbons, and alkanes in the tuber of SV. Among all the crude samples tested, eSV showed the lowest IC50 value treated with SaOS2 cells. 12-O-acetylingol 8-tiglate is one of the phytocompounds identified in eSV extract and has been found to exhibit cytotoxic effects against various cancer cells, as reported in the research. It shows the optimum binding affinity with - 8.59 kcal/mol binding energy with a molecular target protein TNF-α (PDB ID: 7PKA). The observed interactions strongly support the anticancer activity of 12-O-acetylingol 8-tiglate and its role in the medicinal efficacy of the plant. These findings highlight the potential of the compound as a valuable source for the development of a therapeutic agent aimed at combating cancer. However, it is important to note that additional in vitro and in vivo studies are required to validate these findings and establish the therapeutic potential.

Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update.

Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common cause of gynecological complaints in perimenopausal women. The treatment chosen by most of the women having HMB/AUB in the perimenopausal age group when medical therapy fails is hysterectomy, which unfortunately has significant issues related to safety and long-term quality of life apart from being a burden on the health care system and cost to patients. Minimal access surgical techniques like hysteroscopic targeted therapies are available which are conservative and spare the uterus and major surgery and its complications and sequelae. Hysteroscopic management of HMB is a minimally invasive and targeted approach in diagnosing and treating the pathological lesions causing the symptoms and not radical like hysterectomy which has more chances of occurrence of adverse events both intra and postoperatively. In terms of health-related quality of life, women suffering from HMB who underwent a hysteroscopic conservative approach had better scores when compared to those with hysterectomy. The present review aims to review the evidence generated to compare the two surgical modalities, hysteroscopic targeted therapy and hysterectomy, in terms of their effectiveness, safety, and effect on the quality of life of these perimenopausal women having HMB/AUB.

Chronic Glomerulonephritis and Malignant Hypertension With PRES (Posterior Reversible Encephalopathy Syndrome) Presenting As Status Epilepticus: A Case Report.

Hypertension risk is a common complication of chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy. The clinical-radiological phenomenon known as posterior reversible encephalopathy syndrome (PRES) is frequently linked to renal disorders, particularly chronic kidney disease and hypertension. PRES is an acute clinical condition characterized by multiple neurological symptoms such as seizures, impaired consciousness, headaches, visual abnormalities, nausea, and vomiting. In this case report, we discuss status epilepticus due to PRES in a 20-year-old girl who presented with nephrotic syndrome after renal biopsy chronic GN was confirmed. Repeated neuroimaging performed following proper blood pressure management revealed that the lesions had vanished, supporting the diagnosis of PRES. Presumably, PRES remained for 5-7 days in our case. Nephrologists must be familiar with the atypical characteristics of PRES as it is frequently associated with kidney disease. Prompt identification and care prevent irreparable consequences and pointless investigations.

Falciparum Malaria, Leptospirosis, and Vibrio mimicus Encephalitis in a Resilient Patient: A Remarkable Case of Triple Infection Survival.

Malaria is referred to as a "rainy season disease" and is brought on by Plasmodium species. Leptospira interrogans, a spirochete, cause zoonosis leptospirosis. It is pretty uncommon for both diseases to coinfect one another. Before assuming a fever is caused by a vector-borne disease, it is essential to first rule out other possible causes, regardless of the patient's risk factors. This case report demonstrates an unusual coinfection and how it manifests. The patient can avoid many deadly consequences with early detection and prompt treatment. There have been reports of coinfections between malaria and various infectious diseases, including dengue, hantavirus, and filariasis. Recently, a few case reports of coinfection with leptospirosis and malaria have also been published. Leptospirosis and malaria are both spreadable diseases that are prevalent throughout the world, particularly in the tropics. We discuss a case of coinfection with meningoencephalitis, leptospirosis, and malaria in a young male who required intensive care unit (ICU) care. It is difficult to distinguish between single infections and coinfections due to the wide variability in presentation, which may further confound the clinical features. Furthermore, when a coinfection is present but has not yet been identified, the clinical course may worsen because there is no effective treatment. This case report demonstrates the uncommon coinfection appearance and related symptoms. The case study also examined the management of patients with leptospirosis, meningoencephalitis, and life-threatening malaria coinfections as well as the clinical course of such coinfections. A meningeal infection or inflammation that resembles both meningitis and encephalitis is referred to as meningoencephalitis.

Pseudo Broad Ligament Fibroid Posing a Clinical Dilemma: A Case Report.

