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Background Neutrophilic dermatosis of the dorsal hands is an uncommon localised variant of Sweet syndrome first described in 1995. It is characterised by tender erythematous plaques, pustules and bullae on the dorsa of the hands. Literature Review A total of 123 cases of NDDH are included in this review. The mean patient age was 62.1 years and there was a slight female preponderance. 78.0% of cases had reported bilateral involvement and other sites were affected in almost a third of cases. Underlying disease was found in around 40% of patients, with the most common associations being haematological disorders (gammopathies, myelodysplasias or malignancies), recent infection, solid organ tumours and inflammatory bowel disease. Systemic and/or topical corticosteroids were employed in the treatment of 88.1% of cases while dapsone, colchicine and tetracyclines were the commonest steroid-sparing agents used. Improvement was often rapid and complete resolution the norm. Conclusions Whilst being uncommon, NDDH is frequently misdiagnosed and thus, its exact prevalence is probably underestimated. This may have significant implications including treatment delays or incorrect management. Moreover, recognition of NDDH is important since a correct diagnosis should trigger a search for underlying diseases and proper treatment with corticosteroids and/or steroid-sparing agents which is almost invariably curative.

Background Surgical treatment of ophthalmic segment aneurysms (OSAs) remain challenging because of complex anatomy surrounding the aneurysm and entails extensive drilling of anterior clinoid process to define proximal neck of the aneurysm and carotid exposure in the neck for proximal control. Materials and Methods Authors present a retrospective analysis of 36 aneurysms in 35 patients with OSAs operated surgically by first author. Surgical clipping was done for the aneurysms as primary modality of treatment along with wrapping and trapping as required. Results Commonest age group was 40 to 60 years with female preponderance of 3:1. Maximum (23) patients presented with subarachnoid hemorrhage (WFNS Gr 1), followed by asymptomatic patients (six). There were 18 small, 14 large, and four giant aneurysms, 15 dorsal wall, 17 ventral wall, three proximal posterior wall, and one blister aneurysm. Good outcome, as measured by Glasgow Outcome Score (GOS) was achieved in 29 patients. Conclusion OSAs are technically demanding aneurysms, but with due diligence to surgical principles, good outcomes may be obtained.

Objective To explore the reflective capacity as a learning tool in pediatric residents. Study design Survey. Place and duration of study The Children's Hospital Lahore, Pakistan from 20th March to 30th March 2021. Methodology In this cross sectional online survey, the participants were postgraduate residents and registrars of Paediatric Medicine, Paediatric Surgery, and Paediatric Diagnostics, working at The Children's Hospital, Lahore, Pakistan. Reflective practices questionnaire (RPQ) was used for measuring the reflective practices and SPSS-24 for data analysis. Results Out of a total of 175 study participants, 144 (82.3%) were paediatric medicine residents followed by paediatric surgery 18 (10.3%) and paediatric diagnostic 13 (7.4%) with a slight female preponderance 91 (52%). All years of trainees participated; majority was 4th year trainees 58 (33.1%), and 1st year the lowest 17 (9.7%). The overall mean score of the questionnaire was 69.97 ± 10.79 (95% CI: 68.36 ± 71.58) out of 96 total score. The highest score was of critical appraisal 18.52 ± 3.16 (95% CI: 18.04 ± 18.99) out of 24. There was no difference in mean score of different sub-domains and mean scores based on gender, specialty or year of training (p=>0.05). Conclusion The overall reflective capacity of paediatric postgraduate residents is good irrespective of specialty, gender or year of training. Critical appraisal of interaction in the reflection is the highest scored domain. Key Words: Postgraduate, Residents, Medical education, Reflection, Practice, Learning tool.

Background Although atopic dermatitis (AD) is becoming a pressing public health concern in the world, Madagascar is underrepresented in the AD literature. Objective We aimed to study the demographic and clinical pattern of AD in adult dermatology outpatients. Methods A cross-sectional study was conducted in the Department of Dermatology, University Hospital, Antananarivo, Madagascar. Patients >15 years old with a registered diagnosis of AD, from January 2010 to February 2019, were included. AD was diagnosed by a dermatologist according to Hanifin and Rajka criteria. The severity of AD was assessed using scoring atopic dermatitis (SCORAD). Results Forty-two cases of AD were included. The prevalence was 0.5%. The median patient age was 37 years. The age of onset of AD was before the age of 15 years in 38% of the patients and after the age of 15 years in 61.9% of the patients. There was a female preponderance (female to male ratio, 2:1), but no correlation was found between sex and the severity of AD. People living in urban areas were the most affected. According to SCORAD, 37 cases presented moderate AD and 2 cases presented severe AD. Conclusion The prevalence of AD in adult dermatology outpatients is still low, and moderate AD is the most frequent form, according to SCORAD.

