Provisional Diagnosis Research Articles

Oral pyogenic granuloma with calcification

Rationale: Pyogenic granuloma (PG) is a commonly observed reactive soft-tissue lesion, often arising due to prolonged mild irritation or hormonal fluctuations in the oral cavity. Clinically, PG presents as a lesion with a smooth or lobulated appearance, which can be either sessile or pedunculated, and typically exhibits an hemorrhagic tendency. Very few cases of calcification in a PG have been reported in the past as these rarely exhibit ossification when viewed under a microscope. Patient Concerns: The following report is a case of a PG, that presented as a growth with occasional pain in the right upper back region of a 54 year old female. The patient reported no other concerns. Diagnosis: A provisional diagnosis of PG was given following thorough clinical and radiographic investigations. This was confirmed by a histopathological examination following an excisional biopsy. Intervention: The patient was treated with surgical excision as a part of the excisional biopsy of the lesion. Follow-up for the patient was done after 6 months, and there were no signs or indications of recurrence. Outcomes: The histopathological examination revealed regions of calcification, which are uncommon in PG, in addition to the characteristic hallmarks of proliferating endothelial cells, blood vessels, and inflammatory cells.

An unusual case of bilateral conjunctival ulcer post dengue fever: A case report

A 25-year-old male patient presented with redness and pain in both eyes since 2 days with history of fever in the past 1 week and tested positive for dengue. On examination, the patient had bilateral nasal congestion and a whitish-yellow lesion in the right eye canthal region measuring 4 mm × 4 mm and 2 mm × 1 mm in the left eye; the lesion was fluorescein stain-positive. A provisional diagnosis of bilateral conjunctival ulcer was made and sent for culture and sensitivity. Culture revealed mixed bacterial and fungal growth of Pseudomonas aeruginosa and Aspergillus niger. The patient was started on fortified vancomycin 50 mg/mL (5%) and ceftazidime 50 mg/dL (5%) along with natamycin 5% eyedrops and oral ketoconazole 200 mg. The patient reviewed after 5 days showed fluorescein stain-negativity in both eyes and was completely asymptomatic on further follow-up. Opportunistic infections are common in dengue fever and should be treated aggressively to prevent further ocular complications.

Asymptomatic Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a Young Adult: A Case Report and Comprehensive Review

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a rare genetic heart disorder characterized by fibrofatty replacement of the myocardium, which can present as silent disease to ventricular arrhythmias, heart failure and sudden cardiac death. Here, we report a case of ARVC in a 38 years old male, who initially presented to us with complaints of dizziness. Confirmed diagnosis was made with the help of Cardiac MRI, though a provisional diagnosis was made via ECG and ECHO

Antidiuretic hormone deficiency secondary to inactive hydrocephalus: a case report

BackgroundDiabetes insipidus is a syndrome characterized by polyuria, which is almost always associated with polydipsia. The most frequent cause is central diabetes insipidus, which is the result of an inadequate secretion of the antidiuretic hormone, and diagnosis involves differentiating it from other causes of polyuria and polydipsia.Case presentationHere, we present a clinical case of a previously healthy 13-year-old Nepali boy, who, in December 2022, was found to have intense polydipsia accompanied by polyuria. He had bilateral lower limb weakness at the time of presentation. Biochemical evaluation demonstrated raised serum sodium (181 mEq/L), serum creatinine (78 μmol/L), and serum uric acid (560 μmol/L) with suppressed serum potassium (2.7 mEq/L), which was the major concern to the clinicians. Further laboratory workup revealed an increased serum osmolarity (393.6 mOsm/kg) with reduced urine osmolarity (222.7 mOsm/kg). On contrast magnetic resonance imaging of the brain, a thick-walled third ventricular cyst with bilateral foramen obstruction, thin membrane-like structure at top of aqueduct of Sylvius with gross obstructive hydrocephalus (inactive), and compressed and thinned pituitary gland with no bright spot was observed. The laboratory findings, radiological findings, and case presentation provided the provisional diagnosis of diabetes insipidus due to hydrocephalus and third ventricular cyst.ConclusionsCentral diabetes insipidus due to hydrocephalus, though rare, can have serious complications including the predilection to develop a deficit of other pituitary hormones. Thus, even if hydrocephalus is dormant with normal intracranial pressure, it must be addressed during investigations of central diabetes insipidus.

