Comparative analysis, diversification, and functional validation of plant nucleotide-binding site domain genes.

Nucleotide-binding site (NBS) domain genes are one of the superfamily of resistance genes involved in plant responses to pathogens. The current study identified 12,820 NBS-domain-containing genes across 34 species covering from mosses to monocots and dicots. These identified genes are classified into 168 classes with several novel domain architecture patterns encompassing significant diversity among plant species. Several classical (NBS, NBS-LRR, TIR-NBS, TIR-NBS-LRR, etc.) and species-specific structural patterns (TIR-NBS-TIR-Cupin_1-Cupin_1, TIR-NBS-Prenyltransf, Sugar_tr-NBS etc.) were discovered. We observed 603 orthogroups (OGs) with some core (most common orthogroups; OG0, OG1, OG2, etc.) and unique (highly specific to species; OG80, OG82, etc.) OGs with tandem duplications. The expression profiling presented the putative upregulation of OG2, OG6, and OG15 in different tissues under various biotic and abiotic stresses in susceptible and tolerant plants to cotton leaf curl disease (CLCuD). The genetic variation between susceptible (Coker 312) and tolerant (Mac7) Gossypium hirsutum accessions identified several unique variants in NBS genes of Mac7 (6583 variants) and Coker312 (5173 variants). The protein-ligand and proteins-protein interaction showed a strong interaction of some putative NBS proteins with ADP/ATP and different core proteins of the cotton leaf curl disease virus. The silencing of GaNBS (OG2) in resistant cotton through virus-induced gene silencing (VIGS) demonstrated its putative role in virus tittering. The presented study will be further helpful in understanding the plant adaptation mechanism.

Program Directors' Perspectives on Residency Applications in the Post‒United States Medical Licensing Examination Step 1 Era: A Case for Standardized Letters of Recommendation?

INTRODUCTION: The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging. METHODS: The Society of Academic Urologists convened a task force to, in part, assess the perspectives of urology PDs regarding the importance of various aspects of a residency application for predicting clinical performance. An anonymous survey was disseminated to all urology PDs in the US. Perspectives on 11 potential application predictors of clinical performance and demographics were recorded. Descriptive statistics characterized PD responses. Friedman test and pairwise Wilcoxon tests were used to evaluate the relative ranks assigned to application elements by PDs. RESULTS: There was a 60.5% response rate (89/147). Letters of recommendation (LORs) were ranked as the most important predictor, with a mean rank of 2.39, median of 2 (IQR 1-3). Clerkship grades and USMLE Step 1 were comparable and ranked second. Medical school reputation ranked the lowest. There was significant subjective heterogeneity among categories; however, this was less so for LORs, which predominated as the most important factor among application elements (P < .001). CONCLUSIONS: To our knowledge, this is the largest sample size assessing PD perspectives on application factors that predict clinical performance. The second (clerkship grades) and third (USLME Step 1) most important factors moving toward binary pass/fail systems create an opportunity for actionable change to improve assessment objectivity. Our data demonstrate LORs to be the most important factor of residency applications, making a compelling argument for moving toward a standardized LOR to maximize this tool, mitigate bias, and improve interreviewer reliability.

Ayurveda and Yoga management of chronic alcoholism sequelae - A case report.

Alcohol has always been a component in the dietary pattern of human civilization. It is widely used in society for celebration and socialization. Alcohol abuse is among the most serious problems in public health characterized by uncontrolled drinking which causes physical and emotional dependence on alcohol. Chronic alcoholics are at a higher risk of developing vitamin B1 deficiency due to malabsorption, poor diet, and an increased demand for nutrition. Vitamin B1(Thiamine) is an essential nutrient required for the body's energy metabolism and proper functioning of the nervous system. A person who excessively consumes madya (alcohol) and then abruptly discontinues drinking and takes recourse to drinking excess madya once again, suffers from Madatyaya Upadrava(chronic alcoholism) that is Vikshay. Here is a case report of an alcoholic patient who ceased drinking and then resumed alcohol in large amounts. He presented with symptoms of generalized weakness, body ache, aphasia, confusion, fever (on and off), thirst, cough, headache, and numbness. The patient underwent a two-month treatment regimen that combined Satvavajay Chikitsa, Yoga, and Shaman Chikitsa involving Rasayana medications and procedures including snehan (Oleation), swedan (fomentation), nabhi puran (filling oil with navel), nasya (nasal administration), shirodhara (continuous flow of liquid on head) and basti (medicated enema). The intervention outcome showed relief from the aforementioned symptoms and improvement in both symptoms and GCS(Glasgow coma scale) score. This treatment approach aimed to promote vitality, longevity, and an overall sense of balance and well-being. There are not many corroborating cases being reported and managed with Ayurveda. This case report highlights transforming health through the cumulative effects of Rasayana medicines, panchakarma, and yoga.

