Atypical Changes Research Articles

Early detection of cervical tumor cell of origin through Oncogene-induced senescent HPV-positive cells.

Human Papilloma Virus (HPV) is an oncogenic virus and is the most common cause of cervical cancer. HPV has been shown to induce senescence. Cellular senescence is involved in cancer progression and tumorigenesis. Identification and isolation of cells of tumor origin before tumorigeneses is an important step in cancer prevention and treatment. This study aimed to investigate the early cervical atypical senescent cytological preneoplastic change in non-menopausal women. Cervical smears of 121 patients were randomly selected and included in the study which cytopathologically diagnosed as atypical squamous cells of undetermined significance (AS-CUS) in correlation to HPV status, parakeratosis (PK), p16 immunostaining, enlarged Squamous cells nuclei (ES) and inflammatory cells infiltration (ICI). Results revealed that out of the total 121 patients, 32 cases (26%) were positive for high-risk HPV (HR-HPV), 26 cases (22%) were positive for low-risk HPV (LR-HPV) and 63 (52%) were negative for HPV. HPV infections were significantly associated with age groups (p<0.026), PK (p = 0.043), p16 (p = 0.001), ES (p = 0.002) and ICI (p = 0.049). The positive immunostaining expression of p16 was only noticed in two HR-HPV patients. ES cells were found in 9.5% of HPV-negative cases, 27% of LR-HPV cases and 40.5% of HR-HPV cases. High PK cell positivity was seen only in HR-HPV. High ICI scores were seen in 40.6% of HR-HPV patients, 26.9 % of LR-HPV and 17.4 % of negative HPV patients. It was concluded that high PK positivity, high ICI score, positive p16 immunostaining and ES were correlated with HR-HPV in non-menopausal women. These findings could provide potential diagnostic clues for HPV-harboring senescent cells as a strategy for reducing HPV risk of cervical cancer development and identifying the cell of tumor origin, which could be beneficial for improving the utility of senolytic agents and immunotherapy in clinical practice.

Management of Busulfan-Induced Lung Injury in Pediatric Patients with High-Risk Neuroblastoma

Background/Objectives: Integrating the cytotoxic drug busulfan into a high-dose chemotherapy regimen prior to autologous hematopoietic stem cell rescue in patients with high-risk neuroblastoma has improved the survival of children battling this deadly disease. Busulfan-induced toxicities can, however, be severe. Here, we describe the diagnosis and successful treatment of acute pulmonary injury by total-body-weight-adjusted busulfan therapy in two children with high-risk neuroblastoma. Case series: Patient 1 developed life-threatening biphasic acute respiratory failure on days +60 and +100 after busulfan therapy, requiring intubation and invasive mechanical ventilation. Despite intensive anti-inflammatory and immunomodulatory therapy, including systemic corticosteroids, topical inhalation regimens, azithromycin, nintedanib and extracorporal photopheresis, patient 1 required extended intensive care measures and non-invasive respiratory support for a total of 20 months. High-resolution computed tomography showed diffuse intra-alveolar and interstitial patterns. Patient 2 developed partial respiratory failure with insufficient oxygen saturation and dyspnea on day +52 after busulfan therapy. Symptoms were resolved after 6 months of systemic corticosteroids, topical inhalation regimens and azithromycin. High-resolution computed tomography showed atypical pneumonic changes with ground-glass opacities. While both patients fully recovered without evidence of pulmonary fibrosis, cancer therapy had to be paused and then modified until full recovery from busulfan-induced lung injury. Conclusions: Busulfan-induced lung injury requires prompt diagnosis and intervention. Symptoms and signs are nonspecific and difficult to differentiate from other causes. Therapeutic busulfan drug level monitoring and the identification of patients at risk for drug overdosing through promoter polymorphisms in the glutathione S-transferase alpha 1 gene encoding the main enzyme in busulfan metabolism are expected to reduce the risk of busulfan-induced toxicities.

