Leiomyoma of the palatine tonsil - report of a rare and unusual tumor at this site

A leiomyoma is a remarkably rare cause of a benign, one-side tonsillar enlargement. The diagnosis is essentially histologic and will not normally be suspected clinically. Immunohistochemistry is needed for substantiation of the morphology and confirmation. We submit this illustrative case report.

Heavy chain deposition disease in a case of clear cell renal cell carcinoma- A jack in the box

Renal cell carcinoma (RCC) is the most common subtype of adult renal tumors, and its detection rate in the early stages has been increased in the dawn of advanced imaging modalities. Nephrectomy is the mainstay of treatment; determination of tumor category and staging is the primary concern of oncopathologists. Non-neoplastic renal parenchyma is overlooked majority of times and thus misses the opportunity to detect concomitant medical renal diseases which also predict the renal outcome in the postoperative era. Although any kind of glomerular or extraglomerular pathology may be encountered, vascular changes in the form of arterionephrosclerosis are the commonest one. Here, we take the opportunity to report an unusual association of heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48-year-old male of Indian ethnicity.

Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Utility of serum anti-phospholipase A2 receptor antibody as a biomarker in membranous nephropathy: An experience from a tertiary care center of Eastern India

Background: Membranous nephropathy (MN) is a pattern of glomerular injury. Exact categorization into primary membranous nephropathy (PMN) or secondary membranous nephropathy (SMN) is essential for treatment. An endogenous podocyte antigen, M-type phospholipase A2 receptor (PLA2R) has been discovered to be involved in the pathogenesis of PMN. Aims and Objectives: In this article, we aimed to analyze renal tissue PLA2R and serum anti-PLA2R antibodies in MN cases and determined the diagnostic utility. Materials and Methods: The study was of prospective type carried out from March 2019 to August 2020. Analysis of cases of MN was performed with PLA2R paraffin immunoflourescence and serum anti-PLA2R antibody ELISA. Results: Overall sensitivity, specificity, PPV, and NPV of serum anti-PLA2R ELISA for PMN was 91.3%, 80%, 75%, and 93.3%, respectively, and of tissue PLA2R staining for PMN was 91.67%, 81.08%, 75.86%, and 93.75%, respectively. There was strong concordance between two methods. In the patients that were followed up, we found baseline serum anti-PLA2R antibody was less in complete remission group than that in non-remission group and the reduction in serum anti-PLA2R antibody was more in complete remission group than that in non-remission group. Conclusion: Routine light and immunofluorescence examination are incapable of giving exact categorical opinion regarding PMN and SMN. Serum anti-PLA2R antibody detection and renal tissue PLA2R analysis are sensitive and specific in detecting PMN. Baseline serum anti-PLA2R antibody and anti-PLA2R antibody quantification trends are related to prognosis of PMN. So they can be incorporated as additional biomarker.

A study on smart phone use and its perceived health effects among the adolescents attending Medical College and Hospital, Kolkata

Background: Smartphone usage is gradually escalating among Indian adolescents, which is having adverse consequences on their health and well-being. Awareness regarding adverse health impacts of smartphone usage among adolescents is thus necessary. Aims and Objectives: This study assessed the smartphone usage pattern and perception regarding its health effects among adolescents attending adolescent friendly health clinic (AFHC) at Medical College and Hospital, Kolkata. Materials and Methods: This cross-sectional study was conducted among 187 adolescents from January to March 2023 at AFHC of Medical College and Hospital, Kolkata selected by systematic random sampling technique. Pre-designed self-administered questionnaire was utilized for data collection. Data were analyzed using SPSS software. Factors associated with the duration of smartphone usage were analyzed using the Chi-square test. Results: Smartphone was used by all the study participants (n = 187). A significant proportion has utilized smartphones for >3-year duration, whereas 114 (60.9%) used them for 1–2 h per day and 56 (29.9%) used them for ?3 h per day. The major adverse health impacts of smartphone usage perceived by the participants were eye symptoms (64.2%), headache (50.8%), and neck pain (46.5%). Gender (?2=12.98, df = 2, P = 0.0012), type of residence (?2 = 7.98, df = 2, P = 0.018), and socioeconomic status (?2 = 34.96, df = 2, P < 0.001) were factors significantly associated with the duration of smartphone usage per day. Conclusion: Smartphone should be optimized to protect the physical and mental well-being of adolescents. Motivation and counselling regarding the adverse effects of smartphone usage is should be given the utmost priority. Generating awareness among parents at the community level through field health workers is also the need of the hour.

