Terlipressin-Induced Skin Necrosis While Managing Hepatorenal Syndrome: A Rare Case Report From North India.

Terlipressin is an analogue of vasopressin and is often used in the treatment of bleeding esophageal varices and also in the treatment of hepatorenal syndrome associated with liver cirrhosis. Although terlipressin is a safe drug, but it has been rarely associated with potentially serious adverse effects like ischemic necrosis of skin involving the abdominal skin, extremities, and scrotal skin. We present one such rare case where terlipressin-induced skin necrosis in bilateral lower extremities in a 48-year-old male while we were managing hepatorenal syndrome in the same.

Human T2R38 Bitter Taste Receptor Expression and COVID-19: From Immunity to Prognosis.

Background: Bitter taste-sensing type 2 receptor (T2Rs or TAS2Rs) found on ciliated epithelial cells and solitary chemosensory cells have a role in respiratory tract immunity. T2Rs have shown protection against SARS-CoV-2 by enhancing the innate immune response. The purpose of this review is to outline the current sphere of knowledge regarding this association. Methods: A narrative review of the literature was done by searching (T2R38 OR bitter taste receptor) AND (COVID-19 OR SARS-CoV-2) keywords in PubMed and google scholar. Results: T2R38, an isoform of T2Rs encoded by the TAS2R38 gene, may have a potential association between phenotypic expression of T2R38 and prognosis of COVID-19. Current studies suggest that due to different genotypes and widespread distributions of T2Rs within the respiratory tract and their role in innate immunity, treatment protocols for COVID-19 and other respiratory diseases may change accordingly. Based on the phenotypic expression of T2R38, it varies in innate immunity and host response to respiratory infection, systemic symptoms and hospitalization. Conclusion: This review reveals that patients' innate immune response to SARS-COV-2 could be influenced by T2R38 receptor allelic variations.

Challenges in managing anorectal melanoma, a rare malignancy.

INTRODUCTION AND IMPORTANCE: Anorectal melanoma is a rare and aggressive malignancy that can be difficult to diagnose due to its nonspecific presentation. CASE PRESENTATION: We present a case of a 69-year-old woman who presented with painful defecation, bleeding per rectum, and a mass coming out of her anal opening. The initial differential diagnosis included hemorrhoids, rectal polyp, or a malignant lesion of the rectum. However, histopathological evaluation following transanal excision of the rectal mass revealed mucosal melanoma in the anorectal region. Further investigation showed no evidence of locoregional or distant metastasis. CLINICAL DISCUSSION: Surgery remains the primary treatment option for anorectal melanoma, but complete resection is often not feasible, leading to high rates of local recurrence and distant metastasis. The incidence of metastatic disease at the time of presentation is high, and a multidisciplinary approach is necessary to manage these patients. Currently, standard systemic therapies used for cutaneous melanoma are the mainstay of treatment for metastatic anorectal melanoma, but there is a need for further research to develop tailored treatment strategies. CONCLUSION: Our case report highlights the importance of considering anorectal melanoma in the differential diagnosis of patients presenting with anorectal symptoms. It emphasizes the need for a multidisciplinary approach to managing this rare malignancy. Early diagnosis, a multidisciplinary approach, and ongoing research into more effective treatments are crucial for improving outcomes for patients with anorectal melanoma.

Advanced gastric neuroendocrine tumor with hepatic metastasis - A case report.

INTRODUCTION AND IMPORTANCE: Gastric neuroendocrine tumors (NETs) are rare neoplasms that originate from enterochromaffin cells in the gastric mucosa and pose a diagnostic dilemma due to their non-specific presentation. CASE PRESENTATION: We present a 79-year-old woman, who came with complaints of abdominal pain associated with loss of pain and appetite. Although on the first look multiple differentials could be listed, upon complete evaluation she was diagnosed to have type III Gastric NET. Histopathology and immunohistochemistry allowed diagnostic confirmation of the disease along with strong clinical suspicion. The patient however succumbed to the illness due to advanced disease and lack of established protocol for its management. CLINICAL DISCUSSION: The treatment of Gastric NETs primarily involves surgical resection of the tumor and is especially helpful in type I and II cases. For advanced metastatic type III NETs, lines of therapy have not been established although surgical resection can be done if the majority (∼90 %) of the tumor is resectable. Patients should be given a choice in decision making and newer drug therapies should always be considered. CONCLUSION: Since gastric NETs are a rarer cause of abdominal pain, it can often be overlooked in favor of other, more common differentials. One should be aware of this disease and the newer diagnostic methods to have any sort of clinical suspicion when presented with such a scenario. The management of the condition although not been established, novel therapies should be considered if the tumor is not resectable.

