Role of the Cerebellum in Bipolar Disorder: A Systematic Literature Review.

The aim of this systematic literature review was to investigate the role of the cerebellum in the affective symptoms observed in patients with bipolar disorder. The present systematic literature review included clinical studies conducted from 2013-2023 among adult populations with bipolar I and II disorders, along with their specifiers. With regard to cerebellar pathology, it was found that those with bipolar disorder performed worse than their healthy counterparts in their ability to comprehend the mental states of others and in identifying negative mental states. Additionally, individuals with bipolar disorder had reduced gray matter loss in regions such as lobules I-IX, crus I, and crus II, different functional activation patterns of the thalamus, striatum, and hippocampus on functional magnetic resonance imaging (fMRI), and increased cortical thickness. Cerebro-cerebellar functional connectivities were altered in patients with bipolar disorder. The effects of lamotrigine and lithium on cerebellar volume and abnormalities are also discussed in this paper. The present systematic literature review illustrates the emerging involvement of the cerebellum in bipolar disorder and its affective symptoms and paves the way for future research and a better understanding of bipolar disorder.

Framework and Overview of a State-Wide College Mental Health Program in Kerala, India.

Background: Mental health issues are common among college students, and structured services have been proven to enhance outcomes. Despite increased enrolment for higher education in India, college mental health services remain sparse. JEEVANI is the first structured state-wide college mental health service in India. This paper describes its framework and provides an overview of its functioning during the initial five months. Methods: In 2019-2020, the Directorate of Collegiate Education, Government of Kerala, implemented the program in 66 colleges catering to approximately 60,000 students. Qualified counsellors were trained to identify issues and provide interventions and early referrals, using a stepped-care approach. They conducted awareness programs to promote mental health and reduce stigma. Results: The services were accessed by 2,315 students during the assessment period (October 2019 to February 2020). The beneficiaries were predominantly females (54.1%). Over a third (38.8%) belonged to the lower socio-economic strata, and 2.5% had significant vulnerabilities. Although no syndromal diagnoses were made, anxiety and depression were the most common presentations. The counsellors provided 3,758 individual sessions and facilitated support for students who reported academic difficulties or interpersonal issues. Severe mental illness was detected in 54 students, and referrals for specialist mental health input were initiated in 68. Conclusion: Describing the framework, sharing the technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions in low- and middle-income countries to consider similar projects.

Mediastinal parathyroid adenoma removal by video-assisted thoracoscopic surgery.

Ectopic parathyroid adenomas in the mediastinum are rare causes of primary hyperparathyroidism. We report two cases of mediastinal parathyroid adenoma. Functioning parathyroid lesion was localized with the help of nuclear single-photon emission computed tomography scan in both the patients. Video assisted thoracoscopic surgical (VATS) removal of the parathyroid lesions were done. Intraoperative confirmation of parathyroid adenoma was done by frozen section. Further confirmation was done by routine histopathological examination of specimen postoperatively. One patient had left vocal cord paralysis postoperatively. Localization by functional imaging is essential. Minimally invasive methods such as VATS are useful in removing mediastinal parathyroid hyperfunctioning lesions, which carries early postoperative recovery and less complications.

Résumé Les adénomes parathyroïdes ectopiques dans le mediastinum sont des causes rares de l'hyperparathyroïdie primaire. Nous rapportons deux cas d'adénome parathyroïde mediastinal. La lésion parathyroïde de fonctionnement a été localisée avec l'aide du balayage nucléaire de SPECT dans les deux patients. L'enlèvement thoracoscopic aidé vidéo de chirurgie (VATS) des lésions parathyroïdes ont été faits. La confirmation intraopératoire de l'adénome parathyroïde a été faite par section gelée. Une confirmation supplémentaire a été faite par l'examen histopathologique courant du spécimen post opératoirement. Un patient avait laissé la paralysie de corde vocale postopératoirement. La localisation par imagerie fonctionnelle est essentielle. Les méthodes mini-invasives telles que le VATS sont utiles pour enlever les lésions de fonctionnement hyper-médiantinal, qui portent le rétablissement postopératoire tôt et moins de complications.

Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade.

