376 research outputs found

    Multiple myeloma presenting with high-output heart failure and improving with anti-angiogenesis therapy: two case reports and a review of the literature

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    <p>Abstract</p> <p>Introduction</p> <p>Common manifestations of multiple myeloma include osteolytic lesions, cytopenias, hypercalcemia, and renal insufficiency. Patients may also exhibit heart failure which is often associated with either past therapy or cardiac amyloidosis. A less recognized mechanism is high-output heart failure. Diuretic therapy in this setting has little efficacy in treating the congested state. Furthermore, effective pharmacotherapy has not been established. We report two patients with multiple myeloma and high-output heart failure who failed diuretic therapy. The patients were given dexamethasone in conjunction with lenalidomide and thalidomide, respectively. Shortly thereafter, each patient demonstrated a significant improvement in symptoms. This is the first report of successful treatment of multiple myeloma-induced high-output failure via the utilization of these agents.</p> <p>Case presentation</p> <p>Two patients with multiple myeloma were evaluated for volume overload. The first was a 50-year-old man with refractory disease. Magnetic resonance imaging demonstrated diffuse marrow replacement throughout the pelvis. Cardiac catheterization conveyed elevated filling pressures and a cardiac output of 15 liters/minute. He quickly decompensated and required mechanical ventilation. The second patient was a 61-year-old man recently diagnosed with multiple myeloma and volume overload. Skeletal survey demonstrated numerous lytic lesions throughout the pelvis. His cardiac catheterization also conveyed elevated filling pressures and a cardiac output of 10 liters/minute. Neither patient responded to diuretic therapy and they were subsequently started on dexamethasone plus lenalidomide and thalidomide, respectively. The first patient's brisk diuresis allowed for extubation within 48 hours after the first dose. He had a net negative fluid balance of 15 liters over 10 days. The second patient also quickly diuresed and on repeat cardiac catheterization, his cardiac output had normalized to 4.7 liters/minute.</p> <p>Conclusion</p> <p>Multiple myeloma can cause high-output failure. The mechanism is likely extensive bony involvement causing innumerable intramedullary arteriovenous fistulas. Diuretic therapy is not effective in treating this condition. Lenalidomide and thalidomide, both of which inhibit angiogenesis, seem to be viable treatment options. Based on the rapid and effective results seen in these two patients, a potential novel mechanism of 'pharmacologic fistula ligation' with these agents may be the most effective way to treat this presentation.</p

    Phosphate solubilizers enhance NPK fertilizer use efficiency in rice and legume cultivation

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    It has been reported that phosphate solubilizing bacteria (PSB) are the most promising bacteria among the plant growth promoting rhizobacteria (PGPR); which may be used as biofertilizers for plant growth and nutrient use efficiency. Moreover, these soil micro-organisms play a significant role in regulating the dynamics of organic matter decomposition and the availability of plant nutrients such as nitrogen (N), phosphorus (P), potassium (K) and other nutrients. Through this study, the management of nutrient use efficiency by the application of PSB was targeted in order to make the applied nutrients more available to the plants in the rice (Oryza sativa) and yardlong bean (Vigna unguiculata) cultivation. Results have shown that the treatments with PSB alone or in the form of consortia of compatible strains with or without the external application of chemical NPK gave more germination index (G. I.) from 2.5 to 5 in rice and 2.7 to 4.8 in bean seeds. They also showed a higher growth in both shoot and root length and a higher biomass as compared to the control. This gives us an idea about the potentiality of these PSB strains and their application in rice and yardlong bean cultivation to get a better harvest index. Their use will also possibly reduce the nutrient runoff or leaching and increase in the use efficiency of the applied fertilizers. Thus, we can conclude that the NPK uptake and management can be improved by the use of PSB in rice and yardlong bean cultivation, and their application may be much more beneficial in the agricultural field

    A window into fungal endophytism in Salicornia europaea: deciphering fungal characteristics as plant growth promoting agents

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    Aim Plant-endophytic associations exist only when equilibrium is maintained between both partners. This study analyses the properties of endophytic fungi inhabiting a halophyte growing in high soil salinity and tests whether these fungi are beneficial or detrimental when non-host plants are inoculated. Method Fungi were isolated from Salicornia europaea collected from two sites differing in salinization history (anthropogenic and naturally saline) and analyzed for plant growth promoting abilities and non-host plant interactions. Results Most isolated fungi belonged to Ascomycota (96%) including dematiaceous fungi and commonly known plant pathogens and saprobes. The strains were metabolically active for siderophores, polyamines and indole-3-acetic acid (mainly Aureobasidium sp.) with very low activity for phosphatases. Many showed proteolytic, lipolytic, chitinolytic, cellulolytic and amylolytic activities but low pectolytic activity. Different activities between similar fungal species found in both sites were particularly seen for Epiccocum sp., Arthrinium sp. and Trichoderma sp. Inoculating the non-host Lolium perenne with selected fungi increased plant growth, mainly in the symbiont (Epichloë)-free variety. Arthrinium gamsii CR1-9 and Stereum gausapatum ISK3-11 were most effective for plant growth promotion. Conclusions This research suggests that host lifestyle and soil characteristics have a strong effect on endophytic fungi, and environmental stress could disturb the plant-fungi relations. In favourable conditions, these fungi may be effective in facilitating crop production in non-cultivable saline lands
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