Pseudo broad ligament fibroids originate in the uterus but grow into the broad ligament while retaining their attachment to the uterus. We report a case of a right-sided pseudo broad ligament fibroid mimicking an adnexal mass in a 40-year-old woman presenting with dysmenorrhoea and heavy menstrual bleeding. She had a uterine mass corresponding to an 18-week pregnant uterus size, which clinically and radiologically posed a diagnostic dilemma between an ovarian cyst, a bicornuate uterus with multiple fibroids, and a broad ligament fibroid. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, which revealed a pseudo broad ligament fibroid of 12x10x6 centimeters, weighing 1.2 kg. The histopathology report confirmed the diagnosis of a leiomyoma with normal ovaries.

Metastatic mastery: the uncommon journey of papillary thyroid carcinoma to the brain (a case report).

Papillary thyroid carcinoma is one of the most common thyroid malignancy, often has excellent prognosis and low incidence of distant metastatic conditions. Brain metastases from papillary thyroid carcinoma has a rare occurrence, with patients presenting with non-specific symptoms such as headaches, cognitive changes etc., and poor survival outcomes. The standard protocol for diagnosis and treatment remains controversial. We report a patient who presented with cerebral metastasis prior to the diagnosis of papillary thyroid carcinoma, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. A 60-year-old hypertensive male presented with lower back pain, bilateral lower limb weakness, occasional episodes of frontal headache and personality changes. The diagnostic evaluation included computed tomography (CT) scan, magnetic resonance imaging (MRI) with and without contrast enhancement, and color Doppler. Intra-axial complex solid cystic mass lesion in the right parieto-occipital region with significant perilesional oedema, and imaging characteristic of neoplastic etiology were observed. He was posted for excision of tumor and underwent right occipital craniotomy. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. Brain metastases from thyroid malignancy is a sign of detrimental prognosis, hence, thorough clinical, radiological and pathological evaluation for rapid detection is critical. Neurosurgical removal along with radiotherapy should be considered as treatment of choice. The information obtained contributes towards better management and overall long-term outcomes.

Safety and Efficacy of Continuous Theta Burst "Intensive" Stimulation in Acute-Phase Bipolar Depression: A Pilot, Exploratory Study.

OBJECTIVES: Repetitive transcranial magnetic stimulation efficacy in unipolar depression is known, but its efficacy in acute-phase bipolar depression is at best modest. Citing differential right dorsolateral prefrontal cortex hyperconnectivity implicated in BD, we aimed to study the effect of novel continuous theta burst stimulation (cTBS) targeting right dorsolateral prefrontal cortex in a randomized rater blinded placebo control design. MATERIAL AND METHODS: Nineteen patients aged 18 to 59 years (baseline Hamilton Depression Rating Scale [HAM-D] 17 severity score >18) were randomly allocated to active cTBS (n = 11) and sham cTBS (n = 9) groups using block randomization method. They received 15 cTBS sessions (burst of 3 pulses delivered at 50 Hz, repeated every 200 ms at 5 Hz, 600 pulses per session), 3 sessions per day (total of 1800 pulses) for 5 days in a week at 80% resting motor threshold. The HAM-D, Beck Depression Inventory, Hamilton Anxiety Rating Scale, World Health Organization's abbreviated quality of life assessment, and Changes in Sexual Functioning Questionnaire were assessed at baseline, after the last session, and at 2 weeks after repetitive transcranial magnetic stimulation. Intention-to-treat analysis was conducted and missing values (2 patients) were replaced using the last observation carried forward method. RESULTS: On repeated measures analysis of variance, a significant within-group time effect (from pretreatment to 2 weeks after TBS) for HAM-D ( F = 15.091, P < 0.001), Beck Depression Inventory ( F = 22.376, P < 0.001), Hamilton Anxiety Rating Scale ( F = 18.290, P < 0.001), Changes in Sexual Functioning Questionnaire ( F = 9.281, P = 0.001), and World Health Organization's abbreviated quality of life assessment ( F = 24.008, P < 0.001). The integrity of the blind assessed by the guess matrix was good. When significant between group*time effect was compared, none of the variables retained statistical significance. No major adverse effects were reported, and none of the patients discontinued the trial because of adverse effects. CONCLUSIONS: Our trial concludes that although safe and well tolerated, the therapeutic efficacy of intensive intermittent TBS in acute-phase bipolar depression is inconclusive. Choice of lower total number to sessions and smaller intersession interval along with small sample size limit the study findings.

Sexual dysfunction in bipolar depression: Gender differences.