Introduction Coronavirus disease 2019 (COVID-19) is an emerging infection and quickly disseminated around the world. This article studies the epidemiology and early transmission dynamics of COVID-19 in Karnataka, which would be useful for effective epidemic management and policy formulation. Materials and Methods All COVID-19 cases reported in the state of Karnataka, India, till June 12, 2020, are included in the study. The epidemiology and transmission dynamics of COVID-19 in Karnataka is studied through descriptive statistical analysis. Results The findings illustrate a gender-, age-, and region-based disparity in the susceptibility and fatality. There appears to be a male preponderance in the susceptibility, but a female preponderance in fatality. It is also found that the adults are more susceptible to the infection, while the elderly have the risk of high fatality. Further, infected individuals in the region with urbanization have a higher risk of fatality than other regions. The study shows that the chances of recovery for females are lower than males, and further, the chances of recovery are positively related to the age of the infected person. The chances of recovery are higher if the infected individual is younger and they diminish if the individual is older. The study also explores that the chances of recovery are affected by the patient’s geographical location. It is also noted that individuals who returned from foreign travel have better chances of recovery than the locally transmitted individuals. Conclusion Though the risk of susceptibility to COVID-19 infection is equal to all, the burden of getting infected and the burden of fatality is unequally distributed among different demographic categories. To manage the contagious spread of epidemic, to reduce fatality, and to increase the chances of recovery, targeted policy actions are suggested to benefit the vulnerable demographic categories.

Introduction Emphysematous pyelonephritis is a rare, severe acute necrotizing infection characterized by the presence of gas within the renal parenchyma, collecting system, and perirenal tissue. It is an aggressive disease with high morbidity and mortality. Patients have female preponderance and commonly have uncontrolled diabetes. It is caused most commonly by Escherichia coli and very rarely by Candida species. Unlike others, candidal emphysematous pyelonephritis has an indistinctive presentation and diagnosed late, thus delaying prompt treatment. Case presentation A 35-year-old Type 2 diabetic woman developed pyelonephritis. Computerized tomography revealed the gas in the renal parenchyma, establishing the diagnosis. Cultures isolated Candida albicans as a causative organism. The patient was treated successfully with nephrectomy as initial medical therapy and percutaneous nephrostomy failed. Conclusion Rare causative agent should be suspected if clinical presentation is indistinctive and conservative management fails. Nephrectomy is still preferred in such patients.

Background Meningiomas are a group of neoplasms showing a spectrum of histopathological variants, mostly corresponding to World Health Organization (WHO) grade I. However, certain histologic variants correspond histologically to WHO grades II and III. In this study, the histopathological spectrum of the meningiomas received in our department over the past 10 years is being revisited, with the aim to analyze the various histopathological variants, in order to assess their grade as per WHO 2016 criteria and also assess their epidemiology and localization. Materials and Methods A retrospective analysis of the histopathology records and clinical case files was done in 302 cases of histopathologically diagnosed cases of intracranial/intraspinal meningiomas (WHO grade I, II and III) received over a period of 10 years in our department. Hematoxylin and eosin (HE) staining was done for histological typing and grading of the tumors, and the cases were analyzed as per WHO 2016 criterion. Age and sex distribution along with the localization of the 302 cases was also analyzed. Results Among these, grade I meningiomas (93.05%) were the most common. According to histopathological type, transitional meningioma (76.50%) was the most common. Maximum cases were located at the cerebral convexities, reported in the fifth decade with a female preponderance. Conclusion As per WHO 2016, grade I meningiomas are associated with low-risk of recurrence and aggressive behavior, while WHO grade II and III meningiomas are associated with greater likelihood of recurrence and aggressive behavior. This classification itself summarizes the importance of accurate typing and grading of meningiomas on histopathology.

The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

Background: Cooled Radiofrequency ablation is a newer technique for management of chronic knee pain in osteoarthritis. The aim of the study is to evaluate the clinical outcomes in patients with chronic osteoarthritis in terms of pain scores for first six months of cooled radiofrequency ablation using ultrasound guidance. Methods: A cross-sectional study with retrospective review of database was evaluated to analyze the change in the Numerical Rating Scale from baseline scores at 1 day, 1 month and 6 months after the Cooled Radiofrequency ablation of genicular nerves around knee in patients with chronic knee osteoarthritis. Results: Median age was 71 years [ 61-73 years (IQR: 25-75)] with more female preponderance. Numerical Rating Scale (Mean ± S.D.) was significantly less at 1 day (1.87 ± 1.22), 1 month (3.03 ± 0.99) and 6 months (3.37 ± 1.098) from baseline values (6.77 ± 1.00). No soreness and numbness were noted.Conclusions: Cooled Radiofrequency using Ultrasound guidance for management of knee pain in chronic osteoarthritis is promising and reduces Numerical Rating Score significantly from baseline at 1 month and 6 months respectively.Keywords: Cooled radiofrequency ablation; genicular nerve; numeric rating scale

