Large Cutaneous Squamous Cell Carcinoma: A Consequence of Elective Surgery Deferment During the COVID-19 Pandemic.

Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer that can be treated effectively with limited morbidity if caught and treated early with elective surgical procedures. The COVID-19 pandemic caused most healthcare facilities to delay or defer elective surgeries as they allocated workforce and resources to treating significant increases of critically ill patients. This care delay has increased morbidity and mortality of many conditions treated with surgery. A few case reports exist on delayed elective surgeries' effects on patients and healthcare facilities. We report a case of cSCC enlarging and locally spreading due to elective surgery delay during the COVID-19 pandemic.

Pseudo-Thrombotic Thrombocytopenic Purpura Due to Severe Vitamin B12 Deficiency: A Case Report.

Vitamin B12 deficiency is common in vegetarians, as meat is a common source of vitamin B12. In this case presentation, a patient presented to his primary care doctor with signs of severe vitamin B12 deficiency anemia. He had elevated lactate dehydrogenase levels, indirect bilirubin, and schistocytes on the blood smear, all pointing toward a hemolytic process. A severe vitamin B12 deficiency was deemed the cause of this hemolytic anemia after ruling out other causes. We highlight the importance of knowing more about this pathogenesis to avoid unnecessary workup and management for an elementary disorder that can result from severe B12 deficiency.

Nivolumab-Induced PRES (Posterior Reversible Encephalopathy Syndrome).

PRES (posterior reversible encephalopathy syndrome) is a clinical-radiographic syndrome comprising clinical symptoms, including headache, vision abnormalities, nausea/vomiting, seizures, and posterior cerebral white matter edema seen as radiographic changes. Commonly, PRES is known to occur with severely elevated blood pressure, or eclampsia. However, in recent times, increasing cases of PRES have been observed in patients being treated with immunotherapy or chemotherapy. Nivolumab is an immunotherapy used in the treatment of various cancers and is an increasingly identified cause of PRES. A few case reports exist in the literature. We report a case of nivolumab-induced PRES.

Type 1 Pulmonary Hypertension and Silicosis in a Bluestone Cutter: A Case Report on Raising Awareness.

This case report describes a patient who developed pneumoconiosis in the form of silicosis and group 1 pulmonary hypertension (PH) due to his unprotected work as a bluestone cutter. Bluestone is a type of sandstone used in outdoor construction commonly in the North-east region of the US. In the literature and to our knowledge, blue stone mining has not been viewed as a risk factor for pneumoconiosis. This case report aims to increase awareness about this occupational hazard. Additionally, it is known that chronic silicosis with massive pulmonary fibrosis can lead to hypoxemia and group 3 pulmonary hypertension. This case, however, demonstrates a possibility of silica dust exposure leading to group 1 pulmonary arterial hypertension.

The 2022 Monkeypox Epidemic and What Has Led to the Current State of the Disease in the US: A Systematic Review.

Monkeypox virus (MPOX) is a zoonotic disease in humans. It is similar genetically to its virus family member, smallpox. This virus has been studied since the 1970s. The virus remains endemic to the Congo and West African regions, but non-endemic spreads have been cited. The most recent non-endemic outbreak in the spring of 2022 amidst the current COVID-19 pandemic is of interest due to its impact on global medical, economic, and societal climates. This literature review aims to highlight the virology, clinical signs and symptoms, diagnosis, prevention, and treatment of MPOX and discuss the social implications of the recent 2022 outbreak. We hope this review can pinpoint important clinical pearls of the MPOX virus and its societal impacts to further promote important discussion of this virus and its disease.

Blurry Diagnosis of Ocular Syphilis.

The incidence of syphilis is on the rise worldwide which may be due to increased diagnosis. Given the wide variety of presenting symptoms, syphilis can pose many diagnostic and therapeutic difficulties for doctors. In turn, these difficulties frequently lead to a noticeable delay in patient care. Here we present a case of ocular syphilis in a homosexual male patient presenting with uveitis with no prior symptoms except for an itchy rash in the pelvic area. The patient was treated with IV penicillin after which full vision was restored. By presenting this case, we hope to stress the importance of adding syphilis in the differential diagnosis of men who have sex with men (MSM) who present with otherwise unexplained rash and/or uveitis.

Hepatitis B Vaccine and Multiple Sclerosis: Cause or Coincidence.

Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system destroys myelin causing disruption of signals from the brain to the rest of the body. MS can be triggered by a variety of reasons. In this study, we present the case of a patient who developed neurological symptoms immediately (one day) after receiving the hepatitis B vaccine. The temporality of symptoms makes us question whether there is an association between the hepatitis B vaccine and MS. We would like to emphasize the importance of considering MS as a side effect of the hepatitis B vaccine and adding MS to the differential diagnosis of a patient who presents with neurological symptoms after receiving the hepatitis B vaccine.

Development and characterization of spheroidal antidiabetic polyherbal formulation from fresh vegetable juice: A novel approach.

