Interplay of PhoP and DevR response regulators defines expression of the dormancy regulon in virulent Mycobacterium tuberculosis.

The DevR response regulator of Mycobacterium tuberculosis is an established regulator of the dormancy response in mycobacteria and can also be activated during aerobic growth conditions in avirulent strains, suggesting a complex regulatory system. Previously, we reported culture medium-specific aerobic induction of the DevR regulon genes in avirulent M. tuberculosis H37Ra that was absent in the virulent H37Rv strain. To understand the underlying basis of this differential response, we have investigated aerobic expression of the Rv3134c-devR-devS operon using M. tuberculosis H37Ra and H37Rv devR overexpression strains, designated as LIX48 and LIX50, respectively. Overexpression of DevR led to the up-regulation of a large number of DevR regulon genes in aerobic cultures of LIX48, but not in LIX50. To ascertain the involvement of PhoP response regulator, also known to co-regulate a subset of DevR regulon genes, we complemented the naturally occurring mutant phoPRa gene of LIX48 with the WT phoPRv gene. PhoPRv dampened the induced expression of the DevR regulon by >70-80%, implicating PhoP in the negative regulation of devR expression. Electrophoretic mobility shift assays confirmed phosphorylation-independent binding of PhoPRv to the Rv3134c promoter and further revealed that DevR and PhoPRv proteins exhibit differential DNA binding properties to the target DNA. Through co-incubations with DNA, ELISA, and protein complementation assays, we demonstrate that DevR forms a heterodimer with PhoPRv but not with the mutant PhoPRa protein. The study puts forward a new possible mechanism for coordinated expression of the dormancy regulon, having implications in growth adaptations critical for development of latency.

Dipeptidyl peptidase-4 inhibitors (DPP-4i) combined with vitamin D3: An exploration to treat new-onset type 1 diabetes mellitus and latent autoimmune diabetes in adults in the future.

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by destruction of pancreatic beta cells through cell injury caused primarily by cytotoxic T lymphocytes (CD8+). The pathophysiological basis of T1DM seems to be an imbalance between a reduced function of T regulatory lymphocytes and an increased inflammatory activity of Th17 lymphocytes caused by increased production of inflammatory cytokines, as IL-1ß, IL-6, IL-17 and IFN-gamma due to environmental factors and genetic predisposition. The preservation of the reserve of beta cells in new-onset T1DM and latent autoimmune diabetes in adults (LADA) by immunomodulation in addition to the incretin effect seems to be possible with an association of DPP-4 inhibitors and vitamin D3. In this review, we discuss the effects of both drugs on the immune system and on beta cell function and their eventual additive effects in preserving the residual function of beta cells in new-onset T1DM and LADA.

The characteristics of asbestos-related disease claims made to the Korea Workers' Compensation and Welfare Service (KCOMWEL) from 2011 to 2015

BACKGROUND: This study aimed to enhance understanding of the epidemiologic characteristics of asbestos-related diseases, and to provide information that could inform policy-making aimed at prevention and compensation for occupational asbestos exposure, through analyzing asbestos-related occupational disease claims to Korea Workers’ Compensation and Welfare Service from 2011 to 2015. METHODS: We analyzed 113 workers who filed medical care claims or survivor benefits for asbestos exposure and occupational-related disease from 2011 to 2015. Among these claims, we selected approved workers’ compensation claims relating to malignant mesothelioma and lung cancer, and analyzed the general characteristics, exposure characteristics, pathological characteristics, and occupation and industry distribution. RESULTS: Malignant mesothelioma and lung cancer occurred predominantly in males at 89.7 and 94%, respectively. The mean age at the time of diagnosis for malignant mesothelioma and lung cancer was 59.5 and 59.7 years, respectively, while the latency period for malignant mesothelioma and lung cancer was 34.1 and 33.1 years, respectively. The companies involving exposed workers were most commonly situated within the Busan-Ulsan-Gyeongnam region. Histology results for lung cancer indicated adenocarcinoma as the most common form, accounting for approximately one half of all claims, followed by squamous cell carcinoma, and small cell lung cancer. The most common occupation type was construction in respect of malignant mesothelioma, and shipbuilding in respect of lung cancer. CONCLUSIONS: Considering the long latency period of asbestos and that the peak period of asbestos use in Korea was throughout the mid-1990s, damage due to asbestos-related diseases is expected to show a continued long-term increase. Few studies providing an epidemiologic analysis of asbestos-related diseases are available; therefore, this study may provide baseline data to assist in predicting and preparing for future harm due to asbestos exposure. TRIAL REGISTRATION: DUIH 2018–02–004-001. Registered 28 Februrary 2018.