Trichotillomania (hair-pulling disorder) has high female preponderance. It has been suggested that onset in early childhood represents a distinct developmental subtype that is characterized by higher prevalence of males compared to later onset cases. However, the empirical literature is scarce. We conducted a systematic review of case reports to examine the distribution of age at onset/presentation in males and females with trichotillomania or trichobezoar (a mass of hair in the gastrointestinal tract resulting from ingesting hair). We identified 1065 individuals with trichotillomania and 1248 with trichobezoar. In both samples, males, compared to females, had earlier age at presentation and greater proportion of cases in early childhood. These sex differences remained after potential confounding variables were accounted for. The results showed similar sex differences for age at onset, which was reported in 734 and 337 of the trichotillomania and trichobezoar cases, respectively. The findings may reflect neurodevelopmental underpinnings in early childhood trichotillomania.

Objective: Diode-assisted laser turbinoplasty is a popular surgical technique that improves airflow during nasal obstruction. In this study, we aimed to evaluate the efficacy of a diode laser for turbinate hypertrophy by using rhinomanometry. Methods: This cross-sectional study included 199 patients for 13 months. Preoperative, intraoperative, and 6-week postoperative rhinomanometry values were measured. Results: The most common intraoperative symptoms were olfactory annoyance (barbecue smell) (76.4%) and a painful burning or stinging sensation (64.3%). The inspiratory and expiratory mean nasal airflow values increased both intraoperatively and postoperatively, illustrating the effect of decongestants and inferior turbinate surgery. Intraoperatively, inspiration improved by 262.73 ± 196.09 (p < 0.01) and expiration by 247.94 ± 180.05 (p < 0.01). Postoperative inspiration improved by 254.03 ± 199.08 (p < 0.01) and expiration by 244.05 ± 194.57 (p < 0.01). Postoperative snoring (22.6%, p = 0.026) and nasal obstruction (20.2%, p = 0.042) were significantly higher in female than in male patients. Conclusions: The therapeutic efficacy of using diode lasers in inferior turbinate resection was established in this study on the basis of rhinomanometric data with a follow-up of 6 weeks. Postoperative nasal obstruction was effectively decreased and the other symptoms displayed a female preponderance.

BACKGROUND: Severe asthma is a major burden on health-economic resources; hence, knowing the epidemiology of these patients is important in planning and provision of asthma care. In addition, identifying and managing the comorbidities helps improve symptoms and reduce associated morbidity and mortality. OBJECTIVES: Epidemiology of difficult asthma has not been well studied in the Middle East, so in this study, we present the demographic and clinical characteristics of severe asthma in the United Arab Emirates (UAE). METHODS: We retrospectively reviewed the notes of severe asthma patients attending three tertiary care hospitals between May 2015 and December 2019. Data on baseline demographics, asthma characteristics, treatment, and comorbidities were collected. RESULTS: We reviewed the notes of 458 patients (271 females and 187 males) that fulfilled the 2019 Global Initiative for Asthma guidelines for the diagnosis of severe asthma. The mean age was 47.7 (standard deviation 17.2) years. Males had significantly higher asthma control test scores (17.9 vs. 16, P = 0.01) and mean blood eosinophils (0.401 vs. 0.294, P

Cushing’s syndrome (CS) is rare in childhood and adolescence. The most common paediatric cause of CS is exogenous administration of glucocorticoids; either topical, inhaled or oral corticosteroids. Endogenous causes can be classified into adrenocorticotropic hormone (ACTH) independent and ACTH dependent causes. Herein, we report our experience of managing a 12 year old girl who presented with features of CS and was found to have an ectopic, ACTH-secreting bronchial carcinoid tumour, which was resected surgically. Our patient was managed successfully by multidisciplinary approach and has recovered from hypertension and Cushing’s habitus. The English language literature was searched from 2019 back, using PubMed, Google and Google Scholar. Keywords used for the search were; “Ectopic ACTH syndrome (EAS) in children”, “bronchial carcinoid in children” and “Cushing’s Syndrome in children”. Children with bronchial carcinoid tumours causing EAS were identified. Case variables such as age, sex, type of carcinoid, investigations, surgery, recurrences and outcome were reviewed. Fourteen cases of paediatric bronchial carcinoid producing ACTH were found with a mean age of 15.8 years and female preponderance. Most of the patients had a right lung lesion and histological appearance was typical of carcinoid tumour. Bronchial carcinoid is extremely rare in children and only 4% are associated with CS. The postoperative treatment of CS is challenging with a high prevalence of hypertension, increased body mass index and visceral fat mass, impaired cognitive function and decreased quality of life. A careful follow up is indispensable for monitoring recurrence of carcinoid and complete remission of CS.

