A Nepalese bipolar case amidst risk and protective factors during COVID‐19 pandemic

Bipolar disorder is a chronic and recurring psychiatric illness. Emphasis on enhancing key protective factors like social support systems and promoting this to minimize risk factors like non‐compliance is one of the key strategies tied to enhance overall psychological, intellectual, and emotional health for symptoms remission and relapse prevention even during adverse situations like the COVID‐19 crisis. We intend here to point out implication of the dynamics of the protective and risk factors for bipolar mood through a 23‐year patient from eastern Nepal, which is largely harmonious in its multi‐ethnic, multilingual and multicultural social composition. This attribute of social cohesiveness and compassion is evident in this case report. When disturbed and ill, neighbors from native semi‐urban Nepalese society did support even in the times of crisis of COVID‐19 pandemic. The support of other people including neighbors is a key factor for the short‐term and long‐term management of bipolar mood.     

Role of immunotherapy in bacillus Calmette–Guérin-unresponsive non–muscle invasive bladder cancer

Intravesical instillation of live attenuated bacillus Calmette–Guérin (BCG) is the gold standard for patients with intermediate- and high-risk non–muscle-invasive bladder cancer (NMIBC). BCG-failures include a heterogenous population of patients who share a designation of disease recurrence or progression following BCG and include patients with complete unresponsiveness to BCG, patients who respond initially but develop relapse and, in some cases, patients who are intolerant to BCG due to side effects. Given the efficacy and relatively rapid approval of several monoclonal antibodies against PD-L1 or PD-1 for advanced and metastatic bladder cancer, the role of these checkpoint inhibitors in BCG-relapsing disease at various disease stages is under consideration. Data supporting a role for immune checkpoint inhibitors is largely theoretical with limited supportive data from animal models and from clinical evidence of increased PD-L1 expression in BCG-unresponsive tumors. Current trials in BCG-unresponsive disease are underway and expected to provide insight regarding these concepts.     

Tooth in a cyst — Is it always a dentigerous cyst?

We present the case report of an 18-year-old female patient who presented with unilateral nasal obstruction. Computed tomography scanning revealed an unerupted molar in the posterior wall of the right maxillary sinus with a cystic swelling in the sinus. The preoperative diagnosis was a dentigerous cyst. The patient underwent endoscopic removal of the cyst and tooth. The operative findings and histopathology showed that it was an odontogenic keratocyst. This paper stresses the importance of diagnosing this condition and that a tooth in a cyst is not always dentigerous.     

Prolactin: Its role in advanced tongue cancer

Serum prolactin was measured pretherapeutically and sequentially thereafter using immunoradiometric assay method in 37 male patients with advanced tongue cancer and compared with 23 healthy, age-matched controls. Prolactin levels were correlated with age, various clinicopathologic parameters, overall survival, and patients with response and those with progressive disease. Patients with advanced tongue cancer had higher prolactin levels than controls (P < 0.02), but intergroup variation in prolactin was not observed when considering the age, site of the lesion, disease stage, histologic grade, and keratin. Of the patients, 30% had hyperprolactinemia (prolactin >15.0 ng/ml). To assess the prognostic significance of pretherapeutic prolactin level, the patients were divided according to the cutoff level of prolactin (15.0 ng/ml). Hyperprolactinemic patients had more unfavourable prognosis than patients with prolactin <15.0 ng/ml (X²=2.91, df=1, P < 0.0037). In monitoring disease course, patients who responded to treatments had decreased prolactin levels at the end of 18 months as compared to their pretherapeutic levels (P < 0.01). In patients who subsequently developed progressive disease within 18 months, prolactin levels reduced initially at response, whereas with disease progression, prolactin levels increased significantly (P < 0.05). The positive and negative predictive value of prolactin was 100%. Immunohistochemical localization confirmed the ectopic production of prolactin by tongue tumors. In conclusion, our data indicate that hyperprolactinemia may be an independent predictor of short-term prognosis; circulating prolactin may be used as a marker for monitoring disease course in patients with advanced tongue cancer, and prolactin is produced ectopically by tongue tumors. © 1994 Wiley-Liss, inc.     