Relation between Urine Cytological Findings and Renal Function in Patients with Kidney Stones in Taif, Saudi Arabia

Background and Objectives: Urine serves as a vital diagnostic fluid, and urine cytology analysis plays a crucial role in identifying urinary system illnesses such as bladder cancer and kidney stones. The Paris System for Reporting Urinary Cytology establishes a uniform method for diagnosing urinary tract cancer. This study aimed to provide valuable insights that can inform diagnostic strategies related to kidney stones and ultimately improve patient outcomes via the early detection of the cellular changes associated with kidney stones and their relation to kidney function tests. Materials and Methods: A comparative study was conducted and comprised two groups: group 1, consisting of 50 patients diagnosed with kidney stones, and group 2, comprising 50 patients diagnosed with other kidney diseases. Renal function tests and urinalysis (via the PAP staining of urine cellular deposits to detect nuclear changes) were performed, and the results were analyzed. Results: There was a statistically significant increase in urinary red blood cells, white blood cells, and nuclear reactive atypical changes in urinary sediments of kidney stone patients compared to the patients without stones, while there was a decrease in the estimated glomerular filtration rate (eGFR). eGFR showed a 96.7% specificity in detecting cases with nuclear reactive atypia. Conclusions: eGFR emerges as a reliable diagnostic marker for the comprehensive assessment of kidney stones, particularly when associated with nuclear atypia. The significant correlation between the indicators of chronic kidney disease, such as decreased eGFR, and the presence of kidney stones emphasizes the urgent need for efficient diagnostic practices.

Uncommon culprit artery leading to atypical de winter electrocardiographic changes: a case report

BackgroundA subset of patients with acute coronary artery occlusion requiring emergency revascularization, does not present with the typical ECG features of ST-segment elevation myocardial infarction (STEMI).Timely identification of these atypical presentations is crucial.Case presentationThis report describes a 55-year-old male patient who was admitted to the emergency department with chest pain. The electrocardiogram (ECG) recorded atypical de Winter electrocardiographic changes and their evolution.ResultsCoronary angiography confirmed the occlusion of the second diagonal branch (D2). The patient’s condition improved after D2 balloon angioplasty.ConclusionDe Winter electrocardiographic changes can also be observed in D2 occlusions and may present with milder manifestations. Timely recognition of these changes holds significant clinical value.

Atypical changes in the nail apparatus in a patient with atopic dermatitis – a clinical case report

Atopic dermatitis is a chronic recurrent skin disease characterised by itching and eczematous skin lesions. The paper presents the case of a 62-year-old female patient suffering from atopic dermatitis, in whom symptoms were observed within the nail apparatus of the hand, including red rings, Beau lines, lack of cuticle and lichenification with erosions, cracks, scabs, and residual blisters on the backs of the hands. The patient experienced severe itching, which led to increased manipulations within the nail apparatus (onychotillomania), which was reflected in the presence of the so-called tare nails. The patient’s treatment included the use of topical medications, including clobetasol propionate, mometasone, and tacrolimus 0.1%, as well as intensive hand lubrication and the use of specialised hand cleansers. Intensification of mental health care was also recommended. The presented case highlights the importance of a comprehensive approach to the treatment of atopic dermatitis, especially in the era of new therapeutic methods.

Brain functional gradient and structure features in adolescent and adult autism spectrum disorders.