A comprehensive review on the impact of calcium and vitamin D insufficiency and allied metabolic disorders in females.

Calcium is imperative in maintaining a quality life, particularly during later ages. Its deficiency results in a wide range of metabolic disorders such as dental changes, cataracts, alterations in brain function, and osteoporosis. These deficiencies are more pronounced in females due to increased calcium turnover throughout their life cycle, especially during pregnancy and lactation. Vitamin D perform a central role in the metabolism of calcium. Recent scientific interventions have linked calcium with an array of metabolic disorders in females including hypertension, obesity, premenstrual dysphoric disorder, polycystic ovary syndrome (PCOS), multiple sclerosis, and breast cancer. This review encompasses these female metabolic disorders with special reference to calcium and vitamin D deficiency. This review article aims to present and elaborate on available data regarding the worldwide occurrence of insufficient calcium consumption in females and allied health risks, to provide a basis for formulating strategies and population-level scientific studies to adequately boost calcium intake and position where required.

From acute abdomen to hormonal crisis: Case report on a long-delayed Sheehan's syndrome diagnosis.

INTRODUCTION: Sheehan's syndrome (SS) is a rare cause of hypopituitarism resulting from postpartum haemorrhage and pituitary necrosis. It remains an underdiagnosed condition, especially in developing countries due to poor obstetric care and home deliveries. This case report highlights the significance of recognizing atypical presentations of SS, such as pancytopenia, to aid in early diagnosis and management. CASE PRESENTATION: A 40-year-old female presented with acute abdomen symptoms and was initially diagnosed with acalculous cholecystitis. However, a detailed history revealed a history of postpartum haemorrhage 18 years prior, leading to a provisional diagnosis of SS. Further investigations confirmed panhypopituitarism, including hypothyroidism, hypocortisolism, and hypogonadism. Notably, the patient also exhibited pancytopenia, a rarely reported haematological manifestation of SS. DISCUSSION: SS often presents with nonspecific symptoms, leading to delayed or missed diagnoses. In this case, the patient's initial presentation of acute abdomen symptoms was attributed to secondary adrenal insufficiency due to panhypopituitarism. The presence of pancytopenia, along with hyponatremia, further complicated the clinical picture. Hormone replacement therapy led to a remarkable improvement in the patient's condition, emphasizing the importance of early diagnosis and intervention. CONCLUSION: SS is a common cause of panhypopituitarism in developing countries, but its atypical presentations, such as pancytopenia, are rare and often overlooked. This case highlights the need for increased awareness among clinicians to consider SS in patients with unexplained haematological abnormalities, particularly in regions with high rates of postpartum haemorrhage. Early recognition and appropriate hormone replacement therapy can significantly improve patients' outcomes and prevent long-term complications associated with this underdiagnosed syndrome.

Excision of recurrent penile schwannoma with neurovascular bundle sparing: A novel surgical approach.

Penile schwannomas are rare, often painless lesions usually growing on the dorsum of the penis. A young and otherwise healthy male with recurrent painful penile schwannomas and decreased libido was successfully treated with surgical excision. Through fine dissection of the nerve fascicles leading to the primary schwannoma, the lesion was successfully removed without compromising erectile or ejaculatory function. This novel approach allowed for significant symptomatic relief and improved quality of life.

Implementing traditional ayurveda treatment as a primary care management in a survivor of gas geyser syndrome - A case report.

