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BACKGROUND: Multiple myeloma (MM) is a plasma cell neoplasm, which accounts for 1-2% of cancers and approximately 17% of hematological malignancies in the United States each year. Fifty percent of patients with symptomatic MM have three or more primary care visits before being referred to a specialist, which is greater than any other cancer. A delay in the diagnosis of multiple myeloma has been shown to negatively impact the clinical course of the disease; patients with longer diagnostic intervals have been shown to experience shorter disease-free survival and higher rates of treatment-related complications. RESEARCH DESIGN AND METHODS: We performed a retrospective analysis of patients diagnosed with MM in our institution, to determine the time from the first detectable lab abnormality to the diagnosis of MM. RESULTS: We included 92 patients in this study. Fifty-two percent of patients had isolated anemia at the time of diagnosis. Twenty-nine percent of patients had a delay in diagnosis of ≥1 year, while 18% had a delay of ≥3 years. Nine patients in our cohort had anemia and an elevated serum total protein (31%). This group had the longest time to diagnosis with a median of 38 months. CONCLUSIONS: Our results did not show any difference in time to diagnosis by race, ethnicity, gender, or socioeconomic status.

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INTRODUCTION: Nodular pulmonary amyloidosis (NPA) is a localized form of light chain (AL) amyloidosis often found incidentally and typically has an indolent and benign disease course treated with resection or local excision. We present a patient with recurrent localized AL amyloidosis who required further treatment. CASE PRESENTATION: A 63-year-old female with monoclonal gammopathy of undetermined significance (MGUS) was found to have pulmonary AL amyloid on wedge resection and later had recurrence. The patient did not have signs of clonal plasma cell proliferation or systemic AL amyloid. She was treated with daratumumab, cyclophosphamide, bortezomib, and dexamethasone. After initiation of treatment, the patient has had significant hematologic and radiographic response. CONCLUSION: The patient had NPA recurrence with organ dysfunction without systemic disease. Because the presentation of recurrent pulmonary AL amyloidosis is rare, there is no published evidence on treatment. However, the patient has had hematologic and radiographic improvement after initiating treatment with a systemic protocol.

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Sickle cell disease (SCD) is an inherited disorder of hemoglobin mutation in red blood cells, with a patient population that is increasing in age in recent decades due to advances in modern medicine. Hodgkin's lymphoma (HL) is a cancer of white blood cells, and while concomitance of SCD and Hodgkin's has been reported, a discussion of treatment for HL in SCD is lacking from the literature. We present a case of effectively treated HL in SCD and put forth that the regimen used is a practical choice, and as it was completed fully as outpatient, it improved the patient's quality of life compared to an inpatient regimen.

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In this study, we explored the effect of salinity on cadmium (Cd) tolerance and phytoremediation potential of Acacia nilotica. Two-month-old uniform plants of A. nilotica were grown in pots contaminated with various levels of Cd (0, 5, 10, and 15 mg kg-1), NaCl (0%, 0.5%, 1.0% (hereafter referred as salinity), and all possible combinations of Cd + salinity for a period of six months. Results showed that shoot and root growth, biomass, tissue water content and chlorophyll (chl a, chl b, and total chl a+b) contents decreased more in response to salinity and combination of Cd + salinity compared to Cd alone. Shoot and root K concentrations significantly decreased with increasing soil Cd levels, whereas Na and Cl concentrations were not affected significantly. Shoot and root Cd concentrations, bioconcentration factor (BCF) and translocation factor (TF) increased with increasing soil Cd and Cd + salinity levels. At low level of salinity (0.5%), shoot and root Cd uptake enhanced, while it decreased at high level of salinity (1.0%). Due to Cd tolerance, high shoot biomass and shoot Cd uptake, this tree species has some potential for phytoremediation of Cd from the metal contaminated saline and nonsaline soils.

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BACKGROUND: Regardless of high maternal deaths in Pakistan, only 37% of pregnant women make four or more antenatal care visits during pregnancy. This proportion has further been diverged between urban and rural. About 62% of women visit clinics for WHO recommended sets of antenatal care (ANC) check-ups in urban as compared to 26% women in rural areas. This study was conducted with the aim to assess quality of Focused ANC service delivery in terms of examination, screening, treatment, counselling and to determine variation in service delivery with provider's clinical qualification and expertise. METHODS: Cross sectional study design was used. Data was collected from pregnant women when they were visiting hospital for their antenatal visits. Direct observation was also made regarding provision of services. RESULTS: Out of 278, 55% of study women were in 28-33 years age group and 21.2% made at least one visit. While 42.8% reported more than one visit, 98.9% received tetanus toxoid, 82% received proper screening. Counselling was done mostly regarding nutrition and self-care (42.8%), and significant association (p-value <0.05) was observed between provider's clinical qualification and provision of services such as for screening and counselling. CONCLUSIONS: The delivery of antenatal care services to pregnant women varied to some extent. Most of the routine investigation services were in accordance with recommended standards of optimal quality with little divergence from guidelines such as screening for HIV and syphilis. Better quality services were being provided to private participants in terms of counselling and danger sign screening.

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Lymphoma is the most common hematopoietic tumor in dogs and humans, with similar pathogenesis and therapeutic responses. Anticancer drugs like vincristine (VCR) and doxorubicin (DOX) are often used in treating lymphoma. However, the cure rate is generally poor due to chemoresistance. Here, we sought to determine whether stearidonic acid (SDA), a plant-based dietary fatty acid, sensitizes chemoresistant canine lymphoid-tumor cells. GL-1 B-cell lymphoid-tumor cells were found to be highly sensitive to the antitumor-activity of VCR and DOX, while OSW T-cell and 17-71 B-cell lymphoid-tumor cells were moderately and fully resistant, respectively. SDA, at its non-toxic concentrations, significantly promoted the antitumor action of VCR and DOX in both OSW and 17-71 cells. SDA-mediated chemosensitization was associated with SDA inhibition of P-glycoprotein (P-gp) function. This was confirmed in HEK293 cells stably expressing P-gp as well as by increased binding-affinity of SDA to P-gp in P-gp docking analysis. SDA at its chemosensitizing concentrations did not affect the viability of healthy dog peripheral blood mononuclear cells, suggesting that SDA is non-toxic to normal dog peripheral blood leucocytes at its chemosensitizing concentrations. Our study identifies a novel dietary fatty acid that may be used as a dietary supplement in combination with chemotherapy to promote the antitumor efficacy of the chemotherapy drugs in dogs and possibly in humans with chemoresistant lymphoma.

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