Understanding how function and structure are organized and their coupling with clinical traits in individuals with autism spectrum disorder (ASD) is a primary goal in network neuroscience research for ASD. Atypical brain functional networks and structures in individuals with ASD have been reported, but whether these associations show heterogeneous hierarchy modeling in adolescents and adults with ASD remains to be clarified. In this study, 176 adolescent and 74 adult participants with ASD without medication or comorbidities and sex, age matched healthy controls (HCs) from 19 research groups from the openly shared Autism Brain Imaging Data Exchange II database were included. To investigate the relationship between the functional gradient, structural changes, and clinical symptoms of brain networks in adolescents and adults with ASD, functional gradient and voxel-based morphometry (VBM) analyses based on 1000 parcels defined by Schaefer mapped to Yeo's seven-network atlas were performed. Pearson's correlation was calculated between the gradient scores, gray volume and density, and clinical traits. The subsystem-level analysis showed that the second gradient scores of the default mode networks and frontoparietal network in patients with ASD were relatively compressed compared to adolescent HCs. Adult patients with ASD showed an overall compression gradient of 1 in the ventral attention networks. In addition, the gray density and volumes of the subnetworks showed no significant differences between the ASD and HC groups at the adolescent stage. However, adults with ASD showed decreased gray density in the limbic network. Moreover, numerous functional gradient parameters, but not VBM parameters, in adolescents with ASD were considerably correlated with clinical traits in contrast to those in adults with ASD. Our findings proved that the atypical changes in adolescent ASD mainly involve the brain functional network, while in adult ASD, the changes are more related to brain structure, including gray density and volume. These changes in functional gradients or structures are markedly correlated with clinical traits in patients with ASD. Our study provides a novel understanding of the pathophysiology of the structure-function hierarchy in ASD.

Label-Free Monitoring of Endometrial Cancer Progression Using Multiphoton Microscopy

Endometrial cancer is the most common gynecological cancer in the developed world. However, the accuracy of current diagnostic methods is still unsatisfactory and time-consuming. Here, we presented an alternate approach to monitoring the progression of endometrial cancer via multiphoton microscopy imaging and analysis of collagen, which is often overlooked in current endometrial cancer diagnosis protocols but can offer a crucial signature in cancer biology. Multiphoton microscopy (MPM) based on the second-harmonic generation and two-photon excited fluorescence was introduced to visualize the microenvironment of endometrium in normal, hyperplasia without atypia, atypical hyperplasia, and endometrial cancer specimens. Furthermore, automatic image analysis based on the MPM image processing algorithm was used to quantify the differences in the collagen morphological features among them. MPM enables the visualization of the morphological details and alterations of the glands in the development process of endometrial cancer, including irregular changes in the structure of the gland, increased ratio of the gland to the interstitium, and atypical changes in the glandular epithelial cells. Moreover, the destructed basement membrane caused by gland proliferation and fusion is clearly shown in SHG images, which is a key feature for identifying endometrial cancer progression. Quantitative analysis reveals that the formation of endometrial cancer is accompanied by an increase in collagen fiber length and width, a progressive linearization and loosening of interstitial collagen, and a more random arrangement of interstitial collagen. Observation and quantitative analysis of interstitial collagen provide invaluable information in monitoring the progression of endometrial cancer. Label-free multiphoton imaging reported here has the potential to become an in situ histological tool for effective and accurate early diagnosis and detection of malignant lesions in endometrial cancer.

Atypical intrinsic neural timescale in the left angular gyrus in Alzheimer's disease.

Alzheimer's disease is characterized by cognitive impairment and progressive brain atrophy. Recent human neuroimaging studies reported atypical anatomical and functional changes in some regions in the default mode network in patients with Alzheimer's disease, but which brain area of the default mode network is the key region whose atrophy disturbs the entire network activity and consequently contributes to the symptoms of the disease remains unidentified. Here, in this case-control study, we aimed to identify crucial neural regions that mediated the phenotype of Alzheimer's disease, and as such, we examined the intrinsic neural timescales-a functional metric to evaluate the capacity to integrate diverse neural information-and grey matter volume of the regions in the default mode network using resting-state functional MRI images and structural MRI data obtained from individuals with Alzheimer's disease and cognitively typical people. After confirming the atypically short neural timescale of the entire default mode network in Alzheimer's disease and its link with the symptoms of the disease, we found that the shortened neural timescale of the default mode network was associated with the aberrantly short neural timescale of the left angular gyrus. Moreover, we revealed that the shortened neural timescale of the angular gyrus was correlated with the atypically reduced grey matter volume of this parietal region. Furthermore, we identified an association between the neural structure, brain function and symptoms and proposed a model in which the reduced grey matter volume of the left angular gyrus shortened the intrinsic neural time of the region, which then destabilized the entire neural timescale of the default mode network and resultantly contributed to cognitive decline in Alzheimer's disease. These findings highlight the key role of the left angular gyrus in the anatomical and functional aetiology of Alzheimer's disease.