An Unusual Case of Headache: Joining the Dots in the Emergency Room

Headache is one of the commonest presenting complaints in the Emergency Room. In the young population with no significant history of any medical condition or trauma, it seldom raises suspicion of an ominous etiology. In this case report we present an unusual case of a young unmarried female presenting to the ED with acute onset headache and vomiting. After initiation of primary treatment, the patient was subjected to MRA and MRV of the brain which was suggestive of thrombosed mid part of Superior Sagittal Sinus, right Sigmoid and right Transverse sinus. On eliciting the SAMPLE history of the patient, the risk factor of polycystic ovarian syndrome and intake of Norethisterone for Abnormal Uterine Bleeding was known. Provisional diagnosis of Norethisterone induced Cerebral Venous Sinus Thrombosis was considered and patient was initiated on treatment with Enoxaparin (Low Molecular weight Heparin) followed by long term NOAC and lifetime avoidance of Norethisterone and other prothrombotic drugs.

Metastatic gastric cancer in a 23- year-old female Zambian diagnosed posthumously: A case report

Introduction: Gastric cancer is one of the leading causes of cancer mortality globally and in Zambia, its exact burden is unknown. Here, we present a case of gastric cancer in a young adult that was diagnosed posthumously.
 Clinical details: A 23-year-old female patient was referred to the largest tertiary care institution in Zambia, the University Teaching Hospital (UTH). She had been followed up at a district hospital. The patient had a three months’ history of ill-health with symptoms of anaemia, abdominal pain and distension. Upon arrival at UTH, she was noted to be very frail, with pallor, tachycardia and gross abdominal distension and a nodular irregular liver, measuring 10cm below the costal margin. A digital rectal examination revealed the presence of melena. She had no jaundice, lymphadenopathy or finger clubbing but had bilateral pedal oedema. A provisional diagnosis of hepatocellular carcinoma complicated by upper gastrointestinal bleeding was made. Subsequent investigations revealed normal alpha fetoprotein, a Transient Elastography value of 75kPa and negative hepatitis B and C serology. Computerised tomography scan showed multiple liver masses with ascites. The patient continued to deteriorate despite supportive management and died on day 10 of admission. A post mortem was done which revealed a primary gastric adenocarcinoma with metastasis to the liver, lungs and pancreas.
 Conclusion: This is an example of a case of gastric cancer that was not detected while the patient was alive. It illustrates how cases of gastric cancer would be missed by the Zambia National Cancer Registry recording system.

Cleidocranial dysplasia associated with dentigerous cyst-review of literature and case report of two siblings.

Cleidocranial dysplasia (CCD) is a developmental anomaly of the skeleton and teeth which may be inherited, be transmitted as dominant characteristics in either male or female or even appear spontaneously. A case was reported in the department of oral medicine and radiology of two sisters age 17 and 19 years old with a chief complaint of milk teeth not falling since childhood. They presented specific physical and oral findings in common which suggested the idea of an undiagnosed syndrome. The sisters showed CCD characteristics including short stature (4 feet) and frontal bone resorption indicating delayed closure of fontanels. The stature is moderately shortened with the neck appearing long and narrow and the shoulders markedly dropped. Dental abnormalities such as retention of primary dentition, multiple supernumerary teeth, and delayed eruption of permanent dentition. OPG showed the presence of multiple impacted permanent and supernumerary teeth with radiolucency involving the crowns of impacted teeth revealing a cystic lesion. Lateral cephalogram also revealed the presence of multiple impacted teeth. The provisional diagnosis of CCD with dentigerous cyst was given. The enucleation of cyst was done and submitted for histopathological examination. Histopathologically, the soft tissue section suggested the features of dentigerous cyst. The final diagnosis of CCD associated with dentigerous cyst was confirmed.