Domestically, gas geysers are used in developing countries like India to supply hot water in bathrooms. These are of low economic value, with no requirement of electricity and easy installation, hence they are high in demand. A female patient of 14 year visited to a private Ayurved clinic on 27/12/2021 with complaints of difficulty in dysgraphia, dyslexia, dysphonia and fall (sometimes) while walking on uneven and unknown pathway. Four years ago, the patient landed into a vegetative state and was bed ridden, her condition was further diagnosed as Gas Geyser Syndrome. Here an effort has been put forth to reveal the concept of ayurvedic management adopted in a survivor of Gas Geyser Syndrome which is found to be effective. In Ayurveda the symptoms of Acute Gas Geyser syndrome can be correlated with Visha (Toxins) and its vishalakshana (Toxicity symptoms) wherein Murcha (Unconsciousness) and Sanyasa (Stage of Coma) are seen. The long term side effects of Gas Geyser Syndrome can be correlated with Vatavyadhi (Neurological disorders) as the stages of the disease manifestation presents with more neurological deficits. Ayurvedic intervention with internal medications along with the panchakarma procedures in the treatment of Gas geyser syndrome exhibits encouraging results which were seen in improving her cognition, memory and essential skills like writing, verbal communication, thinking skills, use of technology in socializing with the community.

Parental Leave Policies in the Top 20 US Hospitals: A Call for Inclusivity and Improvement.

Objective: To evaluate and compare parental leave policies from the top United States (US) hospitals with a focus on inclusivity of all types of parents. Methods: In September and October of 2021, the parental leave policies of the top 20 US hospitals, ranked by the 2021 US News & World report, were evaluated. Parental leave policies were obtained and reviewed through the hospitals' public websites. Hospitals' Human Relations (HR) departments were contacted to confirm the policies. Hospital policies were scored against a rubric created by the authors. Results: Among the top US hospitals (21 total hospitals), 17 (81%) had publicly available policies, and one policy was obtained by contacting HR. Fourteen of the 18 hospitals (77.8%) had a parental leave policy distinctive from short-term disability and offered paid paternity or partner leave. Thirteen hospitals (72.2%) offered parental leave for parents whose children were carried through surrogacy. Fourteen hospitals (77.8%) included adoptive parents; however, only five hospitals (27.8%) specifically included foster parents. The average paid leave for birthing mothers was 7.9 weeks compared to 6.6 weeks for nonbirthing parents. Only three hospitals offered the same leave for birthing and nonbirthing parents. Conclusion: While a few of the top 20 hospitals have paid parental leave policies that are inclusive and equivalent to all parents, many do not and represent an area for improvement. As healthcare industry leaders, these hospitals should strive for inclusive parental leave policies that care for their employees with the same high standards they set for caring for patients.

Synthesis and applications of MXene-based composites: a review.

Recently, there has been considerable interest in a new family of transition metal carbides, carbonitrides, and nitrides referred to as MXenes (Ti3C2Tx) due to the variety of their elemental compositions and surface terminations that exhibit many fascinating physical and chemical properties. As a result of their easy formability, MXenes may be combined with other materials, such as polymers, oxides, and carbon nanotubes, which can be used to tune their properties for various applications. As is widely known, MXenes and MXene-based composites have gained considerable prominence as electrode materials in the energy storage field. In addition to their high conductivity, reducibility, and biocompatibility, they have also demonstrated outstanding potential for applications related to the environment, including electro/photocatalytic water splitting, photocatalytic carbon dioxide reduction, water purification, and sensors. This review discusses MXene-based composite used in anode materials, while the electrochemical performance of MXene-based anodes for Li-based batteries (LiBs) is discussed in addition to key findings, operating processes, and factors influencing electrochemical performance.

Financial Toxicity for Female Patients with Urinary Incontinence.

PURPOSE OF REVIEW: Urinary incontinence (UI) is a common global condition that has been noted to disproportionately affect women. In this review, the authors present discussion of factors contributing to cost of care and various modalities of cost-effective care for UI for female patients. RECENT FINDINGS: We found insurance and out-of-pocket (OOP) costs strongly impact of costs for patients. Further, in evaluation of UI, diagnosis can be a costly multi-step process for effective treatment. Treatment can be multimodal, including non-surgical (e.g., pessary, vaginal insert, pelvic floor muscle training, or PFMT), of which PFMT is a cost-effective, effective, and accessible treatment. Pharmacologic management is generally second-line for overactive bladder, but anti-muscarinic drugs and beta-3 agonists are cost-effective depending on willingness-to-pay and the health system in which they are acquired, respectively. Surgical management is considered the most cost-effective treatment as willingness-to-pay increased, with minimally invasive slings being the mainstay. Other relatively novel treatments are also discussed (e.g., EMSELLA) but require further research. Additionally, we discuss systematic barriers in decisions to seek care for urinary incontinence. Urologists are key agents in treating UI for their female patients, and seeking cost-effective options for treatment remains pivotal for quality care.

