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The contemporary ideas about the interaction of gene polymorphism and environmental factors during the manifestation of autism spectrum disorders were discussed in this article. The screening tools were provided for assessing the development of a child, and both the provisional diagnosis of autism spectrum disorders by general practitioners and final procedure by a specia-lized doctor. The features of autism spectrum disorders in case of comorbid psychiatric disorders and general medical conditions were described. The article presents a model for the therapy of pervasive developmental disorders developed in the Ukrainian Research Institute of Social and Forensic Psychiatry and Drug Abuse, the features of using psychosocial interventions and drug treatment for comorbid psychiatric and neurological disorders.

PURPOSE Microbial keratitis is an urgent condition in ophthalmology that requires prompt treatment. This study aimed to apply deep learning algorithms for rapidly discriminating between fungal keratitis (FK) and bacterial keratitis (BK). METHODS A total of 2167 anterior segment images retrospectively acquired from 194 patients with 128 patients with BK (1388 images, 64.1%) and 66 patients with FK (779 images, 35.9%) were used to develop the model. The images were split into training, validation, and test sets. Three convolutional neural networks consisting of VGG19, ResNet50, and DenseNet121 were trained to classify images. Performance of each model was evaluated using precision (positive predictive value), sensitivity (recall), F1 score (test's accuracy), and area under the precision-recall curve (AUPRC). Ensemble learning was then applied to improve classification performance. RESULTS The classification performance in F1 score (95% confident interval) of VGG19, DenseNet121, and RestNet50 was 0.78 (0.72-0.84), 0.71 (0.64-0.78), and 0.68 (0.61-0.75), respectively. VGG19 also demonstrated the highest AUPRC of 0.86 followed by RestNet50 (0.73) and DenseNet (0.60). The ensemble learning could improve performance with the sensitivity and F1 score of 0.77 (0.81-0.83) and 0.83 (0.77-0.89) with an AUPRC of 0.904. CONCLUSIONS Convolutional neural network with ensemble learning showed the best performance in discriminating FK from BK compared with single architecture models. Our model can potentially be considered as an adjunctive tool for providing rapid provisional diagnosis in patients with microbial keratitis.

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers.

Objective The aim of this study was to study the incidence of preanalytical errors in the clinical chemistry laboratory attached to a tertiary care hospital. Design and Methods The study was conducted in a clinical chemistry laboratory using the samples and forms received for analysis. Five hundred random samples were analyzed using a predefined set of quality indicators (QIs) over a period of 3 months. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Statistical Analysis Individual QIs were assigned values as 0 and 1 and were used to assess each sample; 0 if the error was present, and 1 if absent. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Result Out of the 500 samples observed, 138 samples were error free, while 21 samples had the maximum number of errors, that is, 6. The error committed most often was the omission of provisional diagnosis being mentioned on the requisition form. No preanalytical error was observed for QIs: selecting the appropriate blood collection vial or storage of sample. Conclusion This study confirms that error rate in the preanalytical phase is high and vastly ignored. Errors committed here may be overlooked, given the large number of samples received in the clinical laboratory of a tertiary center. To reduce these errors, the laboratory should provide training to all workers involved in the preanalytical phase. Daily or weekly QI scores should be recorded to assess and rectify shortcomings, thereby improving patient care.

Objectives: The COVID-19 pandemic prevented people from accessing medical care in person; in such a scenario, telemedicine emerged as a boon. Telemedicine helped to increase the availability of homoeopathy during the pandemic. The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) formulated guidelines to enable registered homoeopathic practitioners (RHPs) to safely provide healthcare using telemedicine. In this study, we demonstrated the scope of telemedicine in homoeopathic practice by incorporating Hahnemannian principles in a case-based learning (CBL) module. Materials and Methods: A retrospective purposive study was conducted on 10 acute cases that were treated with homoeopathy through telemedicine during the COVID-19 lockdown. Patient-physician communications were analysed using Hahnemannian principles. Cases were assessed based on telecommunication application, type of consent, symptoms, signs, nosological provisional diagnosis, risk assessment, comorbidity, miasm and susceptibility status, totality of symptoms, repetition strategy and type of consult. Therapeutic management included building a logical framework of the case and auxiliary counselling. Patients were followed up to determine their health status. Results: All 10 cases were successfully treated with homoeopathy using AYUSH Telemedicine Practice Guidelines (ATPG) and incorporating Hahnemannian principles. Tele-homoeopathy was found to be effective in the pandemic by preventing disease spread and progression from mild to severe stage. Conclusion: Adhering to the ATPG and incorporating Hahnemannian principles can be effectively demonstrated through CBL modules; these enable RHPs to develop rational thinking and learn from clinical experiences.