Effects of exosome on the activation of CD4+ T cells in rhesus macaques: a potential application for HIV latency reactivation.

Exosomes are small extracellular vesicles (EVs), released by a wide variety of cell types, carry donor origin-proteins, cytokines, and nucleic acids, transport these cargos to adjacent or distant specific recipient cells, and thereby regulate gene expression and activation of target cells. In this study, we isolated and identified exosomes in rhesus macaques, and investigated their effects on cell tropism and activation, especially their potential to reactivate HIV latency. The results indicated that plasma-derived exosomes preferentially fuse to TCR-activated T cells and autologous parent cells. Importantly, the uptake of exosomes, derived from IL-2 stimulated CD4+ T cells, effectively promoted reactivation of resting CD4+ T-cell, as indicated by an increased viral transcription rate in these cells. These findings provide premise for the potential application of exosome in the reactivation of HIV latency, in combination its use as functional delivery vehicles with antiretroviral therapy (ART).

The relationship between the latency period, infection markers, and oxidant and antioxidant states in women with preterm premature rupture of membranes.

BACKGROUND: A major cause of perinatal morbidity and mortality has been reported to be preterm premature rupture of membranes (PPROM). Our objective was to evaluate oxidant-antioxidant balance, infection parameters, time interval between rupture of membranes and delivery (latency period), and the relationship among all these parameters. METHODS: Seventy-five cases with PPROM between 24 and 34 gestational weeks were included in the study. A control group of 41 women who gave birth at term were considered as the control group. The relationship among maternal plasma total oxidative stress (TOS), malondialdehyde (MDA), total antioxidant status (TAS), leukocyte counts, CRP, vitamin C and E levels, gestational week, neonatal birthweight, and latency period was evaluated. RESULTS: In cases with PPROM, rupture occurred at an average of 29.4 gestational weeks and premature babies were born at an average of 31.6 gestational weeks. The mortality rate of babies born to PPROM women was 18.7% (14/75) died at or following birth. In the PPROM group, TOS, MDA, and leukocyte counts were found to be significantly higher compared to the control group (p < 0.001). Besides, a significant negative correlation was detected among the latency period, TOS, CRP, and leukocyte counts (p < 0.05). CONCLUSIONS: Appropriate treatment protocols that strengthen antioxidant defense systems and taking into consideration the signs of infection can decrease the incidence of PPROM and/or mortality rates of babies born to PPROM women.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Indolent B-Cell Lymphoid Malignancy in the Spleen of a Man Who Handled Benzene: Splenic Marginal Zone Lymphoma

We present the case of a 45-year-old man with a history of benzene exposure who developed splenic marginal zone lymphoma. For 6 years, he had worked in an enclosed space cleaning instruments with benzene. He was diagnosed with splenic marginal zone lymphoma 19 years after retirement. During his time of working in the laboratory in the 1980s, working environments were not monitored for hazardous materials. We indirectly estimated the cumulative level of past benzene exposure using job-exposure matrices and technical assumptions. Care must be taken in investigating the relevance of occupational benzene exposure in the occurrence of indolent B-cell lymphoma. Because of the long latency period and because occupational measurement data do not exist for the period during the patient's exposure, the epidemiological impact of benzene exposure may be underestimated.

Parental bonding and neuropsychological performance are associated with episodic simulation of future events in trauma-exposed patients with major depressive disorder.

