Purpose: Topical steroids are considered to be the first line of treatment for some forms of idiopathic punctal stenosis causing epiphora. We present a case of epiphora, which was unresponsive to traditional management, but responded to one week of systemic steroids. Observations: A 48-year-old male with no significant medical history, was referred to us for excessive tearing. He was seen earlier by an ophthalmologist for redness in one of his eyes. He was prescribed Pataday (Olopatadine) eye drops and Zylet (Tobramycin, Lotepriol) eye drops for both eyes. The patient was seen again after a week of treatment without much improvement. His treatment was changed to Alrex (Loteprednol) and Azasite (Azithromycin) eye drops. The redness of the eye disappeared in a week but patient noticed excessive tearing of his eyes. He was referred to reconstructive ophthalmologist for treatment of possible punctal stenosis. On examination the height of tear meniscus was increased and diagnostic lacrimal probing and syringing of the lacrimal drainage system demonstrated both lacrimal drainage system patent. Punctal stenosis was diagnosed. Over the next couple of weeks, patient underwent multiple syringing of the lacrimal duct system with temporary relief of symptoms. He was also prescribed Tobradex (Tobramycin+Dexamethasone) eye drops to be used for a month. Eye drops helped for the duration of treatment but symptoms returned after a couple of days of discontinuing eye drops. Patient also received ductal probing and punctal dilation in the office without much relief. Mini perforated plugs were placed in both puncta resulting in temporary relief. At the same time the intra ocular pressure started to rise and Tobradex eye drops were discontinued immediately. After almost three months of treatment and continuation of debilitating symptoms of epiphora, patient decided to consider surgical intervention and consulted an ENT surgeon for second opinion. Since he was responding to topical steroids, which was causing an increase in his intra ocular pressure, the ENT surgeon suggested Medrol Pack (Prednisolone for a week). Patient was symptom free after 4 days of treatment and by 7th day, his eyes were back to normal with complete disappearance of epiphora symptoms. Conclusions and importance: Systemic steroids can be beneficial in patients suffering from Idiopathic/Iatrogenic punctal stenosis unresponsive to topical steroids and conventional treatments.

Introduction: Pain after laparoscopic cholecystectomy is complex in nature and several methods are performed to control it. Transversus Abdominis Plane (TAP) block has been used for postoperative pain for some abdominal surgeries. This study was designed to determine the analgesic efficacy of bilateral TAP block for patients undergoing Laparoscopic Cholecystectomy. Methods: Forty-two patients were randomized into 2 groups. Group 1 received TAP block using bupivacaine 0.25% (n=21), and group 2 received TAP block using saline. Before extubation, blocks were performed bilaterally. Tramadol IV was given for breakthrough pain for the first 24 hours. Pain scores using the visual analog scale (VAS) at 0, 1, 2, 4 ,8 ,12, 24 hour-intervals, number of patient demand for Tramadol and patient satisfaction were collected. Results: Patients in the control group have higher VAS scores both during rest and on movement. However, pain was significantly reduced only on the 2nd hour at rest and on the 1st to 4th hours on movement among patients who received Bupivacaine 0.25% on TAP block. Furthermore, there was no significant difference in the requirement for rescue analgesics (p=0.1160) and the satisfaction rate (p=0.2849) between the two groups. Conclusion: TAP block is safe and improved postoperative analgesia in patients receiving laparoscopic cholecystectomy. But its additional analgesic effect in the presence of a dynamic multimodal pain-control regimen is probably rather small and need further investigation in laparoscopic cholecystectomy.

Background: Homosexual identification among women as lesbian, bisexual or transgender does not encompass the whole pool of women who practice same-sex behavior. Straight women especially youths are more increasingly willing to have sex with fellow women. This article establishes the reasons that influence same-sex orientation and behaviors among women in Tanzania. It explores the self-reported push/pull reasons that ultimately leads women to same-sex behavior among sampled through individuals. Method: This is a cross-sectional descriptive and retrospective study which was conducted in Dar es Salaam between January and February, 2021. The participants of the study were WSW, proxy WSW, and women who at one time had female same-sex relationships. The study also used community members aged 18 years and above but only those who met the inclusion criteria. Data were collected through qualitative in-depth interviews, focus group discussions, interviews, and life stories. All the data generated through the study were analyzed thematically. Results: The findings indicate that women who practice same-sex behavior believe that their behavior occurs naturally through biological reasons. Some of them attribute earlier negative experiences with men as a trigger to opt out of heterosexual sex. Most participants also cited past unpleasant sexual experiences with men such as rape, being emotionally detached from men as factors that lead to developing desires to have sex with fellow women. Conclusion: There are biological and social-economic factors that lead women to practice same-sex behaviors. Women, who are born with male attributes become sexually unattracted to males, opt to engage in same-sex practices because of displeasure from having sex with men. Further, economic hardships in societies force women to engage in same-sex practices through peers who are financially well-off and are searching for peers to exploit sexually. Research should focus on investigating peer influence and social media’s effects on women’s decision to engage in same sex practices.

Introduction: Hernias are abnormal protrusions of any abdominal-pelvic or fat organ, which are produced by a defect in the abdominal wall, the most frequent are inguinal hernias and their content is generally of the omentum or intestinal loops, the presence of pelvic organs is very infrequent and the majority of cases described are in children under five years of age. Objective: To analyze the entity in connection with a case of a patient with a tubo-ovarian inguinal hernia. Clinical case: The case of a 34-year-old female patient is presented, who was under follow-up by the gynecology service due to the presence of a left ovarian cyst, with symptoms of pain in the left iliac fossa for more than 6 months of evolution. which is performed an ultrasound, which reports left inguinal hernia for what is electively scheduled by the general surgery service, when performing the herniorrhaphy incarcerated hernia with left ovary with bleeding follicle and fallopian tube is evidenced. Conclusions: These types of findings are infrequent, documented in the literature with a global incidence of Tubo-ovarian inguinal hernias ranging from 0-8-4.4%, however it is worth clarifying that these studies are in infant patients, so its presentation in adults associated with a hemorrhagic follicle is anecdotal as in this case.