Introduction Dermatologists play essential roles in providing dermatology consultations to inpatients admitted to hospital for care in another speciality ward. Data on dermatology consultations provided to inpatients admitted to general surgery wards are limited. The aim of this study was to analyze the reasons for and diagnoses of consultations provided by dermatologists to hospitalized patients in a general surgery ward and compare the provisional diagnoses by surgical residents and the final diagnoses by dermatologists. Methods Electronic health records were retrieved for patients admitted to a general surgery ward who received dermatology consultations while inpatients in Peking Union Medical College Hospital between 1 September 2015 and 31 August 2020. Sex, age, surgical diagnosis, reason for dermatology consultation, provisional diagnosis by surgical residents, and final diagnosis by dermatologists were reviewed. Results A total of 262 dermatology consultations for 251 patients (n = 251, 123 women and 128 men) were identified, of whom 240 (95.6%) required only one consultation and 11 (4.4%) required two. Dermatology consultations were classified into three categories: preoperative consultation (n = 45, 17.9%), postoperative consultation (n = 65, 25.9%), and consultation unrelated to general surgery diseases or treatments (including surgery) (n = 141, 56.2%). For consultations falling in the category preoperative consultation, common reasons for the consultation were: to evaluate whether the current treatment plan for previously diagnosed skin diseases needed to be changed; to evaluate and manage skin problems that emerged after admission; to evaluate syphilis; and to evaluate whether previously diagnosed skin diseases would affect surgical incision or wound healing. Drug eruption, dermatitis/eczema, infectious skin disorders, and urticaria were the most common skin diseases in the hospitalized general surgery patients. Only 32 (12.7%) provisional diagnoses were made, of which 25 (78.1%) were correct and seven (21.9%) were incorrect. Surgical residents mainly had difficulty distinguishing herpes zoster, drug eruption, and infectious skin disorders from dermatitis/eczema. Conclusion Our results facilitate the understanding of inpatient dermatology consultations in general surgery wards and may help in the design of future educational materials and/or management guidelines.

A pharyngeal hairy polyp (HP) is a rare benign mass that can be surgical detached with few complications. In this report, we describe a hairy polyp in a 7-day-old neonate presented with intermittent respiratory distress and feeding difficulties since birth. Neck computed tomography was performed, and demonstrated a well-defined pedunculated heterogeneous mass arising from the right lateral wall of the nasopharynx extending downward and nearly completely obstructing of the nasopharynx and oropharynx. The central part of the mass was found relatively dense surrounded by low attenuation fatty components with enhancement of the outer wall of the mass. The provisional diagnosis was pharyngeal HP. After autoamputation at the seventh day old, HP was analyzed via histopathology examination that showed a mixture of various ectodermal and mesodermal tissues including skin, cartilage, adipose and fibrous tissue. The patient fully recovered with no residual clinical features. We report this case to elucidate the possibility of this strange behavior of pharyngeal HP.

Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cated and uncomplicated acute appendicitis (AA) preoperatively. However there is a consid­erable difference in the cutoff values of NLR in different studies. This study aimed to establish a cutoff value of NLR to distinguish complicated AA from uncomplicated AA preoperatively at our center. Methods: This was a prospective observational study conducted over 2 years from January 2017 to December 2019 in the department of surgery, Chitwan Medical College Bharatpur. Patients with a provisional diagnosis of AA and undergoing appendectomy were included in the study. The difference in NLR between the two groups was compared by Mann-Whitney U-test. The predictive ability of NLR was estimated by the receiver operating characteristic (ROC) curve analysis. Results: One hundred eighty-eight patients were included in the study, 112 patients were males and 76 were females. Among them, 29.2% (n=55) were complicated AA. Median NLR was signifi­cantly higher in the complicated AA group compared to the uncomplicated group (6.90 vs 4.27, P