INTRODUCTION: Major depressive disorder (MDD) and trauma-related disorders are associated with deficits in remembering the past and imagining the future (i.e., episodic simulation). We examined parental bonding and neuropsychological performance in relation to episodic simulation in trauma-exposed patients with recurrent MDD. METHODS: Trauma-exposed patients with MDD (n = 21) and matched controls (n = 20) completed a future-oriented Autobiographical Interview, the Parental Bonding Instrument, and a standardized neuropsychological battery. RESULTS: Patients with major depressive disorder generated fewer episodic details for future neutral events compared to controls. Although higher reported levels of maternal care were associated with increased specificity of negative future events among the patient group, higher maternal overprotection was related to decreased specificity of negative and positive future events. Higher levels of performance on measures of intelligence, verbal memory, executive functioning, and sustained attention were associated with increased specificity of future events. CONCLUSIONS: Maternal relations during childhood and neuropsychological performance are related to the specificity of episodic simulation in adult patients with MDD. Childhood experience continues to influence memory performance into adulthood.

Pandemic influenza vaccine & narcolepsy: simulations on the potential impact of bias.

Several studies have identified an association between Pandemrix(TM), an AS03 adjuvanted pandemic influenza A(H1N1) vaccine, and narcolepsy, a rare and under-diagnosed sleep disorder with a median onset-to-diagnosis interval of ten years. This paper reviews potential sources of bias in published studies and aims to provide, through simulation, methodological recommendations for assessment of vaccine safety signals. Our simulation study showed that in the absence of an association between the vaccine and the outcome, presence of detection bias and differential exposure misclassification could account for elevated risk estimates. These may play a major role, particularly in alert situations when observation times are limited and the disease has a long latency period. Estimates from the case-control design were less inflated than those from the cohort design when these biases were present. Overall, these simulations provide useful insights for the design and interpretation of future studies.

Remarks on Latency: Onset in Different Cultures.

The features of cultural identity in latency-age children along with the influences of cultural values, transmitted via the family, are the central focus of this essay. In this context, the understanding of how development can appear to bifurcate along a continuum of "individualist" versus "collectivist" cultures can be perceived in what Andreas-Salome referred to as the "dual orientation of narcissism". This essay also discusses the impact of immigration and the adaptation of the individual in a foreign country.

Quantifying risk over the life course - latency, age-related susceptibility, and other time-varying exposure metrics.

Identification of the latency period and age-related susceptibility, if any, is an important aspect of assessing risks of environmental, nutritional, and occupational exposures. We consider estimation and inference for latency and age-related susceptibility in relative risk and excess risk models. We focus on likelihood-based methods for point and interval estimation of the latency period and age-related windows of susceptibility coupled with several commonly considered exposure metrics. The method is illustrated in a study of the timing of the effects of constituents of air pollution on mortality in the Nurses' Health Study. Copyright © 2016 John Wiley & Sons, Ltd.

Breaking object correspondence across saccades impairs object recognition: The role of color and luminance.

Rapid saccadic eye movements bring the foveal region of the eye's retina onto objects for high-acuity vision. Saccades change the location and resolution of objects' retinal images. To perceive objects as visually stable across saccades, correspondence between the objects before and after the saccade must be established. We have previously shown that breaking object correspondence across the saccade causes a decrement in object recognition (Poth, Herwig, & Schneider, 2015). Color and luminance can establish object correspondence, but it is unknown how these surface features contribute to transsaccadic visual processing. Here, we investigated whether changing the surface features color-and-luminance and color alone across saccades impairs postsaccadic object recognition. Participants made saccades to peripheral objects, which either maintained or changed their surface features across the saccade. After the saccade, participants briefly viewed a letter within the saccade target object (terminated by a pattern mask). Postsaccadic object recognition was assessed as participants' accuracy in reporting the letter. Experiment A used the colors green and red with different luminances as surface features, Experiment B blue and yellow with approximately the same luminances. Changing the surface features across the saccade deteriorated postsaccadic object recognition in both experiments. These findings reveal a link between object recognition and object correspondence relying on the surface features colors and luminance, which is currently not addressed in theories of transsaccadic perception. We interpret the findings within a recent theory ascribing this link to visual attention (Schneider, 2013).