Objective: To find sexual dysfunction in acute-phase bipolar depression patients and subsequently characterize the gender-wise differences in sexual functioning. Materials and Methods: A cross-sectional, descriptive, observational, purposeful, and hospital-based study was done with 45 patients (age range: 18-59 years) with moderate to severe acute phase bipolar depression (HAM-D scores >18). The domain-wise (Pleasure, Desire/Frequency Desire/Interest, Arousal/Excitement, and Orgasm/Completion) sexual functioning was assessed by the Change in Sexual Functioning Questionnaire (CSFQ-14) (≤41 for females, ≤47 for males as a cut-off for dysfunction). This study is registered in the CTRI (Clinical Trials Registry India, Number: CTRI-2021-07-035182). Results: The prevalence of sexual dysfunction was 91% of bipolar disorder patients with more male participants (53.3%) compared to females (46.7%). The mean HAM-D score for the study sample was 27.93 ± 8.035. The female gender had more dysfunctional scores in desire/frequency (t = 2.229, P = 0.031), desire/interest (t = 2.448, P = 0.019), orgasm/completion (t = 2.974, P = 0.005), and overall total CSFQ (t = 2.946, P = 0.005). The odds of sexual dysfunction were significant given a one-unit increase in suicidal ideation in the index episode (adjusted OR = 1.222, 95% CI: 1.004-1.488, P = .049). Conclusion: Acute-phase bipolar patients have very high sexual dysfunction rates. Females have both global and specific sexual response cycle deficits in comparison to acute phase bipolar depressed males. Future trials shall amuse neurobiology grounded, more individualistic sexual rehabilitation-based interventional paradigms, and longitudinal research models in acute phase bipolar depression.

Sleep Quality in Patients With Schizophrenia in a Tertiary Care Center in Northern India.

Objective: To assess the quality of sleep among patients with schizophrenia.Methods: A cross-sectional descriptive study was conducted with 100 outpatients with schizophrenia recruited from a tertiary care center in Northern India from July 2022 to December 2022. Eligible participants were required to complete a demographic form, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). The severity of psychosis was assessed with the Positive and Negative Syndrome Scale (PANSS).Results: The mean age of the participants was 38.87 years (SD = 10.564). The prevalence of poor sleep quality (PSQI ≥ 5) among the patients with schizophrenia was 78%, and the mean PSQI score was 11.2 (SD = 5.31). Most of the participants in whom the prevalence of poor sleep quality was marginally higher were female (51%). Of the 7 PSQI components, daytime dysfunction was more affected (49%) compared to the other 6 components. There was a positive correlation between PSQI and ISI scores (r = 0.805, P < .001). PSQI (U = 380, P < .001) and ISI scores (U = 517, P < .001) were significantly lower in schizophrenia patients taking benzodiazepines. The PANSS scores were not significantly correlated with PSQI or ISI scores.Conclusions: Most patients with schizophrenia suffered significantly from poor sleep quality. The results showed the deleterious impact of poor sleep on their daytime functioning, suggesting the need for comprehensive management of sleep problems in such patients.Prim Care Companion CNS Disord 2023;25(6):23m03564. Author affiliations are listed at the end of this article.

Pragmatic issues and prescribing patterns in bipolar disorder: A mental health professional's survey.

Background: There is substantial treatment gap between the suggested guidelines and pragmatic clinical practice for psychotropic usage in bipolar disorder (BD) due to the lack of naturalistic studies and not taking into account the transcultural differences and diverse background. We intend to study this treatment gap and elucidate the preference of psychotropics and prescription patterns, critical clinical issues faced and related pragmatics in BD by conducting the mental health professionals survey. Methodology: After focused discussions, Canadian Network for Mood and Anxiety Treatments guidelines being the primary anchor, a 46-item online survey questionnaire was prepared. With 25.4% response rate, 127 psychiatrists were evaluated using Survey Monkey® electronic platform on the demographics, predominant polarity; usage of antipsychotics, antidepressants, and electroconvulsive therapy, psychotropic's preference (monotherapy vs. polytherapy) in the acute and maintenance phase of BD. Results: Majority of the participants were males (70.9%) and placed in government institute or medical colleges. Majority agreed that child and adolescent and old age bipolar probands are not routinely seen but subthreshold BD cases are frequent; did not prefer mood stabilizer in pregnancy (61.4%) and antidepressants, preferred polytherapy in acute but monotherapy in maintenance phase (after 3rd episode), seldom preferred ECT as an option (more in suicidality), agreed to a subset of BD being refractory and neuroprogressive. Conclusion: This study elucidates the importance of treatment preferences, prescribing patterns and pragmatic issues faced by the clinicians. These patterns if studied longitudinally in a systematic manner would help in modifying the potential treatment strategies and reduce treatment gap.

To compare the continuous and intermittent irrigation method on the removal of dentin debris from root canals and to evaluate the dynamics of irrigant flow using computational fluid dynamics.