Systemic Observation-Surgical Periodontic Approach In The Management Of Amlodipine Induced Gingival Enlargement

Background: Drug induced gingival enlargement is frequently observed in patients taking three main group of drugs like calcium channel blockers (CCBs), immunosuppressant’s and anticonvulsants. Amlodipine belongs to the dihydropyridine-a third generation calcium channel blockers agents that may cause the side effect of drug-induced gingival enlargement and oral bacteria intervention due to calculus retention. This case report describes the management of gingival enlargement in a hypertensive patient taking amlodipine. Purpose: This case report was aimed to discuss the treatment and maintenance of systemic observationsurgical periodontic approach to restore gingival enlargement. Case Report: A 47-years old man was referred to the Department of Periodontology, Faculty of Dentistry, Airlangga University complaining of swellings and bleeding on his gingiva in all region. He felt very uncomfortable as the swelling interfered while chewing and sometimes there was bleeding spontaneously and halitosis. He had hypertension since 5 years and was on medications Captopril 12,5 mg daily during 4 years and Amlodipine 5mg daily during last 1 year. A provisional diagnosis and systemic observation-periodontal phases treatment were taken to restore gingival enlargement condition. Case Management: Systemic observation of medication use, periodontal phases treatment such as scaling root planning, periodontal surgery as flap surgery, home oral hygiene maintenance, control recall every month during first 3 months were taken. Conclusion: The successful of combination carefully systemic observation-surgery periodontal approach are promising to maintain Amlodipine induced gingival enlargement.

The lived experiences and treatment needs of women with opioid use disorder and posttraumatic stress symptoms: A mixed methods study

IntroductionWomen show a gender-specific risk for co-occurring opioid use disorder (OUD) and posttraumatic stress disorder (PTSD). Expert groups have called for the development of integrated treatments for women with OUD/PTSD, but there remains limited information on such interventions. MethodsThis mixed-methods study interviewed and surveyed 10 women with current or past OUD and co-occurring posttraumatic stress symptoms (PTSS) and 16 providers who work with these women. Interviews and surveys queried patient participants' and providers' experiences of OUD/PTSS and how to best design an integrated, trauma-focused treatment for OUD/PTSD. ResultsPatient participants (90 % white, 90 % mothers, Mage = 45.70) met criteria for severe, lifetime OUD and 40 % met a provisional diagnosis for PTSD. Four themes emerged for participants' experiences of OUD/PTSS: 1) numerous stressors; 2) shame; 3) multiple motivations to use opioids; and 4) a cycle of trauma and opioid use. Four themes emerged regarding patient participants' perceptions on the development of an OUD/PTSD treatment: 1) mixed attitudes towards medications for OUD; 2) barriers to treatment (e.g., insufficient treatments and contextual factors); 3) treatment facilitators (e.g., social support); and 4) preferences in treatment (e.g., trauma-focused, gender-focused, family content, ambivalence around group therapy). Providers (Mage = 38.94) were primarily white women (76.5 %). Two themes emerged from their experiences working with women with OUD/PTSS: 1) perceiving women to use opioids to regulate emotions and 2) gender differences in trauma types. Three themes emerged for providers' perceptions on the development of an OUD/PTSD treatment: 1) barriers to treatment (e.g., chaotic lives, contextual factors, family); 2) treatment facilitators (e.g., trust and external motivations); and 3) desired treatment modifications (e.g., stabilization, early skills in therapy, flexibility in therapy, social supports, safety guidelines, and assistance in identifying an index trauma). Most participants (90.0 %) and providers (93.5 %) preferred working on OUD/PTSD symptoms simultaneously rather than separately. ConclusionsFindings demonstrate the need to modify integrated treatments to meet the preferences of providers and women with OUD/PTSS and OUD/PTSD. Treatments should consider therapeutic content, structure, contextual factors, social support, and PTSD severity to enhance uptake and reach.

