Influence of microbiome in intraprostatic inflammation and prostate cancer.

BACKGROUND: Chronic infection and inflammation have been linked to the development of prostate cancer. Dysbiosis of the oral and gut microbiomes and subsequent microbial translocation can lead to pathogenic prostate infections. Microbial-produced metabolites have also been associated with signaling pathways that promote prostate cancer development. A comprehensive discussion on the mechanisms of microbiome infection and the prostate microenvironment is essential to understand prostate carcinogenesis. METHODS: Published studies were used from the National Center for Biotechnology Information (NCBI) database to conduct a narrative review. No restrictions were applied in the selection of articles. RESULTS: Microbiome-derived short-chain fatty acids (SCFAs) have been found to upregulate multiple signaling pathways, including MAPK and PI3K, through IGF-1 signaling and M2 macrophage polarization. SCFAs can also upregulate Toll-like receptors, leading to chronic inflammation and the creation of a pro-prostate cancer environment. Dysbiosis of oral microbiota has been correlated with prostate infection and inflammation. Additionally, pathogenic microbiomes associated with urinary tract infections have shown a link to prostate cancer, with vesicoureteral reflux potentially contributing to prostate infection. CONCLUSIONS: This review offers a comprehensive understanding of the impact of microbial infections linked to intraprostatic inflammation as a causative factor for prostate cancer. Further studies involving the manipulation of the microbiome and its produced metabolites may provide a more complete understanding of the microenvironmental mechanisms that promote prostate carcinogenesis.

An integrated groundwater resource management approach for sustainable development in a tropical river basin, southern India.

Evaluation of aquifer potential is essential, as the potable water demand has increased globally over the last few decades. The present study delineated different zones of groundwater potential and groundwater quality of the Kallada River basin (KRB) in southern India, using geo-environmental and hydrogeochemical parameters, respectively. Geo-environmental variables considered include relative relief, land use/land cover, drainage density, slope angle, geomorphology, and geology, while hydrogeochemical parameters include pH, electrical conductivity (EC), Cl-, Fe3+, and Al3+ concentrations. Analytical hierarchy process (AHP) was used for categorizing groundwater potential and quality zones. Nearly 50% of KRB is categorized as very high and high groundwater potential zones, occupying the western and midland regions. The central and west-central parts of KRB are characterized by excellent groundwater quality zones, while the eastern and western parts are characterized by good and poor groundwater quality zones, respectively. By integrating the groundwater potential and groundwater quality, sustainable groundwater management is observed to be necessary at about 54% of the basin, where site-specific groundwater management structures such as percolation ponds, injection wells, and roof water harvesting have been proposed using a rule-based approach. This integrated groundwater potential-groundwater quality approach helps policymakers to implement the most suitable management strategies with maximum performance.

Gut Microbiome and Risk of Lethal Prostate Cancer: Beyond the Boundaries.

The gut microbiome is critical in balancing human health and in influencing the risk of several chronic diseases, including cancer [...].

Negative Serum Ascites Albumin Gradient (SAAG) in the Setting of Cholangiocarcinoma: A Case Report.

Ascites is the accumulation of fluid in the peritoneal cavity which leads to abdominal distention. Malignant ascites may occur in several tumor types including liver, pancreas, colon, breast, and ovary. Serum ascites albumin gradient (SAAG) is the difference between albumin in the serum and ascitic fluid. A SAAG greater or equal to 1.1 g/dL is characteristic of portal hypertension. A SAAG less than 1.1 g/dL can be seen in hypoalbuminemia, malignancy, or an infectious process. We report a rare case of malignant ascites in a 61-year-old female patient who presented with a chief complaint of abdominal pain with distention that was preceded by a 25-pound weight loss over the last three months. The patient underwent a paracentesis after a computed tomography (CT scan) revealed a heterogenous liver mass with associated ascites. Ascitic fluid analysis revealed a SAAG of -0.4 g/dL. CT-guided core needle biopsy of the hepatic mass revealed a poorly differentiated carcinoma with immunostaining suggestive of an underlying cholangiocarcinoma. Cholangiocarcinoma is an extremely uncommon etiology of acute new-onset ascites and has not been shown to produce high protein ascites with a negative SAAG. It is therefore important for clinicians to get ascitic fluid analysis in order to calculate a SAAG to help develop differential diagnosis for the cause of ascitic fluid buildup.

