Investigating the synergistic effects of biochar, trans-zeatin riboside, and Azospirillum brasilense on soil improvement and enzymatic activity in water-stressed wheat.

BACKGROUND: Water stress is a major danger to crop yield, hence new approaches to strengthen plant resilience must be developed. To lessen the negative effects of water stress on wheat plants, present study was arranged to investigate the role of synergistic effects of biochar, trans-zeatin riboside (t-ZR), and Azospirillum brasilense on soil improvement and enzymatic activity in water-stressed wheat. RESULTS: In a three-replication experiment comprising of four treatments (T0: Control, T1: Drought stress (DS), T2: DS + t-ZR with biochar, T3: DS + A. brasilense with biochar), we observed notable improvements in soil quality and enzymatic activities in water-stressed wheat plants with the application of t-ZR and A. brasilense with biochar. In drought stress, Treatment having the application of A. brasilense with biochar performs best as compared to the other and significant increased the enzymatic activities such as peroxidase (7.36%), catalase (8.53%), superoxide dismutase (6.01%), polyphenol oxidase (14.14%), and amylase (16.36%) in wheat plants. Different enzymatic activities showed different trends of results. Soil organic C, dissolved organic C, dissolved organic N also enhanced 29.46%, 8.59%, 22.70% respectively with the application of A. brasilense with biochar under drought stress condition. CONCLUSIONS: The synergistic action of A. brasilense and biochar creates an effective microbiological environment that supports essential plant physiological processes during drought stress. This enhancement is attributed to improved soil fertility and increased organic matter content, highlighting the potential of these novel strategies in mitigating water stress effects and enhancing crop resilience.

Genetic and Chemical Controls of Sperm Fate and Spermatocyte Dedifferentiation via PUF-8 and MPK-1 in Caenorhabditis elegans.

Using the nematode C. elegans germline as a model system, we previously reported that PUF-8 (a PUF RNA-binding protein) and LIP-1 (a dual-specificity phosphatase) repress sperm fate at 20 °C and the dedifferentiation of spermatocytes into mitotic cells (termed "spermatocyte dedifferentiation") at 25 °C. Thus, double mutants lacking both PUF-8 and LIP-1 produce excess sperm at 20 °C, and their spermatocytes return to mitotically dividing cells via dedifferentiation at 25 °C, resulting in germline tumors. To gain insight into the molecular competence for spermatocyte dedifferentiation, we compared the germline phenotypes of three mutant strains that produce excess sperm-fem-3(q20gf), puf-8(q725); fem-3(q20gf), and puf-8(q725); lip-1(zh15). Spermatocyte dedifferentiation was not observed in fem-3(q20gf) mutants, but it was more severe in puf-8(q725); lip-1(zh15) than in puf-8(q725); fem-3(q20gf) mutants. These results suggest that MPK-1 (the C. elegans ERK1/2 MAPK ortholog) activation in the absence of PUF-8 is required to promote spermatocyte dedifferentiation. This idea was confirmed using Resveratrol (RSV), a potential activator of MPK-1 and ERK1/2 in C. elegans and human cells, respectively. Notably, spermatocyte dedifferentiation was significantly enhanced by RSV treatment in the absence of PUF-8, and its effect was blocked by mpk-1 RNAi. We, therefore, conclude that PUF-8 and MPK-1 are essential regulators for spermatocyte dedifferentiation and tumorigenesis. Since these regulators are broadly conserved, we suggest that similar regulatory circuitry may control cellular dedifferentiation and tumorigenesis in other organisms, including humans.

Restoration of the Original Inhabitants: A Systematic Review on Fecal Microbiota Transplantation for Graft-Versus-Host Disease.