Utility of demographic and clinical signs as diagnostic predictors for leptospiral uveitis: A retrospective study.

Leptospirosis is a waterborne zoonotic disease prevalent in tropical regions, causing significant morbidity and mortality. It can involve any organ in its primary stage, and uveitis is its late complication. While advanced laboratory diagnosis is available only in tertiary care centers globally, a cost-effective bedside assessment of clinical signs and their scoring could offer a provisional diagnosis. To analyze the diagnostic potential of demographic and clinical signs in a large cohort of serologically confirmed leptospiral uveitis patients. In this retrospective study, demographic and clinical parameters of 876 seropositive leptospiral uveitis patients and 1042 nonleptospiral uveitis controls were studied. Multivariable logistic regression analysis with bootstrap confidence interval (CI) characterized the diagnostic predictors. The performance of the model was evaluated using the area under the receiver operating curve (AUROC). Presence of nongranulomatous uveitis (odds ratio [OR] = 6.9), hypopyon (OR = 4.6), vitreous infiltration with membranous opacities (OR = 4.3), bilateral involvement (OR = 4), panuveitis (OR = 3.3), vasculitis (OR = 1.9), disc hyperemia (OR = 1.6), absence of retinochoroiditis (OR = 15), and absence of cystoid macular edema (OR = 8.9) emerged as predictive parameters. The AUROC value was 0.86 with 95% CI of 0.846-0.874. At a cut-off score of 40, the sensitivity and specificity were 79.5 and 78.4, respectively. The study demonstrates that ocular signs can serve as diagnostic predictors for leptospiral uveitis, enabling primary care ophthalmologists to make bedside diagnosis. This can be further confirmed by laboratory methods available at tertiary care centers.

Takotsubo syndrome after bilateral simultaneous total knee arthroplasty - A case report

IntroductionCardiac complications represents a major cause of morbidity and mortality especially after bilateral simultaneous total knee arthroplasty (BS-TKA). Takotsubo syndrome after BS-TKA has not been described in the literature. Case presentationA 60 years-old women underwent BS- TKA and she suddenly developed bradycardia and hypotension after second knee wound closure. The electrocardiography revealed ST elevation and echocardiography showed apical hypokinesia of left ventricle. Coronary angiography revealed normal epicardial coronaries and a provisional diagnosis of Takotsubo cardiomyopathy was made. Serial ECGs revealed resolution of ST elevation and normal LV function within 5 days. On one-year follow up, she was able to do all her normal activities, and 12-lead electrocardiography were back to normal. ConclusionCardiac complications represents a major cause of morbidity and mortality especially after BS-TKA. Surgeons must be vigilant in the postoperative period for any likely precipitating factors of stress induced cardiomyopathy. Takotsubo syndrome should be considered as a differential diagnosis with features of acute coronary syndrome in elderly post-menopausal patients.

The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD

BackgroundPsychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in the literature examining PTSD in ACHD using the current DSM-5 criteria, while assessing patient characteristics and experiences with trauma-focused treatment. MethodsSurveys were offered to outpatients over a six-month enrollment period to be completed via QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo Social Support Scale (OSSS-3), Adverse Childhood Experiences (ACEs) survey, and the PTSD Checklist for DSM-5 (PCL-5). ResultsOf 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%), using a PCL-5 cutoff score of ≥ 31. A positive PTSD screen was associated with younger age, non-white race, presence of heart failure, lower New York Heart Association Functional Class, lower linear Quality of Life score, lower OSSS-3 score, an insecure caregiver relationship, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions was not associated with PTSD, although having undergone no cardiac surgeries until adulthood (≥ 18 years old) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14/48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. Eighteen patients (38%) reported currently having a mental health provider. Thirty patients (62%) had heard of at least one evidence-based trauma-informed therapy, and 14 (29%) had tried at least one. ConclusionsUsing the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few individuals with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.

