Bilateral Presentation Research Articles

Review of atypical optic neuritis.

Optic neuritis (ON), an inflammatory optic neuropathy, is among the most common causes of visual loss. In its initial clinical appearance, ON may have unilateral or bilateral presentation, and anterior (papillitis) or retrobulbar localization. Traditionally, cases are divided into typical and atypical ON. In the Western hemisphere, most typical cases of optic nerve inflammation are associated with multiple sclerosis (MS). However, ON may also be associated with a series of disorders of known or initially undetected origin. Atypical ON has a somewhat different clinical picture from typical ON, and encompasses neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), idiopathic recurrent neuroretinitis (NR), chronic relapsing inflammatory ON (CRION), ON within systemic autoimmune diseases, paraneoplastic and neuritis during or after infectious diseases or vaccination. The causes should be meticulously worked up, to address the therapeutic and prognostic challenges posed by these conditions. Here, we provide a brief overview of atypical ON, as encountered in our clinical practice, and additionally discuss the possible occurrence of optic neuropathies other than inflammatory and other ocular diseases within these disorders.

Misleading Imaging Findings: Bilateral Mylohyoid Defect Presenting as a Submandibular Mass Due to Sublingual Gland Protrusion

Background/Objectives: The muscular base of the oral cavity is formed of the mylohyoid muscle, which forms a sling inferior to the tongue. The muscle is often discontinuous, and defects may include salivary tissues, fat, and/or blood vessels. Hypertrophic sublingual glands located in mylohyoid defects can be herniated into bilateral submandibular spaces and present as palpable masses. The etiology of this condition may be congenital or acquired, and although such anatomical variations are common, they often go unrecognized in clinical practice. Sialoceles are cyst-like structures that result from chronic inflammation or ductal injury, indicating underlying problems with drainage efficiency. Methods: In this case series, we present two patients. Results: The first patient is a 44-year-old female who presented with a slowly enlarging right submandibular mass for two years, while the second is a 70-year-old female who presented with nonspecific neck discomfort, lacking palpable masses. In both, initial imaging (ultrasound and CT) was inconclusive. MRI revealed right sublingual gland herniation through a mylohyoid defect (mylohyoid boutonniere) in both cases. Conclusions: This highlights the importance of comprehensive imaging in the diagnosis of submandibular masses and emphasizes the need for considering mylohyoid boutonniere in cases of bilateral submandibular masses. Further research is warranted into the sialoceles associated with salivary gland abnormalities.

Bilateral Involvement in Childhood Presumed Trematode Induced Granulomatous Anterior Uveitis

ABSTRACT Purpose This study aims to elucidate the clinical spectrum of trematode-induced uveitis (TIU), with a particular focus on its bilateral presentation and providing significant insights into its pathophysiology. Methods A prospective cross-sectional observational study was conducted at the uveitis outpatient clinic of Mansoura University Ophthalmic Center. The study involved children diagnosed with presumed TIU. Comprehensive clinical evaluations were performed, including detailed history taking and thorough ophthalmological examinations of both the anterior and posterior segments, emphasizing the unaffected fellow eye. Results The cohort consisted of 80 children, with a male predominance of 98.75%. The proportion of bilateral involvement was observed in 12 out of 80 (15%). The involvement of the fellow eye was observed as follows: conjunctival hyperemia (3/80), conjunctival phlycten-like lesions (3/80), ciliary injection (10/80), corneal immune infiltration (4/80), retro-corneal membrane (5/80), anterior chamber granuloma (5/80), peripheral anterior synechiae (3/80), complicated cataract (2/80), diffuse cyclitis and choroid thickening (12/80), and intermediate uveitis (11/80). Conclusion This study demonstrates that TIU is not confined to the initially affected eye; the fellow eye may also be affected in a significant number of cases. Therefore, it is crucial to conduct thorough examinations of both eyes in patients diagnosed with TIU to ensure comprehensive clinical management.

Clinical characteristics and optical coherence tomography features of ocular toxoplasmosis inHIV-positive patients: report 1

PurposeThis study aimed to identify the various clinical characteristics and ocular imaging features of ocular toxoplasmosis (OT) in HIV patients.MethodsObservational retrospective study of 52 eyes of 38 HIV patients with...

