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PurposeSustained minimal residual disease (MRD) negativity is associated with long-term survival in multiple myeloma. The gut microbiome is affected by diet, and in turn can modulate host immunity, for example through production of short-chain fatty acids including butyrate. We hypothesized that dietary factors affect the microbiome (abundance of butyrate-producing bacteria or stool butyrate concentration) and may be associated with multiple myeloma outcomes.Experimental designWe examined the relationship of dietary factors (via a food frequency questionnaire), stool metabolites (via gas chromatography-mass spectrometry), and the stool microbiome (via 16S sequencing - α-diversity and relative abundance of butyrate-producing bacteria) with sustained MRD negativity (via flow cytometry at two timepoints 1 year apart) in myeloma patients on lenalidomide maintenance. The Healthy Eating Index 2015 score and flavonoid nutrient values were calculated from the food frequency questionnaire. The Wilcoxon rank sum test was used to evaluate associations with two-sided P < 0.05 considered significant.ResultsAt 3 months, higher stool butyrate concentration (P = 0.037), butyrate producers (P = 0.025), and α-diversity (P = 0.0035) were associated with sustained MRD negativity. Healthier dietary proteins, (from seafood and plants), correlated with butyrate at 3 months (P = 0.009) and sustained MRD negativity (P = 0.05). Consumption of dietary flavonoids, plant nutrients with antioxidant effects, correlated with stool butyrate concentration (anthocyanidins P = 0.01, flavones P = 0.01, and flavanols P = 0.02).ConclusionsThis is the first study to demonstrate an association between a plant-based dietary pattern, stool butyrate production, and sustained MRD negativity in multiple myeloma, providing rationale to evaluate a prospective dietary intervention.

[This corrects the article DOI: 10.1158/2643-3230.BCD-20-0102.].

UNLABELLED: Patients with multiple myeloma have a compromised immune system, due to both the disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in patients with multiple myeloma treated at five large academic centers in New York City in the spring of 2020, during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these, 13 patients (17%) were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 nonadmitted patients, 4 were asymptomatic. There was a higher risk of adverse outcome (intensive care unit admission, mechanical ventilation, or death) in Hispanics/Latinos (n = 21), OR = 4.7 (95% confidence interval, 1.3-16.7), and African American Blacks (n = 33), OR = 3.5 (1.1-11.5), as compared with White patients (n = 36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated (P > 0.05) with adverse outcome: hypertension (n = 56), OR = 2.2 (0.9-5.4); diabetes (n = 18), OR = 0.9 (0.3-2.9); age >65 years (n = 63), OR = 1.8 (0.7-4.6); high-dose melphalan with autologous stem cell transplant

Much has been written in recent years about how historical scholarship can be used to shape practice in the classroom. As an historian of the medieval period now working as an history teacher, Dhwani Patel offers a fresh perspective on these debates. During her PGCE year, Patel found herself reflecting on how the lenses and methodologies that shaped her own practice as an historian could help her tackle the weaknesses she identified in her Year 7 pupils' understanding of how power functioned in the medieval period. In this article she shows how she drew on her research to plan an enquiry exploring the importance of rituals in establishing political authority, and evaluates the potential of using cultural history to build more secure, nuanced understandings of political history.