Transient binocular vision loss and pain insensitivity in Klippel–Feil syndrome: a case report

BackgroundKlippel–Feil syndrome is a rare congenital bone disorder characterized by an abnormal fusion of two or more cervical spine vertebrae. Individuals with Klippel–Feil syndrome exhibit diverse clinical manifestations, including skeletal irregularities, visual and hearing impairments, orofacial anomalies, and anomalies in various internal organs, such as the heart, kidneys, genitourinary system, and nervous system.Case presentationThis case report describes a 12-year-old Pashtun female patient who presented with acute bilateral visual loss. The patient had Klippel–Feil syndrome, with the typical clinical triad symptoms of Klippel–Feil syndrome, along with Sprengel’s deformity. She also exhibited generalized hypoalgesia, which had previously resulted in widespread burn-related injuries. Upon examination, bilateral optic disc swelling was observed, but intracranial pressure was found to be normal. Extensive investigations yielded normal results, except for hypocalcemia and low vitamin D levels, while parathyroid function remained within the normal range. Visual acuity improved following 2 months of calcium and vitamin D supplementation, suggesting that the visual loss and optic nerve swelling were attributed to hypocalcemia. Given the normal parathyroid function, it is possible that hypocalcemia resulted from low vitamin D levels, which can occur after severe burn scarring. Furthermore, the patient received a provisional diagnosis of congenital insensitivity to pain on the basis of the detailed medical history and the findings of severe and widespread loss of the ability to perceive painful stimuli, as well as impaired temperature sensation. However, due to limitations in genetic testing, confirmation of the congenital insensitivity to pain diagnosis could not be obtained.ConclusionThis case highlights a rare presentation of transient binocular vision loss and pain insensitivity in a patient with Klippel–Feil syndrome, emphasizing the importance of considering unusual associations in symptom interpretation.

Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study

BackgroundThe prevalence and risk factors of posttraumatic stress disorder (PTSD) after cesarean delivery, outside high-risk contexts, remain unclear ObjectiveTo assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. Study designProspective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women expected to undergo cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of PTSD symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a PTSD) were assessed by 2 self-administered questionnaires (Impact of Event Scale Revised (IESR) and Traumatic of Event Scale (TES)). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. ResultsIn all, 2785 of 4431 women returned the IES-R questionnaire and 2792 the TES (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval (CI) 7.8-10.3%) and of provisional diagnosis 1.7% (95%CI 1.2-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors - young age, high BMI and Africa-born migrant – and cesarean-related obstetric factors - cesarean delivery after induced labor (adjusted odds ratio [aOR] 1.81, 95%CI 1.14-2.87), postpartum hemorrhage (aOR 1.61, 95%CI 1.04-2.46) and high intensity pain during the postpartum stay (aOR 1.90, 95%CI 1.17-3.11). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (aOR 0.66, 95%CI 0.46-0.98), and women with bad memories of delivery on day 2 postpartum at higher risk (aOR 3.20, 95%CI 1.97-5.12). The IES-R and the TES scales yielded consistent results ConclusionsAround one in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetric interventions and components of cesarean management may influence this risk

Etiology and Biochemical Profile of Rickets in Tertiary Care Centres in Eastern India: A Retrospective Cross-sectional Study.

We aimed to describe the clinical, biochemical and etiological profile of patients referred with a provisional diagnosis of rickets in tertiary care centres. In addition, we tried to propose a diagnostic algorithm for the evaluation of such patients. This was a retrospective cross-sectional study conducted in two tertiary care centres of West Bengal. Data of patients were retrieved between 2014 and 2021. Out of 101 children, 22 had conditions simulating rickets. Renal tubular acidosis (RTA) was the most common (53.2%) etiology of rickets, followed by phosphopenic rickets (PR) (22.8%) and calcipenic rickets (CR) (17.7%). The prevalence of true nutritional rickets (NR) was only 8.9%. Children with RTA had a significantly higher prevalence of chronic ill health (69%) and polyuria (95.2%). Weight standard deviation score (SDS) and body mass index (BMI) SDS scores were significantly lower in the RTA group compared to others. Around 90.5% of children with RTA, and none in the other groups, had hypokalemia. Biochemically, hypophosphatemia and elevated alkaline phosphatase (ALP) were present in all patients with PR and CR. Compared to CR, median serum phosphate was significantly lower in the PR group. A significant difference in ALP values was noticed in patients with hypophosphatemia (815 ± 627 IU/L) compared to those without (279 ± 204 IU/L). Plasma parathyroid hormone (PTH) of 100 pg/ml seemed useful to differentiate CR from other forms. NR is uncommon in tertiary care centres. Children with rickets should be approached systematically with the estimation of ALP, phosphorus, creatinine, calcium, PTH and 25-hydroxy vitamin D to reach an etiological diagnosis.

Appropriateness of the Emergency Referrals Made by Primary Care Clinicians: A cross-sectional review of referral notes.

This study aimed to evaluate the appropriateness of the emergency referrals made by primary care clinicians and determine the factors contributing to inappropriate referrals. This cross-sectional study utilises referral notes review between October 2019 and March 2020. Patients referred to Khawla Hospital's emergency department by a primary care clinician in Muscat Governorate were randomly selected; their referral notes were reviewed by five family physicians. The appropriateness of the referrals was evaluated according to the primary care referral protocol. Any referral that deviated from the protocol was classified as inappropriate. The prevalence and characteristics of inappropriate referrals were identified, and the factors contributing to inappropriate referral were determined using multivariable logistic regression. In total, 591 referrals were reviewed; 354 (59.9%) of them were classified as inappropriate due to inadequate medical notes (291, 82.2%), lack of provisional diagnosis (176, 49.7%), misdirected to a non-concerned emergency (30, 8.4%) or misclassification of urgency (107 [30.2%] were classified as urgent and 45 [12.7%] as routine). After adjusting for multiple variables, insufficient clinical notes, unavailability of referral guidelines and lack of expertise were found to be strong determinants of inappropriate referral, with an odds ratio of 62.52 (95% confidence interval [CI]: 32.04-121.96), 2.88 (95% CI: 1.40-5.92) and 9.37 (95% CI: 4.09-21.43), respectively. While most of the referrals required emergency management, the majority were inappropriate, mainly due to insufficient clinical documentation. Inadequate clinical notes and lack of national guidelines and expertise were found to be strong predictors of inappropriate emergency referrals.

Microbial Spectrum of Keratitis at a Rural Tertiary Care Teaching Hospital.

Microbial keratitis poses a significant threat to vision and is a common ocular infection. Its causative agents encompass a wide spectrum, including bacteria, fungi, viruses, and parasites. The microbiological profile of microbial keratitis is influenced by factors such as patient demographics, geographical location, climate, and occupational hazardsand evolves over time. Corneal scrapings were collected from 75 patients with a provisional diagnosis of microbial keratitis.The samples were processed in the microbiology laboratory, and the bacterial and fungal growth isolated in the study were identified according to standard procedures. Among the 75 patients, 48 (64%) were maleand 27 (36%) were female.Corneal ulceration was found in individuals of all age groups, with the highest prevalence of 77.33% (58/75) observed in the 21-60 age range. Farmers exhibited a higher susceptibility, constituting 66.67% (50/75) of the cases.The study noted a higher occurrence of keratitis from November to February, accounting for 69.33% (52/75). Microbial etiology was identified in 25.33% (19/75) of scrapings, with fungi accounting for 68.42% (13/19) and bacteria for 31.57% (6/19). The prevalent fungal species included Fusarium (7/13, 53.84%),Aspergillus(3/13, 23.07%),Colletotrichum(2/13, 15.38%), andCurvularia​​​​​​​(1/13, 7.69%). Bacterial isolates featuredStreptococcus pneumoniae(5/6, 83.33%) and Klebsiella pneumoniae (1/6, 16.66%). This study underscores the importance of regularly updating local microbial profiles and understanding antimicrobial resistance patterns. Such updates are critical for informed decision-making in selecting optimal topical treatments for microbial keratitis.