The risk of life-threatening ventricular arrhythmias in presence of high-intensity endurance exercise along with chronic administration of nandrolone decanoate.

Anabolic steroids used to improve muscular strength and performance in athletics. Its long-term consumption may induce cardiovascular adverse effects. We assessed the risk of ventricular arrhythmias in rats which subjected to chronic nandrolone plus high-intensity endurance exercise. Animals were grouped as; control (CTL), exercise (Ex): 8 weeks under exercise, vehicle group (Arach): received arachis oil, and Nan group: received nandrolone decanoate 5 mg/kg twice a week for 8 weeks, Arach+Ex group, and Nan+Ex. Finally, under anesthesia, arrhythmia was induced by infusion of 1.5 µg/0.1 mL/min of aconitine IV and ventricular arrhythmias were recorded for 15 min. Then, animals' hearts were excised and tissue samples were taken. Nandrolone plus exercise had no significant effect on blood pressure but decreased the heart rate (P<0.01) and increased the RR (P<0.01) and JT intervals (P<0.05) of electrocardiogram. Nandrolone+exercise significantly increased the ventricular fibrillation (VF) frequency and also decreased the VF latency (P<0.05 versus CTL group). Combination of exercise and nandrolone could not recover the decreasing effects of nandrolone on animals weight gain but, it enhanced the heart hypertrophy index (P<0.05). In addition, nandrolone increased the level of hydroxyproline (HYP) and malondialdehyde (MDA) but had not significant effect on glutathione peroxidase of heart. Exercise only prevented the effect of nandrolone on HYP. Nandrolone plus severe exercise increases the risk of VF that cannot be explained only by the changes in redox system. The intensification of cardiac hypertrophy and prolongation of JT interval may be a part of involved mechanisms.

Compreensão psicodinâmica do ciclo vital de Daenerys Targaryen, personagem da série Game of Thrones / Psychodynamic understanding of "Daenerys Targaryen's" life cycle, character from the series "Game of Thrones"

Este artigo analisa os aspectos psicológicos da personagem Daenerys Targaryen, da série Game of thrones, buscando essencialmente avaliar sua evolução cognitiva, social e comportamental, bem como os conflitos vivenciados em seu ciclo vital e os respectivos mecanismos de enfrentamento das adversidades. Por meio da interpretação subjetiva das simbologias metafóricas citadas na narrativa, extrapola-se a leitura literal da obra, com vistas a compreender também as representações da esfera inconsciente da personagem. Daenerys tem infância conturbada pela morte dos pais, pela fuga da cidade natal, pelo exílio e pelos maus-tratos cometidos pelo irmão. Ademais, são-lhe impostos casamento e erotização precoces, eventos que desrespeitam seu tempo de amadurecimento psíquico, desencadeando encurtamento das fases do seu ciclo vital e desestabilização do processo de latência e desenvolvimento puberal. Contudo, as experiências que vivencia no período, tais quais a gestação e a emancipação por que passa, associadas a variantes inatas da sua personalidade - a exemplo do temperamento dócil, inteligência e autoconfiança na capacidade de resolução de vicissitudes -, permitem a expressão de uma figura icônica de resiliência, com ativação de defesas maduras frente a crises vitais ou acidentais. O estudo permitiu discutir aspectos da realidade contemporânea do desenvolvimento humano e proceder à observação de diversos mecanismos de funcionamento psíquico, além da interação entre variantes intrínsecas e extrínsecas moduladoras da expressão de resiliência frente às dificuldades. Este artigo visa a contribuir para o estudo da teoria psicodinâmica e deve interessar a profissionais da medicina e da psicologia.(AU)