A compelling intervention to maintain healthy gut microbiota in graft-versus-host-disease (GVHD) is fecal microbial transplantation (FMT). To examine its role in GVHD, we conducted a systemic literature search using multiple electronic databases. Upon pooling of data, 79 patients from six studies and five case reports were included. Complete remission (CR) occurred in 55.9% of patients, and partial remission (PR) occurred in 26.5% of patients (82.4% overall response rate). A limited number of patients had treatment-related mortality (TRM), while few showed mild gastrointestinal (GI)-related and non-GI adverse effects. None of the studies directly examined the role of FMT in the prevention of GVHD. In conclusion, FMT seems to be a safe and effective strategy for the management of GVHD based on the current evidence. Due to the small number of patients evaluated and the absence of randomized data, one cannot portray FMT as a standard of care yet; however, the low toxicity along with the clinical improvement justifies this modality to be tested in a randomized fashion.

Isolated Myeloid Sarcoma: A Diagnostic Dilemma.

Myeloid sarcoma (MS)/granulocytic sarcoma/myeloblastoma/chloroma is a rare extramedullary proliferation of blast cells of one or more myeloid lineages along with the destruction of the normal architecture of adjacent tissue. Isolated MS is a rare entity with an incidence of 0.7 out of 1 million children and 2 out of 1 million adults. Varied clinical presentation, the rarity of the diagnosis, inadequate immunophenotyping, and lack of available literature makes the disease difficult to manage. Here, we report a case of MS in a 44-year-old male with an initial presentation of testicular mass without bone marrow involvement, causing diagnostic challenges. In this case report, we discuss the pathogenesis, diagnostic challenges, and therapeutic options of MS.

A Case of Idiopathic Portal Vein Thrombosis in an Immunocompetent Female.

Portal vein thrombosis (PVT) is characterized by a complete or partial occlusion of the portal vein by a thrombus. The formation of the thrombus is usually attributed to an underlying condition that is causing a hypercoagulable state, such as malignancy or cirrhosis. When these causes are ruled out, a hypercoagulable workup can reveal other underlying prothrombotic etiologies. Still, some cases of PVT occur without any definitive underlying condition, leading to the diagnosis of idiopathic PVT. This occurred in our patient, a 53-year-old female who presented with PVT but had no clear underlying condition that led to her pathology after an extensive medical investigation.

All-Cause Mortality Outcomes of Usage of Cardiac Contractility Modulation in Patients With Dilated Cardiomyopathy Ineligible for Cardiac Re-Synchronization Therapy: An Updated Meta-Analysis of Randomized Controlled Trials.

Introduction Dilated cardiomyopathy has been associated with remarkably high mortality despite guideline-directed therapy. This study compares the all-cause mortality rate between a cardiac contractility modulation group and a standard therapy group in patients with dilated cardiomyopathy who were monitored via follow-up for 12 weeks or more. Materials and methods We conducted a systematic search of Medline (PubMed) and Cochrane Central Register of Controlled Trials for abstracts and fully published studies (from inception to October 2018). We searched for articles comparing cardiac contractility modulation device therapy with standard therapy for patients with dilated cardiomyopathy between September 1, 2018, and October 30, 2018. Only fully published randomized clinical trials comparing all-cause mortality outcomes of device therapy and standard therapy for patients with dilated cardiomyopathy were included in our meta-analysis. A total of 673 studies were identified. Studies that were systematic reviews or meta-analyses, study designs or protocols, trials on other regimens, wherein medical therapy was not compared, or wherein the primary outcome of mortality was not assessed, were excluded. Data were abstracted by two independent reviewers. A random-effect model using the Mantel-Haenszel method calculated the weighted risk ratio (RR). Statistical analyses were performed using Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen). The primary outcome of interest was a comparison of all-cause mortality between the two groups when patients were monitored via follow-up for 12 weeks or more. Results Four fully published randomized clinical trials met the inclusion criteria of our analysis. A random-effect model using the Mantel-Haenszel method calculated the weighted RR. Our analysis included a total of 930 patients. The cardiac contractility modulation therapy group showed no significant reduction in all-cause mortality compared to the standard therapy group (RR, 0.63; 95% CI, 0.29-1.35; P = .23). However, the trend was toward device therapy. Tests for statistical heterogeneity did not show any significant heterogeneity (P = .82, I2 = 0%). Conclusions Cardiac contractility modulation device therapy is not associated with significant all-cause mortality reduction in patients with dilated cardiomyopathy. Our meta-analysis underscores the need for a large randomized controlled trial on the efficacy of cardiac contractility modulation in a population with dilated cardiomyopathy who are ineligible for cardiac resynchronization therapy.