Cancer cachexia is mainly characterized by wasting of skeletal muscles and fat and body weight loss, along with severe complications of major organs like liver, heart, brain and bone. There can be diminishing performance of these major organs as cancer cachexia progresses, one such drastic effect on the cardiac system. In the present study, differential effect of histone deacetylase inhibitors (HDACi) on cardiac complications associated with cancer cachexia is studied. Two models were used to induce cancer cachexia: B16F1 induced metastatic cancer cachexia and Lewis lung carcinoma cell induced cancer cachexia. Potential of Class I HDACi entinostat, Class II HDACi MC1568, and nonspecific HDACi sodium butyrate on cardiac complications were evaluated using the cardiac hypertrophy markers, hemodynamic markers, and cardiac markers along with histopathological evaluation of heart sections by Periodic acid-Schiff staining, Masson's trichrome staining, Picro-sirius red staining, and haematoxylin and eosin staining. Immunohistochemistry evaluation by vimentin and caspase 3 protein expression was evaluated. Entinostat showed promising results by attenuating the cardiac complications, and MC1568 treatment further exacerbated the cardiac complications, while non-conclusive effect were recorded after treatment with sodium butyrate. This study will be helpful in evaluating other HDACi for potential in cardiac complications associated with cancer cachexia. Key words: cardiac atrophy, histone deacetylase, histone deacetylase inhibitors, entinostat, MC1568, sodium butyrate. La cachexie liee au cancer est caracterisee avant tout par la perte de muscle squelettique et de tissu adipeux, avec une perte de poids et de graves complications dans les principaux organes comme le foie, le coeur, le cerveau et les os. On peut observer une diminution des performances de ces organes majeurs au fil de l'evolution de la cachexie liee au cancer, dont un effet dramatique sur le systeme cardiaque. La presente etude portait sur les effets differentiels d'inhibiteurs de l'histone desacetylase (iHDAC) sur les complications cardiaques associees a la cachexie liee au cancer. Nous avons provoque une cachexie liee au cancer a l'aide de deux modeles : la cachexie liee au cancer metastatique produite par le B16F1 et la cachexie liee au cancer engendree par la LLC. Nous avons evalue le potentiel de l'entinostat, un iHDAC de classe I, du MC1568, un iHDAC de classe II, et du butyrate de sodium, un inhibiteur non specifique de l'HDAC, sur les complications cardiaques a l'aide de marqueurs de l'hypertrophie cardiaque, de marqueurs hemodynamiques et de marqueurs cardiaques, de meme qu'avec une evaluation histopathologique de coupes de tissu cardiaque a l'aide des colorations par l'acide periodique Schiff, le trichrome de Masson, le rouge Picro-sirius et l'hematoxyline-eosine. Nous avons procede a une evaluation immunohistochimique a l'aide de vimentine ainsi que de l'expression en proteines de la caspase 3. Les resultats avec l'entinostat etaient prometteurs avec une attenuation des complications cardiaques, l'administration de MC1568 entrainait une augmentation de l'exacerbation des complications cardiaques tandis que nous avons obtenu des resultats non concluants apres l'administration de butyrate de sodium. En outre, cette etude sera utile en vue d'evaluer le potentiel d'autres iHDAC quant aux eventuelles complications cardiaques associees a la cachexie liee au cancer. [Traduit par la Redaction] Mots-cles: atrophie cardiaque, histone desacetylase, inhibiteurs de l'histone desacetylase, entinostat, MC1568, butyrate de sodium., Introduction Cancer cachexia is a major factor for cancer associated deaths worldwide. Worldwide cancer cachexia is the cause of 20%-30% of deaths due to cancer (Fearon et al. 2011). About [...]

This letter to the editor published in the Annals of Laboratory Medicine discusses the detection of a high-dose hook effect and the evaluation of dilutions of urine myoglobin specimens using a serum myoglobin assay. The authors explain that commercially available kits for measuring myoglobin levels are designed for serum or plasma, but severe muscle injuries can lead to myoglobin being released into the urine. The authors conducted experiments to determine the appropriate dilution factor for urine specimens to avoid the hook effect while still obtaining accurate results. They found that a 1:400 dilution was necessary for some specimens to obtain accurate results. The article recommends using a predilution step when analyzing urine specimens using the Roche Myoglobin assay. [Extracted from the article]

Introduction: Staphylococcus aureus is responsible for causing a variety of human infections, which may range from minor skin diseases to life-threatening infections. It colonizes healthy individuals and causes severe infection in hospitalized patients. Staphylococcus aureus infections used to respond to ß-lactam and related group of antibiotics but the emergence of Methicillin-resistant S. aureus (MRSA) has posed a serious therapeutic challenge. The present study aimed to determine prevalence of Methicillin-resistant Staphylococcus aureus in Dhiraj General Hospital, Gujarat and to determine antibiotic sensitivity pattern of Methicillin resistant Staphylococcus aureus in various samples and to determine inducible clindamycin resistance strains out of Methicillin resistant Staphylococcus aureus at Dhiraj General Hospital. Materials and methods: The present study was conducted in Microbiology Department of SBKS MI and RC during January 2022 to December 2022. The study comprised of 114 coagulase-positive staphylococci (COPS), isolated from a total of 1470 clinical specimens (like pus, blood, urine, high vaginal swab, sputum, etc.) of patients admitted in Dhiraj General hospital attached to SBKS MI and RC, Hospital, Waghodia, Gujarat. All the isolates were identified by standard procedures. Antimicrobial susceptibility test was carried out on each bacterial isolate using the disc diffusion method on Muller Hinton agar (MHA). Data were entered and analyzed statistically. Results: During one year of study period, a total of 1470 positive culture samples were there. Out of that, 114 positive samples of Staphylococcus aureus were isolated. Out of total Staphylococcus aureus positive samples, 24 strains of Methicillin resistant Staphylococcus aureus (MRSA) were detected. Out of total MRSA, 10 inducible clindamycin resistant Staphylococcus aureus were detected. Conclusion: To conclude, we can say that Vancomycin and Teicoplanin is the drug of choice in MRSA patients. As MRSA is an alarming issue for the health system, one should always think about drug sensitivity test before starting treatment. [ABSTRACT FROM AUTHOR]