A 41-year-old female presented with diminished vision in both eyes with recurrent episodes of pain, redness, and watering. With a provisional diagnosis of primary angle-closure glaucoma in the left eye and primary angle closure in the right eye, anti-glaucoma medications were started in the left eye and laser peripheral iridotomy was done in both eyes. Follow-up showed patent iridotomy in both eyes and dilated fundoscopy revealed total cupping in the left eye. Next day, the patient had angle closure in the right eye. On medical management, symptoms subsided but intraocular pressure (IOP) was still raised. Right eye trabeculectomy with cataract surgery was done. Vision was restored to 6/9 with IOP of 12 mmHg after 2 weeks. The event was considered to be precipitated because of plateau iris configuration which is an anatomical variant of angle in angle-closure patients. This proves patent laser iridotomy is not always a ticket to dilatation and one should be aware of all possible complications.

Bacterial and viral infectious diseases are significant welfare concerns as they cause a range of clinical signs and mortality depending on the body system(s) affected and severity of the disease. Basic skills in the detection of the clinical signs in poultry and provisional diagnosis of the infectious disease is important for the immediate course of action that needs to be taken to eliminate or reduce the impact of the disease on bird’s welfare. Therefore, in this chapter, bacterial and viral diseases of laying hens (chickens) have been described on the basis of their clinical signs and lesions, as opposed to the classes of infecting bacterial or viral agents. Diseases causing sudden death, respiratory illness, ill thrift, diarrhoea, lameness or recumbency, and reduced egg production and quality are discussed.

Rhabdomyosarcoma (RMS) with regional lymph node involvement has a high rate of distant metastases. Lung is the most common site, accounting for 70% of all metastases. The differential diagnosis of lung lesions due to an infectious aetiology versus metastases is usually evaluated by computed tomography (CT) or magnetic resonance imaging. However, it is rare for patients of RMS to present with infectious nodules or masses in the lung during follow-up. More importantly, infections can mimic the imaging characteristics of metastatic RMS in CT. We report two such cases where children diagnosed with head and neck embryonal RMS with lymph node metastasis, presented with pulmonary masses 0.5 and 4 years after end of treatment, without the typical signs and symptoms suggestive of an infection. Chest CT suggested a provisional diagnosis of metastases and biopsies confirmed infectious aetiology (Mycobacterium tuberculosis, Cryptococcus).

Dermatology is a visual medical discipline which demands watchful eyes, profound knowledge of different morphologic patterns of various dermatoses, and extensive clinical experience. A meticulous cutaneous examination always helps in generating the close differential diagnoses and incorporation of past visual experience leads to a provisional diagnosis, obviating the need of further investigations in many cases. Although there is a wide spectrum of morphologic presentations, some dermatoses may have characteristic appearances such as cobblestoning, Peau d' orange, umbilication, and Christmas-tree pattern. Identification of these lesional characteristics or patterns can efficiently avoid the misdiagnosis and unnecessary diagnostic workup. In this article, skin diseases showing cobblestone appearances on both clinical and dermoscopic examination have been compiled and outlined in brief.