This article analyzes the psychological aspects of character Daenerys Targaryen, from Game of Thrones' series, seeking essentially to evaluate her cognitive, social and behavioral evolution, as well as the conflicts experienced to each stage of her life cycle and related adversity coping mechanisms. Through subjective interpretation of metaphoric symbols mentioned in the narrative, the literal reading of the story is extrapolated in order to also comprehend representations of the character's unconscious domain. Daenerys goes through a troubled childhood due to her parents' death, fleeing from her home city, exile and mistreatment committed by her brother. Furthermore, events like marriage and early erotization are imposed to her, which disrespect her psychic development timing, causing shortening of her life cycle's stages, and destabilization of the latency phase process and her pubertal development. Nevertheless, the experiences she goes through in this period, such as pregnancy and emancipation, associated to innate variants of her personality - docile temperament, high cognition and self-confidence in the ability of resolving difficulties -, allow the expression of a resilient iconic figure, with the activation of mature defenses when facing vital or accidental crises. The study allows transpositions to contemporaneous reality of human development and observation of several mechanisms of psychic functions, besides the interaction between intrinsic and extrinsic variants, which modulate the expression of resilience when confronting distress. It contributes to the study of psychodynamic theory and may be of interest to doctors and psychologists, especially those directly involved in psychic development.(AU)

Therapy-related myeloid neoplasms in children and adolescents

BACKGROUND: This retrospective study aimed to characterize and analyze the outcome of therapy-related myeloid neoplasms (t-MNs) in children and adolescents. METHODS: The medical records of 16 patients under 21 years of age at the time of t-MN diagnosis were reviewed. RESULTS: The median patient age was 11.5 years (range, 1.6–20.4 yr). Twelve patients had therapy-related acute myeloid leukemia, 3 patients had myelodysplastic syndrome, and 1 patient had chronic myelomonocytic leukemia. The median latency period was 29 months (range, 11–68 mo). Fourteen patients had cytogenetic aberrations, 8 of whom had an 11q23 abnormality. Of the 13 patients treated with curative intent, 12 patients received myeloid-type induction therapy that led to complete remission (CR) in 8 patients. Nine patients underwent allogeneic transplantation; 4 patients did not undergo transplantation due to chemotherapy-related toxic death (N=3) or parental refusal (N=1). The 5-year overall survival and event-free survival of the 13 patients treated with a curative intent were 46.2% and 30.8%, respectively. For the 9 patients who underwent allogeneic transplantation, the 5-year event-free survival was 66.7%. CONCLUSION: A significant proportion of young patients with t-MNs can experience long-term survival, and allogeneic transplantation plays a key role for attaining cure in these patients.

Neurophysiological indicators of emotional processing in youth psychopathy / Indicadores neurofisiológicos de procesamiento emocional en psicopatía juvenil

BACKGROUND: Research with psychopathic samples using the technique of evoked potentials is rather limited and almost exclusively concerned with the study of the P300 component; no studies have been found (to date) that assess shorter wave latencies. This research focuses on the emotional and attentional processes in young people with psychopathic characteristics, using the evoked potential technique in short-wave latency (N100). METHOD: The experimental group consisted of 22 subjects; all of them met the psychopathic criteria of the Antisocial Process Screening Device (APSD) and the Psychopathy Checklist: Youth Version (PCL: YV). The control sample consisted of 25 subjects, all of them scoring less than 15 points in APSD. RESULTS: In the experimental group, the mechanisms responsible for processing the pleasant stimulation responded earlier and with more intensity (on the N100); premium positivity bias on negativity. CONCLUSIONS: This emotional deficit found in the literature on psychopathy in adults is also found in young people

ANTECEDENTES: en el campo de la psicopatía muy pocos estudios se han centrado en usar la técnica de potenciales evocados, y los pocos que hay han estudiado casi exclusivamente el componente P300, no encontrándose casi estudios sobre ondas de latencia corta. Este artículo estudia los procesos emocionales y atencionales presentes en jóvenes con características psicopáticas, utilizando la técnica de potenciales evocados en ondas de latencia corta ((N100). MÉTODO: el grupo experimental estuvo formado por 22 varones, todos ellos cumpliendo los criterios del Antisocial Process Screening Device (APSD) y de la Psychopathy Checklist: Youth Version (PCL: YV). El grupo control estaba formado por 25 varones con puntuaciones inferiores a 15 puntos en el APSD. RESULTADOS: el grupo experimental respondió más pronto y con más intensidad (en la N100) ante la estimulación placentera, primando el sesgo de la negatividad. CONCLUSIONES: se observa en jóvenes el mismo déficit emocional que se encuentra en la psicopatía adulta

