Marginal Zone Lymphoma Manifesting as Macrophage Activation Syndrome: A Case Report.

Macrophage activation syndrome (MAS) is a form of secondary hemophagocytic lymphohistiocytosis (HLH) when it occurs in the context of rheumatologic disorders. HLH is a rare and potentially life-threatening syndrome characterized by excessive immune system activation. It is mainly seen in children and can be genetic based or related to infections, malignancies, rheumatologic disorders, or immunodeficiency syndromes. MAS can present with nonspecific symptoms, leading to a delay in diagnosis. This report describes a case of a 64-year-old female with marginal zone lymphoma and systemic lupus erythematosus who presented with a purpuric rash and acute kidney injury. She underwent a kidney biopsy and was diagnosed with MAS. This case highlights the importance of promptly recognizing MAS's symptoms and signs, allowing timely diagnosis and early therapeutic intervention. This potentially fatal condition tends to respond well to rapid treatment initiation with corticosteroids and to address the underlying condition.

AIDS-Associated BK Virus Nephropathy in Native Kidneys: A Case Report and Review of the Literature.

BK virus (BKV) is a small DNA virus, a member of the polyomavirus family, that causes an opportunistic infection in immunocompromised patients, especially kidney transplant patients. This virus establishes a lifelong infection in most of the population, and once it reactivates in an immunocompromised state, leads to BKV nephropathy. This review seeks to assess the correlation between severe immunosuppression, evident by low CD4 cell counts in HIV-positive patients, and the reactivation of BKV, causing nephropathy. A literature review was conducted, extracting, and analyzing case reports of HIV-positive patients showing correlations between their degree of immunosuppression, as evidenced by their CD4 counts, and the degree of BKV infectivity, confirmed by kidney biopsy. A total of 12 cases of BKV nephropathy in HIV-infected patients were reviewed. A common finding was the presence of profound immunosuppression, with most patients having CD4 counts ≤50 cells/ mm3. A substantial number also had comorbid malignancies, with some undergoing chemotherapy, potentially increasing the risk of BKV reactivation. In addition to the HIV status and malignancies, other risk factors for BKV reactivation included older age, male gender, diabetes mellitus, Caucasian race, and ureteral stent placement. BKV nephropathy in HIV patients with native kidneys is closely correlated with severe immunosuppression. Although therapeutic strategies exist for post-transplant patients, aside from the treatment of HIV with highly active anti-retroviral therapy (HAART), which potentially helps with clearing BKV by increasing CD4 count, there is no definitive treatment for a native kidney BKV nephropathy in patients with AIDS. The complexity of the cases and severity of comorbidities indicate the need for further research to develop therapeutic strategies tailored to this population.

Detoxification of aflatoxin M1 by probiotics Saccharomyces boulardii, Lactobacillus casei, and Lactobacillus acidophilus in reconstituted milk.

Aim: The current study aimed to remove aflatoxin from reconstituted milk by adding three probiotics, namely Saccharomyces boulardii, Lactobacillus casei, and Lactobacillus acidophilus. Background: Aflatoxins are poisonous substances produced by certain kinds of fungi that are found naturally all over the world. They can contaminate food crops and pose a serious health threat to humans and livestock. Microbial detoxification is one method of eliminating aflatoxins, including aflatoxin M1. Methods: For this purpose, about 109 and 107 cfu/ml of S. boulardii, L. casei, and L. acidophilus were inoculated into skim milk without aflatoxin M1. The samples were then spiked by aflatoxin M1 in concentrations of 0.5 and 0.75 ng/ml. The concentration of the aflatoxin residing in supernatant of milk samples after different storage times (30 and 90 minutes) and temperatures of 4 ℃ and 37 °C was measured by ELISA method, and the results were confirmed by HPLC. Results: The results showed that the highest amount of aflatoxin M1 removal was related to S. boulardii (96.88 ± 3.79c) with a microbial density concentration of 109 cfu/ml and toxin concentration of 0.75 ng/ml at 37 °C for 90 minutes and then to L. acidophilus (71.46 ± 3.79b) with a microbial density concentration of 107 cfu/ml and toxin concentration 0.75 ng/ml at 4 °C for 90 minutes. Furthermore, the maximum level of AFM1 binding to 107 cfu/ml of L. casei with average binding percentages of 64.31 ± 3/79c was 0.75 ng/ml at 37 °C for 90 minutes. Conclusion: The results revealed the possibility of using S. boulardii in combination with the selected probiotics of L. casei and L. acidophilus in the detoxification of AFM1-contaminated milk.