Polyherbal Formulations (PHF) were developed by combining fruit juices of Momordica charantia, Cucumis sativus, and Solanum lycopersicum in different ratios and optimized through Oral Glucose Tolerance Test (OGTT) model. PHF-C pretreated rats showed the highest reduction of Serum Glucose Levels (SGL) after 60 min of glucose administration. PHF-C was incorporated into spheroids using fresh juice (FJS) and lyophilized powder (LPS) of selected plants. In OGTT study, LPS showed a significant reduction of SGL. LPS was characterized as almost spherical, having disintegration time 8 min, adequate friability, and good flow properties. In STZ-induced diabetic rats on 7th, 14th, and 21st days, LPS was reduced SGL by 9.01%, 20.9%, 38.9% (250 mg/kg dose); 20.5%, 33.9%, and 50.7% (500 mg/kg dose), respectively. LPS showed a significant improvement in abnormal body weight, biochemical, and oxidative parameters in comparison to PHF-C and metformin. Novel formulation LPS (500 mg/kg) was found more effective (p < .05) in reversing STZ-induced hyperglycemia as compared to PHF-C (1,000 mg/kg) and at par with metformin (500 mg/kg). PRACTICAL APPLICATIONS: Fresh vegetable juice contains large quantities of vitamins and minerals. Cooking and processing of fruits may destroy their nutritional value. However, FJS also has some limitations, including seasonal specificity, patient compliance, less stability, loss of vitamins and fibers, abnormal sugar level, weak immunity, and difficult to carry by patients. Lyophilization is a well-known method to improve the physical state, shelf life, and stability of phytoconstituents. Poor absorption and less bioavailability also impede the acceptance of PHF. To overcome these limitations, a suitable novel drug delivery system is required which has high therapeutic efficacy and enhanced bioavailability. The patented spheroids of herbal extracts which are in use for the treatment of the number of diseases encouraged the present work. Spheroid protects the constituents of herbal drugs from gastric destruction and gut bacteria. The outcome of present research supports the concept of enhanced stability and bioavailability of phytoconstituents present in FJS.

Hughes Stovin Syndrome, a Rare Form of Behcet's Disease Presenting as Recurrent Intracardiac Thrombus.

Hughes Stovin syndrome (HSS) is a particularly rare disease characterized by multiple pulmonary artery and/or bronchial artery aneurysms with concomitant peripheral venous thrombosis and is believed to be a cardiovascular variant of Behcet's disease. Intracardiac thrombus occurring as a thrombotic manifestation of HSS is an unusual presentation and represents a challenge in diagnosis and treatment. Here we report a 25-year-old male presenting with recurrent right-sided intracardiac thrombi, in whom pulmonary artery aneurysm was later detected in the clinical course corroborating the diagnosis of HSS and leading to appropriate initiation of immunosuppressive agents. The patient required multiple cardiac surgeries during the clinical course for cardiovascular complications associated with recurrent cardiac thrombus. Unfortunately, the patient was readmitted a year later for massive hemoptysis secondary to pulmonary arterial aneurysm rupture requiring left lower lobectomy. Our case highlights also the significant morbidity, complications, and treatment challenges associated with this potentially life-threatening syndrome, which is intensified in the presence of cardiac involvement.

Ashtawarga plants - Suffering a triple standardization syndrome.

Ayurveda is one of the oldest known holistic health care systems recommending diverse medicinal uses of plants for prevention and cure of diseases and illness. World Health Organization (WHO) estimates that the holistic system is gaining more popularity due to its easy availability, low cost, congeniality, better accessibility and higher safety than allopathic medicine. Demand of herbal drugs is increasing day-by-day because of increasing popularity of herbal drugs; however market fails to meet this supply due to numerous factors, one of the important factors being the extinction of these plants from local flora. About 560 herbal species of India have been included in the Red List of Threatened species. Hence to overcome problem of non-availability of endangered species, Department of AYUSH, Govt. of India has permitted the substitution of rare herbal drugs with available substitutes on the basis of Ayurvedic concepts. Due to this, herbal drug industry has started exploiting the situation and now Ayurvedic products are suffering from a serious problem of adulteration with addition of spoiled, inferior, spurious drugs that are inferior in therapeutic/chemical properties and used to enhance profits. Adulteration with other plants degrades the quality and credibility of Ayurvedic medicine. Ashtawarga plants being an important part of many Ayurvedic formulations are also available in a very limited amount and likely to be substituted by cheap adulterants. Keeping in view the above situation, a metadata analysis has been conducted to find out types of adulteration/substitutions malpractices going on for Ashtawarga plants.

Isolation and characterization of quinine from Polygonatum verticillatum: A new marker approach to identify substitution and adulteration.

Polygonatum verticillatum (Mahameda) is an important ingredient of Ashtawarga and Ayurvedic formulations. Nowadays, it comes under the category of endangered plants due to large scale and indiscriminate collection of wild material. To overcome the scarcity, substitutes of Mahameda are also commonly used in market. These additives are different from the authentic plant by Ayurvedic and pharmacological theory of drug action, thereby resulting in substitution/adulteration. Substitution is a critical issue in isolation and quantification of the therapeutically active ingredients that can be used as markers in the identification of substitution/adulteration. Methanolic extract of the rhizomes of P. verticillatum was subjected to preliminary phytochemical screening for the detection of phytoconstituents, followed by column chromatography for isolation of the marker. The column was first eluted with pure hexane, and polarity of the solvent was gradually increased. A total of 1180 fractions were collected and pooled on the basis of thin-layer chromatography profile. The single compound was isolated and confirmed by chemical test, melting point, spectral analysis, and comparison with literature. Phytochemical screening of the extract shows the presence of alkaloids, flavonoids, carbohydrates, terpenoids, and phenolics. A pure white crystalline powder was isolated by column chromatography which was characterized as (6-methoxyquinolin-4-yl-8-vinylquinuclidin-2-yl) methanol, i.e. Quinine. The isolated compound, Quinine, was identified as a novel compound in Mahameda as it has not been reported in the genus Polygonatum, till now. It can be used as a marker for the identification of substitution/adulteration and standardization of P. verticillatum.