Noninvasive recording of the His bundle electrogram in neonates

Summary Twenty-seven normal, nonsedated neonates had high-resolution electrocardiography performed during the first four days of life. Using high amplification, analogue and digital filters, and signal averaging, easily defined His bundle deflections of 0.75–7.75 (mean 2.5) V were detected in 25 (92.6%) of the 27 babies. The PH interval was 60–105 (mean 83) ms and the HV interval 10–25 (mean 17) ms. Surface His bundle electrocardiography is easily performed in the neonate and, as might be predicted, conduction intervals are considerably shorter than those seen in older age groups.A.W.N. and A.J.C. are supported by the British Heart Foundation.     

Disseminated hydatid disease involving orbit,spleen, lung and liver

Orbital hydatid disease is rare, even in endemic areas. We present a case of disseminated hydatid disease involving the orbit, spleen, lung and liver in a lady aged 35 years. Based on a typical clinical presentation, presence of eosinophilia, a positive indirect haemagglutination test for hydatid disease and presence of similar disseminated, anechoic cystic masses in the liver, lung, spleen and orbit on imaging studies, the diagnosis of hydatid cyst was seriously considered before surgery. Aspiration of the cyst, followed by cryo-extraction of the cyst wall through transconjunctival route was safely performed. Histopathological examination confirmed the diagnosis. In conclusion, multisystemic involvement of liver, lung and spleen in a case of orbital hydatid cyst has never been reported before. The surgical technique adopted in this case is safe and effective.     

Neurofibroma of the lacrimal sac

Neurofibroma is an extremely rare neural tumor of the lacrimal sac. We present a case of neurofibroma of the lacrimal sac in a 45-year-old lady. Based on the history of intermittent epiphora, presence of a mass in the lacrimal sac region, dacryocystogram suggestive of space occupying lesion within the lacrimal sac and computed tomographic image of a tumor lying in the lacrimal fossa region, a tentative diagnosis of lacrimal sac neoplasm was made. Excision of the tumor with repair of the lacrimal sac was performed. Histopathology proved it to be neurofibroma of the lacrimal sac. Until now, only four cases have been reported worldwide. The paucity of reported cases limits our knowledge regarding the natural course, treatment, results and prognosis of this tumor.     

Auditory evoked responses during different phases of menstrual cycle

The electrophysiological correlates of changes in sensory function during menstrual cycle has already been studied and attributed to the hormonal influence. Effects of estrogen and progesterone on waves of auditory brainstem responses (ABR) have been reported and a hypothesis has been proposed that sex steroids have more influence on central auditory pathways. As mid-latency responses (MLRs) and slow vertex responses (SVRs) are better indicators of central auditory pathways, so MLRs and SVRs were also recorded besides ABRs in the present study. Waves of ABRs, MLRs & SVRs were recorded in 20 normal cycling females in 4 different phases of menstrual cycles from Cz-A1 and Cz-A2 position with alternating 90dB sound pressure click stimuli. Contralateral ear was masked with a white noise of -40 dBHL. With the same setting by changing the number of click stimuli, intervals of stimuli and filter bandpass the above 3 recordings were taken. The evoked responses in females having ovulatory cycles were compared within the four phases using ANOVA test. There is a trend of increase in peak latencies of ABR waves III and V and IPL I-V in estrogen-peak midcycle while decrease in latencies in progesterone-peak (interpeak latency) midluteal phase. Peak latencies of MLR waves No, Po, Na, Pa and Pb also show a same trend. SVR waves P2 and N2 are significantly delayed in mid-cycle (178.80 +/- 20.49, 276.65 +/- 18.32) while conduction is faster in midluteal phase (166.45 +/- 17.41, 261.95 +/- 21.07). Smallest latencies of all the waves are occurring during menstruation. These findings are suggesting that normal cyclical variations in the levels of estrogen and progesterone during menstrual cycle do affect the auditory pathways and effects are better seen on the central component.