Native chicken-derived Lactobacillus spp. strains with high probiotic, cholesterol-assimilation and aflatoxin-degradation capabilities.

Background and Objectives: Probiotics are added into the food or feed systems and provide beneficial effects to the human or animal health. This study aimed to isolate the gastrointestinal native Lactobacillus strains with high probiotic, cholesterol-assimilation and aflatoxin-degradation capabilities from native chickens. Materials and Methods: About 70 Lactobacillus isolates were isolated from ileum of the Fars province native chickens and were investigated for their probiotic properties. Results: Of 70 Lactobacillus isolates, 10 showed high probiotic capabilities, including survival at acidic conditions (pH up to 2.5), tolerance of 0.5% bile and 6-10% NaCl salts, growth in a wide range of temperature from 15 to 45°C, antagonistic effects against different important bacterial pathogens (Pseudomonas aeruginosa, Escherichia coli, Streptococcus mutans, Clostridium defficile, Enterococcus hirae, Salmonella enterica and Staphylococcus aureus) and sensitivity to some important antibiotics. The selected strains had an aggregation time less than 120 min. The 16S-rDNA sequencing showed that the selected strains were highly related to Lactobacillus reuteri and L. casei. Finally, the selected strains in this study along with 10 other probiotic strains isolated and characterized in our pervious study were used to evaluate their cholesterol assimilation and aflatoxin B1 degradation capabilities. The potentials of cholesterol assimilation of the selected strains were significantly different (P<0.05) and ranged from 2.3% to 99%. The highest content of cholesterol assimilation was obtained in isolates M20 and M4 with more than 98% absorption. Moreover, four strains 43, OR7, M21 and OR9 were able to absorb AFB1 with 58.6%, 52.33%, 47% and 31.6% efficiency respectively. Conclusion: It could be concluded that the strains 43, M21 and OR7 showed high probiotic potentials for application in the poultry industry.

Evaluation of Liver Function Tests and Serum Bilirubin Levels After Laparoscopic Cholecystectomy.

INTRODUCTION: Laparoscopic cholecystectomy has been known as one of the most important prevalent and minimally invasive surgeries in medicine. AIM: The aim here was to investigate the changes in liver enzymes and bilirubin levels after laparoscopic cholecystectomy in patients diagnosed with chronic cholecystitis. METHODS: This cross-sectional study was conducted at Poursina Hospital (Rasht, Iran) and 128 patients who met both inclusion and exclusion criteria were enrolled for further investigations. After collecting the patients' bio-demographic information, levels of serum alkaline phosphatase, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and bilirubin were checked before laparoscopic cholecystectomy and 24 (post-op 1) and 48 (post-op 2) h after laparoscopic cholecystectomy. RESULTS: No significant difference was found in the serum levels of ALP in post-op 1 and 2 compared both to each other and to the baseline (P>0.05). Regarding AST and ALT, there was a significant increase in post-op 1 and 2 compared to their baseline values (P<0.05). However, the difference between post-op 1 and post-op 2 was not significant for these outcomes. Compared to baseline levels, LDH had a significant increase after post-op 2 (P=0.001); but not after post-op 1 (P >0.05). Moreover, total bilirubin levels showed significant increases at post-op 1 and post-op 2 from the baseline and also in comparison with each other (P < 0.05). CONCLUSION: Our results demonstrated a transient increase in liver function tests and bilirubin after laparoscopic cholecystectomy.