Pyoderma Gangrenosum and Palmoplantar Pustular Psoriasis share the common pathogenesis, histological features, age group, and female preponderance that suggests a common etiological link.

Bimalleolar fractures are common injuries, and stable fracture patterns can be treated conservatively, while complicated, unstable fractures would require surgical intervention. This study aimed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures. This was a study of 30 patients with bimalleolar fractures who presented between January 2013 to January 2016 treated with ORIF with a follow-up period of 3 years. Functional outcome was performed with the AOFAS (American Orthopaedic Foot and ankle society) score. The mean age of the patients was 41.6 years. There was a female preponderance seen in our study with the left side being more commonly affected. The mean time to fracture union was 12.13 weeks, and we had excellent outcomes in 18 patients, good in 10, while two patients had a fair result. We did not lose any of our patients to follow up. All of our patients were happy with the functional outcome achieved. No significant complications were seen in our study. ORIF in bimalleolar fractures enables restoration of the ankle mortise to an anatomical position and facilitates early mobilization of the ankle resulting in good functional outcomes.

Background The canine plays an important role in dentofacial aesthetics and function. It supports the base of the alar and upper lip, which are necessary for smile aesthetics. When impacted, these functions are lost, leading to low self-esteem and overall poor health-related quality of life. This study was designed to determine the prevalence and pattern of impacted canines in the southwestern region, Kingdom of Saudi Arabia. Materials and methods This was a retrospective study carried out in a dental center in the southwestern region of Saudi Arabia. A total of 2000 panoramic radiographs were screened, and all patients with impacted canines were further screened both clinically and radiologically (cone beam CT). Demographics, position, laterality, and relationships to the midline were retrieved and recorded. Cone beam CT was used to diagnose palatal or labial impactions. The data were analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp). Results A total of 2000 panoramic radiographs were screened, out of which 107 cases were found to have impacted canines, giving a prevalence of 5.35%. There were 38 males and 69 females with a M:F ratio of 1:1.8. Their age ranged from 15 to 75 years with a mean ± SD age of 20.4 ± 11.1. There were more affected maxillary canines (99 (92.5%)) compared with mandibular canines (8 (7.5%)). Palatal impaction positions were more frequent than labial impactions. Conclusion The prevalence of canine impaction in the southwestern region of Saudi Arabia was 5.35%, with a female preponderance and more palatal positions. The impactions occurred more unilaterally on the left side than on both sides.

Background: Salivary gland tumours constitute 3-10% of head and neck neoplasms. Their varied morphology poses challenge to pathologists as well as clinicians. Methods: The present observational study included 99 cases of salivary gland tumours. Clinical details and findings of histopathological examination were noted. Results: Mean age of the study subjects was 34.7 years. Female preponderance was seen. Most common site involved was parotid (64.7%). Most common tumour encountered was pleomorphic adenoma (76.5%). Malignant changes were seen in 17.6% cases. Most common malignant change seen was mucoepidermoid carcinoma (8.8%).Conclusion: Malignant changes were seen in 17.6% cases. Pleomorphic adenoma was the most common benign neoplasm and mucoepidermoid carcinoma was the most common malignant tumour seen.

Background: Laparoscopic cholecystectomy is common procedure done in minimal invasive procedures. It is the treatment of choice for symptomatic gall stone disease all around the world. Methodology: This is case control study done in 198 patients undergoing laparoscopic cholecystectomy. Patients randomly divided as case and controls based on preoperative clinical criteria and radiological features. Results: 198 patients underwent laparoscopic cholecystectomy. Their mean age was 46.19 ± 13.03 years. There was female preponderance with 143 (72.2%) females as compared to 55 (27.8%) males. Difficult cholecystectomy was labelled in 55 (27.8%) cases based on intra-operative criteria mentioned in methodology. 13 (6.6%%) required conversion to open cholecystectomy. Easy cholecystectomies scored 0.81 as compared to 8.18 in the difficult group. The sensitivity of the preoperative score in predicting difficult cases was 98.2% with the specificity of 95.8%; positive predictive value of 90.0% and the negative predictive value of 99.3%%. The accuracy of the pre-operative scoring system was 96.56%. The area under the ROC curve (AUROC) for Preoperative Score predicting Surgery Difficulty: Difficult vs Surgery Difficulty: Easy was 0.992 (95% CI: 0.983 - 1), thus demonstrating excellent diagnostic performance. Conclusion: The preoperative score has high sensitivity, specificity, and accuracy in predicting difficult cases and can be used for identifying difficult laparoscopic cholecystectomies.