Atypical Image Change of Hepatic Mucinous Cystic Neoplasm.

Atypical Image Change of Hepatic Mucinous Cystic Neoplasm.

Reflectance confocal microscopy as noninvasive tool for monitoring tirbanibulin efficacy in actinic keratosis

Actinic keratosis (AK) is a common precancerous condition found on sun-damaged skin. Tirbanibulin 1 % ointment has been approved for the topical treatment of non-hyperkeratotic facial and scalp Olsen grade I AKs over a contiguous area of 25 cm2 with a daily application for 5 consecutive days. Our aim was to investigate the use of in vivo RCM in the assessment of the response of AKs treated with tirbanibulin, as it has never been described in the published Literature. A total of 10 AKs in 10 consecutive outpatients were enrolled in the present study in May 2023. The follow-up visit was scheduled after 30 days from last application of tirbanibulin ointment. At follow-up visit, a complete response was described by clinical, dermoscopic and in vivo RCM examination in 10 out of 10 lesions, with a recovery of stratum corneum, decrease in atypical honeycomb pattern and changes in dermal collagen. All patients were followed up for at least 8 months and further recurrences were not registered. Based on our experience, we confirm the efficacy and safety of tirbanibulin in treating AKs and the usefulness of RCM in vivo examination for the therapeutic monitoring of such lesions, even in a very early stage.

Correlation of Chemotherapy and Radiation Therapy with Atypical Oral Cellular Changes: A Cytological Study in Cancer Patients

Correlation of Chemotherapy and Radiation Therapy with Atypical Oral Cellular Changes: A Cytological Study in Cancer Patients

Invasive Ductal Carcinoma Arising within a Fibroadenoma: A Case Report and Literature Review.

Background: Invasive ductal carcinoma (IDC) is the most common form of breast cancer, frequently presenting independently. Rarely, IDC arises within a fibroadenoma, a benign breast tumor typically associated with younger women. This case report and literature review aim to highlight the diagnostic challenges and clinical implications of finding IDC within a fibroadenoma. Case Presentation: A 36-year-old female patient presented with a dolent palpable mass in the right breast. Initial mammography described normal fibroglandular structures without significant findings. However, subsequent imaging ultrasound identified an 18x14 mm oval formation at the 9 o'clock position in the right breast, categorized as BI-RADS 3. Further histopathological evaluation after a biopsy confirmed the presence of a fibroadenoma with invasive ductal carcinoma, classified as Grade III with perivascular and neural infiltration. Discussion: The coexistence of IDC within a fibroadenoma poses significant diagnostic challenges due to the benign appearance of fibroadenomas on standard imaging modalities. This case emphasizes the need for a thorough evaluation and possible biopsy of fibroadenomas that exhibit atypical features or changes over time. Conclusion: This report underscores the importance of vigilance and comprehensive diagnostic strategies in cases of fibroadenomas, especially in patients with unusual or evolving lesions. The review of literature confirms that although rare, the occurrence of IDC within fibroadenomas can have significant implications for treatment and prognosis.

An unusual cystic presentation of pelvic skeletal Ewing sarcoma: a case series.