Peripapillary hyperreflective ovoid mass-like structure (PHOMS): prevalence, risk factors, and development over time in Danish myopic children

BackgroundOn optical coherence tomography (OCT) scans of the optic nerve head, peripapillary hyperreflective ovoid mass-like structures (PHOMS) are sometimes seen as a sign of axonal distension. The phenomenon has been reported more frequently in myopic subjects. We investigated PHOMS-prevalence in a myopic pediatric cohort, associated risk factors, and PHOMS development over 18 months during low-dose atropine treatment. MethodsIn this post hoc analysis of an investigator-initiated, placebo-controlled, randomized clinical trial, 97 6- to 12-year-old myopic participants were randomized to 0.1% atropine for 6 months, then 0.01% for 18 months (N = 33), 0.01% for 24 months (N = 32) or placebo for 24 months (N = 32). Primary outcome was presence of PHOMS. Secondary outcome was mean nasal PHOMS diameter measured on OCT B-scan. Outcomes were reported at baseline, 6, and 18 months. Logistic regression and linear mixed modelling were performed. ResultsPHOMS were present in 26% of participants (n = 25), and 52% (n = 13) had bilateral presentation. Optic disk tilt (OR = 10.81; 95% CI, 3.58-32.58 [P < 0.001]) and longer axial length (AL) (OR = 2.06; 95% CI, 1.02-4.17 [P = 0.04]) increased the risk of having PHOMS. Greater increase in nasal peripapillary choroidal thickness over time was associated with smaller PHOMS diameter at 18 months (P = 0.05). ConclusionsPHOMS were common in our cohort of children with myopia. Longer AL increases the risk of, but not size of, PHOMS. The diameter of PHOMS seemed stable over time and unaffected by low-dose atropine.

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

Perception, attitude, and opinion of parents of cleft lip and palate patients treated with nasoalveolar molding (NAM): A cross-sectional questionnaire study.

The main goal of the nasoalveolar molding (NAM) is to mitigate the initial severity of the cleft, facilitating the subsequent surgical procedures. Nevertheless, the use of the appliance entails high stress levels for families. The aim of this study was to assess the perceptions, attitudes, and opinions of parents whose cleft-affected children underwent treatment using the NAM technique. A cross-sectional questionnaire study was conducted on a cohort of relatives of infants born with cleft lip and palate who were treated with the NAM appliance. The parents completed a 59-item questionnaire that had been previously validated. The initial cohort consisted of 104 families. The level of satisfaction was high, and there was a direct correlation with early diagnosis. Satisfaction levels varied depending on the cleft type, with a decrease in cases of bilateral presentation. Satisfaction was influenced by the newborns' adaptation and the absence of complications. Parents who exhibited lower levels of satisfaction contemplated terminating the treatment. Parents expressed high satisfaction with NAM treatment, due to effective management and understanding. Bilateral clefts and delayed diagnosis can significantly impact satisfaction. These results emphasize the importance of personalized approaches to address challenges in NAM treatment, particularly in instances of bilateral clefts and delayed diagnoses.

Secondary parkinsonism associated with focal brain lesions.

Focal imaging abnormalities in patients with parkinsonism suggest secondary etiology and require a distinctive clinical approach to diagnosis and treatment. We review different entities presenting as secondary parkinsonism associated with structural brain lesions, with emphasis on the clinical course and neuroimaging findings. Secondary parkinsonism may be due to vascular causes, hydrocephalus, space-occupying lesions, metabolic causes (including acquired hepatocerebral degeneration, diabetic uremic encephalopathy, basal ganglia calcifications, osmotic demyelination syndrome), hypoxic-ischaemic brain injury, intoxications (including methanol, carbon monoxide, cyanide, carbon disulfide, manganese poisoning and illicit drugs), infections and immune causes. The onset can vary from acute to chronic. Both uni-and bilateral presentations are possible. Rigidity, bradykinesia and gait abnormalities are more common than rest tremor. Coexisting other movement disorders and additional associated neurological signs may point to the underlying diagnosis. Neuroimaging studies are an essential part in the diagnostic work-up of secondary parkinsonism and may point directly to the underlying etiology. We focus primarily on magnetic resonance imaging to illustrate how structural imaging combined with neurological assessment can lead to diagnosis. It is crucial that typical imaging abnormalities are recognized within the relevant clinical context. Many forms of secondary parkinsonism are reversible with elimination of the specific cause, while some may benefit from symptomatic treatment. This heterogeneous group of acquired disorders has also helped shape our knowledge of Parkinson's disease and basal ganglia pathophysiology, while more recent findings in the field garner support for the network perspective on brain function and neurological disorders.

Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of thestudy is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological)classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp.,Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, alongwith one individual having deep vein involvement and a few participants (n=35, 62.5%)having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

Bilateral Horizontal Canal Dysplasia Presenting as Hearing Loss With Recurrent Vertigo Mimicking Meniere's Disease.

We report an extremely rare case with bilateral horizontal semicircular canal (HSC) dysplasia presenting as hearing loss with recurrent vertigo mimicking Meniere's disease in a previously healthy 49-year-old male patient. HSC malformation is one of the common isolated developmental anomalies of the bony labyrinth usually associated with varying degree of hearing loss. He suffered from recurrent episodes of vertigo lasting more than 20 minutes accompanied by left hearing loss and tinnitus for 3 years. Pure-tone audiometry revealed a mild to moderate hearing loss at low frequencies in the left ear. Bithermal caloric testing revealed significant left-sided canal paralysis, but other vestibular testing was normal. Computerized tomography (CT) of the temporal bone showed the left HSC hypoplasia lacking a central bony island fused together with an enlarged vestibule, and right dysplasia, finally diagnosed with bilateral HSC dysplasia. Meniere's disease-like recurrent vertigo attack and hearing loss were suspected to be caused by subsequent endolymphatic hydrops which could be due to HSC dysplasia.

Salzmann Nodular Degeneration in Ocular and Systemic Diseases.

This review aimed to evidence the predisposing conditions for Salzmann nodular degeneration (SND), where particular attention was paid to its association with ocular and systemic diseases. SND is a rare disease characterized by bluish-white nodules located in the mid-periphery of the cornea, which are otherwise completely clear. SND has been found in association with different systemic and ocular diseases, and it may have unilateral or bilateral presentation. Initial forms are only diagnosed occasionally as they are asymptomatic, whereas, in advanced disease, the visual acuity might be seriously impaired. Although SND is well described, its exact etiopathology is currently still unknown and is frequently misdiagnosed. It is associated with ocular surface inflammatory conditions and previous corneal surgery, and it has been described in different systemic diseases. Diagnosis is clinically based with slit lamp examinations, and instrumental assessments with corneal topography permit one to observe the alterations of the corneal profile, whereas anterior segment-optical coherence tomography (AS-OCT) is used to investigate the stromal depth of the nodules. Therapy might be conservative with the objective of improving the ocular surface homeostasis and surgical outcomes, where the aim is to restore the corneal regularity and visual acuity. Ophthalmologists should pay particular attention when detecting nodules in patients with ocular and non-ocular inflammatory diseases to guarantee the patient a timely diagnosis and a better therapeutic outcome. Additionally, collaboration between specialists who deal with treating patients suffering from disorders potentially associated with SND is recommended.

The Linburg-Comstock Anomaly: A Study on Prevalence and Effect on Various Strength Metrics.

The Linburg-Comstock (LC) anomaly is a common tendinous connection between the flexor pollicis longus and flexor digitorum profundus (FDP), most frequently to the FDP of the index finger. The purpose of this study was to obtain epidemiologic data on the LC anomaly in a healthy, ethnically diverse population and to study the effect of the LC anomaly on grip strength, tip pinch strength, key pinch strength, and chuck pinch strength. We examined 500 healthy subjects (292 females and 208 males) bilaterally for the presence of the LC anomaly. Each subject had their grip strength, tip pinch strength, key pinch strength, and chuck pinch strength measured bilaterally using a dynamometer for grip strength and a pinch meter for all pinch strength measurements. The LC anomaly was present in 213 of the 500 subjects (43%). One hundred one subjects (47%) had a unilateral presentation, and 112 (53%) subjects had a bilateral presentation. The LC anomaly was associated with a weaker tip pinch strength. When examining the LC anomaly among different ethnic groups, the highest prevalence was found in the Hispanic (57%) population followed by Caucasian (50%), Asian (41%), and African American (31%) populations. The LC anomaly has different prevalence according to ethnicity, with a higher prevalence in the Hispanic and Caucasian populations and a lower overall prevalence in the African American populations. The LC anomaly can also result in weaker tip pinch strength.