Incidence, clinical features, risk factors, and outcomes of Intraocular inflammation following Brolucizumab in Indian eyes – A multicentric study

Purpose: To report the incidence, clinical features, potential risk factors, and outcomes of intraocular inflammation (IOI) following brolucizumab in Indian eyes. Methods: All consecutive patients diagnosed with brolucizumab?induced IOI from 10 centers in eastern India between October 2020 and April 2022 were included. Results: Of 758 injections given during the study period across centers, 13 IOI events (1.7%) were recorded attributable to brolucizumab. The IOI occurred after the first dose in two eyes (15%) (median 45 days after brolucizumab), second dose in six eyes (46%) (median = 8.5 days), and third dose (39%) in the remaining five eyes (median 7 days). Reinjections of brolucizumab were administered at a median interval of 6 weeks (interquartile range = 4–10 weeks) in the 11 eyes, where IOI occurred after the second or third dose. Eyes that experienced IOI after the third dose had received a significantly greater number of previous antivascular endothelial growth factor injections (median = 8) compared to those who developed it after the first or second dose (median = 4) (P = 0.001). Anterior chamber cells were seen in almost all eyes (n = 11, 85%), while peripheral retinal hemorrhages were seen in two eyes, and one eye showed branch artery occlusion. Two?thirds of patients (n = 8, 62%) recovered with a combination of topical and oral steroids, while remaining recovered with topical steroids alone. Irreversible visual loss was not seen in any eye, and median vision recovered to pre?IOI levels by 3 months’ time point. Conclusion: Brolucizumab?induced IOI was relatively rare, occurring in 1.7% of eyes, was more common after the second or third injection, especially in those who required frequent reinjections every 6 weeks, and occurred earlier with increasing number of previous brolucizumab injections. Continued surveillance is necessary even after repeated doses of brolucizumab.

Ocular conjunctival microbiome profiling in dry eye disease: A case control pilot study

Purpose: Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is a multifactorial disease that results in discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. A pilot study was undertaken to determine if there were any major substantial differences in the ocular microbiome in DED patients versus healthy controls. Methods: The bacterial communities residing in the conjunctiva of patients with DED (n = 4) and healthy controls (n = 4) were assessed by 16S ribosomal RNA (rRNA) gene sequencing of the V4–V5 region. Results: The phyla Proteobacteria, Actinobacteria, Bacteroidetes, and Firmicutes were most dominant and accounted for 97% and 94.5% of all bacterial sequences in patients and controls, respectively. At the genus level, 27 bacterial genera were found with more than two?fold difference between patients and controls. Four of these – Acinetobacter, Corynebacterium, Lactobacillus, and Pseudomonas spp. – dominated the ocular microbiome of all subjects, but were proportionately lower in DED (16.5%) compared to controls (37.7%). Several bacterial genera were found to be unique in DED (34) and controls (24). Conclusion: This pilot study is an attempt to profile the ocular microbiome in patients with DED that demonstrated a higher concentration of microbial DNA compared to controls, with Firmicutes phyla dominating the bacterial population in patients with DED.

Study of the Prevalence of Type 2 Diabetes Mellitus in Patients with Heart Failure in a Tertiary Care Hospital in Eastern India

Heart Failure and Type 2 Diabetes Mellitus are closely related. Diabetic patients have an increased risk of developing Heart Failure and those with Heart Failure are at higher risk of developing diabetes. The objective of the study was to estimate the prevalence of Type 2 Diabetes Mellitus in patients with heart failure. This analytical observational type of epidemiological study with case control design was conducted at in patient department of General Medicine of RG Kar Medical College & Hospital, Kolkata, West Bengal, India from July, 2019 to June, 2020. 100 study subjects by purposive sampling method were taken as per inclusion and exclusion criteria. Data were collected based on History, Clinical examination, relevant investigations and review of records. In this study proportion of Diabetes was much higher among cases with Heart Failure (30%) than controls (10%), among cases with NYHA class IV (56.3%) and among cases with reduced Ejection Fraction (100%). Thus pre-existing or newly development of Type 2 Diabetes Mellitus should be kept in mind in all hospitalized Heart Failure Patients.