Aims: To find out the predictors of intractable epilepsy in childhood and to identify these children prone for intractability at the earliest. Settings and Design: It is a case control study done at Department of Pediatric Neurology at a tertiary care hospital. Methods and Materials: 50 cases and 50 controls were enrolled in the study. Cases were defined as ‘epileptic patients who have seizure frequency of at least 1 attack per month for at least six months despite receiving two antiepileptic drugs with adequate dosage and compliance’. Detailed history, neurologic examination, EEG and neuroimaging were done in all patients to find out factors predicting intractability. Results: A total of 50 patients with intractable epilepsy and 50 patients with well controlled seizures were studied. A female preponderance was seen among case group, females constituting 54% and males 46%. Significant association with a p value Conclusions: Early identification of these children prone to develop intractable seizures is critical for parental counselling, selecting patients for more intensive investigations and treatment, such as early consideration for epilepsy surgery. Keywords: Intractable epilepsy, Myoclonic seizures, Neonatal seizures.

PURPOSE The objective of this study is to present clinical outcomes with addition of topical cyclosporine while managing cases of "idiopathic canalicular inflammatory disease" and to propose a modified treatment protocol. METHODS Prospective case series of 88 canaliculi of 44 eyes of 22 patients diagnosed as "idiopathic canalicular inflammatory disease" at a tertiary care Dacryology service over a period of 2 years. All the patients were diagnosed based on the published major and minor criteria and each of the canaliculus was clinically staged. All patients were treated initially with a combination of topical cyclosporine (0.05%) and rapidly tapering topical steroids followed by punctal dilatation and placement of mini-monoka stents after control of inflammation. Monoka stents were extubated at 6 weeks and the cyclosporine was continued for at least up to 3 months beyond the extubation of stents. Patient demographics, investigations, response to cyclosporine, management modalities, recurrence of inflammation, anatomical and functional outcomes were analyzed. RESULTS Eighty-eight canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (77%, 17/22) and the mean age at presentation was 51 years. All patients presented with bilateral epiphora (mean duration 4.5 months) without any discharge. Staging revealed 18, 27, 24, and 19 canaliculi were involved with stages 1-4, respectively. The mean duration of cyclosporine use was 5.7 months. All patients except 3 (19/22) underwent monoka dilatation. Complete anatomical and functional resolution were noted in 62% (55/88), of which 12 puncta and canaliculi, all stage 1 (13.6%, 12/88) showed complete resolution with cyclosporine alone. Relentless disease progression to stage 5 was noted in 30% (26/88) of the puncta and canaliculi. All the younger patients (

Introduction: Pigmentary disorders of the skin are a great concern to the patient, more so when it involves the face. It is one of the common clinical presentations to the dermatology OPD. Facial pigmentation may be multifactorial and in some etiology may be known by a detailed history. It causes a great deal of psychological, emotional, and in some cases mental distress. Aim: To study the various clinical types and different patterns of facial pigmentation presentation. Materials and Methods: A one year study was done in the skin out-patient department in a tertiary hospital. All the patients with pigmentation of face were included in our study after their consent. Results: A total 102 cases were recorded during this period and the common facial pigmentation noticed was melasma. There was a female preponderance and among few there was a positive family history. Conclusions: Occurrence of pigmentation of face was more common in females and seen among age group of 21-30 years. Sun exposure, family history and cosmetics were the aetiological factors in most of the cases. Stress and refractive errors were other risk factors in Periorbital pigmentation.

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis “Gender differences in self-reporting symptom of depression,” suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

PURPOSE To compare surgical success (cosmetic, anatomical & functional) of 'W' shaped incision versus tear-trough incision in external dacryocystorhinostomy (eDCR). METHODS In a prospective study (November 2018 - March 2020), 61 eyes of chronic dacryocystitis underwent eDCR randomized into group T (30 eyes) & group W (31 eyes). The functional and objective cosmetic assessment was done at 3 months using Munk's and Devoto's scores respectively. The subjective cosmetic evaluation was done using a questionnaire. Grades 0-1 were considered the cosmetic and functional success after assessing the respective scores. The patent lacrimal passage was defined as anatomical success. RESULTS Mean age was 40.1 ± 14.9 years with female preponderance. Intraoperative skin flap button-holing & reversible darkening of their apices were specific complications of Group W. In the early postoperative period, lid edema & epiphora were significantly more in group T (p

