Carneous mole in a depressed patient: a diagnostic dilemma

Carneous mole is a pathological variant of missed abortion of a fetus less than 12 weeks. It’s medically managed by giving repeated doses of misoprostol with or without dilatation and curettage. Due to ambiguity in diagnosis and misleading clinical examination and investigations, surgical exploration was considered as the best approach. The case of carneous mole with depression is reported because of its rarity; as in this case, ammenorrhea was the only presenting complaint and all other laboratory tests, investigations and radiological report failed to detect carneous mole, which was diagnosed incidentally on exploratory laparotomy

Recurrent hydatidiform mole transformed into invasive mole with co-morbid depression- a rare case report

The gestational trophoblastic disease is a group of interrelated lesions that arise from abnormal proliferation of placental trophoblast. It comprises of hydatidiform mole (partial or complete), invasive mole, placental site trophoblastic tumor and choriocarcinoma. The occurrence of hydatidiform mole in more than two conceptions is known as recurrent hydatidiform mole. Although, its incidence is less than 2% but it may progress to invasive mole or choriocarcinoma. The case of 26-year old female is reported; she had five consecutive molar pregnancies and the sixth one developed into invasive mole with co-morbid depression that was managed by methotrexate chemotherapy, antidepressant and psychotherapy.

Pramipexole with leuprolide: a treatment strategy for PGAD

Persistent genital arousal disorder (PGAD) is described as the spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. Whether, its etiology is central or peripheral neurovascular in nature, it is still unclear. However, patient presents with symptoms of persistent engorgement of genital erectile and vascular tissue. The majority of women report PGAD as distressing. The symptoms usually occur in females in the age group 25-58 years especially in perimenopausal phase. The case is reported of PGAD in 19-year old female who was treated successfully with Pramipexole and Leuprolide

Psychiatric morbidity in newly diagnosed carcinoma cervix and its comparison with benign condition

Background: To study the psychiatric morbidity among newly diagnosed carcinoma cervix and its comparison with benign gynaecological diseases of cervix. Cervical cancer is the second most common cancer in the world and ranked first in India. It is mainly caused by sexually transmitted infection (STI) of human papilloma virus (HPV).Methods: It was an open labeled, cross-sectional and extended phase study that screened 158 patients in the age group of 18-70 years who fulfilled both inclusion and exclusion criteria and screened positive on liquid based cytology (LBC), as per guidelines of Bathesda system in Government Medical College, Patiala. 13 patients dropped out of study and finally 145 patients were enrolled. They were further divided after biopsy into two groups as per histopathological examination (HPE) i.e., Group-1, N=47 women HPE positive for cervical intraepithelial neoplasia (CIN) as Cases and Group-2, N=98 HPE negative as Control Hospital Anxiety Depression Scale (HADS) was used to screen psychiatric morbidity for depression and anxiety. Whereas, severity was assessed on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A).Results: Mean age of Group-1 was 38.45±11.22 SD years and Group-2 was 36.67±8.54 SD years. Psychiatric morbidity in Group-1 was 65.95% whereas Group-2 was 21.42%. P value obtained on comparing HADS score of two groups was significant (p <0.050). After active intervention there was a significant reduction in psychiatric morbidity of two groups (72% in Group-1 and 81.3% in Group-2).Conclusions: The study revealed that the breaking of bad news has a significant psycho-social impact on patients suffering from carcinoma cervix than benign group

Venlafaxine induced hepatotoxicity in a carcinoma of breast survivor with co-morbid depression

Drug Induced Liver Injury (DILI) is one of the leading causes of liver damage worldwide and raises concerns about its prescription in lieu of the limited drug options available for the depression. Venlafaxine (VEN) is an antidepressant with dual neurotransmitter receptor modulations i.e., serotonin and norepinephrine reuptake inhibitor (SNRI) and having an additional benefit in management of vasomotor symptoms especially in menopausal patients where hormone replacement therapy (HRT) is contraindicated. VEN induced hepatotoxicity have been reported to occur in less than 1% of patients. Until now, less than 11 cases of VEN-related liver injuries have been reported in literature. We hereby, report a rare case of VEN induced liver injury in a 40-year-old breast cancer survivor with co-morbid depression

Pemphigus vulgaris in pregnancy with transient neonatal pemphigus - can psychological stress be culprit?

Pemphigus vulgaris (PV) is a rare life threatening, autoimmune bullous disease affecting mucous membrane and skin. Pregnancy and emotional stress may be the possible triggering factors for PV. It is a very rare phenomenon with less than 27 cases of pregnancy induced PV and only 9 cases of neonatal pemphigus reported in literature. The lesions may appear transient in neonate which resolve spontaneously over 2-3 weeks. We hereby, report a case of 26-year-old female who developed PV in second trimester of pregnancy with peripartum depression, which was managed by intravenous, oral and topical steroids and selective-serotonin reuptake inhibitor (SSRI). Furthermore, the development of transient neonatal pemphigus raises the possibility of genetic linkage from maternal to fetal transmission

Microinvasive squamous cell carcinoma of uterine cervix with superficial spread to endometrium: a rare case report

Microinvasive squamous cell carcinoma of uterine cervix is defined as carcinoma with invasion of less than 5 mm penetration of the stroma. The spread to uterine corpus occurs rarely, but on lateral spread it involves parametrium and deep myometrium via lymphatic dissemination. Less than 30 cases are reported in literature of superficial spread of microinvasive carcinoma of cervix. We report a case of microinvasive squamous cell carcinoma of cervix with metastasis to uterine corpus due to superficial spread

Evolution of arboreality and fossoriality in squirrels and aplodontid rodents: Insights from the semicircular canals of fossil rodents

Reconstructing locomotor behaviour for fossil animals is typically done with postcranial elements. However, for species only known from cranial material, locomotor behaviour is difficult to reconstruct. The semicircular canals (SCCs) in the inner ear provide insight into an animal's locomotor agility. A relationship exists between the size of the SCCs relative to body mass and the jerkiness of an animal's locomotion. Additionally, studies have also demonstrated a relationship between SCC orthogonality and angular head velocity. Here, we employ two metrics for reconstructing locomotor agility, radius of curvature dimensions and SCC orthogonality, in a sample of twelve fossil rodents from the families Ischyromyidae, Sciuridae and Aplodontidae. The method utilizing radius of curvature dimensions provided a reconstruction of fossil rodent locomotor behaviour that is more consistent with previous studies assessing fossil rodent locomotor behaviour compared to the method based on SCC orthogonality. Previous work on ischyromyids suggests that this group displayed a variety of locomotor modes. Members of Paramyinae and Ischyromyinae have relatively smaller SCCs and are reconstructed to be relatively slower compared to members of Reithroparamyinae. Early members of the Sciuroidea clade including the sciurid Cedromus wilsoni and the aplodontid Prosciurus relictus are reconstructed to be more agile than ischyromyids, in the range of extant arboreal squirrels. This reconstruction supports previous inferences that arboreality was likely an ancestral trait for this group. Derived members of Sciuridae and Aplodontidae vary in agility scores. The fossil squirrel Protosciurus cf. rachelae is inferred from postcranial material as arboreal, which is in agreement with its high agility, in the range of extant arboreal squirrels. In contrast, the fossil aplodontid Mesogaulus paniensis has a relatively low agility score, similar to the fossorial Aplodontia rufa, the only living aplodontid rodent. This result is in agreement with its postcranial reconstruction as fossorial and with previous indications that early aplodontids were more arboreal than their burrowing descendants

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts