Giant Genital Mass: Unveiling a Unique Case of Folliculocystic and Collagen Hamartoma.

Folliculocystic and collagen hamartoma (FCCH) is a rare entity, typically documented in males with tuberous sclerosis complex. Here, we report a unique case of FCCH in a 19-year-old female with an unusual presentation in the external genitalia. The patient presented with a progressively enlarging mass over three years, causing difficulties in walking and sitting. Examination revealed a 10 x 15 cm tender, lobulated, skin-colored tumor with comedo-like openings originating from the right labium majus, with satellite lesions on both labia majora. She had no other symptoms or history suggestive of tuberous sclerosis. Histopathological examination showed dilated hair follicles with keratin, perifollicular fibrosis, and thick dermal collagen bands extending into subcutaneous tissue, confirming FCCH. This case underscores the importance of considering FCCH in the differential diagnosis of genital masses, even without classical clinical associations. Our findings contribute to the limited literature on FCCH and highlight the need for further exploration and awareness within the medical community.

Wild Edible Flowers of Western Himalayas: Nutritional Characterization, UHPLC-QTOF-IMS-Based Phytochemical Profiling, Antioxidant Properties, and In Vitro Bioaccessibility of Polyphenols.

Four edible flowers commonly consumed in the Western Himalayan region, namely, Bauhinia variegata (Kachnar), Tropaeolum majus (Nasturtium), Matricaria chamomilla (Chamomile), and Tagetes erecta (Marigold), were characterized for their nutritional and phytochemical composition. Through the UHPLC-QTOF-IMS-based metabolomics approach, 131 compounds were tentatively identified consisting of phenolic acids, flavonoid glycosides, terpenoids, amino acids, and fatty acid derivatives. Kaempferol and quercetin glycosides for Kachnar, apigenin glycosides and caffeoylquinic acid derivatives for Chamomile, patulin and quercetin derivatives for Marigold, cyanidin and delphinidin glycosides for Nasturtium were the predicted marker metabolites identified through non-targeted metabolomics. Kachnar and Chamomile scored best in terms of macronutrients and essential micronutrients, respectively. Nasturtium contained high concentrations of α-linolenic acid, anthocyanins, and lutein. Kachnar contained the highest total phenolic acids (63.36 ± 0.38 mg GAE g-1), while Marigold contained the highest total flavonoids (118.90 ± 1.30 mg QUE g-1). Marigolds possessed excellent free radical scavenging and metal chelation activities. Chamomile exhibited strong α-glucosidase inhibition activity, followed by Nasturtium. The in vitro gastrointestinal digestibility of flower extracts indicated that the bioaccessibility of phenolic acids was higher than that of flavonoids. Polyphenols from Nasturtium and Chamomile showed the highest bioaccessibility. The study is an attempt to characterize traditionally consumed edible flowers and promote their wider utilization in gastronomy and nutraceuticals.

Outcome of transcanalicular laser dacryocystorhinostomy with endonasal augmentation in acute versus post-acute dacryocystitis.

OBJECTIVE: To study the outcomes of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with endonasal augmentation in acute versus post-acute dacryocystitis and compare it with external DCR in post-acute settings. METHODS: A prospective, randomised study was conducted in 90 adult cases of Acute dacryocystitis. All the patients were started on systemic antibiotics and a 4 mm × 4 mm osteotomy was created using TCL-DCR. The osteotomy was enlarged to 8 mm × 8 mm by endonasal augmentation at the same sitting in group 1, after 10 days in group 2 and after 10 days with external DCR in group 3. The cases were assessed for symptomatic relief and complications. Success was defined as functional and anatomical patency at 36 months. RESULTS: The mean age was 45.33 ± 15.06 years and the male: female ratio was 1:2. The presenting complaints were painful swelling (100%), epiphora or discharge (88.8%), fistula (33%) and fever (6%). The average number of acute episodes was 2.96. The intra-group pain reduction from day 1 to day 4, was significant in all three groups (p = 0.000). Intra-operative (p = 0.015, χ2 = 8.37) and post-operative complications (p = 0.002, χ2 = 0.002) were higher in group. Anatomical success was achieved in all the three groups, however, the functional success in Group 3, Group 2 and Group 1 was 100%, 86.7% and 66.7% respectively (p = 0.002, χ2 = 12.86). CONCLUSIONS: The creation of osteotomy using TCL-DCR provides early relief in symptoms. Single-stage surgery in inflamed tissues is associated with higher complication rates. External DCR in post-acute settings gives the best outcomes with minimal complications, endoscopic augmentation requires a close follow-up.

Monkeypox: a new global health emergency with predominant dermatological manifestations.

Monkeypox is a zoonotic virus belonging to the Orthopoxvirus genus. Previously endemic to Africa, outbreaks have been reported from all over the world, the largest of which is currently ongoing. Dermatologists are principally involved in recognition and diagnosis of the infection. This narrative review primarily focuses on clinical manifestations and highlights the unique epidemiological features of current outbreak. Lesions observed during the current outbreak lack the evolution described in endemic disease. Polymorphic lesions are common and may be confined to anogenital area. Onset of "prodromal" symptoms may coincide with onset of skin rash, and these may be altogether absent. Mortality rates observed are low. The exanthem should be differentiated from other infections such as herpes, molluscum contagiosum, smallpox, and other poxvirus infections. Presentation as an isolated genital lesion warrants differentiation from syphilis, chancroid, and other sexually transmitted diseases. Close intimate contact during sexual encounters is the primary mode of transmission, and other coexisting sexually transmitted infections are frequently diagnosed.

Edible rose flowers: A doorway to gastronomic and nutraceutical research.

The world is moving towards a healthier lifestyle where people are changing their eating habits, which influenced edible rose flowers to emerge as a pioneer in the field of nutraceutical and food industries. Roses are a good source of dietary phytochemicals viz., flavonoids (anthocyanins, flavonols, and flavonols), carotenoids, and phenolic acids. The presence of such phytochemicals makes rose as an anti-oxidant, anti-inflammatory, anti-cancerous, anti-aging, anti-microbial, hepatoprotective, and neurogenic agent. Historically edible rose flowers have been used in the preparation of traditional food products and delicacies such as gulkand, punkhuri, and rose petal tea and have found application in traditional medicine such as Ayurveda to treat hyperacidity, vata, pitta, constipation, abdominal pains, and various other illnesses. Over a period of time, concept of edible flowers has gotten more recognition and now roses are used in the preparation of many food products such as jams, jellies, cookies, salads, ice-creams, juices, and wines. In this review, we established a connection between phytochemicals and their biological activity, nutritional composition, traditional usage, and functional food aspects of edible rose flowers. Overall, these concepts help to set a new trend in culinary science and further research on the nutraceutical composition, and health benefits of edible rose flowers.

Factors affecting surgically induced astigmatism in manual small-incision cataract surgery.

Cataract is the most common cause of avoidable blindness in the world. While cataract surgery is continually evolving, manual small-incision cataract surgery (MSICS) still remains highly relevant, especially with the threat of the coronavirus disease 2019 (COVID-19) still looming large over the world. MSICS today has a renewed significance, since it does not involve the use of any advanced machinery and relies mainly on easily sterilizable instruments, thereby making it a safe and inexpensive option. A self-sealing valvular tunnel entry forms the basis of MSICS, and proper positioning and construction of the tunnel is imperative to the success of the surgery. With more and more people demanding spectacle independence after surgery, it becomes important to have a thorough understanding of the factors that may influence surgically induced astigmatism in MSICS. These include the incision location, size and shape, configuration of the sclero-corneal tunnel, pre-existing ocular pathology, role of sutures, amongst others. With proper knowledge, many of these factors can be modulated to achieve best results.

Candidiasis presenting as pseudocircinate balanitis in a preschooler.

Candidal balanitis typically affects sexually active adult males and may present as eroded papules, pustules, whitish discharge or erythema with dry glazed appearance. We report an unusual presentation of this common infection in an uncommon demographic, candidal balanitis presenting as coalescent vesicles and erosions arranged in an arcuate pattern in a pre-school child.

Small Joint, Tendon, and Myofascial Injections.

Small joint, peritendinous, and myofascial injections can be used for both diagnostic and therapeutic purposes. This article reviews injections for carpal tunnel, first dorsal compartment, trigger finger, ganglion cysts, trigger point, and plantar fascia. Necessary equipment should be gathered before the procedure and informed consent should be obtained. Indications, contraindications, and possible complications should be reviewed. Complete understanding of anatomy before injection is paramount. The injection technique should minimize risk of infection. There are no evidence-based postinjection protocols, and outcomes vary depending on the site and medication injected.

siRNA Mediated GSK3ß Knockdown Targets Insulin Signaling Pathway and Rescues Alzheimer's Disease Pathology: Evidence from In Vitro and In Vivo Studies.

Sporadic Alzheimer's disease (sAD) is a progressive neurodegenerative disorder with dysfunctional insulin signaling and energy metabolism. Emerging evidence suggests impairments in brain insulin responsiveness, glucose utilization, and energy metabolism may be major causes of amyloid precursor protein mishandling. The support for this notion comes from the studies wherein streptozotocin (STZ) induced brain insulin resistance in rodent model resulted in sAD-like neuropathology with cognitive decline. Our previous study showed a compromised insulin signaling pathway, glucose uptake, glucose metabolism, and energy homeostasis in STZ-induced glial-neuronal coculture and in vivo model of sAD. Various components of insulin signaling pathway were examined to understand the metabolic correlation, and GSK3ß was selected for gene knockdown strategy to reverse sAD pathology based on the data. In the present study, we have synthesized carboxylated graphene oxide (GO) nanosheets functionalized with PEG and subsequently with polyethylenimine (PEI) to provide attachment sites for GSK3ß siRNA. Our results showed that siRNA mediated knockdown of the GSK3ß gene reduced expression of amyloid pathway genes (APP and BACE1), which was further confirmed by reduced amyloid beta (Aß) levels in the in vitro STZ-induced sAD model. GSK3ß knockdown also restored insulin signaling, AMPK and Mapk3 pathway by restoring the expression of corresponding candidate genes in these pathways (IR, Glut1/3, Prkaa1/2, Mapk3, BDNF) that reflected improved cellular energy homeostasis, neuronal proliferation, differentiation, maturation, and repair. Behavioral data from Morris water maze (MWM), open field (OF), novel object recognition (NOR), Y maze, and radial arm maze (RAM) tests showed that 0.5 µg nanoformulation (GOc-PP-siRNAGSK3ß) intranasally for 7 days improved spatial memory, rescued anxiety like behavior, improved visual and working memory, and rescued exploratory behavior in STZ-induced sAD rats. GSK3ß silencing resulted in decreased BACE1 expression and prevented accumulation of Aß in the cortex and hippocampus. These molecular findings with improved behavioral performances were further correlated with reduced amyloid beta (Aß) and neurofibrillary tangle (NFTs) formation in the cortex and hippocampus of GOc-PP-siRNAGSK3ß administered sAD rats. Therefore, it is conceivable from the present study that nanoparticle-mediated targeting of GSK3ß in the sAD appears to be a promising strategy to reverse sAD pathology.

Multifarious applications of bioactive glasses in soft tissue engineering.

Tissue engineering (TE), a new paradigm in regenerative medicine, repairs and restores the diseased or damaged tissues and eliminates drawbacks associated with autografts and allografts. In this context, many biomaterials have been developed for regenerating tissues and are considered revolutionary in TE due to their flexibility, biocompatibility, and biodegradability. One such well-documented biomaterial is bioactive glasses (BGs), known for their osteoconductive and osteogenic potential and their abundant orthopedic and dental clinical applications. However, in the last few decades, the soft tissue regenerative potential of BGs has demonstrated great promise. Therefore, this review comprehensively covers the biological application of BGs in the repair and regeneration of tissues outside the skeleton system. BGs promote neovascularization, which is crucial to encourage host tissue integration with the implanted construct, making them suitable biomaterial scaffolds for TE. Moreover, they heal acute and chronic wounds and also have been reported to restore the injured superficial intestinal mucosa, aiding in gastroduodenal regeneration. In addition, BGs promote regeneration of the tissues with minimal renewal capacity like the heart and lungs. Besides, the peripheral nerve and musculoskeletal reparative properties of BGs are also reported. These results show promising soft tissue regenerative potential of BGs under preclinical settings without posing significant adverse effects. Albeit, there is limited bench-to-bedside clinical translation of elucidative research on BGs as they require rigorous pharmacological evaluations using standardized animal models for assessing biomolecular downstream pathways.

Bioactive glass: A multifunctional delivery system.

Bioactive glasses (BAGs) were invented five decades ago and have been widely used clinically in orthopedic and stomatology. However, in the past two decades, BAGs have been explored immensely by several researchers worldwide as a multifunctional delivery system for a multitude of therapeutics ranging from metal ions to small molecules (e.g., drugs) and macromolecules (e.g., DNA). The impetus for devising a BAG-based delivery system in the 21st century is based upon the facilitative properties it offers for entrapment of a wide range of therapeutic molecules and the tailorable controlled release kinetics to the target tissue site along with the biological activity of the ionic dissolution products in several pathological conditions such as osteoporosis, cancer, infection, and inflammation. This review comprises two parts: the first part discusses the need for a new delivery system and how the journey from melt quench progressed towards template-based sol-gel mesoporous. In the second part, we have comprehended the scientific advancements made so far, emphasizing BAGs as a delivery system ranging from therapeutic ions to phytopharmaceuticals. We have also highlighted a few loopholes that have prevented bench-to-bedside clinical translation of a plethora of elucidative researches done so far.

Neuro-nutraceutical potential of Asparagus racemosus: A review.