Establishment of Transcriptional Gene Silencing Targeting the Promoter Regions of GFP, PDS, and PSY Genes in Cotton using Virus-Induced Gene Silencing.

Virus-induced gene silencing (VIGS) by deploying viral-based vectors such as tobacco rattle virus (TRV) is a homology-based gene silencing technique in post-transcriptional gene silencing (PTGS) and transcriptional gene silencing (TGS) to validate the function of particular genes. The study presented here showed the induction of DNA methylation in the promoter regions of three phenotypic marker genes in different cotton accessions, including two endogenous genes such as phytoene desaturase (PDS) and phytoene synthase (PSY), and an exogenous gene, such as green fluorescent protein (GFP). First, DNA methylation was established in transgenic GFP cotton where methylation persisted up to S3 generation. Afterward, the promoter of PSY was targeted following the same conditions. Significant silencing of PSY was observed and methylation of the promoter was found up to S2 generation in red leaf cotton as detected in GFP cotton. Silencing of PDS resulted in a photobleaching phenotype; interestingly, the strength of this phenotype was diverse within the plants and was not observed in the next generation. Bisulfite sequencing results showed methylation percentage of the cytosine residues was high at CG and CHG sites of the targeted promoter sequences in the silenced plants. The findings of this paper suggest that TRV-based vector system can be used to monitor DNA methylation for both exogenous and endogenous gene levels in cotton and offer a very useful tool for plant epigenetic modification.

Phytocompounds targeting epigenetic modulations: an assessment in cancer.

For centuries, plants have been serving as sources of potential therapeutic agents. In recent years, there has been a growing interest in investigating the effects of plant-derived compounds on epigenetic processes, a novel and captivating Frontier in the field of epigenetics research. Epigenetic changes encompass modifications to DNA, histones, and microRNAs that can influence gene expression. Aberrant epigenetic changes can perturb key cellular processes, including cell cycle control, intercellular communication, DNA repair, inflammation, stress response, and apoptosis. Such disruptions can contribute to cancer development by altering the expression of genes involved in tumorigenesis. However, these modifications are reversible, offering a unique avenue for therapeutic intervention. Plant secondary compounds, including terpenes, phenolics, terpenoids, and sulfur-containing compounds are widely found in grains, vegetables, spices, fruits, and medicinal plants. Numerous plant-derived compounds have demonstrated the potential to target these abnormal epigenetic modifications, including apigenin (histone acetylation), berberine (DNA methylation), curcumin (histone acetylation and epi-miRs), genistein (histone acetylation and DNA methylation), lycopene (epi-miRs), quercetin (DNA methylation and epi-miRs), etc. This comprehensive review highlights these abnormal epigenetic alterations and discusses the promising efficacy of plant-derived compounds in mitigating these deleterious epigenetic signatures in human cancer. Furthermore, it addresses ongoing clinical investigations to evaluate the therapeutic potential of these phytocompounds in cancer treatment, along with their limitations and challenges.

Transition of amyloid/mutant p53 from tumor suppressor to an oncogene and therapeutic approaches to ameliorate metastasis and cancer stemness.

The tumor suppressor p53 when undergoes amyloid formation confers several gain-of-function (GOF) activities that affect molecular pathways crucial for tumorigenesis and progression like some of the p53 mutants. Even after successful cancer treatment, metastasis and recurrence can result in poor survival rates. The major cause of recurrence is mainly the remnant cancer cells with stem cell-like properties, which are resistant to any chemotherapy treatment. Several studies have demonstrated the role of p53 mutants in exacerbating cancer stemness properties and epithelial-mesenchymal transition in these remnant cancer cells. Analyzing the amyloid/mutant p53-mediated signaling pathways that trigger metastasis, relapse or chemoresistance may be helpful for the development of novel or improved individualized treatment plans. In this review, we discuss the changes in the metabolic pathways such as mevalonate pathway and different signaling pathways such as TGF-ß, PI3K/AKT/mTOR, NF-κB and Wnt due to p53 amyloid formation, or mutation. In addition to this, we have discussed the role of the regulatory microRNAs and lncRNAs linked with the mutant or amyloid p53 in human malignancies. Such changes promote tumor spread, potential recurrence, and stemness. Importantly, this review discusses the cancer therapies that target either mutant or amyloid p53, restore wild-type functions, and exploit the synthetic lethal interactions with mutant p53.

