The Great Mimicker: Cutaneous Metastatic Melanoma Presenting as a Non-resolving Pleural Effusion.

Although melanoma starts as a local disease, it can metastasize to other sites of the body including the lung, brain, liver, and intestines. However, pleural involvement is a rare presentation. Here, we present a case of a 57-year-old man with a history of stage IIA cutaneous melanoma, that relapsed 3 years after cutaneous resection, presenting with a non-resolving pleural effusion. Pleural fluid analysis was consistent with an exudative effusion, and pleural biopsy confirmed metastatic melanoma. The patient was treated with dual therapy of ipilimumab and nivolumab, as per National Comprehensive Cancer Network guidelines, with good response. Thus, we recommend having a high index of clinical suspicion for metastatic pleural melanoma when a patient with a history of cutaneous melanoma presents with a non-resolving pleural effusion.

Observations on traditional usage of ethnomedicinal plants in humans and animals of Kangra and Chamba districts of Himachal Pradesh in North-Western Himalaya, India.

ETHNOBOTANICAL RELEVANCE: Medicinal plants are frequently used by Gaddi and Gujjar tribes of Kangra and Chamba districts of Himachal Pradesh, India to cure various ailments in humans and livestock. Therefore, extensive field work was conducted to document the traditional use of ethnomedicinal plants by these tribes. MATERIALS AND METHODS: Direct interviews of 208 informants were conducted. The data generated through interviews was analysed using quantitative tools such as use-value (UV), factor informant consensus (Fic) and fidelity level (Fl). RESULTS: A total of 73 plant species in 67 genera and 40 families were observed to be medicinal and used to cure 22 ailment categories. The highest number of ethnomedicinal plants was recorded from the family Asteraceae followed by Lamiaceae, Apiaceae, Acanthaceae, Caesalpiniaceae, Polygonaceae, Ranunculaceae, Rosaceae and Rutaceae. Leaves were the most frequently used plant part used to treat various ailments followed by whole plant and roots or rhizomes. Ajuga parviflora, Berberis lycium, Viola canescens, Vitex negundo and Zanthoxylum armatum were the most important medicinal plants used for treating human diseases, whereas Achyranthes bidentata, Aloe sp., Cassia fistula, Podophyllum hexandrum and Pogostemon benghalensis were the most important medicinal plants used for treating animal diseases as per use value. The important ailment categories classified on the basis of factor informant consensus were gastrointestinal and respiratory disorders. CONCLUSION: The present study revealed that people of the study area are extensively using the ethnomedicinal plants to cure various ailments. Plants with high use value and fidelity level should be subjected to pharmacological investigation for scientific validation.

Refeeding syndrome in a young girl with anorexia nervosa.

We report the case of a 20-year-old anorexic girl (BMI=12.9), who was misdiagnosed the first time and developed severe electrolyte imbalances due to lack of awareness about refeeding syndrome. Few cases of RS have been reported in literature and protocols have been suggested for prevention and management of this syndrome, including the awareness of circumstances in which it is most likely to develop, refeeding slowly and building-up micronutrient content over several days. Improved awareness and understanding of refeeding syndrome along with a well-coordinated plan are vital in delivering safe and effective nutritional rehabilitation. We suggest a slow and gradual increase in nutrition along with nutritional counselling and psychotherapy.

Biological and medicinal properties of grapes and their bioactive constituents: an update.

The grape is one of the most valued conventional fruits, worldwide. Although most of the parts of the grapevine are useful, primarily, the grape is considered as a source of unique natural products not only for the development of valuable medicines against a number of diseases, but also for manufacturing various industrial products. Over the last few decades, apart from the chemistry of grape compounds, considerable progress has been made towards exploring the biological activities of various grape-derived constituents. Today, it is well established that in addition to serving as food, the grape is a major source of several phytochemicals. The main biologically active and well-characterized constituent from the grape is resveratrol, which is known for various medicinal properties in human diseases. This review discusses the roles of various grape-derived phytochemicals in relation to various diseases.