Fatty tumours of the uterus are exceedingly rare. Lipoleiomyoma of the uterus is a rare benign uterine tumour thought to be a variation of leiomyoma. The presence of fatty tissue in the myometrium is anomalous, interpreted as lipomatous degeneration, smooth muscle metaplasia or as a benign tumour called as lipoleiomyoma. Imaging can play an important role in determining the intrauterine location and fatty nature of lipoleiomyomas but most of these are detected by chance pathological findings postoperatively. We report a case of lipoleiomyoma in anterior uterine wall in 66 years old postmenopausal female, who presented with postmenopausal bleeding.

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Background & objectives: The growing incidence and the wide diversity of carbapenemase-producing bacterial strains is a major concern as only a few antimicrobial agents are active on carbapenem-resistant bacteria. This study was designed to study molecular epidemiology of carbapenem-resistant Gram-negative bacterial (GNB) isolates from the community and hospital settings. Methods: In this study, non-duplicate GNB were isolated from clinical specimens, and phenotypic test such as modified Hodge test, metallo β-lactamase E-strip test, etc . were performed on carbapenem-resistant bacteria. Multiplex PCR was performed to identify the presence of bla IMP , bla VIM , bla KPC , bla OXA48 , bla OXA23 , bla SPM , bla GIM , bla SIM and bla NDM . Minimum inhibitory concentration (MIC) of colistin, fosfomycin, minocycline, chloramphenicol and tigecycline was also determined. Results: Of the 3414 GNB studied, carbapenem resistance was 9.20 per cent and maximum resistance (11.2%) was present at tertiary care centre, followed by secondary care (4%) and primary centre (2.1%). Among the carbapenem-resistant bacteria, overall, the most common isolate was Pseudomonas aeruginosa (24%). On multiplex PCR 90.3 per cent carbapenem-resistant isolates were positive for carbapenemase gene. The bla NDM (63%) was the most prevalent gene followed by bla VIM (18.4%). MIC results showed that 88 per cent carbapenem-resistant Enterobacteriaceae were sensitive to fosfomycin, whereas 78 per cent of P. aeruginosa and 85 per cent Acinetobacter spp. were sensitive to colistin. Interpretation & conclusions: Carbapenem resistance in GNB isolates from the community and hospital settings was found to be on the rise and should be closely monitored. In the absence of new antibiotics in pipeline and limited therapeutic options, prudent use of antibiotics and strict infection control practices should be followed in hospital to limit the emergence and spread of multidrug-resistant bacteria.

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osinophils are physiologically present in most parts of the gastrointestinal (GI) tract; the esophageal epithelium, however, is devoid of eosinophils in the healthy state. Presence of eosinophils in the squamous epithelium of the esophagus is abnormal and denotes a broad differential (Box), one of which is eosinophilic esophagitis (EoE). Eosinophilic esophagitis is a chronic inflammatory condition of the esophagus characterized by symptoms of esophageal dysfunction and eosinophilic inflammation (>15 eosinophils per high-power field) of the esophageal mucosa diagnosed after exclusion of other causes of esophageal eosinophilia. 1,2 Eosinophilic esophagitis is being increasingly recognized in Western countries, resulting in a considerable surge in published literature over the past 2 decades. Despite heightened awareness, EoE remains an underdiagnosed condition, partly because the symptoms can be nonspecific. Patients with EoE usually present with gastrointestinal symptoms but recent studies have brought to attention that EoE can present with extraesophageal manifestations including otolaryngologic symptoms that may be refractory to conventional treatment. 3 Extraesophageal manifestations of EoE are especially common in younger children and may be the main presenting symptom(s). In addition, patients with EoE have increased rates of comorbid otolaryngologic conditions and are more likely to undergo otolaryngologic surgeries, such as tonsillectomy, adenoidectomy, and myringotomy with tubes. 4 Although otolaryngologists are familiar with airway manifestations of gastrointestinal conditions such as gastroesophageal reflux, 5 it is important that they be as familiar with the extraesophageal manifestations of EoE; a recent review suggested that up to 10% to 15% of pediatric patients with EoE present first to an otolaryngologist prior to seeing a gastroenterologist. 6 This review discusses common presenting symptoms, associated otorhinolaryngology symptoms, diagnostic workup, endoscopic features, and treatment of EoE for the general otolaryngologist. EpidemiologySeveral population-based studies have shown that the incidence and prevalence of EoE is on the rise, especially in western countries. 7,8 The prevalence of EoE is estimated at 0.5 to 1 in 1000 in western countries, making EoE as common as inflammatory bowel disease. [9][10][11][12] It is unclear if the increase in diagnosis of EoE truly represents an increasing incidence or rather an increased recognition of this condition by primary care physicians, gastroenterologists, otolaryngologists, pulmonologists, and pathologists, or both. Approximately 2% to 7% of adult patients undergoing esophagogastroduodenoscopy (EGD) with biopsies are found to have EoE, 13,14 and this number increases to 22% if dysphagia is the indication for IMPORTANCE Eosinophilic esophagitis (EoE) is a chronic, inflammatory condition of the esophagus. Prevalence of EoE is on the rise and, owing to its associated extragastrointestinal manifestations and comorbidities, otolaryngologists are...