The role of in-person focus groups in the management of urinary incontinence in women from a mixed-methods, randomized pilot study.

PURPOSE: To assess the quantitative and qualitative components of in-person focus groups as a potential intervention for female patients with urinary incontinence. METHODS: Women over the age of 18 seeking treatment for UI were randomized to standard care with focus group participation or to standard care alone. All participants completed validated questionnaires: MESA, UDI-6, OAB-SAT-q, PGI-S, PGI-I, SQoL-F, PHQ-9, IPAQ at the beginning and conclusion of the study. Questionnaires were analyzed with repeated measures of ANOVA models in an intention-to-treat manner. Three moderated focus group sessions were held and audio recorded. Recordings were transcribed and categorized by frequency into themes using grounded theory methodology. RESULTS: A total of ten control and eight intervention participants agreed to participate. Seven women attended all three focus group sessions and were included in the final analysis. Transcripts from focus group sessions observed women identified most with (1) urinary incontinence (UI) as a chronic disease, (2) shame managing UI, and (3) social constraints of toileting. Participants self-reported appreciation of focus group participation and desire for on-going sessions. Analysis of the questionnaires did not demonstrate statistically significant differences. CONCLUSION: Data ascertained from questionnaires were unable to demonstrate a meaningful effect in improved treatment outcomes for control and intervention participants. Grounded theory analysis of transcripts identified four primary themes: (1) appreciation of the focus group, (2) UI as a gendered issue, (3) lack of public awareness, and (4) history of negative provider interactions. All focus group participants self-reported interest in attending future focus group sessions.

Characterization of urethral diverticula in males.

INTRODUCTION: Urethral diverticulum in a male is a rare entity and the literature is limited to case reports and small case series. The aim of our study is to characterize this disease in patients from three Mayo Clinic locations. MATERIALS AND METHODS: Chart analysis was performed of patients across all three Mayo Clinic sites that had International Classification of Diseases (ICD) codes corresponding to urethral diverticulum or urethral diverticulectomy via CPT code. Data were available for patients that were seen from 6/1/2003 through 10/5/2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes. RESULTS: A total of 87 men met the initial search criteria with 52 having documented urethral diverticula. The most common presenting complaint in these men was incontinence (37%). The majority of diverticula (83%) were within the anterior urethra. The most common diagnostic modalities were retrograde urethrogram (46%) and cystoscopy (50%). Most diverticula were iatrogenic (77%). Of the men that were diagnosed, 42% went on to have diverticulectomy. Median follow up was 1.5 years. Eighteen percent of patients had persistent urinary symptoms following diverticulectomy with incontinence being the most common finding. Postoperative complications were experienced by 26% patients with the most prevalent complication being urethrocutaneous fistula. The patients who did not undergo diverticulectomy either had other surgical procedure to manage their coexisting conditions or were managed medically. CONCLUSION: Urethral diverticulum in males is a rare yet important entity that requires special consideration, especially in those who have had prior surgery within the lower urinary tract.

Characterization of Urethral Diverticula in Women.

OBJECTIVE: Urethral diverticulum is a rare, yet important condition for the female pelvic surgeon. We aimed to characterize the women who have been seen for this condition across the three Mayo Clinic locations. METHODS: Medical record review was performed for patients across all three Mayo Clinic sites (Rochester, Arizona, Florida) that had International Classification of Diseases, Ninth Revision, (ICD-9) and International Classification of Diseases, Tenth Revision, (ICD-10) codes corresponding to urethral diverticulum (ICD-9, 599.2; ICD-10, N36.1). We also performed a review of patients who underwent urethral diverticulectomy via Current Procedural Terminology (CPT) code 53235. Data were available for patients from June 1, 2003, to October 5, 2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes. RESULTS: Four hundred forty-seven women met initial coding criteria for urethral diverticula, with 228 women having documented urethral diverticula. The most common presentations were irritative voiding symptoms (93) and infections (92). The most common diagnostic modality was radiographic imaging (198/228) with magnetic resonance imaging accounting for 157 cases. Etiology was unknown in the majority of cases (181/228). Of women who were diagnosed, 172 underwent diverticulectomy with 51 concurrent urethral sling placements. Final pathology demonstrated 2 cases of malignancy. Postoperative follow-up ranged from 0 months to 15 years (mean, 1.4 years; median, 4 months). Forty-three patients had persistent urinary symptoms after diverticulectomy with stress incontinence being the most common. Eight patients underwent subsequent sling placement. Fourteen patients had recurrence. CONCLUSIONS: This appears to be the largest reported series on female urethral diverticula, a rare yet important entity that requires special consideration. Most surgical cases found resolution of symptoms after diverticulectomy. Importantly, less than 2% of urethral diverticula were associated with malignancy.