Introduction: Assessing the capabilities of ChatGPT-4.0 and ChatGPT-3.5 for diagnosing corneal eye diseases based on case reports and compare with human experts., Methods: We randomly selected 20 cases of corneal diseases including corneal infections, dystrophies, degenerations, and injuries from a publicly accessible online database from the University of Iowa. We then input the text of each case description into ChatGPT-4.0 and ChatGPT3.5 and asked for a provisional diagnosis. We finally evaluated the responses based on the correct diagnoses then compared with the diagnoses of three cornea specialists (Human experts) and evaluated interobserver agreements., Results: The provisional diagnosis accuracy based on ChatGPT-4.0 was 85% (17 correct out of 20 cases) while the accuracy of ChatGPT-3.5 was 60% (12 correct cases out of 20). The accuracy of three cornea specialists were 100% (20 cases), 90% (18 cases), and 90% (18 cases), respectively. The interobserver agreement between ChatGPT-4.0 and ChatGPT-3.5 was 65% (13 cases) while the interobserver agreement between ChatGPT-4.0 and three cornea specialists were 85% (17 cases), 80% (16 cases), and 75% (15 cases), respectively. However, the interobserver agreement between ChatGPT-3.5 and each of three cornea specialists was 60% (12 cases)., Conclusions: The accuracy of ChatGPT-4.0 in diagnosing patients with various corneal conditions was markedly improved than ChatGPT-3.5 and promising for potential clinical integration., Competing Interests: Conflict of Interest Mohammad Delsoz: None. Yeganeh Madadi: None Wuqaas M Munir: None Brendan Tamm: None Shiva Mehravaran: None Mohammad Soleimani: None Ali Djalilian: None Siamak Yousefi: Remidio, M&S Technologies, Visrtucal Fields, InsihgtAEye, Enolink

Molecular profiling was performed in 50 problematic ovarian sex cord-stromal tumours (SCSTs) most of which were seen in consultation. Following analysis, 17 were classified as adult granulosa cell tumour (AGCT), 16 of which showed a FOXL2 sequence variant (mutation); the initial favoured diagnosis in five of the cases was benign thecoma/fibrothecoma. Thirteen tumours ultimately classified as cellular fibroma or thecoma were FOXL2 sequence variant negative which was helpful in excluding AGCT. All six Sertoli-Leydig cell tumours (SLCTs) demonstrated DICER1 'hot spot' sequence variants, and one case each of AGCT and SLCT showed high grade histological transformation associated with a concurrent TP53 sequence variant. All eight unclassified SCSTs were negative for FOXL2 mutations and the six tested cases were DICER1 wild type; however, three tumours demonstrated MET, CTNNB1 or TP53 sequence variants. Four cases were classified as juvenile granulosa cell tumour, and one of these harboured a GNAS sequence variant. The single gynandroblastoma and microcystic stromal tumours in the series demonstrated FOXL2 and CTNNB1 alterations, respectively. In summary, molecular analysis aids in accurate classification of challenging ovarian SCSTs and sometimes leads to revision of the favoured provisional diagnosis. TP53 sequence variants may be associated with dedifferentiation in both SLCTs and AGCTs.

Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatologic disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis of skin and mucous membranes, resulting in exfoliation and possible sepsis and/or morbidity/mortality. Exact diagnosis of lesions is very important in terms of therapeutic intervention as well as outcome. As cutaneous hypersensitivity reactions are known to occur with increased frequency in connective tissue disease, differentiating lesions of systemic lupus erythematosus that simulate drug-induced TEN is a challenge in the practical scenario. In this case series, we discuss about three patients aged between 24 and 67 years, who presented with vesiculobullous lesions all over the body and oral mucosal ulcerations. Each of them was initially admitted in the Critical Care Unit with a provisional diagnosis of TEN. Two of the three patients recovered well and were discharged. However, the third patient, who was the oldest and had multiple comorbidities, could not be saved and succumbed after 75 days of hospital stay.

Due to unfavorable conditions for survival and multiplication of Mycobacterium tuberculosis, muscle and soft tissue involvement is probably the rarest form of presentation of musculoskeletal tuberculosis, particularly without a clinically or radiologically apparent primary focus. As in other extrapulmonary forms of tuberculosis, its relative incidence is higher among immunocompromised patients. A progressive swelling is the most common complaint at presentation, which is otherwise mild and nonspecific. We present a case of multifocal (seven) subcutaneous and muscular tuberculous abscesses in a 29-year-old Indian patient who had no apparent underlying risk factors, nor any other organ involvement. Provisional diagnosis was initially made upon Mycobacterium tuberculosis complex nucleic acid detection in an aspirate of one of the collections and later confirmed by a positive culture on Lowenstein-Jensen medium. Two abscesses required aspiration and two others drained spontaneously. The patient responded well to nine months of anti-tuberculous therapy. An extensive review of the literature was made. info:eu-repo/semantics/publishedVersion

