Indira Gandhi Institute of Medical Sciences

Accessory cavitated uterine malformation (ACUM) is a commonly misdiagnosed Mullerian anomaly characterized by the presence of a cavitated, well circumscribed lesion in an otherwise normal uterus showing presence of endometrial gland and stromal components. Commonly presenting as recurrent abdominal pain with dysmenorrhea in young females, their management is often delayed due to misdiagnosis on imaging. Here, we present the case of Accessory cavitated uterine malformation (ACUM) in a 21-year-old nulliparous female presenting with complaints of chronic abdominal pain with periodic dysmenorrhea who was managed with laparotomic excision of the cavity.

Chronic kidney disease (CKD) manifests as progressive renal impairment, frequently requiring renal replacement therapy. Epigenetic modifications, vital for regulating gene expression and function, play a significant role in chronic kidney disease (CKD) pathogenesis. This review examines the intricate relationship between fluoride exposure and kidney health through epigenetic mechanisms. Although fluoride is well-known for its dental benefits, it has been linked to kidney damage. Fluoride disrupts gene expression patterns, exacerbating renal injury by modulating inflammation, oxidative stress, and mitochondrial dysfunction. Key epigenetic mechanisms mediate fluoride-induced kidney damage, including DNA methylation, histone modifications, and non-coding RNAs. Specifically, alterations in DNA methylation at specific CpG sites are associated with the progression of renal fibrosis. Histone modifications also influence gene expression relevant to kidney function and fibrosis. Additionally, microRNAs, which play a role in renal fibrosis, can be affected by fluoride exposure. A deeper understanding of fluoride's epigenetic impact on kidney damage could reveal new therapeutic targets and preventive strategies. This review highlights the need for further research to elucidate the complex interactions between fluoride exposure, epigenetic changes, and kidney health. Such research is crucial to developing strategies to mitigate renal damage, addressing a significant public health concern.

Secondary trigeminal neuralgia (TN) results from underlying pathology such as tumors, multiple sclerosis, or arteriovenous malformations. Cerebellopontine angle (CPA) tumors account for approximately 2-4% of secondary TN cases. However, most existing studies focus on idiopathic TN and are limited by small sample sizes and retrospective designs, leaving a gap in the literature. This study aims to conduct a systematic review, single-arm meta-analysis, and meta-regression to evaluate surgical outcomes in patients with secondary TN induced by CPA tumors. A systematic search was conducted in PubMed, Web of Science, and Scopus for studies evaluating surgical treatment of secondary TN due to CPA tumors. Outcomes of interest included pain relief, pain recurrence, and facial numbness. Statistical analysis was performed using R 4.3.1. Heterogeneity was assessed using the I² statistic and the Cochrane Q test. Proportions withrandom-effects models were computed for all outcomes. A total of 32 studies comprising 662 patients with secondary TN due to CPA tumors were included. Pooled analysis showed that 579 patients (92%; 95% CI) achieved pain relief, 91 patients (18%; 95% CI) experienced postoperative facial numbness, and 40 patients (19%; 95% CI) had pain recurrence. Subgroup analysis by treatment type revealed that surgical resection (SR) was superior to stereotactic radiosurgery (SRS) in achieving pain relief (p = 0.0009; 95% CI; I² = 69.4%) and reducing recurrence rates (p = 0.0267; 95% CI; I² = 74.1%). However, no statistically significant difference was observed between treatment groups in facial numbness (p = 0.5306; 95% CI; I² = 80.3%).Our meta-analysis suggests that surgical treatment provides a 92% pain relief rate and a 19% pain recurrence rate, favoring SR over SRS. Postoperative facial numbness occurred in 18% of patients, with no significant difference between treatment modalities.