Introduction: Pterygium is more common in tropical areas, with prevalence ranging from 0.3 to 29%. Pterygium is more frequent in areas with more ultraviolet radiation, in hot, dry, windy, dusty, and smoky environments. Aim of the study is to assess the pterygium outcome with primary pterygium surgery. Methodology: Hospital based Prospective interventional study with purposive sampling method. Study sample is 60 cases. The present study was conducted in Department of ophthalmology, RVM institute of Medical sciences and hospital, Telangana state. Study period was January 2019 to January 2020. Statistical analysis was done by entering data in excel sheet and expressing the data by frequency distribution, analysis is done by SPSS version: 21. Results: Majority of the patients were between the ages of 30 to 50 years. The average age of the study group was 47.6 years. Female preponderance is observed than the male in this study. Males 21 and females 39. The location of pterygium was nasal in 60 eyes (100%). Majority of the patients presented with type III(50%) and grade III (64%). 12% of the patients presented with type I and 38% of the patients presented with type II pterygium. 36% of the patients presented with grade II pterygium16 patients out of 50 patients (32%) included in the study showed an improvement in visual acuity post-operatively. In 34 patients (68%) visual acuity remained the same. The mean visual acuity preoperatively was 0.52 +/- 0.46.D which improved to 0.68 +0.32 (P = 0.002) post-operatively. Conclusion: Pterygium excision is a safe, effective and economical option for the management of primary pterygium requiring surgical intervention.

Objective: to analyze the provision of medical, including rheumatology, care in Kazakhstan, to study the incidence of systemic lupus erythematosus (SLE), and to develop a registry of patients with this condition.Material and methods. The investigators analyzed the guidelines for the organization of medical, including rheumatology, care in the republic and the official statistical materials of the Ministry of Health of the Republic of Kazakhstan in the period 2012 to 2017. Articles were searched to select activity indices, organ damages and to assess the quality of life and treatment programs in order to create a registry of patients with SLE.Results and discussion. The paper presents the basic principles of providing medical, including rheumatology, care in the republic. It gives data on the issues of providing SLE patients with medicines in outpatient and inpatient settings. It also analyzes trends in the incidence of SLE in the population of Kazakhstan in 2012 to 2017. There were 4,448 SLE patients, including 3,986 women; a comparative analysis of indicators demonstrated a 62.8% increase in the incidence of SLE from 2012 to 2017. The purpose and objectives of the registry of patients with SLE were substantiated.Conclusion. An analysis of morbidity rates suggests that SLE remains to be significant in the republic. The incidence of SLE has been noted to increase in the period from 2012 to 2017; there is a female preponderance (89.6%). The application of the SLE registry in clinical practice will be able to improve the diagnosis of the disease in the early stage and to prevent possible complications.

Canaliculops is a non-inflammatory dilatation of the canaliculus which can be secondary to trauma, punctal agenesis, herpetic infections or chronic drug use. This condition can affect either canaliculi and has shown female preponderance. Treatment described so far has consisted of cyst marsupialization with no literature on the post-operative epiphora in these cases. We describe two cases of canaliculops with punctal agenesis where we have tried to establish lacrimal patency.

INTRODUCTION Vitiligo is a refractory disease in which treatment modalities are not yet established. We aim to assess results obtained 10 years after the initiation of a therapeutic protocol which combines very potent topical corticosteroids (TCS), vitaminotherapy (B12 and C), and suppression of microtraumas in the management of nonsegmental vitiligo in Madagascar. METHODS It was a prospective and descriptive study over a period of 6 years (2011-2016) in the Department of Dermatology, Joseph Raseta Befelatanana, Antananarivo, Madagascar. The diagnosis of vitiligo was based on clinical data. Patients who agreed to follow the treatment protocol, which combined very potent TCS (two applications/day for 10 days, and then one application/day for the following 10 days), oral vitamin C 500 mg/day for 20 days, and oral vitamin B12 100 mg/day for 20 days, were included in the study. Two successive courses of treatment were made 10 days apart. RESULTS The details of 308 vitiligo patients were analyzed. The mean age of patients was 33.3 years. There was a female preponderance (sex ratio: 0.6). The duration of treatment in our patients varied from 3 to 18 months. Two hundred and thirty-nine patients had good therapeutic compliance and attended regular follow-up. Excellent repigmentation (more than 76% area repigmented) was noted in 50 patients (65.7%) less than 14 years of age. Lesions evolving in less than 1 year in 31 patients (36.9%) had excellent response to treatment. Localized lesions responded favorably to treatment with excellent repigmentation in 108 patients. CONCLUSION These results show that therapeutic response is better in young people, lesions less than 1 year of evolution, and for localization of vitiligo in the face and neck.