Ewing sarcoma (ES) is the second mostcommon primarymalignant bone tumour in children and adolescents. About 14.5% of primary malignancies develop in pelvic bones, wherethey typically have worse prognoses than extremity or acral sarcomas. It usually presents with aggressive features onradiology scans, but may also present with different radiological characteristics. In this series, we describe rare appearancesof pelvic skeletal Ewing sarcoma, with large extraosseous cystic component on imaging, defined by the presence of fluid-filledspaces in the extraosseous tumour lesion, which distinguishes it from the solid nature of conventional ES. We report3 cases of cystic presentation of ES, with imaging features supporting diagnosis of a primary malignant bone tumourarising from the superior pubic ramus with associated massive intrapelvic solid and cystic mass. CT-guided biopsy provideddiagnosis of ES, with large intrapelvic soft tissue and cystic component. These patients underwent neo-adjuvantchemotherapy and proton beam therapy with significant reduction in size of the solid components, while the cysticcomponents remained relatively unchanged. Two patients underwent surgical resection of the tumour (navigated P3internal hemipelvectomy and hemipelvis P2/P3 resection, respectively), and one patient died while on treatment. In both whounderwent surgery, histology showed ES with margins clear and more than 99% of treatment-induced necrosis. To theauthors' knowledge, this unusual presentation of pelvic ES is described for the first time in the literature as a case series,with particular reference to atypical extraosseous cystic changes, along with the clinical and radiological characteristics,and their treatment.

ORF virus causes tumor-promoting inflammation in sheep and goats.

ORF virus (ORFV) causes contagious ecthyma ("ORF"), a disease of sheep and goats characterized by lesions ranging from vesicles and pustules to atypical papilloma-like and angiomatous lesions in the skin and mucosae. The authors investigated the molecular factors leading to the ORF-associated atypical tumor-like changes. Fifteen lambs, 15 kids, and an adult ram clinically affected by natural ORFV infection were enrolled in the study and examined by several methods. ORFV was detected by viral culture or real-time polymerase chain reaction (RT-PCR) in the lesioned tissues and in the blood of the clinically affected sheep and goats. Surprisingly, ORFV was also detected in the blood of healthy goats from an affected herd. Microscopically, they found a pseudo-papillomatous proliferation of the epithelium, while the dermis and lamina propria were expanded by a proliferating neovascular component that highly expressed the viral vascular endothelial growth factor (vVEGF) and its host receptor vascular endothelial growth factor receptor 2 (VEGFR2). Immunohistochemistry, immunofluorescence, and in situ hybridization for mRNA showed that epidermal growth factor receptor (EGFR) was expressed in the fibrovascular component, in the infiltrating CD163+ macrophages, and in the basal stratum of the epidermis. Confocal immunofluorescence microscopy demonstrated that CD163+ macrophages were associated with VEGF and VEGFR2. Finally, they found by quantitative RT-PCR the overexpression of the interleukin-6 and VEGFR2 genes in the lesioned tissues. These findings suggest that ORFV activates an inflammatory reaction characterized by CD163+ macrophages expressing EGFR and VEGFR2, which might play an oncogenic role through synergistic action with vVEGF signaling.

Altered intra- and inter-network brain functional connectivity associated with prolonged screen time in pre-school children with autism spectrum disorder.