BACKGROUND Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management. OBJECTIVE Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care. METHODS Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non-profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow-up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed. RESULTS The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0-439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P

Background and aim Cardiac sarcoma is a rare condition and may mimic atrial myxoma. We present a case report of a man with a cardiac sarcoma. Method Case report presentation. Results A 68-year-old man with a permanent pacemaker presented to us with a 4-month history of breathlessness. Echocardiography revealed a large right atrial mass adherent to the pacemaker lead and a provisional diagnosis of atrial myxoma was made based on echocardiographic appearance. A 60 x 30 x 30 mm irregular lobulated tumour was surgically resected from the right atrium. Upon histopathologic examination, the tumour was consistent with an undifferentiated pleomorphic sarcoma. Conclusion Cardiac sarcomas have an extremely poor prognosis and more unfortunately this man developed a surgical site infection and died of acute mediastinitis. We discuss the presentation, imaging and current surgical approaches to cardiac sarcoma. Curative treatment is currently limited for this disease.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in infancy, with a high risk of recurrence, and maybe an indicator of underlying urinary tract abnormality. It is often misdiagnosed due to irregular and unrelated symptomatology in the absence of directed screening. Objectives: The objectives of the study were to assess the feasibility of mid-stream clean catch method in infants for collecting a urine sample, compare the reliability of urinalysis in comparison with urine culture and to determine the prevalence of UTI among febrile infants in a rural setting. Materials and Methods: The study was conducted in a level-2 pediatric hospital involving 320 febrile infants attending the out-patient department from January 1, 2018, to June 30, 2018. Urine specimens were collected using midstream clean-catch urine (CCU) method and tested by urinalysis and culture. Results: Urine sample was successfully obtained by the CCU method in 320 (88.9%) out of 360 infants, of which only 8 (2.5%) showed contamination in culture. A total of 20 (6.25%) infants were culture positive for UTI. Only 14 (70%) of these showed positive urinalysis, while 17 (85%) of the culture-positive cases had a provisional diagnosis other than UTI. Further radiological examination revealed renal abnormalities in two out of six culture-positive infants who underwent subsequent studies. Conclusion: CCU method is reliable method for successful collection of urine and low contamination and can be used reliably in the absence of supra pubic aspiration/catheterization. Urinalysis lacks sensitivity in comparison with urine culture, necessitating the use of urine culture to diagnose/rule out UTI in infants. Culture-positive infants need to undergo a radiological examination to screen for abnormalities of the renal tract.

Catastrophic antiphospholipid antibody syndrome (CAPS) is a severe form of antiphospholipid antibody syndrome (APS) that sometimes represents the first manifestation of the later syndrome. The clinical manifestations of CAPS are relatively non-specific. Hence, the diagnosis may be delayed, resulting in high mortality. We herein present a case of a 40-year-old male who presented with rapid-onset renal failure, gangrene of finger and toe tips and hematological abnormalities with no underlying secondary cause for this complication. The symptoms were precipitated by febrile illness of short duration. A provisional diagnosis of CAPS was made and treatment instituted. With timely diagnosis and intervention, both the life of the patient and kidney function were salvaged. A high index of suspicion for CAPS is important as early treatment can be lifesaving.

Purpose Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices. Method In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback. Results Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future. Conclusions Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.

BACKGROUND Patients with a variety of neuromuscular pathologies may present with gait abnormalities. Accurate assessment of each pattern, coupled with appropriate investigations, facilitates diagnostic accuracy followed by treatment or referral, as required. OBJECTIVE This review outlines the relevant history and examination areas to assess when interpreting gait abnormalities, together with common gait patterns and their aetiologies. DISCUSSION A range of factors should be evaluated, including posture, walking aids and footwear. The gait cycle can be broadly divided into the stance and swing phases, and additional features are assessed to identify specific patterns and generate a provisional diagnosis. Gait examination, from the time the patient is called from the waiting room, will help the clinician focus on the relevant systems to examine, investigate and treat.