D-aspartate modulates nociceptive-specific neuron activity and pain threshold in inflammatory and neuropathic pain condition in mice.

D-Aspartate (D-Asp) is a free D-amino acid found in the mammalian brain with a temporal-dependent concentration based on the postnatal expression of its metabolizing enzyme D-aspartate oxidase (DDO). D-Asp acts as an agonist on NMDA receptors (NMDARs). Accordingly, high levels of D-Asp in knockout mice for Ddo gene (Ddo (-/-)) or in mice treated with D-Asp increase NMDAR-dependent processes. We have here evaluated in Ddo (-/-) mice the effect of high levels of free D-Asp on the long-term plastic changes along the nociceptive pathway occurring in chronic and acute pain condition. We found that Ddo (-/-) mice show an increased evoked activity of the nociceptive specific (NS) neurons of the dorsal horn of the spinal cord (L4-L6) and a significant decrease of mechanical and thermal thresholds, as compared to control mice. Moreover, Ddo gene deletion exacerbated the nocifensive responses in the formalin test and slightly reduced pain thresholds in neuropathic mice up to 7 days after chronic constriction injury. These findings suggest that the NMDAR agonist, D-Asp, may play a role in the regulation of NS neuron electrophysiological activity and behavioral responses in physiological and pathological pain conditions.

Dexmedetomidine protects spatial learning and memory ability in rats.

BACKGROUND: The authors tested the hypothesis that combined use of dexmedetomidine on fetal rats during isoflurane exposure in maternal anesthesia can attenuate the abnormal spatial learning and memory abilities in adults via the renin-angiotensin-aldosterone system. METHODS: Fifty timed-pregnancy rats were randomly assigned to five groups (Dex+Iso, Sal+Iso, Sal+Oxy, Dex+Oxy, and a control group ) on embryonic day 14 to receive five different dispositions, i.e. combined injection of dexmedetomidine (Dex) or saline (Sal) and inhalation of isoflurane (Iso), oxygen (Oxy), or normal air for 4 h (n = 10). RESULTS: The latency time(s) from day 1 to day 4 all showed a decreasing tendency in all four groups. The synaptic count of the Sal+Iso group was significantly lower than the Control group (p < 0.05), suggesting that severe neurodegeneration occurred under the influence of fetal isoflurane exposure. In contrast, the synapse count of the Dex+Iso group was near to that of Control group. The rats are protected in neurodevelopmental, normal development. CONCLUSION: Combine use of dexmedetomidine during exposure to isoflurane in utero during middle-pregnancy can attenuate the impairment of spatial learning and memory abilities for the rats in adulthood.

A Case of Eyelid Paraffinoma Misdiagnosed as a Chalazion

PURPOSE: Paraffinoma is a granulomatous reaction to paraffin or oily substances. We report delayed diagnosis of paraffinoma that was misdiagnosed as chalazion. CASE SUMMARY: A 49-year-old male presented with masses, swelling, and erythema in the right lower eyelid, masses and swelling in the right upper eyelid, and intermittent conjunctival injection that had appeared 3 months ago. The patient admitted having received paraffin injection to the right lateral canthal area and nasal bridge for cosmetic purposes by non-medical personnel 17 years prior to presentation. The mass showed partial response to intralesional triamcinolone injection but did not respond to systemic steroid. CONCLUSIONS: Paraffinoma can present diagnostic confusion given its protracted latency period and discordance of injection area and mass location. Detailed history taking is required and the possibility of paraffinoma should be considered for mass lesions of the eyelid.