Performance of ChatGPT in Diagnosis of Corneal Eye Diseases.

The aim of this study was to assess the capabilities of ChatGPT-4.0 and ChatGPT-3.5 for diagnosing corneal eye diseases based on case reports and compare with human experts. We randomly selected 20 cases of corneal diseases including corneal infections, dystrophies, and degenerations from a publicly accessible online database from the University of Iowa. We then input the text of each case description into ChatGPT-4.0 and ChatGPT-3.5 and asked for a provisional diagnosis. We finally evaluated the responses based on the correct diagnoses, compared them with the diagnoses made by 3 corneal specialists (human experts), and evaluated interobserver agreements. The provisional diagnosis accuracy based on ChatGPT-4.0 was 85% (17 correct of 20 cases), whereas the accuracy of ChatGPT-3.5 was 60% (12 correct cases of 20). The accuracy of 3 corneal specialists compared with ChatGPT-4.0 and ChatGPT-3.5 was 100% (20 cases, P = 0.23, P = 0.0033), 90% (18 cases, P = 0.99, P = 0.6), and 90% (18 cases, P = 0.99, P = 0.6), respectively. The interobserver agreement between ChatGPT-4.0 and ChatGPT-3.5 was 65% (13 cases), whereas the interobserver agreement between ChatGPT-4.0 and 3 corneal specialists was 85% (17 cases), 80% (16 cases), and 75% (15 cases), respectively. However, the interobserver agreement between ChatGPT-3.5 and each of 3 corneal specialists was 60% (12 cases). The accuracy of ChatGPT-4.0 in diagnosing patients with various corneal conditions was markedly improved than ChatGPT-3.5 and promising for potential clinical integration. A balanced approach that combines artificial intelligence-generated insights with clinical expertise holds a key role for unveiling its full potential in eye care.

Examining the role of posttraumatic stress disorder symptoms in intimate partner violence among couples with alcohol use disorder.

Separate literatures indicate that both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are robust risk factors for using intimate partner violence (IPV). Despite the strength of these relative literatures, and the common co-occurrence of AUD and PTSD, their combined effects on IPV have rarely been examined. This study begins to address this gap by exploring the moderating effects of provisional PTSD diagnosis on the relation between heavy alcohol consumption and physical IPV using a multilevel modeling approach. Participants were adult romantic couples (N = 100) with current AUD and a history of physical IPV in their relationship. Results from the between-couple comparison indicate that couples who reported more heavy drinking days also experienced more physical IPV when at least one partner had probable PTSD. However, the within-couple comparison indicated that among partners without a provisional PTSD diagnosis, those with fewer heavy drinking days compared to their partner also reported more physical IPV perpetration. These preliminary and exploratory findings require replication and extension but provide new and important information regarding the complex intersection of heavy drinking, PTSD, and IPV among couples with AUD.

Differential Diagnosis of Retronychia, Onychomycosis and Onychomadesis.

In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts. We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient's complaint was solved after around one year without any specific therapy. The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments. The differential diagnosis of retronychia, onychomycosis and onychomadesis is challenging.Both onychomadesis and retronychia share a common pathophysiologic mechanism.A careful and detailed history prevents a patient from a frightening diagnosis and painful, long-lasting treatment of nail disorders.