AIM: This study aimed to compare the efficiency of continuous and intermittent irrigating methods on the removal of dentin debris from the simulated grooves and to evaluate the dynamics of irrigant using computational fluid dynamics (CFD). METHODOLOGY: Seventy-five extracted human permanent maxillary canines were selected. Access cavities were made, working length was determined, and canals were prepared by crown down technique. The teeth were split longitudinally and standard groove 2.0 mm in length was made in split halves and each groove was filled with dentin debris and the images were taken under a microscope (E200). The halves were re-assembled and divided into five groups based on different irrigation methods. Group 1: ultrasonic Irrigation with continuous flow for 3.0 min; Group 2: ultrasonic irrigation with continuous flow for 1.5 min; Group 3: ultrasonic irrigation with intermittent flow for 3.0 min; Group 4: ultrasonic irrigation with the intermittent flow for 1.5 min; and Group 5: syringe irrigation for 1 min. The root halves were again separated and re-evaluated for debris elimination after the irrigation protocol for all the groups separately. The effect of time and method of passive ultrasonic irrigation were compared. For the computational fluid analysis, a GAMBIT 2.2 (Ansys) software was used for mesh construction. FLUENT 6.2 (Ansys) software was used to set the boundary conditions and reconstruction of the canal; flow patterns and turbulence were graphically constructed. RESULTS: The continuous irrigation methods were better at debris removal than intermittent irrigation flow methods. The CFD showed that the turbulence of flow of irrigant was dependent on the inlet velocity and pressure of the irrigant. CONCLUSION: Debris removal from the simulated grooves was better with continuous irrigation compared with intermittent irrigation. CFD study revealed that the turbulence that was affected by the velocity and pressure of the irrigant introduced and is a variable entity.

Effect of prophylactic instrumentation on surface roughness of tooth-colored restorative material: An in vitro study.

AIM: To compare and evaluate the surface characteristics of different restorative materials used for restoration of cervical defects when subjected to periodontal prophylactic instrumentation techniques. MATERIALS AND METHODOLOGY: Sixty box-shaped cavities were prepared on the labial surface of decoronated permanent maxillary anterior teeth which were randomly divided into two groups (n = 30) based on the instrumentation technique Group I: Manual instrumentation using curettes and Group II: Ultrasonic instrumentation. The samples were further divided into three subgroups based on restorative material subgroups I V and II V-restored with Vitremer, subgroups I F and II F-restored with Filtek Z 250 XT and subgroups I D and II D-restored with Dyract flow, respectively. After finishing and polishing, the samples were subjected to surface profilometry analysis for determining the surface roughness values (Ra). Thereafter, the restored surfaces of all the samples in different subgroups were subjected to prophylactic instrumentation with Gracey's curettes (Group I) and ultrasonic scalers (Group II). Ra values were recorded again after prophylactic instrumentation and after polishing. The data thus obtained were subjected to the statistical analysis using the independent t-test and one-way ANOVA (p<0.05). RESULTS: Ra values were significantly higher for both manual and ultrasonic prophylaxis compared to preprophylaxis and postpolishing in all the three restorative materials. Ultrasonic scaling produced significantly higher Ra for subgroup V as compared to subgroup F and subgroup D, whereas the difference between the materials was not significant for manual scaling. CONCLUSION: Manual prophylaxis resulted in significant reduction in surface roughness of all the three restorative materials while ultrasonic prophylaxis resulted in significant reduction for Vitremer only. Polishing after scaling significantly reduced the effect of both manual and ultrasonic prophylaxis on surface roughness.

Predictors of chronicity in alcohol use disorder: an evoked response potential study.

INTRODUCTION: Evoked response potentials (ERP) can reliably map key neurocognitive processes which are putatively responsible for chronic alcohol use disorder (AUD). Aim of the present study was to study P300 auditory odd ball and N400 visual semantic incongruity paradigm mapping executive functions rubric as a potential biomarker predicting chronicity in AUDs. Methodology: 60 right handed 18 to 54 years age subjects were divided into chronic "CAD" and non chronic alcohol dependence "NAD" in addition to healthy control "HC" (N = 30). Subjects were assessed by Addiction Severity Index (ASI), P300 auditory odd ball paradigm in midline region and visual N400 semantic incongruity task in centro-parietal region in a cross sectional design. Results: All the three groups differed significantly for P300 and N400 amplitude in all the leads with maximum attenuation seen in CAD. On discriminant function analysis (DFA), P300 Pz and N 400 C2 amplitude values could accurately classified 78.3% subjects. Composite sensitivity and specificity of the two predictor variables differentiating CAD subjects from NAD were 79.31 and 77.41%. receiver operating characteristic curve generated an area under the curve of .758 and .847 i.e., "fair to good" ability to predict CAD from NAD. Conclusion: We conclude that specific ERP paradigm can be used as a state marker to map the cognitive deficits and as a biomarker to detect chronic AUDs.