Prolonged screen time (ST) has adverse effects on autistic characteristics and language development. However, the mechanisms underlying the effects of prolonged ST on the neurodevelopment of children with autism spectrum disorder (ASD) remain unclear. Neuroimaging technology may help to further explain the role of prolonged ST in individuals with ASD. This study included 164 cases, all cases were divided into low-dose ST exposure (LDE group 108 cases) and high-dose ST exposure (HDE group 56 cases) based on the average ST of all subjects. Spatial independent component analysis (ICA) was used to identify resting state networks (RSNs) and investigate intra- and inter-network alterations in ASD children with prolonged ST. We found that the total Childhood Autism Rating Scale (CARS) scores in the HDE group were significantly higher than those in the LDE group (36.2 ± 3.1 vs. 34.6 ± 3.9, p = 0.008). In addition, the developmental quotient (DQ) of hearing and language in the HDE group were significantly lower than those in the LDE group (31.5 ± 13.1 vs. 42.5 ± 18.5, p < 0.001). A total of 13 independent components (ICs) were identified. Between-group comparison revealed that the HDE group exhibited decreased functional connectivity (FC) in the left precuneus (PCUN) of the default mode network (DMN), the right middle temporal gyrus (MTG) of the executive control network (ECN), and the right median cingulate and paracingulate gyri (MCG) of the attention network (ATN), compared with the LDE group. Additionally, there was an increase in FC in the right orbital part of the middle frontal gyrus (ORBmid) of the salience network (SAN), compared with the LDE group. The inter-network analysis revealed increased FC between the visual network (VN) and basal ganglia (BG) and decreased FC between the sensorimotor network (SMN) and DMN, SMN and ATN, SMN and auditory network (AUN), and DMN and SAN in the HDE group, compared with the LDE group. There was a significant negative correlation between altered FC values in MTG and total CARS scores in subjects (r = - 0.18, p = 0.018). Conclusion: ASD children with prolonged ST often exhibit lower DQ of language development and more severe autistic characteristics. The alteration of intra- and inter-network FC may be a key neuroimaging feature of the effect of prolonged ST on neurodevelopment in ASD children. Clinical trial registration: ChiCTR2100051141. What is Known: • Prolonged ST has adverse effects on autistic characteristics and language development. • Neuroimaging technology may help to further explain the role of prolonged ST in ASD. What is New: • This is the first study to explore the impact of ST on intra- and inter-network FC in children with ASD. • ASD children with prolonged ST have atypical changes in intra- and inter-brain network FC.

Impact Of Underage Marriage On Reproductive Health In Cileles District

Married women under the age of 16 are usually 10-12 times more likely to develop cervical cancer than those who are married over the age of 20. At that age the uterus of a young woman is very sensitive. The juvenile cervix is ​​more susceptible to carcinogenic stimuli because of the active process of metaplasia, which occurs in the transformation zone during the developmental period. Squamous epithelial metaplasia is usually a physiological process. But under the influence of carcinogens, cell changes can occur resulting in a pathological transformation zone (Melva, 2017). These atypical changes initiate a process called cervical intraepithelial neoplasm (CIN) which is the preinvasive phase of cervical cancer. Under the age of 18, a woman's reproductive organs are still very weak. If she is pregnant, then As a result, it will be easy to miscarry because the uterus is not that strong, making it difficult for the fetus to attach to the uterine wall. This type of research is descriptive research with the method used is a quantitative approach. The sample in this study was taken from the entire population, because the method used was total sampling with a total of 46 people. This study uses a cross-sectional or cross-sectional design which can show the relationship between the independent and dependent variables but cannot show a causal relationship. The results of the study that based on the results of the Paired Samples t Test correlation test obtained a p-value of 0.00. Because the p value is 0.00 (p &lt;0.05), there is a significant impact of early marriage on reproductive health.

Collision tumours: a meningioma and not oedema, but an oligodendroglioma

BackgroundIntracranial collision tumours represent a very rare entity. We hereby report a case involving the coexistence of a meningioma and an underlying oligodendroglioma in the adjacent brain, which could be misdiagnosed as oedema if not carefully examined for atypical changes. This study aimed to shed light on the diagnostic challenges associated with intracranial collision tumours, specifically the coexistence of meningioma and oligodendroglioma.Case presentationA 54-year-old woman presented to the emergency department with seizures and vertigo. Brain CT revealed an expansile extra-axial left frontal lesion with calcifications and homogeneous enhancement after contrast administration, interpreted as a meningioma, with underlying vasogenic oedema. Two months later, MRI revealed a heterogeneous area in the underlying compressed brain with high intensity at T2/FLAIR sequences, initially misconceived as oedema. However, atypical features such as cortex involvement, lower ADC values (compared to vasogenic oedema), an inversion of the choline/NAA ratio, and high rCBV values led to the hypothesis of an underlying oligodendroglioma, later confirmed by histology.ConclusionsThe coexistence of histologically different tumours in the same anatomical location is extremely rare and makes the diagnosis more challenging, requiring cautious evaluation and a high suspicion from the radiologist. The look for atypical findings, described in detail in this study, and the use of additional sequences, such as spectroscopy and perfusion, might be the key to the correct diagnosis.