Introduction In sub‐Saharan Africa (SSA), the prevalence of lifetime epilepsy varies widely between subregions and is higher in rural compared to urban regions. Observed versus expected numbers of patients with epilepsy (PwE) in the northern province of Rwanda did not match the prevalence of 49‰ reported in 2005 in Rwanda. We report a confirmatory prevalence study focused on gender‐specific observations. Methods A cross‐sectional door‐to‐door approach was used in three rural villages. First, epilepsy screening using the Kinyarwanda version of the Limoges questionnaire was performed. Second, confirmation of epilepsy diagnosis was completed by trained physicians. Results In total, 2681 persons (56.14% female) were screened. Of 168 positively screened, 128 persons were diagnosed with epilepsy confirming the prevalence of lifetime epilepsy of 47.7‰ (CI 39.8–56.8). The diagnosis gap was 62.5% with 80 newly diagnosed. The overall female:male ratio was 1.61:1.00. A male preponderance below 9 years of age inverted to a female preponderance above 20 years of age. Female PwE had an older age at first seizure, reported different reasons for not seeking care, and differed from male PwE in possible etiology. For previously diagnosed PwE, the treatment gap was more than 77%. Conclusion A high prevalence in rural areas was confirmed, with an observed female/male ratio among the highest of published door‐to‐door surveys in SSA. Gender differences in associated co‐morbidities and age at first seizure warrant future research of underlying etiologies and possible survival bias. A better understanding and focus on gender‐associated care‐seeking patterns, education, and specific needs are recommended., We confirmed the high prevalence of epilepsy in Rwanda and observed gender differences. Of 2681 screened persons, 168 were positively screened and 128 were diagnosed with epilepsy resulting in an epilepsy prevalence of 47.7‰. Female patients with epilepsy had an older age at first seizure and reported different reasons for not seeking care. This results in a need for further epilepsy etiology research and informs on gender‐specific needs for public health programs.

Introduction: Patients with somatoform abnormalities experience severe emotional suffering, and clinicians face a difficult task. Women tend to be more susceptible to somatization disorder than males. They are said to be more common in rural regions and among those with less education. Materials and Methods: 270 patients with any of the subtypes of somatoform disorders were recruited from the out-patient and in-patient services of the Department of Psychiatry, which is linked with the AVBRH, a tertiary care hospital in Vidarbha. It was a cross- sectional study carried out from October 2010 to July 2012. Results: The study found the greatest number of patients in the 60 to 80 year old age group (48.88 percent), followed by the 40 to 60 year old age group (27.77 percent), with a slight female preponderance (56.67 percent). Females experienced a somatoform condition for a longer period of time than males (4.48 years vs. 3.97 years). In our study, majority of patients with somatization disorder were married (88.9%) followed by widow/widower (7.4%); single (4.1%) and separated (1.9%). Also, majority of patients in our study were Illiterate (20.0%); followed by primary educated (10.0%); secondary educated (40%) and 30% patients were graduates. Conclusion: Females in their forties and fifties are more likely to be afflicted by somatoform diseases, and they suffer for a much longer amount of time.

Objectives: To compare the characteristics of younger (Y, 10-14 yrs) vs. older (O, 15-17 yrs) patients (pts) with T2D in global clinical trials of sitagliptin as initial oral therapy (IOT, NCT01485614) or as add-on to metformin therapy (AMT, NCT01472367, NCT01760447). Methods: Demographic and baseline glycemic parameters were summarized by age group for pts in the studies (Table). Results: The proportion of females was higher in Y groups and that of Whites greater in O groups. All groups had similar BMI percentiles, despite the Y group being shorter, with lower weight and BMI. Duration of T2D was similar across age groups in the IOT study, but duration was less in Y vs. O in AMT studies. Baseline A1C and FPG were comparable across age groups within a study type. Conclusions: The female preponderance reported in youth with T2D (e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038479/) was more apparent in Y groups; it is possible that the proportion of females is lower in O groups, approaching the situation in adults where sex distribution is uniform. Both Y and O pts had similar BMI percentiles. While glycemic parameters were similar across age groups within a study type, duration of diabetes was less in Y pts in AMT studies, suggesting that the need for an additional antihyperglycemic agent may occur sooner in pts diagnosed at a younger age. Disclosure R. S. Newfield: Consultant; Self; Merck Sharp & Dohme Corp. Z. Xu: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. L. W. Scherer: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. S. S. Engel: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. K. D. Kaufman: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. P. Zeitler: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly and Company, Janssen Research & Development, LLC, Merck & Co., Inc. R. Shankar: Employee; Self; AstraZeneca, Merck Sharp & Dohme Corp. A. Deeb: None. M. Y. Jalaludin: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Novo Nordisk. R. Garcia: None. Y. Samoilova: None. C. A. Rosario: None. N. Shehadeh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Self; Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. C. K. Saha: None. Y. Zhang: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. Funding Merck & Co., Inc.