Diagnostic Accuracy of the Government of India Mother and Child Protection Card for Developmental Screening of Indian Children Aged 2-36 Months: A Hospital-based Mixed Method Study

Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2-36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neurodevelopment; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3-93.2) and 90.6% (95% CI 85.2-94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7-9 months, 13-18 months, and 25-36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months.

Internet Addiction and Its Correlates among College Students of Surat City: A Cross Sectional Study

Introduction: The number of internet users in 2018 was 4.021 billion, increased 7 percent year-on-year. More than nine-tenths of Indian teens use Internet. Due to social distancing norms put forward due to COVID-19 dependency and availability of Internet usage has increased. Objective: To assess the extent of Internet addiction and determine its predictors among college students of Surat city. Method: A cross sectional study was conducted from March-September 2021 among 400 first- and second-year students selected by systematic random sampling from four colleges selected purposively. Outcome variables were Young's Internet addiction Test and Duke Health Profile Score which were assessed in terms of mean score. Univariate analysis was done, followed by t-test, ANOVA and Pearson Correlation to establish associations. Predictors were determined by Binary Logistic Regression. Results: Around one-tenth (12.8%) participants were seen with no Internet addiction, with majority being mild (44.8%) and moderately (36.5%) addicted. Severe addiction was seen in around one out of twenty participants (6.1%). Social networking (32%) and education (34.5%) were the major reasons for use of Internet. Higher pocket money (aOR=4.3), greater monthly internet expenditure (aOR=2.8), ownership of internet enabled mobile phone (aOR=3.9), lying down posture while accessing internet (aOR=4.8) and evening (aOR=2.2) or night time (aOR=8.7) of internet access were significant predictors for Internet addicts. Conclusion: In this study more than four fifth of the college students had Internet Addiction even at young age. Physical, Mental, Social and General health were significantly negatively correlated with internet addiction.

Retinal nerve fiber layer thinning found in amyotrophic lateral sclerosis – Correlation with disease duration and severity

Purpose: The retinal involvement of amyotrophic lateral sclerosis (ALS) is a novel idea about a possible correlation between retinal nerve fiber layer (RNFL) thickness in different spectra of ALS patients. Finding the association of RNFL with disease duration and severity will help identify a novel noninvasive biomarker. Methods: The study was designed as a cross?sectional study and was conducted with a suitable proforma. We included the ALS cases based on the revised El Escorial criteria. Healthy controls were age and gender matched. We used the revised ALS functional rating scale (ALSFRS?R) to assess the operational status of the patients. We measured RNFL thickness in the four quadrants with spectral?domain optical coherence tomography (OCT) and analyzed it. Results: We included 30 cases (60 eyes) and 10 healthy controls (20 eyes) having a mean (standard deviation [SD]) age of 49.5 (11.1) years with a median of 50 years, and a majority of them (65%) were middle aged (between 41 and 60 years). We found statistically significant differences in RNFL thicknesses between ALS patients and healthy controls. On segmental analysis, the right eye superior and nasal quadrants and the left eye superior, inferior, and nasal quadrants were significantly affected, along with a gross asymmetry found between the left and right eyes among ALS patients. There was a significant decrease in average RNFL thickness in definite ALS patients than probable ALS patients, with significantly reduced average RNFL thickness in moderate to severe ALS patients. On correlation analysis, disease duration showed a good negative correlation with bilateral average RNFL thickness, and the ALSFRS?R score demonstrated a good positive correlation with bilateral average RNFL thickness, which was statistically significant. Thus, a reduced bilateral RNFL thickness is associated with a decreased ALSFRS?R score. Conclusion: The retinal changes can serve as a marker for diagnosing and monitoring patients with ALS

Bioprospecting of pods of Moringa oleifera Lam. as novel antibacterial agent- Supplementary Data

