Hidden army within:Harnessing the microbiome to improve cancer treatment outcomes

The gut microbiome has emerged as a critical player in cancer pathogenesis and treatment response.Dysbiosis,an imbalance in the gut microbial community,impacts tumor initiation,progression,and therapy outcomes.Specific bacterial species have been associated with either promoting or inhibiting tumor growth,offering potential targets for therapeutic intervention.The gut microbiome in-fluences the efficacy and toxicity of conventional treatments and cutting-edge immunotherapies,highlighting its potential as a therapeutic target in cancer care.However,translating microbiome research into clinical practice requires addres-sing challenges such as standardizing methodologies,validating microbial bio-markers,and ensuring ethical considerations.Here,we provide a comprehensive overview of the gut microbiome's role in cancer highlighting the need for on-going research,collaboration,and innovation to harness its full potential for im-proving patient outcomes in oncology.The current editorial aims to explore these insights and emphasizes the need for standardized methodologies,validation of microbial biomarkers,and interdisciplinary collaboration to translate microbiome research into clinical applications.Furthermore,it underscores ethical consider-ations and regulatory challenges surrounding the use of microbiome-based the-rapies.Together,this article advocates for ongoing research,collaboration,and innovation to realize the full potential of microbiome-guided oncology in impro-ving patient care and outcomes.

Antifungal pipeline:Is there light at the end of the tunnel?

The misuse and overuse of classic antifungals have accelerated the development of resistance mechanisms,diminishing the efficacy of established therapeutic pathways and necessitating a shift towards alternative targets.Despite this pressing need for new treatments,the antifungal drug pipeline has been largely stagnant for the past three decades,primarily due to the high risks and costs associated with antifungal drug development,compounded by uncertain market returns.Extensive research durations,special patient populations and rigorous regulatory demands pose significant barriers to bringing novel antifungal agents to market.In response,the“push-pull”incentive model has emerged as a vital strategy to invigorate the pipeline and encourage innovation.This editorial critically examines the current clinical landscape and spotlights emerging antifungal agents,such as Fosmanogepix,Ibrexafungerp,and Olorofim,while also unraveling the multifaceted challenges faced in new antifungal drug development.The generation of novel antifungals offers a beacon of hope in the battle against antimicrobial resistance,but it is premature to declare them as definitive solutions.Their future role hinges on thorough clinical validation,costeffectiveness assessments,and continuous post-marketing surveillance.Only through strategic implementation and integration with market strategies we can transform the landscape of antifungal development,addressing both the resistance crisis and the treatment challenges.

COVID-19 in pregnancy:Perinatal outcomes and complications

BACKGROUND The risk of severe coronavirus disease 2019(COVID-19)in pregnant women is elevated.AIM To examine the outcomes of pregnant women with COVID-19 and report perinatal outcomes and complications,while providing a brief review of current literature.METHODS The study included pregnant women presenting from April 2020 to February 2022 to the emergency department(ED)of a tertiary hospital.We retrospectively recorded the maternal and perinatal files,including patient epidemiological and clinical characteristics,laboratory values,outcomes,treatment modalities and associations were explored.RESULTS Among the 60 pregnant women,25%required hospitalization,all of whom were symptomatic.Preterm delivery occurred in 30%of cases.Ten percent of neonates required admission to the neonatal intensive care unit,and 5%were classified as small for their gestational age.All mothers survived COVID-19 and pregnancy,with 6.6%requiring invasive mechanical ventilation.Preterm delivery rates did not differ between hospitalized and non-hospitalized pregnant women;composite unfavorable perinatal outcomes,including stillbirth,small for gestational age,or neonatal intensive care unit(ICU)admission,did not significantly increase in the cases hospitalized for COVID-19(P=0.09).The odds of hospitalization increased 2.3-fold for each day of delayed ED presentation[adj.OR(95%CI:1.46-3.624),P<0.001].Comorbidity status was an independent predictor of hospitalization,albeit with marginal significance[adj.OR=16.13(95%CI:1.021-255.146),P=0.048].No independent predictors of adverse fetal outcome(composite)were identified,and eventual hospitalization failed to reach statistical significance by a slight margin(P=0.054).CONCLUSION Delayed ED presentation and comorbidities increase hospitalization odds.This study highlights the importance of continuous and specific guidance for managing pregnant COVID-19 patients,including timely and appropriate interventions to minimize maternal and perinatal morbidity and mortality.

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

BACKGROUND The survival of microorganisms on textiles and specifically on healthcare profes-sionals’(HCP)attire has been demonstrated in several studies.The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients.AIM To evaluate the presence,survival and transmission of different multidrug-resistant bacteria(MDRB)from HCP attire onto skin.METHODS Three MDRB[methicillin-resistant Staphylococcus aureus(MRSA);vancomycin-resistant Enterococcus faecium(VRE);carbapenem-resistant Klebsiella pneumoniae,(CRKP)]were inoculated on textiles from scrubs(60%cotton-40%polyester)and white coat(100%cotton)at concentrations of 108 colony-forming units(CFU),105 CFU,and 103 CFU per mL.The inoculation of swatches was divided in time intervals of 1 min,5 min,15 min,30 min,1 h,2 h,3 h,4 h,5 h,and 6 h.At the end of each period,textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media.Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations,for the whole length of the 6-h experiment.RESULTS MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study.VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h,while showing no growth at 103 CFU/mL.CRKP was recovered from 108 CFU/mL for 6 h,up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL.CONCLUSION Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations.The fact that all MDRB can be sustained and transferred to skin even at lower concentrations,supports that textiles are implicated as vectors of bacterial spread.

Transition beyond the acute phase of the COVID-19 pandemic: Need to address the long-term health impacts of COVID-19

Despite gaps in knowledge,long-term sequelae of coronavirus disease 2019(COVID-19)infections are globally acknowledged and thus require special attention by public health organizations and services.Therefore,it is necessary to support and promote public health initiatives that address long-term disability due to COVID-19.

Acute acalculous cholecystitis due to infectious causes

Acute acalculous cholecystitis(AAC)is an inflammation of the gallbladder not associated with the presence of gallstones.It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals.In this subgroup of patients,infectious causes comprise the primary etiology.We,herein,discuss the pathophysiological mechanisms involved in AAC,focusing on the infectious causes.AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia.Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells,gallbladder vasculitis,obstruction of the biliary tree,and sequestration.We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees.Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens.In conclusion,additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.