Background and Study Aims Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. Materials and Methods We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. Results The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1–60 years), and patients Conclusion Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.

Epilepsy is more prevalent in men but Genetic Generalized Epilepsies (GGE) seem to be more common in women. A predominant maternal inheritance has been previously described in GGE. Our objective was to determine sex and inheritance patterns in a GGE population compared to mesial temporal lobe epilepsy with hippocampal sclerosis (MTLEHS).We performed a prospective observational study including adult GGE and MTLEHS patients followed up at a tertiary epilepsy center from January 2016 to December 2019. Patients' familial history was obtained by a detailed questionnaire. Clinical and demographic data was retrieved from clinical notes.A cohort of 641 patients, 403 with GGE and 238 with MTLEHS, was analyzed. GGE was more common in women than MTLEHS (58.8% vs 44.5%, OR=1.63, p = 0.004). Compared to MTLEHS patients, more GGE patients had familial history of epilepsy (45.4% vs 25.2%; p0.001). The GGE group had a higher percentage of female relatives with epilepsy (55% vs 37%; p = 0.006). The prevalence of maternal inheritance was not different between GGE and MTLEHS groups (62.9% vs 57.7%; p = 0.596). Photosensitivity was more common in females than in males (44.7% vs 34.3%, p = 0.036).There is a female preponderance in GGE when compared to MTLEHS, as both GGE patients and their affected relatives are more frequently women. The prevalence of maternal inheritance was not higher in GGE than in MTLEHS.

Silent corticotroph adenomas (SCAs) can be redefined according to the 2017 World Health Organization pituitary classification system with the introduction of T‑PIT, a transcription factor. We studied the clinical features of these redefined SCAs.We compared 112 patients with SCAs and 198 patients with silent gonadotroph adenomas (SGAs) who underwent surgery from January 2019 to May 2020.The prevalence of SCAs increased from 21.3 to 30.2% under the new classification rules. T-PIT-positive, adrenocorticotropic hormone-negative SCAs and T-PIT-positive, adrenocorticotropic hormone-positive SCAs exhibited similar clinical features. SCAs exhibited significant female preponderance (90.2% vs. 29.8%, P 0.0001); more frequent invasion (36.6% vs. 7.6%, P 0.0001), especially multiple-site invasion (P 0.0001); and marked cystic changes on imaging compared with SGAs (54.5% vs. 19.2%, P 0.0001). SCAs had a softer tumor consistency (89.2% vs. 61.1%, P 0.0001). Gross total resection was achieved in 66.1% of SCAs and 66.2% of SGAs (P 0.9999). The overall recurrence/progression rates of SCAs and SGAs were 9.8% and 6.6% at 14.1 and 13.5 months of follow-up, respectively (P = 0.3765). The proportion of patients with more than two recurrences requiring multiple surgeries and radiation was similar between SCAs and SGAs (7.1% vs. 3.0%, P = 0.1514). However, multiple recurrences of SCAs affected younger patients than SGAs (39.0 vs. 53.5 years, P = 0.0433).The prevalence of SCAs increased with the introduction of T-PIT. SCAs and SGAs exhibited comparable size and recurrence/progression rates, but SCAs showed increased invasion and more marked cystic change. Aggressive SCAs tended to affect younger patients. Close long-term monitoring for SCA recurrence/progression is required.

BACKGROUND While clustering of bullous pemphigoid (BP) with neuropsychiatric diseases is well-established, the clinical and immunological profile of BP patients with this comorbidity remains to be decisively determined. OBJECTIVES To evaluate the burden of neurological and psychiatric comorbidities among patients with BP and to elucidate the clinical, immunological and immunopathological features of patients with BP and comorbid neuropsychiatric conditions. METHODS We performed a retrospective study encompassing patients diagnosed with BP throughout the years 2009-2020 in a specialized tertiary referral centre. Multivariate logistic regression model was used to identify predictors of neuropsychiatric conditions among patients with BP. RESULTS The study included 273 patients with BP, of whom 123 (45.1%) presented with comorbid neuropsychiatric disease. Compared to the remaining patients with BP (n = 150), those with pre-existing neuropsychiatric diseases demonstrated older mean [standard deviation (SD)] age [81.7 (9.1) vs. 76.9 (10.1); P