Identification of preferred reminder systems and patient factors to promote adherence in the management of urinary incontinence.

Objective: To investigate comfort level and preferences of automated reminder systems (mail, email, text message, phone call, patient-portal message, and/or smartphone application) to promote adherence to recommended therapies for patients seeking care for urinary incontinence (UI) at our urology clinic in Phoenix, Arizona. Methods: Anonymous surveys were distributed in English to adult patients with UI from 4/2019-5/2019. Patient demographics, UI type, and access to and use of the Internet, smartphone and patient-portal were assessed. Using a Likert scale, patients indicated level of comfort with each reminder system and numerically ranked each system. Statistical analyses were performed to identify patient characteristics associated with reminder modality and determine significance in ranking of systems. Results: Fifty-seven patients (67.3 ± 16.3 years) completed the survey with an 87% response rate. Text-message and phone call reminder modalities were ranked the highest compared to other modalities (p < 0.05). A Chi-squared test showed no correlation between preferred reminder system modality and type of incontinence, age, gender, race/ethnicity, or language spoken (p > 0.05). Internet usage and access significantly correlated with preference for smartphone application and patient-portal message reminder systems (p < 0.05). Conclusion: Patients reported they were extremely comfortable with all communication modalities, except for smartphone applications in which patients were the least comfortable. The modalities most preferred by patients were phone call and text message and least preferred were patient portal and smart phone application. In conclusion, phone calls and text messages were the most preferred communication modality, with smart phone applications as the least comfortable. Innovation: This study demonstrates the potential utility of specific reminder modalities for patients seeking help with treatment adherence.

Health related quality of life in post-acute coronary patient.

The study aimed to assess the effects of lifestyle-modification counselling on behavioural outcomes among patients after myocardial infarction. This was a quasi-experimental study, conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from December 2018 to February 2019, on 50 post-myocardial infarction (post-MI) patients. Knowledge, attitude, and practice regarding lifestyle was assessed using a self-designed, pre-tested, validated questionnaire. The participants were given health messages regarding lifestyle modifications for 15-20 minutes based on WHO guidelines on the nature of the disease, diet, exercise, smoking cessation, weight and blood pressure monitoring, and salt intake. The mean age of the patients was 58.68±10.8 years. The MI knowledge sufficiently improved (28,100%), positive attitude was observed (27, 96.4%), and healthy practices were anticipated (24, 85.71%) significantly (p<0.001) after counselling. The lifestyle modification counselling improved the knowledge, attitude, and practice among post- MI patients but significant improvement was seen only in knowledge and practice.

Zinc-induced hypocupremia and pancytopenia, from zinc supplementation to its toxicity, a case report.

According to one estimate, zinc supplementation is widely used in the USA by almost 37% of the elderly population above age 71. Zinc has perceived benefits of immune system enhancement without realizing the harmful effects when used in excess. One of its under-recognized side effects is hypocupremia or copper deficiency due to excessive gastrointestinal losses as excessive zinc in the gut competes with copper for absorption. If severe, hypocupremia can cause hematologic changes (anemia, leukopenia/neutropenia, thrombocytopenia, and pancytopenia) with and without neurological deficits. Since zinc-induced hypocupremia is an overlooked entity, there is a lag of 12 months between the onset of symptoms and diagnosis. Most patients usually undergo a series of costly and sometimes invasive tests such as bone marrow biopsies during this lag time. Once diagnosed, the treatment is as simple as discontinuation of zinc and oral copper supplements. Here, we present a case report of zinc-induced hypocupremia and pancytopenia in an 81-year-old lady who was taking zinc supplements for macular degeneration. The patient presented with leukopenia with neutropenia, thrombocytopenia, and moderate anemia. This case report aims to educate clinicians since this is an easily missed entity and likely more prevalent than known due to widely used zinc supplementation.