A Review on Clostridioides Difficile Testing and How to Approach Patients With Multiple Negative Tests: A Case Report.

Clostridioides difficile (C. difficile) is an important nosocomial infection that is commonly associated with antibiotic use with pseudomembranous colitis being present in only 13% of cases. Disease severity ranges from asymptomatic carriers to severe complicated disease, based on clinical and laboratory findings. There is no single rapid FDA-approved test to diagnose C. difficile infections (CDI) and diagnosis usually requires a multi-step diagnostic approach. C. difficile testing usually begins with the C. difficile toxin and glutamate dehydrogenase antigen screen (GDH). If testing is negative for either, then nucleic acid amplification testing (NAAT) is done to confirm the diagnosis. Endoscopic evaluation may be required in rare instances when there is a high clinical suspicion of disease with negative testing. Here, we present an interesting case of a patient with multiple negative C. difficile toxin and GDH tests. Given the high index of clinical suspicion of CDI, the patient underwent a colonoscopy which revealed diffuse pseudomembranous colitis. The patient was then appropriately treated with oral vancomycin. We aim to shed light on the different testing modalities available to clinicians and the indications for doing a colonoscopy to delineate between false positive testing and active CDI.

A Rare Case of Splenic Artery Thrombosis Provoked By Medroxyprogesterone Acetate Requiring Splenectomy.

Splenic artery thrombosis is estimated to occur in only 0.016% of hospital admissions. Hormonal contraception is known to have hypercoagulable side effects, but splenic artery thrombosis (SAT) followed by functional autosplenectomy is a very rare side effect. We report a case of a 48-year-old female with persistent SAT provoked by depot medroxyprogesterone acetate (DMPA). She initially presented with severe left lower quadrant abdominal pain, and imaging revealed an extensive thrombus in the splenic artery. She was immediately started on intravenous heparin, and her symptoms improved after a few days, at which point she was discharged on oral apixaban. Three months after discharge, the patient presented with symptoms similar to the initial presentation. Further history revealed that she received an injectable DMPA shot prior to her initial admission. Other possible causes of SAT were ruled out. On imaging, her previous thrombus had increased in size and now filled the entire splenic artery. Therefore, the patient underwent robotic splenectomy with remarkable improvement in her symptoms. This case represents a rare clinical manifestation of a hypercoagulable state induced by DMPA. We review the existing literature to explain the epidemiology, presentation, diagnosis, and treatment of SAT, and incorporate our patient's presentation into the existing literature regarding the effect of contraception in inducing thrombotic events.

Blame it on the Drug: A Rare Case of Recurrent Doxycycline-Induced Pancreatitis.

Doxycycline is a broad-spectrum bacteriostatic antibiotic that belongs to the tetracycline class. It is a relatively safe medication with reported side effects being gastrointestinal symptoms, bone and teeth discoloration, photosensitivity, and renal toxicity. Acute pancreatitis (AP) is an uncommon adverse effect with only a few reported cases in the literature. Despite tetracyclines being labeled as a probable causative agent of drug-induced pancreatitis (DIP), doxycycline has been rarely implicated. Herein we present the case of a 65-year-old patient who developed recurrent doxycycline-induced pancreatitis after she was inadvertently started on the medication for community-acquired pneumonia. The most common causes of pancreatitis were ruled out during her hospital admission and she was subsequently diagnosed with DIP. She was successfully treated with the cessation of the offending agent and with supportive therapy. It is critical that clinicians are aware of the possible association between doxycycline and pancreatitis to further aid in the prompt diagnosis and treatment of this condition.