BackgroundBody dysmorphic disorder (BDD) is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD.MethodsThe medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria.ResultsOut of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%), being fat (32.8%), skin (14.9%) and nose(14.9%), whereas in females they were being fat (40.4%), skin (24.7%) and teeth (18%). Females were significantly more concerned about being fat (p = 0.005). Male students were significantly more concerned about being thin (p = 0.01) and about head hair (p = 0.012).ConclusionBDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.

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Duplicated ureters, which represent a challenge to the endourologist, are under diagnosed on noncontrast computerized tomography. Urologists and radiologists should be aware of this limitation and contrast studies should be done when anatomical anomalies are suspected.

Vitreomacular adhesion (VMA) describes the adhesion of the posterior hyaloid face to the inner retina in any part of the macula. This can arise after incomplete separation of the posterior vitreous cortex from the macula during vitreous liquefaction. While the VMA may resolve spontaneously, a strong and persistent adhesion can lead to a variety of anatomical changes, including vitreomacular traction (VMT) and macular hole (MH). Both conditions can present with metamorphopsia and decreased vision. In cases of symptomatic VMT and full-thickness macular hole, pars plana vitrectomy has long been the standard of care. However, due to the possible surgical complications and need for postoperative care, many have searched for non-surgical options via pharmacologic vitreolysis. Ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) is a recombinant protease approved in October 2012 for the treatment of symptomatic vitreomacular adhesion (VMA). There have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. This publication reviews the efficacy and safety of ocriplasmin injection for VMA based on previously published data.

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 356;1 www.nejm.org january 4, 2007 67A 59-year-old nonobese man presented with a 7-year history of gradually progressive swelling over the left eye. He had no other clinically significant medical history or history of trauma. There was a soft, yellowish mass in the outer temporal subconjunctival region (Panel A). The patient's vision was normal. Among the disorders in the differential diagnosis, orbital lymphoma was a particular concern. Characteristic features of an orbital lymphoma typically include a lesion of salmon color that is firm on palpation, that has a solid appearance on computed tomography (CT), and that follows the contour of the orbit without bony erosion. The mass was reducible on direct pressure, and it enlarged on retropulsion of the globe (Panel B), suggesting the fluid nature of its content and intraorbital extension. CT revealed a density identical to that of intraorbital fat, confirming the clinical impression of subconjunctival prolapse of orbital fat -a benign entity. Surgical intervention may be needed if such a lesion is cosmetically unacceptable or causes discomfort. Clinical recognition of this condition can spare the patient an extensive lymphoma workup, a biopsy, and further follow-up.

This case reports a reactivation of latent herpes simplex virus with productive ocular infection, triggered by MMC therapy and highlights the importance of awareness of this possible risk associated with the use of MMC.

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