Characteristics of myelinated retinal nerve fibres in associated straatsma syndrome.

To study cases diagnosed of myelinated retinal nerve fibres (MRNF) continuous with the optic disc and describe the plausible pathogenic mechanism for the ocular features in Straatsma syndrome. This retrospective observational study includes clinically diagnosed MRNF cases. MRNF, myopia, and amblyopia defined Straatsma syndrome. MRNF were classified into three types based on location: type 1 in the superior retina, type 2 in the superior and inferior retina, and type 3 in the inferior retina. MRNF size was measured on Optomap® (Optos, Daytona, UK) images and posterior staphyloma location was noted. Demographics and best-corrected refractive error in logMAR units was recorded. Descriptive statistics and Spearman's corelation test were used to analyse MRNF size's relationship to refractive error and logMAR visual acuity. The study included a total of 19 MRNF eyes from 18 patients. Seventeen (89%) eyes had Straatsma syndrome. Median age was 23.50 [range: 4-75] years. One (6%) patient exhibited bilateral presentation. The median logMAR visual acuity was 0.4 log units (interquartile range: 0.18-1.20) and mean refractive error was -7.21 ± 5.32. Type 2 MRNF (n = 14,74%) was the commonest. Average MRNF size was 34.37 ± 40.73 sq.mm. Posterior staphyloma was noted in 17 eyes, all in close MRNF association. Significant positive corelation was noted between logMAR visual acuity and MRNF size (r = 0.5, p = 0.028). Large size MRNF corelated with poor visual acuity in the study. The paper explains the possible pathogenetic mechanisms for the ocular findings seen in MRNF.

CBCT based investigation of frequency of Middle Mesial Canal in Mandibular First Molars of Saudi Sub-population.

One key factor in determining endodontic treatment outcome is the clinicians' comprehension of tooth anatomy, as missed canals may harbor bacteria ultimately leading to apical periodontitis. The study aimed to investigate the prevalence of middle mesial canal (MMC) in Mandibular first molars (MFMs) of Saudi subpopulation. The cross-sectional retrospective study was conducted at Qassim University Dental College from June to August 2023. Overall, 302 CBCT images with 604 bilateral lower first molars were examined by two calibrated assessors. The existence of MMC was noted. The data were coded, and analysis was done in SPPS-24. The reliability of inter-evaluator and intra-evaluator agreement for detecting MMC were estimated using Cohen's kappa. The patients' average age was 30.95±11.61years. The sample's female to male ratio was 1:1.75. The overall frequency of MMC was 14.2%. The differences in the frequency of MMC on the basis of gender, quadrants and age groups were found to be insignificant. Inter-evaluator and intra-evaluator reliability was noted to be 0.78 and 0.74, depicting acceptable reliability. The MMC is an uncommon occurrence with rare bilateral presentation in MFMs of Saudi population. Endodontists performing endodontic treatment in such subjects should mindfully investigate inter mesiobuccal- mesiolingual canals area for locating, negotiating, and managing any present MMC's.

Bilateral Choanal Atresia in 24 Years Old Woman: A Case Report.

Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence. A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana. Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment.

MR Imaging Findings in Anti-Leucine-Rich Glioma Inactivated Protein 1 Encephalitis: A Systematic Review and Meta-analysis.