Pulmonary Embolism in Acquired Hemophilia A: A Rare Complication With Factor VIII Inhibitor Bypassing Activity Therapy.

Acquired hemophilia A (AHA) is an uncommon complication caused by autoantibodies against Factor VIII. The main concern with these patients is hemorrhage, which is often treated with Factor VIII inhibitor bypassing activity (FEIBA). On rare occasions, treatment with FEIBA can result in thromboembolism, a potentially fatal complication. This unfortunate situation occurred in our patient, a 64-year-old female who was treated with FEIBA after being diagnosed with AHA. After initiating FEIBA, she developed clinical signs and symptoms of pulmonary embolism, which was ultimately responsible for her acute death. While pulmonary embolism may be a rare complication of FEIBA treatment, clinicians should be aware of its possibility, especially as the complete safety profile for this treatment is not well known.

Valacyclovir-Induced Thrombotic Thrombocytopenic Purpura.

Valacyclovir is a well-tolerated antiviral drug. Thrombotic thrombocytopenic purpura is a rare adverse effect of valacyclovir therapy. Mostly, it has been reported in clinical trials and case reports in patients with high dose or low dose therapy in immunocompromised patients. Herein we write a case report of the immunocompetent patient, who was taking very low dose valacyclovir therapy for his recurrent genital herpes. This case emphasizes the role of low dose (1000 mg/day) valacyclovir therapy causing thrombotic thrombocytopenic purpura in an immunocompetent patient with no other explainable trigger.

Role of Ivabradine in Patients with Heart Failure with Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of patients with heart failure. HFpEF carries almost similar morbidity and mortality outcomes to heart failure with reduced ejection fraction (HFrEF). Despite many trials, no management has been shown to improve mortality outcomes in HFpEF. An elevated heart rate in patients with HFpEF has been associated with worse outcomes. Previous trials on the use of beta-blockers in reducing the heart rate in patients with HFpEF have shown worse outcomes, possibly due to the negative inotropic effects. The funny current inhibitor, ivabradine, results in a reduced heart rate without affecting inotropy. Two randomized controlled trials and one cross-over study have evaluated the use of ivabradine in HFpEF patients. The outcomes of the trials have been heterogeneous; ivabradine showed improved exercise tolerance, no change in primary endpoints was seen l, and there was a worsening in the outcomes. Our review underscores the requirement of a large randomized clinical trial in the appropriate patient population.

Pulmonary Tumor Embolism: A Rare Cause of Acute Pulmonary Hypertension.

A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.

A Case of Rapidly Deteriorating Lymphangitic Carcinomatosis in a Patient with Stage IV Pancreatic Cancer.

Pulmonary lymphangitic carcinomatosis (PLC) is defined as a tumor in the lung lymphatic vessels. It is rarely seen as a result of malignancy and generally carries a poor prognosis. Proper knowledge of the clinical presentation is important for physicians to be aware of in order to consider a diagnosis of PLC. We present the case of a 52-year-old Caucasian gentleman who initially came to the hospital with a three-week history of dyspnea. In the hospital, a diagnosis of Stage 4 pancreatic cancer with a lymphangitic spread of the tumor to the lungs was made. Despite optimal treatment, the patient required mechanical ventilation for acute hypoxic respiratory failure. PLC is a relatively rare manifestation of malignancy; yet, it generally carries a poor prognosis. It may occur during the course of malignancy or may represent as the first findings in malignancy. It is important for physicians to be aware of the clinical presentations of PLC in order to ensure timely treatment. Oftentimes, PLC can be diagnosed through clinical judgment alone without the need for radiological support and other invasive measures.

Gastropleural Fistula: A Rare Complication of a Common Procedure.