Background Generally, Diffusion-weighted MR imaging (DWI) is known to be more sensitive in diagnosis of acute stroke than other MR sequences. However, fluid attenuated inversion recovery (FLAIR) MR sequence founded to be sometimes more sensitive compared to DWI for the diagnosis of hyperacute stroke. Case presentation An 84 years old female patient brought to ER by ambulance due to loss of speech, dizziness and confusion. Neurological examination showed that the patient can raise her left hand and leg while partially moving her right hand and right leg. The patient had slurred speech. Provisional diagnosis was acute stroke and the patient admitted in the hospital. Non contrast CT scan of the brain was done, was negative for stroke. Then MRI was done showed no areas of restricted diffusion at the DWI sequence or ADC map. Prominent high signal vessels at the left temporal region and on Sylvian fissure were noticed on FLAIR sequence that might have suggested early sign of ischemic vascular insult. Conclusions Arterial hyperintensity on FLAIR images can precede diffusion abnormalities and may provide a clue to the early detection of impending infarction.

A nationwide survey assessed the prevalence and pandemic-related risk factors of major depressive disorder (MDD) at the initial onset of the COVID-19 pandemic. Findings showed a significant increase in the prevalence of MDD (22.7%) compared to the pre-pandemic 12-month estimate (10.4%). Specific pandemic-related concerns, along with significant increases in stress, loneliness, fatigue, and substance use behaviors are noted for those with the provisional diagnosis of MDD. Early screening and detection for potential MDD cases can reduce the severity and duration of maladaptive symptoms, decreasing the risk for future depression episodes and the potential loss of quality of life and productivity.

Paraganglioma of the urinary bladder is a rare neoplasm. It may be functional, secreting catecholamines, or nonfunctional. Clinically and histopathologically, it has the potential to be misdiagnosed as a more common urothelial carcinoma, especially in nonfunctional cases. A high index of suspicion on the part of pathologist can help in identification of characteristic histopathologic feature which coupled with immunohistochemistry can help in establishing the correct diagnosis. We present a case of paraganglioma in a 78-year-old male patient presenting with haematuria. Clinical provisional diagnosis rendered based on cystoscopic findings and radiology was urothelial carcinoma; however, was confirmed to be a case of paraganglioma of bladder on histopathological and immunohistochemical evaluation. A long follow-up is warranted. Herein, we also briefly review the relevant literature.

Rhinosporidiosis is an enigmatic entity and poses a major health problem in the developing countries of South-East Asia. A soft friable polypoid nasal mass is the most common presentation, while sparse literature is available on extranasal involvement. We describe the case of a 35-year-old female patient who presented with a slow-growing soft-tissue swelling with ulceration over the thigh. On clinical and radiological examination, a provisional diagnosis of soft-tissue neoplasm was made. After resection, histopathological sections showed a closely packed cyst with innumerable endospores. The present case report documents the rare occurrence of an incidentally detected cutaneous rhinosporidiosis causing diagnostic difficulty.

Vascular mesenchymal neoplasms of the female genital tract are extremely rare, of which cavernous hemangiomas of the uterine myometrium are uncommon. Only 60 cases have been documented in the world literature and we believe this is the fifth case to be reported in the Indian population. Here, we report a histologically diagnosed case of diffuse cavernous hemangioma of the uterine myometrium in a 40 year old lady, with a provisional diagnosis of adenomyosis. Pathological examination is the mainstay for the diagnosis of this condition. Keywords: Adenomyosis, Hemangioma, Myometrium, Uterus.

Lichen planus (LP) is an inflammatory dermatosis which can affect the skin, nails, and all mucous membranes, including the genitalia. Lichen planus on vulvar keratinized skin can manifest with diverse clinical features, probably due to higher temperature, PH, humidity, and bacterial flora which may modify typical cutaneous features. While lichen planus (LP) may affect the vulva in isolation, it may also be part of generalized outbreak in up to 20% cases. Herein, a case of a 53 year-old female who presented with a severely pruritic plaque over labia majora Since 6 -7 months, with no response to potent topical corticosteroids is reported. Provisional diagnosis of lichen simplex chronicus was considered however, histopathology was suggestive of hypertrophic lichen planus.

Leukoplakia is a potentially malignant disorder of the oral mucosa. It usually presents as a white patch in the oral cavity. The term leukoplakia represents a clinical entity and should preferably be used only for provisional diagnosis and not after histopathology. There are various terminologies and definitions associated with leukoplakia since past times. In this article, we have reviewed the literature to provide a comprehensive update on leukoplakia.