Monkeypox Epidemic: A Throwback From Smallpox Eradication.

The emergence of microbial diseases has become a major concern for humans. In the recent past, we have noticed the emergence and re-emergence of several microbes that include coronaviruses (severe acute respiratory syndrome coronavirus {SARS-CoV}, Middle-East respiratory syndrome coronavirus {MERS-CoV}, SARS-CoV-2), and others like Zika virus, Nipah virus, Influenza virus, and Ebola virus. These microbes have been noted to spill over from animals into humans. Several such microbes which were previously restricted to wild animals are now becoming responsible for infections in humans and have spread across the borders and resulted in pandemics. It has been more than two years since the discovery of the novel SARS-CoV-2 virus responsible for the coronavirus disease 2019 (COVID-19), and we are still struggling to cope-up with it and live normal lives. Recently, the monkeypox virus, which was confined to West and Central African countries, and caused endemic infections in monkeys and humans was associated with human infections in non-endemic regions like the United States of America (USA) and more than 30 other countries. Therefore, in this editorial, we attempt to put the spotlight on the monkeypox virus that is currently threatening to cause another widespread pandemic.

The Obesity Paradox in Chronic Heart Disease and Chronic Obstructive Pulmonary Disease.

Obesity in recent years has become an epidemic. A high body mass index (BMI) is one of today's most crucial population health indicators. BMI does not directly quantify body fat but correlates well with easier body fat measurements. Like smoking, obesity impacts multiple organ systems and is a major modifiable risk factor for countless diseases. Despite this, reports have emerged that obesity positively impacts the prognosis of patients with chronic illnesses such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD), a phenomenon known as the Obesity Paradox. This article attempts to explain and summarize this phenomenon. As it stands, two theories explain this paradox. The muscle mass hypothesis states that obese patients are better adapted to tide through acute exacerbations due to increased reserve because of greater muscle mass. The other theory focuses on brown adipose tissue and its anti-inflammatory effects on the body. We performed a literature review on research articles published in English from 1983 to the present in the following databases - PubMed, Elsevier, and Google Scholar. The following search strings and Medical Subject Headings (MeSH) terms were used: "Obesity," "Heart Failure," "COPD," and "Cardio-Respiratory Fitness." In this review, we looked at the obesity paradox in Heart Failure and COPD. We summarized the current literature on the Obesity Paradox and reviewed its relationship with Cardio-Respiratory Fitness.

Effect of COVID-19 on air pollution related illnesses in India.

Ambient air pollution level not only causes respiratory diseases but also cardiovascular diseases, besides, increased visits to the emergency department for asthma, chronic obstructive pulmonary disease (COPD), bronchitis, allergic rhinitis, attention deficit hyperactivity disorder (ADHD) in children and premature deaths in infants. The occurrence of Coronavirus-19 (COVID-19) pandemic is both, a boon and bane. Despite the deplorable situation aroused by the pandemic, strict lockdown measures implemented to curb the drastic spread of the disease, also culminated into astonishing outcomes that were not prioritized. This article illustrates the effects of the ongoing pandemic on air pollution and provides recommendations aimed at limiting it.

Non-pharmacological integrative therapies for chronic cancer pain.

OBJECTIVE: Chronic pain is one of the most detrimental symptoms exhibited by cancer patients, being an indication for opioid therapy in up to half of the patients' receiving chemotherapy and in 90% of advanced cases. Various successful non-pharmacological integrative therapy options have been explored and implemented to improve the quality of life in these patients. This review aims to highlight the mechanisms implicated; assessment tools used for cancer pain and summarize current evidence on non-pharmacological approaches in the treatment of chronic cancer pain. DATA SOURCES: A review of the literature was conducted using a combination of MeSH keywords including "Chronic cancer pain," "Assessment," "Non-pharmacological management," and "Integrative therapy." DATA SUMMARY: Data on the approach and assessment of chronic cancer pain as well as non-pharmacological integrative options have been displayed with the help of figures and tables. Of note, non-pharmacological integrative management was divided into three subcategories; physical therapy (involving exercise, acupuncture, massage, and transcutaneous electric nerve stimulation), psychosocial therapy (e.g. mindful practices, supportive therapy), and herbal supplementation. CONCLUSIONS: The use of non-pharmacological integrative therapy in the management of chronic cancer pain has been grossly underestimated and must be considered before or as an adjuvant of other treatment regimens to ensure appropriate care.