Introduction: Burkholderia cepacia complex (BCC) is ubiquitous in nature, present in water, soil, and plants. BCC is comprised of Gram-negative non-lactose-fermenting bacteria. Gram negative, non lactose fermenting Burkholderia cepacia complex has emerged as an opportunistic nosocomial pathogen causing significant morbidity and mortality in hospitalized patients owing to its high antibiotic resistance. This study was aimed to determine prevalence of Burkholderia cepacia complex and to evaluate sensitivity pattern of Burkholderia cepacia complex in blood stream infections in Dhiraj Hospital, Gujarat which is a tertiary care hospital and teaching institute. Materials and Methods: The present study was conducted in the Department of Microbiology for a period from January 2022 to December 2022 of Dhiraj General Hospital, SBKS MI & RC, Waghodia, Gujarat. All samples were received in central laboratory and blood cultures were processed in BD BACTEC FX40. The positive culture bottles were sub cultured on Mac Conkey agar, Blood agar and Nutrient agar and were incubated for 24 hours at 37°C. The data was collected and analyzed statistically. Results: During the study period 31 positive samples for BCC were isolated from a total of 612 culture samples, thus the prevalence rate was 5.06% in our setup. BCC was found majorly in ICUs (65%) and in wards (35%). The isolates showed maximum sensitivity to Co-Trimoxazole (83.87%), followed by Ceftazidime (58.06%), Meropenem (54.83%) and Minocycline (51.61%). Conclusion: From various studies and our study we could conclude that there were variations in the results of drug sensitivity. So, there is need to properly isolate and do antibiotic sensitivity testing for better patient management. Prompt diagnosis is essential step to reduce mortality and establish infection control practices. [ABSTRACT FROM AUTHOR]

Introduction: Acinetobacter species are aerobic gram-negative bacteria that are ubiquitous in nature. Being a multidrug-resistant and an invasive pathogen, Acinetobacter baumannii is one of the major causes of nosocomial infections in the current healthcare system. It has been recognized as an agent of pneumonia, septicemia, meningitis, urinary tract and wound infections, and is associated with high mortality. We aimed this study to evaluate resistance pattern of a threatening pathogen i.e., Acinetobacter baumannii. Materials and method: The present study was conducted in Microbiology Department of SBKSMIRC, Dhiraj Hospital, Waghodia, Gujarat during May 2022 to December 2022. This study included all Acinetobacter baumannii isolated from all ages and microbiological specimens which were referred to Central Microbiology Laboratory of Dhiraj Hospital. The Non-Lactose fermenting, oxidase negative organisms are kept in VITEK 2 automated system for identification and sensitivity. All isolates identified as Acinetobacter baumannii were included in the study. Results: This study included a total of 52 isolates of A.baumannii. Out of which 33% were respiratory samples (sputum, Endo-tracheal secretions), 33% were pus samples, 11% were urine samples and 23% were included in other (blood, CSF, Body fluids). The most resistant drug was ceftriaxone (88.46%). Tigecycline was found to be 100% sensitive. Conclusion: This study concludes that Tigecycline is the only drug which is most sensitive for A. baumannii and other higher drugs such as Polymixin B, Colistin etc. shows less resistance. Acinetobacter infection would remain a therapeutic challenge in our hospital and health care settings due to the increasing rate of Acinetobacter species with traits of MDR and resistance to high potent antimicrobial agents. [ABSTRACT FROM AUTHOR]

Introduction: Renal impairment is characterized by a progressive decline in glomerular filtration rate, a significant public health issue worldwide associated with high morbidity and mortality. In most cases, renal impairment is associated with comorbidities such as hypertension and diabetes, which require multiple drug therapy during a course of treatment, leading to polypharmacy. Objective: The objective of this study was to assess the prescribing pattern of drugs in renal-impaired patients at Dhiraj General Hospital. Materials and Methods: A total of 150 patients with renal impairment were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study conducted over 6 months in a tertiary care teaching hospital, directorate general of hydrocarbons. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Of the total 150 patients, 94 (63%) were male and 56 (37%) female. The highest numbers of patients were in the age group >60 years (59 patients, 39.3%). Anemia was the most common comorbidity (143 patients, 95%) observed, followed by hypertension (129 patients, 86%) and diabetes mellitus (64 patients, 43%). A total of 1693 drugs were prescribed to 150 renal-impaired patients. Each patient received an average of 11.19 ± 3.51 (8%) drugs. Polypharmacy was seen in all patients. Drugs acting on the cardiovascular system constituted the bulk of the prescriptions (25.87%), followed by gastrointestinal (GI) drugs (18.72%), vitamins and minerals (14.94%), and antibiotics (8.33%). Conclusion: There is polypharmacy in patients with renal impairment due to associated comorbidities. The prevalence of polypharmacy was high in patients with chronic kidney disease (CKD). Antihypertensive drugs, drugs used for the GI system, antibiotics, and antidiabetic drugs were frequently used in CKD patients. [ABSTRACT FROM AUTHOR]