Antibodies against leucine-rich glioma inactivated protein 1 (LGI1) constitute a common form of autoimmune encephalitis. On MR imaging, it may show T2 FLAIR hyperintensities of the medial temporal lobe (T2 FLAIR-MTL), involve the basal ganglia, or be unremarkable. We performed a systematic review and meta-analysis to obtain prevalence estimates of abnormal findings on MR imaging in anti-LGI1 encephalitis. A human brain map of the LGI1 microarray gene expression was derived from the Allen Human Brain Atlas. PubMed and Web of Science were searched with the terms "LGI1" and "encephalitis" from inception to April 7, 2022. Thirty-one research publications, encompassing case series and retrospective cohort and case-control studies, with >10 patients with anti-LGI1 encephalitis and MR imaging data were included. Pooled prevalence estimates were calculated using Freeman-Tukey double-arcsine transformation. Meta-analysis used DerSimonian and Laird random effects models. Of 1318 patients in 30 studies, T2 FLAIR-MTL hyperintensities were present in 54% (95% CI, 0.48-0.60; I2 = 76%). Of 394 patients in 13 studies, 27% showed bilateral (95% CI, 0.19-0.36; I2 = 71%) and 24% unilateral T2 FLAIR-MTL abnormalities (95% CI, 0.17-0.32; I2 = 61%). Of 612 patients in 15 studies, basal ganglia abnormalities were present in 10% (95% CI, 0.06-0.15; I2 = 67%). LGI1 expression was highest in the amygdala, hippocampus, and caudate nucleus. Only part of the spectrum of MR imaging abnormalities in anti-LGI1 encephalitis could be included in a meta-analysis. MR imaging findings were not the main outcomes in most studies, limiting available information. I2 values ranged from 62% to 76%, representing moderate-to-large heterogeneity. T2 FLAIR-MTL hyperintensities were present in around one-half of patients with anti-LGI1. The prevalence of unilateral and bilateral presentations was similar, suggesting unilaterality should raise the suspicion of this disease in the appropriate clinical context. Around 10% of patients showed basal ganglia abnormalities, indicating that special attention should be given to this region. LGI1 regional expression coincided with the most frequently reported abnormal findings on MR imaging. Regional specificity might be partially determined by expression levels of the target protein.

Primary mucinous gland lesions of fallopian tube: a clinicopathological analysis of fourteen cases

Objective: To investigate the clinical and pathological characteristics of primary mucinous gland lesions of the fallopian tubes. Methods: The clinical data, pathomorphological characteristics and immunophenotype of 14 cases of primary mucinous gland lesions of the fallopian tube diagnosed at Obstetrics and Gynecology Hospital of Fudan University from 2015 to 2023 were analyzed retrospectively. In addition, a comprehensive review of relevant literature was conducted. Results: The age of 14 patients ranged from 53 to 83 years, with an average of 65 years. Among them, 13 cases exhibited unilateral involvement while one case showed bilateral presentation. Nine cases were mucinous metaplasia of the fallopian tube, four cases were invasive mucinous adenocarcinoma and one case was mucinous carcinoma in situ. Morphologically, mucinous metaplasia of the fallopian tube was focal, with or without inflammation. The cells of mucinous adenocarcinoma or mucinous carcinoma in situ exhibited characteristics indicative of gastrointestinal differentiation. Immunohistochemical analysis revealed diffuse positive expression of CK7, and negative expression of SATB2. CDX2 demonstrated positive staining in two cases. One case exhibited diffuse and strongly positive mutant expression of p53, whereas the remaining cases displayed wild-type expression. MUC6 showed diffuse or focally positive staining in mucinous gland lesions characterized by gastric differentiation. Some cases of mucinous adenocarcinoma of fallopian tube were subject to AB-PAS staining, resulting in red to purple cytoplasmic staining. Conclusions: Primary mucinous lesions of the fallopian tube are exceedingly uncommon. All cases of mucinous adenocarcinoma of fallopian tubes in this study exhibit the morphology and immunohistochemical characteristics of gastrointestinal differentiation. Mucinous metaplasia of the fallopian tube is a benign lesion of incidental finding, which is closely related to inflammation or gastric differentiation. Mucinous lesions of cervix, ovary and digestive tract are excluded in all patients, confirming the independent existence of mucinous lesions within fallopian tubes.

