Wastewater-based epidemiology (WBE) is a popular tool for the early indication of community spread of infectious diseases. WBE emerged as an effective tool during the COVID-19 pandemic and has provided meaningful information to minimize the spread of infection. Here, we present a combination of analyses using the correlation of viral gene copies with clinical cases, sequencing of wastewater-derived RNA for the viral mutants, and correlative analyses of the viral gene copies with the bacterial biomarkers. Our study provides a unique platform for potentially using the WBE-derived results to predict the spread of COVID-19 and the emergence of new variants of concern. Further, we observed a strong correlation between the presence of SARS-CoV-2 and changes in the microbial community of wastewater, particularly the significant changes in bacterial genera belonging to the families of Lachnospiraceae and Actinomycetaceae. Our study shows that microbial biomarkers could be utilized as prediction tools for future infectious disease surveillance and outbreak responses. Overall, our comprehensive analyses of viral spread, variants, and novel bacterial biomarkers will add significantly to the growing body of literature on WBE and COVID-19.
Evasion of innate immunity represents a frequently employed method by which tumor cells survive and thrive. Previously, the development of immunotherapeutic agents capable of overcoming this evasion has realized pronounced clinical utility across a variety of cancer types. More recently, immunological strategies have been investigated as potentially viable therapeutic and diagnostic modalities in the management of carcinoid tumors. Classic treatment options for carcinoid tumors rely upon surgical resection or non-immune pharmacology. Though surgical intervention can be curative, tumor characteristics, such as size, location, and spread, heavily limit success. Non-immune pharmacologic treatments can be similarly limited, and many demonstrate problematic side effects. Immunotherapy may be able to overcome these limitations and further improve clinical outcomes. Similarly, emerging immunologic carcinoid biomarkers may improve diagnostic capabilities. Recent developments in immunotherapeutic and diagnostic modalities of carcinoid management are summarized here.
Introduction: Rhabdomyolysis is a potential life-threatening condition caused by extensive skeletal muscle breakdown with leakage of toxic muscle contents into the circulation. The most dreaded complication is acute renal failure caused by toxic effects of myoglobin in the kidneys. The causes of rhabdomyolysis are classified into traumatic, non-traumatic exertional, and non-traumatic rhabdomyolysis. The pathophysiologic hallmark of rhabdomyolysis regardless of etiology is increased free ionized calcium due to cellular energy depletion (ATP) or direct plasma membrane rupture and consequent intensified muscle contractility, mitochondrial dysfunction, and production of oxygen radicals. Case Report: We report a case of a middle-aged black woman with rhabdomyolysis that was caused by intense shivering chills, and rigor from pneumonitis. She had no personal or family history of muscle disorder and was admitted to the hospital after a weeklong history of upper and lower respiratory symptoms that led to the worse shivering and shaking chills she ever had. She was noted to have elevated creatine phosphokinase (CPK) of 200,000 uL (26–192 uL) and creatinine level of 5.52 (0.81–1.2 mg/dL). She was started on intravenous fluid with half-isotonic saline (0.45%) or 77 mmol/L sodium, 75 mmol/L sodium bicarbonate, and hemodialysis with progressive improvement in kidney function that took up to seven weeks to full recovery. Conclusion: Shivering and shaking chills from respiratory infection can cause rhabdomyolysis with severe muscle damage and renal failure in a patient with no known underlying muscular-skeletal disorder condition but has good recovery with fluid management and hemodialysis. Renal function has returned back to normal.
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