Debilitating neuropsychiatric and neurodegenerative conditions are associated with complex multifactorial pathophysiology. Their treatment strategies often only provide symptomatic relief, delaying disease progression without giving a complete cure. Potent and safer treatment alternatives beyond symptomatic relief are sought. Herbal supplements have surely been explored due to their multiple component nature to enhance the effect of western medications. One such well-documented nutraceutical in the ancient Greek, Chinese, and Ayurvedic medicine system known for its various medicinal benefits is Asparagus racemosus. Widely used for its lactogenic properties, A. racemosus is also cited in Ayurveda as a nervine tonic. A. racemosus based nutraceuticals have shown to possess adaptogenic, neuroprotective, antioxidant, anti-inflammatory, and nootropic activity under preclinical and clinical settings without posing significant adverse effects. A. racemosus extracts restore the perturbed neurotransmitters and prevent oxidative neuronal damage. From the available neuropharmacological researches, the physiological actions of A. racemosus can ultimately be directed for either augmentation of cognitive ability or in the management of neurological conditions such as stress, anxiety, depression, epilepsy, Parkinson's, and Alzheimer's disease. The studies focus on the multi-component extract, and the lack of standardization has been a major hurdle in preventing the allotment of reported neuropharmacological activity to one of the phytoconstituent. Herbal standardization of the plant extract based on a specific biomarker can help elucidate the intricate biomolecular pathway and neurocircuitries being involved. This, followed by rigorous standardized clinical trials, fixing dosages, and determining contraindications would facilitate the translation of A. racemosus to a FDA-approved neuromedicine for neurological disorders.

Unusual Tumours Hidden in Blind Eyes.

INTRODUCTION: This case report describes 3 cases of unsuspected neoplasms in previously blind eyes, with recent onset pain. Cases and observations: Case 1: Female with pain, redness in the non-seeing right eye (R/E) for two months. R/E had total cataract, low intraocular pressure and a well-defined globular mass lesion at the posterior pole, seen on ultrasound. Enucleation with an implant was done. Histopathology clinched the diagnosis of choroidal melanoma. Case 2: A 20-year male, developed pain, redness in left eye (L/E) for two months. L/E was blind since childhood, secondary to trauma. The patient underwent enucleation and detailed histopathological examination and immunohistochemistry supported a diagnosis of ependymoma with vascular malformation. Case 3: A 24-year male with pain, redness in L/E for six months, with decrease in size of eyeball. L/E had low vision since childhood. On examination, L/E was phthisical with diffuse conjunctival congestion, band-shaped keratopathy, cataract, and neovascularization of iris. Imaging revealed a small distorted globe with highly reflective mass along the posterior pole. Histopathology of the enucleated specimen confirmed the diagnosis of choroidal osteoma, with gliosis of the adjacent RPE. CONCLUSION: In the management of a painful blind eye, it is extremely important to rule out an intraocular malignancy, particularly in patients with recent onset of pain.

Genetically encoded sensors enable micro- and nano-scopic decoding of transmission in healthy and diseased brains.

Neural communication orchestrates a variety of behaviors, yet despite impressive effort, delineating transmission properties of neuromodulatory communication remains a daunting task due to limitations of available monitoring tools. Recently developed genetically encoded neurotransmitter sensors, when combined with superresolution and deconvolution microscopic techniques, enable the first micro- and nano-scopic visualization of neuromodulatory transmission. Here we introduce this image analysis method by presenting its biophysical foundation, practical solutions, biological validation, and broad applicability. The presentation illustrates how the method resolves fundamental synaptic properties of neuromodulatory transmission, and the new data unveil unexpected fine control and precision of rodent and human neuromodulation. The findings raise the prospect of rapid advances in the understanding of neuromodulatory transmission essential for resolving the physiology or pathogenesis of various behaviors and diseases.

Extending Arms of Insulin Resistance from Diabetes to Alzheimer's Disease: Identification of Potential Therapeutic Targets.

BACKGROUND & OBJECTIVE: Type 3 diabetes (T3D) is chronic insulin resistant state of brain which shares pathology with sporadic Alzheimer's disease (sAD). Insulin signaling is a highly conserved pathway in the living systems that orchestrate cell growth, repair, maintenance, energy homeostasis and reproduction. Although insulin is primarily studied as a key molecule in diabetes mellitus, its role has recently been implicated in the development of Alzheimer's disease (AD). Severe complications in brain of diabetic patients and metabolically compromised status is evident in brain of AD patients. Underlying shared pathology of two disorders draws a trajectory from peripheral insulin resistance to insulin unresponsiveness in the central nervous system (CNS). As insulin has a pivotal role in AD, it is not an overreach to address diabetic condition in AD brain as T3D. Insulin signaling is indispensable to nervous system and it is vital for neuronal growth, repair, and maintenance of chemical milieu at synapses. Downstream mediators of insulin signaling pathway work as a regulatory hub for aggregation and clearance of unfolded proteins like Aß and tau. CONCLUSION: In this review, we discuss the regulatory roles of insulin as a pivotal molecule in brain with the understanding of defective insulin signaling as a key pathological mechanism in sAD. This article also highlights ongoing trials of targeting insulin signaling as a therapeutic manifestation to treat diabetic condition in brain.