Weight loss surgeries are evident to be highly beneficial in patients with morbid obesity (body mass index (BMI) ≥40.0 kg/m2) and severe obesity (BMI between 35.0 and 39.9 kg/m2 with co-morbidities). While this results in significant mortality benefit, there is always the possible risk of postsurgical complications. Gastrobronchial and gastropleural fistulas are two rare, post-operative pulmonary complications associated with these surgeries. Our patient is a 54-year-old female who underwent a biliopancreatic diversion with a duodenal switch. A few weeks later, she started developing a cough, fever, and shortness of breath. Computed tomography (CT) chest showed the presence of a loculated right sided hydropneumothorax. A gastrointestinal fluoroscopic contrast study performed showed a large fistula originating from the distal end of the stomach and ending towards the right pleural cavity. The fistula was successfully closed with the endoscopic fulguration of fistulous opening with argon beam coagulation and orthoscopic clipping, resulting in complete obliteration of the fistula tract. The right-sided hydropneumothorax was initially treated conservatively with antibiotics and chest tube drains followed by video-assisted thoracoscopic decortication with chest tube placement. Gastropleural fistula formation is rare but is nonetheless a serious postoperative complication of bariatric procedures and mimics pneumonia clinically. It is, therefore, essential to obtain detailed imaging work-up to rule out fistula formation, which, in turn, can be timely treated without causing further devastating results to the patient.

Role of Bisphosphonate Therapy in Patients with Osteopenia: A Systemic Review.

By contrast to clinical trials exploring osteoporosis, clinical trials specifically designed for the osteopenic population are limited. Thus, less clinical data are available regarding treatment benefits and cost-effectiveness of treating a patient population with a bone mass density in the osteopenic range (T-score between -1 and -2.5). In this article, we aimed to highlight this high-risk population with a low bone mass density (BMD) susceptible to high fracture risk by reviewing different national and international guidelines for treating osteopenia. The cost-effectiveness of the therapy for the above-mentioned patient population is also discussed. By reviewing different clinical trials, we have specifically highlighted the role of bisphosphonate therapy for fracture risk reduction and increment in bone mineral density (BMD) in patients with osteopenia.

Tumor Lysis Syndrome: A Rare Complication of Chemotherapy for Metastatic Breast Cancer.

Tumor lysis syndrome (TLS) is a fatal complication of chemotherapy treatment. It is rarely seen in the treatment of solid tumors particularly in breast cancer. We presented the case of a chemo-naïve 58-year-old Caucasian woman who developed tumor lysis syndrome (TLS) after a single treatment dose of gemcitabine for metastatic breast cancer. Despite optimal management, the patient clinically deteriorates and is referred to inpatient hospice. Although targeted chemotherapy options have become increasingly effective, physicians should be aware of the rare, yet often fatal complications of TLS. Similarly, physicians should be able to quickly recognize the development of TLS to ensure swift and effective prophylaxis or treatment.

Updated Treatment for Calcium Pyrophosphate Deposition Disease: An Insight.

Calcium pyrophosphate disease (CPPD) is caused by the deposition of calcium pyrophosphate (CPP) crystals in the joint tissues, particularly fibrocartilage and hyaline cartilage. CPP crystals trigger inflammation, causing local articular tissue damage. Our review article below covers different aspects of CPPD. It discusses how CPPD can manifest as different kinds of arthritis, which may be symptomatic or asymptomatic. The metabolic and endocrine disease associations and routine investigations used in the diagnostic workup are briefly reviewed. Conventional and newer therapies for the treatment of CPPD are outlined. Overall, this extensive review would provide an updated insight to clinicians for evidence-based treatment of CPPD.

Effect of Beta-blockers on Tachycardia in Patients with Pulmonary Embolism.