In the treatment of bacterial diseases, increasing resistance to traditional chemotherapeutics has drawn the necessity for substitute remedies. In this context, here, we evaluated the bactericidal activity of pods of Moringa oleifera Lam., an ethno medicinal plant, against eight pathogenic bacterial strains, both Gram positive (Bacillus licheniformis, B. mycoides, B. subtilis and Staphylococcus aureus) and Gram negative (Escherichia coli, Pseudomonas aeruginosa, P. fluorescens and P. putida). Different organic solvent extracts, like ethyl acetate, acetone and alcohol, of pods of M. oleifera were examined for bactericidal activity against test microorganisms. Minimum inhibitory concentration, chromatographic analyses along with infrared spectroscopy, gas chromatography-mass spectroscopy and nuclear magnetic resonance spectroscopy was carried out for chemical characterization of active ingredient responsible for antibacterial activity. Both the Gram positive and Gram negative organisms showed variable sensitivity to different solvent extracts of M. oleifera pods. Ethyl acetate extracts showed maximum antibacterial activity with MIC value ranging from 1.30 to 4.10 mg/mL. IR analysis provided preliminary information about the amines, amides, aromatics and sulphur containing compounds of the active ingredient. GC-MS and NMR analyses indicated the presence of principal bioactive antibacterial compound 2-(benzoylsulfanyl)-1,3- thiazol,4-yl, benzoate with molecular formula C17H11NO3S2 from ethyl acetate extract of M. oleifera pods. The study concludes that the compound 2-(benzoylsulfanyl)-1,3-thiazol,4-yl, benzoate from ethyl acetate extract of pods of M. oleifera possess the antibacterial activity against the tested strains.

Bioprospecting of pods of Moringa oleifera Lam. as novel antibacterial agent

In the treatment of bacterial diseases, increasing resistance to traditional chemotherapeutics has drawn the necessity for substitute remedies. In this context, here, we evaluated the bactericidal activity of pods of Moringa oleifera Lam., an ethno medicinal plant, against eight pathogenic bacterial strains, both Gram positive (Bacillus licheniformis, B. mycoides, B. subtilis and Staphylococcus aureus) and Gram negative (Escherichia coli, Pseudomonas aeruginosa, P. fluorescens and P. putida). Different organic solvent extracts, like ethyl acetate, acetone and alcohol, of pods of M. oleifera were examined for bactericidal activity against test microorganisms. Minimum inhibitory concentration, chromatographic analyses along with infrared spectroscopy, gas chromatography-mass spectroscopy and nuclear magnetic resonance spectroscopy was carried out for chemical characterization of active ingredient responsible for antibacterial activity. Both the Gram positive and Gram negative organisms showed variable sensitivity to different solvent extracts of M. oleifera pods. Ethyl acetate extracts showed maximum antibacterial activity with MIC value ranging from 1.30 to 4.10 mg/mL. IR analysis provided preliminary information about the amines, amides, aromatics and sulphur containing compounds of the active ingredient. GC-MS and NMR analyses indicated the presence of principal bioactive antibacterial compound 2-(benzoylsulfanyl)-1,3- thiazol,4-yl, benzoate with molecular formula C17H11NO3S2 from ethyl acetate extract of M. oleifera pods. The study concludes that the compound 2-(benzoylsulfanyl)-1,3-thiazol,4-yl, benzoate from ethyl acetate extract of pods of M. oleifera possess the antibacterial activity against the tested strains.

Monkeypox, a global health concern: A study on awareness and adherence to preventive measures among medical students in a tertiary care hospital, Kolkata

Background: The re-emerging Monkeypox disease is spreading worldwide, thus if prevention measures are not followed or awareness is not raised, chaos could result. Aims and Objectives: The present study aimed to assess the awareness and preventive measures of Monkeypox among medical students in a tertiary care hospital of Kolkata. Materials and Methods: A hospital-based, descriptive, observational, and cross-sectional study was conducted over 6 weeks, among final year MBBS students of Medical College Kolkata. Convenience sampling was done. Minimum sample size calculated was 110. A pre-designed, pre-tested, semi-structured, and self-administered questionnaire which was face and content validated by experts used as the study tool in this study. Questionnaire was answered while keeping their identities confidential. Data were collected and entered in a coded manner in MS Excel. Using SPSS version 25, tabulation, the necessary tables, and diagrams were created. The Institutional Ethics Committee of the Medical College in Kolkata was consulted for ethical approval. Results: The students lacked sufficient information. Majority of them responded well when asked about the disease’s cause, incubation period, natural host signs and symptoms, mode of transmission, preventive measures, and treatment, but it was clear that they were unsure about identification of a suspected, probable, or confirmed case and definitive diagnosis. Conclusion: The present study reported that the students had limited knowledge about Monkeypox disease.