CONTEXT: Assessment of individual sonographic features provides vital clues about the biological behavior of breast masses and can assist in determining histological grade of malignancy and thereby prognosis. AIMS: Assessment of individual sonographic features of biopsy proven invasive ductal breast carcinomas as predictors of malignancy grade. SETTINGS AND DESIGN: A retrospective analysis of sonographic findings of 103 biopsy proven invasive ductal breast carcinomas. MATERIALS AND METHODS: Tumor characteristics on gray-scale ultrasound and color flow were assessed using American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) Atlas Fifth Edition. The sonographic findings of masses were individually correlated with their histopathologic grades. STATISTICAL ANALYSIS USED: Chi square test, ordinal regression, and Goodman and Kruskal tau test. RESULTS: Breast mass showing reversal/lack of diastolic flow has a high probability of belonging to histological high grade tumor (ß 1.566, P 0.0001). The masses with abrupt interface boundary are more likely grade 3 (ß 1.524, P 0.001) in comparison to masses with echogenic halos. The suspicious calcifications present in and outside the mass is a finding associated with histologically high grade tumors. The invasive ductal carcinomas (IDCs) with complex solid and cystic echotexture are more likely to be of high histological grade (ß 1.146, P 0.04) as compared to masses with hypoechoic echotexture. CONCLUSIONS: Certain ultrasound features are associated with tumor grade on histopathology. If the radiologist is cognizant of these sonographic features, ultrasound can be a potent modality for predicting histopathological grade of IDCs of the breast, especially in settings where advanced tests such as receptor and molecular analyses are limited.

Antithyroid Peroxidase Antibodies in Women with Polycystic Ovary Syndrome.

OBJECTIVE: To find the prevalence of thyroid autoimmunity in PCOS women of reproductive age group. METHODS: Study design: Observational study was done at ESIMC and PGIMSR K.K. Nagar March 2013-Feb 2014. Ninety cases of women with PCOS based on Rotterdam's criteria and an equal number of age-matched controls (women without PCOS) were included in the study. Thyroid profile, antithyroid peroxidase titre, serum progesterone, testosterone and fasting blood sugar were estimated using standardised techniques. RESULTS: Menstrual irregularity (oligomenorrhoea and amenorrhoea) was the most common abnormality found in patients with PCOS compared with non-PCOS (p < 0.0001). Hyperandrogenism was the second most common manifestation present in PCOS of our study group. Hirsutism was the striking hyperandrogenic feature that was present in study group. PCOS patients had higher BMI compared to controls (p < 0.0001). The prevalence of thyroid dysfunction was not significantly different in both the groups (p < 0.80). Anti-TPO titre was higher in PCOS patients (25.8 ± 2.9 IU/ml) compared to the controls (14.5 ± 2.3 IU/ml) (p < 0.009). CONCLUSION: The present study shows that PCOS was associated with increased anti-TPO titres, thus emphasising the importance of screening all PCOS patients for anti-TPO along with routine thyroid profile.

CHAOS: Prenatal imaging findings with post mortem contrast radiographic correlation.

Congenital high airway obstruction syndrome is a rare fetal anomaly with characteristic constellation of prenatal findings on ultrasound and MRI. The typical triad of imaging features are enlarged and echogenic lungs, flattening or inversion of diaphragm and fetal hydrops. Early prenatal recognition of congenital high airway obstruction syndrome by ultrasound and/or MRI is mandatory for the appropriate perinatal management. We report a case of a male fetus with typical imaging findings of congenital high airway obstruction syndrome on ultrasound and MRI at 19 weeks of gestation. The role of contrast radiographs of fetal airways, including retrograde laryngogram, in confirming the postnatal diagnosis of this fetal condition is demonstrated. The prenatal imaging findings were correlated with contrast radiographs of upper airways, sonography of aborted fetus and fetal autopsy findings.

A Case of Erythroderma Secondary to Hypereosinophilia.

Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterised by marked peripheral eosinophilia and end organ damage attributable to eosinophilia without secondary cause. Early recognition and treatment are essential to prevent morbidity and mortality. Cytoreduction with Steroids, Hydroxyurea and Imatinib are the main stay of treatment. Molecular studies like Fip1-like-1 fused with platelet derived growth factor receptor alpha (FIP1L1-PDGFRα) etc., are recommended in view of therapeutic implication. In this paper we report a rare case of HES developing in a lady 6 months after surgical removal of lymphangioma of spleen, which in itself is rare.

Skin to serosa: scar endometrioma.

Extra pelvic endometriosis, an underappreciated and misdiagnosed gynaecological problem has been reported here for its rare location. Patient presented with swelling and cyclical pain over vertical scar (caesarean). Diagnosis was made on high index of clinical suspicion which was complimented by Magnetic Resonance Imaging (MRI). Scar endometrioma extended from the skin upto the uterine serosa which is extremely rare. Wide excision of endometrioma followed by mesh repair was done. Histopathology confirmed the diagnosis.

Endoscopic Removal of Granular Cell Tumors of Stomach: Case Report and Review of Literature.

Gastrointestinal granular cell tumors (GCTs), usually benign, soft-tissue tumors, are thought to arise from Schwann cells that may occur at many sites. Only 5-7% of these lesions are detected in the gastrointestinal tract. Histologically, it is composed of sheets or nests of plump round or polygonal cells having abundant slightly amphophilic granular cytoplasm with centrally located uniform pyknotic nuclei and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. In this study, we reported a case of a solitary GCT of the stomach that was completely removed after endoscopic submuscosal resection.

A case of primary extraosseous penile osteosarcoma and review of the literature.

Primary extraskeletal osteosarcoma of the penis (ESO) is a very rare condition. As per our knowledge, this is the seventh reported case in the world literature. We report a case of primary ESO of the penis in a young male, which was treated with surgery and adjuvant chemotherapy. This case is presented for its rarity and the scarcity in the literature regarding its treatment and prognosis.

Morphological evidence for a probable secretory site of the male sex pheromones of Nauphoeta cinerea (blattaria, blaberidae). 2. electron microscope studies.

Light and electron microscopy of the glandular epithelium of intersegmental membranes between sternites three and seven and tergites two and eight of various age groups of Nauphoeta cinerea male adults and one age group of female adults discloses differences in the epithelia of the intersternite and intertergite. The intersternal epithelium appears thicker, more glandular, and stratified. Altogether, seven cell types are recognizable, six in the male and two in the female. They are designated as types 1, 2a, 2b, 2c, 3, 4, and 5. Of these, types 1, 2a, 3, and 4 are recognizable on the sternum; types 1, 2b, and 5 on the tergum of the mature male integuments. Types 1 and 2c are found on the sternum of mature female. The cell types undergo morphological differentiation after adult emergence and show different stages of secretory activity. Type 1 are squamous cuticle-secreting cells; type 2a, 2b, and 2c are columnar-glandular and contain electron-transparent secretory vesicles of various sizes, which increase greatly in number and size in the 5-day-old adult males when the glands are most active. The vesicular size and number also differ between types 2a, 2b, and 2c cells of the same age group. The vesicles are assumed to be derived from smooth endoplasmic reticulum. The type 2 gland cells are also provided with a secretory end apparatus lined by cuticle and bordered by microvilli through which the secretion is believed to be released by exocytosis. The end apparatus leads into a cuticular ductule that opens to the surface of the cuticle as a cup-shaped receptacle, which is more conspicuous in the male intersternite. In the active gland cells, the mitochondria near the end apparatus are swollen and vacuolated. Type 3 cells are seen only on the intersternum and are believed to secrete the cuticular ductule that proceeds from the end apparatus. Type 4 cells are also recognizable only on the male intersternum and contain closely packed, electron-dense bodies, which are most numerous in mature (5-day-old) males. Type 5 cells with their dense cytoplasm are located basally in the intertergal epithelium. The functional significance of type 4 and 5 cells in the males and type 2c cells in the female is not clear. On the basis of differences in morphology, pheromone activity, and sexual behavior, it is suggested that the pheromones secreted by the intersternal and intertergal glands in the male are different, the former secreting a seducin that attracts the female to the male and the latter an "aphrodisiac" acting as a contact pheromone important in accomplishing mating.