A Comparative Study between Laparoscopic Varicocelectomy and Open Varicocelectomy in the Treatment of Varicocele

Background: Varicocele is a vein anomaly affecting 15% of adult males, with prevalence increasing to 35% in men seeking infertility evaluation and 81% in those with secondary infertility. It is primarily due to a prevalent and remediable factor. Objective: The objective of this study is to do a comparative analysis of the post-operative outcomes between open inguinal varicocelectomy and laparoscopic varicocelectomy. Methods: The present investigation was undertaken within the surgical department of (Hospital name) over a duration of two years, spanning from December 2019 to December 2021. This study employed a prospective design and involved the inclusion of a cohort comprising 50 patients diagnosed with clinically severe varicocele. The participants were allocated into two distinct groups. Group A consisted of 25 individuals who underwent laparoscopic surgery, while Group B consisted of 25 individuals who received an open approach. Results: In our study comprising a cohort of 50 patients, we observed a range of ages from 20 to 49 years. Among these patients, 19 reported experiencing scrotal pain, 25 exhibited testicular swelling, and 7 presented with infertility. The mean operation time for laparoscopic varicocelectomy was 48 minutes, while for open surgery it was 57 minutes. Interestingly, we found that the postoperative analgesic requirement was similar in both groups. Furthermore, the average duration of hospital stay was 35.6 hours for laparoscopic procedures and 50.6 hours for open procedures. The duration of the operative procedure in Laparoscopic Varicocelectomy was found to be 17.25 ± 2.1 minutes in cases where the condition was unilateral, whereas it was 29.32 ± 2.8 minutes in situations where the condition was bilateral. The average length of surgery for unilateral cases in Open Varicocelectomy was found to be 42.5 ± 3.4 minutes, whereas for bilateral presentations, it was 67.25 ± 2.5 minutes. The observed difference between the two groups was found to be statistically significant, with a p-value of less than 0.001 . The recurrence rate was higher in laparoscopic group. Conclusion: Laparoscopic varicocelectomy offers similar outcomes to open techniques, with minimal morbidity and shorter hospitalization periods. It treats bilateral varicoceles without extra incisions and has a higher recurrence rate, but overall patient satisfaction makes it a preferred surgical technique. Keywords: laparoscopic varicocelectomy, Open varicocelectomy, Infertility.

A low-endotoxic Salmonella enterica Gallinarum serovar delivers infectious bronchitis virus immunogens via a dual-promoter vector system that drives protective immune responses through MHC class-I and -II activation in chickens

An effective vaccine strategy is indispensable against infectious bronchitis virus (IBV) and fowl typhoid (FT), both of which threaten the poultry industry. This study demonstrates a vector system, pJHL270, designed to express antigens in prokaryotic and eukaryotic cells. The vector system stimulates immune responses via synchronized antigen presentation to MHC class-I and -II molecules to produce balanced Th1/Th2 responses. The vaccine antigens were crafted by selecting the consensus sequence of the N-terminal domain of the spike protein (S1-NTD) and a conserved immunogenic region of the nucleocapsid protein (N321-406 aa) from IBV strains circulating in South Korea. The vaccine antigen was cloned and transformed into a live-attenuated Salmonella Gallinarum (SG) strain, JOL2854 (∆lon, ∆cpxR, ∆rfaL, ∆pagL, ∆asd). Western blot analysis confirmed concurrent antigen expression in Salmonella and eukaryotic cells. Oral immunization with the SG-based IBV vaccine construct JOL2918 induced IBV antigen and Salmonella-specific humoral and cell-mediated immune responses in chickens. PBMCs collected from immunized chickens revealed that MHC class-I and -II expression had increased 3.3-fold and 2.5-fold, respectively, confirming MHC activation via bilateral antigen expression and presentation. Immunization induced neutralizing antibodies (NAbs) and reduced the viral load by 2-fold and 2.5-fold in the trachea and lungs, respectively. The immunized chickens exhibited multifaceted humoral, mucosal, and cell-mediated responses via parallel MHC class-I and -II activation as proof of a balanced Th1/Th2 immune response. The level of NAbs, viral load, and gross and histological analyses provide clear evidence that the construct provides protection against IBV and FT.