Knowledge on prevention and management of snake bite among adults in rural area of West Bengal

Background: Snake bite and its consequences may be largely prevented with adequate knowledge. Better knowledge can lead to positive attitude and subsequently good practices. Hence, it is of utmost need that people should have adequate knowledge regarding snake bite and its management. Aims and Objectives: The aims of this study were to assess the knowledge regarding prevention and management of snake bite among adults in a rural area of West Bengal and to find out any association between sociodemographic profile and knowledge on prevention as well as management of snake bite among the study participants. Materials and Methods: A community-based and observational descriptive study was conducted in the rural field practice area of Medial College, Kolkata, West Bengal for of 2 months. The study participants who were willing to participate in the study and gave written informed consent were included in the study. A pre-designed, pre-tested, and semi-structured data collection form was used. It was developed based on similar type of previous studies and was modified according to the local culture. The data collection form comprised sociodemographic profile of the study participants, their knowledge regarding snake bite, and its prevention and availability of first aid management. Results: A total of 134 participants were included in the study. The mean age was 45.81 ± 8.00 years. It was observed that majority of the study subjects believed in the knowledge that all types of snakes are poisonous (93.2%) and leads to death (90.3%). First aid measures such as application of tourniquet that was seen in only 4.4% of the cases. However, more than half of the study subjects (71.6%) believed in sucking the venom out of the wound. It was noted that higher education status, improved social class had better knowledge score of snake bite prevention and management as compared to their counterparts and this association was found to be statistically significant (P < 0.001). Conclusion: Knowledge of the study subjects on snake bite and its prevention is good, but still a large number of participants have inadequate knowledge on snake bite and its prevention. Community-based awareness program on prevention and management of snake bite, use of personal protective measures, and training of peripheral health workers ware specifically recommended.

Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes in Malaysia / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.@*Methodology@#ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline to end of study (EOS).@*Results@#Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.@*Conclusion@#Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.

A survey on factors affecting knowledge and satisfaction with care among persons with diabetes mellitus in an urban health centre and its outreach clinics in South India / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To determine the level of knowledge and factors affecting knowledge and satisfaction with diabetes care among persons with diabetes at urban health centre (UHC) and community health worker (CHW)-led outreach clinics (ORC) in South India.@*Methodology@#A cross-sectional study was carried out using a structured questionnaire. One hundred patients at the UHC and 200 patients at the ORC were included.@*Results@#Patients with DM of more than eight years, with co-morbidities and maintained on insulin had good knowledge at the UHC. At the ORC, participants who received education beyond the primary level and belonging to non - Hindu religion had higher knowledge. Patients at the ORC experienced better satisfaction in terms of waiting time for appointments, consultation, registration system and counselling. At the UHC, those who received primary education or those with lower educational attainment had better satisfaction. Overall, knowledge (p=0.03) and satisfaction (p=0.00001) of diabetes care was better at the ORC than at the UHC.@*Conclusions@#Our study found better knowledge and satisfaction with diabetes care at the ORC than at the UHC. Whether or not the difference can be attributed to CHW-based clinics in the community needs to be further elucidated.

Serum estradiol levels decrease after oophorectomy in transmasculine individuals on testosterone therapy / 亚洲男科学杂志(英文版)

Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.

Dermal cylindroma of the external auditory canal

ABSTRACT External auditory canal (EAC) cylindroma is a rare tumor that mainly presents as a painless mass over the lateral aspect of the ear canal. They have been designated under different nomenclatures in the literature, and controversies persist about their etiology and histogenesis. Moreover, a clinical diagnosis of EAC cylindroma is often challenging because of their rarity and a close resemblance with other adnexal benign and malignant tumors. None of the previous authors have extensively reviewed the dermal cylindroma of the EAC. We provide an extensive review involving PubMed and Google Scholar and report by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. A total of 8 cases are included in the current study. The mean age is 55.13 years. There are six females and two males. The left and right ear are involved in 62.50% and 37.50% of cases, respectively. The most common sign/symptom is painless mass (50%). Five authors reported a primary lesion (62.50%), while the remaining 3 reported a recurrent tumor (37.50%). Benign versus malignant cylindroma is reported in 87.50% and 12.50% of cases, respectively. All, except one case, reported a solitary swelling. Surgical excision was employed in all the cases. Primary defect closure versus defect closure with local/distant skin graft /flap is utilized in 37.50% and 62.50% of cases, respectively.

Dysthyroid optic neuropathy: Demographics, risk factors, investigations, and management outcomes

Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON). Methods: This is a retrospective, single?center study carried out on consecutive patients presenting with DON over a period of 4 years (2013–2016). The VISA classification was used at the first visit and subsequent follow?ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed. Results: Thirty?seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty?six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best?corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics. Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.