Dysbiosis is implicated by many studies in the pathogenesis of Parkinson’s disease (PD). Advances in sequencing technology and computing have resulted in confounding data regarding pathogenic bacterial profiles in conditions such as PD. Changes in the microbiome with reductions in short-chain fatty acid (SCFA)-producing bacteria and increases in endotoxin-producing bacteria likely contribute to the pathogenesis of PD. GPR109A, a G-protein coupled receptor found on the surface of the intestinal epithelium and immune cells, plays a key role in controlling intestinal permeability and the inflammatory cascade. The absence of GPR109A receptors is associated with decreased concentration of tight junction proteins, leading to increased intestinal permeability and susceptibility to inflammation. In inflammatory states, butyrate acts via GPR109A to increase concentrations of tight junction proteins and improve intestinal permeability. Niacin deficiency is exacerbated in PD by dopaminergic medications. Niacin supplementation has been shown to shift macrophage polarization from pro-inflammatory to an anti-inflammatory profile. Niacin and butyrate, promising nutrients and unique ligands for the G protein-coupled receptor GPR109A, are reviewed in this paper in detail.

The ongoing pandemic resulting from severe acute respiratory syndrome—caused by coronavirus 2 (SARS-CoV-2)—has posed a multitude of healthcare challenges of unprecedented proportions. Intestinal enterocytes have the highest expression of angiotensin-converting enzyme-2 (ACE2), which functions as the key receptor for SARS-CoV-2 entry into cells. As such, particular interest has been accorded to SARS-CoV-2 and how it manifests within the gastrointestinal system. The acute and chronic alimentary clinical implications of infection are yet to be fully elucidated, however, the gastrointestinal consequences from non-SARS-CoV-2 viral GI tract infections, coupled with the generalized nature of late sequelae following COVID-19 disease, would predict that motility disorders are likely to be seen in these patients. Determination of the chronic effects of COVID-19 disease, herein defined as GI disease which is persistent or recurrent more than 3 months following recovery from the acute respiratory illness, will require comprehensive investigations comprising combined endoscopic- and motility-based evaluation. It will be fascinating to ascertain whether the specific post-COVID-19 phenotype is hypotonic or hypertonic in nature and to identify the most vulnerable target portions of the gut. A specific biological hypothesis is that motility disorders may result from SARS-CoV-2-induced angiotensin-converting enzyme 2 (ACE2) depletion. Since SARS-CoV-2 is known to exhibit direct neuronal tropism, the potential also exists for the development of neurogenic motility disorders. This review aims to explore some of the potential pathophysiologic mechanisms underlying motility dysfunction as it relates to ACE2 and thereby aims to provide the foundation for mechanism-based potential therapeutic options.

Introduction: The role of serum albumin as a prognostic factor has been well established in various medical conditions including some hematologic malignancies such as multiple myeloma and myelodysplastic syndromes . In this retrospective analysis, we examined the prognostic value of serum albumin at diagnosis prior to any therapy in a cohort of patients with acute myeloid leukemia (AML) irrespective of treatment modality. Methods: Data were collected retrospectively in a cohort of 257 AML patients who received treatment between 2002 to 2019. The cohort included patients who received conventional 7+3 induction, patients who were not candidates for induction receiving lower intensity chemotherapy +/- targeted drug, and patients who were placed on clinical trials. Patients under the age of 17 were excluded, as well as patients who received their initial diagnosis and induction at an outside hospital whose initial laboratory data for albumin were not available. We excluded patients who were not identified as Caucasian or African American in our final analysis. 46 patients were lost to follow up before 6-months and were excluded from all analysis. Analysis were performed with Epi Info software. Our patients were dichotomized by serum albumin ≥3.5 (normal albumin) and <3.5 (hypoalbuminemia [HA]). Chi-square test was performed for univariate analysis of categorical variables and logistic regression was performed for multivariable analysis. Results: Of the 211 patients, the median age was 59.4 years (17 - 83.4) with 1:1 male to female ratio. 171 patients survived to 6 months and were included in our analysis. There was no significant age difference between normal albumin and HA groups (median age 59 and 59.7 respectively, p=0.854). There was an equal distribution of patients with HA with respect to sex (33.0% male and 36.9% female, p=0.560). With regards to race, more African Americans were found to have hypoalbuminemia compared to Caucasians (46% African Americans vs. 30% Caucasians, p=0.027). Patients with HA had an overall survival rate of 72.2% at 6 months while those with normal albumin levels had a survival rate of 85.1% (p=0.027). Multivariate logistic regression analysis including age, race, sex and albumin levels showed that age, sex and albumin levels were statistically significant independent predictors of survival at 6 months [Table 1]. Patients with albumin ≥3.5 were significantly more likely to survive controlling for age, race, and sex (OR=2.16, p=0.044). Multivariate analysis additionally showed that age was inversely associated with survival at 6-months (p=0.003) and males were more likely to survive than females (p=0.034). Though African Americans were shown to have a higher incidence of HA in univariate analysis, race was not an independent predictor for survival in the multivariate analysis when controlling for age, sex, and albumin level. Conclusions: In this cohort of AML patients, we found that hypoalbuminemia is an independent predictor survival. Serum albumin <3.5 was associated with a significantly decreased overall survival at 6-months. Age and sex were additional independent predictors of 6-month survival. This data suggests that hypoalbuminemia, defined as albumin <3.5, has prognostic utility in AML patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Introduction: Patients with hematological malignancies are at increased risk of infections which leads to increased morbidity and mortality. Particularly, they are at an increased risk of developing central line associated bloodstream infection (CLABSI) since they frequently require central venous catheters for various essential reasons including chemotherapy, blood transfusions, and parenteral nutrition. Prophylaxis with antibiotics is the key in the management for these patients but is not always effective and sometimes associated with complications. Hence, the main objective of the study is to examine the rate of developing CLABSI in patients with hematological malignancies receiving antimicrobial prophylaxis and in those who did not receive prophylaxis. Methods We conducted a retrospective study involving patients diagnosed with a hematological malignancy admitted to the Augusta University Medical Center from 2002 to 2019. IRB approval was obtained to review the patients' charts. Patients who developed CLABSI are defined as those who had positive blood cultures after central venous catheter had been placed. Percentage of patients who received prophylaxis and those who didn't get antimicrobial prophylaxis were calculated. The difference between the two percentages was examined to determine whether or not it is statistically significant. Results The charts of 268 patients admitted for hematological malignancies were reviewed. Among 173 patients receiving antibiotic prophylaxis (65.0%), 78 (45.1%) developed CLABSI. Among the patients who didn't receive prophylaxis, 64 (68.8%) developed CLABSI. The difference between the two groups was statistically significant (p<0.01), and the relative risk of developing CLABSI in patients who did not receive prophylaxis is 0.57 (95% confidence interval 0.41 - 0.79). Conclusion Patients who had been diagnosed with a hematologic malignancy and admitted at the academic institution from 2002 to 2019 were analyzed for the risk of developing CLABSI that was associated with the use of antibiotic prophylaxis. We found that the non-prophylactic group has statistically significant higher risk of developing CLABSI than the prophylactic group. Thus prophylaxis with antibiotics may play a major role in decreasing the rate of CLABSI in patients admitted with hematological malignancy. Disclosures No relevant conflicts of interest to declare.