Hypothesis Beta-blockers (BBs) lower the heart rate, which may mask the diagnosis of pulmonary embolism (PE) since one of the main clinical diagnoses of PE is tachycardia. The endpoint of our retrospective study is to determine if the pre-existing use of (BB) significantly affects the utility of these scoring criteria in diagnosing PE. Introduction Diagnosing PE is a challenge because of the non-specificity of its symptoms and signs. The initial step is to assess the patient's likelihood of having a PE. This involves using a scoring system to stratify patients into different levels of risk of having PE (for example, as 'low,' 'moderate,' or 'high' risk). Some of the commonly used criteria are Wells' Score, Geneva Score, and Pulmonary Embolism Rule-out Criteria (PERC) Rule (Charlotte Rule). Methodology This retrospective study was conducted at St. Francis Medical Center. Subjects were taken from a patient population with a new diagnosis of PE (between 2010 and 2017) on the basis of computed tomography angiography (CTA) of the chest. Patients with sepsis or septic shock, heart block, atrioventricular (AV) nodal ablation, pacemaker placement, or taking more than one AV nodal blocker were excluded from the study. Subjects were categorized on the basis of beta-blocker consumption. Result Out of a total of 170 cases, 71 patients were taking beta-blockers and 99 patients were not taking beta-blockers. Among the participants taking BBs, 30.4% had a heart rate <60 and 55.8% had a heart rate between 60 and 100. Conclusion BBs significantly obviate tachycardia in patients with PE. It falsely decreases the Wells' Score and the Geneva Score and results in the inappropriate fulfilling of PERC criteria.

Pseudogout: An Autoimmune Paraneoplastic Manifestation of Myelodysplastic Syndrome.

Myelodysplastic syndrome (MDS) is often associated with autoimmune paraneoplastic manifestations. Seronegative arthritis is among one of them. Very rarely, pseudogout demonstrated as paraneoplastic autoimmune manifestations of MDS has been adumbrated so far. Our case would be the another addition in the series. Our patient is an 83-year-old male lately diagnosed with MDS. After six months of initial diagnosis, he had a sudden onset episode of pain and swelling involving left wrist. Synovial fluid analysis from respective radiocarpal joint confirmed the presence of intracellular positively birefringent rhomboid shaped crystals of calcium pyrophosphate dihydrate (CPPD). This was followed by another two flares of pseudogout involving right knee and lumbar spine at separate time intervals. Each of the episodes mentioned above responded well to intravenous and oral steroids. After the third bout, he was started treatment with azacitidine which showed effective abatement of further episodes of pseudogout up until now.

An Unusual Case of Pulmonary Cryptococcus.

Cryptococcal infections are caused by encapsulated fungi Cryptococcus gattii and C. neoformans. Inhalation commonly causes innocuous colonization but may cause meningitis or disseminated disease via hematogenous spread. Cryptococcosis occurs most commonly in immunocompromised patients including those with acquired immunodeficiency syndrome, meningoencephalitis or disseminated disease. However, cryptococcosis can occur as asymptomatic isolated pulmonary nodules in immunocompetent patients. Here we present a unique retrospective case report of a 55-year-old immunocompetent man who presented with pleuritic chest pain, productive cough, dyspnea on exertion, chills, night sweats, and weight loss. A computed tomography scan of his chest revealed multiple ground-glass opacities throughout both lung fields. The results of his autoimmune evaluation and human immunodeficiency virus tests were negative. A biopsy obtained through video-assisted thoracoscopic surgery revealed mucicarmine staining capsules confirming Cryptococcus, requiring treatment with amphotericin, flucytosine, and fluconazole. This case highlights the rarely studied presentation of symptomatic diffuse pulmonary cryptococcal infection in an immunocompetent patient requiring treatment.

Gastrointestinal Neuroendocrine Tumor, Colon Adenocarcinoma, and Hyperparathyroidism: An Unorthodox Synchronism.

Synchrony of colorectal adenocarcinoma with neuroendocrine tumor (NET) and hyperparathyroidism with colon adenocarcinoma is a rare entity, reported in a handful of cases. We authors would like to report a rare case of coexistence of poorly differentiated colon adenocarcinoma, NET of appendix and hyperparathyroidism. A 43-year-old Caucasian female was diagnosed with metastatic colon adenocarcinoma involving the caecum and appendiceal orifice. The resected specimen also confirmed presence of concurrent well-differentiated NET in distal half of appendix. For this patient, serum chemistry was significant for severe hypercalcemia with elevated parathyroid hormone and fairly normal range parathyroid hormone-related peptide. Importantly, association among the aforementioned conditions remains elusive and warrants further research; nevertheless, surveillance procedures could be performed in patients, if a correlation exists at all.