A 3-year-old boy with a reported history of road traffic crash 1 hour ago presented to the ED in an unconscious state. In view of poor GCS (E1V1M1), he was intubated and mechanically ventilated. His circulation was stable. Both pupils were dilated and sluggishly reactive to light. On secondary survey, minor bruises were present on the left side of the face. A provisional diagnosis of severe traumatic brain injury was made and immediate non-contrast …

Different aetiologies with various clinical presentations are evident in cases of gingival enlargement. We report a case of 34-year-old male who presented with the chief complaint of gingival overgrowth in upper and lower front teeth region. Patient was systemically healthy and gave no history of common medications known to cause gingival enlargement. He had a history of marijuana consumption for two consecutive years following which gingival swelling increased in severity. Based on clinical and histopathologic findings, provisional diagnosis of combined inflammatory + marijuana induced gingival enlargement was made. Treatment consisted of scaling and root planing followed by sextant wise gingivectomy. Results were stable until three months follow-up. Signs of inflammation were evident when the patient reported after 1.5 years. Keywords: Gingival enlargement; gingivectomy; marijuana.

Objective This study was conducted to analyse data from emergency ophthalmology referrals after-hours from different hospitals to identify the most common pathologies and compare accuracy of diagnoses. The primary objective was to identify common presenting entities and common causes of misdiagnosis in the emergency department to help guide education initiatives. Design This was a retrospective chart review that looked at consults occurring between September 1, 2015, and October 21, 2016. Methods Emergency ophthalmology consults were reviewed and the date, time, age, sex, and provisional diagnosis were recorded. Ophthalmic diagnosis was compared with provisional diagnosis to compare agreement rate. Diagnoses were categorized to determine most frequent etiologies presenting on an emergent basis. Results A total of 697 consults were reviewed. The most common consults by diagnostic category were anterior segment (36.4%) and posterior segment (27.4%) pathologies. Together, these categories accounted for over 60% of all consults. Agreement between provisional diagnosis and final ophthalmology diagnosis was 65.8%. Conclusions There was a reasonable agreement rate between referring services diagnosis and ophthalmology diagnosis. The retrospective nature of this study and use of categories to determine agreement are potential biases and the agreement rate may not reflect clinical practice. Most common diagnoses were similar to previous studies. The authors noted several diagnostic categories that could be targeted as areas for medical education to help increase recognition in the primary care setting and facilitate appropriate ophthalmic referral.

Aim To determine the incidence and severity of Post-Traumatic Stress Disorder (PTSD) in maxillofacial trauma patients and to assess the predisposing factors. Methods and results Post-Traumatic Stress Disorder (PTSD) was assessed as per the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The PTSD checklist for DSM-5 (PCL-5), was used initially to screen patients for PTSD for a provisional diagnosis. These provisionally diagnosed patients were then subjected to a structured interview by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The PTSD status outcome of PCL-5 and CAPS-5 were correlated. PTSD was compared among patients with different types of facial fractures/injuries and also compared based on their anatomic location. The reliability of PCL-5 scale in relation to the structured CAPS-5 was assessed and the specificity was found to be 71.4%. Patients with both aesthetic and functional deformity exhibited greater severity of injury and showed higher incidence of PTSD with higher conversion rate from the 1st month to 3rd month. The frequency of PTSD in deformities with higher severity like zygomaticomaxillary complex injuries was found to be statistically significant. Conclusion A high incidence of PTSD is associated with maxillofacial trauma and early detection is essential.

A case report of gingival metastasis of uterine cervical adenocarcinoma is discussed. The oral metastases are usually seen in the advanced stage of the disease. The diagnosis of such lesion poses a challenge to the clinician and pathologist. In the present case, the provisional diagnosis was non-specific conditioned gingival enlargement. Histopathologically the biopsy tissue revealed a metastatic adenocarcinoma. The tumor cells showed diffuse positivity to CK7 and mCEA, focal positivity to p16INK4A and negativity to CK20, ER and vimentin. The patient had a very poor prognosis and succumbed to it within a very short duration of one month.