Prevalence and characteristics of hepatic hemangiomas assessed by ultrasound: A single-center experience

Introduction/Objective. Liver hemangioma is the most common benign tumor of the liver, with estimated prevalence of 2.5-4%. This study aimed to investigate the prevalence and clinical characteristics of hepatic hemangioma in one Primary Care Center in Serbia. Methods. We conducted a cross-sectional study, which included patients examined in Primary Care Center "Dr Simo Milosevic" in Belgrade, Serbia (December 2017 - March 2020). Patients with suspected atypical changes, malignancies, viral hepatitis infections, and liver cirrhosis were excluded from the study. Results. A total of 567 patients were included in this study (men 42.5%). In 27 patients (4.76%) a diagnosed of hemangioma was made (male:female ratio: 1.1:1). The total number of hemangiomas detected was 48. Hemangiomas were most commonly found in the right liver lobe (32/48, 66,7%). In this study, hemangiomas were most commonly localized in the fourth liver segment (11/48, 22.9%). The mean diameter of the hemangioma was 13.8 mm. In the half of patients diagnosed with hemangioma, more than one hemangioma was detected (13/27, 48.1%). Conclusion. Hemangiomas of the liver are commonly multiple. No sex difference in hemangioma prevalence was noted. The right liver lobe is the most common hemangioma localization in this study cohort.

Skull Base Osteomyelitis- Marauders of the Skull.

Skull base osteomyelitis is a vicious infection of temporal bone associated with very high morbidity and mortality. But few studies have been undertaken recently for eliciting its increasing incidence. Hence this study aims to describe the clinical profile of skull base osteomyelitis and changes noted in the post-covid period, and encourage a uniform treatment policy globally. This descriptive study was conducted among 140 patients diagnosed with skull base osteomyelitis. Data was collected using semi-structured proforma, HRCT temporal bone findings, microbiological reports, histopathology of granulation tissue, ESR and House-Brackmann grading. Male patients in 61-70 age group were most commonly affected and all patients had uncontrolled diabetes mellitus, usually presenting with nocturnal otalgia, ear canal granulation and cranial nerve palsy. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. Among fungal pathogens, candida albicans were the most common. 29.3% patients had extensive disease according to Thakar et al. staging and on follow up, 43.75% patients showed a satisfactory response. Coronary artery disease and cerebrovascular accidents were the leading cause of death. More atypical organisms, extensive disease and changes in antibiotic sensitivity were noted in the post-covid period. Prolonged treatment with culture sensitive antibiotic is the main stay of treatment. A uniform treatment guideline is needed for proper management of such patients. Level of Evidence 4.

Atypical characteristic changes of surface morphology and structural covariance network in developmental dyslexia.

Developmental dyslexia (DD) is a neurodevelopmental disorder that is characterized by difficulties with all aspects of information acquisition in the written word, including slow and inaccurate word recognition. The neural basis behind DD has not been fully elucidated. The study included 22 typically developing (TD) children, 16 children with isolated spelling disorder (SpD), and 20 children with DD. The cortical thickness, folding index, and mean curvature of Broca's area, including the triangular part of the left inferior frontal gyrus (IFGtriang) and the opercular part of the left inferior frontal gyrus, were assessed to explore the differences of surface morphology among the TD, SpD, and DD groups. Furthermore, the structural covariance network (SCN) of the triangular part of the left inferior frontal gyrus was analyzed to explore the changes of structural connectivity in the SpD and DD groups. The DD group showed higher curvature and cortical folding of the left IFGtriang than the TD group and SpD group. In addition, compared with the TD group and the SpD group, the structural connectivity between the left IFGtriang and the left middle-frontal gyrusand the right mid-orbital frontal gyrus wasincreased in the DD group, and the structural connectivity between the left IFGtriang and the right precuneus and anterior cingulate was decreasedin the DD group. DD had atypical structural connectivity in brain regions related to visual attention, memory and which might impact the information input and integration needed for reading and spelling.