Vicarious menstruation is a rare clinical phenomenon where cyclical bleeding occurs from extragenital sites in synchrony with the menstrual cycle. It has been reported in fewer than 1% of women with endometriosis and remains largely underdiagnosed due to its atypical presentation. We report the case of a 28-year-old woman with a 10-year history of recurrent monthly bleeding from her nose, ears, and finger pulps coinciding with menses. Conventional evaluations for bleeding disorders were unremarkable, and no obvious lesions were identified on otolaryngologic or dermatologic examination. A clinical diagnosis of vicarious menstruation was made based on the striking cyclical pattern of bleeding. Histopathological analysis of a finger pulp lesion was inconclusive. Ovulation suppression was initiated with a gonadotropin-releasing hormone (GnRH) analogue, resulting in amenorrhea. Concomitant complete cessation of the aberrant bleeding confirmed a therapeutic diagnosis. The patient was subsequently transitioned to oral maintenance therapy with dienogest, a progesterone. The case report highlights the diagnostic challenge of vicarious menstruation. Timely recognition and hormonal management can provide significant relief and prevent ongoing physical and psychological distress in affected patients.
Background: Intradialytic hypertension (IDH) is a clinical condition frequently encountered in patients undergoing hemodialysis and has been linked to an increased risk of cardiovascular complications. Despite its prevalence, IDH remains underrecognized and lacks standardized management protocols. Objectives: This study aimed to investigate the factors that contribute to the occurrence of IDH among patients receiving hemodialysis. Methods: A cross-sectional study was conducted from January to March 2025 at Panti Waluyo Hospital and Universitas Muhammadiyah Malang Hospital. Data were obtained using structured questionnaires covering demographic, clinical, and hemodynamic parameters and were analyzed using GraphPad Prism. Results: A total of 398 patients undergoing routine hemodialysis were included, of whom 118 experienced IDH and 280 did not. Patients with IDH were generally younger, had lower predialysis systolic, diastolic, and mean arterial pressures, and showed greater increases in blood pressure after dialysis. Additionally, calcium channel blocker (CCB) use was more frequent in the IDH group. Conclusion: Age, blood pressure profiles, and CCB usage were significantly associated with IDH. These findings suggest the need for more personalized approaches in managing hypertension among hemodialysis patients.
Thoracic endometriosis, a rare extra-pelvic form of endometriosis, can cause cyclical catamenial pneumothorax or hemothorax and is often missed. We report a 43-year-old woman with recurrent bilateral hydropneumothorax and hemorrhagic chest-drain output linked to menses. Imaging showed bilateral hydropneumothorax and pleural fluid was exudative. Video-assisted thoracoscopy revealed dark pleural nodules; biopsy confirmed endometrial glands and stroma with positive ER/PR staining. The patient declined diaphragmatic repair and received oral dienogest 2 mg daily, with marked symptomatic improvement and reduced drainage at 12-month follow-up. Thoracoscopic biopsy with histology/IHC is essential for diagnosis; hormonal therapy is a viable option when surgery is refused.
A Rarity Abstract Plexiform schwannoma is a sporadic benign tumor, with intraosseous presentation being an unusual site in the calcaneum. We present a 33-year-old male with a history of heel swelling since 2.5 years. MRI revealed an expansile osteolytic lesion with cortical breach, resembling a giant cell tumor. Histopathology showed a nodular benign tumor with Antoni A and Antoni B patterns of spindle cells; S-100 positivity was seen on immunohistochemistry. The above features thus confirm the diagnosis of schwannoma. The lesion was excised completely with preservation of adjacent structures, and recovery was uneventful. Complete excision ensures an excellent prognosis with negligible recurrence and no malignant potential.
Background: The global prevalence of Type II diabetes mellitus (T2DM) has risen markedly, contributing to substantial morbidity and mortality through its long-term complications. Methylglyoxal (MGO), a reactive metabolite that promotes advanced glycation end products (AGEs) formation, plays a pivotal role in the pathogenesis of diabetic complications, and is detoxified through the glyoxalase pathway by glyoxalase I ( Glo1 ) and II ( Glo2 ) enzymes. In diabetes, the activity of these enzymes becomes impaired. While extensive research has focused on Glo1 , role of Glo2 remains comparatively underexplored. Aim: To assess the gene expression of Glo2 in early T2DM and evaluate its potential as a biomarker for early detection of diabetic complications. Study Design: Observational case-control pilot study. Methods: The study was conducted at a tertiary care teaching hospital in South India. Fourteen participants (seven early T2DM patients of <6 months’ duration and seven non-diabetic controls), aged 18–65 years, were enrolled between April and June 2024. Venous blood samples were collected under aseptic precautions. Glo2 gene expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and results were statistically analyzed using unpaired t -test. Results: Relative hydroxyacylglutathione hydrolase ( HAGH ) mRNA expression was significantly reduced in T2DM patients compared with non-diabetic controls ( P = 0.0142, t = 2.867, df = 12). Conclusion: Study demonstrates significant downregulation of Glo2 gene expression in early T2DM, indicating its potential role as a novel biomarker for predicting early complications of diabetes.