Frontal-orbital-ethmoid mucocele is a slow-growing retention cyst of the fronto-ethmoid complex secondary to blockage of the sinus ostia. It may produce significant disfigurement of the periorbital region necessitating surgical intervention. Prior to surgery, it is imperative to study the mucocele's extent through the variable patterns of ethmoid pneumatization as evident from clinical, imaging (computed tomogram) and endoscopic evaluation. This is illustrated in a case study of a 41-year-old woman presenting with fullness below the right eyebrow, progressive proptosis, and gaze restriction. The provisional diagnosis of frontal-orbital-ethmoid muco(pyo)cele was confirmed at endoscopic surgery, when it was drained and marsupialized through ethmoidectomy and frontal sinusotomy. Understanding the relationship of an enlarging mucocele with the inconsistent pattern of ethmoid pneumatization is the primary determinant for an uneventful and complete surgery, and to minimize recurrence. The gradually expanding mucocele occupies the path of least resistance and encroaches into the available spaces of ethmoid labyrinth, distorting key anatomic landmarks and making surgical intervention potentially challenging. Thus, preoperative imaging corroborated with naso-endoscopy is of paramount importance to trace the lesion along ethmoid pneumatization, and determine the relative positions of structures vulnerable to surgery. This often requires a comparative study of the contralateral side because the mucocele generally obscures the pneumatization pattern and vital landmarks on its side. The present imaging tutorial studies the extent of a large frontal-orbital-ethmoid mucocele through interpretation of multiplanar computed tomography cuts, keeping in mind the unpredictable nature of its expansion as a function of the highly individualistic ethmoid pneumatization. Keywords: Frontal-orbital-ethmoid mucocele, Ethmoid pneumatization, Computed tomography scan, Lateral sinus of Grünwald, Supra-orbital cell, Anterior ethmoid artery

Cementoblastoma is a rare benign odontogenic neoplasm of jaws mostly occurring in younger age group. Here, we present a case of swelling associated with deciduous second molar. Based on the clinical and radiographic features, a provisional diagnosis of cementoblastoma was made. The lesion was surgically removed along with the associated tooth and confirmed as cementoblastoma histopathologically. A 1-year follow-up showed no recurrence.

Aim Giggle incontinence is a distinct entity of childhood daytime urinary incontinence (DUI), where children wet themselves only when they laugh. The prevalence of true giggle incontinence is unknown, with confusion about the diagnosis of urinary incontinence occurring during laughter and true giggle incontinence. The aim of the study is to improve our understanding of urinary incontinence during laughter by comparing those children with children who have DUI at other times, but not with laughter. Methods We conducted a retrospective medical record review of children with DUI who presented to a tertiary continence service from 2017 to 2018, collecting data on age, gender, associated comorbidities, lower urinary tract symptoms, investigations, provisional diagnosis at first visit and initial treatment responses. Differences between those with DUI occurring during laughter and those with DUI at other times, but not with laughter were compared using standard statistical methods. Results Of the 277 new patients seen during the study period, 140 (51%) had DUI, and of these, 72 (51%) had DUI occurring during laughter. Children with incontinence occurring during laughter were more likely to have incontinence associated with other activities. One child had giggle incontinence according to the International Children's Continence Society's definition. Four other children were referred specifically for urinary incontinence associated with laughter, with the term giggle incontinence sometimes used by the referring doctor. Conclusion Children with DUI commonly experience incontinence during laughter, but true giggle incontinence is rare. Correct diagnosis is essential as it directs treatment.

Melioidosis is an infectious disease most commonly found in places with tropical climates. Definitive diagnosis can be confirmed by culture or pathological results of blood or infected organ. However, imaging study is helpful in providing early provisional diagnosis and guiding therapy. Point-of-care ultrasound can be currently performed bedside by non-radiological staff such as emergency physicians or intensivists. We present the case of a pediatric patient who got diagnosed with melioidosis after detection of multiple splenic and hepatic abscesses by point-of-care ultrasound, leading to early diagnosis and appropriate empirical antibiotic selection, resulting in good treatment outcome.